• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.177-193
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• 2005

Purpose: To identify genes specifically expressed in biliary atresia, we compared the patterns of gene expression between biliary atresia and neonatal hepatitis syndrome using cDNA microarray analysis. Methods: Liver tissues were taken from livers of 11 patients (7 patients with biliary atresia and four with neonatal hepatitis) with neonatal cholestasis by needle biopsy. Normal control could be obtained from donor liver tissue during living-related liver transplantation. Total RNA was extracted from each samples and reversely transcribed to make cDNA. Then fluorescent cDNA were pooled and hybridized to the clones on the microarray. Fluorescence intensities at the immobilized targets were measured. Utilizing cDNA arrays of 4.7 K human genes, gene expression profiles were analyzed. Results: Among 4,700 microarray clones, 17 cDNA clones were significantly over-expressed in all 11 patients with neonatal cholestasis, while 20 clones were significantly decreased. Genome-wide expression analysis was carried out in livers obtained at the time of diagnosis. We could identify 49 genes, in which there showed differential expression between biliary atresia and neonatal hepatitis syndrome. Conclusion: This study shows the pattern of differentially expressed genes in biliary atresia and neonatal hepatitis syndrome. We believe that this study can contribute to the understanding of pathogenesis of neonatal cholestasis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.172-176
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• 2005

Purpose: There have been a few data about esophageal length in children and previous data are improper for application to various procedures. Because of the variability in height and weight of each the individuals especially in children, measurable external parameters are needed. Methods: We measured distance from upper incisor to esophago-gastric junction using a flexible endoscope and compared these data with age, height and weight in 262 children who underwent upper gastrointestinal endoscopy. Results: The mean age was $9.0{\pm}3.6year$ (from 2 days to 16 year of age), mean height was $132.89{\pm}23.49cm$ and mean length from upper incisor to esophago-gastric junction was $33.34{\pm}5.42cm$. Correlation between distance from upper incisor to esophago-gastric junction and height was the mostly predictable indicator of the esophageal length (Pearson correlation=0.944). We propose a formula [Esophageal length=4.419+($0.218{\times}height$)] as a indicator of the esophageal length (p=0.000, $R^2=0.891$). Conclusion: The esophageal length in children and for application to various procedures can be reliably predicted by using the height.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.1
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• pp.63-67
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• 2000

Purpose: Biliary atresia, one of the major causes of neonatal cholestais, is an idiopathic, serious disorder, affecting the newborn that results in complete obstruction of biliary tract. Successful reestablishment of bile flow is dependent on early surgical intervention, early diagnosis is imperative. The authors evaluate the utility of Tc-99m-labeled diisoprpyliminodiacetic acid (DISIDA) hepatobiliary scintigraphy in the diagnosis of biliary atresia. Methods: From January, 1995 to August, 1999, total 60 patients with neonatal cholestasis underwent Tc-99m DISIDA hepatobiliary scintigraphy at Asan Medical Center. Results: The undelying causes of neonatal cholestasis were biliary atresia in 14, neonatal hepatitis in 33, intrahepatic bile duct paucity in 9, and total parenteral nutrition induced cholestasis in 4. All patient with biliary atresia were interpreted correctely in DISIDA hepatobiliary scintigraphy, showing 100% sensitivity. Of the 46 patients with neonatal hepatitis and other causes, 37 patients had intestinal radioactivity showing 80% specificity. Conclusion: Visualization of DISIDA in the intestinal tract indicates patency of the biliary ducts and excludes the diagnosis of biliary atresia. But the absence of intestinal excretion on the DISIDA hepatobiliary scintigraphy dose not necessarily indicate biliary atresia.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.1
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• pp.56-62
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• 2000

Purpose: The aim of this study was to evaluate the efficacy and histologic changes of interferon-alfa therapy on chronic hepatitis B virus infection in children. Patients and Methods: Thirty five children aged 3~16 years who were seropositive for HBV DNA, HBsAg and HBeAg were enrolled. Interferon-alfa 2a ($3.4\;MU/m^2$) were given for 6 months. Serologic markers of viral replication was evaluated 1 year after therapy. Post treatment liver biopsy was performed in 18 patients who showed serologic response. Results: Serum HBeAg and viral DNA became negative in 22 (63%) of treated children at 12 months after therapy. Serum aminotransferase levels normalized in all of the responders and HBsAg became negative in one responder. Horizontal transmission, serum aminotransferase levels more than twice normal, and active inflammation on liver biopsy were predictive factors for response to interferon therapy. Periportal piecemeal necrosis, lobular activity, portal inflammation, fibrosis, and total histologic activity index were reduced in responders. Conclusion: In children with chronic hepatitis B, interferon alfa promotes loss of viral replication and improves aminotransferase. Serologic response is associated with improvement in hepatic histology.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.1
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• pp.41-46
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• 2000

Purpose: It is important to have the epidemiologic data of rotavirus serotypes for the application of polyvalent rotavirus vaccines. Epidemiological studies of rotavirus serotypes in Korea have been reported only in limited areas with small number of cases. Authors tried to investigate the distribution of rotavirus G serotypes in ChungJu area with RT-PCR. Method: Stool specimens were collected from 202 children with acute diarrheal symptoms, who admitted to or visited Kon-Kuk University Hospital in ChungJu from June 1998 to May 1999. Samples were screened for rotavirus with EIA method (TestPack Rotavirus, Abbott Laboratories) and rotavirus G Serotypes were determined by RT-PCR. Results: Rotavirus was positive in 46.6%. The incidence of G serotypes was as follows; G1 10%, G2 10%, G3 28%, G4 26%, and G9 20%. There were three cases of multiple serotypes; G1 with G9, G2 with G9, and G4 with G9. Serotype of G8 was not found. Conclusion: The proportion of G serotypes in ChungJu is much different from previous reports. Serotype of G9 was found which had not been reported in Korean children till now. Long term plans for the investigation of rotavirus serotypes must be needed in wide area.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.6 no.2
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• pp.112-119
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• 2003

Purpose: Helicobacter pylori infection is thought to be correlated with iron-deficiency anemia (IDA) at puberty. The H. pylori feoB gene, a high-affinity ferrous iron transporter, plays a central role in iron acquisition. This study aims to analyze the H. pylori feoB status according to the presence of antral gastritis with or without IDA. Methods: Fourteen H. pylori-positive patients aged from 10~18 years were categorized into subgroups based on the presence or absence of IDA. Eight patients had IDA, and the other six showed normal hematological findings. Genomic DNA was isolated from cultured H. pylori. Five sets of primers were used for PCR amplification of the feoB gene. The feoB region, 1.93 kb, was generated by linking of the PCR products and sequenced. The feoB gene sequences of H. pylori J99 and 26695 were used to compare with the clinical strains. Sequence comparisons of the feoB regions between the IDA (+) and (-) groups were performed. Results: Sequence analysis of the complete coding region of the feoB revealed 16 sites of polymorphism. Among these, 3 polymorphisms-Glu/Thr254Ala, Ile263Val, and Lys511Gln - were indigenous to Korean strains. Although statistically significant differences appear in 4 sites between IDA (+) and (-), the number of specimens are too low to assess the real differences. Conclusion: The 4 polymorphisms in the feoB gene seem to be related with IDA, but it is unclear yet because of small number of study strains. Further studies are required to prove the correlation of IDA and H. pylori infection.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.14 no.1
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• pp.74-80
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• 2011

Purpose: Based on previous research findings, it is well-known that the timing of surgery is generally considered the most important prognostic factor for a Kasai portoenterostomy, the primary treatment for biliary atresia. This research aimed to identify the optimal timing of a Kasai portoenterostomy and to verify if the proposed optimal timing corresponds to previous studies. All patients were classified by the timing of surgery, and pre- and post-operative fibrotic changes of the liver were measured with the elasticity value from fibroscans. Methods: The stiffness scores of the pre- and post-operative fibroscans in 34 patients who were treated by Kasai portoenterostomy from October 2007 to September 2010 in Severance children's hospital were reviewed. Results: The earlier the patients were treated by Kasai portoenterostomy, the lower the fibroscan scores. When the patients were treated prior to the 8th week, the post-operative scores of the fibroscans were significantly better than those patients who were treated after the 8th week, and some even recovered partially. Moreover, when operated before the 8th week, the differences between each pre- and postoperative fibroscan score also showed statistical relevance (p=0.0002). Conclusion: The earlier the patient was treated by Kasai portoenterostomy, the less liver fibrosis that developed, the lower the level of post-operative fibrosis, and the less the degree of fibrotic progress before and after the operation. Thus, this research proposal reconfirms once more that the 8th week is the optimal timing for a Kasai portoenterostomy.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.14 no.1
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• pp.45-51
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• 2011

Purpose: The antimicrobial resistance of Helicobacter pylori is one of the critical factors in failure of eradication therapy. The purpose of this study was to evaluate antimicrobial resistance of H. pylori in Korean children. Methods: Gastric mucosal specimens for H. pylori were obtained from children with dyspepsia who were cared for at Asan Medical Center Children's Hospital in Seoul, Korea between 2003 and 2009. Antimicrobial resistance tests were performed using the disk diffusion method for clarithromycin and amoxicillin and the E-test for metronidazole and tetracycline. Most children with H. pylori infections were treated using triple therapies. Results: Thirty-three children had positive H. pylori cultures, although a resistance test was only performed in 28 patients. Resistant strains were found in 9 children (32.1%). The resistance rates to clarithromycin and metronidazole were 25% and 17.8%, respectively. There was no resistance to amoxicillin or tetracycline. The resistance rates decreased from 44.4% (2003~2006) to 26.3% (2006~2009) during the study period. Conclusion: Korean children demonstrated relatively high antimicrobial resistance to H. pylori in this study. However, there was a temporarily decreasing trend during the study period. A larger multi-regional study may be needed to determine the optimal antimicrobial treatment for pediatric patients infected with H. pylori.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.15 no.1
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• pp.29-37
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• 2012

Purpose: To examine the prevalence of $Clostridium$ $difficile$ ($C.$ $difficile$) colonization (CDC) and potential neonatal determinants of CDC in hospitalized preterm infants. Methods: Fecal samples were serially collected within 72 h after birth and at 1, 2, and 4-6 weeks of age from preterm infants in the neonatal intensive care units (NICUs) of two different university hospitals. Total bacterial DNA was extracted from each fecal sample from 49 infants, and polymerase chain reaction (PCR) was performed with primers for the 16S gene of $C.$ $difficile$ and the toxin A and toxin B genes. The correlation between the results of $C.$ $difficile$ PCR assays and the clinical characteristics of the infants was analyzed. Results: The prevalence rates of CDC were 34.7, 37.2, 41.3, and 53.1% within 72 h after birth and at 1, 2, and 4.6 weeks of age, respectively. The toxin positivity rate was significantly higher in the infants with persistent CDC than in those with transient CDC (8/12 [66.7%] vs. 6/25 [24.5%] ($p$=0.001). Among the various neonatal factors, only the feeding method during the first week after birth was significantly associated with persistent CDC. Exclusive breast-milk feeding (EBMF) significantly decreased the risk of persistent CDC compared to formula or mixed feeding (adjusted odds ratio: 0.133, 95% confidence interval: 0.02-0.898, $p$=0.038). Conclusion: The prevalence of CDC increased with the duration of hospitalization in preterm infants in the NICU. EBMF during the first week after birth in hospitalized preterm infants may protect against persistent CDC.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.2
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• pp.122-129
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• 2008

Purpose: Patients with chronic gastrointestinal disease are at risk for trace element deficiency due to impaired absorption and gastrointestinal loss. The aim of this study was to evaluate the trace element status of patients with gastrointestinal disease by blood and hair analysis, and to determine the usefulness of hair mineral analysis for diagnosing trace element deficiency not detected by a blood test. Methods: An analysis of hair minerals was performed and compared with blood mineral analysis in 13 patients with chronic gastrointestinal disease. The concentration of each element in the hair and blood was compared in the subgroups based on parenteral nutritional support or clinical symptoms. Results: Almost all patients had trace element deficiency. The trace elements deficient in the blood or hair analysis included zinc, selenium and copper. The hair zinc concentration was significantly lower in the group receiving parenteral nutritional support. The hair selenium concentration was statistically associated with the clinical symptoms of hair loss, brittle hair and loss of hair pigmentation. Conclusion: The results of this study suggest that patients with chronic gastrointestinal disease should receive adequate zinc and selenium replacement to avoid trace element deficiency especially when treated with long-term parenteral nutrition. Hair mineral analysis is useful as a complementary tool for the detection of a trace element deficiency.