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سال:1393 | دوره:19 | شماره:2 |تعداد مقالات:11

Background: Most diagnostic tests for biliary atresia (BA) are invasive. This study evaluates the sensitivity and specificity of serum tumor necrosis factor-a (TNF-a) for diagnosing extra hepatic biliary duct atresia (EHBA) in infants.Materials and Methods: Infants with cholestasis who were admitted to Children′s Medical Center Hospital were evaluated. A total of 50 infants (20 with EHBA and 30 non-EHBA) were included in this study. We evaluated the definite cause of cholestasis. Intra-operative cholangiography and, if possible, Kasai portoenterostomy were performed in infants with high suspicion for EHBA. Upon admission and prior to surgical intervention, infants had their serum TNF-a levels measured by ELISA. We compared the mean TNF-a level between the two groups, in addition to the sensitivity and specificity of serum TNF-α for diagnosis of EHBA.Results: This study enrolled 28 (56%) male and 22 (44%) female infants. Infants'' mean age was 2.87 months in the EHBA group and 2.6 months in the non-EHBA group. Sensitivity of serum TNF was 60% and its specificity was 76.66% for predicting EHBA. The positive predictive value was calculated as 63.1%, the negative predictive value was 74.1%, and accuracy was 70%. There was a significantly higher mean serum TNF-a level in the EHBA group (220 pg/ml) compared to the non-EHBA group (79.8 pg/ml, p=0.023). Serum TNF-a cut off point for determining EHBA from non-EHBA was calculated as 80 pg/ml. Mean serum TNF-a in males (171.28 pg/ml) was more than females (90.80 pg/ml).Conclusion: There was a significantly higher mean serum TNF-a level in the EHBA group than the non-EHBA group. Serum TNF-α could be a proper test that has comparatively good sensitivity, specificity, positive predictive value and negative predictive value for predicting EHBA.

Eosinophilic gastroenteritis (EGE) was a rare gastrointestinal disease that was seen in all ages usually associated with dyspepsia, diarrhea, vomiting, abdominal pain, blood loss in stools and malabsorption. We reported a six-month-old boy with rectorrhagia, family history of allergy, elevated IgE and eosinophil in blood with normal endoscopy. Because of eosinophilic infiltration in lamina properia in colon, diagnosis of EGE confirmed and oral corticosteroid initiated. Patient had symptomatic response and was doing well. The heterogeneity in the clinical presentation of EGE determined by the site and depth of eosinophilic intestinal infiltration and lower gastrointestinal bleeding, although was rare but may be one the clinical manifestations of disease in patients with allergic eosinophilic gastroenteritis (AEG).