- Email: [email protected]
Impact of the therapy on health-related quality of life in paediatric patients with inflammatory bowel disease
Abstracts / Digestive and Liver Disease 40 (2008) A41–A118
A63
PP26 ASSOCIATION OF ELEVATED ALANINEAMINOTRANSFERASE WITH METABOLIC FACTORS IN OBESE CHILDREN: GENDERRELATED ANALYSIS
Results. The percentage of obese children with elevated ALT was 36% in boys and 55% in girls. Obese boys with ALT > 30 IU/L showed higher mother’s BMI (P < 0.025), BMI, waist circumference, HOMA-IR (P < 0.0001, for all), systolic and diastolic blood pressure (P < 0.025, for both) compared to those with ALT ≤ 30 IU/L. ALT levels correlated positively with BMI mother’s (P < 0.001), BMI, waist circumference, HOMA-IR (P < 0.001, for all), triglycerides (P < 0.05) and blood pressure (P < 0.01). At linear regression analysis, waist circumference resulted the only independent factor associated with ALT level (beta = 0.370, t = 3,905, P < 0.0001). Obese girls with ALT > 19 IU/L exhibited lower age (P < 0.025), Tanner stage (P < 0.05), and higher triglycerides (P < 0.0001) than girls with ALT ≤ 19 IU/L. ALT levels correlated positively with triglycerides (P < 0.0001) and HOMA-IR (P < 0.025) and negatively with age, and Tanner stage (P < 0.025). At linear regression analysis, ALT levels was independently associated only with triglycerides (beta = 0.330, t = 4.588, P < 0.0001). Conclusions. A high proportion of obese children present elevated ALT levels. This abnormality is associated, in boys more than in girls, with several components of the metabolic syndrome. Our observations underscore the need to adopt genderrelated cut off of ALT levels also for children. Prospective studies will verify the predictive power of these limits.
P. Di Bonito, G. Boccia, E. Sanguigno, T. Di Fraia, C. Forziato, F. Saitta, M.R. Iardino, B. Capaldo
doi:10.1016/j.dld.2008.07.211
Dept. of Inter. Med., Dept. of Pediatrics, Dept. of Cl. Pathology, “S. Maria delle Grazie”, Pozzuoli Hospital, Dep. Clin. Exp. Med., Federico II University Naples, Italy
PP27 IMPACT OF THE THERAPY ON HEALTH-RELATED QUALITY OF LIFE IN PAEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Results. Main clinical differences between the two groups are reported in table. First plasma Cit levels significantly correlated with bowel length (r2 = 0.21, p = 0.004). Median time between first and second plasma Cit evaluation was 5 months. Discussion. In children with SBS plasma Cit strongly correlates with residual bowel length. Only in patients weaned off TPN during the study period, and therefore with transient intestinal failure, plasma Cit level was >17 M/l. In this patients second Cit value was significantly higher than first Cit value, while no differences was found in patients with permanent intestinal failure. Changes in plasma Cit levels seem to predict the duration of TPN. In conclusion plasma Cit detection represents a useful tool in the follow-up of children with SBS, because it early predict enteral tolerance and duration of dependence to TPN. Variables
Group A
Group B
Median bowel length (cm) Median TPN duration (days) Median final citrulline value (M/l)
37.5 (15–80) 424 (300–1184) 51 (25–54)
10.5 (4–15) <0.01 1477 (754–3013) <0.01 13.5 (6–17) <0.01
P (Mann–Whitney U-test)
doi:10.1016/j.dld.2008.07.210
Alanine aminotransferase (ALT) elevations are considered a surrogate of non-alcoholic liver disease and predict later development of diabetes and metabolic syndrome in adults. The aim of the present study is to evaluate the prevalence of high ALT levels in obese children using updated and genderrelated cut-off ALT value (ALT > 30 IU/L for boys and 19 U/L for girls). We also analyzed the association of ALT levels with the metabolic factors in the two sexes. Materials and methods. The study population included 358 obese children, 168 boys and 190 girls, with an age range of 6–16 years, consecutively observed among subjects attending the Outpatient Unit of the Pediatric Department. Inclusion criteria were: obesity, defined by an individual Body Mass Index (BMI) ≥95th percentile for age and sex, negativity of markers for viral hepatitis, and no alcohol consumption. In all subjects were analyzed: Tanner stage, BMI in both parents of obese children, BMI, waist circumference, blood pressure, ALT, AST, fasting plasma glucose, cholesterol, triglycerides, HDL-cholesterol, FT3, FT4 and insulin. HOMA-IR was calculated as index of insulin-resistance. The statistical analysis relative to insulin, HOMA-IR, triglycerides, ALT, AST and FT4 was applied after log-transformation.
M.S. Basso a , F. Bracci a , Di Ciommo b , B. Papadatou a , A. Diamanti a , A. Daniele a , C. Noto a , D. Baldini c , M. Castro a a
Gastroenterology Unit, Children Hospital “Bambino Gesù”, Rome, Italy b Epidemiology Unit, Children Hospital “Bambino Gesù”, Rome, Italy c ASL RMD DSM District II, Rome, Italy Introduction. Health-related quality of life (HRQOL) questionnaires have been used to measure and to evaluate the impact of a chronic illness and its treatment on patient. The morbidity associated and the therapies for inflammatory bowel disease (IBD) have the potential to profoundly affect this patients, overall children and adolescents. It has been recently demonstrated that dexamethasone, the most frequently steroid used in IBD, introduced as dexamethasone 21 P (DEX 21-P) into red blood cells (RBC) and infused to the same patient, exerts therapeutical effect in maintenance of remission in mild-severe, steroid-dependent Crohn Disease (CD) and ulcerative colitis (UC) in children and adolescents.
A64
Abstracts / Digestive and Liver Disease 40 (2008) A41–A118
The aim of this study was to assess the impact of two different therapeutic interventions on own perception of HRQOL in IBD patient. Methods and materials. Children and adolescents affected by IBD were divided in two groups: first group in standard therapy (5ASA and azathioprine); second group in standard therapy plus monthly infusions of autologous red blood cell loaded with dexametasone -21P, because of their dependence. Quality of life was assessed by a self-administered questionnaire, Short Form 36 Health Survey (SF-36), that all subjects completed. The SF-36 is divided in two major groups physical and mental, which include 7 domains. Mann–Whitney U-test was performed to compare the HRQOL between the 2 groups of IBD patients. Results. A total of 76 IBD patients followed at our Gastroenterology Unit aged 8-18 years were included. Among them 35 were affected by CD and 41 by UC (42 boys, 34 girls). 56 patients were treated with the standard therapy and 20 with standard therapy plus the infusions of autologous RBC loaded with DEX 21-P (11 CD and 9 CU). No significant differences were found between the two groups for physical and mental indexes (median 77, IQR 63–81 versus 85, IQR 70–94 p = 0.07, and 71, IQR 52–82 versus 74, IQR 60–89 p = 0.5 respectively). Regarding the different domains, perception of general health was significantly lower in the group of patients treated with the infusions of autologous RBC loaded with DEX-21P in comparison to the group treated with standard therapy. No other significant differences were found in other domains (Physical Functioning, Body Pain, Vitality, Social Function, Emotional and Mental Health). Conclusion. Perception of general health seems to be lower in the group of patients treated with the infusions of autologous RBC loaded with DEX-21P. We can hypothesize that these group of patients had more severe or active disease, and the monthly hospitalization impacts on their general health. Future research should investigate to correlate their disease activity with HRQOL. doi:10.1016/j.dld.2008.07.212 PP28 ANTI-GLIADIN, ANTI-ENDOMYSIUM AND ANTITISSUE TRANSGLUTAMINASE ANTIBODIES IN THE SERUM OF CELIAC CHILDREN YOUNGER THAN TWO YEARS A. Tosco, M. Maglio, F. Paparo, B. Colicchio, A. Sannino, V. Granata, V. Indolfi, V. Discepolo, L. Rapacciuolo, R. Auricchio, R. Troncone Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy Introduction. Anti-endomysium (EMA) and antitransglutaminase (anti-TG2) antibodies are very specific and
sensitive tools for the diagnosis of celiac disease (CD). Data from literature suggest a less sensitivity of such antibodies in patients younger than two years. Aim of the study. To evaluate the sensitivity of different serological markers for CD in children younger than two years. Patients and methods. The study involved 359 children (100 aged less than 2 years) who underwent a small intestinal biopsy in our Department from January 2000 to December 2007. In all of them the diagnosis of CD was based on the finding of intestinal mucosa villous atrophy and clinical improvement on gluten-free diet. The serum of 265/359 children was analysed to evaluate the levels of antigliadin (AGA), EMA and anti-TG2 antibodies. Results. AGA IgA antibodies were positive in 232/265 patients, while AGA IgG in 204/265; moreover EMA were present in 252/265 children; finally, anti-TG2 were higher than the cut off in 250/265 patients. Evaluating these antibodies according to the age, we observed that in the group of patients younger than two years, 92/100 (92%) presented high levels of AGA IgA and 96/100 (96%) of AGA IgG. In the group of patients older than two years, 140/165 (85%) showed high levels of AGA IgA and 108/165 (65%) of AGA IgG. The presence of EMA was found in 90/100 (90%) children in the first group, and in 162/165 (98%) children in the second group. Finally, levels of anti-TG2 higher than the cutoff were found in 91/100 (91%) patients younger than two years and in 159/165 (96%) of the older children. Conclusions. Our experience confirms that EMA and antiTG2 antibodies are a more accurate diagnostic tool in children older than two years compared to those of younger age. In this last group of patients. AGA IgA have still an important role for the identification of children with CD. doi:10.1016/j.dld.2008.07.213 PP29 ANTI-TISSUE TRANSGLUTAMINASE ANTIBODIES AND INFECTIOUS DISEASES IN CHILDREN S. Pastore, S. Quaglia, F. Ferrara, S. Martelossi, A. Ventura, T. Not, R. Giorgi IRCCS Burlo Garofolo, Pediatric Department of Trieste University, Trieste, Italy Background. A considerable interest focus on the hypothesis that some pathogens which share antigenic determinants with gliadin or tissue transglutaminase enzyme might lead to the development of celiac disease in susceptible individuals thanks to a mechanism of molecular mimicry. Aim. In this study we verified the relationship between the acute infectious diseases and the presence of serum anti-tTG antibodies. Methods. We prospectively enrolled 154 children (from March to August 2007), suffering from fever and gastrointestinal or respiratory complaints at emergency service of our children’s hospital. 154 sera samples were tested
A63
PP26 ASSOCIATION OF ELEVATED ALANINEAMINOTRANSFERASE WITH METABOLIC FACTORS IN OBESE CHILDREN: GENDERRELATED ANALYSIS
Results. The percentage of obese children with elevated ALT was 36% in boys and 55% in girls. Obese boys with ALT > 30 IU/L showed higher mother’s BMI (P < 0.025), BMI, waist circumference, HOMA-IR (P < 0.0001, for all), systolic and diastolic blood pressure (P < 0.025, for both) compared to those with ALT ≤ 30 IU/L. ALT levels correlated positively with BMI mother’s (P < 0.001), BMI, waist circumference, HOMA-IR (P < 0.001, for all), triglycerides (P < 0.05) and blood pressure (P < 0.01). At linear regression analysis, waist circumference resulted the only independent factor associated with ALT level (beta = 0.370, t = 3,905, P < 0.0001). Obese girls with ALT > 19 IU/L exhibited lower age (P < 0.025), Tanner stage (P < 0.05), and higher triglycerides (P < 0.0001) than girls with ALT ≤ 19 IU/L. ALT levels correlated positively with triglycerides (P < 0.0001) and HOMA-IR (P < 0.025) and negatively with age, and Tanner stage (P < 0.025). At linear regression analysis, ALT levels was independently associated only with triglycerides (beta = 0.330, t = 4.588, P < 0.0001). Conclusions. A high proportion of obese children present elevated ALT levels. This abnormality is associated, in boys more than in girls, with several components of the metabolic syndrome. Our observations underscore the need to adopt genderrelated cut off of ALT levels also for children. Prospective studies will verify the predictive power of these limits.
P. Di Bonito, G. Boccia, E. Sanguigno, T. Di Fraia, C. Forziato, F. Saitta, M.R. Iardino, B. Capaldo
doi:10.1016/j.dld.2008.07.211
Dept. of Inter. Med., Dept. of Pediatrics, Dept. of Cl. Pathology, “S. Maria delle Grazie”, Pozzuoli Hospital, Dep. Clin. Exp. Med., Federico II University Naples, Italy
PP27 IMPACT OF THE THERAPY ON HEALTH-RELATED QUALITY OF LIFE IN PAEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Results. Main clinical differences between the two groups are reported in table. First plasma Cit levels significantly correlated with bowel length (r2 = 0.21, p = 0.004). Median time between first and second plasma Cit evaluation was 5 months. Discussion. In children with SBS plasma Cit strongly correlates with residual bowel length. Only in patients weaned off TPN during the study period, and therefore with transient intestinal failure, plasma Cit level was >17 M/l. In this patients second Cit value was significantly higher than first Cit value, while no differences was found in patients with permanent intestinal failure. Changes in plasma Cit levels seem to predict the duration of TPN. In conclusion plasma Cit detection represents a useful tool in the follow-up of children with SBS, because it early predict enteral tolerance and duration of dependence to TPN. Variables
Group A
Group B
Median bowel length (cm) Median TPN duration (days) Median final citrulline value (M/l)
37.5 (15–80) 424 (300–1184) 51 (25–54)
10.5 (4–15) <0.01 1477 (754–3013) <0.01 13.5 (6–17) <0.01
P (Mann–Whitney U-test)
doi:10.1016/j.dld.2008.07.210
Alanine aminotransferase (ALT) elevations are considered a surrogate of non-alcoholic liver disease and predict later development of diabetes and metabolic syndrome in adults. The aim of the present study is to evaluate the prevalence of high ALT levels in obese children using updated and genderrelated cut-off ALT value (ALT > 30 IU/L for boys and 19 U/L for girls). We also analyzed the association of ALT levels with the metabolic factors in the two sexes. Materials and methods. The study population included 358 obese children, 168 boys and 190 girls, with an age range of 6–16 years, consecutively observed among subjects attending the Outpatient Unit of the Pediatric Department. Inclusion criteria were: obesity, defined by an individual Body Mass Index (BMI) ≥95th percentile for age and sex, negativity of markers for viral hepatitis, and no alcohol consumption. In all subjects were analyzed: Tanner stage, BMI in both parents of obese children, BMI, waist circumference, blood pressure, ALT, AST, fasting plasma glucose, cholesterol, triglycerides, HDL-cholesterol, FT3, FT4 and insulin. HOMA-IR was calculated as index of insulin-resistance. The statistical analysis relative to insulin, HOMA-IR, triglycerides, ALT, AST and FT4 was applied after log-transformation.
M.S. Basso a , F. Bracci a , Di Ciommo b , B. Papadatou a , A. Diamanti a , A. Daniele a , C. Noto a , D. Baldini c , M. Castro a a
Gastroenterology Unit, Children Hospital “Bambino Gesù”, Rome, Italy b Epidemiology Unit, Children Hospital “Bambino Gesù”, Rome, Italy c ASL RMD DSM District II, Rome, Italy Introduction. Health-related quality of life (HRQOL) questionnaires have been used to measure and to evaluate the impact of a chronic illness and its treatment on patient. The morbidity associated and the therapies for inflammatory bowel disease (IBD) have the potential to profoundly affect this patients, overall children and adolescents. It has been recently demonstrated that dexamethasone, the most frequently steroid used in IBD, introduced as dexamethasone 21 P (DEX 21-P) into red blood cells (RBC) and infused to the same patient, exerts therapeutical effect in maintenance of remission in mild-severe, steroid-dependent Crohn Disease (CD) and ulcerative colitis (UC) in children and adolescents.
A64
Abstracts / Digestive and Liver Disease 40 (2008) A41–A118
The aim of this study was to assess the impact of two different therapeutic interventions on own perception of HRQOL in IBD patient. Methods and materials. Children and adolescents affected by IBD were divided in two groups: first group in standard therapy (5ASA and azathioprine); second group in standard therapy plus monthly infusions of autologous red blood cell loaded with dexametasone -21P, because of their dependence. Quality of life was assessed by a self-administered questionnaire, Short Form 36 Health Survey (SF-36), that all subjects completed. The SF-36 is divided in two major groups physical and mental, which include 7 domains. Mann–Whitney U-test was performed to compare the HRQOL between the 2 groups of IBD patients. Results. A total of 76 IBD patients followed at our Gastroenterology Unit aged 8-18 years were included. Among them 35 were affected by CD and 41 by UC (42 boys, 34 girls). 56 patients were treated with the standard therapy and 20 with standard therapy plus the infusions of autologous RBC loaded with DEX 21-P (11 CD and 9 CU). No significant differences were found between the two groups for physical and mental indexes (median 77, IQR 63–81 versus 85, IQR 70–94 p = 0.07, and 71, IQR 52–82 versus 74, IQR 60–89 p = 0.5 respectively). Regarding the different domains, perception of general health was significantly lower in the group of patients treated with the infusions of autologous RBC loaded with DEX-21P in comparison to the group treated with standard therapy. No other significant differences were found in other domains (Physical Functioning, Body Pain, Vitality, Social Function, Emotional and Mental Health). Conclusion. Perception of general health seems to be lower in the group of patients treated with the infusions of autologous RBC loaded with DEX-21P. We can hypothesize that these group of patients had more severe or active disease, and the monthly hospitalization impacts on their general health. Future research should investigate to correlate their disease activity with HRQOL. doi:10.1016/j.dld.2008.07.212 PP28 ANTI-GLIADIN, ANTI-ENDOMYSIUM AND ANTITISSUE TRANSGLUTAMINASE ANTIBODIES IN THE SERUM OF CELIAC CHILDREN YOUNGER THAN TWO YEARS A. Tosco, M. Maglio, F. Paparo, B. Colicchio, A. Sannino, V. Granata, V. Indolfi, V. Discepolo, L. Rapacciuolo, R. Auricchio, R. Troncone Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy Introduction. Anti-endomysium (EMA) and antitransglutaminase (anti-TG2) antibodies are very specific and
sensitive tools for the diagnosis of celiac disease (CD). Data from literature suggest a less sensitivity of such antibodies in patients younger than two years. Aim of the study. To evaluate the sensitivity of different serological markers for CD in children younger than two years. Patients and methods. The study involved 359 children (100 aged less than 2 years) who underwent a small intestinal biopsy in our Department from January 2000 to December 2007. In all of them the diagnosis of CD was based on the finding of intestinal mucosa villous atrophy and clinical improvement on gluten-free diet. The serum of 265/359 children was analysed to evaluate the levels of antigliadin (AGA), EMA and anti-TG2 antibodies. Results. AGA IgA antibodies were positive in 232/265 patients, while AGA IgG in 204/265; moreover EMA were present in 252/265 children; finally, anti-TG2 were higher than the cut off in 250/265 patients. Evaluating these antibodies according to the age, we observed that in the group of patients younger than two years, 92/100 (92%) presented high levels of AGA IgA and 96/100 (96%) of AGA IgG. In the group of patients older than two years, 140/165 (85%) showed high levels of AGA IgA and 108/165 (65%) of AGA IgG. The presence of EMA was found in 90/100 (90%) children in the first group, and in 162/165 (98%) children in the second group. Finally, levels of anti-TG2 higher than the cutoff were found in 91/100 (91%) patients younger than two years and in 159/165 (96%) of the older children. Conclusions. Our experience confirms that EMA and antiTG2 antibodies are a more accurate diagnostic tool in children older than two years compared to those of younger age. In this last group of patients. AGA IgA have still an important role for the identification of children with CD. doi:10.1016/j.dld.2008.07.213 PP29 ANTI-TISSUE TRANSGLUTAMINASE ANTIBODIES AND INFECTIOUS DISEASES IN CHILDREN S. Pastore, S. Quaglia, F. Ferrara, S. Martelossi, A. Ventura, T. Not, R. Giorgi IRCCS Burlo Garofolo, Pediatric Department of Trieste University, Trieste, Italy Background. A considerable interest focus on the hypothesis that some pathogens which share antigenic determinants with gliadin or tissue transglutaminase enzyme might lead to the development of celiac disease in susceptible individuals thanks to a mechanism of molecular mimicry. Aim. In this study we verified the relationship between the acute infectious diseases and the presence of serum anti-tTG antibodies. Methods. We prospectively enrolled 154 children (from March to August 2007), suffering from fever and gastrointestinal or respiratory complaints at emergency service of our children’s hospital. 154 sera samples were tested