Marin Burlea

Helicobacter pylori infection and gastroesophageal reflux in children

Some studies suggest that Helicobacter pylori (H. pylori) infection would be a protective factor for the gastroesophageal reflux. The aim of this study was to explore this fact. A group of 72 children, admitted in a pediatric gastroenterology regional center in Northeast Romania, diagnosed with gastroesophageal reflux by 24-hour continuous esophageal pH monitoring (results were interpreted using the Boix-Ochoa score), underwent upper endoscopy with gastric biopsy to detect the presence of H. pylori by the rapid urease testing and for bacteriological and histologic examination. 19 children (26.39%) had H. pylori infection, while 53 (73.61%) did not. The grade of esophagitis was classified according to the Los Angeles classification system. Out of 47 children with esophagitis A, 16 (34.04%) had H. pylori infection, while out of the 25 children with esophagitis B, only 3 (12%) had H. pylori infection, with statistic significance (χ2 = 54.69, P << 0.05, 95% confidence interval [CI]). Regarding the value of the Boix-Ochoa score, it appears that the presence of the H. pylori determines lower pH-metry scores (F = 8.13, P = 0.0015, 95% CI). The presence of the H. pylori was not an important factor in the gastroesophageal reflux. On the other hand its relationship with esophagitis appears to be inverse ratio. The fact that the H. pylori presence is statistically greater in the grade A esophagitis could confirm the hypothesis that the bacteria would slow down the development of the esophagitis.

Effects of prophylactic ibuprofen and paracetamol administration on the immunogenicity and reactogenicity of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugated vaccine (PHiD-CV) co-administered with DTPa-combined vaccines in children: An open-label, randomized, controlled, non-inferiority trial

ABSTRACT Prophylactic paracetamol administration impacts vaccine immune response; this study (www.clinicaltrials.gov: NCT01235949) is the first to assess PHiD-CV immunogenicity following prophylactic ibuprofen administration. In this phase IV, multicenter, open-label, randomized, controlled, non-inferiority study in Romania (November 2010–December 2012), healthy infants were randomized 3:3:3:1:1:1 to prophylactically receive immediate, delayed or no ibuprofen (IIBU, DIBU, NIBU) or paracetamol (IPARA, DPARA, NPARA) after each of 3 primary doses (PHiD-CV at age 3/4/5 months co-administered with DTPa-HBV-IPV/Hib at 3/5 and DTPa-IPV/Hib at 4 months) or booster dose (PHiD-CV and DTPa-HBV-IPV/Hib; 12–15 months). Non-inferiority of immune response one month post-primary vaccination in terms of percentage of infants with anti-pneumococcal antibody concentrations ≥0.2 µg/mL (primary objective) was demonstrated if the upper limit (UL) of the 98.25% confidence interval of difference between groups (NIBU vs IIBU, NIBU vs DIBU) was <10% for ≥7/10 serotypes. Immunogenicity and reactogenicity/safety were evaluated, including confirmatory analysis of difference in fever incidences post-primary vaccination in IBU or DIBU group compared to NIBU. Of 850 infants randomized, 812 were included in the total vaccinated cohort. Non-inferiority was demonstrated for both comparisons (UL was <10% for 9/10 vaccine serotypes; exceptions: 6B [NIBU], 23F [IIBU]). However, fever incidence post-primary vaccination in the IIBU and DIBU groups did not indicate a statistically significant reduction. Prophylactic administration (immediate or delayed) of paracetamol decreased fever incidence but seemed to reduce immune response to PHiD-CV, except when given only at booster. Twenty-seven serious adverse events were reported for 15 children; all resolved and were not vaccination-related.

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.

OC-56 Adjusting problems to extrauterine life in newborns delivered by caesarean section

The transition from intrauterine to extrauterine life is a complex physiological adaptation. The most common adjustment problems are present in preterm and in term infants delivered by caesarean section. Caesarean section performed at the request of the mother (in the absence of maternal or fetal indications) increase the risk of prolonged hospitalisation, can cause breathing problems in children and increases the risk of complications in a subsequent pregnancy. Also, breast feeding is delayed in children born by caesarean section. Birth by caesarean benefits are for short term: fewer surgical complications, low risk of bleeding, and absence of urinary incontinence. There are authors who claim that birth by caesarean section performed at the request of the mother, as well as emergency caesarean delivery is associated with a high morbidity risk to both mother and fetus.

OC-29 Digestive endoscopy – the essential factor in the development of gastroenterology

The special catalyst for paediatric gastroenterology was the introduction of digestive endoscopy, a diagnostic and therapeutic technique for children with gastroenterological diseases. Therapeutic endoscopy is an efficient and very low aggressive way solving of paediatric emergencies. Development of therapeutic endoscopy allows solving effective, rapid and less aggressive of diseases previously affordable only by surgery. Initially, many different types of rigid gastroscopes were developed. In 1932, Schinlder developed the flexible gastroscope. In Iaşi, there are 25 years of paediatric diagnostic endoscopy and 24 years of paediatric therapeutic endoscopy. Using various types of equipment and endoscopes, endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography and small-bowel enteroscopy can also be performed. Endoscopy remains a keystone in the structure of modern gastroenterology.

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.

Ulcerative colitis associated with vitiligo and IgA deficiency in a young girl

Ulcerative colitis (UC) is a chronic inflammatory disease of non-infectious and plurifactorial etiology, exclusively affecting the colon, with variable expansion. The selective deficiency of immunoglobulin A (IgA) can be frequently associated with UC, as well as with recurrent respiratory tract infections, autoimmune diseases, atopy. The incidence of vitiligo among UC patients is significantly higher compared to the general population. At the same time, recent studies proved a higher incidence of Clostridium difficile infections in patients with inflammatory bowel disease (Crohn’s disease and ulcerative colitis) compared to the general population. We are presenting the case of a 9 year old girl, where UC associated with selective deficiency of IgA and vitiligo hampered the diagnosis and therapeutic approach, particularly in the conditions of a preexisting Clostridium difficile infection. The association of these entities is rare in the pediatric population and a multidisciplinary team approach (gastroenterology, dermatology and immunology) can ensure an effective therapeutic management in the case of such patients.