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Mo1986 Gastric Adenocarcinoma in an Adolescent With Dyspepsia
AGA Abstracts
Mo1984
Mo1986
Stool Secretory IgA Levels in Preterm Infants With and Without Necrotising Enterocolitis Ma Wenwen, Lynne M. Beattie, Christine A. Edwards, Andrew R. Barclay, Douglas Morrison, Judith H. Simpson, Emilie Combet
Gastric Adenocarcinoma in an Adolescent With Dyspepsia Prateek D. Wali We present a 16-year-old Caucasian male with chronic cough, dyspepsia, and epigastric abdominal pain. The patient was seen 3 months before diagnosis for intermittent cough and episodes of shortness of breath at night. He was treated with antibiotics, bronochodilators and a proton pump inhibitor. Over the next 2 months, the patient began to experience dysphagia, early satiety, and weight loss. His labs revealed an elevated LDH 783, ALT 173, AST 109, and lipase 191. He was seen by pediatric gastroenterology and underwent EGD, which revealed a large, ulcerated, gastric fundal mass. Esophageal and gastric biopsies obtained revealed a poorly differentiated adenocarcinoma, positive for CK-7 and CDX-2 confirming gastric origin. Immunohistochemistry was negative for CD34, thus unlikely to be a NUT rearrangement. Imaging showed metastases in the lung, liver, and widespread lymphadenopathy. The patient received one chemotherapy course of epirubicin, oxaliplatin, and capecitabine without an adequate response. He deteriorated clinically and died 6 weeks later. Gastric adenocarcinoma (GAC) is extremely rare in children. Primary GAC represents 0.05% of all childhood cancers. It is more commonly seen in patients over the age of 50 and the median survival time is 7-10 months with metastatic GAC. There are mainly isolated case reports in pediatrics. In a retrospective study by Subbiah et al covering an 18 yr span, only 5 patients were found under the age of 18 out of 4,204 patients with gastric cancer. The median age at diagnosis was 17 years, and ranged from 8-17 years. The median duration of symptoms prior to diagnosis was 3 months. Four out of the five patients had metastatic disease at presentation. Two of the five patients were found to have Helicobacter pylori. Chemotherapy regimens were mainly platinum-based and two of the five patients underwent surgical resection. In their study four of the five patients died with a mean time of 2.8 months. The etiology of GAC in adults is multifactorial including dietary intake of high salt, nitroso compounds, and infectious factors such as Epstein-Barr virus and Helicobacter pylori infection. Our patient was negative for both infections. In children, GAC can occur de novo or with hereditary polyposis syndromes. Germline mutations in E-cadherein (CDH-1) have been seen in patients with gastric cancer; however our patient was not tested for this mutation. Surgical resection is an option for patients with localized disease with postoperative chemotherapy or radiation therapy. Children presenting with metastatic disease may benefit from palliative therapy with chemotherapy agents such as 5-FU and cisplatin. The rarity of pediatric GAC makes a standardized approach difficult; however an international tumor registry with tissue samples would benefit future children with this unfortunate disease.
Introduction Secretory Immunoglobulin A (SIgA) is the most prolific immunoglobulin of the GI tract, and high levels in preterm infants may prevent necrotising enterocolitis, the most devastating disease of the gut of early life. Our aim was to determine and compare the levels of SIgA in stool samples of preterm neonates and breast milk in their mothers. Design The NAPI Study (see abstract 1299049) sequentially recruited infants <32 weeks gestation and <1.5Kg birth weight within week 1. NEC was staged according to Bell's Criteria. SIgA titres of 34 preterm neonates and 9 mothers were determined from 100 mg of stool and 100 μl of milk collected weekly for the first month using an enzyme linked immunosorbant assay. Results Among all preterm infants (n=34), stool sIgA concentration were significantly higher in week 3 (p=0.020) and week 4 (p=0.027) than week 1. There were no significant differences in stool sIgA concentration between infants with NEC and those who did not (p>0.05) within all the four weeks. A significant increase in mean stool sIgA concentration appeared from week 2 to week 3 (p=0.0485) in NEC infants and from week 1 to week 2 (p=0.005) for those without NEC. For all breastfed preterm neonates (n=6) in the first four weeks, the level of milk sIgA was significant higher on week 1 (colostrum) than week 2 (p=0.021) and week 3 (p=0.034). Conclusions Our study illustrates immunological adaptation of maternal milk sIgA level for the preterm newborn and that exclusive breast milk feeding may increase stool sIgA more than mixed breast milk and formula. Levels found in stool and milk are significantly higher than for infants and mothers at term. Mo1985 Older Adult Drosophila Females Exhibit Shorter Intestinal Transit Times Than Young Females Kate Buzzi, Benjamin Ohlstein Peristalsis is a complex mechanism that relies on neurological, endocrine and peptide factors to create slow, coordinated muscle waves that propel nutrients anterograde through the intestines. Gastrointestinal disorders of peristalsis such as irritable bowel syndrome, chronic intestinal pseudo-obstruction and constipation have a significant negative economic, social and functional impact on society. The alimentary canal of Drosophila has a significant number of similarities to mammals making it an ideal model to study intestinal motility. Aging has a remarkable effect on organ functions and thus would likely have an impact on peristalsis. To test the hypothesis that intestinal transit changes with aging in Drosophila, the intestinal transit time of standard control flies at different ages was measured using a defecation assay. Wild type yellow white (y w) flies were raised on standard corn molasses food and aged 23 DAE (days after eclosion), 6-7 DAE, 13-14 DAE and 20-21 DAE. Adult female flies were placed individually in petri dishes with a small amount of blue yeast paste per dish. The time for intestinal transit can be calculated by determining the difference in time from the fly's abdomen turning blue to the appearance of a blue waste spot. Between 18 and 102 female flies per age were observed in this study. The flies 2-3 DAE had a transit time averaging 73.6 minutes and the flies 6-7 DAE had a transit time averaging 62.8 minutes, while the average transit time of flies 13-14 DAE was 36.4 minutes and the average transit time of flies 20-21 DAE was 38.5 minutes (Figure 1). These results were statistically significant with a p value <0.05 between both 2-3 DAE and 6-7 DAE flies when compared to both 13-14 DAE and 20-21 DAE flies. The 13-14 DAE and 20-21 DAE flies had an intestinal transit time half that of the 2-3 DAE and 6-7 DAE flies. There was no statistical significance between the transit times of of the flies 2-3 DAE compared to flies 6-7 DAE, nor were the transit times of 13-14 DAE flies compared to 20-21 DAE flies statistically significant. This study shows that the time needed for intestinal transit decreases as flies age. Further studies will be performed histologically and genetically to determine the factors that result in increased transit with aging. The identification and characterization of factors that influence intestinal transit would have great implications for human applications.
Mo1987 Association of Chronic Gastrointestinal Symptoms With Sleep Problems May Help Identify Distinct Subgroups of Autism Spectrum Disorders Kent C. Williams, Fievos L. Christofi, Traci Clemmons, Daniel Rosenberg, George J. Fuchs Background: One in 91 children (1.1%) in the U.S. is estimated to have an Autism Spectrum Disorders (ASD). Previous studies indicate gastrointestinal (GI) and sleep disorders are significant comorbidities in children with ASD. However, all previous studies had significant methodological limitations, including small numbers of children. Currently, the relationship between GI disorders, sleep problems, and ASD remains unclear. Objective: To better characterize relationship between chronic GI complaints, sleep problems, and ASD. Methods: Autism Treatment Network (ATN) Registry enrolled 3122 children (2-18yo) with ASD between September 2007 and July 2011 at 14 sites in US and Canada. Parents completed a GI symptom inventory and a Child Sleep Health Questionnaire (CSHQ). GI symptoms were considered chronic if present >3 months. A Total CSHQ score of >41 was used as a cut-off to determine presence of a sleep problem. Results: Of the 3122 patients enrolled into the ATN registry, combined CSHQ and GI symptom inventory results were available for 2707 children with ASD. Almost 1/3 (32%) of study population reported at least one chronic GI symptom. The most common chronic complaint was constipation (14%), followed by abdominal pain (10%), bloating (8.9%), diarrhea (7.3%) and nausea (5.4%). Each chronic GI complaint was independently associated with increased sleep dysfunction (p<0.0001). CSHQ showed that 67% of study population had sleep problems. Combined results revealed that 42.5% had sleep problems only, 24.5% had sleep problems and chronic GI symptoms, 25.2% had neither sleep nor GI problems, and 7.8% had a chronic GI complaint only. Analysis of individual chronic GI complaints revealed that sleep problems occurred in 79% of children with chronic constipation (n=381), 78% of children with chronic abdominal pain (n=427), 82% of children with chronic diarrhea (n=197), 81% of children with chronic bloating (n=242), and 84% of children with chronic nausea (n=147). Conclusion: A strong association exists between chronic GI symptoms and sleep dysfunction in children with ASD. In fact, sleep problem status with or without chronic GI symptoms appears to identify 3 primary groups in ASD population: ASD with sleep problems/chronic GI problems, ASD with sleep problems only, and ASD without sleep/chronic GI problems. Further studies are needed to determine whether sleep and chronic GI problems can help identify distinct ASD subgroups. Results from this study support screening of all children with ASD for sleep problems and chronic GI problems. Mo1988 Thickened Gastrointestinal Wall Findings on Computed Tomography in Children: How Worried Should We Be? Steve B. Min, Mazen I. Abbas, Milissa Carter, Cara H. Olsen, Matthew Goldman BACKGROUND: Abdominal pain is one of the most common presenting symptoms in children within the emergency room or primary care setting. Computed tomography (CT) has become increasingly used as a diagnostic tool to evaluate common gastrointestinal (GI) complaints. The presence of bowel wall thickening on abdominal CT scans in children presenting with abdominal pain often raises concern for inflammatory bowel disease (IBD). This may lead to a gastroenterology referral with potential endoscopic examination to evaluate for the presence of organic disease. However, the significance of these radiological findings
Figure 1
AGA Abstracts
S-714
Mo1984
Mo1986
Stool Secretory IgA Levels in Preterm Infants With and Without Necrotising Enterocolitis Ma Wenwen, Lynne M. Beattie, Christine A. Edwards, Andrew R. Barclay, Douglas Morrison, Judith H. Simpson, Emilie Combet
Gastric Adenocarcinoma in an Adolescent With Dyspepsia Prateek D. Wali We present a 16-year-old Caucasian male with chronic cough, dyspepsia, and epigastric abdominal pain. The patient was seen 3 months before diagnosis for intermittent cough and episodes of shortness of breath at night. He was treated with antibiotics, bronochodilators and a proton pump inhibitor. Over the next 2 months, the patient began to experience dysphagia, early satiety, and weight loss. His labs revealed an elevated LDH 783, ALT 173, AST 109, and lipase 191. He was seen by pediatric gastroenterology and underwent EGD, which revealed a large, ulcerated, gastric fundal mass. Esophageal and gastric biopsies obtained revealed a poorly differentiated adenocarcinoma, positive for CK-7 and CDX-2 confirming gastric origin. Immunohistochemistry was negative for CD34, thus unlikely to be a NUT rearrangement. Imaging showed metastases in the lung, liver, and widespread lymphadenopathy. The patient received one chemotherapy course of epirubicin, oxaliplatin, and capecitabine without an adequate response. He deteriorated clinically and died 6 weeks later. Gastric adenocarcinoma (GAC) is extremely rare in children. Primary GAC represents 0.05% of all childhood cancers. It is more commonly seen in patients over the age of 50 and the median survival time is 7-10 months with metastatic GAC. There are mainly isolated case reports in pediatrics. In a retrospective study by Subbiah et al covering an 18 yr span, only 5 patients were found under the age of 18 out of 4,204 patients with gastric cancer. The median age at diagnosis was 17 years, and ranged from 8-17 years. The median duration of symptoms prior to diagnosis was 3 months. Four out of the five patients had metastatic disease at presentation. Two of the five patients were found to have Helicobacter pylori. Chemotherapy regimens were mainly platinum-based and two of the five patients underwent surgical resection. In their study four of the five patients died with a mean time of 2.8 months. The etiology of GAC in adults is multifactorial including dietary intake of high salt, nitroso compounds, and infectious factors such as Epstein-Barr virus and Helicobacter pylori infection. Our patient was negative for both infections. In children, GAC can occur de novo or with hereditary polyposis syndromes. Germline mutations in E-cadherein (CDH-1) have been seen in patients with gastric cancer; however our patient was not tested for this mutation. Surgical resection is an option for patients with localized disease with postoperative chemotherapy or radiation therapy. Children presenting with metastatic disease may benefit from palliative therapy with chemotherapy agents such as 5-FU and cisplatin. The rarity of pediatric GAC makes a standardized approach difficult; however an international tumor registry with tissue samples would benefit future children with this unfortunate disease.
Introduction Secretory Immunoglobulin A (SIgA) is the most prolific immunoglobulin of the GI tract, and high levels in preterm infants may prevent necrotising enterocolitis, the most devastating disease of the gut of early life. Our aim was to determine and compare the levels of SIgA in stool samples of preterm neonates and breast milk in their mothers. Design The NAPI Study (see abstract 1299049) sequentially recruited infants <32 weeks gestation and <1.5Kg birth weight within week 1. NEC was staged according to Bell's Criteria. SIgA titres of 34 preterm neonates and 9 mothers were determined from 100 mg of stool and 100 μl of milk collected weekly for the first month using an enzyme linked immunosorbant assay. Results Among all preterm infants (n=34), stool sIgA concentration were significantly higher in week 3 (p=0.020) and week 4 (p=0.027) than week 1. There were no significant differences in stool sIgA concentration between infants with NEC and those who did not (p>0.05) within all the four weeks. A significant increase in mean stool sIgA concentration appeared from week 2 to week 3 (p=0.0485) in NEC infants and from week 1 to week 2 (p=0.005) for those without NEC. For all breastfed preterm neonates (n=6) in the first four weeks, the level of milk sIgA was significant higher on week 1 (colostrum) than week 2 (p=0.021) and week 3 (p=0.034). Conclusions Our study illustrates immunological adaptation of maternal milk sIgA level for the preterm newborn and that exclusive breast milk feeding may increase stool sIgA more than mixed breast milk and formula. Levels found in stool and milk are significantly higher than for infants and mothers at term. Mo1985 Older Adult Drosophila Females Exhibit Shorter Intestinal Transit Times Than Young Females Kate Buzzi, Benjamin Ohlstein Peristalsis is a complex mechanism that relies on neurological, endocrine and peptide factors to create slow, coordinated muscle waves that propel nutrients anterograde through the intestines. Gastrointestinal disorders of peristalsis such as irritable bowel syndrome, chronic intestinal pseudo-obstruction and constipation have a significant negative economic, social and functional impact on society. The alimentary canal of Drosophila has a significant number of similarities to mammals making it an ideal model to study intestinal motility. Aging has a remarkable effect on organ functions and thus would likely have an impact on peristalsis. To test the hypothesis that intestinal transit changes with aging in Drosophila, the intestinal transit time of standard control flies at different ages was measured using a defecation assay. Wild type yellow white (y w) flies were raised on standard corn molasses food and aged 23 DAE (days after eclosion), 6-7 DAE, 13-14 DAE and 20-21 DAE. Adult female flies were placed individually in petri dishes with a small amount of blue yeast paste per dish. The time for intestinal transit can be calculated by determining the difference in time from the fly's abdomen turning blue to the appearance of a blue waste spot. Between 18 and 102 female flies per age were observed in this study. The flies 2-3 DAE had a transit time averaging 73.6 minutes and the flies 6-7 DAE had a transit time averaging 62.8 minutes, while the average transit time of flies 13-14 DAE was 36.4 minutes and the average transit time of flies 20-21 DAE was 38.5 minutes (Figure 1). These results were statistically significant with a p value <0.05 between both 2-3 DAE and 6-7 DAE flies when compared to both 13-14 DAE and 20-21 DAE flies. The 13-14 DAE and 20-21 DAE flies had an intestinal transit time half that of the 2-3 DAE and 6-7 DAE flies. There was no statistical significance between the transit times of of the flies 2-3 DAE compared to flies 6-7 DAE, nor were the transit times of 13-14 DAE flies compared to 20-21 DAE flies statistically significant. This study shows that the time needed for intestinal transit decreases as flies age. Further studies will be performed histologically and genetically to determine the factors that result in increased transit with aging. The identification and characterization of factors that influence intestinal transit would have great implications for human applications.
Mo1987 Association of Chronic Gastrointestinal Symptoms With Sleep Problems May Help Identify Distinct Subgroups of Autism Spectrum Disorders Kent C. Williams, Fievos L. Christofi, Traci Clemmons, Daniel Rosenberg, George J. Fuchs Background: One in 91 children (1.1%) in the U.S. is estimated to have an Autism Spectrum Disorders (ASD). Previous studies indicate gastrointestinal (GI) and sleep disorders are significant comorbidities in children with ASD. However, all previous studies had significant methodological limitations, including small numbers of children. Currently, the relationship between GI disorders, sleep problems, and ASD remains unclear. Objective: To better characterize relationship between chronic GI complaints, sleep problems, and ASD. Methods: Autism Treatment Network (ATN) Registry enrolled 3122 children (2-18yo) with ASD between September 2007 and July 2011 at 14 sites in US and Canada. Parents completed a GI symptom inventory and a Child Sleep Health Questionnaire (CSHQ). GI symptoms were considered chronic if present >3 months. A Total CSHQ score of >41 was used as a cut-off to determine presence of a sleep problem. Results: Of the 3122 patients enrolled into the ATN registry, combined CSHQ and GI symptom inventory results were available for 2707 children with ASD. Almost 1/3 (32%) of study population reported at least one chronic GI symptom. The most common chronic complaint was constipation (14%), followed by abdominal pain (10%), bloating (8.9%), diarrhea (7.3%) and nausea (5.4%). Each chronic GI complaint was independently associated with increased sleep dysfunction (p<0.0001). CSHQ showed that 67% of study population had sleep problems. Combined results revealed that 42.5% had sleep problems only, 24.5% had sleep problems and chronic GI symptoms, 25.2% had neither sleep nor GI problems, and 7.8% had a chronic GI complaint only. Analysis of individual chronic GI complaints revealed that sleep problems occurred in 79% of children with chronic constipation (n=381), 78% of children with chronic abdominal pain (n=427), 82% of children with chronic diarrhea (n=197), 81% of children with chronic bloating (n=242), and 84% of children with chronic nausea (n=147). Conclusion: A strong association exists between chronic GI symptoms and sleep dysfunction in children with ASD. In fact, sleep problem status with or without chronic GI symptoms appears to identify 3 primary groups in ASD population: ASD with sleep problems/chronic GI problems, ASD with sleep problems only, and ASD without sleep/chronic GI problems. Further studies are needed to determine whether sleep and chronic GI problems can help identify distinct ASD subgroups. Results from this study support screening of all children with ASD for sleep problems and chronic GI problems. Mo1988 Thickened Gastrointestinal Wall Findings on Computed Tomography in Children: How Worried Should We Be? Steve B. Min, Mazen I. Abbas, Milissa Carter, Cara H. Olsen, Matthew Goldman BACKGROUND: Abdominal pain is one of the most common presenting symptoms in children within the emergency room or primary care setting. Computed tomography (CT) has become increasingly used as a diagnostic tool to evaluate common gastrointestinal (GI) complaints. The presence of bowel wall thickening on abdominal CT scans in children presenting with abdominal pain often raises concern for inflammatory bowel disease (IBD). This may lead to a gastroenterology referral with potential endoscopic examination to evaluate for the presence of organic disease. However, the significance of these radiological findings
Figure 1
AGA Abstracts
S-714