Italian survey on non-steroidal anti-inflammatory drugsand gastrointestinal bleeding in children

AIM: To investigate gastrointestinal complications associated with non-steroidal anti-inflammatory drug(NSAIDs) use in children.METHODS: A retrospective, multicenter study was conducted between January 2005 and January 2013, with the participation of 8 Italian pediatric gastroenterology centers. We collected all the cases of patients who refer to emergency room for suspected gastrointestinal bleeding following NSAIDs consumption, and underwent endoscopic evaluation. Previous medical history, associated risk factors, symptoms and signs at presentation, diagnostic procedures, severity of bleeding and management of gastrointestinal bleeding were collected. In addition, data regarding type of drug used, indication, dose, duration of treatment and prescriber(physician or selfmedication) were examined. RESULTS: Fifty-one patients, including 34 males, were enrolled(median age: 7.8 years). Ibuprofen was the most used NSAID [35/51 patients(68.6%)]. Pain was the most frequent indication for NSAIDs use [29/51 patients(56.9%)]. Seven patients had positive family history of Helicobacter pylori(H. pylori) infection or peptic ulcer, and 12 had associated comorbidities. Twenty-four(47%) out of 51 patients used medication inappropriately. Hematemesis was the most frequent symptom(33.3%). Upper gastrointestinal endoscopy revealed gastric lesions in 32/51(62%) patients, duodenal lesions in 17(33%) and esophageal lesions in 8(15%). In 10/51(19.6%) patients, a diagnosis of H. pylori gastritis was made. Forty-eight(94%) patients underwent medical therapy, with spontaneous bleeding resolution, while in 3/51(6%) patients, an endoscopic hemostasis was needed.CONCLUSION: The data collected in this study confirms that adverse events with the involvement of the gastrointestinal tract secondary to NSAID use are also common in

A Brazilian experience of the self transglutaminase-based test for celiac disease case finding and diet monitoring

AIM:To evaluate the effectiveness of a rapid and easy fingertip whole blood point-of-care test for celiac disease(CD)case finding and diet monitoring. METHODS:Three hundred individuals,206 females (68.7%)and 94 males(31.3%),were submitted to a rapid and easy immunoglobulin-A-class fingertip whole blood point-of-care test in the doctor’s office in order to make immediate clinical decisions:13 healthy controls, 6 with CD suspicion,46 treated celiacs,84 relatives of the celiac patients,69 patients with dyspepsia,64 with irritable bowel syndrome(IBS),8 with Crohn’s disease and 9 with other causes of diarrhea. RESULTS:Upper gastrointestinal endoscopy with duodenal biopsies was performed in patients with CD suspicion and in individuals with positive test outcome: in 83.3%(5/6)of the patients with CD suspicion,in 100%of the patients that admitted gluten-free diet transgressions(6/6),in 3.8%of first-degree relatives (3/79)and in 2.9%of patients with dyspepsia(2/69). In all these individuals duodenal biopsies confirmed CD(Marsh’s histological classification).The studied test showed good correlation with serologic antibodies, endoscopic and histological findings.CONCLUSION:The point-of-care test was as reliable as conventional serological tests in detecting CD cases and in CD diet monitoring.