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215 Characterization of gastroesophageal reflux with combined multichannel intraluminal impedance–pH (MII-pH) in a group of children with CF
S114
10. Gastroenterology/Nutrition
215 Characterization of gastroesophageal reflux with combined multichannel intraluminal impedance−pH (MII-pH) in a group of children with CF J. Brecelj1,2 , R. Orel1,2 . 1 University Children’s Hospital, Department of Gastroenterology, Hepatology and Nutrition, Ljubljana, Slovenia; 2 University of Ljubljana, Faculty of Medicine, Department of Pediatrics, Ljubljana, Slovenia Objectives: Gastroesophageal reflux (GER) is an important patogenetic factor in CF. The aim of the study was to retrospectively analyze the extent of pathological GER in a group of children with signs or symptoms of gastroesophageal reflux disease (GERD). Methods: MII-pH (MMS Ohmega) was performed in children who were suspected to have GERD. On the basis of the percentage of pH less than 4 and DeMeester index patients were separated in those having no pathological reflux and in those with GERD. Patients with GERD were treated with PPI and had another MII-pH performed after average 2 months of treatment. The same parameters, including baseline impedance were compared in both groups. Results: 21 children (13 females (61.9%), median age 10.3±5.4 years, percentile of BMI 27.9 +/− 29.5; no differences between both groups) with CF who underwent MII-pH during last 5 years were identified. All had symptoms and signs suggestive of GERD. Pathological GER was measured in 14 pts (66.7%). There was no difference between baseline impedance of upper and lower 2 electrodes between both groups. The group with GERD had normalization of the percentage of pathological GER and DeMeester index after the treatment with PPI (omeprazole, 1 mg/kg/BW up to 40 mg in total). There was no difference in baseline impedance before and after the treatment. Conclusion: GERD is very prevalent in symptomatic children with CF. Treatment with PPI is effective in usual dosages. In our (small) sample we could not find statistical difference in baseline impedance between GERD and non-GERD group, nor before and after the treatment with PPI in the group of children with CF and GERD.
Posters
218 Body composition estimation by bioelectrical impedance: Validation of an equation adapted to children with cystic fibrosis A.-M. Charatsi1,2 , H. Rossin3 , G. Maruani4 , C. Pires-Kutala1 , M. Le Bourgeois1 , A. Letourneur3 , E. Attlan5 , C. Lambe6 , J. De Blic1 , G. Casimir2 , I. SermetGaudelus1 . 1 Hˆopital Necker Enfants Malades, Pediatric Pulmonology Department, Paris, France; 2 Hˆopital Universitaire des Enfants Reine Fabiola, Pediatric Pulmonology Department, Brussels, Belgium; 3 Aminogram, Marseille, France; 4 Hˆ opital Necker Enfants Malades, Physiology Department, Paris, France; 5 Hˆopital Necker Enfants Malades, Radiology Department, Paris, France; 6 Hˆopital Necker Enfants Malades, Pediatric Gastro-Enterology Department, Paris, France Objectives: Nutritional status is an important factor which determines the respiratory outcome in cystic fibrosis (CF) patients. Body composition (BC), and more specifically fat free mass (FFM), impacts on respiratory function in adults; however data concerning pediatric cohorts are sparse. The gold standard method to estimate BC is dual X-Ray absorptiometry (DXA), but it is radiating, time consuming and frequently unavailable. Bioelectrical impedance analysis (BIA) is reproducible and easily feasible. Our objective is to validate an equation adapted to the pediatric CF population in order to calculate FFM by BIA. We also aim to investigate the correlation between BC and pulmonary function testing (PFT). Methods: CF children and non-CF controls are evaluated prospectively using fourelectrode multiple-frequency BIA (Aminostats Bio-ZM II). DXA (Hologic QDR 4500) is performed a few minutes later without modification of patients’ hydration status. Results of FFM obtained by BIA are compared to those calculated by DXA in order to validate the accuracy of the BIA equation. Correlation between FFM and PFT (FEV1, maximum inspiratory pressure) is also evaluated. Results: The equation proves accurate in CF children. BC of CF patients is under evaluation and will be compared to that of controls matched for age and sex. Correlation between BC and PFT will be presented. Conclusion: BIA is a helpful method to estimate BC. We have validated an equation adapted to the pediatric CF population. Repetitive measures of BC will allow clinicians to adjust nutritional care in order to improve the respiratory outcome of CF patients.
216 Gastrostomy button primary placement using an endoscopically guided gastropexy technique in cystic fibrosis: A single centre’s early experience
219 Nutritional intervention in paediatric cystic fibrosis patients leads to improvement of nutritional status − Preliminary results of a prospective study
P. Hutchings1 , K. Lee1 , K. Watson1 , B. Hayee2 , C. Elston1 . 1 King’s College Hospital, Adult Cystic Fibrosis Centre, London, United Kingdom; 2 King’s College Hospital, Department of Gastroenterology, London, United Kingdom
S. Mexia1 , I. Asseiceira1 , T. Rodrigues2 , L. Pereira1 , C. Barreto1 . 1 Santa Maria Hospital, Lisboa, Portugal; 2 Medical University of Lisbon, Lisboa, Portugal
Background and Objective: Endoscopically guided gastropexy technique (EGGT) is a one-stage procedure that supersedes button gastrostomy insertion following prior tract formation by a percutaneous endoscopic gastrostomy. During EGGT, the button is placed in the centre of three gastropexy sutures. We sought to investigate adult Cystic Fibrosis patients’ experience of EGGT for primary placement of gastrostomy buttons. Method: Semi-structured interviews were conducted with six patients who underwent button insertion via EGGT. Questions included reasons for choosing a button over alternative feeding tubes, experience post-procedure, impact of a button on health, and benefits and concerns of the EGGT procedure. Time taken to consent to the procedure, post-procedure complications, and change in body mass index (BMI) were established from retrospective record review. Results: Prominent themes included patient preference for a button due to its discrete size (3/6) and avoidance of uncomfortable nasogastric tubes (3/6). EGGT was regarded as uncomplicated due its single-procedure nature (4/6). All patients felt that the button positively impacted on their health and stated that they would recommend EGGT. Median time taken to consent to EGGT button placement was 4.5 months. There were no unexpected or severe post-procedure complications. One patient required dilatation of the tract due to weight gain. Median weight gain was 6.7 kg at one year follow-up; median BMI increased from 17.9 kg/m2 to 20.5 kg/m2 . Conclusion: EGGT button placement was well accepted by our patients. No severe post-procedure complications were noted. Weight gain was achieved by all patients at follow-up.
Objective: To assess the evolution of nutritional status and dietary intake in a group of patients with cystic fibrosis (CF) after implementation of a systematic nutritional approach. Methods: Prospective study with 39 patients followed in a CF center in Lisbon. All data were collected in two different timepoints: T0 (2012) and T2 (2014). We recorded demographic and clinical data: sex, age, genotype, pancreatic and pulmonary function; anthropometric parameters: weight, height and body mass index (BMI); dietary intake was assessed by 24 h recall. Statistical analysis: IBM® SPSS® 22. Results: Thirty-nine patients were included; 53.8% were male; age 10.0±4.5 y in T0 and 11.0±4.5 y in T2 . The most common genotype was DF508 homozygotic (76.9%); 92.3% had pancreatic insufficiency. FEV1 decreased from 88.9±22.9% (T0 ) to 85.9±24.5% (T2 ). According to BMI, 23.1% (T0 ) and 20.5% (T2 ) had underweight, 61.5% (T0 ) and 69.2% (T2 ) were eutrophic and 15.4% (T0 ) and 10.3% (T2 ) had excess weight. A positive correlation between FEV1 and z-score of BMI was found in both evaluation moments (T0 : r = 0.530, p = 0.002; T2 : r = 0.463, p = 0.007). Regarding dietary intake, patients consumed 1987 kcal in T0 and 2436 kcal in T2 and 19% protein, 47.4% carbohydrates and 31.9% fats in T0 and 17.8% protein, 43.9% carbohydrates and 32.1% fats in T2 . Percentage of patients with nutritional supplementation decreased from 51.3% in T0 to 35.9% in T2 . The nutritional status of our sample had a significant improvement due to a structured nutritional approach, since there was a decrease in the prevalence of under and over nutrition. Additionally we observed a decrease of the prescription of nutritional supplements without impact on the nutritional status and dietary intake.
10. Gastroenterology/Nutrition
215 Characterization of gastroesophageal reflux with combined multichannel intraluminal impedance−pH (MII-pH) in a group of children with CF J. Brecelj1,2 , R. Orel1,2 . 1 University Children’s Hospital, Department of Gastroenterology, Hepatology and Nutrition, Ljubljana, Slovenia; 2 University of Ljubljana, Faculty of Medicine, Department of Pediatrics, Ljubljana, Slovenia Objectives: Gastroesophageal reflux (GER) is an important patogenetic factor in CF. The aim of the study was to retrospectively analyze the extent of pathological GER in a group of children with signs or symptoms of gastroesophageal reflux disease (GERD). Methods: MII-pH (MMS Ohmega) was performed in children who were suspected to have GERD. On the basis of the percentage of pH less than 4 and DeMeester index patients were separated in those having no pathological reflux and in those with GERD. Patients with GERD were treated with PPI and had another MII-pH performed after average 2 months of treatment. The same parameters, including baseline impedance were compared in both groups. Results: 21 children (13 females (61.9%), median age 10.3±5.4 years, percentile of BMI 27.9 +/− 29.5; no differences between both groups) with CF who underwent MII-pH during last 5 years were identified. All had symptoms and signs suggestive of GERD. Pathological GER was measured in 14 pts (66.7%). There was no difference between baseline impedance of upper and lower 2 electrodes between both groups. The group with GERD had normalization of the percentage of pathological GER and DeMeester index after the treatment with PPI (omeprazole, 1 mg/kg/BW up to 40 mg in total). There was no difference in baseline impedance before and after the treatment. Conclusion: GERD is very prevalent in symptomatic children with CF. Treatment with PPI is effective in usual dosages. In our (small) sample we could not find statistical difference in baseline impedance between GERD and non-GERD group, nor before and after the treatment with PPI in the group of children with CF and GERD.
Posters
218 Body composition estimation by bioelectrical impedance: Validation of an equation adapted to children with cystic fibrosis A.-M. Charatsi1,2 , H. Rossin3 , G. Maruani4 , C. Pires-Kutala1 , M. Le Bourgeois1 , A. Letourneur3 , E. Attlan5 , C. Lambe6 , J. De Blic1 , G. Casimir2 , I. SermetGaudelus1 . 1 Hˆopital Necker Enfants Malades, Pediatric Pulmonology Department, Paris, France; 2 Hˆopital Universitaire des Enfants Reine Fabiola, Pediatric Pulmonology Department, Brussels, Belgium; 3 Aminogram, Marseille, France; 4 Hˆ opital Necker Enfants Malades, Physiology Department, Paris, France; 5 Hˆopital Necker Enfants Malades, Radiology Department, Paris, France; 6 Hˆopital Necker Enfants Malades, Pediatric Gastro-Enterology Department, Paris, France Objectives: Nutritional status is an important factor which determines the respiratory outcome in cystic fibrosis (CF) patients. Body composition (BC), and more specifically fat free mass (FFM), impacts on respiratory function in adults; however data concerning pediatric cohorts are sparse. The gold standard method to estimate BC is dual X-Ray absorptiometry (DXA), but it is radiating, time consuming and frequently unavailable. Bioelectrical impedance analysis (BIA) is reproducible and easily feasible. Our objective is to validate an equation adapted to the pediatric CF population in order to calculate FFM by BIA. We also aim to investigate the correlation between BC and pulmonary function testing (PFT). Methods: CF children and non-CF controls are evaluated prospectively using fourelectrode multiple-frequency BIA (Aminostats Bio-ZM II). DXA (Hologic QDR 4500) is performed a few minutes later without modification of patients’ hydration status. Results of FFM obtained by BIA are compared to those calculated by DXA in order to validate the accuracy of the BIA equation. Correlation between FFM and PFT (FEV1, maximum inspiratory pressure) is also evaluated. Results: The equation proves accurate in CF children. BC of CF patients is under evaluation and will be compared to that of controls matched for age and sex. Correlation between BC and PFT will be presented. Conclusion: BIA is a helpful method to estimate BC. We have validated an equation adapted to the pediatric CF population. Repetitive measures of BC will allow clinicians to adjust nutritional care in order to improve the respiratory outcome of CF patients.
216 Gastrostomy button primary placement using an endoscopically guided gastropexy technique in cystic fibrosis: A single centre’s early experience
219 Nutritional intervention in paediatric cystic fibrosis patients leads to improvement of nutritional status − Preliminary results of a prospective study
P. Hutchings1 , K. Lee1 , K. Watson1 , B. Hayee2 , C. Elston1 . 1 King’s College Hospital, Adult Cystic Fibrosis Centre, London, United Kingdom; 2 King’s College Hospital, Department of Gastroenterology, London, United Kingdom
S. Mexia1 , I. Asseiceira1 , T. Rodrigues2 , L. Pereira1 , C. Barreto1 . 1 Santa Maria Hospital, Lisboa, Portugal; 2 Medical University of Lisbon, Lisboa, Portugal
Background and Objective: Endoscopically guided gastropexy technique (EGGT) is a one-stage procedure that supersedes button gastrostomy insertion following prior tract formation by a percutaneous endoscopic gastrostomy. During EGGT, the button is placed in the centre of three gastropexy sutures. We sought to investigate adult Cystic Fibrosis patients’ experience of EGGT for primary placement of gastrostomy buttons. Method: Semi-structured interviews were conducted with six patients who underwent button insertion via EGGT. Questions included reasons for choosing a button over alternative feeding tubes, experience post-procedure, impact of a button on health, and benefits and concerns of the EGGT procedure. Time taken to consent to the procedure, post-procedure complications, and change in body mass index (BMI) were established from retrospective record review. Results: Prominent themes included patient preference for a button due to its discrete size (3/6) and avoidance of uncomfortable nasogastric tubes (3/6). EGGT was regarded as uncomplicated due its single-procedure nature (4/6). All patients felt that the button positively impacted on their health and stated that they would recommend EGGT. Median time taken to consent to EGGT button placement was 4.5 months. There were no unexpected or severe post-procedure complications. One patient required dilatation of the tract due to weight gain. Median weight gain was 6.7 kg at one year follow-up; median BMI increased from 17.9 kg/m2 to 20.5 kg/m2 . Conclusion: EGGT button placement was well accepted by our patients. No severe post-procedure complications were noted. Weight gain was achieved by all patients at follow-up.
Objective: To assess the evolution of nutritional status and dietary intake in a group of patients with cystic fibrosis (CF) after implementation of a systematic nutritional approach. Methods: Prospective study with 39 patients followed in a CF center in Lisbon. All data were collected in two different timepoints: T0 (2012) and T2 (2014). We recorded demographic and clinical data: sex, age, genotype, pancreatic and pulmonary function; anthropometric parameters: weight, height and body mass index (BMI); dietary intake was assessed by 24 h recall. Statistical analysis: IBM® SPSS® 22. Results: Thirty-nine patients were included; 53.8% were male; age 10.0±4.5 y in T0 and 11.0±4.5 y in T2 . The most common genotype was DF508 homozygotic (76.9%); 92.3% had pancreatic insufficiency. FEV1 decreased from 88.9±22.9% (T0 ) to 85.9±24.5% (T2 ). According to BMI, 23.1% (T0 ) and 20.5% (T2 ) had underweight, 61.5% (T0 ) and 69.2% (T2 ) were eutrophic and 15.4% (T0 ) and 10.3% (T2 ) had excess weight. A positive correlation between FEV1 and z-score of BMI was found in both evaluation moments (T0 : r = 0.530, p = 0.002; T2 : r = 0.463, p = 0.007). Regarding dietary intake, patients consumed 1987 kcal in T0 and 2436 kcal in T2 and 19% protein, 47.4% carbohydrates and 31.9% fats in T0 and 17.8% protein, 43.9% carbohydrates and 32.1% fats in T2 . Percentage of patients with nutritional supplementation decreased from 51.3% in T0 to 35.9% in T2 . The nutritional status of our sample had a significant improvement due to a structured nutritional approach, since there was a decrease in the prevalence of under and over nutrition. Additionally we observed a decrease of the prescription of nutritional supplements without impact on the nutritional status and dietary intake.