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A longitudinal prospective study of pediatric patients with Inflammatory Bowel Disease (IBD) using cytogenetic and immunological markers
treatment of these disorders is the likely reason for their effectiveness. The therapy has long lasting effects and provides the economic advantages of decreased use in medication and physician resources.
100
g o o ] ~ ~- 8o/
" t._
T1346
!_
A Longitudinal Prospective Study"of Pediatric Patients with Inflammatory Bowel Disease (IBD) Using Cytogenetic and Immunological Markers Melvin B, Heyman, Paul Harmatz, Daniel W. Golden, Paurene Duramad, Jin Bae, Jennifer CoopeL Rommder Momi, Connie Chert, Nan E. Hubbard, Nina T. Holland Inflammatory Bowel Disease (IBD), characterized by inflammatory infiltrates in the gastrointestinal tract, is associated with folate deficiency and increased risk of cancer. Although a genetic predlaposition is now reported, the its pathological underlying mechanisms of IBD remains unknownpoorly characterized This longitudinal, prospective case control study was performed to determine whether IBD in children is associated with increased markers of cytogenetic and immunological abnornlalities, and whether the findings can be improved by Mate supplementation and treatment, Methods: Biomarkers of genetic damage were evaluated in 31 IBD patients (19 Crohn's disease [CDI), 12 ulcerative colitis [UC]) and 23 controls. IBD subjects and controls were matched tbr age (mean = 12 years) and gender (56% males). Blood, urine and buccal samples were collected at the time of initial diagnosis and after one month of Mate supplementation and treatment (1BD patients) or only folate sopplementation (controls). Markers of inflammatory and cytogenetic and inflammatory' damage included serum lgE levels and mieronucleus (MN) assay and serum IgE levels, Genetic endpoints in human lymphocytes included frequencies of MN and bridges. Cell death was assessed by percem of apoptotic and necrotic ceils, and cell proliferation by" replicative index, Results: CD and UC patiems were different from control subjects and from each other for most of the endponits, and had higher levels of cellular damage compared with control subjects. Treatment and folate supplementation had a positive effect on the levels of cell death and decreased cytogenetic damage in [BD patients. Control subjects showed decreased cytogenetic damage m their lymphocytes and epithelial cells follmvmg folate supplementation. Serum IgE levels were significantly different (all p<0.05) in CD (mean= 112 IU/L) vs. UC (42 IU/I_) and both versus compared with control subjects (23 1U/I-). Conclusions: Our model illustrates differences in markers of cytogenetic injury and immune response in patients with CD and UC, and compatvd with controls. These preliminary findings need expansion to determine their role in the pathogenests of these diseases and their possible relationship to the eventual development of cancer in some patients. Supported by grants from the Packard Foundation, the Crohn's and Colitis Foundation of America, and NIH (M01 RR01271 and K24 DK60617).
Age in years
T1344 Depression and Chronic Abdominal Pain: A study of 20,000 Adolescents Nader N, Youssef, Richard Strauss, Joel R. Rash AIM: Chronic abdominal pain is a commcm complaint in adolescence and is associated with significant morbidity including depression and social withdrawal The aim of this study is to detennme the prevalence of depressive symptoms in a large cohort of patients with recurrent abdominal pani (RAP). SUBJECTS & METHODS: A prospective, cross-sectional, nationally representative sample of 20 ] 6 2 adolescents in grades 7 through 12 (mean age 14.8 +/- 2.6, 49 % male) completed m-home interviews and separate in-school questionnaires for the National Lungitudinal Study in Adolescent Health. Depressed mood was assessed with the Center for Epidemiologic Studies Depression Scale. Freqnency of abdominal pare over the previous l-year was rated as rare (0 to 1 episode / week); moderate (2 to 3 episodes / week) or recurrent (daily"or almost dady episodes). In addition, social function data including Khool activities and home activities were collected. Parents gave intbrnration on household income and parental education. RESULTS: Complete data was available on over 90% of subjects In this representatiw:.' population, 16% of adoleseents are at risk for developing depression. Of those at m k tbr depression ~,ersus no risk, the m41ority are female (65% vs. 48%, P
T1347 Increasing incidence of Crohn's disease in children in Victoria, Australia Anthony G Catto-Smith, Don Cameron, Sanguansak Rerksuppaphol Background: The incidence of Crohn's has been increasing in Western communities, but there are no published studies which have examined this change in children in Australia. The centralization of pediatric gastroenterology services in Victoria provide an opportunity to examine these changes within one state. Methods: We undertook a ~vtmspective study over a 31 year period of all children aged 16 years or less initially diagnosed with Crohns disease at either the Royal Children's Hospital, or Monash Medical Centre, Melbourne, Victoria. Results: We identified 351 patients who met the diagnostic criteria between 19712001. The incidence of Crohn's in children aged 16 years or lass rose tram 0.128 to 2.0 per 100,000 per year over the 3 decades (r = 0.964, p<0.01). There was a disproportionate over-representation of children |ram an urban background (incidence rate ratio 1.66, 95% C1 1.28-2.16). Children currently" being diagnosed had on average a lower ESR and higher albumin than m previous decades. The use of flexible endoscopy has increased markedly (1970's 60%, 1990's 96%, p<0.05) and the proportion of children recognized at diagnosis with upper gastrointestinal and colonic involvement has increased significantly. Conclusion: There has been a significant increase in the incidence of Crohn's disease in Victorian children. The pattern of disease has also changed with colonic disease now more frequent, and inflammatory indices less abnormal. The increased use of endoscopy has established the frequent involvement of the upper gastrointestinal tract.
T1345 Integrative Medicine in the Treatment of Childhood Functional Gastrointestinal Disorders Nader N. Yonssef, Joel R, Rash, Stephanie Schuckalo, Barbara Fabling, Richard L Manes, Mar}"koughran, Ann N. Cotter AIM: Children with chronic abdominal pain associated with functional gastrointestinal disorders (FGIDs) can have si~ificant school absence, social withdrawal and an impaired quality of lit), Tbe aim of this study was to determine the efficacy of two integrative medical therapies (guided imagery and deep breathing exercises) at reducing the negative eftects of childhood FGIDs SUNECTS & METHODS: From September 2001 to August 2002, a total of 12 patients (8 male, ages 1119 +A 4.2 years) diagnosed with FGIDs were referred to our Mind-Body Institute (MB1) tar their persistence of symptoms (13,8 +/- 18.3 months) Anatomic, metabolic, and mucosal disease had been excluded. The children were classified into functional dysp,epsia (3), irritable bowel s'y~dmme (4), and functional abdominal pain (5), Ten of 12 patients had been tried on low dose amitriptyline (range 10-50 mg daily') for duration of 4.6 +/- 6,0 months. At the MB1, patients were treated with guided imagery in 100% and deep breathing exercise in 90% of sessmns. One-hour sessions / week were performed, The mean nmnber of sessions / pauent was 4.5 +/- 3,4 Outcome measures mcNded change in abdominal pain and measurement of quality of life with the validated PedsQL. Follow-up was 4 6 +/- 1.8 months after the last session. RESULTS: Improvement was seen malI outcome measures: abdominal pain was better in 11 of 12 patients (91%); pare episodes / week decreased from 5.7 +/- 1.1 to 1.8 l- 2.7 (p<0.05); pare intensity (0 to 3 scale) &creased tram 2.7 +/- 0.6 to 0.8 +/-0.7 (p<0.04); missed school days/month decreased from 4,4 +/- 5.7 to 2.4 +/- 6.2 (p<0.05); nurnber of social activities / week increased from 0.3 + / 0 . 6 to 1.3 +/- 0.6 (p<0.05); physician office wsits / year decreased from 24 +/- 102 to 8.7 +/- 131 (p=O.07); patients on amitriptyline decreased from 10 to 3 (p<0.02) PedsQL scores (0 to 100 scale) improved frum 58.3 +/- 11.9 to 80.0 +/10.7 (p<0 03) Improvement was not related to either gender or specific FGID There were no side effects CONCLUSIONS: Guided imagery and deep breathing exercises can safely and effectively reduce chronic abdominal pain in children with FGIDs An integrative treatment approach improves social functioning and allows children to remru to school in a short period of time. Incorporation of the biopsychosocial model for disease into the
t_
3,0
L., 25 n 0 g
20
d
O x--- 15 e~ 10 ID O rID 05 O e--
O0 1970
1975
1980
1985
1990
1995
2000
Year
A-515
AGA Abstracts
100
g o o ] ~ ~- 8o/
" t._
T1346
!_
A Longitudinal Prospective Study"of Pediatric Patients with Inflammatory Bowel Disease (IBD) Using Cytogenetic and Immunological Markers Melvin B, Heyman, Paul Harmatz, Daniel W. Golden, Paurene Duramad, Jin Bae, Jennifer CoopeL Rommder Momi, Connie Chert, Nan E. Hubbard, Nina T. Holland Inflammatory Bowel Disease (IBD), characterized by inflammatory infiltrates in the gastrointestinal tract, is associated with folate deficiency and increased risk of cancer. Although a genetic predlaposition is now reported, the its pathological underlying mechanisms of IBD remains unknownpoorly characterized This longitudinal, prospective case control study was performed to determine whether IBD in children is associated with increased markers of cytogenetic and immunological abnornlalities, and whether the findings can be improved by Mate supplementation and treatment, Methods: Biomarkers of genetic damage were evaluated in 31 IBD patients (19 Crohn's disease [CDI), 12 ulcerative colitis [UC]) and 23 controls. IBD subjects and controls were matched tbr age (mean = 12 years) and gender (56% males). Blood, urine and buccal samples were collected at the time of initial diagnosis and after one month of Mate supplementation and treatment (1BD patients) or only folate sopplementation (controls). Markers of inflammatory and cytogenetic and inflammatory' damage included serum lgE levels and mieronucleus (MN) assay and serum IgE levels, Genetic endpoints in human lymphocytes included frequencies of MN and bridges. Cell death was assessed by percem of apoptotic and necrotic ceils, and cell proliferation by" replicative index, Results: CD and UC patiems were different from control subjects and from each other for most of the endponits, and had higher levels of cellular damage compared with control subjects. Treatment and folate supplementation had a positive effect on the levels of cell death and decreased cytogenetic damage in [BD patients. Control subjects showed decreased cytogenetic damage m their lymphocytes and epithelial cells follmvmg folate supplementation. Serum IgE levels were significantly different (all p<0.05) in CD (mean= 112 IU/L) vs. UC (42 IU/I_) and both versus compared with control subjects (23 1U/I-). Conclusions: Our model illustrates differences in markers of cytogenetic injury and immune response in patients with CD and UC, and compatvd with controls. These preliminary findings need expansion to determine their role in the pathogenests of these diseases and their possible relationship to the eventual development of cancer in some patients. Supported by grants from the Packard Foundation, the Crohn's and Colitis Foundation of America, and NIH (M01 RR01271 and K24 DK60617).
Age in years
T1344 Depression and Chronic Abdominal Pain: A study of 20,000 Adolescents Nader N, Youssef, Richard Strauss, Joel R. Rash AIM: Chronic abdominal pain is a commcm complaint in adolescence and is associated with significant morbidity including depression and social withdrawal The aim of this study is to detennme the prevalence of depressive symptoms in a large cohort of patients with recurrent abdominal pani (RAP). SUBJECTS & METHODS: A prospective, cross-sectional, nationally representative sample of 20 ] 6 2 adolescents in grades 7 through 12 (mean age 14.8 +/- 2.6, 49 % male) completed m-home interviews and separate in-school questionnaires for the National Lungitudinal Study in Adolescent Health. Depressed mood was assessed with the Center for Epidemiologic Studies Depression Scale. Freqnency of abdominal pare over the previous l-year was rated as rare (0 to 1 episode / week); moderate (2 to 3 episodes / week) or recurrent (daily"or almost dady episodes). In addition, social function data including Khool activities and home activities were collected. Parents gave intbrnration on household income and parental education. RESULTS: Complete data was available on over 90% of subjects In this representatiw:.' population, 16% of adoleseents are at risk for developing depression. Of those at m k tbr depression ~,ersus no risk, the m41ority are female (65% vs. 48%, P
T1347 Increasing incidence of Crohn's disease in children in Victoria, Australia Anthony G Catto-Smith, Don Cameron, Sanguansak Rerksuppaphol Background: The incidence of Crohn's has been increasing in Western communities, but there are no published studies which have examined this change in children in Australia. The centralization of pediatric gastroenterology services in Victoria provide an opportunity to examine these changes within one state. Methods: We undertook a ~vtmspective study over a 31 year period of all children aged 16 years or less initially diagnosed with Crohns disease at either the Royal Children's Hospital, or Monash Medical Centre, Melbourne, Victoria. Results: We identified 351 patients who met the diagnostic criteria between 19712001. The incidence of Crohn's in children aged 16 years or lass rose tram 0.128 to 2.0 per 100,000 per year over the 3 decades (r = 0.964, p<0.01). There was a disproportionate over-representation of children |ram an urban background (incidence rate ratio 1.66, 95% C1 1.28-2.16). Children currently" being diagnosed had on average a lower ESR and higher albumin than m previous decades. The use of flexible endoscopy has increased markedly (1970's 60%, 1990's 96%, p<0.05) and the proportion of children recognized at diagnosis with upper gastrointestinal and colonic involvement has increased significantly. Conclusion: There has been a significant increase in the incidence of Crohn's disease in Victorian children. The pattern of disease has also changed with colonic disease now more frequent, and inflammatory indices less abnormal. The increased use of endoscopy has established the frequent involvement of the upper gastrointestinal tract.
T1345 Integrative Medicine in the Treatment of Childhood Functional Gastrointestinal Disorders Nader N. Yonssef, Joel R, Rash, Stephanie Schuckalo, Barbara Fabling, Richard L Manes, Mar}"koughran, Ann N. Cotter AIM: Children with chronic abdominal pain associated with functional gastrointestinal disorders (FGIDs) can have si~ificant school absence, social withdrawal and an impaired quality of lit), Tbe aim of this study was to determine the efficacy of two integrative medical therapies (guided imagery and deep breathing exercises) at reducing the negative eftects of childhood FGIDs SUNECTS & METHODS: From September 2001 to August 2002, a total of 12 patients (8 male, ages 1119 +A 4.2 years) diagnosed with FGIDs were referred to our Mind-Body Institute (MB1) tar their persistence of symptoms (13,8 +/- 18.3 months) Anatomic, metabolic, and mucosal disease had been excluded. The children were classified into functional dysp,epsia (3), irritable bowel s'y~dmme (4), and functional abdominal pain (5), Ten of 12 patients had been tried on low dose amitriptyline (range 10-50 mg daily') for duration of 4.6 +/- 6,0 months. At the MB1, patients were treated with guided imagery in 100% and deep breathing exercise in 90% of sessmns. One-hour sessions / week were performed, The mean nmnber of sessions / pauent was 4.5 +/- 3,4 Outcome measures mcNded change in abdominal pain and measurement of quality of life with the validated PedsQL. Follow-up was 4 6 +/- 1.8 months after the last session. RESULTS: Improvement was seen malI outcome measures: abdominal pain was better in 11 of 12 patients (91%); pare episodes / week decreased from 5.7 +/- 1.1 to 1.8 l- 2.7 (p<0.05); pare intensity (0 to 3 scale) &creased tram 2.7 +/- 0.6 to 0.8 +/-0.7 (p<0.04); missed school days/month decreased from 4,4 +/- 5.7 to 2.4 +/- 6.2 (p<0.05); nurnber of social activities / week increased from 0.3 + / 0 . 6 to 1.3 +/- 0.6 (p<0.05); physician office wsits / year decreased from 24 +/- 102 to 8.7 +/- 131 (p=O.07); patients on amitriptyline decreased from 10 to 3 (p<0.02) PedsQL scores (0 to 100 scale) improved frum 58.3 +/- 11.9 to 80.0 +/10.7 (p<0 03) Improvement was not related to either gender or specific FGID There were no side effects CONCLUSIONS: Guided imagery and deep breathing exercises can safely and effectively reduce chronic abdominal pain in children with FGIDs An integrative treatment approach improves social functioning and allows children to remru to school in a short period of time. Incorporation of the biopsychosocial model for disease into the
t_
3,0
L., 25 n 0 g
20
d
O x--- 15 e~ 10 ID O rID 05 O e--
O0 1970
1975
1980
1985
1990
1995
2000
Year
A-515
AGA Abstracts