- Email: [email protected]
Su1260 Prevalence of Functional Gastrointestinal Disorders – A Large Multisite Study in Colombian School Children
Su1260
were 80, 38, 41, and 20 episodes respectively, which are similar to previously published adult values (Shay S. Am J Gastroenterol 2004). Comparing this group with the GERD group, the two differed significantly in all reflux parameters, thereby validating the values for normal impedance (Table). Nineteen patients had positive SI. Of those, 12 patients had normal RI. Comparing patients with positive SI with and without high RI, the total and nonacid reflux did not differ significantly (Median episodes per 24 hrs for positive SI with and without high RI: Total: 52 vs 50 p=0.2, Non-acid: 17 vs 25 p=0.9, Acid: 42 vs 23 p<0.01, pH 20 vs 7 p<0.01). This suggests that the symptoms in these individuals were due to nonacid reflux. Furthermore, patients with positive SI and a normal RI, had significantly higher nonacid episodes than the control group (Median episodes for controls vs positive SI: Total: 21 vs 50 p<0.01, Non-acid: 9 vs 25 p<0.01, Acid: 12 vs 23 p=0.3, pH: 4 vs 7 p=0.2). This also points towards nonacid reflux as a mechanism for symptoms in these patients. Conclusion: We are reporting normal impedance parameters in children using a cohort with no GI symptoms. Our numbers discriminate well from patients with abnormal acid reflux burden. Our data also suggests that patients with positive SI have high nonacid reflux that may be contributing to their symptoms. Table: Reflux Episodes In Controls and GERD Patients
AGA Abstracts
Prevalence of Functional Gastrointestinal Disorders - A Large Multisite Study in Colombian School Children Miguel Saps, Diana Nichols-Vinueza, Jairo E. Moreno, Luis G. Vinasco, Carlos A. Velasco The prevalence of pediatric functional gastrointestinal disorders (FGIDs) in Latin America remains largely unknown. There have been few published studies with small sample size and poor external validity. Aims: To assess the prevalence and risk factors of FGIDS in children in several cities in Colombia. Methods: A large multisite study in school children. The QPGS was translated from English into Spanish with reverse translation into English following validated standard methods by our group. Adequate understanding of the terms used in the QPGS by the children was established. School-children of public and private schools of 7 geographically dispersed mid and large cities in Colombia (Cali, Sotavento, Pereira, Cucuta, Soledad, Pasto, Bogota) completed the Rome III Questionnaire of Pediatric Gastrointestinal Symptoms (QPGS). Sociodemographic, family structure information and medical history were obtained from parents. Anthropometrics were measured and children were plotted into growth curves. Children with a history of an organic GI disorder were excluded. Results: 3483 children were enrolled (mean age, 11.3 +2.2 years). 25.1% school children were diagnosed with FGIDs: 13.2% constipation, 4.9% irritable bowel syndrome, 2.6% functional abdominal pain/syndrome, 1.1% aerophagia, 1.1% abdominal migraine. Females (OR: 1.4 CI: 1.2-1.6), public school (OR: 1.3 CI 1.12-1.57), separated parents (OR: 1.22 CI 1.01-1.48), only child (OR: 1.2 CI: 1.1-1.6) were associated with risk for FGIDs. Malnutrition and growth failure were not significantly associated with FGIDs. Conclusion: This is the first multisite city to investigate the prevalence of FGIDs in Latin American children. FGIDs are common in Colombian school children. Female gender, attending public school, children of separated parents and being an only child were associated with a higher risk for FGIDs.
* Reflux episodes in GERD patients were significantly different from controls, p<0.05 Su1263
Su1261
Bacterial Overgrowth in Patients With Antro-Duodenal Motility Disorders Sean Trauernicht, Sergio Pinillos, Leonel Rodriguez, Rachel L. Rosen, Anees Siddiqui, Samuel Nurko
Pain Response At the End of First Week of Treatment Predicts Outcome in Children With Functional Abdominal Pain (FAP) John Lavigne, Nader Youssef, Adrian Miranda, Samuel Nurko, Paul E. Hyman, Jose Cocjin, Carlo Di Lorenzo, Miguel Saps
It has been reported in adults that an abnormal antroduodenal (AD) motility can lead to small intestinal bacterial overgrowth. The pathophysiology is not well understood, but stasis of food and bacteria in the upper GI tract, use of acid suppression or the presence of Gtubes have been implicated as possible causes The aims of this study were to establish the prevalence of bacterial overgrowth in patients referred for AD manometry and to study the characteristics of those patients with bacterial overgrowth. Methods : We retrospectively reviewed the charts of 71 patients who underwent a simultaneous upper endoscopy with duodenal culture followed by placement of an AD manometry catheter. A positive duodenal culture was diagnosed when more than 10 (5) organisms per milliliter were present. To be considered as taking a PPI , patients needed to be on the medication for at least 30 days before the culture was taken. Results: The mean patient ages were 9.8+/- 0.6 years. They ranged from 1-20 years. Fifty one percen were female and 49% male. From these 71 patients, 35 (49.5%) had a positive culture and 33 (46.5%) had a negative culture (Table). There were 54 patients with an abnormal AD motility, and of those 48% had a positive culture.There were 9 patients with an absent phase III of the MMC, and 55% had a positive culture. From the 41 patients taking PPI, 20 (49%) had a positive culture. There were 35 patients with G-tubes, and 19 (54%) had a positive culture. At the time of the duodenal culture a serum folic acid was measured in 32 patients, and it was higher than 20ng/ml in 14 (44%). Using logistic regression we found that an abnormal AD motility, PPI use, presence of a G-tube, or high levels of folic acid were not significant predictors of bacterial overgrowth. Conclusions : There was a high prevalence of bacterial overgrowth in patients referred for AD manometry . We found that in our cohort bacterial overgrowth was not associated with the presence of dismotility. Future studies to better understand the factors that contribute to bacterial overgrowth in this population are needed. TABLE 1
Persistence of abdominal pain (AP) despite medical treatment is common. Children who fail initial drug treatment are often recommended a second drug or psychological therapy. Optimal time of treatment success/failure assessment is not defined. Establishing validity of patient AP reports and identifying predictors for early success/failure of treatment may allow to improve care. Early gains (EG) based on measuring clinically significant change (CSC) scores, defined as changes on severity from baseline to end of first week of treatment have been shown to predict response to psychotherapy in children. We examined the role of EG in AP intensity in assessing treatment response in FAP children. Methods: 74 FAP children (8-17 y) who participated in a randomized clinical trial on efficacy of amitriptyline (AM) in FAP completed daily AP reports using a visual analogue scale (VAS) at baseline and during 4 weeks of treatment. For each child, a "reliable change index" (RCI) for the VAS that accounts for test-retest reliability of AP reports was calculated. Patients with significant RCIs have < 5% chance that rate improvement is due to imperfect reliability of the AP measure. Results: Mean one-week test-retest reliability (mean r =0 .77) of VAS for the placebo group was used to determine CSC values and child RCIs. CSC for 100 mm VAS was 18.66 points. Two RCI values were calculated per child: EG from baseline to week 1 and improvement from baseline to week 4 (end of trial). Children achieving CSC for the whole trial: 16/ 37 AM group vs. 9/37 placebo group (p= .085). 19/74 (25.7%) children achieved EG. 19/19 (100%) children who had significant EG, showed a clinically significant gain from baseline to week 4 (OR 9.0, 95%CI 3.1-25.9) and only 6/ 55 (10.9%) children without clinically significant EG, showed a gain at week 4. A clinically significant EG significantly predicted clinically significant gains in the whole trial (chi-sq 33.5, p<.001). Children achieving EG were 4.2 times more likely to achieve CSC at end of trial. Children in AM group (35.1%) were more likely to achieve EG than placebo group (16.2%) (t=3.47, p = 0.06). EG were associated with lower anxiety level at baseline (t=2.74, p=0.007), but not with initial pain level, somatization tendencies, depression, gender, or functional impairment. Conclusion: The use of CSC scores to calculate EG at the end of the first week of treatment significantly predicts response to treatment in children with FAP. EG assessment may be a useful tool to optimize treatment by establishing time to follow up and the minimum interval of time recommended for treatment modification in refractory cases. Su1262 Defining Normal Impedance Parameters in Children Meenakshi Ganesh, Rachel L. Rosen, Carly Milliren, Samuel Nurko Multichannel Intraluminal Impedance (MII) with pH is the gold standard for diagnosis of gastroesophageal reflux; however, normal impedance parameters for children have not been established. A positive symptom index (SI) has therefore been used as a criteria for pathologic reflux, athough the impedance characteristics of those patients have not been well defined.Aims:1. Define impedance parameters in children without reflux ("controls"). 2. Compare those with patients with reflux ("GERD"), defined only by reflux index (RI) >6%. 3 Determine if patients with a positive SI have increased number of reflux episodes independent of their RI. Methods:We reviewed all MII studies performed between 200413 to identify control and GERD patients. We excluded patients on acid suppression therapy, with enteral tubes, history of GI surgeries, or underlying systemic diseases. The indications for MII included cough and hoarseness. For aim 1, we included those with RI <6%, no GI symptoms, and normal esophageal biopsies as controls. For aim 2, GERD patients were defined as those with RI >6%. For aim 3, we included patients with a positive SI independent of their RI. Results: We identified 463 patients who underwent MII study. Of those, 31 patients fulfilled criteria for inclusion as "controls" and 36 as "GERD". The mean age of controls was 6±4 yrs, of GERD patients, 7±4 yrs; the two were not significantly different. In the control group, the 95th percentiles for total, nonacid, acid and pH only episodes
AGA Abstracts
Su1264 High Resolution Manometry With Impedance: A Novel Tool to Diagnose Rumination Syndrome and Define Its Subtypes Rachel L. Rosen, Leonel Rodriguez, Samuel Nurko Background: Differentiating reflux from rumination is difficult and equivocal cases often require invasive testing, including antroduodenal manometry, to confirm the presence of R waves. However, this test is invasive and not available at all institutions. We propose that prolonged high resolution esophageal manometry with impedance (HRM-MII) is a novel, superior test to diagnose rumination that not only identifies R waves but more importantly documents retrograde esophageal fluid movement which allows for differentiation of true
S-418
were 80, 38, 41, and 20 episodes respectively, which are similar to previously published adult values (Shay S. Am J Gastroenterol 2004). Comparing this group with the GERD group, the two differed significantly in all reflux parameters, thereby validating the values for normal impedance (Table). Nineteen patients had positive SI. Of those, 12 patients had normal RI. Comparing patients with positive SI with and without high RI, the total and nonacid reflux did not differ significantly (Median episodes per 24 hrs for positive SI with and without high RI: Total: 52 vs 50 p=0.2, Non-acid: 17 vs 25 p=0.9, Acid: 42 vs 23 p<0.01, pH 20 vs 7 p<0.01). This suggests that the symptoms in these individuals were due to nonacid reflux. Furthermore, patients with positive SI and a normal RI, had significantly higher nonacid episodes than the control group (Median episodes for controls vs positive SI: Total: 21 vs 50 p<0.01, Non-acid: 9 vs 25 p<0.01, Acid: 12 vs 23 p=0.3, pH: 4 vs 7 p=0.2). This also points towards nonacid reflux as a mechanism for symptoms in these patients. Conclusion: We are reporting normal impedance parameters in children using a cohort with no GI symptoms. Our numbers discriminate well from patients with abnormal acid reflux burden. Our data also suggests that patients with positive SI have high nonacid reflux that may be contributing to their symptoms. Table: Reflux Episodes In Controls and GERD Patients
AGA Abstracts
Prevalence of Functional Gastrointestinal Disorders - A Large Multisite Study in Colombian School Children Miguel Saps, Diana Nichols-Vinueza, Jairo E. Moreno, Luis G. Vinasco, Carlos A. Velasco The prevalence of pediatric functional gastrointestinal disorders (FGIDs) in Latin America remains largely unknown. There have been few published studies with small sample size and poor external validity. Aims: To assess the prevalence and risk factors of FGIDS in children in several cities in Colombia. Methods: A large multisite study in school children. The QPGS was translated from English into Spanish with reverse translation into English following validated standard methods by our group. Adequate understanding of the terms used in the QPGS by the children was established. School-children of public and private schools of 7 geographically dispersed mid and large cities in Colombia (Cali, Sotavento, Pereira, Cucuta, Soledad, Pasto, Bogota) completed the Rome III Questionnaire of Pediatric Gastrointestinal Symptoms (QPGS). Sociodemographic, family structure information and medical history were obtained from parents. Anthropometrics were measured and children were plotted into growth curves. Children with a history of an organic GI disorder were excluded. Results: 3483 children were enrolled (mean age, 11.3 +2.2 years). 25.1% school children were diagnosed with FGIDs: 13.2% constipation, 4.9% irritable bowel syndrome, 2.6% functional abdominal pain/syndrome, 1.1% aerophagia, 1.1% abdominal migraine. Females (OR: 1.4 CI: 1.2-1.6), public school (OR: 1.3 CI 1.12-1.57), separated parents (OR: 1.22 CI 1.01-1.48), only child (OR: 1.2 CI: 1.1-1.6) were associated with risk for FGIDs. Malnutrition and growth failure were not significantly associated with FGIDs. Conclusion: This is the first multisite city to investigate the prevalence of FGIDs in Latin American children. FGIDs are common in Colombian school children. Female gender, attending public school, children of separated parents and being an only child were associated with a higher risk for FGIDs.
* Reflux episodes in GERD patients were significantly different from controls, p<0.05 Su1263
Su1261
Bacterial Overgrowth in Patients With Antro-Duodenal Motility Disorders Sean Trauernicht, Sergio Pinillos, Leonel Rodriguez, Rachel L. Rosen, Anees Siddiqui, Samuel Nurko
Pain Response At the End of First Week of Treatment Predicts Outcome in Children With Functional Abdominal Pain (FAP) John Lavigne, Nader Youssef, Adrian Miranda, Samuel Nurko, Paul E. Hyman, Jose Cocjin, Carlo Di Lorenzo, Miguel Saps
It has been reported in adults that an abnormal antroduodenal (AD) motility can lead to small intestinal bacterial overgrowth. The pathophysiology is not well understood, but stasis of food and bacteria in the upper GI tract, use of acid suppression or the presence of Gtubes have been implicated as possible causes The aims of this study were to establish the prevalence of bacterial overgrowth in patients referred for AD manometry and to study the characteristics of those patients with bacterial overgrowth. Methods : We retrospectively reviewed the charts of 71 patients who underwent a simultaneous upper endoscopy with duodenal culture followed by placement of an AD manometry catheter. A positive duodenal culture was diagnosed when more than 10 (5) organisms per milliliter were present. To be considered as taking a PPI , patients needed to be on the medication for at least 30 days before the culture was taken. Results: The mean patient ages were 9.8+/- 0.6 years. They ranged from 1-20 years. Fifty one percen were female and 49% male. From these 71 patients, 35 (49.5%) had a positive culture and 33 (46.5%) had a negative culture (Table). There were 54 patients with an abnormal AD motility, and of those 48% had a positive culture.There were 9 patients with an absent phase III of the MMC, and 55% had a positive culture. From the 41 patients taking PPI, 20 (49%) had a positive culture. There were 35 patients with G-tubes, and 19 (54%) had a positive culture. At the time of the duodenal culture a serum folic acid was measured in 32 patients, and it was higher than 20ng/ml in 14 (44%). Using logistic regression we found that an abnormal AD motility, PPI use, presence of a G-tube, or high levels of folic acid were not significant predictors of bacterial overgrowth. Conclusions : There was a high prevalence of bacterial overgrowth in patients referred for AD manometry . We found that in our cohort bacterial overgrowth was not associated with the presence of dismotility. Future studies to better understand the factors that contribute to bacterial overgrowth in this population are needed. TABLE 1
Persistence of abdominal pain (AP) despite medical treatment is common. Children who fail initial drug treatment are often recommended a second drug or psychological therapy. Optimal time of treatment success/failure assessment is not defined. Establishing validity of patient AP reports and identifying predictors for early success/failure of treatment may allow to improve care. Early gains (EG) based on measuring clinically significant change (CSC) scores, defined as changes on severity from baseline to end of first week of treatment have been shown to predict response to psychotherapy in children. We examined the role of EG in AP intensity in assessing treatment response in FAP children. Methods: 74 FAP children (8-17 y) who participated in a randomized clinical trial on efficacy of amitriptyline (AM) in FAP completed daily AP reports using a visual analogue scale (VAS) at baseline and during 4 weeks of treatment. For each child, a "reliable change index" (RCI) for the VAS that accounts for test-retest reliability of AP reports was calculated. Patients with significant RCIs have < 5% chance that rate improvement is due to imperfect reliability of the AP measure. Results: Mean one-week test-retest reliability (mean r =0 .77) of VAS for the placebo group was used to determine CSC values and child RCIs. CSC for 100 mm VAS was 18.66 points. Two RCI values were calculated per child: EG from baseline to week 1 and improvement from baseline to week 4 (end of trial). Children achieving CSC for the whole trial: 16/ 37 AM group vs. 9/37 placebo group (p= .085). 19/74 (25.7%) children achieved EG. 19/19 (100%) children who had significant EG, showed a clinically significant gain from baseline to week 4 (OR 9.0, 95%CI 3.1-25.9) and only 6/ 55 (10.9%) children without clinically significant EG, showed a gain at week 4. A clinically significant EG significantly predicted clinically significant gains in the whole trial (chi-sq 33.5, p<.001). Children achieving EG were 4.2 times more likely to achieve CSC at end of trial. Children in AM group (35.1%) were more likely to achieve EG than placebo group (16.2%) (t=3.47, p = 0.06). EG were associated with lower anxiety level at baseline (t=2.74, p=0.007), but not with initial pain level, somatization tendencies, depression, gender, or functional impairment. Conclusion: The use of CSC scores to calculate EG at the end of the first week of treatment significantly predicts response to treatment in children with FAP. EG assessment may be a useful tool to optimize treatment by establishing time to follow up and the minimum interval of time recommended for treatment modification in refractory cases. Su1262 Defining Normal Impedance Parameters in Children Meenakshi Ganesh, Rachel L. Rosen, Carly Milliren, Samuel Nurko Multichannel Intraluminal Impedance (MII) with pH is the gold standard for diagnosis of gastroesophageal reflux; however, normal impedance parameters for children have not been established. A positive symptom index (SI) has therefore been used as a criteria for pathologic reflux, athough the impedance characteristics of those patients have not been well defined.Aims:1. Define impedance parameters in children without reflux ("controls"). 2. Compare those with patients with reflux ("GERD"), defined only by reflux index (RI) >6%. 3 Determine if patients with a positive SI have increased number of reflux episodes independent of their RI. Methods:We reviewed all MII studies performed between 200413 to identify control and GERD patients. We excluded patients on acid suppression therapy, with enteral tubes, history of GI surgeries, or underlying systemic diseases. The indications for MII included cough and hoarseness. For aim 1, we included those with RI <6%, no GI symptoms, and normal esophageal biopsies as controls. For aim 2, GERD patients were defined as those with RI >6%. For aim 3, we included patients with a positive SI independent of their RI. Results: We identified 463 patients who underwent MII study. Of those, 31 patients fulfilled criteria for inclusion as "controls" and 36 as "GERD". The mean age of controls was 6±4 yrs, of GERD patients, 7±4 yrs; the two were not significantly different. In the control group, the 95th percentiles for total, nonacid, acid and pH only episodes
AGA Abstracts
Su1264 High Resolution Manometry With Impedance: A Novel Tool to Diagnose Rumination Syndrome and Define Its Subtypes Rachel L. Rosen, Leonel Rodriguez, Samuel Nurko Background: Differentiating reflux from rumination is difficult and equivocal cases often require invasive testing, including antroduodenal manometry, to confirm the presence of R waves. However, this test is invasive and not available at all institutions. We propose that prolonged high resolution esophageal manometry with impedance (HRM-MII) is a novel, superior test to diagnose rumination that not only identifies R waves but more importantly documents retrograde esophageal fluid movement which allows for differentiation of true
S-418