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January Newsletter & Notes From Nancy Happy New Year! I hope that all of you have a wonderful 1999! This month has been very busy for me--more personally than for IARP. Now that the holidays are over, now I can get focused once again. My first order of business is to find another attorney. I told you last month that I had made an arrangement with an attorney. Well, unfortunately he backed out on us! So, I'm back to square one again. If you know of an attorney who is familiar with the paperwork necessary for setting up a nonprofit, please let me know! Thanks. I got IARP registered with a web site called, I-GIVE. This site gives money to nonprofit organizations! They are giving $5.00 right now to IARP for everyone who registers with their site and lists IARP as their worthy cause. Please go and register--it's free and you will really be helping us continue to help parents like you who need support. Go there by clicking here: IGIVE Email me if you need anything! 1: Diagnosis and treatment of gastroesophageal reflux in children and adolescents with severe asthma 2: Use of 24-hour oesophageal pH-metry for the detection of gastro-oesophageal reflux in infants: what is the ideal score and the optimal threshold? A receiver-operating-characteristic analysis. 3: Effects of cisapride on parameters of oesophageal motility and on the prolonged intraoesophageal pH test in infants with gastro-oesophageal reflux disease. 4: Gastroesophageal reflux in children and its relationship to erosion of primary and permanent teeth. 5: Great Site for those of you with children suffering from various food allergies. 1: Diagnosis and treatment of gastroesophageal reflux in children and adolescents with severe asthma Abstract Background: The ability of gastroesophageal reflux disease to provoke asthma is controversial. Recent reports have suggested that reflux to the proximal esophagus may be especially likely to aggravate asthma, but the prevalence of proximal reflux in children and adolescents is poorly documented. It is also unclear how sensitive and specific the commonly used tests of reflux, barium swallow, and scintiscan are compared with pH probe studies in young patients. There is limited information on the effectiveness of the combination of H-2 blockers and prokinetic agents in controlling reflux in children. Objective: There were three objectives in this study: (1) to determine the prevalence of both proximal and distal gastroesophageal reflux in asthmatic children and adolescents; (2) to determine the sensitivity, specificity, positive and negative predictive values of barium swallow and scintiscan studies; and (3) to determine the effectiveness of standard antireflux pharmacotherapy. Methods: A 24-hour, 2-channel pH probe study was carried out in 79 asthmatic children aged 2 to 17 years. The prevalence of abnormal proximal and distal gastroesophageal reflux was calculated from the findings. In 63 of these patients, barium swallow and Technetium99 scintiscan were carried out and the findings used to calculate the sensitivity, specificity, positive and negative predictive value of these studies relative to pH probe. In 11 subjects a follow-up, 24- hour pH probe was carried out after at least 3 weeks of therapy with an H-2 blocker and prokinetic agent to determine the efficacy of therapy. Results: There was abnormal proximal esophageal reflux in 64.5% of subjects and abnormal distal reflux in 73.4%. The sensitivity, specificity, positive and negative predictive values of barium swallow were 46.1%, 83.3%, 82% and 51%, respectively. Those of scintiscan were 15%, 72.7%, 50% and 32%, respectively. Of 11 subjects studied by repeat pH probe, 10 had persistent abnormal reflux. Conclusion: Abnormal reflux into the proximal esophagus occurs in the majority of asthmatic children with difficult-to-control disease. The barium swallow and scintiscan compare poorly with pH probe in diagnosing reflux. Treatment of reflux with recommended does of H-2 blockers and prokinetic agents has a high failure rate, and follow-up studies are essential. Journal--
Authors Balson,B.M. ; Kravitz,E.K.S. ; McGeady,S.J. Ital J Gastroenterol Hepatol 1997 Aug;29(4):297-302 2: Use of 24-hour oesophageal pH-metry for the detection of gastro-oesophageal reflux in infants: what is the ideal score and the optimal threshold? A receiver-operating-characteristic analysis. Carroccio A, Cavataio F, Acierno E, Montalto G, Lorello D, Tumminello M, Soresi M, Li Voti G, Iacono GDept. of Internal Medicine, University of Palermo, Italy. BACKGROUND: The search for the ideal score and best cut-off value to interpret the data from 24-hour continuous pH-monitoring interests both gastroenterologists with adult patients and paediatric gastroenterologists. AIMS: To evaluate 24-hour continuous pH monitoring as a discriminatory test in the diagnosis of gastro-oesophageal reflux disease in a paediatric population, using various pH-metry scores and cut-off values. PATIENTS: One hundred and one patients presenting gastro-oesophageal reflux disease (endoscopic diagnosis of oesophagitis or coincidence between apnoea and reflux episodes observed during pH-metry), median age 10 months, were studied, together with a control group of 84 subjects, median age 11 months. RESULTS: After plotting the receiver operating characteristic curves and calculating the area below them, the evaluation of the total percentage reflux time proved to have a higher capacity for distinguishing between the patients and controls than the Euler score (p < 0.05). The cut-off value of 5.2% for the total percentage reflux time had a sensitivity of 75% and was 88% specific. Using higher cut-off values according to age, a 95% specificity and a 49% sensitivity were obtained. The most sensitive score was the Jolley score: 96% with a cut-off of 64 and 90% with a cut-off of 100 (a value determining the maximum diagnostic accuracy); specificity, however, was low: 39-61%. In addition, the Jolley score was the most useful parameter in detecting patients with apnoeic episodes secondary to gastro-oesophageal reflux disease and allowed a correct diagnosis in 12/13 cases. CONCLUSIONS: a) The simple determination of total percentage reflux time, according to the methodology used, has a higher predictive capacity than the more complex pH-monitoring scores; b) the best cut-off value for total percentage reflux time is 5.2% as it combines a good specificity and sensitivity which are necessary for this test; c) age-dependent cut-off values are highly specific but sensitivity is much too low; d) the Jolley score is very sensitive and this was maintained even when the cut-off was raised to a value of 100; it is the best predictive score for episodes of gastro-oesophageal reflux-dependent apparent life-threatening events. Comments:
4: Gastroesophageal reflux in children and its relationship to
erosion of
primary and
permanent teeth 5: Food Allergy Network and some allergy free recipes:
Allergy-Free RecipesThe Food Allergy News(Their Newsletter) contains two pages of allergy-free recipes in each issue. Keep in mind that ingredients sometimes change without warning; read the ingredient statements every time you shop.
Chocolate Pancakes (M, E, P, S, N)
In a deep bowl, mix flour, sugar cocoa, baking powder, and salt. Add water and oil and stir until batter is completely blended. If the batter is too stiff, add a little more water. Let the batter sit for a few minutes. Preheat griddle. Prepare strawberry sauce (see recipe below). Pour batter into hot griddle; flip pancakes when bubbles appear on top. Remove to plates and top with strawberry sauce. Strawberry Sauce (M, E, W, P, S, N)
Pour all ingredients into small saucepan. Cook over medium-low heat, stirring constantly. Bring to a slow boil and remove from heat. Spoon over warm pancakes. |
