C. Di Camillo

PA29 PRESUMPTIVE SAFETY FOR CELIAC PATIENTS OF WHEAT BAKED GOODS RENDERED GLUTEN-FREE DURING SOURDOUGH FERMENTATION

After several interviews, this teenager admitted participation to an unusual dietary party with three peers, 4 days before admission. They ate a “soup” formed by gravel, wheat flour and water, for slimming purposes. The soup recipe had been found on an unidentified web site. After the party, one of the friends underwent emergency appendectomy for appendix occlusion caused by a gravel stone, another had been admitted for acute abdominal pain followed by passage of gravel stones in the stool while the third eliminated the stones in the stools without any complaint. Discussion: This case-report highlights the risks related to improper use of uncontrolled information found on the internet. There is a rising and widespread use of the web among children and adolescents. Recent studies showed that adolescents disclose personal information and may display risky behaviour. Sylvia wanted to loose weight even though her BMI was normal (18.7 = 25th percentile for age and gender). Concerns about weight, body shape and dieting are common among adolescent girls and may represent risk factors for eating disorders. One’s body image perception is influenced by several factors, including personal, parental and friends’ judgement, sociocultural environment and media pressures, that are believed to encourage the development of an unrealistically thin ideal of body shape. Independent of age and BMI, parental and media influences on adolescents are predictive of becoming highly concerned with weight and a constant dieter. Abdominal ultrasound is usually the first-line (and often the only) imaging investigation performed in the diagnostic process of children with AAP, to exclude appendicitis or other surgical conditions (e.g. intussusception). Abdominal ultrasound has however limitations (e.g. presence of excessive intestinal gas and operator dependence) and does not always identify ingested foreign bodies. In this patient, the intestinal stones were indeed detected only by a standard abdominal x-ray. Conclusions: Acute or recurrent abdominal pain is a frequent complaint in adolescents, particularly of those experiencing emotional and socio-familial difficulties. A careful interview can help to identify risky behaviours that could be responsible for this distressing disorder. As suggested by this case-report, the use of junk information retrieved by uncontrolled internet sources should be investigated. The deliberate ingestion of foreign bodies is a possible cause of AAP in teenagers.

PO8 OATS IN THE DIET OF CHILDREN WITH CELIAC DISEASE: PRELIMINARY RESULTS OF A RANDOMIZED, DOUBLE-BLIND, MULTICENTER ITALIAN STUDY

and 6 months (6mo). PCDAI was calculated at the beginning and at 6 months. Statistical analysis was performed using Student’s t test and the value of p< 0.05 was considered statistically significant. Calprotectin mean value was 1296.4±1203.8mcg/ml at the onset, 645.9±623.8 at 1 month (p< 0.05); 633.6±722.5 (p< 0.05) at 3 months; 642.89±532.00 (p< 0.05) at 6 months. PCDAI of all patients was 20.00±4.5 at the beginning of NT, 14.8±5.5 at 6mo (p< 0.05), that indicates reduction of values, but not complete clinical remission (PCDAI <10). Patients were then divided in two groups on the basis of their personal feeling about wellbeing. Twelve patients (48%) referred clinical improvement (group 1), while 13 did not (group 2). In group 1 PCDAI was 19.5±4.4 pre-treatment and 10.4±2.9 at 6mo (p = 0.0004). In group 2 PCDAI was 20.5±4.6 pretreatment and 18.5±4.4 at 6mo (p = n.s.). No difference in PCDAI values was observed at the beginning of the treatment between the two groups (p = n.s.). PCDAI values at 6mo were significantly different between the two groups (p = 0.000). NT demonstrated to be effective in inducing significant clinical improvement in half of patients in our series. When after years of follow-up we revaluated our data on the basis of the disease evolution, we noted that 3 patients (23%) of the group 2 presented a severe inflammatory form, 31% developed a penetrating disease and 46% a stricturing form. Only one patient (8%) of the group 1 developed a complicated form (penetrating). Our data confirm that NT can be useful to induce and maintain clinical remission in moderated CD pediatric patients. The fact that we observed that most of non responders developed a complicated form of disease suggests that the absence of response to NT could be associated to a more complicated course of CD.

PA44 AN UNUSUAL GUT BLEEDING IN CHILDHOOD SUCCESSFULLY TREATED WITH OCTREOTIDE

Objective: Menetrier’s disease, also called hypoproteinemic hypertrophic gastropathy, is a rare, acquired, premalignant disorder of the stomach. It is generally characterized by giant hypertrophic folds that most often involve the fundus, excessive mucus secretion, decreased acid secretion (hypochlorhydria), and hypoproteinemia due to selective loss of serum proteins across the gastric mucosa. Aims and methods: A four year old boy was referred to our Pediatric Gastroenterology and Liver Unit because of iron deficiency anemia. The child had been healthy since his birth; no illness during the delivery or the neonatal period were accounted. He had been breastfed till 12 months of age, his physical and psychological development was unremarkable and his growth curves were within the normal ranges. At medical history, it was reported that his grandfather suffered from Menetrier’s disease. Therefore, on suspicion of chronic obscure gastrointestinal bleeding, we performed upper gastrointestinal tract (GI) endoscopy which disclosed markedly thickened gastric folds with nodularity, erythema, and exudate involving the proximal stomach (corpus and fundus); the antrum and pylorus did not show pathological features. Histological specimens of the stomach obtained by multiple superficial cold forceps biopsies showed only foveolar hyperplasia and dilatation of some glands. Helicobacter pylori was not found. Cytomegalovirus (CMV) PCR on gastric aspiration, serum and urine did not show the presence of viral load. Results: After one month, we re-performed upper GI endoscopy in order to obtain a wider sample for histological examination by jumbo forceps. At this time, the pathologist identified marked foveolar hyperplasia and elongation of gastric pits, cystic dilatation of gastric gland in the deeper part of the mucosa, moderate atrophy of fundic glands; in the lamina propria there was no inflammation, but marked dilatation and congestion of small vessels, and diffuse edema has been observed. These findings suggested the diagnosis of Menetrier’s disease, and the child was thus treated with Octreotide longacting release (LAR) which brought to clinical amelioration of the anemia. Conclusion: The cause of Menetrier’s disease is unknown, although in children infection by CMV and by Helicobacter Pylori have been implicated. Classical symptoms include epigastric pain, vomiting, edema, anorexia, and weight loss. In this case of pediatric Menetrier’s disease, the only clinical feature was iron deficiency anemia, probably due to congested small vessel leakage. We might speculate that this child had not expressed yet all the other features of the disease, such as the protein-loss syndrome, because of his early diagnosis. The medical treatment of Menetrier’s disease consists of Octreotide administration, which is a somatostatin analogue, and in our case successfully controlled hemorrhage from gastric lesions.

CO15 DIAGNOSTIC USEFULNESS OF SINGLE BALLOON ENTEROSCOPY IN CHILDREN WITH GASTROINTESTINAL DISORDERS UNDEFINED AT CONVENTIONAL ENDOSCOPY

IFX for remission 7 were still in remission, 5 restarted biologic therapy (3 Adalimumab, 2 IFX), 1 underwent ileal resection. No serious adverse events or malignancies were reported. Conclusions: In our cohort of IBD pts, IFX maintenance therapy was a durable and effective treatment over a 3-year period in children with CD, it appeared also an effective therapeutic option to avoid or postpone colectomy in UC pts.

PP23 ARGON PLASMA COAGULATOR IN A 2-MONTH-OLD CHILD WITH TRACHEO-OESOPHAGEAL FISTULA

A 2 month-old boy was admitted to the authors’ hospital because of regurgitation and persistent cough during breastfeeding. A chest X-ray examination and a barium esophagogram disclosed small amounts of barium passing in the trachea, suggesting a tracheoesophageal fistula (TEF). Bronchoscopy combined with upper gastrointestinal (GI) endoscopy performed with the patient under general anesthesia confirmed the fistula. The TEF was treated by injection of 1 ml Glubran 2 from the esophageal side. A nasogastric tube was placed for feedings, and 7 days later, a barium esophagogram showed a reduction of caliber but not complete closure of the TEF. Unsuccessful fistula obliteration with Glubran was attributed to technical difficulties in catheterization of the fistula orifice, mainly resulting from its close proximity to the upper esophageal sphincter and to its small caliber. Therefore, an argon plasma coagulator (APC) probe with a circumferentially oriented nozzle was used from the esophageal side as an alternative technique to fulgurate the residual fistula orifice (see video). A nasogastric tube was placed for feedings. Oral feeding was started 7 days later when a barium esophagogram confirmed complete fistula closure. At the 2-year follow-up visit, the boy was asymptomatic, and the barium esophagogram was negative. This report describes a case in which esophagoscopy gave a clear view of the fistula due to its direction from esophagus to trachea. Complete fistula obliteration was not obtained with Glubran. However, APC was successfully used to close the residual fistula orifice. The authors suggest that APC can be used as an alternative endoscopic technique to repair TEF when other techniques fail.