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

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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<br />

UPDATES IN PEDIATRIC OBESITY: WHY SHOULD WE CARE?<br />

Nadine H Yazbeck, MD<br />

Obesity is currently the single most prevalent disease in Childhood; obese children constitute a<br />

significant portion <strong>of</strong> every primary care and specialty practice in Pediatrics.<br />

It is <strong>of</strong> utmost importance to use the percentile BMI for age and gender as the most appropriate<br />

and easily available method to screen and diagnose overweight and obesity in the general<br />

pediatrician’s clinic.<br />

In this talk I will quickly go over the different possible etiologies <strong>of</strong> this global epidemic and review<br />

the wide spectrum <strong>of</strong> complications including the respiratory, gastroenterology, endocrinology<br />

and psychological problems.<br />

I will stress mainly on the treatment with its three primary components: the dietary modifications,<br />

the increase in physical activity and the behavioral modifications for both the patient and the<br />

family.<br />

Superficially, it would seem that the treatment <strong>of</strong> overweight is straight forward: counsel children<br />

to eat less and be more physically active. In practice, treatment <strong>of</strong> childhood overweight is time<br />

consuming, frustrating, difficult and expensive. <strong>The</strong> considerable challenges <strong>of</strong> addressing and<br />

treating obesity throughout the life cycle have led to increase in interest in preventing obesity<br />

altogether.<br />

EOSINOPHILIC COLITIS<br />

Sibylle Koletzko MD and Haunersches Kinderspital, MD<br />

Eosinophilic colitis (EC) is a descriptive term for a condition characterized by eosinophilic<br />

infiltration <strong>of</strong> one or more layers <strong>of</strong> the total colon or some segments, but it is not a single entity.<br />

Primary EC is a manifestation within the eosinophilic gastrointestinal disease (EGID) spectrum 1 and<br />

occurs in all age groups, particularly during infancy. Primary EC needs to be distinguished from<br />

secondary forms, due to different infectious diseases, particularly helminth or parasitic infections,<br />

inflammatory bowel disease, hyper-eosinophilic syndrome and drugs such as rifampicin, gold<br />

or non-steroidal anti-inflammmatory drugs 2 . More recently secondary EC has been recognized<br />

in a proportion <strong>of</strong> children after liver transplantation as a side effect <strong>of</strong> immunosuppression with<br />

tacrolimus 3 .<br />

<strong>The</strong> clinical spectrum varies from hardly any symptoms to rectal bleeding, dysmotility with<br />

constipation or diarrhoea, abdominal pain or even ascitis. A peripheral eosinophilia is common;<br />

however a normal differential blood count does not exclude EC. <strong>The</strong> diagnostic work up depends<br />

on age, but infections and drug-induced EC should be ruled out. In breastfed or formula fed<br />

infants with hematochezia endoscopy is rarely needed, because in most cases the condition is<br />

self-limiting or resolves after dietary intervention 4 . Colonoscopy should be performed if symptoms<br />

persists, or in older children to differentiate from secondary forms, particularly inflammatory bowel<br />

disease. <strong>The</strong> macroscopic appearance may vary from normal to aphthous ulcerations with or<br />

without lymphatic hyperplasia. Eosinophilic infiltrations may be segmental or continuous.<br />

Treatment includes nutritional exclusion and corticosteroids. In breast-fed infants the elimination<br />

<strong>of</strong> cow’s milk protein from the maternal diet or addition <strong>of</strong> supplementary feeding after 17 weeks<br />

42

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