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PA36 BREASTFEEDING AND HELICOBACTER PYLORI INFECTION IN PRE-SCHOOL CHILDREN
Abstracts of XVI National Congress of SIGENP / Digestive and Liver Disease 41S (2009), S199–S239 PA34 NASAL CROHN’S DISEASE, A RARE EXTRAINTESTINAL MANIFESTATION AMONG YOUNG CHILDREN. THE REPORT OF TWO CASES L. Rubert, G. Gortani, S. Pastore, S. Martelossi, G. Di Leo, D.L. Grasso, A. Ventura IRCCS Burlo Garofolo, Trieste, Italy Introduction: We report two cases of nasal involvement in two young children affected by severe CD. Case 1: L. is a 3-year-old boy affected by steroid-dependent CD by the age of 8 months. 3 months after steroids suspension, with Azathioprine as therapy, he presented recurrent epistaxis. The anterior rhinoscopy showed an inflamed and easily bleeding nasal mucosa. The nasal biopsy revealed mucosal erosions and areas with inflammatory granulomatous tissue suggestive of CD. Soon after the onset of nasal bleeding intestinal symptoms reappeared. Laboratoristic and endoscopic findings confirmed the disease relapse. Considering Azathioprine as ineffective, Thalidomide was started. After the gastrointestinal improvement the nose bleeding ceased. Case 2: B. is a 5-year-old girl with known CD. Her disease, broken out at 8 months of age, was steroid-dependent with little or no response to the other immunosuppressant tested. A marked clinical improvement was obtained after total colectomy at the age of 3. When the nasal bleeding appeared, her clinical condition were quite good, despite frequent diarrhoea and small oral aphthous ulcers. The rhinoscopy revealed the narrowing of the vestibule and right choana due to fibrous tissue. The biopsy showed erosions of the epithelium with lymphoplasmocytic infiltrate and microgranulomas suggestive of CD. Topical therapy did not work out. Systemic steroids were so used, with further improvement of intestinal symptoms and cessation of the nose bleeding. Conclusion: Up to 50% of adults with IBD have at least one extraintestinal manifestation; a higher prevalence is reported in the few studies done among children. With the exception of aphtous stomatitis, head manifestations of CD are uncommon at any age. These two cases had a precocious onset and an aggressive course of CD. When nose bleeding appeared, both patients were quite well and the recurrent epistaxis seemed to anticipate a relapse. Topical treatment had been ineffective since symptoms improved only after the complete control of the disease.
PA35 TOLERANCE TO A NEW FREE AMINO ACID-BASED FORMULA IN CHILDREN WITH COW’S MILK PROTEIN ALLERGY S. Ruotolo, R. Nocerino, M. Tardi, L. Cosenza, G. Terrin, A. Passariello, A. Braucci, R. Troncone, R. Berni Canani Department of Paediatrics and European Laboratory for the Investigation of Food Induced Disease (ELFID), University of Naples “Federico II”, Italy Background: Cow’s milk protein allergy (CMPA) is best treated by complete elimination of cow’s milk from the diet. For infants with CMPA who cannot be breast-fed, formulas based on extensively hydrolyzed proteins or on amino acids are the preferred substitutes for cow’s milk-based formulas. Children affected by CMPA could react to these substitute formulas. To be labeled hypoallergenic, these formulas must demonstrate in clinical studies that they do not provoke reactions in 90% of infants or children with confirmed CMPA with 95% confidence when given in a placebo-controlled challenge. Objective: A prospective clinical assessment of tolerance to a new free amino acid-based formula (Aaf) (Sineall, Humana, Milan, Italy) was carried out in children affected by IgE- and non-IgE-mediated CMPA. Methods: Children affected by IgE- or non-IgE-mediated CMPA, confirmed at placebo-controlled challenge, aged 1 month to 4 years, were
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enrolled. The work-up included: i) skin prick tests (SPT) with whole milk, alpha-lactalbumin (ALA), beta-lactoglobulin (BLG), casein and Aaf; ii) specific serum IgE determinations; and iii) atopy patch tests (APT) with whole milk and Aaf. A placebo-controlled challenge was carried out with increasing doses of the Aaf in all subjects. Results: Twenty-nine children (22 boys, 75.9%, median age 37, 95%CI 34.5-39.6 months) affected by CMPA were evaluated (IgE-mediated: 12, 41.3%; non-IgE-mediated: 17, 58.7%). Clinical symptoms of CMPA were gastrointestinal (48.2%, vomiting, chronic diarrhea, hematochezia), cutaneous (37.8%, atopic dermatitis, urticaria, angioedema), respiratory (6.8% asthma), and anaphylaxis (3.4%). At the enrolment 11 children (37.9%) had positive SPT to whole milk, 10 to ALA (34.4%), 8 to BLG (27.5%) and 4 to casein (13.7%), no one to Aaf. Specific IgE determinations for cow’s milk were positive in 10 patients (34.4%). Thirteen patients (44.8%) presented an APT positive to whole milk, only one to Aaf. Challenge with Aaf resulted negative in all subjects. Conclusion: The new Aaf (Sineall) is safe and well tolerated in infants diagnosed with CMPA.
PA36 BREASTFEEDING AND HELICOBACTER PYLORI INFECTION IN PRE-SCHOOL CHILDREN T. Sabbi, M. Palumbo Pediatric Unit Belcolle Hospital, Viterbo, Italy Background: Helicobacter pylori (Hp) infection is mainly acquired during childhood; it is recognised as a cause of gastritis and peptic ulcer and it has been classified as a group A carcinogen by the World Health Organization. Childhood nutrition may influence acquisition of Hp infection. There are few current data to elucidate this association. Aim To investigate the relation between breastfeeding and Hp infection in children. Methods: We interviewed, with questionnaire, 150 pre-school children (98 male; mean age 5.9 years). The infection status of children and of the accompanying mother was determined by 13C-Urea Breath Test. Results: In all 150 children and their mothers were included in the final analysis. Hp prevalence was 8.7% in children and 30.2% in their mothers. There was a strong association between children’s and mother’s infection. Of the children, 78.3% had ever been breastfed. Duration of breastfeeding showed a positive association with Hp prevalence in pre-school age. Prevalence of Hp infection was higher in children breastfed compared to never breastfed children (9.8% versus 7.9%). Conclusions: Even if breastfeeding is protective against a variety of infant illnesses and also has a beneficial effect on general morbidity, our study suggests no protective effect of breastfeeding history on Hp infection in pre-school age.
PA37 CHILDREN WITH IRON DEFICIENCY ANEMIA: CELIAC DISEASE AND HELICOBACTER PYLORI T. Sabbi, M. Palumbo Pediatric Unit Belcolle Hospital, Viterbo, Italy Background: Helicobacter pylori (Hp) causes one of the most widespread infections worldwide. This infection has been recognized as a cause of chronic gastritis, peptic ulcer, atrophic gastritis, gastric cancer, but it has a role in refractory iron deficiency anemia, delayed statural growth, dyspepsia and extradigestive diseases. Aim: To analyzed the prevalence of celiac disease and Hp in patients with resistant iron deficiency anemia. Patients and methods: 20 patients (12 males; age range 6-18 years) with refractory iron deficiency anemia (not responding to iron therapy for 3 months). Blood sample was taken analysis of antibodies for
PA35 TOLERANCE TO A NEW FREE AMINO ACID-BASED FORMULA IN CHILDREN WITH COW’S MILK PROTEIN ALLERGY S. Ruotolo, R. Nocerino, M. Tardi, L. Cosenza, G. Terrin, A. Passariello, A. Braucci, R. Troncone, R. Berni Canani Department of Paediatrics and European Laboratory for the Investigation of Food Induced Disease (ELFID), University of Naples “Federico II”, Italy Background: Cow’s milk protein allergy (CMPA) is best treated by complete elimination of cow’s milk from the diet. For infants with CMPA who cannot be breast-fed, formulas based on extensively hydrolyzed proteins or on amino acids are the preferred substitutes for cow’s milk-based formulas. Children affected by CMPA could react to these substitute formulas. To be labeled hypoallergenic, these formulas must demonstrate in clinical studies that they do not provoke reactions in 90% of infants or children with confirmed CMPA with 95% confidence when given in a placebo-controlled challenge. Objective: A prospective clinical assessment of tolerance to a new free amino acid-based formula (Aaf) (Sineall, Humana, Milan, Italy) was carried out in children affected by IgE- and non-IgE-mediated CMPA. Methods: Children affected by IgE- or non-IgE-mediated CMPA, confirmed at placebo-controlled challenge, aged 1 month to 4 years, were
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enrolled. The work-up included: i) skin prick tests (SPT) with whole milk, alpha-lactalbumin (ALA), beta-lactoglobulin (BLG), casein and Aaf; ii) specific serum IgE determinations; and iii) atopy patch tests (APT) with whole milk and Aaf. A placebo-controlled challenge was carried out with increasing doses of the Aaf in all subjects. Results: Twenty-nine children (22 boys, 75.9%, median age 37, 95%CI 34.5-39.6 months) affected by CMPA were evaluated (IgE-mediated: 12, 41.3%; non-IgE-mediated: 17, 58.7%). Clinical symptoms of CMPA were gastrointestinal (48.2%, vomiting, chronic diarrhea, hematochezia), cutaneous (37.8%, atopic dermatitis, urticaria, angioedema), respiratory (6.8% asthma), and anaphylaxis (3.4%). At the enrolment 11 children (37.9%) had positive SPT to whole milk, 10 to ALA (34.4%), 8 to BLG (27.5%) and 4 to casein (13.7%), no one to Aaf. Specific IgE determinations for cow’s milk were positive in 10 patients (34.4%). Thirteen patients (44.8%) presented an APT positive to whole milk, only one to Aaf. Challenge with Aaf resulted negative in all subjects. Conclusion: The new Aaf (Sineall) is safe and well tolerated in infants diagnosed with CMPA.
PA36 BREASTFEEDING AND HELICOBACTER PYLORI INFECTION IN PRE-SCHOOL CHILDREN T. Sabbi, M. Palumbo Pediatric Unit Belcolle Hospital, Viterbo, Italy Background: Helicobacter pylori (Hp) infection is mainly acquired during childhood; it is recognised as a cause of gastritis and peptic ulcer and it has been classified as a group A carcinogen by the World Health Organization. Childhood nutrition may influence acquisition of Hp infection. There are few current data to elucidate this association. Aim To investigate the relation between breastfeeding and Hp infection in children. Methods: We interviewed, with questionnaire, 150 pre-school children (98 male; mean age 5.9 years). The infection status of children and of the accompanying mother was determined by 13C-Urea Breath Test. Results: In all 150 children and their mothers were included in the final analysis. Hp prevalence was 8.7% in children and 30.2% in their mothers. There was a strong association between children’s and mother’s infection. Of the children, 78.3% had ever been breastfed. Duration of breastfeeding showed a positive association with Hp prevalence in pre-school age. Prevalence of Hp infection was higher in children breastfed compared to never breastfed children (9.8% versus 7.9%). Conclusions: Even if breastfeeding is protective against a variety of infant illnesses and also has a beneficial effect on general morbidity, our study suggests no protective effect of breastfeeding history on Hp infection in pre-school age.
PA37 CHILDREN WITH IRON DEFICIENCY ANEMIA: CELIAC DISEASE AND HELICOBACTER PYLORI T. Sabbi, M. Palumbo Pediatric Unit Belcolle Hospital, Viterbo, Italy Background: Helicobacter pylori (Hp) causes one of the most widespread infections worldwide. This infection has been recognized as a cause of chronic gastritis, peptic ulcer, atrophic gastritis, gastric cancer, but it has a role in refractory iron deficiency anemia, delayed statural growth, dyspepsia and extradigestive diseases. Aim: To analyzed the prevalence of celiac disease and Hp in patients with resistant iron deficiency anemia. Patients and methods: 20 patients (12 males; age range 6-18 years) with refractory iron deficiency anemia (not responding to iron therapy for 3 months). Blood sample was taken analysis of antibodies for