ArticlesSodium cromoglycate in the management of chronic or recurrent enterocolitis in patients with Hirschsprung's disease*
Section snippets
Materials and methods
During 1997 and 1998, 8 consecutive patients, with symptoms of chronic or frequently relapsing enterocolitis, were enrolled to the sodium cromoglycate trial. The age range of the patients was from 4 to 22 years. All patients had undergone repair of Hirschsprung's disease during the first year of life. The original reconstruction was Duhamel operation in 2 patients and transanal endorectal coloanal anastomosis11 in 6 patients.
Five of the patients had symptoms of chronic enterocolitis. Three of
Results
At endoscopy the macroscopic findings were consistent with mild to moderate colitis predominantly in the left colon. None of the patients had megacolon. The histology results findings showed chronic inflammation in all cases, especially in the distal biopsies. In histology there were no specific findings suggesting other forms of chronic colonic inflammatory disease such as ulcerative colitis or Crohn's disease. Biopsy results from distal ileum were normal in all patients. Biopsy specimens for
Discussion
The prevalence of chronic or frequently recurring enterocolitis among patients with surgically repaired Hirschsprung's disease is unknown. It is clear that this problem affects more commonly patients with defective immune systems such as those with Down's syndrome. In the current series 4 of the 8 patients had Down's syndrome and 2 more had other chromosomal aberrations. Postoperative enterocolitis also has been attributed to bowel outlet obstruction.6 In the current series none of the patients
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Cited by (29)
In vitro study of disodium cromoglicate as a novel effective hydrotrope solvent for hypericin utilisation in photodynamic therapy
2020, Journal of Photochemistry and Photobiology B: BiologyCitation Excerpt :Disodium cromoglicate (DSCG) is a chromone (Fig. 1) derived from khellin, which is a furanochromone that naturally occurs in the North African plant Ammi visnaga [26]. DSCG has been used since 1970 in clinical practice [27] as local anti-allergic drug to treat asthma and other hypersensitivity conditions in the gastrointestinal tract, mucosa and epidermis [28–30]. DSCG likely acts as mast-cell stabiliser and is able to prevent histamine release after mast cells are activated [31].
Hirschsprung-associated enterocolitis
2019, Gastrointestinal Diseases and Their Associated InfectionsPrevention and management of recurrent postoperative Hirschsprung's disease obstructive symptoms and enterocolitis: Systematic review and meta-analysis
2018, Journal of Pediatric SurgeryCitation Excerpt :Sodium cromoglycate is a nonabsorbable mast cell stabilizing agent that has been documented to be effective in the treatment of inflammatory bowel disease. There has not been a follow-up study to the paper published by Rintala et al. [36] and we were not able to identify any further evidence on the use of anti-inflammatory drugs for prevention of HAEC. Since most of the papers did not separately present results on the different type of surgical procedures, we were not able to perform a subset analysis to identify difference in outcomes based on the type of procedure.
Long-term outcomes of Hirschsprung's disease
2012, Seminars in Pediatric SurgeryCitation Excerpt :Down's syndrome patients are more susceptible to enterocolitis than other HD patients. Enterocolitis may become chronic in Down's syndrome.45 Chronic enterocolitis is uncommon in nonsyndromic HD patients.
Hirschsprung-associated enterocolitis: Prevention and therapy
2012, Seminars in Pediatric SurgeryCitation Excerpt :Metronidazole is the most commonly used agent for treatment of both simple and complicated disease and should be instituted even if patients are manifesting mild symptoms.54 Alternatively, one may empirically use metronidazole and norfloxacin for antibiotic therapy as described by Rintala and Lindahl.57 Stool cultures should be sent to identify causal organisms and also to rule out other infectious etiologies (such as, Shigella).
The pathogenesis of Hirschsprung's disease-associated enterocolitis
2012, Seminars in Pediatric SurgeryCitation Excerpt :One study showed that patients with HAEC carry C difficile for prolonged periods compared with control subjects.85 Several other studies, however, report very few patients positive for C difficile.19,15,86 The fact that up to 90% of healthy neonates have C difficile in their stools and may secrete the toxin suggests that the pathogen alone does not cause HAEC.87
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Address reprint requests to R.J. Rintala, MD, PhD, Professor of Paediatric Surgery, Children's Hospital, University, P.O. Box 281, FIN-00029 HYKS, Finland.