Ultrassonografia com Doppler em cores e em escala de cinzas para avaliação intestinal em lactentes assintomáticos e com alergia à proteína do leite de vaca

• Ano de defesa: 2010
• Autor(a) principal: Epifanio, Matias
• Orientador(a): Baldisserotto, Matteo
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre
• Palavras-chave em Português: MEDICINA; PEDIATRIA; GASTROENTEROLOGIA; DIAGNÓSTICO POR IMAGEM; ULTRASSONOGRAFIA DE DOPPLER; INTESTINOS; HIPERSENSIBILIDADE ALIMENTAR; CRIANÇAS - DOENÇAS; HIPERSENSIBILIDADE A LEITE
• Link de acesso: http://hdl.handle.net/10923/4645

Aim Evaluate whether the intestinal inflammation in children with CMA, can be detected by ultrasound in gray scale and color Doppler. Introduction Cow’s milk allergy is a common pediatric clinical problem with a variability of clinical signs, symptoms and it's hard to diagnose. Gray scale and color Doppler ultrasonography have been increasingly used to evaluate abdominal disorders and intestinal inflammation. Methods This study evaluated clinical findings and gray scale and color Doppler sonograms of 34 infants. The study was divided into two stages, with additional designs: an initial step, making a study of cases and controls and a second stage constitutes a clinical trial Seventeen infants aged 0 to 6 months with a suspicion of cow’s milk allergy and 17 non-symptomatic infants were evaluated by a blinded investigator who determined the percentage of vessel density and the thickness of different parts of the bowel. Clinical and ultrasonographic variables were evaluated at three time points: at presentation, after 4 weeks of amino acid-based formula feeding, and after challenge test. Likelihood ratio and ROC curve were used to define a cutoff point for percentage of vascular density. Results The difference in percentage of vessel density between patients with cow’s milk allergy (28. 1%) and control infants (7. 77%) was statistically significant. ROC analysis showed that a cutoff point of 18. 7% could differentiate between patients with cow’s milk allergy and control infants with 81. 8 % sensitivity and 94. 1% specificity. Positive and negative predictive values were greater than 88%. Area under the curve was 0. 941. Likelihood ratio of 10. 8, when using a cut-off 20%. Difference in bowel wall thickness between the two groups was very little. Conclusion Color Doppler may be used when cow’s milk allergy is suspected. We suggest a cut-off point of 18. 7% for percentage of vessel density. The use of the thickness of the intestinal wall presents difficult applicability.