Su1098 Age Stratification of Presenting Symptoms and Biochemical Markers of Pediatric Patients With Celiac Disease

AGA Abstracts

Su1097

(p=0.03) in younger population (0-6 yrs). CONCLUSION: Younger patients are more likely to have growth abnormalities while symptoms seen in the older population can be mistaken for IBS. Constipation should raise a concern for celiac disease in the younger population. A significant proportion of patients 14-18 yrs old could present with nausea; which has not been traditionally thought to be associated with Celiac disease. Table 1: Presenting Symptoms and Biochemical Characterization of Patients With Celiac Disease Stratified By Age Group

Effect of Hypoallergenic Formulae on Gastric Emptying : A Double Blind Randomised Controlled Crossover Study Neil Shah, Rosan Meyer, Michail Papadopoulos, Robert Dziubak, Gloria DominguezOrtega, Claire De Koker, Margot Selleslagh, Eveline Deloose, Sofie Verschueren, Kristin Verbeke, Jan F. Tack, Nathalie Rommel Background: Cow's milk protein allergy (CMPA) affects 1.9-4.9% of UK children. In the UK alone, over £25million per annum is spent on management of CMPA including hypoallergenic formulae as mainstay. These feeds comprise of Casein-based Extensively Hydrolysed Formula (EHFC), Whey-based extensively hydrolysed formula (EHFW) and Amino Acid Formulas (AAF). Limited data is available on appropriately nutritionally matched hypoallergenic formulae and their impact on gastric emptying (GE). Gastric dysmotility such as gastro-esophageal reflux, diarrhea and vomiting are frequent in CMPA. From our clinical observations, these formulae seem paradoxically to make some symptoms worse e.g. vomiting, suggesting that components that make up these formulae may directly influence gastrointestinal motility independent of an anti-allergy effect. Aim: Proof of principle study to evaluate impact of hypoallergenic formulae on GE. Patients and Methods : 8 healthy, non-allergic adult volunteers were recruited. Blind randomised controlled crossover trial of 4 formulae containing matched amounts of energy with each a unique protein blend distinguishing them: whole protein infant formula with whey: casein ratio 60:40, EHFW, EHFC and an AAF. GE was assessed using a non-invasive 13C Octanoic acid breath test. Nutritional properties of formulae are shown in Table. After overnight fasting, subjects ingested a formula(350mL,~250 kcal) labeled with 100mg sodium 13C-octanoate. Basal breath samples were collected in Exetainers. Test lasted 6 hours, breath samples taken every 5min (first 2hrs) and after that every 10min (for 4hrs). 13CO2 excretion data analysis by non-linear regression to allow curve fitting/calculation of gastric half-emptying time (t½). Variables compared using repeated measures ANOVA/Friedman and post-hoc T-Test/Wilcoxon Signed Rank, Bonferroni corrected. Results: In healthy adult controls (3M, mean age 27,5yrs;21-51y), median GE t½ were 87 minutes (min)[IQR 63-133] for whole CMP,111 [IQR 75-157] min for EHFC, 152 [IQR 93-259] min for EHFW and 127 [IQR 74 -224] min for AAF. GE of hydrolysed whey based formula was significantly slower compared to whole CMP (p=0.012: delta 65 min) and to EHFC (p=0.025:delta 41 min). There was a trend towards slower GE of EHFW compared to AAF (p=0.080:delta 25min). Finally, a tendency for slower GE was observed in AAF and in casein based EHF compared to whole CMP Formula (resp p=0.063:delta 40min;p=0.092:delta 24min). Conclusion: Pilot study indicating that GE rates in healthy adults differ substantially for different hypoallergenic formulae containing different protein blends. Results indicate that, irrespective of presence of allergy, these formulae may influence intrinsic GE properties which may contribute to their clinical effects. Further studies are required to elucidate the factors underlying this difference in GE.

N/A in patients ,2 yrs. bTop three presenting symptoms in bold cn=2 patients asymptomatic n=5 patients asymptomatic en=2 patients asymptomatic

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Su1099 A Translational Porcine Model of Intestinal Stem Cells Liara Gonzalez, Anthony Blikslager, Jorge A. Piedrahita, Scott T. Magness Background & Aims: The availability of a large animal model to study intestinal stem cell (ISC) function will advance translational, stem cell and gastrointestinal (GI) fields of research. The murine model is commonly used to study human disease but is limited by gross size and physiologic difference in response to GI insult. The pig model overcomes these constraints and is a logical means to enhance understanding of GI disease. The ability to investigate the ISC responses to insult has previously not been possible in a large animal model due to the lack of biomarkers for ISCs and their differentiated progeny. The aim of this study was to identify all epithelial cell populations in porcine intestine. Establishing this model will contribute to knowledge of reparative processes driven by stem/progenitor populations and is likely to facilitate the development of novel strategies for interventional therapies. Methods: Intestinal tissue from healthy 8 week-old Yorkshire cross pigs was collected. Tissue for immunofluorescence was fixed and embedded. Tissue for gene expression analysis utilizing qRT-PCR was obtained. Results: Differentiating cells of epithelial origin from other mucosal cell types was initially pursued. Villin, epithelial cell adhesion molecule and βcatenin all positively identified epithelial cells. Once we had completed this step, stem and progenitor cell identification was undertaken due to their importance in epithelial repair. The transcription factor, SOX9, localized to the entire stem/progenitor cells zone while HOPX only identified +4/quiescent stem cells. Given the proliferative capacity of these cell types we expected co-localization of a marker of cellular proliferation. Most cells of the proliferating stem/progenitor cell zone in the crypt base positively marked with PCNA, colocalizing with SOX9. Injury may induce changes in populations of post-mitotic cell lineages and identification of these cells types was deemed necessary. Mucin 2, carbonic anhydrase and sucrase isomaltase identified goblet cells and absorptive cells, respectively. Chromogranin A, gastrin and somatostatin identified enteroendocrine cells. Despite inconclusive evidence for Paneth cells in the pig, a post-mitotic cell type was identified at the crypt base that lacked PCNA expression and was SOX9 and MUC2 positive. In addition, the development and optimization of primers for cell identifying gene markers, growth factors and signaling molecules were completed. Conclusion: Commercially developed antibodies to identify mucosal cell types in murine and human intestine demonstrate cross reactivity with pig tissue. The biomarkers will facilitate detailed analysis of cell types impacted in pig models of human disease and injury. The findings related to a possible post-mitotic cell functioning similar to the Paneth cell are intriguing, but require further study.

Table : Nutritional properties of the hypoallergenic fomulae used. Su1098 Age Stratification of Presenting Symptoms and Biochemical Markers of Pediatric Patients With Celiac Disease Arvind I. Srinath, Eric Carroll, John Ozolek, Alka Goyal BACKGROUND: Celiac disease is a common gastrointestinal condition. Symptoms and disease severity have a wide spectrum. There is lack of data on correlation of presenting symptoms by age groups or symptoms with histological severity. OBJECTIVES: (1) Identify the most common presenting symptoms of Celiac disease in a pediatric cohort of patients (2) Identify differences in presenting symptoms across age groups (3) Identify symptoms that correlated with TTG-IgA levels and Marsh-Oberhuber Criteria HYPOTHESES: Younger children are more likely to have and growth abnormalities. While, subtle symptoms in older patients may mimic irritable bowel syndrome. METHODS: A retrospective chart review was performed for newly diagnosed patients with Celiac disease from 2002-2012. Inclusion criteria were: ages 0-18 yrs. at diagnosis, serum and histopathological diagnosis of Celiac disease. Exclusion criteria were: pre-existing Type 1 Diabetes Mellitus, Eosinophilic gastrointestinal disease, co-existing gastrointestinal inflammatory disorders, and hypothyroidism. Patients were stratified into the following age groups at diagnosis: 0-6 yrs, 7-13 yrs., and 14-18 yrs. RESULTS: Ninety (N=90) patients were included in the study. Mean age at diagnosis was 9.3 yrs (range 1.1-17.0 yrs). The overall most common presenting symptom in the study population was abdominal pain (53.3%), diarrhea (27.8%), and vomiting (21.1%). 9/67 patients were IgA deficient. 9/90 patients were asymptomatic. Table 1 details the growth parameters amd most common presenting symptoms across age groups. The most common presenting symptom in patients 0-6 yrs at diagnosis was diarrhea (38.7%), while in 7-13 yrs., and 14-18 yrs abdominal pain (66.7%) predominated. No presenting symptom significantly correlated with TTG-IgA. Marsh-Oberhuber histological severity correlated significantly with nausea in older children (14-18yrs; p=0.02) and failure to thrive

AGA Abstracts

Su1100 Marine Lipid Suppositories for Constipation in Children Orri T. Ormarsson, Gudrun M. Asgrimsdottir, Einar Stefansson, Thorsteinn Loftsson, Einar Bjornsson Background: Rectal laxatives are commonly used in children. However, only a few clinical trials have been undertaken on their use in children. A well documented, clinically proven and a well tolerated medicine for per rectum treatment of constipation in children is needed. Suppositories containing free fatty acids, derived from cod-liver oil, as the active ingredient have been developed and shown to have laxative effect (Ormarsson et al. Marine Drugs

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