Journal of pediatric gastroenterology and nutrition
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J. Pediatr. Gastroenterol. Nutr. · Dec 2010
ReviewOverlap, common features, and essential differences in pediatric granulomatous inflammatory bowel disease.
Overlap in the clinical presentation of pediatric granulomatous inflammatory bowel disease may be substantial, depending on the mode of presentation. Chronic granulomatous disease (CGD) may present with granulomatous colitis, perianal abscesses, hepatic abscesses or granulomas, failure to thrive, and obstruction of the gastrointestinal tract (including esophageal strictures and dysmotility, delayed gastric emptying, and small bowel obstruction). Anemia, thrombocytosis, elevated C-reactive protein and erythrocyte sedimentation rate, and hypoalbuminemia are nonspecific and may occur in any of the granulomatous inflammatory bowel diseases. ⋯ CD and CGD share defects in the defense mechanisms against different microbes. In the present review, common features and essential differences are discussed in clinical presentation and diagnostics--including histology--in CGD, sarcoidosis, and CD, together with 2 other granulomatous inflammatory bowel diseases, namely abdominal tuberculosis and Hermansky-Pudlak syndrome. Instructions for specific diagnosis and respective treatments are provided.
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J. Pediatr. Gastroenterol. Nutr. · May 2009
ReviewPharmacological interventions for nonalcoholic fatty liver disease in adults and in children: a systematic review.
Uncertainty exists regarding the treatment of patients with nonalcoholic fatty liver disease (NAFLD) who are unable to lose weight and/or change lifestyle. The present study assesses the effectiveness and safety of pharmacological and dietary supplement interventions for NAFLD. ⋯ Limited data do not allow one to draw firm conclusions on the efficacy of various treatments for NAFLD.
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Clinical trials use scientific methods to evaluate the effectiveness and safety of treatments or other interventions. Trials should have both internal and external validity, and a well-conducted randomised controlled trial is considered to be the most powerful tool for evaluating interventions. ⋯ In an internally valid trial, external validity refers to the ability of the results to be generalised to the "real world" population. Issues to consider in determining the external validity of a study include the setting of the trial, the study population, the types of interventions used, duration of follow-up, and the types of outcome and how they were assessed.
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J. Pediatr. Gastroenterol. Nutr. · Dec 2007
ReviewUse of Lactobacillus casei subspecies Rhamnosus GG and gastrointestinal colonization by Candida species in preterm neonates.
Candida species increasingly cause morbidity and mortality in the premature infant in neonatal intensive care units, and the gut reservoir is the site from which dissemination most frequently starts in such patients. Specific antifungal prophylaxis is the most suitable strategy with which to limit the severity and the frequent neurodevelopmental impairment in survivors that is associated with neonatal invasive fungal infections. Recent interest has focused on the use of probiotics for the treatment of several diseases in neonatal patients. ⋯ Basic research has shown that in mice models, the Lactobacillus casei subsp Rhamnosus GG (LGG) is effective in preventing Candida gut colonization and systemic dissemination. A pilot, randomized, double-blind, placebo-controlled trial in human preterm neonates has demonstrated that LGG administered in the first month of life significantly reduces enteric Candida colonization. The present article summarizes the state of the art about probiotics and Candida-related diseases in the preterm neonate and emphasizes the need for further investigations to determine unequivocally the possible role of LGG in the prevention and management of the fungal diseases in preterm neonates.