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PP17 NON INVASIVE STOOL MARKERS IN ASSESSING BOWEL INFLAMMATION IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE
S210
Abstracts of XVI National Congress of SIGENP / Digestive and Liver Disease 41S (2009), S199–S239
upper and lower GI endoscopy had not revealed specific features, WCE disclosed CD lesions in the SB in 9 (64.2%), whereas other entities were detected in 5 (35.7%) (polyps, vascular malformations, drug-induced lesions). Of the 7 IBDU patients, WCE was diagnostic for CD in 5 (71.4%), whereas IBD remained unclassified in 2 (28.6%). Conclusions: In children investigated for IBD, WCE is a very helpful tool for defining a diagnosis of IBD (if traditional methods are inconclusive) and for discriminating between the two classical forms (CD, UC) of IBD. Of great clinical value is the fact that WCE may definitely classify IBDU. These results have important clinical and therapeutic implications.
PP17 NON INVASIVE STOOL MARKERS IN ASSESSING BOWEL INFLAMMATION IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE M. Neaga a , F. Nuti a , E. Del Giudice a , F. Civitelli a , F. Viola a , M. Aloi a , V. Pannone a , A. Di Lillo a , O. Borrelli a , I. Antonozzi b , S. Cucchiara a , P. Mariani b a Gastroenterology b Pathology
and Liver Unit,Sapienza University of Rome, Italy; Clinic A,Sapienza University of Rome, Italy
Aims: Previous studies indicate the value of fecal markers (FM) in patients (pts) with inflammatory bowel disease (IBD) for diagnostic purposes, as indexes of disease activity, for predicting relapses and monitoring therapy. The number of studies in children is small and a comparative evaluation among different markers has not yet been accomplished. The relationship between FM and inflammation of intestinal mucosa has rarely been investigated. Considering that mucosal healing is now a primary objective of IBD therapy, a non-invasive marker for mucosal inflammation could reduce the need of further invasive procedures, a burden in pediatric age. Aims of the study were to determine the value of different FM in defining extension and degree of intestinal inflammation, defined by endoscopy and histology, and the ability in discriminating between IBD and non-IBD pediatric pts. Patients and Methods: All pts who underwent colonoscopy in the period of the study were enrolled; 22 had Crohn’s disease (CD), 23 ulcerative colitis (UC) and 20 lymphoid hyperplasia or polyps. Disease activity was defined through PCDAI and PUCAI, endoscopic (SES-CD and Rachmilewitz) and histologic scores. The concentrations of calprotectin (FC) and lactoferrin (FL) were measured by calproctectin ELISA kit (Calprest Eurospital) and Lactoferrin (Cell Sciences Inc). Results: In pts with IBD median FC and FL concentration were 892 mg/kg (range 18-8500) and 770 μg/g (range 137-10000) respectively. In non IBD patients the median value was 48.35 mg/kg (range 19-99) and 349 μg/gr (range 55-10000) respectively. FC correlated closely with PCDAI (r 0.53; p 0.0125), SES-CD (r 0.62; p 0.0025) and histologic inflammation (r 0.69; p 0.0005) in CD. A good correlation was found with PUCAI (r 0.65; p 0.0009) and Rachmilewitz (r 0.51; p 0.016) scores in UC, the histological one correlated but not in a significant way (r 0.21; p 0.34). The correlation between FL and PCDAI (r 0.23; p 0.32), SES-CD (r 0.34; p 0.13), histological score (r 0.34; p 0.14) in CD and PUCAI (r 0.24; p 0.23), Rachmilewitz (r 0.11; p 0.67) and histological score (r 0.18, p 0.49) in UC was less discriminative than FC. Conclusions: FC reflected bowel inflammation in pts with IBD, whiles FL resulted less valuable. Both FM distinguished between IBD and non-IBD, but FC appeared more accurate. In conclusion FC appears to predict the presence of bowel inflammation in children and may be used to select pts that should undergo to invasive procedures.
PP18 USE OF A BALLOON-EXPANDABLE VASCULAR METAL STENT FOR PALLIATION OF OBSTRUCTIVE JAUNDICE IN A POST-SURGICAL PEDIATRIC PATIENT G. Curcio, I. Tarantino, L. Barresi, M. Traina ISMETT – Gastroenterologia Palermo, Italy Background: In patients with biliary obstruction, the primary goal is to relieve the jaundice, which can be performed by surgical, radiological, or endoscopic means. Endoscopic treatment for pediatric patients is poorly described in the literature, because of the low incidence of biliary obstructions in children and the rarity of the procedure. Case report: We report a case of obstructive jaundice in a 16-month-old boy after right hepatectomy for malignant metatastatic hepatic tumor. Ultrasound, CT scan and MRI showed mild intrahepatic biliary dilation due to the presence of a hilar mass with a diameter of 5 cm, suggestive of lymphonodal involvement. Jaundice, precluding prosecution of chemotherapy, became the major problem to resolve. Surgery was precluded because of the advanced stage of disease, and a percutaneous approach was unfeasible because of the right hepatectomy and a very mild dilation of the intrahepatic biliary tracts. This prompted us to perform an endoscopic retrograde cholangiopancreatography (ERCP) for the palliation of jaundice. The size of the operative channel in the pediatric duodenoscope allows for the introduction of devices with a maximum diameter of 7 French. Considering greater patency rates and overall cost-effectiveness of self-expanding metal stents relative to plastic stents, we placed a 19 mm length balloon-expandable vascular metal stent. No complications related to the procedure were recorded in the two weeks of follow-up, and chemotherapy was re-started. Conclusions: This report shows the safety and usefulness of expandable vascular metal stents for non-operable pediatric patients with biliary stenosis and/or leak.
PP19 ROLE OF URSODEOXYCOLIC ACID THERAPY IN CHILDREN WITH CHRONIC CRYPTOGENIC HYPERTRANSAMINASEMIA G. Ranucci, F. Ferrari, M.P. Cicalese, S. Minichiello, F. Cirillo, E. Nicastro, R. Iorio Department of Pediatrics, University Federico II, Naples, Italy Aim: Ursodeoxycholic acid (UDCA) is the first choice therapy for many cholestatic syndromes, but favourable biochemical effects have been also observed in non-cholestatic liver diseases. Aim of this study was to analyze biochemical response to UDCA in children with cryptogenic chronic hypertransaminasemia. Patients and Methods: Twenty-one children (13 males; median age 80 months, range 7-145) with hypertransaminasemia were retrospectively evaluated. All had cryptogenic hypertransaminasemia for more than 6 months in absence of an overt etiology. None showed clinical signs of liver disease. Eleven (52%) had isolated hypertransaminasemia, 10 (48%) had also high gamma glutamyl transpeptidase (GGT) levels. Bilirubin and other liver function tests were normal in all. On admission, mean ± SD alanine aminotrasferase levels (ALT) were 228±208 UI/L; aspartate aminotrasferase (AST) 145±154 UI/L. Among patients with hyper GGT, mean GGT levels were 86±56 UI/L. Liver biopsy, performed in 6 patients before UDCA, showed non-specific features of chronic liver disease. All children were treated with UDCA (mean dose 20 mg/kg/d) for 48 months (range 2-168). AST, ALT and GGT during treatment were analyzed. Results: Four (19%) patients had persistence of hypertransaminasemia on UDCA while 17 (80%) had a favourable response: 13 (76%) normalized transaminases in a median period of 3 months (range 1-17) and
Abstracts of XVI National Congress of SIGENP / Digestive and Liver Disease 41S (2009), S199–S239
upper and lower GI endoscopy had not revealed specific features, WCE disclosed CD lesions in the SB in 9 (64.2%), whereas other entities were detected in 5 (35.7%) (polyps, vascular malformations, drug-induced lesions). Of the 7 IBDU patients, WCE was diagnostic for CD in 5 (71.4%), whereas IBD remained unclassified in 2 (28.6%). Conclusions: In children investigated for IBD, WCE is a very helpful tool for defining a diagnosis of IBD (if traditional methods are inconclusive) and for discriminating between the two classical forms (CD, UC) of IBD. Of great clinical value is the fact that WCE may definitely classify IBDU. These results have important clinical and therapeutic implications.
PP17 NON INVASIVE STOOL MARKERS IN ASSESSING BOWEL INFLAMMATION IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE M. Neaga a , F. Nuti a , E. Del Giudice a , F. Civitelli a , F. Viola a , M. Aloi a , V. Pannone a , A. Di Lillo a , O. Borrelli a , I. Antonozzi b , S. Cucchiara a , P. Mariani b a Gastroenterology b Pathology
and Liver Unit,Sapienza University of Rome, Italy; Clinic A,Sapienza University of Rome, Italy
Aims: Previous studies indicate the value of fecal markers (FM) in patients (pts) with inflammatory bowel disease (IBD) for diagnostic purposes, as indexes of disease activity, for predicting relapses and monitoring therapy. The number of studies in children is small and a comparative evaluation among different markers has not yet been accomplished. The relationship between FM and inflammation of intestinal mucosa has rarely been investigated. Considering that mucosal healing is now a primary objective of IBD therapy, a non-invasive marker for mucosal inflammation could reduce the need of further invasive procedures, a burden in pediatric age. Aims of the study were to determine the value of different FM in defining extension and degree of intestinal inflammation, defined by endoscopy and histology, and the ability in discriminating between IBD and non-IBD pediatric pts. Patients and Methods: All pts who underwent colonoscopy in the period of the study were enrolled; 22 had Crohn’s disease (CD), 23 ulcerative colitis (UC) and 20 lymphoid hyperplasia or polyps. Disease activity was defined through PCDAI and PUCAI, endoscopic (SES-CD and Rachmilewitz) and histologic scores. The concentrations of calprotectin (FC) and lactoferrin (FL) were measured by calproctectin ELISA kit (Calprest Eurospital) and Lactoferrin (Cell Sciences Inc). Results: In pts with IBD median FC and FL concentration were 892 mg/kg (range 18-8500) and 770 μg/g (range 137-10000) respectively. In non IBD patients the median value was 48.35 mg/kg (range 19-99) and 349 μg/gr (range 55-10000) respectively. FC correlated closely with PCDAI (r 0.53; p 0.0125), SES-CD (r 0.62; p 0.0025) and histologic inflammation (r 0.69; p 0.0005) in CD. A good correlation was found with PUCAI (r 0.65; p 0.0009) and Rachmilewitz (r 0.51; p 0.016) scores in UC, the histological one correlated but not in a significant way (r 0.21; p 0.34). The correlation between FL and PCDAI (r 0.23; p 0.32), SES-CD (r 0.34; p 0.13), histological score (r 0.34; p 0.14) in CD and PUCAI (r 0.24; p 0.23), Rachmilewitz (r 0.11; p 0.67) and histological score (r 0.18, p 0.49) in UC was less discriminative than FC. Conclusions: FC reflected bowel inflammation in pts with IBD, whiles FL resulted less valuable. Both FM distinguished between IBD and non-IBD, but FC appeared more accurate. In conclusion FC appears to predict the presence of bowel inflammation in children and may be used to select pts that should undergo to invasive procedures.
PP18 USE OF A BALLOON-EXPANDABLE VASCULAR METAL STENT FOR PALLIATION OF OBSTRUCTIVE JAUNDICE IN A POST-SURGICAL PEDIATRIC PATIENT G. Curcio, I. Tarantino, L. Barresi, M. Traina ISMETT – Gastroenterologia Palermo, Italy Background: In patients with biliary obstruction, the primary goal is to relieve the jaundice, which can be performed by surgical, radiological, or endoscopic means. Endoscopic treatment for pediatric patients is poorly described in the literature, because of the low incidence of biliary obstructions in children and the rarity of the procedure. Case report: We report a case of obstructive jaundice in a 16-month-old boy after right hepatectomy for malignant metatastatic hepatic tumor. Ultrasound, CT scan and MRI showed mild intrahepatic biliary dilation due to the presence of a hilar mass with a diameter of 5 cm, suggestive of lymphonodal involvement. Jaundice, precluding prosecution of chemotherapy, became the major problem to resolve. Surgery was precluded because of the advanced stage of disease, and a percutaneous approach was unfeasible because of the right hepatectomy and a very mild dilation of the intrahepatic biliary tracts. This prompted us to perform an endoscopic retrograde cholangiopancreatography (ERCP) for the palliation of jaundice. The size of the operative channel in the pediatric duodenoscope allows for the introduction of devices with a maximum diameter of 7 French. Considering greater patency rates and overall cost-effectiveness of self-expanding metal stents relative to plastic stents, we placed a 19 mm length balloon-expandable vascular metal stent. No complications related to the procedure were recorded in the two weeks of follow-up, and chemotherapy was re-started. Conclusions: This report shows the safety and usefulness of expandable vascular metal stents for non-operable pediatric patients with biliary stenosis and/or leak.
PP19 ROLE OF URSODEOXYCOLIC ACID THERAPY IN CHILDREN WITH CHRONIC CRYPTOGENIC HYPERTRANSAMINASEMIA G. Ranucci, F. Ferrari, M.P. Cicalese, S. Minichiello, F. Cirillo, E. Nicastro, R. Iorio Department of Pediatrics, University Federico II, Naples, Italy Aim: Ursodeoxycholic acid (UDCA) is the first choice therapy for many cholestatic syndromes, but favourable biochemical effects have been also observed in non-cholestatic liver diseases. Aim of this study was to analyze biochemical response to UDCA in children with cryptogenic chronic hypertransaminasemia. Patients and Methods: Twenty-one children (13 males; median age 80 months, range 7-145) with hypertransaminasemia were retrospectively evaluated. All had cryptogenic hypertransaminasemia for more than 6 months in absence of an overt etiology. None showed clinical signs of liver disease. Eleven (52%) had isolated hypertransaminasemia, 10 (48%) had also high gamma glutamyl transpeptidase (GGT) levels. Bilirubin and other liver function tests were normal in all. On admission, mean ± SD alanine aminotrasferase levels (ALT) were 228±208 UI/L; aspartate aminotrasferase (AST) 145±154 UI/L. Among patients with hyper GGT, mean GGT levels were 86±56 UI/L. Liver biopsy, performed in 6 patients before UDCA, showed non-specific features of chronic liver disease. All children were treated with UDCA (mean dose 20 mg/kg/d) for 48 months (range 2-168). AST, ALT and GGT during treatment were analyzed. Results: Four (19%) patients had persistence of hypertransaminasemia on UDCA while 17 (80%) had a favourable response: 13 (76%) normalized transaminases in a median period of 3 months (range 1-17) and