Small intestinal bacterial overgrowth and cystic fibrosis: Epidemiology, clinical impact and efficacy of rifaximin therapy

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Abstracts / Digestive and Liver Disease 46 (2014) e85–e127

calprotectin and number of pulmonary exacerbations was observed (r = 0.7, P < 0.0001; Fig. 7). Conclusions: In our study we found an high level of fecal calprotectin and a correlation with clinical conditions, suggesting that the assessment of the state of intestinal inflammation is very important in patients with CF. http://dx.doi.org/10.1016/j.dld.2014.07.060 SMALL INTESTINAL BACTERIAL OVERGROWTH AND CYSTIC FIBROSIS: EPIDEMIOLOGY, CLINICAL IMPACT AND EFFICACY OF RIFAXIMIN THERAPY Alessandra De Alessandri 1,∗ , Marta Bassi 1 , Maria Haupt 1 , Manuele Furnari 2 , Paolo Gandullia 3 , Riccardo Haupt 4 , Francesca Bagnasco 4 , Giulia Romanisio 1 , Vincenzo Savarino 2 , Laura Minicucci 1 1 Cystic Fibrosis Center, IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy 2 Department of Internal Medicine, Gastroenterology Unit, San Martino Hospital, University of Genoa, Genoa, Italy 3 Gastroenterology and Pediatric Endoscopy Unit, IRCCS G. Gaslini Institute, Genoa, Italy 4 Epidemiology and Biostatistic Service, IRCCS G. Gaslini Institute, Genoa, Italy

Objective: Recent scientific literature shows a high prevalence of Small Intestinal Bacterial Overgrowth (SIBO) in patients affected by Cystic Fibrosis (CF). The role of SIBO in nutritional status and gastrointestinal symptoms in CF is not known. Our aims were to study epidemiology and clinical manifestations of SIBO in CF patients and to assess the efficacy of rifaximin in eradicating SIBO and controlling gastrointestinal symptoms in CF patients. Methods: A symptoms questionnaire and Glucose breath test (GBT) were given to 79 CF patients. Patients with a positive GBT were enrolled in the trial and were randomized into two groups to receive rifaximin (1200 mg/day or 30 mg/kg/die for children < 14 years) for 14 days or no treatment. Patients repeated GBT and symptoms questionnaire 1 month after withdrawal of therapy or 45 days after the first negative GBT. Results: Twenty-five patients resulted affected by SIBO (31.6%) with a significant correlation with a lower BMI. Twenty-three patients took part in the randomized trial, 13 patients (56.5%) in rifaximin group and 10 patients (43.5%) in control group. Eradication rate of SIBO was 9/10 (90%) in rifaximin group and 2/5 (40%) in control group. In rifaximin group clinical improvement was observed in 4/5 patients aged ≤14 years and in 0/5 patients aged > 14 years (p = 0.048). In control group clinical improvement was observed in 2/5 patients. Conclusions: CF patients show a high prevalence of SIBO. Rifaximin therapy is well tolerated and the results are very encouraging in terms of efficacy and tolerability in CF patients. http://dx.doi.org/10.1016/j.dld.2014.07.061

CONE-LIKE RESECTION AND SLEEVE IN THE SURGICAL TREATMENT OF PEDIATRIC PERIANAL CROHN DISEASE: UNICENTER PRELIMINARY EXPERIENCE Girolamo Mattioli 1,∗ , Marcello Carlucci 1 , Lorenzo Leonelli 1 , Serena Arrigo 2 , Arrigo Barabino 2 1

Pediatric Surgery Unit, IRCCS G. Gaslini, Genova, Italy 2 Pediatric Gastroenterology Unit, IRCCS G. Gaslini, Genoa, Italy Objective: Abscess and perianal fistulae represent the most common early symptoms in pediatric Crohn disease and they are associated with poor quality of life. Several surgical techniques were proposed in the treatment of perianal Crohn disease reporting an elevated incidence of failure, incontinence and relapse. This study aims to present the surgical technique used in our institution, focusing on surgical details, preliminary results and follow-up. Methods: Data of patients who underwent to surgical treatment (cone-like resection and sleeve) between January 2009 and June 2014 were retrospectively collected (demography, surgical details, complications and follow-up). Results: Eleven patients with transphinteric fistulae underwent to surgery (10 male, 1 female). In 6 cases completely remission was obtained after 1 operation; two patients needed for a second treatment and 12 other patients needed more than 3 operations. No patient present incontinence on mid-term follow up. Conclusions: Although several procedures may be required to reach a complete remission of the perianal lesions, the proposed surgical technique seems to be effective and safe, preserving continence in all treated cases. Obviously it needs the support of an adequate medical treatment to be effective. http://dx.doi.org/10.1016/j.dld.2014.07.062 ITALIAN-STYLE GLUTEN-FREE DIET CHANGES THE SALIVARY MICROBIOTA AND METABOLOME OF AFRICAN (SAHARAWI) CELIAC CHILDREN Ruggiero Francavilla 1,∗ , Danilo Ercolini 2 , Lucia Vannini 3 , Flavia Indrio 1 , Teresa Capriati 1 , Raffaella Di Cagno 4 , Giuseppe Iacono 5 , Maria De Angelis 4 , Marco Gobbetti 4 1 Dipartimento Interdisciplinare di Medicina, University of Bari Aldo Moro, Bari, Italy 2 Department of Agricultural Sciences, Division of Microbiology, University of Naples Federico II, Portici, Italy 3 Department of Agricultural and Food Sciences, University of Bologna, Bologna, Italy 4 Department of Soil, Plant and Food Sciences, University of Bari Aldo Moro, Bari, Italy 5 Unit of Pediatric Gastroenterology, Di Cristina Hospital, Palermo, Italy

Objective: The role of human microbiota in celiac disease (CD) as well as the effect of the diet on the oral microbiota is still unclear. In this study, we measured variations of salivary microbiota and metabolome of Saharawi CD children and evaluated their potential associations with CD and gluten-free diet (GFD). Methods: Fourteen Saharawi children, with biopsy-proved CD, under GFD treatment for at least two-years (T-CD) and following African-style dietary habits, were enrolled. Saharawi T-CD children were subjected to GFD under Italian-style dietary habits for 60 days. Salivary microbiota and metabolome under African and Italian-