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Oesophageal Disorders in Children
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Early patient management should focus on maintaining a patent airway and preventing the aspiration of saliva and upper pouch secretions. The baby should be nursed prone with a sump suction (Replogle) tube in the upper pouch set on continuous aspiration. This tube should be injected regularly with air to prevent blockage. Endotracheal intubation and ventilation should be avoided if possible. Positive pressure ventilation in the presence of a TOF may result in large amounts of gas passing into the stomach and intestine. This trapped gas may have no easy route of escape, especially if the baby has an associated intestinal abnormality, like an atresia or anorectal malformation. Abdominal distension due to gaseous distention may impair ventilation and result in hypoxia, hypercapnia and acid-base upset. Gastrointestinal perforation in such cases can have a devastating outcome.4
Spontaneous intestinal perforation
Published in Prem Puri, Newborn Surgery, 2017
SIP occurs predominantly in VLBW or ELBW premature babies born between 25 and 27 weeks’ gestation. The key differential diagnosis is NEC with gastrointestinal perforation. It is important to try and distinguish these two conditions because they are managed differently and have a different outcome (discussed next).
Systemic therapy for appendiceal cancer
Published in Wim P. Ceelen, Edward A. Levine, Intraperitoneal Cancer Therapy, 2015
Bevacizumab can be administered IV over 30 minutes and can be added to regimens containing 5-fluorouracil, capecitabine, oxaliplatin, or irinotecan, without adding drastic side effects [27]. Because bevacizumab is a humanized monoclonal antibody, infusion-related reactions are uncommon, and preemptive premedication with histamine antagonists is not necessary. Other adverse reactions seen with bevacizumab include hypertension, headache, and impaired wound healing. Impaired wound healing is an important side effect to keep in mind when patients may be undergoing surgery or have incompletely healed wounds or fistulas. Uncommon, yet severe adverse reactions include hemorrhage, arterial and venous thromboembolism, and gastrointestinal perforation. It is important to be attentive to disease burden and location with regard to gastrointestinal perforation. Patients with appendiceal cancer often have a high disease burden contained within the abdominal cavity, amalgamated with the intestines, and there is a substantial risk of bowel perforation in patients with appendiceal cancer. These patients should be educated and monitored for signs of symptoms of bowel perforation, which include, but are not limited to, abdominal pain accompanied by constipation, nausea and vomiting, or fever [27].
Promising phase II biologics for future Crohn’s disease therapy
Published in Expert Opinion on Investigational Drugs, 2023
Pauline Wils, Silvio Danese, Laurent Peyrin-Biroulet
Olamkicept (sgp130Fc), a monoclonal antibody that specifically interferes with the IL-6 trans-signaling, may have safety advantages in comparison with pan-IL-6 inhibitors. Olamkicept was tested in 16 IBD patients (including 7 CD patients) in a 12-week, open-label, prospective, phase IIa study [33]. It was administered at 600 mg IV every two weeks for 12 weeks. Based on the CDAI, two CD patients achieved clinical response and one patient was in clinical remission at week 12. One patient had endoscopic remission and one other endoscopic response at week 14 [33]. No case of gastrointestinal perforation was observed in this exploratory study. Olamkicept (or TJ 301) was investigated in a placebo-controlled phase II trial in ulcerative colitis (NCT03235752), published in abstract form [26]. In this study, biweekly olamkicept 600 mg induction therapy demonstrated clinical efficacy and mucosal healing in patients with active UC, with a favorable safety profile, encouraging its development in IBD patients.
The effect of drugs used in rheumatology for treating SARS-CoV2 infection
Published in Expert Opinion on Biological Therapy, 2021
Fabiola Atzeni, Elisabetta Gerratana, Manuela Giallanza, Laura La Corte, Valeria Nucera, Gianfranco Miceli, Donatella Sangari, Ignazio Francesco Masala
Most of the data concerning the safety of tocilizumab come from studies of patients with rheumatoid arthritis (RA), one of which showed that the intravenous use of tocilizumab in more than 4,000 subjects was associated with an increased risk of developing serious infections (4.7/100 patient-years vs 3.5/100 patient-years), the most frequent of which were pneumonia, gastroenteritis and urinary tract infections [60]. However, it is worth remembering that RA patients are twice as likely to develop infections as the general population [61,62] because of the intrinsic characteristics of the disease (such as changes in the immune system) [63], the frequent co-existence of co-morbidities, and treatment with glucocorticoids [60]. Cases of gastrointestinal perforation have also been reported, especially in patients with a history of diverticulosis and the chronic use of glucocorticoids [60]. Tocilizumab may also cause a slight rise in transaminases (AST and ALT) levels, although this is not associated with any signs or symptoms of liver damage [60].
Clinical characteristics and associating risk factors of gastrointestinal perforation in children with IgA vasculitis
Published in Annals of Medicine, 2021
Qingyin Guo, Xiaolei Hu, Chundong Song, Xianqing Ren, Wensheng Zhai, Ying Ding, Xia Zhang, Meng Yang, Jian Zhang, Miao Jiang
The pathogenesis of GP in IgAV children is still not fully understood. Causes of GP may include diverticulitis, gastric ulcer, and intestinal ischaemia [20]. It was reported that thrombus caused by vasculitis may cause intestinal ischaemia, followed by necrosis and perforation of the intestinal wall [21]. Ultrasonography or CT signs are useful to confirm the diagnosis of GP. The key ultrasonographic finding of gastrointestinal perforation is the free gas under the diaphragm and a small amount of gas and fluid next to the perforation. When the perforation is small, the subphrenic gas is less, or the intestinal perforation is wrapped by other surrounding tissue so that the gas cannot reach the subdiaphragm. Or the patient has a large amount of air in the intestinal loop, which affects the colour ultrasound diagnosis. In our study, 5 patients did not show perforation under ultrasonography, and was diagnosed by CT subsequently. Therefore, GP should not be ruled out with a negative ultrasonography finding. CT examination is highly recommended for GP diagnosis.