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PO64 COMPARATIVE STUDY OF HELICOBACTER PYLORI ERADICATION RATES WITH 10-DAY QUADRUPLE “CONCOMITANT” THERAPY AND SEQUENTIAL THERAPY IN CHILDREN
Posters / Digestive and Liver Disease 44 Suppl. 4 (2012) S259–S292
and clinical data were recorded. All underwent the following serological determinations at the onset of T1DM and every 6−12 months: anti-TTG-IgA antibody, anti-endomisial antibody and total serum IgA; HLA class II antigens; haemoglobin A1c (HbA1c) concentration; nutritional parameters (cholesterol, triglycerides, iron, ferritin, haemoglobin). Celiac disease was diagnosed according to the ESPGHAN criteria. In order to compare the clinical and laboratory data of diabetic children with and without CD a group of children with T1DM without CD was frequency matched for sex, age (±1 year), and T1DM duration (±1 year). The data presented for the groups with serological/histological evidence of CD was that of the time of first appearance of CD serology (anti-TTGA and EmA). Results: 419 children (F: 44%) were diagnosed in the study period. During follow-up, 58 children (13%) had a positive serological evidence of CD: 31 (56%) were symptomatic and diagnosed as CD and started a gluten free diet; 37 (46%) were asymptomatic and entered a follow-up while on a gluten containing diet with progressive decline/negativity of serological titres for CD. 15 children (26%) normalized CD serology and three became subsequently positive. Two children had a diagnosis of CD before that of T1DM. Overall, the prevalence of CD in T1DM is 7.8% (95%CI: 5.2–10.3) while the prevalence of positive CD autoimmunity is 14.3% (95%CI: 10.8– 17.5); therefore children with T1DM have a 7 times higher risk of having CD as compared to healthy children (OR: 7.2; CI 95%: 4.4– 11.8). Female gender is at higher risk for developing CD (p < 0.03) and children born by caesarean section developed biopsy proven CD at a younger age as compared to those who were born by vaginal delivery (3.7±3.2 vs. 7.1±3.5; p < 0.01). The age at first anti-TTGA positivity was significantly lower in children who had developed CD as compared to those who became negative (5.5±3.7 vs. 8.6±3.6; p < 0.006). Conclusion: Our study in a large cohort of children with T1DM confirms that the prevalence of CD is significantly higher than expected in the general paediatric population and that the prevalence of positive CD autoimmunity doubles the prevalence of the disease. Females are at higher risk of developing CD and those born from caesarean section have a higher risk of CD diagnosis at younger age. PO64 COMPARATIVE STUDY OF HELICOBACTER PYLORI ERADICATION RATES WITH 10-DAY QUADRUPLE “CONCOMITANT” THERAPY AND SEQUENTIAL THERAPY IN CHILDREN C. Fontana1 , F. Indrio1 , L. Mastrototaro1 , S. Castellaneta2 , T. Capriari1 , L. Cavallo1 , R. Francavilla1 . 1 Dipartimento interdisciplinare di Medicina, Universit`a di Bari, Italy; 2 Clinica Pediatrica, Ospedale San Paolo, Bari, Italy Background and Aim: The currently recommended first-line eradication treatment of Helicobacter pylori (HP) in children is usually successful in about 75%. Recently, a novel 10-day sequential treatment (omeprazole plus amoxicillin for 5 days, followed by omeprazole plus clarithromycin plus tinidazole for another 5 days) has achieved an eradication rate of 90% in children although it has been criticized for the difficult scheme and a simpler strategy has been proposed (concomitant: omeprazole plus amoxicillin plus clarithromycin plus tinidazole for 10 days) with high success rate in adults. The aim of the study was to assess the HP eradication rate of the concomitant compared to sequential treatment in children. Materials and Methods: Eighty-five consecutive children with HP infection were randomized to receive either concomitant [n: 44; median age: 10.8 years (4.5−16 years)] or sequential therapy [n: 41;
S285
median age: 9.8 years (4.8−16 years)]. HP infection was based on 2 out of 3 positive tests results: 13 C-urea breath test, rapid urease test, and histology. Side effects and compliance were assessed during treatment. Eradication was assessed by 13 C-urea breath test 8 weeks after therapy. All children completed the Gastrointestinal Symptom Rating Scale (GSRS) at entry, during and after treatment. Results: HP eradication was achieved in 40 children receiving sequential treatment (91%; 95% confidence interval: 87.1–98.5) and 35 children receiving concomitant treatment (85%; 95% confidence interval: 81.5–93.1) (P = NS). Compliance with therapy was good (>95%) in all. Overall, GSRS score were similar in both groups during and at the end of treatment (P = NS); however, children treated with concomitant treatment complained more often abdominal pain (18% vs. 42%; difference: −24%; P < 0.03). Concomitant treatment doubles the costs of antibiotic treatment as compared to sequential regimen. Conclusion: Our study shows that concomitant is not superior to sequential treatment that provides the best eradication rates, optimal compliance with the lowest risk of antibiotic associated side effects and costs. PO65 ROLE OF PARIS CLASSIFICATION AND OF THE PCDAI (PEDIATRIC CROHN’S DISEASE ACTIVITY INDEX) AT DIAGNOSIS AND FOR THE PROGNOSIS OF CHILDHOOD ONSET CROHN’S DISEASE L. Garassino2 , M. Baldi1 , P.L. Calvo1 , M. Surace1 , D. Dell’Olio, C. Barbera2 . 1 Dipartimento Scienze Pediatriche Universit`a OIRM Torino, Italy; 2 Universit`a di Torino, Italy Specific objectives: Childhood onset Crohn’s disease (CD) is a polymorphic entity with regard to predisposing factors, clinical presentation, course and response to treatment. The aim of this work was to analyze the diagnostic and predictive effectiveness of PCDAI in relation to the Paris classification (PC), the most recently introduced instrument for the evaluation of pediatric CD. Materials and Methods: After the analysis of clinical data of 55 CD patients, referred to our service in the years 1991–2011, a database was created. Of each patient PCDAI was determined at onset and the disease phenotype described according to PC. The two parameters have been subsequently each other correlated. Results: In our series the average PCDAI at diagnosis was 31.4 (range 7.5 to 50), regardless of age of the patients. Stratification of our patients according to PC some observations emerged: patients aged between 10 and 17 years have a more pronounced inflammatory situation, indicated by the alteration of the median values of ESR, albumin and haematocrit values and confirmed by significantly increased acute phase proteins. Stratifying patients according to the location of the lesions according to the PC, it was possible to note a prevalence of colic ones, while in patients with ileo-caecal localization a significantly higher age at diagnosis. The inflammatory situation, is more marked in colic locations, where they also had higher values of gamma-GT, as consistent with the known association between IBD and the localization of colonic autoimmune liver disease (sclerosing cholangitis). Dividing the patients for disease prevalent forms of behavior is not complicated. Considering the evolution of the MC one, two and five years after diagnosis, in one third of cases the disease activity may become extinct within the first year of therapy and the PCDAI is reduced in line with this trend. At one year follow up 73% of patients still have persistent symptoms and this condition is associated with younger age at diagnosis and less weight recovery. Even the classification of Paris captures this phenomenon, since a greater number of patients with persistent MC belongs to the group of age <10 years.
and clinical data were recorded. All underwent the following serological determinations at the onset of T1DM and every 6−12 months: anti-TTG-IgA antibody, anti-endomisial antibody and total serum IgA; HLA class II antigens; haemoglobin A1c (HbA1c) concentration; nutritional parameters (cholesterol, triglycerides, iron, ferritin, haemoglobin). Celiac disease was diagnosed according to the ESPGHAN criteria. In order to compare the clinical and laboratory data of diabetic children with and without CD a group of children with T1DM without CD was frequency matched for sex, age (±1 year), and T1DM duration (±1 year). The data presented for the groups with serological/histological evidence of CD was that of the time of first appearance of CD serology (anti-TTGA and EmA). Results: 419 children (F: 44%) were diagnosed in the study period. During follow-up, 58 children (13%) had a positive serological evidence of CD: 31 (56%) were symptomatic and diagnosed as CD and started a gluten free diet; 37 (46%) were asymptomatic and entered a follow-up while on a gluten containing diet with progressive decline/negativity of serological titres for CD. 15 children (26%) normalized CD serology and three became subsequently positive. Two children had a diagnosis of CD before that of T1DM. Overall, the prevalence of CD in T1DM is 7.8% (95%CI: 5.2–10.3) while the prevalence of positive CD autoimmunity is 14.3% (95%CI: 10.8– 17.5); therefore children with T1DM have a 7 times higher risk of having CD as compared to healthy children (OR: 7.2; CI 95%: 4.4– 11.8). Female gender is at higher risk for developing CD (p < 0.03) and children born by caesarean section developed biopsy proven CD at a younger age as compared to those who were born by vaginal delivery (3.7±3.2 vs. 7.1±3.5; p < 0.01). The age at first anti-TTGA positivity was significantly lower in children who had developed CD as compared to those who became negative (5.5±3.7 vs. 8.6±3.6; p < 0.006). Conclusion: Our study in a large cohort of children with T1DM confirms that the prevalence of CD is significantly higher than expected in the general paediatric population and that the prevalence of positive CD autoimmunity doubles the prevalence of the disease. Females are at higher risk of developing CD and those born from caesarean section have a higher risk of CD diagnosis at younger age. PO64 COMPARATIVE STUDY OF HELICOBACTER PYLORI ERADICATION RATES WITH 10-DAY QUADRUPLE “CONCOMITANT” THERAPY AND SEQUENTIAL THERAPY IN CHILDREN C. Fontana1 , F. Indrio1 , L. Mastrototaro1 , S. Castellaneta2 , T. Capriari1 , L. Cavallo1 , R. Francavilla1 . 1 Dipartimento interdisciplinare di Medicina, Universit`a di Bari, Italy; 2 Clinica Pediatrica, Ospedale San Paolo, Bari, Italy Background and Aim: The currently recommended first-line eradication treatment of Helicobacter pylori (HP) in children is usually successful in about 75%. Recently, a novel 10-day sequential treatment (omeprazole plus amoxicillin for 5 days, followed by omeprazole plus clarithromycin plus tinidazole for another 5 days) has achieved an eradication rate of 90% in children although it has been criticized for the difficult scheme and a simpler strategy has been proposed (concomitant: omeprazole plus amoxicillin plus clarithromycin plus tinidazole for 10 days) with high success rate in adults. The aim of the study was to assess the HP eradication rate of the concomitant compared to sequential treatment in children. Materials and Methods: Eighty-five consecutive children with HP infection were randomized to receive either concomitant [n: 44; median age: 10.8 years (4.5−16 years)] or sequential therapy [n: 41;
S285
median age: 9.8 years (4.8−16 years)]. HP infection was based on 2 out of 3 positive tests results: 13 C-urea breath test, rapid urease test, and histology. Side effects and compliance were assessed during treatment. Eradication was assessed by 13 C-urea breath test 8 weeks after therapy. All children completed the Gastrointestinal Symptom Rating Scale (GSRS) at entry, during and after treatment. Results: HP eradication was achieved in 40 children receiving sequential treatment (91%; 95% confidence interval: 87.1–98.5) and 35 children receiving concomitant treatment (85%; 95% confidence interval: 81.5–93.1) (P = NS). Compliance with therapy was good (>95%) in all. Overall, GSRS score were similar in both groups during and at the end of treatment (P = NS); however, children treated with concomitant treatment complained more often abdominal pain (18% vs. 42%; difference: −24%; P < 0.03). Concomitant treatment doubles the costs of antibiotic treatment as compared to sequential regimen. Conclusion: Our study shows that concomitant is not superior to sequential treatment that provides the best eradication rates, optimal compliance with the lowest risk of antibiotic associated side effects and costs. PO65 ROLE OF PARIS CLASSIFICATION AND OF THE PCDAI (PEDIATRIC CROHN’S DISEASE ACTIVITY INDEX) AT DIAGNOSIS AND FOR THE PROGNOSIS OF CHILDHOOD ONSET CROHN’S DISEASE L. Garassino2 , M. Baldi1 , P.L. Calvo1 , M. Surace1 , D. Dell’Olio, C. Barbera2 . 1 Dipartimento Scienze Pediatriche Universit`a OIRM Torino, Italy; 2 Universit`a di Torino, Italy Specific objectives: Childhood onset Crohn’s disease (CD) is a polymorphic entity with regard to predisposing factors, clinical presentation, course and response to treatment. The aim of this work was to analyze the diagnostic and predictive effectiveness of PCDAI in relation to the Paris classification (PC), the most recently introduced instrument for the evaluation of pediatric CD. Materials and Methods: After the analysis of clinical data of 55 CD patients, referred to our service in the years 1991–2011, a database was created. Of each patient PCDAI was determined at onset and the disease phenotype described according to PC. The two parameters have been subsequently each other correlated. Results: In our series the average PCDAI at diagnosis was 31.4 (range 7.5 to 50), regardless of age of the patients. Stratification of our patients according to PC some observations emerged: patients aged between 10 and 17 years have a more pronounced inflammatory situation, indicated by the alteration of the median values of ESR, albumin and haematocrit values and confirmed by significantly increased acute phase proteins. Stratifying patients according to the location of the lesions according to the PC, it was possible to note a prevalence of colic ones, while in patients with ileo-caecal localization a significantly higher age at diagnosis. The inflammatory situation, is more marked in colic locations, where they also had higher values of gamma-GT, as consistent with the known association between IBD and the localization of colonic autoimmune liver disease (sclerosing cholangitis). Dividing the patients for disease prevalent forms of behavior is not complicated. Considering the evolution of the MC one, two and five years after diagnosis, in one third of cases the disease activity may become extinct within the first year of therapy and the PCDAI is reduced in line with this trend. At one year follow up 73% of patients still have persistent symptoms and this condition is associated with younger age at diagnosis and less weight recovery. Even the classification of Paris captures this phenomenon, since a greater number of patients with persistent MC belongs to the group of age <10 years.