Abstracts S544
1446
Correlation of Incidental Gastrointestinal Wall Th ickening at Computer Tomography to Endoscopy and Serum Albumin Levels
Hiral Shah, MD,1 Anchal Sud, MD,3 Bikram Bal, MD,1 Raman Battish, MD,1 Michael Gold, MD, FACG,1 Timothy Koch, MD, FACG2. 1. Washington Hospital Center, Division of Gastroenterology, Washington, DC; 2. Washington Hospital Center, Department of Surgery, Washington, DC; 3. Washington Hospital Center/Georgetown University Hospital Department of Internal Medicine, Washington, DC.
Purpo: Widespread u of CT imaging frequently leads to incidental fi nd-ing of gastrointestinal wall thickening (GIWT). Th e signifi cance of the fi ndings is unclear and is commonly further investigated with costly and invasive endoscopic procedures. Currently there are no guidelines on the approach to such radiology results. Current published literature primarily address non-specifi c colonic CT results. Th e aim of our study is to deter-mine the correlation of incidental GIWT to endoscopy and rum albumin levels.
Methods:Th is is a retrospective computer record review from January 2007 - January 2008 of patients who had CT reports of stomach, duodenum, ileum and colon thickening. Patients with follow up EGD or colonoscopy to investigate CT results were included in the study. Sex, age, CT reports, endos-copy fi ndings, pathology reports and rum albumin were recorded. Results: Th ere were a total of 69 patients. 19 patients had CT imaging show-ing thickened stomach or duodenum: 3 with normal EGD, 1 adenocarcinoma, 7 with ulcer dia, 9 non-specifi c duodenitis/gastritis. Th e remaining 50 patients had CT fi ndings of thickened colon or ileum: 18 with normal colonos-copy; 6 new diagnosis of infl ammatory bowel dia new; 6 adenocarcinoma;
13 non-specifi c colitis, 5 ischemic colitis. All diagnos had histology con-fi rmation. Of the patients with normal colonoscopy, 7 (39%) had low rum albumin (< 3.5 gm/dL). Overall, 30% of patients with abnormal CT reports showing GIWT had normal histology and endoscopic appearance and biopsy; 30% had non-specifi c infl ammation of no clinical signifi cance. Serum albumin correlation to endoscopic appearance: Chi-squared 2x2 p = 0.46 & p = .61 for EGD and colonoscopy respectively.
Conclusion: CT imaging commonly prompts endoscopic evaluation. Bad on our review, the majority of patients (60%) with incidental GIWT on CT did not correlate with any clinical relevance as confi rmed by endoscopy and histology. Further, rum albumin did not appear to have an eff ect on
endo-scopic appearance. However, CT fi ndings of upper gastrointestinal reports of GIWT appear to have a stronger correlation with abnormal EGD fi nd-ings. 6 cas did prompt endoscopic workup unveiling a new diagnosis of infl ammatory bowel dia. Guidance regarding endoscopic practice with CT fi ndings of GIWT remains spar and needs to be better defi ned for practicing gastroenterologists. Th e upper GI tract may be more nsitive to luminal CT fi ndings than the colon. Further studies are needed to evaluate the eff ects of low rum albumin in relation to CT fi ndings of gastrointesti-nal thickening.
1447
Post-operative Gastrointestinal Complications and Endoscopic Outcome Following Roux-en-Y Gastric Bypass Surgery
Urmee Siraj, MD. Wright State University, Beavercreek, OH.
Purpo: Roux-en-Y Gastric Bypass (RYGB) is the most common bariatric operation which is eff ective in reducing weight and associated morbidity. However, RYGB surgery can be associated with a variety of complications either due to surgery or becau of the alteration in the upper gastrointestinal anatomy. Diagnosis of the complications is oft en challenging due to the lack of sp
ecifi city of the prenting signs and symptoms.Purpo is to determine the yield of upper endoscopy in patients with RYGB prenting with the symp-toms of gastrointestinal (GI) bleeding, abdominal pain, naua, vomiting, early satiety and dysphagia.
Methods: Clinical data of all patients who underwent RYGB surgery and had an endoscopic evaluation at Miami Valley Hospital between January 1998 - January 2008 was reviewed.Results: During the study period 355 patients underwent RYGB surgery and 64 (18%) underwent EGD for any GI symptoms. Th ere were 55 (86%) female with the median age of 47 years. Positive endoscopic fi ndings were noted in 44 (69%) patients which include marginal ulcers in 5 (11%), bleeding gastric pouch in 3 (7%), anastomotic site bleeding in 4 (9%), esophagitis in 2 (4%), gastritis in 3 (7%), erosions in 2 (4%), and stomal stenosis in 25 (58%). Mean time interval between RYGB and prentation with GI symptoms was 7 weeks in patients with positive fi ndings on EGD as compared to 20 weeks in patients with negative EGD and this diff erence was statistically signifi cant (P < 0.02). Conclusion: EGD is a safe and appropriate initial test to evaluate patients who prent with upper GI symptoms aft er RYGB surgery. Our data suggests that upper endoscopy yield is higher in patients who prent early aft er RYGB sur-gery compare to tho who prent late.
PEDIATRICS
1448
Clostridium diffi cile Infection in Children: A Community-bad Epidemio-logical Study
Sahil Khanna, MBBS, Scott Aronson, MD, Patricia Kammer, CCRP, Robert Orenstein, M.D., Darrell Pardi, M.D. Mayo Clinic College of Medicine, Rochester, MN.
Purpo: Numerous recent reports have shown increasing incidence and verity of Clostridium diffi cile infection (CDI), as well as decread respon to metronidazole, in adults. Little is known about the epidemiology or respon to treatment of CDI in children.
Methods: A computerized diagnostic index, which captures all inpatient and outpatient medical encounters for Olmsted County, MN residents, was ud to identify children with CDI. All cas <18 years of age who were county residents from 1991-2005 were reviewed to confi rm the diagnosis, docu-ment demographic data, and asss risk factors and treatment outcomes. Defi nite CDI was defi ned as a positive C. diffi cile stool assay or pudo-membranous colitis on endoscopy or histology. Severe dia was defi ned by a WBC > 15,000, creatinine ri of > 50% from baline, ICU admission, need for surgery, or death. Hospital acquired CDI was defi ned as ont of symptoms >=48 hours aft er hospitalization, or within 4 weeks from hospital discharge.
Results: 8% of all cas (30/385) occurred in children. 60% of pediatric cas occurred aft er 2001. Median age at symptom ont was 19 months (range: 1 month to 17 years), and 43% were female. 73% of cas occurred in children < 3 years of age. 27% had hospital-acquired infection and 83% had community acquired infection, of which 4 ended up being hospitalized for CDI. 25 of 30 (83%) had been treated with an antibiotic within 90 days of CDI diagnosis. 8/30 (27%) had a recent hospitalization. 17% children had neither recent hos-pitalization nor antibiotic exposure. Metronidazole was the initial treatment in 22/30 cas (71%) and oral vancomycin in 5 cas (16%). Th ere was no documented treatment in the other 3 cas. 22% of the children treated with metronidazole had one or more recurrence, and 20% treated with vancomycin had a recurrence. Th ere were no documented changes in the initial treatment cour due to non-respon. Th ere were 4 vere cas, all defi ned by leukocyte count > 15,000. Of the vere cas, 2 were already in the hospital and 1 was hospitalized for CDI. All vere cas responded to initial therapy with no complications. One vere ca had 2 recurrences.
Conclusion: In this population-bad cohort, CDI was uncommon in chil-dren from 1991-2005, although there was a signifi cant increa in cas aft er 2001. A substantial fraction of cas were community acquired, and would be misd if hospital information was the primary source of data. Se
vere infec-tion was uncommon, responded to standard therapy and lead to no com-plications. Metronidazole was the most common treatment, and there were no diff erences in respon or recurrence rates between metronidazole and vancomycin.
零是不是正数
Th is rearch was supported by an industry grant from ViroPharma.
Abstracts S545
1449
Children with Small Bowel Lacta Enzyme Defi ciency Have Positive Genetic Maker for Lacto Intolerance the C/T -13910 Hypolactasia Variant
Bisher Abdullah, MD. Mary Bridge Children’s Hospital and Health Center, Tacoma, WA.
Purpo: Primary lacto intolerance is associated with C/T -13910, an autosomal recessive genetic variant prent upstream of the lactaphlori-zin hydrola (LPH) gene. The LPH enzyme is responsible for the break-down of lacto in the gut. In adults, the C/T -13910 variant is associated with adult ont lacta non-persistence and correlates with reduced LPH activity. However, the prence of the C/T -13190 hypolactasia variant (HLV) in the pediatric population with lacta non-p
ersistence has not been studied.
Methods: We evaluated 24 pediatric subjects with suspected lacto intoler-ance between the age 1.6 to 18 years (median 11.5), referred to the pediatric gastroenterology clinic with abdominal pain and or diarrhea. Genetic maker for lacto intolerance the C/T -13910 hypolactasia variant, jejuneal biopsies and disaccharida analysis were performed in all patients to elucidate the value of genotyping in clinical practice when identify individuals with lacto non-persistence.
Results: Of the twenty-four individuals with suspected lacto non-persistence ven (29%) were positive for the genetic marker C/C-13910 and 17 were nega-tive. Of the negative individuals, ven were heterozygous C/T-13910 and 10 were homozygous T/T -13910. 100% of the C/T -13910 HLV positive children (n=5) displayed very low-to-low jejuneal LPH enzyme activity (median: 2.6; range: 1.2 to 14.6 micro m/min/gm protein). Th e median age of the children with verifi ed lacto non-persistence was higher 13 vs. 10 years of age. Seventy-one percent of the subjects with suspected lacto intolerance were negative for the C/T-13910 HLV. Only two individuals testing negative for the variant had low jejuneal LPH activity, suggesting that the individuals had a condary reason for their lacto intolerance.
Conclusion: In summary, of the pediatric patients referred with suspected lacto intolerance, 71% of the individuals did not have primary lacto non-persistence as evidenced by negative C/T-13910 HLV status, suggesting that the other possible diagnosis may explain the subject’s complaints. All of the biopsy-proven lacta non-persistence subjects were also C/T-13910 HLV pos-itive indicating the prence of primary hypolactasia in 29% of children with suspected lacto intolerance. Given the invasive nature of jejuneal biopsies to verify lacta defi ciency and the unreliability of indirect methods, such as the hydrogen breath test, utilizing genetic markers for evaluating primary lacto intolerance in the pediatric population may be a uful diagnostic tool.
1450
Nitazoxanide to Treat Exacerbations of Pediatric Infl ammatory Bowel Dia (IBD)
Alexandra Eidelwein, MD, Youhanna Al-Tawil, MD, Clarisa Cuevas, MD, Wendy Taylor, RN, MSN, CPNP, Molly Hann, MPH. Children’s Hospital Pediatric Gastroenterology, Knoxville, TN.
Purpo: Nitazoxanide (NTZ) is a thiazolide antibiotic indicated for the treat-ment of Cryptosporidium parvum and Giardia lamblia in adults and children as young as one year of age. NTZ also has excellent in vitro activity against anaerobic bacteria. Unlike many antibiotics ud in IBD, NTZ has a
潘彼得>欧阳修秋声赋unique pharmacokinetic profi le in which 2/3 of the drug concentrates in the bowel and 1/3 is absorbed, allowing for drug on both sides of the gastrointestinal lumen. Furthermore, NTZ is well tolerated, not associated with peripheral neuropathies, and does not induce Clostridium diffi cile dia. Th is paper documents our clinical experience utilizing NTZ in pediatric patients with exacerbations of IBD.
Methods: An IRB approved review of children with IBD experiencing dis-ea exacerbation and treated with NTZ. To qualify for evaluation, patients needed to be on at least maintenance 5-ASA therapy and prent with one of the following symptoms: 1) GI bleeding, 2) diarrhea, or 3) abdominal pain. Effi cacy was measured as resolution of prenting symptoms, and patient/ parent reported overall wellness at follow-up evaluation. Patients with a known infectious origin of dia like Clostridium diffi cile were excluded from the study.
Results: Twenty patients mean age 12 years (range 3-18) met the inclusion cri-teria. Of the, 9 had Crohn’s dia, 6 ulcerative colitis, and 5 indeterminate colitis. NTZ was dod 100-500 mg (age adjusted) BID for 5-14 days (mean 10 days), 8 patients also received a prednisone cour. Symptom prentation was as follows: 70% (14/20) GI bleeding, 60% (12/20) diarrhea, and 85% (17/20) abdominal pain; 25% (5/20), 35% (7/20), and 40% (8/20) prented with 1, 2, and 3 sympto
ms respectively. Effi cacy measures are detailed in Table 1. No signifi cant adver reactions to therapy were identifi ed.
Conclusion: Nitazoxanide with or without adjunctive steroids is well toler-ated and appears to improve symptoms associated with IBD exacerbations in pediatric patients. Further studies are warranted to confi rm this obrva-tion.
Disclosure: Dr Al-T awil- Unrestricted educational grant, Romark Laboratories. Dr Eidelwein, Dr Cuevas, Wendy T aylor, and Molly Hann have nothing to disclo.
1451
Th e Relationship of Steatosis Grade, Zone and Type to Key Histological Features in Children with Nonalcoholic Fatty Liver Dia
Christine Carter-Kent, MD,1 Lisa Yerian, MD,2 Elizabeth Brunt, MD,3 Paul Angulo, MD,4 Rohit Kohli, MD,5 Simon Ling, MD,6 Stavra Xanthakos, MD,5 Peter Whitington, MD,7 Phunchai Charatcharoenwitthaya, MD,4 Jason Yap, MD,6 Rocio Lopez, MS,8 Naim Alkhouri, MD,1 Arthur McCullough, MD,9 Ariel Feldstein, MD10. 1. Pediatric Gastroenterology, Cleveland Clinic, Cleveland, OH;
2. Department of Pathology, Cleveland Clinic, Cleveland, OH;
3. Department of Pathology and Immunology, Washington University, St. Louis, MO;
李白祖籍4. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN;九上语文作业本答案
5. Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH;
6. Division of Gastroenterology and Hepatology, Th e Hospital for Sick Children - Toronto, Toronto, ON, Canada;
7. Division of Gastroenterology and Hepatology, Children’s Memorial Hospital, Chicago, IL;
8. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH;
9. Digestive Dia Institute, Cleveland Clinic, Cleveland, OH; 10. Pediatric Gastroenterology and Cell Biology, Cleveland Clinic, Cleveland, OH.
Purpo:Th e relationship between the characteristics of hepatic steatosis and histological features o
f hepatocellular injury and fi brosis in children with nonalcoholic fatty liver dia has not been examined. Th us, the aims of this study were to establish the association between steatosis amount, type, and dis-tribution in pediatric NAFLD to various histopathological features of dia verity in a large well-characterized group of children with biopsy-proven NAFLD.
Methods: A total of 108 children with NAFLD en from 1995 to 2007 in fi ve centers in the US and Canada were studied. Other liver dias were excluded in all cas. Extensive clinical and laboratory data were collected. H&E and Masson’s trichrome were evaluated by two expert liver pathologists at parate and joint readings. Steatosis grade (0=< 5%, 1=5-33%, 2=>33-66%, 3=> 66%),
type (macro-, micro-vesicular, or mixed), and zonal distribution (zone 1,
Am J Gastroenterol 2009; 104:S545–S559; doi:10.1038/ajg.2009.492
Abstracts S546
zone 3, azonal or scattered, and pan-acinar) were determined for each patient. Th e NAFLD activity score (NAS) was calculated and fi brosis stage was scored using the 7-point scale propod by the NASH CRN.
Results: Th e median age of patients was 12yrs, 63% were boys and the median BMI 31 kg/m2. Fibrosis was prent in 87% (stage 3 in 20%). No patient had cirrhosis. Th e median NAS was 4. Mild (Grade 1), moderate (Grade 2) and vere (Grade 3) steatosis was prent in 37%, 34% and 24% of biopsies, respectively. Macrovesicular steatosis was prent in 81% of patients, while mixed pattern was prent in the other 19%. Pan-acinar was the most frequent distribution (40%), followed by azonal (27%). A positive correlation was found between steatosis grade and portal infl ammation (p= 0.018), but not with lob-ular infl ammation, ballooning, or fi brosis. For each one level increa in the grade of steatosis prent, the likelihood of having a portal infl ammation score of 2 incread by 2.3 folds (95% CI: 1.1, 4.8). Azonal (scattered lobular) steato-sis distribution was associated with prence of ballooning (p=0.03). Indeed, the patients were 13, 5, and 4.8 times more likely to hav
e any ballooning than tho with either zone one, three, or pan-acinar steatosis, respectively. Finally, children with mixed pattern of steatosis were 21 times more likely to have mega-mitochondria than tho with macrovesicular steatosis. (95% CI: 2.3, 204.9) Th ere was no relationship between steatosis type, and zone to stage of fi brosis.
Conclusion: Increasing verity of steatosis in children is associated with v-eral histological markers of steatohepatitis. Fibrosis and lobular infl ammation does not appear to be associated with hepatic steatosis characteristics.
1452
A Randomized, Open-Label, Parallel-Group Study to Determine the Phar-macokinetics (PK), Safety and Tolerability of Delayed-Relea Mesalamine Tablets in Children and Adolescents with Active Ulcerative Colitis (UC) Melvin Heyman, MD,1 George Ferry, MD,2 William Aronstein, PhD, MD,3 Funmi Ajayi, PhD,4 Guhan Balan, PhD,4 Barbara Kuzmak, PhD,4 Nancy Smith-Hall, PharmD,4 Harland Winter, MD5. 1. University of California San Francisco, San Francisco, CA; 2. Texas Children’s Hospital, Houston, TX; 3. CTI Clinical Trial & Consulting Services, Inc., Cincinnati, OH; 4. Procter & Gamble Pharmaceuticals, Inc., Mason, OH; 5. Mass General Hospital, Boston, MA. Purpo
: To characterize the PK of mesalamine (5-ASA) and N-Ac-5-ASA and to obtain safety and tolerability data following oral administration of delayed-relea mesalamine (Asacol® 400mg tablets) for 28 days given in divided dos every 12 hours to patients, ages 5-17 years, with active UC.
Methods: Pediatric patients, stratifi ed by age (5-8 and 9-17 years), were ran-domized to 30, 60, or 90 mg/kg/day of mesalamine. Plasma and urine samples were obtained prior to fi rst do and at various post do times during the 28 day study. Do proportionality and regression analys were ud to explore relationships between PK parameters, total daily do (mg), and age or body weight. Safety asssments included laboratory evaluations and collection of adver events (AEs).
Results: 34 patients (6 age 5-8 years; 28 age 9-17 years) were enrolled. Steady state was achieved for both analytes by Day 7. Key PK parameters are shown in table below. Th ere was a do related increa in PK parameters within each age group (e table). Do proportionality was achieved for 5-ASA and N-Ac-5-ASA Cmax and AUC using total daily do (mg) and actual weight adjusted do (mg/kg). Age or body weight showed no eff ect (p>0.05) on Cmax and AUC, using total daily do (mg) in the exposure-do regression relation-ship. Mean total urinary excretion (5-ASA plus N-Ac-5-ASA) ranged from 19-24.2% across the various do cohorts. No clinically relevant changes from ba
line were obrved in rum chemistry or hematology parameters in any of the 3 do groups. Th e frequency and verity of AEs were similar across do and age groups, and similar in nature to AEs obrved in the adult UC population.
Conclusion: PK parameters of 5-ASA and N-Ac-5-ASA were do propor-tional following administration of delayed-relea mesalamine for 28 days. Regression analysis further indicates that 5-ASA and N-Ac-5-ASA PK param-eters are a function only of total daily do (mg), without regard to age or body weight. Delayed-relea mesalamine was well-tolerated in the pediatric UC population included in this study.Disclosure: Dr Heyman - Consultant, Rearch Support - Procter & Gamble Pharmaceuticals, Inc. Dr Ferry - Consultant, Rearch Support - Procter & Gamble Pharmaceuticals, Inc. Dr Aronstein - Former employee of Procter & Gamble Pharmaceuticals, Inc. Dr Ajayi, Dr Balan, Dr Kuzmak, Dr Smith-Hall - Employees of Procter & Gamble Pharmaceuticals, Inc. Dr Winter - Consultant, Rearch Support - Procter & Gamble Pharmaceuticals, Inc.
1453
Paediatric Gastroesophageal Varices: A 10-years Experience
Barbara Bizzarri, MD, PhD, Laura Bianchi, MD, Filippo Boccellari, MD, Francesca Vincenzi, MD, Lau
ra Rizzuti, MD, Alessia Ghilli, MD, Fabiola Fornaroli, MD, Gian Luigi de’ Angelis, Prof. Gastroenterology and Endoscopy Unit, Parma, Italy.
Purpo: Gastroesophageal varices are a relatively infrequent evenience in paediatric age. Th e are usually graded bad on endoscopic criteria (location, form, fundamental and red color signs). Most common caus, pathogeneti-cally related to portal hypertension, are portal cavernoma (PC), cystic fi brosis (CF), autoimmune hepatitis (AH),chronic hepatitis for HBV or HCV infec-tion (CH) and congenital cardiopathies (CC) as tricuspidal pathology. Th e aim of the study is to report a 10-years experience of detection and treatment of paediatric gastroesophageal varices endoscopically found in our University Centre
Methods: Between 1998 and 2008, 25 patients (mean age 13.8 years; range 4 months- 18 years; 12 males, 13 females) underwent endoscopic diag-nosis of gastroesophageal varices during the follow-up for chronic hepa-topathy, casual examination, or subquently to various symptoms such as hematemesis or anaemia. All the patients had an endoscopic re-examination aft er one month, six months and then once a year. Th e interval between examinations was shortened or lengthened according to the variceal degree or treatment requirements. All the procedures were associated with proton pump inhibitors (PPI) therapy, 24-h fasting dietary regimen, and hematocrit detection.
Results: Twenty-fi ve cas of gastroesophageal varices were found at our Uni-versity centre. 14 patiens were aff ected by PC, 2 by AH, 5 by CF, and 4 by CH. Nine subjects showed F3 graded varices (markedly enlarged, nodular, or tumor shaped, with or without red color signs), 14 subjects F2 graded varices (mod-erately enlarged, beady), and 2 patients F1 graded varices. Gastroesophageal varices were found on mean oesophagus (9 patients), on terminal oesophagus and cardias (11), and on gastric fundus (5 patients). Six patients have been treated in emergency. 16 patients were treated with endoscopic variceal liga-tion (9 single ligation, 2 multiple ligation), 7 with variceal sclerotherapy. Two patients were only obrved in a follow-up protocol for the prence of F1 graded varices. No periprocedural complications were registered. Follow-up examinations showed regression of varice extension (17 patients) or residual F1 graded varices (6 patients).
Conclusion: E ndoscopic variceal ligation appears in our experience a valid alternative to sclerotherapy, which is traditionally associated with a higher num-ber of complications, such as perforations, strictures, mediastinitis and motility dysfunction. Unfortunately endoscopic variceal ligation is hardly be applicable
in very young children (under 1 year of age) becau of its dimension.
Abstracts S547
1454
Risk Factors Aff ect Outcome of Esophageal Injuries Caud by Caustic Ingestion in Children
Bashir Chomeili, Associate Professor of Pediatric Gastroenterology,1 Gholamreza Khatami, Professor of Pediatric Gastroenterology,2 Nasrolah Ostadian, Associate Professor of Pediatric Surgery,1 Pooya Chomeili, General Physician1. 1. Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 2. Tehran University of Medical Sciences, Tehran, Iran. Purpo: Ingestion of caustic materials is a worldwide challenge. Th e study aim was to identify the factors tha
t infl uence the outcome and prognosis of esophageal injuries aft er caustic ingestion in children.
Methods: We retrospectively reviewed all fi les of patients with history of caustic ingestion, their endoscopy results and follow up, who were admitted at Pediatrics Gastroenterology ward of Aboozar Children’s Hospital, Ahwaz, South -Western of Iran.
Results: During 10 years (October 1998- 2008) a total of 81 children (mean 2.7, range 1-5 y), 46 male, with history of caustic ingestion were enrolled in our study. Ingestable alkaline were drain, pipe, oven, grill and barbecue clean-ers, dish washer detergent and bleaches (Totally 61%) and acidic materials as drain openers, toilet cleaners and battery liquid (Totally 39%). Th e grade(G) of esophageal injury with regard of the ingested caustic materials was: G0 (history of ingestion, no injury, 18.5% in bleaches ingestion), G1 (edema and erythema, no transmucosal injury, 11% in very small amount acid and dish washer ingestion), G2 a/b (transmural injury, hemorrhage, circumferential ulceration, 64% in large amount of acid ingestion and vomiting ,alkaline inges-tion and delay in hospital admission), G3 a/ b (scattered deep ulceration and necrotic tissue 6.5% in large amount of alkaline ingestion and vomiting and/ or delay in hospital admission). Our follow up study showed that 11 (13.5%) cas developed esophageal stricture about 3 weeks aft er caustic ingestion despite proper treatment including dexametasone and antibiotic (Picture). Th e stric-ture co
nfi rmed by a cond endoscopy and contrast media study. All the 11 patients had grade 2+ esophageal injury. Dilatation by boogies or balloon was done for the cas and 2 of them needed further surgery treatment which 1 of them died.
Conclusion: Caustic ingestion by children is a worldwide preventable medical problem. In this study, we found that the alkali, large amount of ingested caus-tic agent, delayed referral to hospital and treatment including vomiting aft er ingestion worn the outcome and prognosis.Prevention is paramount. 1455
Electronic Mail Improves Physician-Patient Communication—Prelimi-nary Results of an Outpatient Survey河南高招考生服务平台
Zack Port, BS, Charis Sy, BS, Lillian Berns, BA, Patricia Brassard, RN, Doron Kahana, MD, FACG. Harbor-UCLA Medical Center, Torrance, CA. Purpo: Th e objective of this study was to asss patient attitudes concerning the eff ectiveness of electronic mail (Email) to facilitate physician-patient com-munication and its potential to aff ect patient compliance.
Methods: A twelve-question survey was created bad on previously published results. Th e tting was a Pediatric Gastroenterology clinic in a community-bad, county facility rving a large indigent
and immigrant population of low-economic status. Th e study enrolled either patients, 15-years-old and over, or their guardians (e.g. parents) in a prospective manner and the question-naire was administered either in person or over the telephone. Physicians were blinded to patient recruitment. Informed connt was obtained from all subjects and no protected health information (PHI) was indulged. Questions addresd the importance of physician-patient communication for health care, in general, and the role of Email for communication, in particular. Results: A total of forty-one patients and guardians were enrolled in this pilot study. Refusal rate was very low at 2%. One questionnaire was incomplete. Only 13% of our patients and guardians currently communicate with their physician by Email. However, 68% (95% CI: 52-82%) of patients and guardians would be interested in communicating with their physicians by Email, if available, and 80% believe that E mail can improve physician-patient communication. Th e vast majority of patients and guardians (87.5%; CI: 73-96%) continue to prefer communicating with their physicians by telephone, although 82% (95% CI: 67-93%) think that Email can improve communication and 74% (95% CI: 58-87%) think that their overall care would improve if they were able to com-municate with their physician via Email.
Conclusion: Physician-patient communication was viewed to be very impor-tant for the delivery of good health care. Th e vast majority of patients reported that Email can improve their communication
with their physician and that improved physician-patient communication would improve their overall care.
1456
Obstructive Jaundice Associated with Situs Inversus, Polysplenia, Biliary Atresia, Intestinal Malrotation and Immotile Cilia Syndrome
Naim Alkhouri, MD, Sarika Rohatgi, MD, Victor Uko, MD, Bijan Eghtesad, MD, Kdadakkal Radhakrishnan, MD. Cleveland Clinic Foundation, Cleveland, OH. Purpo: Th is is a 20 month old female who was born at 36 weeks by cesarean ction to a healthy non-consanguineous couple with father aged 46 years and mother aged 36 years. Prenatal ultrasound showed evidence of situs inversus and dextrocardia with normal cardiac anatomy at 18 weeks. Th e patient was admit-ted to the neonatal ICU shortly aft er her birth due to tachypnea and abdominal distension. She had no dysmorphic features and her clinical exam was signifi cant for a soft but distended abdomen. Initial laboratory evaluation revealed elevated total and direct bilirubin. Real time abdominal ultrasound showed three small rounded spleens clustered in the right upper quadrant with an enlarged midline
liver. Doppler studies of the abdominal and thoracic vasculature revealed the
Abstracts S548电脑搜索不到wifi
abnce of the normal intrahepatic inferior vena cava with a left sided hemia-zygous venous continuation and three hepatic veins draining into the heart. Abdominal CT Scans and X rays demonstrated situs inversus and small bowel dilatation. She underwent a gastrograffi n enema with evacuation of meconium plugs but had no improvement in her abdominal distension. An exploratory laparatomy was performed on her 4th day of life which revealed intestinal malro-tation, polysplenia, an atretic gall bladder, situs inversus and a distal ileal volvu-lus for which she had 30 cm of non-viable bowel rected. She underwent a Kasai portoenterostomy at 3 weeks of age due to extra hepatic biliary atresia (EHBA) evident by worning jaundice, deranged liver function tests and an abnormal HIDA scan. Nasal and bronchial brush biopsies were also obtained due to the prence of a chronic cough and the showed abnormal ciliary motility and abnce of the dynein arms consistent with immotile ciliary syndrome. She con-tinued to have acholic stools, vere failure to thrive and evidence of worning liver function as such she underwent a live donor liver transplant at the age of 9 months with her mother as the donor. She recovered quickly aft er her transplan-tation with resolution of her jaundice and signifi cant weight gain. Simultaneous occurrence of polysplenia, EHBA, situs inversus, and abnormal cilia is rare and has only been reported twice in the medical liter
ature. Patients with the embry-onic type of EHBA associated with other congenital abnormalities oft en do not do well with Kasai procedure, possibly due to the fact that their dia starts early in life and by the time they prent postnatally there is signifi cant level of biliary cirrhosis. To our knowledge, this is the fi rst ca report on successful liver transplantation in a patient with this constellation of abnormalities.
1457
Th e Eff ect of Ondantron and Dexamethasone for the Prevention of Postoperative Vomiting Following Endoscopic Retrograde Cholangiopan-creatography in Children
2009 Presidential Poster
Lindsay Smith, BS, MA,2 Jagdish Nachnani, MD,2 Stephanie Page, MD,1 James Daniel, MD,1 Owen Smith, MD, FACG1. 1. Children’s Mercy Hospital, Kansas City, MO; 2. University of Missouri-Kansas City School of Medicine, Kansas City, MO.
Purpo: Postoperative vomiting (POV) is a frequent pediatric problem occurring at highly variable rates following diff erent surgical procedures. Endoscopic retrograde cholangiopancreatography (ER
CP) is performed with increasing frequency in children and has become largely a therapeutic pro-cedure. POV is felt to result from both patient and procedure related factors. Although not a surgical procedure, pediatric ERCP utilizes general anesthesia and involves extensive pharyngeal manipulation; thus, POV may occur. Th is study was undertaken to determine the frequency of POV following ERCP in children and to evaluate two commonly ud regimens of POV prophylaxis. Methods: Th is is a retrospective review of 66 children who underwent ERCP on 68 occasions between 2005 and 2009. Demographic data was recorded, and patients were divided into two groups for the purpo of analysis. Th e choice of prophylaxis was at the discretion of the anesthesiologists bad on their asss-ment of risk. Group A consisted of 31 patients (17 female, mean age 9.65 years, range 3 months-14 years) who received prophylaxis for POV with ondantron alone. Group B was compod of 37 patients (21 female, mean age 9.72 years, range 4-14 years) who received prophylaxis with a combination of ondan-tron and dexamethasone. Univariate and multivariate analysis was performed to compare the two methods of prophylaxis and to identify the demographic traits, endoscopic fi ndings, and therapeutic interventions associated with POV. Results: POV occurred in 22/68 (32.4%) of children, including 14/31 (45.1%) of Group A and 8/37 (21.6%) of Group B. POV occurred with similar frequency in males and females. On univariate analysis a history of motion sickness (p=0.002) and increasing age (p=0.02) were associat
ed with POV. Th erapeu-tic interventions found to be risk factors for POV include common bile duct (CBD) sphincterotomy (p=0.005), CBD stone extraction (p=0.001), and com-bined endoscopic sphincterotomy with balloon sphincteroplasty (E ST/BS) (p=0.005). Wire guided cannulation (p=0.003), as well as the duration of ERCP (p=0.01), were associated with POV. On multivariate analysis prophylaxis with dexamethasone combined with ondantron was more eff ective than odan-tron alone in the prevention of POV (OR=0.155, 95% CI=0.033-0.722).Conclusion: 1. POV occurred in 32.3% of children following ERCP, a fi nding similar to many surgical procedures. 2. Prophylaxis with ondantron combined with dexamethasone was more eff ective in preventing POV than ondantron alone. 3. Motion sickness, increasing age, and duration of ERCP are POV risk fac-tors. 4. Th erapeutic interventions identifi ed as risk factors for POV included CBD sphincterotomy, EST/BS, CBD stone extraction, and wire guided technique. 1458
Long Term U of Adalimumab in Pediatric Crohn’s Dia: A Multi-Center Study
Joel Rosh, MD, FACG,1 Trudy Lerer, M.S.,2 James Markowitz, MD, FACG,2 Petar Mamula, MD,2 Marian Pfeff erkorn, MD,2 Anne Griffi ths, MD,2 Subra Kugathasan, MD,2 David Keljo, MD,2 Maria Oliva-Hemker, MD,2 Wallace Crandall, MD,2 Ryan Carvalho, MD,2 David Mack, MD,2 Jeff rey Hyams, MD2.
1. Pediatric Gastroenterology, Goryeb Children’s Hospital/Atlantic Health, Morristown, NJ;
2. Pediatric Infl ammatory Bowel Dia Collaborative Rearch Group, Hartford, CT.
Purpo: To characterize common indications, safety, tolerability, and clinical respon to the u of adalimumab (ADA) beyond one year in a multi- c enter cohort of pediatric patients with Crohn’s Dia (CD).
Methods: Data were obtained via retrospective chart review carried out by 12 sites of the Pediatric IBD Collaborative Rearch Group. Clinical, labora-tory, and demographic data were obtained on all CD patients in the respective practices who received at least one year of ADA. Indication for ADA, con-comitant medications and dia activity at baline and beyond 12 months were recorded for each patient using Physician Global Asssment (PGA) and PCDAI scores. Serious adver events, including surgery, hospitalization, infection, malignancy, and death, were identifi ed.
Results: 24 patients (50% female) received at least one year of ADA. Mean age at CD diagnosis was 10.2 ± 2.4 yrs (6.6-16.4), fi rst ADA do was given at 4.1 ± 2.1 yrs (1.0-8.4) aft er diagnosis and duration of follow-up was 21.2 ±7.6 months (12-40). Most frequent induction regimens were 80/40 in 50%, 40/40 in 29% and 160/80 in 8% of patients. Most frequent maintenance dosing was 40 mg eve
柚子的功效和作用ry other week in 87.5% of patients, with 5% receiving weekly ADA. Infl iximab (IFX) treatment preceded ADA in all patients, with a mean of 9 IFX infusions (range 3-22). IFX was discontinued becau of loss of respon (42%) and infusion reaction or IFX intolerance (54%). Concomitant corticosteroids u was 33% at ADA baline, 8% at one year and 17% at end of follow-up. Concomitant immunomodulator (thiopurines/methotrexate) u was 71% at baline, 46% at 12 months and 37.5% at end of follow-up. Clinical outcomes measured by PGA at baline 12 months and end of follow-up showed 33% had mild/inactive dia at ADA baline compared to 87.5% at 12 months and end of study. Mean PCDAI scores at baline, 12 months and end of study were 28 ±12.5, 7.5 ±7.9, and 11.8 ±12.7 respectively. Th ere were no malignan-cies, rious infections or deaths in patients who received long-term ADA. Conclusion: ADA was a well-tolerated, eff ective and durable rescue therapy for moderate to vere pediatric CD patients previously treated with IFX. For the majority of this cohort, ADA maintained steroid free remission through a mean of 21 months with a decreasing u of concomitant immunomodulators. Prospective trials of ADA in pediatric patients with CD will be required to confi rm the results.
Disclosure: 1. Joel Rosh, MD: Centocor consultant and Speaker, Schering-Plough consultant, Astra Zeneca rearch support, Abbott consultant, rearch sup-port, speaker’s bureau, Shire speaker’s b
ureau, Prometheus speaker 2. Jeff rey Hyams, M.D. Centocor consultant, rearch support, speaker’s bureau, Astra Zeneca rearch support, Abbott consultant, rearch support, Elan consultant; UCB Consultant 3. Trudy Lerer, M.S.: Astra Zeneca rearch support 4. Anne Griffi ths, M.D. Centocor consultant, rearch support, speaker’s bureau, Scher-ing-Plough consultant, rearch support, speaker’s bureau, Abbott consultant, rearch support, speaker’s bureau, UCB consultant 5. Marian Pfeff erkorn, M.D. Centocor rearch support, Abbott rearch support 6. Subra Kugathasan, M.D. Centocor consultant, rearch support 7. David Mack, M.D.: Schering-Plough rearch support, speaker’s bureau, Astra Zeneca speaker’s bureau, Abbott speak-er’s bureau 8. Wallace Crandall, M.D.: Centocor: Rearch Support, Consultant; Abbott: Rearch Support 9. Maria Oliva-Hemker, M.D.: Centocor unrestricted grant, Abbott rearch support 10. James Markowitz, M.D.: Centocor consul-tant, rearch support, speaker’s bureau, Astra Zeneca rearch support, Abbott
Abstracts S549
consultant, rearch support, UCB consultant , Prometheus consultant, rearch support 11. David Keljo, MD, PhD: Nothing to disclo 12. Ryan Carvalho: Noth-ing to disclo 13. Petar Mamula: Nothing to disclo.
Th is rearch was supported by an industry grant from Abbott.
1459
Music Inspires Health: Obesity Prevention Multimedia Campaign for Adolescents
Benjamin Levy, MD,1 Elisa Wershba, MD,2 Tyler Wind, MD3. 1. University of Arizona, Tucson, AZ; 2. Phoenix Children’s Hospital, Phoenix, AZ; 3. Medical University of South Carolina, Charleston, SC.
Purpo: According to recent statistics from the CDC, obesity has become a huge problem in America for adolescents ages 12 to 18. Approximately 30.4 percent of adolescents are overweight and 15.5 percent are considered obe by BMI. Physicians and medical students at Emory University, University of Vir-ginia, and George Washington University recently organized a new national health education campaign called “Music Inspires Health” aimed at teaching middle school, high school, and college students about obesity prevention. Our goal was to educate young Americans from diff erent socioeconomic, racial, and educational backgrounds about nutrition and exerci through innovative and empowering multimedia projects.
Methods: A national online survey was created and administered on www. betwe
en 2006-2008. We conducted internet and paper surveys at both public and private schools to identify which music celebrities adolescents trust to prent accurate health information about obesity preven-tion. We also determined the most preferred multimedia education methods for each age group and gender. Finally, adolescents helped us choo an obesity prevention campaign name and slogan. Survey items were written by medical students, physicians, and public health experts on our national medical advi-sory board. Recruitment of 3,250 survey responders occurred via posters and emails to middle and high school student bodies. All paper and online survey responders in the study agreed to an informed connt form and fi lled out demographic info. Survey respon options were jumbled at random to pre-vent order bias. A sampling of the college campus that participated included: University of Virginia, University of North Carolina, University of Georgia, Georgia State, Morehou, Spelman, University of Florida, University of Texas, University of Arizona, UCLA, and UC Berkeley.
Results: U2, Dave Matthews Band, Will Smith, and Sheryl Crow were lected as the most trusted musicians to teach about obesity prevention. Middle school, high school, and college students preferred the terms exer-ci and nutrition instead of obesity prevention for any future health educa-tion campaign due to overu of the word “obesity” by the media. 74% of survey responders believe
d that health education short fi lms should be ud to encourage Americans to get into shape and reduce fat in their diets. 83% reported that a national health education concert tour would be the most innovative and empowering way to teach about obesity prevention. Conclusion: Th is formative obesity prevention rearch fi ne-tuned plans for our spring 2008 national health education concert tour, health education website, poster campaign, and short fi lms created by young directors in Hollywood.
1460
Predictors of Complications in Acute Pancreatitis (AP) in Children
M. Shah, MD,1 R. Saagar, MD,1 M. Klooster, MD,1 G. Yanni, MD,1 M. Siccama, MD,1 J. Beck, MD,1 D. Th orpe, MS2. 1. Pediatrics, Loma Linda University, Loma Linda, CA; 2. Epidemiology, Loma Linda University, Loma Linda, CA. Purpo: Review our experience with AP in children and identify predictors of Complications (C).
Methods: Retrospective review of charts of patients admitted to LL Children’s Hosp with AP between 02/02 and 03/09. AP was diagnod if patient had abdominal pain &/or vomiting and elevated rum amyla (SA) or lipa (SL) (at least 2x). Records were reviewed in detail including history, physical
exam-ination, lab tests, imaging studies and C. Univariate (UV) and m ultivariate (MV) logistic regression analys were done to determine if any clinical parameter could predict occurrence of C.
Results: Th ere were total 108 patients (50M: 58F) with AP during study period with age ranging from 9mo to 20yr (average 10.6 yr, 15% were <5yr and 58% were >10yr). Prenting symptoms were abdominal pain (82%), vomiting (71%), naua (51%), diarrhea (19%) and abdominal distension (2%). Peak SA was 496 IU/L and SL was 1173 IU/L. Of 108 cas, etiology could be identifi ed in 63 (gall stones-9, hereditary pancreatitis with abnormal PRESS or SPINK -9, trauma-9, autoimmune dis-9, cystic fi brosis-6, misc-23) while 45 (42%) were idiopathic. 75 (69%) patients developed at least one of the following C: abnor-mal liver enzymes-53, low rum albumin-40, ascites-20, pleural eff usion-24, infection-14, hyperglycemia-9, pudocyst-8, necrotizing pancreatitis-7 and others-17. 1 patient died of cau unrelated to pancreatitis. Average length of stay was 9.3(1-66) days. All except 2 patients had pancreatic imaging by either ultrasound (US), CT, MRCP or ERCP. US was abnormal in 47/90(52%), CT in 42/56(75%), MRCP in 12/20(60%) and ERCP in 7/7 (100%) cas. UV analysis of the eff ect of initial clinical measure on the occurrence of C revealed high AST on admission (OR1.08, p 0.005), low rum albumin (OR 0.24, p 0.003), number of imaging abnormalities (OR 2.83, p 0.001) and fi rst episode of recur-rent pancreatitis (OR 0.27, p 0.005 for su
bquent episode) were associated with occurrence of C. When analyzed using MV models, recurrence had no eff ect on C. Age and x also had no eff ect on C.
Conclusion: 1. AP in children is associated with signifi cant occurrence of C. 2. Following variables were associated with occurrence of C: high AST, low rum albumin and imaging abnormality (higher number of abnormalities were asso-ciated with incread risk of C). 3. Prospective studies are needed to confi rm ufulness of above in predicting complications in pediatric patients with AP. 1461
Th e Diagnostic Value of Barium Enema in Children and Infants Evaluated for Hirschsprung Dia; to Do or Not to Do?
Bisher Abdullah, MD, Lisa Philichi, ARNP, Jane Ulrigg, RN. Mary Bridge Children’s Hospital and Health Center, Tacoma, WA.
Purpo: Compare the diagnostic value for barium enema to suction rectal biopsies in children bad on diff erent age groups.
Methods: Retrospectively reviewed the records of all children who underwent both barium enema (BE) and suction or full thickness rectal biopsies (RB) at our institution between 2004 and 2008.
Results: Total 77 patients were identifi ed. Twenty one patient less than one year of age, Fift y one males (66.2%) and 26 females (33.8%) were part of study. For the patients over one year the age was ranging from 1 to 18 years with a mean age of 5 years. Th e indications were constipation and/or delayed passage of meconium. In the lected patients less than one year of age compared to over one year of age BE and RB were both normal in 57.2% and 55.3% respectively. In patients with abnormal BE, Hirschsprung dia was diagnod in 19% and 1.8% respectively, and the RB was normal in 23.8% and 39.2% respectively. All children less than one year of age, with normal BE had no Hirschsprung dia on RB compared to 2/56 (3.7%) in older patients.
Conclusion: In patients less than one year of age, the BE diagnostic yield for Hirschsprung dia was higher compared to older patients, but can be ud as a uful non-invasive screening tool in all age groups, that in diff erence to the recommendations of the constipation guideline committee of the North American society for pediatric gastroenterology, hepatology and nutrition (NASPGHAN), as BE considered unnecessary beyond infancy.
1462
Ruminant Healthy Adolescents? Chew on Th at!
Kiranmai Gorla, MD, FACG,1 Hayat Mousa, MD,2 Patrice Tyson, MD1.
1. Pediatric Gastroenterology and Nutrition, Rainbow Babies and Children’s Hospital, Cleveland, OH;
2. Nationwide Children’s Hospital, Columbus, OH. Purpo: Rumination syndrome (RS) is defi ned as a condition characterized by the repetitive, eff ortless regurgitation of recently ingested food into the mouth
