Gabriela Paduraru

Correlation between the different pH-metry scores in gastroesophageal reflux disease in children.

AbstractThe 24-hour esophageal pH-metry is the most widely used method to diagnose the gastroesophageal reflux disease (GERD). The study compares the different scores obtained during the 24-hour esophageal pH-metry. A retrospective study over 5 years including 234 children (1 month and 18 years old) admitted in a pediatric gastroenterology regional center in Northeast Romania, with suspicion of GERD. They underwent 24- hour esophageal pH-metry, and the scores obtained (Boix-Ochoa, DeMeester, Johnson-DeMeester) were compared. Out of the 234 children, 172 (73.50%) had positive Boix-Ochoa score and 62 (26.50%) had normal Boix-Ochoa score (<11.99). Based on the DeMeester score, 149 children (63.68%) were positive and 85 (36.32%) were negative. The correlation of the Demeester score with the Boix-Ochoa score was very high (r = 0.978, P <  < 0.01, 95% confidence interval). Considering the Johnson-DeMeester score, 120 cases (51.28%) had GERD and 114 (48.72%) did not. The correlation of the Johnson-DeMeester score with the Boix-Ochoa score was still high (r = 0.94, P <  < 0.01, 95% 95% confidence interval). As considered until now, the Boix-Ochoa score is the most accurate score to be used in pediatrics for the diagnosis of GERD. The use of the different scores—Boix-Ochoa, DeMeester, Johnson-DeMeester—showed a high sensitivity and specificity of the pH-metry measurements applied to the study lot, but the last score has a higher risk of false-negative results.

Heterotopic Gastric Mucosa in the Distal Part of Esophagus in a Teenager: Case Report.

Abstract Heterotopic gastric mucosa (HGM) of the esophagus is a congenital anomaly consisting of ectopic gastric mucosa. It may be connected with disorders of the upper gastrointestinal tract, exacerbated by Helicobacter pylori. The diagnosis of HGM is confirmed via endoscopy with biopsy. Histopathology provides the definitive diagnosis by demonstrating gastric mucosa adjacent to normal esophageal mucosa. HGM located in the distal esophagus needs differentiation from Barretts esophagus. Barretts esophagus is a well-known premalignant injury for adenocarcinoma of the esophagus. Malignant progression of HGM occurs in a stepwise pattern, following the metaplasia–dysplasia–adenocarcinoma sequence. We present a rare case of a teenage girl with HGM located in the distal esophagus, associated with chronic gastritis and biliary duodenogastric reflux. Endoscopy combined with biopsies is a mandatory method in clinical evaluation of metaplastic and nonmetaplastic changes within HGM of the esophagus.

P254 Children vaccination: civic obligation or personal choice?

One of the greatest achievements of medicine was the discovery and introduction of vaccination for all major contagious diseases. Romania was one of the countries that have contributed to the development of vaccinology. Currently, one of the most intensely debated issues is related to a person’s right to accept or not vaccination. The patient can be put in different situations, which is why the authors discuss these issues. Given that it is easier and cheaper to prevent than cure, through vaccination this goal can be achieved. The compulsory vaccins should meet the necessary criteria of mandatory and optional ones remain at the discretion of the patient or legal caregivers. Facing the major risks that an epidemic outbreak represents, general interest prevails, because ultimately, the freedom and security of any person ceases where it affects another person’s freedom and security.

OC-43 A family case of an adenomatous polyposis

Introduction The inherited gastrointestinal polyposis syndromes are divided into adenomatous and hamartomatous varieties. The adenomatous polyposis syndromes include familial adenomatous polyposis coli, Gardner’s syndrome and Turcot’s syndrome. Gardner’s syndrome is characterised by the presence of numerous intestinal polyps, with extra-intestinal manifestations of bone and soft-tissue such as desmoid fibromatosis, lipomas, osteomas and epidermal cysts. Cases report We report the cases of 2 brothers (17-year-old girl and 15-year-old boy) with typical symptoms of Gardner’s syndrome who were sent from the Genetics Clinic at the V-th Paediatrics Clinic of “St. Mary” Children’s Emergency Hospital to perform a colonoscopy (for highlighting the colonic mucosa damage). Their mother and their maternal grandfather had a suggestive history of a similar disease. The patients were diagnosed to have colonic polyps. Conclusion The patients with Gardner’s syndrome must be closely followed-up, since there is a constant threat to their lives at any age.

P253 Subocclusive intestinal syndrome secondary to cytomegalovirus infection in an infant

Background Subocclusive intestinal syndrome is caused by a heterogeneous group of enteric neuromuscular diseases that causes abnormalities of gut motility. Subocclusive syndrome can occur at any age, but in young children, most often, can be fatal. This may be due to intrinsic primary or secondary visceral disorders (drug toxicity, ischemia, inflammatory or autoimmune diseases, infection with Epstein-Barr virus or cytomegalovirus, myopathies). Case presentation We present the case of an infant male, 1 month and 2 week old, admitted in the Paediatric Gastroenterology Clinic, „St. Mary’ Children Emergency Hospital, Iasi, Romania for jaundice and the appearance of flatulence, with progressive intensification from the age of 3 week old, with loose stools. Laboratory analysis revealed a positive Cytomegalovirus IgG and IgM antibodies. Conclusion Cytomegalovirus infection should be considered in intestinal pseudo-obstruction in order to initiate appropriate treatment and avoid serious complications that may arise.

PO-0125 Correlation Between Esophageal Ph-metry And Esophagitis In Gastroesophageal Reflux Disease

Background and aims The study compares the 24 h esophageal pH-metry, used to be considered the “gold diagnosis” for the gastroesophageal reflux, with the esophagitis degree observed at the upper digestive endoscopy. Material 72 children were included, aged over 4 years old, admitted in a paediatric gastroenterology regional centre in northeast Romania, diagnosed with gastroesophageal reflux disease (GERD) by 24 hours pH-metry (with a positive Boix Ochoa score), which also underwent the upper digestive endoscopy. Results Out of the 72 children diagnosed with GERD, 47 (65.28%) had first degree esophagitis and 25 (34.72%) second degree esophagitis. In GERD associated with second degree esophagitis the Boix Ochoa score is statistically significant higher compared with the GERD associated with first degree esophagitis (F = 9.76, p = 0.0036, 95% CI). Conclusions Upper digestive endoscopy performed in patients with gastroesophageal reflux disease shows the constant presence of esophagitis at all patients. There were only first and second degree esophagitis due to the fact that they are young patients with a relative short history of the disease. The correlation tests show a perfect parallel between the pH-metry scores and the endoscopic lesion. The correlation is so accurate that the pH-metry scores can be sufficient to prove the disease and the esophagitis degree, the upper digestive endoscopy being reserved only for the cases that does not respond to the medical treatment or have other complications.

Esophageal Stenosis - a Notable Complication of Epidermolysis Bullosa - case report

Epidermolysis bullosa is a rare condition caused by a genetic defect of the anchoring proteins between the epidermis and the dermis with an incidence of 1/50000. A 2 years and 7 months old, male infant was admitted in the Gastroenterology department of the pediatric hospital for severe dysphagia, the physical exam revealing skin lesions, scarring and nail abnormalities suggestive for Epidermolysis bullosa. The upper gastrointestinal endoscopy revealed a friable mucosa with ulcerative injuries and a severe esophageal stenosis. Epidemolysis bullosa, a condition involving mostly the skin can also be associated with severe mucosal injury that may cause serious medical complications.

886 Varicella Complicated with Lobar Pneumonia and Parapneumonic Pleurisy

Background and Aims Chickenpox is an acute, benign, highly contagious disease characterized by generalized vesicular exanthema with self-limited evolution. Pneumonia is the most serious complication of varicella, occurring more frequently in adults (>20%) than in children. An outbreak of the disease started in late autumn 2011 in Romania and continues in present. Methods and results: The authors present the case of a 4 years old boy admitted into the Infectious Diseases Hospital with chickenpox. On the 4-th day of the disease high fever, dyspnea with tachypnea, intercostal retractions, pleuritic pain and cough appeared and the patient was transferred to the Children Hospital. Clinical examination showed abolished left basal vesicular breath sound with wet crackles in the middle and superior lung area; chest X-ray finded inferior left lobe pneumonia and mild pleural effusion. Tracheal aspirate culture was negative. Leucokytosis with neutrophilia and increased ESR and C-reactive protein was founded. Broad spectrum antibiotherapy was started with favourable evolution after 3 weeks. Conclusions Among the most serious complications of varicella is pneumonia; it is less common in children than in adults but it may lead to death. However, the epidemic status in Romania in 2011–2012 was associated with an increased number of viral pneumonias; in our case the radiological aspect was highly suggestive for a secondary bacterial infection even with negative aspirate culture (explained by prior antibiotherapy). The history for chickenpox vaccine was negative in our patient. In Romania, the chickenpox immunization is not included into the National Programe of Immunisations at this moment.