@article {8485, title = {Oral zinc provision in acute diarrhea.}, journal = {Curr Opin Clin Nutr Metab Care}, volume = {19}, year = {2016}, month = {2016 May}, pages = {239-43}, abstract = {

PURPOSE OF REVIEW: The clinical management of acute diarrhea is based on the use of oral rehydration salts and appropriate nutrition. In addition, the WHO and The United Nations Children{\textquoteright}s Fund recommend zinc supplementation for diarrhea in children below 5 years. This article aims at reviewing recent literature on the effects of oral zinc for treating acute diarrhea in children.

RECENT FINDINGS: Recent studies confirm that zinc supplementation has a benefit in children below 5 years with acute diarrhea in countries at medium or high risk of zinc deficiency. A few small trials have reported a benefit of zinc in children at low risk of zinc deficiency, with heterogeneity in results. No recent study has explored the effects of zinc in children younger than 6 months, and in this age group previous research refuted any benefit from zinc.

SUMMARY: Current literature supports the use of oral zinc in treating diarrhea in children older than 6 months, especially if at risk of zinc deficiency, such as children with poor diets exposed to recurrent gastrointestinal infections. More research is needed to confirm findings in children at low risk of zinc deficiency. Currently there is no evidence that zinc benefits children younger than 6 months.

}, issn = {1473-6519}, doi = {10.1097/MCO.0000000000000276}, author = {Lazzerini, Marzia} } @article {7745, title = {Orofacial granulomatosis in children: think about Crohn{\textquoteright}s disease.}, journal = {Dig Liver Dis}, volume = {47}, year = {2015}, month = {2015 Apr}, pages = {338-41}, abstract = {

BACKGROUND: The term orofacial granulomatosis is conventionally used to describe patients with granulomatous lesions affecting the orofacial tissues, in absence of intestinal lesions. Lip swelling and facial swelling are the most common clinical signs. Despite the fact that histologically it is not distinguishable from Crohn{\textquoteright}s disease, and that both diseases have a chronic/recurrent course, the relationship between orofacial granulomatosis and Crohn{\textquoteright}s disease is still debated.

METHODS: Herein we present five cases of orofacial granulomatosis.

RESULTS: All patients presented concomitant Crohn{\textquoteright}s disease, supporting the hypothesis that orofacial granulomatosis and Crohn{\textquoteright}s disease may be one single disease. Thalidomide was effective in inducing remission of oral and intestinal symptoms in all five cases and could be considered a valid treatment opportunity for these patients.

CONCLUSIONS: Orofacial granulomatosis and Crohn{\textquoteright}s disease may be part of the same disease; both may respond to thalidomide.

}, keywords = {Adolescent, Biopsy, Child, Colonoscopy, Crohn Disease, Diagnosis, Differential, Female, Granulomatosis, Orofacial, Humans, Immunosuppressive Agents, Male, Thalidomide}, issn = {1878-3562}, doi = {10.1016/j.dld.2014.12.012}, author = {Lazzerini, Marzia and Martelossi, Stefano and Cont, Gabriele and Bersanini, Chiara and Ventura, Giovanna and Fontana, Massimo and Zuin, Giovanna and Ventura, Alessandro and Taddio, Andrea} } @article {1925, title = {Oral zinc for treating diarrhoea in children.}, journal = {Cochrane Database Syst Rev}, volume = {6}, year = {2012}, month = {2012}, pages = {CD005436}, abstract = {

BACKGROUND: In developing countries, diarrhoea causes around two million child deaths annually. Zinc supplementation during acute diarrhoea is currently recommended by the World Health Organization and UNICEF.

OBJECTIVES: To evaluate oral zinc supplementation for treating children with acute or persistent diarrhoea.

SEARCH METHODS: In February 2012, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2011, Issue 11), MEDLINE, EMBASE, LILACS, CINAHL, mRCT, and reference lists. We also contacted researchers.

SELECTION CRITERIA: Randomized controlled trials comparing oral zinc supplementation with placebo in children aged one month to five years with acute or persistent diarrhoea, including dysentery.

DATA COLLECTION AND ANALYSIS: Both authors assessed trial eligibility and risk of bias, extracted and analysed data, and drafted the review. Diarrhoea duration and severity were the primary outcomes. We summarized dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD) with 95\% confidence intervals (CI). Where appropriate, we combined data in meta-analyses (using the fixed- or random-effects model) and assessed heterogeneity.The quality of evidence has been assessed using the GRADE methods

MAIN RESULTS: Twenty-four trials, enrolling 9128 children, met our inclusion criteria. The majority of the data is from Asia, from countries at high risk of zinc deficiency, and may not be applicable elsewhere.Acute diarrhoeaThere is currently not enough evidence from well conducted randomized controlled trials to be able to say whether zinc supplementation during acute diarrhoea reduces death or hospitalization (very low quality evidence).In children aged greater than six months with acute diarrhoea, zinc supplementation may shorten the duration of diarrhoea by around 10 hours (MD -10.44 hours, 95\% CI -21.13 to 0.25; 2091 children, five trials, low quality evidence), and probably reduces the number of children whose diarrhoea persists until day seven (RR 0.73, 95\% CI 0.61 to 0.88; 3865 children, six trials, moderate quality evidence). In children with signs of moderate malnutrition the effect appears greater, reducing the duration of diarrhoea by around 27 hours (MD -26.98 hours, 95\% CI -14.62 to -39.34; 336 children, three trials, high quality evidence).Conversely, In children aged less than six months, the available evidence suggests zinc supplementation may have no effect on mean diarrhoea duration (MD 5.23 hours, 95\% CI -4.00 to 14.45; 1334 children, two trials, low quality evidence), and may even increase the proportion of children whose diarrhoea persists until day seven (RR 1.24, 95\% CI 0.99 to 1.54; 1074 children, one trial, moderate quality evidence).No trials reported serious adverse events, but zinc supplementation during acute diarrhoea causes vomiting in both age groups (RR 1.59, 95\% 1.27 to 1.99; 5189 children, 10 trials, high quality evidence).Persistent diarrhoeaIn children with persistent diarrhoea, zinc supplementation probably shortens the duration of diarrhoea by around 16 hours (MD -15.84 hours, 95\% CI -25.43 to -6.24; 529 children, five trials, moderate quality evidence).

AUTHORS{\textquoteright} CONCLUSIONS: In areas where the prevalence of zinc deficiency or the prevalence of moderate malnutrition is high, zinc may be of benefit in children aged six months or more.The current evidence does not support the use of zinc supplementation in children below six months of age.

}, keywords = {Acute Disease, Age Factors, Child, Child, Preschool, Diarrhea, Humans, Infant, Randomized Controlled Trials as Topic, Time Factors, Trace Elements, Zinc}, issn = {1469-493X}, doi = {10.1002/14651858.CD005436.pub3}, author = {Lazzerini, Marzia and Ronfani, Luca} }