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Down Syndrome Abstract
of the Month: Jan 2008

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Clinical audit of gastrointestinal conditions occurring among adults with Down syndrome attending a specialist clinic.

Wallace RA
J Intellect Dev Disabil. 2007 Mar;32(1):45-50.

Mater and Princess Alexandra Hospitals, Brisbane, Australia.

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BACKGROUND: Adults with Down syndrome (DS) are predisposed to syndromic and environmental gastrointestinal conditions. METHOD: In a hospital-based clinic for adults with DS, a chart audit was conducted to assess the range and frequency of gastrointestinal conditions. RESULTS: From January 2003 to March 2005, 57 patients attended the clinic, average age 37 years (range 17-63), 34(60%) male, and 12(21%) with a history of institutionalisation. Of these, 56 were found to have at least one gastrointestinal concern. Of the genotypic conditions, the prevalence was as follows: 6(12%) of 51 tested had likely celiac disease, 1(2%) had achalasia, 1(2%) inflammatory bowel disease, 1(2%) cholelithiasis, 2(4%) unexplained abnormal liver function tests, 1(2%) extrinsic oesophageal compression, and 5(9%) gastro-oesophageal reflux. Of the environmental conditions, 29(67%) of 43 tested had H. pylori infection; 13(25%) of 53 tested had hepatitis B infection (including 2 HbsAg positive, 0 HbeAg positive), 22(42%) non-immune and 4(7%) not tested; 17(36%) of 47 tested were immune to hepatitis A, 30(64%) non-immune and 10(18%) not tested. Of the conditions of uncertain link with Down syndrome, 11(19%) of the 57 patients had unexplained constipation; 11(19%) had unexplained chronic diarrhoea; 1(2%) had haemochromatosis; and 39(68%) presented with overnutrition. CONCLUSION: On specific enquiry, a majority of adults with DS have a gastrointestinal condition. As many of the conditions require hospital services, specially designed protocols in this setting should be developed.

My comments:

I'm not surprised by the celiac disease or the reflux. I was surprised by the large number with H. pylori, a type of bacterium associated with ulcers and gastritis. Adults with DS with chronic abdominal pain or reflux should be tested for this germ, which involves a simple blood test.

Hepatitis B has long been associated with adults with DS, but mostly from the days where most adults with DS were found in institutions. The study did not state what percentage of subjects with Hepatitis B had been in institutions. With the existence of good vaccines against both Hepatitis A and B, this should stop being a problem.

The term "overnutrition" in the abstract refers to obesity.
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