Enteral nutrition is effective in treatment of active Crohn's disease. Differences in nitrogen sources of enteral feeds are not relevant to their therapeutic efficacy, as polymeric and elemental diets are equally effective.
Different authors use different definitions of operative mortality rate when reporting results of their operations. Four definitions used in current literature were applied to our own series of 578 patients with colorectal carcinoma. The operative mortality rate was found to vary from 7.3 per cent to 12.2 per cent, depending on the definition used. 'Death within 30 days of the last operation' was the definition which best reflected true operative deaths. We urge that this definition of operative mortality rate be adopted as a standard for all operations.
Severe cases of hidradenitis suppurativa affecting the perineum and gluteal regions may be treated successfully by 'deroofing' the sinus and fistulae tracts. These lie in the dermis and are partly epithelialized by cells from involved hair follicles and disrupted sweat glands. Careful preservation of the floor of the tracts leads to re-epithelialization with disease-free skin. More radical surgery is unnecessary and the problems of covering widely excised areas in this heavily contaminated region are avoided. By spreading the treatment over several operating sessions and hospital admissions, postoperative discomfort and in-patient nursing requirements are minimized. The technique of deroofing is described and the treatment of three severe cases is discussed. One patient illustrated the recognized complication of malignant change occurring in long-standing untreated disease. A fourth case illustrates the difficulties in diagnosing perianal hidradenitis suppurativa and literature cited suggests it to be a more common condition than once thought and a diagnosis frequently missed.
Background and Aims
Functional bowel disorders (FBD), such as irritable bowel syndrome (IBS), are increasingly more common in children and affect up to 20% of children. The etiology is multifactorial with no clear organic cause. Symptoms are recurrent and are associated with a reduced quality of life, school absences, and psychological challenges. Treatment options are variable. FODMAPs are short‐chained carbohydrates, poorly absorbed by the gastrointestinal tract due to their increased osmotic activity and excess gas production from the bacterial fermentation process. There is a paucity of data examining dietary interventions that restrict carbohydrates in children with IBS. The aim of this study was to examine the use of the low FODMAP diet (LFD) in children with an FBD.
Methods
A retrospective clinical case note review of children with an FBD managed with an LFD was undertaken. Anthropometry and clinical data were collected by a pediatric gastroenterology dietitian. An IBS satisfaction survey was used to assess diet outcomes. Statistical analyses were completed using Excel.
Results
Of the 29 children included in this study, complete resolution of gastrointestinal symptoms was observed for 11 of 12 (92%) of those with bloating, 13 of 15 (87%) of those with diarrhea, and 17 of 22 (77%) of those with abdominal pain. Twenty‐three (79%) participants reported an improvement of symptoms. Fructans were the most common symptom‐causing carbohydrate.
Conclusion
The LFD is a useful dietary treatment strategy for children with FBD. This study adds to the small body of evidence supporting FODMAP dietary interventions in children with FBD. Further prospective studies are required.
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