Selected probiotics (mainly Lactobacilli, and particularly LGG, and Saccharomyces boulardii) have... more Selected probiotics (mainly Lactobacilli, and particularly LGG, and Saccharomyces boulardii) have recently demonstrated a therapeutic efficacy in acute diarrhoea, if used in the early phase of infection and at high concentration. Further data are needed to clarify their effect for prevention and travellers' diarrhoea. The mechanisms of action of probiotics need to be fully elucidated but seem to include a complex interaction of epithelial, molecular, metabolic and immune responses. There is an increasing evidence that different micro-organisms show different properties and efficacy. An accurate identification and selection of the strains, the dose and the patients are thus crucial for a correct therapeutic approach. Prebiotics can modify the intestinal flora and interact with the immune system of the host against specific pathogens. However, clinical trials are currently limited and a beneficial effect of prebiotics in acute diarrhoea is still lacking. In developing countries zinc supplementation demonstrated a significant reduction of fecal excretion, duration, severity and persistency of diarrhoea. Moreover, zinc may improve immune status, intestinal permeability, epithelial and enzymatic functions, and transport of electrolytes. The use of zinc in addition to oral rehydration solution (ORS) could thus theoretically improve the treatment and reduce the complications of diarrhoea worldwide. However, in developed countries, no trial using zinc supplementation in patients with acute diarrhoea has been published yet and the cost-benefit ratio of zinc supplementation needs to be assessed.
ABSTRACT GER and GERD are frequent conditions in infants, children, and adolescents. Symptoms dif... more ABSTRACT GER and GERD are frequent conditions in infants, children, and adolescents. Symptoms differ with age, although the main pathophysiologic mechanism, transient relaxations of the lower esophageal sphincter, is identical at all ages. Although infant regurgitation is likely to disappear with age, little is known about the natural evolution of pediatric GER and GERD. The majority of reflux episodes are weakly acid, but the majority of “esophageal” symptomatic reflux is likely to be acid related. Regarding “extraesophageal manifestations,” measurement of nonacid reflux may be more relevant. Symptoms of GER are not specific and not sensitive. There is no golden-standard diagnostic technique. Impedance in combination with pH-metry is likely to replace simple pH-metry in the future. Treatment of regurgitation and moderate reflux disease should focus on reassurance and dietary and possibly positional treatment. Medical therapeutic options usually involve inhibition of acid suppression, although not all reflux symptoms and disease are caused by acid reflux. Alginates or antacids are useful when immediate symptom relief is required. No currently available prokinetic drug is indicated in the treatment of childhood GERD. Laparoscopic fundoplication is the recommended surgical procedure in selected cases of particularly severe and chronic GERD.
Gastroesophageal reflux (GER) is a common phenomenon occurring at any age with a benign prognosis... more Gastroesophageal reflux (GER) is a common phenomenon occurring at any age with a benign prognosis in the majority of cases, but requiring prompt evaluation and treatment when presenting with alarm symptoms or when persisting [1]. The involuntary passage of gastric contents into the esophagus is the definition of GER. Since every individual has a number of episodes of GER, it is a physiological phenomenon. Most reflux episodes are limited to the distal esophagus, are brief and asymptomatic. The difference between physiologic reflux and reflux disease is to a lesser extent defined by the frequency, duration, content, and severity of the reflux episodes. The occurrence of symptoms, manifestations severe enough to impair quality of life, or complications suggest GER disease (GERD) [2, 3. When this occurs, and the forces overcome the defense, the esophageal mucosa may become damaged, with significant consequences for the affected individual [3].
International Journal of Pediatrics and Child Health
SARS-CoV-2 infection commonly presents with mild to severe respiratory symptoms and possibly othe... more SARS-CoV-2 infection commonly presents with mild to severe respiratory symptoms and possibly other organs involvement. Gastrointestinal manifestations have been frequently documented in adult patients whilst their occurrence in children is uncertain. This study aimed to perform a Systematic Review of gastrointestinal symptoms in children with Coronavirus disease (COVID-19) and to compare these clinical findings with those reported in a cohort of Italian children in the early phase of pandemic. Methods: Literature search was conducted using the Cochrane Library and MEDLINE (via Pubmed) databases from 1st December 2019 to 28th April 2020, according to the PRISMA guidelines. The following search terms were inserted: “Coronavirus” OR “COVID-19” OR “SARS-CoV-2” AND “gastrointestinal” or “diarrhea”. Only papers including children (0-18 years) and gastrointestinal symptoms were considered as eligible. Data records of children living in Lombardy, Italy, with infection of SARS-CoV-2 diagnose...
Introduction: COVID-19 is the disease caused by the novel coronavirus SARS-CoV-2, responsible of ... more Introduction: COVID-19 is the disease caused by the novel coronavirus SARS-CoV-2, responsible of the pandemic declared in March 2020 and still ongoing. COVID-19 affects all ages but presents less complications and fatalities in children. Neonatal infections have rarely been reported worldwide, and vertical transmission is uncertain. Methods: We conducted a prospective cohort study of all infants born to SARS-CoV-2-positive mothers admitted to 2 hospitals in South (Bari) and North (Varese) of Italy from April to December 2020. A molecular nasopharyngeal swab for SARS-CoV-2 using a reverse transcriptase polymerase chain reaction was made at birth for all enrolled newborns to evaluate vertical transmission of infection. We also evaluated postnatal transmission with a second nasopharyngeal swab made at 1 month of life and described maternal and neonatal clinical findings and short-term outcomes. Results: 176/179 (97%) newborns were SARS-CoV-2 negative at birth and 151/156 (97%) infants ...
Selected probiotics (mainly Lactobacilli, and particularly LGG, and Saccharomyces boulardii) have... more Selected probiotics (mainly Lactobacilli, and particularly LGG, and Saccharomyces boulardii) have recently demonstrated a therapeutic efficacy in acute diarrhoea, if used in the early phase of infection and at high concentration. Further data are needed to clarify their effect for prevention and travellers' diarrhoea. The mechanisms of action of probiotics need to be fully elucidated but seem to include a complex interaction of epithelial, molecular, metabolic and immune responses. There is an increasing evidence that different micro-organisms show different properties and efficacy. An accurate identification and selection of the strains, the dose and the patients are thus crucial for a correct therapeutic approach. Prebiotics can modify the intestinal flora and interact with the immune system of the host against specific pathogens. However, clinical trials are currently limited and a beneficial effect of prebiotics in acute diarrhoea is still lacking. In developing countries zinc supplementation demonstrated a significant reduction of fecal excretion, duration, severity and persistency of diarrhoea. Moreover, zinc may improve immune status, intestinal permeability, epithelial and enzymatic functions, and transport of electrolytes. The use of zinc in addition to oral rehydration solution (ORS) could thus theoretically improve the treatment and reduce the complications of diarrhoea worldwide. However, in developed countries, no trial using zinc supplementation in patients with acute diarrhoea has been published yet and the cost-benefit ratio of zinc supplementation needs to be assessed.
ABSTRACT GER and GERD are frequent conditions in infants, children, and adolescents. Symptoms dif... more ABSTRACT GER and GERD are frequent conditions in infants, children, and adolescents. Symptoms differ with age, although the main pathophysiologic mechanism, transient relaxations of the lower esophageal sphincter, is identical at all ages. Although infant regurgitation is likely to disappear with age, little is known about the natural evolution of pediatric GER and GERD. The majority of reflux episodes are weakly acid, but the majority of “esophageal” symptomatic reflux is likely to be acid related. Regarding “extraesophageal manifestations,” measurement of nonacid reflux may be more relevant. Symptoms of GER are not specific and not sensitive. There is no golden-standard diagnostic technique. Impedance in combination with pH-metry is likely to replace simple pH-metry in the future. Treatment of regurgitation and moderate reflux disease should focus on reassurance and dietary and possibly positional treatment. Medical therapeutic options usually involve inhibition of acid suppression, although not all reflux symptoms and disease are caused by acid reflux. Alginates or antacids are useful when immediate symptom relief is required. No currently available prokinetic drug is indicated in the treatment of childhood GERD. Laparoscopic fundoplication is the recommended surgical procedure in selected cases of particularly severe and chronic GERD.
Gastroesophageal reflux (GER) is a common phenomenon occurring at any age with a benign prognosis... more Gastroesophageal reflux (GER) is a common phenomenon occurring at any age with a benign prognosis in the majority of cases, but requiring prompt evaluation and treatment when presenting with alarm symptoms or when persisting [1]. The involuntary passage of gastric contents into the esophagus is the definition of GER. Since every individual has a number of episodes of GER, it is a physiological phenomenon. Most reflux episodes are limited to the distal esophagus, are brief and asymptomatic. The difference between physiologic reflux and reflux disease is to a lesser extent defined by the frequency, duration, content, and severity of the reflux episodes. The occurrence of symptoms, manifestations severe enough to impair quality of life, or complications suggest GER disease (GERD) [2, 3. When this occurs, and the forces overcome the defense, the esophageal mucosa may become damaged, with significant consequences for the affected individual [3].
International Journal of Pediatrics and Child Health
SARS-CoV-2 infection commonly presents with mild to severe respiratory symptoms and possibly othe... more SARS-CoV-2 infection commonly presents with mild to severe respiratory symptoms and possibly other organs involvement. Gastrointestinal manifestations have been frequently documented in adult patients whilst their occurrence in children is uncertain. This study aimed to perform a Systematic Review of gastrointestinal symptoms in children with Coronavirus disease (COVID-19) and to compare these clinical findings with those reported in a cohort of Italian children in the early phase of pandemic. Methods: Literature search was conducted using the Cochrane Library and MEDLINE (via Pubmed) databases from 1st December 2019 to 28th April 2020, according to the PRISMA guidelines. The following search terms were inserted: “Coronavirus” OR “COVID-19” OR “SARS-CoV-2” AND “gastrointestinal” or “diarrhea”. Only papers including children (0-18 years) and gastrointestinal symptoms were considered as eligible. Data records of children living in Lombardy, Italy, with infection of SARS-CoV-2 diagnose...
Introduction: COVID-19 is the disease caused by the novel coronavirus SARS-CoV-2, responsible of ... more Introduction: COVID-19 is the disease caused by the novel coronavirus SARS-CoV-2, responsible of the pandemic declared in March 2020 and still ongoing. COVID-19 affects all ages but presents less complications and fatalities in children. Neonatal infections have rarely been reported worldwide, and vertical transmission is uncertain. Methods: We conducted a prospective cohort study of all infants born to SARS-CoV-2-positive mothers admitted to 2 hospitals in South (Bari) and North (Varese) of Italy from April to December 2020. A molecular nasopharyngeal swab for SARS-CoV-2 using a reverse transcriptase polymerase chain reaction was made at birth for all enrolled newborns to evaluate vertical transmission of infection. We also evaluated postnatal transmission with a second nasopharyngeal swab made at 1 month of life and described maternal and neonatal clinical findings and short-term outcomes. Results: 176/179 (97%) newborns were SARS-CoV-2 negative at birth and 151/156 (97%) infants ...
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Papers by Silvia Salvatore