- Email: [email protected]
Su1167 Outcome Measures for Infant Colic - What Do Health Professionals Think?
out of 5 patients had a social stressor or atypical behavior. Conclusion: RP is a disease of young children, most common under age 3. Chronic constipation remains the most common underlying condition. Prolonged straining during defecation was a frequent complaint and more common than passing hard stools. Attempts to avoid straining and accurate sitting position during defecation may be most influential in managing these patients. Cystic fibrosis is no longer a common diagnosis in patients with RP because of newborn screening; sweat chloride tests should be reserved when clinically indicated. Two patients had celiac disease, suggesting this be considered in the workup of RP, if clinically relevant. Many patients diagnosed as idiopathic had social stressors or atypical behavior and required multiple surgical corrections. Mental health referral should be implemented early on in management of these patients, as they are at risk for recurrent prolapse. Table 1. Demographics and Clinical Characteristics
Su1165 The Rising Cost of Hospital Care for Children With Gastroparesis and Irritable Bowel Syndrome Peter L. Lu, Hayat Mousa Background: The cost of care for gastroparesis (GP) and irritable bowel syndrome (IBS) in adults has been increasing as the number and cost of hospital admissions for GP and IBS rise. This has not been studied in children. Our aim is to evaluate the cost of hospital care for children with GP and IBS. Methods: A retrospective review of the Pediatric Health Information System database was performed. Admissions with a diagnosis of GP (ICD-9 536.3), IBS (564.1), dyspepsia and other specified disorders of function of stomach (536.8), and unspecified functional disorder of stomach (536.9) from 2004-2013 were selected. The latter two diagnoses were included given the overlap in presentation of these diagnoses with GP and IBS. Number of admissions, demographic information, admission cost, and length of stay (LOS) were recorded. Costs were adjusted for inflation. Data was analyzed using one-way ANOVA, t-test, and linear regression. Results: 5,323 pediatric GP and 8,715 pediatric IBS patients were admitted during this time period. The IBS group had a higher proportion of females (64% vs. 55%, p<0.05) and IBS patients were older than GP patients (15.8y vs. 11.9y, p<0.05). Annual number of admissions for GP increased from 242 to 1,185 (p<0.0001) and total cost increased from $6,185,390 to $35,654,075 from 2004-2013 (p=0.0001). Annual number of admissions for IBS increased from 351 to 858 (p<0.0001) and total cost increased from $3,331,524 to $11,479,651 (p<0.0001). The average cost per admission for GP increased from $25,559 to $30,088 and for IBS increased from $9,492 to $13,380. However, only the increase in average cost for IBS was significant (p<0.01). LOS for IBS admissions did not change significantly and does not explain the increase in average cost. Annual number of admissions for related diagnostic codes (536.8 and 536.9) increased significantly from 2004-2013 as well (p<0.0001, p<0.0001). Conclusion: In this first evaluation of the cost of hospital care for GP and IBS in children, we found that the financial burden of hospital admissions for both diagnoses has been increasing dramatically over the past decade. The annual cost of admissions increased over five-fold for GP and over three-fold for IBS from 2004-2013. This is primarily a result of a steady rise in the annual number of admissions for both diagnoses. The increase in average cost of each admission was not statistically significant. Admissions for related ICD-9 codes have also been increasing over time, suggesting that the increasing number of GP and IBS admissions do not result from changes in coding practices. Our findings emphasize the importance of cost-effective evaluation and management of children with functional and motility disorders. Further studies are needed to evaluate the cost of outpatient care for GP and IBS and to compare the cost-effectiveness of various treatment options.
Table 2.
Su1166 Rectal Prolapse and It's Clinical Characteristics in Children Kristen E. Cares, Mohammad El-Baba Background: Rectal prolapse (RP) is a protrusion of rectal mucosa through the anal sphincter. The last review of its characteristics, associated diagnoses, and management in children was published in 1988. Many medical advancements have taken place since that time and published reports describe medical conditions previously unknown to present with RP. Thus, our aim of the study was to perform a retrospective descriptive analysis of children diagnosed with RP. Methods: A retrospective chart review was conducted on children less than 18 years of age who were diagnosed with RP from January 1999 to May 2014 at Children's Hospital of Michigan. Information – including patients' demographics, associated condition, anthropometrics, and management – were analyzed. Results: 160 patients were diagnosed with RP. The mean age at diagnosis was 3 years, 11 months (Range = 2.5weeks to 17 years). 94 (59%) were males. Additional demographics are listed in Table 1. 8% were failure to thrive; 13% were premature. 45% required digital pressure for resolution of prolapse. 27% required medical personnel to manually reduce prolapse, or surgical correction. Constipation was the common underlying condition (87 patients; 54.4%). The second was idiopathic in 25 patients (15.6%), as no underlying cause was confirmed. Complete list of diagnoses is seen in Table 2. Cystic fibrosis was diagnosed in 4 patients (2.5%). In patients with constipation, most common complaint was prolonged straining (66%). 35 patients (22%) required surgical management. The types of surgical corrections are listed in Table 1. Mean age of patients that required surgical intervention was 4 years and 10 months. 12 patients (7.5%) failed their first surgical procedure. The most common diagnosis in patients who required multiple surgical procedures was idiopathic (5 patients), and 4
Su1167 Outcome Measures for Infant Colic - What Do Health Professionals Think? Nina Steutel, Judith Korterink, Marc A. Benninga, Miranda Langendam, Merit Tabbers Objectives and study Infant colic (IC) is a common problem with a prevalence of 5 - 25%. This self-limiting disorder can have negative long-term consequences such as increased susceptibility to abdominal pain, disturbed parent-infant interaction and even child abuse. To date, its etiology remains unknown, resulting in a wide variety in interventions. Previous
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AGA Abstracts
AGA Abstracts
nausea and/or vomiting and 41% had symptoms of anxiety or depression Results: ACNES treatment. 59% had one block, 13% two, 13% three, 4% four blocks and 9% five blocks. Eventually 4 patients underwent surgical intervention. Abdominal Pain intensity: Average pain decreased from 4.3 + 3 at baseline to 1.7 + 2 at first follow-up post-block (P<.002) (1.7 + 1.4 months after the first block). Degree of relief: At first follow up 12.5% reported no relief; 25 % reported minimal relief (0-30% pain reduction), 12.5% excellent relief (>75% pain reduction) and 50 % complete relief. Duration of relief: 77% percent reported immediate relief after the block on the day of the procedure, 42% had relief for1- 3 months, 20% for more than 6 months and 6.7% more than a year. Long term follow up. Taking all interventions for ACNES, at the time of the last follow up (7 + 2 months) : 52% of patients had poor abdominal pain reduction, 8% a significant reduction, 8% good reduction, 4% excellent pain reduction, and 21% were asymptomatic Associated GI symptoms after ACNES treatment: Among those with additional (non-ACNES related) GI symptoms 54% reported resolution of associated symptoms, 23% improved, 4% were worse, and 12.5% developed a new GI symptoms ( P< 0.02, compared to baseline). Conclusions: ACNES is a frequently overlooked reason for focal abdominal pain in patients diagnosed with FAP and IBS. ACNES pain may exacerbate the pain amplification related to underlying etiology and may be a treatable trigger. USG nerve block procedures are a viable treatment option, with significant immediate pain relief reported by most patients. Relapses are common and are treated with repeat blocks. A subset of patients experienced longer term relief of weeks to months. Resolution of the focal abdominal pain after treatment was also associated with improvement in other GI symptoms in a significant proportion of patients.
AGA Abstracts
research revealed that outcome measures used across therapeutic trials of IC are heterogeneous as well. In order to be able to compare results between trials and not to overlook important outcome measures, development of a core outcome set is necessary. Therefore, as a first step, we aimed to investigate which outcome measures are important to health professionals when treating IC. Methods In 2014 health professionals visiting two international pediatric conferences were personally invited to participate in our survey. One of our two investigators handed them a questionnaire on paper. They were asked to list up to 5 harmful and/or beneficial treatment outcomes, which they considered to be important and which guided their clinical decision making in both outpatient and inpatient setting. The questionnaire was completed at the conference. Answers were processed anonymously. Results 133 of 180 (74%) health professionals responded. They originated from 29 countries and included 63 pediatric gastroenterologists, 26 general pediatricians, 18 fellows, 4 residents, 4 nutritionists, 4 researchers, 2 neonatologists, 2 pediatric allergy specialists and 10 others. For the outpatient setting a total of 50 different outcome measures were reported - crying duration (63%), discomfort (26%) and sleeping time (19%) of the infant were considered to be the most relevant outcome measures. In the inpatient setting even 59 outcome measures were reported - crying duration (50%), duration of hospitalization (23%) and discomfort of the infant (17%) were considered as most important outcome measures. Conclusions This study clearly shows that there is a large variation of outcome measures used by health professionals worldwide when treating IC. Therefore, there is a need to achieve consensus for which further development of a core outcome set is necessary.
on endoscopy. Findings in these patients included gastritis 60% (17/28), esophagitis 39% (11/28) and duodenitis 7% (2/28). Among patients with gastritis, eosinophilia was noted in 52% (9/17). In univariate and multivariate analysis, there was no meaningful correlation between symptoms and/or screening laboratory values, and diagnosis of gastroparesis (Table 1). Additionally, in patients with gastroparesis, symptoms did not predict positive findings on endoscopy (Table 2). Conclusions: Clinically significant findings on endoscopy were common in both controls and gastroparetics. As more than one third of patients had findings on endoscopy, we conclude that upper endoscopy remains an important part of the evaluation process of patients with dyspeptic symptoms and suspected gastroparesis. As gross abnormalities were frequently not present with histologic changes, routine biopsy is required. It was not possible to identify a clinical algorithm to diagnose gastroparesis and identify those with endoscopic abnormalities based on symptoms and screening bloodwork alone. A comprehensive evaluation of children with dyspeptic symptoms including endoscopy with biopsy and solid phase gastric emptying scan is required to accurately make the diagnosis. Table 1: Univariate analysis showing no correlation between symptoms / laboratory values and diagnosis of gastroparesis
Su1168 Towards Optimal Dosing of Peppermint Oil (PO) in Irritable Bowel Syndrome (IBS): A Pilot Study of Menthol Pharmacokinetics (PK) Gregory L. Kearns, Susan Abdel-Rahman, Uttam Garg, Bruno P. Chumpitazi, Robert J. Shulman INTRODUCTION Menthol, the primary constituent in peppermint oil (PO) has been used to treat abdominal ailments dating to ancient Egypt, Greece and Rome. Meta-analyses support the efficacy of PO in treating adults with IBS. One randomized, double blind trial showed efficacy in children with IBS. Despite its use, little is known regarding optimal dosing. Our aim was to explore the PK of menthol in children with IBS to begin to delineate the appropriate range of dosing. METHODS We conducted a single site, pilot study of menthol PK following a single, 187 mg dose of PO (Colpermin®, Tillots Pharma AG; approximately 83 mg of menthol per capsule). Subjects with pediatric Rome III IBS (n=6, 7-15 yrs. of age) with no intercurrent illness were enrolled. Children were fasted overnight. A venous blood sample was obtained the following morning prior to PO ingestion and at 10 discrete time points following ingestion over a 12-hr post dose period. Menthol was quantitated from plasma using a validated, GC-MS technique (range of linearity = 5-1000 ng/ml; inter/intraassay coefficient of variation [CV] < 10%). Menthol PK parameters were determined using a standard noncompartmental approach (Kinetica v.5.1, Thermo Scientific) and examined using standard descriptive statistics. RESULTS PK parameters are summarized in the Table. Following a dose of PO, a substantial lag time (Tlag) was seen in all subjects for the appearance of menthol which in turn produced a delayed time of peak (Tmax) and plasma menthol concentration (Cmax). Tmax and Tlag were significantly more variable than the two parameters related to overall menthol exposure, Cmax and total area under the curve (AUC). The mean residence time (MRT) of menthol in blood was the least variable PK parameter (CV 15.4%). CONCLUSIONS Delayed appearance of menthol in plasma after oral PO administration in children is likely a formulation-specific event which, in IBS, could increase intestinal residence time of the active ingredient, likely affecting efficacy. This pilot study demonstrates the need to determine menthol PK in a larger group of children (and possibly adults) with IBS to define the impact of concentration versus exposure relationships for menthol to determine optimal dosing and thus, efficacy.
RUQ= right upper quadrant, ESR= erythrocyte sedimentation rate, CRP= C-reactive protein, TTG= tissue transglutaminase Table 2: Univariate analysis showing no meaningful relationship between symptoms / laboratory values and positive findings on endoscopy (Patients with Gastroparesis)
Su1169 Yield of Endoscopy in Pediatric Gastroparesis Tara A. Altepeter, Stephen Shaffer Background/Aims: Outside of post-infectious cases, the etiology of pediatric gastroparesis is poorly defined. Chronic inflammation is known to cause motility abnormalities, yet the incidence of significant upper GI tract inflammation in pediatric gastroparesis is unknown. The aim of the study was to assess the diagnostic yield of upper endoscopy in children with gastroparesis, as well as to develop a clinical model for gastroparesis using common symptoms and screening blood tests. Methods: We retrospectively reviewed charts of 196 patients aged 4-18yr evaluated for gastroparesis between 2009-2013. All patients completed a solid phase gastric emptying scan and upper endoscopy within a 12 month period. Gastroparesis was diagnosed by scintigraphy, using published normative data. We analyzed gross and histologic endoscopy findings. Data was collected on dyspeptic symptoms (abdominal pain, epigastric pain, nausea, vomiting, bloating, early satiety or appetite change, heartburn, refractory heartburn, regurgitation), as well as classic "red flag" symptoms such as nocturnal pain, right upper quadrant abdominal pain, unintentional weight loss, and dysphagia. Results of screening laboratory tests (hemoglobin, erythrocyte sedimentation rate, c-reactive protein, tissue transglutaminase IgA antibody) were also collected. Results: We analyzed 70 patients with gastroparesis and 126 controls. Clinically significant endoscopic findings were noted in 35% of controls (44/126) and 40% of gastroparetics (28/70), p=0.48. Of those with gastroparesis and histologic abnormality on biopsy, only 50% (14/28) had gross findings
AGA Abstracts
RUQ= right upper quadrant, ESR= erythrocyte sedimentation rate, CRP= C-reactive protein
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Su1165 The Rising Cost of Hospital Care for Children With Gastroparesis and Irritable Bowel Syndrome Peter L. Lu, Hayat Mousa Background: The cost of care for gastroparesis (GP) and irritable bowel syndrome (IBS) in adults has been increasing as the number and cost of hospital admissions for GP and IBS rise. This has not been studied in children. Our aim is to evaluate the cost of hospital care for children with GP and IBS. Methods: A retrospective review of the Pediatric Health Information System database was performed. Admissions with a diagnosis of GP (ICD-9 536.3), IBS (564.1), dyspepsia and other specified disorders of function of stomach (536.8), and unspecified functional disorder of stomach (536.9) from 2004-2013 were selected. The latter two diagnoses were included given the overlap in presentation of these diagnoses with GP and IBS. Number of admissions, demographic information, admission cost, and length of stay (LOS) were recorded. Costs were adjusted for inflation. Data was analyzed using one-way ANOVA, t-test, and linear regression. Results: 5,323 pediatric GP and 8,715 pediatric IBS patients were admitted during this time period. The IBS group had a higher proportion of females (64% vs. 55%, p<0.05) and IBS patients were older than GP patients (15.8y vs. 11.9y, p<0.05). Annual number of admissions for GP increased from 242 to 1,185 (p<0.0001) and total cost increased from $6,185,390 to $35,654,075 from 2004-2013 (p=0.0001). Annual number of admissions for IBS increased from 351 to 858 (p<0.0001) and total cost increased from $3,331,524 to $11,479,651 (p<0.0001). The average cost per admission for GP increased from $25,559 to $30,088 and for IBS increased from $9,492 to $13,380. However, only the increase in average cost for IBS was significant (p<0.01). LOS for IBS admissions did not change significantly and does not explain the increase in average cost. Annual number of admissions for related diagnostic codes (536.8 and 536.9) increased significantly from 2004-2013 as well (p<0.0001, p<0.0001). Conclusion: In this first evaluation of the cost of hospital care for GP and IBS in children, we found that the financial burden of hospital admissions for both diagnoses has been increasing dramatically over the past decade. The annual cost of admissions increased over five-fold for GP and over three-fold for IBS from 2004-2013. This is primarily a result of a steady rise in the annual number of admissions for both diagnoses. The increase in average cost of each admission was not statistically significant. Admissions for related ICD-9 codes have also been increasing over time, suggesting that the increasing number of GP and IBS admissions do not result from changes in coding practices. Our findings emphasize the importance of cost-effective evaluation and management of children with functional and motility disorders. Further studies are needed to evaluate the cost of outpatient care for GP and IBS and to compare the cost-effectiveness of various treatment options.
Table 2.
Su1166 Rectal Prolapse and It's Clinical Characteristics in Children Kristen E. Cares, Mohammad El-Baba Background: Rectal prolapse (RP) is a protrusion of rectal mucosa through the anal sphincter. The last review of its characteristics, associated diagnoses, and management in children was published in 1988. Many medical advancements have taken place since that time and published reports describe medical conditions previously unknown to present with RP. Thus, our aim of the study was to perform a retrospective descriptive analysis of children diagnosed with RP. Methods: A retrospective chart review was conducted on children less than 18 years of age who were diagnosed with RP from January 1999 to May 2014 at Children's Hospital of Michigan. Information – including patients' demographics, associated condition, anthropometrics, and management – were analyzed. Results: 160 patients were diagnosed with RP. The mean age at diagnosis was 3 years, 11 months (Range = 2.5weeks to 17 years). 94 (59%) were males. Additional demographics are listed in Table 1. 8% were failure to thrive; 13% were premature. 45% required digital pressure for resolution of prolapse. 27% required medical personnel to manually reduce prolapse, or surgical correction. Constipation was the common underlying condition (87 patients; 54.4%). The second was idiopathic in 25 patients (15.6%), as no underlying cause was confirmed. Complete list of diagnoses is seen in Table 2. Cystic fibrosis was diagnosed in 4 patients (2.5%). In patients with constipation, most common complaint was prolonged straining (66%). 35 patients (22%) required surgical management. The types of surgical corrections are listed in Table 1. Mean age of patients that required surgical intervention was 4 years and 10 months. 12 patients (7.5%) failed their first surgical procedure. The most common diagnosis in patients who required multiple surgical procedures was idiopathic (5 patients), and 4
Su1167 Outcome Measures for Infant Colic - What Do Health Professionals Think? Nina Steutel, Judith Korterink, Marc A. Benninga, Miranda Langendam, Merit Tabbers Objectives and study Infant colic (IC) is a common problem with a prevalence of 5 - 25%. This self-limiting disorder can have negative long-term consequences such as increased susceptibility to abdominal pain, disturbed parent-infant interaction and even child abuse. To date, its etiology remains unknown, resulting in a wide variety in interventions. Previous
S-425
AGA Abstracts
AGA Abstracts
nausea and/or vomiting and 41% had symptoms of anxiety or depression Results: ACNES treatment. 59% had one block, 13% two, 13% three, 4% four blocks and 9% five blocks. Eventually 4 patients underwent surgical intervention. Abdominal Pain intensity: Average pain decreased from 4.3 + 3 at baseline to 1.7 + 2 at first follow-up post-block (P<.002) (1.7 + 1.4 months after the first block). Degree of relief: At first follow up 12.5% reported no relief; 25 % reported minimal relief (0-30% pain reduction), 12.5% excellent relief (>75% pain reduction) and 50 % complete relief. Duration of relief: 77% percent reported immediate relief after the block on the day of the procedure, 42% had relief for1- 3 months, 20% for more than 6 months and 6.7% more than a year. Long term follow up. Taking all interventions for ACNES, at the time of the last follow up (7 + 2 months) : 52% of patients had poor abdominal pain reduction, 8% a significant reduction, 8% good reduction, 4% excellent pain reduction, and 21% were asymptomatic Associated GI symptoms after ACNES treatment: Among those with additional (non-ACNES related) GI symptoms 54% reported resolution of associated symptoms, 23% improved, 4% were worse, and 12.5% developed a new GI symptoms ( P< 0.02, compared to baseline). Conclusions: ACNES is a frequently overlooked reason for focal abdominal pain in patients diagnosed with FAP and IBS. ACNES pain may exacerbate the pain amplification related to underlying etiology and may be a treatable trigger. USG nerve block procedures are a viable treatment option, with significant immediate pain relief reported by most patients. Relapses are common and are treated with repeat blocks. A subset of patients experienced longer term relief of weeks to months. Resolution of the focal abdominal pain after treatment was also associated with improvement in other GI symptoms in a significant proportion of patients.
AGA Abstracts
research revealed that outcome measures used across therapeutic trials of IC are heterogeneous as well. In order to be able to compare results between trials and not to overlook important outcome measures, development of a core outcome set is necessary. Therefore, as a first step, we aimed to investigate which outcome measures are important to health professionals when treating IC. Methods In 2014 health professionals visiting two international pediatric conferences were personally invited to participate in our survey. One of our two investigators handed them a questionnaire on paper. They were asked to list up to 5 harmful and/or beneficial treatment outcomes, which they considered to be important and which guided their clinical decision making in both outpatient and inpatient setting. The questionnaire was completed at the conference. Answers were processed anonymously. Results 133 of 180 (74%) health professionals responded. They originated from 29 countries and included 63 pediatric gastroenterologists, 26 general pediatricians, 18 fellows, 4 residents, 4 nutritionists, 4 researchers, 2 neonatologists, 2 pediatric allergy specialists and 10 others. For the outpatient setting a total of 50 different outcome measures were reported - crying duration (63%), discomfort (26%) and sleeping time (19%) of the infant were considered to be the most relevant outcome measures. In the inpatient setting even 59 outcome measures were reported - crying duration (50%), duration of hospitalization (23%) and discomfort of the infant (17%) were considered as most important outcome measures. Conclusions This study clearly shows that there is a large variation of outcome measures used by health professionals worldwide when treating IC. Therefore, there is a need to achieve consensus for which further development of a core outcome set is necessary.
on endoscopy. Findings in these patients included gastritis 60% (17/28), esophagitis 39% (11/28) and duodenitis 7% (2/28). Among patients with gastritis, eosinophilia was noted in 52% (9/17). In univariate and multivariate analysis, there was no meaningful correlation between symptoms and/or screening laboratory values, and diagnosis of gastroparesis (Table 1). Additionally, in patients with gastroparesis, symptoms did not predict positive findings on endoscopy (Table 2). Conclusions: Clinically significant findings on endoscopy were common in both controls and gastroparetics. As more than one third of patients had findings on endoscopy, we conclude that upper endoscopy remains an important part of the evaluation process of patients with dyspeptic symptoms and suspected gastroparesis. As gross abnormalities were frequently not present with histologic changes, routine biopsy is required. It was not possible to identify a clinical algorithm to diagnose gastroparesis and identify those with endoscopic abnormalities based on symptoms and screening bloodwork alone. A comprehensive evaluation of children with dyspeptic symptoms including endoscopy with biopsy and solid phase gastric emptying scan is required to accurately make the diagnosis. Table 1: Univariate analysis showing no correlation between symptoms / laboratory values and diagnosis of gastroparesis
Su1168 Towards Optimal Dosing of Peppermint Oil (PO) in Irritable Bowel Syndrome (IBS): A Pilot Study of Menthol Pharmacokinetics (PK) Gregory L. Kearns, Susan Abdel-Rahman, Uttam Garg, Bruno P. Chumpitazi, Robert J. Shulman INTRODUCTION Menthol, the primary constituent in peppermint oil (PO) has been used to treat abdominal ailments dating to ancient Egypt, Greece and Rome. Meta-analyses support the efficacy of PO in treating adults with IBS. One randomized, double blind trial showed efficacy in children with IBS. Despite its use, little is known regarding optimal dosing. Our aim was to explore the PK of menthol in children with IBS to begin to delineate the appropriate range of dosing. METHODS We conducted a single site, pilot study of menthol PK following a single, 187 mg dose of PO (Colpermin®, Tillots Pharma AG; approximately 83 mg of menthol per capsule). Subjects with pediatric Rome III IBS (n=6, 7-15 yrs. of age) with no intercurrent illness were enrolled. Children were fasted overnight. A venous blood sample was obtained the following morning prior to PO ingestion and at 10 discrete time points following ingestion over a 12-hr post dose period. Menthol was quantitated from plasma using a validated, GC-MS technique (range of linearity = 5-1000 ng/ml; inter/intraassay coefficient of variation [CV] < 10%). Menthol PK parameters were determined using a standard noncompartmental approach (Kinetica v.5.1, Thermo Scientific) and examined using standard descriptive statistics. RESULTS PK parameters are summarized in the Table. Following a dose of PO, a substantial lag time (Tlag) was seen in all subjects for the appearance of menthol which in turn produced a delayed time of peak (Tmax) and plasma menthol concentration (Cmax). Tmax and Tlag were significantly more variable than the two parameters related to overall menthol exposure, Cmax and total area under the curve (AUC). The mean residence time (MRT) of menthol in blood was the least variable PK parameter (CV 15.4%). CONCLUSIONS Delayed appearance of menthol in plasma after oral PO administration in children is likely a formulation-specific event which, in IBS, could increase intestinal residence time of the active ingredient, likely affecting efficacy. This pilot study demonstrates the need to determine menthol PK in a larger group of children (and possibly adults) with IBS to define the impact of concentration versus exposure relationships for menthol to determine optimal dosing and thus, efficacy.
RUQ= right upper quadrant, ESR= erythrocyte sedimentation rate, CRP= C-reactive protein, TTG= tissue transglutaminase Table 2: Univariate analysis showing no meaningful relationship between symptoms / laboratory values and positive findings on endoscopy (Patients with Gastroparesis)
Su1169 Yield of Endoscopy in Pediatric Gastroparesis Tara A. Altepeter, Stephen Shaffer Background/Aims: Outside of post-infectious cases, the etiology of pediatric gastroparesis is poorly defined. Chronic inflammation is known to cause motility abnormalities, yet the incidence of significant upper GI tract inflammation in pediatric gastroparesis is unknown. The aim of the study was to assess the diagnostic yield of upper endoscopy in children with gastroparesis, as well as to develop a clinical model for gastroparesis using common symptoms and screening blood tests. Methods: We retrospectively reviewed charts of 196 patients aged 4-18yr evaluated for gastroparesis between 2009-2013. All patients completed a solid phase gastric emptying scan and upper endoscopy within a 12 month period. Gastroparesis was diagnosed by scintigraphy, using published normative data. We analyzed gross and histologic endoscopy findings. Data was collected on dyspeptic symptoms (abdominal pain, epigastric pain, nausea, vomiting, bloating, early satiety or appetite change, heartburn, refractory heartburn, regurgitation), as well as classic "red flag" symptoms such as nocturnal pain, right upper quadrant abdominal pain, unintentional weight loss, and dysphagia. Results of screening laboratory tests (hemoglobin, erythrocyte sedimentation rate, c-reactive protein, tissue transglutaminase IgA antibody) were also collected. Results: We analyzed 70 patients with gastroparesis and 126 controls. Clinically significant endoscopic findings were noted in 35% of controls (44/126) and 40% of gastroparetics (28/70), p=0.48. Of those with gastroparesis and histologic abnormality on biopsy, only 50% (14/28) had gross findings
AGA Abstracts
RUQ= right upper quadrant, ESR= erythrocyte sedimentation rate, CRP= C-reactive protein
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