Journal of pediatric gastroenterology and nutrition, 2018
Thirty-six founding members from Europe were present in 1968, when the European Society of Paedia... more Thirty-six founding members from Europe were present in 1968, when the European Society of Paediatric Gastroenterology (ESGA) had its first meeting in Paris. The aim was to create a forum for presentations and discussions of research activities in paediatric gastroenterology in Europe. At the second meeting of ESGA 1969 in Interlaken, an important landmark was set for all gastroenterologists in the world. In this conference, the first ever criteria for "the Diagnosis of Coeliac Disease" (CD) were established. In 1990, the revised criteria for the diagnosis of CD were published. After the introduction of new noninvasive techniques, like tissue transglutaminase 2-antibodies and the HLADQ2/HLADQ8 determinations in blood, "new" criteria for the diagnosis of CD were published in 2012 by the European society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Close collaboration of ESPGHAN and the North American Society of Paediatric Gastroenterology, H...
Journal of pediatric gastroenterology and nutrition, 2018
Since the conception of an idea of a few paediatric gastroenterologists in Europe to create a soc... more Since the conception of an idea of a few paediatric gastroenterologists in Europe to create a society for Paediatric Gastroenterology in 1967, and its foundation in 1968, half a century has passed. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) now celebrates its 50th anniversary and its utmost success in combining clinical and scientific expertise in the fields of paediatric gastroenterology, haepatology, and nutrition. To describe this success story 14 of the still living presidents of ESPGHAN recount their impressions of the steady growth of ESPGHAN with all the historical facets from their own points of view. This historical view of ESPGHAN over the last 5 decades provides personal accounts of the development of all activities and creations of this great European Society. The Society started as a small family of experts in the field into a global working open society involved in a large variety of activities within the subspecialties, be...
... Robert D. Bovenschulte, Vice President for Publishing GASTRIC-OUTLET OBSTRUCTION IN CHILDREN ... more ... Robert D. Bovenschulte, Vice President for Publishing GASTRIC-OUTLET OBSTRUCTION IN CHILDREN Gastric-outlet obstruction in infants causes vom ... Institute of Child Health and Hospital for Sick Children London WC1N 1EH, United Kingdom Peter J. Milla, MD References 1 ...
Digestive Diseases and Sciences 41 1292 1297, Aug 1, 1996
This study aimed to characterize the disturbance of gastric electrical control activity in chroni... more This study aimed to characterize the disturbance of gastric electrical control activity in chronic intestinal pseudoobstruction (CIP) and to determine whether surface electrogastrography (EGG) could be used to diagnose the presence and type of CIP. Gastric electrical control activity was recorded for 30 rain in each of the fasting and fed states by EGG in 14 adults with CIP proven on clinical, radiological, and histological grounds, and in 14 age-and sex-matched controls. Electrical activity was recorded from four pairs of Ag-AgC1 bipolar skin electrodes, the captured signal amplified and digitalized, and running spectral analysis performed. The dominant frequency and power of sPectrum were calculated using a sequence of computerized algorithms. Results were correlated with the known pathological diagnoses [visceral myopathy (M), N = 7; visceral neuropathy (N), N = 4; undifferentiated (U), N = 3]. Dysrhythmias were present in 13 of 14 patients. Tachygastria (electrical control activity frequency >5 cycles/minute) and a normal amplitude response to food, was seen in five patients (N = 4, U = 1). Irregular continuous activity without a dominant frequency or bradyarrhythmia, together with a diminished electrical response activity (ERA) to food, were found in six patients (M = 5, U = 1). Mixed abnormalities were seen in two patients (M = 1, U = 1), and normal activity with a clear dominant frequency of 3 cycles/minute was present in only one patient (M = 1). This noninvasive technique is both sensitive and specific in providing evidence of a dysrhythmia in patients with CIP and discriminates between primary pathologies. EGG may prove diagnostically useful in these disorders and may provide insight into the disturbance of electrical control activity.
The first experiences with endoscopic closure of esophageal perforations in animal survival studi... more The first experiences with endoscopic closure of esophageal perforations in animal survival studies encouraged us to extend these procedures to full-thickness resections of pieces of the esophageal wall (FTEW). To learn the feasibility, safety, and long-term effects of FTEW removal and defect closure. Feasibility animal study. Approved animal facility. Twelve pigs were used for 3-month survival studies, autopsy, and histologic examination. Resection of a 2-cm piece of wall was performed with needle-knife and forceps/snare. Closure was performed by using prototype endoscopic suturing. Feasibility and complication assessment of this new endoscopic method. There were no complications relating to incision, resection, or closure. All pigs recovered quickly. In 2 animals a larger piece of wall causing a larger defect was removed, resulting in much air penetrating into the mediastinum, causing difficult ventilation. This was resolved with thoracic drain. In 3 of 12 animals a toxic substance slipped into the mediastinum, resulting in an abscess in 1 pig and misfire of an anchor as a result of obscured vision. This caused temporary illness of the animal but not death. Autopsy and histologic study confirmed no mediastinitis and well-healed scars in all but one. Animal study. FTEW has proven to be feasible. Long-term survival demonstrated no mediastinitis and only 1 abscess after contamination of the mediastinum. These first experiences encourage further animal studies because the prospect of endoscopic full-thickness removal of esophageal lesions in patients might be very advantageous.
In neurologically impaired children, retching and recurrent vomiting are common after Nissen fund... more In neurologically impaired children, retching and recurrent vomiting are common after Nissen fundoplication. The aim of this study was to identify whether there are preoperative factors that predict their occurrence. Twenty neurologically impaired children (8 boys, 12 girls; age range, 3 months to 8 years) were studied prospectively by taking a detailed history of behaviors and symptoms associated with feeding before and after Nissen fundoplication for gastroesophageal reflux. Preoperatively, children could be classified into 2 groups. Children in group A had symptoms suggestive of only gastroesophageal reflux (effortless "vomiting" or regurgitation), whereas children in group B exhibited one or more features associated with activation of the emetic reflex (pallor, sweating, retching, forceful vomiting). Postoperatively 0 of 8 in group A retched compared with 8 of 12 in group B (P <.005, Fishers Exact test). Children at high risk of retching, and ultimately vomiting, after antireflux surgery may be identified clinically preoperatively. They have symptoms that are specifically caused by activation of the emetic reflex rather than to gastroesophageal reflux. In these cases, antireflux surgery could be considered inappropriate and hence be avoided.
Poor fetal and infant nutrition has been linked to impaired glucose tolerance in later life. We s... more Poor fetal and infant nutrition has been linked to impaired glucose tolerance in later life. We studied the effect of protein deficiency during gestation and the suckling period in a rat model and found that poor nutrition 'programmes' pancreatic β-cell GK (glucokinase; known as the glucose sensor) and glucose-stimulated insulin secretion response in newborn, suckling and adult rat offspring. Pregnant female rats were divided into three groups: a control group was kept on a normal protein (20 %) diet, another group was fed a low-protein (LP) (6 %) diet during gestation and suckling periods (LP-G + S group) and another was fed a LP diet during gestation then a normal protein diet during the suckling period (LP-G group). The pulsatile glucose-stimulated insulin secretion response was acutely disrupted and the peak insulin secretion was markedly decreased in newborn and 3-week-old offspring of the LP-G + S group compared with the control group. Also, there was an altered pulsatile secretory response in adults of the LP-G + S and 3-week-old and adult offspring of the LP-G groups compared with the control group. GK protein levels, detected by Western blotting, were decreased in newborn and 3-week-old offspring of both LP-G + S and LP-G groups compared with the control groups. The K m and V max of GK were altered. The prenatal and postnatal LP diet appeared to have a permanent effect in increasing the affinity of GK for glucose (indicated by decreased K m values) and decreasing the V max. This showed that the critical period of programming of the function of GK was after birth and during the postnatal weaning period, since the adult offspring of the LP-G + S group when fed a normal protein diet showed no reversal in the K m values of the enzyme. Similar experiments in adult offspring of the LP-G group showed normalization of the K m values of GK at 3 weeks of age. In conclusion, fetal and infantile nutrition 'programmes' pancreatic β-cell function; poor nutrition during this period caused irreversible effects on glucose homoeostatic mechanisms in the offspring, which may predispose the offspring to diabetes in later life.
A 15-month-old male presented with severe gastrointestinal bleeding and heart failure. Imaging re... more A 15-month-old male presented with severe gastrointestinal bleeding and heart failure. Imaging revealed a superior mesenteric artery arteriovenous malformation, associated with a congenital portosystemic shunt. The heart failure was cured by resection of the arteriovenous malformation.
Data Revues 00165107 V75i4ss S0016510712016112, Apr 1, 2012
2 good (small amounts of feces not interfering with examination), 3 fair (enough feces to prevent... more 2 good (small amounts of feces not interfering with examination), 3 fair (enough feces to prevent a completely reliable examination) and 4 poor (large amount of fecal residue). Patients registered tolerability and adverse effects (hunger, fatigue, abdominal pain, bloating or vomiting) related to the bowel preparation. Results: Fifty patients (26 male, mean age 55Ϯ8 years) were included. Patient's tolerability was reported as good in 43%, moderate in 42 % and poor in 15 %. Adverse effects were hunger (22%), fatigue (36%), abdominal pain (4%), bloating (24%), but no vomiting (0%). Excellent and good bowel preparation quality was higher in right side colon (80%) than left side colon (68 %). Domperidone administration was significantly more frequent in the group of patients with poor preparation quality (P ϭ 0,0132), probably reflecting delayed gastric emptying. Excretion rate was 48 %. Conclusion: NUTRIPEG is well tolerated by patients with a low rate of adverse effects and gives high rates of adequate cleansing level in right colon. Quality of cleansing is less satisfactory in left colon and the capsule excretion rate is relatively low, mainly due to the need of NaP as booster dose. Delayed gastric emptying may be an early sign of global slow intestinal motility and suggest the need of administration of 2nd booster dose.
Journal of pediatric gastroenterology and nutrition, 2018
Thirty-six founding members from Europe were present in 1968, when the European Society of Paedia... more Thirty-six founding members from Europe were present in 1968, when the European Society of Paediatric Gastroenterology (ESGA) had its first meeting in Paris. The aim was to create a forum for presentations and discussions of research activities in paediatric gastroenterology in Europe. At the second meeting of ESGA 1969 in Interlaken, an important landmark was set for all gastroenterologists in the world. In this conference, the first ever criteria for "the Diagnosis of Coeliac Disease" (CD) were established. In 1990, the revised criteria for the diagnosis of CD were published. After the introduction of new noninvasive techniques, like tissue transglutaminase 2-antibodies and the HLADQ2/HLADQ8 determinations in blood, "new" criteria for the diagnosis of CD were published in 2012 by the European society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Close collaboration of ESPGHAN and the North American Society of Paediatric Gastroenterology, H...
Journal of pediatric gastroenterology and nutrition, 2018
Since the conception of an idea of a few paediatric gastroenterologists in Europe to create a soc... more Since the conception of an idea of a few paediatric gastroenterologists in Europe to create a society for Paediatric Gastroenterology in 1967, and its foundation in 1968, half a century has passed. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) now celebrates its 50th anniversary and its utmost success in combining clinical and scientific expertise in the fields of paediatric gastroenterology, haepatology, and nutrition. To describe this success story 14 of the still living presidents of ESPGHAN recount their impressions of the steady growth of ESPGHAN with all the historical facets from their own points of view. This historical view of ESPGHAN over the last 5 decades provides personal accounts of the development of all activities and creations of this great European Society. The Society started as a small family of experts in the field into a global working open society involved in a large variety of activities within the subspecialties, be...
... Robert D. Bovenschulte, Vice President for Publishing GASTRIC-OUTLET OBSTRUCTION IN CHILDREN ... more ... Robert D. Bovenschulte, Vice President for Publishing GASTRIC-OUTLET OBSTRUCTION IN CHILDREN Gastric-outlet obstruction in infants causes vom ... Institute of Child Health and Hospital for Sick Children London WC1N 1EH, United Kingdom Peter J. Milla, MD References 1 ...
Digestive Diseases and Sciences 41 1292 1297, Aug 1, 1996
This study aimed to characterize the disturbance of gastric electrical control activity in chroni... more This study aimed to characterize the disturbance of gastric electrical control activity in chronic intestinal pseudoobstruction (CIP) and to determine whether surface electrogastrography (EGG) could be used to diagnose the presence and type of CIP. Gastric electrical control activity was recorded for 30 rain in each of the fasting and fed states by EGG in 14 adults with CIP proven on clinical, radiological, and histological grounds, and in 14 age-and sex-matched controls. Electrical activity was recorded from four pairs of Ag-AgC1 bipolar skin electrodes, the captured signal amplified and digitalized, and running spectral analysis performed. The dominant frequency and power of sPectrum were calculated using a sequence of computerized algorithms. Results were correlated with the known pathological diagnoses [visceral myopathy (M), N = 7; visceral neuropathy (N), N = 4; undifferentiated (U), N = 3]. Dysrhythmias were present in 13 of 14 patients. Tachygastria (electrical control activity frequency >5 cycles/minute) and a normal amplitude response to food, was seen in five patients (N = 4, U = 1). Irregular continuous activity without a dominant frequency or bradyarrhythmia, together with a diminished electrical response activity (ERA) to food, were found in six patients (M = 5, U = 1). Mixed abnormalities were seen in two patients (M = 1, U = 1), and normal activity with a clear dominant frequency of 3 cycles/minute was present in only one patient (M = 1). This noninvasive technique is both sensitive and specific in providing evidence of a dysrhythmia in patients with CIP and discriminates between primary pathologies. EGG may prove diagnostically useful in these disorders and may provide insight into the disturbance of electrical control activity.
The first experiences with endoscopic closure of esophageal perforations in animal survival studi... more The first experiences with endoscopic closure of esophageal perforations in animal survival studies encouraged us to extend these procedures to full-thickness resections of pieces of the esophageal wall (FTEW). To learn the feasibility, safety, and long-term effects of FTEW removal and defect closure. Feasibility animal study. Approved animal facility. Twelve pigs were used for 3-month survival studies, autopsy, and histologic examination. Resection of a 2-cm piece of wall was performed with needle-knife and forceps/snare. Closure was performed by using prototype endoscopic suturing. Feasibility and complication assessment of this new endoscopic method. There were no complications relating to incision, resection, or closure. All pigs recovered quickly. In 2 animals a larger piece of wall causing a larger defect was removed, resulting in much air penetrating into the mediastinum, causing difficult ventilation. This was resolved with thoracic drain. In 3 of 12 animals a toxic substance slipped into the mediastinum, resulting in an abscess in 1 pig and misfire of an anchor as a result of obscured vision. This caused temporary illness of the animal but not death. Autopsy and histologic study confirmed no mediastinitis and well-healed scars in all but one. Animal study. FTEW has proven to be feasible. Long-term survival demonstrated no mediastinitis and only 1 abscess after contamination of the mediastinum. These first experiences encourage further animal studies because the prospect of endoscopic full-thickness removal of esophageal lesions in patients might be very advantageous.
In neurologically impaired children, retching and recurrent vomiting are common after Nissen fund... more In neurologically impaired children, retching and recurrent vomiting are common after Nissen fundoplication. The aim of this study was to identify whether there are preoperative factors that predict their occurrence. Twenty neurologically impaired children (8 boys, 12 girls; age range, 3 months to 8 years) were studied prospectively by taking a detailed history of behaviors and symptoms associated with feeding before and after Nissen fundoplication for gastroesophageal reflux. Preoperatively, children could be classified into 2 groups. Children in group A had symptoms suggestive of only gastroesophageal reflux (effortless "vomiting" or regurgitation), whereas children in group B exhibited one or more features associated with activation of the emetic reflex (pallor, sweating, retching, forceful vomiting). Postoperatively 0 of 8 in group A retched compared with 8 of 12 in group B (P <.005, Fishers Exact test). Children at high risk of retching, and ultimately vomiting, after antireflux surgery may be identified clinically preoperatively. They have symptoms that are specifically caused by activation of the emetic reflex rather than to gastroesophageal reflux. In these cases, antireflux surgery could be considered inappropriate and hence be avoided.
Poor fetal and infant nutrition has been linked to impaired glucose tolerance in later life. We s... more Poor fetal and infant nutrition has been linked to impaired glucose tolerance in later life. We studied the effect of protein deficiency during gestation and the suckling period in a rat model and found that poor nutrition 'programmes' pancreatic β-cell GK (glucokinase; known as the glucose sensor) and glucose-stimulated insulin secretion response in newborn, suckling and adult rat offspring. Pregnant female rats were divided into three groups: a control group was kept on a normal protein (20 %) diet, another group was fed a low-protein (LP) (6 %) diet during gestation and suckling periods (LP-G + S group) and another was fed a LP diet during gestation then a normal protein diet during the suckling period (LP-G group). The pulsatile glucose-stimulated insulin secretion response was acutely disrupted and the peak insulin secretion was markedly decreased in newborn and 3-week-old offspring of the LP-G + S group compared with the control group. Also, there was an altered pulsatile secretory response in adults of the LP-G + S and 3-week-old and adult offspring of the LP-G groups compared with the control group. GK protein levels, detected by Western blotting, were decreased in newborn and 3-week-old offspring of both LP-G + S and LP-G groups compared with the control groups. The K m and V max of GK were altered. The prenatal and postnatal LP diet appeared to have a permanent effect in increasing the affinity of GK for glucose (indicated by decreased K m values) and decreasing the V max. This showed that the critical period of programming of the function of GK was after birth and during the postnatal weaning period, since the adult offspring of the LP-G + S group when fed a normal protein diet showed no reversal in the K m values of the enzyme. Similar experiments in adult offspring of the LP-G group showed normalization of the K m values of GK at 3 weeks of age. In conclusion, fetal and infantile nutrition 'programmes' pancreatic β-cell function; poor nutrition during this period caused irreversible effects on glucose homoeostatic mechanisms in the offspring, which may predispose the offspring to diabetes in later life.
A 15-month-old male presented with severe gastrointestinal bleeding and heart failure. Imaging re... more A 15-month-old male presented with severe gastrointestinal bleeding and heart failure. Imaging revealed a superior mesenteric artery arteriovenous malformation, associated with a congenital portosystemic shunt. The heart failure was cured by resection of the arteriovenous malformation.
Data Revues 00165107 V75i4ss S0016510712016112, Apr 1, 2012
2 good (small amounts of feces not interfering with examination), 3 fair (enough feces to prevent... more 2 good (small amounts of feces not interfering with examination), 3 fair (enough feces to prevent a completely reliable examination) and 4 poor (large amount of fecal residue). Patients registered tolerability and adverse effects (hunger, fatigue, abdominal pain, bloating or vomiting) related to the bowel preparation. Results: Fifty patients (26 male, mean age 55Ϯ8 years) were included. Patient's tolerability was reported as good in 43%, moderate in 42 % and poor in 15 %. Adverse effects were hunger (22%), fatigue (36%), abdominal pain (4%), bloating (24%), but no vomiting (0%). Excellent and good bowel preparation quality was higher in right side colon (80%) than left side colon (68 %). Domperidone administration was significantly more frequent in the group of patients with poor preparation quality (P ϭ 0,0132), probably reflecting delayed gastric emptying. Excretion rate was 48 %. Conclusion: NUTRIPEG is well tolerated by patients with a low rate of adverse effects and gives high rates of adequate cleansing level in right colon. Quality of cleansing is less satisfactory in left colon and the capsule excretion rate is relatively low, mainly due to the need of NaP as booster dose. Delayed gastric emptying may be an early sign of global slow intestinal motility and suggest the need of administration of 2nd booster dose.
Uploads
Papers by Peter Milla