Lactobacillus rhamnosus GG treatment: A promising tool for improving hypertransaminasemia of obese children

Abstracts / Digestive and Liver Disease 38 (2006) A87–A120 Endocinch endoscopic suturing system was used. Two stitches were placed separately horizontally and later a knot brought the two stitches together, forming a plication. This technique was repeated three times placing the two plications in the small curvature 1.5 cm and 1 cm, respectively, below the ‘Z’ line, and one plication on the large curvature 1.5 cm below. Since it is necessary to introduce the endoscope many times, a metallic overtube can be useful. This was used for the first three patients, and because of a complication directly due to the dimension and the inflexibility of the overtube, it was not used anymore. The final result was a correction of the gaping oesophagus. A general anaesthesia with intubation is always requested. Results. In 11 patients (92%), the procedure was correctly applied in a mean time of 55 min. In 1 patient (11 years, 33 kg of weight) placing the overtube led to a mucosal lesion of the oesophagus, preventing from completing the exam. None of the patient presented side effects; they all were discharged after 24–36 h with half dosage of proton pomp inhibitor. Two months later, a control upper endoscopy was performed; the applied stitches were correctly placed, the cardia was continent; in nine patients no oesophagitis was revealed; therefore, the IPP treatment was stopped; in two patients the treatment was maintained, for persistence of symptoms. One year later, in three patients the endoscopic check showed the loose of 1–2 stitches that have been re-placed, with a second EndoCinh procedure. Conclusion. The Endocinch results were found to be, even in our limited paediatric experience, a good alternative to surgery that has to be any more validated in comparison to the traditional open surgery and currently to the laparoscopic technique. Long term results are not available anymore, therefore more studies need to be done, and it is important to remember that the result that will be obtained, to be considered valid have to be superimposable on the ones obtained with traditional surgery and laparoscopic technique. doi:10.1016/j.dld.2006.07.022 CO 5 TNF-ALPHA AND A SINGLE NON-INVASIVE INDEX PREDICT NAS SCORE IN NAFLD CHILDREN V. Nobili, M. Manco, M.R. Sartorelli, R. Guidi, D. Comparcola, M. Marcellini Ospedale Bambino Ges`u, Dipartimento Medico-Chirurgico di Epatogastroenterologia e Nutrizione, Rome, Italy Context. Prevalence of non-alcoholic fatty-liver-disease (NAFLD) among children is dramatically increasing. Information on the stage of liver damage requires liver biopsy. Hence, there is a need to develop accurate and reliable non-invasive means to predict this damage. Objective. The aim of the present study is to construct one simple model consisting of laboratory data to predict severity of liver damage in paediatric NAFLD in order to select patients who can be advantaged from liver biopsy. Design. Cross-sectional study. Bambino Ges`u Hospital. Patients and methods. Seventy-two consecutive biopsy-proven NAFLD children were studied. Laboratory routine tests included assay of TNFalpha and leptin. The NAFLD activity score (NAS) was computed (NAS >5 was diagnostic of NASH, and NAS <2 was diagnostic of simple steatosis). Patients were divided into two sequential cohorts: training set (n = 31) and validation set (n = 31). Univariate analysis was performed to estimate variables significantly associated with a NAS >5 and ROC analysis to estimate the diagnostic value of the selected variables. Results. TNF-alpha (5.48 ± 1.18 versus 9.34 ± 2.58 pg/ml; P < 0.0001), leptin (13.93 ± 6.61 versus 21.87 ± 4.65 ng/ml; P = 0.001); triglycerides (82.32 ± 32.14 versus 135.18 ± 88.47 mg/dl; P = 0.013), and phosphatase alkaline (623.37 ± 164 versus 767.63 ± 146 UI/l; P = 0.046) were significantly associated with a NAS >5. TNF-alpha and leptin predicted the risk to have a NAS >5 [Risk score = 0.440 + (1.454 ln leptin) + (4.617 ln TNFalpha]. Areas under ROC curves for TNF-alpha, leptin, and the score were 0.911 (CV 0.809–1.0), 0.833 (CV 0.70–0.964), 0.964 (CV 0.911–1.0) in

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the training set; and 0.940 (CV 0.829–1.0), 0.796 (CV 0.653–0.940) and 0.985 (CV 0.956–1.00) in the validation set. Accordingly, cut-off values were defined predicting a NAS >5 in 83–90% of the patients from the validation set. Conclusion. Levels of TNF-alpha alone or combined with leptin in a single risk score are able to accurately predict a NAS >5. After external validation, the application of this index may decrease the need for staging liver biopsy specimens among NAFLD children. doi:10.1016/j.dld.2006.07.023 CO 6 LACTOBACILLUS RHAMNOSUS GG TREATMENT: A PROMISING TOOL FOR IMPROVING HYPERTRANSAMINASEMIA OF OBESE CHILDREN M. Caropreso, S. Lenta, M. Passaretti, P. Colicchio, C. Mandato, G. Capuano, A. Franzese, M.I. Spagnuolo, P. Vajro Department of Pediatrics, University of Naples “Federico II”, Pediatrics, Naples, Italy Aim. It has recently been proposed that small intestine-liver axis malfunction may contribute not only to alcoholic but also to non-alcoholic fatty liver disease. The aim of our study is to evaluate the influence of a probiotic treatment upon several inflammatory, metabolic, intestinal and hepatic parameters in a group of children with obesity-related liver disease. Patients and methods. Thirty-five consecutive obese (BMI >95%) children (age 6–13 years) with (GROUP I, n = 20) and without (GROUP II, n = 15) obesity-related liver disease [persistent hypertransaminasemia and ultrasonographic (US) bright liver] were enrolled. All underwent demographic, clinical and instrumental (circumferences, skinfold thickness, US, bioelectrical impedance analysis) anthropometric evaluation, liver function tests, lactulose H2 breath test, intestinal permeability, serum IgG,A,M Abs anti-peptidoglycan-polysaccharide (PG-PS) polymers, serum endotoxins, insulin resistance (FGIR and HOMA), serum levels of lipids, TNFa, and IL6. In the 20 hepatopatic obese patients of GROUP I, the initial tests were monitored also during and after a controlled double blind pilot study: 2 months with lactobacillus rhamnosus GG (12 billions CFU/day) or placebo; 2 months with inverted treatment; 2 months washout. Results. All initial parameters were comparable between GROUPS I and II, except for anti-PG-PS IgA levels which were higher in GROUP I (0.65 ± 0.28 versus 0.42 ± 0.17 OD; p 0.008). During the phases of the therapeutic trial, clinical and instrumental anthropometrical tests, TNFa, IL6, FGIR and HOMA, anti-PG-PS Abs, and US bright liver remained stable whereas ALT values (U/L) decreased from 65.2 ± 33.4 to 40.8 ± 15.4 (p 0.006) after 2 months of treatment with probiotics and from 63.6 ± 18.5 to 61.6 ± 31.8 (p NS) after placebo; ALT values became normal in 70% versus 30%, respectively. After washout no further changes of ALT values were observed. Summary and conclusion. Increased levels of IgA anti-PG-PS polymers (which are integral cell wall components of most bacterial species, including intestinal Bacteroides) suggest that small intestine-liver axis abnormalities may contribute to obesity-related liver damage in children. Manipulation of intestinal flora by means of probiotics seems to be a promising tool to improve hypertransaminasemia in those hepatopatic obese children who are unable to follow slimming diets and/or to change lifestyle. Further studies are necessary to confirm the results of our pilot study. doi:10.1016/j.dld.2006.07.024