Marcin Banasiuk - Profile on Academia.edu (original) (raw)
Papers by Marcin Banasiuk
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus / I.S.D.E, Jan 3, 2014
High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esop... more High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esophageal function. Our aim was to assess the inter-observer agreement for diagnosis of esophageal motility disorders using this technology. Practitioners registered on the HRM Working Group website were invited to review and classify (i) 147 individual water swallows and (ii) 40 diagnostic studies comprising 10 swallows using a drop-down menu that followed the Chicago Classification system. Data were presented using a standardized format with pressure contours without a summary of HRM metrics. The sequence of swallows was fixed for each user but randomized between users to avoid sequence bias. Participants were blinded to other entries. (i) Individual swallows were assessed by 18 practitioners (13 institutions). Consensus agreement (≤2/18 dissenters) was present for most cases of normal peristalsis and achalasia but not for cases of peristaltic dysmotility. (ii) Diagnostic studies were ass...
Very early and early nutrition in children with pancreatitis—A randomised trial
Journal of pediatric gastroenterology and nutrition, Jun 27, 2024
PubMed, Aug 1, 2021
Objective: Dyssynergic defecation (DD) may be one of the most important causes of constipation, b... more Objective: Dyssynergic defecation (DD) may be one of the most important causes of constipation, but its diagnostic criteria have not been formally validated in children. This study aims to evaluate constipated children with 3DHRAM (three-dimensional high-resolution anorectal manometry) and determine a new pediatric cut-off for DD variables. Patients and methods: 205 patients diagnosed with functional constipation (FC) based on Rome III criteria were prospectively enrolled. Data were compared to a historical control group (C). Initially, the diagnosis of DD was based on adult criteria and divided into 4 types. A new cut-off value for percent anal relaxation was determined based on ROC curve analysis. Results: The FC group presented significantly lower values of percent anal relaxation during straining compared to the C group (9.5% vs. 20%, respectively, p=0.03). Based on adult criteria, DD was found in 53% of the FC group and 46% of the C group (p=0.3), with type II occurring most frequently (35.8%). New cut-off value of 31% for percent anal relaxation in children was derived based on the ROC curve analysis. Based on this new cut-off value, DD was diagnosed in 69.3% of constipated children, with type IV occurring most frequently (28.9%). The analysis of segmental pressure showed significant influence of segments at the locations of the puborectalis muscle and external anal sphincter. Conclusions: We found that during bear down maneuver the percent anal relaxation variable significantly differed between patients and controls. The higher cut-off value should be used when 3DHRAM and the standard four-type classification are used to diagnose DD in children.
Dietary Fiber Intake in Children With Inflammatory Bowel Disease
Journal of Pediatric Gastroenterology and Nutrition, Apr 1, 2018
ABSTRACT Objectives: The aim of the study was to estimate intake of total dietary fiber, and its ... more ABSTRACT Objectives: The aim of the study was to estimate intake of total dietary fiber, and its soluble and insoluble fractions, by children with inflammatory bowel disease (IBD) in comparison with healthy controls. Methods: This was a prospective controlled study on children with IBD. Food consumption data were collected by using the 3-day diet record. For intake of soluble and insoluble fibers author's questionnaire was used. Results: The study included 50 children with IBD (80% in clinical remission) and 50 healthy controls. There were no statistically significant differences in age, weight, height, and BMI percentiles between both groups. The mean disease duration was 3.5 ± 2.5 years. The daily median dietary fiber intake in patients was 15.3 ± 4.2 g, whereas controls consumed about 14.1 ± 3.6 g/day; differences were not statistically significant. The median intake of soluble fiber in the study group was 5.0 g/day and in controls 4.7 g/day, whereas the intake of insoluble fractions was 10.2 versus 9.7 g/day, respectively. The total fiber intake significantly increased with age and it was higher among boys in each age group. The boys better achieved adequate intake recommendations (P = 0.003). Both, children with IBD and healthy controls, did not meet the adequate intake recommendations. Conclusions: Intake of fiber in patients with IBD and healthy controls was comparable; however, in both groups, it was lower than recommended.
Nutrients, Aug 11, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Inflammatory Bowel Diseases, Dec 1, 2017
Background: Interestingly, Clostridium difficile infection (CDI) worsens the course of inflammato... more Background: Interestingly, Clostridium difficile infection (CDI) worsens the course of inflammatory bowel disease (IBD); however, there is a paucity of data regarding the treatment of CDI in this group of patients. Methods: This was a prospective, single-blind trial. Children with flare of IBD and CDI were randomly assigned to receive metronidazole or rifaximin orally for 14 days. CDI was diagnosed based on a positive well-type enzyme immunoassay (EIA) toxins A/B stool test for C. difficile toxins A and/or B. The cure rate was defined as the percentage of patients with a negative EIA stool test for C. difficile toxins A/B measured 4 weeks after the end of treatment. Recurrence was defined as a repeat CDI within 2 to 8 weeks. Results: In total, we included 31 patients with IBD including 12 patients with Crohn's disease and 19 with ulcerative colitis. Of them, 17 received metronidazole and 14 received rifaximin. There were no statistically significant differences between the 2 study groups including age, type of treatment, and disease activity. There was no statistically significant difference in the cure rate between patients treated with metronidazole and rifaximin (70.6% versus 78.6%, respectively, P ¼ 0.5). We found no difference in recurrence rate between the 2 study treatment types (17% versus 0%, respectively, P ¼ 0.3). We did not find an association between immunosuppressive therapy and CDI cure rate or CDI recurrence rate. Conclusions: Metronidazole and rifaximin were similarly effective treatments for CDI in pediatric patients with IBD.
Comparison of Anorectal Function as Measured with High-Resolution and High-Definition Anorectal Manometry
Digestive Diseases, Aug 10, 2021
Introduction: Anorectal manometry (ARM) provides comprehensive assessment of pressure activity in... more Introduction: Anorectal manometry (ARM) provides comprehensive assessment of pressure activity in the rectum and anal canal. Absolute pressure values might depend on the catheter used. Objective: Our aim was to compare the results obtained by different anorectal catheters in children with functional anorectal disorders. Methods: Children diagnosed with functional defecation disorders based on the Rome IV criteria were prospectively enrolled. ARM was performed in the supine position successively using 2 different probes in each patient in random order. Resting, squeeze pressures, and bear-down maneuver variables obtained by high-resolution (2-dimensional [2D]) and high-definition (3-dimensional [3D]) catheters were compared. Results: We prospectively included 100 children {mean age 7.5 [standard deviation (SD) ± 4.3] years; 62 boys}. Mean resting pressures were significantly higher when measured with the 3D than with the 2D catheter (71 [SD ± 19.4] vs. 65 [SD ± 20.1] mm Hg, respectively; p = 0.000). Intrarectal pressure measured by 3D and 2D catheters was similar (35 vs. 39 mm Hg, respectively; p = 0.761), but the percent of anal relaxation appeared to be higher for the 3D than for the 2D probe (12 vs. 5%, respectively; p = 0.002). Dyssynergic defecation (DD) was diagnosed in 41/71 patients (57.7%) using the 3D probe and in 51/71 children (71.8%) using the 2D probe (p = 0.044). Cohen’s kappa showed only fair agreement between the catheters (κ = 0.40) in diagnosis of DD. Conclusions: Our study demonstrated significantly different values of pressures obtained with different types of catheters. Normal ranges for conventional manometry cannot be applied to high-resolution systems, and results obtained by different types of manometry cannot be compared without adjustments (NCT02812823).
Polish Journal of Radiology, 2018
Purpose: To assess the extent to which a radiation dose can be lowered without compromising image... more Purpose: To assess the extent to which a radiation dose can be lowered without compromising image quality and diagnostic confidence in congenital urinary tract abnormalities in children by using a CT scanner with an iterative reconstruction algorithm. Material and methods: 120 CT urography image series were analysed retrospectively. Image series were divided into four study groups depending on effective radiation dose (group 1: 0.8-2 mSv; group 2: 2-4 mSv; group 3: 4-6 mSv; group 4: 6-11 mSv). Objective and subjective image quality were investigated. In objective analysis, measurements of attenuation and standard deviation (SD) in five regions of interest (ROIs) were performed in 109 excretory image series, and image noise was evaluated. In subjective analysis, two independent radiologists evaluated 138 kidney units for subjective image quality and diagnostic confidence. Results: There were no significant differences in image noise in objective evaluation between the following study groups: 2 vs. 3 and 3 vs. 4 in all ROIs (with the only exception in spleen SD measurement between study groups 2 vs. 3), while there was significantly more image noise in group 2 in comparison to group 4. For all other ROIs in all study groups, there was more image noise on lower dose images. There were no significant differences in pairwise comparisons between study groups in subjective image quality. Diagnostic confidence was not significantly different between all study groups. Conclusions: Low-dose CT urography can be a valuable method in congenital urinary tract abnormalities in children. Despite poorer image quality, diagnostic confidence is not significantly compromised in examinations performed with lower radiation doses.
Alimentary Pharmacology & Therapeutics, Oct 2, 2016
syndrome), we did not observe a higher prevalence of fatty liver in our HIV-infected subjects. Th... more syndrome), we did not observe a higher prevalence of fatty liver in our HIV-infected subjects. This finding was similar to that observed in the Multicenter AIDS Cohort Study. 3 In our multivariate model (in which various metabolic conditions and intrahepatic triglyceride content were adjusted), both HIV infection and central obesity were independent predictors of liver fibrosis. Of note, while only 4.1% and 6.1% of those with HIV infection and central obesity alone respectively had significant liver fibrosis, significant liver fibrosis was observed in 32.1% when both conditions were present, implying a possible synergistic interaction between HIV infection and components of metabolic syndrome in producing excessive liver fibrosis. The role and mechanism of obesity on chronic liver disease and other comorbidities in HIV-infected subjects deserve further evaluation. 4 We acknowledge the high prevalence of metabolic comorbidities in our HIV-infected cohort, and the results of our study should be interpreted within this context. As metabolic syndrome and other metabolic complications are prevalent in up to >30% of the HIV-infected population receiving anti-retroviral therapy, 5 we hope that our results would contribute to optimising care of this group of individuals.
Journal of Pediatric Gastroenterology and Nutrition, Oct 1, 2015
Background: Chronic constipation is one of the most common chronic disease in children. Most of c... more Background: Chronic constipation is one of the most common chronic disease in children. Most of cases are functional, however some has problem of organic myopathic or neuropathic colon. Colonic transit study with oro-anal transit markers is the basic diagnostic tool for colonic dysmotility in clinical practice, colonic manometry is the recommended investigation in the next step. Nevertheless, the colonic manometry is considered more invasive, expensive and also unavailable in many countries. The aim of this study is to assess the diagnostic value of conventional method as colonic transit study compared with the novel high-resolution colonic manometry in diagnose colonic abnormalities. Methods: Fifty constipated children in Great Ormond Street hospital were retrospectively reviewed in demographic data and investigation result. The diagnosis of constipation was based on history and physical examination which followed Rome III criteria. All of enrolled patients received colonic manometry investigation before colonic transit study in order to reduce the bias. For colonic transit protocol, patients had to ingest a 10-markers capsule on 3 consecutive days and an abdominal x-ray was obtained on day 4. The cutoff values for abnormal segmental and total colonic transit time(CTT) were based on Arhan et al publication. Results: Fifty constipated children with the mean age of 9.77 years (1.15-17.32) were included. Of all, 39 (78%) patients had colonic abnormality detected by colonic manometry while 38(76%) patients had abnormal CTT. The sensitivity, specificity, and positive predictive value(PPV) of colonic transit study for abnormal total CTT were 46.2%, 72.7% and 85.7%, respectively. In aspect of abnormal segmental CTT, the sensitivity, specificity and PPV of right colon are 66.7%, 63.6% and 20%; left colon are 16.7%, 72.7% and 7.69%; and rectosigmoid colon are 29.4%, 68.8% and 66.7%, respectively. Conclusions: Colonic transit study seemed to have satisfied posttest probability to diagnose total colonic abnormality. However, for segmental CTT, this test might be invalid and the consideration to use as predictor of segmental abnormality was not recommended.
Pediatria Polska
Desmosis coli (DC) is an extremely rare condition of unknown pathogenesis. Only a few cases have ... more Desmosis coli (DC) is an extremely rare condition of unknown pathogenesis. Only a few cases have been reported in the literature. It is characterised by the absence of connective tissue between muscle layers in the colon. Chronic constipation is the main manifestation of DC; thus, it largely resembles Hirschsprung disease. Moreover, neither DC nor Hirschsprung disease responds to conventional treatment. This paper describes a case of a patient with a diagnosis of DC. It was written to highlight the importance of proper diagnosis and to raise awareness of this uncommon disorder. A mini-review of the literature on DC is also provided.
Annals of Agricultural and Environmental Medicine
Introduction and objective. Eosinophilic esophagitis (EoE) is an inflammatory immune-mediated oes... more Introduction and objective. Eosinophilic esophagitis (EoE) is an inflammatory immune-mediated oesophageal disease of growing prevalence. The aim of this study is to characterise the clinical symptoms, endoscopic features and histological findings, as well as their possible correlations, in newly-diagnosed EoE paediatric patients. Materials and method. Between 2009-2018, the clinical records of patients diagnosed with EoE at the Paediatric Hospital in Warsaw, Poland, were retrospectively reviewed. Inclusion criteria were upper gastrointestinal tract symptoms in association with oesophageal mucosal biopsy specimens containing not less than 15 intraepithelial eosinophils per hpf. The prevalence and the possible correlations between symptoms, endoscopic features and the density of eosinophilic infiltration were analysed; the medical history of the comorbidities were also assessed. Results. The study included 47 children (median age 9.5 years). The most common clinical symptoms were abdominal pain (53%) and GERD-like symptoms (26%). The most common macroscopic changes were white plaques and exudates in 47% and furrows in 34%. A macroscopically normal oesophagus was observed in 28% of the children. The median number of eosinophils was estimated to be 45 eosinophils/hpf (IQR: 30-60), and no significant differences were found between the density of eosinophil infiltration and clinical symptoms or endoscopic features. Moreover, 70% of the children had a history of an allergy disease, older children (>3 years) tended to have pollen allergy more often than younger children (p<0.05). Conclusions. The density of oesophageal eosinophilia does not correlate with symptoms or endoscopic findings in children with newl-diagnosed EoE.
Pediatria Polska
Paediatric ulcerative colitis (UC) has a tendency to run in an extensive manner, with frequent ex... more Paediatric ulcerative colitis (UC) has a tendency to run in an extensive manner, with frequent exacerbations. As a result, treatment of paediatric patients is a complex process demanding thorough evaluation, careful monitoring, and selection of appropriate medication. We present a case report of UC in an 11-year-old boy diagnosed at the age of 7 years. During 3 years of treatment many therapeutic methods were used, but none brought a long-lasting therapeutic effect. Due to exhaustion of available therapeutic options, off-label treatment with vedolizumab was introduced. Currently, in his 15th month of the therapy, the patient remains in remission. This case, in line with the available literature, indicates that there might be a need to include vedolizumab to the UC standard treatment regimens. Moreover, it should also be considered for inclusion in funding programs of national health insurance companies. It is of a crucial importance for patients because in some cases it remains the last treatment option.
Characteristics of gastroesophageal reflux disease in children with interstitial lung disease
Pediatric Pulmonology
BackgroundChildhood interstitial lung disease (chILD) is a rare group of respiratory tract disord... more BackgroundChildhood interstitial lung disease (chILD) is a rare group of respiratory tract disorders. One of the factors suggested to be associated with its etiopathogenesis is microaspiration related to gastroesophageal reflux disease (GERD). The aim of the present study was to determine the frequency and characteristics of GERD in children with chILD, with a particular focus on proximal GER episodes.MethodsThis was a prospective cross‐sectional study. Consecutive patients with chILD underwent 24‐h multichannel intraluminal pH‐impedance monitoring. Different types of gastroesophageal reflux episodes (GER) were recorded and compared with regard to the GERD diagnosis.ResultsSixty‐two children (median age of 1.22 years) were included. GERD was diagnosed in 20 (32.3%) of them. The GERD (+) and GERD (−) subgroups differed mainly in their esophageal exposure to acid content (2.9 vs. 1.0%, p = 0.02) and bolus exposure (3.0 vs. 1.4%, p < 0.0001), as well as total number of GER (72.5 vs....
Pediatria Polska
Solitary rectal ulcer syndrome (SRUS) is a rare condition, usually affecting young adults, with f... more Solitary rectal ulcer syndrome (SRUS) is a rare condition, usually affecting young adults, with few cases in children. Solitary rectal ulcer syndrome appears in the mucosa of the large intestine, typically the rectum, and has the form of singular or multiple lesions-most commonly ulcerations. Its aetiology remains unclear. However, there are some theories explaining its onset. The disease can manifest, e.g., as a rectal bleeding, mucoid discharge or abdominal pain. There is a particular constellation of features in the histopathological examination that confirms the diagnosis of SRUS. In spite of the fact that there are many pharmacological and non-pharmacological forms of treatment, managing SRUS remains unsatisfactory. The paper describes a case of a patient with a very unusual cause of SRUS-tailgut cyst. It is reported to raise the awareness of such a disease and emphasize the importance of further testing when the treatment fails.
Pediatria Polska, 2021
Herlyn-Werner-Wunderlich syndrome, also known as OHVIRA (Obstructed Hemivagina and Ipsilateral Re... more Herlyn-Werner-Wunderlich syndrome, also known as OHVIRA (Obstructed Hemivagina and Ipsilateral Renal Anomaly), is an extremely rare abnormality of the Müllerian ducts, characterized by the presence of double uterus, unilateral cervico-vaginal obstruction and renal agenesis and/or other urinary tract anomalies. Most cases are diagnosed after menarche through an MRI, CT or ultrasound. There are no specific symptoms of this syndrome. Patients presented fever and vomiting during menstruation, intermenstrual bleeding and palpable abdominal, pelvic or vaginal mass. Thorough history taking is extremely important as common symptoms in pediatrics (vomiting, constipation, abdominal pain) may be a part of a more complex condition, not only within the GI tract but also including other systems.
Scientific Reports, 2022
Excessive laxity of the connective tissue refers to a group of inherited abnormalities manifested... more Excessive laxity of the connective tissue refers to a group of inherited abnormalities manifested by disturbances in the functioning of internal organs, including the gastrointestinal tract. Increased susceptibility to stretching of the distal part of the large intestine and abnormal colonic motor function could explain the predisposition to the development of functional constipation in some children. Our aim was to determine whether patients with functional constipation are more likely to be characterized by congenital laxity of connective tissue compared to the population of healthy children. Children diagnosed with functional constipation according to the Rome III criteria were prospectively enrolled in the study (study group, S) and compared to otherwise healthy children (control group, C). Excessive laxity of the connective tissue was evaluated using the Beighton Score (BS) and expressed as median and interquartile range (IQR). The study included 411 patients (median age 7.8 ye...
Frontiers in Pediatrics, 2021
Introduction:Antibiotic-associated diarrhea (AAD) is a common adverse reaction to antibiotic trea... more Introduction:Antibiotic-associated diarrhea (AAD) is a common adverse reaction to antibiotic treatment affecting up to 21% of children. The aim of the study is to evaluate whether bovine lactoferrin (bLf) might be used for AAD prevention.Materials and Methods:In this prospective, randomized, double-blind, placebo-controlled, single-center study, we enrolled 156 children aged between 1 and 18 years, treated with antibiotic due to acute respiratory or urinary tract infection. We randomly allocated children 1:1 to receive 100 mg of bLf or a placebo twice a day orally for the whole period of antibiotic therapy. The primary outcome was the occurrence of antibiotic-associated diarrhea during and up to 2 weeks after antibiotic therapy. The secondary endpoint was intravenous rehydration or antibiotic withdrawal due to diarrhea. We performed intention-to-treat analysis.Results:We included 150 patients in intention-to-treat analysis. AAD occurred in 16 of 75 (21.3%) patients in bLf group and ...
Comparison of Anorectal Function as Measured with High-Resolution and High-Definition Anorectal Manometry
Digestive Diseases, 2021
Introduction: Anorectal manometry (ARM) provides comprehensive assessment of pressure activity in... more Introduction: Anorectal manometry (ARM) provides comprehensive assessment of pressure activity in the rectum and anal canal. Absolute pressure values might depend on the catheter used. Objective: Our aim was to compare the results obtained by different anorectal catheters in children with functional anorectal disorders. Methods: Children diagnosed with functional defecation disorders based on the Rome IV criteria were prospectively enrolled. ARM was performed in the supine position successively using 2 different probes in each patient in random order. Resting, squeeze pressures, and bear-down maneuver variables obtained by high-resolution (2-dimensional [2D]) and high-definition (3-dimensional [3D]) catheters were compared. Results: We prospectively included 100 children {mean age 7.5 [standard deviation (SD) ± 4.3] years; 62 boys}. Mean resting pressures were significantly higher when measured with the 3D than with the 2D catheter (71 [SD ± 19.4] vs. 65 [SD ± 20.1] mm Hg, respectiv...
Children, 2021
Deleted in malignant brain tumours 1 protein (DMBT1) and surfactant protein D (SFTPD) are antimic... more Deleted in malignant brain tumours 1 protein (DMBT1) and surfactant protein D (SFTPD) are antimicrobial peptides previously linked to inflammatory bowel disease (IBD) susceptibility. This study attempts to link the most potential IBD-associated polymorphisms in DMBT1 and SFTPD with the disease severity in children. A total of 406 IBD patients (Crohn’s disease (CD) n = 214 and ulcerative colitis (UC) n = 192) were genotyped using hydrolysis probe assay. Clinical expression was described by disease activity scales, albumin and C-reactive protein levels, localisation and behaviour (Paris classification), systemic steroid, immunosuppressive, biological, and surgical treatment, number of exacerbation-caused hospitalisations, relapses and nutritional status. IBD patients with the risk genotype (AA) in DMBT1 rs2981804 had more frequent biological treatment (AA: vs. AG/GG; p = 0.012), concomitant diseases (AA vs. AG vs. GG; p = 0.015) and cutaneous manifestations (AA vs. AG/GG, p = 0.008). ...
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus / I.S.D.E, Jan 3, 2014
High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esop... more High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esophageal function. Our aim was to assess the inter-observer agreement for diagnosis of esophageal motility disorders using this technology. Practitioners registered on the HRM Working Group website were invited to review and classify (i) 147 individual water swallows and (ii) 40 diagnostic studies comprising 10 swallows using a drop-down menu that followed the Chicago Classification system. Data were presented using a standardized format with pressure contours without a summary of HRM metrics. The sequence of swallows was fixed for each user but randomized between users to avoid sequence bias. Participants were blinded to other entries. (i) Individual swallows were assessed by 18 practitioners (13 institutions). Consensus agreement (≤2/18 dissenters) was present for most cases of normal peristalsis and achalasia but not for cases of peristaltic dysmotility. (ii) Diagnostic studies were ass...
Very early and early nutrition in children with pancreatitis—A randomised trial
Journal of pediatric gastroenterology and nutrition, Jun 27, 2024
PubMed, Aug 1, 2021
Objective: Dyssynergic defecation (DD) may be one of the most important causes of constipation, b... more Objective: Dyssynergic defecation (DD) may be one of the most important causes of constipation, but its diagnostic criteria have not been formally validated in children. This study aims to evaluate constipated children with 3DHRAM (three-dimensional high-resolution anorectal manometry) and determine a new pediatric cut-off for DD variables. Patients and methods: 205 patients diagnosed with functional constipation (FC) based on Rome III criteria were prospectively enrolled. Data were compared to a historical control group (C). Initially, the diagnosis of DD was based on adult criteria and divided into 4 types. A new cut-off value for percent anal relaxation was determined based on ROC curve analysis. Results: The FC group presented significantly lower values of percent anal relaxation during straining compared to the C group (9.5% vs. 20%, respectively, p=0.03). Based on adult criteria, DD was found in 53% of the FC group and 46% of the C group (p=0.3), with type II occurring most frequently (35.8%). New cut-off value of 31% for percent anal relaxation in children was derived based on the ROC curve analysis. Based on this new cut-off value, DD was diagnosed in 69.3% of constipated children, with type IV occurring most frequently (28.9%). The analysis of segmental pressure showed significant influence of segments at the locations of the puborectalis muscle and external anal sphincter. Conclusions: We found that during bear down maneuver the percent anal relaxation variable significantly differed between patients and controls. The higher cut-off value should be used when 3DHRAM and the standard four-type classification are used to diagnose DD in children.
Dietary Fiber Intake in Children With Inflammatory Bowel Disease
Journal of Pediatric Gastroenterology and Nutrition, Apr 1, 2018
ABSTRACT Objectives: The aim of the study was to estimate intake of total dietary fiber, and its ... more ABSTRACT Objectives: The aim of the study was to estimate intake of total dietary fiber, and its soluble and insoluble fractions, by children with inflammatory bowel disease (IBD) in comparison with healthy controls. Methods: This was a prospective controlled study on children with IBD. Food consumption data were collected by using the 3-day diet record. For intake of soluble and insoluble fibers author's questionnaire was used. Results: The study included 50 children with IBD (80% in clinical remission) and 50 healthy controls. There were no statistically significant differences in age, weight, height, and BMI percentiles between both groups. The mean disease duration was 3.5 ± 2.5 years. The daily median dietary fiber intake in patients was 15.3 ± 4.2 g, whereas controls consumed about 14.1 ± 3.6 g/day; differences were not statistically significant. The median intake of soluble fiber in the study group was 5.0 g/day and in controls 4.7 g/day, whereas the intake of insoluble fractions was 10.2 versus 9.7 g/day, respectively. The total fiber intake significantly increased with age and it was higher among boys in each age group. The boys better achieved adequate intake recommendations (P = 0.003). Both, children with IBD and healthy controls, did not meet the adequate intake recommendations. Conclusions: Intake of fiber in patients with IBD and healthy controls was comparable; however, in both groups, it was lower than recommended.
Nutrients, Aug 11, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Inflammatory Bowel Diseases, Dec 1, 2017
Background: Interestingly, Clostridium difficile infection (CDI) worsens the course of inflammato... more Background: Interestingly, Clostridium difficile infection (CDI) worsens the course of inflammatory bowel disease (IBD); however, there is a paucity of data regarding the treatment of CDI in this group of patients. Methods: This was a prospective, single-blind trial. Children with flare of IBD and CDI were randomly assigned to receive metronidazole or rifaximin orally for 14 days. CDI was diagnosed based on a positive well-type enzyme immunoassay (EIA) toxins A/B stool test for C. difficile toxins A and/or B. The cure rate was defined as the percentage of patients with a negative EIA stool test for C. difficile toxins A/B measured 4 weeks after the end of treatment. Recurrence was defined as a repeat CDI within 2 to 8 weeks. Results: In total, we included 31 patients with IBD including 12 patients with Crohn's disease and 19 with ulcerative colitis. Of them, 17 received metronidazole and 14 received rifaximin. There were no statistically significant differences between the 2 study groups including age, type of treatment, and disease activity. There was no statistically significant difference in the cure rate between patients treated with metronidazole and rifaximin (70.6% versus 78.6%, respectively, P ¼ 0.5). We found no difference in recurrence rate between the 2 study treatment types (17% versus 0%, respectively, P ¼ 0.3). We did not find an association between immunosuppressive therapy and CDI cure rate or CDI recurrence rate. Conclusions: Metronidazole and rifaximin were similarly effective treatments for CDI in pediatric patients with IBD.
Comparison of Anorectal Function as Measured with High-Resolution and High-Definition Anorectal Manometry
Digestive Diseases, Aug 10, 2021
Introduction: Anorectal manometry (ARM) provides comprehensive assessment of pressure activity in... more Introduction: Anorectal manometry (ARM) provides comprehensive assessment of pressure activity in the rectum and anal canal. Absolute pressure values might depend on the catheter used. Objective: Our aim was to compare the results obtained by different anorectal catheters in children with functional anorectal disorders. Methods: Children diagnosed with functional defecation disorders based on the Rome IV criteria were prospectively enrolled. ARM was performed in the supine position successively using 2 different probes in each patient in random order. Resting, squeeze pressures, and bear-down maneuver variables obtained by high-resolution (2-dimensional [2D]) and high-definition (3-dimensional [3D]) catheters were compared. Results: We prospectively included 100 children {mean age 7.5 [standard deviation (SD) ± 4.3] years; 62 boys}. Mean resting pressures were significantly higher when measured with the 3D than with the 2D catheter (71 [SD ± 19.4] vs. 65 [SD ± 20.1] mm Hg, respectively; p = 0.000). Intrarectal pressure measured by 3D and 2D catheters was similar (35 vs. 39 mm Hg, respectively; p = 0.761), but the percent of anal relaxation appeared to be higher for the 3D than for the 2D probe (12 vs. 5%, respectively; p = 0.002). Dyssynergic defecation (DD) was diagnosed in 41/71 patients (57.7%) using the 3D probe and in 51/71 children (71.8%) using the 2D probe (p = 0.044). Cohen’s kappa showed only fair agreement between the catheters (κ = 0.40) in diagnosis of DD. Conclusions: Our study demonstrated significantly different values of pressures obtained with different types of catheters. Normal ranges for conventional manometry cannot be applied to high-resolution systems, and results obtained by different types of manometry cannot be compared without adjustments (NCT02812823).
Polish Journal of Radiology, 2018
Purpose: To assess the extent to which a radiation dose can be lowered without compromising image... more Purpose: To assess the extent to which a radiation dose can be lowered without compromising image quality and diagnostic confidence in congenital urinary tract abnormalities in children by using a CT scanner with an iterative reconstruction algorithm. Material and methods: 120 CT urography image series were analysed retrospectively. Image series were divided into four study groups depending on effective radiation dose (group 1: 0.8-2 mSv; group 2: 2-4 mSv; group 3: 4-6 mSv; group 4: 6-11 mSv). Objective and subjective image quality were investigated. In objective analysis, measurements of attenuation and standard deviation (SD) in five regions of interest (ROIs) were performed in 109 excretory image series, and image noise was evaluated. In subjective analysis, two independent radiologists evaluated 138 kidney units for subjective image quality and diagnostic confidence. Results: There were no significant differences in image noise in objective evaluation between the following study groups: 2 vs. 3 and 3 vs. 4 in all ROIs (with the only exception in spleen SD measurement between study groups 2 vs. 3), while there was significantly more image noise in group 2 in comparison to group 4. For all other ROIs in all study groups, there was more image noise on lower dose images. There were no significant differences in pairwise comparisons between study groups in subjective image quality. Diagnostic confidence was not significantly different between all study groups. Conclusions: Low-dose CT urography can be a valuable method in congenital urinary tract abnormalities in children. Despite poorer image quality, diagnostic confidence is not significantly compromised in examinations performed with lower radiation doses.
Alimentary Pharmacology & Therapeutics, Oct 2, 2016
syndrome), we did not observe a higher prevalence of fatty liver in our HIV-infected subjects. Th... more syndrome), we did not observe a higher prevalence of fatty liver in our HIV-infected subjects. This finding was similar to that observed in the Multicenter AIDS Cohort Study. 3 In our multivariate model (in which various metabolic conditions and intrahepatic triglyceride content were adjusted), both HIV infection and central obesity were independent predictors of liver fibrosis. Of note, while only 4.1% and 6.1% of those with HIV infection and central obesity alone respectively had significant liver fibrosis, significant liver fibrosis was observed in 32.1% when both conditions were present, implying a possible synergistic interaction between HIV infection and components of metabolic syndrome in producing excessive liver fibrosis. The role and mechanism of obesity on chronic liver disease and other comorbidities in HIV-infected subjects deserve further evaluation. 4 We acknowledge the high prevalence of metabolic comorbidities in our HIV-infected cohort, and the results of our study should be interpreted within this context. As metabolic syndrome and other metabolic complications are prevalent in up to >30% of the HIV-infected population receiving anti-retroviral therapy, 5 we hope that our results would contribute to optimising care of this group of individuals.
Journal of Pediatric Gastroenterology and Nutrition, Oct 1, 2015
Background: Chronic constipation is one of the most common chronic disease in children. Most of c... more Background: Chronic constipation is one of the most common chronic disease in children. Most of cases are functional, however some has problem of organic myopathic or neuropathic colon. Colonic transit study with oro-anal transit markers is the basic diagnostic tool for colonic dysmotility in clinical practice, colonic manometry is the recommended investigation in the next step. Nevertheless, the colonic manometry is considered more invasive, expensive and also unavailable in many countries. The aim of this study is to assess the diagnostic value of conventional method as colonic transit study compared with the novel high-resolution colonic manometry in diagnose colonic abnormalities. Methods: Fifty constipated children in Great Ormond Street hospital were retrospectively reviewed in demographic data and investigation result. The diagnosis of constipation was based on history and physical examination which followed Rome III criteria. All of enrolled patients received colonic manometry investigation before colonic transit study in order to reduce the bias. For colonic transit protocol, patients had to ingest a 10-markers capsule on 3 consecutive days and an abdominal x-ray was obtained on day 4. The cutoff values for abnormal segmental and total colonic transit time(CTT) were based on Arhan et al publication. Results: Fifty constipated children with the mean age of 9.77 years (1.15-17.32) were included. Of all, 39 (78%) patients had colonic abnormality detected by colonic manometry while 38(76%) patients had abnormal CTT. The sensitivity, specificity, and positive predictive value(PPV) of colonic transit study for abnormal total CTT were 46.2%, 72.7% and 85.7%, respectively. In aspect of abnormal segmental CTT, the sensitivity, specificity and PPV of right colon are 66.7%, 63.6% and 20%; left colon are 16.7%, 72.7% and 7.69%; and rectosigmoid colon are 29.4%, 68.8% and 66.7%, respectively. Conclusions: Colonic transit study seemed to have satisfied posttest probability to diagnose total colonic abnormality. However, for segmental CTT, this test might be invalid and the consideration to use as predictor of segmental abnormality was not recommended.
Pediatria Polska
Desmosis coli (DC) is an extremely rare condition of unknown pathogenesis. Only a few cases have ... more Desmosis coli (DC) is an extremely rare condition of unknown pathogenesis. Only a few cases have been reported in the literature. It is characterised by the absence of connective tissue between muscle layers in the colon. Chronic constipation is the main manifestation of DC; thus, it largely resembles Hirschsprung disease. Moreover, neither DC nor Hirschsprung disease responds to conventional treatment. This paper describes a case of a patient with a diagnosis of DC. It was written to highlight the importance of proper diagnosis and to raise awareness of this uncommon disorder. A mini-review of the literature on DC is also provided.
Annals of Agricultural and Environmental Medicine
Introduction and objective. Eosinophilic esophagitis (EoE) is an inflammatory immune-mediated oes... more Introduction and objective. Eosinophilic esophagitis (EoE) is an inflammatory immune-mediated oesophageal disease of growing prevalence. The aim of this study is to characterise the clinical symptoms, endoscopic features and histological findings, as well as their possible correlations, in newly-diagnosed EoE paediatric patients. Materials and method. Between 2009-2018, the clinical records of patients diagnosed with EoE at the Paediatric Hospital in Warsaw, Poland, were retrospectively reviewed. Inclusion criteria were upper gastrointestinal tract symptoms in association with oesophageal mucosal biopsy specimens containing not less than 15 intraepithelial eosinophils per hpf. The prevalence and the possible correlations between symptoms, endoscopic features and the density of eosinophilic infiltration were analysed; the medical history of the comorbidities were also assessed. Results. The study included 47 children (median age 9.5 years). The most common clinical symptoms were abdominal pain (53%) and GERD-like symptoms (26%). The most common macroscopic changes were white plaques and exudates in 47% and furrows in 34%. A macroscopically normal oesophagus was observed in 28% of the children. The median number of eosinophils was estimated to be 45 eosinophils/hpf (IQR: 30-60), and no significant differences were found between the density of eosinophil infiltration and clinical symptoms or endoscopic features. Moreover, 70% of the children had a history of an allergy disease, older children (>3 years) tended to have pollen allergy more often than younger children (p<0.05). Conclusions. The density of oesophageal eosinophilia does not correlate with symptoms or endoscopic findings in children with newl-diagnosed EoE.
Pediatria Polska
Paediatric ulcerative colitis (UC) has a tendency to run in an extensive manner, with frequent ex... more Paediatric ulcerative colitis (UC) has a tendency to run in an extensive manner, with frequent exacerbations. As a result, treatment of paediatric patients is a complex process demanding thorough evaluation, careful monitoring, and selection of appropriate medication. We present a case report of UC in an 11-year-old boy diagnosed at the age of 7 years. During 3 years of treatment many therapeutic methods were used, but none brought a long-lasting therapeutic effect. Due to exhaustion of available therapeutic options, off-label treatment with vedolizumab was introduced. Currently, in his 15th month of the therapy, the patient remains in remission. This case, in line with the available literature, indicates that there might be a need to include vedolizumab to the UC standard treatment regimens. Moreover, it should also be considered for inclusion in funding programs of national health insurance companies. It is of a crucial importance for patients because in some cases it remains the last treatment option.
Characteristics of gastroesophageal reflux disease in children with interstitial lung disease
Pediatric Pulmonology
BackgroundChildhood interstitial lung disease (chILD) is a rare group of respiratory tract disord... more BackgroundChildhood interstitial lung disease (chILD) is a rare group of respiratory tract disorders. One of the factors suggested to be associated with its etiopathogenesis is microaspiration related to gastroesophageal reflux disease (GERD). The aim of the present study was to determine the frequency and characteristics of GERD in children with chILD, with a particular focus on proximal GER episodes.MethodsThis was a prospective cross‐sectional study. Consecutive patients with chILD underwent 24‐h multichannel intraluminal pH‐impedance monitoring. Different types of gastroesophageal reflux episodes (GER) were recorded and compared with regard to the GERD diagnosis.ResultsSixty‐two children (median age of 1.22 years) were included. GERD was diagnosed in 20 (32.3%) of them. The GERD (+) and GERD (−) subgroups differed mainly in their esophageal exposure to acid content (2.9 vs. 1.0%, p = 0.02) and bolus exposure (3.0 vs. 1.4%, p < 0.0001), as well as total number of GER (72.5 vs....
Pediatria Polska
Solitary rectal ulcer syndrome (SRUS) is a rare condition, usually affecting young adults, with f... more Solitary rectal ulcer syndrome (SRUS) is a rare condition, usually affecting young adults, with few cases in children. Solitary rectal ulcer syndrome appears in the mucosa of the large intestine, typically the rectum, and has the form of singular or multiple lesions-most commonly ulcerations. Its aetiology remains unclear. However, there are some theories explaining its onset. The disease can manifest, e.g., as a rectal bleeding, mucoid discharge or abdominal pain. There is a particular constellation of features in the histopathological examination that confirms the diagnosis of SRUS. In spite of the fact that there are many pharmacological and non-pharmacological forms of treatment, managing SRUS remains unsatisfactory. The paper describes a case of a patient with a very unusual cause of SRUS-tailgut cyst. It is reported to raise the awareness of such a disease and emphasize the importance of further testing when the treatment fails.
Pediatria Polska, 2021
Herlyn-Werner-Wunderlich syndrome, also known as OHVIRA (Obstructed Hemivagina and Ipsilateral Re... more Herlyn-Werner-Wunderlich syndrome, also known as OHVIRA (Obstructed Hemivagina and Ipsilateral Renal Anomaly), is an extremely rare abnormality of the Müllerian ducts, characterized by the presence of double uterus, unilateral cervico-vaginal obstruction and renal agenesis and/or other urinary tract anomalies. Most cases are diagnosed after menarche through an MRI, CT or ultrasound. There are no specific symptoms of this syndrome. Patients presented fever and vomiting during menstruation, intermenstrual bleeding and palpable abdominal, pelvic or vaginal mass. Thorough history taking is extremely important as common symptoms in pediatrics (vomiting, constipation, abdominal pain) may be a part of a more complex condition, not only within the GI tract but also including other systems.
Scientific Reports, 2022
Excessive laxity of the connective tissue refers to a group of inherited abnormalities manifested... more Excessive laxity of the connective tissue refers to a group of inherited abnormalities manifested by disturbances in the functioning of internal organs, including the gastrointestinal tract. Increased susceptibility to stretching of the distal part of the large intestine and abnormal colonic motor function could explain the predisposition to the development of functional constipation in some children. Our aim was to determine whether patients with functional constipation are more likely to be characterized by congenital laxity of connective tissue compared to the population of healthy children. Children diagnosed with functional constipation according to the Rome III criteria were prospectively enrolled in the study (study group, S) and compared to otherwise healthy children (control group, C). Excessive laxity of the connective tissue was evaluated using the Beighton Score (BS) and expressed as median and interquartile range (IQR). The study included 411 patients (median age 7.8 ye...
Frontiers in Pediatrics, 2021
Introduction:Antibiotic-associated diarrhea (AAD) is a common adverse reaction to antibiotic trea... more Introduction:Antibiotic-associated diarrhea (AAD) is a common adverse reaction to antibiotic treatment affecting up to 21% of children. The aim of the study is to evaluate whether bovine lactoferrin (bLf) might be used for AAD prevention.Materials and Methods:In this prospective, randomized, double-blind, placebo-controlled, single-center study, we enrolled 156 children aged between 1 and 18 years, treated with antibiotic due to acute respiratory or urinary tract infection. We randomly allocated children 1:1 to receive 100 mg of bLf or a placebo twice a day orally for the whole period of antibiotic therapy. The primary outcome was the occurrence of antibiotic-associated diarrhea during and up to 2 weeks after antibiotic therapy. The secondary endpoint was intravenous rehydration or antibiotic withdrawal due to diarrhea. We performed intention-to-treat analysis.Results:We included 150 patients in intention-to-treat analysis. AAD occurred in 16 of 75 (21.3%) patients in bLf group and ...
Comparison of Anorectal Function as Measured with High-Resolution and High-Definition Anorectal Manometry
Digestive Diseases, 2021
Introduction: Anorectal manometry (ARM) provides comprehensive assessment of pressure activity in... more Introduction: Anorectal manometry (ARM) provides comprehensive assessment of pressure activity in the rectum and anal canal. Absolute pressure values might depend on the catheter used. Objective: Our aim was to compare the results obtained by different anorectal catheters in children with functional anorectal disorders. Methods: Children diagnosed with functional defecation disorders based on the Rome IV criteria were prospectively enrolled. ARM was performed in the supine position successively using 2 different probes in each patient in random order. Resting, squeeze pressures, and bear-down maneuver variables obtained by high-resolution (2-dimensional [2D]) and high-definition (3-dimensional [3D]) catheters were compared. Results: We prospectively included 100 children {mean age 7.5 [standard deviation (SD) ± 4.3] years; 62 boys}. Mean resting pressures were significantly higher when measured with the 3D than with the 2D catheter (71 [SD ± 19.4] vs. 65 [SD ± 20.1] mm Hg, respectiv...
Children, 2021
Deleted in malignant brain tumours 1 protein (DMBT1) and surfactant protein D (SFTPD) are antimic... more Deleted in malignant brain tumours 1 protein (DMBT1) and surfactant protein D (SFTPD) are antimicrobial peptides previously linked to inflammatory bowel disease (IBD) susceptibility. This study attempts to link the most potential IBD-associated polymorphisms in DMBT1 and SFTPD with the disease severity in children. A total of 406 IBD patients (Crohn’s disease (CD) n = 214 and ulcerative colitis (UC) n = 192) were genotyped using hydrolysis probe assay. Clinical expression was described by disease activity scales, albumin and C-reactive protein levels, localisation and behaviour (Paris classification), systemic steroid, immunosuppressive, biological, and surgical treatment, number of exacerbation-caused hospitalisations, relapses and nutritional status. IBD patients with the risk genotype (AA) in DMBT1 rs2981804 had more frequent biological treatment (AA: vs. AG/GG; p = 0.012), concomitant diseases (AA vs. AG vs. GG; p = 0.015) and cutaneous manifestations (AA vs. AG/GG, p = 0.008). ...