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PP11 EFFECT OF LACTOBACILLUS GG ON INTESTINAL, RESPIRATORY AND SYSTEMIC INFLAMMATION IN CHILDREN WITH CYSTIC FIBROSIS
XVIII National Congress SIGENP Abstracts / Digestive and Liver Disease 43S (2011), S397–S447 history of respiratory distress and ab ingestis bronchial-pneumonia and at 2 years old, he underwent surgical intervention for ultra-short Hirshproung Disease. After the exclusion of neurological and otolaryngological causes, he underwent upper endoscopy, which showed two Mallory-Weiss bleeding tears of about 1.5 cm each. He was immediately admitted and received intravenous treatment with Omeprazole and Ampicillin/Sulbactam. After one week of hospitalization a control upper endoscopy showed superficial erosions till the middle oesophagus, improved over the last. Besides the oesophagus presented a “trachealized” aspect, suspicious for eosinophilic oesophagitis and an hyperaemic gastropathy at the body and at the antrum. However the histological report defined an eosinophilic gastritis. He, also, underwent a ileocolonoscopy that described a linfoid nodular hyperplasia and an severe inflammation of ileo-caecal valve, left-colon and sigmoid-rectum tract to complete the diagnosis. The eosinophilic infiltrate was also significant at the colic level. Finally, chest X-ray, brain RNM and abdominal ultrasound resulted negative while allergic test were positive to many allergens (kiwi, hazelnuts). Faecal research of bacterial and parasites were negative; the peripheral blood smear was negative for blasts. Between biochemical parameters, eosinophils were increased (12.6%) as well as ECP (200 μg/l) and triptase (3 μg/l). According to the allergologist, the child begin a steroid therapy at full dose, a diet restriction and stopped the assumption of Montelukast, because of the possible increasing of eosinophilia. At the moment, his clinical conditions are improved: he no longer vomits, his biochemical parameters are normalizing (eosinophils: 8.2%; ECP: 86 μg/l; triptase: 2.47 μg/l), the last upper endoscopy was showed no lesions and at the histology the eosinophilic infiltrate is decreasing. Discussion: EGIDs are a group of emerging disease, which manifestations can be unspecific and chronic, but also, like in this case, severe and sudden. More studies are needed to evaluate if there were conditions that could trigger the disease (eg. drugs -Montelukast-). Finally, we report this case because of the Mallory-Weiss Syndrome is a rarely complication of EGIDs.
PP11 EFFECT OF LACTOBACILLUS GG ON INTESTINAL, RESPIRATORY AND SYSTEMIC INFLAMMATION IN CHILDREN WITH CYSTIC FIBROSIS R. Scotto, E. Ruberto, E. Bruzzese, A. Woody, F. Chiatto, I. Liguoro, E. Del Core, A. Guarino Department of Pediatrics University Federico II of Naples Aims: Children with Cystic Fibrosis (CF) showed abnormalities of intestinal microflora. Prolonged administration of Lactobacillus GG (LGG) reduces respiratory exacerbations and intestinal inflammation in CF patients. Aims of the study were to investigate intestinal and extraintestinal inflammation using not invasive procedures and to evaluate the effects LGG administration in reducing inflammatory markers. Patients And methods: CF children in stable conditions without acute intestinal or extraintestinal diseases and who were not currently assuming probiotics, antibiotics or corticosteroids were enrolled. For each child, intestinal, respiratory and systemic inflammation were evaluated. Intestinal inflammation was assessed by fecal calprotectin (CLP) concentration and rectal nitric oxide (NO) production. Respiratory inflammation was evaluated by NO and IL-8 production in nasal brushing. Systemic inflammation was evaluated by serum concentration of TNF-α and IL-8. A group of ten age matched healthy children was used as control. CF patients were then treated with LGG (6×109 CFU/day for 30 days) and the same parameters were evaluated again at the end of the treatment. Results: Ten CF patients were enrolled (median age 10 years; age range 7–14 years). CF children showed a significantly higher concentration of CLP and rectal NO compared to healthy controls (141±128μg/g vs 60.6±69μg/g; and 10.6±4 ng/ml vs 2.3±1.6 ng/ml respectively; p<0.01). 8/10 patients showed a fecal CLP above the normal range (50μg/g) and 8/9 children showed a NO concentration in rectal dialysis above the normal range (5μmol/ml). Mean concentration of NO in nasal brushing was significantly higher in CF pa-
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tients compared to healthy matched controls (5.1±1μmol/L vs 4±1.2μmol/L; p=0.049). Mean value of nasal brush IL-8 was higher in children with CF compared to healthy matched controls, although this difference did not reach the statistical significance. Finally mean serum TNF-α concentration was higher in CF patients compared to healthy matched controls. No difference between the mean concentration of IL8 in serum between CF and healthy controls was observed. Both intestinal inflammatory markers were reduced after LGG administration. Fecal CLP was lower in 5/9 (56%) patients and rectal NO was reduced in 5/8 (63%) patients. Interestingly LGG administration is able to reduce the concentration of NO in nasal brushing in the 100% of treated patients and the mean concentration of NO in nasal brushing was significantly lower in CF patients after LGG assumption compared to what observed before the treatment (1.8±0.6μmol/L vs. 5.1±1.1μmol/L; p<0.01). Finally serum concentration of TNF-α was reduced in 9/9 (100%) patients after LGG administration. Conclusions: LGG administration in CF children was able to reduce both, intestinal and respiratory/systemic inflammation. The reduction of inflammatory markers support the hypothesis that intestinal bacteria may strongly influence local and systemic immune response. These data suggest that probiotic administration, delaying respiratory damage, may improve the quality of life of CF children.
PP12 EFFICACY OF INFLIXIMAB IN REDUCING PCDAI AND PUCAI SCORE IN A COHORT OF SEVERE PEDIATRIC IBDS: A SINGLE CENTRE EXPERIENCE S. Accomando, C. Albino, M. Bonanno, F. Scavuzzo, C. Zicari, G. Corsello Sezione di Pediatria; Dipartimento Materno Infantile; Università di Palermo Background: Treatment of IBD is complex and based on different drugs. The biological treatments act on different stages of immuno-physiopathological processes of the disease to change the evolution or natural history. At present the most studied and used biological drug is a chimerical monoclonal antibody to TNF-α known as Infliximab. Aim: The aim of our study is to prove the effectiveness of early introduction of infliximab in improving the clinical course of refractory IBD, resistant to conventional therapy. Method: In our study, which includes the triennial period going from 2008 to 2010, in our centre at our Department of Paediatrics in Palermo University we looked at 13 patients, 6 males and 7 females (range 4–18 years). Among these, 10 patients were affected by Crohn’s disease and 3 by Ulcerative Colitis. The prognostic factors that we considered for including patients in the group of biological therapy (Group A) were: early disease onset, presence of fistulas at presentation, extra intestinal manifestations, loss of response to conventional therapy. Four patients, who met the criteria we considered (Group A), were treated with Infliximab according the ACCENT 1 study at a dose of 5 mg/kg (at week 0, 2, 6 and then every 8 weeks). The other nine (Group B) continued their conventional therapy. The concomitant medications were maintained during the study: Aza, Mesalazine, Probiotics, Methronidazole. Results: From the comparison made, we found that at the beginning of our study, patients in group A had a worse clinical and serological condition of the group B, with a greater PCDAI and/or PUCAI score at the disease onset, while, following the biological treatment, after only the first 3 infusions, they all showed an improvement in clinical and laboratory parameters, with a rapid decrease of the PCDAI and/or PUCAI score, and their prognosis has become comparable to that of group B. Conclusions: Our study data confirm the effectiveness of early introduction of Infliximab in refractory IBD and that the response to biological drug therapy is rapid and happens during the induction period (week 0, 2, 6) when present.
PP11 EFFECT OF LACTOBACILLUS GG ON INTESTINAL, RESPIRATORY AND SYSTEMIC INFLAMMATION IN CHILDREN WITH CYSTIC FIBROSIS R. Scotto, E. Ruberto, E. Bruzzese, A. Woody, F. Chiatto, I. Liguoro, E. Del Core, A. Guarino Department of Pediatrics University Federico II of Naples Aims: Children with Cystic Fibrosis (CF) showed abnormalities of intestinal microflora. Prolonged administration of Lactobacillus GG (LGG) reduces respiratory exacerbations and intestinal inflammation in CF patients. Aims of the study were to investigate intestinal and extraintestinal inflammation using not invasive procedures and to evaluate the effects LGG administration in reducing inflammatory markers. Patients And methods: CF children in stable conditions without acute intestinal or extraintestinal diseases and who were not currently assuming probiotics, antibiotics or corticosteroids were enrolled. For each child, intestinal, respiratory and systemic inflammation were evaluated. Intestinal inflammation was assessed by fecal calprotectin (CLP) concentration and rectal nitric oxide (NO) production. Respiratory inflammation was evaluated by NO and IL-8 production in nasal brushing. Systemic inflammation was evaluated by serum concentration of TNF-α and IL-8. A group of ten age matched healthy children was used as control. CF patients were then treated with LGG (6×109 CFU/day for 30 days) and the same parameters were evaluated again at the end of the treatment. Results: Ten CF patients were enrolled (median age 10 years; age range 7–14 years). CF children showed a significantly higher concentration of CLP and rectal NO compared to healthy controls (141±128μg/g vs 60.6±69μg/g; and 10.6±4 ng/ml vs 2.3±1.6 ng/ml respectively; p<0.01). 8/10 patients showed a fecal CLP above the normal range (50μg/g) and 8/9 children showed a NO concentration in rectal dialysis above the normal range (5μmol/ml). Mean concentration of NO in nasal brushing was significantly higher in CF pa-
S415
tients compared to healthy matched controls (5.1±1μmol/L vs 4±1.2μmol/L; p=0.049). Mean value of nasal brush IL-8 was higher in children with CF compared to healthy matched controls, although this difference did not reach the statistical significance. Finally mean serum TNF-α concentration was higher in CF patients compared to healthy matched controls. No difference between the mean concentration of IL8 in serum between CF and healthy controls was observed. Both intestinal inflammatory markers were reduced after LGG administration. Fecal CLP was lower in 5/9 (56%) patients and rectal NO was reduced in 5/8 (63%) patients. Interestingly LGG administration is able to reduce the concentration of NO in nasal brushing in the 100% of treated patients and the mean concentration of NO in nasal brushing was significantly lower in CF patients after LGG assumption compared to what observed before the treatment (1.8±0.6μmol/L vs. 5.1±1.1μmol/L; p<0.01). Finally serum concentration of TNF-α was reduced in 9/9 (100%) patients after LGG administration. Conclusions: LGG administration in CF children was able to reduce both, intestinal and respiratory/systemic inflammation. The reduction of inflammatory markers support the hypothesis that intestinal bacteria may strongly influence local and systemic immune response. These data suggest that probiotic administration, delaying respiratory damage, may improve the quality of life of CF children.
PP12 EFFICACY OF INFLIXIMAB IN REDUCING PCDAI AND PUCAI SCORE IN A COHORT OF SEVERE PEDIATRIC IBDS: A SINGLE CENTRE EXPERIENCE S. Accomando, C. Albino, M. Bonanno, F. Scavuzzo, C. Zicari, G. Corsello Sezione di Pediatria; Dipartimento Materno Infantile; Università di Palermo Background: Treatment of IBD is complex and based on different drugs. The biological treatments act on different stages of immuno-physiopathological processes of the disease to change the evolution or natural history. At present the most studied and used biological drug is a chimerical monoclonal antibody to TNF-α known as Infliximab. Aim: The aim of our study is to prove the effectiveness of early introduction of infliximab in improving the clinical course of refractory IBD, resistant to conventional therapy. Method: In our study, which includes the triennial period going from 2008 to 2010, in our centre at our Department of Paediatrics in Palermo University we looked at 13 patients, 6 males and 7 females (range 4–18 years). Among these, 10 patients were affected by Crohn’s disease and 3 by Ulcerative Colitis. The prognostic factors that we considered for including patients in the group of biological therapy (Group A) were: early disease onset, presence of fistulas at presentation, extra intestinal manifestations, loss of response to conventional therapy. Four patients, who met the criteria we considered (Group A), were treated with Infliximab according the ACCENT 1 study at a dose of 5 mg/kg (at week 0, 2, 6 and then every 8 weeks). The other nine (Group B) continued their conventional therapy. The concomitant medications were maintained during the study: Aza, Mesalazine, Probiotics, Methronidazole. Results: From the comparison made, we found that at the beginning of our study, patients in group A had a worse clinical and serological condition of the group B, with a greater PCDAI and/or PUCAI score at the disease onset, while, following the biological treatment, after only the first 3 infusions, they all showed an improvement in clinical and laboratory parameters, with a rapid decrease of the PCDAI and/or PUCAI score, and their prognosis has become comparable to that of group B. Conclusions: Our study data confirm the effectiveness of early introduction of Infliximab in refractory IBD and that the response to biological drug therapy is rapid and happens during the induction period (week 0, 2, 6) when present.