• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.1
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• pp.44-50
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• 2010

Purpose: To estimate the viral suppressive effect of entecavir monotherapy in Korean children and adolescents with lamivudine-resistant chronic hepatitis B (CHB). Methods: One milligram of entecavir was administered once daily to 6 patients (4 boys; mean age, 17.5 years; range, 15.10~24.6 years) with lamivudine-resistant CHB for a mean duration of therapy of 13.4 months (range, 1~21.1 months). The therapeutic results were compared with 11 patients who received adefovir (0.3 mg/kg/day [maximal dose 10 mg]) for at least 12 months (mean, 33.4 months; range, 12.4~58.3 months). The serum HBV DNA level and serologic markers were measured every 2 months. Results: The interval to a HBV DNA titer decrement (>1 $log_{10}$) was 1.2${\pm}$0.2 and 4.4${\pm}$5.2 months (p=0.185) for the entecavir and adefovir groups, respectively. The interval to a HBV DNA titer decrement (>2 $log_{10}$) was 2.4${\pm}$2.3 and 9.2${\pm}$7.3 months (p=0.025), for the entecavir and adefovir groups, respectively. Conclusion: The therapeutic efficacy of entecavir was favorable in children and adolescents, especially in shortening the interval to a >2 $log_{10}$ decrement in the HBV DNA titer. Long-term follow up is needed to determine the therapeutic efficacy of entecavir for lamivudine-resistant CHB in children and adolescents.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.120-132
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• 2009

Purpose: We diagnosed pediatric functional gastrointestinal disorders in Korean children and adolescents using Rome III criteria and investigated the clinical validity of QPGS-Rome III. Methods: Diagnosis based on QPGS was compared with the physician's diagnosis based on Rome III criteria. One hundred and thirty eight children and their parents completed the QPGS. Agreement rates were measured using Kappa method. Results: In physician's diagnoses, the most prevalent disorders were functional dyspepsia (39.1%), irritable bowel syndrome (38.4%), and functional abdominal pain (18.8%). Among QPGS based diagnoses, the most prevalent disorders were irritable bowel syndrome (39.1%), functional dyspepsia (29.7%), and functional abdominal pain (21.7%). The agreement rate was substantial (${\kappa}$=0.72, p=0.00). Diagnostic disagreements probably resulted from different patient responses to bowel movement form and bowel frequency. Conclusion: Functional dyspepsia, irritable bowel syndrome, and functional abdominal pain were the most common disorders by Rome III criteria in the Korean pediatric and adolescent patients. The agreement rate between physician's diagnoses and QPGS based diagnoses supported the validity of the QPGS-Rome III in Korean pediatric and adolescent patients. QPGS seems to be useful in diagnosis of patients with functional gastrointestinal disorders by Rome III criteria.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.111-119
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• 2009

Purpose: Chronic abdominal pain is a common complaint encountered in pediatric clinics. This study aimed to investigate chronic functional abdominal pain in Korean children and adolescents by applying the Rome III criteria. Methods: A prospective study on chronic abdominal pain in 194 patients was conducted between July 2006 and August 2007. The parents of the subjects were asked to respond to a questionnaire based on the Rome III criteria. These responses were evaluated by pediatricians, and subsequently, the patients were clinically evaluated. Results: On the basis of the results of the medical evaluation, 167 of the 194 patients (86.1%) were diagnosed with functional gastrointestinal disorders, i.e., no organic causes of chronic abdominal pain were detected during the medical evaluation. Of these 167 patients, 89.8% of the patients satisfied one of the Rome III criteria, while 10.2% of the patients did not satisfy any of the Rome III criteria for chronic abdominal pain-related functional gastrointestinal disorders (functional dyspepsia, 29.3%; irritable bowel syndrome, 25.7%; abdominal migraine, 7.8%; childhood functional abdominal pain, 27.0%; and childhood functional abdominal pain syndrome, 12.6%). Compared to other symptom subtypes, children with childhood functional abdominal pain experienced an earlier onset and a shorter duration of symptoms. Conclusion: The Rome III criteria are more comprehensive; the use of these criteria will provide more accurate information and better diagnoses for children and adolescents with chronic abdominal pain.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.194-198
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• 2009

Purpose: Severe abdominal distension is not uncommon symptom in the neonate. Two major causes of this symptom are benign transient intestinal ileus (BTII) and Hirschsprung`s disease (HD). But it is difficult to differentiate BTII from HD based on the symptoms and simple abdominal x-ray findings. The aim of this retrospective study was to assess the clinical aspects and diagnostic tests differencing two diseases. Methods: From August 2004 to March 2009, nineteen patients with severe abdominal distension, who underwent barium enema, anorectal manometry, and rectal suction biopsy (triple tests) due to a suspicion of HD, were enrolled. A comparison of clinical data associated with BTII and HD based on the clinical features and results of triple tests. Results: The age of onset of symptom was between 2 and 6 weeks in BTII and within 3 weeks in HD. On the barium enema, transitional zone revealed in 6 (50%) patients in BTII and 4 (57.1%) in HD. On anorectal manometry, the anorectal inhibitory reflex was present in 11 (91.7%) patients in BTII and 1 (14.3%) in HD. On rectal suction biopsy, ganglion cell was present in 9 (75%) patients in BTII and 0 (0%) in HD. Abdominal distension was improved within 3 months of life in all cases of BTII. Conclusion: We think that anorectal manometry may be more simple and useful diagnostic method than barium enema and rectal suction biopsy for differential diagnosis of transient intestinal ileus and Hirschsprung's disease.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.171-176
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• 2009

Purpose: The aim of this study was to evaluate hematologic features in Korean children with inflammatory bowel disease (IBD) in order to determine appropriate management strategies. Methods: We retrospectively analyzed the complete blood count (CBC) profiles and assessed the incidence of anemia in 25 children with IBD (Crohn disease, 16; and ulcerative colitis, 9). The correlation between hemoglobin (Hb) and duration of illness and the activity index of IBD were also investigated. Results: The incidence of anemia was 76% in IBD, 88% in Crohn disease, and 56% in ulcerative colitis. Leukocytosis and thrombocytosis were only found in Crohn disease (56% and 25%, respectively). No statistically significant correlation was observed between Hb and duration of illness in Crohn disease and ulcerative colitis or between Hb and the activity index in Crohn disease and ulcerative colitis. Conclusion: The incidence of anemia found in this study was slightly higher than in previous reports. Additionally, there was no correlation between Hb and the duration of illness or the activity index. Therefore, even if the duration of illness is short, or the activity index is low, appropriate management of children with IBD should include careful evaluation for anemia.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.1
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• pp.86-91
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• 2010

Retroperitoneal cystic lymphangiomas are benign, extremely rare tumors. Although surgical resection is the treatment of choice, sclerotherapy should be considered initially. A 9-year-old boy was admitted due do worsening abdominal pain of 4 days duration. Serial complete blood counts revealed a hemoglobin level of 12.8 g/dL on admission to 10.6 g/dL on hospital day 3. An abdominal computed tomography (CT) scan showed a large, lobulated, septated, retroperitoneal cystic mass ($10{\times}9.5{\times}5cm$) in the left anterior pararenal space with intracystic hemorrhage surrounding the inferior mesenteric vein (IMV). Because of the high operative risk, we performed a tubogram of the cystic mass, percutaneous catheter drainage (PCD), and ethanol sclerotherapy. The follow-up abdominal CT scan showed that the cystic mass had decreased in size. He is well without relapse of the retroperitoneal cystic mass for 13 months after discharge. Sclerotherapy with PCD should be considered as initial therapy for patients with retroperitoneal cystic lymphangiomas at high surgical risk.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.215-220
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• 2009

Purpose: Recently, the favorable merits of breast feeding have received widespread attention and the number of breast feeding children is increasing. We investigated the weaning practices between breast feeding infants and non-breast feeding infants with respect to iron deficiency anemia (IDA). Methods: Between March 2006 and January 2009, we surveyed 70 parents, the children of whom had been medically diagnosed with IDA, and 140 parents, the children of whom did not have IDA, about how they feed their children and how much they know about the weaning process. The infants and children were 6∼36 months of age and attended the Inha University hospital. Results: IDA patients started weaning later than non-IDA patients. Also, breast feeding in IDA patients was more frequent than in non-IDA patients (82% vs. 30%). The breast feeding group began weaning at approximately 6.4 months of age, which was statistically meaningfully compared to non-breast feeding infants. There were no differences in knowledge between the two groups of parents. Conclusion: According to our research, we assume that if weaning begins at 6 months, we cannot supply sufficient iron to meet the infant's needs, which increase sharply around 6 months of age because of depletion of stored iron. Thus, infants need to initiate weaning from breast feeding at 4 months of age to furnish an ample amount of iron or take iron-containing supplements. These methods would be expected to prevent IDA in breast feeding infants.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.150-155
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• 2009

Purpose: The aim of this study was to evaluate observed changes in the prevalence of biopsy-proven Helicobacter pylori infection in Korean children with functional recurrent abdominal pain during the past 18 years. Methods: Between July 1991 and December 2008, 1,194 children with functional recurrent abdominal pain (499 males and 695 females) 9.2${\pm}$3.1 years of age were included. Upper gastrointestinal endoscopies were performed in all patients. H. pylori infection was assessed by the CLO test. Changes in the prevalence of the endoscopic diagnosis of H. pylori infection during 18 years were analyzed. Results: The prevalence of H. pylori infection between 1991 and 1993, 1994 and 1996, 1997 and 1999, 2000 and 2002, 2003 and 2005, and 2006 and 2008 were 25.1% (56/223), 23.1% (45/195), 19.3% (28/145), 16.1% (39/242), 11.3% (24/213), and 10.8% (19/176), respectively; these serial decreases in the prevalence over 18 years were statistically significant (p<0.001). Regardless of gender and age, the prevalence of H. pylori infection decreased. This decrease was inversely related to socioeconomic improvement as represented by the per capita gross national income growth of Korea. Conclusion: The prevalence of H. pylori infection has decreased significantly for the past 18 years in Korean children. This decrease might be caused by an improvement in socioeconomic status.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.3
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• pp.231-242
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• 2020

Purpose: In East Asian countries, there are only a few epidemiologic studies of eosinophilic esophagitis (EoE) and no studies in children. We investigated the incidence and compared the clinical characteristics of EoE and eosinophilic gastroenteritis involving the esophagus (EGEIE) in Korean children. Methods: A total of 910 children, who had symptoms of esophageal dysfunction, from 10 hospitals in Korea were included. EoE was diagnosed according to diagnostic guidelines and EGEIE was diagnosed when there were >15 eosinophils in the esophagus per high power field (HPF) and >20 eosinophils per HPF deposited in the stomach and duodenum with abnormal endoscopic findings. Results: Of the 910 subjects, 14 (1.5%) were diagnosed with EoE and 12 (1.3%) were diagnosed with EGEIE. Vomiting was the most common symptom in 57.1% and 66.7% of patients with EoE and EGEIE, respectively. Only diarrhea was significantly different between EoE and EGEIE (p=0.033). In total, 61.5% of patients had allergic diseases. Exudates were the most common endoscopic findings in EoE and there were no esophageal strictures in both groups. The median age of patients with normal endoscopic findings was significantly younger at 3.2 years, compared to the median age of 11.1 years in those with abnormal endoscopic findings (p=0.004). Conclusion: The incidence of EoE in Korean children was lower than that of Western countries, while the incidence of EGEIE was similar to EoE. There were no clinical differences except for diarrhea and no differences in endoscopic findings between EoE and EGEIE.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.4
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• pp.346-355
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• 2020

Purpose: Peroxisome proliferator-activated receptor gamma (PPAR-γ) has a key role in hepatic fibrogenesis by virtue of its effect on the hepatic stellate cells (HSCs). Although many studies have shown that PPAR-γ agonists inhibit liver fibrosis, the mechanism remains largely unclear, especially regarding the cross-talk between PPAR-γ and other potent fibrogenic factors. Methods: This experimental study involved 25 male Wistar rats. Twenty rats were subjected to bile duct ligation (BDL) to induce liver fibrosis, further divided into an untreated group (BDL; n=10) and a group treated with the PPAR-γ agonist thiazolidinedione (TZD), at 14 days post-operation (BDL+TZD; n=10). The remaining 5 rats had a sham operation (sham; n=5). The effect of PPAR-γ agonist on liver fibrosis was evaluated by histopathology, protein immunohistochemistry, and mRNA expression quantitative polymerase chain reaction. Results: Histology and immunostaining showed markedly reduced collagen deposition, bile duct proliferation, and HSCs in the BDL+TZD group compared to those in the BDL group (p<0.001). Similarly, significantly lower mRNA expression of collagen α-1(I), matrix metalloproteinase-2, platelet-derived growth factor (PDGF)-B chain, and connective tissue growth factor (CTGF) were evident in the BDL+TZD group compared to those in the BDL group (p=0.0002, p<0.035, p<0.0001, and p=0.0123 respectively). Moreover, expression of the transforming growth factor beta1 (TGF-β1) was also downregulated in the BDL+TZD group (p=0.0087). Conclusion: The PPAR-γ agonist inhibits HSC activation in vivo and attenuates liver fibrosis through several fibrogenic pathways. Potent fibrogenic factors such as PDGF, CTGF, and TGF-β1 were downregulated by the PPAR-γ agonist. Targeting PPAR-γ activity may be a potential strategy to control liver fibrosis.