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Is faecal calprotectin dosage really useful in the management of children presenting with gastrointestinal symptoms?
A76
Abstracts / Digestive and Liver Disease 39 (2007) A49–A87
PA 8 IS FAECAL CALPROTECTIN DOSAGE REALLY USEFUL IN THE MANAGEMENT OF CHILDREN PRESENTING WITH GASTROINTESTINAL SYMPTOMS?
PA 9 ANTIBODIES TO RECOMBINANT HUMAN TISSUE TRANSGLUTAMINASE LEVELS ARE RELATED WITH HISTOLOGICAL LESIONS
A. Berti a , P. Melli b , L. Battigelli a , P. Collarile d , E. Tonutti c , A. Tenore b a
R. Nenna a , F.M. Magliocca b,∗ , R.P.L. Luparia a , C. Perricone a , M. Montuori a , F. Lucantoni c , C. Tiberti c , M. Bonamico a
b
a
Cattedra di Pediatria, DPMSC, Universit`a di Udine, Italy Clinica di Pediatria, Az. Ospedaliera-Universitaria di Udine, Italy c Lab. Di Immunoallergologia e Patologia Az. Ospedaliera-Universitaria di Udine, Italy d Cattedra di Igiene ed Epidemiologia, Universit` a di Udine, Italy Introduction. Faecal calprotectin (FC) is a sensitive non-invasive diagnostic tool to detect intestinal inflammation throughout the whole gastrointestinal tract. Many studies have demonstrated the usefulness of FC for detection of colonic inflammation and to differentiate functional disease from organic inflammatory illnesses. Objectives. The aims of this study were: - To confirm the diagnostic accuracy of FC to distinguish functional gastrointestinal disorders (FIGDs) from organic gastrointestinal diseases. - To evaluate FC utility in the diagnosis and follow-up of organic pathologies. - To evaluate FC meaning in a group of children with coeliac disease (CD). Patients and methods. FC values were measured using a commercially available ELISA test (Calprest, Eurospital, Trieste, Italy), recommending cut-off levels <100 mg/kg. From January 2005 to May 2007, 81 children (43 males, mean age 9 years, range 1.2–16.5) with gastrointestinal or systemic symptoms (FUO or growth retardation) were enrolled. The results were correlated to blood tests, endoscopic and histopathological findings.
Department of Paediatrics, University “Sapienza” Rome, Italy Department of Experimental Medicine and Pathology, University “Sapienza” Rome, Italy c Department of Clinical Science, University “Sapienza” Rome, Italy b
Aim. In coeliac disease (CD) children the small bowel lesions can be patchily distributed or present only on the bulb mucosa (JPGN, 2004). Anti-tissue transglutaminase autoantibody (tTGAb) assay is a useful tool in selecting candidates undergoing intestinal biopsy. Serum tTGAb detected with the novel fluid-phase radioimmunoprecipitation (RIA) method proved to be the most sensitive test (Am J Gastroenterol, 2001; JPGN, 2006). The aim of this study was to investigate whether tTGAb levels are related to histological lesions. Materials and methods. One hundred and eighty-seven CD patients (66 males, median age 7.6 years), tested for the sensitive RIA tTGAb at diagnosis, underwent upper endoscopy with multiple biopsies (one sample from bulb mucosa and four from the distal duodenum). Patients were divided according to the intestinal lesions distribution: Group 1, diffuse; Group 2, patchily; Group 3, only bulb. Group 1 children were subdivided in groups: 1A (partial villous atrophy), 1B (subtotal villous atrophy) and 1C (total villous atrophy). Results. The table shows the percentages of Ab positivity and tTGAb titres (mean ± S.D.) of CD children in the groups of patients.
No. of patients
Group 1 (n = 152)
Group 2 (n = 21)
Group 3 (n = 14)
Group 1A (n = 152)
Group 1B (n = 152)
Group 1C (n = 152)
tTGAb titres (%)
98
95.2
100
85.7
96.9
100
Mean ± S.D.
0.79 ± 0.4
0.61 ± 0.4
0.46 ± 0.24
0.46 ± 0.43
0.71 ± 0.72
0.86 ± 0.37
Results. Fifty-four patients (66.6%) received a conclusive diagnosis of FIGDs, according to the Rome III criteria. All of them had normal values of FC: average 33.51 mg/kg, S.D. 32 (range <6–135 mg/kg). Twenty-seven patients (33.4%) had an organic intestinal disease. The average value of FC in this group was 318.9 mg/kg, S.D. 219.3 (range <6–1700 mg/kg). The difference between the average values of the two groups was statistically significant (p < 0.05). Five children were diagnosed for chronic inflammatory bowel disease: they had elevated levels of FC, even though there was no correlation between FC value and the clinical and endoscopic activity of illness. Ten patients had coeliac disease: the average value of FC in these children was 167 mg/kg (range <6–363 mg/kg). Three of them had a negative histological pattern, grade 0 according to Marsh-Oberhuber classification (potential coeliac disease) and their FC was normal. In the remaining seven cases, with documented intestinal atrophy, there was no correlation between FC level and mucosal damage. In the last 12 patients with organic pathologies, we saw the normalization of FC levels after treatment. Conclusions. We confirm that FC is useful in differentiating children with FIGDs from those affected by organic inflammatory illnesses, in which it can be used for follow-up to verify the efficacy of treatment and the mucosal healing. In coeliac disease, we found different results that might suggest that some patients may have a greater amount of neutrophils in the mucosal infiltrate. Anyway, the utility of FC in coeliac disease remains uncertain. doi:10.1016/j.dld.2007.07.119
The differences between mean tTGAb value of Group1 versus 2 and versus 3 (p < 0.01 and p < 0.001, respectively) and Group1A versus 1B and versus 1C and Group1B versus 1C (p < 0.05) were statistically significant. Conclusion. The study demonstrates that histological lesions distribution and severity may influence RIA tTGAb titres in CD children at the diagnosis, with significantly higher levels in subjects with diffuse lesions and total villous atrophy. doi:10.1016/j.dld.2007.07.120 PA 10 WHAT’S NEW IN THE MATTER OF GLUCOSE ABNORMALITIES IN OBESE CHILDREN? GUT INFLAMMATION M.P. Cicalese, L.R. Assante, V. Squeglia, A. Russo Raucci, C. Postiglione, A. Franzese, M.I. Spagnuolo, A. Guarino Department of Pediatrics, University of Naples, Federico II, Italy Background. Obesity is the main risk factor for chronic diseases such as insulin-resistance, diabetes, hypertension and atherosclerosis. The insulin-resistance represents the main pathogenetic factor in the evolution of alteration of glucose and lipid metabolisms. Many evidences suggest the association of obesity and gut inflammation. Aims. To evaluate in obese children the frequency of glucose abnormalities and signs of systemic and gut inflammation and to study the relationship between metabolic disorders and systemic and gut inflammation. Patients and methods. Patients with severe obesity (BMI > 95%) were considered for the enrolment in the study. Obese subjects were screened for weight, height, body mass index (BMI) and diabetes using an oral glucose
Abstracts / Digestive and Liver Disease 39 (2007) A49–A87
PA 8 IS FAECAL CALPROTECTIN DOSAGE REALLY USEFUL IN THE MANAGEMENT OF CHILDREN PRESENTING WITH GASTROINTESTINAL SYMPTOMS?
PA 9 ANTIBODIES TO RECOMBINANT HUMAN TISSUE TRANSGLUTAMINASE LEVELS ARE RELATED WITH HISTOLOGICAL LESIONS
A. Berti a , P. Melli b , L. Battigelli a , P. Collarile d , E. Tonutti c , A. Tenore b a
R. Nenna a , F.M. Magliocca b,∗ , R.P.L. Luparia a , C. Perricone a , M. Montuori a , F. Lucantoni c , C. Tiberti c , M. Bonamico a
b
a
Cattedra di Pediatria, DPMSC, Universit`a di Udine, Italy Clinica di Pediatria, Az. Ospedaliera-Universitaria di Udine, Italy c Lab. Di Immunoallergologia e Patologia Az. Ospedaliera-Universitaria di Udine, Italy d Cattedra di Igiene ed Epidemiologia, Universit` a di Udine, Italy Introduction. Faecal calprotectin (FC) is a sensitive non-invasive diagnostic tool to detect intestinal inflammation throughout the whole gastrointestinal tract. Many studies have demonstrated the usefulness of FC for detection of colonic inflammation and to differentiate functional disease from organic inflammatory illnesses. Objectives. The aims of this study were: - To confirm the diagnostic accuracy of FC to distinguish functional gastrointestinal disorders (FIGDs) from organic gastrointestinal diseases. - To evaluate FC utility in the diagnosis and follow-up of organic pathologies. - To evaluate FC meaning in a group of children with coeliac disease (CD). Patients and methods. FC values were measured using a commercially available ELISA test (Calprest, Eurospital, Trieste, Italy), recommending cut-off levels <100 mg/kg. From January 2005 to May 2007, 81 children (43 males, mean age 9 years, range 1.2–16.5) with gastrointestinal or systemic symptoms (FUO or growth retardation) were enrolled. The results were correlated to blood tests, endoscopic and histopathological findings.
Department of Paediatrics, University “Sapienza” Rome, Italy Department of Experimental Medicine and Pathology, University “Sapienza” Rome, Italy c Department of Clinical Science, University “Sapienza” Rome, Italy b
Aim. In coeliac disease (CD) children the small bowel lesions can be patchily distributed or present only on the bulb mucosa (JPGN, 2004). Anti-tissue transglutaminase autoantibody (tTGAb) assay is a useful tool in selecting candidates undergoing intestinal biopsy. Serum tTGAb detected with the novel fluid-phase radioimmunoprecipitation (RIA) method proved to be the most sensitive test (Am J Gastroenterol, 2001; JPGN, 2006). The aim of this study was to investigate whether tTGAb levels are related to histological lesions. Materials and methods. One hundred and eighty-seven CD patients (66 males, median age 7.6 years), tested for the sensitive RIA tTGAb at diagnosis, underwent upper endoscopy with multiple biopsies (one sample from bulb mucosa and four from the distal duodenum). Patients were divided according to the intestinal lesions distribution: Group 1, diffuse; Group 2, patchily; Group 3, only bulb. Group 1 children were subdivided in groups: 1A (partial villous atrophy), 1B (subtotal villous atrophy) and 1C (total villous atrophy). Results. The table shows the percentages of Ab positivity and tTGAb titres (mean ± S.D.) of CD children in the groups of patients.
No. of patients
Group 1 (n = 152)
Group 2 (n = 21)
Group 3 (n = 14)
Group 1A (n = 152)
Group 1B (n = 152)
Group 1C (n = 152)
tTGAb titres (%)
98
95.2
100
85.7
96.9
100
Mean ± S.D.
0.79 ± 0.4
0.61 ± 0.4
0.46 ± 0.24
0.46 ± 0.43
0.71 ± 0.72
0.86 ± 0.37
Results. Fifty-four patients (66.6%) received a conclusive diagnosis of FIGDs, according to the Rome III criteria. All of them had normal values of FC: average 33.51 mg/kg, S.D. 32 (range <6–135 mg/kg). Twenty-seven patients (33.4%) had an organic intestinal disease. The average value of FC in this group was 318.9 mg/kg, S.D. 219.3 (range <6–1700 mg/kg). The difference between the average values of the two groups was statistically significant (p < 0.05). Five children were diagnosed for chronic inflammatory bowel disease: they had elevated levels of FC, even though there was no correlation between FC value and the clinical and endoscopic activity of illness. Ten patients had coeliac disease: the average value of FC in these children was 167 mg/kg (range <6–363 mg/kg). Three of them had a negative histological pattern, grade 0 according to Marsh-Oberhuber classification (potential coeliac disease) and their FC was normal. In the remaining seven cases, with documented intestinal atrophy, there was no correlation between FC level and mucosal damage. In the last 12 patients with organic pathologies, we saw the normalization of FC levels after treatment. Conclusions. We confirm that FC is useful in differentiating children with FIGDs from those affected by organic inflammatory illnesses, in which it can be used for follow-up to verify the efficacy of treatment and the mucosal healing. In coeliac disease, we found different results that might suggest that some patients may have a greater amount of neutrophils in the mucosal infiltrate. Anyway, the utility of FC in coeliac disease remains uncertain. doi:10.1016/j.dld.2007.07.119
The differences between mean tTGAb value of Group1 versus 2 and versus 3 (p < 0.01 and p < 0.001, respectively) and Group1A versus 1B and versus 1C and Group1B versus 1C (p < 0.05) were statistically significant. Conclusion. The study demonstrates that histological lesions distribution and severity may influence RIA tTGAb titres in CD children at the diagnosis, with significantly higher levels in subjects with diffuse lesions and total villous atrophy. doi:10.1016/j.dld.2007.07.120 PA 10 WHAT’S NEW IN THE MATTER OF GLUCOSE ABNORMALITIES IN OBESE CHILDREN? GUT INFLAMMATION M.P. Cicalese, L.R. Assante, V. Squeglia, A. Russo Raucci, C. Postiglione, A. Franzese, M.I. Spagnuolo, A. Guarino Department of Pediatrics, University of Naples, Federico II, Italy Background. Obesity is the main risk factor for chronic diseases such as insulin-resistance, diabetes, hypertension and atherosclerosis. The insulin-resistance represents the main pathogenetic factor in the evolution of alteration of glucose and lipid metabolisms. Many evidences suggest the association of obesity and gut inflammation. Aims. To evaluate in obese children the frequency of glucose abnormalities and signs of systemic and gut inflammation and to study the relationship between metabolic disorders and systemic and gut inflammation. Patients and methods. Patients with severe obesity (BMI > 95%) were considered for the enrolment in the study. Obese subjects were screened for weight, height, body mass index (BMI) and diabetes using an oral glucose