- Email: [email protected]
Pediatric eosinophilic esophagitis is a chronic relapsing disease of the esophagus
Abstracts / Digestive and Liver Disease 49(4S) (2017) e243–e286
adherence frequency varies between 32% and 81%. Biagi’s score is a reliable tool to assess GFD adherence. Objective: To assess GFD adherence using Biagi’s score, stating possible correlated factors to poor compliance and the relation between specific serology and Biagi’s Score in children. A retrospective observational study on 349 coeliac patients was conducted (age 2–18; F 65.9%; M 34.1%). It was investigated the correlation between sex, age of diagnosis, symptoms at diagnosis, age of follow-up, diagnosis with or without biopsy, coeliac familiarity, comorbidity, specific serology and adherence to GFD. Good adherence (Biagi’s score 3 and 4) was observed in 88.3% of patients. GFD adherence distribution was statistically significant (p < 0.05) in the group of age of follow-up (good adherence: 94.3% in 2–5 years, 92.6% in 6–12 years; 80.3% in 13–18 years) and of diagnosis (good adherence: 93.8% in 2–5 years; 82.3% in 6–12 years; 62.5% in 13–18 years). All other variables were not statistically significant, including biopsy at diagnosis. Our data confirm those reported in literature, according to which poor GFD adherence is more frequent in teenage years, when parental control is lower. Only specific serology is not sufficient to evaluate GFD adherence and further research is required to find other markers to improve the assessment in children. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.066 P063 Pediatric eosinophilic esophagitis is a chronic relapsing disease of the esophagus C. Boscardin 1,∗ , G. Minca 1 , P. Gaio 1 , M. Pescarin 1 , L. Bosa 1 , S. Bozzetto 1 , S. Carraro 1 , G. Perilongo 1 , C. Mescoli 2 , S. Zanconato 1 , M. Cananzi 1 1
Dipartimento di salute della donna e del bambino, Padova, Italy 2 Dipartimento di Medicina, Padova, Italy Introduction: Little is known about the course of eosinophilic esophagitis (EoE) over time and the long-term response to treatment. Aims: To estimate the frequency of EoE in children evaluated at the Pediatric Department of Padova for esophageal symptoms; to evaluate the characteristics of EoE patients, the course of EoE over time and the presence of factors predictive of response to treatment. Methods: We searched all children (0–17 years) discharged from our Department with an ICD9 diagnosis of esophagitis/dysphagia, between January 2010/December 2016. Patients with diagnosis of EoE were then identified. Results: 241 children were discharged with a diagnosis of dysphagia/esophagitis. The 16% had a diagnosis of EoE. EoE patients were mostly males (86%), pre-adolescents/adolescents, Caucasian, with history of atopy/allergy (99%). Mean diagnostic delay was of 25.6 months. All patients received medical treatment and were followed for an average of 29.9 months. The majority (83%) of patients achieved histologic remission (HR) with steroid therapy, and 80% experienced a resolution of symptoms. Among non-responders to a first cycle of steroids, two-thirds reached HR either prolonging treatment or optimizing the compliance. The 70% of patients who suspended the steroid treatment after achieving remission relapsed; among them only 25% presented a flare-up of symptoms. No factors were identified to predict non-response to therapy or relapse. Conclusions: EoE is a common esophageal disease that still suffer of a long diagnostic delay. It presents a good response to steroid
e267
therapy but it tends to relapse in the majority of patients after steroid withdrawal. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.067 P064 Increased prevalence of abdominal pain-functional gastrointestinal disorders in pediatric celiac patients V.P. Bentivoglio 1 , L. Raguseo 1 , M. Tripaldi 1,2 , F. Indrio 1,2 , A. Gentile 1 , M. De Toma 1 , F. Cristofori 1,∗ , S. Castellaneta 2 , R. Francavilla 1 1 Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Italy 2 Department of Pediatrics San Paolo Hospital, Bari, Italy
Recently, in 2016, the revised Rome IV criteria for the diagnosis of functional abdominal pain disorders (FAPDs) have been published. In adults, a recent meta-analysis suggest that patients with celiac disease (CD) have an higher risk of complaining symptoms compatible with irritable bowel syndrome (IBS) that might persist despite a strict gluten free diet (GFD). Few data are available in children. Aim of our study was to assess the prevalence of AP-FGIDs in a cohort of paediatric patients with CD after a long period of strict GFD. Methods: We studied 417 patients (62.83% Female) with a mean age of 13.7 years (range: 4.2–16 years) who were diagnoses as having CD according to ESPGHAN criteria on strict GFD for at least one year and with at least two consecutive negative celiac serological test. To assess the prevalence of AP-FGIDs a revised Questionnaire on Paediatric Gastrointestinal Symptoms-Rome III (QPGS-RIII) in full respect of new Rome IV criteria was used. Three-hundred seventy-three children (45% female) with a mean age of 13.5 years (range: 4.3–20 years) enrolled among the closest, non celiac, sibling of the patient (or if no siblings available, the next child in kinship) were used as control. Results: Considering the new Rome IV criteria, 48 children in the CD group and 25 children in the control group (6.70%) met criteria for a functional abdominal pain disorders [(11.5% vs. 6.7%; p < 0.05); RR 1.57: CI 95%: 0.98–2.52)]. In particular, when we compared celiac children versus controls we found that IBS was diagnosed in 30 as compared to 12 (7.2% vs. 3.4%; p < 0.05; RR 2.3: CI 95%: 1.2–4.3), functional dyspepsia (FD) in 6 in both groups (1.4% vs. 1.6%; p = NS), abdominal migraine (AM) in 2 as compared to nil (0,5%) and not Otherwise Specified (FAP-NOS) in 7 as compared to 5 (1.9% vs. 1.3%; p = NS). Finally, the prevalence of constipation was higher in the CD group as compared to controls (39) [19.9% vs. 10.5; p < 0.001; RR 1.9: CI 95% 1.4–2.7). Conclusion: Patients with CD have an increased risk of developing a functional abdominal pain disorders, and in particular IBS and constipation despite strict adherence to a gluten free diet. Our results suggest that new strategies aiming at the management of IBS in celiac patients should be planned. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.068
adherence frequency varies between 32% and 81%. Biagi’s score is a reliable tool to assess GFD adherence. Objective: To assess GFD adherence using Biagi’s score, stating possible correlated factors to poor compliance and the relation between specific serology and Biagi’s Score in children. A retrospective observational study on 349 coeliac patients was conducted (age 2–18; F 65.9%; M 34.1%). It was investigated the correlation between sex, age of diagnosis, symptoms at diagnosis, age of follow-up, diagnosis with or without biopsy, coeliac familiarity, comorbidity, specific serology and adherence to GFD. Good adherence (Biagi’s score 3 and 4) was observed in 88.3% of patients. GFD adherence distribution was statistically significant (p < 0.05) in the group of age of follow-up (good adherence: 94.3% in 2–5 years, 92.6% in 6–12 years; 80.3% in 13–18 years) and of diagnosis (good adherence: 93.8% in 2–5 years; 82.3% in 6–12 years; 62.5% in 13–18 years). All other variables were not statistically significant, including biopsy at diagnosis. Our data confirm those reported in literature, according to which poor GFD adherence is more frequent in teenage years, when parental control is lower. Only specific serology is not sufficient to evaluate GFD adherence and further research is required to find other markers to improve the assessment in children. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.066 P063 Pediatric eosinophilic esophagitis is a chronic relapsing disease of the esophagus C. Boscardin 1,∗ , G. Minca 1 , P. Gaio 1 , M. Pescarin 1 , L. Bosa 1 , S. Bozzetto 1 , S. Carraro 1 , G. Perilongo 1 , C. Mescoli 2 , S. Zanconato 1 , M. Cananzi 1 1
Dipartimento di salute della donna e del bambino, Padova, Italy 2 Dipartimento di Medicina, Padova, Italy Introduction: Little is known about the course of eosinophilic esophagitis (EoE) over time and the long-term response to treatment. Aims: To estimate the frequency of EoE in children evaluated at the Pediatric Department of Padova for esophageal symptoms; to evaluate the characteristics of EoE patients, the course of EoE over time and the presence of factors predictive of response to treatment. Methods: We searched all children (0–17 years) discharged from our Department with an ICD9 diagnosis of esophagitis/dysphagia, between January 2010/December 2016. Patients with diagnosis of EoE were then identified. Results: 241 children were discharged with a diagnosis of dysphagia/esophagitis. The 16% had a diagnosis of EoE. EoE patients were mostly males (86%), pre-adolescents/adolescents, Caucasian, with history of atopy/allergy (99%). Mean diagnostic delay was of 25.6 months. All patients received medical treatment and were followed for an average of 29.9 months. The majority (83%) of patients achieved histologic remission (HR) with steroid therapy, and 80% experienced a resolution of symptoms. Among non-responders to a first cycle of steroids, two-thirds reached HR either prolonging treatment or optimizing the compliance. The 70% of patients who suspended the steroid treatment after achieving remission relapsed; among them only 25% presented a flare-up of symptoms. No factors were identified to predict non-response to therapy or relapse. Conclusions: EoE is a common esophageal disease that still suffer of a long diagnostic delay. It presents a good response to steroid
e267
therapy but it tends to relapse in the majority of patients after steroid withdrawal. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.067 P064 Increased prevalence of abdominal pain-functional gastrointestinal disorders in pediatric celiac patients V.P. Bentivoglio 1 , L. Raguseo 1 , M. Tripaldi 1,2 , F. Indrio 1,2 , A. Gentile 1 , M. De Toma 1 , F. Cristofori 1,∗ , S. Castellaneta 2 , R. Francavilla 1 1 Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Italy 2 Department of Pediatrics San Paolo Hospital, Bari, Italy
Recently, in 2016, the revised Rome IV criteria for the diagnosis of functional abdominal pain disorders (FAPDs) have been published. In adults, a recent meta-analysis suggest that patients with celiac disease (CD) have an higher risk of complaining symptoms compatible with irritable bowel syndrome (IBS) that might persist despite a strict gluten free diet (GFD). Few data are available in children. Aim of our study was to assess the prevalence of AP-FGIDs in a cohort of paediatric patients with CD after a long period of strict GFD. Methods: We studied 417 patients (62.83% Female) with a mean age of 13.7 years (range: 4.2–16 years) who were diagnoses as having CD according to ESPGHAN criteria on strict GFD for at least one year and with at least two consecutive negative celiac serological test. To assess the prevalence of AP-FGIDs a revised Questionnaire on Paediatric Gastrointestinal Symptoms-Rome III (QPGS-RIII) in full respect of new Rome IV criteria was used. Three-hundred seventy-three children (45% female) with a mean age of 13.5 years (range: 4.3–20 years) enrolled among the closest, non celiac, sibling of the patient (or if no siblings available, the next child in kinship) were used as control. Results: Considering the new Rome IV criteria, 48 children in the CD group and 25 children in the control group (6.70%) met criteria for a functional abdominal pain disorders [(11.5% vs. 6.7%; p < 0.05); RR 1.57: CI 95%: 0.98–2.52)]. In particular, when we compared celiac children versus controls we found that IBS was diagnosed in 30 as compared to 12 (7.2% vs. 3.4%; p < 0.05; RR 2.3: CI 95%: 1.2–4.3), functional dyspepsia (FD) in 6 in both groups (1.4% vs. 1.6%; p = NS), abdominal migraine (AM) in 2 as compared to nil (0,5%) and not Otherwise Specified (FAP-NOS) in 7 as compared to 5 (1.9% vs. 1.3%; p = NS). Finally, the prevalence of constipation was higher in the CD group as compared to controls (39) [19.9% vs. 10.5; p < 0.001; RR 1.9: CI 95% 1.4–2.7). Conclusion: Patients with CD have an increased risk of developing a functional abdominal pain disorders, and in particular IBS and constipation despite strict adherence to a gluten free diet. Our results suggest that new strategies aiming at the management of IBS in celiac patients should be planned. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.068