The frequency of cholelithiasis in the study population was 45%. One-third of the patients were diagnosed before 10 years of age. Patients with the SS homozygous or Sb heterozygous phenotype were at a higher risk for the development of cholelithiasis than patients with sickle cell disease. About 50% of patients with gallstones were asymptomatic, the most of them did not undergo surgery and did not present complications during a 7-year follow-up period. Cholecystectomy must be considered in symptomatic patients. In asymptomatic patients, conservative management seems to be the better choice.

-Background -Few studies on autoimmune hepatitis have enrolled non-Caucasian groups. Aims -To evaluate Brazilian children with type 1 and 2 autoimmune hepatitis regarding outcome and clinical and biochemical parameters.Patients and Methods -Thirty-six patients were submitted to a protocol that evaluated the clinical history, physical and biochemical data, and the course of the disease. Twenty-four children had type 1 autoimmune hepatitis, seven had type 2 and five had unclassified autoimmune hepatitis. Most patients were females (77%), with a median age at diagnosis of 11 years, and the median duration of symptoms was 5.5 and 8 months for types 1 and 2, respectively. Jaundice and choluria were the most common clinical manifestations. Results -Treatment with azathioprine and prednisone was successful in patients with type 1 and 2 autoimmune hepatitis. AST and ALT decreased after 4 to 8 weeks of treatment compared to pretreatment levels in type 1 autoimmune hepatitis. Increased GGT values returned to pretreatment levels after 1 year in the two types. Three patients died and three other patients underwent liver transplantation. Conclusions -Non-Caucasian children had a similar disease when compared to Caucasian ones with autoimmune hepatitis. Increased levels of GGT during the first year of treatment should not be the only parameter for the indication of cholangiopathy.

RESUMO -Contexto -O tratamento cirúrgico da doença do refluxo gastroesofágico está indicado para pacientes com doença crônica, associada ou não a complicações. A fundoplicatura é frequentemente indicada em substituição ao uso contínuo dos inibidores de bomba de prótons, para pacientes sem resposta, resposta parcial, ou dependentes de tratamento medicamentoso, ou ainda, quando houver recurrência dos sintomas com a descontinuação das medicações. No período pós-operatório, ocorrências de desmanche da válvula com recurrência da doença do refluxo indicam a necessidade de monitorização do procedimento cirúrgico. A avaliação do funcionamento da válvula, baseada na presença de sintomas, tem se mostrado instrumento ineficaz para essa monitorização. Objetivo -Identificar a frequência de anormalidades na válvula antirrefluxo e a frequência de complicações pépticas do esôfago no período de pós-operatório tardio da fundoplicatura em crianças e adolescentes. Métodos -Em estudo transversal, prospectivo e descritivo, em que foram avaliados 45 pacientes (idade = 16 meses a 16,9 anos) que tinham realizado fundoplicatura de Nissen num período de 12 a 30 meses prévios à avaliação. O aspecto da fundoplicatura e da mucosa esofágica foram avaliados por meio de endoscopia digestiva alta e estudo histológico. Resultados -Doentes com encefalopatia crônica corresponderam a 26/45 (57,8%) dos casos. Válvula antirrefluxo intacta foi identificada em 41/45 (91,1%) dos pacientes. A fundoplicatura foi efetiva no tratamento do processo inflamatório esofágico, mesmo quando identificadas subestenose ou estenose de esôfago, no pré-operatório. As complicações identificadas foram esofagite péptica (6/45 pacientes) e necessidade de nova fundoplicatura (2/45 pacientes). A presença de anormalidades na válvula antirrefluxo associou-se ao achado de esofagite péptica (P = 0,005). Dois pacientes receberam o diagnóstico de esôfago de Barrett. Conclusão -A fundoplicatura pela técnica de Nissen se mostrou eficiente no controle das complicações esofágicas da doença do refluxo gastroesofágico. A endoscopia digestiva alta foi um exame útil na monitorização pós-operatória de crianças que realizaram fundoplicatura por doença do refluxo gastroesofágico. Permitiu avaliar a condição da válvula antirrefluxo e diagnosticar complicações relacionadas à recidiva da doença, mesmo em pacientes assintomáticos. DESCRITORES -Fundoplicatura. Refluxo gastroesofágico, cirurgia. Esofagite. Estenose esofágica. Esôfago de Barrett. Endoscopia gastrointestinal. Criança. INTRODUÇÃONa doença do refluxo gastroesofágico (DRGE), a passagem involuntária do conteúdo gástrico para o esôfago causa repercussão negativa sobre a saúde da criança (26) . Podem ocorrer alterações relacionadas à nutrição, à mucosa esofágica, à função respiratória ou ao aparecimento de sintomas neurocomportamentais (6) . Para as crianças com DRGE associada a complicações graves e/ou à doença crônica, as melhores opções terapêuticas são o tratamento medicamentoso com inibidor de bomba de prótons e a cirurgia antirrefluxo...

BACKGROUD: Chronic liver diseases in childhood often cause undernutrition and growth failure. To our knowledge, growth parameters in infants with neonatal cholestasis are not available AIM: To evaluate the nutritional status and growth pattern in infants with intrahepatic cholestasis and extrahepatic cholestasis. PATIENTS AND METHODS: One hundred forty-four patients with neonatal cholestasis were followed up at the Pediatric Gastroenterology Service of the Teaching Hospital, State University of Campinas, Campinas, SP, Brazil, in a 23-year period, from 1980 to 2003. The records of these patients were reviewed and patients were classified into two groups, according to their anatomical diagnosis: patients with intrahepatic cholestasis - group 1, and patients with extrahepatic cholestasis - group 2. Records of weight and height measurements were collected at 4 age stages of growth, in the first year of life: 1) from the time of the first medical visit to the age of 4 months (T1); 2) from the 5th to the 7th month (T2); 3) from the 8th to the 10th month (T3); and 4) from the 11th to the 13th month (T4). The weight-by-age and height-by-age Z-scores were calculated for each patient at each stage. In order for the patient to be included in the study it was necessary to have the weight and/or height measurements at the 4 stages. Analyses of variance and Tukey's tests were used for statistical analysis. Repeated measurement analyses of variance of the weight-by-age Z-score were performed in a 60-patient sample, including 29 patients from group 1 and 31 patients from group 2. The height-by-age data of 33 patients were recorded, 15 from group 1 and 18 from group 2 RESULTS: The mean weight-by-age Z-scores of group 1 patients at the 4 age stages were: T1=-1.54; T2=-1.40; T3=-0.94; T4=-0.78. There was a significant difference between T2 X T3 and T1 X T4. The weight-by-age Z-scores for group 2 patients were :T1=-1.04; T2=-1.67; T3=-1.93 and T4=-1.77, with a significant difference between T1 X T2 and T1 X T4. The mean weight-by-age Z-scores also showed a significant difference between group 1 and group 2 at stages T3 and T4. The mean height-by-age Z-scores at the four stages in group 1 were: T1=-1.27; T2=-1.16; T3=-0.92 and T4=-0.22, with a significant difference between T3XT4 and T1XT4. The scores for group 2 patients were: T1=-0.93; T2=-1.89; T3=-2.26 and T4=-2.03, with a significant difference between T1XT2 and T1XT4. The mean height-by-age Z-scores also showed a significant difference between group 1 and group 2 at T3 and T4 CONCLUSION: The weight and height differences between the groups became significant from the 3rd measurement onward, with the most substantial deficit found in the extrahepatic group. In this group, there is evidence that the onset of weight and height deficit occurs between the first and second evaluation stages.