The IX t h Makassed Medical Congress - American University of Beirut

T h e I X t h M a k a s e d M e d i c a l C o n g r e s s
UPDATES IN PEDIATRIC OBESITY: WHY SHOULD WE CARE?
Nadine H Yazbeck, MD
Obesity is currently the single most prevalent disease in Childhood; obese children constitute a
significant portion of every primary care and specialty practice in Pediatrics.
It is of utmost importance to use the percentile BMI for age and gender as the most appropriate
and easily available method to screen and diagnose overweight and obesity in the general
pediatrician’s clinic.
In this talk I will quickly go over the different possible etiologies of this global epidemic and review
the wide spectrum of complications including the respiratory, gastroenterology, endocrinology
and psychological problems.
I will stress mainly on the treatment with its three primary components: the dietary modifications,
the increase in physical activity and the behavioral modifications for both the patient and the
family.
Superficially, it would seem that the treatment of overweight is straight forward: counsel children
to eat less and be more physically active. In practice, treatment of childhood overweight is time
consuming, frustrating, difficult and expensive. The considerable challenges of addressing and
treating obesity throughout the life cycle have led to increase in interest in preventing obesity
altogether.
EOSINOPHILIC COLITIS
Sibylle Koletzko MD and Haunersches Kinderspital, MD
Eosinophilic colitis (EC) is a descriptive term for a condition characterized by eosinophilic
infiltration of one or more layers of the total colon or some segments, but it is not a single entity.
Primary EC is a manifestation within the eosinophilic gastrointestinal disease (EGID) spectrum 1 and
occurs in all age groups, particularly during infancy. Primary EC needs to be distinguished from
secondary forms, due to different infectious diseases, particularly helminth or parasitic infections,
inflammatory bowel disease, hyper-eosinophilic syndrome and drugs such as rifampicin, gold
or non-steroidal anti-inflammmatory drugs 2 . More recently secondary EC has been recognized
in a proportion of children after liver transplantation as a side effect of immunosuppression with
tacrolimus 3 .
The clinical spectrum varies from hardly any symptoms to rectal bleeding, dysmotility with
constipation or diarrhoea, abdominal pain or even ascitis. A peripheral eosinophilia is common;
however a normal differential blood count does not exclude EC. The diagnostic work up depends
on age, but infections and drug-induced EC should be ruled out. In breastfed or formula fed
infants with hematochezia endoscopy is rarely needed, because in most cases the condition is
self-limiting or resolves after dietary intervention 4 . Colonoscopy should be performed if symptoms
persists, or in older children to differentiate from secondary forms, particularly inflammatory bowel
disease. The macroscopic appearance may vary from normal to aphthous ulcerations with or
without lymphatic hyperplasia. Eosinophilic infiltrations may be segmental or continuous.
Treatment includes nutritional exclusion and corticosteroids. In breast-fed infants the elimination
of cow’s milk protein from the maternal diet or addition of supplementary feeding after 17 weeks
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