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CO6 GASTRIC XANTHOMATOSIS: A RARE FINDING IN THE PAEDIATRIC AGE
Oral Communications / Digestive and Liver Disease 44 Suppl. 4 (2012) S241–S257
included in this study. Patients were followed-up with the use of the Eckardt score, barium swallow contrast studies and esophageal manometry at baseline, 1, 3, 6 months after dilation, and every year thereafter. Patient outcome was evaluated according to the Eckardt score. Wilcoxon non parametric test was used to compare baseline characteristics between patients responding to the first PD and those needing to repeat treatment. PDs were performed under general anesthesia by using polyethylene balloon system. Results: PD success rate was 67%. In 8 subjects there was a failure at first PD, but only 1 of them decided to undergo surgery for personal choice. Of the 7 patients who repeated the treatment 3 (43%) had a second failure. Overall only 3 patients out of 24 underwent surgery (overall success rate, after a maximum of 3 PDs, was 87%). Multivariate analysis showed that only older age was independently associated to a higher probability of the procedure success (HR 0.66; 95%CI: 0.45−0.97). Conclusions: PD is a safe and effective technique in the management of pediatric achalasia. Young age is an independent negative predictive factor for successful clinical outcome. CO6 GASTRIC XANTHOMATOSIS: A RARE FINDING IN THE PAEDIATRIC AGE M. Gasparetto1 , G. Pennelli2 , M. Cananzi1 , F. Galuppini2 , M. Pescarin1 , G. Guariso1 . 1 University Hospital of Padova, Department of Paediatrics Unit of Gastroenterology, Digestive Endoscopy, Hepatology, and Care of the Child with Liver Transplantation, Italy ; 2 University Hospital of Padova, Department of Medicine DIMED Surgical Pathology and Cytopathology Unit, Italy Background: Gastric xanthoma are rare benign lesions most frequently found in the antrum. They can be associated with inflammation of the gastric mucosa, especially in patients with chronic gastritis, Helicobacter pylori, intestinal metaplasia, bile reflux. Their etiology is nevertheless not completely known as they are rarely described. Just a few number of adult cases aging >35 years has been reported [1], whereas to our knowledge only one previous paediatric case was described as yet [2]. Specific aim: We report a rare paediatric case of gastric xanthomatosis, whose endoscopic follow-up demonstrates the evolution of lesions and their correlation with Proton Pump Inhibitors (PPI) treatment administered. Case Report: A 13 year old girl came to our attention for disphagia, chest burning, feeling of regurgitation and rumination after each meal. Neither abdominal pain, nor alteration in stool frequency were referred. The clinical assessment was normal, except for a mild decrease in body weight (from 25th to 10th percentile) with respect to the height (50th percentile). The general blood tests performed were all negative, gastro-panel included [3]. A first upper-GI tract endoscopy previously performed had identified two whitish kissing lesions with diameter of 0.3 cm surrounded by hyperhaemic mucosa, in the middle of the small gastric curve, and a mild hyperhaemic antral mucosa. The histologic examination demonstrated inactive chronic gastritis at the antrum as well as in the areas next to the two lesions; no Helicobacter pylori was detected. A therapeutic trial with PPI was suggested and performed for one month, with only partial remission of symptoms. Given a relapse of symptoms fifteen days after the suspension of the PPI treatment, we decided to perform at our Unit another upper-GI-tract endoscopy two months after the previous one, in order to evaluate the effect of the ongoing treatment on the gastric lesions. Six gastric lesions were found this time: they appeared as nodules and soft pseudo-polyps and measuring 0.5−1 cm, with a
S243
greyish-whitish top resembling a papilloma. The presence of bile reflux was observed. The histologic examination evidenced foamy histiocytes being compatible with gastric xanthoma. Discussion: It is important not to misrecognize the nature of these lesions, since they may present at endoscopy an ulcer-like aspect, so that an anti-acidic treatment could be therefore inappropriately prescribed. Taking biopsies during upper GI-endoscopy is thus fundamental to diagnose gastric xanthoma as well as to exclude gastric tumors. Reference(s) [1] Gravina AG, Iacono A, Alagia I, D’Armiento FP, Sansone S, Romano M. Image of the Month: Gastric xanthomatosis associated with gastric intestinal metaplasia in a dyspeptic patient. Dig Liv Dis 2009; 41: 765. [2] Wetzler G, Felix AA, Lipton JF. Image of the Month: Gastric Xanthelasma. Jour Ped Gastroenterol Nutr 2010; 51: 1. [3] Guariso G, Basso D, Bortoluzzi CF, Meneghel A, Schiavon S, Fogar P, Farina M, Navaglia F, Greco E, Mescoli C, Zambon CF, Plebani M. GastroPanel: evaluation of the usefulness in the diagnosis of gastroduodenal mucosal alterations in children. Clin Chim Acta 2009; 402(1−2): 54−60.
CO7 S100 A8/A9 PROTEIN AS A MARKER FOR EARLY DIAGNOSIS OF NECROTIZING ENTEROCOLITIS IN NEONATES G. Terrin1 , A. Passariello2 , S. Caoci3 , V. Cardi3 , M. De Curtis3 , F. Messina4 , R. Berni Canani5 . 1. Department of GynecologyObstetrics and Perinatal Medicine, University “La Sapienza”, Rome, Italy; 2. Neonatology Unit, AORN “Monaldi”, Naples, Italy; 3. Department of Pediatrics, University “La Sapienza”, Rome, Italy; 4. Department of Perinatal Medicine, Hospital “V. Betania”, Naples, Italy; 5. Department of Pediatrics, University “Federico II”, Naples, Italy Background and Aim: Innate immune inflammatory components have a central role in the pathogenesis of necrotizing enterocolitis (NEC). The potential diagnostic utility of these mediators remain largely uninvestigated in neonates with suspected NEC. Measurement of serum levels of S100 myeloid-related proteins A8/A9, one of the principal mediators of innate immune response, has been proposed as diagnostic marker for several inflammatory conditions. We evaluated the diagnostic accuracy of s-S100 A8/A9 in neonates with suspected NEC. Methods: Prospective multicenter study enrolling neonates with gestational age (GA) <32 weeks with suspected NEC. Exclusion criteria were congenital defects, early onset sepsis, and critical conditions. Clinical details were collected at the enrollment, together with a blood sample to determine s-S100 A8/A9 concentrations using an ELISA kit. We evaluated if s-S100 A8/A9 is able to predict development of definite NEC (Bell stage 2) within 72 h from the enrolment. Results: Out of 72 newborns with suspect of NEC (male 42; birth weight 1094 g, 95%CI 1047–1141; GA 28.9 w, 95%CI 28.4–29.4; postnatal age 12.2 d, 95%CI 12.3–14.2), 16 developed definite NEC (Bell stage 2), 11 culture-proven sepsis, 4 intestinal obstruction and 41 remain stable (Bell stage 1) or showed a resolution of symptoms and were considered as controls. Of the 16 neonates with definite NEC, 10 evolved in advanced disease (Bell stage 3) requiring surgery. The s-S100 A8/A9 level was significantly (p < 0.001) higher in newborns with NEC (4.04 mcg/ml; 95%CI 3.7−4.3) compared with those affected by sepsis (2.7 mcg/ml, 95%CI 2.5−2.8), intestinal obstruction (1.2 mcg/ml, 95%CI 0.81–1.59) and controls (0.68 mcg/ml; 95%CI 0.58–0.78). We calculated the accuracy of s-S100 A8/A9 (sensitivity 100%, 95%CI 79.4–100%; specificity
included in this study. Patients were followed-up with the use of the Eckardt score, barium swallow contrast studies and esophageal manometry at baseline, 1, 3, 6 months after dilation, and every year thereafter. Patient outcome was evaluated according to the Eckardt score. Wilcoxon non parametric test was used to compare baseline characteristics between patients responding to the first PD and those needing to repeat treatment. PDs were performed under general anesthesia by using polyethylene balloon system. Results: PD success rate was 67%. In 8 subjects there was a failure at first PD, but only 1 of them decided to undergo surgery for personal choice. Of the 7 patients who repeated the treatment 3 (43%) had a second failure. Overall only 3 patients out of 24 underwent surgery (overall success rate, after a maximum of 3 PDs, was 87%). Multivariate analysis showed that only older age was independently associated to a higher probability of the procedure success (HR 0.66; 95%CI: 0.45−0.97). Conclusions: PD is a safe and effective technique in the management of pediatric achalasia. Young age is an independent negative predictive factor for successful clinical outcome. CO6 GASTRIC XANTHOMATOSIS: A RARE FINDING IN THE PAEDIATRIC AGE M. Gasparetto1 , G. Pennelli2 , M. Cananzi1 , F. Galuppini2 , M. Pescarin1 , G. Guariso1 . 1 University Hospital of Padova, Department of Paediatrics Unit of Gastroenterology, Digestive Endoscopy, Hepatology, and Care of the Child with Liver Transplantation, Italy ; 2 University Hospital of Padova, Department of Medicine DIMED Surgical Pathology and Cytopathology Unit, Italy Background: Gastric xanthoma are rare benign lesions most frequently found in the antrum. They can be associated with inflammation of the gastric mucosa, especially in patients with chronic gastritis, Helicobacter pylori, intestinal metaplasia, bile reflux. Their etiology is nevertheless not completely known as they are rarely described. Just a few number of adult cases aging >35 years has been reported [1], whereas to our knowledge only one previous paediatric case was described as yet [2]. Specific aim: We report a rare paediatric case of gastric xanthomatosis, whose endoscopic follow-up demonstrates the evolution of lesions and their correlation with Proton Pump Inhibitors (PPI) treatment administered. Case Report: A 13 year old girl came to our attention for disphagia, chest burning, feeling of regurgitation and rumination after each meal. Neither abdominal pain, nor alteration in stool frequency were referred. The clinical assessment was normal, except for a mild decrease in body weight (from 25th to 10th percentile) with respect to the height (50th percentile). The general blood tests performed were all negative, gastro-panel included [3]. A first upper-GI tract endoscopy previously performed had identified two whitish kissing lesions with diameter of 0.3 cm surrounded by hyperhaemic mucosa, in the middle of the small gastric curve, and a mild hyperhaemic antral mucosa. The histologic examination demonstrated inactive chronic gastritis at the antrum as well as in the areas next to the two lesions; no Helicobacter pylori was detected. A therapeutic trial with PPI was suggested and performed for one month, with only partial remission of symptoms. Given a relapse of symptoms fifteen days after the suspension of the PPI treatment, we decided to perform at our Unit another upper-GI-tract endoscopy two months after the previous one, in order to evaluate the effect of the ongoing treatment on the gastric lesions. Six gastric lesions were found this time: they appeared as nodules and soft pseudo-polyps and measuring 0.5−1 cm, with a
S243
greyish-whitish top resembling a papilloma. The presence of bile reflux was observed. The histologic examination evidenced foamy histiocytes being compatible with gastric xanthoma. Discussion: It is important not to misrecognize the nature of these lesions, since they may present at endoscopy an ulcer-like aspect, so that an anti-acidic treatment could be therefore inappropriately prescribed. Taking biopsies during upper GI-endoscopy is thus fundamental to diagnose gastric xanthoma as well as to exclude gastric tumors. Reference(s) [1] Gravina AG, Iacono A, Alagia I, D’Armiento FP, Sansone S, Romano M. Image of the Month: Gastric xanthomatosis associated with gastric intestinal metaplasia in a dyspeptic patient. Dig Liv Dis 2009; 41: 765. [2] Wetzler G, Felix AA, Lipton JF. Image of the Month: Gastric Xanthelasma. Jour Ped Gastroenterol Nutr 2010; 51: 1. [3] Guariso G, Basso D, Bortoluzzi CF, Meneghel A, Schiavon S, Fogar P, Farina M, Navaglia F, Greco E, Mescoli C, Zambon CF, Plebani M. GastroPanel: evaluation of the usefulness in the diagnosis of gastroduodenal mucosal alterations in children. Clin Chim Acta 2009; 402(1−2): 54−60.
CO7 S100 A8/A9 PROTEIN AS A MARKER FOR EARLY DIAGNOSIS OF NECROTIZING ENTEROCOLITIS IN NEONATES G. Terrin1 , A. Passariello2 , S. Caoci3 , V. Cardi3 , M. De Curtis3 , F. Messina4 , R. Berni Canani5 . 1. Department of GynecologyObstetrics and Perinatal Medicine, University “La Sapienza”, Rome, Italy; 2. Neonatology Unit, AORN “Monaldi”, Naples, Italy; 3. Department of Pediatrics, University “La Sapienza”, Rome, Italy; 4. Department of Perinatal Medicine, Hospital “V. Betania”, Naples, Italy; 5. Department of Pediatrics, University “Federico II”, Naples, Italy Background and Aim: Innate immune inflammatory components have a central role in the pathogenesis of necrotizing enterocolitis (NEC). The potential diagnostic utility of these mediators remain largely uninvestigated in neonates with suspected NEC. Measurement of serum levels of S100 myeloid-related proteins A8/A9, one of the principal mediators of innate immune response, has been proposed as diagnostic marker for several inflammatory conditions. We evaluated the diagnostic accuracy of s-S100 A8/A9 in neonates with suspected NEC. Methods: Prospective multicenter study enrolling neonates with gestational age (GA) <32 weeks with suspected NEC. Exclusion criteria were congenital defects, early onset sepsis, and critical conditions. Clinical details were collected at the enrollment, together with a blood sample to determine s-S100 A8/A9 concentrations using an ELISA kit. We evaluated if s-S100 A8/A9 is able to predict development of definite NEC (Bell stage 2) within 72 h from the enrolment. Results: Out of 72 newborns with suspect of NEC (male 42; birth weight 1094 g, 95%CI 1047–1141; GA 28.9 w, 95%CI 28.4–29.4; postnatal age 12.2 d, 95%CI 12.3–14.2), 16 developed definite NEC (Bell stage 2), 11 culture-proven sepsis, 4 intestinal obstruction and 41 remain stable (Bell stage 1) or showed a resolution of symptoms and were considered as controls. Of the 16 neonates with definite NEC, 10 evolved in advanced disease (Bell stage 3) requiring surgery. The s-S100 A8/A9 level was significantly (p < 0.001) higher in newborns with NEC (4.04 mcg/ml; 95%CI 3.7−4.3) compared with those affected by sepsis (2.7 mcg/ml, 95%CI 2.5−2.8), intestinal obstruction (1.2 mcg/ml, 95%CI 0.81–1.59) and controls (0.68 mcg/ml; 95%CI 0.58–0.78). We calculated the accuracy of s-S100 A8/A9 (sensitivity 100%, 95%CI 79.4–100%; specificity