الفهرس 
Epidemiology and CausesOnly 14 pages are availabe for public view
 |  | from | 249 |  |  |
| | | from | 249 | | |
Abstract
The aim of this work is to define the causes of recurrent vomiting among a sample of infants and children presenting to a tertiary referral hospital.
So, this clinical study was carried to evaluate infants who presented to the Pediatric Outpatient Clinic, Children Hospital, Ain Shams University because of persistent vomiting They were diagnosed in the Pediatric Gastroenterology unit between June 2011 and July 2012. The study included any patient a total of 119 infants who attended our Children Hospital during one year of the study they were 73 males (61.3%) and 46 females (38.7%) with mean age 1 month to 36 months with mean age 11 ±7.7 months.
All patients have undergone medical history taking, with special emphasis on the analysis of vomiting (age of onset, duration, color of vomitus, relation of vomitus to meal, relation of vomitus to posture, need for IV fluid), associated gastrointestinal symptoms (abdominal pain, diarrhea, constipation, Distension, hematemesis and bleeding per rectum), associated systemic manifestations (CNS symptoms as convulsion, Respiratory troubles) and family history (allergy, GI surgical and GI diseases), dietetic history (breast fed, bottle fed, both types, age of introduction of cow’s milk protein).
Patients have undergone careful clinical examination with special emphasis on vital data (heart rate, respiratory rate, blood pressure and temperature), pallor, weight, abdominal examination (distension, tenderness, rigidity and organomegaly).
Extensive diagnostic work-up was done according to the clinical data of each patient and included detailed laboratory investigations (stool analysis and culture, CBC, CRP, ESR, liver enzymes, kidney functions, platelet functions and serological test to suspected patients as RAST for specific IgE against cow milk protein and IgA and IgG tissue transglutaminase (tTG) for CD, SPT and Cow’s milk challenge test. radiological assessment (barium meal and follow through, barium meal in Trendlenberg position and abdominal ultrasound), Esophago-gastro-dudenoscopy (EGD) and 24 PH monitoring.
It was found that cow’s milk protein allergy is the most common cause of vomiting in this age group (25.4%), Followed by GERD (22.7%). The 3rd common causes of persistent vomiting among this group of age are surgical causes of vomiting (13.4%). While Systemic causes represented (12.6%) of cases. In this study the frequancy of SI pathology among this group of age is 11.8%. At last Gastritis represents 8.4% of this study.
Related to the age, below 6m, common causes of persistent vomiting included GERD (66.7%), followed by CMPA (33.3%). While gastritis (100%), surgical causes (81.2%) and SI pathology (78.6%) are common between 6m and 2years.
Regarding the duration of vomiting gastritis, systemic and surgical causes have the prolonged duration of vomiting with mean 12.7±7m, 10.3±7.5m and 10.9±6.7m respectively while GERD has shortest duration of 5.8±4.8m; duration of vomiting of CMPA is 7.8±5.9m;
Analysis of the frequency of associated symptoms showed that persistent vomiting mostly related to meal (86.7%) and not posture (4.2%), associated frequently with chest infection (69.5%), abdominal pain (61.7%), abdominal distention (38.3%) and constipation (15.8%). Dysphagia was found in 5% of patients and was common with significant high frequency among infants with gastritis (20%), systemic (13.3%) and of surgical disease (12.5%). Hematemesis was found in 12.5% of patients and was common with significant high frequency among infants with surgical diseases (43.8%) and gastritis (30%). Diarrhea was found in 36.7% and was common with significant high frequency among infants with SI pathology (71.4%) and CMPA (50%).
Examination on presentation, there is loss of weight for 60.5% of patients. SI pathology, systemic and surgical diseases cause marked loss of weight while CMPA have less.
Laboratory investigations showed the presence of anemia (Hb% < 11 gm/dl) in 88.37% of all patients, CMPA and GERD cause mild anemia mainly (9-11 mg/dl), patients with SI pathology and Systemic disease suffering moderate anemia mainly (7-11 mg/dl).
PH monitor: 6 patients undergo ph metery procedure 5 of them diagnosed as acidic GERD and one have alkaline GERD.
Barium study was done for 34 patients. Normal study was found in 20.6%. It helped in diagnosis in 100% of surgical cases and 75% of GERD cases.
Evidence of GERD was found in 11 patients 6 of them are 1ry GERD (17.6%), while 5 patients (14.7%) had GERD 2ry to CMPA (3%), SI Pathology (eosinophilic enteritis; 6%) and systemic causes (renal and post-encephalitic sequalea; 6%).
Evidence of pyloric obstruction was found in 5 patients (14.7%), 4 of them have true gastric outlet obstruction while one had diagnosed as H-pylori infection had false finding indicated pyloric