Percutaneous endoscopic gastrostomies in children.
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Biomedical subjects
Publications and source records attributed to K J Benkov.
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A child with acquired immune deficiency syndrome became severely malnourished presumably as a result of multiple gastrointestinal infections, with numerous organisms including campylobacter, giardia, and cryptosporidium. These opportunistic infections preceded laboratory evidence of immune deficiency. Despite severe diarrhea and marked weight loss, there was no laboratory evidence of significant malabsorption. By using nasogastric feedings, we were successful in promoting a 60% weight gain, and a rise in serum albumin from 1.2 to 4.3 g/dl. While eventual outcome was not altered, this particular patient's clinical course was improved. We suggest that malnutrition should not be accepted as inevitable and that malabsorption should not be assumed in similar acquired immune deficiency syndrome patients. Appropriate studies for malabsorption should be done, and high caloric enteral feedings should be used whenever feasible.
Chronic peptic ulcer disease is not generally considered to cause failure to thrive. We are reporting a 9-year-old child who suffered from chronic recurrent abdominal pain and failure to thrive. Investigation revealed that the child also had bacterial overgrowth and evidence of malabsorption. These findings were considered to be due to chronic peptic ulcer disease which caused intermittent small bowel obstruction and gastric outlet obstruction. Successful treatment of the ulcer alone resulted in catch-up growth and an end to the chronic recurrent pain. Recurrent abdominal pain when associated with atypical features or failure to thrive should be adequately investigated. Although rare, chronic peptic ulcer disease with its sequelae should be considered in the differential diagnosis of failure to thrive.
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