D. Rossetti

A New Formulation of Oral Viscous Budesonide in Treating of Paediatric Eosinophilic Oesophagitis: a Pilot Study

Objectives: Oral viscous budesonide is a recent therapeutic option for eosinophilic oesophagitis (EoE) compared with dietary restriction and inhaled steroids. This single-centre, open-label, not blinded study aims to evaluate the efficacy and safety of a new, preprepared oral viscous budesonide suspension (PVB) in children and adolescents with EoE. Methods: We treated 36 children with PVB (29 boys; median age 12 years) with EoE diagnosed according to European Society for Paediatric Gastroenterology Hepatology and Nutrition guidelines. Patients <150 and >150 cm height received 2 and 4 mg PVB daily, respectively, for 12 weeks. Upper gastrointestinal endoscopy was performed at baseline, after 12 weeks of therapy and 24 weeks after the end of therapy. Baseline and post-treatment scores were calculated for symptoms, endoscopy, and histology. Serum cortisol was performed at baseline, 12, and 36 weeks. Results: At the end of PVB trial, endoscopy showed macroscopic remission in 32 patients (88.9%), whereas at histology median pre- and post-treatment peak eosinophil count/high power field (HPF) markedly decreased from 42.2 (range: 15–100) to 2.9 (range: 0–30); moreover, mean symptom and histology scores impressively improved compared with baseline (P < 0.01). At 24 weeks after the end of PVB therapy, endoscopy showed oesophageal relapse in 21 patients (58.3%), whereas 15 (41.7%) were still in remission. Seven children (19.4%) with positive multichannel intraluminal impedance-pH were treated also with proton pump inhibitors. No significant difference between pre-/post-treatment morning cortisol levels occurred. Conclusions: The new PVB suspension presented in the present study is effective and safe for treating children with proven EoE. Larger placebo-controlled clinical trials would provide more information about dosing, efficacy, and long-term safety of this formulation, specifically designed for the oesophagus.

PP-11 PROLONGED INTRA-ESOPHAGEAL PH PROFILE AND ESOPHAGEAL MOTILITY IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS (EOE).

Background: Patients (pts) with eosinophilic esophagitis (EoE), a chronic immune-mediated disorder, may exhibit symptoms of disturbed food transit (i.e. dysphagia, impaction) or mimicking gastro-oesophageal reflux (GOR). We aimed at characterizing in EoE pts the intra-esophageal pH pattern with 24-h multichannel intraluminal impedance (MII-pH) as well as the esophageal motility with high-resolution manometry (EHRM) Methods: during a 30 month period we studied 57 patients (pts), median age 11 years (range: 7–16): 25 with EoE, diagnosed according to widely agreed criteria (JPGN 2014;58:107–18; ESPGHAN guidelines) and 32 with GOR disease (GORD). All underwent esophagogastro-duodenoscopy, MII-pH and EHRM. The pH-MII and data analysis were done according to ESPGHAN EURO-PIG protocol (JPGN 2012;55:230–4); variables analysed: reflux index, symptom index, number and type of liquid reflux, number of long lasting reflux episodes, correlation symptom-reflux. The test was diagnostic of GORD if at least ≥ 2 of the previous variables were positive. The EHRM was performed with water perfused catheters and swallow contractile patterns categorized using criteria recently reported by a paediatric group (Am J Gastroenterol 2010;105:460–7). Several motility variables were analysed: esophago-gastric junction (EGJ) morphology, end-expiratory and end-inspiratory EGJ pressure, distal contractile integral (DCI), pressurization front velocity (cm/s), peristaltic propagation pattern. Results: An abnormal MII-pH profile was markedly more common in GORD pts (27; 84.37%) than in EoE pts (4; 16%; p < 0.001). On the contrary, EHRM irregularities were detected more commonly in EoE that the GORD pts: in particular, when motility tracing were analysed no significant difference for EGJ pressure and deglutitive EGJ relaxation was detected between the 2 groups; however, abnormalities such as peristaltic dysfunction (i.e. failed peristalsis, aperistalsis, and esophageal spasm features) and lower distal contractile integral adjusted for esophageal body length (DCIa) were more common in EoE (17; 68%) than in GORD pts (15; 46.8%) (p < 0.05) Conclusions: 1) The great majority of EoE pts have a normal MII-pH profile that doesn’t support the use of proton pump inhibitory therapy. 2) EoE pts exhibit higher prevalence of oesophageal motility abnormalities than GORD: this feature is likely sustained by the inflammatory infiltrate that characterizes the esophageal wall in EoE and accounts for the esophageal dysmotility complaints often detected in EoE pts.

Intestinal lymphoid nodular hyperplasia in children: The relationship to food allergy

Lymphoid nodular hyperplasia (LNH) of the lower gastrointestinal tract is a common finding during paediatric colonoscopies, and its clinical significance has not yet been clearly established.

Combined multichannel intraluminal impedance and pH monitoring is helpful in managing children with suspected gastro-oesophageal reflux disease

BACKGROUND Gastro-oesophageal reflux is very common in the paediatric age group. There is no single and reliable test to distinguish between physiologic and pathological gastro-oesophageal reflux, and this lack of clear distinction between disease and normal can have a negative impact on the management of children. AIMS To evaluate the usefulness of 24-h oesophageal pH-impedance study in infants and children with suspected gastro-oesophageal reflux disease. METHODS Patients were classified by age groups (A-C) and reflux-related symptoms (typical and atypical). All underwent pH-impedance study. If the latter suggested an abnormal reflux, patients received therapy in accordance with NASPGHAN/ESPGHAN recommendations, while those with normal study had an additional diagnostic work-up. The efficacy of therapy was evaluated with a specific standardized questionnaire for different ages. RESULTS The study was abnormal in 203/428 patients (47%) while normal in 225/428 (53%). Of those with abnormal study, 109 exhibited typical symptoms (54%), and 94 atypical (46%). The great majority of the patients with abnormal study were responsive to medical anti-reflux therapy. CONCLUSIONS We confirm the utility of prolonged oesophageal pH-impedance study in detecting gastro-oesophageal reflux disease in children and in guiding therapy. Performing oesophageal pH-impedance monitoring in children with suspected gastro-oesophageal reflux disease is helpful to establish the diagnosis and avoid unnecessary therapy.