title: Gastrointestinal disorders next to respiratory infections as leading symptoms of X-linked agammaglobulinemia in children - 34-year experience of a single center.
abstract: BACKGROUND
  Respiratory tract infections constitute the most frequent manifestation of X-linked agammaglobulinemia (XLA). There are not many papers elucidating gastrointestinal (GI) disorders, including inflammatory bowel disease (IBD), in such patients. The aim of the study was to evaluate the occurrence of gastrointestinal disorders and IBD compared to respiratory tract infections in XLA individuals.
  
  
  METHODS
  Of 1563 patients with primary immunodeficiencies diagnosed in the Department of Immunology, the Children's Memorial Health Institute (CMHI), 66 boys had a provisional diagnosis of agammaglobulinemia. Forty-four subjects fulfilled definitive ESID (European Society for Immunodeficiencies) diagnostic criteria of XLA. A retrospective analysis of medical history of XLA patients was undertaken.
  
  
  RESULTS
  Recurrent respiratory tract infections, particularly bronchitis (73%) and pneumonia (59%), were the most common symptoms of XLA. The GI disorders constituted the next main manifestation (63.6%), followed by upper respiratory tract infections. Twenty-six of 28 XLA patients with GI disorders complained of diarrhea, which was resolved generally after immunoglobulin therapy introduction. Single but prolonged episodes ofCampylobacter jejunidiarrhea were reported in two individuals. Inflammatory bowel disease of mild to moderate activity was diagnosed in 1 patient, and local enteritis of mild activity in another one.
  
  
  CONCLUSIONS
  Gastrointestinal disorders were one of the main manifestations of XLA, reported almost as often as lower respiratory tract infections. The most common GI symptom was diarrhea, which usually resolved after immunoglobulin therapy was started. Infections caused byGiardia lambliawere reported occasionally. Inflammatory bowel disease was diagnosed quite exceptionally, which presumably may be connected with normal T cell immunity.
authors.affiliation: Department of Immunology, The Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Pac
authors.affiliation: Department of Immunology, The Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Ewa A
authors.initials: EA
authors.lastname: Bernatowska
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition Disorders, The Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Kierkuś
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition Disorders, The Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Józef P
authors.initials: JP
authors.lastname: Ryżko
authors.affiliation: Department of Pathology, The Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Cielecka-Kuszyk
authors.affiliation: Department of Pediatrics, Medical Center of Postgraduate Education, Department of Pediatrics, Bielański Hospital, Warsaw, Poland.
authors.forename: Teresa
authors.initials: T
authors.lastname: Jackowska
authors.affiliation: Department of Pediatrics, Medical University, Bialystok, Poland.
authors.forename: Bożena
authors.initials: B
authors.lastname: Mikołuć
keywords: children; inflammatory bowel disease; primary antibody deficiency; respiratory infections