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Biomedical subjects

Rosemary J Young

Publications and source records attributed to Rosemary J Young.

At least 19 recordsLinked to original sources
PubMed2007

A retrospective, case-control pilot study of the natural history of pediatric gastroesophageal reflux.

The duration of gastroesophageal reflux disease (GERD) is an important factor in the development of esophageal complications. The objective of this study was to examine in a retrospective, case-controlled manner the prevalence of GERD in adults who were diagnosed with GERD in infancy or early childhood. Infants and children with nonsyndromic GERD diagnosed by an experienced pediatric gastroenterologist from 1976 to 1980 and control subjects seen for well-child care from 1980 to 1985 were included in this study. The subjects were located and contacted by telephone or mail and administered a brief structured questionnaire relating to their current history of GERD. GERD-A was defined as weekly heartburn or regurgitation of any severity, and GERD-B was defined as monthly heartburn or regurgitation greater than mild in severity. Sixty-five participants (31 patients and 34 controls) returned completed questionnaires and were subdivided into the three study groups as follows: Infant (15), Child (16), and Control (34). The prevalence of adulthood GERD-A was 13, 31, and 21% in the Infant, Child, and Control groups, respectively. Similarly, the prevalence of adulthood GERD-B was 20%, 44%, and 24%, respectively. The Child group tended to report more severe heartburn than the other groups. The Infant group tended to report more frequent regurgitation, and the Child group also reported a higher prevalence of nocturnal heartburn and more frequent use of GERD medications, although these were not statistically significant. These data suggest that pediatric GER is a heterogeneous disorder and that GERD occurring after infancy may be more predictive of the presence of GERD during adulthood. Longitudinal follow-up of a larger number of children is needed to answer the question of when classic adulthood GERD begins.

Adolescent↗
PubMed2006

Enteric microbial flora, bacterial overgrowth, and short-bowel syndrome.

Small intestinal bacterial overgrowth (SIBO) occurs commonly in short-bowel syndrome (SBS) and, in some instances, may result in significant problems. SIBO is characterized by a variety of signs and symptoms resulting from nutrient malabsorption caused by an increased number and/or type of bacteria in the small intestine. The anatomic and physiologic changes that occur in SBS together with medications commonly used in these patients facilitate the development of SIBO. Because many aspects related to SIBO in the SBS population remain poorly understood, it was our aim to review the current understanding of the gut flora and issues related to SIBO occurring in SBS.

Humans↗
PubMed2005

Neonatal and infant feeding: effect on bone density at 4 years.

OBJECTIVE: The aim of this study was to determine whether the type of feeding during the first 4 months of life affects bone mineral density at 4 years of age. METHODS: Healthy 4-year-old children were recruited from the offices of primary health care providers. After confirming the type of infant feeding by history, dual energy x-ray absorptiometry analysis was obtained at the University of Nebraska Medical Center and evaluated by a radiologist blinded as to feeding type. RESULTS: One hundred and seventy-eight children completed the study (58% male, 85% Caucasian; mean age, 4.5 years). All children had exclusively consumed human milk (n = 57), an infant formula containing no palm olein oil (n = 56) or an infant formula containing palm olein oil (n = 65) during the first 4 months of life. At 4 years of age, no significant differences were noted in bone mineral content or bone mineral density (P = 0.51 and 0.89, respectively) among the three feeding groups as measured by dual energy x-ray absorptiometry. Total body bone mineral content and bone mineral density varied by gender, with males having significantly higher values than females regardless of feeding type (P = 0.028 and P < 0.001, respectively). CONCLUSION: There is no association between the use of palm olein formula during the first 4 months of life and subsequent bone mineral content and bone mineral density in healthy 4-year-old children.

Absorptiometry, Photon↗
PubMed2004

Current and potential uses of probiotics.

OBJECTIVE: To present data that support the current and potential use of probiotics in treating or preventing allergic disorders of the gastrointestinal tract and other disorders. DATA SOURCES: Case reports, double-blind studies, and animal studies were reviewed. STUDY SELECTION: Studies were selected based on the expert opinion of the authors. CONCLUSIONS: Well-designed research studies suggest that supplementary consumption of certain probiotic strains may temporarily alter the intestinal microflora of infants and children to produce a beneficial effect. However, generalization of probiotic effects must not be made and critical scientific evaluation must be used in directing patients to select the appropriate probiotic.

Acute Disease↗
PubMed2004

Intestinal rehabilitation and the short bowel syndrome: part 1.

The management of patients with intestinal failure due to short bowel syndrome (SBS) is complex, requiring a comprehensive approach that frequently necessitates long-term, if not life-long, use of parenteral nutrition (PN). Despite tremendous advances in the provision of PN over the past three decades, which have allowed significant improvements in the survival and quality of life of these patients, this mode of nutritional support carries with it significant risks to the patient, is very costly and, ultimately, does not attempt to improve the function of the remaining bowel. Intestinal rehabilitation refers to the process of restoring enteral autonomy and, thus, allowing freedom from parenteral nutrition, usually by means of dietary, medical, and, occasionally, surgical strategies. While recent investigations have focused on the use of trophic substances to increase the absorptive function of the remaining gut, whether intestinal rehabilitation occurs as a consequence of enhanced bowel adaptation or is simply a result of an optimized, comprehensive approach to the care of these patients remains unclear. In Part 1 of this review, an overview of SBS and pathophysiological considerations related to the remaining bowel anatomy in these patients will be provided. Additionally, a review of intestinal adaptation and factors that may enhance the adaptive process, focusing on evidence derived from animal studies, will also be discussed. In Part 2, relevant data on the development of intestinal adaptation in studies involving humans will be reviewed as will the general management of SBS. Lastly, the potential benefits of a multidisciplinary intestinal rehabilitation program in the care of these patients will also be discussed.

Adaptation, Biological↗
PubMed2004

Intestinal rehabilitation and the short bowel syndrome: part 2.

The management of patients with intestinal failure due to short bowel syndrome is complex, requiring a comprehensive approach that frequently necessitates long-term, if not life-long, use of parenteral nutrition. Despite tremendous advances in the provision of parenteral nutrition over the past three decades, which have allowed significant improvements in the survival and quality of life of these patients, this mode of nutritional support carries with it significant risks to the patient, is very costly, and ultimately, does not attempt to improve the function of the remaining bowel. Intestinal rehabilitation refers to the process of restoring enteral autonomy, and thus, allowing freedom from parenteral nutrition, usually by means of dietary, medical, and occasionally, surgical strategies. While recent investigations have focused on the use of trophic substances to increase the absorptive function of the remaining gut, whether intestinal rehabilitation occurs as a consequence of enhanced bowel adaptation or is simply a result of an optimized, comprehensive approach to the care of these patients remains unclear. In Part 1 of this review, we provided an overview of short bowel syndrome and pathophysiological considerations related to the remaining bowel anatomy in these patients. We also reviewed intestinal adaptation and factors that may enhance the adaptive process, focusing on evidence derived from animal studies. In Part 2, relevant data on the development of intestinal adaptation in humans are reviewed as is the general management of short bowel syndrome. Lastly, the potential benefits of a multidisciplinary intestinal rehabilitation program in the care of these patients are also discussed.

Adaptation, Physiological↗
PubMed2003

Role of probiotics in the management of patients with food allergy.

OBJECTIVE: This review will concentrate on the potential use of probiotics in treating or preventing allergic disorders of the gastro-intestinal tract. In small infants, most reactions to foods are manifested in the gastro-intestinal tract. As children get older, cutaneous and even systemic or respiratory manifestations of food intolerances may be more common. In most instances, allergic disorders in the gut cause inflammation in the mucosa. DATA SOURCES: Recently, the role of gut microflora in allergic disease has gained increasing interest with reports of probiotics being used to treat food allergy. STUDY SELECTION: Pertinent scientific reports on the role of probiotics in the management of patients with food allergy will be reviewed. A recent study to determine the effect of very early probiotic colonization will be extensively reviewed as it presents an intriguing concept of a preventive strategy related to food allergy development RESULTS: Significant improvement has been noted in infants receiving Lactobacillus GG in their extensively hydrolyzed formula. CONCLUSIONS: It is likely more studies will be forthcoming with different probiotic organisms in the prevention and treatment of allergic disorders in children and adults.

Decision Making↗
PubMed2003

Enteral and parenteral nutrition in the care of patients with short-bowel syndrome.

Short-bowel syndrome is a challenging entity for the gastroenterologist, requiring integration of medical, nutritional, surgical and psychological therapies. Treatment must be based on the patient's age, remaining gastrointestinal anatomy, baseline nutritional status and underlying general health as well as the numerous complications which may arise. This chapter reviews physiological alterations that occur with short-bowel syndrome and how therapies can be tailored to most adequately meet the needs of these patients. Emphasis on early stages of therapy to enhance intestinal adaptation is focused on as management during this time has a significant impact on the long-term outcome of these patients.

Enteral Nutrition↗
PubMed2003

Limitations of probiotic therapy in acute, severe dehydrating diarrhea.

BACKGROUND: Recent studies have shown that probiotics, most commonly, may be useful in treating acute gastroenteritis. However, beneficial effects appear to be limited to a modest decrease in the duration of diarrhea. No studies have evaluated this therapy in moderate to severe dehydrating diarrhea in a metabolic facility. METHODS: Male children less than 2 years of age were admitted to a metabolic unit of the Department of Pediatrics at the Federal University of Bahia, Brazil, with moderate dehydration and were randomized in a double-blind, placebo-controlled fashion. Oral rehydration solution (ORS) was administered per protocol and either placebo or was given in combination with the ORS. Output of urine, stool, and vomitus was recorded along with stool weight, nude body weight, and standard laboratory assessments for hydration. RESULTS: There was no significant reduction in diarrhea duration and stool output in the group. However, Kaplan-Meier survival analysis demonstrated that, even in moderate to severe diarrhea, resolution of the illness occurred so rapidly, that statistically significant benefits of probiotic therapy could not be demonstrated. CONCLUSION: Our data implies that colonization must occur before benefits of probiotics can be realized. Probiotics are, therefore, likely to be of limited benefit in treating diarrheal illnesses of short duration such as viral enteritis. The beneficial effects of probiotics may be limited to prophylactic usage in high-risk populations.

Acute Disease↗
PubMed2003

Overview of considerations for the pediatric patient receiving home parenteral and enteral nutrition.

Pediatric home nutrition support is a common practice used to provide children with impaired gastrointestinal function and their caregivers a therapeutic environment for the delivery of needed nutrition for proper growth and development. Specialized teams and equipment are now available to make this a successful experience for all involved. This paper will review items specific to the care of infants and children receiving both enteral and parenteral nutrition.

Journal Article↗
PubMed2003

New and emerging therapies for short bowel syndrome in children.

This review provides an overview of traditional as well as emerging therapies useful in the management of pediatric short bowel syndrome. Pediatric short bowel syndrome is relatively uncommon; however, when it does occur, it presents a unique challenge to medical care providers. The use of parenteral and enteral nutrition to maximize growth and enhance intestinal adaptation so as to increase absorptive surface area has been the primary focus of therapy. In recent years, the advent of pharmacologic advances, including the use of antibacterial drugs, anti-motility drugs and hormonal therapies, has had a significant impact on this condition. At times, surgery may be indicated for dealing with complications, or providing alternative therapy such as transplantation. With ongoing research, it is likely that improved pharmacologic therapy will be available for enhanced intestinal adaptation, control of gut motility, treatment of small bowel bacterial overgrowth, and treatment of rejection following small intestinal transplantation.

Bacteria↗