G‐OP001. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐OP001.1. RISK FACTORS FOR AUTOIMMUNE DISEASES IN PEDIATRIC ONSET CELIAC DISEASE
Ferass Abu Hanna 1, Maia Sirkin2, Bar Sofer3, Rania Egbarieh1, Sameh Tatour1, Avishay Lahad1, Sarit Peleg4, Tal Almagor1, Firas Rinawi1
1Emek Medical Center, Afula, Israel, 2Children's Hospital at Montefiore, New York, United States of America, 3Faculty of Medicine Technion, Haifa, Israel, 4Haifa And West Galilie District, Clalit Health Services, Haifa, Israel
Objectives and Study: Objectives: Patients with Celiac disease (CeD) have an increased risk of developing other autoimmune diseases (ADs), however risk factors and predictors for ADs remain unclear. The study objective is to assess predictors for development of ADs among pediatric onset CeD patients.
Methods: The study included pediatric onset CeD patients, evaluated at Emek Medical Center, and followed for at least 2 years from April 2008 to April 2022. Data were collected from medical records, and included baseline and follow‐up data of demographics, clinical manifestations, laboratory variables, and subsequent development of ADs.
Results: 930 children with CeD were included, 790 fulfilled inclusion criteria. Patients were followed for a median of 4.9 years (range 2‐16 years). During follow‐up, 45%, 68%, and 80% normalized their tissue transglutaminase (TTG) levels by 6, 12, and 24 months, respectively. Among the entire cohort, 16 patients (2%) developed type 1 diabetes mellitus, 35 (4.4%) developed Hashimoto's thyroiditis and 11 (1.3%) developed other ADs. Of 510 patients with sustained serological remission, 39 (7.6%) patients developed ADs compared to 23 (11.5%) of patients without sustained serological remission. In multivariate cox models, shorter time to TTG normalization (Hazard Ratio [HR] 0.94 CI 95% 0.88‐0.99) and sustained TTG levels less than three times the upper limit of normal (HR 0.87 CI 95% 0.72‐0.96) were significantly associated with reduced risk of developing ADs.
Conclusions: Conclusion: Early diagnosis and effective management of celiac disease, including timely TTG normalization, might be important for reducing the risk of subsequent development of ADs in pediatric‐onset CeD.
Contact e‐mail address: ferass@gmail.com
G‐OP002. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐OP002.1. A NEW HİSTOPATHOLOGİCAL APPROACH TO DİAGNOSİNG CELİAC DİSEASE: SUPRANUCLEAR LYMPHOCYTE COUNTİNG AND İNFİLTRATİON PATTERN PROVİDES A MORE RELİABLE AND ACCURATE PREDİCTİON
Gül Çirkin 1, Fatih Yılmaz2, Kadri Atay3
1Tepecik Training and Research Hospital, izmir, Turkey, 2Pathology Laboratory, Mardin Training and Research Hospital, izmir, Turkey, 3Gastroenterelogy, Mardin Training and Research Hospital, Mardin, Turkey
Objectives and Study: Aim: Current intraepithelial lymphocyte (IEL) thresholds used for diagnosing celiac disease (CD) have limited specificity. This study assessed the diagnostic value of IEL localization‐based evaluation and supranuclear lymphocyte counting in diagnosing CD.
Methods: Methods: This retrospective study included 418 patients who underwent duodenal biopsy in pediatric and adult gastroenterology clinics from 2021 to 2023. Total and supranuclear IEL counts per 100 and 20 enterocytes (IEL/100, SupIEL/100, IEL/20, SupIEL/20) were determined on CD3‐stained slides. SupIEL ratio (SupIEL/Total IEL) was calculated. IEL distribution patterns were categorized as basal, mixed, or apical based on whether >60% of IELs were localized to a specific region relative to the enterocyte nucleus. ROC analysis identified thresholds for predicting CD.
Results: Results: Among the 418 biopsy samples, the mixed pattern was predominant in the CD group (65.1%), while the basal pattern was common in the non‐CD group (95.5%). All apical pattern cases (100%) were CD, and 98.6% of basal pattern cases were non‐CD. ROC analysis revealed optimal thresholds for SupIEL, including SupIEL/100 > 16 (sensitivity: 94.4%, specificity: 96.4%, PPV: 95.8%, NPV: 95.1%) and SupIEL/20 > 3 (sensitivity: 97.9%, specificity: 97.3%, PPV: 97.0%, NPV: 98.2%). These thresholds significantly outperformed traditional IEL/100 > 25, which had high sensitivity (99.5%) but low specificity (69.1%) and a higher overlap rate (16.7%). Supranuclear methods reduced overlapping cases to as low as 4.6% (Table 1) (Figure 1).
Conclusions: Conclusion: This study demonstrates that IEL localization‐based evaluation and supranuclear lymphocyte counting offer higher accuracy and reliability in diagnosing CD compared to conventional methods. This novel approach improves the identification of mucosal pathology and enhances etiological predictions for patients suspected of CD.
Contact e‐mail address: gul_cirkin@hotmail.com
G‐OP003. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐OP003.1. LET ESPGHAN SHINE INITIATIVE: THE DYNAMIC OF IGG ANTIBODIES IN CHILDREN WITH CELIAC DISEASE AND SELECTIVE IGA DEFICIENCY
Ester Donat 1, Maria Roca2, Ilma Korponay‐Szabó3, Renata Auricchio4, Marco Crocco5, Victorien Wolters6, Joanna Bierła7, Carolien Meijer8, Gieneke Gonera‐De Jong9, Gemma Castillejo10, Margreet Wessels11, Josefa Barrio‐Torres12, Henedina Antunes13, Zrinjka Mišak14, Alina Popp15, Alice Monzani16, Raquel Vecino‐López17, Peter Gillett18, Carmen Ribes‐Koninckx2, Espghan Celiac Disease Special Interest Group19
1Pediatric Gastroenterology And Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain, 2Celiac Disease And Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe. Hospital Universitario y Politécnico La Fe, Valencia, Spain, 3Department Of Paediatrics, University of Debrecen, Debrecen, Hungary, 4Department Of Translational Medical Science, University Federico II of Naples, Naples, Italy, 5IRCCS Istituto Giannina Gaslini, Genova, Italy, 6Paediatric Gastroenterology, Wilhelmina Children's hospital, UMC Utrecht, Utrecht, Netherlands, 7The Children Memorial Health Institute, Warsaw, Poland, 8Leiden University Medical Center ‐ Willem Alexander Children's Hospital, Leiden, Netherlands, 9Department Of Paediatrics, Wilhelmina Hospital, Assen, Netherlands, 10Paediatric Gastroenterology, Hospital Universitario Sant Joan, Reus, Spain, 11Dept. Of Pediatrics, Rijnstate Hospital, Arnhem, Netherlands, 12Paediatric Gastroenterology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain, 13Pediatric Gastroenterology, Hospital de Braga, Braga, Portugal, 14Referral Centre For Paediatric Gastroenterology And Nutrition, Children's Hospital Zagreb, Zagreb, Croatia, 15University of Medicine and Pharmacy ‘‘Carol Davila’’, National Institute for Mother and Child Health, Bucharest, Romania, 16Department Of Health Sciences, Division Of Pediatrics, University of Piemonte Orientale, Novara, Italy, 17Paediatrics, Hospital Clínico San Carlos, Madrid, Spain, 18., Royal Hospital for Children and Young People, Edinburgh, United Kingdom, 19ESPGHAN, GENEVA, Switzerland
Objectives and Study: Patients with IgA deficiency (IgAD) and Celiac Disease (CD) have an IgG class serological response, mainly antitransglutaminase antibodies (anti‐tTG‐IgG) that differ from immunocompetent subjects. The aim of this study is to describe the peculiarities of this response and especially the anti‐tTG‐IgG dynamics after starting a gluten‐free diet (GFD)
Methods: A retrospective European multicenter study (17 centers), including IgAD patients diagnosed with CD in the last 10 years (2012‐2021) was conducted. Analysis of the time until anti‐tTG‐IgG negativization by Kaplan‐Meier survival curves.
Results: 135 patients have been included. There are no significant differences of the mucosal damage, at the bulb (Test of Kruskal‐Wallis, p = 0.54) or in the duodenum (Kruskal‐Wallis, p = 0.45) and the anti‐tTG‐IgG levels. Neither is a correlation found for DGP‐IgG nor for EMA‐IgG. The decrease of the antibodies after establishing a GFD occurs slowly. The anti‐tTG‐IgG values had normalized only in 18.2% and 36.3% after respectively 1 and 2 years of GFD. 50% of the IgAD patients were negative for anti‐tTG‐IgG in an average of 35.5 months (95% CI: 25‐48 m) after starting GFD. There are no significant differences between the Kaplan‐Meier curves generated for the different antibodies.
Conclusions: In children with IgAD, a small bowel biopsy (SBB) is mandatory to confirm CD diagnosis as IgG class antibodies do not have a good correlation with the mucosal injury. IgG class antibodies show a slow disappearance dynamics after the start of a GFD, being anti‐tTG‐IgG still positive in 50% of the IgAD children after 3 years of starting the GFD. In the follow‐up period, invasive tests (SBB) based exclusively on the antibodies result should be avoided considering the dynamic of IgG based antibodies.
Contact e‐mail address: donat_est@gva.es
G‐OP004. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐OP004.1. LET ESPGHAN SHINE INITIATIVE: COELIAC DISEASE DEVELOPMENT BEFORE AND DURING PUBERTY: PROSPECTIVE DATA FROM THE PREVENTCD STUDY
Stephan Kok 1, Renata Auricchio2, Gemma Castillejo3, Ester Donat4, Reut Klein5, Sibylle Koletzko6, Ilma Korponay‐Szabó7, Eva Martínez‐Ojinaga8, M Luisa Mearin1, Isabel Polanco8, Hein Putter9, Carmen Ribes‐Koninckx4, Virginia Rodriguez1, Raanan Shamir5, Hania Szajewska10, Riccardo Troncone2, Katharina Werkstetter6, Carolien Meijer1
1Pediatric Gastroenterology, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands, 2Translational Medical Sciences And European Laboratory For The Investigation Of Food‐induced Disease, University Federico II Naples, Naples, Italy, 3Paediatric Gastroenterology Unit, Hospital Universitario Sant Joan de Reus, Reus, Spain, 4Pediatric Gastroenterology Unit, La Fe Hospital, Valencia, Spain, 5Institute For Gastroenterology, Nutrition And Liver Disease, Schneider Children's Medical Center, School of Medicine, Faculty of Medical Sciences and Health, Tel Aviv University, Tel Aviv, Israel, 6Pediatric Gastroenterology And Hepatology, Ludwig Maximilian's University Munich Medical Center, Dr. von Hauner Children's Hospital, Munich, Germany, 7Coeliac Disease Center, Heim Pál National Paediatric Institute, Budapest, Hungary, 8Paediatric Gastroenterology And Nutrition, La Paz University Hospital, Madrid, Spain, 9Medical Statistics, Leiden University Medical Center, Leiden, Netherlands, 10Pediatrics, The Medical University of Warsaw, Warsaw, Poland
Objectives and Study: Prospective cohort studies suggest that coeliac disease (CD) develops early in life, mainly before puberty. This study aims to gain insight regarding the frequency of CD‐development in high‐risk children during and after puberty.
Methods: Prospective data were obtained from the PreventCD‐cohort involving 944 genetically predisposed children with an affected first‐degree relative. They were enrolled at birth from 2007 and followed for CD development by frequent determinations of tissue‐transglutaminase‐antibodies (TTGA) in serum. Suspected CD was confirmed according to ESPGHAN‐guidelines. In September 2023 and 2024, luteinizing hormone (LH) was determined in previously collected samples to assess puberty development (LH ≥ 0.3mU/L). Since the onset of puberty usually occurs between 8‐13 (girls) and 9‐14 years (boys), children <8 years were considered pre‐puberal and those >15 years were considered adolescent. Preferable ages for LH‐determination were 10.5‐11.5 (girls) and 11.5‐12.5 years (boys).
Results: On December 2024, the median age of the cohort (n = 944) was 16.2 y (range 14.4‐17.9). 142/944 developed CD (60% female, median age at seroconversion: 3.6 y (IQR 2.2‐5.3)). 408/802 (51%) children without CD underwent at least one TTGA‐determination during 2021‐2024 and were considered to be in follow‐up for CD‐development. In 281 children (30% of the cohort and 69% of the active follow‐up) LH‐determination was performed. 291 children in the follow‐up were considered pubertal (i.e. followed until >15 y and/or LH ≥ 0.3mU/L). 14/142 CD diagnoses were established after >8 years: based on LH‐determination, 3 of them were pre‐puberal and 4 puberal. Assuming that the 7 CD children without LH‐determination were puberal, the frequency of diagnoses before and after puberty was respectively 93.0% (132/142 (78 girls); median age at seroconversion: 3.3 y (IQR 2.1‐5.0)) and 7.0% (10/142 (7 girls); median age at seroconversion: 9.0 y (IQR 8.2‐10.4))(p < 0.001).
Conclusions: Our results show a significantly lower frequency of CD‐development for high‐risk children after puberty than before it, suggesting that screening frequency in post‐puberal children may be reduced.
Contact e‐mail address: s.c.kok@lumc.nl
G‐OP005. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐OP005.1. IS COELIAC DISEASE INCREASING? RESULTS OF 20 YEARS POPULATION SCREENING AT AGE 6
Ilma Korponay‐Szabó 1,2, Márta Balogh3, Judit Gyimesi1, Piroska Bódi4, Éva Pollák5, Ágnes Horváth6, Antal Dezsofi‐Gottl7, Ildikó Kis8, Judit Czelecz9, Boglárka Bozóki10, Laura Sándor11
1Coeliac Disease Center, Heim Pál National Paediatric Institute, Budapest, Hungary, 2University of Debrecen, Debrecen, Hungary, 3Vas County Markusovszky Teaching Hospital, Szombathely, Hungary, 4Pándy Kálmán Hospital, Gyula, Hungary, 5Magyar Imre Hospital, Ajka, Hungary, 6Csolnoky Ferenc County Hospital, Veszprém, Hungary, 7Pediatric Center, Semmelweis University, Budapest, Hungary, 8St. Barbara Komárom‐Esztergom County Hospital, Tatabánya, Hungary, 9Bethesda Children's Hospital, Budapest, Hungary, 10Bács‐Kiskun County Teaching Hospital, Kecskemét, Hungary, 11Hetényi Géza County Hospital, Szolnok, Hungary
Objectives and Study: Coeliac disease (CeD) is increasingly diagnosed with higher awareness and easier availability of antibody tests, but it is unclear whether the total prevalence has truly increased. In this study we evaluated the results of yearly population screenings conducted with uniform methodology between 2005 and 2024.
Methods: Children entering the first grade in the respective year were offered CeD screening in all day care centers and schools in selected settlements (5 medium and 3 small cities with surrounding municipalities) and in 3 districts of the capital city for a median of 13 consecutive years (range 3‐19) funded by the local governments or foundations. The Biocard rapid test (Labsystems, Finland) was used throughout, which detects transglutaminase‐specific IgA antibodies and total serum IgA from finger prick blood. Children with a positive IgA test line or with a missing total IgA control line (suggesting IgA deficiency) were referred to paediatric gastroenterology centers for the laboratory determination of coeliac autoantibodies from serum and for diagnosing CeD by histology or by the non‐biopsy ESPGHAN criteria as appropriate. Results were compared with screenings conducted at older ages by laboratory testings.
Results: Altogether 39064 children (84% of the eligible population) participated and 488 new cases were detected. Onsite Biocard positivity had 98.4% positive predictive value for the final diagnosis of CeD. Considering 65 already known additional CeD cases and 2 IgA deficient CeD detected in laboratory, the mean disease‐prevalence at age 6 was 1.42% (95% confidence interval 1.417‐1.425) with non‐significant yearly variations between 1.22 and 1.67%, p = 0.998 (Figure). Similar prevalence values were obtained at age 14‐18 years by laboratory testings‐controlled population screening (1.36%, n = 2205).
Conclusions: Population screening does not reveal significant increase in CeD prevalence during childhood & adolescence in the last 20 years. Rapid test‐based screening is efficient in detecting undiagnosed CeD and was well received by the population.
Contact e‐mail address: Ilma.Korponay-Szabo@tuni.fi
G‐OP006. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐OP006.1. GLUTEN‐FREE DIET REDUCES THE INCIDENCE OF SUBSEQUENT TYPE‐1 DIABETES
Ilma Korponay‐Szabó 1,2,3, Judit Gyimesi1, Katalin Szabados4, Jánosné Pusztai5, Heikki Hyöty6
1Coeliac Disease Center, Heim Pál National Paediatric Institute, Budapest, Hungary, 2Celires, Faculty Of Medicine And Health Technology, Tampere University, Tampere, Finland, 3Department Of Paediatrics, University of Debrecen, Debrecen, Hungary, 4Hetényi Géza County Hospital, Szolnok, Hungary, 5Jász‐Nagykun‐Szolnok County Health Officer Service, Szolnok, Hungary, 6Department Of Virology, Faculty Of Medicine And Health Technology, Tampere University, Tampere, Finland
Objectives and Study: The causal relationship between coeliac disease (CeD) and type‐1 diabetes (T1DM) is still unclear. Transglutaminase‐specific antibody deposition has been shown in the pancreatic islets in T1DM organ donors with undiagnosed CeD, suggesting that T1DM may be an extraintestinal, but irreversible manifestation of CeD. In this study, we explored to which extent a gluten‐free diet (GFD) can reduce subsequent development of T1DM.
Methods: Incidence of new T1DM was assessed in three cohorts of children: A/One‐year population birth cohort (n = 4278), which had received CeD screening at the age of 6 years with treatment of all detected CeD cases, evaluated after 10 years, B/Control birth cohorts (n = 17446); 1 and 2 years older, and 1 and 2 years younger than Cohort A, living in the same geographic and social environment. C/Children with CeD (n = 4002) followed for altogether 34481 patient years on GFD with regular dietary and serology surveillance.
Results: At age 6, 38 CeD cases were diagnosed and subsequently treated in Cohort A, none developed T1DM in 10 years. Incidence of T1DM in the rest of Cohort A was significantly lower than in the control B cohorts (Table). In Cohort C, 145/4002 (3.6%) patients developed manifest T1DM until CeD diagnosis (p < 0.0001 vs B). Incidence of new T1DM was reduced on GFD in not yet diabetic CeD patients close to normal population level or slightly even below, dependent on the strictness of GFD adherence.
| Number | Observation years | T1DM incidence per 100,000/year | p versus NP | |
|---|---|---|---|---|
| Normal population reference (NP) | 26 | |||
| Cohort A‐ screened | 4278 | 10 | 9.35 | 0.025 |
| Cohort B‐ not screened | 17446 | 10 | 28.1 | ns |
| Cohort C‐ until CeD diagnosis | 4002 | 11.2 | 323.1 | <0.0001 |
| Cohort C‐ treated CeD | 3857 | 9.1 | 29.0 (seronegative subgroup: 17.4) | ns |
Conclusions: T1DM has multifactorial etiology, however, a fraction of new T1DM cases may be preventable by the screening, early diagnosis and treatment of CeD.
Contact e‐mail address:
G‐OP007. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐OP007.1. CELL‐FREE EMA SUBSTRATE IMPROVES SENSITIVITY AND RECOGNITION OF ENDOMYSIAL ANTIBODY POSITIVITY IN COELIAC DISEASE
Ilma Korponay‐Szabó 1,2, Judit Gyimesi1, Róbert Király3, Markku Mäki4
1Coeliac Disease Center, Heim Pál National Paediatric Institute, Budapest, Hungary, 2Department Of Paediatrics, University of Debrecen, Debrecen, Hungary, 3Department Of Biochemistry And Molecular Biology, University of Debrecen, Debrecen, Hungary, 4Celires, Faculty Of Medicine And Health Technology, Tampere University, Tampere, Finland
Objectives and Study: Although having excellent specificity and confirmatory value for coeliac disease (CeD) in doubtful cases and in the non‐biopsy diagnostic protocol, the endomysial antibody test (EMA) is often criticised as being observer‐dependent and less sensitive than ELISA methods. Furthermore, ethical concerns restrict the availability of monkey or human tissue substrates. Recently, we developed endomysial‐type human biomatrix preparations produced in cell culture and tested here whether their use in decellularised form (d‐EMA) can overcome some of these technical difficulties.
Methods: Serum samples from untreated CeD patients positive for EMA‐IgA (Group A, n = 66) or negative for EMA‐IgA (Group B, n = 61) by conventional testing, as well as from 52 non‐coeliac controls (Group C), none IgA‐deficient, were tested in dilutions of 1:2.5 and 1:10 using the new d‐EMA substrate. Results were compared with those of transglutaminase antibody (TGA)‐IgA ELISA and duodenal histology. A subset of d‐EMA slides was counterstained for transglutaminase antigen by AlexaFluor 647‐labelled secondary antibodies for automated image processing for co‐localisation with patient IgA binding.
Results: Both d‐EMA and monkey oesophagus were positive with silver impregnation which defines endomysial structures in histopathology. All 66 patients in Group A, 28/61 (45%) in Group B and none in Group C showed EMA‐type positivity on the d‐EMA biomatrix. Group B CeD patients had lower TGA‐IgA serum concentrations (median 3xULN) than CeD patients in Group A (median >10xULN). Positive d‐EMA reaction was observed in 3/5 samples at 1‐2xULN and in 8/16 at 2‐3xULN TGA‐IgA levels. The simple positivity pattern was similarly recognised by expert and untrained evaluators or by computer.
Conclusions: The novel d‐EMA test demonstrated markedly improved sensitivity compared to classical EMA and retained high specificity. Transglutaminase counterstaining invisible to human eye at 647 nm enabled the computer to recognise the correct positivity pattern without disturbing the usual microscopic evaluation.
Contact e‐mail address: ilma.korponay-szabo@tuni.fi
G‐OP008. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐OP008.1. INCREASED DENSITY OF CYTOLYTIC MARKERS AT DIAGNOSIS IS ASSOCIATED WITH DEVELOPMENT OF VILLOUS ATROPHY IN POTENTIAL CELIAC PATIENTS
Mariantonia Maglio 1, Antonella Marano2, Roberta Mandile1,2, Riccardo Troncone1,2, Luigi Greco2, Renata Auricchio1,2, Valentina Discepolo1,2
1European Laboratory for the Investigation of Food Induced Diseases (ELFID), University Federico II of Naples, Italy, Naples, Italy, 2Department Of Traslational Medical Science, University of Naples Federico II, Naples, Italy
Objectives and Study: Potential celiac disease (PCeD) patients display a normal intestinal mucosal architecture despite positive serum anti‐tissue‐transglutaminase2 (TG2) antibodies. A subset of PCeD develop full‐blown disease over time. Understanding the inflammatory events leading to villous atrophy may help defining predictive models. To this end we longitudinally studied several immunohistochemical markers and assessed their ability to predict PCeD outcome during follow‐up.
Methods: We enrolled 35 PCeD patients longitudinally followed‐up at the University Federico II of Naples for whom at least three duodenal biopsies were collected overtime (median follow‐up duration: 5 years and 10 months). 14 out of 35 patients (40%) eventually developed villous atrophy (PCeD‐VA). Overall, 105 biopsies were investigated, 37 were Marsh (M) 0, 54 M1 (CD3+IELs>34cells/mm of epithelium) and 14 M3 (VA). Immunohistochemistry was performed to assess: CD3 + , TCRγδ + , perforin+ (PFN) and NKG2D+ IELs counts in the epithelial compartment, density of CD25 + , IL‐15 and IL‐21 cells in the lamina propria.
Results: Considering biopsies taken at diagnosis, more PCeD‐M1 patients developed VA in comparison to PCeD‐M0 (50% vs 26%, p < 0.01), and yet, looking at epithelial compartment, PCeD‐VA patients showed increased number of CD3 + , TCR‐γδ+ and PFN+IELs in comparison to those who retained a normal mucosa over time (PCeD‐PP, p < 0.05). When comparing the biopsy at diagnosis (1st) and the one at outcome (3rd) we observed an increase in NKG2D+IELs and IL15 epithelial expression, as well as in CD25 + , IL15+ and IL21+ cells in the lamina propria in PCeD‐VA compared to PCeD‐PP. Stepwise canonical discriminant analysis indicated TCR‐γδ+ and PFN+IELs densities at diagnosis as best predictors of development of VA (80%).
Conclusions: Our study suggests that the increase in TCR‐γδ + IELs is the earliest event impacting progression of PCeD, in particular, the infiltration IELs with cytotoxic potential (PFN + ) may contribute to predict full‐blown diseases development.
Contact e‐mail address: mariantonia.maglio@unina.it
G‐OP009. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐OP009.1. SIGNS OF MORPHOMETRICAL ALTERATION AND IMMUNOLOGICAL ACTIVATION OF DUODENAL EPITHELIAL COMPARTMENT REVEAL HETEROGENEITY ACROSS POTENTIAL CELIAC PATIENTS
Mariantonia Maglio 1, Antonella Marano2, Roberta Mandile2, Pasqualina Angelino2, Anna Mirra2, Riccardo Troncone1,2, Renata Auricchio1,2, Valentina Discepolo1,2
1European Laboratory for the Investigation of Food Induced Diseases (ELFID), University Federico II of Naples, Naples, Italy, Naples, Italy, 2Department Of Traslational Medical Science, University of Naples Federico II, Naples, Italy
Objectives and Study: Potential celiac disease (PCeD) may precede full‐blown disease (CeD). PCeD patients show positive serology but a normal duodenal architecture with (Marsh1) or without (Marsh0) increased IELs. We investigated mucosal architectural and immunological features of duodenal epithelium in PCeD.
Methods: 40 PCeD‐M0, 40 PCeD‐M1 and 40 CTR‐M0 biopsies were studied. Morphometrical analysis included evaluation of Villus height (VH), Crypt depth (CD) and their ratio (VH/CD). Immunohistochemistry was employed to assess CD3+ and γδ + IELs densities in the whole cohort, as well as the number of Perforin+ (PFN) and NKG2D+ IELs, HLAE and IL15 epithelial expression in 35 PCeD (15 M0 and 20 M1) and 15 CTR‐M0.
Results: PCeD‐M0 showed a reduced, even if within the limit of normal (>2) VH/CD ratio (3 ± 0.35) compared to CTR‐M0 (3.2 ± 0.33), resulting from an increased CD (117 ± 14.7 μm vs 106 ± 11), rather than a decrease of VH. Moreover, PCeD‐M0 showed increased γδ + IELs (5.8 ± 3 cells + /mm of epithelium) and higher epithelial IL15 expression compared to CTR‐M0 (2.3 ± 2). PCeD‐M1 showed also a higher expression of the cytotoxic molecule PFN in IELs (13.2 ± 5) compared to both PCeD‐M0 (6.5 ± 5) and CTR‐M0 (7.0 ± 4). Activating NKG2D receptor expression on IELs and epithelial HLA‐E were comparable across groups.
Conclusions: Deeper crypts, increased γδ + IELs and IL15 epithelial expression were already observed in PCeD‐M0, suggesting an early start of tissue remodelling and inflammatory response, preceding CD3+IELs increase. In addition, PCeD‐M1 displayed increased expression of PFN+ but not NKG2D in IELs suggesting the lack of a full activated cytolytic phenotype in PCeD‐M1, in line with the lack of villous atrophy. Overall, our data reveal heterogeneity across PCeD group that contributes to dissect the events preceding and leading to tissue damage in this population. Further longitudinal analysis will test which of those features could be predictive of future full‐blown disease.
Contact e‐mail address: mariantonia.maglio@unina.it
G‐OP010. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐OP010.1. A SET OF SERUM PROTEOMIC BIOMARKERS DIFFERENTIATE CELIAC CHILDREN FROM AGE AND HLA MATCHED CONTROLS
Roberta Mandile 1, Michele Francesco Di Tolla1, Martina Carpinelli1, Janneke Samsom2, Rossella De Cegli3, Maria Vittoria Barone1, Riccardo Troncone1, Pietro Formisano1, Luigi Greco1, Renata Auricchio1
1Department Of Translational Medical Science, University Federico II of Naples, Naples, Italy, 2Erasmus University Medical Centre ‐ Sophia Children's Hospital, Rotterdam, Netherlands, 3Telethon Institute of Genetics and Medicine, TIGEM, Pozzuoli (Naples), Italy, Pozzuoli, Italy
Objectives and Study: The latest criteria for Celiac Disease (CD) diagnosis reduced the requirement for a small intestinal biopsy in 35‐40% of children. Still, for more than half of the cases a small intestinal biopsy is required for a safe diagnosis, hence the attempt to identify serum biomarkers that could replace, in most of these latter cases, the requirement of the biopsy (what is called a ‘liquid biopsy’). Aim of this work is to identify a set of serum biomarkers able to differentiate celiac from non‐celiac children.
Methods: Relative concentration of 92 inflammation‐linked proteins were examined in the sera of 50 children with CD compared with 50 HLA DQ2/8 and age matched controls born, in genetically at risk families but without CD using the Olink multiplex arrays
Results: Three different multivariate analysis localized a cluster of 8 molecules (CXCL9, NT‐3, SIRT2, CASP8, ST1A1, STAMBP, LIF, IL‐1α) with remarkable diagnostic potential, able to differentiate around 90% of CD patients from controls.
Conclusions: Patients with CD, compared to age and HLA matched healthy controls, show in their sera an increased expression of inflammatory molecules, involved in the pathways of NF‐kB, cytokine signalling pathway, cell apoptosis and crypts proliferation. A set of 8 of these proteins can differentiate cases from controls with an accuracy higher than 90%. The implementation of this approach in the clinical setting will facilitate a non‐invasive and individualized approach for CD diagnosis.
Contact e‐mail address: dottoressamandilepediatra@gmail.com
G‐OP011. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐OP011.1. PRENATAL MATERNAL EXPOSURE TO ANTIBIOTICS IS ASSOCIATED WITH INCREASED PREVALENCE OF CELIAC DISEASE
Raouf Nassar 1,2, Elad Brav1, Gadi Howard1,2, Rotem Shalve Shamay1,2, Slava Kogan1,2, Galina Ling1,2, Baruch Yrushalmi1,2
1Faculty Of Health Sciences, Ben‐Gurion University of the Negev, Beer‐Sheva, Israel, Beer Sheva, Israel, 2Pediatric Gastroneterology, Hepatology, And Nutrition Unit, Saban Children Hospital, Soroka University Medical Center, Beer Sehva, Israel
Objectives and Study: Celiac disease (CD) is an immune‐mediated enteropathy triggered by ingesting gluten‐containing grains in genetically susceptible individuals. The prevalence of CD has increased dramatically over the last decades, with a prevalence of 1%‐3%. Several risk factors for CD are reported, including genetic, nutritional, infections, mode of delivery, and exposure to postnatal antibiotics. We aim to examine the association between prenatal exposure to antibiotics and CD.
Methods: A retrospective cohort study comparing the prevalence of CD among children born to mothers who purchased one or more antibiotics during their pregnancy compared to mothers who did not. We used the MDClone platform, which contains all the medical records of people registered to the “Clalit” health maintenance organization (HMO), the largest HMO in Israel. Exclusion criteria included stillborn, prematurity, or children with missing or incomplete data.
Results: A total of 987,668 births took place at Clalit" HMO between 2000‐ and 2022; 967,072 (97.9%) of them met the inclusion criteria, and only 658,889 were born by mothers who belonged to "Clalit" HMO and were included in the study. Out of this number, 239,035 mothers were exposed to antibiotics (36.28%). Among the offspring, a total of 5,706 children were diagnosed with CD, with a prevalence of 0.86:100. This included 2,176 (38.1%) children born to mothers who received one or more antibiotic treatments during the pregnancy (prevalence of 0.9:100), compared to 3,530 children who were born to mother who didn't receive any antibiotic treatment during pregnancy (prevalence of 0.8:100) (P value = 0.003). A multivariable regression including known risk factors for CD: the mother's age, mode of delivery, and history of a CD of the mother showed an incidence rate ratio (IRR) of 1.08 (95% CI 1.02‐1.14, P value = 0.005).
Conclusions: Our study demonstrates for the first time a significant association between prenatal maternal antibiotic exposure and CD in the offspring.
Contact e‐mail address: Raouf.n@gmail.com
G‐OP012. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐OP012.1. SUDDEN ELEVATION OF TTG‐IGA ANTIBODIES IN CHILDREN AT RISK FOR CELIAC DISEASE: INSIGHTS FROM THE CDGEMM COHORT
Francesco Valitutti1, Maureen Leonard2, Valentina Pucinischi 3, Victoria Kenyon2, Monica Montuori4, Giovanni Di Nardo5, Pasqua Piemontese6, Ruggiero Francavilla7, Lorenzo Norsa8, Maria Elisabetta Baldassarre9,10, Chiara Maria Trovato11, Michela Perrone12, Tiziana Passaro13, Naire Sansotta14, Marco Crocco15, Annalisa Morelli16, Federica Malerba15, Fernanda Cristofori17, Alessio Fasano2
1Pediatrics Section, Depart. Of Medicine And Surgery, University of Perugia, Perugia, Italy, 2Pediatric Gastroenterology & Nutrition, MassGeneral Hospital for Children, Boston, United States of America, 3Department Of Neurosciences, Mental Health And Sensory Organs (nesmos), Sapienza University of Rome, Rome, Italy, 4Maternal And Child Health Department, Sapienza University of Rome, rome, Italy, 5Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy;, Rome, Italy, 6Nicu, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, 7Interdisciplinary Department of Medicine, Pediatric Section, Pediatric Hospital Giovanni XXIII, Bari, Italy, 8Pediatric Department, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy, 91 Section of Neonatology and NICU, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy., Bari, Italy, 10Section of Neonatology and NICU, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy., Bari, Italy, 11Uos Riabilitazione Nutrizionale, Uoc Gastroenterologia E Nutrizione, Ospedale Pediatrico Bambino Gesù, Rome, Italy, 12University of Milan, Milan, Italy, 13Pediatrics ‐ Cava De' Tirreni, Salerno University Hospital, Salerno, Italy, 14Paediatric Hepatology, Gastroenterology And Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy, 15IRCCS Istituto Giannina Gaslini, Genova, Italy, 16Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, Baronissi (SA), Italy, 17Interdisciplinary Department Of Medicine, Pediatric Section, University of Bari Aldo Moro, Bari, Italy
Objectives and Study: There is limited data available examining the trajectory of tissue transglutaminase IgA (tTG‐IgA) antibodies prior to celiac disease (CeD) onset. The CDGEMM study is an international birth cohort if infants from birth who are at‐risk for CeD. Here we utilize this cohort to evaluate tTG‐IgA titers at disease onset and 6 months prior to onset to determine the early trajectory of this test.
Methods: We examined 34 children from the CDGEMM cohort who had elevated titers for CeD between 2014‐2024. We included 25 children who had elevated titers for CeD (onset) and a titer 6‐months prior to seroconversion. All samples are tested for CeD antibodies including tTG‐IgA. Samples are tested centrally at Massachusetts General Hospital in Boston, MA following BioFlash procedure (Werfen, Bedford, MA, USA). We extracted the data for each subject to examine the tTG‐IgA titer at seroconversion and 6 months prior and compared the value against manufacturers value of normal (20 chemiluminescent units (CU)).
Results: Of the 25 patients reviewed, the median value of tTG‐IgA at time of seroconversion was 562 CU (range of 34.1 – 4965.5). However, 6 months prior, the median value of tTG‐IgA for these cases was 1.9 CU (range 1.9‐17.7). Thus, all of these patients had normal tTG‐IgA 6 months prior to seroconversion and then displayed titers that were <5x ULN (n = 7), 5‐10x ULN (n = 3), and >10x ULN (n = 15).
Conclusions: In children at‐risk for CeD tested prospectively, titer of tTG‐IgA higher than x5 ULN at diagnosis are found in 72% of cases who were tTG‐IgA negative 6 months earlier. Thus, high anti‐transglutaminase antibodies may appear suddenly and are not indicative of diagnostic delay in our cohort. Further work examining the trajectory of tTG‐IgA in patients not prospectively followed, those on a gluten‐containing diet, and the trajectory and timeline of mucosal changes are needed.
Contact e‐mail address: francesco.valitutti@unipg.it
G‐OP013. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐OP013.1. GASTROINTESTINAL BENEFITS OF TRIKAFTA® IN CF PATIENTS WITH F508DEL MUTATION: RESULTS OF A MULTICENTER PROSPECTIVE STUDY
Liron Birimberg‐Schwartz 1, Tanja Gonska2, Chee Ooi3,4, Farah Khan5, Jessica Halim3,4, Irina Rabkin1, Yuval Ishay6, Tiberiu Hershcovici6, Michael Wilschanski1
1Department Of Pediatric Gastroenterology, Hadassah Medical Center and the Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel, 2Division Of Gastroenterology, Hepatology And Nutrition, Department Of Pediatrics, University Of Toronto, The Hospital for Sick Children, Toronto, Canada, 3Department Of Gastroenterology, Sydney Childrens Hospital, Sydney, Australia, 4School Of Clinical Medicine, Discipline Of Paediatrics And Child Health, UNSW Medicine & Health, University of New South Wales, Sydney, Australia, 5Research Institute, The Hospital for Sick Children, Toronto, Canada, 6The Institute Of Gastroenterology And Liver Diseases, Hadassah medical center and Faculty of Medicine, Hebrew university of Jerusalem, Jerusalem, Israel
Objectives and Study: Gastrointestinal (GI) complications are common in cystic fibrosis (CF), often preceding respiratory symptoms. While the respiratory benefits of CFTR modulators like TRIKAFTA® are well‐established, data on GI outcomes remain limited. This multi‐center, prospective, observational study evaluates changes in GI symptoms and quality of life (QOL) in CF patients following TRIKAFTA® treatment.
Methods: Thirty‐five CF patients (mean age: 16.7 years; 62.86% male) carrying the F508del mutation were enrolled across three centers: Hadassah Hebrew University Medical Center (Israel), Hospital for Sick Children (Canada), and Sydney Children's Hospital (Australia). Patients were assessed at baseline, and at 6 and 12 after initiating TRIKAFTA® therapy. Evaluations included patient‐reported GI symptoms (GI Symptom Tracker, Quittner, 2015), abdominal ultrasound, capsule endoscopy, and stool and blood biomarker. GI symptoms were categorized into six domains: daily functioning, GI symptoms, enzyme management, dietary behavior, psychosocial, and bowel symptoms, with an overall QOL score calculated.
Results: Baseline data from 34 patients showed that 24 patients (70.59%) reported mild GI‐related QOL impairment, 8 patients (23.53%) minimal, 2 patients (5.88%) moderate, with none having severe QOL impairment. Significant QOL improvements were observed at 6 months (p = 0.0071) and 12 months (p = 0.0012). At 12 months, the number of patients reporting minimal QOL impact increased from 8 (23.53%) to 13 (44.83%), while the number reporting mild impairment decreased from 24 (70.59%) to 15 (51.72%). Improvements were notable in specific domains, including GI symptoms (p = 0.0044), dietary behavior (p = 0.0104), and bowel symptoms (p = 0.0415).
Conclusions: TRIKAFTA® therapy significantly improves GI‐related QOL in CF patients, particularly in bowel symptoms and dietary behaviors. These findings suggest potential improvements in pancreatic function, intestinal dysbiosis, and inflammation. We are continuing to analyze biomarkers, microbiome composition, imaging findings, and capsule endoscopy results, with these additional outcomes to be reported in the future.
Contact e‐mail address: lbschwartz@hadassah.org.il
G‐OP014. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐OP014.1. DEVELOPMENT AND VALIDATION OF A SIMPLE NOMOGRAM FOR PREDICTING SEVERE ACUTE PANCREATITIS IN CHILDREN
Cai‐Xia Feng, Qing‐Wen Shan
Department Of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
Objectives and Study: The objective of this research was to create and verify a simple nomogram for predicting severe acute pancreatitis (SAP) in children, thereby aiding clinicians in the early identification and intervention of this potentially fatal condition.
Methods: We retrospectively analyzed pediatric acute pancreatitis (AP) patients from two hospitals, using the Least Absolute Shrinkage and Selection Operator (LASSO) regression to select optimal predictors and logistic regression to build a nomogram. Internal and external validations were performed.
Results: For the training cohort, we enrolled 152 pediatric AP patients, among which 23 patients (15.1%) were categorized as SAP. In the external validation cohort, we included 60 pediatric AP patients, with 7 patients (11.7%) being classified as SAP. Significant predictors of SAP identified through LASSO regression included fever, C‐reactive protein, blood urea nitrogen, albumin and calcium. The constructed nomogram demonstrated good discrimination with an AUC of 0.875 (95% CI: 0.811‐0.939), sensitivity of 0.913, specificity of 0.76 in the training cohort and an AUC of 0.97 (95% CI: 0.91‐1), sensitivity of 0.857, specificity of 1 in the external validation cohort. Excellent calibration as evidenced by the Hosmer‐Lemeshow test (p > 0.05) and the Calibration Curve, and high clinical utility as shown by the Clinical Decision Curve.
Conclusions: Our research created and validated a simple nomogram for predicting SAP in children, enabling early risk stratification and guiding effective interventions.
Contact e‐mail address: fengcxdaydayup@163.com
G‐OP015. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐OP015.1. CYSTIC FIBROSIS SCREEN POSITIVE INCONCLUSIVE DIAGNOSIS: INSIGHTS FROM A SPANISH CENTER
Sara Fernández González 1, Ana Moreno Álvarez1, Ana Lucía González Torres2, Alfonso Solar Boga1
1Gastroenterology, Hepatology And Nutrition, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain, 2Pneumology, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
Objectives and Study: Neonatal cystic fibrosis (CF) screening has been implemented in Galicia since 2003, leading to increased detection of CFTR gene variants with uncertain clinical significance. This led to the introduction the concept of CF screen‐positive, inconclusive diagnosis (CF‐SPID), encompassing uncertain CFTR mutations and atypical sweat chloride levels. These cases pose challenges in diagnosis and interpretation of neonatal screening results. The aim of our study is to describe patients with CF‐SPID diagnosed in our community, their mutations, clinical evolution and treatment.
Methods: This retrospective review analyzed 48 patients diagnosed with CFTR variants of uncertain significance in Galicia between 2003 and 2023. The study included a population of 402,800 births during this period. Currently, 32 patients are being followed (52% girls; mean age: 9.8 ± 6.6 years).
Results: Currently, 32 patients are being followed (52% girls; mean age: 9.8 ± 6.6 years). The most common genetic combination was D1270N/R74W in 10 patients, followed by F508del/L206W in 4 patients. Five patients received CFTR modulators—three asymptomatic and two with bronchiectasis—all carrying F508del and another variant of uncertain significance. Among the 27 patients not on modulators, one has pancreatic insufficiency (R1066C/G1069), and four have sweat chloride levels ≥60 mmol/L (all with normal lung function, though one has bronchiectasis, and another presented stercoraceous colitis and pneumomediastinum). Ten patients have sweat chloride levels of 30–59 mmol/L, and 12 have levels <30 mmol/L—all asymptomatic with normal lung function. Of those with chloride levels ≥60 mmol/L, two carry F508del/L206W, one R1162X/E588V, and the other one F508del/D1270N.
Conclusions: Patients with pancreatic insufficiency and elevated sweat chloride levels warrant careful clinical consideration, as they may have disease profiles similar to those with two CF‐causing variants. This highlights the importance of re‐evaluating uncertain CFTR variants over time and underscores the need for cautious management of CF‐SPID cases to optimize diagnosis and treatment.
Contact e‐mail address: sara.maria.fernandez.gonzalez@sergas.es
G‐OP016. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐OP016.1. NEXT GENERATION SEQUENCING IDENTIFIED HIGH FREQUENCY OF CFTR GENE VARIANTS IN CHILDREN WITH ACUTE RECURRENT/CHRONIC PANCREATITIS – REPORT FROM INSPPIRE‐2
Tanja Gonska 1,2,3, Chee Ooi4, Michael Wilschanski5, Fuchenchu Wang6, Gretchen Cress7, Maisam Abu‐El‐Haija8, Ankur Chugh9, Reuven Zev Cohen10, Elissa M. Downs11, Douglas S. Fishman12, A. Jay Freeman13, Mathew Giefer14, Amit Grover15, Sohail Z. Husain16, Douglas Lindblad17, Quin Liu18, Asim Maqbool19, Mark Jacob20, Brian Mcferron21, Megha Mehta22, Veronique Morinville23, Kenneth Ng24, Robert Adam Noel25, Emily R. Perito26, Yuhua Zheng27, Ying Yuan6, Mark E. Lowe28, Aliye Uc7
1Pediatric Gastroenterology, Hospital for Sick Children, Toronto, Canada, 2Division Of Gastroenterology, Hepatology And Nutrition, Department Of Pediatrics, University Of Toronto, The Hospital for Sick Children, Toronto, Canada, 3Translational Medicine Program, Sickkids Research Institute, Toronto, Canada, 4UNSW Medicine and Health, Sydney, Australia, 5Hadassah Hebrew University Hospital, Jerusalem, Israel, 6MD Anderson Cancer Center, Houston, United States of America, 7Stead Family Children's Hospital, Iowa City, United States of America, 8Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America, 9Medical College of Wisconsin, Milwaukee, United States of America, 10Children's Healthcare of Atlanta and Emory University, Atlanta, United States of America, 11University of Minnesota Masonic Children's Hospital, Minnesota, United States of America, 12Baylor College of Medicine and Texas Children's Hospital, Texas, United States of America, 13Nationwide Children's Hospital, Columbus, United States of America, 14Ochsner Hospital for Children, New Orleans, United States of America, 15Boston Children's Hospital, Boston, United States of America, 16Stanford Children's Health, Palo Alto, United States of America, 17Children's Hospital of Pittsburgh, Pittsburgh, United States of America, 18Cedars‐Sinai Medical Center, Los Angeles, United States of America, 19Children's Hospital of Philadelphia, Philadelphia, United States of America, 20Children's Hospital Colorado, Aurora, United States of America, 21Riley Hospital for Children, Indianapolis, United States of America, 22MUniversity of Texas Southwestern Medical Sc, Dallas, United States of America, 23Montreal Children's Hospital, Montreal, Canada, 24Johns Hopkins Children's Center, Baltimore, United States of America, 25Baylor College of Medicine, San Antonio, United States of America, 26University of California San Francisco, San Francisco, United States of America, 27Children's Hospital Los Angeles, Los Angeles, United States of America, 28Washington University School of Medicine, St. Louis, United States of America
Objectives and Study: Introduction: Mutations in pancreatitis‐associated genes are the most common cause of acute recurrent/chronic pancreatitis (ARP/CP) in children. Among those are CFTR gene mutations. Identification of these mutations depended so far on the individual applied CFTR gene panel and/or CFTR exon sequencing making it difficult to understand the full extent of the frequency of CFTR gene variants in ARP/CP populations. The objective of this study is to evaluate the frequency and kind of CFTR gene variants in children with ARP/CP.
Methods: Method: INSPPIRE‐2 is the largest international pediatric ARP/CP cohort with 24 participating centers. Around 50% of all study subjects underwent next generation sequencing by Ariel Precision Medicine to comprehensively capture all variants in pancreatitis‐associated genes. A subset of study participants had clinically performed CFTR gene analysis.
Results: Results: Of 1134 INSPPIRE‐2 patients 497 underwent Ariel sequencing. Of those 438 had at least one CFTR gene variant with detection of 111 different CFTR gene variants. When compared to a control cohort (GnomAD) 26 CFTR alleles were enriched in the INSPPIRE‐2 cohort with 9 variants identified as pathogenic and 9 as benign. Based on clinical analysis, 95 INSPPIRE‐2 subjects were identified with CFTR gene variants. CFTR modulator drug‐responsive gene variants listed to be response to treatments were found in 83 patients following Ariel sequencing and 37 patients identified clinically. In the next step, we will sort these patients as per severity of the CFTR genotype and evaluate for clinical differences.
Conclusions: Conclusion: CFTR gene variants largely contribute to ARP/CP in children. It is currently the only gene defect with available therapy. The frequency of CFTR gene variants in our cohort was higher than expected warranting researchers/clinicians to perform CFTR gene analysis more extensively in their pancreatitis cohorts
Contact e‐mail address: tanja.gonska@sickkids.ca
G‐OP017. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐OP017.1. CFTR MODULATOR THERAPY REDUCES ACUTE PANCREATITIS EPISODES IN CHILDREN WITH CFTR VARIANTS: REPORT FROM INSPPIRE‐2 COHORT
Michael Wilschanski 1, Gila Ginzburg2, Ankur Chugh2, Mark Jacob3, Nicholas Antos4, Tanja Gonska5, Chee Ooi6, Gretchen Cress7, Maisam Abu‐El‐Haija8, Reuven Zev Cohen9, Elissa Downs10, Douglas Fishman11, Cheryl Gariepy12, Mathew Giefer13, Amit Grover14, Douglas Lindblad15, Quin Liu16, Asim Maqbool17, Brian Mcferron18, Megha Mehta19, Veronique Morinville20, Kenneth Ng21, Robert Adam Noel22, Emily Perito23, Zachary Sellers24, Fuchenchu Wang25, Feng Tian26, Ying Yuan26, Mark Lowe27, Aliye Uc7
1Pediatric Gastroenterology, Hadassah Medical Organization, Jerusalem, Israel, 2Medical College of Wisconsin/Children's Wisconsin, Milwaukee, United States of America, 3Pediatric Gastroenterology, Childrens Hospital of Colorado, Aurora, United States of America, 4Pediatric Pulmonology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, United States of America, 5Pediatric Gastroenterology, Hospital for Sick Children, Toronto, Canada, 6Pediatric Gastroenterology, Sydney Childrens Hospital, Sydney, Australia, 7Pediatric Gastroenterology, University of Iowa, Iowa, United States of America, 8Pediatric Gastroenterology, Cincinnati Childrens Hospital, Cincinnati, United States of America, 9Childrens Healthcare Atlanta, Atlanta, United States of America, 10University of Minnesota Masonic Children"s Hospital, Minneapolis, United States of America, 11Texas Childrens Hospital, Houston, United States of America, 12Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, United States of America, 13Pediatric Gastroenterology, Ochsner Hospital for Children, The University of Queensland, New Orleans, United States of America, 14Pediatric Gastroenterology, Boston Childrens Hospital, Boston, United States of America, 15Pediatric Gastroenterology, Childrens Hospital of Pittsburgh, Pittsburgh, United States of America, 16Pediatric Gastroenterology, Cedars‐Sinai Medical Center, Los Angeles, United States of America, 17Childrens Hospital of Philadelphia, Philadelphia, United States of America, 18Pediatric Gastroenterology, Riley Hospital for Children, Indianapolis, United States of America, 19Pediatric Gastroenterology, University of Texas, Dallas, United States of America, 20Pediatric Gastroenterology, Montreal Childrens Hospital, Montreal, Canada, 21Pediatric Gastroenterology, Johns Hopkins Childrens Center, Baltimore, United States of America, 22Pediatric Gastroenterology, Baylor College of Medicine and Texas Children's Hospital, San Antonio, United States of America, 23Pediatric Gastroenterology, University of California, San Fransisco, United States of America, 24Stanford University, San Fransisco, United States of America, 25Pediatric Gastroenterology, University of TexasMD Anderson Cancer Center, Houston, United States of America, 26University of TexasMD Anderson Cancer Center, Houston, United States of America, 27Washington University School of Medicine, St Louis, United States of America
Objectives and Study: Cystic fibrosis transmembrane regulator (CFTR) modulator therapies have been shown to reduce acute pancreatitis (AP) episodes in people with pancreatic sufficient cystic fibrosis (CF). CFTR variants are present in 20‐30% of children and adults with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). We hypothesize that highly effective modulator therapy (HEMT), elexacaftor/tezacaftor/ivacaftor (ETI) and ivacaftor, will decrease the frequency of AP episodes in children with ARP or CP who are CFTR variant carriers.
Methods: This was a multi‐center retrospective cohort study of children with ARP or CP enrolled in the INternational Study Group of Pediatric Pancreatitis: In search for a cuRE‐2 (INSPPIRE‐2) cohort. Inclusion criteria were at least one CFTR variant, but not CF, receiving HEMT. The number of AP episodes before and while on HEMT were compared using incidence rate, accounting for different person‐years of follow‐up.
Results: Of the 1,025 INSPPIRE‐2 patients, 11 subjects on HEMT were CFTR variant carriers; 73% male, 73% had ARP, and 27% had CP; 82% had one CF causing variant: 73% were heterozygous F508del, and 9% were heterozygous G551D. The remaining CFTR polymorphisms were variants of unknown significance or non‐CF causing. 73% were on ETI and 27% on ivacaftor. There was marked significant (90%) reduction in AP incidence density pre‐CFTR modulator vs on‐CFTR modulator (1.17 vs. 0.18, p < 0.001).
Conclusions: HEMT significantly decreased the number of AP episodes in children with ARP or CP that were CFTR variant carriers. This observation was found with multiple types of CFTR variants. Given the high prevalence of CFTR variants in pediatric ARP or CP patients, this suggests the potential to use HEMT for reduction of AP episodes in this patient population. Future multicentered prospective studies on the efficacy of HEMT for the treatment of AP in patients with CFTR variants is warranted.
Contact e‐mail address: michaelwil@hadassah.org.il
G‐OP018. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐OP018.1. EXCLUSIVE INHALATIONAL ANAESTHESIA FOR PAEDIATRIC ENDOSCOPIES ‐ A MULTICENTER EXPERIENCE
Bhaswati Acharyya 1, Sanjay Mahawar2
1Paediatric Gastroenterology, Manipal Hospitals, Kolkata, India, 2Anaesthesia, Manipal Hospitals, Kolkata, India
Objectives and Study: There are limited data regarding the safety of sedatives in Paediatric GI endoscopic procedures.
Although intravenous sedation is preferred we currently practice exclusive inhalational anaesthesia (EIA) for GI endoscopies in children by trained staff or by an anaesthetist.
Thereby, a retrospective study is undertaken to 1)To determine the effectiveness of exclusive inhalational sedation by comparing it with intravenous sedation 2) To estimate the frequency of inability to complete the procedure and the need to use additional intravenous sedation.
Methods: A retrospective analysis of case records of all children aged 3 months to 12 years undergoing daycare‐GI endoscopies (both diagnostic and therapeutic) in 2 tertiary centers from January 2018 to September 2023 was carried out to record the induction time, recovery time, procedural sedation‐related adverse events(PSAE), discharge time and any need to convert to intravenous sedation. For inhalation, children were administered 66% nitrous and Sevoflurane 5‐8% exclusively via an appropriately sized facemask and Jackson Rees Paediatric Circuit. No IV access was obtained (though kept ready). For intravenous sedation(IVS), Propofol was used, and an anesthetist was always present. All children were monitored properly.
Results:
| comparison between EIA and IVS group | |||
|---|---|---|---|
| parameters | EIA = 2893 | IVS = 1032 | p value |
| OGD | 1952 | 630 | |
| OGD + COLON | 959 | 322 | |
| COLONOSCOPY | 302 | 80 | |
| THERAPEUTIC | 483 | 152 | |
| Mean induction time(mins) | 2.5 + 5 | 3 + 0.5 | ns |
| Mean emergent time(mins) | 2.5 + 5 | 3 + 0.4 | ns |
| Mean complete recovery time(mins) | 6.2 + 2.5 | 22 + 5.7 | <.0001 |
| Mean Discharge Time(mins) | 59 + 16 | 125 + 19 | <.0001 |
Records of a total of 3925 children, with a mean age of 60 ± 6 months, were analyzed, of which 2893 were EIA. Conversion to additional IVS was required only in 20 cases (0.7%). Therapeutic endoscopies) were carried out in 483 children of EIA (Table 1).
Conclusions: This study emphasized that exclusive inhalation anesthesia with Sevoflurane is very easy, time‐saving, and effective for deep sedation in paediatric GI endoscopic procedures
Contact e‐mail address: bacharyya21@gmail.com
G‐OP019. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐OP019.1. COMPARISON OF THE EFFICIENCIES OF CARBON DIOXIDE AND AIR INSUFFLATION METHODS DURING PEDIATRIC UPPER GASTROINTESTINAL ENDOSCOPY UNDER INTRAVENOUS SEDATION: A RANDOMIZED CONTROL TRIAL
Shin‐Ichiro Hagiwara, Takatoshi Maeyama, Ryutaro Saura, Tatsuya Ishikawa, Yuki Yamano, Yoshikazu Miura, Keinosuke Hizuka, Yuri Etani
Department Of Pediatric Gastroenterology, Nutrition And Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
Objectives and Study: Insufflation with either carbon dioxide (CO₂) or air is required for observation during upper gastrointestinal endoscopy (UGI endoscopy). Although previous studies have evaluated insufflation methods in children, CO₂ levels in the systemic circulation were not measured and sedation protocols were inconsistent, resulting in insufficient evidence. In this study, we conducted a randomized controlled trial to compare CO₂ insufflation and air insufflation during pediatric UGI endoscopy, focusing on their safety and efficacy.
Methods: This study included 91 participants who underwent UGI endoscopy under intravenous sedation in our department between May 2021 and September 2024. The primary outcomes were transcutaneous CO₂ (pCO₂) levels (mmHg) during the procedure measured using the transcutaneous blood gas monitoring system (TOSCA®), pre‐ and post‐procedure abdominal circumference, and post‐procedure pain assessed using the FLACC pain scale.
Results: Of the 91 participants, 80 (38 in the CO₂ group and 42 in the Air group) were included in the analysis. There were no significant differences between the groups in mean pCO₂ immediately before the procedure (47.0 vs. 46.0, p = 0.96), maximum pCO₂ during the procedure (57.0 vs. 52.0, p = 0.067), or pCO₂ at the end of the procedure (55.5 vs. 52.5, p = 0.267). However, the difference between pre‐procedure pCO₂ and maximum pCO₂ during the procedure (ΔpCO₂) was significantly greater in the CO₂ group (9.0 vs. 7.0, p = 0.008). The difference in abdominal circumference before and after the procedure was significantly greater in the Air group, but no significant differences were observed on the FLACC pain scale.
Conclusions: In the CO₂ group, ΔpCO₂ levels were significantly higher, and no significant differences were observed in post‐procedure pain scores compared with air insufflation. These findings suggest that CO₂ insufflation may not offer significant advantages for pediatric UGI endoscopy under sedation.
Contact e‐mail address:
G‐OP020. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐OP020.1. AI‐BASED CAPSULE ENDOSCOPY INTERPRETATION IS HIGHLY EFFECTIVE AND EFFICIENT IN DIAGNOSING PEDIATRIC CROHN'S DISEASE
Jeongwoo Ju1, Haejin Lee1, Juwon Hwangbo1, Yeoun Joo Lee 1,2, Heechul Jung1,3, Jonghyuck Lee1
1Seoreu Co., Ltd., Yangsan, Korea, Republic of, 2Department Of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea, Republic of, 3Artificial Intelligence, Kyungpook National University, Daegu, Korea, Republic of
Objectives and Study: Pediatric Crohn's disease (CD) requires extensive time for interpreting small bowel (SB) capsule endoscopy (CE) due to the diverse range and number of lesions. This study analyzes the diagnostic accuracy and efficiency of an AI‐based system that selects frames with lesions, allowing gastroenterologists to focus on interpreting only the relevant frames.
Methods: Between January and October 2024, 60 CE videos recorded for SB evaluation of pediatric‐onset CD were analyzed along with their corresponding diagnostic results evaluated by gastroenterologists. The AI‐based system (Captos, Seoreu Co., Ltd., Yangsan) analysis results were compared with those of the gastroenterologists. Videos with one or more definite ulcers in the SB were classified as the active CD group.
Results: Out of 60 videos, gastroenterologists diagnosed 19 as CD without active small bowel lesions (inactive CD group) and 41 as CD with active small bowel lesions (active CD group). On average, gastroenterologists reviewed 11,434 ± 5,985 frames corresponding to the small bowel section per video. In contrast, the AI‐based system yielded 739.24 ± 751.32 frames per active CD group and 55.42 ± 75.85 frames per inactive CD group. Specifically, for the active CD group, the AI‐based system detected 763.58 ± 923.50 ulcers and 208.02 ± 344.08 bleeding/hyperemia lesions. For the inactive CD group, AI system counted 41.05 ± 71.99 bounding boxes (bboxes) as ulcers and 15.73 ± 25.03 bboxes as bleeding/hyperemia lesions. In the active CD group, there was no video in which the ulcer bboxes was not detected at all.
Conclusions: The AI‐based system significantly reduces the number of frames to be reviewed by 95.56%, potentially alleviating physical and mental fatigue for gastroenterologists. The system demonstrated effective and efficient diagnostic performance in detecting small intestinal lesions in children with CD via CE.
Contact e‐mail address:
G‐OP021. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐OP021.1. ATTITUDES TOWARDS AND EXPERIENCE OF ERGONOMICS IN ENDOSCOPY: A BSPGHAN ENDOSCOPY WORKING GROUP SURVEY OF UNITED KINGDOM‐WIDE PRACTICE
Joseph Machta1,2, Lucy Howarth2,3, Shishu Sharma 2,4
1Paediatric Hepatology, King's College Hospital London NHS Foundation Trust, London, United Kingdom, 2BSPGHAN Endoscopy Working Group, United Kingdom, United Kingdom, 3Paediatric Gastroenterology, Oxford University Hospital, Oxford, United Kingdom, 4Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom
Objectives and Study: Ergonomic endoscopy is the study and optimisation of an endoscopist's interaction with their environment, to reduce rates of work‐related injury(1). The risk and prevalence of endoscopy related injury (ERI) is established in adult gastroenterology,(2–4) and USA‐based paediatricians,(5) but there are no UK‐based data on this. ASGE developed ERI prevention guidelines and best practice recommendations for ergonomics, highlighting the importance of posture, room set‐up, and equipment‐handling in paediatric endoscopy.(1,6) There exists no similar guidance for European audiences.(7) We aim to ascertain attitudes towards ergonomic endoscopy and the prevalence, nature, and risk factors of ERI amongst UK paediatric endoscopists.
Methods: 26‐point questionnaire survey distributed to BSPGHAN members, covering demographics, clinical experience; history of ERI; experience with ergonomic modification.
Results: 65 respondents, response rate 20.1% (323 eligible). 50.8%(n = 33) female. 52.3%(n = 34) aged 35‐44 years, 24.6%(n = 16) 45‐54 years. 53.8%(n = 35) consultant‐grade. 76.9%(n = 50) performed 1‐4 hours of endoscopy weekly, 18.5%(n = 12) 5‐10 hours. 53.8%(n = 35) previously experienced ERI. Most common ERI: hand/digit pain 62.2%(n = 23); backache 35.1%(n = 13); arm pain 24.3%(n = 9); neck‐ache 16.2%(n = 6).
29.2%(n = 19) experienced pain during endoscopy monthly.
18.5%(n = 12) had taken analgesia for ERI. 86.2%(n = 56) never had training on ergonomics/reducing ERI.
6.2%(n = 4) included ergonomics in theatre brief. Significant differences in ERI frequency in females vs males (69.7% vs 37.5%, p = 0.013), and endoscopists performing weight/resistance exercise vs not (39.4% vs 68.8%, p = 0.025). ERI frequency was equivocal in consultants vs non‐consultants (54.3% vs 55.5%); using water‐assisted colonoscopy vs not (36.9% vs 60.1%, p = 0.103); age <45years vs >45years (56.1% vs 50%, p = 0.79); and performing cardiovascular exercise vs not (63.6% vs 51.9%, p = 0.52).
Conclusions: This is the first UK‐wide study of ergonomics/ERI amongst paediatric endoscopists. Over half endoscopists surveyed experienced ERI. Most endoscopists had never had ergonomics training. We found that women and endoscopists not performing resistance exercises were significantly more likely to experience ERI. Our findings provide impetus for development of ergonomics training/guidelines to reduce risks of injury amongst paediatric endoscopists.
Contact e‐mail address: joseph.machta@nhs.net
G‐OP022. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐OP022.1. ENDOSCOPIC TREATMENT OF PROTEIN LOSING ENTEROPATHY IN CHILDREN AFTER FONTAN PROCEDURE
Kirill Marakhouski 1, Aleh Sautin1, Paval Charnahlaz2, Uladzislau Kolbik3, Palina Marakhouskaja4, Kanstantsin Drazdouski5
1Endoscopy Department, Republican Research and Practical Center for Pediatric Surgery, Minsk, Belarus, 2X‐ray Surgery Department, Republican Research and Practical Center for Pediatric Surgery, Minsk, Belarus, 3Department Of Cardiac Pediatric Surgery, Republican Research and Practical Center for Pediatric Surgery, Minsk, Belarus, 4Computed Tomography Unit, Republican Research and Practical Center for Pediatric Surgery, Minsk, Belarus, 5Director, Republican Research and Practical Center for Pediatric Surgery, Minsk, Belarus
Objectives and Study: Protein‐losing enteropathy (PLE) occurs in 3‐20% of patients after the Fontan procedure in children with single‐ventricle heart defects. One possible pathophysiological pathway for PLE in these patients is thought to be hypertension in the collaterals between the hepatic and duodenal lymphatic ducts, which can lead to the formation of transmural fistulas and subsequent leakage into the duodenal lumen. The original technique for endoscopic‐assisted treatment of PLE after the Fontan procedure consists of several steps: 1) cannulation of the lymphatic vessels of the right lobe of the liver under ultrasound/X‐ray control; 2) injection of a lipoidol and methyl blue solution; 3) endoscopic detection of blue staining and leakage sites in the duodenum; 4) endoscopic administration of glue and lipoidol solution; and 5) control through subsequent cannulations, including those of the left lobe of the liver, and repeated endoscopic examinations.
Methods: This study was a case‐series research involving 9 patients diagnosed with protein‐losing enteropathy following the Fontan procedure. We replicated the original technique for endoscopic glue embolization of transmural lymphatic fistulas.
Results: When we reproduced the endoscopic component of the technique, it became evident that it was necessary to clear the duodenal wall and lumen. To achieve this, we utilized 3 to 4 liters of fluid per procedure, resulting in underwater endoscopy. During the procedure, we achieved direct endoscopic visualization of the functioning fistula. To date, we have performed endoscopic treatment on 9 patients. The results have been inconsistent; we observed 4 successful cases with follow‐ups extending up to one year, while 2 cases did not yield a successful outcome. Furthermore, we understand that the number of lymphatic fistulas may exceed 10, and in such instances, the method may not be effective.
Conclusions: The high‐resolution underwater endoscopy can singly detect defect duodenal protein‐fluid leak in PLE patients, making treatment technique endoscopic only.
Contact e‐mail address: sautin.oleg@gmail.com
G‐OP023. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐OP023.1. CAP‐ASSISTED, BAND LIGATED EN BLOC RESECTION OF ESOPHAGEAL ABRIKOSSOFF'S TUMOR IN A TEENAGER
Kirill Marakhouski, Aleh Pataleta, Aleh Sautin
Endoscopy Department, Republican Research and Practical Center for Pediatric Surgery, Minsk, Belarus
Objectives and Study: Granular cell tumors were first described by Weber in 1854. However, their muscular origin was suggested, studied in detail, and differentiated by the pathologist A.I. Abrikosov in 1926. With the development of immunohistochemical analysis, a revised understanding of Abrikosov's tumor pathogenesis emerged, proposing its origin from Schwann cells. Currently, the expression of S‐100 and CD68 proteins in tumor cells, as determined through histochemical analysis, serves as a diagnostic criterion for Abrikossoff's tumor.
In the treatment of granular cell tumors of the esophagus, preference is given to minimally invasive endoscopic techniques, as conservative therapy has proven to be ineffective. Considering that in most cases the tumor is benign, many authors have recently recommended endoscopic mucosal resection and endoscopic submucosal dissection.
Methods: This video presents the experience of treating a teenager with an Abrikossoff's tumor in the lower third of the esophagus using a rare endoscopic technique.
Results: The described clinical case proved to be a difficult diagnostic task, since Abrikossoff's tumor of the esophagus in a teenager is an extremely rare pathology with a rare localization. To remove the tumor, a non‐standard endoscopic technique was chosen that allowed the formation to be removed in a single block, i.e., radically, since preoperative morphological verification was impossible. This video demonstrates the high efficiency and safety of endoscopic tumor removal in this localization.
Conclusions: The use of this endoscopic treatment technique made it possible to radically remove the tumor and ensure a smooth course of the postoperative period.
Contact e‐mail address: sautin.oleg@gmail.com
G‐OP024. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐OP024.1. ISOLATED INTESTINAL LYMPHATIC ANOMALY: UNDERWATER ENDOSCOPIC IDENTIFICATION AND THERAPEUTIC INTERVENTION
Ashley Polachek 1, Geoffrey Daves2, David Troendle1, Sheena Pimpalwar1, Suren Reddy1, Bhaskar Gurram1, Christian Wysocki1
1University of Texas Southwestern ‐ Children's Medical Center Dallas, Dallas, United States of America, 2UTSW ‐ Children's Medical Center Dallas, Dallas, United States of America
Objectives and Study: We present a 12‐month‐old, 10 kg male with PLE secondary to presumed PIL with acute on chronic watery diarrhea, peripheral edema and associated hypoalbuminemia, hypogammaglobulinemia and lymphopenia. His symptoms were refractory to medical management, thus dynamic contrast‐enhanced magnetic resonance lymphangiography (DCMRL), cardiac catheterization and esophagogastroduodenoscopy (EGD) were performed. DCMRL revealed suspected lymphatic leakage into the duodenum. Cardiac catheterization was normal.
Methods: The procedure was conducted in the cardiac catheterization laboratory with patient under general anesthesia in a supine position. An EGD was performed using a 27 F outer diameter flexible endoscope, which was advanced to the second portion of the duodenum.
Results: The esophagus and stomach appeared grossly normal. However, lymphangiectasia was observed in the first and second portions of the duodenum, manifesting as several white punctate lesions, while the third and fourth portions appeared normal. Underwater endoscopic submersion of the duodenum revealed white lymph aggressively flowing from a singular location on the lateral wall of the major papilla, distinct from the biliary orifice. Following the injection of methylene blue and lipiodol into the lymphatics by interventional radiology, drainage of this mixture was observed from the identified site confirming lymphatic leak. Therapeutic intervention was performed using silver probe bipolar cautery and argon beam coagulation for tissue destruction at the site of lymphatic leakage. Post‐treatment underwater examination demonstrated cessation of visible drainage from the treated area. The patient's clinical symptoms and laboratory abnormalities subsequently resolved quickly and were durable at 4 months after the procedure.
Conclusions: Underwater endoscopic visualization of intestinal lymphatic leak contributes to the understanding of the pathophysiology of lymphatic disorders and protein‐losing enteropathy, leading to improved diagnostic and treatment strategies. Endoscopic treatment of localized leaks can lead to durable resolution of PLE and should be considered when identified.
Contact e‐mail address: ashley.polachek@UTSouthwestern.edu
G‐OP025. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐OP025.1. PER ORAL ENDOSCOPIC MYOTOMY FOR PEDIATRIC ACHALASIA CARDIA
Aathira Ravindranath 1, Rajkumar Wadhwa2
1Pediatric Gastroenterology, Apollo BGS Hospital, Mysore, India, 2Gastroenterology, Apollo BGS Hospital, Mysore, India
Objectives and Study: Management modalities of Achalasia cardia include pneumatic dilatation and Heller's myotomy. Per Oral Endoscopic Myotomy (POEM) is a more recently introduced endoscopic technique.
Methods: A 10 year old boy was symptomatic for 2 years with dysphagia for liquids and solids, nocturnal cough and weight loss (Eckardt score:7). Gastroscopy showed a dilated esophagus with food residue and tight gastro‐esophageal junction. Esophageal manometry demonstrated an integrated relaxation pressure (IRP) of 18.8 mmHg. Timed barium swallowed showed a dilated esophagus with hold‐up of contrast and bird beak appearance of the lower end. Pre‐procedure prophylactic antibiotics and esophageal wash with povidone iodine were given. POEM was performed under general anaesthesia. Standard gastroscope (9.2 mm diameter, 2.8 mm working channel) with distal attachment cap was used. At 5′o clock position, 10 cm above the gastroesophageal junction mucosa was elevated by injecting a solution of methylene blue and normal saline. A 2 cm mucosal incision was made and submucosal space was entered. Submucosal tunnelling was performed with Triangle tip Knife J (KD‐645L). Traversing vessels were coagulated with Coagrasper – 5 mm (FD‐410LR). Care was taken to travel along the tunnel closer to the muscle wall until gastric cardia was reached. Selective myotomy of the inner circular fibres was performed for a length of 7 cm in esophagus and 2 cm in stomach after which open gastro‐esophageal junction was confirmed on the luminal aspect. A thorough inspection of the submucosal tunnel was done to coagulate any bleeding vessels. Mucosal defect was closed with endoclips. 24 hours later contrast esophagogram was done to rule out leak and free flow of contrast into the stomach, after which soft diet was initiated.
Results: After 2 months of POEM the child remained asymptomatic (Eckardt score: 0), gained 3 kilogram weight, esophageal manometry showed an IRP of 9.1 mmHg.
Conclusions: POEM is a safe and effective technique to treat children with Achalasia cardia.
Contact e‐mail address: aathira.r@gmail.com
G‐OP026. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐OP026.1. MINOR PAPILLA STENTING FOR PAIN RELIEF IN CHRONIC PANCREATITIS WITH PANCREAS DIVISUM
Aathira Ravindranath 1, Rajkumar Wadhwa2
1Pediatric Gastroenterology, Apollo BGS Hospital, Mysore, India, 2Gastroenterology, Apollo BGS Hospital, Mysore, India
Objectives and Study: Endoscopic interventions aimed at reducing ductal hypertension can provide pain relief in patients with chronic pancreatitis (CP). In those with pancreas divisum (PD) minor papillotomy and/or stenting can achieve pain relief albeit the procedure is more challenging compared to cannulation of major papilla.
Methods: All children with CP with persistent pain and PD with dilated pancreatic duct diagnosed on magnetic resonance pancreatogram (MRP) were taken up for endoscopic minor papilla stenting. The procedure was performed using standard duodenoscope under intravenous sedation in prone position. Minor papilla was identified 1‐2 cm cephalad to major papilla at 1‐2o'clock position, characterised by absence of the longitudinal fold. Duodenoscope was stabilised and guidewire assisted cannulation of the minor papilla was performed with close coordination between the endoscopist and the assistant. After cannulation and guidewire exchange pancreatogram was performed. Small sphincterotomy of 5 mm was done. Stones, if present were removed with basket catheter. 5‐7Fr plastic stent was placed into the pancreatic duct through the minor papilla.
Results: Three children (10‐14 years, girls) with chronic pancreatitis and persistent pain abdomen who had PD with ductal dilatation on MRP were included. All underwent minor papilla sphincterotomy, stenting with 7Fr single pigtail plastic stent. One patient required stone removal with basket catheter. The mean time to complete the procedure was 15 min (12 to 20). None developed post‐procedure pancreatitis or pain. After 3 months stents were removed. At a mean follow‐up of 15 months (12 to 24), all remained pain‐free.
Conclusions: Minor papilla stenting can provide sustained pain relief in children with CP and PD. Minor papilla cannulation is more difficult due to the small size of the papilla and cephalad position that makes stabilisation of the duodenoscope difficult. Wire‐guided cannulation can aid in entering the minor papilla.
Contact e‐mail address: aathira.r@gmail.com
G‐OP027. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐OP027.1. BILIARY ASCARIASIS IN CHRONIC PANCREATITIS
Moinak Sen Sarma, Manjit Kaur, Anshu Srivastava
Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Objectives and Study: Biliary obstruction in pancreatitis has multiple causes. We describe an unusual case of biliary obstruction in an adolescent with chronic pancreatitis.
Methods: A 16‐year‐old girl from rural North India, known case of chronic pancreatitis, undergoing endoscopic pancreatic duct stenting sessions, presented with recurrent biliary colic for ten days. Ultrasonography followed by computerised tomography (CT) abdomen during the asymptomatic period showed hyperdense contents in an 8 mm common bile duct (CBD) and dilated intrahepatic biliary radicles suggestive of CBD obstruction. Duodenoscopy during the pain episode revealed a wide major papilla (post sphincterotomy) with pancreatic stents in place. Two live roundworms were observed to enter the common bile duct opening, which were removed using biopsy forceps. Cholangiogram showed a third worm as a single linear filling defect in the dilated CBD which was retrieved by repeated balloon sweeping. The largest worm measured 28 cm in length.
Results: Post‐procedure, the cholangiogram was normal with immediate pain relief and decompression of the biliary system on repeat imaging. The child and family members were dewormed with weekly albendazole until stool routine examination demonstrated the absence of Ascaris lumbricoides ova.
Conclusions: In endemic areas, hepatobiliary ascariasis ought to be considered as a differential diagnosis for a new‐onset CBD obstruction in chronic pancreatitis. Endoscopic sphincterotomy is a predisposing risk factor.
Contact e‐mail address:
G‐OP028. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐OP028.1. LONG‐TERM DUPILUMAB MAINTAINS HISTOLOGIC AND ENDOSCOPIC IMPROVEMENTS IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS (EOE): 100‐WEEK RESULTS FROM THE OPEN‐LABEL EXTENSION (OLE) OF THE EOE KIDS STUDY
Mirna Chehade 1, Evan Dellon2, Robert Pesek3, Margaret Collins4, Dhandapani Ashok5, Ruiqi Liu6, Margee Louisias7, Allen Radin6
1Mount Sinai Center For Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, United States of America, 2University of North Carolina School of Medicine, Chapel Hill, United States of America, 3Division Of Allergy/immunology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, United States of America, 4Division Of Pathology And Laboratory Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America, 5Children's Hospital, London Health Sciences Centre, Western University, London, Canada, 6Regeneron Pharmaceuticals Inc., Tarrytown, United States of America, 7Sanofi, Cambridge, United States of America
Objectives and Study: EoE is a chronic, progressive, type 2 inflammatory disease of the esophagus. Dupilumab, a fully human monoclonal antibody that blocks interleukin‐4 and interleukin‐13, significantly improved histologic and endoscopic outcomes versus placebo in Parts A and B of the EoE KIDS study in pediatric (1–11 years) patients with EoE (NCT04394351). We assessed safety and efficacy of long‐term dupilumab in the Part C OLE.
Methods: Patients completing Week (W)52 in Part B were eligible for Part C, where they received the weight‐tiered, open‐label dupilumab regimen later approved by the FDA (similar to the Part A and B higher‐exposure regimen). Part C ended early with FDA approval of dupilumab for pediatric patients with EoE; efficacy data to the last prespecified assessment at W100 are reported.
Results: 102 patients enrolled in Part A, 98 in Part B, and 61 in Part C. At W100, the proportions of patients achieving peak esophageal intraepithelial eosinophil counts of ≤6 and <15 eosinophils/high‐power field (eos/hpf) were similar/improved vs those observed with higher‐exposure dupilumab through W52 of Part B: 70.7% vs 62.9% (Figure) and 92.7% vs 85.7%, respectively. Additionally, mean (standard deviation) changes from Part A baseline at W100 were similar to those with higher‐exposure dupilumab through W52 of Part B in EoE‐Histologic Scoring System grade and stage scores (‐0.85 [0.39] vs ‐0.97 [0.39], and ‐0.85 [0.36] vs ‐0.89 [0.32], respectively) and EoE‐Endoscopic Reference Score (‐5.34 [2.54] vs ‐4.77 [3.08]). Overall, 53/61 (86.9%) patients reported mild or moderate adverse events (AEs) and 3/61 (4.9%) reported serious AEs (none deemed related to dupilumab). The most common treatment‐related AE during Part C was injection site reaction.
Conclusions: Dupilumab had a consistent, acceptable safety profile and maintained histologic and endoscopic efficacy in pediatric patients with EoE to W100. Future analyses will evaluate symptoms.
Contact e‐mail address: mirna.chehade@mssm.edu
G‐OP029. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐OP029.1. TRANSCRIPTOMIC ANALYSIS OF ESOPHAGEAL BIOPSIES REVEALS DISEASE‐SPECIFIC MOLECULAR FEATURES WITHOUT SITE‐SPECIFIC DIFFERENCES IN EOSINOPHILIC ESOPHAGITIS
Guixia Chen 1, Xinyi Wei1, Sabrina Degen1, Tobias Rechenauer2, Ida Allabauer1, Arndt Hartmann3, Joachim Woelfle1, Ralf Rieker3, André Hoerning1
1Pediatric Gastroenterology, Hepatology And Endoscopy, Department Of Pediatrics And Adolescent Medicine, University Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, Erlangen, Germany, 2Pediatric Gastroenterology And Hepatology, Klinikum Dritter Orden, Munich, Germany, 3Department Of Pathology, University Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, Erlangen, Germany
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic immune‐mediated disorder characterized by eosinophilic infiltration and tissue remodeling. While EoE typically affects the entire esophagus, the potential for regional differences in transcriptomic profiles and eosinophilic infiltration—potentially influenced by factors such as gastric acid reflux or allergen exposure—remains unclear. Additionally, the molecular distinctions between EoE and healthy controls have not been fully elucidated.
Methods: Thirteen untreated pediatric patients diagnosed with EoE and four healthy controls were prospectively enrolled in the study. Esophageal biopsies were collected from the upper, middle, and lower regions of the esophagus for each participant. Transcriptomic analysis was performed using the nCounter® Human Immunology v2 Panel, targeting 594 immune‐related genes. Differentially expressed genes were identified using nSolver Analysis Software v4.0 and R statistical tools, with statistical significance defined as Log2 fold change (Log2FC) > 1 and adjusted p‐value < 0.05. Histopathological evaluation quantified eosinophilic infiltration as eosinophils per high‐power field(Eos/HPF). Comparisons of Eos/HPF counts among the upper, middle, and lower esophageal regions were performed using Repeated Measures ANOVA, followed by Tukey's multiple comparisons test.
Results: Biopsies from the upper, middle, and lower esophageal regions of healthy controls revealed no significant differences in transcriptomic profiles. Similarly, no significant differences in either transcriptomic profiles or eosinophilic infiltration were observed across the three esophageal regions in EoE patients. However, a comparison of the esophageal immune transcriptomes between EoE patients and healthy controls identified 15 differentially expressed genes (CCL26, IL1R1, CFI, KIT, etc.), all of which were significantly upregulated in the EoE group.
Conclusions: Our findings suggest that there are no significant regional differences in the immune transcriptomic profiles across the upper, middle, and lower esophagus in EoE patients. As expected, transcriptomic analysis revealed distinct immune‐related gene expression patterns in EoE compared to healthy controls.
Contact e‐mail address: Andre.Hoerning@uk-erlangen.de
G‐OP030. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐OP030.1. BEYOND THE EOSINOPHIL COUNT: THE INDEX OF SEVERITY FOR EOSINOPHILIC ESOPHAGITIS (I‐SEE) REFLECTS LONGITUDINAL TREATMENT RESPONSE IN CHILDREN
Carolina Gutiérrez Junquera 1, Alejandro García Díaz1, Sonia Fernández Fernández2, Pilar Guadalupe Tena García2, Angela Marazuela1, Elisabet Díez‐Vela2, Maria Luz Cilleruelo1, Enriqueta Román1
1Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain, 2Hospital Universitario Severo Ochoa. Leganés, Madrid, Spain
Objectives and Study: The Index of Severity of Eosinophilic Esophagitis (I‐SEE) is a recently proposed tool that integrates symptom frequency, complications, and inflammatory and fibrostenotic findings at the endoscopic and histologic levels. We aimed to categorize the severity of EoE in children using the I‐SEE, to assess the longitudinal response of the I‐SEE to treatment, and to correlate baseline severity with outcome variables.
Methods: A retrospective analysis of a prospectively enrolled cohort of children at two centers was performed. I‐SEE was calculated at diagnosis (I‐SEE1), at the second endoscopy after initial treatment (I‐SEE2), and at the last endoscopy at a mean of 35 months (I‐SEE3). We analyzed clinical, endoscopic, and histologic characteristics at baseline by disease severity, examined the change in severity at the second and last endoscopy, and evaluated the association of baseline disease severity with treatment variables.
Results:
Of 95 children meeting inclusion criteria, 35%, 63%, and 2% had mild, moderate, and severe I‐SEE scores at baseline. Between baseline and the second endoscopy, the median I‐SEE decreased from 7 (7‐8) to 2 (0‐5) (p < 0.001) and to 0 (0‐3) at the last endoscopy, with 53% of patients having inactive and 47% having mild scores (p < 0.001) (Figure). We observed a significant decrease in all I‐SEE domains between baseline and the second and final endoscopy. Patients with histologic response at the second and final endoscopy had lower I‐SEE scores than non‐responders (p < 0.001). In multivariable analysis, a higher baseline I‐SEE score was associated with increased odds of receiving 2 or more sequential or combined treatments (OR 95% CI 1.28 (1.03‐1.59) and (1.18 (1.04‐1.39), respectively).
Conclusions: The I‐SEE score reflects longitudinal treatment response in children with EoE beyond peak esophageal eosinophil counts. Patients with higher baseline I‐SEE may be at higher risk of requiring more than one treatment, sequentially or in combination.
Contact e‐mail address: carolinagjunquera@gmail.com
G‐OP031. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐OP031.1. PSMB8 STRATIFY THERAPY RESPONSE IN PEDIATRIC EOSINOPHILIC ESOPHAGITIS PATIENTS
Xinyi Wei 1, Sabrina Degen1, Theresa Hironimus1, Tobias Rechenauer2, Katharina Yankouskaya1, Aline Rückel1, Margit Schmid1, Daniel Rieger1, Adrian Regensburger3, Alexander Schnell1, Ida Allabauer1, Arndt Hartmann4, Joachim Woelfle1, Ralf Woelfle4, André Hoerning1
1Pediatric Gastroenterology, Hepatology And Endoscopy, Department Of Pediatrics And Adolescent Medicine, University Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, Erlangen, Germany, 2Pediatric Gastroenterology And Hepatology, Klinikum Dritter Orden, Munich, Germany, 3Pediatric Gastroenterology, Hepatology And Endoscopy, Department Of Pediatrics And Adolescent Medicine, University Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, erlangen, Germany, 4Department Of Pathology, University Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, Erlangen, Germany
Objectives and Study: Proton‐pump inhibitors (PPI) serve as an effective first‐line therapy for Eosinophilic Esophagitis (EoE) in about one third of pediatric patients. Yet the underlying biological mechanisms driving the variability in PPI response remain unclear, with no reliable predictive markers for treatment outcomes. Therefore, this study was designed to explore the differences in esophageal immunologic transcriptome between PPI‐non‐responders (PPI‐NR) and PPI‐responders (PPI‐R) to elucidate the molecular mechanisms and identify potential biomarkers that could predict therapeutic outcomes.
Methods: Pediatric EoE patients who were treated with PPI‐therapy were prospectively enrolled at University Hospital Erlangen and subsequently classified as PPI‐NR or PPI‐R. The pre‐treatment esophagus biopsy and clinical information were collected for transcriptomic analysis. We performed differential expression analysis between PPI‐NR and PPI‐R patients and conducted protein‐protein interaction network analysis. The hub gene revealed through these analyses were further validated via immunohistochemistry.
Results: No significant differences were observed between the PPI‐NR and PPI‐R groups in clinical symptoms, endoscopic findings, or histological eosinophil counts. However, differential expression analysis revealed that the immunological transcriptomic profile partially differed between PPI‐NR and PPI‐R groups as 12 differentially expressed genes (DEGs) were upregulated and 1 downregulated. The protein‐protein interaction network analysis generated by these 13 DEGs identified PSMB8 as hub gene differing between PPI‐NR and PPI‐R groups, and immunohistochemistry validation showed a significant higher expression levels in the PPI‐NR group (p < 0.0001). Additionally, the ROC curve analysis of PSMB8 demonstrate a highly predictive value in differentiating between PPI‐NR and PPI‐R patient.
Conclusions: PPI‐NR patients exhibited a more pronounced dysregulation of immunological gene expression compared to PPI‐R patients. The hub gene PSMB8 emerged as a potential biomarker for predicting PPI responsiveness in pediatric EoE patients, potentially guiding more personalized therapeutic strategies.
Contact e‐mail address: Andre.Hoerning@uk-erlangen.de
G‐OP032. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐OP032.1. LONG‐TERM RESULTS OF SERIAL TRANSVERSE ENTEROPLASTY (STEP) FOR SHORT BOWEL SYNDROME (SBS)
Javier Artero López 1, Rocío González Sacristán1, Camila Allende Chaves1, Silvia Gómez Anca1, Pedro Luis Pérez Hernández1, Alida Alcolea Sánchez1, Eva Peña Saínz‐Pardo1, Alba Sánchez‐Galán2, Ane Andres2, Francisco Hernandez‐Oliveros2, Esther Ramos Boluda1
1Pediatric Gastroenterology, Hospital Universitario La Paz, Madrid, Spain, 2Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain
Objectives and Study: Serial transverse enteroplasty (STEP) is a small bowel lengthening procedure used as a surgical treatment for short bowel syndrome (SBS). It is indicated after adequate conservative management has been attempted for a sufficient period, without success in weaning from parenteral nutrition (PN) or in cases of bacterial overgrowth with significant dilations caused by intestinal obstruction or intestinal adaptation. There are few reports on STEP in children with SBS and these often lack long‐term follow‐up data. This study aimed to analyze a recent cohort of children who underwent STEP despite the best medical management in a tertiary hospital Intestinal Rehabilitation Unit (IRU) and to evaluate their long‐term outcomes.
Methods: We conducted a single center retrospective observational study including all children with SBS who underwent a STEP procedure between 2008‐2024. A descriptive analysis was performed.
Results: STEP was performed in 11 children; the most common cause of SBS was gastroschisis (55%), followed by volvulus (18%) and jejunal atresia (18%). The median age at first STEP procedure was 24 months. At the time of surgery, all patients presented with bowel dilatation and no one had ileocecal valve. The median bowel length gain after first STEP was 30 cm. Weaning from PN was successful in 1 patients (9%). The median follow‐up was 6 years. Re‐dilatation occurred in all patients (100%) with the recurrence of the symptoms that led to the initial indication for STEP. A second STEP was required in 4 patients (36%), with the same results. One patient experienced bowel perforation post‐surgery, but no other major complications were reported. Two patient required intestinal transplantation (18%).
Conclusions: In our study, the long‐term outcomes of STEP were discouraging. Despite initial clinical improvement, all patients experienced symptom recurrence during follow‐up and successful weaning from PN was rare with limited evidence to suggest it was attributable to the procedure.
Contact e‐mail address: javier.artero@salud.madrid.org
G‐OP033. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐OP033.1. QUALITY OF LIFE AT THE AGE OF 6 YEARS IN CHILDREN OPERATED AT BIRTH FOR ESOPHAGEAL ATRESIA
Eugénie Bitoumbou 1, Arnaud Bonnard2, Alexandre Lapillonne3, Matthieu Antoine4, Catherine Jacquier5, Nicolas Caron6, Audrey Guinot7, Thierry Lamireau8, Sabine Irtan9, Laure Bridoux‐Henno10, Clémentine Dumant11, Anne Breton12, Joséphine Lirussi‐Borgnon13, Isabelle Talon14, Alexandre Fabre15, Nicoleta Panait16, Aline Ranke17, Francesco Laconi18, Virginie Fouquet19, Nicolas Kalfa20, Djamal‐Dine Djeddi21, Stephanie Willot22, Claire Dupont‐Lucas23, Anne Turquet24, Clara Crémilleux25, Estelle Darviot26, Corinne Borderon27, Olivier Jaby28, Myriam Pouzac29, Cécile Pelatan30, Aurélie Comte31, Philine De Vries32, Audrey Nicolas33, Valérie Triolo34, Cécilia Tolg35, Stéfan Geiss36, Laurine Cadart37, Frédéric Gottrand4, Madeleine Aumar4
1CHU de Lille, Lille, France, 2Centre Hospitalier Universitaire Robert Debré APHP, Paris, France, 3Centre Hospitalier Universitaire APHP Necker‐Enfants Malades, Paris, France, 4Service De Gastroentérologie, Hépatologie Et Nutrition Pédiatriques, Lille Hospital, Lille Cedex, France, 5Centre Hospitalier Universitaire de Grenoble, Grenoble, France, 6CHU de Lyon HCL ‐ GH Est‐Hôpital Femme Mère Enfant, Bron, France, 7Centre Hospitalier Universitaire de Nantes, Nantes, France, 8Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France, 9Centre Hospitalier APHP Armand‐Trousseau, Paris, France, 10Centre Hospitalier Universitaire de Rennes, Rennes, France, 11Pediatric Gastroenterology, Rouen, France, 12CHU Toulouse Purpan, Toulouse, France, 13Centre Hospitalier Universitaire de Dijon, Dijon, France, 14Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France, 15Centre Hospitalier Universitaire de Marseille ‐ Timone, Marseille, France, 16Centre Hospitalier Universitaire de Marseille ‐ Nord, Marseille, France, 17Centre Hospitalier Universitaire de Nancy, Nancy, France, 18AMERICAN MEMORIAL HOSPITAL CHU REIMS, Reims, France, 19Centre Hospitalier Universitaire APHP Kremlin‐Bicêtre, Le Kremlin‐Bicêtre, France, 20Centre Hospitalier Universitaire de Montpellier, Montpellier, France, 21Centre Hospitalier Universitaire de Amiens, Amiens, France, 22CHU Tours, Tours, France, 23Department of Paediatrics, Caen University Hospital, Caen, France, 24Centre Hospitalier Universitaire de La Réunion, Saint Denis, France, 25Centre Hospitalier Universitaire de Saint‐Etienne, Saint‐Etienne, France, 26Centre Hospitalier Universitaire d'Angers, Angers, France, 27Centre Hospitalier Universitaire de Clermont‐Ferrand, Clermont‐Ferrand, France, 28Centre Hospitalier Intercommunal de Créteil, Créteil, France, 29Centre Hospitalier Régional d'Orléans, Orléans, France, 30Centre Hospitalier du Mans, Le Mans, France, 31Centre Hospitalier Universitaire de Besançon, Besançon, France, 32Centre Hospitalier Universitaire de Brest, Brest, France, 33Centre Hospitalier Universitaire de Limoges, Limoges, France, 34Pediatrics, CHU Nice‐ Hôpital LENVAL, Nice, France, 35Centre Hospitalier Universitaire de Fort de France, Fort de France, France, 36Centre hospitalier de Colmar, Colmar, France, 37Ea 2694 ‐ Santé Publique : Épidémiologie Et Qualité Des Soins, Unité De Biostatistiques, Centre Hospitalier Universitaire de Lille, Lille, France
Objectives and Study: Since esophageal atresia (EA) is a lifelong chronic condition, it may impact on the daily life of the patients. This study aimed to assess the quality of life (QoL) at age 6 years in children with EA as reported by children and their parents. Secondary objectives were to evaluate the concordance between child and parent responses, compare QoL in children with pure EA versus other EA types, and identify predictors of impaired QoL.
Methods: This prospective, population‐based nested‐cohort study included data at 6 years of children born between 2010 and 2012 within our national EA registry. QoL was prospectively assessed for both parents and children using the generic PedsQL 4.0 scale.
Results: A total of 230 children were included. At age 6, the median overall QoL score assessed by children was 80/100 (IQR: 69.7–89.2) while the median parental score was 78.4/100 (IQR: 65.0–88.3), with a moderate but significant concordance (intraclass correlation coefficient: 0.47, p < 0.05). QoL in children with pure EA was not significantly different from that of other EA types (p = 0.52 for children, p = 0.75 for parents). Long‐term respiratory treatment at age 1 was the only factor significantly associated with impaired QoL (p = 0.045). At age 6, respiratory symptoms and at least one respiratory exacerbation in the preceding year were strongly associated with poorer QoL in children (p = 0.007 and p = 0.017, respectively). Parental assessments further identified respiratory symptoms, exacerbations and orthopedic abnormalities as significant predictors of impaired QoL (p = 0.001, p = 0.009, and p = 0.026, respectively).
Conclusions: Our findings reveal a good overall QoL at age 6 in children with EA, highlighting the effectiveness of adaptive coping strategies developed in the context of a chronic condition from birth. However, respiratory and orthopedic complications remain critical factors influencing QoL and warrant targeted interventions.
Contact e‐mail address: eugenie.bitoumbou@chu-lille.fr
G‐OP034. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐OP034.1. EFFECT OF IBP‐9414, A LIVE BIOTHERAPEUTIC PRODUCT ON NECROTIZING ENTEROCOLITIS IN VERY LOW BIRTH WEIGHT INFANTS: RESULTS FROM THE ‘CONNECTION STUDY’
Josef Neu1, Michael Caplan2, Teresa Del Moral 3, Scott Guthrie4, Mark Hudak5, Flavia Indrio6, Jae Kim7, Anders Kronström8, Neena Modi9, Jonas Rastad8, Rachana Singh10, Staffan Strömberg8, Hania Szajewska11, Marcus Thuresson8, Camilia Martin12
1University of Florida, Gainesville, United States of America, 2Endeavor Health/University of Chicago, Pritzker School of Medicine, Chicago, United States of America, 3Miller School of Medicine, Florida, United States of America, 4Vanderbilt University School of Medicine, Nashville, United States of America, 5University of Florida College of Medicine, Jacksonville, United States of America, 6Department of Experimental Medicine, University of Salento, Lecce, Italy, 7Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America, 8Infant bacterial therapeutics, Stockholm, Sweden, 9Imperial College London, London, United Kingdom, 10Tufts University School of Medicine, Boston, United States of America, 11Department Of Paediatrics, Medical University of Warsaw, Warsaw, Poland, 12Weill Cornell Medicine, New york city, United States of America
Objectives and Study: Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in very low birth weight (VLBW) neonates. The effects of probiotic supplementation on NEC are inconsistent and there are no FDA or EMA approved products for this indication. We report results of the ‘Connection Study’ a phase 3 trial on IBP‐9414 (NCT03978000) conducted under US IND and EU CTXs in 95 NICUs.
Methods: 2117 infants with birth weight 500‐1500 g (median, 850 g) were randomized 1:1 to IBP‐9414 (Lactobacillus reuteri) or placebo and dosed once daily from <48 hours after birth until a postmenstrual age of 346/7 weeks. A primary efficacy endpoint was prevention of NEC diagnosed by X‐ray and NEC with intestinal necrosis diagnosed at surgery or autopsy with pre‐specified sensitivity analysis of events occurring beyond the first 14 days in the study. This is a time when spontaneous intestinal perforation becomes uncommon and the actions by Lactobacillus reuteri become clinically evident.
Results: The overall incidence of NEC was 8.7% in the IBP‐9414 arm and 10.2% in the placebo arm (p = 0.24) and with greater treatment effect after 14 days of treatment (p = 0.07). After this time, the relative risk was 0.29 for NEC with verified intestinal necrosis (p = 0.046) and NEC with intestinal necrosis combined with NEC as cause of death was more than halved (p < 0.05) by IBP‐9414 (Fig. 1). There were no safety concerns as regards adverse events of any seriousness and IBP‐9414 was not found in blood cultures. Fig. 1. Kaplan Meier curves for events of intestinal necrosis combined with NEC as cause of death.
Conclusions: IBP‐9414 supplementation had beneficial effects on intestinal necrosis and NEC death after 14 days of treatment. Together with the absence of safety concerns, these data support a positive benefit‐risk profile of IBP‐9414 in the prevention of NEC.
Contact e‐mail address: neuj@peds.ufl.edu
G‐OP035. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐OP035.1. USING GASTROINTESTINAL BIOPSY TISSUE TO CREATE A UNIQUE PATIENT‐SPECIFIC GUT ORGANOID MODEL SYSTEM FOR HYPOTHESIS TESTING IN CHILDREN WITH AUTISM
Yosauri Fernandez Figuereo 1, Trang Simon1, Arthur Krigsman2, Melinda A. Engevik3, Lynsey Zuar4, Stephen J. Walker1
1Wake Forest Institute For Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, United States of America, 2Pediatric Gastroenterology, Pediatric Gastroenterology Resources of NY & TX, Texas, United States of America, 3Microbiology & Immunology, Medical University of South Carolina, Charleston, United States of America, 4Pediatric Gastroenterology, Atrium Health Wake Forest Baptist Pediatric Gastroenterology, Winston Salem, United States of America
Objectives and Study: To establish a robust platform that enables the discovery of autism spectrum disorder (ASD) patient‐specific mechanisms underlying gastrointestinal (GI) dysfunction and supports the design of targeted treatments based on the unique molecular profiles of individual patients.
Methods: Biobanking : Biopsy samples from the distal duodenum, terminal ileum (TI), and right colon were collected from ASD and typically developing (TD) children undergoing clinically indicated endoscopy. Intestinal crypts were isolated through enzymatic digestion, embedded in Matrigel, and cultured in Intesticult growth medium (StemCell Technologies) supplemented with RHO/ROCK pathway inhibitor (10 uM) and gentamicin (50 mg/ml). Organoids were expanded through multiple passaging before being transferred to liquid nitrogen for cryopreservation. Experimental : To test the organoid exposure response to a proinflammatory stimulus (flagellin), a small pilot study was performed using TI organoids from 4 ASD patients. Cryopreserved organoids were thawed, passaged twice, and cultured in differentiation medium (StemCell Technologies) for 4‐5 days prior to stimulation. For the stimulation experiment, 1 μg/ml flagellin was added to media and organoids were incubated at 37°C with 5% CO₂. Following a 20 h incubation, the supernatants were collected and assayed for IL‐8.
Results: To date, we have successfully banked 52 organoids from individual mucosal biopsy samples (38 = ASD; 14 = TD). We were able to expand 70% of the ASD and 78% of the TD organoids. No significant differences were observed between ASD and TD controls in average time for expansion. H&E staining showed that both groups exhibited similar morphologies. Differentiated ASD organoids were positive for key gut cell markers, including lysozyme, villin, MUC2, and chromogranin A (Figure 1). Following stimulation with flagellin, ASD organoids showed increased IL‐8 secretion, indicating retention of response to proinflammatory activity under in vitro conditions (Figure 2).
Conclusions: These results confirm the feasibility of generating and cryopreserving ASD‐specific organoids without compromising their viability, demonstrating their suitability for experimental studies.
Contact e‐mail address: yfernan@wakehealth.edu
G‐OP036. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐OP036.1. CONGENITAL SHORT BOWEL SYNDROME: CHARACTERIZATION OF PHENOTYPES
Barblin Remund, Susanne Schibli, Christiane Sokollik
Division Of Paediatric Gastroenterology, Hepatology, And Nutrition, Berne University Hospital, Inselspital, Berne, Switzerland
Objectives and Study: Congenital short bowel syndrome (CSBS) is a rare intestinal disorder characterized by inborn shortening of the bowel. Common mutations included Coxsackie and Adenovirus receptor‐like membrane protein (CLMP) and Filamin A (FLNA) gene mutations. We aim to enhance patient care by proposing diagnostic approaches and identifying prognostic factors through the analysis of published cases.
Methods: A PubMed search with predefined terms was conducted in July 2024, limited to English‐language human studies published between 2000 and 2024. Papers dealing with animal cases, analyses of previously published data, and non‐congenital short bowel syndrome were excluded, resulting in 32 publications for extraction of patients’ characteristics and clinical data.
Results: There was a slight male predominance (52.4%) among the 63 CSBS cases, with all 9 FLNA cases being male due to X‐linked inheritance. Genetic mutations were CLMP (34.9%), FLNA (14.3%), and others (7.9%). Consanguinity was common (42.4%), highest in CLMP (58.3%). Most were term births with normal birth weights (median [IQR] z‐score: ‐0.6 [1.8]). Median [IQR] first onset of symptoms was 0.6 [2.1] weeks, with vomiting (47.4%), bilious vomiting (29.0%), and diarrhea (21.1%) being the most reported symptoms. Mean [SD] small bowel length was 50.9 [18.0] cm, slightly longer in FLNA (62.7 [15.7] cm) and other genetic mutations (65 [28.3] cm). Comorbidities included gastrointestinal (bowel malrotation in 87.2%), dysmorphic and neurological abnormalities. Nearly all required parenteral nutrition (PN), with 60% achieving enteral autonomy after a median [IQR] follow‐up of 15 [19.2] months. PN duration was median [IQR] 4 [10.7] months. Death was the most common complication (9 cases), mainly due to sepsis, all before age 2. No intestinal malignancy was reported.
Conclusions: CSBS presents shortly after birth with a high rate of reaching enteral autonomy. Complications associated with PN represent the greatest risk for negative outcomes. Frequent achievement of enteral autonomy may lead to underestimation of incidence rates.
Contact e‐mail address: barblin.remund@insel.ch
G‐OP037. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐OP037.1. ESSENTIAL FATTY ACID STATUS AND NEURODEVELOPMENTAL SCREENING IN CHILDREN WITH CHRONIC INTESTINAL FAILURE RECEIVING HOME PARENTERAL NUTRITION
Xavier Werner, Aysenur Demirok, Merit Tabbers, Suzanne Van Zundert
Department Of Pediatrics, Division Of Gastroenterology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands
Objectives and Study: This study aims to evaluate the status of essential fatty acids in patients with chronic intestinal failure, evaluate their neurocognitive developmental status, and determine whether a correlation exists between essential fatty acid deficiency and lower neurocognitive performance.
Methods: We conducted a cross‐sectional observational pilot study at the Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC). The study included children aged 4‐17 years diagnosed with chronic intestinal failure and receiving home parenteral nutrition. Essential fatty acid status was measured in erythrocytes through capillary‐column gas chromatography capillary‐column gas chromatography at the Amsterdam University Medical Centers laboratory. Cognitive assessments were performed using the Wechsler Intelligence Scale for Children, 5th Edition, and the Wechsler Preschool and Primary Scale of Intelligence, 4th Edition.
Results: twelve children with chronic intestinal failure (males n = 7) were included for cognitive assessment. Out of these 12, a total of 5 children had essential fatty acid deficiency. The study found that children with chronic intestinal failure had significantly lower Total Intelligence Quotient scores (mean 87.1 ± 17.5) compared to the normative population. Furthermore, children with essential fatty acid deficiency had multiple cognitive subscores significantly below the norm. Patients with essential fatty acid deficiency exhibited significantly lower Cognitive Processing Index scores (mean 81.2 ± 6.3) compared to patients without essential fatty acid deficiency (mean 101.7 ± 20.9), indicating impaired cognitive processing speed and working memory.
Conclusions: The study highlights the important role of essential fatty acids in brain development and white matter functioning. Children with chronic intestinal failure and essential fatty acid deficiency are at a higher risk for neurocognitive impairments. These findings emphasize the importance of balanced lipid provision in home parenteral nutrition to optimize cognitive outcomes in this vulnerable population. Follow‐up studies with regular screening of neurocognition and essential fatty acids are recommended to monitor and manage potential cognitive impairments.
Contact e‐mail address: x.w.werner@amsterdamumc.nl
G‐OP038. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐OP038.1. LONG‐TERM SAFETY OF FAECAL MICROBIOTA TRANSPLANTATION IN CHINESE CHILDREN FROM 2013 TO 2023: A SINGLE‐CENTER RETROSPECTIVE STUDY
Pei Xiao, Xiaolu Li, Fangfei Xiao, Yongmei Xiao, Pei Xiao
Shanghai Children's Hopsital, China, Shanghai, China
Objectives and Study: There is limited prospective long‐term safety data available for children following Fecal microbiota transplantation (FMT). In this study, we aimed to investigate the long‐term safety outcomes after FMT in children at a single center in China.
Methods: A retrospective study was conducted on 813 patients who underwent FMT treatments at our hospital from December 2013 to December 2023. The safety of these treatments was retrospectively assessed, focusing on adverse events (AEs) and serious adverse events (SAEs). Various potential influencing factors for AEs were examined as independent variables. Significant independent factors and their associated risk ratios with 95% confidence intervals (CI) were determined through multivariate logistic regression analysis. A P‐value < 0.05 was considered statistically significant.
Results: A total of 813 patients underwent FMT, with a median age of 93 months and 68.02% being women. The average follow‐up time was 32.31 months. All short‐term AEs resolved within 48 hours, with an overall incidence of 5.78% (47/813). The most common short‐term AEs included vomiting (1.72%), abdominal pain (1.60%), fever (0.74%). Multivariable analysis revealed patients with inflammatory bowel disease (IBD) (OR: 4.36, 95% CI: 1.74‐10.89, P = 0.000) and those who received FMT via capsules (OR: 0.14, 95% CI: 0.04‐0.43, P = 0.000) were independent risk factors for FMT‐related AEs. All 813 patients were followed up for at least 1 month, with 78.84% followed for more than 12 months. No autoimmune, metabolic, rheumatologic conditions, or tumor‐related illnesses were reported during the extended follow‐up period, and no long‐term AEs occurred during the longest follow‐up period of 122 months.
Conclusions: FMT is a promising treatment option. This study stands out for its substantial sample size, being the largest reported series in pediatrics, as well as for having the longest follow‐up period for FMT in this population.
Contact e‐mail address:
G‐OP039. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP039.1. FECAL CALPROTECTIN RESPONSE TO TASTY&HEALTHY™ DIETARY INTERVENTION IN ASYMPTOMATIC CHILDREN AND YOUNG ADULTS WITH BIOLOGICALLY ACTIVE CROHN'S DISEASE: RESULTS OF THE “TASTI‐E” RANDOMIZED CONTROLLED TRIAL
Luba Plotkin1, Yonat Aharoni‐Frutkoff 1, Zivia Shavit‐Brunschwig1, Gili Focht1, Jessica Livovsky1, Rachel Buchuk1, Raffi Lev‐Tzion1, Rotem Sigall Boneh2, Batia Weiss3, Mordechai Slae4, Iris Dotan5, Lihi Godny5, Jaroslaw Kierkus6, Małgorzata Matuszczyk6, Efrat Broide7, Galit Moshe7, Anne Griffiths8, Inez Martincevic9, Timna Naftali10, Lee Abramas10, Marina Aloi11,12, Roberta Mercurio11, Anat Yerushalmy‐Feler13, Tobias Schwerd14, Eileen Crowley15, Ram Reifen16, Dan Turner1
1Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Jerusalem, Israel, 2The E. Wolfson Medical Center, Pediatric Gastroenterology and Nutrition Unit, Holon, Israel, 3Division Of Pediatric Gastroenterology And Nutrition, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel‐Hashomer, Ramat Gan, Israel, 4Hadassah Ein Kerem, The Pediatric Gastroenterology Center, Jerusalem, Israel, Jerusalem, Israel, 5Rabin Medical Center, Petah Tikva, Israel, 6Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 7Pediatric Gastroenterology, Hepatology And Nutrition, Shamir Medical Center, Zeriffin, Israel, 8Department Of Gastroenterology, Hospital for Sick Children, Toronto, Canada, 9Dietetics, The Hospital for Sick Children, Toronto, Canada, 10Meir Hospital, Gastroenterology, Kfar Saba, Kfar Saba, Israel, 11Maternal And Child Health Department, Sapienza University of Rome, rome, Italy, 12Department Of Pathophysiology And Transplantation, Università degli Studi di Milano ‐ Pediatric Gastroenterology, Hepatology and Cystic Fibrosis Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy, 13Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Faculty of Medical and Health Sciences, Tel aviv, Israel, 14Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital LMU, 80337 Munich, Germany, Munich, Germany, 15London Health Sciences Centre, London, Canada, 16The Hebrew University of Jerusalem, Institute of Biochemistry, Food Science and Nutrition Robert H. Smith Faculty of Agriculture, Food and Environment, Jerusalem, Israel, Rehovot, Israel
Objectives and Study: Tasty&Healthy™ (T&H) is a whole food diet designed to reduce inflammation in Crohn's disease (CD). It excludes processed food, gluten, red meat, and dairy (except yogurt) but does not mandate specific ingredients or formula as CDED. This "TASTI‐E" randomized‐controlled trial compared T&H with habitual diet for subclinical inflammation in CD (NCT#04239248).
Methods: Patients with CD aged 6–40 years, in clinical remission or with minimal symptoms (wPCDAI<20/CDAI < 200) but with bowel inflammation (MINI ≥ 8) were randomized to an 8‐week T&H intervention or continuation their habitual diet. Thereafter, the habitual group was offered T&H. The primary outcome was decrease in calprotectin by >50%. Secondary outcomes included adherence, MINI and CRP. Due to COVID‐19‐related challenges, the study was terminated early.
Results: Among 46 randomized patients (mean age 18.2 ± 7.6 years; median disease duration 9.01 months [IQR 2.9‐17.1]), 19 were allocated to T&H and 27 to habitual diet. Calprotectin response was higher in the T&H arm (37%) versus habitual (15%, RR = 3.23 [95%CI 1.15‐9.01]). Among 15 patients who crossed‐over to T&H after 8 weeks of habitual, showed higher rates of calprotectin<250 mcg/g at week 16 compared with their baseline (47% vs. 17%, p = 0.005) and MINI < 8 (60% vs 20%, p = 0.0013). Compared with the habitual diet, the median improvement from baseline (pre‐post delta) was higher in the T&H arm vs. habitual for ΔCRP (0.48 mg/dL (IQR 0.18‐0.81) vs. 0.36 mg/dL (0.1‐0.36); p = 0.0012) and ΔMINI (10 (9‐13) vs. 7 (5‐10.5); p = 0.047). Adherence was high in the T&H group, with 85% testing negative for fecal gluten vs. 10% in the habitual. Micro‐ and macronutrient consumption was similar between the groups, with higher potassium and fiber intake with T&H.
Conclusions: The T&H diet reduces inflammation in CD patients with subclinical inflammation. Its flexibility, without formula feeds or mandatory ingredients, led to high adherence even in asymptomatic patients.
Contact e‐mail address: lubap@szmc.org.il
G‐OP040. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP040.1. PERSONALIZED TASTY&HEALTHY™ WHOLE‐FOOD DIET FOR MAINTAINING REMISSION IN CHILDREN AND ADULTS WITH CROHN'S DISEASE: RESULTS FROM THE MYTASTY OPEN‐LABEL TRIAL
Luba Plotkin1, Yonat Aharoni‐Frutkoff 1, Zivia Shavit‐Brunschwig1, Gili Focht1, Jessica Livovsky1, Rachel Buchuk1, Raffi Lev‐Tzion1,2, Oren Ledder1,3, Amit Assa4, Rotem Shalve Shamay5, Batia Weiss6, Mordechai Slae7, Iris Dotan8, Jaroslaw Kierkus9, Efrat Broide10, Anne Griffiths11, Timna Naftali12, Marina Aloi13,14, Anat Yerushalmy‐Feler15, Tobias Schwerd16, Ram Reifen17, Dan Turner18
1The Juliet Keidan Institute Of Pediatric Gastroenterology And Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel, 2Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel, 3The Juliet Keidan Institute Of Paediatric Gastroenterology Hepatology And Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel, 4The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel, 5Faculty Of Health Sciences, Ben‐Gurion University of the Negev, Beer‐Sheva, Israel, Beer Sheva, Israel, 6Division Of Pediatric Gastroenterology And Nutrition, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel‐Hashomer, Ramat Gan, Israel, 7Hadassah Ein Kerem, The Pediatric Gastroenterology Center, Jerusalem, Israel, Jerusalem, Israel, 8Rabin Medical Center, Petah Tikva, Israel, 9The Children's Memorial Health Institute‐ Warsaw‐ Poland, Gastroenterology‐ Hepatology‐ Feeding Disorders and Paediatrics, WARSZAWA, Poland, 10Shamir Medical Center, Zriffin, Israel, 11Department Of Gastroenterology, Hospital for Sick Children, Toronto, Canada, 12Meir Hospital, Gastroenterology, Kfar Saba, Kfar Saba, Israel, 13Department Of Pathophysiology And Transplantation, Università degli Studi di Milano ‐ Pediatric Gastroenterology, Hepatology and Cystic Fibrosis Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy, 14Maternal And Child Health Department, Sapienza University of Rome, Rome, Italy, 15Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel aviv, Israel, 16Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital LMU, 80337 Munich, Germany, Munich, Germany, 17The Hebrew University of Jerusalem, Institute of Biochemistry, Food Science and Nutrition Robert H. Smith Faculty of Agriculture, Food and Environment, Jerusalem, Israel, Rehovot, Israel, 18The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
Objectives and Study: Tasty&Healthy™ (T&H) diet is a whole‐food‐diet, a flexible alternative to exclusive enteral nutrition for inducing remission in Crohn's disease (CD). It excludes processed foods, gluten, red meat, and dairy but avoids formula and mandatory ingredients. "MyTasty" clinical trial assessed T&H's effectiveness in maintaining remission during gradual reintroduction of gluten and dairy.
Methods: Patients with CD (ages 4–37 years) in deep remission (MINI index<8 and wPCDAI<12.5/CDAI < 150) induced by T&H in prior TASTI‐MM and TASTI‐E trials, were enrolled in this 16‐week open‐label trial. Gluten and dairy were reintroduced monthly, after which home‐based fecal calprotectin (FC) was measured. FC increase by >30% prompted re‐exclusion of the food. At week‐16, patients underwent capsule‐endoscopy or ileocolonoscopy.
Results: Forty‐three patients were enrolled (mean age 16 ± 5.8 years; 10 adult). In ITT analyses at week‐16, 32/43 (75%) had FC < 250 and normal CRP, 34/43 (79%) had MINI < 8 (reflecting mucosal heaing), and 37/43 (86%) maintained clinical remission. Of the 34 (79%) patients who completed the study, 19 (55%) successfully reintroduced gluten and dairy with normal FC; in 13 (38%) FC increased after either dairy or gluten, which resolved upon re‐exclusion in 12 (92%). Of the 23 patients who underwent capsule‐endoscopy or ileocolonoscopy, 14 (61%) had healing or at most aphthous ulcers. Nutritional analysis showed adequate macro‐ and micronutrient intake, except for calcium and potassium. Nineteen patients (55%) reported improved eating‐related satisfaction, compared to the period of the unmodified T&H diet.
Conclusions: Overall, 61% of patients whose remission was previously induced by exclusive whole‐food Tasty&Healthy TM diet maintained deep remission with a FC‐guided T&H approach. We show the feasibility of personalized dietary treatment with FC home‐kits, allowing for dietary flexibility in most patients. Calcium supplement may be needed when T&H is followed over time.
Contact e‐mail address: lubap@szmc.org.il
G‐OP041. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP041.1. EFFECTIVENESS AND SAFETY OF ORAL VANCOMYCIN IN THE TREATMENT OF NON‐PRIMARY SCLEROSING CHOLANGITIS PAEDIATRIC INFLAMMATORY BOWEL DISEASE (NON‐PSC PIBD) PATIENTS: A REAL‐WORLD SINGLE‐CENTER COHORT STUDY
Silvana Ancona 1, Laura Gianolio1, Katherine Armstrong1, Rosalind Rabone1, Victoria Merrick1, Paul Henderson1,2, David Wilson1,2, Richard Russell1,2
1Department Of Paediatric Gastroenterology And Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, 2Child Life And Health, University of Edinburgh, Edinburgh, United Kingdom
Objectives and Study: Oral vancomycin (Vanc‐os) limited use in paediatric Inflammatory Bowel Disease (PIBD) reported efficacy in primary sclerosing cholangitis (PSC‐PIBD), acute severe colitis as part of quadruple‐antibiotic regimen, and very early onset IBD. This study evaluates Vanc‐os effectiveness and safety as a single‐agent therapy in non‐PSC PIBD.
Methods: This single‐centre retrospective study included PIBD patients started on Vanc‐os for active disease or steroid/topical therapy dependency from 01/2017 to 08/2024. Exclusion criteria were PSC diagnosis, C. difficile infection, induction treatments started <3 weeks prior, and vancomycin as part of quadruple‐antibiotic regimen. Disease activity (PUCAI/wPCDAI, faecal calprotectin (FC), blood parameters) was assessed at baseline, 1, 3, 6 and 12 months; biochemical remission was defined as FC<250 μg/g. Vanc‐os was started at 250 mg/125 mg (≥30 kg/<30 kg), TDS or QDS, and tapered in responders after ≥1 month.
Results: Thirty‐one patients (16 males; median age 15.1 years, IQR:11.7‐16.6) were included: 23 Ulcerative Colitis (UC), 4 IBD‐Unclassified (IBDU), 4 Crohn's Disease (CD). Vanc‐os regimen was 17.5 mg/kg/day (IQR:15.3‐21.6) for a median of 4 months (IQR:1‐9). Clinical and biochemical remission was achieved/maintained in 17/31 (55%; 13 UC, 3 IBDU, 1 CD), with 15/17 reducing/stopping other treatments (4/10 discontinued and 2/10 reduced biologic regimens). Conversely, 14/31 (45%) discontinued Vanc‐os due to non‐response (11/14) or intolerance (3/14), with 11 stopping within 1 month. Responders had lower baseline disease activity score and platelet count (p < 0.05). A striking difference in response was noticed at 1 month (Figure1): responders’ FC dropped from 686 μg/g to 60 μg/g (p = 0.001), while remained high in non‐responders. Five responders stopped Vanc‐os after 4 months (IQR:2‐9): 3 restarted due to relapse, recapturing remission in 2/3. No severe adverse events occurred.
Conclusions: Vanc‐os was rapidly effective in 55% of non‐PSC PIBD cases, enabling 48% to reduce or stop other treatments. It proved most beneficial in mild UC/IBDU, serving as a medium‐ to long‐term option for antibiotic‐responsive, biologic‐resistant patients.
Contact e‐mail address: silvana.ancona@gmail.com
G‐OP042. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP042.1. ANALYSIS AND REAL‐LIFE OUTCOMES OF STANDARD BIOLOGIC THERAPY WITH INFLIXIMAB AND ADALIMUMAB IN PEDIATRIC IBD: A MONOCENTRIC EXPERIENCE
Simone Bellucca, Antonio Pizzol, Anna Opramolla, Michele Pinon, Laura Giugliano, Pier Luigi Calvo
Paediatric, Pediatric Gastroenterology, Regina Margherita Children Hospital, Turin, Italy
Objectives and Study: Infliximab (IFX) and Adalimumab (ADA), anti‐TNF biologics, have revolutionized the treatment of pediatric inflammatory bowel diseases (IBD), including Crohn's Disease (CD) and Ulcerative Colitis (UC). This monocentric retrospective study evaluates real‐life outcomes of first‐line biologic therapy with in pediatric IBD patients.
Methods: Between February 2018 and June 2024, 89 pediatric IBD patients (52 CD, 33 UC, 4 IBD‐U) were treated at Regina Margherita Children's Hospital in Turin, Italy. We retrospectively analyzed Clinical, biochemical, and endoscopic outcomes. Patients received either IFX or ADA based on clinical characteristics and disease severity. Treatment optimization, therapeutic drug monitoring (TDM), and escalation strategies were employed as necessary.
Results: IFX was the primary biologic for 79% of CD and 91% of UC patients, while ADA was used in 21% of CD and 9% of UC cases. Clinical response was achieved in 82% of patients (73/89) with similar percentage both in UC and in CD patients, with 63% (56/89) reaching biochemical remission. IFX showed higher luminal efficacy, with endoscopic remission rates of 67% compared to 25% for ADA (p = 0.021). UC was associated with a higher early‐failure rate (within the first 6 months) than CD (p 0.045); Discontinuation rates at 3 years of therapy are approximately 50% for both diseases. Among CD patients, IFX led to clinical remission in 90% versus 73% for ADA, and biochemical remission in 73% versus 27% (p < 0.01). Adalimumab showed better outcomes as a second‐line therapy. TDM as pro‐active and re‐active led to a change of therapy in nearly 50% of cases.
Conclusions: This study confirms IFX as the most effective first‐line biologic in real life pediatric IBD. Longterm management and loss of response are mayor issues in paediatric IBD. Tailored treatment strategies and TDM are crucial in optimizing outcomes for pediatric IBD patients.
Contact e‐mail address: si.bellucca@gmail.com
G‐OP043. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP043.1. MACROSCOPIC ATYPICAL PHENOTYPES IN PAEDIATRIC ULCERATIVE COLITIS: INSIGHTS FROM THE REAL‐WORLD PIBD‐SETQUALITY COHORT
Anouk Camman 1, Renz Klomberg1, Pranita Peters1, Christos Tzivinikos2, Sibylle Koletzko3,4, Richard Russell5, Natalia Nedelkopoulou6, Nicholas Croft7, Lissy De Ridder1
1Paediatric Gastroentrology, Erasmus MC ‐ Sophia Children's Hospital, Rotterdam, Netherlands, 2Department Of Pediatric Gastroenterology, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates, 3Department Of Pediatrics, Division Of Pediatric Gastroenterology, LMU University Hospital Munich, Dr. von Hauner Children's Hospital, Munich, Germany, 4Department Of Pediatrics, Gastroenterology And Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Olsztyn, Poland, 5Department Of Paediatric Gastroenterology And Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, 6Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom, 7Department of Paediatric Gastroenterology, Barts Health NHS Trust, The Royal London Children's Hospital, London, United Kingdom
Objectives and Study: The heterogeneity of paediatric ulcerative colitis (P‐UC) complicates diagnosis and prompt start of optimal induction treatment, which is crucial for adequate disease control. Recognizing and understanding atypical disease patterns in P‐UC will decrease misclassification and contribute to validation of standardized classification tools. This study provides insight in the real‐world prevalence of atypical and uncommon phenotypes in newly diagnosed P‐UC.
Methods: Data were collected from the Paediatric Inflammatory Bowel Diseases Network for Safety, Efficacy, Treatment and Quality improvement of care (PIBD‐SETQuality) cohort, an international, prospective, observational study. Therapy naive children diagnosed with UC between January 2017 and June 2024 were enrolled. Diagnostic criteria were based on the PIBD‐classes algorithm by the Paediatric IBD Porto group and the revised Porto criteria. Mann‐Whitney U and Chi‐square tests were used to compare, respectively, numerical and categorical data between patient groups.
Results: Baseline data of 197 P‐UC patients were included, of which 134 (68.1%) presented with pancolitis and 49 (24.9%) with acute severe colitis. Macroscopic atypical and uncommon phenotypes occurred in 69 (35.0%) patients, with relative rectal sparing as the most common feature (Table 1). Non‐specific upper gastrointestinal inflammation occurred in 17 (10.6%) patients of whom 6 also presented with atypical features. Multiple features were present in approximately 1 out of ten patients with atypical features. Patients with atypical or uncommon phenotypes did not show significant differences compared to patients with classic phenotypes in time to diagnosis (107 vs. 104 days, p = 0.19), PUCAI score (40 [IQR 30‐55] vs. 35 [IQR 25‐58.75], p = 0.10), initial induction therapy and need for treatment intensification during induction therapy (8 vs. 4 patients, p = 0.22).
Conclusions: Atypical phenotypes are common in P‐UC in this real‐world cohort, including the presence of combined atypical features. In this cohort, the presence of macroscopic atypical or uncommon phenotypes did not result in a diagnostic delay or treatment intensification during induction therapy.
Contact e‐mail address: a.camman@erasmusmc.nl
G‐OP044. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP044.1. USTEKINUMAB OPEN‐LABEL INDUCTION AND RANDOMIZED BLINDED MAINTENANCE THERAPY IN PAEDIATRIC PARTICIPANTS WITH MODERATELY TO SEVERELY ACTIVE CROHN'S DISEASE: THE PHASE 3 UNITI JR STUDY
Elisabeth De Greef 1, Richard Strauss2, Els Van Limbergen3, Stanley Cohen4, Dan Turner5, Anne Griffiths6, Jeffrey Hyams7, Joel Rosh8, Omoniyi Adedokun2, Lilianne Kim2, Sheri Volger2
1KidZ Health Castle‐ UZ Brussels, Brussels, Belgium, 2Janssen Research & Development, LLC., Spring House, United States of America, 3Janssen Research & Development, Belgium, Antwerp, Belgium, 4Morehouse School of Medicine, Atlanta, United States of America, 5The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel, 6The Hospital for Sick Children, University of Toronto, Toronto, Canada, 7Connecticut Children's Medical Center, Hartford, United States of America, 8Liver Disease And Nutrition, The Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, United States of America
Objectives and Study: UNITI Jr is a study evaluating efficacy, safety, and pharmacokinetics of ustekinumab, an antagonist of the p40 subunit of interleukin‐12 and interleukin‐23, intravenous induction therapy followed by subcutaneous maintenance therapy in paediatric participants with moderately to severely active Crohn's disease (CD). Here we report interim results through Week 52.
Methods: Participants ≥40 kg with a Paediatric CD Activity Index [PCDAI] score of >30 received a single intravenous weight‐tiered induction dose of ustekinumab dosing matching the adult posology. After 8 weeks of induction, participants were randomized [1:1] to receive a single subcutaneous 90 mg ustekinumab maintenance dose every 8/12 weeks. The primary endpoint was clinical remission at Week 8 (PCDAI score ≤10). Secondary endpoints included clinical response (PCDAI reduction of ≥12.5 compared to baseline, total score of ≤30) at Week 8 and 52, endoscopic response (reduction in SES‐CD score of ≥50% or SES‐CD score ≤2 in participants with a baseline score of ≥3) at Week 16 and 52, clinical remission at Week 52 among participants in remission at Week 8, and corticosteroid‐free remission (PCDAI score of ≤10 points and no corticosteroids for ≥90 days prior to Week 52).
Results: Intention to treat analysis was available for 48 patients. All patients completed the induction period and 3 (6.3%) terminated between Week 8‐52. Baseline characteristics were similar between treatment groups. At Week 8, 52.1% (25/48) of participants achieved clinical remission, and 93.8% (45/48) achieved clinical response. At Week 16, 29.8% (14/47) of participants achieved endoscopic response. Clinical outcomes through Week 52 are shown in Figure 1. Rates of adverse events were similar between groups.
Observed serum ustekinumab concentrations were within the range of concentrations observed in adults with CD receiving the approved dose regimen.
Conclusions: Ustekinumab induction and maintenance therapy is effective and safe through 52 weeks in paediatric participants weighing ≥40 kg with moderately to severely active CD.
Contact e‐mail address: elisabeth.degreef@uzbrussel.be
G‐OP045. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP045.1. PREDICTIVE POTENTIAL OF MICRORNA EXPRESSION FOR JUVENILE IDIOPATHIC ARTHRITIS DEVELOPMENT IN PAEDIATRIC INFLAMMATORY BOWEL DISEASE
Maria Dorn‐Rasmussen 1,2, Jaslin James3, Mikkel Malham1,2, Johan Burisch2,4, Helene Ingels5, Lene Riis3, Vibeke Wewer1,2
1Department Of Paediatric And Adolescence Medicine, Copenhagen University Hospital ‐ Amager and Hvidovre, Hvidovre, Denmark, 2Copenhagen Center For Inflammatory Bowel Disease In Children, Adolescents, And Adults, Amager And Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark, 3Department Of Pathology, Copenhagen University Hospital ‐ Herlev and Gentofte, Herlev, Denmark, 4Gastrounit, Medical Division, Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark, 5Department Of Paediatrics And Adolescence Medicine, Copenhagen University Hospital ‐ Rigshospitalet, København Ø, Denmark
Objectives and Study: Children diagnosed with inflammatory bowel disease (IBD) often have a severe disease course, and up to 50% develop extra‐intestinal manifestations (EIMs). Juvenile idiopathic arthritis (JIA), the most common EIM, affects 16–33% of paediatric IBD patients, increasing risks of complications such as uveitis, joint destruction, reduced physical activity, and psychological challenges. MicroRNAs (miRNAs), small non‐coding RNA molecules regulating gene expression, play key roles in immune processes and hold potential as biomarkers and therapeutic targets. The aim of this study was to investigate whether miRNA expressed in intestinal biopsies can identify paediatric patients with IBD at risk of developing JIA.
Methods: Paediatric patients under 18 years diagnosed with IBD between 1 May 2021 and 1 May 2024, along with healthy controls from the Copenhagen IBD Inception Cohort, were enrolled. One biopsy from either the ileum or colon was collected during index endoscopy. Biopsies from paediatric IBD‐JIA patients diagnosed before 1 May 2021 were retrieved from the Department of Pathology, Copenhagen University Hospital, Hvidovre. Total RNA was extracted from formalin‐fixed paraffin‐embedded (FFPE) tissue, and miRNA expression was analysed using the GeneChip™ microarray platform.
Results: The study included 62 biopsies from 62 patients (27 with IBD, 25 with both IBD and JIA (IBD‐JIA), and 10 HC). Patient characteristics are shown in table 1. Analysis identified 532 significantly differentially expressed probe sets (adjusted p < 0.05) among IBD, IBD‐JIA, and HC (Figure 1). Among these, 123 probe sets, including miR‐486‐2, let‐7b‐5p, and miR‐92a‐3p, exhibited a more than two‐fold change (adjusted p < 0.001) between IBD and IBD‐JIA, with 120 miRNAs upregulated and 3 downregulated in IBD‐JIA compared to IBD.
Conclusions: This study provides the first evidence of differential miRNA expression in paediatric patients with IBD and co‐occurring JIA. These miRNAs may serve as novel biomarkers for the early detection, aiding in timely diagnosis and better management of paediatric IBD patients.
Contact e‐mail address: maria.dorn-rasmussen@regionh.dk
G‐OP046. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP046.1. INFLIXIMAB MAY BE MORE EFFECTIVE THAN USTEKINUMAB FOLLOWING ADALIMUMAB PHARMACODYNAMIC FAILURE IN PEDIATRIC PATIENTS WITH CROHN'S DISEASE
Galit Driban 1, Manar Matar2, Raffi Lev‐Tzion1, Oren Ledder1, Maya Granot3, Anat Yerushalmy‐Feler4, Ramit Magen Rimon5, Eyal Zifman6, Dan Turner7, Amit Assa1
1Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel, 2Institute Of Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center, Petach Tikva, Israel, 3Pediatric Gastroenterology Unit, Edmond & Lily Safra Children's Hospital, Sheba Medical Center, Ramat‐Gan, Faculty of Medicine, Tel‐Aviv University, Tel Aviv, Israel, 4Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel aviv, Israel, 5Pediatric Gastroenterology & Nutrition Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus and the Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel, 6Meir Medical Center, Kfar Saba, Israel, 7The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
Objectives and Study: Loss of response (LOR) to first biologic agent is not uncommon. One of the most challenging mechanisms of LOR is pharmacodynamic LOR (inflammatory activity in the presence of adequate trough concentrations, TC). We aimed to explore the outcomes of pediatric patients with Crohn's disease following adalimumab pharmacodynamic failure.
Methods: We conducted a retrospective longitudinal cohort study in 6 Israeli pediatric centers. Data of patients who experienced adalimumab LOR (as first biologic agent) with adequate TC ( > 7.5 mcg/ml) and switched to either infliximab or ustekinumab were retrieved.
Results: The cohort included 67 patients (66% males, mean age at diagnosis 12.2 ± 2.8), with median duration on adalimumab of 17 (IQR 8‐24) months and follow‐up of 13 months (IQR 7‐29) on the subsequent therapy. Median adalimumab TC before switching was 11.4 (IQR 8.5‐16 mcg/ml). For the overall cohort, corticosteroid‐free clinical remission and response were achieved in 43% and 67%, respectively and 25% achieved endoscopic remission. The two treatment groups (infliximab (n = 32) and ustekinumab (n = 35)) were comparable for all basic, demographic and disease severity parameters at the time of switching with a similar follow‐up. The infliximab group demonstrated better outcomes over ustekinumab in terms of clinical response (97% vs. 57%; p < 0.001), corticosteroid‐free clinical remission (56% vs. 31%; p = 0.04), endoscopic response (83% vs. 28%; p = 0.002), fecal calprotectin<250 (60% vs. 27%; p = 0.03), drug sustainability (91% vs. 31%; p < 0.001) and surgical rate (3% vs. 23%; p = 0.02, 1 infliximab, 8 ustekinumab). Month 3 PCDAI was significantly lower [8.7 (IQR 0‐17.5) vs. 21 (IQR 9‐35); p < 0.01), CRP remission was higher (60% vs. 23%; p = 0.01) and median albumin concentration was higher [4.3 (IQR 39‐4.5) vs. 3.8 (IQR 3.4‐4); p = 0.005] in the infliximab group.
Conclusions: Pediatric patients with Crohn's disease following adalimumab pharmacodynamic failure demonstrated moderate response to subsequent therapy. A switch in‐class to infliximab may be more effective than a switch out of class to ustekinumab.
Contact e‐mail address: dr.amit.assa@gmail.com
G‐OP047. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP047.1. THE IMPACT OF OVERWEIGHT AND OBESITY ON THE CLINICAL COURSE OF PEDIATRIC IBD: A MULTICENTER, RETROSPECTIVE STUDY ON BEHALF OF THE SIGENP IBD WORKING GROUP
Maria Teresa Fioretti 1, Massimo Martinelli1, Ugo Cucinotta2, Vanessa Nadia Dargenio3, Matteo Bramuzzo4, Chiara Longo5, Simona Gatti6, Naire Sansotta7, Giovanna Zuin8, Luca Scarallo9, Giulia D'Arcangelo10, Marisa Piccirillo11, Francesco Graziano12, Enrico Felici13, Caterina Strisciuglio14, Claudio Romano2, Ruggiero Francavilla3, Antonio Colucci14, Sara Lega4, Serena Arrigo5, Sara Quattrini6, Matteo Motta7, Margherita Calia8, Paolo Lionetti9, Marina Aloi15, Giovanni Di Nardo11, Annamaria Staiano1, Erasmo Miele1
1Department Of Translational Medical Science, Section Of Pediatrics, University of Naples Federico II, NAPOLI, Italy, 2Pediatric Gastroenterology and Cystic Fibrosis Unit, University Hospital “G. Martino”, Messina, Italy, 3Interdisciplinary Department of Medicine, Pediatric Section, Pediatric Hospital Giovanni XXIII, Bari, Italy, 4Institute for Maternal and Child Health‐IRCCS "Burlo Garofolo", Trieste, Italy, 5Pediatric Gastroenterology and Endoscopy Unit – IRCCS Istituto Giannina Gaslini, Genova, Italy, 6Università Politecnica Delle Marche, Department of Pediatrics, Ancona, Italy, 7Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 8Paediatric Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy, 9Gastroenterology And Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy, 10Pediatric Gastroenterology and Liver Unit, Umberto I Hospital, Sapienza University of Rome, Rome, Italy, 11Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy;, Rome, Italy, 12Pediatric Unit, Villa Sofia Cervello Hospital, Palermo, Italy, 13Pediatric and Pediatric Emergency Unit, Children Hospital, AOU SS Antonio e Biagio e C. Arrigo, Alessandria, Italy, 14Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy, 15Pediatric Gastroenterology, Hepatology And Cystic Fibrosis Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
Objectives and Study: Obesity is emerging as a significant problem in children with inflammatory bowel disease (IBD). We aimed to evaluate the impact of overweight and obesity at diagnosis on the clinical course of pediatric IBD.
Methods: This was a multicentre retrospective study, including children diagnosed with Ulcerative colitis (UC) or Crohn disease (CD) between January 2016 and January 2023 and at least 6‐months follow‐up. Based on BMI‐for‐age and gender percentile charts (pc), overweight (BMI ≥ 85°pc) and obese (BMI > 95°pc) children at diagnosis were used as cases, while patients with normal weight (BMI 5‐84°pc) as controls. Baseline disease demographics, laboratory exams and therapeutic history were collected at diagnosis and during the follow‐up from the SIGENP‐IBD‐Registry.
Results: Five‐hundred‐seven children (median age at diagnosis: 12.2 years (0‐17);M/F:304/203; UC/CD: 273/234)were enrolled, of whom 82 cases (overweight/obese:41/41) and 425 patients with normal weight. The prevalence of overweight/obesity at diagnosis was significantly higher in children with UC than CD [55/273 (67%) versus 27/234 (p = 0.01)]. At diagnosis no significant differences were found in terms of sex, disease activity and laboratory values between groups. Concerning the CD behaviour, a penetrating phenotype was greater in cases than controls [6/27 (22%) versus 20/207 (10%)(p = 0.01)].Obese children showed a significant higher rate of early relapse at 6 months when compared with controls [16/41 (39%) versus 97/328 (22.8%)(p = 0.03)].Both overweight and obese children demonstrated an increased need of biologics’ use during the follow‐up [(43%) versus 127/425 (29.9%)(p = 0.02)]. A higher rate of disease extension with a trend towards statistical significance (p = 0.07) and an increased risk of colectomy [3/27 (11.1%) versus 8/246 (3.2%)] without reaching the statistical significance (p = 0.1) were observed in obese UC children.Kaplan–Meier analysis confirmed the increased cumulative probabilities of biologic therapy in cases (p = 0.001) and showed higher risk of colectomy in obese UC children than controls (p = 0.01)(Figure).
Conclusions: Obesity and overweight at diagnosis seem to be associated with more severe disease course in children with IBD.
Contact e‐mail address:
G‐OP048. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP048.1. ASSESSING THE PREVALENCE AND INCIDENCE OF RECORDED FATIGUE CODES AMONGST PAEDIATRIC IBD PATIENTS: A NATIONWIDE STUDY FROM THE EPI‐IIRN
Gili Focht 1,2, Rachel Buchuk2, Yiska Loewenberg Weisband3, Amir Ben ‐Tov4, Galia Zacay5, Eran Matz6, Iris Dotan7, Ora Paltiel8, Dan Turner2
1Braun School Of Public Health And Community Medicine, Hadassah Medical Organization, Faculty Of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel, 2Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Jerusalem, Israel, 3Clalit Health Services, Clalit Research Institute, Tel aviv, Israel, 4Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel, 5Research institute, Meuhedet Health Services, Tel aviv, Israel, 6Leumit Health Services, Tel aviv, Israel, 7Rabin Medical Center, Petah Tikva, Israel, 8Hadassah Medical Organization, Jerusalem, Israel
Objectives and Study: Fatigue is a burdensome symptom in Inflammatory Bowel Disease (IBD), yet it remains understudied, especially in paediatric IBD. We aimed to assess the prevalence and incidence of recorded fatigue amongst PIBD in a nationwide cohort.
Methods: We utilised the epi‐IIRN cohort, encompassing all PIBD patients in Israel across the four Health Maintenance Organisations (HMOs), matched to non‐IBD controls. We included children diagnosed from 2005. Fatigue was identified using ICD‐9 codes for “Malaise and Fatigue”/“Chronic Fatigue”. Patients with fatigue codes prior to IBD diagnosis were excluded. Associations with disease severity, reflected in blood tests, and other recorded comorbidities known to contribute to fatigue were explored. Predictors of fatigue in IBD patients were assessed using a multivariate Cox‐proportional model.
Results: We included 5,567 children with IBD (3,674 with Crohn's‐disease [66%, CD]; mean age 14.3 ± 3.1 years) matched with 11,209 non‐IBD controls. Fatigue was recorded in 469 (8.4%) PIBD patients compared to 518 (4.6%) controls (OR = 1.90, 95%CI 1.67–2.16; p < 0.001). Fatigue was more frequent in females (OR = 1.43, 95%CI 1.23–1.66). Time to fatigue was shorter in males compared to matched controls (p < 0.001; figure). Fatigue rates were higher in CD (557 [15.1%]) vs. ulcerative colitis (250 [11.6%]; OR = 1.17, 95%CI 1.00–1.38). PIBD patients with fatigue had higher rates of anaemia compared to those without, yet had similar rates of anxiety, depression, iron deficiency and sleeping disorders. In a multivariate Cox model, females, frequent physician visits, anaemia, anxiety, and sleep disorders were associated with fatigue. Disease severity was not independently associated with fatigue (HR = 0.93 95%CI 0.74‐1.15 and 0.75 95%CI 0.57‐0.98 respectively).
Conclusions: In this nationwide unselected cohort, fatigue was more frequently reported in paediatric patient with IBD compared to controls and was associated with anaemia. The burden of fatigue is PIBD is underestimated.
Contact e‐mail address: gilif@szmc.org.il
G‐OP049. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP049.1. PREDICTORS OF FAECAL CALPROTECTIN NORMALISATION FOLLOWING TREATMENT WITH EXCLUSIVE ENTERAL NUTRITION IN CHILDREN WITH CROHN'S DISEASE; RESULTS FROM THE INTENSIVE POST‐ENTERAL NUTRITION STUDY (IPENS)
Konstantinos Gkikas 1, Maria Lima1, Shona Mckirdy1, Ben Nichols1, Caroline Kerbiriou1, Lisa Gervais2, Gillian Smith3, Lawrence Armstrong4, Thomas Jordan3, Iain Chalmers5, Hannah Barlow6, Ghassan Al Hourani7, Rafeeq Muhammed8, David Wands2, Priya Narula9, Minal Patel10, Umer Ijaz11, Simon Milling12, Marco Gasparetto13, Paul Henderson14, David Wilson15, Richard Hansen16, Richard Russell15, Konstantinos Gerasimidis1
1School Of Medicine, University of Glasgow, Glasgow, United Kingdom, 2Paediatric Gastroenterology, Hepatology And Nutrition, Royal Hospital for Children, Glasgow, United Kingdom, 3Department Of Paediatrics, University Hospital Wishaw, Wishaw, United Kingdom, 4Department Of Paediatrics, University Crosshouse Hospital, Crosshouse, United Kingdom, 5Department Of Paediatric Gastroenterology, Aberdeen Children's Hospital, Aberdeen, United Kingdom, 6Department Of Paediatrics, Royal Manchester Children's Hospital, Manchester, United Kingdom, 7Department Of Paediatrics, Forth Valley Royal Hospital, Larbert, United Kingdom, 8Department Of Paediatric Gastroenterology, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom, 9Department Of Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom, 10Department Of Paediatric Gastroenterology, Royal London Children's Hospital, London, United Kingdom, 11James Watt School Of Engineering, University of Glasgow, Glasgow, United Kingdom, 12School Of Infection And Immunity, University of Glasgow, Glasgow, United Kingdom, 13Norfolk and Norwich University Hospital, Jenny Lind Children's Hospital, and University of East Anglia, Norwich Medical School, Norwich, United Kingdom, 14Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, 15Department Of Paediatric Gastroenterology And Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, 16Department Of Child Health, University of Dundee, Dundee, United Kingdom
Objectives and Study: Normalisation of faecal calprotectin (FCAL) following exclusive enteral nutrition (EEN) varies among patients with Crohn's disease (CD). Identifying factors influencing EEN efficacy may provide insights into EEN's mechanism of action. This study investigated clinical and microbial parameters associated with FCAL normalisation.
Methods: Children with CD (6‐17 years), clinically responding to EEN, were recruited from 11 UK hospitals (January 2020‐June 2024, NCT04225689) and provided a faecal sample 2‐3 days before EEN completion. Patients were categorised as FCAL responders (FCAL<250 mg/kg) and FCAL non‐responders (FCAL > 250 mg/kg). Faecal short and branched chain fatty acids (SCFA, BCFA), sample characteristics (pH, water content (%), Bristol stool score), total microbial load (qPCR), microbiome a‐diversity (16S rRNA), anthropometric, clinical parameters (blood inflammatory markers, immunomodulator use, disease duration, disease location) were compared between the two groups. Multicomponent random forest analysis identified parameters predicting FCAL normalisation at EEN completion.
Results: Of 116 recruited patients, 112 provided a faecal sample. 40/112 (35%) were FCAL responders. Age and anthropometry z‐scores did not differ between the two groups. Responders were more likely to have had an established CD diagnosis (23% vs 8%, p = 0.04) and to have used immunomodulators during EEN (75% vs 44%, p = 0.002). Higher faecal pH, lower microbial load and lower BCFA and SCFA concentration were observed in FCAL responders (Figure 1). Relative abundance of 16 genera differed between the two groups. Random forest analysis including clinical, anthropometric and microbial variables generated a model with 76% accuracy (sensitivity: 65%, specificity: 82%, p < 0.001) to predict FCAL normalisation. Higher faecal pH was the most influential parameter relating to normalisation of FCAL at EEN completion.
Conclusions: We have shown luminal parameters associated with efficacy of EEN; the mechanism of action remains unknown but may relate to modification of the luminal microenvironment, microbiome composition and function, and their downstream effects on inflammatory response.
Contact e‐mail address: konstantinos.gkikas@glasgow.ac.uk
G‐OP050. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP050.1. PERIPHERAL BLOOD CYTOKINES IN PATIENTS WITH PAEDIATRIC‐ONSET INFLAMMATORY BOWEL DISEASE – A SYSTEMATIC REVIEW AND META‐ANALYSIS
Sabine Jansson 1,2, Andrea Ehrström1,2, Charlotte Ulrikka Rask3,4, Johan Burisch1,5,6, Michael Eriksen Benros5,7, Jakob Seidelin5,8, Mikkel Malham1,2,9,10, Vibeke Wewer1,2,5
1Copenhagen Center For Inflammatory Bowel Disease In Children, Adolescents, And Adults, Amager And Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark, 2Department Of Paediatrics And Adolescent Medicine, Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark, 3Department Of Child And Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark, 4Department Of Clinical Medicine, Aarhus University, Aarhus, Denmark, 5Department Of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark, 6Gastro Unit, Medical Division, University of Copenhagen, Hvidovre, Denmark, 7Copenhagen Research Centre For Biological And Precision Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark, 8Department Of Digestive Diseases, Transplantation, And General Surgery, Ibd Section, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark, 9Department Of Paediatric Gastroenterology And Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, 10Copenhagen Health Complexity Center, University of Copenhagen, Copenhagen, Denmark
Objectives and Study: Cytokines play a central role in the aetiology, disease severity and treatment of adult‐onset inflammatory bowel disease (IBD). However, despite the aggressive phenotype reported in paediatric‐onset IBD, little is known about the cytokine levels in paediatric‐onset IBD. We aimed to summarize findings of cytokine levels in peripheral blood in patients with paediatric‐onset IBD compared to healthy controls.
Methods: This systematic review followed the PRISMA guidelines and was registered at Prospero [CRD42024579684]. A literature search was performed on the 1st of August 2024 in PubMed, EMBASE, Web of Science and Scopus. We included studies that reported levels of cytokines in plasma or serum, in patients with paediatric‐onset IBD and healthy controls. To ensure a complete overview, we did not exclude studies based on patients' treatment status. Pooled effect sizes of mean values were calculated using Hedges’ g for any cytokine reported by two or more studies. The Newcastle‐Ottawa scale was used for quality assessment.
Results: The literature search revealed 10,110 papers (4,582 duplicates), and 5,528 articles were independently screened by two authors. Twenty‐three articles met the inclusion criteria including a total of 1028 patients with paediatric‐onset IBD, and 634 healthy controls. Studies reported on 57 different cytokines. Meta‐analysis was performed for interleukin‐6 (IL‐6) (13 studies, of which 8 provided mean values) and tumour necrosis factor‐α (TNF‐α) (8 studies, of which 3 provided mean values). Meta‐analysis of other cytokines could not be performed. Pooled effect sizes showed increased levels of IL‐6 (standardized mean difference: 1.71, 95% confidence interval: 1.00‐2.43). However, the heterogeneity between studies was high (Figure 1). Levels of TNF‐α did not differ between patients and controls (standardized mean difference: 0.22 95% confidence interval: ‐0.17‐0.60). Overall, the included studies had moderate‐good quality.
Conclusions: IL‐6 was increased in the peripheral blood of patients with paediatric‐onset IBD. Data on other cytokines were scarce.
Contact e‐mail address: sabine.sophie.jansson@regionh.dk
G‐OP051. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP051.1. A DISTINCT METABOLOMIC PROFILE IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE RELATIVE TO HEALTHY CONTROLS
Asha Jois 1, Toby Mansell2, Josef Wagner2, Sarah Thomas2, Mark Oliver1, George Alex1, Melanie Neeland3, Boris Novakovic4, Julie Bines1,5, Anthony Catto‐Smith6, Carl Kirkwood5, Richard Saffery4
1Department Of Gastroenterology And Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia, 2Inflammatory Origins, Murdoch Children's Research Institute, Melbourne, Australia, 3Respiratory, Murdoch Children's Research Institute, Melbourne, Australia, 4Molecular Immunity, Murdoch Children's Research Institute, Melbourne, Australia, 5Enteric Diseases, Murdoch Children's Research Institute, Melbourne, Australia, 6University of New England, Armidale, Australia
Objectives and Study: Despite an increase in therapeutic options, paediatric inflammatory bowel disease (IBD) continues to have high morbidity. Metabolomics, the comprehensive measurement of small metabolites, could uncover biomarkers to predict disease course and treatment outcomes. We aimed to characterise the blood metabolome in children with IBD compared to non‐IBD controls and its correlation with disease outcomes.
Methods: Single‐centre, prospective cohort study of children with IBD compared to non‐IBD controls, recruited between 2003 to 2013 at the Royal Children's Hospital, Melbourne, Australia. Baseline characteristics, disease activity, medications, and bloods were recorded at each visit, with serum stored at ‐800C prior to analysis. Serum metabolites were measured through high‐throughput proton nuclear magnetic resonance spectroscopy (Nightingale Health, Finland). Clinical outcomes included surgery, stricturing or penetrating complications and malignancy. Baseline differences and longitudinal models were determined through linear regression, adjusted by age and sex. Logistic regression models were used to determine baseline biomarkers predictive of clinical outcomes.
Results: 246 participants (53% male) were included with a median age of 12.6 years. Of these, 127 had Crohn's disease (CD), 41 ulcerative colitis (UC), and 78 were non‐IBD controls. 120 participants were recruited at diagnosis and 34 had longitudinal samples collected at a median of 2.2 years. Long‐term outcomes were obtained at a median of 9 years. At baseline, there were marked differences in several metabolites, including cholesterols, apolipoproteins, amino acids, and total lipid levels, in children with any IBD compared to controls (Figure 1), with minimal differences across IBD subtypes. Despite management, several metabolites at baseline, including elevated total triglycerides, VLDL‐TG and LDL‐TG, monounsaturated fatty acids, polyunsaturated to monounsaturated fatty acid ratio, and ApoB persisted at follow‐up. No baseline metabolites were strong predictors of future disease outcomes.
Conclusions: In conclusion, differences in the blood metabolome at baseline persisted at follow‐up but were not predictive of IBD outcomes.
Contact e‐mail address: asha.jois@rch.org.au
G‐OP052. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP052.1. CEREBRAL VENOUS SINUS THROMBOSIS IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE: RESULTS FROM THE INTERNATIONAL PROSPECTIVE PIBD‐SETQUALITY SAFETY REGISTRY
Renz Klomberg 1, Shannon Edwards2, Paul Henderson3,4, Victorien Wolters5, Katalin Eszter Müller6, Anthony Wiskin7, Daniela Knafelz8, Matthew Carroll9, Astrid Hellendoorn1, Anouk Camman1, Heleen Van Ommen10, Nicholas Croft2,11, Lissy De Ridder1
1Paediatric Gastroentrology, Erasmus MC ‐ Sophia Children's Hospital, Rotterdam, Netherlands, 2Department of Paediatric Gastroenterology, Barts Health NHS Trust, The Royal London Children's Hospital, London, United Kingdom, 3Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, 4Child Life And Health, University of Edinburgh, Edinburgh, United Kingdom, 5Paediatric Gastroenterology, Wilhelmina Children's hospital, UMC Utrecht, Utrecht, Netherlands, 6Gastroenterology And Nephrology Department, Heim Pal National Pediatric Institute, Budapest, Hungary, 7Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, United Kingdom, 8Gastroenterology And Nutrition Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy, 9Division Of Pediatric Gastroenterology & Nutrition, University of Alberta, Edmonton, Canada, 10Erasmus MC‐Sophia Children's hospital, Rotterdam, Netherlands, 11Queen Mary University of London, Centre for Immunobiology, The Blizard Institute, London, United Kingdom
Objectives and Study: Children with inflammatory bowel disease (IBD) have an increased risk of venous thromboembolic events (VTE), particularly cerebral venous sinus thrombosis (CVST), but the pathophysiology remains unclear. This study analyzed VTE characteristics and risk factors by VTE type in children with IBD, using data from an international registry.
Methods: From November 2016 to December 2024, pediatric gastroenterologists participating in the prospective multicenter PIBD‐SETQuality Safety Registry reported any severe complication of IBD, including VTE and mortality, occurring in their patient population via monthly surveys. Detailed data, including VTE specifics and IBD disease characteristics, were collected. Risk factors were assessed based on the 2018 ESPGHAN pediatric UC guideline.
Results: Sixty‐nine unique VTE cases were reported (52% girls; median age 14.7 years [IQR 11.4‐16.5]). These included 33 [48%] CVST cases, and 36 [52%] other VTE types (n = 24 deep vein thrombosis, n = 5 pulmonary embolus, n = 2 portal vein thrombosis, n = 5 other). No differences in IBD subtype, disease activity, or setting between patients with a CVST and with other VTE types were found (Crohn's disease diagnosis in 24% vs. 25%; moderate or severe disease in 67% vs. 69%; during admission in 58% vs. 56%, respectively). Children with CVST were more likely to lack general VTE risk factors (73% vs. 42%, p = 0.009) (Figure 1), receive steroids (67% vs. 42%, p = 0.038), and tended to be younger (≤15 years; 64% vs. 42%, p = 0.07), than children with other VTE types. Seven patients received thromboprophylaxis (2 CVST, 5 other VTE types). Three CVST patients died (15% of all reported mortality cases).
Conclusions: CVST is a relatively common VTE type in pediatric IBD, with potentially devastating consequences. Younger age and steroid use, rather than traditional VTE risk factors, may be contributing factors. Early recognition and improved prevention strategies are crucial to mitigate the impact of this complication.
Contact e‐mail address: r.klomberg@erasmusmc.nl
G‐OP053. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP053.1. EARLY PROACTIVE THERAPEUTIC DRUG MONITORING OF INFLIXIMAB IN PEDIATRIC IBD: INTERIM RESULTS FROM THE EPIC TRIAL
Sara Lega 1, Francesca Laganà2, Manuela Distante3, Luca Scarallo4, Paolo Maria Pavanello5, Chiara Longo6, Patrizia Alvisi7, Fatima Tizi1, Fabiana Ziberna1, Debora Curci1, Manuela Giangreco1, Veronica Lazzaretto1, Veronica Grigoletto1, Valeria Dipasquale2, Giovanna Lopresti2, Delia De Mitri3, Serena Arrigo6, Stefano Martelossi5, Paolo Lionetti4, Marina Aloi3,8, Claudio Romano2, Matteo Bramuzzo1
1Pediatrics, Institute For Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy, 2Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital "G. Martino", Messina, Italy, 3Maternal And Child Health Department, Sapienza University of Rome, Rome, Italy, 4Gastroenterology And Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy, 5Gastroenterology Unit, Department of Pediatrics Regional Hospital, Treviso, Italy, Treviso, Italy, 6Pediatric Gastroenterology and Endoscopy Unit – IRCCS Istituto Giannina Gaslini, Genova, Italy, 7Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy, 8Department Of Pediatric Gastroenterology, Hepatology, Transplantation, And Cystic Fibrosis, University of Milan, Milan, Italy
Objectives and Study: The EPIC study is a multicenter, open‐label, randomized controlled trial (ClinicalTrials.gov ID: NCT05280405) evaluating the efficacy of early proactive therapeutic drug monitoring (EpTDM) in improving infliximab durability, efficacy, and safety compared to standard dosing in pediatric patients with IBD. The primary composite outcome is the frequency of infliximab discontinuation or treatment intensification due treatment failure (non‐response or loss of response) or adverse events, within the first year of treatment. Secondary outcomes include rates of sub‐therapeutic infliximab levels and of antibodies to infliximab (ATI).
Methods: Children aged 6–17 years with an indication for anti‐TNF therapy were randomized using a stratified procedure accounting for IBD type, perianal disease, and immunomodulator use. The EpTDM group received infliximab with interval and dose adjustments based on pre‐infusion drug concentrations from week 6 onward. The standard of care (SOC) group followed fixed dosing at 5 mg/kg every 8 weeks. Data were analyzed using an intention‐to‐treat approach.
Results: The interim analysis included 51 patients. The primary outcome occurred in 1/25 patients (4%) in the EpTDM group versus 10/26 patients (39%) in the SOC group (p = 0.01). No patients in the EpTDM group discontinued treatment, and only 1 (4%) required treatment intensification due to treatment failure, compared to 1 discontinuation (4%, p = 1.0) and 9 treatment intensifications (35%,p = 0.01) in the SOC group. The likelihood of sub‐therapeutic infliximab levels was lower in the EpTDM group (24% vs. 86%, p = 0.001). No patients in the EpTDM group developed ATI or experienced infusion reactions, versus 4 patients (15%, p = 0.1) and 1 patient (4%, p = 1.0), respectively, in the SOC group.
Conclusions: This interim analysis suggests that EpTDM enhances infliximab effectiveness and safety, potentially due to higher drug levels and reduced immunogenicity. Pending final analysis, these findings suggest that EpTDM might represent a safe and effective approach to optimizing infliximab therapy in pediatric IBD.
Contact e‐mail address: sara.lega@burlo.trieste.it
G‐OP054. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP054.1. MACHINE LEARNING FOR PREDICTING PEDIATRIC CROHN'S DISEASE FROM ROUTINE BLOOD TESTS YEARS BEFORE DIAGNOSIS: RESULTS FROM THE EPI‐IIRN
Raffi Lev‐Tzion 1, Amir Dolev2, Shira Yuval Bar Asher1, Yiska Weisband3, Amir Ben‐Tov4, Galia Zacay5, Eran Matz6, Iris Dotan7, Dan Turner8, Boaz Lerner2
1The Juliet Keidan Institute Of Paediatric Gastroenterology Hepatology And Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel, 2Industrial Engineering And Management, Ben‐Gurion University of the Negev, Beersheva, Israel, 3Clalit Innovation, Clalit Health Services, Ramat‐Gan, Israel, 4Kahn Sagol Maccabi Research And Innovation Center, Maccabi Healthcare Services, Tel‐Aviv, Israel, 5Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel‐Aviv, Israel, 6Community Medicine, Leumit Health Services, Tel‐Aviv, Israel, 7Division Of Gastroenterology, Rabin Medical Center, Tel‐Aviv, Israel, 8The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
Objectives and Study: Various biomarkers may help predict inflammatory bowel disease (IBD) in advance of diagnosis, but these are mostly not routinely tested and thus are more challenging for screening. In this nationwide study, we used the epi‐IIRN validated cohort to explore the utility of routine blood tests as markers for predicting pediatric IBD occurrence.
Methods: We used the epi‐IIRN cohort to collect results of all blood tests performed up to 15 years before diagnosis, from all IBD patients diagnosed between 2005‐2020 and insured by Israeli health maintenance organizations (HMOs); each patient was individually matched to two non‐IBD controls. Means were compared using Welch's t‐test with false discovery rate correction to account for multiple comparisons. We then used machine learning to build a model using the 15 most statistically significant blood tests to predict Crohn's disease.
Results: Pre‐diagnosis results from 84 different blood tests were collected for 8,630 Crohn's disease (CD) patients and 6,791 ulcerative colitis (UC) patients, including 1,162 children with CD and 580 children with UC and their matched controls. Seventeen blood tests showed consistent differences earlier than 1 year pre‐diagnosis, including 6 (hemoglobin and red cell distribution width (RDW) were the earliest to show changes) that diverged >2 years pre‐diagnosis. No test showed significant differences between UC cases and controls. The machine‐learning model had an area under the curve (AUC) of 0.68 for predicting future CD 1 year before diagnosis.
Conclusions: We were able to detect significant changes in routinely collected blood tests long before CD diagnosis and to predict future CD using a machine learning model. This opens the possibility of detecting early signals of future CD in patients undergoing routine blood tests, which may be used for developing screening and prediction models for prevention strategies.
Contact e‐mail address: raffilv@szmc.org.il
G‐OP055. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP055.1. MULTIOMICS ANALYSIS IDENTIFIES KEY PATHWAYS ASSOCIATED WITH SEVERE DISEASE COURSE IN CHILDREN WITH IBD: A PROSPECTIVE STUDY
Asaf Azulay1, Yael Talmor2, Gili Focht1, Oren Ledder1, Esther Orlanski‐Meyer1, Raffi Lev‐Tzion 1, Dotan Yogev1, Amit Assa1, Elhanan Borenstein2,3,4, Dan Turner1
1The Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Jerusalem, Israel, 2School of Computer Science‐ Tel Aviv University, Tel Aviv, Israel, 3Faculty of Medicine‐ Tel Aviv University, Tel Aviv, Israel, 4Santa Fe Institute, Santa Fe, United States of America
Objectives and Study: Identifying biological pathways may improve early risk stratification and guide targeted therapeutic approaches in inflammatory bowel diseases (IBD). We aimed to integrate multi‐omics data obtained at disease onset to explore pathways associated with disease course in pediatric IBD, focusing on both microbial and host‐derived signals.
Methods: Children with IBD were enrolled at disease onset and followed prospectively for 18 months. Samples for whole exome sequencing, microbiome and serum/stool metabolomics, were analyzed using MaAsLin2 for differential expression following pathway enrichment analyses. Machine learning was used for outcome prediction for each omic, with late integration approach for multi‐omics prediction. Severe disease course was reflected by steroid‐dependency, need for early/multiple biologics, or IBD‐related hospitalizations/surgeries.
Results: 182 children were enrolled (123 CD, 28% severe and 59 UC, 39% severe). Several pathways were differentially enriched in the severe group (Figure1A‐B). Shared pathways across CD and UC included AGE‐RAGE signaling , implicated in oxidative stress and inflammation (CD: OR = 36 [95%CI:3‐459] and UC: OR = 92 [7‐1121]), and choline metabolism in cancer , associated with lipid signaling, inflammation and fibrosis (OR = 37 [4‐382], OR = 66 [3‐475]). CD‐specific pathways included sphingolipid metabolism (OR = 30 [2‐393]), linked to barrier dysfunction and chronic inflammation, glycerolipid metabolism (OR = 11 [1‐160]), and fat digestion and absorption (OR = 16 [3‐167]), highlighting disruptions in nutrient absorption and inflammation. UC‐specific pathways included pathways in cancer (OR = 2 3[3‐263]), inflammatory regulation of TRP channels (OR = 14 [1‐143]), contributing to colonic inflammation, sensory perception and purine metabolism (OR = 5[0.4‐58]). Machine learning models showed modest to no predictive performance of the multi‐omics analyses (range of AUROC curve 0.41‐0.67 in CD and 0.38‐0.72 in UC; Figure1C).
Conclusions: Key biological pathways were identified in association with severe disease course in pediatric IBD, utilizing genetics, metabolomics and microbiome. The findings offer insights into mechanisms underlying pediatric IBD and potential therapeutic targets but with no clear utility as biomarkers for early intervention.
Contact e‐mail address: turnerd@szmc.org.il
G‐OP056. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP056.1. EVOLVING DRUG TREATMENT PATTERNS IN PEDIATRIC INFLAMMATORY BOWEL DISEASE: INSIGHTS FROM A SWEDISH NATIONWIDE STUDY (2008–2022)
Petter Malmborg 1, Daniel Molin2, Siri Voghera3, Mehdi Osooli3, Helena Rolandsdotter1, Jonas Halfvarson4, Jan Marsal2, Ola Olén5
1Department Of Paediatric Gastroenterology, Sachs' Children and Youth Hospital, Stockholm, Sweden, 2Department Of Clinical Sciences, Lund University, Lund, Sweden, 3Division Of Clinical Epdemiology, Departement Of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden, 4Department Of Gastroenterology, Faculty Of Medicine And Health, Örebro University, Örebro, Sweden, 5Department Of Medicine, Division Of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
Objectives and Study: The number of drugs for treating inflammatory bowel disease (IBD) has increased in recent years. While few of these drugs are approved for treatment of pediatric IBD patients (<18 years of age), Swedish authorities have not imposed any restrictions on their use in the publically‐financed paediatric health care system. Pediatric gastroenterologists in Sweden are guided in their decision‐making by international, national and regional IBD treatment guidelines created by the profession. The aim of this study was to investigate the evolution of drug utilization among paediatric patients with IBD in Sweden during the last two decades.
Methods: We used the National Patient Register (NPR) and the Swedish IBD Quality Register (SWIBREG) to identify 4,321 patients with a paediatric‐IBD diagnosis (ulcerative colitis, n = 2,090) and Crohn's disease, n = 2,231) between 2008‐2022. Drug exposures for the patients, before their 18:th birthday, during the study period were retrieved from the Prescribed Drug Register, NPR and SWIBREG. To study changes in pharmacological treatment over time, we compared the three calender periods: 2008‐2012, 2013‐2017, and 2018‐2022.
Results: TNFa‐inhibitors were increasingly prescribed throughout the study period (cumulative incidence of exposure, 3 years after diagnosis: 2008‐2012, 23%; 2013‐2017, 44%; 2018‐22, 57%; p < 0,001). Only few paediatric‐IBD patients (n = 9) were given other targeted therapies (vedolizumab, ustekinumab or tofacitinib) as first‐line therapy throughout the study period (Figure 1). Except for decreasing use of 5‐ASA over time in patients with Crohn's disease (cumulative incidence of exposure, 3 years after diagnosis: 2008‐2012, 89%; 2013‐2017, 72%; 2018‐2022, 55%; p < 0,001), no changes in utilization of conventional drugs (5‐ASA, corticosteroids or immunomodulators) were observed.
Conclusions: During the study period 2008‐2022 an increasing proportion of children with IBD were prescribed targeted therapies. Our findings supports the idea that most pediatric gastroenterologists in Sweden adhere to professional guidelines but also that it takes time to change well‐accustomed treatment patterns.
Contact e‐mail address: petter.malmborg@ki.se
G‐OP057. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP057.1. DEVELOPMENT AND VALIDATION OF A SEXUAL QUALITY OF LIFE SCORE FOR YOUTHS WITH INFLAMMATORY BOWEL DISEASE
Alexandre Mancheron 1,2, Agnès Dumas3, Isabelle Nion Larmurier4, Cécilia Landman4, Laurent Peyrin Biroulet5, Bénédicte Caron5, Clotilde Baudry6, Matthieu Allez6, Mélanie Serrero7, Dalal Yahioune1, Stéphane Nancey8, Céline Roman7, Rémi Duclaux‐Loras8, Stéphanie Degryse9, Priscilla Boizeau10, Mathilde Husson11, Shaya Sable12, Iona Tarbet13, Corinne Devos14, Aurélie Bourmaud12, Christine Martinez‐Vinson1
1Department Of Pediatric Gastroenterology And Nutrition, Robert Debré Hospital, PARIS, France, 2Université Paris Cité, PARIS, France, 3Inserm, Ird, Isspam, Sesstim, Sciences Economiques & Sociales De La Santé & Traitement De L'information Médicale, Equipe Calipso, Aix Marseille University, MARSEILLE, France, 4Department Of Gastroenterology, Saint Antoine University Hospital, PARIS, France, 5Department Of Gastroenterology, Infiny Institute, Inserm Ngere, Chru Nancy, F‐54500 Vandœuvre‐lès‐nancy, CHRU NANCY, NANCY, France, 6Saint Louis Hospital, PARIS, France, 7Marseille Hospital, MARSEILLE, France, 8Lyon Hospital, LYON, France, 9Lille Hospital, LILLE, France, 10Clinical Epidemiology Department, And Cic 1426 Inserm, Robert Debré University Hospital, Paris, France Inserm Umr 1137 Iame, Robert Debré Hospital, PARIS, France, 11Clinical Epidemiology Department, And Cic 1426 Inserm, Robert Debré University Hospital, Paris, France, Robert Debré Hospital, PARIS, France, 12Clinical Epidemiology Department, Robert Debré University Hospital, Paris, France, Robert Debré Hospital, PARIS, France, 13King's College Longon GKT School of Medical Education, LONDON, United Kingdom, 14Association François Aupetit Crohn RCH France, PARIS, France
Objectives and Study: Inflammatory Bowel Diseases (IBD) could have an impact on sexual health. It is therefore recommended to assess the sexual health of patients at the time of diagnosis and during follow‐up using a sexual quality of life score. However, no tool exists to assess the sexual quality of life of young people with IBD. This study aimed to develop and validate BLOOMI, a new patient‐reported outcome measure designed to assess sexual quality of life (QoL) in 15‐25‐year‐old patients diagnosed with IBD.
Methods: A multidisciplinary team (including gastroenterologists, a sexologist, a sociologist, and a patient advocate) developed BLOOMI. This tool takes the form of a user‐friendly disk incorporating 10 items: Sexual desire, Self‐pleasure, Orgasm, Pleasure of the other, Erection and Penetration, Fatigue, Body image, Sexual pain, Abdominal pain and Anal leakage. To ensure its validity, BLOOMI was compared to established sexual QoL measures (the International Index of Erectile Function for men and the Sexual Function Questionnaire 28 for women) in a national cross‐sectional study. This study was approved by a local ethics committee
Results: 104 questionnaires from 7 French centers were analyzed. The study confirmed a strong correlation between BLOOMI and the existing gold standard questionnaires, demonstrating its accuracy in assessing sexual QoL. Furthermore, BLOOMI showed good internal consistency. The study identified fatigue and concerns about body image as significant factors associated with poorer sexual QoL.
Conclusions: BLOOMI is the first sexual QoL measure specifically designed and validated for adolescents and young adults with IBD. Its innovative disk format and focus on patient comfort promote open communication about sensitive topics.
Contact e‐mail address: mancheron.alexandre@outlook.fr
G‐OP058. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP058.1. THE ROLE OF CROHN'S DISEASE EXCLUSION DIET AS AN ADJUNCTIVE THERAPY TO ANTI‐TNF ALPHA: A RETROSPECTIVE STUDY IN A PEDIATRIC COHORT
Tiziana Miraglia 1, Saverio Pochesci2, Luca Scarallo3,4, Alessia De Blasi2, Elena Banci5, Paolo Lionetti2,3
1Gastroenterology And Nutrition, Meyer Children's Hospital, IRCCS, Florence, Italy, 2Gastroenterology And Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy, 3Neurofarba, University of Florence, Florence, Italy, 4Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy, 5Dietetics Unit, Meyer Children's Hospital IRCCS, Florence, Italy
Objectives and Study: This study aimed at evaluating the role of combining Crohn's Disease Exclusion Diet (CDED) coupled with Partial Enteral Nutrition (PEN) with Anti‐TNF alpha agents (ATA) in pediatric patients with moderate‐to‐severe Crohn's Disease.
Methods: This was a single‐center retrospective study, conducted at a tertiary level referral center. We compared a cohort of pediatric CD patients treated with ATA in combination with CDED + PEN with a control group treated with ATA alone. Data were collected at baseline (T0), at the end of phase I (8 weeks (T1)), at the end of phase II (16 weeks (T2), and at 1 year (T3) follow up and included clinical, auxological, and biochemical parameters. Primary outcomes included clinical and biochemical remission rates.
Results: A total of 37 patients were included: 21 received ATA monotherapy and 16 received CDED + ATA. wPCDAI at baseline was significantly higher in the latter. At 8 weeks, a significantly higher proportion of patients in the CDED + PEN group achieved normalization of ESR and CRP levels (100% vs. 71.4%, p = 0.027 and 100% vs. 61.9%, p = 0.0506, respectively). No statistically significant differences were observed between the two groups regarding wPCDAI scores, fecal calprotectin levels, clinical relapses, or surgical interventions at any time point. Although not statistically significant, patients in the CDED + ATA group showed greater improvement in weight [Δ 3.3 kg (Q1‐Q3: 2–6.8) vs. 0.35 kg (Q1‐Q3: ‐0.93–0.37), p = 0.231] sustained at 1 year [Δ 6.3 kg (Q1‐Q3: 4.3–9) vs. 0.27 kg (Q1‐Q3: ‐1.1–0.28), p = 0.23].
Conclusions: In our cohort, the combination of ATA and CDED + PEN was associated with higher CRP and ESR remission rates at week 8. Additionally, CDED + PEN may offer nutritional benefits as an adjunctive therapy to biological agents in pediatric patients with CD. Further prospective studies are warranted to confirm these findings and assess long‐term outcomes.
Contact e‐mail address: tiziana.miraglia22@gmail.com
G‐OP059. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP059.1. IMPACT OF PRENATAL AND BREASTFEEDING EXPOSURE TO BIOLOGIC DRUGS ON FIRST‐YEAR INFANT GROWTH IN MOTHERS WITH INFLAMMATORY BOWEL DISEASE: FINDINGS FROM GETECCU'S DUMBO REGISTRY
Laura Palomino 1, Marta Velasco Rodríguez‐Belvis1, María José Casanova2, Eduardo Leo‐Carnerero3, Cristina Calviño Suarez4, Montserrat Rivero5, Marta Calvo6, María Teresa Arroyo7, Agnes Fernández‐Clotet8, Isabel Pérez‐Martínez9, Ángeles Masedo González10, Vicent Hernández11, Alexandra Ruiz‐Cerulla12, Pilar López Serrano13, Pablo Vega14, Iago Rodríguez‐Lago15, Raquel Vicente Lidón16, Miguel Ángel De Jorge17, Iván Guerra18, Lara Arias García19, Gema Molina Arriero20, Daniel Hervías Cruz21, David Busquets22, Ana Gutiérrez Casbas23, Manuel Van Domselaar24, Gemma Valldosera Gomis25, Juan María Vázquez Morón26, Marta Piqueras Cano27, Alfredo J Lucendo28, María Dolores Martín Arranz29, Patricia Ramírez De La Piscina30, María Del Pilar Martínez Tirado31, Virginia Robles Alonso32, Sandra Marín Pedrosa33, Raquel Camargo Camero34, Edisa Armesto Gonzalez35, Carlos Tardillo Marín36, Esther Bernardos Martín37, María Carmen Rodríguez Grau38, José M. Huguet39, Lucía Márquez‐Mosquera40, Pau Sendra Rumbeu41, Luis Bujanda42, Carlos Castaño‐Milla43, Empar Sáinz Arnau44, Luis Hernández45, Laura Ramos46, Mm Boscá‐Watts47, Noemí Manceñido Marcos48, Miquel Sans49, Victor Jair Morales50, Ana Garre2, Elvira Cañedo Villaroya51, Agustín De La Mano Hernández51, Rosa Ana Muñoz Codoceo51, Alberto García‐Salido52, Javier P. Gisbert2, María Chaparro2
1Hospital Infantil Universitario Niño Jesús and Instituto de Investigación Sanitaria Princesa (IIS‐Princesa), Madrid, Spain, 2Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS‐Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain, 3Hospital Universitario Virgen del Rocío, Sevilla, Spain, 4Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain, 5Hospital Universitario Marqués de Valdecilla e IDIVAL, Santander, Spain, 6Hospital Universitario Puerta de Hierro, Majadahonda, Spain, 7Hospital Clínico Universitario Lozano Blesa, IIS Aragón and CIBEREHD, Zaragoza, Spain, 8Hospital Clinic de Barcelona, CIBEREHD, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, 9Hospital Universitario Central de Asturias, Oviedo Diet, Microbiota and Health Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain, 10Hospital Universitario 12 de Octubre, Madrid, Spain, 11Xerencia Xestión Integrada de Vigo, SERGAS Grupo de Investigación de Patología Digestiva, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS UVIGO, Vigo, Spain, 12Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain, 13Hospital Universitario Fundación Alcorcón, Madrid, Spain, 14Complexo Hospitalario Universitario de Ourense, Ourense, Spain, 15Hospital Universitario de Galdakao, Biobizkaia Health Research Institute, Galdakao, Spain, 16Hospital Universitario Miguel Servet de Zaragoza, Zaragoza, Spain, 17Hospital Universitario de Cabueñes, Gijón, Spain, 18Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain, 19Hospital Universitario de Burgos, Burgos, Spain, 20Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain, 21Hospital General Universitario de Ciudad Real, Cuidad Real, Spain, 22Hospital Trueta de Girona, Girona, Spain, 23Hospital General Universitario Dr. Balmis Alicante, ISABIAL, CIBERehd, Alicante, Spain, 24Hospital Universitario de Torrejón and Universidad Francisco de Vitoria, Madrid, Spain, 25Hospital Universitario Joan XXIII, Tarragona, Spain, 26Hospital Universitario Juan Ramón Jiménez, Huelva, Spain, 27Consorci Sanitari de Terrassa (CST), Barcelona, Spain, 28Hospital General de Tomelloso, Instituto de Investigación Sanitaria La Princesa, Instituto de Investigación Sanitaria de Castilla‐La Mancha (IDISCAM) and CIBEREHD, Tomelloso, Spain, 29Hospital Universitario La Paz, Madrid, Spain, 30Hospital Universitario de Álava, Vitoria‐Gasteiz, Spain, 31Hospital Clínico Universitario San Cecilio, Granada, Spain, 32Hospital Vall d'Hebrón, Barcelona, Spain, 33Hospital Universitario Reina Sofía, Córdoba, Spain, 34Hospital Universitario Virgen de La Victoria, Málaga, Spain, 35Hospital Universitario San Agustín, Avilés, Spain, 36Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain, 37Hospital Mancha Centro, Alcázar de San Juan, Spain, 38Hospital Universitario del Henares, Coslada, Madrid, Spain, 39Hospital General Universitario de Valencia, Valencia, Spain, 40Hospital del Mar, Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain, 41Hospital Universitario Son Espases, Palma de Mallorca, Spain, 42Bioodonostia Health Research Institute – Donostia University Hospital, Universidad del País Vasco (UPV/EHU), CIBEREHD, San Sebastián, Spain, 43Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain, 44Hospital Sant Joan de Déu, Manresa and Hospital Universitario de La Princesa and CIBEREHD, Madrid, Spain, 45Hospital Santos Reyes Aranda de Duero SACyL, Aranda de Duero, Spain, 46Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain, 47Hospital Clínico Universitario de Valencia, Valencia, Spain, 48Hospital Universitario Infanta Sofía San Sebastián de los Reyes, Madrid, Spain, 49ISADMU Centro Médico Teknon, Barcelona, Spain, 50Hospital de Granollers, Barcelona, Spain, 51Pediatric Nutrition, Hospital Infantil Niño Jesús, Madrid, Spain, 52Intensive Care Unit, Hospital Infantil Niño Jesús, Madrid, Spain
Objectives and Study: Elevated systemic inflammatory markers during pregnancy are linked to adverse birth outcomes and impaired infant growth. However, limited research exists on inflammatory bowel disease (IBD) and the impact of biologic drug exposure on early anthropometric outcomes. This study aimed to evaluate anthropometric development and malnutrition risk during the first year of life in infants born to IBD mothers, focusing on intrauterine and breastfeeding exposure to biologics.
Methods: The study analyzed data from the DUMBO registry, a prospective multicenter registry involving 60 centers in Spain since 2019. Mothers with IBD and their infants were included, with maternal data collected at conception, each trimester, and postpartum. Infant assessments were conducted at birth and at 3, 6, 9, and 12 months. Nutritional status was determined using ASPEN anthropometric criteria, with weight‐for‐height/length z‐scores defining malnutrition as ≤ ‐1.0 (mild: ‐1.0 to ‐1.9; moderate: ‐2.0 to ‐2.9; severe: ≤ ‐3.0). Z‐scores between ‐1.0 and +1.0 were considered adequate for sex and age (or corrected age in preterm infants).
Results:
The study included 352 children born to 343 women with IBD. Of these, 134 infants (38%) were exposed to biologics during pregnancy, and 80 (23%) during both pregnancy and lactation. Maternal characteristics, IBD activity during pregnancy, and child outcomes in the first year showed no statistically significant differences based on biologic exposure. Normal growth in height and weight was observed regardless of exposure (Tables 1a and 1b). At 1 month, malnutrition risk was higher in non‐exposed than exposed infants (33% vs. 21%, p < 0.05). By 3 months, non‐exposed infants had a significantly higher prevalence of moderate to severe malnutrition (47% vs. 20%, p < 0.05) (Table 1c).
Conclusions: Biologic exposure during pregnancy and breastfeeding appears safe and may positively influence children's growth and weight development. These findings highlight the importance of maternal inflammation control, beyond symptom relief, to improve child development outcomes.
Contact e‐mail address: laura_palomino_perez@hotmail.es
G‐OP060. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP060.1. CYCLIC EXCLUSIVE ENTERAL NUTRITION TO MAINTAIN LONG‐TERM DRUG‐FREE REMISSION IN PAEDIATRIC CROHN'S DISEASE: THE CD HOPE STUDY OF THE GETAID PÉDIATRIQUE
Bénédicte Pigneur 1, Christine Martinez‐Vinson2, Aurélie Bourmaud3, Swellen Gastineau4, Rémi Duclaux‐Loras5, Jean Pierre Hugot2, Céline Roman6, Clémentine Dumant7, Claire Spyckerelle8, Vincent Guinard Samuel9, Stephanie Willot10, Claire Dupont‐Lucas11, Anne Breton12, Nicolas Caron5, Emilie Chaillou13, Laurent Rebouissoux14, Valérie Bertrand15, Valérie Triolo16, Justine Pages3, Djamal Djeddi17, Marjorie Bonneton18, Stéphanie Uhlen19, Natacha Catteau20, Stéphanie Degryse21, Patricia Lepage22, Jérôme Viala2, Frank Ruemmele1
1Pediatric Gastroenterology And Nutrition Unit, Necker Enfants Malades Hospital, PARIS, France, 2Department Of Pediatric Gastroenterology And Nutrition, Robert Debré Hospital, PARIS, France, 3Clinical Epidemiology Department, Robert Debré University Hospital, Paris, France, Robert Debré Hospital, PARIS, France, 4Pediatric Gastroenterology, Rennes, France, 5Lyon Hospital, LYON, France, 6Marseille Hospital, MARSEILLE, France, 7Pediatric Gastroenterology, Rouen, France, 8Pediatric Gastroenterology, Lille, France, 9Trousseau Hospital, Paris, France, 10CHU Tours, Tours, France, 11Department of Paediatrics, Caen University Hospital, Caen, France, 12CHU Toulouse Purpan, Toulouse, France, 13CHU Angers, Angers, France, 14CHU Bordeaux, Bordeaux, France, 15Department of Paediatrics, Le Havre Hospital, Le Havre, France, 16Pediatrics, CHU Nice‐ Hôpital LENVAL, Nice, France, 17CHU Amiens Picardie, Amiens, France, 18CHU Nancy, Nancy, France, 19CH Valenciennes, Valenciennes, France, 20CH Nimes, Nimes, France, 21Lille Hospital, LILLE, France, 22Micalis, INRAE, Jouy en Josas, France
Objectives and Study: To address the question if paediatric CD patients responding to nutritional induction therapy can be maintained in remission on dietary therapy without the use of immunosuppressive drugs, we designed a prospective randomized trial (CD‐HOPE) comparing cyclic exclusive enteral nutrition (EEN) to daily supplement over a 12‐month period.
Methods: CD patients (6‐17 years) in clinical remission (wPCDAI <12.5) after at least 6 weeks of EEN were randomized to cyclic EEN (100% of caloric requirement) every 8 weeks for 2 weeks (group A n = 51), or daily supplementary nutrition (25% of caloric requirement; group B n = 49). Oral MODULEN IBD® was used for EEN and the supplement. Except for the two weeks of EEN in group A, food access was not restricted. The microbiota composition was analyzed using 16S ribosomal RNA gene sequencing with Illumina MiSeq. Multivariate analyses were performed to identify microbial profiles linked to relapse at 12 months.
Results: A significantly higher clinical remission rate was observed on EEN with 25/49 patients (51%) in group A compared to 12/51 patients (23.5%) in group B (p = 0.004). Time to first relapse was significantly shorter in group B. Alpha diversity was significantly lower in patients on cyclic EEN compared to group B. High proportions of Klebsiella, Enterobacter, Citrobacter, Flavonifractor, Faecalimonas at inclusion were predictive for relapse and significantly associated with a shorter time to relapse. In the Enterobacter High‐ group at inclusion, 88% of patients relapsed over time.
Conclusions: This is first randomized trial indicating that children/adolescents with CD responding to EEN as induction therapy can be maintained on long‐term remission with a nutritional therapy without use of immunosuppressive drugs/biologics. The identification of new clinical and microbial predictors allows to select patients with a high likelihood to respond to long‐term nutrition. This study was supported by an unrestricted grant from Nestlé Health Science
Contact e‐mail address: benedicte.pigneur@aphp.fr
G‐OP061. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP061.1. PRECISE MULTISPECTRAL OPTOACOUSTIC TOMOGRAPHY FOR ASSESSMENT OF HEMODYNAMICS IN MURINE COLITIS
Adrian Bühler1, Emma Brown2, Felix Wachter1, Henriette Mandelbaum1, Merle Claßen1, Markus Neurath1, Joachim Woelfle1, Joachim Waldner1, Oliver Friedrich3, Ferdinand Knieling1, Sarah Bohndiek2, Adrian Regensburger 1
1University Hospital Erlangen, Erlangen, Germany, 2University of Cambridge, Cambridge, United Kingdom, 3Institute Of Medical Biotechnology, FAU Erlangen‐Nürnberg, Erlangen, Germany
Objectives and Study: Multispectral optoacoustic tomography (MSOT) is promising imaging modality to asses disease activity in IBD by the transmural hemoglobin and oxygenation status. However, biomarker validation by pre‐clinical MSOT imaging in murine colitis models has previously been limited. Here, we present an innovative approach by introducing a transrectal absorber guide (TAG), enabling precise imaging of disease activity in animal models.
Methods: Dextran sulfate sodium (DSS) was used to induce colitis in Balb/C mice to model acute colonic inflammation. MSOT imaging was performed to assess oxygenated (HbO2), deoxygenated hemoglobin (HbR) and oxygen saturation (mSO2 = HbO2/HbT). A custom made transrectal absorber guide was used as a high‐contrast landmark for precise localization of the intestinal wall. Health parameters and endoscopy were monitored and correlations with optoacoustic biomarkers were calculated.
Results: Severe colitis was induced by the administration of two cycles of DSS. After spectral unmixing for hemoglobin, severe inflammation could be observed in 3D TAG‐MSOT images. A concentration of 3% DSS in drinking water during the first cycle was used to induce mild colitis and caused a slight increase in mSO2. HbO2 and HbR did not change significantly. A second cycle of 5% DSS induced severe inflammation at day 28 with decrease in HbR (P = 0.0064), and an increase in mSO2 (P < 0.0001), when compared to day 0. Greatest correlation between MSOT parameters and health scores showed mSO2 and disease activity score (rs = 0.55, P < 0.0001) and endoscopic (MEICS) score (rs = 0.55, P < 0.0001) (Figure 2).
Conclusions: In this work, a TAG‐MSOT was implemented, allowing precise localization and three‐dimensional imaging of the colon wall for quantification of oxygenated and deoxygenated hemoglobin and the respective oxygenation status.
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G‐OP062. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP062.1. EXCLUSION DIET VS. EXCLUSION DIET PLUS PARTIAL ENTERAL NUTRITION IN MANAGEMENT OF PEDIATRIC CROHN'S DISEASE
Mohammadhassan Sohouli1, Pejman Rohani 2
1Tehran University of Medical Sciences, Tehran, Iran, 2Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran. Iran., Tehran, Iran
Objectives and Study: Exclusive enteral nutrition (EEN) induces remission in children with active mild to moderate Crohn's disease (CD), while partial enteral nutrition (PEN) with a free diet have failed to be effective in these patients. The effects of CD exclusion diet (CDED) alone has not yet been evaluated in pediatric CD. The current study aimed to compare the effects of CDED alone vs. CDEN plus PEN on children and adolescents with mild to moderate CD.
Methods: A prospective randomized trial was conducted on children with mild to moderate Crohn's Disease (CD), aged 4‐18 years. Eligible children were included in the study based on the inclusion and exclusion criteria and after the approval of the diagnosis by a pediatric gastroenterologist. Patients were assigned to receive either CDED + PEN, or only CDED. The study evaluated remission, disease activity, inflammatory markers, anthropometric measurements, quality of life, fecal calprotectin (FC), and albumin after 8 weeks of intervention.
Results: Sixty patients were randomly assigned to two groups (30 to CDED + PEN group and 30 to CDED) and included in the analysis. At eight weeks, our analysis showed no significant difference in response (P = 0.92) and remission (P = 0.71) between two groups. However, both groups experienced remission rates of over 60%. The study found no differences in anthropometric measurements, inflammatory markers, disease activity and FC between groups, while CDED + PEN significantly improved quality of life.
Conclusions: CDED is as effective as CDED plus PEN in induction of remission in active mild to moderate pediatric CD.
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G‐OP063. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP063.1. PLASMA IMMUNE PROTEIN PROFILES IN THERAPY‐NAÏVE ULCERATIVE COLITIS RELATE TO EXTENT OF AFFECTED TISSUE AND DENSITY OF INTESTINAL INFILTRATION, DIFFERENTIATING PATIENTS WITH DISCREET DISEASE COURSES
Janneke Samsom 1, Beatriz Calado1, Maud Heredia1, Renz Klomberg2, Danielle Barendregt1, Danielle Hulleman1, Bastiaan Tuk1, Lisette Van Berkel1, Johanna Escher3, Lissy De Ridder3
1Pediatrics, Laboratory Of Pediatrics, Erasmus University Medical Centre ‐ Sophia Children's Hospital, Rotterdam, Netherlands, 2Paediatric Gastroentrology, Erasmus MC ‐ Sophia Children's Hospital, Rotterdam, Netherlands, 3Paediatric Gastroenterology, Erasmus MC ‐ Sophia Children's Hospital, Rotterdam, Netherlands
Objectives and Study: Ulcerative colitis (UC) is a chronic intestinal inflammation driven by inflammatory memory T helper cell (Tm) reactivation. Heterogeneity in clinical disease and variable treatment responses require new strategies targeting the patient's underlying immune disease. As inflammation in UC affects the intestinal mucosa, it is debated whether peripheral blood immune responses could reliably reflect ongoing intestinal immune disease.
Methods: To unequivocally establish this, we performed deep immune characterization of therapy‐naïve pediatric UC patients (n = 34) and controls (n = 55) by measuring 92 plasma immune proteins, circulating Tm subpopulations, intestinal mRNA expression, and intestinal immunohistochemistry. Extensive clinical follow‐up was related to immune responses, clinical disease severity and therapy response.
Results: At diagnosis, 23 plasma proteins were differentially abundant in UC compared to controls. Increased protein concentrations mainly related to the IL‐17 pathway (IL‐17, IL‐8, CCL20), tissue remodelling (MMP‐10, MMP1, HGF), acute phase response (IL‐6, OSM) and chemokinesis (CXCL9, CXCL10, CCL3). Intestinal mRNA expression of highly abundant plasma proteins similarly increased, whereas no proportional changes in circulating Tm were detected. Unbiased hierarchical clustering of plasma immune profiles yielded two clusters of UC patients; UC_A with significantly increased concentrations of 17 proteins, many of which Th17/neutrophil‐related, versus UC_B with lower concentrations. Notable increases in UC_A were: IL‐ 17 A; OSM, a neutrophil product previously associated with anti‐TNF therapy resistance; CXCL9 and CXCL11, IFN‐γ‐induced chemokines. Strikingly, this UC_A immune profile strongly related to increased size of the affected intestinal surface and degree of infiltrating IL‐17A+ cells and number of neutrophils in the biopsies. Clinically, UC_A patients had higher clinico‐pathological parameters, more severe intestinal disease at endoscopy and on histology, and required earlier treatment intensification during 1.5‐year follow‐up, compared to UC_B patients.
Conclusions: Our study establishes that, even though inflammation in UC affects the intestinal mucosa, peripheral blood immune protein responses reliably reflect the degree of ongoing intestinal immune disease in UC.
Contact e‐mail address:
G‐OP064. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP064.1. DISTINCTIVE PATHOGENIC MEMORY T CELL AND NEUTROPHIL RESPONSES AT DIAGNOSIS IDENTIFY PEDIATRIC CROHN'S DISEASE PATIENTS WHO DEVELOP SEVERE THERAPY RESISTANT DISEASE
Janneke Samsom 1, Beatriz Calado1, Wlico Smits1, Maud Heredia1, Danielle Barendregt1, Meike Grillmaier1, Bastiaan Tuk1, Danielle Hulleman1, Lisette Van Berkel1, Renz Klomberg2, Anouk Camman2, Stephanie Vuijk3, Johanna Escher3, Maria Fernanda Pascutti1, Lissy De Ridder2
1Pediatrics, Laboratory Of Pediatrics, Erasmus University Medical Centre ‐ Sophia Children's Hospital, Rotterdam, Netherlands, 2Paediatric Gastroentrology, Erasmus MC ‐ Sophia Children's Hospital, Rotterdam, Netherlands, 3Paediatric Gastroenterology, Erasmus MC ‐ Sophia Children's Hospital, Rotterdam, Netherlands
Objectives and Study: CD4+ memory T cells (Tm) drive chronicity of inflammation in Crohn's disease (CD). Recently, we have established that a subgroup of CD patients with high frequencies of circulating gut‐homing IFN‐γ‐secreting ex‐Th17‐TIGITneg Tm at time of diagnosis develop a severe disease course, failing to reach remission within 6 months or lose remission within 1 year, despite anti‐TNF treatment. As neutrophils are key targets of Tm function, we hypothesized the pathogenic gut‐homing Tm alter intrinsic neutrophil transcriptional programming at an early stage, before the cells enter the tissue, associating with therapy resistant intestinal disease.
Methods: We analyzed therapy‐naive pediatric CD patients (n = 33) and IBD‐negative controls (IBDneg; n = 15) from the PIBD‐SETQ cohort at time of diagnosis; performed bulk RNA‐seq of purified circulating neutrophils, bulk RNAseq of intestinal biopsies, multiparameter flow cytometry of circulating immune cells and plasma proteomics using Proximity Extension Assay technology.
Results: At diagnosis, CD neutrophils differentially expressed 263 genes (DEGs) compared to IBDneg. CD neutrophil transcriptomes were enriched for pathways related to neutrophil activation, granule biology, and IFN signaling. Hierarchical clustering of CD patients based on the 263 DEGs identified two patient clusters: cluster_1 with a neutrophil transcriptional pattern similar to IBDneg, and cluster_2 with a pronounced enrichment in IFN and TNF signaling and complement genes. As hypothesized, neutrophil cluster_2 patients had higher frequencies of circulating gut‐homing IFN‐γ‐secreting ex‐Th17‐TIGITneg Tm, reduced frequencies of inhibitory Tm and higher plasma concentrations IFN‐γ pathway‐associated proteins compared to cluster_1 patients. Crucially, lesional diagnostic colonic biopsies of neutrophil cluster_2 patients were transcriptionally distinct from cluster_1 with a signature of increased IFN‐γ signaling, extracellular matrix re‐organization and Fc‐receptor expression. As anticipated, cluster_2 patients had lower rates of FCP remission at 1 year.
Conclusions: We define a subgroup of pediatric CD patients who have a distinctive pathogenic Tm‐neutrophil immunotype at diagnosis and develop severe therapy resistant disease.
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G‐OP065. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP065.1. BOWEL ULTRASOUND SCAN (BUS) IN PEDIATRIC ACUTE SEVERE COLITIS (ASC): A MULTICENTER PROSPECTIVE STUDY ON BEHALF OF THE IBD PORTO GROUP
Luca Scarallo 1, Patrizia Alvisi2, Matteo Bramuzzo3, Marina Aloi4, Ilse Broekaert5, Jan De Laffolie6, Jaroslaw Kierkus7, Manar Matar8, Arianna Pranzetti2, Sara Renzo1, Marta Velasco Rodríguez‐Belvis9, Caterina Strisciuglio10, Laura Tasciotti1, Paolo Lionetti1
1Gastroenterology And Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy, 2Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy, 3Institute for Maternal and Child Health‐IRCCS "Burlo Garofolo", Trieste, Italy, 4Department Of Pediatric Gastroenterology, Hepatology, Transplantation, And Cystic Fibrosis, University of Milan, Milan, Italy, 5Pediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany, 6Department Of General Paediatrics And Neonatology, Justus‐Liebig University, Gießen, Germany, 7The Children's Memorial Health Institute‐ Warsaw‐ Poland, Gastroenterology‐ Hepatology‐ Feeding Disorders and Paediatrics, WARSZAWA, Poland, 8Institute Of Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center of Israel, Petha‐Tikva, Israel, 9Pediatric Nutrition, Hospital Infantil Niño Jesús, Madrid, Spain, 10Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy
Objectives and Study: The aim of this study was to evaluate the role of bowel ultrasound scan (BUS) in predicting short‐term treatment outcomes in pediatric Acute Severe Colitis (ASC).
Methods: This was a multicenter prospective longitudinal study, conducted across ten European centers. Biologic‐naïve children with Ulcerative Colitis hospitalized for ASC, were included. Each patient underwent two BUS, the first one within the first 48 hours of from IVCS intravenous corticosteroids administration and the second one within 5‐7 days from treatment initiation. Key metrics assessed included colonic wall thickness (CWT), colonic wall stratification (CWS) and colonic wall blood flow via power Doppler. Furthermore, Milan ultrasound criteria (MUC) score was also calculated for each colonic quadrant.
Results: 59 patients (61% males, median age at ASC: 14.2 years) were included. Almost 60% of patients had pancolitis, 22 (37.3%) experienced ASC at disease onset. Figure 1. summarizes patients’ characteristics at ASC. 38 (64.4%) patients failed to respond intravenous corticosteroids (IVCS) and required second‐line therapy with infliximab (IFX). Patients who required step‐up treatment with IFX had higher colonic wall thickness (CWT) and more frequently an increased vascularization (Limberg score > 2) (p = 0.041 and p = 0.005, respectively). Furthermore, patients who failed to respond to IVCS and required escalation to IFX had a higher MUC score at firs BUS (p = 0.042). Ten patients (16.9%) failed to respond to medical treatment and required short‐term colectomy (within 8 weeks of follow‐up). Patients who required colectomy had a higher CWT both at first and at second BUS (p = 0.033 and p = 0.004, respectively). Moreover, patients who responded to medical therapy had higher DCWT (difference between worse CWT at first and at second BUS) compared to those who required surgery (p = 0.0018).
Conclusions: BUS may serve as an effective noninvasive tool to predict first‐line therapy failure and the need for colectomy in patients with ASC.
Contact e‐mail address: luca.scarallo@gmail.com
G‐OP066. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP066.1. THE ASSOCIATION OF INFLAMMATORY BOWEL DISEASE WITH BEHCHET'S DISEASE: AN ISRAELI NATIONWIDE STUDY FROM THE EPI‐IIRN
Ibrahim Shamasneh 1, Rona Lujan1, Yiska Loewenberg Weisband2, Amir Ben ‐Tov3, Galia Galia Zacay4, Eran Matz5, Iris Dotan6, Dan Turner7
1Pediatric Gastroenterology, Shaare zedek medical center, Jerusalem, Israel, 2Clalit Health Services, Clalit Research Institute, Tel aviv, Israel, 3Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel, 4Research institute, Meuhedet Health Services, Tel aviv, Israel, 5Community Medicine, Leumit Health Services, Tel‐Aviv, Israel, 6Division Of Gastroenterology, Rabin Medical Center, Tel‐Aviv, Israel, 7The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
Objectives and Study: Inflammatory Bowel Disease (IBD) and Behcet's disease (BD) are auto‐inflammatory diseases with common clinical and biological features. We aimed to explore the prevalence of Behcet's disease among IBD patients and non‐IBD patients and to the association between Behcet's and disease course in IBD.
Methods: We utilized data from the epi‐IIRN cohort that includes data from all four health maintenance organizations (HMOs) in Israel, covering 98% of the population. We matched IBD patients to non‐IBD controls and excplored BD cases within each population, matched by propensity score. Poor disease course was defined as IBD‐related surgery, steroid‐dependency or >1 biologic class.
Results:
Of the 37,672 IBD patients (56% Crohn's disease [CD] and 44% UC), 140 (0.4%) had BD vs. 51 (0.1%) of the 83,303 non‐IBD controls (OR = 6.08 [95%CI 4.44‐8.45]). There was no difference in BD prevelence between pediatric‐onset compared to adult‐onset IBD (22/5,823 [0.4%] vs. 118/31,849 [0.3%], (OR = 1.03 [0.63‐1.59])). CD patients had a higher prevalence of BD compared to UC (103/21271 [0.5%] vs. 37/16401 [0.2%]; OR = 2.14 [1.48‐3.16])) in the total population and in pediatrics. Propensity score successfully matched 126 BD‐IBD patients to 251 non‐BD‐IBD controls. In a Cox model, BD‐IBD was associated with shorter time to poor disease course vs. non BD‐IBD (HR = 1.64 95%CI 1.12‐2.4). The probability of poor disease course was higher in BD‐IBD patients vs non‐BD‐IBD controls at 3 (44% vs 21%), 5 (49% vs 27%) and 10 (55% vs 38%) years, p < 0.001; Figure. A sub‐group analysis showed that BD‐CD was associated with poor disease course vs. non‐BD‐CD controls (at 10 years 59% vs 34%, p < 0.001), but not in BD‐UC patients (at 10 years 54% vs 53%, p = 0.94).
Conclusions: BD is more prevalent in IBD than in the general population especially in children with CD. Concurrent diagnosis of Behchet's disease is associated with poor disease course in CD but not in UC.
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G‐OP067. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP067.1. UPADACITINIB FOR INDUCTION OF REMISSION IN PEDIATRIC DIFFICULT – TO‐ TREAT CROHN'S DISEASE – A SINGLE‐CENTER EXPERIENCE
Malgorzata Sladek 1, Aleksandra Medyńska‐Przęczek1, Lukasz Cichy1, Paulina Dumnicka2, Roma Herman1
1Department Of Pediatrics, Gastroenterology And Nutrition, Jagiellonian University Medical College, Faculty of Medicine, Krakow, Poland, 2Chair In Medical Biochemistry, Jagiellonian University Medical College, Faculty of Medicine, Kraków, Poland
Objectives and Study: Upadacitinib (UPA), a selective JAK inhibitor, was recently approved for the treatment of Crohn's disease (CD) but only in adults. Data on its efficacy and safety in children and adolescents are still limited.
Methods: This single‐center, retrospective study enrolled pediatric patients with CD treated with UPA for the induction of remission in active and refractory CD who completed 12 weeks of therapy. Data were collected regarding demographics, Paris classification, indications for UPA use, previously and concomitant medications, number of biological failures, adverse events (AEs), CD activity based on clinical indices (PCDAI, MINI) and endoscopic (SES‐CD) and intestinal ultrasound (PCD‐US) scores as well as inflammatory biomarkers (C‐reactive protein, FC – fecal calprotectin) at UPA introduction and at week 12.
Results: Fourteen children (8 boys), diagnosed with CD at age <17 years, commenced UPA therapy at a mean age of 14.9 years (±2.6). All patients had at least one biologic therapy failure, and 43% had two or more biologic therapies fail. Indications for the introduction of UPA were: refractory CD (78%), side effects after the use of TNF antagonists (21%), and fulminant CD in 1 patient (7%). All but one (93%) achieved clinical remission (PCDAI ≤ 10) at week 12 with significant reductions in endoscopic (14.5 vs 4.5, p = 0.001) and transmural (6.3 vs 4.0, p = 0.001) scores. Combined clinical remission (PCDAI ≤ 10) with CRP ( < 5 mg/l) and FC ( < 150 mcg/g) was achieved in 57% of patients. The most common AEs were acne (n = 6), hyperlipidemia (n = 4), and herpes zoster (n = 1). A patient with acute, severe colitis was successfully treated laparoscopically for intestinal perforation. At week 12, treatment with UPA was maintained in all but one patient.
Conclusions: This study indicates the efficacy of upadacitinib in induction therapy for refractory pediatric Crohn's disease even in difficult‐to‐treat cases. Efficacy should be considered against potential risk for AEs.
Contact e‐mail address: misladek@cyfronet.pl
G‐OP068. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP068.1. THE INCIDENCE AND DISEASE COURSE OF PERIANAL DISEASE IN PAEDIATRIC‐ONSET CROHN'S DISEASE: A DANISH NATIONWIDE COHORT STUDY, 1980‐2022
Annika Ström 1,2, Sabine Jansson1,2, Mads Wewer2,3, Johan Burisch2,3,4, Mikkel Malham1,2,5,6, Vibeke Wewer1,2,4
1Department Of Paediatric And Adolescent Medicine, Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark, 2Copenhagen Center For Inflammatory Bowel Disease In Children, Adolescents, And Adults, Amager And Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark, 3Gastrounit, Medical Division, Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark, 4Department Of Clinical Medicine, Faculty Of Health And Medical Sciences, University of Copenhagen, Copenhagen, Denmark, 5Department Of Paediatric Gastroenterology And Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, 6Copenhagen Health Complexity Center,department Of Public Health, University of Copenhagen, Copenhagen, Denmark
Objectives and Study: Perianal Crohn's disease (CD) is characterised by fistulae and/or abscesses in the anal region and leads to significant morbidity. We aimed to estimate the incidence and describe the disease course of perianal disease in paediatric‐onset CD patients.
Methods: In a nationwide registry‐based study, we identified all incident paediatric‐onset CD patients (<18 years) in Denmark from 1980 to 2018. We followed the patients until emigration, death, or 31‐12‐2022, and recorded the cumulative incidence of perianal disease. Using perianal disease as exposure and biological age as the timescale, we assessed the risks of major abdominal surgeries, colorectal and anal cancer, and mortality with multivariate Cox regression. Hazard ratios were adjusted (aHR) for sex, family income, and calendar year of CD diagnosis.
Results: We identified 2,356 paediatric‐onset CD patients, of whom 769 (32.6%) developed perianal CD. The cumulative incidence of perianal CD was 14.0%, 21.1%, and 28.1% after 1, 5, and 10 years after CD diagnosis, respectively. The incidence density was 29/1,000 person‐years (95% confidence interval [CI]: 26.8–30.9), corresponding to 45.2% after 30 years. Among perianal CD patients, 460 (59.8%) had perianal abscesses, 399 (51.9%) perianal fistulas, and 627 (81.5%) underwent perianal surgery. Of CD patients with perianal disease, 308 (40.1%) required a stoma compared to 147 (9.3%) of patients without, corresponding to aHR 2.8 (95% CI: 2.3‐3.4). The aHRs for major abdominal surgery, cancer, and mortality were 1.5 (95%CI: 1.3–1.8), 0.8 (95% CI: 0.2–2.7), and 1.5 (95%CI: 0.9–2.7), respectively (Figure 1). Of the 68 patients that died, 35 (2.2/1,000 person‐years) had perianal disease, whereas 33 (1.4/1,000 person‐years) had not.
Conclusions: We report a high incidence of perianal disease in patients with paediatric‐onset CD. Patients with perianal CD were more likely to require major abdominal surgery, including stoma surgery, and had a higher risk of mortality compared to patients without perianal CD.
Contact e‐mail address: annikaeva.strom@gmail.com
G‐OP069. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP069.1. EFFICACY, SAFETY, AND PHARMACOKINETICS OF GOLIMUMAB IN PAEDIATRIC PATIENTS WITH MODERATELY‐TO‐SEVERELY ACTIVE ULCERATIVE COLITIS: RESULTS FROM THE PHASE 3 OPEN‐LABEL PURSUIT 2 STUDY
Dan Turner 1, Kathleen Lomax2, Genevieve Veereman3, Anne Griffiths4, Jaroslaw Kierkus5, Ben Kang6, Katherine Berezny2, Lakshmi Padgett2, Gary Mao2, Yevgeny Zitser2, Richard Strauss2, Jeroen Verhoeven2, Omoniyi Adedokun2, Jeffrey Hyams7
1The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel, 2Janssen Research & Development, LLC., Spring House, United States of America, 3Universitair Ziekenhuis, Vrije Universiteit Brussel, Brussels, Belgium, 4The Hospital for Sick Children, Toronto, Canada, 5The Children's Memorial Health Institute‐ Warsaw‐ Poland, Gastroenterology‐ Hepatology‐ Feeding Disorders and Paediatrics, WARSZAWA, Poland, 6Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea, Republic of, 7Connecticut Children's Medical Center, Hartford, United States of America
Objectives and Study: Golimumab (GLM), an anti‐tumour necrosis factor alpha (TNFα) biologic agent, has been approved for adults with moderately‐to‐severely active ulcerative colitis (UC). The Phase 3 open‐label PURSUIT 2 study evaluated the efficacy, safety, and pharmacokinetics (PK) of GLM in paediatric patients with moderately‐to‐severely active UC, as they have limited approved treatment options.
Methods: Patients 2 to <18 years old, biologic‐naïve, with a Mayo score of 6‐12 (endoscopy subscore ≥2), who were receiving conventional therapies, had inadequate response/were intolerant of conventional therapies, or were corticosteroid‐dependent were enroled. Patients received subcutaneous GLM (weight‐based doses; Figure) at Week (Wk)0 and Wk2 during the 6‐wk induction phase and every 4 wks from Wk6 during the 48‐wk maintenance phase. The primary endpoint was clinical remission (a Mayo score ≤2 points with no individual subscore >1) at Wk6. Secondary endpoints included clinical remission (by Pediatric Ulcerative Colitis Activity Index), clinical response, symptomatic remission, endoscopic improvement (definitions in Figure), and maintenance of efficacy at Wk54 among Wk6 clinical remitters. Safety and PK were also assessed.
Results: Of the 69 patients (mean age, 13.4 ± 3.3 years; female, 53.6%; median Mayo score, 7.0), 31.9% were in clinical remission at Wk6 (Figure; adult study remission rate, 17.8%), and of those, 12 patients (54.5%) remained in clinical remission at Wk54. Additional efficacy outcomes are shown in the Figure. Wk6 serum GLM concentrations were comparable to those observed in a reference adult UC population. At Wk54, adverse events (AEs) were reported for 93.5% of patients, serious AEs for 33.9%, and serious infections for 14.5%. No new safety concerns were identified.
Conclusions: Among these biologic‐naïve paediatric patients with moderately‐to‐severely active UC receiving GLM, nearly one‐third achieved clinical remission after 6wks induction and over half of those patients maintained clinical remission. The safety and PK profiles were consistent with the known GLM profiles in adults with UC.
Contact e‐mail address: kberezny@its.jnj.com
G‐OP070. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP070.1. LONG TERM MAINTENANCE TREATMENT WITH VEDOLIZUMAB IN PEDIATRIC IBD: A THREE‐YEAR FOLLOW‐UP OF THE PROSPECTIVE MULTICENTER VEDOKIDS STUDY
Ohad Atia1, Zivia Shavit‐Brunschwig1, Esther Orlanski‐Meyer1, Ronen Stein2, Efrat Broide3, Jeffrey Hyams4, Maya Granot5, Joel Rosh6, Séamus Hussey7, James Markowitz8, Richard Russell9, Dan Turner 1
1The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel, 2Children's Hospital of Philadelphia, Philadelphia, PA, USA, Philadelphia, United States of America, 3Pediatric Gastroenterology, Hepatology And Nutrition, Shamir Medical Center, Zeriffin, Israel, 4Connecticut Children's Medical Center, Hartford, United States of America, 5Pediatric Gastroenterology Unit, Edmond & Lily Safra Children's Hospital, Sheba Medical Center, Ramat‐Gan, Faculty of Medicine, Tel‐Aviv University, Tel Aviv, Israel, 6Pediatric Gastroenterology, Hepatology & Nutrition, Atlantic Health System/Atlantic Children's Health, Atlantic, United States of America, 7National Children's Research Center, Dublin, Ireland, Dublin, Ireland, 8The Feinstein Institute for Medical Research, Northwell, USA, Northwell, United States of America, 9Human Nutrition, School of Medicine, Dentistry & Nursing, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, G31 2ER, Glasgow, UK, Glasgow, Ireland
Objectives and Study: Long‐term data on the use of vedolizumab in children with Crohn's disease (CD) and ulcerative colitis (UC) are lacking. In this prospective multicenter cohort study we aimed to assess the effectiveness and safety of vedolizumab as maintenance therapy in pediatric CD/UC.
Methods: Children commenced on vedolizumab at any disease duration were enrolled in 17 pediatric centers and followed prospectively through 3 years. The primary outcome was complete remission at 3 years (i.e. steroid‐free clinical remission and normal ESR/CRP with sustained vedolizumab treatment and without surgery). Secondary outcome was loss of response in those achieving clinical remission at week 6.
Results: Altogether, 137 children were enrolled, of whom 53 (39%) continued vedolizumab through three years. Sustainability was higher in UC (35/73 [48%]) than CD (18/64 [28%]; OR 2.4 [95%CI 1.2‐4.8]). Complete remission at three years was achieved in 19/73 (26%) children with UC vs. 9/64 (14%) with CD (OR 2.2 [95%CI 0.9‐5.2]). The best predictor of remission at 3 years was clinical remission at week‐6 measured in CD by wPCDAI≤12.5 (AUROC = 0.78 [95%CI 0.64‐0.963]), and in UC by PUCAI < 10 (0.74 [0.63‐0.85]). In multivariable logistic regression, complete remission at 3 years was more likely in week‐6 remitters or responders compared to non‐responders (HR = 2.6 [95%CI 1.1‐7.2]). Of the 51 (37%) children who achieved remission at week 6, the likelihood of achieving complete remission at 3 years was 41% for UC and 26% for CD (OR 1.9 [95%CI 0.6‐6.6]; Figure). Forty adverse events were recorded in 23 children (17%) as possibly related to vedolizumab, none were serious.
Conclusions: Vedolizumab was safe and effective for maintaining long‐term remission in more so in UC than CD. Achieving clinical remission by week 6 after initiation of the drug was the best predictor of long‐term effectiveness in both UC and CD.
Contact e‐mail address: ohadatia89@gmail.com
G‐OP071. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP071.1. ONE‐YEAR OUTCOMES WITH USTEKINUMAB THERAPY IN BIONAIVE PAEDIATRIC CROHN'S DISEASE: A PROSPECTIVE MULTI‐CENTRE COHORT STUDY FROM THE CANADIAN CHILDREN IBD NETWORK (CIDSCANN)
Thomas Walters 1, Hien Huynh2, Jennifer De Bruyn3, Hayley Mckay1, Ayub Shaikh1, Colette Deslandres4, Eytan Wine2, Wael El‐Matary5, Eileen Crowley6, Sally Lawrence7, Rilla Schneider8, Anthony Otley9, Mary Sherlock10, Nicholas Carman1, Matthew Carroll2, Eric Benchimol1, Kevan Jacobson7, Jeff Critch11, Amanda Ricciuto1, Anne Griffiths1
1Paediatrics, Division Of Gastroenterology, Hepatology And Nutrition, The Hospital for Sick Children, Toronto, Canada, 2Division Of Pediatric Gastroenterology & Nutrition, University of Alberta, Edmonton, Canada, 3Alberta Children's Hospital, Calgary, Canada, 4CHU Sainte‐Justine, University of Montreal, Montreal, Canada, 5University of Manitoba, Winnipeg, Canada, 6Division Of Pediatric Gastroenterology, Schulich School of Medicine and Dentistry, Western University, Children's Hospital of Western Ontario, London, Canada, 7Division Of Gastroenterology, Hepatology And Nutrition, British Columbia Children's Hospital, Vancouver, Canada, 8McGill University, Montreal, Canada, 9IWK Health Centre, Halifax, Canada, 10McMaster Children's Hospital ‐ Hamilton Health Sciences, Hamilton, Canada, 11Eastern Health Newfoundland, St John's, Canada
Objectives and Study: Paediatric Ustekinumab (USTE) data have been retrospective and accrued in the setting of prior anti‐TNF failure. We prospectively examined USTE effectiveness in bionaive paediatric CD.
Methods: Beginning 10/2021 children aged<17years undergoing investigation for suspected CD were prospectively followed. This analysis includes confirmed CD patients given USTE as first biologic before 05/2024. IV induction and subcut maintenance guidelines followed ongoing phase 3 paediatric USTE trial with option to intensify to q4wk and/or repeat IV dose. Serum USTE levels were measured. Primary outcome was steroid‐free clinical‐biochemical remission (SFCBR: wPCDAI <12.5 and CRP < 5) at one year. Secondary outcomes included USTE durability and mucosal improvement (no ulcers at colonoscopy or fecal calprotectin <250ug/g if colonoscopy not repeated).
Results: 61 children (61% male; median age 13.0 yrs, IQR 10.9‐15.5) with CD (19%L1, 22%L2, 59%L3) received IV‐USTE as first biologic therapy. Median (IQR) wPCDAI and SES‐CD at diagnosis: 45 (29‐66) and 14.5 (9.3‐20.8). Median duration of diagnosed CD pre USTE 33 days (IQR 3‐92). Therapy pre‐USTE: EEN 13%, CS 41%, methotrexate 18%. Mean (range) IV loading dose 6.7 mg/kg (5‐11) or 213 mg/m2 (159‐280). Median wk8 [Uste] was 6.7ug/mL (IQR: 3.1‐10.5), 2 subjects had undetectable levels. During 12mths follow‐up, 25 escalated to q4w; 10 had IV re‐load. At one year, 39 (64%) achieved the primary outcome of SFCBR with continued USTE; 37 (61%) demonstrated mucosal improvement. Durability of USTE (Figure) was 92%, 80% and 75% at 4mths, 8mths and 12mths. 15 patients stopped USTE: 4 primary non‐response; 9 unsatisfactory response (1 with high‐titre‐ADA); 2 adverse reactions. After stopping USTE 2 underwent surgery, 13 switched out of class to anti‐TNF.
Conclusions: In this prospective cohort of children with bionaive short duration CD treated with USTE, attainment of treatment targets was at least comparable to that observed in bionaive adults. USTE could be considered as alternate first biologic in paediatric CD.
Contact e‐mail address: thomas.walters@sickkids.ca
G‐OP072. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP072.1. UPADACITINIB FOR INDUCTION OF REMISSION IN PEDIATRIC ULCERATIVE COLITIS: AN INTERNATIONAL MULTI‐CENTER STUDY
Anat Yerushalmy‐Feler 1, Elizabeth A Spencer2, Michael T Dolinger2, David L Suskind3, Katarina Mitrova4, Ondrej Hradsky4, Máire A Conrad5, Judith R Kelsen5, Holm Uhlig6, Christos Tzivinikos7, Silvana Ancona8, Magdalena Wlazlo9, Lukas Hackl10, Dror Shouval11, Matteo Bramuzzo12, Darja Urlep13, Christine Olbjørn14, Giulia D'Arcangelo15, Gemma Pujol‐Muncunill16, Dotan Yogev17, Ben Kang18, Marco Gasparetto19, Christine Rungø20, Kaija‐Leena Kolho21, Iva Hojsak22, Lorenzo Norsa23, Firas Rinawi24, Naire Sansotta25, Ramit Magen Rimon26, Maya Granot27, Luca Scarallo28, Eunice Trindade29, Marta Velasco Rodríguez‐Belvis30, Dan Turner31, Shlomi Cohen1
1Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Faculty of Medical and Health Sciences, Tel aviv, Israel, 2Division of Pediatric Gastroenterology, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, United States of America, 3University of Washington Medical School, Seattle, WA 98109, USA; Seattle Children's Hospital IBD Center, Seattle, WA, United States of America, 4Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic, 5Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, United States of America, 6Translational Gastroenterology Unit, University of Oxford, Oxford, United Kingdom; Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; Department of Paediatrics, University of Oxford, Oxford, United Kingdom, Centre of Human Genetics, Oxford, United Kingdom, 7Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates, 8Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, 9Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 10Department of Pediatrics I, Medical University Innsbruck, Innsbruck, Austria, 11Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, and Faculty of Medicine, Tel‐Aviv University, Tel Aviv, Israel, 12Institute for Maternal and Child Health‐IRCCS "Burlo Garofolo", Trieste, Italy, 13Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia, 14Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway, 15Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza‐University of Rome, Rome, Italy, 16Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain, 17The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel, 18Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea, Republic of, 19Norfolk and Norwich University Hospital, Jenny Lind Children's Hospital, and University of East Anglia, Norwich Medical School, Norwich, United Kingdom, 20Department of Paediatric and Adolescence Medicine, Copenhagen University Hospital ‐ Amager and Hvidovre, Hvidovre, Denmark, 21Department of Paediatric Gastroenterology, Children's Hospital, HUS and University of Helsinki, Helsinki, Finland, 22Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia, 23Pediatric Department, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy, 24Pediatric Gastroenterology Unit and Faculty of Medicine Technion, Haifa, Emek Medical Centre, Afula, Israel, 25Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 26Pediatric Gastroenterology & Nutrition Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus and the Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel, 27Pediatric Gastroenterology Unit, Edmond & Lily Safra Children's Hospital, Sheba Medical Center, Ramat‐Gan, Faculty of Medicine, Tel‐Aviv University, Tel Aviv, Israel, 28Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Florence, Italy, 29Pediatric Gastroenterology and Nutrition Unit, Centro Hospitalar Universitário São João, Porto, Portugal, 30Department of Pediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain, 31The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
Objectives and Study: Data on upadacitinib therapy in children with ulcerative colitis (UC) or unclassified inflammatory bowel disease (IBD‐U) are scarce. We aimed to evaluate the effectiveness and safety of upadacitinib as an induction therapy in pediatric UC or IBD‐U.
Methods: In this multicenter retrospective study, children treated with upadacitinib for induction of remission of active UC or IBD‐U from 30 centers worldwide were enrolled. Demographic, clinical and laboratory data as well as adverse events (AEs) were recorded at week 8 post induction.
Results: One hundred children were included (90 UC and 10 IBD‐U, median age 15.6 [interquartile range 13.3–17.1] years). Ninety‐eight were previously treated with biologic therapies, and 76 were treated with ≥2 biologics. At the end of the 8‐week induction period, clinical response, clinical remission, and corticosteroid‐free clinical remission (CFR) were observed in 84%, 62%, and 56% of the children, respectively. The corresponding rates of 22 children with acute severe colitis were 82%, 59% and 55%, respectively. Normal C‐reactive protein and fecal calprotectin (FC) < 150 mcg/g were achieved in 75% and 50%, respectively. Combined CFR and FC remission was observed in 18/46 (39%) children with available data at 8 weeks. AEs were recorded in 37 children, including one serious AE of an appendiceal neuroendocrine tumor. The most frequent AEs were hyperlipidemia (n = 13), acne (n = 12), and infections (n = 10, five of whom with herpes viruses).
| Daily dose | All cohort (n = 100) | Weight < 40 kg (n = 15) | Weight < 30 kg (n = 7) |
|---|---|---|---|
| 45 mg | 87 (87%) | 7 (47%) | 2 (29%) |
| 30 mg | 10 (10%) | 7 (47%) | 4 (57%) |
| 15 mg | 3 (3%) | 1 (7%) | 1 (14%) |
| Dose in mg/BSA | 35.5 (27.4‐40.5) | 33 (29.1‐39.8) | |
| Dose in mg/kg | 1.26 (0.97‐1.40) | 1.26 (1.09‐1.48) |
Conclusions: Upadacitinib is an effective induction therapy for refractory pediatric UC and IBD‐U. Efficacy should be weighed against the potential risks of AEs.
Contact e‐mail address: Yes
G‐OP073. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP073.1. UPADACITINIB FOR INDUCTION OF REMISSION IN PEDIATRIC CROHN'S DISEASE: AN INTERNATIONAL MULTICENTER STUDY
Shlomi Cohen1, Elizabeth A Spencer2, Michael T Dolinger2, David L Suskind3, Katarina Mitrova4, Ondrej Hradsky4, Máire A Conrad5, Judith R Kelsen5, Holm Uhlig6, Christos Tzivinikos7, Paul Henderson8, Magdalena Wlazlo9, Lukas Hackl10, Dror Shouval11, Matteo Bramuzzo12, Darja Urlep13, Christine Olbjørn14, Giulia D'Arcangelo15, Gemma Pujol‐Muncunill16, Dotan Yogev17, Ben Kang18, Marco Gasparetto19, Christine Rungø20, Kaija‐Leena Kolho21, Iva Hojsak22, Lorenzo Norsa23, Firas Rinawi24, Naire Sansotta25, Ramit Magen Rimon26, Maya Granot27, Luca Scarallo28, Eunice Trindade29, Marta Velasco Rodríguez‐Belvis30, Dan Turner31, Anat Yerushalmy‐Feler 1
1Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Faculty of Medical and Health Sciences, Tel aviv, Israel, 2Division of Pediatric Gastroenterology, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, United States of America, 3University of Washington Medical School, Seattle, WA 98109, USA; Seattle Children's Hospital IBD Center, Seattle, WA, United States of America, 4Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic, 5Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, United States of America, 6Translational Gastroenterology Unit, University of Oxford, Oxford, United Kingdom; Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; Department of Paediatrics, University of Oxford, Oxford, United Kingdom, Centre of Human Genetics, Oxford, United Kingdom, 7Aljalial children's specialty hospital, DUbai, United Arab Emirates, 8Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, 9Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 10Department of Pediatrics I, Medical University Innsbruck, Innsbruck, Austria, 11Institute Of Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center of Israel, Petha‐Tikva, Israel, 12Institute for Maternal and Child Health‐IRCCS "Burlo Garofolo", Trieste, Italy, 13Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia, 14Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway, 15Department Of Maternal And Child Health, Sapienza University, Paediatric Gastroenterology Unit, Rome, Italy, 16Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain, 17The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel, 18Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea, Republic of, 19Norfolk and Norwich University Hospital, Jenny Lind Children's Hospital, and University of East Anglia, Norwich Medical School, Norwich, United Kingdom, 20Department of Paediatric and Adolescence Medicine, Copenhagen University Hospital ‐ Amager and Hvidovre, Hvidovre, Denmark, 21Department of Paediatric Gastroenterology, Children's Hospital, HUS and University of Helsinki, Helsinki, Finland, 22Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia, 23Pediatric Department, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy, 24Pediatric Gastroenterology Unit and Faculty of Medicine Technion, Haifa, Emek Medical Centre, Afula, Israel, 25Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 26Pediatric Gastroenterology & Nutrition Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus and the Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel, 27Pediatric Gastroenterology Unit, Edmond & Lily Safra Children's Hospital, Sheba Medical Center, Ramat‐Gan, Faculty of Medicine, Tel‐Aviv University, Tel Aviv, Israel, 28Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Florence, Italy, 29Pediatric Gastroenterology and Nutrition Unit, Centro Hospitalar Universitário São João, Porto, Portugal, 30Department of Pediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain, 31The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
Objectives and Study: Data on upadacitinib therapy in children with Crohn's disease (CD) are scarce. We aimed to evaluate the effectiveness and safety of upadacitinib as an induction therapy in pediatric CD.
Methods: A multicenter retrospective study of children treated with upadacitinib for the induction of remission of active CD from 30 centers worldwide affiliated with the IBD Interest and Porto group of the ESPGHAN between 2022 and 2024. Demographic, clinical, laboratory, and imaging data as well as adverse events (AEs) were recorded at week 8 post induction. The analysis of the primary outcome was based upon the intention‐to‐treat (ITT) principle.
Results: One‐hundred children (median age 15.8 [interquartile range 14.3–17.2] years) were included. All children were previously treated with biologic therapies and 89 with ≥2 biologics. The dosing regimen of upadacitinib is presented in Table 1. At the end of the 8‐week induction period, clinical response, clinical remission and corticosteroid‐ and exclusive enteral nutrition‐free clinical remission (CFR) were observed in 75%, 56% and 52% of the children, respectively. Normal C‐reactive protein was achieved in 68% of the children and fecal calprotectin (FC) < 150 mcg/g in 58%. Combined CFR and FC remission was observed in 13/31 (42%) children with available data at 8 weeks [13% of the ITT population]. AEs were recorded in 24 children, the most frequent was acne (n = 12). Two AEs (severe acne and hypertriglyceridemia) led to discontinuation of therapy.
| Daily dose | All cohort (n = 100) | Weight 30‐40 kg (n = 13) | Weight 20‐30 kg (n = 5) |
|---|---|---|---|
| 45 mg | 86 (86%) | 9 (69%) | 2 (40%) |
| 30 mg | 12 (12%) | 4 (31%) | 3 (60%) |
| 15 mg | 2 (2%) | 0 | 0 |
| Dose in mg/m2 BSA | 35.8 (27.1‐36.9) | 33.2 (31.5‐42.4) | |
| Dose in mg/kg | 1.2 (0.9‐1.3) | 1.3 (1.3‐1.6) |
Conclusions: Upadacitinib is an effective induction therapy for refractory pediatric CD. Efficacy should be weighed against the potential risks of AEs.
Contact e‐mail address: Yes
G‐OP074. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐OP074.1. A PHARMACOGENETIC SCORE EXTRACTED FROM EXOMES FOR PREDICTING LONG‐TERM RESPONSE TO INFLIXIMAB IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE
Paula Zapata Cobo 1, Perceval Velosillo2, Sara Salvador Martín1, Marta Velasco Rodríguez‐Belvis3, Laura Palomino Pérez3, Ana Moreno Álvarez4, Montserrat Montraveta5, Begoña Pérez6, María José Fobelo7, Ruth García Romero8, Diana García‐Tirado9, César Sánchez Sánchez10, Gemma Pujol‐Muncunill11, Víctor Manuel Navas‐López12, Oscar Segarra Canton13, María Sanjurjo Sáez1, Luis Andrés López Fernández1
1Pharmacy, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain, 2Unidad de Investigación Materno‐infantil Fundación Familia Alonso (UDIMIFFA), Hospital General Universitario Gregorio Marañón, Madrid, Spain, 3Department of Pediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain, 4Pediatric Gastroenterology, Hospital Materno‐Infantil Teresa Herrera de A Coruña, A Coruña, Spain, 5Pediatric Gastroenterology Unit, Hospital Germans Trias i Pujol, Badalona, Spain, 6Pediatric Gastroenterology, Hospital Universitario Infanta Leonor, Madrid, Spain, 7Pediatric Gastroenterology, Hospital Universitario de Valme, Sevilla, Spain, 8Pediatric Gastroenterology, Hospital Infantil Miguel Servet, Zaragoza, Spain, 9Pediatrics, Consorci Sanitari Parc Tauli, Sabadell, Spain, 10Pediatric Department. Pediatric Gastroenterology Unit, H.G.U. Gregorio Marañón. H. Materno Infantil, Madrid, Spain, 11Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain, 12Pediatric Gastroenterology And Nutrition, Hospital Regional Universitario de Málaga, Málaga, Spain, 13Pediatric Gastroenterology And Clinical Nutrition Unit., Vall d'Hebron Hospital, Barcelona., Barcelona, Spain
Objectives and Study: Some paediatric patients diagnosed with inflammatory bowel disease (IBD) do not respond properly to anti‐TNFs. Although some genetic variants associated with response have been identified, they do not fully explain the observed variability and most of them have been identified in adult studies. Therefore, there are no predictive markers suitable for clinical practice in children with IBD treated with infliximab. The aim of this study is to identify single nucleotide variants (SNVs) associated with long‐term response to infliximab in paediatric IBD by exome sequencing, and to generate a pharmacogenetic score predictive of response with the selected variants.
Methods: A total of 132 exomes were selected from children with IBD on infliximab treatment. The exomes were performed at the National Centre for Genomic Analysis. Bioinformatic datasets were analysed with a Lasso/Ridge regression model and a COX model. Subsequently, survival analyses were performed using Kaplan Meier curves.
Results: The Lasso/Ridge regression model identified the 246 variants that contribute most to the variance in response over time to infliximab. Following this, application of the COX model selected 107 variants with significant association to infliximab response. Among these, the most significantly associated variants (p‐value < 2 × 10⁻¹⁶) allowed the generation of a predictive score for infliximab response. An inverse correlation was observed between the number of variants carried and treatment response. Additionally, a subgroup of paediatric patients who did not fail infliximab treatment was identified, comprising Crohn's disease patients with a score ≤4.
Conclusions: Exome sequencing identified 107 SNVs as potential predictive biomarkers of response to infliximab in pIBD. In addition, we generated a score with the most significant SNVs that can identify children at high risk of failure to infliximab and a subgroup of elite responder children to infliximab therapy.
Contact e‐mail address: paula.zapata@iisgm.com
G‐OP075. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐OP075.1. THE RELATIONSHIP BETWEEN FUNCTIONAL LUMINAL IMAGING PROBES AND ESOPHAGEAL MANOMETRY MEASUREMENTS IN CHILDREN ‐ CAN FLIP REPLACE THE ESOPHAGEAL MANOMETRY?
Tal David Berger, Samuel Nurko, Christopher Chalmers, Evrim Ozcan, Elise Delaney, Grace Nemec, Rachel Rosen
Boston Children's Hospital, Boston, United States of America
Objectives and Study: As part of the diagnostic work up for children with dysphagia, esophageal high‐resolution impedance manometry (HRIM) and functional luminal imaging probes (FLIP) panometry are jointly performed to assess for disorders of peristalsis. Additional pediatric studies to determine the degree of concordance between FLIP and HRIM are needed.
Methods: We retrospectively reviewed the HRIM records and FLIP 2.0 tracings for 74 patients. In each FLIP tracing we obtained esophagogastric junction (EGJ) distensibility (DI), presence of repetitive antegrade contractions (RACs) and their characteristics. Each esophageal manometry was measured for integrated relaxation pressure (IRP) and distal contractile integral (DCI). The patients were classified according to the Chicago classification v4.0 and the HRIM measurements into 5 groups which were then compared to the FLIP tracings (Table 1).
Results: The mean age of patients was 12.9 ± 6.4 years. The HRIM was normal in 31% patients, 20.2% had achalasia, 14.9% had ineffective peristalsis, 18.9% had absent peristalsis and 14.9% had EGJOO) Table1). There was a significant difference in the mean DCI in patients with abnormal or absent RACs (557 + 110 mmHg‐s‐cm) and patients with normal RACs (1089 + 168 mmHg‐s‐cm; p < 0.012). There was a strong correlation between IRP and DI (r = 0.449; p < 0.001). We then determined the relationship between primary peristalsis by HRIM and secondary peristalsis by FLIP (achalasia patients excluded); in the 23 patients with normal peristalsis by HIRM, 65% had normal RACs and, in the 25 patients with abnormal peristalsis,13(52%) had an abnormal FLIP. Of the 47 patients with a normal IRP, 3 had an abnormal DI and, of the 11 patients with EJGOO, 28% had an abnormal DI.
Conclusions: FLIP diagnoses differed from the Chicago classification diagnoses in a significant proportion of children. These tools are complementary and should not be used in isolation except for patients with untreated achalasia.
Contact e‐mail address: Talberger10@gmail.com
G‐OP076. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐OP076.1. ATTITUDES TOWARDS THE USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE IN CHILDREN WITH GASTROINTESTINAL SYMPTOMS, A MULTICENTER SURVEY STUDY AMONG PARENTS AND PEDIATRICIANS
Michelle Bloem 1, Desiree Baaleman1, Ilan Koppen1, Merijn Bijlsma2, Arine Vlieger3, Joery Goede4, Franz Plötz5, Sarah Teklenburgroord6, Fleur De Lorijn1, Marc Benninga1
1Pediatric Gastroenterology And Nutrition, Amsterdam University Medical Center, Emma Children's Hospital, Amsterdam, Netherlands, 2Department of Pediatrics, Amsterdam University Medical Centre location AMC, Amsterdam, The Netherlands, Amsterdam, Netherlands, 3Department of Pediatrics, St Antonius Hospital, Nieuwegein, the Netherlands, Nieuwegein, Netherlands, 4Spaarne Gasthuis, Haarlem, Netherlands, 5Department of Pediatrics, Tergooi MC, Blaricum, The Netherlands, Tergooi, Netherlands, 6Department of Pediatrics, Isala Clinics, Zwolle, The Netherlands, Zwolle, Netherlands
Objectives and Study: Disorders of gut brain interaction (DGBI) are common in children and often persist despite conventional treatments. Many patients and parents turn to complementary and alternative medicine (CAM), especially for chronic conditions with limited treatment options. However, research on CAM for pediatric DGBI is scarce. This study assessed parents' and pediatricians' experiences with CAM for children with gastrointestinal symptoms, factors predicting CAM use, and willingness to join future CAM studies on efficacy and safety.
Methods: Parents and pediatricians of children (0–18 years) with DGBI (infant colic, functional constipation, functional abdominal pain [FAP]) and gastroesophageal reflux disease (GERD) from six Dutch hospitals were invited to participate. DGBI diagnoses were based on Rome IV criteria. GERD diagnosis was based on the NASPGHAN/ESPGHAN guidelines. Parental surveys included questions on their child's health, medication, CAM use, reasons for CAM, and views on CAM research. Pediatricians’ surveys included questions on their experiences and attitudes toward CAM for pediatric DGBI.
Results: A total of 668 parents (70.1%) and 73 pediatricians (76%) responded. Preliminary analysis showed that 32.5% of patients used CAM, mainly manual therapies (e.g., osteopathy; 27.2%), homeopathy (12.2%), and natural remedies (9.8%). Sixty‐two percent indicated willingness in participating in future research with CAM for their symptoms. Among pediatricians, 62.4% of pediatricians had recommended some form of CAM for any DGBI and GERD.
Conclusions: Over 30% of children with DGBI or GERD visiting pediatric clinics used CAM, highlighting the need for pediatricians to be well‐informed about its benefits, risks, and potential interactions with conventional treatment. This percentage is in line with the increased interest in CAM in pediatric care over recent years. Despite earlier calls for more research, additional studies on effectiveness and safety of specific CAM treatments for pediatric DGBI are needed. Nearly two‐thirds of parents indicated willingness to participate in CAM research for their child's symptoms.
Contact e‐mail address: m.n.bloem@amsterdamumc.nl
G‐OP077. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐OP077.1. COMPARISON OF EFFICACY OF PEPPERMINT OIL AND DROTAVERINE FOR THE TREATMENT OF FUNCTIONAL ABDOMINAL PAIN IN 4‐18 YEARS CHILDREN: SINGLE BLIND, RANDOMIZED CONTROLLED TRIAL
Rajkali Rajendiran1, Rishi Bolia 1, Prateek Panda2, Nowneet Bhat1, Indar Sharawat2
1Department Of Pediatric Gastroenterology, All India institute of medical sciences, Rishikesh, rishikesh, India, 2Department Of Pediatric Neurology, All India institute of medical sciences, Rishikesh, rishikesh, India
Objectives and Study: To compare efficacy of oral Drotaverine and Peppermint oil in children aged 4‐18 years with FAP‐NOS using the Revised Abdominal Pain Index (rAPI) score.
Methods: Children diagnosed with FAP‐NOS as per ROME‐IV criteria were enrolled in the Drotaverine or Peppermint oil arm following variable block randomization, which was done using computer generated random numbers. Drotaverine 20 mg TID for children 4‐6 years and 40 mg TID for those 6‐18 years was prescribed in Drotaverine arm. Peppermint oil 0.2 ml/capsule, one capsule TID was prescribed for those <45 kgs and two capsules TID for those >45 kg. Revised API score was assessed at baseline and at end of four weeks. An Investigator, unaware of the allocation arm, performed assessments for final outcomes.
Results: Fifty children (twenty five in each arm) were enrolled of which two were lost to follow‐up in each arm. The baseline clinical, demographic, and laboratory characteristics were comparable between both groups. The baseline rAPI score (2.17 ± 0.49vs2.42 ± 0.49, p = 0.16) was comparable between the two arms. There was significant improvement in rAPI score at the end of four weeks within both the Drotaverine arm (2.17 ± 0.49 vs. 0.96 ± 0.57, p < 0.0001) and Peppermint oil arm (2.42 ± 0.49 vs. 1.27 ± 0.46. p < 0.0001), however there was no difference in the degree of change in rAPI score from baseline and at the end of four weeks between the two arms (‐1.21 ± 0.47 vs ‐1.15 ± 0.52, p = 0.67).
Conclusions: Drotaverine and Peppermint oil are effective in children with FAP‐NOS, however neither appears to be superior to the other.
Contact e‐mail address: r.rajkali@yahoo.co.in
G‐OP078. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐OP078.1. THE ROLE AND MECHANISM OF VASOACTIVE INTESTINAL PEPTIDE IN VISCERAL HYPERSENSITIVITY IN A MATERNAL SEPARATION MICE MODEL WITH IRRITABLE BOWEL SYNDROME
Yuhao Wu, Ziyu Liu, Fei Gao, Rui Guo, Mizu Jiang
Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
Objectives and Study: Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder causing abdominal pain and bowel habit changes. Early life stress, like childhood trauma, disrupts brain‐gut axis development, increasing IBS risk. Maternal separation models link IBS to visceral hypersensitivity via immune activation. Vasoactive Intestinal Peptide (VIP), a neuropeptide regulating intestinal blood flow, may influence visceral hypersensitivity in IBS, though its mechanisms remain unclear. This research explores VIP's role and its regulation of intestinal blood flow in IBS.
Methods: C57/BL6 mice with IBS maternal separation were treated with VPAC antagonists to assess IBS phenotypes, VIP levels, and visceral sensitivity. Methods included ELISA, immunofluorescence, Western blot, electron microscopy, H&E staining, laser speckle imaging, and 16S rRNA sequencing to analyze mast cells, inflammation, blood flow, and microbiota.
Results: Maternal separation (MS) in mice caused lower body weight (P < 0.05), increased defecation count (P < 0.01), fecal water content (P < 0.05), and visceral hypersensitivity. VPAC antagonists reversed fecal water increases and pain threshold reductions (P > 0.05). MS raised VIP levels in plasma, small intestine, and colon, which VPAC antagonists reduced. VPAC1 expression increased in the colon of the MS group (P < 0.05), while VPAC2 showed no change. Mast cell degranulation and histamine levels increased in MS but were normalized by VPAC antagonists. MS also elevated VEGF expression and intestinal blood flow, correlating with pain sensitivity, both mitigated by VPAC antagonists. Intestinal microbiota diversity was disrupted by MS but partially restored following antagonist administration. These findings suggest VPAC antagonists alleviate MS‐induced IBS‐like symptoms, including visceral hypersensitivity, VIP expression, mast cell activation, and intestinal microcirculation changes.
Conclusions: Maternal separation induces IBS and visceral hypersensitivity in mice, increasing VIP levels and VPAC1 expression in the colon, along with mast cell activation. VPAC antagonists modulate visceral hypersensitivity by affecting intestinal microcirculation and VEGF expression.
Contact e‐mail address: mizu@zju.edu.cn
G‐OP079. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐OP079.1. EVALUATION OF BEHAVIORAL PATTERNS OF POST‐REFLUX SWALLOW‐INDUCED PERISTALTIC WAVES INDEX MEASURED BY PH/IMPEDANCE IN CHILDREN WITH SUSPECTED GASTROESOPHAGEAL REFLUX
Maria Manin, Jhoanna Adauto, Florencia Ursino, Marina Orsi, Veronica Busoni, Emilia Cohen
Gastroenterologia Infantil, Hospital italiano de buenos aires, BUENOS AIRES, Argentina
Objectives and Study: The post‐Reflux Swallow‐Induced Peristaltic Wave (PSPW) is a parameter which shows chemical clearance; it has been reported that approximately 50% of reflux episodes in healthy adults. There are no established normal PSPW values in pediatric population. The aim is to evaluate PSPW behavior in children.
Methods: A retrospective study was conducted between 2019 and 2024. All pH/MII tracings performed in children referred for suspected gastroesophageal reflux were analyzed. They were divided into three groups according to different ages: GI (0‐2 ys), GII (3‐9 ys) and GIII (10‐18 ys). Only studies with normal reflux index ≤ 3, without symptomatic correlation and with normal number of reflux episodes were included (Mousa et al). Exclusion criteria were patients on PPI or had underlying conditions. The PSPW index was calculated manually for all records.
Results: A total of 211 tracings were analyzed (53% female, n = 111): GI 28.7% (n = 60), GII 37.5% (n = 79), GIII 33.8% (n = 72). Median reflux events were higher in GI: 38 (IQR 26.7–52.2) vs. GII: 26 (IQR 20–36) and GIII: 32 (IQR 22–45) (p = 0.004). Non‐acid reflux predominated in GI: 17 vs. GII: 8 and GIII: 15 (p < 0.001). Proximal extent was greater in GI: 18.5 (IQR 9.7–28.2) vs. GII‐GIII: 11 (IQR 7–19) (p = 0.005). PSPW index was lower in GI: 42.14 (IQR 26.9–53.1) vs. GII: 52.6 (IQR 40–67.6) and GIII: 50 (IQR 35.1–67.8) (p = 0.009).
Conclusions: In this pediatric cohort, it was observed that children under 2 years of age exhibited a higher frequency of reflux events, with these events reaching a greater proximal extent. Additionally, these younger children displayed a lower PSPW index compared to older children (>2 years) who presented with similar characteristics to adult patient. It's important to consider these age‐related differences when evaluating and managing gastresophageal reflux in pediatric patients.
Contact e‐mail address: paula.manin@hospitalitaliano.org.ar
G‐OP080. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐OP080.1. HYPNOTHERAPY SELF‐EXERCISES WITH AUDIO FILES FOR CHILDREN AND ADOLESCENTS WITH DISORDERS OF GUT‐BRAIN INTERACTION – A FEASIBILITY STUDY IN SWEDEN
Tea Soini 1,2, Frida Andersson1,3, Maria Lalouni4, Marianne Bonnért5, Siri Voghera1, Brjánn Ljótsson6, Marc Benninga7, Arine Vlieger8, Helena Rolandsdotter2,3, Agneta Uusijärvi9, Ola Olén1,2,3
1Department Of Medicine, Division Of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden, 2Department Of Clinical Science And Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden, 3Department Of Pediatric Gastroenterology And Nutrition, Sachs' Children's Hospital, Stockholm, Sweden, 4Department Of Clinical Neuroscience, Division Of Neuro, Karolinska Institutet, Stockholm, Sweden, 5Department Of Clinical Neuroscience, Centre For Psychiatry Research, Karolinska Institutet, Stockholm, Sweden, 6Department Of Clinical Neuroscience, Division Of Psychology, Karolinska Institutet, Stockholm, Sweden, 7Department Of Pediatric Gastroenterology And Nutrition, Amsterdam University Medical Center, Emma Children's Hospital, Amsterdam, Netherlands, 8Department of Pediatrics, St Antonius Hospital, Nieuwegein, Netherlands, 9Astrid Lindgren Children's Hospital, Karolinska University Hospital, Huddinge, Sweden
Objectives and Study: This uncontrolled within‐group feasibility study was performed to assess the effect sizes and feasibility of gut‐directed hypnotherapy delivered via audio files as preparation for a large‐scale randomized controlled trial.
Methods: Thirty‐two children and adolescents (aged 8‐17 years) diagnosed with irritable bowel syndrome, functional abdominal pain, or functional dyspepsia (Rome IV criteria). Participants engaged in a 12‐week online gut‐directed hypnotherapy program using audio files adapted from an RCT‐validated treatment protocol developed in the Netherlands. Data were collected at baseline, post‐treatment, and at three‐week intervals. Outcome measures included gastrointestinal symptoms, pain, quality of life, stress, depression, anxiety, school absenteeism, treatment satisfaction, and subjective treatment effect. Means, standard deviations, and Cohen's d effect sizes were estimated using linear mixed models.
Results: Twenty‐five of 32 participants (78%) completed treatment and provided post‐treatment data. Significant improvements were observed in primary outcome Peds‐QL Gastrointestinal Symptoms Short Scale, with a moderate effect size based on child‐reported data (d = 0.63, P < .001, CI 0.36–0.9) and a large effect size based on parent‐reported data (d = 0.81, P < .001, CI 0.45–1.17). Forty percent of participants achieved clinically significant improvement in gastrointestinal symptoms (defined as a > 30% reduction). Pain intensity showed small but statistically significant reductions in both child‐reported (d = ‐0.24, P < .005, CI ‐0.3 to ‐0.18) and parent‐reported data (d = ‐0.28, P < .005, CI ‐0.35 to ‐0.21). Effect sizes were smaller than in previous Dutch studies, but differences in outcome measures complicate direct comparison.
Conclusions: This study shows a significant reduction in gastrointestinal symptoms in children and adolescents using gut‐directed hypnotherapy with audio files. Further validation in a larger randomized controlled trial using consistent outcome measures is needed to confirm treatment efficacy and identify predictors of treatment outcomes.
Contact e‐mail address: tea.soini@ki.se
G‐OP081. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐OP081.1. INTERRATER RELIABILITY IN PEDIATRIC HIGH‐RESOLUTION ANORECTAL MANOMETRY RECORDINGS
Julia Van Der Zande 1,2, Marc Benninga3, Bruno Chumpitazi4, Anil Danbari5, Jose Garza6, Julie Khlevner7, Samuel Nurko8, Miguel Saps9, Karla Vaz1, Sujithra Velayuthan1, Rejuan Haque10, Carlo Di Lorenzo1, Peter Lu1
1Division Of Gastroenterology, Hepatology,and Nutrition, Nationwide Children's Hospital, Columbus, United States of America, 2Department Of Pediatric Gastroenterology And Nutrition, Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands, 3Department Of Pediatrics, Division Of Gastroenterology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands, 4Department Of Pediatrics, Duke University School of Medicine, Durham, United States of America, 5Division Of Gastroenterology And Nutrition, Children's National Hospital, Washington, United States of America, 6Ga Neurogastroenterology And Motility Program Children's Healthcare Of Atlanta, GI Cares for Kids, Atlanta, United States of America, 7Division Of Gastroenterology, Hepatology And Nutrition, Columbia University College of Physicians and Surgeons, New York, United States of America, 8Boston Children's Hospital, Boston, United States of America, 9Division Of Gastroenterology, Hepatology And Nutrition, Miller School of Medicine, University of Miami, Coral Gables, United States of America, 10Center For Biostatistics, Department Of Biomedical Informatics, The Ohio State University, Columbus, United States of America
Objectives and Study: Despite its widespread use in pediatric gastroenterology, the interrater reliability of High‐resolution anorectal manometry (HR‐ARM) in children has not been previously studied. The aim of this study was to assess the interrater reliability of pediatric HR‐ARM studies.
Methods: Pediatric gastroenterologists with expertise in neurogastroenterology and motility (NGM) from multiple institutions were asked to analyze ten deidentified pediatric HR‐ARM studies using dedicated analysis software (Solar GI HRM v9.1, Medical Measurement Systems, Enschede, the Netherlands). Anal canal resting pressure, squeeze pressure and duration, presence of recto‐anal inhibitory reflex (RAIR), push test (normal/abnormal), and final interpretation of the study (normal/abnormal) were evaluated. Reliability was calculated using Fleiss' Kappa (κ) and intraclass correlation coefficient (ICC) for categorical and continuous data, respectively. Commonly used scales for κ and ICC values were used: 0.00=no agreement, 0.01‐0.20=slight agreement, 0.21‐0.40=fair agreement, 0.41‐0.60=moderate agreement, 0.61‐0.80=substantial agreement, 0.81‐0.99=excellent agreement, and 1.00=perfect agreement.
Results: Analysis of all ten studies was completed by ten NGM experts. Interrater reliability was excellent for resting pressure (ICC 0.97, CI 95% 0.93‐0.99), squeeze pressure (ICC 0.97, CI 95% 0.94‐0.99), and squeeze duration (ICC 0.93, CI 95% 0.85‐0.98). A fair interrater agreement for the RAIR (k = 0.35) was seen (Figure 1), and a moderate interrater agreement was seen for interpretation of the push test (Figure 1) and the final interpretation of the recording (k = 0.50 and k = 0.43, respectively).
Conclusions: This study demonstrated suboptimal consistency in the interpretation of key manometric parameters. Specifically, interrater agreement for detection of a RAIR was only fair and agreement on whether the push test was normal or not was moderate. These findings raise concern regarding the current application of HR‐ARM in assessment for disorders like HD, internal anal sphincter achalasia, and pelvic floor dyssynergia. This underscores the need for comprehensive reevaluation of HR‐ARM protocols and interpretation criteria to ensure diagnostic consistency.
Contact e‐mail address: j.m.vanderzande@amsterdamumc.nl
G‐OP082. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐OP082.1. REGURGITATION PREVALENCE IN 2574 PRESUMED HEALTHY INFANTS
Koen Huysentruyt1, Katerina Bajerova2, Christophe Dupont3, Mikael Kuitunen4, Rosan Meyer5, Anna Nowak‐Wegrzyn6, Carmen Ribes‐Koninckx7, Silvia Salvatore8, Raanan Shamir9, Annamaria Staiano10, Hania Szajewska11, Carina Venter12, Yvan Vandenplas 13
1KidZ Health Castle, UZ Brussel, Brussels, Belgium, 2Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic, 3Clinique Marcel Sembat, Ramsay Group, Boulogne‐Billancour, France, 4Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, 5Department Dietetics, Winchester University, Winchester, United Kingdom, 6Hassenfeld Children's Hospital, New York, United States of America, 7Paediatric Gastroenterology And Hepatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain, 8Department of Medicine and Technological Innovation, Pediatrics, Hospital "F. Del Ponte", University of Insubria, Varese, Italy, 9Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 10University of Naples "Federico II", Naples, Italy, 11Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland, 12Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, United States of America, 13KidZ Health Castle UZ Brussel, Brussels, Belgium
Objectives and Study: Regurgitation occurs in healthy infants, but often causes concern. This study aims to establish regurgitation behavior in presumed healthy infants.
Methods: Original data of prospective studies investigating Cowʼs Milk‐related Symptom Score (CoMiSS) values in presumed healthy infants (≤12 months) were pooled. Regurgitation was categorized (range 0‐6): ≤2 episodes, ≥3‐ ≤ 5 small volumes, >5x >1coffee spoon, >5 episodes of half the feeds in <50% of the feeds, continuous small volumes >30 mins after each feed, 50‐100% of the feed in ≥50% of the feeds, complete feed after each feeding. The 50th, 90th and 97th centiles of regurgitation scores were modeled using GAMLSS (generalized additive models for location, scale and shape) using Lower Aikake Information Criteria (AIC) in R v4.1.3. Logistic regression models investigated the relation of age and sex with regurgitation, including country as a random effect.
Results: CoMiSS was collected from 2,574 infants (52% boys; difference between countries: p = 0.476) from Belgium (n = 300), Brazil (n = 101), Bulgaria (n = 60), Czech Republic (n = 206), Egypt (n = 808), Indonesia (n = 286), Italy (n = 200), Mexico (n = 106), Poland (n = 366) and Spain (n = 141). The overall median (Q1;Q3) age was 5.2 (2.6;8.7) months (difference between countries: p < 0.001). Solid feeds were started in 60.5% of the 1,976 infants without missing data. Regurgitating more than 5x/day was common in the first 7 months (±7‐11% with a peak at 16‐17% between 1‐4 months) but rare (<2‐4%) thereafter (Figure 1). Age, but not sex was a significant predictor of regurgitating more than 5x per day (OR 0.87, 95% CI 0.82;0.92). Using a Negative Binomial type I distribution, respectively 56.0%, 96.5% and 98.2% of the observed data fell below the 50th, 90th and 97th regurgitation score centile.
Conclusions: Regurgitation of more than 5 times per day is common in infants in their first 7 months. Understanding “normal” regurgitation patterns helps reassuring parents without unnecessary investigations or treatments.
Contact e‐mail address: yvan.vandenplas@uzbrussel.be
G‐OP083. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐OP083.1. RISK FACTORS FOR LOSS TO FOLLOW‐UP AND LOW THERAPY COMPLIANCE IN CHILDREN WITH HELICOBACTER PYLORI INFECTION: RESULTS FROM THE EUROPEDHP REGISTRY
Thu Giang Le Thi1, Kallirroi Kotilea2, José Cabral3, Michal Kori4, Maria Luz Cilleruelo5, Marta Tavares6, Josefa Barrio‐Torres7, Vaidotas Urbonas8, Matjaž Homan9, Zrinjka Mišak10, Nicolas Kalach11, Pedro Urruzuno12, Martina Klemenak13, Andreas Krahl14, Andrea Chiaro15, Josef Sykora16, Meltem Korkut Ugras17, Jan De Laffolie18, Erasmo Miele19, Alexandra Papadopoulou20, Sibylle Koletzko 1
1Department Of Pediatrics, Division Of Pediatric Gastroenterology, LMU University Hospital Munich, Dr. von Hauner Children's Hospital, Munich, Germany, 2Pediatric Gastroenterology, Hopital Universitaire des Enfants Reine Fabiola. Hopital Universitaire de Bruxelles., Brussels, Belgium, 3Child and Adolescent Centre, CUF Tejo Hospital, Lisbon, Portugal, 4Paediatric Gastroenterology, Kaplan medical center, Rehovot, Israel, 5Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain, 6Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, ICBAS ‐ Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal, 7Paediatric Gastroenterology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain, 8Vilnius University Hospital Santariskiu Klinikos ‐ Childrens Hospital, Vilnius, Lithuania, 9Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia, 10Referral Center For Pediatric Gastroenterology And Nutrition, Children's Hospital Zagreb, Zagreb, Croatia, 11Saint Antoine Pediatric clinic, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Catholic University, Lille, France, 12Pediatric Gastroenterology Unit. Hospital 12 de Octubre, Madrid, Spain, 13Gastroenterology, Hepatology and Nutrition Unit, Department of Paediatrics, University Medical Centre Maribor, Maribor, Slovenia, 14Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany, 15Pediatric Gastroenterology and Endoscopy Unit, Institute Giannina Gaslini, Genoa, Italy, 16Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Pilsen, Czech Republic, 17Department of Pediatrics, Gastroenterology Hepatology and Nutrition, Yeditepe University Faculty of Medicine, İstanbul, Turkey, 18Department Of General Paediatrics And Neonatology, Justus‐Liebig University, Gießen, Germany, 19Scienze Mediche Traslazionali (sez. Pediatria‐ Ed11), Università degli Studi di Napoli "Federico II", NAPOLI, Italy, 20Children's Hospital Agia Sofia, Athens, Greece
Objectives and Study: The EuroPedHp Registry (2017‐2020) surveyed management of 1543 Helicobacter pylori (H.p.) infected children from 30 centers across 17 countries. This analysis explored (I) characteristics of children with prescribed therapy who were lost to follow‐up (f/u), (II) effect of therapy compliance on eradication rates (ER), and (III) factors associated with loss to f/u and low compliance.
Methods: We classified treated children without monitoring visits as “lost to f/u”, and children taking ≤90% prescribed medication as “low compliance”. Risk factors for “lost to f/u” or low compliance were identified applying multivariable logistic regression.
Results: Among 1263 children with prescribed treatment, 390 (31%) had no f/u data. Factors associated with “lost to f/u” included older age, living in Israel or Türkiye, medical history of dyspepsia, nausea or gastrointestinal bleeding, duodenal nodularity at endoscopy, and infection with metronidazole resistant H.p. strains compared to fully susceptible strains (Figure 1 A). Of 873 children with f/u data, 70 (8%) reported low compliance resulting in significantly lower ER. Of 574 therapy naïve children who were treated with 2‐weeks triple therapy tailored to antibiotic suscpetibility results (TTT), ER reached 93% with high compliance compared to 63% with low compliance. In children with previously failed therapy, ER of TTT with high versus low compliance were 69% and 22%, respectively. Low compliance was associated with reported vomiting or gastrointestinal bleeding prior and adverse events during therapy, and visible erosions (Figure 1B). Immigrant children did not have higher rates of lost to f/u, but tended to have lower compliance. Previous treatment failure was not associated with loss to f/u or low compliance.
Conclusions: Monitoring patients after H.p. eradication therapy by 13C‐urea breath test or monoclonal stool antigen test is crucial, because improvement of symptoms does not predict treatment success. To improve treatment adherence, we recommend using H.p.‐flyers in different languages provided by ESPGHAN (https://www.espghan.org/knowledge-center/education/H-Pylori-Patient-Parent-Guide).
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G‐OP084. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐OP084.1. ANALYSIS OF THE EFFECTS OF HELICOBACTER PYLORI INFECTION ON THE PROTEOMIC EXPRESSION PROFILE OF GASTRIC EPITHELIAL CELLS IN CHILDREN USING LABEL‐FREE QUANTITATIVE PROTEOMICS
Yaofeng Yang, Ziyu Liu, Fei Gao, Rui Guo, Mizu Jiang
Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
Objectives and Study: H. pylori infection significantly affects pediatric gastric health, leading to chronic gastritis, ulcers, and even cancer. This study used label‐free quantitative proteomics and bioinformatics to identify differentially expressed proteins in infected gastric epithelial cells, revealing impacts on host metabolism, immune regulation, and stress response pathways. Findings provide insights for new therapies.
Methods: The study included gastric mucosal samples from 32 pediatric patients with gastric diseases, divided into four groups: H. pylori‐positive with gastric nodularity or without gastric nodularity(HP + GN+ or HP + GN‐), H. pylori‐negative with gastric nodularity or without gastric nodularity(HP‐GN+ or HP‐GN‐). Label‐free proteomics and bioinformatics methods, including ANOVA, logistic regression, PCA, pathway enrichment, and STRING analysis, identified differentially expressed proteins.Western Blot validated key differential protein expression levels in gastric mucosa across groups.
Results: A total of 5,950 proteins were identified through label‐free proteomics analysis. Multi‐group comparisons revealed significant protein expression changes between H. pylori‐positive (HP + GN + , HP + GN‐) and negative groups (HP‐GN + , HP‐GN‐), particularly in pathways related to metabolism, immune evasion, and stress responses. The HP + GN+ group showed increased age and protein diversity, with PCA confirming distinct protein profiles (P < 0.01). KEGG and GO analyses revealed upregulated pathways, including glycolysis/gluconeogenesis (P < 0.01), lipid metabolism (P = 0.003), and ER stress response (P = 0.008), while immune‐related pathways, including complement C3/C5, were downregulated (P < 0.05). STRING analysis highlighted key proteins (TARBP2, SERPINA5, RIT1, RAB4A) involved in metabolic and immune regulation. Western blot validated SERPINA5 and RAB4A upregulation in HP + GN‐, RIT1 in HP + GN + , and TARBP2 in HP‐GN‐. These proteins likely regulate H. pylori‐associated metabolism and immune microenvironments.
Conclusions: This study identified significant protein expression changes in pediatric gastric epithelial cells under H. pylori infection and nodularity. Proteins involved in metabolism, ER stress, and immune pathways were altered. KEGG and GO analyses highlighted related biological processes, providing foundational data for understanding H. pylori‐related pathologies.
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G‐OP085. Topic: AS01. GASTROENTEROLOGY/AS01j. Polyposis
G‐OP085.1. DECIPHERING EPITHELIAL TRANSFORMATION BY ENTERIC BACTERIA IN PRECURSORS OF COLON TUMORS ‐ DETECT
Moritz Niesert 1, Markus Großmüller1, Kyanna Ouyang2, Sabine Schmidt3, Timo Utecht2, Maximillian Stich1, Michael Zimmermann4, Jens Puschhof2, Alexander Fichtner1
1Medical Faculty Heidelberg, Department Of Pediatrics I, Heidelberg University, Heidelberg, Germany, 2Junior Research Group Epithelium Microbiome Interactions, German Cancer Research Center, Heidelberg, Germany, 3Division Of Microbiome & Cancer, German Cancer Research Center, Heidelberg, Germany, 4Molecular Systems Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
Objectives and Study: A plethora of associations between colorectal bacteria and carcinogenesis have been described. Patients with familial adenomatous polyposis (FAP) harbor a heterozygous germline mutation of the APC gene. As the major mutagenic metabolite of genotoxic E. coli, colibactin, preferentially mutates the APC gene, these patients provide an opportunity to study the contribution of bacterial genotoxins to APC‐dependent tumourigenesis.
Methods: Techniques for the collection and sequencing of high‐quality mucosa‐associated microbiome samples have been developed. In the course of routine endoscopic procedures, eight sample sites were selected, comprising four adenomas and four healthy‐appearing mucosa samples. Mucosa‐associated microbiome samples and corresponding tissue samples were obtained. The samples were subjected to 5 R 16S low biomass microbial sequencing. Bacteria were cultivated from swabs and tissue biopsies, and bacterial whole genome sequencing was performed on the cultured bacteria. Somatic whole genome sequencing was performed on tissue samples to generate mutational profiles. Inter‐ and intra‐individual associations between mutagenic bacteria, the presence of bacterial virulence factors, and mutation profiles were analysed. In addition organoids were prepared from the collected tissue samples for functional analysis.
Results: 20 paediatric patients with FAP have been enrolled in this study. Sex ratio was 1:3 (m:f), mean age was 13.5 years. Approximately 300 bacterial isolates from patient biopsies and swabs, together with paired organoid lines derived from healthy and adenomatous colon tissue of the same patient, underwent sequencing. The resulting data were integrated into a local database of tumour‐associated bacteria. In some patients, new potential tumorigenic bacteria strains were identified, exhibiting a specific combination of adhesive factors and colibactin (pks + ). These strains were not found in healthy adjacent colon samples (Figure 1).
Conclusions: The preliminary findings of our study indicate that bacterial strains with a particular combination of virulence factors are enriched at adenomas and may play a role in the early development of adenomas in FAP‐patients.
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G‐EP001. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP001.1. BODY DENSITY IN THE LOSS OF IMMUNE TOLERANCE TO GLUTEN: A CONTRIBUTING FACTOR IN CELIAC DISEASE?
Maria Boccia 1, Antonella Marano1, Mariantonia Maglio2, Anna Mirra1, Antonietta Scala1, Roberta Mandile1, Riccardo Troncone1,2, Renata Auricchio1,2, Valentina Discepolo1,2
1Department Of Translational Medical Science, Section Of Pediatrics, University of Naples Federico II, Naples, Italy, 2European Laboratory for the Investigation of Food Induced Diseases (ELFID), University Federico II of Naples, Italy, Naples, Italy
Objectives and Study: Potential Celiac Disease (PCD) is characterized by positive CD‐specific antibodies in the absence of villous atrophy (VA). Around 20% of PCD evolve to VA (PCD_VA), 30% toward antibodies normalization (seronegative, PCD_neg), while 50% continue producing antibodies without developing VA (persistent‐positive, PCD_PP). Which factors contribute to PCD progression remains elusive. As childhood overweight/obesity and autoimmunity have shown a parallel rise in the last decades, we hypothesize that a higher metabolic pressure may contribute to progression to VA.
Methods: To test this hypothesis, we designed a retrospective study to investigate early feeding and biometric parameters in PCD at diagnosis and their relation with disease progression. We retrospectively collected data on breastfeeding, birthweight, weight, height and BMI at diagnosis of 203 PCD patients divided into 74 PCD_VA, 64 PCD_PP, 65 PCD_neg.
Results: No difference in birthweight or breastfeeding was found between the three groups. A higher weight‐percentile at diagnosis was found in PCD_VA (mean±DS: 62.06 ± 28.04) and PCD_PP (52.03 ± 28.71) than PCD_neg (41.97 ± 31.44, p < 0.01 and p = 0.05 respectively) (Figure 1 A). Similarly, PCD_VA had higher BMI at diagnosis (absolute 17.86 ± 3.112, percentile 60.12 ± 29.38, z‐score 0.2977 ± 1.177) than PCD_PPs (16.81 ± 3.196, p = 0.05; 45.93 ± 33.06, p = 0.07; ‐0.1428 ± 1.267, p = 0.11) and especially PCD_neg (16.21 ± 2.401, p < 0.01; 41.26 ± 32.32, p < 0.05; ‐0.3744 ± 1.214, p < 0.05) (Figure 1B).
Conclusions: Our data suggest that a higher weight/BMI at diagnosis, even when not defining an overweight or obesity status, are associated with evolution toward intestinal damage (PCD_VA), while a lower weight/BMI with normalization of serology (PCD_neg), indicating that body density (a proxy for nutritional status) at time of diagnosis of PCD (which is the closest time to loss of immune‐tolerance to gluten), might contribute to PCD progression.
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G‐EP002. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP002.1. EVALUATION OF THE EFFECT OF ORAL GLUTAMINE SUPPLEMENTATION ON THE INFLAMMATORY PROCESS IN NEWLY DIAGNOSED CELIAC DISEASE PATIENTS
Mehmet Terkeşli1, Buket Daldaban Sarica 2, Ahmet Eken3, Derya Altay4, Duran Arslan5
1Pediatrics, ERCIYES UNIVERSITY SCHOOL OF MEDICINE, Kayseri, Turkey, 2Pediatric Gastroenterology, KAYSERI CITY HOSPITAL, Kayseri, Turkey, 3Medical Biology, ERCIYES UNIVERSITY SCHOOL OF MEDICINE, Kayseri, Turkey, 4Department Of Pediatric Gastroenterology, Erciyes University Children's Hospital, KAYSERI, Turkey, 5Pediatric Gastroenterology, Erciyes University Children's Hospital, KAYSERI, Turkey
Objectives and Study: This study aimed to evaluate the effect of oral glutamine supplementation on inflammatory cytokines and clinical findings in newly diagnosed celiac disease (CD) patients.A total of 30 newly diagnosed CD patients,aged 2‐18 years,were included.The participants were divided into two groups:one group received only a gluten‐free diet(n = 15), and the other group received a gluten‐free diet along with oral glutamine supplementation(2 g/m²/day for 3 months)(n = 15).The patients were compared based on anthropometric measurements,anti‐transglutaminase levels, hemoglobin,white blood cell count,mean platelet volume, platelet count, AST, ALT, albumin,CRP,and a range of inflammatory cytokines, including IL‐1β,IFN‐α2,IFN‐γ,TNF‐α,MCP‐1,IL‐6,IL‐8,IL‐10,IL‐12p70,IL‐17A,IL‐18,IL‐23,and IL‐33.
Methods: The data were analyzed using IBM SPSS Statistics software.For the comparison of clinical data,Pearson's Chi‐square and Fisher's exact tests were used.For the comparison of variables,the Mann‐Whitney‐U test was applied for non‐normally distributed data, while the Student's t‐test was used for normally distributed data.A p‐value of <0.05 was considered statistically significant.
Results: A significant difference was observed in the anti‐transglutaminase levels measured at the third month (76.53 U/ml in the diet‐only group vs. 136.07 U/ml in the glutamine supplementation group, p = 0.016). Regarding the inflammatory cytokines measured at the third month, the levels of IL‐1β,IFN‐α2,IFN‐γ,TNF‐α,IL‐6,and IL‐17 were lower in the glutamine supplementation group, but this difference was not statistically significant (respectively,54.8 vs.20.7 pg/ml,9.8 vs.5.5 pg/ml,94.3 vs.57.8 pg/ml,39.3 vs.16.3 pg/ml,14.5 vs.13.6 pg/ml,and 8.5 vs.6.6 pg/ml).Glutamine is an essential substrate for critical immune system cells, particularly lymphocytes and macrophages.Therefore, glutamine is considered an important component in nutrition plans aimed at supporting immune function.The results of this study suggest that the combination of a gluten‐free diet and oral glutamine supplementation has a positive effect on serological markers and inflammatory cytokine levels
Conclusions: Oral glutamine may have a beneficial effect on reducing inflammatory cytokine levels and improving certain serological markers in CD.This approach could potentially support immune system function and contribute to the management of celiac disease.
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G‐EP003. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP003.1. IS A SMALL BOWEL BIOPSY ALWAYS MANDATORY FOR COELIAC DISEASE DIAGNOSIS IN CHILDREN WITH DIABETES MELLITUS?
Paula Nuñez1, Mariam Blanch Ruiz2, Ester Donat 3, Carmen Ribes‐Koninckx1
1Unidad De Enfermedad Celiaca E Inmunopatología Digestiva, Instituto de investigacion sanitara la FE, valencia, Spain, 2Unidad De Enfermedad Celiaca E Inmunopatología Digestiva, Instituto de Investigación Sanitaria La Fe, Valencia, Spain, 3Pediatric Gastroenterology And Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
Objectives and Study: Transient serological markers for celiac disease (CD) have been observed in children with Type 1 Diabetes Mellitus (T1DM). Consequently, the 2020 ESPGHAN criteria recommend performing an intestinal biopsy (SBB) in all T1DM cases to confirm CD. Objective: To evaluate the efficacy of CD autoantibodies in children with T1DM and to determine whether a biopsy‐free approach could be a safe option.
Methods: Patients and Methods: Retrospective analysis of anonymized sera (‐80°C) from T1DM children with suspected CD due to elevated anti‐tissue transglutaminase antibodies (tTG‐IgA) (EliA Celikey IgA, Thermo Fisher Scientific) and/or symptoms. Anti‐endomysium IgA antibodies (EMA) (Byosystems®) and deamidated gliadin peptide IgA and IgG antibodies (DGP) (EliA GliadinDP IgATM) were also measured.
Results: Results: Of 30 patients, 15 had tTG‐IgA >10× the upper limit of normal (ULN); all were positive for IgA‐EMA, and in 13 CD was confirmed. Among 11 patients with tTG‐IgA levels 1‐3× ULN, five were positive for IgA‐EMA, but only in two was CD confirmed by an SBB. In all EMA‐negative cases, CD was ruled out through clinical and serological follow‐up. IgA‐DGP was positive in all CD patients (4 > 10× ULN; 3 at 1‐2× ULN). All non‐CD patients tested negative for IgA‐DGP. One patient repeatedly showed tTG‐IgA > 10× ULN and positive IgA‐EMA but had no histological lesions in two consecutive biopsies. Sensitivity was: 100% for tTG‐IgA. 64.7% for tTG IgG, 88,2% for DGP IgA and 100% for DGP IgG and EMA IgA. Combination of tTG‐IgA plus DGP‐IgA (with or without EMA) display a PV and a NPV of 100%.
Conclusions: Conclusions: Both tTG‐IgA and EMA antibodies show lower diagnostic efficacy in T1DM children compared to the general population. The negativity of IgA DGP and/or IgA‐EMA could be useful to rule out CD in T1DM children with positive tTG‐IgA. For diagnostic confirmation, performing a BI is still essential.
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G‐EP004. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP004.1. THE ECONOMIC AND ORGANIZATIONAL IMPACT OF A REGIONAL COELIAC DISEASE SCREENING PROGRAM: A PROSPECTIVE MULTISTAKEHOLDER COST ANALYSIS
Laura Gianolio 1, Letizia Magnani2, Matilde Topa3, Cristina Cocuccio4, Alessia Poli2, Elena Groppali4, Cecilia Mantegazza4, Marta Marsilio2, Luca Elli5, Gian Vincenzo Zuccotti1,6, Lorenzo Norsa4
1Department Of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy, 2Department Of Economics, Management, And Quantitative Methods, University of Milan, Milan, Italy, 3Department Of Pathophysiology And Transplantation, University of Milan, Milan, Italy, 4Department Of Paediatrics, Vittore Buzzi Children's Hospital, Milan, Italy, 5Gastroenterology And Endoscopy Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy, 6Department Of Biomedical And Clinical Sciences, University of Milan, Milan, Italy
Objectives and Study: A 2023 Italian law introduces mass‐screening for coeliac disease (CeD) in the pediatric population to identify clinically asymptomatic children and enable early diagnosis. This study evaluates the economic and organizational practical sustainability of implementing such a mass‐screening program at a regional scale.
Methods: A prospective multistakeholder cost analysis was conducted in Lombardy. The mass‐screening model targets children at three timepoints (at 2, 6, and 10 years old), testing for coeliac‐specific autoantibodies (anti‐tissue transglutaminase IgA and IgG) and HLA‐DQ2/DQ8 genotyping. A diagnostic and follow‐up pathway for children tested positive for both genetics and serology, developed in alignment with ESPGHAN guidelines, was validated by pediatric gastroenterologists. Epidemiological and demographic data from regional (Lombardy) databases and prior Italian cohorts were utilized; costs were derived from ministerial and national databases.
Results: Based on the 2023 data from the Italian National Institute of Statistics, the targeted population in Lombardy comprises 70,583, 82,080, and 90,813 children aged 2, 6, and 10, respectively. Projected annual new diagnoses include 3,076 CeD cases and 319 potential CeD cases. Over a 10‐year projection, the average annual cost for the mass‐screening program is estimated at €31.8 million: €20.7 million for screening, €1.6 million for follow‐up, and €9.5 million for gluten‐free diet. Regarding cost distribution among stakeholders, the Regional Healthcare Service incurs €31 million/year (direct costs) and €1.5 million/year (opportunity costs); caregivers incur €27,000/year (direct costs) and €350,000/year (opportunity costs) (Figure1). In terms of healthcare system workload, the mass‐screening program would require 4,090 additional visits annually and 1,841 additional endoscopies, on top of those currently provided on a regional basis.
Conclusions: Regional CeD mass‐screening in pediatrics imposes significant economic and resource demands on the healthcare system, despite enhancing CeD diagnosis rates. These findings highlight the need for thorough feasibility assessments before large‐scale implementation to balance clinical benefits with sustainability considerations.
Contact e‐mail address: laura.gianolio@unimi.it
G‐EP005. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP005.1. ADVANCES IN CELIAC DISEASE DIAGNOSIS ON A GLUTEN‐FREE DIET: A COMPARATIVE ANALYSIS OF DIFFERENT APPROACHES AVOIDING LONG‐TERM GLUTEN CHALLENGE
Concepción Núñez1, Sara Gómez‐Aguililla 1, Sergio Farrais2, Natalia López‐Palacios1, Carla Senosiain3, Beatriz Arau4, María Corzo1, Eva Tristán4, Andrés Bodas1, Eva Martínez‐Ojinaga5, Rodrigo Barderas6, Ana Montero‐Calle6, Carolina Sousa7
1Hospital Clínico San Carlos, IdISSC, Madrid, Spain, 2Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain, 3Hospital Universitario Ramón y Cajal 80344, Madrid, Spain, 4Hospital Universitari Mutua Terrassa, Terrassa, Spain, 5Gastroenterología Pediátrica, Hospital Universitario La Paz, Madrid, Spain, 6Functional Proteomics Unit, Chronic Disease Programme, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain, 7Departamento de Microbiología y Parasitología. Facultad de Farmacia. Universidad de Sevilla, Sevilla, Spain
Objectives and Study: We aimed to compare the diagnostic accuracy of the three most‐promising methods described in the literature for diagnosis of celiac disease (CD) in adult patients on a gluten‐free diet (GFD). Additionally, we provide data of one methodology in children.
Methods: Multicenter prospective study including 29 adults on a GFD: 17 CD and 12 non‐CD subjects (9 healthy controls and 3 with suspected gluten‐related functional bowel disease symptoms). Upper endoscopy (excepting non‐CD subjects) was followed by a 3‐day 10 g gluten challenge (GC). Blood was drawn at baseline and 4 hours and 6 days after the first gluten dose. Duodenal biopsy was used to determine the percentage of TCRγδ+ intraepithelial lymphocytes by flow cytometry; blood samples to determine IL‐2 levels (basal and at 4‐hour) by SMC immunoassay; and the percentage of activated gut‐homing CD8+ T cells by flow cytometry (basal and at day‐6). Furthermore, 13 children with self‐prescribed GFD or uncertain CD diagnosis underwent a 3‐day GC with blood samples collected at baseline and at day‐6 to determine activated gut‐homing CD8+ T cells.
Results: Sensitivity was 88.2% for the percentage of TCRγδ+ intraepithelial lymphocytes; sensitivity and specificity were 82.4% and 83.3% for IL‐2; and 88.2% and 100% for CD8 + T cells. The percentage of TCRγδ+ intraepithelial lymphocytes met the criteria for CD diagnosis in 1 out the 2 CD patients with a negative result in the CD8 + T cell‐based test. In children, gut‐homing CD8+ T cells increased at day 6 in 4 cases, all seropositive at initial diagnosis, and a standard long‐term GC confirmed the absence of CD in all negative cases for CD8+ T‐cell analysis.
Conclusions: A blood test based on activated gut‐homing CD8+ T cells, combined with a 3‐day GC, may represent an alternative to the long‐term GC required for CD diagnosis in adults and children.
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G‐EP006. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP006.1. IN VITRO COMPARISON OF THE EFFECTS OF VARIOUS INHIBITORS ON THE ACTIVITY OF RECOMBINANT AND CELL SURFACE TRANSGLUTAMINASE 2
Pauline Grunst 1, Silvia Rudloff1,2, Jan De Laffolie1, Sebastian Stricker1
1Department Of General Paediatrics And Neonatology, Justus‐Liebig University, Gießen, Germany, 2Department Of Nutritional Science, Justus‐Liebig‐University, Giessen, Germany
Objectives and Study: Transglutaminase 2 (TG2) plays a central role in the pathogenesis of coeliac disease (CD) by modifying distinct gliadin peptides. This process significantly increases the immunogenicity of these peptides, initiating an immune response that ultimately leads to the destruction of the intestinal mucosa. As a result, TG2 has emerged as a promising target for therapeutic intervention. In this study, we aimed to compare several inhibitors with different inhibitory mechanisms on the activity of recombinant and extracellular TG2. In detail, we investigated the effects of ERW1041 and KCC009 (irreversible specific TG2 inhibition), cysteamine (competitive inhibition), LDN‐27219 (GTP antagonism), S‐Nitroso‐N‐acetyl‐DL‐penicillamine, SNAP (S‐nitrosylation) and zinc chloride (calcium antagonism).
Methods: Crosslinking of biotinylated gliadin peptide P56‐88 by recombinant TG2 was assessed using a photometric assay. The appropriate inhibitor‐concentrations for intestinal epithelial cells (Caco‐2) were determined using a resazurin‐based cell viability assay. Lastly, the impact of the inhibitors on TG2‐mediated crosslinking of 5‐biotinopentylamine (5BP) on the surface of Caco‐2 cells was investigated by fluorometry.
Results: The inhibitors ERW1041, KCC009 and cysteamine significantly reduced crosslinking of P56‐88 by recombinant TG2 in a concentration‐dependent manner, achieving reductions by about 80 % (p < 0.0001). LDN‐27219 reduced TG2‐activity by about 50 % (p < 0.05), whereas SNAP and zinc chloride only showed moderate effects at high concentrations of 1 mM. In Caco‐2 cells, ERW1041, KCC009, LDN‐27219 (100 µM each), and cysteamine (1 mM) reduced TG2‐mediated crosslinking by 30‐45 % (p < 0.05). In contrast, SNAP and zinc chloride only slightly reduced TG2‐activity at high doses close to cytotoxic concentrations.
Conclusions: The substances ERW1041, KCC009, cysteamine and LDN‐27219 effectively inhibited recombinant and extracellular TG2 in non‐cytotoxic concentrations. Future research should further evaluate their applicability as potential drug candidates in CD.
Contact e‐mail address: pauline.grunst@med.uni-giessen.de
G‐EP007. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP007.1. ROLE OF SEROLOGY IN THE DIAGNOSIS OF COELIAC DISEASE IN PATIENTS WITH IGA DEFICIENCY: NOT SO BAD, NOT TOO GOOD
Mehmet Balkan1, Hayriye Hizarcioglu Gulsen2, Hulya Demir2, Inci Nur Saltik Temizel2, Hasan Ozen2, Ersin Gumus 2
1Pediatrics, Hacettepe University, Ankara, Turkey, 2Pediatric Gastroenterology, Hacettepe University, Ankara, Turkey
Objectives and Study: We evaluated the ability of serology to predict Coeliac Disease (CD) in patients with low total IgA levels who were assessed for CD via endoscopy.
Methods: A total of 88 patients aged 1–18 years with low total IgA levels (total IgA<0.2 g/L or lower than ‐2 standard deviations of normal levels according to age) who underwent endoscopy with a preliminary diagnosis of CD were included in the study. Patients with selective IgA deficiency (total IgA<0.07 g/L, n = 45) were also evaluated as a subgroup. Histology was used as the reference standard against which the performance characteristics of serology (anti‐tissue transglutaminase (tTG) IgA, anti‐endomysium (EMA) IgA, and anti‐tTG IgG) were compared.
Results: Among patients with low total IgA levels, any positivity of anti‐tTG IgA, anti‐EMA IgA, and anti‐tTG IgG were found to be related with biopsy‐proven CD (p = 0.001, p = 0.001 and p = 0.002, respectively). The sensitivity of anti‐tTG IgA was found to be 59.1%, specificity 91.5%, positive predictive value (PPV) 76.5%, and negative predictive value (NPV) 82.7%. For anti‐EMA IgA, sensitivity was 55%, specificity 90.4%, PPV 68.8%, and NPV 83.9%. The anti‐tTG IgG test, which is recommended by ESPGHAN, showed 61.1% sensitivity, 82% specificity, 55% PPV, and 85.4% NPV for predicting CD. In selective IgA deficient patients, only anti‐tTG IgG positivity reached statistical significance in terms of predicting CD (p = 0.002). However, its diagnostic performance was not optimal for considering a diagnosis without biopsy, with 77.8% sensitivity, 82.1% specificity, 58.3% PPV, and 92% NPV.
Conclusions: The diagnosis of CD is challenging in patients with low IgA levels, and serology is less reliable compared to patients without IgA deficiency. Based on relatively low sensitivity and PPV, omitting biopsy and diagnosing solely based on serological tests in this subgroup of patients cannot be recommended. In selective IgA deficient patients anti‐tTG IgG is the test of choice for initial evaluation.
Contact e‐mail address: ersin.gumus@hacettepe.edu.tr
G‐EP008. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP008.1. ACCURACY OF “NO‐BIOPSY” APPROACH FOR DIAGNOSING COELIAC DISEASE: BIOPSY IS AVOIDABLE
Mehmet Balkan1, Hayriye Hizarcioglu Gulsen2, Hulya Demir2, Inci Nur Saltik Temizel2, Hasan Ozen2, Ersin Gumus 2
1Pediatrics, Hacettepe University, Ankara, Turkey, 2Pediatric Gastroenterology, Hacettepe University, Ankara, Turkey
Objectives and Study: The accuracy of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) 2020 “no‐biopsy” approach was retrospectively evaluated in a tertiary care centre cohort of Coeliac Disease (CD) patients who were diagnosed via endoscopic biopsy.
Methods: A total of 5243 upper GI endoscopies performed between January 1, 2004, and September 30, 2022, at the Department of Paediatric Gastroenterology were reviewed. Histology was used as a reference standard against which the performance characteristics of serology (anti‐tissue transglutaminase (tTG) IgA) and ESPGHAN 2020 “no‐biopsy” approach were evaluated. ROC analysis was used to determine the optimal threshold for tTG titres.
Results: A total of 701 patients aged 1‐18 years were identified to underwent endoscopy with a preliminary diagnosis of CD and have available tTG IgA results. Among the 472 biopsy‐proven CD patients who also had endomysial antibody (EMA) testing results at the time of diagnosis, 382 (80.9%) met the ESPGHAN 2020 “no‐biopsy” diagnostic criteria. The sensitivity of the “no‐biopsy” approach was found to be 80.9%, specificity 97.0%, positive predictive value (PPV) 98.7%, and negative predictive value (NPV) 64.0%. tTG IgA levels ≥10× upper limit of normal (ULN) alone provided 82.5% sensitivity, 95.6% specificity, 98.2% PPV, and 65.7% NPV for the diagnosis of CD. Addition of EMA testing did not improve diagnostic performance. The optimal threshold of tTG IgA for predicting CD was calculated as 5.15×ULN (sensitivity 90.2%, specificity 89.6%, PPV 96.1%, and NPV 76.2%). High titres of tTG IgA (≥10×ULN) had an acceptable diagnostic accuracy in identifying both villous atrophy and CD (p < 0.001) (Figure 1).
Conclusions: Endoscopy could have been avoided in 4 out of every 5 patients diagnosed via endoscopy by using the “no‐biopsy” approach. High tTG IgA titers (particularly ≥10×ULN) reliably predict villous atrophy and CD, supporting the safe use of the ESPGHAN 2020 “no‐biopsy” approach in CD diagnosis.
Contact e‐mail address: ersin.gumus@hacettepe.edu.tr
G‐EP009. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP009.1. FISH AND MARINE FATTY ACID INTAKE IN PREGNANCY AND ASSOCIATIONS WITH THE CHILD'S RISK OF CELIAC DISEASE IN THE MOBA COHORT
Elin Hård Af Segerstad 1,2, Nicolai Lund‐Blix3, Anne Lise Brantsæter4, German Tapia5, Lars Christian Stene5, Ketil Størdal6
1Celiac And Diabetes Unit, Clinical Sciences Malmoe, Lund University, Malmoe, Sweden, 2Pediatric Research Institute, Oslo University Hospital, Oslo, Norway, 3The Norwegian Childhood Diabetes Registry, Division Of Childhood And Adolescent Medicine, Oslo University Hospital, Oslo, Norway, 4Department Of Food Safety, Centre For Sustainable Diets, Norwegain Institute for Public Health, Oslo, Norway, 5Department Of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway, 6University of Oslo, Oslo, Norway
Objectives and Study: Prenatal and early life marine n‐3 polyunsaturated fatty acids (n‐3 LCPUFA) associate with the immune‐mediated diseases asthma and type 1 diabetes in the child, but data on celiac disease are scarce. We aimed to investigate if n‐3 LCPUFA and fish intake in pregnancy associates with the child's risk of celiac disease.
Methods: Intake of n‐3 LCPUFA and fish was estimated by a validated food frequency questionnaire collected mid‐pregnancy in 85,244 women in the Norwegian Mother, Father, and Child study. Celiac disease in the child was collected from the Norwegian Patient Registry and in questionnaires. We used logistic regression to estimate associations between pregnancy n‐3 LCPUFA and fish intake as exposures and the child's risk of celiac disease. We adjusted for maternal factors (birth country, educational level, delivery age, and pregnancy smoking, dietary quality, gluten intake), parental celiac disease and the child's birth year.
Results: Within mean 16.1 (standard deviations 1.8) years, 1,363 children (1.6%) were diagnosed with celiac disease. Mean intake of n‐3 LCPUFA and fish are shown in Figure. Supplements containing n‐3 LCPUFA was used by 58,636 (68.8%). Pregnancy intake of n‐3 LCPUFA from food and supplements, and total fish intake were not associated with celiac disease in the child (Figure). The use of n‐3 LCPUFA supplements during pregnancy associated with a higher risk of celiac disease in the child. The findings remained when further adjusting for early life factors in the child (infections, dietary gluten, fish, and fish oil supplementation), and when restricted to those carrying one or two risk allele tagging for HLA DQ2 or DQ8 (46.8% of the cohort).
Conclusions: Pregnancy Fish and n‐3 LCPUFA intake was not associated with celiac disease in the child. In contrast with the hypothesis, there was a modest positive association with the use of n‐3 LCPUFA supplementation.
Contact e‐mail address: elin.malmberg_hard_af_segerstad@med.lu.se
G‐EP010. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP010.1. EARLY LIFE FISH INTAKE AND FISH OIL SUPPLEMENT USE ARE NOT ASSOCIATED WITH THE LATER RISK OF CELIAC DISEASE; A COHORT STUDY
Elin Hård Af Segerstad 1,2, Nicolai Lund‐Blix3, Anne Lise Brantsæter4, German Tapia5, Lars Christian Stene5, Ketil Størdal6
1Clinical Sciences Malmoe, Lund University, Malmoe, Sweden, 2Pediatric Research Institute, Oslo University Hospital, Oslo, Norway, 3The Norwegian Childhood Diabetes Registry, Division Of Childhood And Adolescent Medicine, Oslo University Hospital, Oslo, Norway, 4Department Of Food Safety, Centre For Sustainable Diets, Norwegain Institute for Public Health, Oslo, Norway, 5Department Of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway, 6University of Oslo, Oslo, Norway
Objectives and Study: Intake of fish and marine long chain fatty acids (n‐3 LCPUFA) in early life may have anti‐inflammatory effects but remains to be studied in celiac disease. We aimed to investigate associations between early life fish intake and n‐3 LCPUFA supplementation and the subsequent risk of celiac disease in children from the general population.
Methods: In 64,889 children in the Norwegian Mother, Father, and Child study, total fish intake and n‐3 LCPUFA supplementation was estimated by a parental‐reported questionnaire at the child's age of 18 months. Celiac disease diagnosis (age >2 years) was extracted from the Norwegian Patient Registry and questionnaires collected at age 7‐8 years. We used logistic regression to estimate adjusted odds ratios (aOR) and adjusted for maternal factors (birth country, pregnancy smoking, gluten, fiber, fish and n‐3 LCPUFA supplementation), parental celiac disease, birth year, and early life factors (infections, gluten intake, diet diversity). Celiac‐permissive HLA DQ2 and/or DQ8 were prevalent in 23,779 (46.8%) children who had been genotyped.
Results: During a follow‐up of mean 16.1 (standard deviation [SD] 1.8) years, 1,038 children (1.6%) had been diagnosed with celiac disease. Fish intake was mean 2.3 (SD 1.5) servings/week and 36,654 (56.5%) children used n‐3 LCPUFA supplements. Neither fish intake or the use of n‐3 LCPUFA supplements were associated with the subsequent risk of celiac disease diagnosis (aOR 0.99 95% confidence interval [CI] = 0.94‐1.03, aOR 0.96 95%CI = 0.84‐1.10, respectively, Figure). Results were similar after restricting the analyses to children carrying the celiac‐permissive HLA haplotypes, and when further adjusting for birth season.
Conclusions: We found no association between intake fish or n‐3 LCPUFA supplementation in early life and the later risk of celiac disease in this population‐based cohort. The findings suggest that n‐3 LCPUFA intake in early life does not modify the risk of celiac disease in children.
Contact e‐mail address: elin.malmberg_hard_af_segerstad@med.lu.se
G‐EP011. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP011.1. FOLLOW‐UP OF CHILDREN WITH POTENTIAL CELIAC DISEASE CONSUMING A GLUTEN CONTAINING DIET: A MULTICENTER STUDY
Barak Laxer 1, Anat Guz Mark2, Firas Rinawi3, Nadya Ziv‐Sokolovskaya4, Raanan Shamir5, Michal Kori6
1Paediatrics Ward, Kaplan Medical Center, Rehovot, Israel, 2Schneider Children's Medical Center, Petah Tikvah, Israel, 3Pediatric Gastroenterology Unit and Faculty of Medicine Technion, Haifa, Emek Medical Centre, Afula, Israel, 4Kaplan Medical Center, Rehovot, Israel, 5Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 6Paediatric Gastroenterology, Kaplan medical center, Rehovot, Israel
Objectives and Study: Potential Celiac Disease (PCD) is defined by positive celiac serology without villous atrophy. We aimed to study the outcome of children with PCD consuming a gluten‐containing diet (GCD) over time.
Methods: Follow‐up of 90 children, diagnosed between 12.2018 ‐ 1.2022 with PCD who continued a GCD. Follow‐up data was collected until 10.2024. Baseline data included demographics, celiac serology and duodenal biopsy. Follow‐up data included celiac serology and intestinal biopsy results when performed. Minimum follow‐up was 12 months.
Results: Follow‐up data [median follow‐up of 39 (range 12‐69) months] was available for 86/90 (95.5%). Sixteen (18.6%) children started a gluten‐free diet (GFD) after a repeated biopsy. In 15/16, the biopsy demonstrated villous atrophy confirming Celiac Disease (CeD), and in 1 the mucosa was normal and GFD was started due to symptoms. Among the cohort with follow‐up data; anti‐tissue transglutaminase (TTG) normalized in 38/86 (44.2%), was stable in 30/86 (34.8%), and increased or remained >10 times upper limit of normal (ULN) in 2/86 (2.3%). Among the 70 patients continuing a GCD; TTG normalized in 38/70 (54.3%) was stable in 30/70 (42.6%) and increased or remained >10 ULN in 2/70 (2.9%). Interestingly, of the 17 patients with TTG above X10 ULN at diagnosis, continuing a GCD, TTG normalized in eight.
Conclusions: Among pediatric PCD, during a mean follow–up of 3.3 years, approximately a fifth progressed to CD, more than 40% normalized TTG levels, including nearly half of the children with baseline TTG > 10 ULN, emphasizing the need for periodic serologic and histologic follow‐up of PCD patients.
Contact e‐mail address: baraklax@clalit.org.il
G‐EP012. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP012.1. LIFESTYLES AND DIETARY HABITS IN DIFFERENT STAGES OF CELIAC DISEASE: A CROSS‐SECTIONAL PROSPECTIVE STUDY
Antonella Marano 1, Maria Boccia1, Antonietta Scala1, Anna Mirra1, Alessandra Vitiello1, Mariantonia Maglio2, Riccardo Troncone1,2, Renata Auricchio1,2, Valentina Discepolo1,2
1Department Of Traslational Medical Science, University of Naples Federico II, Naples, Italy, 2European Laboratory for the Investigation of Food Induced Diseases (ELFID), University Federico II of Naples, Italy, Naples, Italy
Objectives and Study: During the last decades, we observed a parallel increase in the incidence of autoimmune diseases, including Celiac Disease (CD), and obesity, especially in industrialized countries, suggesting that the metabolic load related to westernized dietary habits may be a major environmental factor contributing to the onset and progression of autoimmune diseases, including CD. Here we investigated dietary habits in different CD stages.
Methods: We collected data on dietary habits in 20 potential (PCD), 18 active (ACD), 20 treated CD patients on a gluten‐free diet (GFD), and 20 non‐CD controls (CTR) through the Mediterranean Diet Index (KIDMED) questionnaire and a 24‐hour food diaries.
Results: PCD (mean±DS: 7.700 ± 2.557) showed a highest adherence to Mediterranean diet, compared to ACD (5.667 ± 1.645; p < 0.05), GFD (5.650 ± 2.390, p < 0.05), and CTR (5.500 ± 2.065, p < 0.01). ACD had an increase in the caloric intake (1586 ± 445.8 kcal/die), also when adjusted on the dietary reference values for nutrients and energy for Italians (98.02 ± 33.64 %LARN) compared to CTR (1304 ± 476.6 kcal/die, p = 0.0681; 75.02 ± 24.73 %LARN, p < 0.05) and GFD (1355 ± 337.3 kcal/die, p = 0.0776;:70.78 ± 26.08 %LARN, p < 0.05). ACD showed a decreased consumption of carbohydrates/die (38.41 ± 7.575) compared to PCD (43.02 ± 7.849, p = 0.0866) and GFD (44.59 ± 7.614, p < 0.05), while an increased consumption of fats/die (45.55 ± 7.703) versus CTR (39.11 ± 9.277, p < 0.05), PCD (40.44 ± 8.351, p = 0.0545), and GFD (39.75 ± 7.326, p < 0.05). No differences were found in protein and fiber intake. Advanced Glycation End‐products (AGEs) intake was evaluated: increased AGEs‐CML and AGEs‐MGH1 was observed in PCD (AGEs‐CML:2.383 ± 1.161; AGEs‐MGH1:14.76 ± 11.02) and ACD (AGEs‐CML: 2.263 ± 1.325; AGEs‐MGH1:15.65 ± 12.90) versus CTR (AGEs‐CML:1.623 ± 0.8885, p < 0.05 and p = 0.0862, respectively; AGEs‐MGH1: 9.686 ± 4.695, p = 0.0655 and p = 0.0611, respectively).
Conclusions: Our data suggest that the Mediterranean diet may play a protective role in the progression of CD, while a higher caloric intake, characterized by higher fat and lower carbohydrate consumption, may promote progression toward full‐blown CD. Moreover, our data suggest that AGEs may play a role in the loss of tolerance to gluten rather than in disease progression.
Contact e‐mail address: antonellamarano.na@gmail.com
G‐EP013. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP013.1. DIAGNOSTIC ADVANCEMENTS IN DERMATITIS HERPETIFORMIS: THE ROLE OF NEO‐EPITOPES AND MULTIPARAMETRIC ANTIBODY PROFILING
Ania Szaflarska‐Popławska1, Torsten Matthias 2, Simon Lytton3, Patricia Wusterhausen2
1Pediatric Endoscopy And Gastrointestinal Function Testing, Nicolaus Copernicus University, Bydgoszcz, Poland, 2Research & Development, AESKU.Diagnostics GmbH & Co. KG, Wendelsheim, Germany, 3SeraDiaLogistics, München, Germany
Objectives and Study: Dermatitis herpetiformis (DH) is a skin manifestation of gluten‐related disorders (GRD), strongly linked to celiac disease. Neo‐epitopes generated by enzymatic processes are central to its pathogenesis. The AESKUBLOTS® GRD IgA assay offers a novel approach for detecting autoantibodies, including IgA against tissue transglutaminase (tTG), epidermal transglutaminase (TG3), and microbial transglutaminase (mTG). This study evaluated the diagnostic accuracy of AESKUBLOTS® GRD IgA in distinguishing DH from other autoimmune blistering diseases and explored the significance of neo‐epitope‐targeting antibodies in DH.
Methods: Serum samples from 45 DH patients and 27 controls (bullous pemphigoid and pemphigus vulgaris) were analyzed for antibody titers. Receiver operating characteristic (ROC) curves assessed the performance of assay antigens, and antibody profiles were correlated with clinical history.
Results: The assay demonstrated excellent diagnostic performance, particularly for anti‐tTG neo IgA (AUC: 0.961, CI: 0.885–0.992), anti‐TG3 IgA (AUC: 0.947, CI: 0.867–0.986), and anti‐mTG‐neo IgA (AUC: 0.961, CI: 0.885–0.992). Specificity reached 100% (CI: 89.424–100%), reliably differentiating DH patients from controls.
Conclusions: Antibodies against gliadin‐mTG complexes were identified as potential biomarkers, emphasizing their role in disease pathogenesis. The AESKUBLOTS® GRD IgA assay proves to be a robust diagnostic tool, offering rapid and comprehensive antibody profiling. By targeting neo‐epitopes like gliadin‐mTG complexes, it provides new insights into DH pathogenesis and could refine diagnostic criteria. These findings support dietary interventions, such as excluding mTG‐containing processed foods, to improve DH management, while reducing reliance on invasive biopsies.
Contact e‐mail address: wusterhausen@aesku.com
G‐EP014. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP014.1. OPTIMIZING THE CASE‐FINDING STRATEGY FOR COELIAC DISEASE AT THE PREVENTIVE YOUTH HEALTH CARE CENTRES IN THE NETHERLANDS BY ADDING HLA‐TYPING (GLUTEN‐GEN). PRELIMINARY RESULTS
Carolien Meijer 1, Lucy Smit2, Veerle Huizer2, Jos Drabbels3, Dave Roelen3, Virginia Rodriguez1, Floris Van Overveld4, Luisa Mearin1
1Leiden University Medical Center ‐ Willem Alexander Children's Hospital, Leiden, Netherlands, 2Youth Health Care Center Kennemerland, Kennemerland, Netherlands, 3Immunology/Hla Laboratory, Leiden University Medical Centre, LEIDEN, Netherlands, 4Dutch Coeliac Society, Naarden, Netherlands
Objectives and Study: Because of high negative predictive value of HLA‐DQ2/8 for coeliac disease (CD), repeated CD‐testing will be unnecessary in HLA‐DQ2/8 negatives. The aim is to evaluate the feasibility of HLA‐testing in case‐finding at the Dutch Youth Health Care Centres (YHCC).
Methods: HLA‐haplotype DQ2 and DQ8 (isolation: EZ‐1‐XL‐Advanced; typing: LIFECODES® HLA SSO/Immucor/Werfen) were determined in dried blood spots obtained by a finger prick and collected on filter paper (GenSaver). 1.Validation: Children (<18 y) visiting the pediatric department of the LUMC for (suspicion of) CD during November 2023‐February 2024 were invited. In addition to the traditionally determined HLA‐typing in venous blood, HLA was determined in dried blood spots. The results of the two techniques were compared. 2.Feasibility: From May‐December 2024 children (1‐4 years) who attend the YHCCs and underwent a point‐of‐care test for tissue transglutaminase (BioHit, tTG) via a fingerprick, were invited. Dried blood spots on filter paper were sent once a week to the LUMC‐lab for HLA‐determination. Outcome was feasibility and number (percentage) of children with presence of HLA‐DQ2/8. Ethical approval was given by the METC‐LDD.
Results: Validation: 52/97 (53.6%) gave informed consent (mean age 8.5 y; male 53.8%). In all participants sufficient DNA could be isolated from dried blood spots. The results for HLA‐typing between the two sampling techniques were consistent in all children, demonstrating a sensitivity of 100%. Feasibility: 296 gave informed consent for HLA‐typing (female 57%;median age 2.5 y). In 150 children (50.6%) the HLA‐DQ2/8 typing was positive: HLA DQ2/DQ2 4.4%, DQ2/DQ8 5.4%, DQ2/other 27.2%, DQ8/other 13.6%. This percentages are comparable with the frequencies in the Dutch general population. Costs of the test is €24.07,‐ excl VAT
Conclusions: HLA‐typing from dried blood spots using a fingerprick is feasible and reliable. It can optimize the case finding strategy for CD at YHCCs in the Netherlands. Cost‐effectiveness and acceptability analyses are needed for implementation.
Contact e‐mail address:
G‐EP015. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP015.1. PARENTAL PERSPECTIVES ON PEDIATRIC SCREENING FOR COELIAC DISEASE, TYP 1 DIABETES AND AUTOIMMUNE THYROID DISORDER IN SWEDEN: REPORTS FROM THE TRIAD STUDY
Jessica Melin, Maria Naredi Scherman, Daniel Agardh
Department Of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
Objectives and Study: Objectives and study: Screening for autoimmune diseases in pediatric populations is increasingly being implemented worldwide. Limited knowledge exists regarding parental reactions to receiving a positive screening test result for their child. The aim was to evaluate parental risk perception, anxiety, and overall satisfaction with the screening process of coeliac disease (CD), type 1 diabetes (T1D) and autoimmune thyroid disease (AITD) after being informed of their child's test outcome.
Methods: Methods: The TRIAD study is a population‐based screening in southern Sweden analyzing home capillary blood samples for autoantibodies associated with CD, T1D and AITD. Parental risk perception, anxiety, and study satisfaction were assessed in a subset of randomly invited participants using questionnaires administered after parents received both oral and written information about their child's positive autoantibody test results. Data were analyzed using logistic and linear regression models to identify predictors of parental reactions and to evaluate the relationships between test outcomes, perceived risk, emotional responses, and satisfaction with the study process.
Results:
Results: Overall, 320/3,877 (8.3%) screened positive for autoantibodies associated with either CD, T1D or AITD of whom 58/3,877 (1.5%) were diagnosed with a disease. Among invited parents,111/152 (73%) completed the questionnaire. Majority of parents (85%) demonstrated an accurate understanding of their child's disease risk after receiving both oral and written information, and 73% reported satisfaction with their participation in the screening program, with notable differences between groups (Figure 1). Factors associated with higher parental anxiety included living alone, belonging to an ethnic minority group, having a male child, and the child testing positive for T1D‐associated autoantibodies. Conversely, parents with a university degree or a first‐degree family history of autoimmune disease were more likely to have an accurate perception of their child's risk.
Conclusions: Conclusion: Psychosocial impact of screening for autoimmune diseases in children is dependent on disease outcome and socio‐demographic background.
Contact e‐mail address: jessica.melin@med.lu.se
G‐EP016. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP016.1. RISK OF GLUTEN CROSS CONTACT WHEN DINING OUT: IS IT ALWAYS A SAFE GLUTEN‐FREE EXPERIENCE? THE INTERNATIONAL CELIAC DISEASE MULTICENTER PIZZA PROJECT (CD‐MUPP)
Chiara Monachesi 1, Milena Ascani2, Anil Verma2, Simona Gatti2, Sara Quattrini2, Francesco Valitutti3, Elin Hård Af Segerstad4,5, Ketil Størdal5, Christine Henriksen6, Cathrine Strandskogen6, Alice Monzani7, Carlo Catassi1,2, Maria Elena Lionetti1,2
1Division Of Pediatrics, Salesi Children's Hospital, AOU delle Marche, Ancona, Italy, 2Division Of Pediatrics, Disco Department, Polytechnic University of Marche, Ancona, Italy, 3Pediatrics Section, Depart. Of Medicine And Surgery, University of Perugia, Perugia, Italy, 4Department Of Pediatric Research, Oslo University Hospital, Oslo, Norway, 5Department Of Pediatrics, Skane University Hospital, Malmö, Sweden, 6Department Of Nutrition, Institute Of Basic Medical Sciences, University of Oslo, Oslo, Norway, 7Department Of Health Sciences, Division Of Pediatrics, University of Piemonte Orientale, Novara, Italy
Objectives and Study: The risk of gluten exposure while dining out is scarcely investigated and impacts the quality of life of celiac disease (CD) patients. Gluten‐free pizza is particularly vulnerable to gluten contamination in kitchens preparing both gluten‐free and wheat‐based pizzas. The aim of the study is to quantify gluten contamination rates and associated risk factors in supposed gluten‐free pizzas from restaurants across Europe.
Methods: This ongoing multi‐center, cross‐sectional study aims to enroll 140 pediatric CD patients (2‐18 years old) adhering to a gluten‐free diet (GFD) from 11 European and non‐European countries. Participants collect a representative sample of restaurant‐bought pizza claimed to be gluten‐free and store it frozen until delivery to the center personnel. Gluten quantification is performed by Ridascreen Gliadin Sandwich R5 ELISA. Pizzeria staff are unaware of the study.
Results: To date, 98/140 samples were collected in Italy, Sweden, and Norway. Two samples from Italy and one from Sweden exceeded the safe threshold (<20 mg/kg), containing 50, 58, and 29 mg/kg of gluten, respectively. The contaminated pizza samples from Italy were collected from a pizzeria not recommended by the National Celiac Association and not cooked in a dedicated oven. The contaminated pizza sample from Sweden was collected from a restaurant using ready‐made gluten‐free pizza crust, prepared in a designated area, but handled with the same ladle for regular pizzas. Considering the mean weight of a whole pizza about 300 g, the estimated amounts of ingested gluten per pizza were 15, 17, and 9 mg, respectively.
Conclusions: Preliminary findings indicate that in countries with high CD awareness, gluten cross‐contact in gluten‐free pizzas is relatively uncommon and in low amounts. Data from all participating centers will further clarify the level of risk for CD patients consuming gluten‐free pizzas in regular restaurants and help healthcare providers develop interventions to minimize gluten contamination.
Contact e‐mail address: Yes
G‐EP017. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP017.1. BMI STATUS AT DIAGNOSIS OF CELIAC DISEASE AND AFTER 12–18 MONTHS ON A GLUTEN‐FREE DIET IN ITALIAN CHILDREN
Alice Monzani 1, Elena Pozzi2, Luisa Abbattista3, Luigi Ferrari2, Marco Crocco4, Federica Malerba4, Isabella Cordara5, Sara Ceresoli4, Monica Montuori6, Giulia Gagliostro6, Beatrice Eligi6, Claudia Mandato7, Angelo Colucci8, Fernanda Cristofori9, Ruggiero Francavilla9, Federica Pagliero1, Giovanna Zuin10, Sigi Petrela10, Alessandra Vicini10, Camilla Alberti11, Caterina Remiddi11, Francesco Valitutti11, Francesco Graziano12, Michele Citrano12, Martina Busè13, Simona Spetrino14, Roberta Mandile15, Maria Elena Lionetti16, Dorina Pjetraj16, Andrea Di Siena17, Angelo Di Giorgio18, Massimo Spina19, Desirée Balconara19, Chiara Maria Trovato20, Francesca Ferretti20, Barbara Parma21, Gaia Colnaghi21, Maurizio Mennini22, Marisa Piccirillo22, Giulia Casati23, Enrico Felici24, Elisabetta Augustoni25, Maria Teresa Illiceto26, Chiara Terzi27, Federica Ferrari28, Licia Pensabene29, Lorenza Scotti30, Renata Auricchio15
1Department Of Health Sciences, Division Of Pediatrics, University of Piemonte Orientale, Novara, Italy, 2Paediatrics, Buzzi Children's Hospital, University of Milan, Italy, 3Vittore Buzzi Hospital, Milan, Italy, 4IRCCS Istituto Giannina Gaslini, Genova, Italy, 5Department Of Internal Medicine, University of Genova, Genoa, Italy, 6Uoc Gastroenterologia Ed Epatologia Pediatrica, Policlinico Universitario Umberto I/Sapienza, Rome, Italy, 7Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Pediatrics Section, University of Salerno, Baronissi, Salerno, Italy, 8Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatric section, University of Salerno, Baronissi (Salerno), Italy, 9Interdisciplinary Department Of Medicine, Pediatric Section, University of Bari Aldo Moro, Bari, Italy, 10Paediatric Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy, 11Pediatrics Section, Depart. Of Medicine And Surgery, University of Perugia, Perugia, Italy, 12Pediatric Unit, Villa Sofia Cervello Hospital, Palermo, Italy, 13Medical Genetics, Villa Sofia Cervello Hospital, Palermo, Italy, 14Department Of Translational Medical Sciences, University of Naples Federico II, Naples, Italy, 15Department Of Traslational Medical Science, University of Naples Federico II, Naples, Italy, 16Department Of Specialized Clinical Sciences And Odontostomatology, Università Politecnica delle Marche, ANCONA, Italy, 17Santa Maria della Misericordia University Hospital, Udine, Italy, 18Pediatrics, University of Udine, Udine, Italy, 19University of Catania, Catania, Italy, 20Uos Riabilitazione Nutrizionale, Uoc Gastroenterologia E Nutrizione, Ospedale Pediatrico Bambino Gesù, Rome, Italy, 21Pediatric Department, "mariani" Center For Fragile Child, Asst Lariana, Sant'Anna Hospital, Como, Italy, 22Dipartimento Di Neuroscienze, Salute Mentale E Organi Di Senso (nesmos) ‐ U.o.c. Pediatria, Azienda Ospedaliera Universitaria Sant'Andrea ‐ Sapienza Università di Roma, Rome, Italy, 23Paediatric Hepatology Gastroenterology And Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 24Pediatric and Pediatric Emergency Unit, Children Hospital, AOU SS Antonio e Biagio e C. Arrigo, Alessandria, Italy, 25Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Aou Città Della Salute E Della Scienza Di Torino, University of Turin, Turin, Italy, 26Pediatric Gastroenterology And Digestive Endoscopic Unit, Department Of Pediatrics, "Santo Spirito" Hospital of Pescara, Pescara, Italy, 27Pediatric Unit, Bolognini Hospital, Seriate, Bergamo, Italy, 28Pediatric Unit, Sant'Eugenio Hospital, Rome, Italy, 29Department Of Medical And Surgical Sciences, Pediatric Unit, University Magna Graecia of Catanzaro, Catanzaro, Italy, 30Department Of Translational Medicine, University of Piemonte Orientale, Novara, Italy
Objectives and Study: We aimed to evaluate the clinical characteristics associated with BMI status at the time of celiac disease (CD) diagnosis in Italian children and to assess the effect of gluten‐free diet (GFD) on BMI.
Methods: We retrospectively reviewed the BMI distribution of patients with a new diagnosis of CD from 23 Italian Pediatric Gastroenterology Units (2013‐2023). Subjects were classified based on their BMI z‐scores as underweight (UW), normal weight (NW), overweight (OW), or obese (OB). We also assessed changes in BMI status after 12–18 months on a GFD.
Results: We enrolled 4,967 children (M:F = 1,827:3,140, mean age 7.1, SD 4.1 years). At diagnosis, 4.4% were UW, 77.5% NW, 12.7% OW, and 5.4% OB. Compared to NW and UN peers, children with an increased BMI status (OW/OB) had a higher prevalence of positive family history of CD (33.8% vs 29.4% and 24.8%, p = 0.0099), CD‐related diseases (14.8 vs 8.9% and 8.2%, p < 0.0001), and asymptomatic presentation (32.1% vs 22% and 18.3%, p < 0.0001), but a lower prevalence of biopsy‐sparing diagnoses (52.2% vs 58.7% and 61.6%, p = 0.0008). Follow‐up data after 12‐18 months of GFD were available for 3,679 subjects. Among those who were UW at diagnosis, 41.1% remained UW, 55.7% became NW, and 3.2% OW/OB. Among the NW at diagnosis, 87.4% remained NW, 10.9% became OW/OB, and 1.7% UW. Among the OW/OB at diagnosis, 76% remained OW/OB, 23% reverted to NW, and 0.1% became UW.
Conclusions: At diagnosis, most children were NW, but 18.1% had a high BMI status, being more frequently asymptomatic, probably screened for a positive family history or CD‐related conditions, and diagnosed by biopsy. After 12‐18 months of GFD, BMI reverted to NW in more than half of UW but in fewer than a quarter of OW/OB subjects. Notably, 10.9% of NW and 3.2% of UW children at diagnosis became OW/OB.
Contact e‐mail address: alice.monzani@med.uniupo.it
G‐EP018. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP018.1. NEONATAL OUTCOMES OF PREGNANT CELIAC DISEASE PATIENTS
Ketil Størdal 1, Claire Knodell2, German Tapia3, Lars Christian Stene3
1University of Oslo, Oslo, Norway, 2Cleveland clinic, Cleveland, United States of America, 3Norwegian Institute of Public Health, Oslo, Norway
Objectives and Study: The impact of maternal celiac disease during pregnancy on her offspring remains understudied. Because maternal nutritional status is important, we aimed to study neonatal outcomes in treated and untreated celiac disease.
Methods: In an observational cohort study of pregnant Norwegian women prospectively enrolled in the population‐based Mother and Child Cohort Study (MoBa), 98,052 mothers were included across Norway. Exclusion criteria were multiple fetus pregnancies, unclear celiac disease status or celiac diagnosis during pregnancy. Pregnant women with diagnosed celiac disease (treated) were compared to women later found to have celiac disease in the national patient registry (untreated) and controls without celiac disease. Primary outcome of interest was infant birth weight, and secondary outcomes were maternal, peripartum, and neonatal health measures.
Results: Mean age and pre‐pregnancy BMI (25.1 vs 24.4 vs 24.6 kg/m2) were similar between controls, treated celiac disease (n = 347), and untreated celiac disease (n = 609) women respectively. Mean birth weight for offspring of untreated celiac disease women was lower than controls (3555 g vs 3601 g; p < 0.05) [Table]. Birth weight for offspring of treated celiac disease women was 3577 g. Mean gestation age was similar, but higher odds of preterm delivery <37 weeks was seen in untreated celiac disease women compared to controls (OR 1.09, 95% CI 1.00‐1.18). Pre‐eclampsia was more common in untreated celiac disease women compared to controls (OR 1.23, 95% CI, 1.03‐1.47). Gestational weight gain and hemoglobin levels (11.9 vs 11.6 vs 11.7 g/dL) were not significantly different across groups.
Conclusions: Babies born to pregnant women with untreated celiac disease were smaller than babies born to women without celiac disease and to treated celiac disease. This large population‐based study suggests treating celiac disease with a gluten‐free diet may improve neonatal outcomes.
Contact e‐mail address:
G‐EP019. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EP019.1. MICROBIAL TRANSGLUTAMINASE INCREASES THE UPTAKE OF THE IMMUNOGENIC GLIADIN PEPTIDE P56‐88 IN HUMAN DUODENAL BIOPSIES
Sebastian Stricker 1, Jan De Laffolie1, Klaus‐Peter Zimmer1, Silvia Rudloff1,2
1Department Of General Paediatrics And Neonatology, Justus‐Liebig‐University, Giessen, Germany, 2Department Of Nutritional Science, Justus‐Liebig‐University, Giessen, Germany
Objectives and Study: Transglutaminase 2 (TG2)‐mediated enzymatic modification of gliadin peptides plays a critical role in celiac disease (CD). In addition, microbial transglutaminase (mTG) might be involved in the pathogenesis by modifying gliadin peptides in the same way as TG2. mTG is used as a processing aid in the production of food items and it might also be released in an active form by the intestinal microbiota. In this study, we investigated the impact of mTG on the integrity of the intestinal epithelial barrier and on the uptake of the immunogenic gliadin peptide P56‐88 by human duodenal biopsies.
Methods: Intestinal epithelial cells (Caco‐2) were seeded on transwell inserts. The effect of mTG on the integrity of the intestinal barrier was measured over a time period of 24 hours using a volt‐ohm meter. Duodenal biopsies from 5 CD and 5 control patients with gastritis or esophagitis were incubated ex vivo with biotinylated gliadin peptide P56‐88 with and without mTG using circular aperture sliders. The localization of mTG and P56‐88 was detected by immunofluorescence microscopy.
Results: mTG did not affect the intestinal epithelial barrier integrity in the cell culture model. mTG and P56‐88 were taken up and colocalized in the duodenal lamina propria after 30 minutes of incubation. Coincubation of P56‐88 with mTG increased the uptake of the peptide (130 ± 20 %, p < 0.05) in both groups compared to incubation with P56‐88 alone.
Conclusions: mTG increases the uptake of the immunogenic gliadin peptide P56‐88 in human duodenal biopsies. This observation might be explained by an increased transcellular transport since mTG did not alter the intestinal epithelial barrier integrity in the cell culture model. In conclusion, mTG either derived from food items or released by the intestinal microbiota might significantly increase the uptake of the immunogenic gliadin peptide P56‐88, which may contribute to the pathogenesis of CD.
Contact e‐mail address: Sebastian.Stricker@paediat.med.uni-giessen.de
G‐EP020. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EP020.1. ANALYTICAL AND CLINICAL VALIDATION OF IMMUNOREACTIVE TRYPSINOGEN AS A BIOMARKER OF EXOCRINE PANCREAS FUNCTION IN CHILDREN
Vybhav Gummadi 1, Lusia Sepiashvili2,3, Annie Ren3, Li Zhang2, Susie Eagle4,5, Benjamin Jung2,3, Jesus Arenos‐Abril6, Govind Chavhan6, Khosrow Adeli2,3, Matthew Henderson4,5, Tanja Gonska1,7
1Division Of Gastroenterology, Hepatology And Nutrition, Department Of Pediatrics, The Hospital For Sick Children, University of Toronto, Toronto, Canada, 2Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada, 3Laboratory Medicine And Pathobiology, University of Toronto, Toronto, Canada, 4Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada, 5Pediatrics, University of Ottawa, Ottawa, Canada, 6Diagnostic Imaging And Radiology, The Hospital for Sick Children, Toronto, Canada, 7Translational Medicine Program, Sickkids Research Institute, Toronto, Canada
Objectives and Study: Immunoreactive trypsin(IRT) has the potential to be a pancreas health biomarker. Serum trypsin detects acute pancreas inflammation and is as effective as the gold standard direct pancreatic function testing for measuring exocrine pancreatic insufficiency (EPI). With the unavailability of older radioimmunoassay (RIA)‐trypsin tests and global availability of IRT testing as part of cystic fibrosis (CF) newborn‐screening programs, IRT can easily be made accessible for routine clinical use. We aimed to evaluate the analytical/clinical validity of IRT for exocrine pancreas function in children with different defined pancreas phenotypes beyond the newborn‐age group.
Methods: Analytical validation of IRT including imprecision, stability, and patient comparison was evaluated as per Clinical and Laboratory Standards Institute guidelines in 25 children[mean(SD)age:13(4.5)yrs; CF‐12, pancreatitis‐13] with known pancreas status (EPI defined as fecal elastase<100 μg/g stool) with simultaneous RIA‐trypsin. IRT was tested on dried blood‐spot samples using AutoDELFIA‐Neonatal‐IRT‐fluoroimmunoassay(Perkin Elmer Inc.). Clinical validity was evaluated in 158 children [mean(SD) age:11.3(4.3)yrs; 60%boys] with well‐established pancreas phenotypes [114:CF‐pancreas insufficiency and sufficiency(PI/PS); 44‐pancreatitis]. Available radiological investigations in children with pancreatitis were reviewed for evidence of pancreas atrophy.
Results:
Total imprecision of IRT specimens ranged from 7.1‐16.4% and repeat analysis demonstrated stability of samples at ‐200C for 28‐days. Comparison of IRT with RIA‐trypsin showed excellent correlation (r = 0.95, p < 0.001, figure‐1A). IRT replicated similar results as RIA‐trypsin in discriminating CF‐PI/PS groups (figure‐1B). Among children with pancreatitis median IRT levels in those with EPI were significantly lower compared to those without EPI [4.9(3.1,8) vs 10.8(8.5,15.7); p = 0.005] as well as in patients with atrophy on imaging compared to those without [5.1(3.8,10.9) vs 10.8(8.7,15.8); p = 0.005].
Conclusions: We have successfully validated IRT as a new biomarker of exocrine pancreas function in‐lieu of serum RIA‐trypsin test. We suggest that IRT is a useful clinical tool for evaluation of EPI and pancreas atrophy. Future studies are planned to further elucidate how to best utilize IRT for EPI diagnostics.
Contact e‐mail address: tanja.gonska@sickkids.ca
G‐EP021. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EP021.1. PREVENTATIVE EFFECT OF PANCREATITIS BY LONG‐TERM PANCREATIC DUCT STENTING IN PEDIATRIC PATIENTS WITH ACUTE RECURRENCE PANCREATITIS OR CHRONIC PANCREATITIS
Yasuaki Hachisu 1, Satoshi Nakano1, Hiroki Saito1, Saeko Hirai1, Shigeto Ishii2, Toshio Fujisawa2, Hiroyuki Isayama2, Mitsuyoshi Suzuki1
1Pediatrics, Juntendo University Graduated school of Medicine, Tokyo, Japan, 2Gastroenterology, Juntendo Univercity Graduated school of Medicine, Tokyo, Japan
Objectives and Study: A step‐up strategy involving endoscopic treatment followed by surgery has become a standard approach for managing recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP), even in children. This study aimed to verify the efficacy and safety of endoscopic treatment for pediatric patients with RAP or CP.
Methods: A retrospective selection of pediatric RAP or CP patients from medical records between 2010 and 2024 in Japan was conducted. The study included nine pediatric patients (seven male), with genetic abnormalities identified in seven cases (PRSS1 in three, SPINK1 in four). All patients exhibited pancreatic duct stenosis, and two had pancreatic divisum. The endoscopic treatment protocol involved pancreatic duct intubation, sphincterotomy, stenting, and balloon dilation as needed. The plastic stent (PS) was replaced after about three months, and removed about one year after the number of PS is increased to two or more, confirming improvement of pancreatic duct stenosis.
Results: The duration of stenting ranged from three to fifty months (median of twelve and a half months). A significant reduction in the frequency of pancreatitis attacks after endoscopic treatment (mean ± SD; before treatment: 2.72 ± 1.94 per year vs. after treatment: 0.14 ± 0.36 per year, p = 0.0078) was observed. Only two patients experienced pancreatitis attacks during stenting, and post‐ERCP pancreatitis occurred in 5% of recorded events (4/80). No patients developed exocrine dysfunction or diabetes during the observation period (mean ± SD: 10.2 ± 3.05 year). One patient with a SPINK1 mutation required surgery (pancreaticojejunostomy) after unsuccessful endoscopic attempts due to recurrent pancreatic duct stenosis.
Conclusions: The findings demonstrate that endoscopic treatment is a safe and effective first‐line therapy for pediatric RAP or CP. It significantly reduces episodes of pancreatitis and helps avoid long‐term complications, supporting its role in minimizing the need for surgical intervention.
Contact e‐mail address:
G‐EP022. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EP022.1. EPİDEMİOLOGİCAL AND COMPLİCATİON TRENDS İN PEDİATRİC PANCREATİTİS: İNSİGHTS FROM A DECADE
Aysel Majıdova 1, Elif Turkmen1, Demet Demirkol2, Lale Alıbaylı1, Zuhal Bayramoğlu3, Zeynep Günal Türk1, Zerrin Önal1, Metin Uysalol4, Ozlem Durmaz1
1Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul University Faculty of Medicine, Istanbul, Turkey, 2Pediatric İntensive Care, Istanbul University, Istanbul Faculty of Medicine, İstanbul, Turkey, İstanbul, Turkey, 3Pediatric Radiology, Istanbul University, Istanbul Faculty of Medicine, İstanbul, Turkey, 4Pediatric Emergency, Istanbul University, Istanbul Faculty of Medicine, İstanbul, Turkey
Objectives and Study: The incidence of pancreatitis has been increasing in recent years. We aimed to investigate the epidemiological trend and predictors for complications in pediatric pancreatitis.
Methods: We retrospectively reviewed the patients with pancreatitis between 2014 and 2024. Demographic features, clinical symptoms, complications, etiological factors, laboratory parameters, radiological imaging, and treatment modalities were recorded. Severity was defined according to 2017 NASPGHAN guidelines.
Results:
Fortytwo children (28 boys, mean age±SD; 11 ± 4.5 years) were included in the study. The main etiological factors were metabolic disorders (26.2%), biliary diseases (21.4%) and drug use (21.4%). Complications (10 local, 1 systemic) were identified in 11 patients (8 boys, mean age ± SD; 10.8 ± 4.7 years) (Table 1). Over all 33.3% were diagnosed between 2014‐2018 (Era 1), 66.7% were 2019‐2024 (Era 2). Complication rate was higher in patients in Era 2. Pancreatitis had been classified as mild in 61%, moderate in 28%, and severe in 9%. Pancreatitis was acute in 69%, chronic in 5%, and acute recurrent in 29% with similar complication rates in all groups. Increase in lipase levels (1903 ± 749 U/L) were higher in patients with complications (p = 0.01). Complications presented with abdominal pain (100%), vomiting (91%) and fever (18.2%). Vomiting was more common in patients with complications (p = 0.02). No significant relationship was found between age, gender, etiological factors and complications. USG detected complications in 100% of cases, with a PPV of 96.73% and NPV of 100%. All patients received IV hydration, and antibiotics were used in 19%, primarily in those with complications (54.5%, p < 0.05).
Conclusions: The frequency and awareness of pancreatitis in children has increased recently. Moderate‐severe pancreatitis, highly elevated lipase levels and vomiting is associated with complications. USG is an effective modality for detecting complications.
Contact e‐mail address:
G‐EP023. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EP023.1. LOW ADHERENCE TO THE INSPPIRE CONSENSUS FOR THE DIAGNOSIS AND MANAGEMENT OF PAEDIATRIC AUTOIMMUNE PANCREATITIS
Francesco Pellegrino
Paediatric Gastroenterology, Regina Margherita Children's Hospital, Turin, Italy
Objectives and Study: OBJECTIVES AND STUDY— In 2018 the International Study Group of Pediatric Pancreatitis: In search for a cuRE (INSPPIRE) published the first consensus on paediatric autoimmune pancreatitis (P‐AIP), addressing a gap previously filled by adult AIP guidelines. This study aimed to assess whether the INSPPIRE consensus contributed to standardize the diagnosis and management of P‐AIP.
Methods: METHODS—A systematic review of PubMed, Embase, and grey literature was conducted, including studies on human subjects published between January 2019 and December 2024, with no language restrictions. Data on demographics, clinical symptoms, laboratory tests, imaging, histology, associated diseases, treatment, and outcome were analyzed.
Results: RESULTS— Fifteen cases of P‐AIP were identified, 10 of whom were diagnosed and managed according to the adult International Consensus Diagnostic Criteria. Auto‐antibody testing was performed in 6/15 cases, and only four underwent further evaluations to exclude concomitant immune‐mediated diseases. Ultrasound (US) was the first line techinique in 11/15 patients, while 4/15 underwent firstly CT scans. Magnetic resonance cholangiopancreatography (MRCP) was performed in 13/15 patients, with focal pancreas enlargement as most common finding in 9/15 children. Pancreatic biopsies were conducted in 11/15 cases. Prednisone (1 mg/kg) was administered in 8/15 patients, while others received alternative corticosteroids. Clinical response within two weeks was assessed in 9/15 cases, whereas imaging response after three months adhered to appropriate timing in only 2/15 cases. The mean follow‐up duration was 11 months, though 3/15 patients lacked a reported follow‐up. Long‐term complications, including exocrine pancreatic insufficiency and diabetes, were documented in only 3/15 cases.
Conclusions: CONCLUSIONS—Despite the publication of INSPPIRE consensus, the management of P‐AIP remains inconsistent and often based on adult guidelines. Limited data on mid‐ and long‐term outcomes, particularly on exocrine and endocrine pancreas function, highlight the need for standardized care. Establishing a European registry could improve awareness and promote uniform management of this rare and underestimated condition.
Contact e‐mail address: francesc.pellegrino5@gmail.com
G‐EP024. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EP024.1. CHARACTERIZATION OF A CILIOGENIC PANCREATOPATHY REVEALS THE ESSENTIAL ROLE OF CENTROACINAR CELLS IN PANCREATIC HOMEOSTASIS
Isabelle Scheers 1, Memoona Rajput Bhatti2, Raphael Helaers3, Axelle Loriot4, Younes Achouri2, Laurent Gatto4, Sophie Saunier5, Amandine Viau5, Alice Serafin5, Valentine Gillion6, Nathalie Godefroid7, Patrick Jacquemin2
1Pediatric Gastroenterology And Hepatology, Cliniques universitaires Saint‐Luc, Brussels, Belgium, 2Lpad, UCLouvain, Brussels, Belgium, 3Gehu, UCLouvain, Brussels, Belgium, 4Cbio, UCLouvain, Brussels, Belgium, 5Institut Imagine, Paris, France, 6Nephrology, Cliniques universitaires Saint‐Luc, Brussels, Belgium, 7Pediatric Nephrology, Cliniques universitaires Saint‐Luc, Brussels, Belgium
Objectives and Study: Ciliopathies are a group of genetic diseases causing cilia dysfunction. To date, a link between ciliopathies and pancreatic disease has not been established. In this context, we observed that certain patients followed for ciliopathies presented pancreatic abnormalities. We therefore sought to establish a link between ciliopathies and pancreatic disease.
Methods: We explored the presence of ciliary gene mutations in our cohort of patients and analyzed their pancreatic phenotype by imaging (MRI allowing quantification of the fat fraction). In parallel, we generated and analyzed two NPHP3 transgenic mouse models. The first model replicated the NPHP3 gene mutations present in a patient in our cohort (NPHP3mut1/mut2 model), the other allowed conditional inactivation of the NPHP3 gene in pancreatic ductal cells (NPHP3f/f model).
Results: We found mutations in the NPHP3 and HNF1b genes in some patients. Phenotypic analysis of both mouse models demonstrated that loss of function of NPHP3 in pancreatic ductal cells resulted in mild inflammation and fibrosis associated with significant acinar atrophy and severe lipomatosis. Further analysis revealed that ciliary dysfunction affects the function of centroacinar cells by disrupting the communications they establish with acinar cells and pancreatic fibroblasts. To investigate the possible presence of pancreatic lipomatosis in patients with NPHP3 and HNF1β mutations, we analyzed MRI on these patients and confirmed a significant increase in the percentage of fat in their pancreas compared to the pancreas of healthy controls.
Conclusions: These results highlight fundamental elements of pancreatic biology previously unknown, namely the existence of intercellular communications between different types of exocrine cells, and between exocrine cells and fibroblasts. They further reveal that disruption of ciliary function affects these communications and leads to a new form of pancreatic disease that we call ciliogenic pancreatopathy.
Contact e‐mail address: isabelle.scheers@saintluc.uclouvain.be
G‐EP025. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EP025.1. CONTRAST‐ENHANCED MULTISPECTRAL OPTOACOUSTIC TOMOGRAPHY FOR THE ASSESSMENT OF THE GASTROINTESTINAL TRANSIT IN PATIENTS WITH CYSTIC FIBROSIS
Johanna Fuchte, Felix Wachter, Merle Claßen, Lars‐Philipp Paulus, Henriette Mandelbaum, Adrian Buehler, Gregor Siebenlist, Jörg Jüngert, Joachim Woelfle, André Hoerning, Ferdinand Knieling, Adrian Regensburger, Alexander Schnell
University Hospital Erlangen, Erlangen, Germany
Objectives and Study: Cystic Fibrosis (CF) can affect the gastrointestinal tract. However, examinations of the gastrointestinal transit usually require invasive measures or the use of ionizing radiation. New imaging techniques like multispectral optoacoustic tomography (MSOT), offer new diagnostic approaches. When the dye indocyanine green is given orally, the signal can be detected in different sections of the intestine using MSOT1. We examined the gastrointestinal passage in CF patients by contrast‐enhanced MSOT (CE‐MSOT) in order to identify alterations.
Methods: Patients with CF and healthy volunteers received a standardized breakfast with ICG. One measurement using MSOT was taken before breakfast and then further 6 over a period of 6 hours. The anatomical regions examined were the gastric antrum, terminal ileum and sigmoid colon. Wavelengths of 700, 730, 760, 800, 850 nm were used to spectrally unmix for ICG and determining the transit time. Three stool samples were examined to confirm the presence of ICG in the stool by fluorescence imaging.
Results:
While we were unable to detect any significant increase in the ICG signal measured in the gastric antrum and sigmoid colon during the investigation, a significant change over time in the terminal ileum in both groups in absolute measured values and values normalized to a baseline value were detected (Figure 1). In the healthy patient group, there was a significant increase in the ICG signal after 240 minutes (p < 0.01). In the group of patients with cystic fibrosis, this significant increase could be seen at 120 minutes after ICG ingestion (p < 0.05). This could indicate a possible faster intestinal transit in the CF patients compared to the healthy control subjects. Signals of ICG were verified in three consecutive stool samples by fluorescence imaging.
Conclusions: In this study, we were able to asses the intestinal transit time in patients with cystic fibrosis with CE‐MSOT for the first time.
Contact e‐mail address:
G‐EP026. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EP026.1. TIME OF COMPLICATIONS AFTER DIGESTIVE POLYPECTOMY IN CHILDREN
Anne Cordesse 1, Alexis Mosca1, Marc Bellaiche1, Solène Ganousse1, Hélène Lengliné1, Arnaud Bonnard2, Jérôme Viala1,3,4
1Paediatric Gastroenterology And Nutrition Department, Universitary Robert‐Debré Hospital, APHP, Paris, France, PARIS, France, 2Paediatric Surgery, Universitray Robert‐Debré Hospital, APHP, Paris, France, 3Umr 1149, INSERM, Paris, France, 4Paris‐Cité University, Paris, France
Objectives and Study: Although rare, complications can occur during or after digestive polypectomy in children. Our aim was to define the occurrence time of post polypectomy complications in children to improve post polypectomy monitoring.
Methods: A retrospective observational study was performed with children who underwent endoscopic polypectomy. Frequencies of complication were compared at 3 times: 0‐6 hours, 6‐24 hours, and >24 hours to 3 months following polypectomy.
Results: 209 endoscopy procedures with polypectomy were performed in 119 patients (42,9% girls), with a median age of 12 years [1‐18 years]. The causes of polypectomy were isolated juvenile polyp, familial adenomatous polyposis (FAP), Peutz‐Jeghers syndrome (PJS), juvenile polyposis syndrome (JPS) and others, in 22%, 44%, 14%, 14% and 6% of procedures respectively. Thirty‐four complications occurred in 27 (12.9%) procedures. The complications were bleeding, perforation and infection in 31 (91.2%), 1 (2.9%) and 2 (5.9%) cases respectively. Complications occurred within 0‐6 h, 6‐24 and > 24 h periods in 25 (73.5%), 2 (5.9%) and 7 (20.6%) cases respectively. At the 3 timings, the ratio of severe complications were 2/25 (8%), 0/2 and 5/7 (71.4%) respectively (p < 0.002). The global risk of complication/procedure was significantly increased in case of symptoms before procedure (21% vs 79%, p = 0.002), JPS patients (p < 0.001), resection of >20 mm polyp (p < 0.001), use of endoscopic haemostasis technic (p < 0.001), and reduced in FAP patients (p < 0.001). The risk of complication was not correlated to sex, age, type of endoscopy, technique of polypectomy and location of polyps.
Conclusions: Polypectomy complications were more frequent around procedure and more frequently severe > 24 hours after polypectomy. We suggest monitoring patient in hospital during the first 6 hours and after discharge patients must be advised of warning signs of post endoscopic complications.
Contact e‐mail address: jerome.viala@aphp.fr
G‐EP027. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EP027.1. GASTROPEXY DEVICE IMPACTION IN CHILDREN WITH PUSH PERCUTANEOUS ENDOSCOPIC GASTROSTOMY
Juliette Viart, Frédéric Gottrand
Service De Gastroentérologie, Hépatologie Et Nutrition Pédiatriques, Lille Hospital, Lille Cedex, France
Objectives and Study: One‐step button percutaneous endoscopic gastrostomy (B‐PEG) is a method for gastrostomy placement. Few studies have described complications associated with T‐fasteners. This study aimed to assess the incidence and risk factors of post‐gastrostomy T‐bar retention.
Methods: Children who underwent one‐step button percutaneous endoscopic gastrostomy (B‐PEG) placement in our tertiary center between 2009 and 2020 were included in this retrospective study. Patient characteristics, comorbidities, complications, and potential risk factors (e.g., undernutrition, underlying disease, T‐fastener complications, proton pump inhibitor use, age <1 year) were analyzed. All post‐procedure radiological examinations, T‐bar numbers, and durations post‐procedure were collected. T‐bar retention was considered at least one T‐bar after 6 weeks post‐B‐PEG.
Results: A total of 679 children (337 boys; median age at B‐PEG, 1.7 years) were included. B‐PEG was indicated for mainly nutritional reasons. Among 468 patients with radiological examinations analyzed, 361 (74.7%) had at least one T‐bar impaction at the first radiological examination (median time after B‐PEG, 0.55 years). Younger age at B‐PEG was a risk factor for T‐bar impaction (odds ratio [OR]: 2.82, 95% confidence interval [CI]: [1.71–4.66], P < .0001), while neurological disorder appeared to be protective against T‐bar impaction (OR: 0.52, 95% CI: [0.34–0.78], P = .0018).
Conclusions: Nearly 75% of children presented T‐bar impaction. These data indicate that to avoid gastropexy complications, discussion of early removal of T‐fasteners post‐B‐PEG is warranted.
Contact e‐mail address:
G‐EP028. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EP028.1. POST‐ENDOSCOPIC FEVER AND INFECTION IN PAEDIATRIC PATIENTS WITH INTESTINAL FAILURE
Johannes Hilberath 1, Omar Afrigh1, Toni Illhardt1, Drieke Vermeulen1, Christoph Slavetinsky2, Bernd Fode3, Hanna Renk4, Justus Lieber2, Jörg Fuchs2, Ekkehard Sturm1
1Paediatric Gastroenterology And Hepatology, University Children's Hospital Tübingen, Tübingen, Germany, 2Paediatric Surgery And Urology, University Children's Hospital Tübingen, Tübingen, Germany, 3General Paediatrics, Department Of Haematology And Oncology, University Children's Hospital Tübingen, Tübingen, Germany, 4Institute Of Medical Microbiology And Hygiene, University Hospital Tübingen, Tübingen, Germany
Objectives and Study: Bacteraemia can occur during medical interventions and 20‐40% of paediatric centres perform antimicrobial prophylaxis (AMP) for gastrointestinal endoscopic procedures in children with a central venous catheter (CVC) [Snyder, 2002]. However, the incidence of post‐endoscopic fever (PEF) and infection, and the usefulness of AMP in children with intestinal failure (IF) are unknown. This study evaluated fever and infection rates post‐endoscopy and the role of AMP in children with IF and CVC.
Methods: This was a retrospective chart analysis of all children (0‐17 years) with IF and CVC who underwent gastrointestinal endoscopy at our intestinal rehabilitation centre between 2019‐2024. Outpatients were excluded from this study. Group 1 (i.v. AMP with Piperacillin/Tazobactam) and group 2 (no i.v. AMP) were compared using the chi‐square and t‐test. This study was approved by the local institutional ethics board (606/2023BO2).
Results: A total of 233 endoscopies in 108 inpatients with IF and CVC were analysed: median age at endoscopy, 68 months (range 1‐206 months); female, 54.6%; short bowel syndrome, 73.1%. Intravenous AMP was used in 71.2% of the procedures. There were no differences between the groups in terms of age, type of endoscopy, interventional procedures, or peri‐endoscopic use of enteral antibiotics or proton‐pump inhibitors. The overall PEF rate was 6%, with no significant difference between groups (p = 0.987). No infections, including central line‐associated bloodstream infections, were observed.
Conclusions: The frequency of PEF in children with IF is approximately 10x higher than the recently reported incidence rate of 0.55% in paediatric patients following gastrointestinal endoscopy [Boster, 2021]. Potential contributing factors include a disturbed mucosal barrier, intestinal bacterial overgrowth, and motility disorders in patients with IF. Since no bloodstream infections were confirmed, and AMP did not prevent PEF, routine administration of peri‐interventional AMP for diagnostic endoscopies in otherwise healthy children with IF is not warranted.
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G‐EP029. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EP029.1. PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) PLACED IN THE DIRECT PUNCTURE TECHNIQUE IN CHILDREN WITH A BODY WEIGHT BELOW 10 KG: EXPERIENCE OF A SINGLE CENTRE
Christina Horváth, Ilse Broekaert, Miriam Gutting, Mona Ströhlein, Julius Machtens, Christoph Hünseler
Pediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
Objectives and Study: Placement of percutaneous endoscopic gastrostomy (PEG) is often required in young children <10 kg with swallowing disorders or increased caloric needs. The newer direct puncture technique may offer advantages compared to the pull‐through technique. We report on safety, efficacy and complications of the direct puncture technique in children <10 kg based on a single center experience.
Methods: Data of all children <10 kg who underwent the direct puncture technique between 2016 and 2024 were retrospectively collected, including demographics (age, gender, diagnosis, weight), procedure details (duration, hospital stay, use of antibiotics) and complications classified using the Clavien‐Dindo system. Early postoperative complications (within 30 days) were analyzed focusing on grade I–III. Multivariate analysis examined correlations between age, weight, and diagnostic group with complication rates.
Results: Seventy children (median age 346 days, median weight: 7.2 kg) were included. The majority had neuromuscular/genetic (40%) or renal (34.3%) diseases. Median procedure time was 20 minutes, 95.7% received periinterventional antibiotics. Hospital stays averaged 4 days for elective admissions. The acute complication rate was 28.5%, mostly minor (grade I: 17.1%, grade II: 7.1%). Grade IIIb complications occurred in 4.3% (n = 3), requiring surgical interventions (gastric perforation in 2 cases, subcutaneous abscess in 1 case). Skin infections and problems with T‐fastener were common but resolved with conservative management. Multivariate analysis showed no correlation between age, weight, or diagnosis and complication rates.
Conclusions: The direct puncture technique for PEG placement is feasible and safe in children <10 kg, with a majority of complications being minor. Careful handling of T‐fasteners and retaining buttons is essential to prevent perforation and skin complications, particularly in very small children. This procedure should be performed by an experienced team to minimize risks. The observed complication rates align with previously reported outcomes in children after PEG placement in direct puncture technique.
Contact e‐mail address: christina.horvath@uk-koeln.de
G‐EP030. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EP030.1. INTRALESIONAL STEROID INJECTION VERSUS TOPICAL MITOMYCIN‐C USE IN PEDIATRIC BENIGN RECURRENT ESOPHAGEAL STRICTURE: A RANDOMIZED CONTROL TRIAL
Anjum Saeed 1, Huma Cheema2, Tehreem Fatima2
1Department Of Pediatric Gastroenterology, Hepatology & Nutrition, The Children's hospital & University of child health sciences, Lahore, Lahore, Pakistan, 2The Department Of Pediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & University of Child Health sciences, Lahore, Pakistan
Objectives and Study: To compare the efficacy of intralesional triamcinolone injection versus topical mitomycin‐C application, in the treatment of pediatric benign recurrent esophageal strictures.
Methods: This randomized control trial was conducted at the department of Pediatric Gastroenterology and Hepatology, University of Child Health Sciences, Lahore, from 1st July 2023 to 30th June 2024. Patients with recurrent esophageal strictures, fulfilling the inclusion and exclusion criteria were enrolled in the study. They were randomly allocated into two groups; group A and group B. Patients in both groups were treated with endoscopic esophageal dilation with a CRE balloon. After adequate dilation of stricture, patients in Group A were treated with topical Mitomycin, which was applied to four quadrants at the stricture site. Whereas, patients in group B were treated with injection Triamcinolone, injected into four quadrants at the stricture site, using a sclerotherapy injector. Patients in both groups were followed and dysphagia severity score was noted at 0, 2 and 6 weeks of intervention. Dilation‐free period and the number of dilations needed per month were noted and compared in both groups.
Results: A total of 24 patients were enrolled in study – 12 in each, Group A (Mitomycin) and Group B (Triamcinolone). Median Dysphagia Severity Score (DSS) at 2 weeks post‐intervention was 1 (0‐1.5) in group A; whereas 2 (1‐2) in group B (p‐value = 0.01). Median DSS at 6 weeks post‐intervention was 1.5 (1‐2) in group A; whereas it was 3 (2‐3) in group B (p‐value = <0.001).
Conclusions: Topical Mitomycin was found to be more effective in our study, than injection Triamcinolone, in the treatment of pediatric benign recurrent esophageal strictures, in terms of symptomatic improvement (reduced Dysphagia Severity Score).
Contact e‐mail address: anjuj2002@gmail.com
G‐EP031. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EP031.1. CHARACTERISTICS OF PEDIATRIC PATIENTS WITH ACHALASIA AND EFFICACY OF PERORAL ENDOSCOPIC MYOTOMY: A LARGE‐SCALE MULTICENTER STUDY IN JAPAN
Ryusuke Yagi 1, Yuto Shimamura2, Hiroki Sato3, Hirofumi Abe4, Hironari Shiwaku5, Junya Shiota6, Chiaki Sato7, Kenta Hamada8, Masaki Ominami9, Yoshitaka Hata10, Hisashi Fukuda11, Ryo Ogawa12, Jun Nakamura13, Tetsuya Tatsuta14, Yuichiro Ikebuchi15, Haruhiro Inoue2
1Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan, 2Digestive Diseases Center, Showa University Koto‐Toyosu Hospital, Tokyo, Japan, 3Gastroenterology & Hepatology, Niigata University, Niigata, Japan, 4Gastroenterology, Kobe University Hospital, Kobe, Japan, 5Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Hukuoka, Japan, 6Gastroenterology & Hepatology, Nagasaki University Hospital, Nagasaki, Japan, 7Advanced Surgical Science And Technology, Tohoku University School of Medicine, Miyagi, Japan, 8Practical Gastrointestinal Endoscopy, Okayama University, Okayama, Japan, 9Gastroenterology, saka Metropolitan University Graduate School of Medicine, Osaka, Japan, 10Medicine And Bioregulatory Science, Kyushu University, Fukuoka, Japan, 11Gastroenterology, Jichi Medical University, Tochigi, Japan, 12Gastroenterology & Hepatology, Oita University, Oita, Japan, 13Endoscopy, ukushima Medical University Hospital, Fukushima, Japan, 14Gastroenterology And Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan, 15Gastroenterology And Nephrology, Tottori University Faculty of Medicine, Tottori, Japan
Objectives and Study: Peroral endoscopic myotomy (POEM) was introduced in 2010 as a minimally invasive and effective treatment for pediatric achalasia. However, its safety and long‐term outcomes in children have not been sufficiently studied. This study aims to clarify the clinical features of pediatric achalasia and evaluate the safety and long‐term efficacy of POEM in children.
Methods: A multicenter study involving 14 high‐volume centers was conducted. We compared clinical features of achalasia and outcomes following POEM between children (<18 years) and adults (<65 years).
Results: A total of 3421 achalasia patients including 50 children (1.5%) were enrolled from 2011 and 2021. Children were diagnosed earlier than adults (median 1.0 year vs. 3.4 years; p < 0.001) but presented with lower Body mass index (17.8 kg/m² vs. 20.9 kg/m²; p < 0.001), less esophageal dilation (46.0% vs. 64.1%; p = 0.013), and higher LES pressure (37.3 mmHg vs. 29.9 mmHg; p = 0.002). Despite severe weight loss in children, the increase of failure to thrive was not observed in children. POEM procedure times were shorter for children than adults (58.0 minutes vs. 83.0 minutes; p < 0.001) due to shorter esophageal myotomy lengths (8.0 cm vs. 9.0 cm; p = 0.010). The short‐term outcomes, including the severity of symptoms, reflux esophagitis (RE), and symptomatic GERD, in pediatric and adult patients were not significantly different (p = 0.998, p = 0.132, and p = 0.487, respectively). During a 5‐year follow‐up, children had lower rates of RE compared to adults (11.0% vs. 26.4%; p = 0.013). There was one case each of aspiration pneumonitis, pneumothorax, and mucosal perforation, all of which resolved with conservative treatment. The adverse event rates of the children and adults did not differ significantly (p = 1.000).
Conclusions: POEM is recommended for pediatric patients with esophageal achalasia because of its high efficacy and safety.
Contact e‐mail address: r-yagi@gunma-u.ac.jp
G‐EP032. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EP032.1. IS ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE PEDIATRIC POPULATION WITH CHRONIC PANCREATITIS SAFE AND EFFECTIVE? A POPULATION‐BASED STUDY
Yu Zhu 1, Zhaohui Deng1, Li Hong2
1Department Of Gastroenterology, Shanghai Children's Medical Center, Shanghai, China, 2Department Of Clinical Nutrition, Shanghai Children's Medical Center, Shanghai, China
Objectives and Study: Background and aims: Chronic pancreatitis (CP) in pediatric patients pose diagnostic and therapeutic challenges, often necessitating endoscopic retrograde cholangiopancreatography (ERCP). However, data on pediatric CP, especially in the Chinese population, remain limited. This study aimed to evaluate the safety, efficacy, and nutritional status of pediatric CP patients undergoing ERCP, along with long‐term follow‐up outcomes.
Methods: The study was conducted on 154 patients between 2019 and 2022, follow‐up assessments were conducted for 2 years to evaluate recurrence of pancreatitis, abdominal pain relief, BMI improvement and endocrine/exocrine function.
Results: The median age of patients was 9.5 years, with abdominal pain being the predominant symptom (88.96%). Genetic results identified SPINK1 and PRSS1 mutations in 90% of tested patients, with SPINK1 c.194+2 T＞C being the most common variant. 18% patients exhibited low BMI while 5% were classified as overweight or obese. Vitamin D deficiency was observed in 61.2% of patients. ERCP successful cannulation rate was 99.17%, with pancreas divisum (24.02%) and other anatomical anomalies observed. Early adverse events included post‐ERCP pancreatitis (PEP) (30.83%) and infection (0.28%). Age under 6 years old was identified as a risk factor for PEP (P = 0.024). ERCP significantly relieved abdominal pain in 75% of patients, especially in school‐aged children (81.63%). Recurrent pancreatitis occurred less frequently in school‐aged children than preschool‐aged children. The BMI increased significantly with a linear trend in school‐aged children (> 6 years old) (P = 0.054). One patient developed diabetes mellitus and no patients suffered from steatorrhea.
Conclusions: ERCP is a safe and effective procedure for managing pediatric CP, particularly in children older than 6 years. Regular nutritional assessment, vitamin D monitoring, and a multidisciplinary approach are essential for optimal management.
Contact e‐mail address: zhuyu_sjtu@163.com
G‐EP033. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐EP033.1. A HIGH‐RISK FOREIGN BODY REMOVAL
Bhaswati Acharyya
Paediatric Gastroenterology, Institute of Child Health, Kolkata, India
Objectives and Study:
A 5‐year‐old boy came with a history of ingestion of an open safety pin 1 day back. A chest x‐ray showed that the safety pin penetrated the oesophageal wall. The child was hemodynamically stable. A CT scan of the chest was undertaken to view where, in the mediastinum, the sharp tip of the pin pierced. It revealed that the sharp end pierced the right atrium. An endoscopy was done after taking a high‐risk consent and successfully removed the safety pin without any complication
Methods: The foreign body was removed by a rat toothed forceps. After taking it to the stomach the safety pin was drawn into the overtube and the scope was withdrawn gradually with the overtube with the safety pin in side the overtube.
Results: Post‐procedure, an echocardiography revealed a normal heart. A repeat chest CT scan showed no blood in the mediastinum
Conclusions: A calm brain and expertise is required to handle difficult foreign body removal
Contact e‐mail address: bacharyya21@gmail.com
G‐EP034. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐EP034.1. ENDOSCOPIC FULL‐THICKNESS RESECTION AND ITS ROLE IN THE DIAGNOSIS OF HIRSCHSPRUNG'S DISEASE IN PEDIATRIC PATIENTS
Ronaldo González García, Miriam Riedel, Marion Appel, André Hoerning
Pediatric Gastroenterology, Hepatology And Endoscopy, Department Of Pediatrics And Adolescent Medicine, University Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, Erlangen, Germany
Objectives and Study: Hirschsprung's disease is a congenital anomaly that affects intestinal motility. Its main characteristic is the absence of ganglion cells in the distal intestine, resulting in chronic constipation. The disease has an incidence of 1:5000, with males being more affected than females by a ratio of 4:1. Hirschsprung's disease is classified into 4 types. Short Hirschsprung (75‐80%), long Hirschsprung (10%), total colonic aganglionosis (5%), and ultrashort Hirschsprung (5‐10%). If Hirschsprung's disease is clinically suspected, imaging studies should be performed, and contrast enema is the radiologic test of choice. The gold standard to confirm the diagnosis is a full‐thickness biopsy of the distal rectal wall. For a biopsy to be considered adequate, it should be at least 3 mm in diameter. The submucosa should represent at least one‐third, ideally one‐half, of the thickness of the biopsy. Until now, confirmatory biopsies have been obtained through suction biopsies or an open surgical procedure. Therapeutic Endoscopic full‐thickness resection (EFTR) has been successfully used in adult endoscopy to treat various diseases of the lower gastrointestinal tract. This procedure has been shown to be safe and effective.
Methods: Case Report: We report two cases of patients in whom EFTR was succesfully performed for the diagnosis of Hirschsprung's disease.
Results: We present the cases of two pediatric patients, one male and one female, aged 8 and 10 respectively, in whom we succesfully performed EFTR for the diagnosis of Hischsprung's disease. The standard diagnostic measures yielded normal results. Because of the therapy refractory obstipation, we still suspected at least an ultrashort variant of Hirschsprung's disease. After reviewing the taken biopsies with our pathologists, the biopsies met the requirements to validate and exclude a suggested Hirschsprung's disease.
Conclusions: Endoscopic full‐thickness resection is a safe, time‐saving and successful method for obtaining biopsies in pediatric patients with suspected Hirschsprung's disease.
Contact e‐mail address: ronaldo.gonzalez@uk-erlangen.de
G‐EP035. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐EP035.1. BALLOON DILATATION OF CONGENITAL PERFORATED DUODENAL WEB IN NEWBORN
Kirill Marakhouski, Aleh Sautin
Endoscopy Department, Republican Research and Practical Center for Pediatric Surgery, Minsk, Belarus
Objectives and Study: The first endoscopic restoration of the duodenal lumen in patients with congenital perforated duodenal web (CPDW) was published in 1989 by the Okamatsu group from Tokyo. To date, only about 100 such cases have been published.
Methods: The study enrolled patients between December 2021 and December 2024. We performed upper gastrointestinal endoscopy preoperatively for all cases of congenital duodenal obstruction. The method we used in CDPW was balloon dilation over a pre‐installed guidewire. We aim to cannulate even endoscopically invisible holes in the membrane when fluoroscopic signs indicate contrast passage behind it. Cannulation is deemed successful when approximately 2‐3 cm of the rigid part of the guidewire is positioned behind the membrane. After securing the guidewire in place, we remove the endoscope. A balloon dilator is then advanced to the proximal end of the guidewire and passed into the stomach under direct endoscopic visualization. The balloon is positioned at the membrane level and inflated to the working pressure. Dilation is considered successful when the endoscope passes easily behind the web.
Results: All our patients (n = 9) during the period from 2021 to 2024 were neonates. The mean age at the time of the first operation was 0.1 months, and the mean weight was 3081.25 g [25th percentile: 2430 g; 75th percentile: 3650 g]. For all newborns, we started with an 8 mm balloon size and a dilation duration of 5 minutes. Two patients required conversion to laparotomy, which represents approximately 22% of the entire group. One year follow‐up shows age‐appropriate weight gain and no clinical signs of duodenal transit disorder, as well as a decrease in ratio of pre‐ and post‐ membrane diameters of the duodenum.
Conclusions: The use of the endoscopic method to treat CDPW in newborns is associated with better long‐term results; however, it also carries a high risk of duodenal perforation.
Contact e‐mail address: sautin.oleg@gmail.com
G‐EP036. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP036.1. TRIPLE REMISSION WITH DUPILUMAB IN PEDIATRIC REFRACTORY EOSINOPHILIC ESOPHAGITIS: A RETROSPECTIVE STUDY OF CLINICAL, ENDOSCOPIC, AND HISTOLOGICAL OUTCOMES
Ali Alsarhan 1, Zuhair Gahelnabi2, Christos Tzivinikos3
1Pediatrics Gastroenterology, Aljalial children's specialty hospital, DUbai, United Arab Emirates, 2Dubai Hospital, dubai, United Arab Emirates, 3Aljalial children's specialty hospital, DUbai, United Arab Emirates
Objectives and Study: Eosinophilic esophagitis is increasingly diagnosed in pediatrics, with many patients being refractory toconventional treatments like topical steroids, elimination diet or proton pump inhibitor. For such patients, weevaluated the response rates to Dupilumab, an Interleukin 4 and 13 inhibitor, with a focus on clinical, endoscopy,and histological outcomes. Remission was defined as <6 eosinophils per high power field (eos/hpf), and aresponse was considered with 6‐15 eos/hpf. Additionally, we assessed EoE Endoscopic Reference Scores (EREFS)and symptom resolution after 6‐months of treatment.
Methods: A cohort of 15 patients, aged 8 to 18 years, refractory to conventional treatments, underwent a six‐monthtreatment with Dupilumab. Two patients received top‐down treatment with Dupilumab due to multiple atopiccomorbidities and fibrosis observed on histology. Symptom evaluation utilized the Pediatric EoE Symptom Score(PEESS), endoscopic assessments were conducted using EREFS, and histological remission was assessed using theEoE Histological Severity Score (EOEHSS). These evaluations were performed both at the beginning and after sixmonths of treatment.
Results: Patients received Dupilumab injections of 300 mg weekly for those >12 years old and 200 mg weekly for those <12years old. Histological response was observed in 14% of cases, with 86% achieving remission. The EOEHSS score showed significant improvement, with the average grade dropping from 0.56 to less than 0.1, and the average stage decreasing from 0.42 to less than 0.1 (Figure). Initially, total PEESS scores ranged between 45 and 60. After six months of treatment, a substantial average reduction of 85% was noted, impacting 92% of patients. For all patients at the 6‐month mark, EREFS was zero. No notable side effects were reported, except for transient self‐resolved arthralgia. The use of other EoE medications and diet were discontinued with Dupilumab treatment.
Conclusions: In summary, our study confirms that Dupilumab can lead to clinical, endoscopic, and histological remission inpatients with refractory EoE or severe cases which failed conventional treatment.
Contact e‐mail address: dr.ali.sarhand@gmail.com
G‐EP037. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP037.1. IMPACT OF DUPILUMAB ON CAREGIVER‐REPORTED SIGNS OF EOE, USING PESQ‐C OVER 52 WEEKS: RESULTS FROM THE PHASE 3 EOE KIDS STUDY
Jonathan Spergel1, Mirna Chehade 2, Dhandapani Ashok3, Changming Xia4, Sherif Zaghloul5, Bram Raphael4, James Angello5, Amr Radwan4, Sarette Tilton6, Eilish Mccann4
1Children's Hospital of Philadelphia, Philadelphia, United States of America, 2Mount Sinai Center For Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, United States of America, 3Children's Hospital, London Health Sciences Centre, Western University, London, Canada, 4Regeneron Pharmaceuticals Inc., Tarrytown, United States of America, 5Sanofi, Bridgewater, United States of America, 6Sanofi, Cambridge, United States of America
Objectives and Study: We assessed the effect of dupilumab on signs of eosinophilic esophagitis (EoE) using the Pediatric EoE Sign/Symptom Questionnaire‐Caregiver version (PESQ‐C) in children aged 1–11 with active EoE in the phase 3 EoE KIDS study.
Methods: In Part A, patients were randomized to receive weight‐tiered dupilumab or placebo for 16 weeks. In Part B, all patients received weight‐tiered dupilumab for 36 weeks. The PESQ‐C measures occurrence of EoE signs observed by caregivers (stomach pain, heartburn, acid reflux, regurgitation, vomiting, food refusal, trouble swallowing food, food stuck in throat). The percentage change from Part A baseline in the proportion of days with ≥1 EoE sign, measured by PESQ‐C, over the 14‐day period prior to their assessment was assessed.
Results: At Week 16, the percent reduction from baseline in proportion of days with ≥1 EoE sign was numerically greater with dupilumab (percentage least‐squares [LS] mean [95% confidence interval (CI)] −48.5% [−73.4%, −23.6%]) vs placebo (−19.7% [−45.3%, 6.0%]) (P = 0.0975). At Week 52, both dupilumab groups showed similar reduction from baseline (placebo/dupilumab: −83.4% [−100.0%, −100.0%]); dupilumab/dupilumab: −80.7% [−100.0%, −68.5%]). At Week 16, food refusal (LS mean difference [95% CI] vs placebo: −17.89 [ − 49.2, 13.5]; P = 0.2641), trouble swallowing (−14.9 [ − 55.6, 25.9]; P = 0.4748), and acid reflux (−11.3 [ − 43.5, 20.9]; P = 0.4911) were the individual signs that showed the largest placebo‐adjusted improvement with dupilumab from baseline (Figure). At Week 16, dupilumab improved PESQ‐C scores vs placebo across all ages (≥1 − < 4, ≥4 − < 8, and ≥8 − 11 years).
Conclusions: Dupilumab improved (reduced) the proportion of days with one or more caregiver‐reported EoE signs at Week 16 in the phase 3 EoE KIDS study; results were sustained and/or improved up to 52 weeks. Food refusal, trouble swallowing, and acid reflux were the signs that showed the most improvement from baseline with dupilumab treatment vs placebo.
Contact e‐mail address: SPERGEL@chop.edu
G‐EP038. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP038.1. DUPILUMAB IS EFFECTIVE IN TREATING EOE IN PATIENTS WEIGHING ≥ 15 KG REGARDLESS OF CONCOMITANT PPIS, HISTORY OF SWALLOWED CORTICOSTEROIDS, OR ELIMINATION DIETS
Mirna Chehade 1, Salvatore Oliva2, Antonella Cianferoni3, Changming Xia4, Sherif Zaghloul5, Bram Raphael4, Amr Radwan4, James Angello5
1Mount Sinai Center For Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, United States of America, 2Pediatric Digestive Endoscopy, Pediatric Gastroenterology And Liver Unit, University Hospital Umberto, Sapienza University of Rome, Rome, Italy, 3Department Of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States of America, 4Regeneron Pharmaceuticals Inc., Tarrytown, United States of America, 5Sanofi, Bridgewater, United States of America
Objectives and Study: Dupilumab is approved in the USA and EU for the treatment of patients aged ≥1 year, weighing ≥15 kg with eosinophilic esophagitis (EoE). The objective was to evaluate dupilumab's efficacy by previous treatment history, focusing on the approved pediatric population weighing ≥15 kg.
Methods: In Part A of EoE KIDS (NCT04394351), patients were randomized to receive weight‐tiered dupilumab or placebo for 16 weeks. In Part B, all patients received weight‐tiered dupilumab for 36 weeks. Endpoints evaluated were the primary endpoint of EoE KIDS: proportion of patients achieving ≤6 eosinophils per high‐powered field (eos/hpf); and secondary endpoints; proportion achieving <15 eos/hpf, and change in Endoscopic Reference Score (EREFS) and Pediatric EoE Sign/Symptom Questionnaire‐Caregiver version (PESQ‐C). Treatment efficacy was analyzed in 3 subgroups: prior use of swallowed topical corticosteroids (STCs), concomitant proton pump inhibitor (PPI) treatment, and history of food elimination diet (FED).
Results: Dupilumab improved rates of histologic remission vs placebo at Week 16, regardless of prior STC use (yes: 59.3% vs 0.0%, no: 100.0% vs 20.0%), treatment with concomitant PPIs (yes: 82.4% vs 0.0%, no: 46.7% vs 4.8%), or history of FE diet (yes: 67.9% vs 4.0%, no: 50.0% vs 0.0%). Responses were maintained at Week 52 in patients continuing dupilumab and improved in patients who switched from placebo to dupilumab, regardless of prior STC use, treatment with concomitant PPIs, or history of FED, although patient numbers in some subgroups were small. A similar pattern of improvement regardless of subgroup was observed in patients achieving <15 eos/hpf, EREFS total score, and PESQ‐C in patients weighing ≥15 kg (Table). Dupilumab was generally well tolerated.
Conclusions: Dupilumab demonstrated improvements vs placebo in histologic, endoscopic, and symptomatic aspects of EoE in the ≥15 kg population up to Week 52, regardless of concomitant PPIs, or history of STCs or elimination diets.
Contact e‐mail address: mirna.chehade@mssm.edu
G‐EP039. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP039.1. TSLP ISOFORMS AND ITS RECEPTOR IN PEDIATRIC PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
Antonio Colucci 1, Martina Milano1, Caterina Strisciuglio1, Anne Lise Ferrara2, Stefania Loffredo3, Leonardo Cristinziano3, Mara Creoli1, Remo Poto3, Diego Torre1, Claudia Chiantese4, Marianna Casertano4, Erasmo Miele5, Massimo Martinelli5, Gilda Varricchi3
1Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy, 22department Of Translational Medical Sciences, University of Naples Federico II, Naples, Italy, 3Department Of Translational Medical Sciences, University of Naples Federico II, Naples, Italy, 4Department Of Translational Medical Science, Section Of Pediatrics, University of Naples "Federico II", Napoli NA, Italy, 5Department Of Translational Medical Science, Section Of Pediatrics, University of Naples Federico II, NAPOLI, Italy
Objectives and Study: Thymic stromal lymphopoietin (TSLP) is a pleiotropic cytokine which exerts its biological effects by binding to a high‐affinity heteromeric complex (TSLP receptor:TSLPR) chain and IL‐7Rα). TSLP is primarily expressed by intestinal and lung epithelial cells. There are two TSLP variants in human tissues: the main isoform (short form: sfTSLP) expressed in steady state and the long form (lfTSLP), which can be upregulated in inflammatory conditions. TSLP/TSLPR axis plays a central role in type 2 inflammatory diseases, including asthma, atopic dermatitis, and eosinophilic esophagitis (EoE).
Methods: In this study, we evaluated the constitutive expression of TSLP isoform mRNAs and its receptor chains (TSLPR and IL‐7Rα) in esophageal biopsies in 8 children with EoE at diagnosis enrolled consecutively. Total RNA was isolated with RNeasy plus Minikit. RNA quality and integrity was estimated with 2100 Agilent Bionalyzer. Total mRNA was reverse‐transcribed (high capacity cDNA RT) and quantitative RT‐PCR was carried out in Master Cycler realplex using iTaqtm Universal SYBR® Green Supermix.
Results: Constitutive sfTSLP mRNA was expressed in esophageal biopsies of all eight patients with EoE. lfTSLP mRNA was expressed to a lesser extent in biopsies of the same donors. TSLPR mRNA was also expressed in esophageal biopsies of all eight subjects. By contrast, IL‐7Rα mRNA was constitutively expressed only in a minority of examined subjects.
Conclusions: Our findings indicate that the TSLP/TSLPR axis is involved in the pathobiology of pediatric EoE, and these proteins could be novel therapeutic targets as there is already the drug that regulates this axis. The lower expression of lfTSLP may be associated with a compensatory mechanism; however, further studies are needed to better understand its role.
Contact e‐mail address:
G‐EP040. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP040.1. TRANSLATION AND VALIDATION OF PEDIATRIC QUALITY OF LIFE INVENTORY, EOSINOPHILIC ESOPHAGITIS MODULE (PEDS QL EOE) IN A FRENCH POPULATION
Ambre Filippi1, Virginie Dupont1, Gael Kornitzer2, Mathilde Butori1, Valérie Triolo1, Dany Ngwanou1, Olivier Courbette 1
1Pediatrics, CHU Nice‐ Hôpital LENVAL, Nice, France, 2Pediatric Gastroenterology, Hopitaux Shriners pour enfants, Montréal, Canada
Objectives and Study: Objective: Eosinophilic esophagitis (EoE) is a chronic esophageal disorder. The Pediatric quality of life questionnaire (PedsQL) EoE module was developed in English. The purpose of the present study was to translate and cross‐culturally adapt this questionnaire into French and to study the reliability and validity of this version.
Methods: The translation and cross‐cultural adaptation of the original “PedsQL EoE module" was performed according to established guidelines. The translation part was carried out in five stages: (I) two initial translations from English to French; (II) synthesis of the two translations; (III) backward translations; (IV) comparison between the backward translations and the original questionnaire by an expert and (V) approval of the final version of the French‐language questionnaire. To validate this questionnaire, 19 children and 19 parents/caregivers were recruited. The internal consistency of the questionnaire was tested, as well as its test–retest reliability.
Results: The French version of the “PedsQL EoE module” was generated without any major difficulties. A high internal consistency (Cronbach's alpha of 0.88) for the 8‐12 years old and 13‐18 years old subscales and an excellent test–retest reliability (Pearson's correlation of 0.97 (IC 95%: 0.96‐0.98)) indicated that the questionnaire is reliable in those age groups. Low floor effects and ceiling effects were observed. Inter‐rater and intra‐rater correlation were excellent, respectively with ICC of 0.9 and 0.93.
Conclusions: Conclusion: The French version of the « PedsQL EoE module » was successfully translated and cross‐culturally adapted. The questionnaire is consistent, valid and reliable for evaluating French‐speaking children with eosinophilic esophagitis.
Contact e‐mail address: olivier.courbette@gmail.com
G‐EP041. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP041.1. EREFS SCORE EFFECTIVENESS IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS: A 10 YEARS EXPERIENCE
Emanuele Esposito, Giulia Farina, Cosimo Ruggiero, Giusy Russo, Carla Giordano, Paola Papoff, Salvatore Oliva
Maternal And Child Health Department, Sapienza University of Rome, Rome, Italy
Objectives and Study: Primary objective was to evaluate the association between endoscopic score EREFS and histological activity within a pediatric cohort with Eosinophilic Esophagitis (EoE). Study also aimed to evaluate EREFS items predictivity, independently of total score and cut‐off of 2, and to calculate sensitivity and specificity of EREFS and its single items identifying patients with histological activity.
Methods: A retrospective longitudinal single‐centre study was conducted, collecting data about endoscopies performed in EoE referral centre over the last 10 years, including EoE pediatric patients without other eosinophilic diseases nor esophageal chronic conditions. Associations were analyzed through chi‐squared tests, predictivity was assessed through logistic regressions. A p‐value < 0.05 was used to define the statistical significance.
Results: Data about 257 endoscopies from 52 patients were collected, with 1.10 ± 1.19 mean EREFS. A positive score was significantly associated with histological activity (≥ 2 in 61.3% of endoscopies with disease activity, 6.9% of those in remission), such as each single item except of “stenosis”, because of its rarity in children. Ability of EREFS to predict histological activity was confirmed by Odds Ratio (OR) of 6.69. In multivariate analysis only “exudates” and “furrows” showed statistically significant OR (7.207 and 7.453, respectively). EREFS ≥ 2 showed poor sensitivity (61.29%) and good specificity (93.08%). Exudates presence showed poorer sensitivity and similar specificity, furrows showed greater sensitivity but poorer specificity (Table 1).
Table 1
| Parameter | Sensitivity (95% CI) | Specificity (95% CI) |
|---|---|---|
| EREFS ≥ 2 | 61.29% (52.13% – 69.90%) | 93.08% (87.26% ‐ 96.79%) |
| Exudates | 54.92% (45.65% ‐ 63.94%) | 93.85% (88.23% ‐ 97.31%) |
| Furrows | 70.49% (61.56% ‐ 78.40%) | 79.23% (71.24% ‐ 85.84%) |
Conclusions: Our study showed significant association between EREFS and histological activity in a pediatric cohort, with predictivity of inflammatory items “exudates” and “furrows”. A better stratification of these two parameters could improve score variability and sensitivity, thus enhancing the value of endoscopy in therapeutic management of EoE children.
Contact e‐mail address: emanuele.esposito@uniroma1.it
G‐EP042. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP042.1. IS SUSTAINED HISTOLOGICAL REMISSION POSSIBLE AFTER TREATMENT DISCONTINUATION IN PAEDIATRIC PATIENTS WITH EOSINOPHILIC OESOPHAGITIS?
Alejandro García Díaz 1, Celia Montero Torres2, Tamara Arauzo Otero3, Sergio Martín Lozoya2, Sonia Fernández Fernández4, Enriqueta Román1, Maria Luz Cilleruelo1, Carolina Gutiérrez Junquera1
1Paediatric Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain, 2Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain, 3Hospital Severo Ochoa, Leganés (Madrid), Spain, 4Paediatric Gastroenterology, Hospital Universitario Severo Ochoa. Leganés, Madrid, Spain
Objectives and Study: Eosinophilic oesophagitis (EoE) is a chronic disease that relapses without treatment. There is limited data on its progression after discontinuation of treatment. The aims of this study are to describe the clinical profile of patients who have discontinued treatment and to assess the rate of histological relapse.
Methods: Retrospective study of patients diagnosed with EoE in two hospitals. Inclusion criteria were: 1) patients < 18 years of age at diagnosis; 2) in histological remission with treatment; 3) treatment discontinued and histological evaluation at least 3 months after discontinuation. Data on treatments administered, clinical, endoscopic and histological findings were analysed. Histological relapse was defined as the presence of ≥ 15 eos/hpf in any of the biopsies.
Results: Of the 246 patients reviewed, treatment was discontinued in 36 (14.4%). Those patients showed mostly inflammatory phenotype (83%) and 80% of them presented sustained remission with the first treatment. Treatment discontinued was PPIs in 28 (78%), STCs in 7 (19%) and diet in one. Thirty[CG1] ‐nine percent (14/36) of patients remained in histological remission after cessation of treatment, representing 5.6% of our cohort (14/246), with a time until the last endoscopy of 35 months (17.8‐50.8). Histological relapse occurred in 61% (22/36) of patients, with a time from discontinuation to relapse of 16.7 months (9.3‐28.6). No differences in demographic, clinical, endoscopic and histological data at diagnosis were observed between patients who experienced histological relapse and those who did not. However, the duration of the last treatment to its discontinuation was longer in the group that maintained remission (23.2 vs. 35.9 months, p = 0.006).
Conclusions: In our cohort, treatment was discontinued in patients with mild clinical profile, and almost 40% of them maintained histological remission for an average of 35 months. Patients that did not relapse had received treatment for a longer period before discontinuation.
Contact e‐mail address:
G‐EP043. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP043.1. ABERRANT NOTCH SIGNALING IN PEDIATRIC EOSINOPHILIC ESOPHAGITIS: IMPLICATIONS FOR IMMUNE DYSREGULATION
Sarah Shamim Khan1, Farinaz Nazmi 2, Ozgur Albayrak3, Cigdem Arikan1,2
1KOC UNIVERSITY HOSPITAL, GRADUATE SCHOOL OF HEALTH SCİENCES, ISTANBUL, TURKEY, ISTANBUL, Turkey, 2KOC UNIVERSITY HOSPITAL, PEDİATRIC HEPATOLOGY AND NUTRITION, ISTANBUL, TURKEY, ISTANBUL, Turkey, 3KOC UNIVERSITY CENTER CENTER FOR TRANSLATIONAL MEDICINE (KUTTAM), KOC UNIVERSITY, ISTANBUL, TURKEY, ISTANBUL, Turkey
Objectives and Study: T cells play a crucial role in the pathogenesis of eosinophilic esophagitis (EoE), and Notch signaling is essential for T cell development. Given the overlap between EoE and allergic diseases, where dysregulated Notch signaling has been reported, this study hypothesizes a role for aberrant Notch signaling in EoE.
Methods: Pediatric patients with active EoE (n = 17), EoE in remission (n = 17), and healthy controls (n = 7) were evaluated. Lymphocytes were isolated from peripheral blood and biopsy samples (esophagus and duodenum) and analyzed by flow cytometry for Notch‐1, ‐2, ‐3, and ‐4 receptor expression on CD45+ lymphocytes, T cell subsets, CD20 + B cells, memory T cells, MAIT cells, and regulatory T cells.
Results: Active EoE showed a significant increase in esophageal CD45+ cells (median = 55%) compared to healthy controls (median = 6%) (p = 0.01) and remission patients (median = 7%) (p = 0.002), indicating localized esophageal inflammation. Notch receptor expression, particularly Notch‐1, was significantly reduced during active EoE across MAIT cells in PBMCs (2.635% ‐0.77%, p = 0.01), esophagus (0.1%‐14%, p = 0.01), and duodenum (0.75%‐5.9%, p = 0.03) as well as Tregs (0.3% ‐1.3%, p = 0.0004), (0.1%‐7%, p = 0.003), (0.1%‐ 8.2%, p = 0.02) in PBMCs, esophagus and duodenum respectively. Patients with basal cell hyperplasia (BCH) had lower Notch receptor levels (median = 0.3%,) compared to those without BCH (median = 0.7%) (p = 0.04), suggesting a role for Notch signaling in epithelial barrier dysfunction. Positive correlations between Notch receptor expression in PBMCs and tissue samples (esophagus and duodenum) (P = 0.003, r = 0.6863) indicated systemic dysregulation, while negative correlations with eosinophil counts (p = 0.002, r = ‐0.4594) highlighted an association between reduced Notch signaling and disease severity.
Conclusions: Notch‐1 downregulation may underlie immune dysregulation in EoE, contributing to disease pathogenesis and epithelial changes. Reduced Notch‐1 expression on MAIT cells suggests its potential as a biomarker for disease severity and a target for therapeutic intervention.
Contact e‐mail address: cigdemarikanmd@yahoo.com
G‐EP044. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP044.1. DUPILUMAB IMPROVES CAREGIVER‐REPORTED EOSINOPHILIC ESOPHAGITIS SYMPTOMS IN CHILDREN AGED 1–11 YEARS: 16‐WEEK RESULTS FROM THE PHASE 3 EOE KIDS STUDY
Dhandapani Ashok1, Marc Rothenberg2, Benjamin Gold3, Navneet Virk Hundal4, Salvatore Oliva 5, Changming Xia6, Sherif Zaghloul7, Bram Raphael6, Sarette Tilton8, Ryan Thomas6
1Pediatrics, Western University, London, Canada, 2Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America, 3Children's Center for Digestive Healthcare, LLC, Gi Care for Kids, LLC, Atlanta, United States of America, 4Food Allergy Center, Massachusetts General Hospital, Boston, United States of America, 5Pediatric Digestive Endoscopy, Pediatric Gastroenterology And Liver Unit, University Hospital Umberto, Sapienza University of Rome, Rome, Italy, 6Regeneron Pharmaceuticals Inc., Tarrytown, United States of America, 7Sanofi, Bridgewater, United States of America, 8Sanofi, Cambridge, United States of America
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic, type 2 inflammatory disease characterized by esophageal barrier dysfunction as well as mucosal inflammation, and, in some patients, esophageal narrowing and scarring. The validated Pediatric Eosinophilic Esophagitis Symptom Score, version 2.0 (PEESSv2.0) measures patient‐relevant domains (dysphagia, gastroesophageal reflux disease [GERD], nausea/vomiting, and pain). The objective of this research was to evaluate the proportion of pediatric patients with EoE symptoms achieving a measurable improvement in symptom response scores, as measured by the PEESSv2.0.
Methods: This post hoc analysis of data from the phase 3 EoE KIDS study (NCT04394351) included patients aged 1–11 years with EoE who were randomized to weight‐tiered dupilumab higher exposure, or placebo, to Week 16. PEESSv2.0 total score (0–100; higher scores indicate greater symptom burden) was evaluated at baseline and Week 16. Response rates in dupilumab‐ and placebo‐treated patients were compared across a range of percent reduction from baseline response thresholds (≥25%, ≥50%, ≥75%, and 100%).
Results: Dupilumab treatment led to a greater reduction in PEESSv2.0 total score versus placebo at Week 16 (least squares mean difference [95% confidence interval] ‐8.03 [‐15.39, ‐0.67]). Greater proportions of patients achieved a range of PEESSv2.0 total score reduction thresholds with dupilumab versus placebo at Week 16 (Table). Overall safety was consistent with the known dupilumab safety profile.
Conclusions: Sixteen weeks of dupilumab treatment led to an improvement in caregiver‐reported symptoms (including pain, dysphagia, GERD, nausea, and vomiting) versus placebo across all symptom scoring thresholds assessed using PEESSv2.0. These findings suggest that dupilumab is a viable treatment option for pediatric patients aged 1–11 years with EoE.
Contact e‐mail address: mirna.chehade@mssm.edu
G‐EP045. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP045.1. HEALTH‐RELATED QUALITY OF LIFE IN ITALIAN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS: CORRELATIONS WITH SYMPTOMS, PSYCHOLOGICAL DISTRESS AND THERAPIES‐THE EXPERIENCE OF OUR CENTER
Alessandra Maria Ricci 1, Francesco Milo2, Renato Tambucci3, Monica Malamisura3, Maria Cristina Artesani4, Sara Urbani5, Alessandro Giovanni Fiocchi6, Paola De Angelis3, Francesca Rea3
1Gastroenterology and Nutrion Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy, 2Clinical Psychology Unit, Bambino Gesù Children's Hospital, Rome, Italy, 3Gastroenterology And Nutrition Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy, 4Allergy Unit, Bambino Gesù Children's Hospital IRCCS, rome, Italy, 5Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy, 6Allergy Unit, Bambino Gesù Children's Hospital, IRCCS., Rome, Italy
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic inflammatory and immune‐mediated disorder, characterized by esophageal dysfunction and mucosal eosinophilic inflammation. Symptoms, invasive diagnostic procedures and therapies can significantly affect the quality of life (QoL) of children and their families. There is no study in the literature assessing QoL of Italian children with EoE. The aims of this study were: 1) to evaluate QoL in an Italian pediatric cohort with EoE, and 2) to investigate the correlation between QoL, PEESS, EREFS, and I‐SEE scores, psychosocial distress symptoms, and the impact of different therapies on QoL.
Methods: QoL was assessed using PedsQL‐4.0 generic and PedsQL‐EoE, translated into Italian following international guidelines. Demographic and clinical characteristics were retrieved from medical charts. Hospital anxiety and depression scale (HADS) was used to screen anxiety and depression symptoms.
Results: Eighty‐two Caucasian children with EoE (mean age: 14.9 ± 5; 78% male) and 82 parents were enrolled. Symptom I (vomiting, nausea, heartburn), Symptom II (dysphagia), Treatment, and Concerns were significantly lower compared to other areas of Peds‐EoE (p < 0.01). Self‐reports and parent reports showed good agreement. Peds‐EoE showed a strong correlation with PEESS (r = ‐0.40; p < 0.01), but not with EREFS. Statistically significant correlations were found between Peds‐EoE and I‐SEE in Symptom II area (r = ‐0.35; p < 0.01), and between Peds‐EoE and HADS (r = ‐0.43; p < 0.01 and r = ‐0.34; p < 0.01). No statistically significant differences in QoL were found based on gender or type of therapy.
Conclusions: QoL of our cohort is comparable to that of children with EoE in other countries. Dysphagia is the most impactful symptom, reflecting disease severity. Anxiety and depression worsen QoL, emphasizing the need for psychological evaluations. The Italian PedsQL‐EoE version may be a useful instrument for QoL assessment, pending further validation.
Contact e‐mail address: alemaria.ricci@gmail.com
G‐EP046. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP046.1. IMPACT OF DUPILUMAB IN PEDIATRIC PATIENTS WITH EOE OVER 52 WEEKS: ENDOSCOPIC RESULTS FROM THE PHASE 3 EOE KIDS STUDY
Shauna Schroeder1, Calies Menard‐Katcher2, Christoph Schlag 3, Changming Xia4, Sherif Zaghloul5, Bram Raphael4, James Angello5, Amr Radwan4
1Division Of Gastroenterology, Hepatology, And Nutrition, Phoenix Children's Hospital, Phoenix, United States of America, 2Gi Digestive Health Institute, Children's Hospital Colorado, Aurora, United States of America, 3Department Of Gastroenterology And Hepatology, University Hospital Zürich, Zürich, Switzerland, 4Regeneron Pharmaceuticals Inc., Tarrytown, United States of America, 5Sanofi, Bridgewater, United States of America
Objectives and Study: We assessed the impact of dupilumab on EoE‐Endoscopic Reference Score (EREFS) in children aged 1–11 years with active EoE through 52 weeks in the phase 3 EoE KIDS study (NCT04394351).
Methods: EoE KIDS consisted of a 16‐week, double‐blind period (Part A) and 36‐week extension (Part B). Patients were randomized to receive weight‐tiered dupilumab or placebo in Part A, followed by dupilumab in Part B. We report EREFS total and sub‐scores based on the worst observed region.
Results: At Week 16, the mean percent change (standard deviation) from baseline was significantly greater with dupilumab vs placebo for EREFS total score (‐48.3 [28.0] vs 11.3 [70.2], P < 0.0001) and inflammation sub‐score (‐54.4 [22.9] vs 11.4 [55.6], P < 0.0001; Figure). The proportion of patients achieving endoscopic remission (EREFS total score ≤2) was significantly greater with dupilumab vs placebo at Week 16 (Table). At Week 52, improvements were maintained or increased with dupilumab, and improvements were observed in patients who switched to dupilumab at Week 16.
Table. Proportion of patients with EREFS score ≤2 and 0 by worst observed region at Weeks 16 and 52.
| Week 16 | Week 52 | |||
|---|---|---|---|---|
| Placebo | Dupilumab | Placebo | Dupilumab | |
| EREFS score 0, n (%) | 0 (0.0) | 1 (2.7) | 2 (12.5) | 10 (30.3) |
| Difference (95% CI)a | 2.7 (‐2.5, 8.0) | |||
| EREFS score ≤2, n (%) | 3 (8.8) | 27 (73.0) | 9 (56.3) | 28 (84.8) |
| Difference (95% CI)a | 64.3 (47.5, 81.1)**** | |||
****P < 0.0001. aDifferences between treatment groups at Week 16 are based on Mantel–Haenszel method, stratified by baseline weight group (≥5– < 15 kg, ≥15– < 30 kg, ≥30– < 60 kg).
CI, confidence interval; EREFS, Endoscopic Reference Score.
Conclusions: The validated EREFS tool is a systematic endoscopic scoring system. Dupilumab improved EREFS total score and inflammation sub‐scores, and proportions of patients achieving total scores ≤2 (remission) and 0 (normalization).
Contact e‐mail address: sschroeder3@phoenixchildrens.com
G‐EP047. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP047.1. TRANSCRIPTOME CHARACTERIZATION BY SINGLE CELL RNA SEQUENCING IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
Laura Stronati 1, Claudia Carissimi1, Salvatore Oliva2, Giusy Russo2, Danila Volpe2, Giuseppe Pietropaolo1, Ilaria Laudadio1, Giuseppe Sciumè1, Valerio Fulci1, Aliberti Arianna1, Fionda Cinzia1, Helena Stabile1, Salvatore Cucchiara2
1Department Of Molecular Medicine, Sapienza University of Rome, Rome, Italy, 2Department Of Maternal Infantile And Urological Sciences, Sapienza University of Rome, rome, Italy
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic immune‐mediated disorder characterized by eosinophilic inflammation and esophageal dysfunction symptoms mainly triggered by exposure to dietary antigens. EoE has risen rapidly worldwide over the last 15 years in western countries, making the disease a serious scientific and clinical challenge. EoE pathogenesis mainly relies on a complex interplay of genetic predisposition and exposure to food or environmental allergens that activate a Th2‐mediated immune response. In this study, we aimed to comprehensively characterize the transcriptome and biological functions of CD45+ cells in EoE using single‐cell RNA sequencing (scRNA‐seq) approach.
Methods: Ten EoE patients were enrolled at the Pediatric Gastroenterologist Unit of the Sapienza University of Rome‐Policlinico Umberto I Hospital. CD45+ cells, isolated from the esophageal biopsies of subjects with active EoE (n = 5) and in clinical remission EoE (n = 5), were profiled by scRNA‐seq. Besides, cell‐cell communication was investigated using Cellchat software.
Results: Seven distinct CD45+ cell populations were identified using established prototype markers, namely CD4, CD8, mast cells, CD8, B cells, Th2, natural killer and Tregs. Obtained data did not show any difference between EoE patients with active and inactive disease in term of cell type populations. Further, cell‐cell communication network among cell populations was analyzed between the two EoE patient groups. Results showed an increased number of potential cell‐cell communication networks in the active compared to inactive EoE subjects. Moreover, in Th2 and Treg cells, a de‐regulation of MHC‐I, Cyclophilin A and CLEC (C‐type lectins) signaling patterns in active EoE patients was observed.
Conclusions: This study suggests that the improper regulation in Th2 and Treg cells of MHC‐I, Cyclophilin A and CLEC (C‐type lectins) extracellular signaling pathways may be involved in the pathogenesis of EoE.
Contact e‐mail address: laura.stronati@uniroma1.it
G‐EP048. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EP048.1. DUPILUMAB IMPROVES HISTOPATHLOGIC DISEASE ACTIVITY OVER 52 WEEKS IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS: FINDINGS FROM THE PHASE 3 EOE KIDS STUDY
Margaret Collins1, Diana Lerner2, Robert Pesek3, Noam Zevit 4, Changming Xia5, Sherif Zaghloul6, Bram Raphael5, James Angello6, Amr Radwan5
1Division Of Pathology And Laboratory Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, United States of America, 2Section Of Gastroenterology, Hepatology, And Nutrition, Medical College of Wisconsin, Milwaukee, United States of America, 3Division Of Allergy/immunology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, United States of America, 4Institute Of Gastroenterology, Nutrition, And Liver Disorders, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, 5Regeneron Pharmaceuticals Inc., Tarrytown, United States of America, 6Sanofi, Bridgewater, United States of America
Objectives and Study: To determine the histopathologic effect of dupilumab on esophageal inflammation in patients aged 1–11 years with eosinophilic esophagitis (EoE) from the phase 3 EoE KIDS trial.
Methods: In Part A, patients were randomized to receive weight‐tiered dupilumab or placebo for 16 weeks. In Part B, all patients received weight‐tiered dupilumab for 36 weeks. Biopsies from proximal, mid, and distal esophageal regions were analyzed. Peak eosinophil count (PEC) and EoE Histologic Scoring System (HSS) grade/stage scores were assessed at baseline, Week 16, and Week 52.
Results: At Week 16, dupilumab vs placebo treatment resulted in significantly greater improvements in PEC (least squares mean percent change ‐86.09% vs 20.98%, respectively; P < 0.0001; Figure) and improvements from baseline were observed in EoE‐HSS grade and stage total scores, and inflammatory and architectural sub‐scores (Table). Improvements were maintained at Week 52 with continued dupilumab. For those who switched from placebo at Week 16, improvements were observed at Week 52. Improvements in individual component scores were also observed.
Table. Mean percent change from Part A baseline in EoE‐HSS scores at Weeks 16 and 52.
| Week 16a | Week 52 | ||||
|---|---|---|---|---|---|
| Placebo (N = 34) | Dupilumab (N = 37) | LS mean difference | Placebo (N = 18) | Dupilumab (N = 37) | |
| EoE‐HSS grade | |||||
| Total score | 5.0% | ‐64.4% | ‐69.4**** | ‐63.6% | ‐68.5% |
| Inflammatory sub‐score | 5.7% | ‐77.4% | ‐83.1**** | ‐79.4% | ‐83.7% |
| Architectural sub‐score | 1.0% | ‐50.5% | ‐51.5**** | ‐45.3% | ‐55.5% |
| EoE‐HSS stage | |||||
| Total score | 5.8% | ‐62.3% | ‐68.1**** | ‐58.2% | ‐63.5% |
| Inflammatory sub‐score | 7.9% | ‐96.3% | ‐104.3**** | ‐89.6% | ‐96.6% |
| Architectural sub‐score | 9.0% | ‐41.0% | ‐50.0**** | ‐32.4% | ‐51.0% |
****P < 0.0001. aLS mean percent change.
EoE‐HSS, Eosinophilic Esophagitis Histologic Scoring System; LS, least squares.
Conclusions: Dupilumab treatment improved a range of histopathologic aspects of EoE through 52 weeks versus placebo in children aged 1–11 years with EoE.
Contact e‐mail address: Margaret.Collins@cchmc.org
G‐EP049. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EP049.1. THE COMBINATION OF LACTOBACILLUS ACIDOPHILUS AND LIMOSILACTOBACILLUS REUTERI DSMZ 25441 HAS AN IMPACT ON CHILDREN WITH ACUTE INFECTIOUS DIARRHEA: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
Necibe Goktas1, Ener Dinleyici 2, Sirin Guven1
1Department Of Pediatrics, University of Health Sciences, Sancaktepe Training and Research Hospital, Istanbul, Turkey, 2Department Of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
Objectives and Study: Previous studies and society guidelines have proposed probiotics as a complementary therapy for acute diarrhea, but the effect was strain‐specific. We aim to evaluate the effect of a combination of Lactobacillus acidophilus and Limosilactobacillus reuteri on the duration of diarrhea in children with acute infectious diarrhea.
Methods: Children (6 to 120 months) with acute infectious diarrhea lasting less than 24 hours participated in this single‐center, randomized clinical trial. The children received conventional therapy with or without the combination of L. acidophilus and L. reuteri DSMZ 25441 for five days. The primary endpoint was the duration of diarrhea (in hours). The secondary outcome measures included the percentage of children who did not have diarrhea at 72 hours, 120 hours, and the 10th day of the study.
Results: We analyzed the data of 145 children, 79 in the probiotic group and 66 in the control. The duration of diarrhea was significantly reduced in the probiotic group compared to the control group (46.4 ± 29.6 hours vs. 81.6 ± 38.5 hours, p < 0.001). The percentage of diarrhea‐free children was significantly larger in the probiotic group at 72 hours compared to the control (86.0% vs. 33.3%, p < 0.001). The percentage of diarrhea‐free children was significantly larger in the probiotic group at 120 hours compared to the control (93.6% vs. 83.3%, p < 0.001). There is no difference on the 10th day of the study. The combination of L. acidophilus and L. reuteri is well tolerated, and no adverse events have been reported.
Conclusions: This is the first clinical trial to test the combination of L. acidophilus and L. reuteri and show its effects on diarrhea duration in children with acute infectious diarrhea. Adding probiotics to treatment is well tolerated and reduces the duration of diarrhea by approximately 35 hours when it starts in the early hours of infection.
Contact e‐mail address:
G‐EP050. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EP050.1. CHARACTERIZATION OF EOSINOPHILIC ESOPHAGITIS IN PATIENTS WITH ESOPHAGEAL ATRESIA: A MULTICENTER INTERNATIONAL STUDY
Madeleine Aumar1, Khrishan Usha2, Hayat Mousa3, Matthieu Antoine1, Christophe Faure4, Mário Vieira5, Renato Tambucci6, Luca Maria Antoniello7, Jan Svensson8, Antti Koivusalo9, Kallirroi Kotilea10, Michiel Van Wijk11, Ciğdem Ulukaya Durakbaşa12, Salvatore Oliva13, Saskia Vande Velde14, Noam Zevit15, Raouf Nassar16, Tutku Soyer17, Nikhil Thapar18, Hannes Hölz19, Christos Tzivinikos20, Steffen Husby21, Vaidotas Urbonas22, Fügen Çullu Çokuğraş23, Maria Do Céu Espinheira24, Alexandra Papadopoulou25, Léa Mortain26, Mélanie Leroy1, Frédéric Gottrand 1
1Service De Gastroentérologie, Hépatologie Et Nutrition Pédiatriques, Lille Hospital, Lille Cedex, France, 2Sydney children's Hospital, Sydney, Australia, 3The Children's Hospital of Philadelphia, Philadelphia, United States of America, 4Sainte Justine Hospital, Montreal, Canada, 5Hospital Pequeno Príncipe, Curitiba, Brazil, 6Ospedale Pediatrico Bambino Gesù, Roma, Italy, 7Azienda Ospedale Università, Padova, Italy, 8Karolinska University Hospital, Stockholm, Sweden, 9Helsinki University Central Hospital, Helsinki, Finland, 10Hôpital Universitaire de Bruxelles, Bruxelles, Belgium, 11Emma Children's hospital, Amsterdam, Netherlands, 12Istanbul Medeniyet Üniversitesi, Istanbul, Turkey, 13Policlinico Umberto I ‐ Sapienza Università di Roma, Roma, Italy, 14UZ Ghent, ghent, Belgium, 15Schneider Children's Medical Center of Israel, Petah Tikva, Israel, 16Pediatric Gastroenterology, Hepatology, And Nutrition Unit, Soroka University Medical Center, Beer Sehva, Israel, 17Hacettepe University School of Medicine, Ankara, Turkey, 18Children's Health Queensland Hospital and Health Service, South Brisbane, Australia, 19Dr. von Hauner Children's Hospital, München, Germany, 20Aljalial children's specialty hospital, DUbai, United Arab Emirates, 21Odense University hospital, Odense, Denmark, 22Vilnius University Hospital Santariskiu Klinikos ‐ Childrens Hospital, Vilnius, Lithuania, 23İstanbul Üniversitesi‐Cerrahpaşa, Istabul, Turkey, 24Centro Hospitalar Universitário São João, Porto, Portugal, 25Children's Hospital Agia Sofia, Athens, Greece, 26Lille Hospital, Lille Cedex, France
Objectives and Study: An elevated prevalence of eosinophilic esophagitis (EoE) has been observed in patients with esophageal atresia (EA), but precise phenotyping is lacking. This study aimed to better understand this association by examining the clinical presentation and outcomes of EA patients with EoE, comparing them to those with isolated EoE and EA without EoE.
Methods: A dedicated database was created, including 264 cases of EoE in EA patients from 25 centers worldwide, with data on history, characteristics at diagnosis, and treatment. These patients were compared to 907 patients with isolated EoE from the pEEr registry, and to 361 EA patients from the COMAD6 cohort.
Results: The EA/EoE cohort had a mean age of 4 ± 4 years at diagnosis. Fifty‐eight percent were on PPIs, and 61% had recurrent anastomotic strictures. Common symptoms included dysphagia (58%), feeding difficulties (55%), and vomiting (40%). Endoscopy showed abnormalities in 81% of cases, with strictures (54%) and edema (32%) being most common. Treatment was initiated in 88% of cases, with PPIs (53%) and topical corticosteroids (27%). At follow‐up, endoscopic improvements were noted, including reduced edema and strictures (p < 0.001), and eosinophil counts decreased (p < 0.001). Thirty‐three percent of patients had a complete histological response, and 24% had a partial response. The mean annual number of strictures requiring dilation was significantly lower post‐treatment (p < 0.001). Compared to patients with isolated EoE, those with EoE/EA were significantly younger, less often male, and had fewer allergies. The EoE/EA group also presented more severe forms of EA and had more frequent recurrent fistulas and gastrostomy placements.
Conclusions: This study highlights that EoE in EA patients has distinct characteristics, including early diagnosis, fewer males, and a lower rate of allergies, but it occurs in more severe forms of EA. Acknowledgement: supported by an ESPGHAN networking grant
Contact e‐mail address: frederic.gottrand@chu-lille.fr
G‐EP051. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EP051.1. IBP‐9414, A LIVE BIOTHERAPEUTIC PRODUCT, REDUCE ALL‐CAUSE MORTALITY IN VERY LOW BIRTHWEIGHT INFANTS: RESULTS FROM THE ‘CONNECTION STUDY’
Josef Neu1, Michael Caplan2, Teresa Del Moral3, Scott Guthrie4, Mark Hudak5, Flavia Indrio 6, Jae Kim7, Anders Kronström8, Camilia Martin9, Jonas Rastad8, Rachana Singh10, Staffan Strömberg8, Hania Szajewska11, Marcus Thuresson8, Neena Modi12
1University of Florida, Gainesville, United States of America, 2Endeavor Health/University of Chicago, Pritzker School of Medicine, Chicago, United States of America, 3Miller School of Medicine, Florida, United States of America, 4Vanderbilt University School of Medicine, Nashville, United States of America, 5University of Florida College of Medicine, Jacksonville, United States of America, 6Department of Experimental Medicine, University of Salento, Lecce, Italy, 7Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America, 8Infant bacterial therapeutics, Stockholm, Sweden, 9Weill Cornell Medicine, New york city, United States of America, 10Tufts University School of Medicine, Boston, United States of America, 11Department Of Paediatrics, Medical University of Warsaw, Warsaw, Poland, 12Imperial College London, London, United Kingdom
Objectives and Study: Mortality remains high among very low birth weight (VLBW) infants under NICU care. We report mortality results of the ‘Connection Study’, a phase 3 trial of IBP‐9414 (NCT03978000) conducted under US IND and EU CTXs in 95 NICUs.
Methods: 2117 VLBW infants born at gestational age (GA) between 23 and 32 weeks (median, 27w) were randomized 1:1 to a daily enteral dose of IBP‐9414 (Lactobacillus reuteri) or placebo from within 48 hours of birth until a postmenstrual age of 346/7 weeks. All‐ cause mortality was a secondary efficacy endpoint of the study that was analysed with the Cochran‐Mantel‐Haenszel test.
Results: Totally 155 infants (8.7%) died and the relative risk (RR) of death from any cause in infants receiving IBP‐9414 versus placebo was 0.73 (p = 0.04). Similar effects on overall mortality were found in subgroups of birth weight and GA. The RR of death was 0.54 (p = 0.02) at post hoc analysis of deaths occurring after 14 days of treatment (Fig. 1). The reduction in mortality was primarily due to fewer deaths from gastrointestinal, cardiopulmonary, and respiratory causes. Analysis of adverse and serious adverse events did not identify any safety concerns. No blood culture obtained in the evaluation of sepsis showed IBP‐9414. Fig. 1. Kaplan Meier survival curves for the IBP‐9414‐ and placebo‐ treated infants.
Conclusions: Treatment with IBP‐9414 compared to placebo was associated with reduced overall mortality, which related to local actions of L. reuteri on the gut and systemic actions of a possibly anti‐inflammatory character. These findings together with the absence of safety concerns show a positive benefit: risk ratio for IBP‐9414 on mortality in VLBW infants.
Contact e‐mail address: neuj@peds.ufl.edu
G‐EP052. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EP052.1. AI AS A TOOL IN RADIOLOGICAL ASSESMENT OF ESOPHAGEAL DISORDERS
Michał Kolejwa 1,2, Anna Socha‐Banasiak1, Natalia Lwow1, Bartosz Polis3, Artur Fabijan3, Agnieszka Zawadzka‐Fabijan4, Krzysztof Zakrzewski3, Emilia Nowoslawska3, Robert Fabijan5, Roza Kosinska3, Elzbieta Czkwianianc1
1Gastroenterology, Allergology And Pediatrics, Polish Mother's Memorial Hospital, Lodz, Poland, 2Department Of Pediatrics, Immunology And Nephrology, Medical University of Lodz, Lodz, Poland, 3Department Of Neurosurgery, Polish‐Mother's Memorial Hospital Research Institute, Lodz, Poland, 4Department Of Rehabilitation Medicine, Medical University of Lodz, Lodz, Poland, 5Independent Reasercher, Luton, United Kingdom
Objectives and Study: BiomedCLIP, an advanced multimodal AI model integrating Vision Transformer and PubMedBERT architectures, has shown promising results in biomedical imaging tasks.
Methods: In this study, we evaluated BiomedCLIP's performance in classifying pediatric esophageal X‐ray images into three clinical categories: full esophageal visibility, contrast usage, and esophageal strictures. We used 143 radiograms of esopagus performed during diagnostic process. 128 of those X‐rays visualized esophagus fulfilled with contrast, in 29 any features of confticion were observed by radiologist. The model, fine‐tuned on the PMC‐15M dataset of 15 million image‐text pairs, leverages zero‐shot classification capabilities to address the complexities of medical diagnostics. Our methodology involved fine‐tuning BiomedCLIP using optimized hyperparameters and conducting extensive statistical and calibration analyses to assess its diagnostic accuracy. Metrics such as overall accuracy, precision, recall, F1‐score, and calibration measures were employed to evaluate its classification performance and reliability.
Results: The results demonstrated moderate success in predicting contrast visibility (accuracy: 67.8%; AUC: 85.4%) but revealed significant limitations in detecting esophageal strictures (accuracy: 24%; AUC: 26%). Key findings include the model's high precision in identifying positive cases of contrast (88.7%) but poor specificity (20%) and high false positive rates. The analysis of calibration curves highlighted systematic deviations, with overconfident predictions at higher probabilities and underestimations at lower probabilities. For esophageal strictures, poor sensitivity (44%) and specificity (18%) underscored the model's inability to differentiate cases reliably. Despite these challenges, BiomedCLIP demonstrated internal consistency, with predicted probabilities for occurrence and non‐occurrence summing to 1.0, reflecting adherence to a probabilistic framework.
Conclusions: In conclusion, while BiomedCLIP shows potential in certain diagnostic tasks, its poor calibration, low specificity, and imbalanced dataset handling limit its clinical applicability. Future work should focus on domain‐specific recalibration, dataset expansion, and addressing model biases to enhance its diagnostic reliability and utility in clinical settings.
Contact e‐mail address: michal.kolejwa@iczmp.edu.pl
G‐EP053. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EP053.1. LACTYLATION‐DRIVEN ALKBH5 DIMINISHES MACROPHAGE NLRP3 INFLAMMASOME ACTIVATION IN PATIENTS WITH G6PT DEFICIENCY
Zexiong Su1,2, Jiaoli Lan 2, Ying Wang2, Ni Ma2, Jing Yang2, Danxia Liang2, Hanshi Zeng2, Yupeng Li2, Min Yang2
1Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China, 2Department Of Pediatrics, Guangdong Provincial People's Hospital Affiliated to Southern Medical University, Guangzhou, China
Objectives and Study: Background Neutropenia represents an important clinical problem in patients with glycogen storage disease type Ib (GSD‐Ib), characterized by genetic deficiency in glucose‐6‐phosphate translocase (G6PT/SLC37A4). However, the role of G6PT in macrophages has not been elucidated. Objective We sought to investigate the function of G6PT in macrophage inflammation.
Methods: Functional assays (including immunoblotting, real‐time quantitative polymerase chain reaction, flow cytometry, immunofluorescence staining, and enzyme linked immunosorbent assay) and RNA sequencing were performed.
Results: We find that macrophages from patients deficient in G6PT exhibited diminished NLRP3 inflammasome activation. Mechanistically, deficiency of G6PT promotes glycolysis and lactate production in macrophages. Lactate accumulation potently induces ALKBH5 upregulation via H3K18 lactylation. ALKBH5 decreases m6A modification on NLRP3 mRNA, attenuating its transcript stability and thus inhibiting inflammasome activation. Furtherly, treating G6PT‐deficient macrophages with an inhibitor of the lactate dehydrogenase to lower their lactate levels restores NLRP3 inflammasome activation and rescues bacterial handling defect.
Conclusions: These findings unveil a previously unknown pathogenic mechanism of lactylation‐driven defective NLRP3 inflammasome signaling and subsequent impaired antimicrobial activity as driving factors in these inflammatory disorders, and indicates glycolysis/lactate/histone lactylation cascade as a potential therapeutic target for GSD‐Ib.
Contact e‐mail address: yangmin1008@gdph.org.cn
G‐EP054. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EP054.1. PEDIATRIC COLLAGENOUS GASTRITIS: A CASE SERIES OF A RARE DISEASE
Bertrand Leduc, Anna Wieckowska, Guillermo Costaguta, Julie Castilloux
Centre Hospitalier Universitaire de l'Université Laval, Quebec, Canada
Objectives and Study: Collagenous gastritis (CG) is a rare gastrointestinal disease whose pathogenesis and adequate treatments are yet to be established. CG is characterized by gastric subepithelial collagen deposition and chronic inflammation on histology. Pediatric CG is particularly understudied, with scarce literature available. We report eleven pediatric cases from our tertiary care centre in Québec, Canada. We described the clinical presentation, diagnostic challenges and treatment outcomes of pediatric CG.
Methods: We conducted a retrospective review of pediatric patients diagnosed with CG at our tertiary care centre. Clinical, endoscopic and histopathological data were reviewed.
Results: Eleven patients (ages 9‐14 at first presentation) were included. On upper endoscopy, all 11 had nodular gastritis (all negative for Helicobacter pylori infections) with eosinophilic infiltration and subepithelial collagen band on histology compatible with CG. Almost all patients had at least one or more gastrointestinal symptoms, namely abdominal pain, decreased appetite, weight loss, pyrosis, nausea or vomiting. One patient presented with two episodes of spontaneously‐perforated gastric ulcers who underwent gastrorrhaphy with epiploonoplasty and two years later a partial gastrectomy. Five patients presented with severe‐to‐moderate iron‐deficiency anemia (hemoglobin of 26‐85 g/L), three of them requiring blood transfusions. Seven patients achieved normal hemoglobin levels with oral iron supplements only. Seven patients were prescribed proton pump inhibitors (PPI), while three patients were additionally treated with oral budesonide. The patient who presented with the most severe iron‐deficiency anemia (hemoglobin of 26 g/L), requiring multiple blood transfusions, oral iron supplementation, oral budesonide and PPI, was found to have resolved CG on repeat endoscopy 3 years later.
Conclusions: Despite being described as an exceedingly rare disease in the literature, the number of cases reported in our center shows that CG is probably under‐diagnosed, with iron‐deficiency anemia being the most common presentation in pediatrics. Further research is needed to understand the pathogenesis and optimal management of this condition.
Contact e‐mail address:
G‐EP055. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EP055.1. ORAL PROBIOTICS FOR THE TREATMENT OF INFANTILE COLIC: A SYSTEMATIC REVIEW AND META‐ANALYSIS
Shiyao Liu, Amin Sohani, Aderonke Ajiboye, Gabriela Franco‐Katz, Vasiliki Sinopoulou, Morris Gordon
School Of Medicine And Dentistry, University of Central Lancashire, Preston, United Kingdom
Objectives and Study: Infantile colic (IC) is a common disease that can cause significant distress for infants, parents and carers. Probiotics have been suggested as effective and safe treatment for IC. The objective of this study was to assess the effects of probiotics for infantile colic.
Methods: Databases were searched for randomized controlled trials (RCTs), including infants up to four months of age treated with probiotic or synbiotic. The primary outcomes were treatment success, crying time, number of cases of IC and withdrawal due to adverse events. Random‐effects meta‐analyses were used to calculate pooled risk ratio (RR), mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CI). RoB 1 and GRADE were used for risk of bias and certainty of the evidence assessment.
Results: A total of 1,736 studies were screened on title and abstract. Nine RCTs were eligible for inclusion. Four studies involving 227 infants (114 in the probiotic group, 113 in the control group) reported the treatment success at various time points. When comparing probiotic to placebo at Day 7 (Figure 1), probiotic might lead to more treatment success (RR 2.81, 95% CI 1.61 to 4.92, I 2 = 0%; GRADE certainty: low). A similar finding was observed on Day 21 (RR 2.07, 95% CI 1.23 to 3.49; I 2 = 77%; GRADE certainty: low).
Conclusions: The results of our systematic review suggest that probiotics may be a promising treatment option for infantile colic. Future research should focus on the long‐term follow‐up after the cessation of therapy to assess sustained benefits and potential side effects.
Contact e‐mail address: sliu43@uclan.ac.uk
G‐EP056. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EP056.1. SMALL STOOLS, BIG CLUES: ROLE OF LYSOZYME, CALGRANULIN‐C (S100A12) AND CALPROTECTIN AS FECAL BIOMARKERS IN FOOD PROTEIN INDUCED ALLERGIC PROCTOCOLITIS
Ezgi Mollaoglu 1, Erkan Akkus2, Dogukan Ozbey3, Pinar Yilmazbas4, Guzide Dogan5, Nevzat Aykut Bayrak6, Bekir Kocazeybek3, Haluk Cokugras7, Fügen Çullu Çokuğraş8, Omer Beser9
1Department Of Pediatrics, Istanbul University‐Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey, 2Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey, Istanbul, Turkey, 3Medical Microbiology, Istanbul University‐Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey, 4Department Of Pediatrics, University of Health Sciences, Prof. Dr. Cemil Tascioglu State Hospital, Istanbul, Turkey, 5Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul Medipol University, Istanbul, Turkey, 6University of Health Sciences, Zeynep Kamil Women & Children's Training & Research Hospital, Istanbul, Turkey, 7Department Of Pediatric Allergy And Immunology, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 8Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Demiroglu Bilim University, Faculty of Medicine, Istanbul, Turkey, 9Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
Objectives and Study: Food protein induced allergic proctocolitis (FPIAP) is a non‐IgE‐mediated allergic disorder of infancy, characterized by blood‐streaked stools. To this day, the diagnosis of FPIAP relies on patient history, elimination and provocation tests. Our study aims to unveil potential non‐invasive biomarkers for the diagnosis and follow up of FPIAP patients.
Methods: In our prospective, multi‐center study we enrolled 49 infants aged 1 to 12 months that were diagnosed with FPIAP according to the ESPGHAN guidelines and 50 age and gender matched healthy controls. We measured fecal levels of Lysozyme, Calgranulin and Calprotectin with ELISA method in the study group during active disease and after elimination diet and compared them to the healthy control group. Patient histories, presenting symptoms and physical examinations were documented and evaluated for statistical significance.
Results: When comparing biomarker levels of healthy infants and FPIAP patients before elimination diet, levels of Calgranulin in FPIAP patients were significantly higher than the control group (p < 0,001). In contrast, fecal lysozyme levels during active disease were lower than of the healthy control group (p < 0,001). The presence of bloody stool was correlated with higher levels of Calgranulin among the infants with FPIAP at the time of first admission and following remission (p = 0,045 and p = 0,038). Evaluation of biomarker levels within the FPIAP group before and after elimination diet and subsequent remission revealed statistically significant differences of all three markers (Table. 1).
Conclusions: Levels of fecal Calgranulin and Lysozyme show valuable potential in diagnosing FPIAP, whereas all three biomarkers could be used in monitoring response to therapy. Future prospective studies with larger sample sizes are needed to further validate our findings in diagnosing and managing FPIAP.
Contact e‐mail address: ezgimollaoglu@gmail.com
G‐EP057. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EP057.1. STUDY OF THE QUALITY OF LIFE IN CHILDREN WHO HAVE UNDERGONE SURGERY FOR ESOPHAGEAL ATRESIA, WITH COMPARISON TO A CONTROL GROUP. BELGIAN PROSPECTIVE MULTICENTER STUDY
Laetitia Piraux 1, Anna Poupalou1, Kallirroi Kotilea1, Viola Weeda1, Helena Reusens1, Frédéric Mergan2, Leslie Remont3, Michaela Dellenmark‐Blom4, Pierre Lingier1, Henri Steyaert1
1Pediatric Surgery, Hopital Universitaire des enfants Reine Fabiola, Brussels, Belgium, 2Centre Hospitalier Universitaire de Tivoli, La Louvière, Belgium, 3Hôpital Civil Marie Curie, Lodelinsart, Belgium, 4The Queen Silvia Children's Hospital SU/Östra, Gothenburg, Sweden
Objectives and Study: Esophageal atresia (EA) is a rare congenital malformation often associated with other congenital malformations. While recent advancements in neonatal surgical treatment as well as management of its complications, have led to survival rates exceeding 90%, the long‐term quality of life (QoL) for these patients remains underexplored. This study aims to prospectively evaluate QoL in children with EA, focusing on identifying key factors that significantly influence their health outcomes.
Methods: This multicenter, prospective observational study included 81 children born with EA between January 1, 2005, and December 31, 2020, across five hospitals in Belgium. QoL was evaluated using the PedsQL (generic) and the EA‐QOL (specific to EA). We compared QoL data from the EA cohort with a control group of age‐matched schoolchildren without gastrointestinal comorbidities. To identify correlating factors, univariate and multivariate linear regression models were applied.
Results: The analysis revealed a significant reduction in QoL among EA patients, with notable associations between poor outcomes and the following factors: genetic anomalies, female sex, and a need of gastroesophageal reflux surgery. Additionally, early brain injury (including acute fetal distress, neonatal resuscitation, and repeated general anesthesia) was linked to impaired academic performance. These findings highlight critical areas for targeted interventions and personalized care strategies.
Conclusions: This study underscores the complex, multifactorial nature of QoL in EA patients, emphasizing the importance of long‐term, multidisciplinary follow‐up. By identifying key determinants that impact patient well‐being, our work lays the foundation for refining clinical practices and improving the management of these patients. Furthermore, this research represents an important first step toward establishing a national registry for EA patients in Belgium, which will ultimately contribute to enhanced quality of care and better outcomes.
Contact e‐mail address: laetitia.piraux@ulb.be
G‐EP058. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EP058.1. INCREASED PROLIFERATION AND MUCOSAL INFLAMMATION IN DUODENAL BIOPSIES OF CHILDREN WITH DOWN SYNDROME AND NON‐CELIAC VILLOUS ATROPHY
Roberta Rotondo 1,2, Francesca Furone2, Claudia Bellomo2, Iris Scala3, Riccardo Troncone2,4, Merlin Nanayakkara2,4, Mariantonia Maglio2,4, Renata Auricchio2,4, Maria Vittoria Barone2,4
1Department Of Medicine And Surgery, Pediatric Clinic, University of Parma, Parma, Italy, 2Department Of Translational Medical Science, Section Of Pediatrics, University of Naples Federico II, Naples, Italy, 3Department Of Maternal And Child Health, Section Of Pediatrics, University of Naples Federico II, Naples, Italy, 4European Laboratory For The Investigation Of Food Induced Diseases (elfid), Department Of Translational Medical Science, Section Of Paediatrics, University of Naples Federico II, Naples, Italy
Objectives and Study: Children with Down Syndrome (DS) have a 6‐10 times higher risk of developing Celiac Disease (CD). It has been shown that 14% of DS presented villous atrophy (VA) not CD‐associated, 3% of them developed CD two years later. A survey conducted through the Italian Society of Pediatric Gastroenterology (SIGENP) showed that 64% of Italian centres use CD‐serology as the sole criterion for esophagogastroduodenoscopy, without considering alarm symptoms and/or blood test abnormalities, probably underestimating the involvement of intestinal alterations in these patients. Our aim was to study different features between intestinal biopsies of DS and non‐DS children including those with VA not CD‐associated, VA CD‐associated and normal mucosa.
Methods: Twenty‐two duodenal biopsies from DS children (3‐18 years), collected retrospectively between 2014 and 2023, were assessed for lamina propria CD25+ cells, intraepithelial lymphocytes (TCRγdelta + , CD3+ cells), epithelial crypt proliferation (%Ki67) and anti‐tissue‐transglutaminase‐IgA (anti‐tTG) deposits.
Results: In our cohort of DS children, 54,5% (12/22) showed VA CD‐associated (DS/VA‐CD) and 22,7% (5/22) VA not CD‐associated (DS/VA‐NO‐CD). The latter, similar to VA not CD‐associated in the non‐DS group, were negative for TCRγdelta+ and CD3+ cells, but showed high CD25+ levels and increased epithelial crypt proliferation (%Ki67). Anti‐tTG deposit were positive only in DS/VA‐NO‐CD, similar to the entire VA CD‐associated group. Interestingly, DS normal mucosa presented high crypt proliferation and positivity for anti‐tTG deposits.
Conclusions: In DS duodenal mucosa there is inflammation and increased proliferation even in absence of VA. The management of these patients is still to be defined. Future research will focus on studying the molecular mechanisms underlying these alterations, investigating whether they can be modulated by diet, including gluten consumption, and exploring the potential link between intestinal inflammation and cognitive deficit, typical of DS.
Contact e‐mail address: robertarot.97@gmail.com
G‐EP059. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EP059.1. DURATION OF PH‐IMPEDANCE MONITORING IN NEWBORNS AND INFANTS: 12 OR 24 HOURS?
Giulia Rotunno 1, Yvan Vandenplas2, Dario Ummarino3, Silvia Salvatore4, Paolo Quitadamo5, Arianna Aceti6, Maria Elisabetta Baldassarre7, Thomas Gestels2, Valentina Giorgio8, Giovanni Vento8, Rossella Turco5, Stefano Nobile1
1Mother, Child And Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, 2KidZ Health Castle UZ Brussel, Brussels, Belgium, 3Ospedale San Leonardo, Castellamare di Stabia (NA), Italy, 4Neonatal And Pediatric Unit, University of Insubria, Varese, Italy, 5Pediatric Gastroenterology and Hepatology Unit, Santobono‐Pausilipon Children's Hospital, Naples, Italy, Naples, Italy, 6Università di Bologna, Bologna, Italy, 71 Section of Neonatology and NICU, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy., Bari, Italy, 8Università Cattolica del Sacro Cuore, Rome, Italy
Objectives and Study: Current studies on esophageal Multichannel Intraluminal Impedance pH test (MII‐pH) in newborns and infants suggest an optimal duration of 16‐24 hours (Cresi et al. J Neurogastroenterol Motil 2020;26:370‐377) based on the usual timing of feeds and sleep in pediatric and adult populations. Among infants, sleep and mealtimes are distributed over the 24 hours. We aimed to assess the diagnostic performance of 12 h vs. 24 h MII‐pH.
Methods: Restrospective multicentre study. Each 24 h MII‐pH was evaluated also in the first 12 h, and data were compared. GERD was diagnosed in presence of one of the following (Quitadamo et al. Dig Liver Dis 2019;51(11):1522‐1536): • N. of GER episodes ≥100 in 24 hours; • N. of proximal GER episodes >44 (acid) or 57 (non‐acid); • Reflux index (time with pH <4) > 7%; • Bolus Exposure Index (BEI) > 2.4%; • Bolus Clearance Time (BCT) > 18 s; • Symptom index (SI) ≥ 50%, Symptom Association Probability (SAP) ≥ 95%. T‐test, Mann‐Whitney test, chi‐square test were performed to compare data using SPSS v.25.
Results: 127 (60 F, 67 M) infants were studied. Median age at MII‐pH 61 days (IQR 27‐116). 49 were born preterm, 31 were fed with a gastric tube; MII‐pH indications were: GI symptoms (83), cardio‐respiratory symptoms (47), poor growth (22). There were no significant differences between the 12 h and the 24 h analysis regarding: n. of GER events/h, reflux index, n. of proximal GER events/h, BCT, positive SI/SAP. BEI > 2.4% was observed in 31.2% and 17.5% respectively (p = 0.035), GER events lasting >5 minutes/h were 1.97 ± 0.27 and 1.83 ± 0.44 respectively (p < 0.001). The 12 h analysis had 87.7% sensitivity, 75.6% specificity, 89.7% positive predictive value, 71.7% negative predictive value for GERD.
Conclusions: 12 h MII‐pH had a good diagnostic performance compared to 24 h recording. Only BEI and GER events lasting >5 minutes were significantly different between the two.
Contact e‐mail address: stefano.nobile@policlinicogemelli.it
G‐EP060. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EP060.1. RISK FACTORS, MANAGEMENT AND LONG‐TERM OUTCOMES OF BARRETT'S ESOPHAGUS IN PEDIATRICS
Ozlem Sumer Cosar 1, Hakan Öztürk1, Sınan Sarı1, Ozgur Ekıncı2, Odul Egrıtas Gurkan1, Buket Dalgıc1
1Division Of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 2Division Of Medıcıne Pathologhy, Gazi University Faculty of Medicine, Ankara, Turkey
Objectives and Study: Barrett's esophagus (BE) is a rare premalignant condition in the pediatric population. This study aims to evaluate the prevalence, risk factors, and management strategies of children with BE.
Methods: This study was conducted through a retrospective data analysis from 7,082 patients who underwent upper GI endoscopy between 2008 and 2024. BE was diagnosed based on the Prague classification and histological findings.
Results:
The prevalence of BE was 0.17% (n = 12). Ages ranged from 4 to 16 years (median 10.6), with 58% male. Nine patients had comorbidities potentially associated with the development of BE, including eosinophilic esophagitis (EoE) in five patients, esophageal atresia in three patients, chromosomal anomalies in two patients, pediatric intestinal pseudo‐obstruction (PIPO) in one patient, and anal atresia in one patient (Table 1). The most common symptoms were dysphagia, vomiting, hematemesis, and epigastric pain. According to the Prague classification, nine cases were classified as long‐segment BE. Esophageal strictures and/or circumferential ulcers were observed in seven patients. High‐dose proton pump inhibitors were administered to all patients. Endoscopic dilatation and/or fundoplication were performed in six patients who were unresponsive to medical therapy and/or strictures (Table 1). During a median follow‐up period of 24 months (2–120 months), no dysplasia or malignancies were detected among the eight patients under surveillance.
Conclusions: BE is a rare condition in the pediatric population. The majority of patients have comorbidities that predispose them to BE, including neurological disorders, esophageal atresia, and chromosomal abnormalities. Although it is challenging to determine whether EoE is a cause or a consequence, its presence in approximately half of our patients is considered a noteworthy finding. High‐dose PPI therapy proved effective as the cornerstone treatment, with endoscopic dilatation and/or fundoplication required in severe or refractory cases. Patients with BE should undergo long‐term surveillance for malignancy.
Contact e‐mail address: dr.ozlemcosar@gmail.com
G‐EP061. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP061.1. TASTY&HEALTHY™ DIET INDUCES CLINICAL AND BIOLOGICAL REMISSION IN PATIENTS WITH MILD‐MODERATE CROHN'S DISEASE, SIMILAR TO EEN: RESULTS FROM THE "TASTI‐MM" RANDOMIZED, PHYSICIAN‐BLINDED, CONTROLLED TRIAL
Yonat Aharoni‐Frutkoff 1, Luba Plotkin2, Zivia Shavit‐Brunschwig1, Gili Focht1, Jessica Livovsky1, Ruth Cytter‐Kuint1, Raffi Lev‐Tzion2, Oren Ledder3, Amit Assa3, Dotan Yogev4, Esther Orlanski‐Meyer2, Efrat Broide5, Jaroslaw Kierkus6, Ben Kang7, Batia Weiss8, Marina Aloi9,10, Tobias Schwerd11, Dror Shouval12, Anne Griffiths13, Dan Turner14
1The Juliet Keidan Institute Of Pediatric Gastroenterology And Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel, 2Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Jerusalem, Israel, 3The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel, 4The Juliet Keidan Institute Of Paediatric Gastroenterology Hepatology And Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel, 5Pediatric Gastroenterology, Hepatology And Nutrition, Shamir Medical Center, Zeriffin, Israel, 6The Children's Memorial Health Institute‐ Warsaw‐ Poland, Gastroenterology‐ Hepatology‐ Feeding Disorders and Paediatrics, WARSZAWA, Poland, 7Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea, Republic of, 8Division Of Pediatric Gastroenterology And Nutrition, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel‐Hashomer, Ramat Gan, Israel, 9Maternal And Child Health Department, Sapienza University of Rome, rome, Italy, 10Department Of Pathophysiology And Transplantation, Università degli Studi di Milano ‐ Pediatric Gastroenterology, Hepatology and Cystic Fibrosis Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy, 11Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital LMU, 80337 Munich, Germany, Munich, Germany, 12Institute Of Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center of Israel, Petha‐Tikva, Israel, 13Department Of Gastroenterology, Hospital for Sick Children, Toronto, Canada, 14The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
Objectives and Study: Exclusive enteral nutrition (EEN) effectively induces remission in Crohn's disease (CD) but faces adherence challenges. The Tasty&HealthyTM (T&H) diet excludes processed food, gluten, red meat, and dairy (except yogurt) without requiring partial enteral nutrition (PEN) or mandatory ingredients. This randomized‐controlled trial compared the tolerability and effectiveness of T&H vs. EEN in children and young adults with mild‐to‐moderate CD (NCT#04239248).
Methods: Patients aged 6–25 years were randomized to T&H or EEN for 8 weeks, receiving weekly dietary support; physicians were blinded to the allocation. Outcomes included clinical remission (wPCDAI/CDAI), MINI index (<8 points indicating mucosal healing), calprotectin, CRP/ESR, and intestinal ultrasound. Fecal microbiome was analyzed by metagenomics. Tolerability/adherence were evaluated by weekly interviews and intake diaries. Data were analyzed by the ITT approach unless per‐protocol (PP) is specified.
Results: Among 83 included patients (41 T&H, 42 EEN; mean age 14.5 ± 3.7), 88% tolerated T&H vs. 52% for EEN (OR 6.3; 95%CI 2.2‐22 p < 0.001). Calprotectin, CRP and ESR decreased significantly in both groups, with no between‐group differences. Clinical remission was achieved in 56% vs. 38%, respectively (p = 0.1; PP: 67% vs. 76%, p = 0.47) and calprotectin <250 μg/g in 38% vs. 41% (p = 0.84). MINI < 8 rate was higher in T&H (54%) vs. EEN (41%; p = 0.026), figure 1. Radiological improvement was similar across groups (31% vs. 42%, respectively, in the terminal ileum; p = 0.66). Microbiome
Conclusions: Tasty&HealthyTM demonstrated comparable effectiveness to EEN for inducing remission in mild‐to‐moderate CD, with better tolerability and higher microbial diversity. T&H offers a flexible, alternative for managing CD, without the need for PEN or mandatory ingredients.
Contact e‐mail address: lubap@szmc.org.il
G‐EP062. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP062.1. VACCINATIONS AND IMMUNIZATION STATUS IN PEDIATRIC INFLAMMATORY BOWEL DISEASE: DATA FROM THE FIRST PHASE OF VIP II STUDY
Rossana Albano 1, Massimo Martinelli1, Giulia D'Arcangelo2, Marina Aloi2, Kristýna Zárubová3, Jiri Bronsky3, Ruta Kucinskienne4, Antonio Colucci5, Caterina Strisciuglio5, Aleksandra Banaszkiewicz6, Iva Hojsak7, Víctor Manuel Navas‐López8, Claudio Romano9, Vaidotas Urbonas10, Annamaria Staiano1, Erasmo Miele1
1Translational Medical Science, Section Of Pediatrics, University of Naples ‘Federico II’, Napoli, Italy, 2Department Of Maternal And Child Health, Sapienza University, Paediatric Gastroenterology Unit, Rome, Italy, 3Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic, 4Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania, 5Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy, 6Department Of Pediatric Gastroenterology And Nutrition, Medical University of Warsaw, Warsaw, Poland, 7Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia, 8Pediatric Gastroenterology And Nutrition, Hospital Regional Universitario de Málaga, Málaga, Spain, 9Pediatric Gastroenterology and Cystic Fibrosis Unit, University Hospital “G. Martino”, Messina, Italy, 10Vilnius University Hospital Santariskiu Klinikos ‐ Childrens Hospital, Vilnius, Lithuania
Objectives and Study: Vaccine‐preventable diseases and opportunistic infections in inflammatory bowel disease (IBD) are increasingly recognized issues. The aim of the first phase of the VIP II study was to evaluate vaccinations and immunization status at diagnosis and before starting immunosuppressants (IM) or biologics in children with IBD.
Methods: The VIP II is a prospective multiphase, European study including 10 different European centers and selected within ESPGHAN networking grant 2022. In the first phase of the study children newly diagnosed with IBD or patients with a known diagnosis of IBD starting IM or biologic therapy were consecutively enrolled. Diagnosis, therapeutic history, vaccinations and immunization status screening at diagnosis or at IM/biologic initiation and reasons for incomplete immunization were retrieved.
Results: Ninety‐two children with IBD were consecutively enrolled from June 2023 to December 2024 (median age: 12 years; M/F: 56/36, UC/CD/IBD‐U: 52/37/3), of whom 52 (56.5%) newly diagnosed IBD children, 3 (3.3%) patients at IM starting and 37 children (40.2%) before undergoing biologic therapy. Complete immunisation at diagnosis was reported only in 30% of the children with significant differences among different countries. Among children with incomplete immunisation, specific vaccinations, before starting IM therapy, were recommended in 55/92 (59.2%) of children. In the remaining patients, the reasons for not vaccinating were: need for immediate IM therapies (61%) and parental refuse (31%).
Annual flu vaccine was performed only in 17/92 (18.5%) children. Screening for latent tuberculosis (TB) before biologics starting was performed in 31/37 (83.7%). Tubercolin skin test was the most used screening exam (80.6%), followed by quantiferon (64.5%). Chest x ray was performed in 19/31 children (64.5%).
Conclusions: The first phase of the VIP II study demonstrated a poor compliance to the current guidelines for vaccination and immunisation in children with IBD among European tertiary centres, highlighting the need for implementation.
Contact e‐mail address: albano.rossana9@gmail.com
G‐EP063. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP063.1. PROACTIVE THERAPEUTIC DRUG MONITORING IN PAEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE ON ANTI‐TUMOUR NECROSIS FACTOR: WEEK 6 AND 14 MONITORING FOR GUIDING TREATMENT ESCALATION
Carla Bloom, Nicholas Croft, Protima Deb, Natasha Burgess, Sabrina Barr, Ahmed Kadir, Sandhia Naik
Department of Paediatric Gastroenterology, Barts Health NHS Trust, The Royal London Children's Hospital, London, United Kingdom
Objectives and Study: The objective of this study was to show that treatment of children with inflammatory bowel disease (IBD) with anti‐tumour necrosis factor (TNF) agents could be optimised by timely therapeutic drug monitoring (TDM). Historically, reactive TDM was used to measure drug levels when a clinical suspicion of relapse arose. A 2022 observational pilot study supported the use of proactive TDM at week 14. We aimed to add to the evidence base supporting proactive TDM, and elucidate whether monitoring levels earlier than week 14, specifically at week 6, could minimise time spent with sub‐therapeutic IFX levels, and hence optimise biologic treatment.
Methods: This was a single centre observational study. Our patient cohort was 124 patients treated with anti‐TNF drugs from January‐June 2024. We recorded data on week 6 and 14 trough drug levels, and corresponding dosing regime changes, using PowerChart. We used this data to calculate positive and negative predictive values of week 6 levels on week 14 levels.
Results: Our data showed low week 6 levels had an 80% positive predictive value for low week 14 levels. The negative predictive value was 31%. 83% of our cohort required treatment escalation. Of the 103 patients who required treatment escalation, 7.8% were escalated based solely on low week 6 levels, and 57.3% were escalated solely based on week 14 levels. The remainder were escalated due to clinical or endoscopic evidence of relapse.
Conclusions: Our data show that proactive TDM for children with IBD on anti‐TNF biologics prevents sub‐therapeutic treatment. We provide new evidence for monitoring drug levels prior to week 14 to optimise anti‐TNF treatment. Specifically, we showed that subtherapeutic week 6 levels have an 80% positive predictive value for low week 14 levels, and therefore measuring anti‐TNF drug trough levels earlier than week 14 in treatment can prevent loss of response and relapse.
Contact e‐mail address:
G‐EP064. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP064.1. PERFORMANCE OF ADULT‐DERIVED USTEKINUMAB POPULATION PHARMACOKINETIC MODELS IN CHILDREN AND ADOLESCENTS WITH INFLAMMATORY BOWEL DISEASE
Marleen Bouhuys 1, Patrick Van Rheenen1, Tim De Meij2, Paola Mian3, Johanna Escher4
1Paediatric Gastroenterology, University Medical Center, University of Groningen, Groningen, Netherlands, 2Paediatric Gastroenterology, Emma Children's hospital, Amsterdam UMC, VU University, Amsterdam, Netherlands, 3Clinical Pharmacy And Pharmacology, University Medical Center Groningen, Groningen, Netherlands, 4Paediatric Gastroenterology, Erasmus Medical Centre ‐ Sophia Children's hospital, Rotterdam, Netherlands
Objectives and Study: Ustekinumab is increasingly prescribed in children and adolescents with inflammatory bowel disease (IBD) who are refractory, intolerant, or have lost response to anti‐TNF treatment. Data on ustekinumab pharmacokinetics and its application to guide individual dosing in this age group are scarce. We aimed (1) to identify existing population pharmacokinetic (popPK) models of ustekinumab for adult patients and (2) externally validate them using prospectively collected real‐world data from 3 Dutch paediatric IBD centers.
Methods: We searched PubMed to identify ustekinumab popPK models and rebuilt those models using NONMEM®. The validation set consisted of 121 ustekinumab concentrations from 33 patients (median age 15 years). Standard ustekinumab dosing consisted of an intravenous dose (6 mg/kg), followed by subcutaneous maintenance (45 or 90 mg) every 56 days. In case of non‐response or loss‐of‐response, ustekinumab was escalated. To assess popPK model performance, we compared observed drug levels with model predictions, checked for consistency in the predictions over time (using weighted residuals), and used visual tools (prediction‐corrected visual predictive checks [pcVPC]). We also assessed prediction error.
Results: Four popPK models were identified. The observed versus predicted ustekinumab concentrations showed a good fit in two of the models. The model by Wang et al. was superior based on residuals and pcVPC. Results of this model are presented in the Figure. The median prediction error based on population predictions was ‐2.17%.
Figure: Performance of the model by Wang et al.
Dots: ustekinumab concentration measurements.
Colored lines/areas: regression lines/standard error.
Dashed lines: limits of acceptability.
a. Observed concentrations (OBS) versus individual predictions
b. Individual weighted residuals versus time after dose
Conclusions: The adult‐derived popPK model by Wang et al. outperformed the other models and performed well in our adolescent‐dominated validation set. Current dosing recommendations, based on extrapolations from adult data, appear to be appropriate for this patient group.
Contact e‐mail address: m.bouhuys@umcg.nl
G‐EP065. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP065.1. ASSOCIATION OF SERUM LEVELS OF USTEKINUMAB, VEDOLIZUMAB, AND FAECAL CALPROTECTIN IN PAEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASES – RESULTS FROM AN EXTENDED PROSPECTIVE OBSERVATION
Jiri Bronsky 1, Kristýna Zárubová2, Ivana Copova1, Marianna Durilova1, Denis Kazeka1, Michal Kubat1, Tereza Lerchova1, Katarina Mitrova1, Eva Vlckova1, Jana Duskova1, Julie Dostalikova1, Ondrej Hradsky1
1Dept. Of Paediatrics, University Hospital Motol, Prague, Czech Republic, 2Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
Objectives and Study: Ustekinumab (USTE) and vedolizumab (VEDO) are increasingly used in paediatric patients with inflammatory bowel diseases (pIBD). However, data on the usefulness of therapeutic drug monitoring (TDM) in children are scarce. This prospective observational study evaluated the association between disease activity, measured by faecal calprotectin (F‐CPT), and serum trough levels (TLs) of USTE and VEDO.
Methods: Of the 87 patients (51 Crohn's disease (CD),30 ulcerative colitis (UC),6 IBD unclassified (IBDU)), drug serum levels and antibodies were measured in 49 treatment courses of USTE (282 observations) and 38 courses of VEDO (359 observations). Clinical and laboratory data were obtained from the nationwide prospective registry CREdIT.
Results: In a linear multiple regression mixed model, an association was observed between logF‐CPT levels and USTE treatment duration (b ‐0.0010, 95% CI ‐0.0015 ‐ ‐0.0006, p < 0.001), but not with USTE TLs (p = 0.12). VEDO and (log)F‐CPT levels were negatively associated both in the linear (b ‐0.0173, 95% CI ‐0.0292‐ ‐0.0053, p = 0.005) and categorical models (p = 0.026), even after adjusting for time. A VEDO level of 15.1 ug/mL showed the best, though still poor combination of sensitivity (0.82) and specificity (0.32) to predict F‐CPT < 250 ug/g (AUC 0.56, 95% CI 0.49 ‐ 0.63). Slightly elevated anti‐drug antibodies were detected in 5 USTE and 16 VEDO observations, with no clinical implications.
Conclusions: TDM of USTE does not appear to be useful in pIBD. However, TDM of VEDO may assist in therapeutic strategy decisions, though establishing clinically useful cut‐offs remains challenging. Funding: This work was supported by the Ministry of Health, Czech Republic, for conceptual development of research organizations [00064203/6001, University Hospital Motol, Prague, Czech Republic], and GAUK 227023.
Contact e‐mail address: jiri.bronsky@gmail.com
G‐EP066. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP066.1. EXPLORING PEDIATRIC CROHN'S DISEASES THROUGH PATIENT‐DERIVED INTESTINAL ORGANOIDS
Ky Young Cho 1, Jae Sung Ko2, Jin Soo Moon2
1Department Of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea, Republic of, 2Department Of Pediatrics, Seoul National University Hospital, Seoul, Korea, Republic of
Objectives and Study: Pediatric Crohn's disease (CD) often leads to growth retardation, delayed puberty, and follows a different disease course compared to adult‐onset CD. These unique clinical features highlight the need for establishing pediatric‐specific patient‐derived intestinal organoids (PDOs). This study aimed to establish and characterize PDOs from children with CD for understanding the pathophysiology of the pediatric CD and evaluating potential therapeutic approaches.
Methods: To generate PDOs, endoscopic biopsy specimens were obtained from non‐inflamed duodenal bulbs of normal controls and CD patients. The organoids were developed using a 3D culture system optimized for intestinal epithelial cell growth, preserving their in vivo structure and function. To verify the presence of PDOs, histological staining and quantitative reverse transcription polymerase chain reaction (RT‐qPCR) analyses were performed.
Results: PDOs were successfully established in normal controls (n = 2) and CD patients (n = 2). Hematoxylin and eosin staining of formalin‐fixed, paraffin‐embedded PDO sections revealed crypt and villus structures, whereas immunofluorescence staining with EpCAM and DAPI confirmed the epithelial‐specific architecture of the PDOs. RT‐qPCR results revealed a significant increase in Lgr5, Si, and Chga gene expression and a decrease in Olfm4 and Muc2 expression in CD patients compared to normal controls, suggesting altered stem cell activity and mucosal barrier function (p < 0.05).
Conclusions: We successfully established and characterized PDOs in children with CD, providing a valuable tool for understanding the pathophysiology of the disease and evaluating potential therapeutic approaches. The differential gene expression of PDOs in CD patients might be caused by the complex interplay between epithelial adaptation and inflammation in the intestinal epithelium.
Contact e‐mail address:
G‐EP067. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP067.1. A SYSTEMATIC REVIEW AND META‐ANALYSIS ON THE CO‐EXISTENCE AND PREVALENCE OF AMOEBIASIS IN INFLAMMATORY BOWEL DISEASE
Ghaida Dahlwi 1, Rabia Khan2, Ziyad Mirza3, Yagoub Bin‐Taleb1
1Department of Paediatrics, Division of Gastroenterology, Hepatology, and Nutrition, King Abdul‐Aziz University, Jeddah, Saudi Arabia, Jeddah, Saudi Arabia, 2Children's Hospital of Eastern Ontario, Ottawa, Canada, 3Division of Pediatric Gastroenterology, Department of Pediatrics, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia, Jeddah, Saudi Arabia
Objectives and Study: To conduct a systematic review and meta‐analysis to assess the prevalence of amoebic colitis in inflammatory bowel disease (IBD) patients and examine whether amoebiasis contributes to disease flares or severe disease in this population
Methods: The protocol for this review was registered in PROSPERO under ID 626322. We included observational studies that: 1) involved IBD patients (both paediatric and adult); 2) reported the prevalence of amoebic colitis; and/or 3) discussed the clinical impact of amoebiasis and IBD outcomes. A random‐effects meta‐analysis was used to calculate the pooled prevalence of amoebic colitis in IBD. Subgroup analyses were performed based on IBD phenotype.
Results: Of 288 studies initially identified, 9 met the inclusion criteria, encompassing a total of 1,825 IBD patients. Most patients had ulcerative colitis (UC) (n = 1,515, 83%). The pooled prevalence of amoebic colitis in IBD patients was 19.3% (95% CI 10.4%‐30.1%) (Figure.1). Specifically, in UC patients, the prevalence was 20.1% (95% CI 9.9%‐32.7%), and in Crohn's disease (CD) patients, it was 11% (95% CI 5.4%‐18.5%). The high I² value indicated substantial inter‐study heterogeneity.
Conclusions: Amoebic colitis is a significant consideration as a differential diagnosis in IBD patients, particularly in endemic regions. Screening for amoebiasis is strongly advised in IBD patients, especially those with UC, during disease flares or persistent symptoms, given its potential to exacerbate disease activity.
Contact e‐mail address: Gdahlwi@kau.edu.sa
G‐EP068. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP068.1. EVALUATING THE LAPAROSCOPIC AND ROBOTIC APPROACH FOR THE SURGICAL MANAGEMENT OF PAEDIATRIC ULCERATIVE COLITIS: INSIGHTS FROM AN ITALIAN NATIONAL REFERRAL CENTRE
Martina Di Benedetto 1, Luca Scarallo1,2, Federico Perna3, Emilio Paolo Emma3, Riccardo Coletta2,4, Stefano Scaringi3, Paolo Lionetti1,2
1Gastroenterology And Nutrition Unit, Meyer Children's Hospital, Firenze, Italy, 2Department Of Neurofarba, University of Florence, Firenze, Italy, 3Inflammatory Bowel Disease Surgical Unit, Careggi University Hospital, Firenze, Italy, 4Pediatric Surgical Unit, Meyer Children's Hospital, Firenze, Italy
Objectives and Study: To present a single‐centre experience with minimally invasive surgery for ulcerative colitis (UC) in children and identify potential risk factors for early postoperative complications.
Methods: A retrospective analysis of children with UC treated at the Gastroenterology Unit of Meyer Children's Hospital (MCH) IRCSS, who underwent abdominal surgery between 2000 and 2023. Surgical procedures were performed both by paediatric surgeons from MCH and adult surgeons from Careggi Hospital IBD‐Unit.
Results: Seventy‐two surgical procedures in 31 patients were analysed. All patients underwent subtotal colectomy as the first surgical step. As second stage, 24/31 underwent an ileal‐pouch‐anal anastomosis (IPAA) followed by ileostomy closure whereas 2/31 underwent a direct ileo‐anal anastomosis. Of the 31 colectomies, 80.7% (n = 25) were performed laparoscopically, while 19.3% (n = 6) were open. Among the 24 IPAA procedures, 20.8% (n = 5) were performed with an open approach, 50% (n = 12) were video‐laparoscopic assisted, and 29.2% (n = 7) were robotic. Open and laparoscopic approaches had comparable safety, with no significant difference in early complications (p = 0.998 colectomy, p = 0.515 IPAA). However, laparoscopic surgery showed a significantly shorter times to regular diet, intestinal recanalization, and hospital discharge for both colectomies (p = 0.005, 0.002, and 0.025, respectively) and IPAA (p = 0.008, 0.001, and 0.044 respectively). Robotic approach showed a shorter time to intestinal recanalization compared to laparoscopic surgery (p = 0.032). Eight patients (25.8%) who underwent colectomy experienced early postoperative complications. Univariate analysis identified Very Early Onset ‐ IBD as a significant risk factor for complications (p = 0.026; OR: 10.5; 95% CI:1.4–38). Biologic therapies or immunomodulators in the four weeks prior to surgery was not linked to an increased risk.
Conclusions: Laparoscopic surgery for pediatric ulcerative colitis (UC) is effective, offering advantages over open surgery by reducing intestinal recovery time and hospital stays. The robotic approach also demonstrates promising results, with shorter recovery times. Larger multicentre studies are needed to better understand risk factors for early postoperative complications.
Contact e‐mail address: martina.dibenedetto@unifi.it
G‐EP069. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP069.1. COMPARISON OF TIME TO NORMALISATION OF ANAEMIA BETWEEN DIFFERENT INTRAVENOUS IRON PREPARATIONS IN PAEDIATRIC PATIENTS WITH IBD: A PROPENSITY SCORE ANALYSIS
Julie Dostalikova, Ivana Copova, Ondrej Hradsky, Jiri Bronsky
Dept. Of Paediatrics, University Hospital Motol, Prague, Czech Republic
Objectives and Study: Using propensity score matching, we compared the time to normalisation of anaemia between different intravenous (IV) iron preparations.
Methods: Among 260 screened patients, 226 met the inclusion criteria, with 138 patients analysed after matching. The primary outcome was the time to haemoglobin (Hb) normalisation or its increase by 20 g/L. Secondary outcomes included responder rates at week 12, the number of IV iron applications required for response, predictors of treatment success, and adverse events (AE), including hypophosphataemia.
Results: FCM‐treated patients (N = 69) achieved faster Hb normalisation (HR = 0.67, 95%CI: 0.47‐0.95, p = 0.02) and had a higher likelihood of Hb increase (HR = 0.61, 95%CI: 0.38‐0.97, p = 0.04) compared to those receiving IS (N = 69). By week 12, Hb normalisation occurred in 69% of FCM‐treated patients versus 50% in the IS group (p < 0.001), with 41% and 29%, respectively, achieving a 20 g/L increase (p < 0.001). FCM required fewer applications to achieve treatment response (1.2 ± 0.6 vs. 1.6 ± 0.8, p < 0.001). Female sex (HR = 0.52, 95%CI: 0.35‐0.79, p = 0.002) and Crohn's disease (CD) remission as defined by PCDAI (HR = 1.68, 95%CI: 1.13‐2.51, p = 0.011) were associated with an increased likelihood of treatment response across both groups. The incidence of hypophosphataemia was identical in both groups at 26%, with CD and upper gastrointestinal involvement identified as risk factors for hypophosphataemia (p = 0.006 and p = 0.019, respectively). Overall, AE rates were comparable between the two groups.
Conclusions: FCM treatment in PIBD appears to be associated with 50% faster haemoglobin normalisation compared to IS, with both therapies exhibiting similar safety profiles. Female sex and CD remission emerged as key predictors of treatment response in both groups.
Contact e‐mail address: julie.dostalikova@fnmotol.cz
G‐EP070. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP070.1. ITEM GENERATION AND REDUCTION TOWARD DEVELOPING THE PEDIATRIC IBD FATIGUE INDEX (PIFI): CONCEPT ELICITATION INTERVIEWS
Gili Focht 1,2, Liron Marcovitch1, Sarah Kenigsberg1, Reut Rappaport1, Jenna Hatfield3, Ronen Stein4, Eileen Crowley5, Anthony Otley3, Oren Ledder1, Raffi Lev‐Tzion1, Amit Assa1, Ora Paltiel2, Dan Turner1
1Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Jerusalem, Israel, 2Braun School Of Public Health And Community Medicine, Hadassah Medical Organization, Faculty Of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel, 3IWK Health Centre, Halifax, Canada, 4Children's Hospital of Philadelphia, Philadelphia, PA, USA, Philadelphia, United States of America, 5Division Of Pediatric Gastroenterology, Schulich School of Medicine and Dentistry, Western University, Children's Hospital of Western Ontario, London, Canada
Objectives and Study: Fatigue is a common and burdensome symptom in pediatric‐IBD (PIBD) but is often overlooked. No validated, disease& age‐specific patient‐reported outcome measure (PROM) exists to assess fatigue in PIBD. This study is the first of three phases towards developing the Pediatric IBD Fatigue Index (PIFI), a PROM to measure fatigue in PIBD. We aimed to explore signs&symptoms important to children with IBD and their caregivers in reflecting disease‐related fatigue.
Methods: Semi‐structured‐concept‐elicitation‐qualitative interviews were conducted with children diagnosed with Crohn's disease (CD), ulcerative colitis (UC), or IBD‐unclassified (IBD‐U) and their caregivers at two centers. Participants described fatigue‐related symptoms across different disease states and duration.
Results: Eighteen children (mean age 11.6 ± 3.4 years, range 5.8–17.7;44% girls,61% with CD,17% with active disease) and five caregivers were included. Nine children (50%) had difficulty in defining fatigue or differentiating it from weakness or being tired. Regarding mood‐related fatigue, 12 children(67%) and four caregivers (80%) stated children were either cranky, grumpy, angry or sad (Table), and eight(44%) said they were feeling unmotivated to do anything. Regarding fatigue‐related behaviour, eight children(44%) reported waking up in the morning after a good night sleep and still feeling tired, seven children (39%) and two caregivers(40%) reported that the child required rest during the day. As for IBD related symptoms affecting fatigue, 11 children (61%) and two caregivers (40%) reported stomach‐ache as related to fatigue, scoring importance of 4 and 4.5 respectively. Six of the children (33%) could not identify a specific IBD symptom related to their fatigue. Eleven (61%) of the children reported they could recall if they experience fatigue in the past 24 h, nine (50%) in the past 48 h and four (22%) in the past week.
Conclusions: In this phase‐1 of PIFI development, children and caregivers identified key fatigue‐related symptoms and behaviours in IBD. Cognitive interviews will refine and rank potential items while determining response options.
Contact e‐mail address: turnerd@szmc.org.il
G‐EP071. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP071.1. BIOCHEMICAL RESPONSE TO EXCLUSIVE ENTERAL NUTRITION IS ASSOCIATED WITH CHANGES IN THE FECAL MICROBIOME AND METABOLOME IN CHILDREN WITH ACTIVE CROHN'S DISEASE
Konstantinos Gkikas 1, Ben Nichols1, Caroline Kerbiriou1, Anna Mascellani2, Simon Milling3, Umer Ijaz4, Vaios Svolos1, Jaroslav Havlik2, Richard Hansen5, Richard Russell6, Konstantinos Gerasimidis1
1School Of Medicine, University of Glasgow, Glasgow, United Kingdom, 2Department Of Food Science, Czech University of Life Sciences Prague, Prague, Czech Republic, 3School Of Infection And Immunity, University of Glasgow, Glasgow, United Kingdom, 4James Watt School Of Engineering, University of Glasgow, Glasgow, United Kingdom, 5Department Of Child Health, University of Dundee, Dundee, United Kingdom, 6Department Of Paediatric Gastroenterology And Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
Objectives and Study: Exclusive enteral nutrition (EEN) is an effective treatment for active Crohn's disease (CD), with a putative mechanism of action involving the gut microbiome. We explored how shifts in fecal microbiome and metabolome relate to faecal calprotectin (FCAL) in children with active CD treated with EEN.
Methods: Children (6‐17 years, 38% female) with active CD (weighted paediatric Crohn's disease activity index>12.5 and FCAL>250 mg/kg) receiving EEN were prospectively recruited from Scottish paediatric hospitals. Faecal samples were collected before, at four and eight weeks of EEN. Response was defined as a > 50% reduction in FCAL from baseline at EEN completion. Age‐ and gender‐matched healthy children provided single faecal samples. Faecal microbiota and metabolites were analysed using 16S rRNA gene sequencing and 1H NMR, respectively.
Results: Following EEN treatment, 20/32 (63%) of patients were classified as responders. Microbial richness remained significantly lower in patients with CD compared to healthy controls throughout EEN, with further reductions observed only in non‐responders. Microbiome composition (β‐diversity) shifted away from that of healthy controls by EEN completion and varied significantly according to FCAL response at EEN completion (R2 = 0.052, p = 0.03). In responders, forty‐six microbial taxa changed significantly (23 increased, 23 decreased) against only four decreasing in non‐responders (Figure 1). Veillonella, Peptostreptococcus and Haemophilus were lower in responders than non‐responders at EEN completion; no differences were observed at baseline. The concentration of faecal short‐chain fatty acids decreased, while faecal pH and total sulphide increased in all patients. Responders exhibited distinct metabolomic changes, including reduced faecal amino acid concentration and elevated p‐cresol levels. At EEN completion, faecal pH and sulphide were higher in responders, whereas faecal ammonia, choline and glycine were higher in non‐responders (Figure 1).
Conclusions: Patients biochemically responding to EEN display marked shifts in faecal microbiome and metabolome. Efficacy of EEN may result from depleting microbial taxa and downstream effects on nitrogen‐containing compounds.
Contact e‐mail address: konstantinos.gkikas@glasgow.ac.uk
G‐EP072. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP072.1. EFFICACY AND SAFETY OF MULTIPLE SWITCHING FROM INFLIXIMAB ORIGINATOR TO DIFFERENT BIOSIMILARS IN PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Sofie De Groote1, Karen Van Hoeve2, Ilse Hoffman 2
1Department Of Pediatrics, University Hospitals Leuven, Leuven, Belgium, 2Department Of Pediatric Gastroenterology, Hepatology & Nutrition, Universital Hospitals Leuven, Leuven, Belgium
Objectives and Study: Infliximab (IFX) is highly effective but costly, promoting the development of biosimilars. Data on double switching from originator IFX to biosimilars in paediatric inflammatory bowel disease (IBD) patients remain limited. This study evaluated the safety and efficacy of sequential switching from originator IFX to two IFX biosimilars (CT‐P13) in IBD.
Methods: In this single‐centre study, all paediatric IBD patients on maintenance IFX therapy were sequentially switched from originator (Remicade®) to CT‐P13 (Inflectra®, cohort A) in 2018 and then to CT‐P13 (Remsima®, cohort B) in 2022. Cohort C includes patients who underwent both switches. Demographics, disease activity, and IFX levels were collected from six months before to six months after each switch. Baseline refers to data collected six months before first switch on IFX originator. Data are presented as median [interquartile range].
Results: A total of 42 children (cohort A) and 44 children (cohort B) underwent a single switch to CT‐P13, with a median duration on IFX of 13.5 [6.8‐35.5] and 21.5 [11.2‐39.4] months, respectively, before switching. Among them, 14 children (cohort C) underwent multiple switches. No significant changes in IFX trough levels occurred after switching. Median baseline IFX trough level was 7.9 [5.3‐10.6] versus 8.2 [6.7‐10.0] µg/mL six months after second switch (p = 0.792). Antibodies to IFX developed in one patient (cohort A) post‐switch. Clinical/biological remission rates remained stable, except for higher clinical remission rate in cohort C six months post‐switch (p = 0.039) compared to baseline. No clinically significant changes were noted in C‐reactive protein, erythrocyte sedimentation rate, or albumin. The safety profile was similar, with fewer adverse events in cohort B post‐switch, likely due to seasonality, no serious events reported.
Conclusions: Switching to CT‐P13 biosimilars maintains remission without significant changes in pharmacokinetic or adverse events. These findings confirm safety and efficacy of single and multiple switches in paediatric IBD patients.
Contact e‐mail address: ilse.hoffman@uzleuven.be
G‐EP073. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP073.1. NOVEL MUTATIONS IN SASH3 CAUSE MIBD BY IMPAIRING THE NF‐_B AND MTORC1 PATHWAYS
Wenjuan Tang1, Longhuan Piao2, Huaqing Zhong1, Jie Mao3, Zhinong Jiang3, Taosheng Huang4, Ying Huang 5
1Children's Hospital of Fudan University, Shanghai, China, 2Institute of Medical Genetics and Genomics, Fudan University, Shanghai, China, 3Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China, 4National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China, 5Children's Hospital of Fudan University, Shanghai, China
Objectives and Study: Human SAM and SH3 domain‐containing 3 (SASH3) variants globally affect TCR signaling including its downstream mTORC1 and NF‐kB signaling which all play great roles in the pathogenesis of monogenic forms of IBD (mIBD). Here, we study a patient (P1) who was ultimately diagnosed with a novel SASH3 deficiency in the nuclear localization signal 1(NLS1) of the protein presenting with mIBD along with his adult uncle clinically asymptomatic (P2) who carries the identical variant. It is the first time to confirm the SASH3 variants implicated in mIBD
Methods: a 3.2‐year‐old boy suspected mIBD was evaluated in our clinic. Genomic DNA extracted from the peripheral blood mononuclear cells of the child and parents, were subjected to whole‐exome sequencing (WES) and sanger sequencing. Sanger sequencing were performed for their relatives, the immunological features of our patients were analyzed. Western blot (WB) was performed to study the protein level.
Results: P1 was diagnosed with Crohn's disease, according the endoscopy and biopsies.WES and Sanger sequencing identical a variant at exon1 in SASH3 (c.10 C > T/p.R4C) in him, his mother was a heterozygous carrier. Sanger sequencing confirmed that P2 who was clinically asymptomatic to date, carries the identical variant which inherited from P1′ grandmother. The SASH3 variants identified in them is located in NLS1 of the protein, it caused the protein is exclusively located in the cytoplasm and no protein was found inside the nucleus which were proved by WB. The immune phenotype were not seriously damaged in our 2 patients at homeostatic conditions, but upon stimulation with anti‐CD3 and anti‐CD28, both CD4+ and CD8 + T cells from P1, demonstrated impaired expression of CD71 and GLUT1. The WB demonstrated that both the level of p‐NFkB‐p65 and p‐S6 was markedly reduced in P1.
Conclusions: We identified a novel mutations in SASH3 cause mIBD by impairing the NF‐kB and mTORC1 pathways.
Contact e‐mail address: yhuang815@163.com
G‐EP074. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP074.1. EFFECTS OF SINGLE NUCLEOTIDE VARIANTS IN THE STING GENE ON THE PROGNOSIS OF INFLAMMATORY BOWEL DISEASE
Miray Karakoyun 1, Gizem Akyol2, Dogan Barut1, Ezgi Kıran Taşcı1, Şuayıp Bora Kunay1, Ezgi Oğuz1, Eylem Tazegül Çokgezer1, Funda Çetin1, Vildan Bozok2
1Pediatric Gastroenterology, Hepatology And Nutrition, Ege University Medical School, Izmir, Turkey, 2Medical Biology, Ege University Medical School, Izmir, Turkey
Objectives and Study: Inflammatory Bowel Diseases (IBD) are increasing globally among children and adults. Genetic and environmental factors significantly contribute to IBD development. The cGAS‐STING pathway, critical in host defense, is also implicated in autoinflammatory diseases, with hyperactivation disrupting gastrointestinal homeostasis. This study aimed to analyze R232H, R293Q, G230A, and R71H variants in the STING gene of pediatric IBD patients and investigate their association with prognosis.
Methods: Pediatric patients (0–18 years) newly or previously diagnosed with IBD at Ege University were included. STING variants were identified through endpoint genotyping analysis following RT‐PCR. Tissue mRNA levels of STING and interferon‐induced genes were assessed via qRT‐PCR, and protein levels were determined using western blot. Prognostic indicators such as treatment response, flare‐up frequency, duration, and remission time were statistically analyzed based on genotypes.
Results: The study included 37 patients (18 males, 19 females), with 32 diagnosed with ulcerative colitis and 5 with Crohn's disease. The median follow‐up was 27.1 months. Thirteen patients had ≥4 flare‐ups, and 21 had flare‐up durations ≥4 days. Genotyping revealed significant associations between the G230A variant and flare‐up frequency, and the R232H variant with treatment response, flare‐up count, and duration. Homozygous R232H patients had longer flare‐ups compared to heterozygous ones.
Conclusions: Heterozygous R232H patients responded better to initial treatments than homozygous patients. These findings suggest that STING gene variants may guide the development of personalized, genetics‐based treatment strategies for IBD.
Contact e‐mail address: ezgikiran@gmail.com
G‐EP075. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP075.1. EXPLORING THE MECHANISM OF NEC INTESTINAL INJURY USING SINGLE‐CELL SEQUENCING TECHNOLOGY
Xi Kedi 1, Shuping Han2
1Nanjing Women and Children's Healthcare Hospital, Nanjing, China, 2Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
Objectives and Study: Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the neonatal period. Single‐cell sequencing offers a cutting‐edge, high‐throughput platform to characterize genomic, transcriptomic, epigenetic, proteomic, and multi‐omic profiles at the single‐cell level, enabling detailed insights into cellular heterogeneity and function. This study aimed to elucidate the mechanisms underlying NEC‐induced intestinal injury using single‐cell sequencing technology.
Methods: Intestinal tissue samples were collected from patients with NEC and from non‐NEC control patients. Single‐cell sequencing was performed to compare cellular composition, identify distinct cell populations, and reveal changes associated with NEC pathogenesis.
Results: Compared to controls, NEC samples showed a significant increase in multiple immune cell populations and a marked decrease in intestinal epithelial cell subtypes. Within the epithelial compartment, absorptive enterocytes were notably reduced, while crypt stem cells were proportionally increased in the NEC group. Additionally, a unique subset of Paneth cells was identified, characterized by both classical Paneth cell markers (DEFA5, DEFA6, LYZ) and high expression of stemness‐related genes (e.g., OLFM4). Further differential gene expression and enrichment analyses of stem cell‐related genes highlighted that the NEC‐associated molecular alterations were predominantly linked to oxidative phosphorylation, metabolic pathways, and protein processing.
Conclusions: This study provides a single‐cell resolution map of intestinal epithelial cell populations in NEC. Our findings reveal altered epithelial and immune cell dynamics and identify a distinct Paneth cell subset with stem‐like characteristics in NEC‐affected tissues. These results offer novel insights into NEC pathogenesis and may pave the way for the development of targeted therapeutic interventions.
Contact e‐mail address:
G‐EP076. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP076.1. SERUM CLAUDIN‐1 CONCENTRATION IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE
Paulina Krawiec, Elżbieta Pac‐Kożuchowska
Department Of Paediatrics And Gastroenterology, Medical University of Lublin, Lublin, Poland
Objectives and Study: Intestinal epithelial tight junction barrier dysregulation plays a significant role in the pathogenesis of inflammatory bowel disease (IBD). Tight junctions are composed of proteins such as claudins or occludins. Claudins expression has not been extensively investigated in paediatric‐onset IBD although it appears to be a significant pathogenic factor and potential treatment target. We aimed to evaluate concentration of serum claudin‐1 in children with IBD and determine its clinical utility in the diagnostics of IBD
Methods: We enrolled 68 children with IBD to study group including 38 patients with ulcerative colitis and 30 with Crohn's disease. In the control group there were 20 children. All children underwent blood tests including complete blood count, C‐reactive protein (CRP), and erythrocyte sedimentation rate (ESR) according to the routine laboratory procedures. Concentration of serum claudin‐1 was measured using commercially available enzyme‐linked immunosorbent assay kits (ELISA assay kit for claudin‐1; human) according to the manufacturer's recommendations (Cloud‐Clone Corp. Katy USA, Serial No: 6FF5960FAA). Stool samples were obtained for faecal calprotectin. Statistical analysis was performed using the Statistica v.13.0 program. The study was approved by the local bioethical committee (KE‐0254/117/2021).
Results: In children with IBD serum claudin‐1 (mean ± SD: 0.046 ± 0.100 ng/ml) did not differ significantly compared to the control group (mean ± SD: 0.037 ± 0.024 ng/ml) (p = 0.27). Detailed analysis demonstrated that there was also no difference in the concentration of serum claudin‐1 between patients with Crohn's disease (mean ± SD: 0.030 ± 0.019 ng/ml) and ulcerative colitis (mean ± SD: 0.025 ± 0.133 ng/ml) (p = 0.51). We did not find significant relationship between serum claudin‐1 and ESR (p = 0.69; R = ‐0.05), CRP (p = 0.66; R = ‐0.44), faecal calprotectin (p = 0.85; R = 0.02), Paediatric Ulcerative Colitis Activity Index (p = 0.75; R = ‐0.05), and Paediatric Crohn's Disease Activity Index (p = 0.92; R = 0.02).
Conclusions: Concentration of serum claudin does not appear to reflect disrupted intestinal epithelial tight junction barrier in children with inflammatory bowel disease. However, further studies are needed to understand regulatory mechanisms of tight junction barrier in children with IBD.
Contact e‐mail address: paulina.krawiec@umlub.pl
G‐EP077. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP077.1. USE OF USTEKINUMAB IN PEDIATRIC INFLAMMATORY BOWEL DISEASE AFTER ANTI‐TNF FAILURE IN A SHORT INTERVAL THERAPEUTIC REGIMEN: A MULTICENTER STUDY FROM ARGENTINA
Santiago Kuyumciyan 1, Maria Gallo1, Luciana Guzman2, Maria Arcucci1, Veronica Busoni1, Lorena Menendez3, Emilia Cohen1, Katia Kulay1, Marina Orsi1
1Buenos Aires, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 2hiaep sor maria ludovica, LA PLATA, Argentina, 3Sor Maria Ludovica Children's hospital, La Plata, Argentina
Objectives and Study: To evaluate ustekinumab response and side effects using a short interval regimen in pediatric inflammatory bowel disease (pIBD) patients after anti‐TNF failure at different stages of treatment.
Methods: A multicenter, retrospective study was conducted in pediatric patients (<18 years) with pIBD who failed an anti‐TNF therapy seen at two reference centers in the last decade. Demographic data with clinical scores and laboratory markers were collected. All patients who required ustekinumab due to primary or secondary anti‐TNF failure were included. Follow up outcomes were assessed at weeks 0 ‐ 12 ‐ 52. Ustekinumab induction was administered intravenously at 6 mg/kg in a 4 week interval followed by a maintenance subcutaneous dose of 90 mg/dose.
Results: Among 162 patients with anti‐TNF therapy,17 (10.49%,10 girls) were switched to ustekinumab due to biologic failure (14 second‐line, 3 third‐line with vedolizumab). Median age at IBD diagnosis:11.9 yo, median ustekinumab initiation age of 14.2 yo (IQR 9.5‐15.8). The median follow‐up was 11 months (IQR 5.5‐24). At baseline, the median PCDAI of 26.2, median calprotectin of 1000 µg/g, Hb 10.85 g/dL, albumin 3.75 g/dL, and CRP 2.9 mg/L. At 12 weeks, median PCDAI improved to 5 (mean change: ‐21.2). Hb increased (mean: 11.9 g/dL), albumin improved (mean: 4 g/dL), and CRP decreased (median: 1.2 mg/L). Of the 9 patients with 52 weeks follow up an overall improvement trend was observed. Only median calprotectin levels showed statistical significance between baseline and week 12 (1000 vs 415 µg/g, p0.01), and week 52 (1000 vs 320 µg/g, p0.01). No adverse effects were reported.
Conclusions: In this pediatric cohort, ustekinumab in a 4‐week interval regimen demonstrated clinical and laboratory improvement without side effects. These results suggest ustekinumab can be considered a safe option in this shortened frequency scheme in children after pediatric approved biologics fail. Further studies are needed to validate these preliminary results.
Contact e‐mail address: santiago.kuyumciyan@hospitalitaliano.org.ar
G‐EP078. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP078.1. PIEZO TYPE MECHANOSENSITIVE ION CHANNEL COMPONENT 1 IMPROVED MUCOSAL BARRIER FUNCTION THROUGH ACTIVATION OF CYCLIC‐AMP RESPONSE BINDING PROTEIN‐MEDIATED MUCIN‐2 EXPRESSION IN INFLAMMATORY BOWEL DISEASE
Jiaoli Lan 1,2, Rongwei Niu3, Ni Ma1, Ying Wang1, Zexiong Su1, Jing Yang1, Danxia Liang1, Wanfu Xu4, Min Yang1
1Department Of Pediatrics, Guangdong Provincial People's Hospital Affiliated to Southern Medical University, Guangzhou, China, 2Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China, Guangzhou, China, 3The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China, Guangzhou City, Guangdong Province, China, 4Department Of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China., Guangzhou City, Guangdong Province, China
Objectives and Study: The intestinal mucosal barrier plays an important role in influencing inflammatory bowel disease (IBD). Our previous work revealed that piezo‐type mechanosensitive ion channel component 1 (PIEZO1) was enriched in the colonic mucosal epithelial cells of patients with IBD. In this study, we aimed to explore the possible function of PIEZO1 in mucin expression in intestinal epithelial cells (IECs).
Methods: Colonic mucosa from patients with IBD was used to detect the expression of PIEZO1 and mucin in IECs using immunofluorescence and AB‐PAS staining. PIEZO1 activator (Yoda1), PIEZO1 inhibitor (GsMTx4) and PIEZO1‐knockdown IECs were used to analyze the function and mechanism of PIEZO1 in MUC2 expression in IECs using real‐time polymerase chain reaction, western blot, and immunofluorescence. The mouse intestinal organoids were used for further validation. Yoda1 or GsMTx4 combined with dextran sulfate sodium (DSS)‐induced colitis and villin‐PIEZO1flox/flox mice were used to confirm the function of PIEZO1 in vivo.
Results: Yoda1 treatment significantly upregulated the MUC2 expression in IECs, whereas PIEZO1 inhibition or depletion in IECs suppressed MUC2 expression in vitro and in mouse intestinal organoids. Mechanistically, silencing of PIEZO1 expression in IECs inhibited CREB1 phosphorylation and nuclear translocation, which was attributed to the interactions between CRTC2 and CREB1 caused by PIEZO1 deletion. Moreover, CREB1 overexpression via plasmid transfection strongly reversed MUC2 downregulation in PIEZO1‐deficient IECs. Importantly, similar results were observed in Yoda1 or GsMTx4 combined with DSS‐induced colitis and villin‐PIEZO1flox/flox mice.
Conclusions: Our results revealed that PIEZO1 plays an important role in regulating MUC2 expression in IECs in a CRTC2/CREB1‐dependent manner, suggesting that the activation of PIEZO1 signaling is important for sustaining intestinal mucus barrier homeostasis in IBD.
Contact e‐mail address: yangmin1008@gdph.org.cn
G‐EP079. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP079.1. EARLY SURGERY IN PEDIATRIC‐ONSET ILEOCECAL CROHN'S DISEASE IS ASSOCIATED WITH IMPROVED LONG‐TERM OUTCOMES: A POPULATION‐BASED STUDY
Delphine Ley 1, Clémence D'alès2, Hélène Sarter1, Mathurin Fumery3, Claire Dupont‐Lucas4, Dominique Turck1, Valérie Bertrand5, Pauline Wils1, Nicolas Richard2, Corinne Gower‐Rousseau6, Hugues Coevoet7, Thierry Paupard8, Nathalie Guillon1, Guillaume Savoye9, Ariane Leroyer1
1Univ. Lille, Inserm, CHU Lille, U1286 ‐ INFINITE ‐ Institute for Translational Research in Inflammation, Lille, France, 2Gastroenterology Unit, Rouen University Hospital, Rouen, France, 3Gastroenterology Unit, Amiens University Hospital, and Peritox, UMRI01, Université de Picardie Jules Verne, Amiens, France, 4Department of Paediatrics, Caen University Hospital, Caen, France, 5Department of Paediatrics, Le Havre Hospital, Le Havre, France, 6University Hospital of Reims, Research and Public Health Division, Reims, France, 7Private Hospital des Bonnettes, Gastroenterology, Arras, France, 8General Hospital of Dunkerque, Gastroenterology, Dunkerque, France, 9Gastroenterology Unit, Rouen University Hospital, UMR 1073 University of Rouen Normandy, Rouen, France
Objectives and Study: Early surgery in Crohn's disease (CD) seems to be efficient and safe in recently diagnosed adult ileocecal CD as compared to anti‐TNF. We aimed to compare long‐term disease course in paediatric‐onset CD treated within one year of diagnosis with ileocecal resection (ICR) or anti‐TNF.
Methods: Paediatric‐onset (< 17 years) ileocecal CD, treated with ICR or anti‐TNF within one year of diagnosis, were included from a population‐based cohort. The cumulative incidence of unfavourable disease course, defined as CD‐related hospitalization, major CD‐related surgery, systemic corticosteroids or perineal CD, was calculated at 1, 3 and 5 years. A Cox regression model with a propensity score was performed.
Results: Among 1,007 CD patients diagnosed between 1988 and 2011, 134 with ileocecal involvement at diagnosis were included (n = 67 in the ICR group, n = 67 in the anti‐TNF group). The median follow‐up was 6.0 years, IQR (3.2‐11.1). 19% patients in the anti‐TNF group had complicated behaviour at diagnosis, compared to 94% in the ICR group (p < 0.001). The cumulative incidence of unfavourable disease course was 17%, 26% and 30% respectively at 1, 3 and 5 years in the ICR group, versus 24%, 54% and 71% in the anti‐TNF group (p < 0.0001). Using propensity score, patients in the ICR group had better disease course than patients in the anti‐TNF group with a hazard ratio (HR) of 0.16 [0.08‐0.35] over time. Clinical remission was achieved in 83% of patients in the ICR group and 41% in the anti‐TNF group (p < 0.001) at 5 years. Sixteen patients (23%) experienced an early postoperative complication, including 6 (9%) severe complications. Only emergency surgery was associated with late complications (HR = 6.9 [2.3‐20.6]).
Conclusions: Early surgery in paediatric‐onset ileocecal CD was significantly associated with less unfavourable outcome and seemed safe. These data support the role of early elective surgery in the first‐line treatment of paediatric‐onset ileocecal CD.
Contact e‐mail address: delphine.ley@chu-lille.fr
G‐EP080. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP080.1. LONG‐TERM OUTCOME OF CHILDREN WITH VERY‐EARLY‐ONSET NON‐MONOGENIC COLITIS: A SINGLE CENTER RETROSPECTIVE STUDY
Giuseppe Logrieco 1,2, Ugo Cucinotta3, Frank Rümmele1, Cécile Talbotec1, Florence Campeotto1, Elie Abi‐Nader1, Elise Payen1, Monica Ronconi1, Fabienne Charbit‐Henrion4, Bénédicte Pigneur1
1Gastroenterology And Nutrition Unit, Pediatric Hospital Necker Enfants malades, Paris, France, 2Gastroenterology And Nutrition Unit, Pediatric Hospital Bambino Gesù, Rome, Italy, 3Hepatology Unit, Pediatric Hospital Necker Enfants malades, Paris, France, 4Genetic Department, Pediatric Hospital Necker Enfants malades, Paris, France
Objectives and Study: Very early‐onset inflammatory bowel disease (VEOIBD), diagnosed before 6 years, is a challenging condition with complex clinical features and limited long‐term data. Our study describes the long‐term outcome of patients diagnosed with VEOIBD without any identified genetic mutation.
Methods: Data of all consecutive patients aged 0–6 years diagnosed with colitis (CD, UC, or IBD‐U) at Necker Hospital (Paris, France) between 2013 and 2023 were retrospectively reviewed. Patients with monogenic forms of VEOIBD and perianal disease were excluded. Clinical, biological, and endoscopic data were collected at diagnosis and during follow‐up (1, 3 and 5 years). Comparisons were made between groups (remission/active disease, diagnosis before and after 2 years). A standardized questionnaire regarding environmental factors during pregnancy and infancy was sent to parents.
Results: Sixty‐five patients (49% male, mean follow‐up 4.8 ± 2.9 years), including 28 (41%) with infantile IBD (IO‐IBD), diagnosed < 2 years, were included. There were 8 (12%) patients with Crohn's disease, 22 (34%) with ulcerative colitis and 35 (54%) with IBD unclassified. Most of the patients had pancolitis. Only 3 patients underwent colectomy or diversion during follow‐up. Corticosteroid‐free remission rates were 48%, 67% and 76% at 1, 3 and 5 years. 64% of patients were treated with an immunosuppressant during follow‐up, mainly azathioprine. Earlier initiation of corticosteroids was associated with better 1‐year remission rates. Patients with IO‐IBD had more severe disease at diagnosis (higher disease activity and endoscopic scores, greater need for steroids; p = 0.04). However, IO‐IBD patients had better long‐term outcomes, with lower anti‐TNF‐alpha use and fewer therapy escalations at 3 and 5 years (p < 0.05). Finally, poorer outcomes were associated with maternal consumption of processed foods, paternal smoking and western lifestyle.
Conclusions: Patients with VEOIBD without genetic mutation exhibit low rate of complications and surgical interventions at the long term. Environmental factors seem to impact the disease burden even in VEOIBD.
Contact e‐mail address: giu.logrieco@gmail.com
G‐EP081. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP081.1. ACCURACY OF INTESTINAL ULTRASOUND (IUS) IN EVALUATING PAEDIATRIC INFLAMMATORY BOWEL DISEASE
Mario Mašić 1, Ana Močić Pavić1, Mia Šalamon Janečić1, Zrinjka Mišak1,2, Iva Hojsak1,2,3
1Referral Center For Pediatric Gastroenterology And Nutrition, Children's Hospital Zagreb, Zagreb, Croatia, 2School Of Medicine, University of Zagreb, Zagreb, Croatia, 3School Of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
Objectives and Study: Intestinal ultrasound (IUS) has gained recognition as a reliable modality for diagnosing and monitoring inflammatory bowel disease (IBD). This study aimed to evaluate the diagnostic accuracy of IUS in identifying IBD within the paediatric population.
Methods: We conducted a single‐centre prospective study involving children undergoing evaluation for IBD between June 2023 and December 2024. Eligible participants underwent IUS, clinical and biochemical assessments, and ileocolonoscopy. The IUS examinations were performed prior to endoscopy and evaluated using the International Bowel Ultrasound Segmental Activity Score (IBUS‐SAS) and the Milan Ulcerative Colitis (MUC) score. Endoscopic activity was assessed using the Simple Endoscopic Score for Crohn's Disease (SES‐CD) in CD and the Mayo Score in UC. Disease activity was quantified using the Paediatric Crohn's Disease Activity Index (PCDAI) and the Paediatric Ulcerative Colitis Activity Index (PUCAI).
Results: The study involved 177 patients (45% female, mean age 13.3 years) referred for newly suspected IBD (65%), IBD relapse (19%), and quiescent IBD (16%). Newly diagnosed IBD was confirmed in 55% of suspected patients. Of all patients, 26% had CD, 35% had UC, and 39% had normal endoscopy. PCDAI correlated with SES‐CD (coef. 0.444, p = 0.012), and with IBUS‐SAS (coef. 0.422, p = 0.006), while the PUCAI correlated with Mayo score (coef. 0.693, p < 0.001) and MUC (coef. 0.54, p < 0.001). Positive correlation was found for SES‐CD and IBUS‐SAS (coef. 0.422, p = 0.02), and Mayo score and MUC (coef. 0.771, p < 0.001). IUS demonstrated 92% sensitivity, and 96% specificity compared to endoscopy (PPV 97% and NPV 88%). Univariate logistic regression identified faecal calprotectin, C‐reactive protein, albumin, haemoglobin, and pathological findings on ultrasound predictive of inflammation on endoscopy; however, multivariate analysis revealed only pathological ultrasound findings as significant (p < 0.001).
Conclusions: Intestinal ultrasound is a highly accurate, reliable and non‐invasive diagnostic tool for paediatric inflammatory bowel disease, demonstrating a strong predictive value for endoscopic inflammation.
Contact e‐mail address: mario.masic@kdb.hr
G‐EP082. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP082.1. COMPARABLE LONG TERM OUTCOMES OF HIGH RISK AND LOW RISK CROHN'S DISEASE CHILDREN FOLLOWING EARLY ANTI TNF TREATMENT
Filippo Mondi' 1, Giulia D'Arcangelo1, Francesca Zucconi1, Miriam D'Orsi1, Tonia Raso1, Sara Curto1, Rosangela Grieco1, Alessandro Inglese1, Silvia Rotulo1, Manuela Distante1, Marina Aloi2
1Department Of Maternal And Child Health, Sapienza University, Paediatric Gastroenterology Unit, Rome, Italy, 2Department Of Pediatric Gastroenterology, Hepatology, Transplantation, And Cystic Fibrosis, University of Milan, Milan, Italy
Objectives and Study: High‐risk (HR) pediatric Crohn's disease (CD) is associated with an increased likelihood of surgical intervention and disease progression. This study aims to evaluate the impact of an upfront anti‐TNFαtreatment strategy on clinical outcomes in HR‐CD pediatric patients, with a particular focus on surgical rates and mucosal healing (MH). The analysis involves comparing the rates of intestinal resection at various time points (6, 12, 24, 36, 48, and 60 months) and assessing the rates of mucosal healing in HR and Low‐Risk (LR) patients. Additionally, survival analysis is performed to investigate potential differences in long‐term outcomes between these two risk groups.
Methods: This retrospective observational case‐control study included children (≤18 years) diagnosed with CD between January 2009 and January 2024, with a minimum follow‐up of 12 months. Patients were stratified into HR and Low‐Risk (LR) groups based on the 2020 ESPGHAN guidelines. Over a 5‐year follow‐up period, the risk of surgery and probability of achieving MH were analyzed and compared between the groups.
Results: A total of 138 children (median age 11.8 years, 38% female; mean follow‐up 56 ± 29 months) were included, with 92 (67%) in the HR group and 46 (33%) in the LR group. The risk of surgery (bowel resection) was similar between HR and LR groups (Log‐Rank p = 0.58, HR = 0.74). The cumulative 5‐year surgical rate was 14% (13/92) in the HR group and 11% (5/46) in the LR group (p = 1). The likelihood of achieving MH was also comparable (Log‐Rank p = 0.5, HR = 1.2). Multivariate analysis identified no independent risk factors for surgery or MH.
Conclusions: These findings suggest that a top‐down strategy with upfront anti‐TNFα therapy enables HR‐CD pediatric patients to achieve outcomes similar to those of LR patients. This approach appears to be effective in altering the disease's natural history and represents a valuable therapeutic strategy.
Contact e‐mail address: filippo.mondi94@gmail.com
G‐EP083. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP083.1. VERY EARLY ONSET IBD; MONOGENIC CAUSES AND PROGNOSES IN A SINGLE TERTIARY CENTRE STUDY
Elizabeth Morrisroe, Rebecca Foulkes, Lisa Charlton, Andrew Fagbemi, Loveday Jago, Maureen Lawson, Virginia Chatzidaki, Chai Lee, Adnaan Kala, Sian Copley
Royal Manchester Children's Hospital, Manchester, United Kingdom
Objectives and Study: Over 80 monogenic causes for very early onset inflammatory bowel disease (veoIBD) have been identified; encapsulating primary immune deficiencies as well as epithelial defects.1,2 The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommend gene sequencing in patients 2 years or under or 2‐6 years with red flag criteria (family history, consanguinity, clinical features of immunodeficiency).3 Genetic panels were reviewed for IBD patients diagnosed aged 6 years or younger in a single tertiary paediatric centre. The aim was to quantify the proportion with a monogenic diagnosis and how this affected management and prognosis.
Methods: 94 veoIBD patients diagnosed between 2010 and 2024 were identified from the departmental IBD database. Data was collected on epidemiology, severity at presentation, genetic testing, management and clinical outcomes. In patients with pathogenic gene variants, management changes and clinical remission status were analysed.
Results: 10/94 (10.6%) of the veoIBD cohort and 4/10 (40%) under 2 years had a monogenic cause, in keeping with published rates of 0 ‐33% and 13‐41% respectively.3 4/10 (40%) proceeded to bone marrow transplant, with 1 more planned. 2 patients received colchicine for familial Mediterranean fever (FMF). 8/10 (80%) are in clinical remission and in 7/10 (70%) IBD treatment has been discontinued.
| Diagnosis | Number of patients |
|---|---|
| Interleukin 10 deficiency | 3 |
| FMF | 2 |
| Chronic granulomatous disease | 2 |
| Cytoplasmic isoleucyl‐tRNA synthetase (IARS) deficiency | 1 |
| Nucleotide‐binding oligomerization domain‐containing protein 2 (NOD2) defect | 1 |
| Tumour necrosis factor alpha induced protein 3 (TNFAIP3) related disease | 1 |
Table 1: Summary of monogenic defects identified.
Conclusions: Rates of monogenic disease were similar in this cohort to published data. In 7/10 identification of a monogenic cause has led to targeted treatment. Genetic sequencing should be considered in all patients presenting with veoIBD, those with red flags or those refractory to standard treatment.3
Contact e‐mail address:
G‐EP084. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP084.1. RISK OF RAPIDLY PROGRESSIVE DISEASE COURSE IN PATIENTS WITH PEDIATRIC‐ONSET ULCERATIVE COLITIS
Giulia D'Arcangelo1, Tonia Raso 1, Sara Curto1, Miriam D'Orsi1, Ludovica Fede1, Manuela Distante1, Silvia Rotulo1, Francesca Zucconi1, Marina Aloi2,3
1Maternal And Child Health Department, Sapienza University of Rome, Rome, Italy, 2Department Of Pediatric Gastroenterology, Hepatology, Transplantation, And Cystic Fibrosis, University of Milan, Milan, Italy, 3Pediatric Gastroenterology, Hepatology And Cystic Fibrosis Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
Objectives and Study: Ulcerative colitis (UC) disease course is unpredictable at diagnosis and its management is based on a "one size‐fits‐all" approach. We aimed to investigate predictive factors of a rapidly progressive course in pediatric UC.
Methods: Retrospective case‐control study including all newly diagnosed UC children, with a minimum follow‐up of 24 months. Demographic and clinical data, laboratory, endoscopic and histologic findings at diagnosis were compared between patients with indolent UC and those with a rapidly progressive (RP) course, defined if they experienced one of the following within the first 24 months after diagnosis: acute severe colitis under antiTNFα unresponsive to IV steroids, colectomy and need for second‐line biologics or advanced small molecules with at least two different mechanisms of action.
Results: 142 children were included, 61 (43 %) with a RP course and 81 (57 %) with an indolent disease. RP children had higher age than those with indolent course (11.3 ± 4.2 vs 9 ± 4, p = 0.0002) and a higher PUCAI (50 ± 13 vs 40.4 ± 12, p < 0.0001) at diagnosis. Hemoglobin was lower in RP group (11.6 ± 1.8 vs 12.4 ± 1.2 g/dL, p = 0.001). RP children had higher rate of cecal patch at endoscopy (19% vs 2% p = 0.001) and lower rate of sclerosing cholangitis (0 vs 8%, p = 0.01). Endoscopic activity was more severe in RP compared to indolent patients: rate of Mayo3 score 18% vs 2%, p = 0.002, and median UCEIS 3.9 ± 1 vs 3.3 ± 0.9, p = 0.001. The presence of a cecal patch at endoscopy was the only independent predictor for a rapidly progressive disease at the multivariate logistic regression analysis [OR 9.2 (95% CI 1.9‐67.1), p = 0.0009].
Conclusions: Children with a RP course present with older age and a more clinically and endoscopically severe disease. However, only the presence of a cecal patch emerged as an independent predictor of this course. These findings warrant confirmation in larger prospective cohorts to support a future personalized approach to UC.
Contact e‐mail address: giuliadarcangelo87@gmail.com
G‐EP085. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP085.1. REVERSE‐ENGINEERED EXCLUSIVE ENTERAL NUTRITION IN PEDIATRIC CROHN'S DISEASE: DECREASED INFLAMMATORY SERUM CYTOKINES AND CIRCULATING TH1 ACTIVATION
Elizabeth Reznikov 1, Dale Lee1, David L Suskind1, Theo Bammler2, Donna Shows3, Benjamin Krautwald3, Melissa Melough4, Sheela Sathyanarayana2,5, James Macdonald2, James Lord3
1Pediatrics, Division Of Gastroenterology And Hepatology, University of Washington, Seattle Children's Hospital, Seattle, United States of America, 2Department Of Environmental And Occupational Health Sciences, University of Washington, Seattle, WA., Seattle, United States of America, 3Center For Translational Immunology, Benaroya Research Institute at Virginia Mason, Seattle, United States of America, 4Health Behavior And Nutrition Sciences, University of Delaware, Newark, United States of America, 5Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, United States of America
Objectives and Study: Exclusive Enteral Nutrition (EEN) has demonstrated efficacy in inducing remission in Crohn's disease (CD). We previously reported clinical remission in patients after 4‐weeks of a reverse‐engineered EEN (RE‐EEN) using whole foods to produce a nutritionally complete smoothie. Our objective was to assess serum cytokines, cell‐surface markers, and transcriptome profiling in sort‐purified cells. We hypothesized RE‐EEN suppressed systemic inflammatory profiles.
Methods: Newly diagnosed pediatric patients with mild to moderate CD received 100% RE‐EEN. 10 subjects enrolled, 8 completed the 4‐week trial, and 3 continued to week 8. The 4 week timepoint was used for primary analysis. Serum was analyzed with a multiplex panel. Lymphocytes were analyzed by flow cytometry. Cell‐sorted populations were sent for RNA sequencing. Data was analyzed by paired t tests for week 4 against baseline.
Results: In paired analyses we observed significant (p < 0.05) results for serum cytokines expressed as log fold change ± standard error of the mean (SEM): IFNγ ‐1.07 ± 0.40, and MIP‐3α 0.22 ± 0.07. Observed changes for TNFα ‐0.22 ± 0.11, IL‐12 ‐0.52 ± 0.22, and IL‐6 ‐0.82 ± 0.39 were suggestive, and they did not meet threshold for statistical significance. Flow cytometry data demonstrated a significant (p < 0.05) drop by week 4 in the Th1 (CXCR3+CD161‐) subset of effector/memory (CCR7‐, CD45RA‐) CD4 T cells bearing the activation marker CD38 (Figure 1). RE‐EEN also revealed a significant drop in the mean fluorescence intensity (MFI) of CD38 on these Th1 cells.
Conclusions: We saw decreased inflammatory cytokines, including those central to effector function (IFN‐γ) of Th1 cells. RE‐EEN was associated with decreased activation specifically in Th1 cells. As Th1 cells were also sort‐purified for cDNA analysis, future analyses will determine if transcriptome differences in these cells correlate with response to RE‐EEN. Larger controlled clinical trials with RE‐EEN are required to establish mechanism and efficacy.
Contact e‐mail address: elizabeth.reznikov@seattlechildrens.org
G‐EP086. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP086.1. BURDEN OF DEPRESSION AND ANXIETY AMONG PATIENTS WITH PEDIATRIC‐ONSET INFLAMMATORY BOWEL DISEASES: A NATIONWIDE STUDY FROM THE EPI‐IIRN
Firas Rinawi 1, Stav Bloch‐Priel2, Uri Kopylov2, Guy Schusheim1, Eran Matz3, Amir Ben ‐Tov4, Raffi Lev‐Tzion5, Iris Dotan6, Maram Soluiman1, Galia Zacay7, Yiska Loewenberg Weisband8, Dan Turner9
1Emek Medical center, Afula, Israel, 2The Edmond & Lili Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel, 3Leumit Health Services, Tel aviv, Israel, 4Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel, 5Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel, 6Rabin Medical Center, Petah Tikva, Israel, 7Research institute, Meuhedet Health Services, Tel aviv, Israel, 8Clalit Health Services, Clalit Research Institute, Tel aviv, Israel, 9The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
Objectives and Study: Data regarding burden of depression and anxiety in pediatric‐onset inflammatory bowel diseases (PIBD) are limited. We aimed to study the prevalence of depression and anxiety in a nationwide cohort of PIBD and their effect on developing poor disease course (PDC).
Methods: Data were retrieved from the epi‐IIRN, a nationwide cohort of the 4 Israeli Health Maintenance Organizations covering 98% of the population from 2005. We matched PIBD children to non‐IBD controls for calculating time to depression/anxiety. PDC was defined as IBD‐related surgery, steroid‐dependency, or need for more than one biologic class. A time‐dependent Cox‐proportional‐hazard‐ratio model was fit to examine predictors of the development of depression/anxiety over time. Inverse probability weights were calculated to estimate the probability that an individual will develop depression at each time point. Weighted time‐varying Cox regression models were used to assess the impact of depression/anxiety diagnosis on PDC.
Results: In total, 4,960 PIBD cases were included [mean age 13.4 ± 3.8 years; 3,304 (67%) with Crohn's disease (CD) and 1,656 (33%) ulcerative colitis (UC)], translating into 32,700 person‐years of follow‐up. These were individually matched to 4,806 non‐IBD children. In a univariable Cox proportional regression model. The probability of depression/anxiety was higher in PIBD patients vs controls at 3 (6% vs 2.5%) and 10 years (17.5% vs 10.2%; p < 0.001, Figure 1). In multivariable Cox proportional regression model, steroid dependency [HR 1.5, (95%CI 1.05‐2.1)] in UC and perianal disease [HR = 1.5 (95%CI 1.3‐2)] and hospitalizations [HR = 1.4 (95%CI 1.1‐1.9)] in CD, were associated with developing anxiety/depression. In a separate analysis, a diagnosis of depression/anxiety was not associated with PDC in either CD (HR 0.84 95%CI 0.63‐1.13) or UC (HR 1.28 95%CI 0.77‐2.14).
Conclusions: Our study highlights the substantial burden of depression/anxiety in PIBD and identifies risk factors for these conditions. These findings emphasize the need for mental health monitoring and early intervention in this population.
Contact e‐mail address:
G‐EP087. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP087.1. EFFECTIVENESS AND SAFETY OF ADVANCED THERAPIES IN VERY EARLY‐ONSET IBD ‐ A MULTICENTRE STUDY FROM THE PAEDIATRIC IBD PORTO GROUP OF ESPGHAN
Luca Scarallo 1, Yael Weintraub2, Edyta Kawalkowska3, Lauren Collen4, Victoria Riedl5, Christian Jakobsen6, Gemma Pujol‐Muncunill7, Kaija‐Leena Kolho8, Marta Velasco Rodríguez‐Belvis9, Katarina Mitrova10, Darja Urlep11, Bénédicte Pigneur12, Firas Rinawi13, Cedata Group14, Karl Mårild15, Anat Yerushalmy‐Feler16, Raffi Lev‐Tzion17, Maya Granot18, Marina Aloi19, Elizabeth De Greef20, Christos Tzvinikos21, Christoph Norden22, Caterina Strisciuglio23, Kwang Yang Lee24, Rémi Duclaux‐Loras25, Naire Sansotta26, Pejman Rohani27, Dror Shouval28, Paolo Lionetti1
1Gastroenterology And Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy, 2Institute Of Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center of Israel, Petha‐Tikva, Israel, 3The Children's Memorial Health Institute‐ Warsaw‐ Poland, Gastroenterology‐ Hepatology‐ Feeding Disorders and Paediatrics, WARSZAWA, Poland, 4Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA 02215, Boston, United States Minor Outlying Islands, 5Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital LMU, 80337 Munich, Germany, Munich, Germany, 6Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital‐Amager and Hvidovre, Hvidovre, Denmark, Hvidovre, Denmark, 7Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain, 8Children's Hospital, University Of Helsinki, Helsinki, Finland, 9Pediatric Nutrition, Hospital Infantil Niño Jesús, Madrid, Spain, 10Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic, 11Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia, 12Pediatric Gastroenterology And Nutrition Unit, Necker Enfants Malades Hospital, PARIS, France, 13Pediatric Gastroenterology Unit and Faculty of Medicine Technion, Haifa, Emek Medical Centre, Afula, Israel, 14CEDATA Group, Germany, Germany, 15Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden, Gotheburg, Sweden, 16Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Faculty of Medical and Health Sciences, Tel aviv, Israel, 17Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel, 18Pediatric Gastroenterology Unit, Edmond & Lily Safra Children's Hospital, Sheba Medical Center, Ramat‐Gan, Faculty of Medicine, Tel‐Aviv University, Tel Aviv, Israel, 19Department Of Pediatric Gastroenterology, Hepatology, Transplantation, And Cystic Fibrosis, University of Milan, Milan, Italy, 20Department of Paediatric Gastroenterology and Nutrition, Kidz Health Castle UZ Brussels, Free University Brussels, Brussels, Belgium, Brussels, Belgium, 21Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Mohammed Bin Rashid University, Dubai, United Arab Emirates, Dubai, United Arab Emirates, 22Hvidovre University Hospital, Copenhagen, Denmark, Copenhagen, Denmark, 23Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy, 24Department of Paediatric Gastroenterology, Bristol Children's Hospital, Bristol, United Kingdom, Bristol, United Kingdom, 25Lyon Hospital, LYON, France, 26Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 27Pediatric Gastroenterology and Hepatology Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran, Teheran, Iran, 28Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, and Faculty of Medicine, Tel‐Aviv University, Tel Aviv, Israel
Objectives and Study: Patients with very early‐onset IBD (VEO‐IBD) often require advanced therapies, yet limited pediatric data exist. We assessed Vedolizumab (VDZ) and ustekinumab (UST) effectiveness and safety in VEO‐IBD patients.
Methods: A retrospective study involving 25 sites affiliated with the IBD Porto Group and IBD Interest Group of ESPGHAN and in North America. Demographic, clinical and laboratory data were collected from patients with VEOIBD who commenced VDZ or UST before 6 years of age, between 2014‐2024.
Results: Eighty‐three VEO‐IBD patients (61.4% males) were included. Median age at diagnosis was 2.25 (0.35‐4.15) years. Twenty‐six (31.3%) were diagnosed with Crohn's disease (CD), 57 (68.7%) with either ulcerative colitis (UC) or IBD‐unclassified. Seventy‐one (85.5%) were previously treated with infliximab, 21 (25%) with adalimumab and 19 (22.9%) with both. Fifty‐seven (68.7%) patients were treated with VDZ, 30 (36.1%) with UST, 12 (14.4%) received > 1advanced therapy and 5 (6%) both simultaneously. Median time from diagnosis to VDZ and UST initiation was 14 (9‐24) and 24 (10‐37) months. Clinical scores decreased from baseline both CD and UC/IBDU patients treated with both UST and VDZ (Figure 1). A significant improvement in C‐reactive protein and fecal calprotectin were observed with VDZ and UST (Figure 1). Median follow‐up lasted 19 (7‐49) months. Durability of UST and VDZ therapy at 12, 24 and 36 months were 92%, 81%, 81% and 81%, 69% and 58%, respectively. 3/30 (10%) nonsevere infections were reported in the UST‐treated and 4/57 (7%) in VDZ patients. No deaths were reported.
Figure 1. (A), (B) VDZ wPCDAI, PUCAI, (C), (D) UST wPCDAI, PUCAI, (E), (F) VDZ CRP, Fcal, (G), (H) UST, CRP, Fcal (*<0.05, **<0.01, *** < 0.001).
Conclusions: VDZ and UST therapy appeared to be efficient and safe in inducing and maintaining clinical and biochemical remission in patients with VEO‐IBD. Durability on UST was higher than VDZ overtime.
Contact e‐mail address: luca.scarallo@gmail.com
G‐EP088. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP088.1. PROGNOSTIC FACTORS AND PREDICTIVE MODEL DEVELOPMENT FOR PEDIATRIC INFLAMMATORY BOWEL DISEASE WITH IL‐10RA DEFICIENCY: A RETROSPECTIVE COHORT STUDY
Xiu Shi, Lai Qian, Hailin Wu, Lin Wang, Ziqing Ye, Song Sun, Xiaowen Qian, Xiaowen Zhai, Kuiran Dong, Ying Huang
Children's Hospital of Fudan University, Shanghai, China
Objectives and Study: Patients with IL10RA‐deficient inflammatory bowel disease (IBD) generally have a poor prognosis, with high mortality and a significant rate of intestinal surgeries. Hematopoietic stem cell transplantation (HSCT) is currently the main cure, but most patients still face death after transplantation. The study analyzes the prognosis of patients without HSCT, aiming to explore factors associated with mortality, as well as to establish short‐term prognostic models.
Methods: The study retrospectively enrolled 138 patients admitted to our center from January 2012 to July 2024. We defined death as outcomes and used K‐M survival analysis, Cox regression models, and XGBoost algorithm to explore long‐term prognostic factors. Additionally, optimal subset regression, and logistic regression were employed to establish a short‐term prognostic model. The model was internally validated using the Bootstrap method and presented with a risk heatmap.
Results: The median age of onset of 138 patients was 0.3 months (range: 0.2‐1 months), and the median age of admission was 8.1 months (range: 3.0‐15.2 months). 21.7% had pure homozygous mutations. The most frequent was c.301 C>T, c.537 G>A. 41(29.7%) of patients died, of which 70.7% were transplant‐related. In patients without HSCT, most deaths occurred within the first year. Cox multivariate regression analysis identified thalidomide used as an independent protective factor against mortality (HR = 0.08, 95% CI: 0.01‐0.39, P = 0.002). The XGBoost model highlighted thalidomide, age of onset, mesalazine, and developmental delay as key variables affecting long‐term survival, with thalidomide having the greatest impact. All variables were screened to identify the optimal combination (age of admission, ALB, intestinal perforation) for constructing a short‐term mortality prediction model, which exhibited good discrimination (AUC: 0.945).
Conclusions: Long‐term survival is possible for IL10RA‐deficient patients without HSCT. However, due to the risk of early‐life adverse outcomes, close follow‐up remains essential.
Contact e‐mail address: yhuang815@163.com
G‐EP089. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP089.1. STRUCTURED PHYSICAL ACTIVITY PREVENTS DISEASE RELAPSE DURING THE INTERVENTION, BUT NOT AFTER
Ivana Trivić Mažuranić, Sara Sila, Ana Močić Pavić, Zrinjka Mišak, Iva Hojsak
Referral Center For Pediatric Gastroenterology And Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
Objectives and Study: This study aimed to determine whether structured physical activity (PA) over 6 months has an impact on the relapse rate in children with inflammatory bowel disease (IBD).
Methods: A total of 36 children who performed structured PA (PA group) over 6 months were matched with 34 children with IBD not engaged in PA (nonPA group). Groups were matched according to the age, sex, disease subtype and type of therapy. For nonPA group start of intervention was determined based on the disease duration of the matched pair in the PA group.
Results: There was no difference in age (11.7 vs12.2 years, p = 0.797) and sex (23 vs 24 male, p = 0.875). During the intervention period significantly lower number of patients in PA group compared to nonPA group had a relapse (1 (3%) vs 8 (24%), p = 0.012). After the intervention children were followed for the mean time of 32 ± 2.1 months. There was no difference in the relapse rate in the first 6 months after intervention (5 (14%) vs 8 (24%), p = 0.3) and during the follow‐up (11 (31%) vs 12 (35%), p = 0.642). There was no difference in the number of relapses in the first 6 months after intervention (0.14 ± 0.35 vs 0.24 ± 0.43, p = 0.31) and during the follow‐up (0.34 ± 0.62 vs 0.37 ± 0.59, p = 0.84). There was no difference in the subtype specific analysis. No difference between groups in the use of biologics and surgery was observed. Cox regression showed that belonging to nonPA group did not significantly increase the chance for relapse (HR1.775, 95% CI 0.779‐4.044) (Figure).
Conclusions: These results indicate that PA has a protective effect on the relapse rate in children with IBD, but only during the structure PA program, not after PA ceases.
Contact e‐mail address: ivana.trivic.0@gmail.com
G‐EP090. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP090.1. MAINTENANCE‐PHASE SERUM ANTI‐TNF LEVELS ARE NOT ASSOCIATED WITH MUCOSAL HEALING IN PEDIATRIC CROHN'S DISEASE
Rinat Grabovski1, Manar Matar1,2, Yael Weintraub1,2, Stav Regev3, Raanan Shamir1,2, Dror Shouval1,2, Noa Tal 1,2
1Faculty Of Medicine, Tel Aviv University, Tel Aviv, Israel, 2Institute Of Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center of Israel, Petha‐Tikva, Israel, 3Department Of Paediatric, Lady Davis Carmel Medical Center, Haifa, Israel
Objectives and Study: Mucosal healing (MH) is a key therapeutic target in patients with Crohn's disease (CD) and is associated with improved outcomes. While adult studies indicate a positive correlation between serum anti‐TNF levels and MH, data in pediatric patients is limited. We aimed to define the association of serum anti‐TNF levels with MH in pediatrics patients with CD during maintenance therapy.
Methods: Retrospective data (2014 to 2023) was collected from pediatric CD patients treated with infliximab or adalimumab who performed an ileocolonoscopy at least 26 weeks after initiating therapy. Serum anti‐TNF levels around endoscopic time were compared with endoscopic findings. MH was defined as complete absence of inflammatory or ulcerative lesions across all segments of the gastrointestinal tract. Univariable and multivariable logistic regression analysis was conducted to identify factors associated with MH.
Results: Data was obtained from 107 patients (41 infliximab, 66 adalimumab), median age at diagnosis 12.6 (9.9‐14.0) years. Median time until ileocolonoscopy following anti‐TNF initiation was 89.0 (56.3‐152.3) weeks. MH was identified in 31 (29.0%) patients. Anti‐TNF serum levels were comparable in the MH and non‐MH groups (9.5 [4.9‐13.9] vs. 9.3 [6.4‐15.7] µg/mL; p = 0.73), without differences in patients treated with infliximab or adalimumab. In multivariable analysis, diagnosis weight Z‐score (OR 2.860, 95% CI 1.005–8.138; p = 0.049), along with CRP (OR 0.037, 95% CI 0.002–0.687; p = 0.027) and fecal calprotectin (OR 0.995, 95% CI 0.990–1.000; p = 0.037) at time of ileocolonoscopy were significantly associated with MH.
Conclusions: In our cohort, anti‐TNF levels during maintenance were not associated with MH in pediatric CD.
Contact e‐mail address: noatal10@gmail.com
G‐EP091. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP091.1. ASSESSMENT OF DISEASE ACTIVITY IN THE SMALL BOWEL BY INTESTINAL ULTRASOUND COMPARED TO MAGNETIC RESONANCE ENTEROGRAPHY IN PEDIATRIC CROHN'S DISEASE: A PROSPECTIVE STUDY
Johanna Vos 1,2,3, Elsa Van Wassenaer2, Anouk Konert2, Joost Van Schuppen4, Rick Van Rijn4, Marc Benninga2, Krisztina Gecse5, Geert D'Haens5, Bart Koot2
1Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, Netherlands, 2Department Of Pediatric Gastroenterology And Nutrition, Amsterdam University Medical Center, Emma Children's Hospital, Amsterdam, Netherlands, 3Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, Netherlands, 4Department Of Radiology And Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands, 5Gastroenterology And Hepatology, Amsterdam University Medical Center, Amsterdam, Netherlands
Objectives and Study: In Crohn's disease (CD), Magnetic Resonance Enterography (MRE) is used to assess disease activity in the small bowel. However, MRE is costly and can be challenging for children. Intestinal ultrasound (IUS) is a point‐of‐care and well tolerated monitoring tool in CD. In children the diagnostic accuracy of IUS for small bowel activity has not been systematically studied and a bowel wall thickness (BWT) cut‐off value indicating disease activity has not yet been established. This study aims to evaluate the diagnostic accuracy of IUS in comparison to MRE for small bowel assessment.
Methods: Children with CD were prospectively enrolled and underwent MRE and IUS within 7 days. MRE images were scored using the Tielbeek score by an experienced blinded radiologist. IUS was performed by blinded trained physicians. The terminal ileum (TI), proximal ileum (PI) and jejunum (J) were analyzed separately by IUS and MRE.
Results: Seventy‐six pediatric CD patients (median age:15.0; 49% female) were included. A total of 231 bowel‐segments were analyzed, including 41 with mild (TI = 24; PI = 11; J = 1) and 36 with moderate‐severe (TI = 24; PI = 11; J = 1) disease activity based on MRE. The AUROC of IUS‐BWT for disease activity was for TI 0.91 (95% CI 0.83‐0.98), for proximal Ileum 0.82 (95% CI 0.69‐0.96) and for jejunum 0.66 (95% CI 0.48‐0.83). Based on ROC analysis, the optimal cut‐off for IUS‐BWT in TI was 2.44 mm (sensitivity 87%; specificity 84%). For the proximal ileum the optimal cut‐off for IUS‐BWT was 2.02 mm (sensitivity 78%; specificity 93%). Due to the low number of affected segments in the jejunum, an accurate BWT cut‐off value could not be determined.
Conclusions: IUS is an accurate tool to non‐invasively assess disease activity in the terminal ileum and ileum and less so in jejunum. Based on our results a cut‐off for BWT of 2.4 mm for the terminal ileum in pediatric CD is optimal.
Contact e‐mail address: j.m.vos@amsterdamumc.nl
G‐EP092. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP092.1. CIRCULATING CELL‐FREE DNA AND MITOCHONDRIAL DNA DIFFERENTIATE DISEASE ACTIVITY IN PAEDIATRIC‐ONSET INFLAMMATORY BOWEL DISEASE: INTERIM ANALYSIS FROM SCOTLAND‐WIDE MINI‐MUSIC STUDY (2020‐26)
David Wands1,2,3, Siu‐Ying Lau3, Shaun Chuah3, Rebecca Hall3, Robert Whelan3, Lena Fischer3, Rahul Kalla3, Peter Cartlidge3, Broc Drury3, Iain Chalmers4, Richard Hansen5, Michelle Wilson1, Gareth Jones3, Gwo‐Tzer Ho3, David Wilson 6
1Child Life And Health, University of Edinburgh, Edinburgh, United Kingdom, 2Department Of Paediatric Gastroenterology, Hepatology And Nutrition, Royal Hospital for Children, Glasgow, United Kingdom, 3Centre For Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom, 4Department Of Paediatric Gastroenterology, Aberdeen Children's Hospital, Aberdeen, United Kingdom, 5Department Of Child Health, University of Dundee, Dundee, United Kingdom, 6Department Of Paediatric Gastroenterology, Hepatology And Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
Objectives and Study: Mitochondrial dysfunction has been implicated in the pathogenesis of inflammatory bowel disease (IBD) particularly paediatric‐onset IBD (PIBD). Circulating cell‐free DNA (cfDNA) and mitochondrial DNA (mtDNA) are damage‐associated molecular patterns (DAMPS) released into the bloodstream during tissue damage and cell death. This study aims to present initial data on the potential use of cfDNA and mtDNA as biomarkers in PIBD.
Methods: Mini‐MUSIC and GI‐DAMPS are ongoing longitudinal and cross‐sectional multi‐centre translational research studies in Scotland (2020 – 2026). They aim to investigate the inflammatory mechanisms of IBD, with a focus on multi‐omics aligned to prospective clinical follow‐up. We measured circulating cfDNA (GAPDH) and mtDNA (ND2), using digital droplet PCR, in the peripheral blood plasma of patients diagnosed under 17 years of age (A1 phenotype) and correlated this with phenotypic data and disease activity scores.
Results: Sixty‐five A1 patients were included (39/65 (60%) male; 51 Crohn's disease, 6 ulcerative colitis, 1 inflammatory bowel disease unclassified and 7 symptomatic non‐IBD controls) with a median (IQR) age at diagnosis of 13 (10.0‐15.0) years. mtDNA levels were higher in those with highly active disease compared to those in remission (median [IQR] 145.1 (89.5‐673.7 ng/μl) vs 64.4 (24.3‐167.5 ng/μl), p = 0.008) and compared to non‐IBD controls (median [IQR] 145.1 (89.5‐673.7 ng/μl) vs 28.8 (12.6 – 138.7 ng/μl), p = 0.036). Circulating cell‐free DNA levels were higher in those with highly active disease than non‐IBD controls (4.94 (1.1‐9.9 ng/ul) vs median [IQR] 0.53 (0.0‐1.4 ng/ul), p = 0.017). mtDNA levels were positively correlated with endoscopic disease activity (SES‐CD) in Crohn's disease (Pearson r = 0.7619, p = 0.004).
Conclusions: Our initial data demonstrate that blood levels of cfDNA and mtDNA are potentially valuable biomarkers for differentiating disease activity and identifying PIBD patients where mitochondrial dysfunction is a dominant pathogenic mechanism. These findings can potentially guide the stratification of future human mechanistic studies and the development of mitochondrial‐targeted therapies.
Contact e‐mail address: david.wands4@nhs.net
G‐EP093. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP093.1. BILE ACID SUPPORTS MEGAKARYOCYTES‐INDUCED INNATE LYMPHOID CELL 3 IN INFLAMMATORY BOWEL DISEASE
Yuan Xiao, Jiajia Lv
Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
Objectives and Study: Bile acids (BA) are pivotal signaling molecules that coordinately regulate metabolism and inflammation. We have previously shown a positive correlation between primary BA and disease activity index in pediatrics with inflammatory bowel disease (IBD). Megakaryocytes (MKs) are specialized cells vital for hemostasis that also act as crucial effectors capable of mediating inflammatory and immune response, but their association with BAs and their role in IBD remains unclear.
Methods: MKs were stimulated with glycocholic acid (GA) with or without BX517, a phosphoinositide‐dependent protein kinase‐1 (PDK1) inhibitor. Subsequently, MKs were co‐cultured with peripheral blood mononuclear cells (PBMCs) from healthy donors, and then PBMCs were collected for flow cytometry, RT‐PCR, and western blot. Flow cytometry was also used to determine platelets in the culture medium of MKs. In addition, PBMCs and platelets from healthy subjects and patients with IBD were used to analyze innate lymphoid cell (ILC) 3 by flow cytometry and protein expression by real‐time time PCR, respectively.
Results: In patients with IBD, we discovered increased megakaryocytes in the intestine and increased platelets in the circulation. Platelets in the circulation positively correlated with fecal calprotectin and GA, which was positively associated with FCP and interleukin 17 (IL‐17). In vitro, GA induced platelet generation in a PDK1‐dependent manner and supported ILC3 differentiation from PBMCs, contributing to interleukin‐17 production. GA‐treated MKs produced Dickkopf 1 (DKK‐1), a Wnt antagonist, to support inflammatory cytokine production, which was verified by increased release of DKK‐1 from MKs in the intestinal tissue and increased expression of DKK1 in platelets of patients with IBD.
Conclusions: Our data indicate that GA‐stimulated MKs and MK‐ILC3 axis play a central role in intestinal inflammation and IBD pathogenesis.
Contact e‐mail address:
G‐EP094. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP094.1. FP‐EVS‐MSRNA RELIEVE EXPERIMENTAL COLITIS MICE BY INHIBITING THE ACTIVATION OF THE NLRP3‐MAPKS/NF‐ΚB INTESTINAL INFLAMMATORY SIGNALING PATHWAY
Lin Ye, Fangfei Xiao, Xufei Wang, Xiaolu Li, Yizhong Wang, Pei Xiao
Shanghai Children's Hopsital, China, Shanghai, China
Objectives and Study: The aim of this study was to evaluate the beneficial effect of EVs derived from commensal bacterium, F. prausnitzii (Fp‐EVs) on experimental colitis mice.
Methods: The Fp‐EVs were separated from the supernatant of Fp culture by ultracentrifugation. Fp‐EVs and Fp‐EVs‐msRNA mimics were treated with LPS‐treated intestinal epithelial cells and DSS/TNBS‐induced colitis mice, respectively. RT‐PCR, ELISA, WB, FACS, HE, IHC, IF, TUNEL, FITC were used to analyze the molecular expression of inflammation signaling pathway, Treg cell differentiation, the degree of colon inflammation and permeability of mice. 16S rRNA high‐throughput sequencing was used to analyze the composition of gut microbiota of mice.
Results: Fp‐EVs treatment reduced DSS/TNBS‐induced colitis in mice. Fp‐EVs improved the protein expression of tight junctions. Fp‐EVs alleviated intestinal injury in DSS induced colitis mice by regulating Treg differentiation and expression of inflammatory factors in intestinal, inhibiting oxidative stress injury and activation of phosphorylation of MAPKs/NF‐κB signaling pathway. The expression profile of small RNA of Fp‐EVs were obtained by high‐throughput sequencing. Functional cluster analysis based on KEGG signaling pathway showed that Fp‐EVs‐msRNA could affect several signaling pathways, including MAPKs. In vitro experiments, we found that the Fp‐EVs‐msRNAs‐mimic could reduce the activation of MAPKs/NF‐κB inflammatory signaling pathway in LPS‐stimulated Caco2 cells. Moreover, in animal studies, we also found that Fp‐EVs‐msRNA4486‐agomiR could alleviate colon damage and inhibit the activation of the NLRP3‐MAPKs/NF‐κB induced pyroptosis in DSS induced colitis mice.
Conclusions: Fp‐EVs alleviated colon injury and improved intestinal mucosal barrier by regulating intestinal immunity and resisting oxidative stress damage. Fp‐EVs‐ msRNA could relieve experimental colitis mice by inhibiting NLRP3‐MAPKs/NF‐κB inflammatory signaling pathway activation in experimental colitis
Contact e‐mail address:
G‐EP095. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP095.1. STUDY ON HUMAN MILK‐DERIVED EXOSOMES IN PROTECTING FROM NEONATAL NECROTIZING ENTEROCOLITIS BY REGULATING THE FERROPTOSIS OF INTESTINAL EPITHELIAL CELL
Xiangyun Yan, Shuping Han
Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
Objectives and Study: To validate the role and mechanism of HM‐Exo in regulating ferroptosis to ameliorate NEC at cellular and animal levels.
Methods: The fat and other impurities in the collected human milk were removed by gradient centrifugation to obtain human milk extracellular vesicles.We construct NEC animal model by intragastric administration of cold stimulation, hypoxia and hypertonic milk, and give HM‐Exo intragastric intervention. We used lipopolysaccharide to induce the construction of NEC in IEC6 cells, and then gave HM‐Exo intervention.
Results: 1.The morphology and particle size of HM‐Exo obtained by gradient centrifugation were consistent with the characteristics of exocrine body. 2. In the animal level experiment, HM‐Exo can alleviate intestinal ischemia and necrosis, improve the survival rate of newborn rats in NEC group and reduce the degree of pathological damage of NEC intestinal tissue, lower the content of MDA and Fe2+in the intestine, lower the expression level of ACSL4 in intestinal tissue than that in NEC group, and increase the expression level of GPX4 than that in NEC group. 3.In the cell level experiment, it was found that compared with LPS group, the intervention of Fer‐1 could partially restore the cell proliferation ability, reduce the level of ACSL4 expression water, increase the level of GPX4 expression, reduce the content of MDA and Fe2+ in cells, and partially restore the mitochondrial membrane potential.
Conclusions: We can stably extract extracellular vesicles from human milk by gradient centrifugation. At the level of cell and animal models, HM‐Exo showed significant improvement in the development of NEC, suggesting that exocrine is an important active component of breast feeding in the prevention and treatment of NEC. Further mechanism study: HM‐Exo can inhibit the occurrence of ferroptosis in NEC intestinal epithelial cells by regulating the expression of ACSL4 and GPX4, thus playing a protective role in preventing and treating NEC.
Contact e‐mail address: yan.1993@qq.com
G‐EP096. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EP096.1. SIGMOIDOSCOPY AS A SURVEILLANCE TOOL IN PEDIATRIC ULCERATIVE COLITIS: IS FULL COLONOSCOPY NEEDED?
Shira Yuval Bar‐Asher 1, Raffi Lev‐Tzion1, Esther Orlanski‐Meyer1, Oren Ledder1, Eyal Shteyer1, Ibrahim Shamasneh1, Dotan Yogev1, Amit Assa1, Robert Baldassano2, Anne Griffiths3, Dan Turner1
1The Juliet Keidan Institute Of Paediatric Gastroenterology Hepatology And Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel, 2Division Of Gastroenterology, Hepatology, And Nutrition, The Children's Hospital of Philadelphia, Philadelphia, United States of America, 3Department Of Gastroenterology, Hospital for Sick Children, Toronto, Canada
Objectives and Study: Sigmoidoscopy is a less invasive procedure than full colonoscopy and demands simpler preparation. Despite the continuous nature of inflammation in ulcerative colitis (UC), which typically decreases from distal to proximal colon, the FDA requires three full colonoscopies per year to assess UC in clinical trials. We aimed to assess the necessity of full colonoscopy versus sigmoidoscopy evaluation in pediatric UC.
Methods: We included two prospectively enrolled cohorts of children (0‐18 years) with UC. We recorded the PUCAI score, explicit clinical data, and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) at each colonic segment. The first follow‐up colonoscopy available in our records for each patient was included to allow enough breadth of severity, and to better mirror the scenario of follow‐up.
Results: A total of 85 patients were included (mean age 14 ± 3.4,) representing a broad clinical range from clinical remission to severe colitis. The median UCEIS scores decreased progressively from the rectum and sigmoid (2 IQR:0‐4) to the more proximal colon (descending 1, IQR:0‐3; transverse and ascending 0, IQR:0‐2; p < 0.001). Only 3 patients (3.5%) had inflammation in more proximal segments without having any inflammation in the rectosigmoid. Another 10 patients (12%) had higher inflammation scores in the proximal colon than in the rectosigmoid, though inflammation was present in the rectosigmoid region.
Conclusions: In 96.5% of cases, endoscopic healing in the rectosigmoid region reflected endoscopic healing in the rest of the colon in children with UC. When inflammation was present in the rectosigmoid, in 86% the degree of colitis reflected the maximal endoscopic severity of the entire colon. These findings suggest that sigmoidoscopy may be a suitable routine surveillance tool for pediatric UC patients, especially in clinical trials, in order to maximize feasibility and ethical standards.
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G‐EP097. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EP097.1. PRESSURE FLOW ANALYSIS IN PEDIATRIC ACHALASIA PATIENTS UNDERGOING POEM: A NOVEL TOOL TO EVALUATE BOLUS FLOW
Giulia Chiarazzo 1, Valerio Balassone2, Filippo Torroni1, Chiara Imondi1, Tamara Caldaro2, Paola De Angelis1, Renato Tambucci1
1Gastroenterology And Nutrition Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy, 2Digestive Endoscopy And Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
Objectives and Study: Esophageal manometry is the gold standard for the diagnosis of esophageal achalasia (EA), but it's not useful for evaluating treated patients due to its inability to assess bolus clearance. Adding impedance measurement allows characterization of bolus flow. We firstly described the findings of high‐resolution manometry (HRIM) and pressure flow analysis (PFA: impedance ratio [IR] and distension pressure emptying [DPE]) in EA children who underwent peroral endoscopic myotomy (POEM).
Methods: We included EA children who underwent POEM between 2016 and 2023. The software Swallow Gateway TM was used to characterize HRIM patterns according to Chicago Classification v4.0, to assess PFA metrics, while Eckardt score was used to grade symptom severity.
Results: Nine EA patients (4 female, 13.5 median age) were included (2 type 1, 7 type 2 EA). IRP significantly decreased after POEM (mean pre 28.4 ± 12.1 vs post 17.7 ± 8.1; p = 0.03) with 6 patients still showing values greater than the upper limit of normal (ULN). After POEM all patients experienced clinical improvement with a significant decrease in the Eckardt score (mean pre 4.2 ± 2.5 vs post 0.2 ± 0.6; p = 0.0002). On PFA bolus‐flow improved after POEM with decreased IR (mean pre 0.66 ± 0.09 vs post 0.51 ± 0.17; p = 0.02) and DPE (mean pre 32.4 ± 11.5 vs 20.1 ± 11.1; p = 0.03).
Conclusions: Our study offers new understanding on how POEM can be effective for achalasia. PFA demonstrated improved bolus clearance in children treated with POEM, even if outflow obstruction is suggested by an IRP > ULN.
Contact e‐mail address: giulia.chiarazzo@opbg.net
G‐EP098. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EP098.1. EVALUATION OF DGBIS PREVALENCE (ROME IV CRITERIA) IN OBESE PAEDIATRIC PATIENTS AND CORRELATION WITH INFLAMMATORY MARKERS
Antonio Colucci 1, Mara Creoli1, Giuseppina Rosaria Umano1, Emanuele Miraglia Del Giudice1, Olga Scudiero2, Cristina Mennitti2, Sohail Aziz3, Diego Torre1, Claudia Chiantese1, Anna Di Sessa1, Sabrina Cenni1, Martina Milano1, Caterina Strisciuglio1
1Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy, 2Dipartimento Di Medicina Molecolare E Biotecnologie Mediche, Federico II, Naples, Italy, 3Department Of Experimental Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
Objectives and Study: Childhood obesity has rapidly emerged in recent years. Studies show a greater prevalence of Disorders of Gut‐Brain Interaction (DGBIs) in obese children, though the underlying pathogenesis is unknown. Obese patients exhibit altered inflammatory markers, such as bile acid levels, which may reflect gastrointestinal dysfunction. Currently, no diagnostic tests exist for DGBIs, though markers like bile acids may serve as indicators. This study aims to assess the prevalence of DGBIs in obese children and identify differences in inflammatory markers between those with and without DGBIs.
Methods: This prospective observational study included obese pediatric patients. Data on demographics, clinical history, laboratory tests, and DGBIs (assessed via Rome IV criteria) were collected. Statistical analysis was conducted using R (v4.3.2). Differences in bile acid levels were analyzed using the χ² test, while logistic regressions assessed risk factors for abnormal bile acid levels.
Results: A total of 200 children (mean age: 12.3 ± 2.4 years; 50% male) with BMI >95th percentile participated. The prevalence of DGBIs was 35.5% (71/200), with functional constipation (FC) being the most common (70.4%), followed by functional dyspepsia (FD) (15.5%) and abdominal migraine (14%). Patients with DGBIs were more likely to have abnormal bile acid levels (OR = 1.886; p = 0.0372), independent of age, gender, and BMI Z‐score. Specifically, 70% of FC and 90% of FD cases had abnormal bile acid levels. Significant risk factors for abnormal bile acid levels included age (p = 0.04), triglycerides (p = 0.004), total cholesterol (p = 0.0004), HDL cholesterol (p = 0.007), and DGBIs (p = 0.004). Multivariate analysis confirmed total cholesterol (p = 0.04) and DGBIs (p = 0.009) as significant predictors.
Conclusions: DGBIs are prevalent in obese children, particularly FC. Patients with DGBIs are more likely to exhibit abnormal bile acid levels, suggesting a potential marker for altered gastrointestinal function.
Contact e‐mail address:
G‐EP099. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EP099.1. CHALLENGES OF ANTRODUODENAL MANOMETRY (ADM) IN PAEDIATRIC PATIENTS WITH GASTROINTESTINAL DYSMOTILITY
Mikki Crundwell, Vania Lourenco, Matilde Pescarin, Keith Lindley, Kornilia Nikaki, Anna Rybak, Osvaldo Borrelli
Neurogastroenterology And Motility, Great Ormond Street Hospital, London, United Kingdom
Objectives and Study: Antroduodenal manometry (ADM) is a gold standard investigation for assessing small bowel neuromuscular function. We analysed the rate and causes for the investigation failure.
Methods: This is a retrospective, single centre review of ADM investigation attempts performed between 2012‐2023 at a Tertiary/Quaternary Motility Centre. Indications were suspected GI dysmotility/paediatric intestinal pseudo‐obstruction (PIPO), prior stoma formation/reversal and prior multivisceral transplant. Challenges and failures were identified.
Results: 279 patients (141 females) underwent ADM. Out of 338 ADM attempts, 75 (22%) failed. Twenty‐one patients had repeated studies. Mean patients’ age for all studies was 7.1 years, and 6.5 years for failed procedures. Four failed ADM attempts were excluded (No ICU bed availability n = 1, and cancelled theatre lists, n = 3). The most common challenges were unsuccessful insertion attempts and catheter displacement (n = 32, 43%). Nineteen (25%) patients become unwell (7 during, 12 prior to test), therefore it was subsequently discontinued/cancelled; 10 (13%) patients/families cancelled the test, and 7 (9%) failed test preparation, such as drug discontinuation (fentanyl), abnormal electrolytes (hypocalcaemia n = 2; hypokalaemia n = 1), unresolved anaemia, anaesthetic cancellation due to inadequate clinical history (history of supraglottic stenosis), and inadequate body weight (<8‐10 Kg). Five (7%) patients pulled out the ADM catheters during the study.
Conclusions: Several challenges are associated with ADM procedure. Careful planning ahead of investigation, with the focus on patient/family preparation, appropriate facility and experienced team support is crucial for procedure success and minimisation of procedure failure, re‐admission rate, waiting list times and subsequent care plan delays.
Contact e‐mail address:
G‐EP100. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EP100.1. EFFECTS OF LACTOBACILLUS FERMENTUM CECT5716 ON PHYSICAL AND NEUROLOGICAL DEVELOPMENT AMONG SMALL FOR GESTATIONAL AGE
Yanyu Jin, Xiaohui Chen, Shuping Han, Shushu Li
Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
Objectives and Study: Our previous metagenomic sequencing of Small for Gestational Age (SGA) infants revealed underexpression of fermentative lactobacilli in SGA patients. This study aims to evaluate the impact of Lactobacillus fermentum CECT5716 from human milk on physical and neurological developmental outcomes in SGA mice model.
Methods: Fifty‐seven C57BL6/J mice were randomly assigned to three groups: Appropriate for Gestational Age (AGA) with a normal diet, SGA with a low‐protein diet, and SGA + CECT5716 (S + C) with a low‐protein diet supplemented with 10⁹ CFU CECT5716 orally. Body weight was monitored up to 28 days postnatal. Glucose tolerance tests were conducted at 28 and 56 days. Blood IGF‐1 levels were measured via ELISA. Behavioral assessments included the Morris water maze and open field tests to evaluate spatial learning and memory. Additionally, Golgi staining analyzed hippocampal neurons, focusing on dendritic morphology, spine density, and dendritic complexity.
Results: 1. Physical Development: The S + C group showed a significant increase in body weight (P < 0.05) and growth rate (P < 0.01) compared to the SGA group. 2. Glucose Tolerance: The S + C group exhibited reduced area under the curve (AUC) for both oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) (P < 0.05), alongside elevated blood IGF‐1 levels (P < 0.05) compared to SGA. 3. Neurological Outcomes: In the open field test, male mice in the S + C group demonstrated improved total distance traveled and average speed (P < 0.05). In the Morris water maze, the S + C group showed shorter path lengths, reduced time to locate the platform, and increased dendritic spine density and complexity in hippocampal neurons (P < 0.01) compared to the SGA group.
Conclusions: Lactobacillus fermentum CECT5716 significantly enhances physical growth, glucose metabolism, and neurological development in SGA mice. These findings suggest that CECT5716 holds substantial potential for clinical applications in SGA, offering promising avenues to improve developmental outcomes.
Contact e‐mail address: lishushu@njmu.edu.cn
G‐EP101. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EP101.1. UTILITY OF COLONIC MANOMETRY IN CHILDREN WITH HIRSCHSPRUNG DISEASE
Martina Chiara Pascuzzi1, Maria Giovanna Puoti 2, Thazin Koko1, Matilde Pescarin1, Osvaldo Borrelli1, Anna Rybak1
1Paediatric Gastroenterology, Division Of Neurogastroenterology And Motility, Great Ormond Street Hospital NHS Trust, London, United Kingdom, 2Department Of Paediatric Gastroenterology And Hepatology, Santobono‐Pausilipon Children's Hospital, Naples, Italy
Objectives and Study: Persistent defecation disorders are reported in up to 20% of children with post pull‐through Hirschsprung disease (PT‐HSCR). Colonic manometry (CM) can identify the pathophysiology underlying the defecation disorder and guide the decision‐making in management. We aimed to review the impact of CM in our cohort of PT‐HSCR children with persistent defecation disorders.
Methods: We retrospectively reviewed clinical records and CM traces of all PT‐HSCR children with defecation disorders referred for motility assessment between July 2018 and November 2024.
Results: Twenty‐six children (22 males; mean age 8.3 years) underwent CM, due to isolated (n = 12) and retentive (n = 14) fecal incontinence. In 7/12 children referred for isolated fecal incontinence, CM identified features of neuropathic colonic dysmotility suggestive of overflow incontinence secondary to constipation. Table 1 summarised all CM findings. Outcomes of colonic intertia (n = 6) led to surgial step‐up treatment with ileostomy. Normal high amplitude propagated contractions (HAPCs), but with the lack of rectal break (n = 5) led to formation of anterograde continence enema (ACE) (n = 2), transanal irrigation (TAI) (n = 2) and ileostomy formation (n = 1). Common cavity in distal colon (n = 17) and neurophatic HAPCs (n = 9) were the most common findings and, when not associated to other neurophatic changes, led to optimisation of oral and stimulant laxatives (n = 5) and, when failed, to escalation to ACE (n = 2). Overall, CM helped identifying colonic dysfunction in 18/26 (69%) PT‐HSCR children with defecation disorders and abnormalities observed in CM led to change of the management in 13/18 (72%) cases.
Conclusions: CM is an efficient diagnostic tool in dysmotility assessment of PT‐HSCR children with defecation disorders and it aids change of the management. Our data support use of CM in clinical decision‐making in patients with complications post surgery for HSCR. Table 1
| CM findings | Patients (%) |
| Normal | 8 (31) |
| Dysmotility | 18 (69) |
| Common cavity | 17 |
| Neuropathic HAPCs | 9 |
| Colonic inertia | 6 |
| Absent rectal break | 5 |
Contact e‐mail address: martina.pascuzzi@gosh.nhs.uk
G‐EP102. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EP102.1. GENOTYPE‐PHENOTYPE CHARACTERISTICS OF PATIENTS WITH VISCERAL MYOPATHY
Anna Rybak 1, Lucy Jackman2, Mikki Crundwell3, Matilde Pescarin3, Kornilia Nikaki3, Nikhil Thapar4, Osvaldo Borrelli3
1Department Of Gastroenterology, Neurogastroenterology And Motility Division, Great Ormond Street Hospital, London, United Kingdom, 2Department Of Dietetics, Great Ormond Street Hospital, London, United Kingdom, 3Neurogastroenterology And Motility, Great Ormond Street Hospital, London, United Kingdom, 4Children's Health Queensland Hospital and Health Service, Brisbane, Australia
Objectives and Study: Visceral myopathies (VM) are ultrarare, life‐threatening disorders that result in pediatric intestinal pseudo‐obstruction syndrome (PIPO) due to abnormal function and/or structure of the bowel smooth muscles. We present a genotype‐phenotype description of patients with VM and PIPO with confirmed mutations within the ACTG2 gene.
Methods: Patients referred to National Specialised PIPO Diagnostic Service at GOSH, between 2012‐2023, with genetic conformation of ACTG2 variants, were included in the analysis. Clinical evaluation included functional studies of gastro‐intestinal dysmotility (manometry of the small bowel and colon, gastric emptying scintigraphy), histopathology of full thickness biopsies, surgeries, and nutrition.
Results: Out of 120 patients diagnosed with PIPO, 18 had visceral myopathy. In this cohort, 10 had confirmed ACTG2 variant (7 females, median age of symptoms onset 0.5 months) (Table 1.). 6 different variants of ACTG2 mutation were found (2xR257H, 4x R257C, 1x R211, 1x R40, 1x R178L, 1x R178C). All patients had megacystis/bladder dysfunction, and all underwent defunctioning ileostomy and venting gastrostomy formation. Of the 7 patients who had motility assessment, 4 had neuro‐myopathic, 2 had neuropathic and 1 myopathic changes. 4 had pan‐enteric disease. Variant R257 was associated with better nutritional outcomes (oral/enteral feeding tolerance). One patient (R178C) died from liver failure complications while awaiting multivisceral transplant.
Conclusions: VM is rare and heterogeneous group of disorders, with severe clinical outcomes (dependence on TPN, mortality), where phenotyping is still difficult and therefore prognostic factors are poorly defined. An international registry is essential to support further research of this orphan condition.
Contact e‐mail address: anna.rybak@gosh.nhs.uk
G‐EP103. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EP103.1. GENOTYPE‐PHENOTYPE CORRELATION AND MANAGEMENT IN MEGACYSTIS‐MICROCOLON‐INTESTINAL HYPOPERISTALSIS SYNDROME: A TERTIARY REFERRAL CENTRE EXPERIENCE
Christoph Slavetinsky 1, Anna Sanders1, Ilias Tsiflikas2, Justus Lieber1, Jörg Fuchs1, Ekkehard Sturm3, Steven Warmann4, Johannes Hilberath3
1Paediatric Surgery And Urology, University Children's Hospital Tübingen, Tübingen, Germany, 2Diagnostic And Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany, 3Paediatric Gastroenterology And Hepatology, University Children's Hospital Tübingen, Tübingen, Germany, 4Charité University Hospital, Berlin, Germany
Objectives and Study: Megacystis‐Microcolon‐Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare genetic smooth muscle myopathy predominantly affecting the bladder and intestine, with most clinical and management insights derived from case series. The genetic and phenotypic variability of the condition remains poorly characterized. This study investigates the (gastrointestinal) phenotypic and genotypic profiles of MMIHS patients managed at our tertiary intestinal rehabilitation centre, including subsequent treatment and clinical outcome.
Methods: This is a retrospective, single‐centre chart analysis of patients (n = 25) treated for MMIHS at a tertiary referral centre for intestinal rehabilitation. All patients with confirmed genetic or working diagnoses of paediatric‐onset MMIHS, who were followed up between 2012 and 2024, were included in the study.
Results: This study analysed 25 patients with MMIHS, with a median age of 97 months at last follow‐up; 60% were female. The most common genetic mutation was in ACTG2 (14/18), followed by MYH11 (2/18), MYLK (1/18), and LMOD1 (1/18). Megacystis was present in 96%, defective intestinal peristalsis in 100%, and microcolon in 60%. Cholelithiasis was identified in 68% of patients. Intestinal stenosis was diagnosed in 36% (9/25), necessitating surgical intervention in 6 cases. All patients experienced clinical ileus, with 88% requiring a decompressing stoma and parenteral nutrition, indicative of unfavourable outcomes. Notably, patients with ACTG2 variants p.Arg40His or p.Pro39Arg had significantly better outcomes, avoiding stoma placement and parenteral nutrition. Despite these challenges, long‐term survival was favourable, with 88% of patients alive at follow‐up.
Conclusions: This study elucidates the phenotypic and genotypic characteristics of MMIHS in one of the largest single‐centre analysis, so far. Beyond its hallmark features, a clinically significant prevalence of small bowel stenosis and cholelithiasis was observed. Notably, patients with p.Arg40 or p.Pro39 gene variants demonstrated more favourable outcomes, yet subsequent delays in diagnosis, underscoring the importance of early genotypic analysis for optimized management and patient counselling.
Contact e‐mail address:
G‐EP104. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EP104.1. EFFICACY AND SAFETY OF 7‐DAY BISMUTH‐BASED QUADRUPLE THERAPY VS. 14‐DAY STANDARD TRIPLE THERAPY FOR HELICOBACTER PYLORI ERADICATION IN CHILDREN: A RANDOMIZED CONTROLLED STUDY
Matjaž Homan 1, Anja Šterbenc2, Bor Vratanar3, Eva Miler Mojškerc4
1Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia, 2Institute of Microbiology and Immunology, Ljubljana, Slovenia, 3Institute For Biostatistics And Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia, 4Slovenj Gradec General Hospital, Slovenj Gradec, Slovenia
Objectives and Study: The updated ESPGHAN/NASPGHAN guidelines for the management of Helicobacter pylori infection in children and adolescents recommend a 10–14‐day bismuth‐based quadruple therapy as an empiric first‐line eradication regimen when antimicrobial susceptibility testing is unavailable. However, limited data exist on safety and especially efficacy of shorter (7‐day) bismuth‐based eradication protocols in pediatric patients.
Methods: Between 2020 and 2024, we conducted a randomized controlled trial including treatment‐naïve children and adolescents (ages 5–19 years) with confirmed H. pylori infection according to the current guidelines. Participants were randomly assigned to receive either standard 14‐day triple therapy (omeprazole + amoxicillin + clarithromycin/metronidazole) or 7‐day bismuth‐based quadruple therapy (bismuth oxide + omeprazole + amoxicillin + clarithromycin/metronidazole) according to the results of antibiotic susceptibility testing. Eradication was assessed two months post‐treatment using two‐step monoclonal stool antigen test. Adverse events were monitored via a standardized questionnaire.
Results: A total of 73 children were enrolled. Demographic data and eradication rates for 14‐day triple therapy vs. 7‐day bismuth‐based quadruple therapy are presented in Table 1. No serious adverse events were recorded. Moreover, adverse event rates were comparable between groups, except for a significantly higher incidence of metallic taste in the control group (Figure 1). Table 1. Demographics and eradication rates.
| 7‐day bismuth‐based therapy | 14‐day standard therapy | p ‐value | |
| Number of patients (%) | 38 (52) | 35 (48) | |
| Gender (male/female) | 19/19 | 15/20 | 0.5 |
| Age, years (median) | 14.1 | 14.6 | 0.7 |
| Eradication rate | |||
| Intention‐to‐treat analysis (95% CI) | 91% (78–97%) | 87% (70–95%) | 0.7 |
| Per protocol analysis (95% CI) | 94% (79–98%) | 87% (70–95%) | 0.4 |
Figure 1. Proportion of patients experiencing adverse events in each study group during the course of treatment, presented with 95% confidence intervals.
Conclusions: The shorter, 7‐day bismuth‐based quadruple therapy, demonstrated high eradication rates and a safety profile comparable to the standard 14‐day triple therapy, making it a viable therapeutic option for treatment of pediatric H. pylori infection
Contact e‐mail address: matjaz.homan@guest.arnes.si
G‐EP105. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EP105.1. CHARACTERISTICS CHILDREN AFTER TREATMENT FAILURE FOR H. PYLORI‐INFECTION: RESULTS FROM THE EUROPEDHP REGISTRY FROM 2013‐2020
Thu Giang Le Thi1, Michal Kori2, Nicolas Kalach3, Pedro Urruzuno4, Maria Luz Cilleruelo5, Zrinjka Mišak6, Maria José Martinez Gomez7, Patrick Bontems8, Vaidotas Urbonas9, Ana Isabel Lopes10, José Cabral11, Meltem Korkut Ugras12, Erasmo Miele13, Francesca Rea14, Andrea Chiaro15, Thomas Casswall16, Matjaž Homan17, Angelika Kindermann18, Sibylle Koletzko 1
1Department Of Pediatrics, Division Of Pediatric Gastroenterology, LMU University Hospital Munich, Dr. von Hauner Children's Hospital, Munich, Germany, 2Paediatric Gastroenterology, Kaplan medical center, Rehovot, Israel, 3Saint Antoine Pediatric clinic, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Catholic University, Lille, France, 4Pediatric Gastroenterology Unit. Hospital 12 de Octubre, Madrid, Spain, 5Paediatric Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain, 6Referral Center For Pediatric Gastroenterology And Nutrition, Children's Hospital Zagreb, Zagreb, Croatia, 7Gastroenterology and Nutrition Department, Niño Jesús University Children Hospital, Madrid, Spain, 8Pediatric Gastroenterology, Hopital Universitaire des Enfants Reine Fabiola. Hopital Universitaire de Bruxelles., Brussels, Belgium, 9Vilnius University Hospital Santariskiu Klinikos ‐ Childrens Hospital, Vilnius, Lithuania, 10Pediatrics Department, Gastroenterology Unit, Hospital Santa Maria, Medical Faculty, University of Lisbon, Lisbon, Portugal, 11Child and Adolescent Centre, CUF Tejo Hospital, Lisbon, Portugal, 12Department of Pediatrics, Gastroenterology Hepatology and Nutrition, Yeditepe University Faculty of Medicine, İstanbul, Turkey, 13Scienze Mediche Traslazionali (sez. Pediatria‐ Ed11), Università degli Studi di Napoli "Federico II", NAPOLI, Italy, 14Gastroenterology And Nutrition Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy, 15Pediatric Gastroenterology and Endoscopy Unit, Institute Giannina Gaslini, Genoa, Italy, 16Division For Paediatrics, Department Clinical Interventions And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 17Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia, 18Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
Objectives and Study: The EuroPedHp Registry, initiated by ESPGHAN Helicobacter pylori (H.p.) Special Interest Group, monitored the management of H.p.‐infected children from 2013‐2020. This analysis reports on children who failed previous therapy and the success to second line therapy tailored to antibiotic susceptibility over 8 years.
Methods: We merged data of 1460 (2013‐2016) and 1605 (2017‐2020) H.p.‐infected children from 17 European countries. All children with endoscopy‐proven H.p. infection after previously failed treatment were included. Due to low patient numbers, only descriptive statistics were applied.
Results: We identified 356 children with previous treatment failure (54% female, median age: 12.9 years, 40% from Southern Europe) with slightly increasing rates over time (2013‐2016: 10%‐15%, 2017‐2020: 15%‐20%). Most patients reported abdominal pain (72%) and/or dyspepsia (16%). Endoscopic abnormalities included antral nodularity (85%), peptic ulcers (5%), and erosions (15%). Antibiotic susceptibility testing revealed full susceptibility to clarithromycin (CLA) and metronidazole (MET) in 29%, single resistance to CLA or MET and double resistance in 21%, 23%, and 27%, respectively. Over eight years, we observed an increase of treatment duration (from 10 to 14 days) and use of alternative antibiotics or bismuth‐based regimens. The median daily dose of proton pump inhibitors (PPI) increased from 1.0 to 1.6 mg/kg, while median AMO daily dose went up only slightly (46.2 to 52.6 mg/kg). The overall eradication success was low (63%). High dose AMO (100 mg/kg, max. 3 g/d) PAM (PPI + AMOhigh + MET) and bismuth‐based regimens seem to perform better than PAC (PPI + AMOhigh + CLA) (Figure 1). From 2017‐2020, in patients with excellence compliance, PAM‐14 days achieved 79% eradication compared to 56% with PAC‐14 days (p = 0.036).
Conclusions: Our registry results revealed rising numbers of children with treatment failure. PAM with high dose AMO tended to achieve higher success rates and should be used for children after treatment failure, including those with fully susceptible strains.
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G‐EP106. Topic: AS01. GASTROENTEROLOGY/AS01j. Polyposis
G‐EP106.1. PROTEOMIC AND PHOSPHOPROTEOMIC LANDSCAPE OF PEUTZ‐JEGHERS POLYPS IN PEDIATRIC PATIENTS UNDERGOING THERAPEUTIC ENTEROSCOPY
Thomas Attard 1, Irina Pushel1, Shahid Umar2, Caitlin Lawson3, Michael Washburn4
1The University Of Missouri In Kansas City School Of Medicine, Division Of Gastroenterology, Hepatology And Nutrition, Children's Mercy Hospital, Kansas City, United States of America, 2Surgery, University of Kansas Medical Center, Kansas City, United States of America, 3Genetics, Children's Mercy Hospital, Kansas City, United States of America, 4Cancer Biology, Kansas University Medical Center, Kansas City, United States of America
Objectives and Study: Peutz‐Jeghers syndrome (PJS) is a rare disorder characterized by hamartomatous polyps and increased cancer risk. While histopathologic features of PJS polyps are well described, their molecular mechanisms remain unclear, particularly in pediatric patients. This study aimed to define the proteomic, kinase, and phosphoproteomic profiles of PJS polyps and adjacent normal mucosa to elucidate key signaling pathways.
Methods: Fresh‐frozen PJS polyps and matched adjacent normal mucosa were obtained from pediatric patients undergoing therapeutic enteroscopy. Global proteomic and phosphoproteomic profiling were performed using high‐resolution mass spectrometry, with bioinformatic analyses identifying differentially expressed proteins, enriched pathways, and kinase activity shifts.
Results: Proteomic analysis revealed significant upregulation of PAK2, PKG, GSK3B, PKCD, ERK2, and PAK1 in polyps when compared to mucosa (Fig 1a), implicating cytoskeletal remodeling, cell migration, and tumorigenesis. Loss of STK11 (LKB1) may contribute to PAK1 dysregulation, while PKG activation suggests a link between epithelial barrier integrity and inflammation. Phosphoproteomic analysis identified overexpression of YWHAE (14‐3‐3ε), SUB1, ASAP2, and PNKP, indicating increased cell survival, proliferation, and DNA repair activity(Fig 1b). Elevated CALU, DEK, and TOP2B, implicated in colorectal cancer, suggests early neoplastic changes(Fig. 1.c).
Conclusions: This analysis reveals activation of PAK, PKG, ERK, and Wnt‐related kinases, alongside phosphorylation of tumor‐promoting proteins, linking metabolic stress, inflammation, and aberrant growth in PJS polyps. These findings identify potential therapeutic targets, including kinase inhibitors, for early intervention in PJS‐associated pathology.
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G‐RF001. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF001.1. PREVALENCE OF CELIAC DISEASE AMONG PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS TYPE 3 (PFICIII) PATIENTS: SINGLE CENTER EXPERIENCE
Homoud Alhebbi 1, Awad Alqahtani2, Sarah Algubaisi2, Faisal Alhafaf2, Nour Alsaati2, Sami Wali2
1Pediatric Gastroenterology, PSMMC, Riyadh, Saudi Arabia, 2Prince Sultan Military Medical City, Riyadh, Saudi Arabia
Objectives and Study: Celiac disease was reported in patients with progressive familial intrahepatic cholestasis type 3 (PFIC III) The aim of this study is to evaluate the prevalence of celiac disease among PFIC III confirmed patients in comparison to 1.5% prevalence in the general population of Saudi Arabia.
Methods: We retrospectively revised the files of 80 patients diagnosed with familial intrahepatic cholestasis type 3. We followed Celiac markers in the form of anti‐tissue transglutaminase (anti‐TTG antibody), anti‐deamidated gliadin IGA, IGG, and endomysial IGA antibody. For those who exhibited markedly high anti‐TTG, duodenal biopsies were obtained to confirm the diagnosis.
Results: Celiac markers were sent for 44 patients out of 80 with confirmed PFIC III genetically. Eight patients had at least one positive serological marker. Still, only four out of 44 (9%) had significant elevations in all. Hence, the biopsies were optioned and confirmed the presence of villous atrophy and increased intraepithelial lymphocytes, keeping with the diagnosis of celiac disease. Though 20 different mutations were identified in our patients, only 4 mutations were found to be associated with celiac disease; Mutation c.2906 G>A (p.R969H), mutation C.526 > T(P.R176W), mutation c.965 T>C (p.L322P), and mutation c.628‐643 del p.(phe210serfs*5). Other autoimmune diseases like autoimmune hepatitis with overlap syndrome and vitiligo were observed in these mutations.
Conclusions: There is high (9%) prevalence of celiac disease in patients with PFIC III in comparison to the prevalence (1.5%) in the general population. Other autoimmune diseases were observed also. Further studied are needed to clarify the relation between PFIC III and autoimmune diseases.
Contact e‐mail address: hhhebby@hotmail.com
G‐RF002. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF002.1. PATIENTS AND PAEDIATRIC GASTROENTEROLOGISTS ASSESSMENTS OF THE FOLLOW‐UP OF COELIAC DISEASE IN SPAIN
David Pérez‐Solís1, Juan Ignacio Serrano‐Vela2, Cristóbal Pérez‐Sixto3, Teresa Bermejo‐Delgado4, Maria Luz Cilleruelo5, Josefa Barrio‐Torres 6, Ester Donat7, Ricardo Torres‐Peral8, Raquel Vecino‐López9, Beatriz Espín10, Eva Martínez‐Ojinaga11, Gemma Castillejo12, Miriam Blanco13, Carmen Miranda‐Cid14, Francisco Javier Eizaguirre‐Arocena15, Salvador García‐Calatayud16, Carmen Ribes‐Koninckx17, Enriqueta Román5, Seghnp Coeliac Disease Working Group18
1Paediatrics, Hospital Universitario de Cabueñes, Gijón, Spain, 2Training And Research, Asociación de Celíacos y Sensibles al Gluten, Madrid, Spain, 3Associació Celíacs de Catalunya, Barcelona, Spain, 4Scientific Dissemination And Communication, Federación de Asociaciones de Celíacos de España (FACE), Madrid, Spain, 5Paediatric Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain, 6Paediatric Gastroenterology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain, 7Paediatric Gastroenterology And Hepatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain, 8Paediatrics, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain, 9Paediatrics, Hospital Clínico San Carlos, Madrid, Spain, 10Paediatric Gastroenterology, Hepatology, And Nutrition, Hospital Universitario Virgen del Rocío, Sevilla, Spain, 11Paediatric Gastroenterology And Nutrition, Hospital Universitario La Paz, Madrid, Spain, 12Paediatric Gastroenterology, Hospital Universitario Sant Joan, Reus, Spain, 13Paediatrics, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain, 14Paediatric Gastroenterology, Hospital General Universitario Gregorio Marañón, Madrid, Spain, 15Paediatric Gastroenterology, Hospital Universitario Donostia, Donostia ‐ San Sebastián, Spain, 16Paediatric Gastroenterology, Hospital Universitario Marqués de Valdecilla, Santander, Spain, 17Celiac Disease And Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe. Hospital Universitario y Politécnico La Fe, Valencia, Spain, 18Spanish Gastroenterology, Hepatology and Paediatric Nutrition Society, Madrid, Spain
Objectives and Study: There is high variability in the follow‐up of paediatric patients with coeliac disease (CD) in Europe. The aim of this study was to know the current reality of paediatric CD follow‐up in Spain through professionals and the patients themselves and their families.
Methods: A cross‐sectional descriptive study was conducted using two anonymous web surveys, one aimed at paediatric gastroenterologists, and the other at members of CD patients’ associations.
Results: A total of 96 responses from paediatricians and 4,745 from patients (1,362 < 15 years) were analysed. Among the professionals, 84.4% carry out follow‐up only at the hospital level. 80.2% lack a joint follow‐up protocol with primary health care. The transition after the paediatric age is made to adult gastroenterologists by 56.2% of professionals (only 8.3% in a protocolized manner). 58.3% do not have a dietitian and 64.6% do not use quality of life questionnaires. The patients stated that they mainly performed follow‐up visits in the hospital (68.8%). Only 15.7% ever consult a dietitian. Scheduled visits were more frequent in paediatric patients than in adults (95.1% vs. 63.5%, p < 0.001). The variable most associated with attendance at follow‐up visits was that the survey had been answered by the patient's parents (odds ratio 2.6, p < 0.001).
Conclusions: In Spain, there is a lack of follow‐up protocols for paediatric CD patients integrating hospitals and primary care, as well as protocols for the transition to adult professionals. The participation of dietitians is very low. Adult patients adhere less to follow‐up visits.
Contact e‐mail address: david@perezsolis.es
G‐RF003. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF003.1. THE CHARACTERISTICS OF ISOLATED BULB CELIAC DISEASE IN CHILDREN: A MULTICENTER RETROSPECTIVE STUDY
Jenni Berliand‐Baru 1, Eyal Zifman2, Bar Sofer3, Michal Kori4, Firas Rinawi5
1Kaplan Medical Center, Rehovot, Israel, 2Meir Medical Center, Kfar Saba, Israel, 3Faculty of Medicine Technion, Haifa, Israel, 4Paediatric Gastroenterology, Kaplan medical center, Rehovot, Israel, 5Emek Medical Centre, Afula, Israel
Objectives and Study: Up to 15% of patients with celiac disease (CD) have mucosal changes limited to the duodenal bulb. We aimed to describe the base‐line characteristics of isolated bulb CD in children.
Methods: A retrospective multicenter study of pediatric patients diagnosed with CD by biopsies taken from the bulb and distal duodenum separately, between 11.2018 – 6.2023. Baseline characteristics included: demographics, anthropometrics, symptoms, associated diseases, family history and celiac serology.
Results: During the study period, 214 children were diagnosed with CD by non‐biopsy approach and 695 children had an esophagogastroduodenoscopy (EGD) for suspected CD; 459 (66%) had classic CD (group A), 127 (18.3%) isolated bulb CD (group B) and 109 (15.7%) potential celiac. Among the 586 children diagnosed by EGD 376 (64.2%) were females, median age 7 years (IQR 5‐11). Prevalence of growth delay was significantly higher in classic CD (19.8%) compared to 9.4% in isolated bulb CD (p = 0.012). Baseline anti‐tissue transglutaminase (TTG) levels were above 10 times the upper limit of normal (ULN) in 328 (71.5%) of group A and 38 (29.9%) in group B, 3–10 × ULN in 114 (24.8%) of group A and 59 (46.5%) of group B and 1–3 × ULN in 17(3.7 %) of group A and 30 (23.6%) of group B, with significant differences between the groups, P < 0.001. In multivariate logistic regression, adjusted for confounding variables, scalloping of the duodenum (OR = 4.7 95%CI 2.8‐8), growth impairment (OR = 2.7 95%CI 1.4‐5.5) and TTG levels above 10 times ULN (OR = 4.5 95%CI 2.8‐7.2) were associated with higher probability of having classic CD.
Conclusions: Isolated bulb CD is common and was diagnosed in almost a fifth of pediatric patients who had an EGD for suspected CD. Having growth impairment, TTG levels above 10 times ULN and scalloping of duodenum were significantly higher in classic CD children.
Contact e‐mail address: jenni.berliand@gmail.com
G‐RF004. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF004.1. EXPERIENCE OF CHILDREN AND CAREGIVERS WITH BIOPSY‐FREE DIAGNOSIS OF COELIAC DISEASE
Helen Evans1,2, Amy Andrews3, Kim Herbison3, Dug Yeo Han4, Jonathan Bishop 1,2
1Department Of Paediatrics, University of Auckland, Auckland, New Zealand, 2Paediatric Gastroenterology And Hepatology, Starship Child Health, Auckland, New Zealand, 3Paediatric Dietetics, Starship Child Health, Auckland, New Zealand, 4Department Of Research And Innovation, Starship Child Health, Auckland, New Zealand
Objectives and Study: Biopsy‐free diagnosis of coeliac disease (CD) has occurred at Starship Child Health since 2018, according to international guidelines. Thereafter, patients are cared for according to the Northern Region Coeliac Disease Health Pathway by their General Practitioner, Community Dietitians and Coeliac New Zealand, who provide peer support and education. This has led to more rapid diagnosis with associated cost savings. We wanted to determine the experience of caregivers of children diagnosed with CD according to diagnostic method.
Methods: Retrospective chart review identified children diagnosed with CD 2018–2022 and managed via the pathway. Data collected include age, gender, ethnicity, and diagnostic method (endoscopic biopsy or biopsy‐free via international guidelines). Caregivers with email addresses available were invited to complete a web‐based questionnaire. Responses were analysed using the Chi‐squared test.
Results: 216 children (61% female, median age 7.8 years, 77% European, 5% Māori), were diagnosed with CD; 166 (77%) by the biopsy‐free method. Sixty‐two of 176 caregivers with e‐mail addresses (35%) responded to the survey. Responses showed high confidence in diagnosis regardless of method, and satisfaction with care provided by clinicians and Coeliac New Zealand. However, caregivers expressed greater impact on family life (p = 0.0160) and less satisfaction with timeliness of results (p = 0.0212) when diagnosed by the biopsy‐free method. Qualitative comments included a perception that the biopsy‐free approach reduced access to tertiary level paediatric gastroenterology, despite expertise being provided in the community instead. There was reported minimal impact to family life and satisfaction with timeliness of results in 16/17 (94.1%) of children diagnosed by biopsy.
Conclusions: Caregivers of children with CD were confident of their diagnosis, but reported greater impact and less satisfaction with biopsy‐free diagnosis, which has become the primary method of diagnosis. These negative perceptions were unexpected. Education of healthcare providers and increased patient information is needed to effectively support families of children with CD.
Contact e‐mail address: hevans@adhb.govt.nz
G‐RF005. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF005.1. ALTERED GUT BACTERIAL COATING IN ADOLESCENTS WITH NEWLY DIAGNOSED COELIAC DISEASE COMPARED TO HEALTHY CONTROLS
Cæcilie Crawley 1,2, Carsten Eriksen3, Anneline Vlamynck3, Ida Bisbo3, Susanne Brix3, Steffen Husby4
1Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark, Odense, Denmark, 2Department Of Paediatrics And Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark, Kolding, Denmark, 3Department Of Biotechnology And Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark, 4Department Of Clinical Research, University of Southern Denmark, Odense, Denmark
Objectives and Study: The pathogenesis of coeliac disease (CeD) remains incompletely understood. Studies have demonstrated differences in gut microbiota composition between treated and untreated CeD patients and healthy controls. Gut immunoglobulins play a role in maintaining microbiota vs. host homeostasis, with previous research identifying elevated levels of IgA‐coated bacteria in the gut of CeD patients. To our knowledge, no studies have characterized gut bacterial coating with different Ig subclasses in CeD. We hypothesize that altered gut bacterial coating may contribute to CeD pathogenesis. This study aimed to characterize the isotype coating of gut bacteria in adolescents with newly diagnosed CeD compared to healthy controls.
Methods: Fecal samples were collected from 14 adolescents with newly diagnosed celiac disease (CeD) on a gluten‐containing diet and 140 sex‐ and age‐matched controls from the previously described GlutenFunen cohort. Absolute and relative bacterial coating with IgA, IgG1, IgG2, IgG4, and IgM (single or multi‐coated) were determined using flow cytometry. Statistical analyses used non‐parametric Wilcoxon rank tests, with a significance threshold of p < 0.05. Multiple testing correction was applied using the Benjamini‐Hochberg procedure. Analyses were conducted in STATA 2018.
Results: No significant differences in total bacterial load per gram of stool were observed between CeD patients and controls. Similarly, there were no differences in the absolute or relative coating of gut bacteria with total IgA, IgG1, IgG2, IgG4, or IgM. Notably, CeD patients had significantly lower relative levels of bacteria multicoated with IgA‐IgG4 compared to controls."
Conclusions: This study assessed gut bacterial coating with immunoglobulin subclasses in CeD. While no differences were observed in the relative and absolute number of bacteria coated with total IgA, IgG1, IG2, IgG4, or IgM, CeD patients had relative lower levels of gut bacteria multicoated with IgA‐Ig4. Further research is needed to explore the potential role of specific bacterial taxa in CeD pathogenesis.
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G‐RF006. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF006.1. IMMUNOCHROMATOGRAPHIC METHODS FOR SEROLOGICAL MARKERS OF CELIAC DISEASE: RAPID, SIMPLE AND EFFICIENT
Paula Nuñez1, Mariam Blanch Ruiz2, Etna Masip3, Ester Donat 4, Carmen Ribes‐Koninckx5
1Unidad De Enfermedad Celiaca E Inmunopatología Digestiva, Instituto de investigacion sanitara la FE, valencia, Spain, 2Unidad De Enfermedad Celiaca E Inmunopatología Digestiva, Instituto de investigacion sanitara la FE, Valencia, Spain, 3Hospital Universitari i Politecnic La Fe, Valencia, Spain, 4Paediatric Gastroenterology And Hepatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain, 5La Fe University, Valencia, Spain
Objectives and Study: Serological tests are the first step in the diagnostic approach to CD. Currently, the detection of various serological markers for CD is generally performed using enzyme immunoassays (ELISA/EliA). The availability of rapid visual immunochromatographic tests (RICT) for their detection could facilitate diagnostic efforts, particularly in screening studies and at‐risk populations. The aim of this study was to evaluate the efficacy RITs compared to conventional ELISA methods.
Methods: A total of 117 anonymized serum samples stored at ‐80°C were retrospectively analysed: 64 samples from children (1‐18 years) with a confirmed diagnosis of CD and 53 from children with other diagnoses. For the determination of deamidated antigliadin peptide (DGP) and anti‐transglutaminase antibodies (tTG), the EliA GliadinDP IgATM and EliA CelikeyTM kits were used, respectively. The RIC tests were CD1WB, which detects tTG‐gA + tTG‐IgG together, and CD2WB (Operon®), which detects tTG ‐gA and DGP‐IgA separately.
Results: The sensitivity was 100% for both the CD1WB (tTG‐IgA + tTG‐IgG) and CD2WB (tTG‐IgA) tests. Specificity was 58.49% and 67.92%, respectively. For the CD2WB DGP‐IgA test, sensitivity and specificity were 71.87% and 92.45%, respectively, with a positive predictive value (PPV) of 92% and a negative predictive value (NPV) of 74.24%. The combination of tTG‐IgA plus DGP‐IgA (both positive or both negative) displays a sensitivity of 97.9% and a NPV of 97%. By comparison, the EliA Celikey™ anti‐tTG IgA, EliA Celikey™ anti‐tTG IgG, and EliA GliadinDP IgA tests yielded sensitivities of 100%, 38.1%, and 82.26%, respectively. Correlation between CDWB1 and ELiA tTG‐IgA + tTG‐IgG was 98.7%.
Conclusions: The evaluated RIC tests are an effective tool for the diagnostic approach to CD. Results should be confirmed using conventional techniques, including endomysial antibodies determination, on a second sample to establish a definitive diagnosis and eventually avoid the intestinal biopsy if criteria for the non‐biopsy diagnosis are fulfilled.
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G‐RF007. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF007.1. IMMUNOREACTIVE GLIADIN PEPTIDES DETECTION IN BIOLOGICAL SAMPLES CAN BE USEFUL TO UNCOVER DIETARY TRANSGRESSIONS TO THE GLUTEN FREE DIET
Paula Nuñez1, Mariam Blanch Ruiz2, Ester Donat 3, Carmen Ribes‐Koninckx1
1Unidad De Enfermedad Celiaca E Inmunopatología Digestiva, Instituto de investigacion sanitara la FE, valencia, Spain, 2Unidad De Enfermedad Celiaca E Inmunopatología Digestiva, Instituto de Investigación Sanitaria La Fe, Valencia, Spain, 3Pediatric Gastroenterology And Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
Objectives and Study: Dietary transgressions (DT) to the gluten‐free diet (GFD) are frequent and challenging to detect. However, alpha‐gliadin 33‐mer peptide is detectable in stool and urine 24‐72 hours after gluten consumption. We aim at investigating the most effective methodology for detecting immunogenic gluten peptides (GIPs) in biological samples to identify DT to the GFD.
Methods: The used methods included qualitative rapid immunochromatographic (RIC) strips: IVYCHECK Stool® BIOMEDAL (professional) and GlutenDetect Stool® (patient self‐monitoring), IVYCHECK Urine® and GlutenDetect Urine®, as well as a semiquantitative method (ELISA), iVYLISA®, for stools. From 17 healthy children (1‐18 years) with quantified gluten consumption, 1 urine/child was obtained. 19 children with CD on a GFD ( > 2 years) filled a 6‐day dietary registry (DR) and contributed with 2 urine and 2 stool samples (Day 3 and 6)
Results: 55 urines were analysed: 17 from healthy children and 38 from CD patients. Additionally, 38 stools from the CD children were analysed. Two subgroups of CD patients were considered according to DR, 12 with no DT and 7 with DT. IVYCHECK Urine® showed a specificity and sensitivity of 95.8% and 14.3%, respectively, with a PPV of 66.7%, while GlutenDetect Urine® showed a specificity and sensitivity of 91.7% and 7.1%, respectively, (PPV 33.33%). GlutenDetect Stool®, IVYCHECK Stool®, and iVYLISA® exhibited specificities of 88%, 95.88%, and 91.3% and NPV 68.75%, 69.7%, and 80.8%, respectively. In the 7 children DT, iVYLISA® in stools showed the highest sensitivity (64.3%).
Conclusions: GIPs detection in stools, specially by iVYLISA®, seems the best of the evaluated methods to detect dietary trangressions to the GFD in pediatric patients. The lower eficacy of GIPs detection in urine could be related to the excretion dynamics of these peptides in the pediatric age as well as to other factors like liquids intake, miccional frequency, etc.
Contact e‐mail address:
G‐RF008. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF008.1. DEVELOPMENT OF CLINICAL SCREENING STRATEGIES FOR COELIAC DISEASE. WHO SCREENS FOR COELIAC DISEASE?
Stine Dydensborg Sander 1,2, Søren Lillevang3, Joseph Murray4, Steffen Husby5
1HCA Research, Odense University Hospital, Odense, Denmark, 2Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark, 3Odense University hospital, Odense, Denmark, 4Mayo Clinic, Rochester, United States of America, 5Department Of Clinical Research, University of Southern Denmark, Odense, Denmark
Objectives and Study: To describe trends in screening for coeliac diseae in a well‐defined geographic area.
Methods: We included all registered tests for tissue transglutaminase IgA antibodies (tTG IgA) requested from hospitals, general practitioners and other health care providers in the admission area for children and adolescents below 18 years of age from 2007 to 2019. The area has a paediatric population of about 90,000 individuals. All tests were analysed at Department of Clinical Immunology at Odense University Hospital. We included the first registered tTG IgA for each individual.
Results: One or more tTG IgA test was registered for 17,746 individuals. The incidence of screening increased from 8 per 1000 in 2007‐2010 to 22 per 1000 children in 2017‐2019. The incidence of children with a positive tTG IgA increased modestly from 0.5 to 0.6 per 1000 children from 2007‐2009 to 2017‐2019. General practitioners requested the first screening test in 8,252 (47%) cases, of which 301 (3.6%) were tTG IgA positive. A hospital department (primarily paediatric) requested the first tTG IgA in 7,352 (41%) cases of which 397 (5.3%) were tTG IgA positive. Paediatricians outside the hospital requested the first tTG IgA in 396 (2%) cases of which 18 (4.5%) were positive. A total of 1,746 children (10%) participated in a research screening study; 28 (1.6%) were tTG IgA positive. The proportion of tests requested by general practitioners increased during the study period from 30% in 2007‐2009 to 55% in 2017‐2019, they were less likely to request screening in the age group below 2 years of age.
Conclusions: Screening for coeliac disease is increasingly initiated by general practitioners. The proportion of positive tests was higher in the hospital reflecting higher pre‐test probability, decreasing during the study period. A higher incidence of screening was not reflected in the diagnostic yield, suggesting a saturation effect.
Contact e‐mail address: stine.dydensborg.sander@rsyd.dk
G‐RF009. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF009.1. CROSSTALK BETWEEN AUTOPHAGY AND INFLAMMATION
Francesca Furone 1, Claudia Bellomo1, Renata Auricchio2,3, Roberta Rotondo4, Francesca Hewa Munasinghege5, Majed Morda5, Maria Vittoria Barone3,6, Merlin Nanayakkara1
1Department Of Translational Medicine, University of Naples, Federico II, Napoli, Italy, 2Department Of Medical Translational Science And European Laboratory For The Investigation Of Food Induced Diseases, Federico II University, Naples, Italy, 3Scienze Mediche Traslazionali (sez. Pediatria‐ Ed11), Università degli Studi di Napoli "Federico II", NAPOLI, Italy, 4Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy, Parma, Italy, 5Università degli studi di Napoli Federico II, Napoli, Italy, 6Department Of Translational Medicine, ELFID‐ European Laboratory for the Investigation of Food Induced Diseases, NAPOLI, Italy
Objectives and Study: Vesicular trafficking can regulate several different pathways including autophagy and inflammation. Data from the literature indicate that intracellular vesicular trafficking, autophagy and inflammation are altered in Celiac Disease (CeD). The aim of this study is to investigate the autophagic flux and its link to inflammation in the intestinal epithelium of biopsies and organoids from patients at gluten‐containing‐diet (GCD‐CeD) and at glute‐free‐diet (GFD‐CeD).
Methods: Biopsies and intestinal organoids from the same patients (GCD‐CeD, GFD‐CeD) and controls (CTR) were obtained. To evaluate autophagy (pE4BP, p62) and inflammation (pNF‐kB) immunofluorescence staining and Western Blot analysis were performed; Bio‐plex analysis was used to evaluate pro‐inflammatory cytokines in the supernatant of organoids; ELISA‐test was used to detect IL1Beta. Bafilomycin, Rapamycin and colture medium of GCD‐CeD organoids were used as treatment of organoids.
Results: In intestinal biopsies from CeD patients the autophagic flux was reduced and inflammation was increased by evaluating p62, p4EBP and pNFKB levels. The same data were reproduced and confirmed in GCD‐ and GFD‐CeD organoids. In CTRs organoids, the block of autophagy induced by bafilomycin treatment was confirmed by increasing of p62 levels, but also an increase of the pE4BP levels was produced indicating that mTOR pathway was activated while inflammation was increased. Rapamycin was able to reduce p62 and E4BP levels in both GCD‐ and GFD‐CeD organoids and inflammation reduced. Bioplex assay showed that 23 out of 27 pro‐inflammatory cytokines were increased in GCD‐CeD and 6 of them were also increased in GFD‐CeD. In CTRs organoids treated with colture medium of GCD‐CeD organoids there was an increase of p62, E4BP, pNFKB and IL1Beta levels.
Conclusions: In conclusion, autophagy and inflammation are closely linked in an interaction that can make the epithelial cells of CeD subjects more prone to stimuli. All these data allow hypotheses of intervention in the prevention and therapy of CeD.
Contact e‐mail address:
G‐RF010. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF010.1. MICRORNA PROFILING OF DUODENAL DENDRITIC CELLS IN CHILDREN WITH COELIAC DISEASE AND HLA‐STRATIFIED CONTROLS
Federica Giachero 1,2, Patrick Weil3, Stefan Wirth3, Jan Postberg3, Andreas Jenke3,4
1Faculty Of Health, Department Of Medicine, Clinical Molecular Genetics And Epigenetics, Centre For Biomedical Education & Research (zbaf), Witten/Herdecke University, Witten, Germany, 2University of Cambridge, Cambridge, United Kingdom, 3Faculty Of Health, Department Of Medicine, Clinical Molecular Genetics And Epigenetics, Centre For Biomedical Education & Research (zbaf), Witten/Herdecke University, witten, Germany, 4Children's Hospital Kassel, Kassel, Germany
Objectives and Study: Celiac disease (CD) is a chronic immune disorder triggered by gluten in genetically predisposed individuals. While approximately 25% of Europeans carry the predisposing HLA‐DQ2/‐DQ8 genotype, only 1% develop CD, suggesting that additional factors, such as microRNAs, may influence disease development by modulating local immune responses. In this study, we investigated the microRNA profile of duodenal dendritic cells (DDC), critical antigen‐presenting cells (APCs) that play a key role in the initiation of CD autoimmunity. We compared the microRNA profiles of DDCs from children with CD to those of HLA‐stratified controls.
Methods: DDCs were isolated from fresh duodenal biopsies of 11 children (average age 13.32 years; 6/11 were girls) using magnetic‐activated cell sorting based on CD209 expression. MicroRNA libraries were prepared and sequenced from both CD209+ DDCs and CD209‐ non‐DDC fractions. HLA‐DQ2/‐DQ8 status was confirmed via allele‐specific PCR from EDTA blood samples.
Results: Among the cohort, two patients were diagnosed with CD, seven controls were HLA‐DQ2/‐DQ8 positive, and two controls were negative. Three controls had Helicobacter pylori infection, two had gastritis, and four had no upper GI pathology. We identified 52 distinct microRNAs across the samples, with similar read numbers between the DDC and non‐DDC fractions. Notably, hsa‐mir‐103 and hsa‐mir‐210 were highly expressed in CD209+ DDCs, comparable to duodenal epithelial cells.
Conclusions: The microRNAs profiling was performed on a small yet homogeneous paediatric cohort. Although no microRNAs reached statistical significance due to the small cohort size, the results demonstrate that isolating and profiling DDCs is feasible. This approach opens new avenues for investigating the role of specialized APCs in CD, complementing traditional studies of other cell types involved in the disease.
Contact e‐mail address:
G‐RF011. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF011.1. SIGNIFICANCE OF PARENTAL SOCIO‐ECONOMIC FACTORS AND EARLY LIFE HEALTHCARE UTILIZATION FOR THE PROBABILITY OF THE CHILD'S CELIAC DISEASE DIAGNOSIS
Laura Kivelä 1,2,3, Elin Hård Af Segerstad4,5, Aino Rantala6,7, German Tapia6, Lars Christian Stene6, Ketil Størdal3,8
1Children's Hospital, Helsinki University Hospital, Helsinki, Finland, 2Celiac Disease Research Center, Tampere University, Tampere, Finland, 3Department Of Pediatric Research, University of Oslo, Oslo, Norway, 4Pediatric Research Institute, Oslo University Hospital, Oslo, Norway, 5Celiac And Diabetes Unit, Clinical Sciences Malmoe, Lund University, Malmoe, Sweden, 6Norwegian Institute of Public Health, Oslo, Norway, 7Center For Environmental And Respiratory Health Research, University of Oulu, Oulu, Finland, 8Department Of Pediatric And Adolescent Medicine, Oslo University Hospital, Oslo, Norway
Objectives and Study: Socio‐economic factors may affect the risk to develop celiac disease (CeD) but also the probability to be diagnosed. We studied the associations of parental socio‐economic factors and early life healthcare utilization with the probability of being diagnosed with CeD in childhood.
Methods: Data on mother's pregnancy diet, parental socio‐economic factors, and child's diet, infections and healthcare visits were collected in repeated parental questionnaires up to age 18 months in the Norwegian Mother, Father and Child Study. CeD diagnosis >3 years of age was collected from the Norwegian Patient Registry. Associations between socio‐economic factors, the number of child healthcare visits and later CeD were studied by logistic regression, adjusted for sex, birth year, maternal country of birth, parity, healthcare region and parental CeD, and additionally for the number of healthcare visits, reported infections, pregnancy and child's diet quality (aOR1), or paternal educational level and reported infections (aOR2).
Results: Of 68,762 children, 1,030 (1.5%) were diagnosed with CeD at mean age of 9.5 (SD 3.9, range 3‐19) years. Higher paternal educational level (aOR1 1.12 [95%CI 1.04, 1.21] per level increase) and family difficulties to cope with unexpected costs (aOR1 0.70 [95%CI 0.50, 0.99] compared to no difficulties) associated with CeD in the child. Mother's educational level or family income were not associated with CeD in the child. A median of 3 (interquartile range 1‐5) doctor's visits were reported between age 6‐18 months. Children later diagnosed with CeD had more doctor's visits than controls (aOR2 1.11 [95%CI 1.04, 1.18] per quartile increase).
Conclusions: Higher father's educational level, stable family finances and higher number of healthcare visits in early childhood associated with the child's later CeD diagnosis. This could be driven by differences in parental healthcare seeking behavior impacting the probability for the child to be diagnosed with CeD.
Contact e‐mail address: laura.kivela@tuni.fi
G‐RF012. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF012.1. POTENTIAL CELIAC DISEASE, DIAGNOSIS AND FOLLOW‐UP; A SINGLE CENTER EXPERIENCE OVER SIX YEARS
Barak Laxer 1, Assaf Hoofien2, Michal Kori2
1Paediatrics Ward, Kaplan Medical Center, Rehovot, Israel, 2Paediatric Gastroenterology, Kaplan medical center, Rehovot, Israel
Objectives and Study: Potential celiac disease (PCD), the presence of positive celiac serology with normal small intestinal mucosa, occurs in up to 20% of Celiac Disease (CD) patients. We characterized children with PCD at diagnosis and followed those remaining on a gluten containing diet.
Methods: A retrospective study of children diagnosed with PCD between 12/2018 and 10/2024. Baseline data; demographics, anthropometrics, clinical symptoms and signs, celiac serology [tissue transglutaminase antibodies (TTG) and endomysial antibody (EMA) levels] and biopsy results. Follow‐up data; repeat serology and biopsy results when preformed.
Results:
PCD was diagnosed in 75/517 (14.5%) children undergoing gastroscopy for suspected CD, 53/75 (70.6%) females, mean age 10.4 years. TTG was above X10 ULN (Upper Limit Normal) in 18 (24%), between X3‐10 ULN in 52 (69.3%) and <X3ULN in 5 (6.6%). EMA was positive in 57 (76%). There were 48 (64%) children with at least 1‐year follow‐up. TTG normalized in 23 (47%), declined or remained unchanged in 22 (45.8%) and increased or remained >X10 ULN in 3 (6.3%). Eight (10.6%) children started a gluten free diet. In 6, CD was confirmed by a repeat biopsy, in one the biopsy was normal however clinical symptoms led to the initiation of a GFD. One child started a GFD due to concomitant eosinophilic esophagitis. There were 11/18 children with an initial TTG > X10 ULN and at least 1‐year follow‐up, TTG normalized in 3 (27.2%), declined in 5 (45.4%) and increased or remained X10 ULN in 3 (27.2%).
Conclusions: PCD is common, even in children with TTG levels above X10 ULN. Up to 50% of children with PCD will normalize TTG. Omitting endoscopy and biopsy at diagnosis may cause over diagnosis of CD.
Contact e‐mail address: baraklax@clalit.org.il
G‐RF013. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF013.1. LOW PREVALENCE OF CELIAC DISEASE IN FRENCH CHILDREN BASED ON THE NATIONAL HEALTH DATA SYSTEM
Marwa Hmimou, Chloe Girard, Axel Renoux, Amélie Arrouy, Maryse Lapeyre Mestre, Emmanuel Mas
Paediatric Gastroentorology, CHU Purpan, TOULOUSE, France
Objectives and Study: Over the past 20 years, the recommendations for celiac disease (CD) diagnosis have evolved. There are differences in the prevalence and incidence across Europe without specific data for France. Our aim was to obtain French epidemiological data of CD in children.
Methods: We used the French Health Data System (SNDS) to identify patients with CD < 18 years between 2011 and 2022. Patients were identified through: 1) diagnosis code of CD during hospitalization; 2) and/or for long term disease coverage; 3) and/or serological diagnoses (at least 2 IgA‐antibodies against transglutaminase‐2 (TGA) within 13 months and 1 endomysium antibody within 7 months after TGA).
Results: Overall, 41.688 children (sex ratio 0.88) with CD were identified for the 2011‐22 period, 65.6% being identified only by serological diagnosis. The number of intestinal biopsies decreased from 12.4% to 7.5% between 2011 and 2022. In 2022, the prevalence rate was 0.15% of children < 18 years living in France, ranging from 0.08 (Pays de Loire) to 0.25% (Provence‐Alpes‐Côte d'Azur). The French annual incidence rate ranged between 16 and 22 children/100,000 person‐years in the < 18 years population (lowest incidence observed in 2020 during Covid pandemic). The median age at diagnosis increased from 6 to 7 years between 2011 and 2022. Looking at comorbidities, the prevalence of thyroid diseases was 1.7%, and type 1 diabetes 9.8%.
Conclusions: The prevalence of pediatric CD is low in France, with differences across regions. However, the age at diagnosis is consistent with recent studies.
Contact e‐mail address:
G‐RF014. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF014.1. CIRCULATING MICRORNAS AS NOVEL NON‐INVASIVE BIOMARKERS OF PAEDIATRIC CELIAC DISEASE AND ADHERENCE TO GLUTEN‐FREE DIET
Antonella Baldassarre1, Alessandro Paolini1, Francesca Ferretti2, Chiara Maria Trovato2, Maria Elena Lionetti3, Claudio Romano4, Ruggiero Francavilla5, Antonella Diamanti6, Andrea Masotti 1
1Research Laboratories, Bambino Gesù Children's Hospital, Rome, Italy, 2Uos Riabilitazione Nutrizionale, Uoc Gastroenterologia E Nutrizione, Ospedale Pediatrico Bambino Gesù, Rome, Italy, 3Department Of Pediatrics, Marche Polytechnic University, Ancona, Italy, 4Pediatric Gastroenterology and Cystic Fibrosis Unit, University Hospital “G. Martino”, Messina, Italy, 5Interdisciplinary Department of Medicine, Pediatric Section, Pediatric Hospital Giovanni XXIII, Bari, Italy, 6Nutritional Rehabilitation, Children's Hospital Bambino Gesù, IRCSS, Rome, Italy
Objectives and Study: Celiac Disease (CD) is a multifactorial autoimmune enteropathy (with a prevalence of approximately 1% worldwide) that exhibits a wide spectrum of clinical, serological and histological manifestations. For the diagnosis of paediatric CD, the gold standard is the combination of serological tests (with high TGA‐IgA values greater than 10 times the upper limit of normal) and duodenal biopsy (with a positive TGA‐IgA but low titer). Therefore, a diagnostic test that totally excludes an invasive approach has not been discovered so far and the discovery of novel biological markers would represent an undoubted advantage for the diagnosis of CD and prognostic evaluation.
MicroRNAs (miRNAs), small non‐coding RNAs (1822 nucleotides) that regulate gene expression at post‐transcriptional level and play important roles in many biological processes, represent a novel class of potential disease biomarkers. Their presence in biological fluids (i.e., serum, plasma, saliva, urine) provides the opportunity to employ circulating miRNAs as novel non‐invasive biomarkers.
Methods: In our prospective observational study, we examined the expression of circulating miRNAs in a cohort of CD patients (both at diagnosis and on gluten‐free diet, respectively referred as CD and GFD) compared to healthy controls. By small RNA‐Seq we discovered a set of circulating miRNAs that were further validated by qPCR with specific assays.
Results: We found that out of the 13 miRNAs able to discriminate the three groups (i.e., CD, GFD and controls), three of them, namely miR‐192‐5p, miR‐215‐5p and miR‐125b‐5p (alone or in combination), were able to discriminate these three groups with high accuracy and specificity.
Conclusions: Our conclusions emphasize that these circulating miRNAs can be employed not only for the diagnosis of CD patients with a low TGA‐IgA titer but also to monitor the adherence to a gluten‐free diet by CD patients.
Contact e‐mail address: andrea.masotti@opbg.net
G‐RF015. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF015.1. NOVEL EPITOPES AND MULTIPARAMETRIC DIAGNOSTICS TO ELIMINATE UNNECESSARY BIOPSIES IN PEDIATRIC CELIAC DISEASE
Torsten Matthias 1, Ania Szaflarska‐Popławska2, Simon Lytton3, Patricia Wusterhausen1
1Research & Development, AESKU.Diagnostics GmbH & Co. KG, Wendelsheim, Germany, 2Pediatric Endoscopy And Gastrointestinal Function Testing, Nicolaus Copernicus University, Bydgoszcz, Poland, 3SeraDiaLogistics, München, Germany
Objectives and Study: Celiac disease diagnosis traditionally relies on small bowel biopsies showing villous atrophy and lymphocytic infiltration, along with serological detection of anti‐tissue transglutaminase (tTG) and/or anti‐endomysial IgA antibodies. To reduce unnecessary biopsies in children and better correlate autoantibody levels with clinical outcomes, the AESKUBLOTS® Gluten Related Disorders (GRD) test was developed for the quantitative determination of IgA antibodies in GRD. Aim, to evaluate the clinical performance of AESKUBLOTS® GRD in Polish children with celiac disease.
Methods: AESKUBLOTS® GRD IgA antibody titers were measured for tTG, tTG‐neo, microbial transglutaminase (mTG), neo‐mTg, deamidated gliadin peptides (DGP), gliadin, Frazer's fraction, human epidermal transglutaminase (TG3), and total IgA in a cohort of 71 pediatric celiac disease patients and 29 controls. Assay performance was assessed using ROC curve analysis and correlation with EMA endpoint titers (EPT) based on patient clinical history.
Results: The assay demonstrated excellent diagnostic performance. The tTG‐neo IgA showed the highest sensitivity and specificity, reaching 91.38% (CI: 81.017–97.141%) and 100.00% (CI: 91.592–100.00%), respectively, with an AUC of 0.957 (CI: 0.896–0.987). Similarly, the mTG‐neo IgA achieved a specificity of 100.00% (CI: 91.592–100.00%) and a sensitivity of 75.86% (CI: 62.831–86.130%), with an AUC of 0.879 (CI: 0.799–0.936). Both tTG‐neo IgA and mTG‐neo IgA strongly correlated with EMA EPT (r² > 0.75, p < 0.001). IgA deficiency (< 7 mg/dL) was reported in 7% of cases, confirmed by total IgA levels. Additionally, three CD patients showed elevated TG3 levels (> 20 U/ml).
Conclusions: tTG‐neo and mTG‐neo IgA are valuable biomarkers for diagnosing celiac disease in children, suitable for routine serology. Elevated TG3 levels, detected through multiparameter testing, may indicate Dermatitis Herpetiformis, which should be considered clinically. Future studies comparing neo‐mTG and neo‐tTG IgA in different age groups are needed to better understand the reactivity influenced by mTG enzymes in processed foods and gluten avoidance diets.
Contact e‐mail address: wusterhausen@aesku.com
G‐RF016. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF016.1. REVOLUTIONARY MULTIPLEX AUTOANTIBODY DETECTION BY AGGLUTINATION‐PCR (ADAP) ASSAYS ENABLES SCREENING FOR COELIAC DISEASE, TYPE 1 DIABETES, AND AUTOIMMUNE THYROID DISEASE IN ONE TEST: TRIAD STUDY
Maria Naredi Scherman, Alexander Lind, Daniel Agardh
Department Of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
Objectives and Study: Screening for multiple autoimmune diseases in the general paediatric population demands screening assays with high diagnostic performance and efficacy to analyse large populations. The aim of this study was to compare the novel multiplex autoantibody detection by agglutination‐PCR (ADAP) assay with gold standard singleplex radiobinding assays (RBA) for detection of autoantibodies associated with coeliac disease (CD), type 1 diabetes (T1D), and autoimmune thyroid disease (AITD).
Methods: Blood samples from 2,271 Swedish schoolchildren from the general population were analysed separately in ADAP and RBA for CD‐associated autoantibodies against tissue transglutaminase (tTGA), T1D‐associated islet autoantibodies against glutamic acid decarboxylase (GADA), insulin (IAA), insulinoma antigen‐2 (IA‐2A), and zinc transporter 8 (ZnT8A), and AITD‐associated autoantibodies against thyroperoxidase (TPOA). Islet autoantibody positive children were categorized as either positive for multiple autoantibodies or not. Agreements between assays were assessed using Cohen's kappa statistics and defined as slight (0.00‐0.20), fair (0.21‐0.40), moderate (0.41‐0.60), substantial (0.61‐0.80), or almost perfect (0.81‐1.00) agreement. Children with persistently positive autoantibodies in RBA were referred to a paediatrician for follow‐up.
Results: Scoring agreement was substantial for children with tTGA and multiple islet autoantibodies, moderate for TPOA, and varied for the islet autoantbodies analysed separately (Table 1). All children diagnosed at follow‐up were identified by both assays. Table 1. Prevalence and scoring agreement of analysed autoantibodies.
| Autoantibody | N positive in RBA (%) | N positive in ADAP (%) | Scoring agreement (K) |
| tTGA | 64 (2.8%) | 88 (3.8%) | 0.701 |
| GADA | 43 (1.9%) | 37 (1.6%) | 0.542 |
| IAA | 39 (1.7%) | 44 (1.9%) | 0.178 |
| IA‐2A | 10 (0.4%) | 18 (0.8%) | 0.569 |
| ZnT8A | 9 (0.4%) | 14 (0.6%) | 0.257 |
| Multiple islet autoantibodies | 14 (0.6%) | 23 (1.0%) | 0.646 |
| TPOA | 116 (5.1%) | 55 (2.4%) | 0.569 |
Conclusions: ADAP and RBA performed equally in detecting children with autoantibodies associated with CD, T1D (multiple islet autoantibodies), and AITD. ADAP is recommended as first‐line method of choice for large‐scale screening of the general population.
Contact e‐mail address:
G‐RF017. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF017.1. COMPREHENSIVE PAEDIATRIC SCREENING: DETECTING COELIAC DISEASE, TYPE 1 DIABETES AND AUTOIMMUNE THYROID DISEASE WITH A SINGLE TEST – TRIAD STUDY FINDINGS
Maria Naredi Scherman, Alexander Lind, Samia Hamdan, Daniel Agardh
Department Of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
Objectives and Study: Automated multiplex autoantibody detection by agglutination‐PCR (ADAP) can detect multiple autoantibodies in <5 uL blood, making it a candidate assay for large‐scale screenings. In this study, ADAP was evaluated as first‐line screening assay for autoantibodies associated with coeliac disease (CD), type 1 diabetes (T1D), and autoimmune thyroid disease (AITD) in a general paediatric population.
Methods: In this study (TRIAD 2023), 1,604 Swedish schoolchildren from the general population were screened for autoantibodies against tissue transglutaminase (tTGA), thyroid peroxidase (TPOA), and islet autoantibodies against insulin (IAA), glutamic acid decarboxylase (GADA), insulinoma antigen‐2 (IA‐2A), and zinc transporter 8 (ZnT8A), using ADAP as first‐line screening assay. Autoantibody‐positive (Aab + ) samples were confirmed with radiobinding assays (RBA). If Aab+ in RBA, a second venous sample was collected and persistently Aab+ were referred for follow‐up. Results were compared with a previous screening using RBA as first‐line screening assay (TRIAD 2021) (Naredi Scherman et al, Frontiers in Pediatrics, 2024).
Results: of the present study (TRIAD 2023) and previous study (TRIAD 2021) are summarized in Table 1. Table 1. Autoantibody‐positive children and diagnosed children in TRIAD 2023 and TRIAD 2021.
| TRIAD 2023 (n = 1,604) | TRIAD 2021 (n = 2,271) | p‐value | |
| Autoantibody | |||
| All Aab + | 109 (6.8%) | 166 (7.3%) | 0.539 |
| tTGA | 49 (3.1%) | 61 (2.7%) | 0.496 |
| TPOA | 47 (2.9%) | 54 (2.2%) | 0.288 |
| Islet Aab + | 23 (1.4%) | 60 (2.6%) | 0.011 |
| IAA | 5 (0.3%) | 29 (1.3%) | 0.002 |
| GADA | 18 (1.1%) | 37 (1.6%) | 0.189 |
| IA‐2A | 8 (0.5%) | 10 (0.4%) | 0.792 |
| ZnT8A | 8 (0.5%) | 9 (0.4%) | 0.635 |
| Multiple islet Aab + | 10 (0.6%) | 14 (0.6%) | 0.978 |
| Screening‐detected diagnosis | |||
| CD | 17 (1.1%) | 26 (1.1%) | 0.803 |
| AITD | 5 (0.3%) | 6 (0.3%) | 0.784 |
| T1D | 1 (0.1%) | 3 (0.1%) | 0.505 |
Conclusions: Screening with ADAP as first‐line assay showed comparable results to RBA as first‐line assays in detecting children with CD, T1D, and AITD and the associated autoantibodies. ADAP is recommended for future pediatric large‐scale screening.
Contact e‐mail address:
G‐RF018. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF018.1. OTHER SPECIAL DIETS BESIDES GLUTEN‐FREE DIET ARE COMMON IN YOUTH WITH CELIAC DISEASE, BUT NOT ASSOCIATED WITH OVERALL WELLBEING OR TREATMENT SUCCESS
Heli Pihlajamäki 1,2,3, Linnea Aitokari2,3,4, Kaija Nissinen5, Laura Kivelä2,3,6, Sanna Arnala7, Pilvi Laurikka2,3, Katri Kaukinen2,3, Kalle Kurppa2,3,8,9
1Seinäjoki Social and Health care Center, Seinäjoki, Seinäjoki, Finland, 2Tampere University, Tampere Center for Child, Adolescent and Maternal Health Research, Tampere, Finland, 3Tampere University, Celiac Disease Research Center, Faculty of Medicine and Life Sciences, Tampere, Finland, 4Valkeakoski Social and Healthcare Center, Wellbeing Services County of Pirkanmaa, Valkeakoski, Finland, 5Seinäjoki University of Applied Sciences, Seinäjoki, Finland, Seinäjoki, Finland, 6Children's Hospital and Paediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, Helsinki, Finland, 7The Finnish Coeliac Society, Tampere, Finland, Tampere, Finland, 8The Tampere University Hospital, Department of Pediatrics, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland, 9The University Consortium of Seinäjoki, Seinäjoki, Finland
Objectives and Study: Various special diets have become increasingly common. These could particularly affect the lives of patients with celiac disease (CeD), who must maintain a restrictive gluten‐free diet (GFD). We studied the use and impact of special diets among adolescents and young adults with CeD.
Methods: Altogether 210 16‐30‐year‐old patients filled a survey about demographic data, education and employment, health‐related issues, diet and treatment of CeD. All variables were compared between patients with and without additional special diet. Non‐CeD controls included 212 age‐matched responders.
Results: In total, 83% of the patients were females, 53% students, 41% working and 6% other; the respective figures for controls were 78%, 81%, 18% and 1%. One‐third of the patients reported special diets, particularly vegetarian/vegan diet (9%), allergy diet (8%) and diet for IBS (7%). The corresponding figures in controls were overall 33%, vegetarian/vegan 14%, allergy 7% and IBS 8%, with no significant differences between them and patients. CeD patients with or without a special diet besides GFD were comparable in sex, current age, age at diagnosis, BMI, student/employment status, physical activity and use of alcohol and tobacco products. Those with only GFD presented less often with gastrointestinal symptoms and had less problems when participating in school and workplace meals than patients with an additional special diet (58% vs. 75%, p = 0.021 and 27% vs. 39%, p = 0.020, respectively). Altogether 11% reported difficulties to combine GFD and other diet, but there were no differences in GFD adherence (91% vs. 93%, p = 0.705), persisting symptoms, health concerns or overall well‐being.
Conclusions: Up to one‐third of adolescents and young adults with CeD reported following other special diets in addition to GFD. Special diets can be a part of a successful GFD, but it is important to note them during follow‐up and the transfer of care from paediatrics to adult healthcare.
Contact e‐mail address: heli_pih@hotmail.com
G‐RF019. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF019.1. FECAL MIRNAS AND METAGENOMIC PROFILING IN PEDIATRIC CELIAC DISEASE: AN OPPORTUNITY TO IMPLEMENT DIAGNOSIS AND MONITORING?
Antonio Francavilla1,2, Antonio Pizzol 3, Anna Opramolla3, Michele Pinon3, Laura Giugliano3, Giuglio Ferrero1,4, Barbara Pardini1,2, Denise Festa1, Sonia Tarallo1,2, Carla Di Battista1,2, Pier Calvo3, Alessio Naccarati1,2
1Italian Institute for Genomic Medicine (IIGM), Candiolo, Torino, Italy, Turin, Italy, 2Candiolo Cancer Institute, FPO‐IRCCS, 10060 Candiolo (TO), Italy, Turin, Italy, 3Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Turin, Italy, 4Department of Clinical and Biological Sciences, University of Torino, Torino, Italy, Turin, Italy
Objectives and Study: Objectives and Study New fecal biomarkers may improve non‐invasive diagnosis and clinical management of pediatric Celiac Disease (CD). For this purpose, fecal small RNAs (sRNAs) and microbial profiles were explored in pediatric CD subjects at diagnosis and after one year of gluten‐free diet (GFD).
Methods: Methods In this observational study, paired xsstool sRNA and shotgun metagenomic sequencing were performed on samples from: 127 untreated pediatric CD (39 individuals with high serum transglutaminase (TG) levels (>10‐fold the positivity threshold, CD‐hTG), 19 Potential CD (pCD), 12 IBD patients, and 44 controls. Data were compared with profiles measured at one year of GFD and integrated with serological measurements of gut permeability markers.
Results: Results The analysis showed a significant increase of inflammatory (TG and, s‐Ab anti Endomysium IgA, and calprotectin) and permeability markers (Occludin, Zonulin, and tight junction protein ZO‐1 concentration) in CD patients. miRNA profiling analysis evidenced 109 miRNAs with significantly different levels between patients and controls (adj. p < 0.05), particularly in CD‐hTG (n = 72) and CD (n = 55). Among them, 41 were similarly dysregulated (rho=0.82‐0.88, p < 0.001) in IBD samples and similar patterns were observed between pCD and CD profiles (rho=0.64, p < 0.001). Immune‐response, apoptosis, and of genes expressed in duodenal stem cells were enriched in the miRNA target genes. No significant differences on microbial alpha and beta diversities were observed among the study groups but 29 taxa were differentially abundant (adj. p < 0.1) in CD‐hTG with respect to controls. Among them, 21 and 19 were characterized by the same trend in CD and pCD samples, respectively. Functional analysis of the microbial comunnities is ongoing as well as investigation of combined miRNA‐microbial signature able to discriminate CD patients from controls.
Conclusions: Conclusions Combined analysis of fecal molecular/microbial profiles highlightes remarkable differences among CD groups and controls and provides an opportunity to identify biomarkers for the non‐invasive disease monitoring.
Contact e‐mail address: pierluigi.calvo@unito.it
G‐RF020. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF020.1. EXPLORING TISSUE TRANSGLUTAMINASE ANTIBODIES AS A CONFIRMATORY TOOL FOR DIAGNOSING COELIAC DISEASE IN CHILDREN
Patricija Levstik1, Mojca Kukovic1, Petra Rižnik 2, Jernej Dolinsek1,2
1Faculty Of Medicine, University of Maribor, Maribor, Slovenia, 2Department Of Pediatrics, University Medical Centre Maribor, Maribor, Slovenia
Objectives and Study: The prerequisite for diagnosing coeliac disease (CD) in children without duodenal biopsy is a tissue transglutaminase antibody (TGA) level exceeding 10 times the upper limit of normal (ULN), along with a positive confirmatory endomysial antibody (EMA) test in a secondary blood sample. The aim of our study was to evaluate whether repeated TGA measurements could serve as an alternative to EMA for confirming the diagnosis of CD.
Methods: A retrospective analysis of medical data was conducted, including children under 19 years old who were diagnosed at our department from January 2013 to December 2023. We reviewed the diagnostic process, focusing on TGA antibody levels at the time of diagnosis and during follow‐up.
Results: Data from 299 CD patients (61.2% female, mean age 7 y) was available for the analysis. In 33 patients (11%), the diagnosis was confirmed without a duodenal biopsy, with initial TGA levels >10xULN. In 22 of these patients (7.3%), TGA was tested alongside EMA as a secondary test, revealing persistently high levels (>10xULN) in the follow‐up sample. In the group of children diagnosed with duodenal biopsy (N = 266; 93.9% Marsh 3), 124 (47.1%) had initial TGA >10xULN. Secondary serology was performed in 41 (33.1%) of these children before starting the gluten‐free diet, with 39 (95.1%) showing TGA >10xULN on the day of the duodenal biopsy. The remaining two had TGA levels of >9xULN and >7xULN, respectively.
Conclusions: Our study suggests that TGA levels exceeding 10×ULN could serve as a reliable alternative to EMA for confirming a diagnosis of coeliac disease in children eligible for the no‐biopsy approach. This method could make the diagnostic process more cost‐effective and efficient while preserving accuracy.
Contact e‐mail address: petra.riznik@gmail.com
G‐RF021. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF021.1. TRACKING THE PATH TO RECOVERY: NORMALISATION OF TGA ANTIBODIES AND SYMPTOMS IN PAEDIATRIC COELIAC DISEASE
Mojca Kukovic1, Patricija Levstik1, Petra Rižnik 2, Jernej Dolinsek1,2
1Faculty Of Medicine, University of Maribor, Maribor, Slovenia, 2Department Of Pediatrics, University Medical Centre Maribor, Maribor, Slovenia
Objectives and Study: Data on the rate of tissue transglutaminase antibody (TGA) normalisation in children with coeliac disease (CD) on a gluten‐free diet (GFD) are limited. The aim of our study was to evaluate the rate of normalisation of TGA and symptom resolution in newly diagnosed children after starting a GFD.
Methods: We conducted a retrospective study on children diagnosed with CD at our department between 2013 and 2023. Medical data was analysed, including clinical presentation and laboratory results at the time of diagnosis and during follow‐up.
Results: Data from 299 children with CD (61.2% female, mean age 7 y) were included in the study. Most children were symptomatic at diagnosis (94.3%). Contrary to symptomatic patients, the majority of asymptomatic patients had a positive family history of CD (76.5% vs 22.0%; p < 0.001). The most common symptoms and signs at the diagnosis were abdominal pain, diarrhoea and iron deficiency anaemia (62.5%, 14.8%, 12.0%, respectively). More than half of children (52.5%) had initial TGA >10x upper level of normal. On average, symptoms resolved 5 months after the introduction of a gluten‐free diet and TGA normalised on average after 12 months. There was no significant difference in the rate of antibody normalisation among symptomatic and asymptomatic children (median time to normalisation 12 m) and among children with or without family history of CD (12 m vs 11 m; NS). In children in whom diagnosis of CD was confirmed using duodenal biopsy (88.3%) the antibody levels normalised slower compared to those, diagnosed using no‐biopsy approach (12 m vs 9 m; NS).
Conclusions: Normalisation of TGA levels typically takes longer than the resolution of clinical symptoms. Interestingly, children who underwent duodenal biopsy exhibited a slower decrease in antibody levels compared to those diagnosed without a biopsy, even though the initial TGA levels were lower in the biopsy group.
Contact e‐mail address: petra.riznik@gmail.com
G‐RF022. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF022.1. THE KNOWLEDGE ABOUT CELIAC DISEASE AMONG MEDICAL STUDENTS
Anja Segula 1, Petra Rižnik2, Jernej Dolinsek2,3
1Faculty of Medicine, University of Maribor, Maribor, Slovenia, 2University Medical Centre Maribor, Maribor, Slovenia, 3Department Of Pediatrics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
Objectives and Study: Previous studies indicate unsatisfactory knowledge about celiac disease (CD) among healthcare professionals. The aim of this study was to assess the knowledge about CD among medical students and to determine relationship between knowledge, the year of medical school, the desired specialty, and the impact of personal experience with CD.
Methods: Web‐based questionnaire consisting of 24 questions was distributed to the medical students of two Slovenian medical schools. The questions focused on epidemiology, clinical presentation, diagnostics, treatment, and follow‐up. Statistical analysis of the scores was performed based on individual demographic characteristic.
Results: The questionnaire was completed by 155 students. Achieved mean score was 38.5%. Results varied significantly depending on the year of medical school (p < 0.001), with the first‐year students scoring an average of 30.5% and the final‐year students 51.8%. A statistically significant difference (p < 0.001) was also found between students who had not yet passed the paediatrics examination according to the curriculum and those who had (mean score 37% vs. 51.8%). Participants who intend to choose paediatrics or internal medicine as their specialty achieved similar scores to those who wish to choose other specialties (40.7%; 31.2% and 39.3% respectively) (p = 0.181). Students whose relatives or friends have CD or have CD themselves scored similarly (mean score 37.5%) as students without those experience (mean score 39.3%) (p = 0.384). No statistically significant differences were observed in the scores of students from the two medical schools (p = 0.069).
Conclusions: The results indicate unsatisfactory knowledge about CD among Slovenian medical students. The higher mean score of final‐year students compared with first‐year students shows that students gain important knowledge about CD during studies. Nevertheless, it is important to motivate students to further participate in awareness‐raising programs about CD.
Contact e‐mail address:
G‐RF023. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF023.1. SHORT‐TERM FOLLOW‐UP OF CHILDHOOD POTENTIAL CELIAC DISEASE: PROGRESSION OR RESOLUTION?
Melek Sonmezocak Akturk 1, Nevzat Aykut Bayrak2
1Pediatrics, University of Health Sciences, Zeynep Kamil Women & Children's Training & Research Hospital, Istanbul, Turkey, 2Pediatric Gastroenterology, Hepatology And Nutrition, University of Health Sciences, Zeynep Kamil Women & Children's Training & Research Hospital, Istanbul, Turkey
Objectives and Study: Potential celiac disease (pCD) is characterized by the presence of celiac disease (CD)‐specific auto‐antibodies, in the absence of histological abnormalities in duodenal biopsies and compatible HLA. Its unclear natural course complicates pCD management and follow‐up. We aimed to evaluate the characteristics and short‐term outcomes of children with pCD on a gluten‐containing diet.
Methods: We reviewed electronic health records of pCD patients (January 2019–November 2024) and recorded demographics, symptoms, comorbidities, TTG IgA levels, endoscopy, histology, and HLA‐DQ2/DQ8 status. TTG levels >200 RU/mL were capped at 200 for analysis. Exclusions: selective IgA deficiency, HLA negativity, incomplete data, gluten‐free diet consumption. Outcomes of patients progressing to CD were compared with those who did not.
Results: Of 284 gastroscopies for suspected CD, 67 had no abnormalities in duodenum (TTG range 79.3‐200 RU/mL; age: 7.95 ± 5.2 years, 62.7% female). The exclusion criteria led to the exclusion of sixteen cases, eight of which were HLADQ2/DQ8 negative (TTG range: 85.6‐200 RU/mL). Remaining 51 patients (age: 8.04 ± 5.21 years, 60.8% female) were studied. CD presentation: classical (33.3%), non‐classical (31.4%), asymptomatic (35.3%). Mean follow‐up: 3.05 ± 1.65 years (range: 11–62 months, median: 34 months). CD developed in 6 (11.7%) patients, and 12 (23.5%) had normalized TTG. No significant differences in age, gender, CD type, TTG, or follow‐up duration (p > 0.05) were observed. A positive family history was higher in those progressing to CD (4/6, p < 0.05).
Conclusions: Our findings showed that only a small percentage of pCD patients (11.7%) developed CD during short‐term follow‐up, while TTG levels normalized in 23.5%. Patients with a family history of CD had a greater risk of progressing from pCD to CD.
Contact e‐mail address: aykutbayrak@hotmail.com
G‐RF024. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐RF024.1. RAPID DETECTION OF INTESTINAL ANTI‐TRANSGLUTAMINASE ANTIBODIES: AN ITALIAN PAEDIATRIC MULTI‐CENTER STUDY
Fabiana Ziberna 1, Luigina De Leo1, Matteo Bramuzzo1, Sara Lega1, Renata Auricchio2, Fabiola Di Dato2, Stefano Martelossi3, Silvia Zago3, Alice Bedini3, Alice Monzani4, Marco Corazzari4, Daniele Giachello5, Claudia Pansieri5
1Pediatrics, Institute For Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy, 2Department of Mother and Child, Section of Pediatrics, Azienda Ospedaliera Universitaria Federico II, University Hospital, Naples, Italy, 3Gastroenterology Unit, Department of Pediatrics Regional Hospital, Treviso, Italy, Treviso, Italy, 4Department Of Health Sciences, Division Of Pediatrics, University of Piemonte Orientale, Novara, Italy, 5Consorzio per Valutazioni Biologiche e Farmacologiche, CVBF, Bari, Italy
Objectives and Study: Intestinal anti‐transglutaminase antibodies (I‐anti‐TG2) are a specific marker of coeliac disease (CD). However, the implementation of this marker in clinical practice is limited by the too demanding detection methods. In a single‐center study, we recently demonstrated that I‐anti‐TG2 can be detected by an immunochromatographic assay after simple mechanical lysis of fresh intestinal biopsy (I‐anti‐TG2 Rapid Test) with very high diagnostic accuracy. The aim of this multicenter study is to further validate the diagnostic accuracy of I‐anti‐TG2 Rapid Test.
Methods: Consecutive paediatric patients referred to the endoscopic gastroenterology unit of the 4 clinical centers involved in the study will be enrolled. For each sampling site, 2 biopsies will be analyzed for standard histology, 1 biopsy to perform the reference assay for I‐anti‐TG2 detection (endomysium [EMA] biopsy), and 1 biopsy to perform I‐anti‐TG2 Rapid Test. The planned sample size includes 266 patients. The primary outcome is the diagnostic accuracy of I‐anti‐TG2 Rapid Test compared with that of the gold standard (serology + histopathology) for CD diagnosis. The secondary outcome is the agreement of I‐anti‐TG2 Rapid Test with EMA biopsy.
Results: Currently 111/266 paediatric patients were enrolled. However, complete data were collected from 64/111 enrolled patients. Of them, 42 were patients with CD and 22 were controls. I‐anti‐TG2 Rapid Test had very high diagnostic accuracy (sensitivity 97.6% and specificity 95%) in diagnosing CD. I‐anti‐TG2 Rapid Test showed high agreement with the EMA biopsy (97% agreement, Cohen K 0.94).
Conclusions: The preliminary results from this multi‐center study seem to confirm the previous data referred to the single‐center study. I‐anti‐TG2 can be detected by an immunochromatographic assay after lysis of fresh tissue with very high diagnostic accuracy. The test is quick and easy to perform and can be widely available in any endoscopy unit. Its implementation would help clinicians in diagnosing CD.
Contact e‐mail address: luigina.deleo@burlo.trieste.it
G‐RF025. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐RF025.1. GENETIC MUTATIONS AND PANCREAS DIVISUM ASSOCIATION IN PEDIATRIC CHRONIC PANCREATITIS
Lorenzo D'antonio 1,2, Valerio Balassone1, Paola De Angelis1, Filippo Torroni1, Luca Cristiani3, Federico Alghisi3, Simona Faraci1
1Gastroenterology, Endoscopy And Surgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy, 2Department Of Translational Medical Sciences ‐ Pediatrics Section, University of Naples Federico II, Naples, Italy, 3Pediatric Pulmonology & Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
Objectives and Study: Pancreas divisum (PD) is a variant of normal pancreas with an incidence of 6–10% in general population. Over 95% of individuals with PD remain asymptomatic and the anomaly is often an incidental finding. Its role as a risk factor for chronic pancreatitis (CP) or acute recurrent pancreatitis (ARP) remains controversial. In literature it's described a possible association with genetic mutations, but underexplored in pediatric populations. This study aims to highlight that the risk of developing ARP or CP in pediatric patients with PD increases, because of an association with genetic mutation.
Methods: This is an observational retrospective study on pediatric patients (0‐18 years) diagnosed with PD and CP/ARP, presenting to our tertiary pediatric center over the past ten years. Among these patients, we assessed which had isolated PD and mutations in genes associated with hereditary pancreatitis. Inclusion and exclusion criteria in figure 1.
Results: A total of 106 patients with CP/ARP were seen during the period from Dicember 2014 to November 2024. Of them, 18 patients with PD were included in the study; 1 was excluded because of Cystic Fibrosis and 2 were excluded due to unavailability of genetic data. Of the 15 remaining patients 11 (73%) had CFTR mutation; 2 (13,3%) SPINK1 mutation; 1 (6,6%) PRSS1 mutation; 2 (13,3%) CTRC mutation; 1 (6,6%) CTSB mutation; 1 (6,6%) KRT8 mutation; 4 of these patients had mutations in different genes; only 2 (13,3%) were tested negative.
Conclusions: Our findings suggest that the risk of CP/ARP in patients with PD is often associated to the presence of genetic mutations. These results underscore the importance of genetic screening in these patients, particularly to identify high‐risk individuals who may benefit from tailored management and follow‐up. Further studies are warranted to explore the underlying pathophysiological mechanisms and to validate these findings in larger cohorts.
Contact e‐mail address: simona.faraci@opbg.net
G‐RF026. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐RF026.1. MUTATION IN THE PRSS1 GENE IN PEDIATRIC PATIENTS WITH CHRONIC PANCREATITIS
Karolina Dziewulska 1, Grzegorz Oracz2
1Department Of Gastroenterology, Hepatology, Feeding Disorders, And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 2The Children Memorial Health Institute, Warsaw, Poland
Objectives and Study: OBJECTIVES AND STUDY The etiology of chronic pancreatitis (CP) in children is diverse, encompassing anatomical anomalies, genetic mutations, and other factors. Among the most significant genes is PRSS1, the cationic trypsinogen gene, where mutations are recognized as a direct cause of pancreatitis. PRSS1 mutations are inherited in an autosomal dominant manner with approximately 80% penetrance and are a primary contributor to hereditary pancreatitis (HP). More than 80% of individuals with these mutations develop the disease before the age of 20. This study aimed to evaluate the role of PRSS1 mutations in pediatric CP.
Methods: METHODS This retrospective, single‐center study analyzed 529 pediatric CP patients hospitalized from 1988 to 2024. Medical records were reviewed for clinical presentation, diagnostic findings (genetic testing and imaging), endoscopic interventions, and surgical treatments.
Results: RESULTS A PRSS1 mutation was identified in 67 patients (12.62%): 44 girls and 23 boys, aged 1.4–16.2 years (mean: 7.4 years). The most common mutations were R122H (36%), R122C (31.5%), N29I (10.5%). In patients without PRSS1 mutations, CP onset ranged from 0.16 to 17.7 years (mean: 8.7 years). Mutations in PRSS1 were less prevalent than in other genes, including SPINK1 (27.22%), CTRC (20.79%), and CFTR (5.86%). Among the 67 patients, anatomical anomalies included pancreas divisum (8.96%), ansa pancreatica (1.49%), and both abnormalities (1.49%). Diabetes developed in 10.45% of PRSS1 patients vs. 4.98% of non‐PRSS1 CP cases. Preventive treatment was sufficient in 47.76% of PRSS1 patients (vs. 52.6% in others). ERCP was performed in 52.24% (vs. 53.25%), and minor papilla stenting in 35.82% (vs. 22.3%), with 21 patients undergoing sphincterotomy. Surgery was required in 11.94% (vs. 12.73%).
Conclusions: CONCLUSIONS 1. PRSS1 mutations are more common in pediatric CP than in the general population. 2. Genetic mutations should be prioritized as etiological factors in CP. 3. Endoscopic procedures are frequently required in pediatric CP management.
Contact e‐mail address:
G‐RF027. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐RF027.1. SMALL BOWEL DYSFUNCTION IN PATIENTS WITH CYSTIC FIBROSIS
Svetlana Geller, Altinoy Kamilova
Gastroenterology, RSSPMC of Pediatrics, Tashkent, Uzbekistan
Objectives and Study: There are very few studies on the status of the enterocytes and intestinal barrier in patients with cystic fibrosis (CF), especially in the pediatric population. The only study by Adriaannse M. et al. dates back to 2015. Therefore, our aim is to assess the state of intestinal barrier, as well as the degree of enterocytes' damage in children with cystic fibrosis.
Methods: Thirty‐four children with mixed form of CF aged from 2 months to 10 years were examined. The diagnosis was established based on an increase in immunoreactive trypsin, sweat chlorides and genetic studies. Determination of the level of intestinal fatty acids binding protein (i‐FABP) was in blood serum by ELISA kit. Detection of zonulin was in stool also by ELISA method. Control group were 30 healthy children.
Results: The results of the study showed that in children with CF the mean zonulin level was 173.4 ± 26.9 ng/ml, which was 2 times higher than the control values ‐ 90,3 ± 15,2 ng/ml (p < 0.001). A significant increase was present in half of children (269.7 ± 34.8 ng/ml, p < 0.001 relative to control). The results of measuring the activity of i‐FABP demonstrated an increase in its values (1717.91 ± 782.09 pg/ml), especially in half of the patients it was a two‐fold excess of the norm ‐ 2282,91 ± 121,7 pg/ml (p < 0.02). We found a direct weak correlation between fecal zonulin and stool frequency. Inverse weak correlations were found between zonulin and Z‐score weight, height, MRI, between zonulin and disease duration. In addition, there was a weak direct correlation between i‐FABP and stool frequency. As well as an inverse relationship with disease duration.
Conclusions: Thus, increase in fecal zonulin, as well as in i‐FABP levels proves both the disruption of the integrity of the tight junctions of the small intestine and damage to the epithelium of the intestinal villi.
Contact e‐mail address: geller_svetlana@mail.ru
G‐RF028. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐RF028.1. ANALGESIA IN ACUTE PAEDIATRIC PANCREATITIS
Jake Hadden 1, Gillian Rivlin2, Andrew Fagbemi2, Maureen Lawson3, Loveday Jago3, Chai Lee3, Virginia Chatzidaki3, Sian Copley3, Adnaan Kala3
1Royal Manchester Children's Hospital, Manchester, United Kingdom, 2Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, United Kingdom, 3Manchester children's hospital, Manchester, United Kingdom
Objectives and Study: Acute pancreatitis (AP) in children and young people (CYP) is a rare disease occurring in less than 1 per 100,000. This presents challenges in ensuring an accurate diagnosis of AP is made and considered. Responding to pain in a timely manner and monitoring pain levels remains a challenge in the paediatric population. We evaluated the pain management of patients presenting to a tertiary hospital with AP.
Methods: Elevated lipase results were identified between September 2022 to June 2024 in CYP less than 18 years old. Patient‐episodes were included if they met NASPGHAN diagnostic criteria for AP. Episodes were excluded if notes were incomplete, died due to other medical causes or remain a current inpatient.
Results: 967 episodes of elevated lipase levels were identified. 60 episodes met criteria for inclusion. Age ranged 2–16 years [average 12 years]. Diagnoses: idiopathic [13], mumps [1], gallstone (GS) pancreatitis [13], acute recurrent pancreatitis (ARP) [11], SPINK1 mutation [1], PRSS1 mutation [1], propionic academic (PA) [5], methylmalonic academia (MMA) [5], azathioprine‐induced [3], chemotherapy‐induced (PEG‐asparaginase) [14], post‐operative complication [2] and post‐ERCP [1]. 17 patient‐episodes were managed with enteral analgesia, average length of stay of 9 days [1–51 days]. 18 patient‐episodes escalated to IV analgesia, average length of stay of 18 days [2–100 days]. 25 patient‐episodes required escalation to opioid infusions with an average length of stay of 28 days [3–239 days]. 5 patient‐episodes required paediatric critical care for pain management: GS‐pancreatitis [2], chemotherapy‐induced [1], PA [1] and idiopathic [1].
Conclusions: Active management of pain is important in the patient journey. 42% of our patient‐episodes required escalation of analgesia to opioid infusions suggesting that earlier intervention with specialist support from the acute pain service will improve pain management and potentially shorten the length of stay. Following this review, we are streamlining analgesia escalation and providing training to staff looking after CYP with AP.
Contact e‐mail address:
G‐RF029. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐RF029.1. THE EFFECT OF CFTR MODULATOR THERAPY ON GLYCEMIC CONTROL IN CHILDREN WITH CYSTIC FIBROSIS: A CASE‐CONTROL STUDY
Orsolya Varannai1, Szabolcs Kiss 1, Péter Mátrai2,3, Klementina Ocskay1,4, Andrea Párniczky1,5,6
1Heim Pál National Pediatric Institute, Budapest, Hungary, 2Institute For Translational Medicine, Szentagothai Research Centre, Medical School, University of Pécs, Pécs, Hungary, 3Institute Of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary, 4Pharmaceutical Sciences And Health Technologies Division, Doctoral School, Semmelweis University, Budapest, Hungary, 5Centre For Translational Medicine, Semmelweis University, Budapest, Hungary, 6Institute For Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
Objectives and Study: This case‐control study aimed to evaluate the impact of cystic fibrosis transmembrane conductance regulator modulators (CFTRm) on glycaemic outcomes in children with cystic fibrosis (CF).
Methods: A total of 160 children with CF (mean age: 11.43 years, standard deviation: 4.91 years; 85 females and 75 males; 80 cases and 80 controls) were included in this single‐centre study and matched using nearest neighbour propensity score matching based on sex and age. Primary outcomes, obtained through prospective data collection, were fasting, 60‐minute, and 120‐minute glucose and insulin levels during oral glucose tolerance test and haemoglobin A1c (HbA1c). Subgroup analyses were performed for patients receiving elexacaftor/tezacaftor/ivacaftor (ETI) and lumacaftor/ivacaftor (LUM/IVA).
Results: Patients receiving CFTRm therapy showed a trend toward improved glycaemic outcomes. Fasting, 60‐minute, and 120‐minute glucose levels were lower by 0.208 mmol/L, 0.495 mmol/L, and 0.243 mmol/L, respectively (p = 0.149, p = 0.417, and p = 0.539), compared to controls. HbA1c was 0.0972% lower (p = 0.365). No clear trend was observed in insulin levels. Subgroup analysis revealed a significant improvement in HbA1c levels in the ETI group compared to controls (p = 0.022). No significant differences were observed in the LUM/IVA group.
Conclusions: CFTRm therapy, particularly ETI, may improve long‐term glycaemic control in children with CF, as reflected by haemoglobin A1c levels. Although trends towards lower glucose levels were observed, further studies with larger cohorts are required to validate these findings and determine their clinical significance.
Contact e‐mail address: kissszabolcs1995@gmail.com
G‐RF030. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐RF030.1. THE EFFECTS OF CFTR MODULATOR THERAPY ON GLYCEMIC CONTROL IN PATIENTS WITH CYSTIC FIBROSIS: A META‐ANALYSIS
Szabolcs Kiss 1, Márk Félix Juhász1, Tamás Kói2,3, Klementina Ocskay1,4, Andrea Párniczky1,3,5
1Heim Pál National Pediatric Institute, Budapest, Hungary, 2Institute Of Mathematics, Department Of Stochastics, Budapest University of Technology and Economics, Budapest, Hungary, 3Centre For Translational Medicine, Semmelweis University, Budapest, Hungary, 4Pharmaceutical Sciences And Health Technologies Division, Doctoral School, Semmelweis University, Budapest, Hungary, 5Institute For Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
Objectives and Study: Cystic fibrosis‐related diabetes (CFRD) significantly impacts health outcomes of people with cystic fibrosis (pwCF). Understanding the effects of cystic fibrosis transmembrane conductance regulator modulator (CFTRm) therapy on glycemic control is crucial for improving overall health. We aimed to evaluate the impact of CFTRm therapy on glycemic control in pwCF.
Methods: A comprehensive literature search was conducted from January 1, 2011 to September 19, 2024, in PubMed, Embase, and Cochrane Central Register of Controlled Trials with no additional restrictions applied. Eligible studies included interventional trials comparing CFTRm therapy with either no treatment or placebo. Observational studies reporting data on glycemic outcomes in pwCF pre‐therapy and on‐therapy, as well as pwCF on‐therapy compared to controls were eligible. Two authors independently extracted data with full adherence to PRISMA guidelines. Data synthesis was performed by calculating mean differences (MD) with 95% confidence intervals (CI); data were pooled using a random‐effects model. Regression analyses were performed to evaluate the relationship between the effects of CFTR modulator therapy and both patient age and length of therapy. Primary outcomes included oral glucose tolerance test (OGTT) results, internationally accepted continuous glucose monitoring (CGM) measures, and hemoglobin A1c (HbA1c) levels as stated in the protocol (CRD42024516198).
Results: Across 77 studies, CFTR modulator therapy significantly improved 120‐minute glucose levels (MD, ‐0.74 mmol/L; 95% CI, ‐1.42 to ‐0.07), lowered HbA1c levels (MD, ‐0.31%; 95% CI, ‐0.55 to ‐0.07), and reduced time spent in hyperglycemia (>10 mmol/L) as measured by CGM (MD, ‐0.92%; 95% CI, ‐1.75 to ‐0.09). Regression analyses showed that earlier therapy initiation was associated with more stable glucose levels (p = 0.0471) and better HbA1c values (p = 0.0001).
Conclusions: CFTR modulator therapy significantly improved glycemic control in pwCF. Earlier treatment initiation was associated with better outcomes. Further studies are warranted to reevaluate cost‐effectiveness and long‐term benefits.
Contact e‐mail address: kissszabolcs1995@gmail.com
G‐RF031. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐RF031.1. ANALYSIS OF SERUM SPHINGOLIPIDS IN CHILDREN WITH ACUTE PANCREATITIS – A PRELIMINARY STUDY
Kamila Kwiatek‐Średzińska 1, Urszula Chlabicz2, Agnieszka Błachnio‐Zabielska2, Urszula Daniluk1, Dariusz Lebensztejn1
1Department Of Paediatrics, Gastroenterology, Hepatology, Nutrition, Allergology And Pulmonology, Medical University of Bialystok, Bialystok, Poland, 2Department Of Hygiene, Epidemiology And Metabolic Disorders, Medical University of Bialystok, Bialystok, Poland
Objectives and Study: Abnormalities in the sphingolipid profile are detected in various diseases. There is currently no research evaluating sphingolipids in paediatric patients with acute pancreatitis (AP). The aim of the study was to analyse the concentrations of sphingolipids in children with AP, taking into account the severity of the disease.
Methods: The concentrations of sphingolipids in serum were assessed by a quantitative method, ultra‐high‐performance liquid chromatography – tandem mass spectrometry. In patients with AP, concentrations of sphingolipids were evaluated at 3 time points: on admission or within 24 h, after 48 h and after 72 h. The severity of the disease was classified according to the North American Society for Paediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommendations. The receiver operating characteristic (ROC) analysis of the statistically significant variables was performed.
Results: The prospective study included 24 children with AP (19 patients diagnosed with mild AP and 5 with severe AP) hospitalized over a 2 years period and 23 healthy controls. Serum concentrations of ceramides (C14:0‐Cer, C16:0‐Cer, C18:1‐Cer, C18:0‐Cer, C20:0‐Cer, C22:0‐Cer) and lactosylceramides (C16:0‐LacCer, C18:0‐LacCer, C24:1‐LacCer and C24:0‐LacCer) differed significantly between paediatric patients with AP and controls. Children with AP had higher C16:0‐Cer, C18:1‐Cer, C18:0‐Cer, C20:0‐Cer and C16:0‐LacCer, C18:0‐LacCer, C24:0‐LacCer concentrations, whereas lower C14:0‐Cer, C22:0‐Cer and C24:1‐LacCer concentrations. The greatest area under the curve (AUC = 1) in ROC analysis was determined for C14:0‐Cer, C16:0‐LacCer, C24:1‐LacCer and C24:0‐LacCer. The concentrations of sphingolipids in patients with mild and severe AP did not vary significantly at any time point.
Conclusions: Disturbances in the sphingolipid profile are associated with AP. The concentrations of sphingolipids may be potential biomarkers of the disease in children.
Contact e‐mail address:
G‐RF032. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐RF032.1. PAIN RELIEF IN CHRONIC PANCREATITIS – ROLE OF ENDOTHERAPY, PANCREATIC ENZYMES, ANTIOXIDANTS AND SURGERY
Aathira Ravindranath 1, Rajkumar Wadhwa2, Rakesh Jp2
1Pediatric Gastroenterology, Apollo BGS Hospital, Mysore, India, 2Gastroenterology, Apollo BGS Hospital, Mysore, India
Objectives and Study: In this study we describe the response to different modalities of treatment for sustained pain relief in children with chronic pancreatitis (CP)
Methods: Cambridge classification was used to classify CP. Those who had evidence of pancreas divisum (PD) underwent minor papilla stenting. Patients with ductal obstruction (stone/stricture) underwent endoscopic retrograde pancreatography (ERP) with stone removal or stricture dilatation with stent placement. ERP was repeated after 3 months. Stent was removed when there was no persistence of obstruction and exchanged if there was ductal obstruction. Children who did not respond to endotherapy underwent lateral pancreatojejunostomy (LPJ). Pancreatic enzyme replacement therapy (PERT) was given in those with exocrine insufficiency. All were given antioxidant supplements. Children with depression were given amitriptyline. Long‐term pain relief with different modalities of treatment was assessed.
Results: Thirty children (15 boys) aged 11.9 years (3 to 17) were included. Duration of illness was 28 months (1‐96). Exocrine insufficiency was present in 11 and endocrine insufficiency in 1. Twnety had Cambridge class 4, 5 had class 3 and 5 had class 2 findings. Four had PD of which 2 had Cambridge class 4 CP and 2 had class 2. Total follow‐up period was 25 months (17‐60). Fifteen children underwent ERP of which 4 had minor papilla stenting and 11 had main pancreatic duct (MPD) stenting. Pain relief after ERP was achieved in all with PD and 9 with MPD stenting (86.6%). Three (10%) underwent LPJ as there was inadequate pain relief after ERP, of whom 2 became asymptomatic and 1 required endoscopic ultrasound guided celiac plexus block for persistent pain. Six (20%) patients achieved pain relief with amitryptiline alone. Cambridge class 2 patients responded well to antioxidants alone. PERT did not affect pain frequency or severity.
Conclusions: Pain relief in CP can be achieved with ERP in the majority with ductal hypertension.
Contact e‐mail address: aathira.r@gmail.com
G‐RF033. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐RF033.1. 6 YEAR REVIEW OF ACUTE NON VARICEAL UPPER GASTROINTESTINAL BLEEDING IN CHILDREN AT A TERTIARY PAEDIATRIC GASTROENTEROLOGY UNIT
Alzubair Almalik 1, Kushila Rupasinghe2, Harween Dogra1, Kirn Sandhu2
1Paediatric Gastroenterology, Kings College Hospital NHS trust, London, United Kingdom, 2Paediatric Gastroenterology Department, King's College Hospital, London, United Kingdom
Objectives and Study: This retrospective study evaluates the indications, intervention, and inpatient burden of children requiring Oesophagogastroduodenoscopy (OGD) for acute non‐variceal upper gastrointestinal bleeding (UGIB).
Methods: A retrospective review was conducted at King's College Hospital from January 2019 to December 2024. Data was collected for patients who required emergency OGDs for non‐variceal UGIB. Clinical presentations, transfusions, intravenous proton‐pump inhibitor (IV PPI) use, OGD timing, interventions, complications, and recurrences were recorded. Patients with variceal bleeding or elective OGDs were excluded.
Results: 26 patients met the inclusion criteria. All presented with melena, hematemesis, or both, with 67% arriving the same day as symptoms. Seven (23%) discharged without endoscopy were readmitted, and 2 had positive findings. Hypotensive shock occurred in 5 (19%), with 1 requiring ICU care. Transfusions were given to 10 (38%), half with >2 g/dl Hb drop. All patients were nil enteral, received IV PPIs, and maintained Hb >8 g/dl pre‐OGD. OGDs were performed within 24 hours in 62% and within 48 hours in 80%, with delays due to staffing and theatre availability. Interventions were needed in 12 (46%) for gastropathy (46%), ulcers (46%), and Mallory‐Weiss tear (8%), with haemostatic powder used in 92%. Post‐OGD, 69% stayed >24 hours. Of those requiring intervention, 4 (33.3%) had recurrent UGIB needing repeat OGD.
| Average time to OGD. 26 patients: 27.7 hours (SD ± 19.87) | ||||
|---|---|---|---|---|
| Time to OGD | patients | Average time | Minimum Time | Maximum time |
| <24 hours | 16 | 15.25 | 7 | 22 |
| 24‐48 hours | 5 | 33.2 | 25 | 45 |
| >48 hours | 5 | 62 | 48 | 73 |
Conclusions: This study emphasizes the need for OGD in children with UGIB, ideally in centers equipped for therapeutic endoscopy. Early endoscopy within 48 hours is advised, as in adults. Interventions were required in 46% of cases, with haemostatic powder being most common. Notably, 23% of discharged patients were readmitted for OGD, highlighting the need for monitoring and follow‐up.
Contact e‐mail address:
G‐RF034. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐RF034.1. ASSESSMENT OF CLINICAL SIGNIFICANCE AND NATURAL HISTORY OF HISTOLOGICAL INFLAMMATORY FINDINGS IN THE ABSENCE OF MACROSCOPIC FINDINGS IN THE ESOPHAGUS
Adi Anafy 1, Gil Berkovitch1,2, Achiya Amir1, Anat Yerushalmy‐Feler1, Hadar Moran‐Lev1, Shlomi Cohen1, Amir Ben‐Tov1
1Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel, 2Pediatric Gastroenterology Institute, Tel Aviv Sourasky Medical Center, Affiliated To The Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel, Tel Aviv, Israel
Objectives and Study: Current guidelines suggest routine tissue sampling in all children undergoing esophagogastroduodenoscopy, even in the absence of visible endoscopic abnormalities. We aimed to determine the clinical significance and natural history of histological inflammatory findings in the absence of macroscopic findings in the esophagus and to assess the yield of routine biopsies from this site.
Methods: Since January 2019, all diagnostic esophagogastroduodenoscopies performed at our endoscopy institute have included routine biopsy sampling from the esophagus. A retrospective review of all children who underwent esophagogastroduodenoscopy between 1/2019 and 12/2021 was conducted, and children with normal macroscopic esophageal appearance and abnormal pathology were examined.
Results: During the study period, 1705 diagnostic esophagogastroduodenoscopies were performed. 1446 (84.8%) procedures showed a normal macroscopic esophagus, and histologically inflammatory findings were observed in 90 (6.2%) cases. Eosinophilic esophagitis (EOE) was found in 6 (0.4%) patients and nonspecific esophagitis in 21 (1.4%) patients, all of whom were treated with PPI. Among those with EOE, 4 (0.3%) patients demonstrated nonspecific complaints that did not require taking routine biopsies from the esophagus.
Conclusions: The presence of inflammatory histological findings in the esophagus without macroscopic abnormalities is not uncommon. However, only a minority of these findings significantly impact patient management and follow‐up regime. Furthermore, more than half of these patients underwent esophagogastroduodenoscopy for a reason indicating taking routine biopsies from the esophagus anyway. Taking routine biopsies from the esophagus without macroscopic findings is of limited yield and should be considered individually in each case.
Contact e‐mail address: adian@tlvmc.gov.il
G‐RF035. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐RF035.1. IN SEARCH OF FLIPPERS IN BOSPHORUS: PENQUIN, A QUEST FOR QUALITY IMPROVEMENT IN ENDOSCOPY REPORTS
Aysu Yonetci Pekuz, Guzide Dogan, Gökhan Baysoy
Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul Medipol University, Istanbul, Turkey
Objectives and Study: Endoscopy reports provide a detailed account of procedures performed on the gastrointestinal tract. Therefore, standardization of reporting elements is essential. Pediatric Endoscopy Quality Improvement Network (PEnQuIN) guidelines for endoscopy reporting elements are published in 2022. We revised our endoscopy reports to align with PEnQuIN standards in early 2024. This study assessed adherence to PEnQuIN and measured post‐implementation changes.
Methods: Endoscopy reports of all patients between December 1st,2022 ‐November 15th,2024 were included in this descriptive study. The procedure reports of all patients were reviewed by the same specialist and benchmarked against the 30 parameters of the PENQuIN endoscopy report elements. Group was divided into two (before and after implementation, BI and AI) according to the implementation date. Data were expressed as percentages, and chi‐square test was used to analyze results with the help of GNU PSPP 2.0.0 program.
Results: 467 (316 BI and 151 AI) patient reports (214 females) were reviewed. There were 345(73.9%) gastroscopies, 122 colonoscopy (26.1%) reports. Among them, 73 were interventional/therapeutic endoscopies. Median age of patients was 7.8 years (3.3‐13.6). Among the reporting elements, 12 remained similar, 2 got worser slightly, and remaining 16 improved significantly between two time periods. A significant improvement was observed, with the number of elements completed in more than 85% of cases rising from 12 to 26 out of 30. Technical constraints, such as standardized automated endoscopy report templates and the inability to capture images during procedures in the operating room, hindered progress on the remaining items.
Conclusions: The integration of PEnQuIN elements into our endoscopy reports has been successful. Surveillance is also important for the quality standards. To further enhance these reports and optimize their impact, future studies should evaluate their influence on gastroenterology education, patient satisfaction, and interdisciplinary communication.
Contact e‐mail address: gbaysoy@hotmail.com
G‐RF036. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐RF036.1. EVALUATION OF PARENTS’ AWARENESS AND KNOWLEDGE ABOUT THE SERIOUS DANGER RELATED TO DISK BATTERY INGESTION IN CHILDREN
Maria Boccia 1, Alessia Salatto1, Piergiorgio Gragnaniello1, Roberta Buonavolontà2, Linda Cosenza3, Ileana Bracale2, Dorothea Del Buono4, Mariano Caldore5, Paolo Quitadamo5, Rossella Turco5
1Department Of Translational Medical Science, Section Of Pediatrics, University of Naples Federico II, Naples, Italy, 2ASL Napoli 1, Naples, Italy, Naples, Italy, 3ASL Napoli 2 Nord, Naples, Italy, Naples, Italy, 4AUSL Romagna, Italy, Romagna, Italy, 5Pediatric Gastroenterology and Hepatology Unit, Santobono‐Pausilipon Children's Hospital, Naples, Italy, Naples, Italy
Objectives and Study: Disk battery (DB) ingestion is a serious health hazard, with several cases of major morbidity and even mortality being worldwide reported. In order to prevent life‐threatening complications, children having ingested DBs require a timely and qualified medical evaluation. The aim of our study was to evaluate the level of parents’ awareness and knowledge about the risk related to DB ingestion in children.
Methods: An observational clinical study by survey was conducted from March 2024 to July 2024 at the Santobono‐Pausilipon Children's Hospital in Naples (Italy) and at the medical offices of four primary care pediatricians (Italy). A 14‐item questionnaire was submitted to 250 parents of children followed‐up for well‐child visits and we subsequently analysed pooled data derived from their answers. The questions aimed at exploring the parents’ knowledge about DBs and the awareness that their ingestion poses a serious danger to their children, whether they had ever been informed and alerted on this topic and by whom and if they had ever implemented preventive measures at home.
Results: 72.3% parents never heard about the possible risks related to DBs ingestion. 83.5% parents do not recognize DBs as a dangerous foreign body whenever ingested. Moreover, among the different kind of commercially available batteries, only 20.2% parents consider DBs as the most dangerous. Of parents who were aware of DB‐related health hazard, about 13.4% have been informed by their pediatrician. 68.9% parents state that they have never implemented preventive measures at home. Finally, 96.7% parents claim more information about the risks related to DB ingestion.
Conclusions: Our data show a very impressive lack of parental knowledge about the serious risk associated with DB ingestion in children. Many cases of ingestion could probably be prevented by increasing the general population awareness about this source of serious danger to the health and even life of children.
Contact e‐mail address: yes
G‐RF037. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐RF037.1. COMPARISON OF PROACTIVE VS. REACTIVE ENDOSCOPIC APPROACHES FOR SURVEILLANCE IN PATIENTS POST‐ESOPHAGEAL ATRESIA REPAIR
Catherine Sanon1,2, Jose Eduardo Frias Mantilla 2, Helene Bacha2, Aridj Bouragbi3, Ana Sant'anna4
1Pediatric Gastroenterology, IWK Health Center, Dalhousie University, Halifax, Canada, 2Pediatrics, Montreal Children's Hospital, Montréal, Canada, 3McGill Medical School, Montreal, Canada, 4Pediatric Gastroenterology, Montreal Children's Hospital, Montreal, Canada
Objectives and Study: The advantage of routine endoscopic surveillance and dilation compared to selective endoscopy and dilatation for symptomatic patients remains unclear. This study aims to evaluate the outcomes of these two approaches in our patient population.
Methods: We analyzed two groups of patients followed for up to 36 months post‐EA repair (n = 24). The proactive group (n = 13) underwent routine and symptom‐driven selective endoscopic surveillance from 2016 to 2019. The reactive group (n = 11), followed from 2019 to 2023, received selective endoscopies only when symptomatic. Follow‐up strategies were determined based on the year of treatment. Variables in both groups such as the type of EA, age at EA repair, length of gap, presence of strictures and number of endoscopies and dilations were described.
Results: In the proactive group, we performed 78 endoscopies with 59 dilations (75.64%). 42 (71.18%) were routine dilations. In the reactive group, 47 endoscopies were conducted, with 46 requiring dilations (97.87%). The mean number of endoscopic interventions per patient was 6 (range: 2–10) in the proactive group and 4.27 (range: 0–9) in the reactive group. The mean dilation was 4.53 (range: 0–10) in the proactive group and 4.18 (range: 0–9) in the reactive group. The odds ratio (OR) comparing the need for dilation between the two groups was approximately 14.81. This difference suggests the increased likelihood in the reactive group of requiring dilations compared to the proactive approach. The most common finding in both groups was stricture. There were two complications (leakages) in the proactive group.
Conclusions: The reactive approach reduced the number of endoscopic procedures in our population. Patients who had a reactive follow‐up were more likely to require dilation therapy. This small study suggests that a reactive strategy can decrease the frequency of anesthetic exposure, risk and procedural costs by reducing the number of endoscopies in patients who do not require dilatation.
Contact e‐mail address: jose.friasmantilla@mail.mcgill.ca
G‐RF038. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐RF038.1. ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN CHILDREN – A RETROSPECTIVE AUDIT AT THE LARGEST PAEDIATRIC CENTRE IN SINGAPORE
Wen Qi Cher1, Christopher Ho Wen Wei 2, Fang Kuan Chiou3
1KK Women's and Children's Hospital, Singapore, Singapore, 2Department Of Gastroenterology, Hepatology And Nutrition Service, kk women's and children's hospital, singapore, Singapore, 3Gastroenterology, Hepatology And Nutrition, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore, Singapore
Objectives and Study: Endoscopic retrograde cholangiopancreatography (ERCP) is a useful tool for management of hepatobiliary and pancreatic disease and is increasingly used in children. Experience in children however, remains relatively limited, owing to the lower incidence of pancreaticobiliary conditions and limited availability of trained endoscopists to perform ERCP in children. In this study, we describe our pediatric ERCP experience at the largest pediatric hospital in Singapore.
Methods: This is a retrospective audit of patients aged 0 to 18 years who underwent ERCP between 2014 and 2024 at KK Women's and Children's Hospital. ERCP was performed by two expert gastroenterologists from Singapore General Hospital which is a tertiary adult hospital in Singapore. Cannulation success was defined as successful deep cannulation of the desired duct based on the pre‐procedure indication. Technical success was defined as successful cannulation and achieving the desired diagnostic/therapeutic outcome.
Results: Thirty‐five ERCPs were performed in 20 patients. The median age was 11 years old (range 19 months to 17 years) with median weight of 42 kilograms (range 8 to 68 kg). Biliary obstruction was the most common indication (17/35, 48.5%). Cannulation success and technical success rates were both 94.3% (33/35). Failed ERCP occurred on both attempts in one patient with pancreatic duct stricture. Complications occurred in 4/35 (11.4%) procedures. These were post‐ERCP cholangitis (n = 1), pancreatic duct perforation (n = 1), post‐ERCP pancreatitis (n = 2) – of which one patient also had post‐sphincterotomy bleeding causing intestinal obstruction (n = 1). Three of these patients had underlying altered anatomy (2 had choledochal cyst and 1 had pancreatic duct stricture with dilated main pancreatic duct).
Conclusions: Our local audit has shown that even in a relatively low‐volume setting, paediatric ERCP is an invaluable tool when performed by experienced adult‐trained endoscopists. It has acceptable safety profiles, and excellent therapeutic and diagnostic yield in pancreaticobiliary disorders in children.
Contact e‐mail address:
G‐RF039. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐RF039.1. UPPER GASTROINTESTINAL BLEEDING IN CHILDREN: A RETROSPECTIVE ANALYSIS TO IDENTIFY THE MAIN UNDERLYING ETIOLOGIES AND KEY PREDICTORS OF POOR OUTCOMES
Lara Limansky 1, Cristina Bucci1, Fabio Savoia2, Francesco Cirillo1, Maria Giovanna Puoti1, Nicola Cecchi1, Rossella Turco1, Sara Isoldi1, Paolo Quitadamo1
1Pediatric Gastroenterology and Hepatology Unit, Santobono‐Pausilipon Children's Hospital, Naples, Italy, 2Epidemiology, Biostatistics, and Pediatric Tumor Registry Unit, Santobono‐Pausilipon Children's Hospital, Naples, Italy
Objectives and Study: While most cases of Acute upper gastrointestinal bleeding (AUGIB) in pediatric patients are self‐limiting, early identification of high‐risk patients requiring endoscopic intervention is crucial for optimal management. This study aimed to analyze the clinical features and endoscopic findings of pediatric patients presenting with AUGB to determine the prevalence of underlying etiologies and assess potential predictors of poor outcomes.
Methods: Children admitted for hematemesis or melena from October 2022 to February 2025 were retrospectively enrolled. Data collection included demographic features, clinical presentation, medication history, biochemical findings and endoscopic results. Patients were classified according to the presence or absence of lesions requiring endoscopic hemostatic treatment (poor outcome). Study data were statistically analyzed to detect predictive factors of poor outcome.
Results: 60 children (mean age: 78.9 months; age range: 1‐180 months) were enrolled. 40 (67%) showed hematemesis, 10 (16.7%) melena and 10 (16.7%) both. 29 (48.3%) underwent upper GI endoscopy. Among them, 8 (27.5%) required endoscopic hemostatic intervention, primarily for ulcer hemostasis or variceal ligation. 21 (35%) children had taken ibuprofen the days before bleeding. Based on clinical data and endoscopic findings, the main purported underlying etiologies included: 18 (30%) NSAID‐induced gastroduodenal ulcers, 6 (10%) Mallory‐Weiss syndrome, 4 (6.7%) H. pylori gastropathy, 4 (6.7%) esophagitis, and 3 (5%) esophageal varices. Hemoglobin levels correlated with poor outcomes, with the odds ratio increasing by 0.5 for each unit decrease in hemoglobin. None of the patients who presented with small amounts of blood in vomit (streaks, traces) and no melena had a poor outcome.
Conclusions: Ibuprofen use emerged as a major risk factor for AUGIB in children, being involved in approximately one third of cases. This finding highlights the need for careful prescribing patterns. Hemoglobin levels were identified as a key predictor of poor outcomes, emphasizing the importance of this parameter for the assessment of the diagnostic work‐up.
Contact e‐mail address: laralimansky@gmail.com
G‐RF040. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐RF040.1. INGESTION OF MICROBLADES FROM ELECTRONIC CIGARETTES: A GENUINE RISK FOR CHILDREN? A CASE SERIES
Cristina Bucci1, Paolo Quitadamo2, Maria Giovanna Puoti 2, Rossella Turco2, Francesco Cirillo2, Sara Isoldi2
1Santobono‐pausilipon Hospital, Naples, Italy, 2Pediatric Gastroenterology and Hepatology Unit, Santobono‐Pausilipon Children's Hospital, Naples, Italy, Naples, Italy
Objectives and Study: Foreign body ingestion is a critical issue in pediatric care, particularly with sharp items that may cause life‐threatening complications like gastrointestinal perforation. Recent challenges include the growing accessibility of novel objects like e‐cigarettes to children. A newer e‐cigarette model includes a metallic microblade (20x15x3mm) designed for rapid tobacco heating, which poses potential risks if ingested. No prior studies address the management of such microblades in pediatric populations.
Methods: This study, conducted from January 2023 to October 2024 at Santobono‐Pausilipon Children's Hospital, reviewed cases of children aged 0–14 who ingested microblade‐containing e‐cigarettes. Comprehensive records, including endoscopic findings and clinical outcomes, were analyzed.
Results: Of 1,645 children admitted for foreign body ingestion, 22 had ingested e‐cigarette components. Among these, 10 cases showed no microblade on X‐rays despite observed ingestion and one child vomited the microblade in the emergency department. In 11 cases with radiographic evidence, no esophageal microblade was detected. Five microblades were retained in the stomach/duodenum, and six passed beyond it. Only one upper endoscopy was performed, but the microblade was obscured by food and nicotine debris. No cases of intestinal perforation, bleeding, or surgical intervention were observed. All microblades were expelled spontaneously within 24–36 hours, with no symptoms from nicotine or sharp edges.
Conclusions: This study is the first to explore the ingestion of e‐cigarette microblades in children. Despite their sharp design, all passed uneventfully through the gastrointestinal tract, either embedded in the butt or alone, without causing complications. Nicotine ingestion similarly resulted in no adverse effects. These findings suggest that such ingestions may typically resolve without intervention. Table 1. study population
| N° of patients 22 | |
| male | 11 |
| age range | 4 below 1 year 17 below 2 years 1 of 7 years old |
| patients with comorbidities | 1 (autism disorder) |
| X‐rays localization | 10 no visible microblade 5 stomach 6 beyond stomach |
Contact e‐mail address: cristinabucci@hotmail.it
G‐RF041. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐RF041.1. EVOLVING MANAGEMENT OF PAEDIATRIC PANCREATIC INJURY: EXPERIENCE OF A TERTIARY CENTRE IN A DECADE
Elisa Salvadoretti 1,2, Lorenzo D'antonio1, Simona Faraci1, Paola De Angelis1, Valerio Balassone1
1Gastroenterology, Endoscopy and Surgery Unit, Bambino Gesu Children's Hospital, IRCCS, Rome, Rome, Italy, 2Pediatrics, Woman's & children university hospital of Verona, Verona, Italy
Objectives and Study: Pancreas is the fourth most injured solid organ in paediatric trauma, the major cause of morbidity and mortality in children. Once hemodynamical stability is confirmed, it can be managed conservatively in the majority of children. The optimal management of ductal injuries and associated complications is still debated. Advances in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound‐guided transmural drainage (EUS‐GTD) have enhanced the less invasive options and therefore patient outcomes. We retrospectively evaluated our experience in the last ten years.
Methods: Consecutive children from December 2014 and November 2024 were enrolled. ERCP, surgical, radiological, and EUS‐GTD procedures were analysed for major technical and clinical outcomes.
Results: Twenty children were included: demographics data, trauma characteristics, and interventions are resumed in figure1. For 95% of traumas with ≥2 AAST grade, a step‐wised endoscopic approach was employed, based on ERCP with sphincterotomy and eventually stenting. According to timing of trauma, imaging and clinical condition, EUS‐GTD and nose‐jejunal tube feeding were associated during the session or subsequently, when necessary. 75% of patients developed a pseudocyst that required EUS‐GTD (double‐pigtails or LAMS) in 53% of them. 1 patient had a dislocation of double‐pigtails and was readmitted for pseudocyst persistence and drained with LAMS (5.88%). Among patients with grade ≥ 3 AAST, 25% underwent major surgery and 60% of them were readmitted for fistula, intestinal obstruction or wound dehiscence. We observed a significantly lower hospital readmission in the endoscopy group when compared to surgical approach (z score = ‐2.76, p = 0.0058).
Conclusions: ERCP with sphincterotomy is becoming a milestone in the management of children with pancreatic trauma. A multi‐modal approach, including EUS‐GTD and nose‐jejunal tube placement, can represent an all‐in‐one option for pseudocysts replenished by a traumatic pancreatic fistula. With the advancement of therapeutic endoscopy, a lower complication rate has been observed.
Contact e‐mail address: elisa.salvadoretti@gmail.com
G‐RF042. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐RF042.1. DOES ADDING ICE LOLLIES AND JELLY TO PEDIATRIC COLONOSCOPY PREPARATION PROTOCOL IMPROVE COMPLIANCE AND QUALITY OF PREPARATION?
Anhar Abu Hjul1, Ron Shaoul 2
1Pediatrics, Bnai Zion medical center, Haifa, Israel, 2Pediatric Gastroenterology, Rambam Health Care Campus, Haifa, Israel
Objectives and Study: Colonoscopy is a routine endoscopic procedure performed in children to assess various gastrointestinal conditions. Adequate bowel preparation is crucial for the procedure's success; however, compliance can be challenging, especially in younger children. This study investigated whether the addition of clear jelly and ice lollies to the standard bowel preparation protocol improves patient compliance and preparation quality.
Methods: This prospective study included 50 children aged 8‐18 years who underwent colonoscopy at Assuta MC between June and December 2023. The study group (n = 26) received clear jelly and ice lollies as part of their bowel preparation, while the control group (n = 24) followed the standard preparation protocol without these additions. Compliance and preparation quality were assessed using a standardized questionnaire and the Boston Bowel Preparation Scale (BBPS).
Results:
| Control group n = 24 Mean (SD) | Intervention group n = 26 Mean (SD) | p | |
|---|---|---|---|
| Age (months) | 170.776(39.54) | 191.577(49.171) | NS |
| Preparation difficulty | 3 | 3 | NS |
| Boston Bowel Preparation Scale | 9 | 9 | NS |
| Picolax bags | 2 | 2 | NS |
| Water glasses | 13 | 11 | NS |
The study found that while the addition of jelly and ice lollies improved patient satisfaction and the subjective experience of preparation, there was no statistically significant difference in the quality of bowel preparation between the study and control groups. Both groups achieved a high BBPS score, indicating good preparation quality. No adverse events were noted.
Conclusions: Although the addition of jelly and ice lollies did not significantly impact the objective quality of bowel
preparation, it enhanced the overall patient experience.
Further research with a larger sample size are recommended to confirm these findings and explore other potential benefits of this approach.
Contact e‐mail address:
G‐RF043. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐RF043.1. ENDOSCOPIC FINDINGS IN THE EVALUATION OF GASTROINTESTINAL SYMPTOMS IN PEDIATRIC PATIENTS POST HEMATOPOIETIC STEM CELL TRANSPLANTATION
Mordechai Slae 1, Mor Segal Ben‐Or1, Ronit Schwell1, Diana Pinhasov2, Anna Elia3, Irina Zaidman4
1Department Of Pediatric Gastroenterology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, 2Department Of Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, 3Department Of Pathology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, 4Department Of Pediatric Bone Marrow Transplant, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Objectives and Study: Gastrointestinal (GI) symptoms of pediatric patients post hematopoietic stem cell transplantation (HSCT) can be a manifestation of Graft‐versus‐host disease (GVHD), GI infections, or other causes. Endoscopy results, including endoscopic appearance and the pathologic analysis of the collected samples, play a pivotal role in diagnosing the cause and directing treatemt. There is very little data on whether endoscopic findings can predict pathological diagnosis or clinical outcomes. The primary objective of this study was to determine the association between macroscopic and microscopic findings of endoscopies performed for evaluating GI symptoms in pediatric patients post HSCT. A secondary objective was to evaluate whether the findings can predict treatment outcomes or differentiate between causes of GI symptoms.
Methods: A single center prospective study was performed, analyzing the results of endoscopic evaluation in pediatric patients with GI symptoms following allogeneic HSCT. Inclusion criteria included patients aged 18 years or younger, who developed GI symptoms during and after HSCT and required an endoscopic examination for diagnosis. Macroscopic and microscopic findings of upper and lower endoscopies were reviewed and compared, thus examining the correlation between the two. Predetermined sites throughout the GI tract were examined for their macroscopic appearance and tissue samples were taken for microscopic evaluation, their results suggesting GVHD, infection or both. Patients' change in treatment and clinical response were also assessed.
Results: A total of 249 tissue samples were macroscopically and microscopically evaluated in 22 patients. When abnormal macroscopic findings were present, microscopic findings were present in 86.2% of the cases. In 72.1% of the endoscopic sites with normal macroscopic results, abnormal microscopic findings were present (P = 0.004). Endoscopic findings influenced patients treatment plans and disease course.
Conclusions: This study provides further evidence supporting the correlation between macroscopic and microscopic evaluation in the diagnosis of GVHD post‐HSCT, however, normal macroscopic findings do not rule out the presence of GVHD.
Contact e‐mail address: morslae@gamil.com
G‐RF044. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐RF044.1. EVALUATION OF PEDIATRIC SMALL BOWEL CAPSULE ENDOSCOPY PATENCY: A SINGLE‐CENTER RETROSPECTIVE OBSERVATIONAL STUDY
Yuki Yamano, Shin‐Ichiro Hagiwara, Tatsuya Ishikawa, Ryutaro Saura, Ayaha Hata, Takatoshi Maeyama, Yuri Etani
Department Of Pediatric Gastroenterology, Nutrition And Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
Objectives and Study: Small bowel capsule endoscopy (SBCE) is useful for identifying small intestinal lesions. However, we must be cautious about the potential risk of capsule retention in diseases, such as Crohn's disease, which can cause small intestinal strictures. There are few reports on methods for evaluating gastrointestinal patency before SBCE in pediatric cases. This study aimed to evaluate the use of patency capsules (PC), ultrasonography, and computed tomography (CT) for pre‐SBCE evaluations.
Methods: This single‐center retrospective observational study included cases from 2020–2024 in which gastrointestinal patency was evaluated before SBCE.
Results: In total, 153 patients (97 with inflammatory bowel disease [IBD]) underwent gastrointestinal patency assessment, and SBCE was performed in 144 patients. No retention of the SBCE was observed. Regarding the methods used to evaluate gastrointestinal patency, 82 PC tests, 123 ultrasonography assessments, and 14 CT were conducted, including overlapping cases. Regarding gastrointestinal patency evaluation with PC, retention was observed in five cases (four with IBD and one with IgA vasculitis). The retention sites were the terminal ileum and colon in one and four cases, respectively. Therefore, SBCE was not performed on these patients. These patients had undergone ultrasonography; however, three cases had no findings of bowel wall thickening or dilation at the retention site. One patient with colonic retention underwent CT, and no abnormalities were observed at the retention site. The specificities of ultrasonography and CT for detecting PC retention were 61.9% and 38.5%, respectively.
Conclusions: No SBCE retention was observed, and gastrointestinal patency was assessed appropriately. However, because ultrasonography and CT may fail to predict SBCE retention in some cases, PC testing is recommended for patients with underlying conditions, such as IBD, which may cause strictures.
Contact e‐mail address:
G‐RF045. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF045.1. HETEROTOPIC GASTRIC MUCOSA IN JEJUNUM IN TWO ADOLESCENTS FOR GUIMARÃES, PORTUGAL
Henedina Antunes 1, José Luís Carvalho2, Rolando Pinho3
1Pediatric Gastroenterology, Hepatology And Nutrition Unit And Clinical Academic Center 2ca‐braga, Hospital De Braga‐ulsb; Life And Health Sciences Research Institute (icvs); Icvs/3b's, Associate Laboratory And School Of Medicine, Minho University, Braga, Portugal, 2Pediatric Surgery Department, Hospital de Braga‐ULSB, Braga, Portugal, 3Gastroenterology, Institute CUF, Porto, Portugal
Objectives and Study: A patient with 11 years, female, with abdominal pain in the left hypochondrium, transferred for Guimarães, Portugal, with abdominal distension, no emission of gases or feces. The abdominal ultrasound “image of intussusception”. Laparoscopy: no lesion identification. Opportunistic appendectomy. Hospitalized after surgery.
Methods: The pediatric gastroenterologist in Hospital de Braga with this symptomatology, the background of an asthma allergic, with hemoglobin: 80 g/L and ferritin: 3 ng/ml, prescribes intravenous iron and put the probable diagnosis of heterotopic gastric mucosa. To confirm this, need to make a videocapsule. The videocapsule confirm the heterotopic gastric mucosa in the jejunum. A double ballon enteroscopy (DBE) was made to mark the area for help the pediatric surgery to remove the heterotopic gastric mucosa.
Results: A patient in emergence department of Hospital de Braga, with 12 years, male, with abdominal pain and with a laparoscopy before without no lesion identification and follow‐up for Pediatric Gastroenterology in ULSSJ‐Porto. The father of the patient asked me a consultation I watched the patient and I see blood in stool, the Pediatric Surgeon ask me the opinion with more two Colleagues and I said the probable diagnosis is a heterotopic gastric mucosa, to confirm, need to make a videocapsule and DBE. The videocapsule confirm the heterotopic gastric mucosa in the jejunum. A DBE was made to mark the area for the laparoscopic segmental enterectomy(LSE) to remove the heterotopic gastric mucosa.
Conclusions: Two adolescents, female, 11 years and after, a male, with 12 years, from Guimarães, Portugal with this congenital malformation carried out the diagnosis only at 11 years and 12 years, but with a rapid diagnosis for a pediatric gastroenterologist. This literacy in health is essential to increase this diagnosis. This abstract is to see the DBE video of heterotopic gastric mucosa in jejunum with mark the area for LSE and LSE video.
Contact e‐mail address: henedinaantunes@gmail.com
G‐RF046. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF046.1. A RARE COLONIC INFLAMMATORY MYOFIBROBLASTIC TUMOR RESECTED BY ENDOSCOPIC POLYPECTOMY IN A CHILD
Anne Cordesse 1, Alexis Mosca1, Arnaud Bonnard2,3,4, Daniel Orbach5, Jérôme Viala1,2,3
1Paediatric Gastroenterology And Nutrition Department, Universitary Robert‐Debré Hospital, APHP, Paris, France, PARIS, France, 2Paris‐Cité University, Paris, France, 3Umr 1149, INSERM, Paris, France, 4Paediatric Surgery, Universitray Robert‐Debré Hospital, APHP, Paris, France, 5Centre Oncologique Siredo, Institut Curie, Paris, France
Objectives and Study: Solitary juvenile polyp could occur in ascending or transverse colon in 4‐30% of cases. However, some other solitary polypoid lesion might be observed in children.
Methods: A 15‐year‐old girl was admitted with abdominal pain and recent vomiting. She had an anemia and a hypo‐albuminemia. A CT‐scan identified a 40 mm polypoid intraluminal mass of the right colon, suggesting a solitary juvenile polyp. During endoscopy, this large polyp seemed to be pedunculated. An electrocautery polypectomy was performed after controlling the stalk by an endoloop. A bleeding was control by clipping, before we observed a 1 cm perforation that was sutured during coelioscopy. Microscopic examination revealed an inflammatory myofibroblastic tumor (IMT), surrounded by normal colic mucosa. ALK‐Protein and CD34 were negative. Next generation sequencing revealed a TFG‐ROS1 gene fusion. A thoracic CT‐scan observed no secondary lesion. After 1‐year of follow‐up, the patient was in remission.
Results: IMT is a rare tumor with a high recurrence rate and low metastasic potential. In most cases, IMT occurred in the abdominal cavity, whereas some cases of intraluminal development led to obstruction, pain, or bleeding. IMT have frequently no specific feature in CT‐scan. Complete surgical resection with healthy margin is considered as the main treatment for IMT.
Conclusions: Differential diagnosis should be considered in case of solitary polypoid lesion in other colic parts than rectosigmoid. Endoscopic resection of IMT should be considered with caution. Because of their submucosal development, the risk of perforation is high.
Contact e‐mail address: jerome.viala@aphp.fr
G‐RF047. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF047.1. IT MAY BE POSSIBLE TO FACILITATE THE REMOVAL TECHNIQUE IN CHILDREN WHO INGEST MULTIPLE MAGNETS
Buket Daldaban Sarica
Pediatric Gastroenterology, KAYSERI CITY HOSPITAL, Kayseri, Turkey
Objectives and Study: Foreign body ingestion is a common concern in pediatric emergency settings, with magnets comprising approximately 2% of such cases. While single magnets typically pass through the gastrointestinal tract without causing significant harm, the ingestion of multiple magnets poses substantial risks. When multiple magnets are swallowed, they can attract each other and cause pressure on the bowel wall, leading to complications such as necrosis, perforation, intestinal obstruction, fistula formation, volvulus, and, in severe cases, toxic shock. The delayed and often subtle onset of symptoms can result in delayed diagnosis and treatment, which can have life‐threatening consequences.
Methods:
This case reports a 2.5‐year‐old female patient who presented to the emergency department with suspected magnet ingestion. She showed no signs or symptoms. An abdominal X‐ray revealed a series of beads arranged vertically within the stomach. Endoscopy was performed, revealing that the upper end of the magnet string was located at the lower esophageal sphincter, with the lower end was at the pylorus. Removing the magnets individually with forceps was deemed impractical, as it would prolong the procedure and carry the risk of magnets detaching and re‐entering the gastrointestinal tract.Instead, the magnets were grasped at the midpoint, and during retrieval, the magnets were arranged in a "T‐shape," enhancing their magnetic attraction and facilitating successful removal.
Results: Pull force provided by a magnetic system is given as Equation (1): F = Bg2A/2μ0 (1) Where, F, Bg, μ0,and A are the pull force, magnetic flux density, magnetic permeability of the space and effective cross area of the magnetic system, respectively.
Conclusions: It is possible to say that if the magnets hold together pull force of the system will be increased. Therefore, this situation has been realized in this application.This method enabled the safe and uncomplicated retrieval of the magnets, avoiding potential complications associated with multiple magnet ingestion.
Contact e‐mail address:
G‐RF048. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF048.1. USE OF EVAC FOR IATROGENIC ESOPHAGEAL RUPTURE
Konstantina Dimakou 1, Aggeliki Krikri1, Maria Rogalidou2, Eleanna Stasinou2, Vasiliki Maria Karagianni1, Irini Gazelopoulou1, David Oikonomopoulos1, Natalia Kelaidi1, Grigorios Iordanoglou1, Alexandra Papadopoulou1
1Gastroenterology, Agia Sofia Children's Hospital, ATHENS, Greece, 2Agia Sofia Children's Hospital, ATHENS, Greece
Objectives and Study: Esophageal perforation is a rare condition in paediatrics but is associated with significant mordidity and mortality up to 30%. In children the etiology of esophageal rupture is often iatrogenic after endoscopic dilatation of an esophagheal stricture or accidental after ingestion of a caustic substance or a foreign body. During the last decade in addition to standard treatment options endoluminar technics have immerged. Vacuum sponge therapy for use intraluminally for perforations of the esophagus was first reported in 2008 in adults. Data on technical success and effectiveness of endoscopic esophageal vacuum assisted closure (EVAC) in pediatric patients were published in 2018 by Manfredi et al. Here we present a case of a 15 month old boy with iatrogenic rupture of the esophagus, secondary to baloon dilatation, treated with EVAC. The boy was born with long gap esophageal atresia and fistula. Five months after the final surgery (end to end esophageal anastomosis) pneumatic dilation sessions were initiated due to anastomotic stricture. At the second session esophageal rupture proximal to the anastomotic site occurred (photo)
Methods: A modified esophageal vacuum sponge was placed endoluminal at the site of the rupture proximal to the stenosis. At the same time replogle suction catheter was placed in the mouth. After four days a new endoscopy was performed and a new EVAC was placed. (video)
Results: Treatment of iatrogenic esophageal perforation with EVAC.
Conclusions: EVAC in pediatric patients is technically feasible and a promising method to treat esophageal ruptures.
Contact e‐mail address:
G‐RF049. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF049.1. CHRONIC ANTIBIOTIC‐REFRACTORY POUCHITIS (CARP): REPORT OF A CASE IN AN ADOLESCENT PATIENT
Valeria Dipasquale, Claudio Romano
Pediatric Gastroenterology and Cystic Fibrosis Unit, University Hospital “G. Martino”, Messina, Italy
Objectives and Study: The most common complication following restorative proctocolectomy and ileoanal anastomosis is the nonspecific inflammation of the ileal pouch reservoir, known as pouchitis. A minority of patients fails to respond to multiple antibiotic therapies and develops chronic antibiotic‐refractory pouchitis (CARP).
Methods: We present the case of a 13‐year‐old girl with CARP and histology demonstrating chronic inflammatory changes.
Results: A 13‐year‐old girl with a history of ulcerative colitis (diagnosed at the age of 10) and a prior restorative proctocolectomy and ileoanal anastomosis (at the age of 12) started complaining of recurrent episodes of bloody diarrhea and anemia one year after surgery. Endoscopic assessment revealed mild‐to‐moderate recurrent pouchitis, with or without cuffitis. Management involved probiotics and several courses of antibiotic therapy with no significant clinical improvement. Infliximab was also attempted but suspended after three doses due to a lack of clinical response. The most recent (August 2024) endoscopic assessment (videoclip) showed moderate‐to‐severe inflammation of the pouch with chronic inflammatory alterations on histology (erosions; distortion and hypotrophy of the glandular units; intense chronic inflammatory finding in basal disposition with high granulocyte quota; cryptitis; poorly represented mucous activity)(Pouchitis Disease Activity Index 13). The ileal histology was normal. The patient started vedolizumab (four infusions so far), which has resulted in a partial decrease in hematochezia episodes.
Conclusions: The current literature on the treatment of CARP is limited, particularly in children. It is critical to keep this differential diagnosis in mind in patients with recurring pouchitis episodes and eventually start first‐ and second‐line immunomodulator therapy rather than repeated courses of antibiotics.
Contact e‐mail address: dipasquale.va@gmail.com
G‐RF050. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF050.1. ARTERIAL BLEEDING FROM THE OSTOMY SITE 16 YEARS AFTER EXTERNAL BILIARY DIVERSION IN A PFIC TYPE 1 PATIENT: A CASE REPORT
Fatma Eren Kurtipek 1, Hakan Öztürk1, Ayşe Can1, Fatma Özlem Koseoglu1, Sınan Sarı2, Mehmet Koray Akkan3, Aydın Dalgiç4, Buket Dalgiç1
1Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 2Division Of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 3Radiology And Imaging, Gazi University Faculty of Medicine, Ankara, Turkey, 4General Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
Objectives and Study: Progressive familial intrahepatic cholestasis (PFIC) is a rare genetic disorder that leads to end‐stage liver disease. Persistent pruritus and chronic diarrhea are symptoms that negatively impact the quality of life in these patients. Partial external biliary diversion (PEBD) is a procedure that can control symptoms, prevent progression to end‐stage liver disease and liver transplantation, and is associated with very low morbidity and rare complications. Here, we present a case of life‐threatening arterial bleeding from the ostomy site 16 years after PEBD in a patient with PFIC type 1.
Methods: Case study
Results: A 17‐year‐old girl with PFIC type 1 presented in 2008 with severe pruritus and jaundice. Family history revealed consanguinity. Serum bile acids were elevated, and liver biopsy confirmed the diagnosis. The patient underwent PEBD when she was 11 months old to manage pruritus and cholestasis. After the procedure, her symptoms were regressed, and liver functions were normal. From 2021, she experienced intermittent minor bleeding into her ostomy pouch. Despite evaluations, no source was identified. In November 2024, she presented with a sudden, pulsatile arterial bleed from the ostomy site, lasting approximately three minutes and causing hypotensive shock. Video evidence confirmed arterial bleeding. Endoscopic evaluation failed to detect the bleeding source. Computed tomography angiography showed a small arterial branch from the superior mesenteric artery and a nearby mesenteric vein extending to the jejunostomy site. Arterial embolisation wasn't attempted due to the risk of stoma necrosis. The bleeding artery and adjacent vein were identified and ligated surgically.
Conclusions: Late complications such as arterial bleeding after PEBD are extremely rare. Chronic irritation or vascular remodeling near the ostomy likely contributed to this event. Although rare, arterial bleeding should be considered in cases of severe hemorrhage at ostomy sites. Multidisciplinary management, including imaging, endoscopy, and surgery, is crucial for patient survival.
Contact e‐mail address: ffatmaeren@gmail.com
G‐RF051. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF051.1. CONGENITAL HIATAL HERNIA: UNUSUAL CAUSE OF NEONATAL VOMITING
Nuša Cesar1, Matjaž Homan 2
1Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia, 2Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
Objectives and Study: Hiatal hernias occur when the stomach protrudes into the chest cavity through a widening of the right diaphragmatic ridge. There are four types: sliding hernia (type I), paraesophageal hernia (type II), a combination of sliding hernia and paraesophageal hernia (type III) and giant paraesophageal hernia (type IV). The most common type is the sliding hernia. Hernias affect 10‐50% of the population but are very rare in the neonatal period.
Methods: We present a case report with a video clip of a newborn diagnosed with a large hiatal hernia.
Results: A 7‐days‐old girl presented to the emergency department with vomiting. She was born after an uncomplicated pregnancy and showed normal weight gain while breastfeeding every 3‐4 hours. However, at 7 days of age, recurrent vomiting occurred approximately 1.5 hours after breastfeeding. She had regular bowel movements. Her laboratory results showed no abnormalities. Initially, pyloric stenosis was suspected, but was omitted by abdominal ultrasonography. An upper gastrointestinal contrast series was performed which showed a frequent sliding hiatal hernia with extensive reflux into the upper oesophagus (Figure 1). An upper endoscopy was performed. The mucosa of the distal part of oesophagus was severely inflammed with several erosions limited to mucosal folds involving more than 75% of esophageal circumference (LA‐D) (Figure 1). At least 4 cm of the fundus was in the thoracic cavity. There were no signs of paraesophageal hernia. Treatment was initiated with proton pump inhibitors, prokinetic therapy and anti‐reflux measures. At follow‐up, the patient's symptoms improved significantly and treatment with proton pump inhibitors was continued.
Conclusions: Even though hiatal hernia is rare in the neonatal period; it should be considered as a possible cause for vomiting in infancy. Endoscopy plays a crucial role in providing diagnosis. When treatment with proton pump inhibitors and anti‐reflux measures is not sufficient, surgical intervention may be required.
Contact e‐mail address: nusa.cesar@kclj.si
G‐RF052. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF052.1. ACUTE ESOPHAGEAL NECROSIS IN A 12‐YEAR‐OLD BOY WITH DIABETIC KETOACIDOSIS
Monika Kaluzna‐Czyz, Magdalena Holon, Urszula Grzybowska‐Chlebowczyk
Department Of Gastroenterology And Pediatrics, UpperSilesian Child's Health Care Centre, Katowice, Poland
Objectives and Study: Acute esophageal necrosis, also known as "black esophagus" or Gurvits syndrome, is a rare condition primarily affecting older individuals with multiple comorbidities. We present a case of acute esophageal necrosis diagnosed in a 12‐year‐old child.
Methods: Case description of a 12‐year‐old boy with Type 1 Diabetes Mellitus, experiencing diabetes decompensation with ketoacidosis.
Symptoms: fever, vomiting of gastric contents, diarrhea, abdominal pain.
Physical examination: notable signs of dehydration, abdominal tenderness.
Laboratory tests: very high inflammatory parameters, elevated procalcitonin, coagulation disorders. Positive blood culture.
Imaging studies: Gastroscopy revealed the lower esophagus coated with a thick layer of fibrin covering the entire lumen. The gastric wall was thickened and swollen, showing large ulcers at the fundus and numerous small erosions on the thickened folds of the gastric body. Histopathological examination: esophageal necrosis.
Results: Occurrence of acute necrosis in children ‐ a case study. In our patient, several factors coexisted: diabetes decompensation, ketoacidosis, and sepsis. The course of acute esophagitis with necrosis was atypical, with the absence of bloody vomiting; the dominant symptom was abdominal pain. Gastroscopy did not show the typical "black esophagus" appearance. Necrosis was confirmed through histopathological examination.
Conclusions: Acute esophageal necrosis can also occur in children and may accompany severe metabolic disorders such as sepsis and ketoacidosis.
Contact e‐mail address: monikakaluzna@autograf.pl
G‐RF053. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF053.1. ENDOSCOPIC DILATION OF COMPLETE OESOPHAGEAL OBSTRUCTIONS WITH A COMBINED ANTEGRADE‐RETROGRADE RENDEZVOUS TECHNIQUE IN CHILDREN. CASE SERIES
Kallirroi Kotilea 1,2, Eleni Iliadis1, Flora Fedele1, Julie Nguyen1, Assaad Salame1, Patrick Bontems1
1Pediatric Gastroenterology, Hopital Universitaire des Enfants Reine Fabiola. Hopital Universitaire de Bruxelles., Brussels, Belgium, 2Faculte De Médecine, Universite Libre de Bruxelles, Brussels, Belgium
Objectives and Study: Esophageal strictures(ES) in children, though rare, present significant treatment challenges. These strictures may be congenital or acquired, often resulting from caustic ingestion or postoperative anastomotic stenosis. There is a lack of standardized approaches and pediatric‐specific endoscopic equipment. While balloon dilation, bougie dilation, and endoscopic injection therapies are common, severe strictures require alternative solutions. This series illustrates the safety, feasibility, and clinical outcomes of the combined antegrade‐retrograde rendezvous technique for treating complete esophageal obstructions in pediatric patients.
Methods: We present three cases of severe esophageal obstruction treated using the rendezvous technique. Case 1: A premature infant with type III esophageal atresia(EA) developed anastomotic strictures 1 month post‐surgery. The esophageal lumen was obliterated, and a combined antegrade‐retrograde approach via gastrostomy was used to insert a guide wire to perform balloon dilation. Case 2: A neonate with type III EA developed a secondary stricture and complete esophageal obstruction following postoperative leakage at 13 days. The rendezvous technique was successfully performed with balloon dilation and short‐term nasogastric tube placement. Case 3: A toddler who had caustic ingestion presented 2 years later with complete esophageal obstruction. The combined approach was used to successfully dilate the 7 cm long stenosis.
Results: Outcome: Repermeabilization of the obliterated esophageal lumen was successful in all cases without complications. Hospital stays were brief, with children fed via gastrostomy the same day. Case 1: Four dilations achieved a 10 mm caliber, full oral feeding by 8 months, gastrostomy removal at 1year. Case 2: Five successful dilations led to partial oral feeding (liquids and solids) by 6 months. Case 3: Six dilations performed, reaching 12 mm. With the child drinking liquids at 5 months but still dependent on gastrostomy feeding.
Conclusions: The combined antegrade‐retrograde rendezvous technique is a safe and effective treatment for severe esophageal strictures in children, offering a less invasive alternative to esophageal resection or replacement.
Contact e‐mail address: kalliroy.kotilea@ulb.be
G‐RF054. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF054.1. A CURIOUS CASE OF DUODENAL STRICTURE
Anupa Thomas1, Dr. R. Bhanu Vikraman Pillai 2
1Department Of Pediatric Gastroenterology And Hepatology, Amrita Institute of Medical Sciences, Kochi, India, 2Paediatric Gastroenterology, AMRITA INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTER, Kochi, India
Objectives and Study: 7 year old boy with Trisomy 21 and congenital hypothyroidism detected at birth on L‐thyroxine replacement presented to us with recurrent abdominal pain of 1 year duration occurring daily, mostly at night associated with non‐bilious vomiting and loss of appetite and weight. On examination he was underweight (17 kg) and had dysmorphic facies consistent with Trisomy 21. Systemic examination was unremarkable except for hypotonia.
Methods: Retrospective case analysis of patient's medical records
Results: Evaluations done Laboratory investigations showed anemia. His serum TTG (tissue transglutaminase) was 49.8 U/ml (Normal : <20 U/ml). Gastroscopy showed deformed and narrowed D1‐D2 junction. RUT was positive and HPE showed features of H pylori gastritis and duodenal mucosa had marked villous atrophy, focal crypt hyperplasia with dense chronic lymphocytic infiltrate in the lamina propria (Marsh 3). He was started on strict gluten free diet along with milk avoidance diet and was given H pylori eradication therapy. CT Abdomen showed tight narrowing of D2 duodenum with dilated proximal duodenum and distended stomach. Subsequently endoscopic CRE dilatation of duodenal stricture was done. He has gradual improvement and underwent further sessions of CRE balloon dilatation with upsizing of balloon sizes. On follow up he had significant improvement in symptoms with good catch up growth and also in duodenal histology (Marsh 1). He may require a pediatric surgery opinion and possibily gastro jejunostomy in future in view of his tight stricture
Conclusions: 1.Causes of duodenal stricture in his case is probably due to H.Pylori Infection. But in view of recurrence of stricture, possibility of Celiac disease should also be considered 2.To screen for celiac disease in cases of duodenal stricture and to take duodenal biopsies
Contact e‐mail address: anupaachammathomas@gmail.com
G‐RF055. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF055.1. WHEN CONSTIPATION TURNS CRITICAL: A RARE CASE OF SIGMOID VOLVULUS IN A TEENAGER
Anja Praprotnik Novak 1, Blaž Trotovšek2, Matjaž Homan3
1Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, University medical centre Ljubljana, Ljubljana, Slovenia, 2Clinical Department Of Abdominal Surgery, University medical centre Ljubljana, Ljubljana, Slovenia, 3Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
Objectives and Study: Sigmoid volvulus (SV) is a torsion of the sigmoid colon around its mesentery, leading to bowel obstruction. It is an exceptionally rare and potentially life‐threatening condition in children, often linked to chronic constipation. Early diagnosis is crucial to prevent severe complications such as bowel ischemia, necrosis, or sepsis, emphasizing the need for a high index of suspicion in pediatric patients.
Methods: We present the clinical case of a 16‐year‐old male with a prolonged history of chronic constipation and a suspected diagnosis of Hirschsprung's disease, who subsequently developed a sigmoid volvulus.
Results: A 16‐year‐old boy with chronic constipation presented with severe abdominal pain that worsened over four days. Despite treatment with analgesics and antispasmodics, the pain persisted. He last had a bowel movement four days ago and had no appetite in the previous days. There was no vomiting. Examination revealed marked abdominal distension and tenderness, but he was hemodynamically stable, had normal electrolytes and no signs of inflammation. Abdominal X‐ray showed distended loops with coffee bean signs, and CT confirmed a sigmoid volvulus with distension of up to 120 mm. As there was no peritonitis and the hemodynamics were stable, we attempted endoscopic derotation, which was not completely successful. The patient underwent rectosigmoid resection (Hartmann procedure), leaving the distal 12 cm of the rectum intact. The histopathology of the resected necrotic segment was negative for aganglionosis. Postoperatively, the patient recovered well. A further aspiration biopsy is planned to definitively rule out Hirschsprung's disease.
Conclusions: SV is a rare condition in children, but it should be considered in the differential diagnosis, especially in cases of chronic constipation with acute abdominal pain and distension. Early recognition and prompt intervention are crucial to prevent severe complications.
Contact e‐mail address:
G‐RF056. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF056.1. ROBOT‐CONTROLLED MAGNET‐ASSISTED CAPSULE ENDOSCOPY OF THE UPPER GASTROINTESTINAL TRACT IN CHILDREN: FEASIBILITY AND ACCEPTABILITY
Shishu Sharma 1, Mike Thomson1, Mark Mcalindon2, Priya Oka2
1Sheffield Children's Hospital, Sheffield, United Kingdom, 2Sheffield teaching Hospital, Sheffield, United Kingdom
Objectives and Study: Magnetically assisted capsule endoscopy (MACE) has been shown to be a safe feasible alternative to upper GI endoscopy (OGD) in adult population1 2. The aim of this study was to evaluate the feasibility of MACE and compare its acceptability with OGD in children.
Methods: The study was conducted after approval from Research Ethics Committee in children between 11‐18 years of age. The MACE procedure (capsule camera 26 X 11 mm) was performed with Ankon® magnet system. OGD was performed within 10 days of MACE to compare the findings.
Results: 14 patients (5 males) with median age 14 years 5 months (13 years – 16 year 8 months), median weight 54.5Kg (38.2 – 101.2) and median height 166.15 cm (146 ‐169.7) were enrolled in the study. The positive predictive value of MACE was almost 100% with negative predictive value of 72.7%. The average gastric examination time was 20 minute and average gastric transit time was 40 minutes. The feasibility and acceptability were evaluated based on a scale test, where 0 score for a terrible test and 10 scored for a very pleasant test experience. The most important aspects of acceptability were being awake during the test, being pain free, no need of needles, ability to see inside stomach, ability to help in research. The concerns associated with test were anxiety, duration of procedure, size of the capsule, difficulty in swallowing the capsule, nausea, fasting before test. The Welch's T‐test showed for statistical analysis. The mean score for MACE was 8.5 and that for OGD was 4.6. Allowing 22 degrees of freedom, the p value was 0.00057 which is significant.
Conclusions: This is the largest paediatric study to assess the feasibility and acceptability of MACE. MACE has good acceptability can be used as a screening test to select patients who need targeted biopsies.
Contact e‐mail address:
G‐RF057. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF057.1. THREE YEAR FOLLOW UP OF FEASIBILITY AND SAFETY OF ENDOSCOPY DELIVERED RADIOFREQUENCY THERAPY FOR GASTRO‐OESOPHAGEAL REFLUX DISEASE IN CHILDREN
Shishu Sharma, Mike Thomson
Sheffield Children's Hospital, Sheffield, United Kingdom
Objectives and Study: The standard treatment for refractory GORD is anti‐reflux surgery i.e. fundoplication but that is associated with concerns of significant complications. The aim of this study is to evaluate the safety and feasibility of the Strettaâ procedure in the paediatric population.
Methods: Children aged 12‐17 years with GORD, based on 24‐hour oesophageal pH monitoring with reflux index (RI) of >4%, and with symptoms refractory to, daily PPIs for at least 6 months, were included. Pre‐procedure baseline included oesophageal manometry, barium swallow and reflux‐specific quality of life clinical assessments. The participants were planned for follow up at 6 weeks, 3 months, 6 months and 12 months after the procedure with QoL and pH study. Our first three patients have complted three years of follow up.
Results: 12 patients have safely had the procedure out of which 8 have completed one year follow up. 5 out of 8 patients have had complete resolution of their symptoms and cessation of PPIs. The median pre‐procedure reflux index was 8.5% and a median reflux index at 1 year of 1.8% (p = 0.34). The median QOLRAD score improved from 117.5 to 175 at one year (p = 0.05). Similarly, the median GORD component of GSRS improved from 27.5 to 11 (p = 0. 028). All of the five above patients have maintained sustained response beyond 2 years (three patients beyond three years). None of our patients encountered acute or late complication, such as bleeding, perforation, bloating, dysphagia, fever, severe pain, or mediastinal inflammation or any other symptomatic adverse effect.
Conclusions: This study concludes that STRETTA is safe and effective in small cohort of patients with sustained response at upto three years of follow up.
Contact e‐mail address:
G‐RF058. Topic: AS01. GASTROENTEROLOGY/AS01d. Endoscopy Video Clip
G‐RF058.1. A NOVEL ENDOSCOPIC TECHNIQUE FOR THE CLOSURE OF TRACHEO‐ESOPHAGEAL FISTULA IN AN ADOLESCENT BOY
Viswanathan Melarcode Sivaramakrishnan 1,2, Hariharan M3, Ubal Dhus3
1Paediatric Gastroenterology, Apollo Children's Hospital, CHENNAI, India, 2Paediatric Gastroenterology, Apollo Children's Hospital, Chennai, India, 3Gastroenterology, Apollo Hospital, Chennai, India
Objectives and Study: Introduction Tracheo‐esophageal fistula (TEF) is a rare congenital anomaly, 90% diagnosed in early infancy. It is rarely diagnosed in adolescents.
Methods: Case Report A sixteen year old boy presented with reflux symptoms, recurrent respiratory tract infections and choking episodes. He was treated elsewhere with antibiotics, anti asthmatics and anti tuberculous medications. No history of foreign body or corrosive ingestions. After initial evaluation, diagnostic oesophagogastroscopy (OGD) was done, on withdrawal of scope an abnormal esophageal communication at 20 cm from the incisor was noticed. After securing the airway with endotracheal (ET) intubation, a reassessment showed the lower end of the ET tube in the abnormal communication confirming a diagnosis of TEF. Later a computerised tomography (CT) chest with contrast revealed a 3.3 mm wide TEF fistula (Type H) at D1‐D2 vertebrae and aspiration pneumonia, CT neck was normal. After obtaining paediatric surgeon and ENT opinion, therapeutic upper GI endoscopy was done. Initially argon plasma coagulation (APC) was applied at the lips of the fistulous opening. Then a padlock clip was applied over the fistula in a good position (Video attached). The procedure was uneventful. On follow up at 1 year he had complete resolution of symptoms with good quality of life.
Results: Discussion In adolscents, congenital or acquired TEF is uncommon. Acquired is insidious, secondary to foreign bodies/corrosive fluids ingestion. Recurrent & acquired TEF are challenging to manage. Current endoscopic tecniques include stenting, de‐epithelialisation, chemical sealant and combined approach. De‐epithelialisation includes diathermy coagulation, laser or argon plasma coagulation (APC). In our case we have done a novel technique of using padlock lip to close the fistula after APC.
Conclusions: TEF in adolescents is rare. We suggest the novel technique of using padlock clip along with APC as it a safe procedure with good outcome. We need to explore newer techniques and optimise the existing ones.
Contact e‐mail address: drmsv21@gmail.com
G‐RF059. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐RF059.1. HELICOBACTER PYLORI AND ITS ASSOCIATION WITH ALLERGIC PROCTOCOLITIS IN INFANTS: A MULTICENTER CASE‐CONTROL STUDY IN TURKEY
Zeren Barış 1, Sümeyye Koç2, Mustafa Arga3, Şirin Kaya4, Pınar Altınkaynak3, Ayşen Bingöl5, Dilara Uygun5, Burcu Güven6, Semra Yılmaz6, Serdar Göktaş7, Nihal Uyar Aksu8, Taha Akın9, Ayben Leblebici10, Duygu Demirtas Guner11, Belkıs Ipekçi12, Cigdem Omur Ecevit11, Özlem Cavkaytar3, Yusuf Aydemir1, Hülya Anıl2, Koray Harmancı2
1Pediatric Gastroenterology, Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Gastroenterology, Eskişehir, Turkey, Eskişehir, Turkey, 2Pediatric Allergy, Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Gastroenterology, Eskişehir, Turkey, Eskişehir, Turkey, 3İstanbul Medeniyet Üniversitesi Tıp Fakültesi Çocuk Alerji ve İmmünoloji B.D., İstanbul, Turkey, 4Şanlıurfa Eğitim ve Araştırma Hastanesi Çocuk Alerji ve İmmünoloji B.D., Şanlıurfa, Turkey, 5Akdeniz University Department of Pediatric Allergy, Antalya, Turkey, 6Pediatric Gastroenterology, Karadeniz Technical University, trabzon, Turkey, 7Van Eğitim Araştırma Hastanesi, Van, Turkey, 8Pediatric Gastroenterology, Kocaeli University, Kocaeli, Turkey, 9Kocaeli University Pediatric Allergy, Kocaeli, Turkey, 10Pediatrics, Eskişehir Osmangazi University, Faculty Of Medicine, https://pediatri.ogu.edu.tr, Eskişehir, Turkey, 11Department Of Pediatrics, Division Of Pediatric Gastroenterology, Hepatology And Nutrition, Dr. Behçet Uz Children's Hospital, Izmir, Turkey, 12Pediatric Gastroenterology, state hospital, Van, Turkey
Objectives and Study: Helicobacter pylori (H. pylori) prevalence has been studied in various pediatric populations; however, its relationship with allergic proctocolitis remains unclear. This multicenter study aimed to evaluate the prevalence of H. pylori in infants with allergic proctocolitis compared to healthy controls in Turkey, while considering maternal and infant‐related factors that could influence colonization.
Methods: Infants aged 1 month to 1 year from seven regions in Turkey were included. Stool samples from 96 infants diagnosed with allergic proctocolitis (AP) in allergy clinics and their mothers (when available) were analyzed for H. pylori using PCR. A control group of 51 age‐ and sex‐matched healthy infants and their mothers (when available) attending well‐baby clinics was also included. Maternal allergic diseases, dyspeptic symptoms, delivery mode, and feeding patterns (exclusive breastfeeding, formula, complementary feeding) were recorded. Additionally, specific IgE levels and eosinophil counts in infants with allergic proctocolitis were evaluated. Participants with antibiotic use in the last two months were excluded. Stool samples were obtained from 27 mothers in the healthy group (53%) and 71 mothers in the AP group (74%).
Results: Demographic and clinical characteristics of infants and mothers are summarized in Table 1. H. pylori positivity in stool samples was observed in 12.5% of infants with AP and 17.6% of healthy controls (p > 0.05). Among mothers, H. pylori positivity was found in 15.6% of the AP group and 7.7% of the healthy group (p > 0.05).
Conclusions: Our findings reveal that H. pylori prevalence in stool samples of infants with allergic proctocolitis and their mothers was not significantly different from healthy controls. These results suggest that H. pylori may not play a prominent role in the pathogenesis of allergic proctocolitis. Further studies are needed to investigate the potential role of gut microbiota in pediatric allergic conditions.
Contact e‐mail address: zeren_baris@yahoo.com
G‐RF060. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐RF060.1. INFLAMMATION AND DELAY OF THE AUTOPHAGY IN INTESTINAL ORGANOIDS FROM REMISSION EOSINOPHILIC ESOPHAGITIS PATIENTS (REM‐EOE)
Claudia Bellomo 1, Caterina Strisciuglio2, Erasmo Miele3, Francesca Furone3, Genoveffa D'Aniello1, Francesco Silvestro1, Violeta Catalina Greu1, Vittoria D'Esposito4, Pietro Formisano4, Renata Auricchio3, Merlin Nanayakkara3, Maria Vittoria Barone1
1Department Of Translational Medicine, ELFID‐ European Laboratory for the Investigation of Food Induced Diseases, NAPOLI, Italy, 2Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy, 3Scienze Mediche Traslazionali (sez. Pediatria‐ Ed11), Università degli Studi di Napoli "Federico II", NAPOLI, Italy, 4Department Of Translational Medicine, Università degli Studi di Napoli "Federico II", NAPOLI, Italy
Objectives and Study: Eosinophilic Esophagitis (EoE) is a chronic, immune‐mediated esophageal disease characterised by eosinophilic infiltration and inflammation in response to allergens, contained in food. The main symptom is dysphagia, and the diagnosis is made by the count of eosinophils infiltration and basal cell hyperplasia in the oesophagus. The current therapeutic treatments are dietary modifications, pharmacotherapy, and sometimes mechanical dilation that can lead to remission with less than 15 eos./HPF (high power field). Although the oesophagus in these patients is known other parts of gastrointestinal tract are less studied. Our aims were to evaluate both inflammation and autophagy in intestinal organoids from subjects in remission phase of EoE and the effects of gliadin peptides.
Methods: We isolated intestinal organoids from duodenal biopsies from 7 controls and 7 patients in remission phase of EoE (REM‐EoE), in which there were less of 15 eos./HPF. pNF‐kB, p62 and pE4BP were used as marker of inflammation, autophagy and mTOR pathway, evaluated by WB. Twenty‐seven inflammatory cytokines, chemokines and growth factors were evaluated, by Bio‐plex, in the organoids cell medium (CM).
Results: In organoids from REM‐EoE levels of pNF‐kB,p62 and pE4‐BP1 were significantly increase respect controls (p < 0,0001; p < .05). In CM there was a statistically significant increase of 7 cytokines, 3 chemokines and 3 growth factors all of them related to inflammation, and with autophagy. Gliadin peptides treatment of organoids from REM‐EoE increased pNF‐kB levels respect to untreated, in 3 (p < .05) patients out of 6, evaluated by WB. Bio‐plex analysis after gliadin peptides treatment showed increase of several cytokines related to the NF‐kB pathway.
Conclusions: These data demonstrated that intestinal organoids from REM‐EoE patients were inflamed independently of the presence of eosinophils in the oesophagus. Moreover, the organoids were sensitive gliadin peptides. Duodenal inflammation and gliadin peptides effects could play a still uncovered a role in EoE pathogenesis.
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G‐RF061. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐RF061.1. THE SAFETY AND EFFICACY OF DUPILUMAB MONOTHERAPY IN TREATING EOSINOPHILIC ESOPHAGITIS IN CHILDREN, A PROSPECTIVE SINGLE CENTER EXPERIENCE
Doaa Zourob1, Enas Sarhan2, Nafae Al Yasi1, Amer Azaz1,3, Mohamad Miqdady3, Rana Bitar 1,3
1Pediatric Gastroenterology And Hepatology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, 2Pediatric Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, 3College Of Medicine, Khalifa University, Abu Dhabi, United Arab Emirates
Objectives and Study: Treatment of eosinophilic esophagitis (EoE) includes dietary elimination, proton‐pump inhibitors, and topical corticosteroids. The European Medicine Agency approved the use of Dupilumab in 2023 for adolescents ³12 years with EoE, weighing at least 40 kg, who are inadequately controlled by, are intolerant to, or who are not candidates for conventional medicinal therapy. We aim to review its’ safety and efficacy as monotherapy in children with eosinophilic esophagitis.
Methods: We prospectively reviewed patients <18 years with EoE in a tertiary pediatric hospital treated with Dupilumab monotherapy after failing to respond to high dose proton pump inhibitors from December 2022 to April 2024. Dupilumab was initiated in patients failing conventual therapy, with esophageal stricture and intolerant to conventional therapy. EoE was diagnosed based on the consensus diagnostic criteria for EoE.
Results: 17 patients were identified, 13 males, median age at initiating dupilumab 11 years(range:1‐16), median eosinophils 0.63x10^9/L(range:0.26‐1.8), median IgE 428IU/mL(range22‐3241), 9/17 had other atopic disease(53%), 6/17 had failure to thrive(35%). All patients demonstrated clinical and histological response to treatment and 64% showed complete histological remission. Median eosinophil count/high power field prior to treatment was 25 (range: 0‐160) in upper, 40 (range:0‐200) in middle and 40 (range:2‐320) in lower esophagus. There was significant reduction in eosinophil count after treatment in the upper, middles and lower esophageal biopsies P = 0.00068, 0.00071, 0.00018 respectively. Patients were followed for 8‐24 months. Two patients reported skin sash, the tow patients had atopic dermatitis, in one patients the medication was stopped and restarted after 6 weeks with no further skin rash and in the other patient the rash self‐resolved.
Conclusions: Dupilumab is a monoclonal antibody suppressing interleukin‐13 and interleukin‐4 signaling. It is effective as a monotherapy for EoE with minimal reported side effects. More studies on its safety and long tern efficacy are needed.
Contact e‐mail address: drranab@doctors.org.uk
G‐RF062. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐RF062.1. HIGH‐THROUGHPUT PROTEOMIC PROFILING OF INFLAMMATORY AND REMODELING PATHWAYS IN EOSINOPHILIC ESOPHAGITIS AND BASAL CELL HYPERPLASIA
Adi Eindor 1, Efrat Broide1, Vered Richter2, Tzippora Shalem1
1Pediatric Gastroenterology, Hepatology And Nutrition, Shamir Medical Center, Zeriffin, Israel, 2Shamir Medical Center, Zriffin, Israel
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic, immune‐mediated disease characterized by eosinophilic infiltration, epithelial remodeling, and fibrosis. While CCL26 is a known driver of eosinophil recruitment, its role in basal cell hyperplasia (BCH) and early disease remodeling is unclear. This study aimed to identify proteomic signatures associated with EoE, BCH, and predictors of Proton pump inhibitor (PPI) response using high‐throughput proteomic analysis.
Methods: We conducted a prospective case‐control study at Shamir Medical Center in Israel. Patients aged 6‐65 undergoing upper endoscopy between March 2023 to January 2025 for suspected EoE were invited to participate. Patients were categorized as EoE patients if they had >15 Eosinophils per hpf in esophageal biopsies. A pathologist recorded BCH in the biopsies. All EoE patients started PPI treatment after diagnosis. We conducted a high‐throughput proteomic analysis using the Olink® Explore 384‐ biomarkers Inflammation Panel on the samples.
Results: Eighty‐ six patients participated in the study. Median age 16 (IQR 10‐17.7) and 55 males (64%). Twenty‐six (30.2%) patients were categorized as EoE and 32 (37.2%) with BCH. Twenty EoE patients underwent subsequent endoscopy (76.9%), among them 8 (40%) reached histologic remission after induction with PPI. CCL26 was significantly upregulated in both EoE (p‐adj=0.0013) and BCH (p‐adj=0.0049), suggesting a potential role beyond eosinophil recruitment. Additional potential biomarkers included IL5RA, COL9A1, and TNFRSF11A (nominal p < 0.05). No biomarkers were significantly associated with PPI remission after multiple testing correction.
Conclusions: This study provides novel evidence linking CCL26 to basal cell hyperplasia, suggesting a direct role in epithelial remodeling beyond eosinophil recruitment. The association of BCH with Th2‐driven inflammation highlights a potential early marker of disease progression, which could inform risk stratification and therapeutic targets to prevent fibrosis. Further validation in larger cohorts is warranted.
Contact e‐mail address:
G‐RF063. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐RF063.1. PEDIATRIC EOSINOPHILIC ESOPHAGITIS: DIAGNOSTIC AND THERAPEUTIC INSIGHTS FROM A 15‐YEAR RETROSPECTIVE STUDY
Sraya Greenberger 1, Zev Davidovics1, Peri Milman1, Tamar Orgad1, Isra Abu‐Rahma1, Elinor Haimov1, Aylana Siegel‐Richman1, Anna Elia2, Michael Wilschanski1, Mordechai Slae1, Liron Birimberg‐Schwartz1
1Department Of Pediatric Gastroenterology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, 2Department Of Pathology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Objectives and Study: Eosinophilic Esophagitis (EoE) is a chronic condition with variable macroscopic and microscopic findings, complicating diagnosis and treatment. Although six biopsies are recommended, the diagnostic value of sampling specific esophageal regions remains unclear. This study examines esophageal sampling practices, clinical features, and treatment trends in pediatric EoE.
Methods: We retrospectively reviewed charts of 139 pediatric EoE patients diagnosed between 2009 and 2024. EoE was defined as compatible symptoms and >15 eosinophils/HPF (high power field) without alternative explanation. Data included demographics, symptoms, macroscopic/microscopic findings, sampling methods, and treatments.
Results: The mean diagnostic age was 7.1 years (range: 0.05–17.4), with 78% males. Common presenting symptoms were vomiting (39%), dysphagia (32%), and food impaction (28%). Among 113 diagnostic endoscopies, macroscopic findings were most frequent in the lower esophagus (85%), followed by the middle (74%) and upper (71%), with furrows (69%) and exudates (55%) being predominant. Multi‐regional sampling (≥2 regions) revealed <15 eosinophils in 20.88% of upper, 7.14% of middle, and 16% of lower esophageal samples, highlighting the importance of sampling to enhance diagnostic accuracy. Discrepancies between macroscopic and microscopic findings were most pronounced in the upper esophagus (26.4%, p < 0.001), compared to only 9.8% (P = 0.002) in the lower esophagus. Figure 1 illustrates the first‐line therapeutic approaches and their corresponding rates of microscopic resolution. Overall, 53 patients (46%) achieved resolution after first‐line therapy. Biologic therapy, introduced in 2021, was initiated after an average of 6.15 procedures per patient (range: 1–12) and resulted in complete histologic resolution in all treated patients (n = 13).
Conclusions: Findings indicate greater disease severity distally and underscore the need for multi‐regional sampling, even in normal‐appearing areas, to enhance diagnostic accuracy. Therapeutic responses varied across treatment combinations and patients, highlighting the need for a personalized approach. Biologic therapies show promise but require validation in larger studies to confirm efficacy and safety.
Contact e‐mail address: sraya.greenberger@gmail.com
G‐RF064. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐RF064.1. EATING BEHAVIORS IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS: A RETROSPECTIVE CASE‐CONTROLLED STUDY
Mohammed Hasosah 1, Feras Baowidan2, Asharf Alsahafi1, Ali Zaidan3, Ghassan Sukkar4, Sameha Khayyat5, Kholoud Otaibi5, Mansour Qurashi6
1Pediatric Gastroenterology, King Saud bin Abdulaziz University for Health Sciences. King Abdullah International Medical Research Center (KAIMRC), National Guard Hospital, Jeddah‐ Saudi Arabia, Saudi Arabia, 21Pediatric Gastroenterology Department, King Saud bin Abdulaziz University for Health Sciences. King Abdullah International Medical Research Center (KAIMRC), National Guard Hospital, Jeddah, KSA., Jeddah, Saudi Arabia, 3Pediatric Gastroenterology Department, King Saud bin Abdulaziz University for Health Sciences. King Abdullah International Medical Research Center (KAIMRC), National Guard Hospital, Jeddah, KSA., Jeddah, Saudi Arabia, 4Pediatric Gastroenterology Department, King Saud bin Abdulaziz University for Health Sciences. King Abdullah International Medical Research Center (KAIMRC, Jeddah, Saudi Arabia, 5Pediatric Gastroenterology Department, King Saud bin Abdulaziz University for Health Sciences. King Abdullah International Medical Research Center (KAIMRC), National Guard Hospital, Jeddah, Saudi Arabia, 6Neonatology Department, King Saud bin Abdulaziz University for Health Sciences. King Abdullah International Medical Research Center (KAIMRC), National Guard Hospital, Jeddah, Saudi Arabia
Objectives and Study: Eosinophilic esophagitis (EoE) is associated with feeding difficulties. We aimed to measure eating behaviors in patients with EoE and compare with controls patients.
Methods: This was a retrospective case‐control study enrolling children aged 0‐16 years, matched by age and gender (1:1 ratio). We measured eating behaviors scores (mean, standard deviation [SD]) in both patients with EoE and controls. We considered Child Behavior Frequency Score > 61, Parent Feelings/Strategies Frequency Score >20 and Total Behavioral Pediatrics Feeding Assessment Scale (BPFAS) score > 84 are abnormal results.
Results: The study involved 80 children (mean [SD]) aged, 6.4 [4.0] years; EoE and mean [SD] aged 8.4 [4.0] years; controls). Of 80 patients identified, 54 (67.5%) were males. There was significant difference between the EoE patients and the controls in terms of child feeding difficulties; mean [SD] score (problems chewing food 2.4[1.6] vs 1.3 [0.7], p < 0.001), (drinking more than eating 2.6[1.7] vs1.6[1.2], p = 002), (taking longer than 20 minutes to finish a meal 3.3 [2.0] vs 2.2 [1.5], p = 0.008), (choking or gaging at mealtime 2.7[1.7] vs 1.3 [0.6] p < 0.001), and (parents get frustrated/anxious when feeding child 2.8 [1.7] vs 1.3 [0.8], p < 0.001). Our results confirmed that parent feelings/strategies frequency mean [SD] score were significantly higher in EoE than in the controls (24.2 [7.4] vs 18.9 [7.6]; 95% confidence interval (CI), 2.0‐8.7, p = 0.002), child behavior frequency mean [SD] score (60.3 [16.9] vs 43.5 [12.7]; CI, 10.2‐23.4, p < 0.001 and total BPFA frequency mean [SD] score (84.5 [22.7] vs 62.3 [19.3]; 95% CI, 12.8‐31.5, P < 0.001) respectively.
Conclusions: Feeding behavior was strongly associated with EoE significantly than children without EoE. Pediatricians should be alert for recognizing the eating/behaviors problems of EoE because symptoms of EoE in young children are nonspecific.
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G‐RF065. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐RF065.1. EOSINOPHILIC ESOPHAGITIS IN PEDIATRIC PATIENTS: APPLICATION OF CURRENT TREATMENT OPTIONS AND CLINICAL EXPERIENCES
Nursena Kologlu Ates 1, Ipek Ulkersoy1, Eymen Pinar2, Ahsen Colakoglu2, Ece Kuduban2, Oguzhan Tin1, Erkan Akkus1, Nuray Kepil3, Nevzat Aykut Bayrak4, Omer Beser1, Haluk Cokugras5, Fügen Çullu Çokuğraş6
1Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 2Department Of Pediatrics, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 3Department Of Pathology, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 4University of Health Sciences, Zeynep Kamil Women & Children's Training & Research Hospital, Istanbul, Turkey, 5Department Of Pediatric Allergy And Immunology, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 6Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Demiroglu Bilim University, Faculty of Medicine, Istanbul, Turkey
Objectives and Study: The prevalence of eosinophilic esophagitis (EoE) has been increasing dramatically, however, there is no consensus on the therapeutic and follow‐up approach for this disorder. In this study, we aimed to present our large cohort group diagnosed with EoE to enhance our knowledge on the treatment and follow‐up procedures of this unique group.
Methods: 64 patients diagnosed according to the updated ESPGHAN guidelines (2024) EoE were included in the study. The demographic data, clinical and laboratory findings, eosphagogastroduodenoscopic and histopathologic evaluations, treatment modalities and response to treatment were recorded.
Results: Among 64 patients (n = 51, 80% male) with the median age at diagnosis 5 years, the most common presenting symptoms were vomiting (n = 31, 48%), food impaction (n = 16, 25%) and abdominal pain (n = 16, 25%). A total of 38 patients (59%) had a history of atopy with seven patients having multiple food allergies while seven having asthma, and four having cow's milk protein allergy. The laboratory findings were consistent with this data: The mean total IgE level at presentation was 315 IU/mL and eosinophil ratio was 6.6%. Topical steroid was initiated in 78% of the patients (n = 50), while proton‐pump inhibitors (PPIs) in 100% (n = 64) and elimination diets in 79% (n = 51). 6 patients needed systemic steroids and 6 patients (all diagnosed with esophageal atresia) needed dilatation. During follow‐up, 50 (78%) patients had macroscopic (esophagogastroduodenoscopic), while 49 (76%) had histopathological and 53 (82%) had clinical response to different treatment modalities with the mean duration of 26.1 weeks. The treatment approach including topical steroid was statistically better than the other treatments.
Conclusions: Treatment and follow‐up modalities for EoE have not yet completely been established and we aimed to reveal the outcomes of patients who received different treatment regimens even within our hospital. It is seen from these data that PPI and elimination compose the most basic part of the treatment.
Contact e‐mail address: nursenakologlu@hotmail.com
G‐RF066. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐RF066.1. DUPEOETALY: A REAL‐WORLD STUDY ON THE LONG‐TERM EFFECTIVENESS OF DUPILUMAB IN EOSINOPHILIC ESOPHAGITIS IN CHILDREN AND ADULTS
Salvatore Oliva 1, Enrico Felici2, Giusy Russo1, Sara Curto3, Domenico Gargano4, Gaia Pellegatta5, Francesca Giugliano5, Fabiola Fornaroli6, Silvia Iuliano6, Alessandra Vultaggio7, Elisa Marabotto8, Elisabetta Favero9, Edoardo Vespa10, Barbara Parma11, Maurizio Fuoti12, Sara Renzo13, Elena Pozzi14, Matteo Ghisa15, Daria Maniero15, Giovanni Sarnelli16, Marcella Pesce17, Antonio Pizzol18, Caterina Strisciuglio19, Luca Bosa20, Sara Lega21, Nicola De Bortoli22, Pierfrancesco Visaggi22, Irene Spinelli23, Renato Tambucci24, Maurizio Mennini25, Antonio Di Sabatino26, Rossella Casella27, Eustachio Nettis27, Edoardo Savarino15
1Pediatric Digestive Endoscopy, Pediatric Gastroenterology And Liver Unit, University Hospital Umberto, Sapienza University of Rome, Rome, Italy, 2Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e C. Arrigo, Alessandria, Italy, 38Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e C. Arrigo, Alessandria, Italy, 4Allergy Unit, Azienda Ospedaliera S. Giuseppe Moscati, Avellino, Italy, 5Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy, 6Pediatrics Department, Azienda Ospedaliero‐Universitaria di Parma, Parma, Italy, 7Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, 8Gastroenterology Unit, Department of Internal Medicine, University of Genoa ‐ Ospedale Policlinico San Martino IRCCS, Genoa, Italy, 9Rare Diseases Referral Center, Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, 31100 Treviso, Treviso, Italy, 10Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy, 11Department of Pediatric, Mariani Foundation Center for Fragile Child, ASST‐Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy, 12University Department Of Pediatrics, Children's Hospital, Spedali Civili, Pediatric Gastroenterology and Endoscopy Unit, Brescia, Italy, 13Gastroenterology And Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy, 14Department Of Paediatrics, Vittore Buzzi Children's Hospital, Milan, Italy, 15Department of Surgery, Oncology and Gastroenterology, University of Padua ‐ Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy, 16Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy, 17Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy, 18Paediatric, Pediatric Gastroenterology, Regina Margherita Children Hospital, Turin, Italy, 19Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy, 20Unit Of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology And Care Of The Child With Liver Transplantation, Department Of Women's And Children's Health, University Hospital of Padova, Padova, Italy, 21Pediatrics, Institute For Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy, 22Department of Translational Research and New Technologies in Medicine and Surgery, Gastroenterology Unit, University of Pisa, Pisa, Italy, 23Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore ‐ Department of Medical and Surgical Sciences, UOC CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universit, Rome, Italy, 24Gastroenterology And Nutrition Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy, 25Dipartimento Di Neuroscienze, Salute Mentale E Organi Di Senso (nesmos) ‐ U.o.c. Pediatria, Azienda Ospedaliera Universitaria Sant'Andrea ‐ Sapienza Università di Roma, Rome, Italy, 26Department of Internal Medicine and Medical Therapeutics, University of Pavia‐ Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy, 27Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico di Bari, Bari, Italy
Objectives and Study: Dupilumab, a monoclonal antibody targeting the IL‐4 and IL‐13 pathways, has been increasingly used for Eosinophilic Esophagitis (EoE) treatment. The DUPEOETALY study evaluates its real‐world effictiveness in an Italian cohort over 72 weeks.
Methods: A retrospective observational analysis was conducted on patients from 50 Italian centers intolerant/refractory to conventional therapies, receiving Dupilumab under compassionate use or off‐label before regulatory approval. Key outcomes, including DSQ (Dysphagia Symptom Questionnaire), EREFS (EoE Endoscopic Reference Score), and eosinophil count per high‐power field (Eos/HPF), were assessed at baseline,12,34,36,48,60 and 72 weeks. Mixed‐effects regression models were used to evaluate changes over time.
Results: The cohort included 150 patients (79.2% male, median age 21.5 years [IQR:15‐32.75]). The median age at diagnosis was 17 years (IQR:12‐27.75). At baseline, 47.2% had a family history of atopy, 86.8% had prior corticosteroid treatment, and 96.2% had received proton pump inhibitors. The median BMI was 21.23 kg/m² (IQR:17.73–24.21). Significant improvements were observed across all primary endpoints, with greater benefits over time. DSQ score decreased from 18.37 ± 23.69 at baseline to 0.24 ± 2.43 at 72 weeks (p < 0.001), with progressive reductions at each time point (Fig.1 A). EREFS improved from 4.42 ± 3.35 to 0.01 ± 0.10 (p < 0.001), and Eos/HPF declined from 39.42 ± 32.88 to 0.05 ± 0.49 (p < 0.001), with more significant reductions in patients on therapy longer (Fig.1B). By week 72, 99.1% of patients achieved remission criteria (DSQ ≤ 5, Eos≤15, and EREFS ≤ 2), indicating a cumulative benefit of prolonged treatment (Fig.1 C). Mixed‐effects modeling confirmed significant improvements independent of baseline demographics and prior therapies. Adverse events were minimal, with 7.5% of patients experiencing mild events at 12 weeks, decreasing to 0% by 60 weeks.
Conclusions: The DUPEOETALY study provides real‐world evidence on Dupilumab's effectiveness in reducing symptomatic, endoscopic, and histological markers of EoE. Our findings confirm that longer therapy duration leads to better outcomes. The favorable safety profile supports Dupilumab as a viable long‐term option for EoE management.
Contact e‐mail address: salvatore.oliva@uniroma1.it
G‐RF067. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐RF067.1. EOSINOPHILIC DUODENITIS WITH STENOSIS IN PEDIATRICS: A CHALLENGING CASE
Mariana Rodrigues Neto, Margarida Moreno Fernandes, Maria Cristina Costa, Andreia Ribeiro
Unidade Local de Saúde Gaia Espinho, Vila Nova de Gaia, Portugal
Objectives and Study: Non‐eosinophilic esophagitis eosinophilic gastrointestinal disorders (non‐EoE EGIDs) are rare, chronic inflammatory conditions of the gastrointestinal (GI) tract with uncertain long‐term outcomes. Classified as eosinophilic gastritis, duodenitis, enteritis, and colitis, these disorders have clinical manifestations that vary by site and severity of eosinophilic inflammation and bowel wall involvement. The pathogenesis involves immune dysregulation, genetic predisposition and environmental triggers, with a challenging diagnosis requiring both clinical symptoms and histologic evidence of inflammation.
Methods: In this case we report a pediatric case with history of atopy (asthma and allergic rhinitis) and eosinophilic esophagitis (EoE), who developed duodenal stenosis due to eosinophilic duodenitis.
Results: Initial symptoms included food impaction and dysphagia, with an upper gastrointestinal endoscopy (EGD) revealing esophageal trachealization, whitish exudate, and non‐transposable stenosis. Histological examination confirmed EoE. Treatment with proton pump inhibitors (PPIs) showed partial improvement, necessitating the addition of swallowed corticosteroids. Dual therapy achieved histological remission. Two years later, the child presented with epigastric pain, persistent vomiting, early satiety, halitosis, and weight loss. An EGD showed mid‐esophageal stenosis, trachealized mucosa, longitudinal grooves (image 1), and, in the distal esophagus, confluent erosions in >75% of the esophageal junction (Los Angeles classification grade D), consistent with stasis esophagitis (image 2). Additionally, antral‐pyloric deformation and ulcerated stenosis at the duodenum were observed (image 3). Histology confirmed eosinophilic duodenitis. An enteric MRI revealed gastric distension and thickened duodenal walls. Oral corticosteroids, optimized PPI therapy, and swallowed fluticasone initially improved symptoms. However, corticosteroid withdrawal led to disease relapse, prompting initiation of biological therapy with Dupilumab.
Conclusions: Non‐EoE EGIDs represent a heterogeneous group of disorders with diverse presentations, challenging diagnostic and variable treatment responses. Increased awareness and advances in pathophysiology and targeted therapies are vital for improving patient outcomes and life quality.
Contact e‐mail address: mirnneto@gmail.com
G‐RF068. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐RF068.1. ALLERGEN AND PANALLERGEN SENSITIZATION PROFILES IN PEDIATRIC EOSINOPHILIC ESOPHAGITIS PATIENTS: A SINGLE CENTRE EXPERIENCE
Raffaella De Santis1, Cristina Ferrigno1, Valentina Silvera 1, Miriam Acunzo1, Laura Gianolio1, Cecilia Mantegazza1, Cristina Cocuccio1, Elena Pozzi1, Lorenzo Norsa1, Enza D'Auria1, Gian Vincenzo Zuccotti1,2
1Paediatrics, Buzzi Children's Hospital, University of Milan, Italy, 2Biomedical And Clinical Sciences, University of Milan, Milan, Italy
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic, immune‐mediated disorder associated with atopic comorbidities and considered a potential late manifestation of the atopic march. This study evaluates the prevalence of sensitization to foods, aeroallergens, and panallergens in pediatric EoE patients and their clinical characteristics and response to proton pump inhibitors (PPIs).
Methods: A prospective cross‐sectional study at Buzzi Children's Hospital, Milan, included pediatric EoE patients diagnosed since January 2016, all undergoing 8 weeks of PPI induction therapy. Data on family history, allergic comorbidities, and sensitization were collected. Clinical, endoscopic, and histological findings were assessed at diagnosis and post‐therapy. Esophageal histological remission was defined as fewer than 15 eosinophils per high‐power field. Statistical analyses included Fisher's exact test and t‐tests.
Results: 24 patients (median age 11 years, IQR 9‐13; 23 males) were enrolled. 79% (19/24) had a family history of atopy and allergic comorbidities, including allergic rhinitis (50%, 12/24), atopic dermatitis (42%, 10/24), asthma (33%, 8/24), and food allergies (25%, 6/24). Total IgEs were elevated in 79% (19/24). Polysensitization to food allergens (≥3 allergens) was common (71%, 17/24), notably to wheat (79%, 19/24), tree nuts (67%, 16/24), and sesame (63%, 15/24). Inhalant sensitization was observed in 70% (14/20), mainly to grass pollen (75%, 15/20) and Betulaceae (65%, 13/20). Panallergen sensitization was present in 64% of the cohort (15/24), with Bet v1 and Phl p12 as the most frequent (42% each, 10/24). Histological remission following PPI therapy was achieved in 25% (6/24). PPI non‐responders (75%, 18/24) showed significantly higher prevalence of panallergen sensitization (78% vs. 17%; p = 0.015) and atopic dermatitis (56% vs. 17%; p < 0.05).
Conclusions: This study highlights, for the first time, the role of panallergens in pediatric EoE and their possible involvement in predicting PPI response. Atopic comorbidities and sensitization profiles should be considered in treatment decisions, though further research is needed to confirm these findings.
Contact e‐mail address: raffaella.desantis@unimi.it
G‐RF069. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐RF069.1. COMPARATIVE ANALYSIS OF COMPLICATION RATES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS AND ASTHMA TREATED WITH DUPILUMAB VS. BUDESONIDE
Melissa Ramirez Escobar1, Shagun Sharma2, Thomas Wallach 3
1Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, United States of America, 2SUNY Downstate Health Sciences University, Brooklyn, United States of America, 3Pediatric Gastroenterology, SUNY Downstate Health Sciences University, Brooklyn, United States of America
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic and progressive type 2 inflammatory condition of the esophagus. Incidence is increasing annually, with high association with other atopic diseases. Given impact on multiple disease domains, we set out to assess the impact of standard (budesonide) vs new therapy (dupilumab) in the clinical burden faced by patients with EoE and asthma.
Methods: This was a retrospective cohort study using the Global Collaborative TriNetX Network. We created cohorts of patients aged 0‐18 years with ICD‐10 diagnosis of Asthma and Eosinophilic Esophagitis on isolated oral budesonide vs isolated dupilumab treatment. Outcomes were identified using ICD‐10 codes for asthma exacerbation, endoscopy, and use of oral steroids occurring within a time window up to 2 years.
Results: A total of 1488 pediatric patients were included (918 in the dupilumab cohort vs 570 in the budesonide cohort). Pediatric patients receiving dupilumab are at a lower risk of unspecified asthma exacerbation [RR 0.310 (0.203, 0.475), p value = <0.005], mild intermittent asthma with acute exacerbation [RR 0.327 (0.153, 0.698), p value = 0.002], moderate persistent asthma with acute exacerbation [RR 0.549 (0.317, 0.953), p value = 0.031], need for endoscopy [RR 0.819 (0.726, 0.924), p value = 0.001], and use of oral steroids [RR 0.769 (0.614, 0.963), p value = 0.022] compared to pediatric patients treated with budesonide.
Conclusions: EoE is a condition with substantial associated clinical burden in the form of atopic disease and endoscopic evaluation. Our study demonstrates that dupilumab use on patients with EoE and asthma significantly reduces the rate of asthma exacerbation, endoscopies, and steroid use in comparison with traditional therapy. These ancillary effects, above and beyond the indication for treatment, suggest that dupilumab may be indicated as a first line therapy in patients with comorbid atopy.
Contact e‐mail address: melissa.ramirezescobar@downstate.edu
G‐RF070. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF070.1. TRANSITION READINESS AND KNOWLEDGE GAPS IN ADOLESCENTS WITH ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULA
Muhannad Abu Abthan 1,2, Hussain Alturki1,3, Margaret Marcon1, Priscilla Chiu1, Theo Moraes1, Michelle Gould1
1The Hospital for Sick Children, Toronto, Canada, 2Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia, 3Pediatric Medicine, University of Toronto, Toronto, Canada
Objectives and Study: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a congenital anomaly requiring early surgical intervention, often associated with other anomalies. Despite improved survival rates, individuals with EA/TEF face ongoing health challenges into adulthood. Education about the condition is typically provided early in life when patients lack the capacity to fully understand the information. This study aimed to identify knowledge gaps and evaluate the readiness of adolescents with EA/TEF for transition to adult care.
Methods: We conducted a retrospective review of adolescents aged 15–18 years with repaired EA/TEF who were followed at a multidisciplinary aerodigestive clinic in a single tertiary care center between September 2023 and October 2024. Participants completed the Transition Readiness Assessment Questionnaire (TRAQ) 6.0 and a clinician‐administered disease‐specific knowledge assessment during follow‐up visits.
Results: Seventeen adolescents (median age: 17 years (IQR: 16–18); 53% male) were included; 53% had additional congenital anomalies. Among the 16 who completed the knowledge assessment, 37.5% (n = 6) could not name their esophageal condition, 81.3% (n = 13) were unaware of their EA/TEF type, and 87.5% were unfamiliar with recommended endoscopic surveillance timing. TRAQ scores showed a median overall readiness of 3.55 out of 5 (IQR: 3.175–4.15) representing “some active participation in self‐management”, with the lowest subscale score in Managing Medications (2.8; IQR: 2–3.5) and the highest in Talking to Providers (4.4; IQR: 3.9–4.8).
Conclusions: Our study reveals significant gaps in disease‐specific knowledge among adolescents with EA/TEF, with many unable to name their condition or describe their future surveillance needs. Although many could identify their medications, low TRAQ scores in the Managing Medications subscale highlight challenges in self‐management. Encouragingly, participants expressed an interest in enhancing their skills in managing prescriptions, appointments, and health tracking. These findings underscore the essential role of providing tailored education to prepare adolescents for adult care with increased self‐management.
Contact e‐mail address: muhannad.abuabthan@sickkids.ca
G‐RF071. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF071.1. ESOPHAGEAL COMORBIDITIES ARE COMMON IN ADOLESCENTS WITH ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULA: RESULTS FROM A RETROSPECTIVE STUDY
Muhannad Abu Abthan 1,2, Hussain Alturki1, Margaret Marcon1, Priscilla Chiu1, Theo Moraes1, Michelle Gould1
1The Hospital for Sick Children, Toronto, Canada, 2Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
Objectives and Study: Survival rates for patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) have improved over recent decades. With increased survival, routine surveillance for long‐term complications of EA/TEF is paramount for ensuring patients remain well across their lifespans. This study aimed to evaluate upper endoscopic findings in adolescents with EA/TEF and identify rates of various long‐term complications.
Methods: We completed a retrospective review of adolescents with EA/TEF followed at a single institution from January 2000 through December 2023. Eligibility criteria included a diagnosis of repaired congenital EA/TEF and at least one esophagogastroduodenoscopy performed at or after the age of 12 years. Abstracted data included patient demographics, type of fistula, gastrointestinal symptoms, esophageal endoscopic findings, esophageal pathology results, and history of anti‐reflux surgery.
Results: A total of 51 adolescents (median age: 17 years; 43% male) with repaired EA/TEF were included. The majority (87.2%) had type C EA/TEF. Abnormal endoscopic esophageal mucosal findings were identified in 31 patients (61%), which included erythema, furrowing, ulceration, or exudate. Six patients (12%) required dilation for anastomotic strictures. Many patients also had abnormal histological findings, including esophagitis (n = 17, 33%), eosinophilic infiltration (>15 eosinophils per high‐power field) (n = 5, 9.8%) and metaplasia (gastric or intestinal) (n = 5, 9.8%). Notably, 55% of patients who had undergone anti‐reflux surgery exhibited microscopic esophagitis in adolescence. Most patients with endoscopic abnormalities also had associated clinical symptoms such as heartburn, regurgitation, or dysphagia (n = 25/27, 92.6%).
Conclusions: Adolescents with EA/TEF may have esophageal abnormalities including some with severe findings like metaplastic changes. While anastomotic strictures and recurrent fistulas are more common in younger children, they can also be identified in adolescents. Endoscopic surveillance plays a critical role in identifying and managing these comorbidities, especially since asymptomatic patients still exhibit abnormalities. This study highlights the need for endoscopic monitoring of adolescents with EA/TEF to mitigate potential long‐term sequelae.
Contact e‐mail address: muhannad.abuabthan@sickkids.ca
G‐RF072. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF072.1. RADIATION‐ASSOCIATED IMAGING BURDEN IN PATIENTS WITH ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULA: RESULTS FROM A RETROSPECTIVE STUDY
Hussain Alturki1,2, Muhannad Abu Abthan 2, Nicholas Shkumat2, Margaret Marcon2, Priscilla Chiu2, Theo Moraes2, Michelle Gould2
1Pediatric Medicine, University of Toronto, Toronto, Canada, 2The Hospital for Sick Children, Toronto, Canada
Objectives and Study: Children with esophageal atresia (EA) and tracheoesophageal fistula (TEF) require long‐term follow‐up, often involving imaging studies. While previous research focused on radiation exposure during infancy, the number of imaging studies these patients undergo throughout childhood remains unclear. We sought to quantify the number of studies involving ionizing radiation that patients with a history of EA/TEF complete from birth until transition to adult care, and whether this changed over time.
Methods: A retrospective review of patients with EA/TEF born between 1999 and 2011 followed at the Hospital for Sick Children was completed. Included patients had consistent follow‐up by the multidisciplinary EA/TEF team (gastroenterology, general surgery, and respirology) from their initial EA/TEF repair until at least 12 years of age. Abstracted data included demographics, fistula/gap type, VACTERL association, and imaging studies (x‐rays, fluoroscopy, CT, and nuclear medicine). Imaging data for patients born before and after 2005 were compared using an unpaired t‐test.
Results: A total of 78 patients were included. Median final follow‐up age was 17 years (IQR 14.25–17), 38 (49%) were male, 22 (28%) had VACTERL association, 18 (23%) had long‐gap EA/TEF, and 63 (81%) had type C TEF. Median imaging studies per patient were: 30.5 x‐rays (IQR 15–58.25), 12 fluoroscopic studies (IQR 6.25–22), 0 CT scans (IQR 0–1.75), and 0 nuclear medicine studies (IQR 0–1). Upper gastrointestinal contrast studies comprised 38% of fluoroscopic studies (mean of 6 per patient). No differences in overall number of studies were found between patients born before and after 2005 (p = 0.32) except a statistically significant (p = 0.03) though clinically insignificant (studies < 1) change in nuclear medicine studies.
Conclusions: EA/TEF patients undergo a large number of radiologic scans with associated radiation exposure across their childhood. Given the potential risks linked to radiation exposure, developing follow‐up protocols minimizing unnecessary imaging while still ensuring effective clinical monitoring is essential.
Contact e‐mail address: hussain.alturki@sickkids.ca
G‐RF073. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF073.1. GENETIC PREDICTION OF PARENTERAL NUTRITION WEANING IN CONGENITAL ENTEROPATHIES
Jade Allée 1, Cécile Lambe2, Bénédicte Pigneur3, Cécile Talbotec2, Elie Abi‐Nader4, Florence Campeotto4, Elise Payen3, Frank Ruemmele3, Fabienne Charbit‐Henrion5,6
1Université de Paris, Paris, France, 2Service De Gastro‐entérologie Et Nutrition Pédiatrique, AP‐HP. Centre‐ Université Paris Cité, Hôpital Necker‐Enfants Malades, Paris, France, Paris, France, 3Pediatric Gastroenterology And Nutrition Unit, Necker Enfants Malades Hospital, PARIS, France, 4Gastroenterology And Nutrition Unit, Pediatric Hospital Necker Enfants malades, Paris, France, 5Genetic Department, Pediatric Hospital Necker Enfants malades, Paris, France, 6Department Of Genomic Medecine Of Rare Diseases, AP‐HP. Centre‐ Université Paris Cité, Hôpital Necker‐Enfants Malades, Paris, France, Paris, France
Objectives and Study: Congenital enteropathies are a heterogeneous group of rare genetic disorders characterized by structural and functional abnormalities in the intestinal epithelium, leading to early onset diarrhea, malabsorption, and failure to thrive. Parenteral nutrition (PN) is the standard treatment and allows patient survival, but remains a symptomatic therapy associated with numerous complications. Intestinal transplantation, once a common alternative, has seen its indications decrease. In certain conditions, weaning from PN is possible, sometimes with dietary interventions or intestinal transplantation, emphasizing the crucial role of understanding genotype‐phenotype correlations in guiding therapeutic strategies.
Methods: We conducted a retrospective, descriptive, monocentric study of 56 patients born between 2000 and 2022, followed at Necker Hospital for a monogenic congenital enteropathiy linked to structural or functional defects of the intestinal epithelium, with an identified mutation, and who received at least 6 months of PN during their follow‐up. We classified the different disorders into 6 subgroups: epithelial trafficking and polarity disorders, epithelial cell adhesion disorders, epithelial enzyme and metabolism disorders, enteroendocrine disorders, epithelial stem cell and DNA reparation disorders, Tricho‐hepato‐enteric syndrome. The degree of dependence on PN was assessed at 1,2,3 and 5 years old using the PN/REE (%) ratio and the PN volume (ml/kg/day).
Results: We included 56 patients affected by 14 different pathologies, resulting from mutations in 19 different genes. Fifteen patients (27%) out of 56 were weaned from PN during the 5 years follow‐up. Weaning was observed in four groups: lipid metabolism disorder (4/5), epithelial trafficking and polarity disorders (6/18), DNA reparation disorders (3/5), EEC disorders (2/8). These patients had mutations in DGAT1, MYO5B, TTC7A, NEUROG3, PCSK1, RECQL4 or ERCC2 genes.
Conclusions: PN weaning in patients with congenital enteropathies is possible, with variability based on the underlying etiology. Assessing genotype‐phenotype correlation is crucial for optimizing patient management, informing families, and improving long‐term outcomes through personalized treatment strategies.
Contact e‐mail address: jade.allee@aphp.fr
G‐RF074. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF074.1. CHARACTERISTICS OF DANISH INFANTS REFERRED WITH GASTROESOPHAGEAL REFLUX DISEASE: A DESCRIPTIVE COHORT STUDY ON RISK FACTORS, SYMPTOMATOLOGY AND INITIAL TREATMENT
Natalia Barkholt 1, Josefine Gradman2, Gitte Zachariassen2
1Department Of Paediatrics, And Syddansk University (sdu), Sygehus Sønderjylland, Aabenraa and Odense, Denmark, 2Department Of Paediatrics, H.C Andersen Childrens Hospital, Odense University Hospital, Odense, Denmark, and Syddansk University (SDU), Odense, Denmark
Objectives and Study: Gastroesophageal reflux disease (GERD) is a prevalent condition in infants, and the disease burden is increasing. Infants with reflux and discomfort cause significant parental concern. This study aims to evaluate the background characteristics, symptomatology and initial treatment of these patients.
Methods: This descriptive prospective cohort study consecutively included infants less than one year of age, referred to three paediatric centres in the Region of Southern Denmark from 2022 to 2024. Data were collected from caregiver questionnaires and patient records.
Results: The study included 97 infants, 50 girls and 47 boys. Median age at first visit was 2,4 months (Interquartile range (IQR): 1,8; 3,6). The majority (75%) were delivered vaginally, with a median birth weight of 3435 g (IQR: 3170; 3783), and 51% were firstborn. Most infants were breastfed, either completely (51%) or partially (37%). In 51% of the cases, at least one of the parents reported having an allergy, while only two parents had reflux. One or more manual treatments were used before referral, 47% had chiropractic treatment, 23% osteopathy, 13% physiotherapy, 15% zone therapy and 7% craniosacral therapy. The most commonly reported symptoms were daily episodes of reflux (91%), discomfort during meals (71%), troublesome breathing (60%), and back‐arching episodes (59%). Based on the clinician's judgement, 47% had uncomplicated gastroesophageal reflux (GER) while 53% had GERD. A cow's milk protein‐free diet was the most frequently used initial therapy (52%), while Proton Pump Inhibitor was prescribed in 12% at first visit, increasing to 36% at second visit.
Conclusions: In this Danish cohort, most infants referred with symptoms of GERD received manual therapy before paediatric referral. The majority was firstborns, breastfed and parental allergy was common. Most frequent treatment at first visit was cow's milk protein free diet. Further research is needed to enhance our understanding of the rising number of infants referred with GERD.
Contact e‐mail address:
G‐RF075. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF075.1. LOSS OF WNT2B IMPAIRS INTESTINAL EPITHELIAL DIFFERENTIATION AND PREDISPOSES TO GASTROINTESTINAL DYSPLASIA IN HUMANS
Leslie Lori1, Valentin Neuranter2, Corinne Lebreton2, Jérémy Berthelet3, Marianna Parlato2, Christina Michail3, Anis Khiat2, Dominique Berrebi4, Julie Bruneau4, Benoit Terris5, Georgia Malamut6, Sylvain Hanein7, Yohann Schmitt8, Céline Banal9, Fernando Rodrigues Lima10, Emilie Azouguene11, Frank Ruemmele12, Cécile Talbotec12, Cécile Lambe12, Nadine Cerf‐Bensussan2, Fabienne Charbit‐Henrion 2,11
1Laboratory Of Intestinal Immunity, Université Paris‐Cité, Institut Imagine, Paris, France, 2Université Paris Cité, Institut Imagine, Laboratory of Intestinal Immunity, INSERM U1163, Paris, France., Paris, France, 3Epigenetics And Cell Fate, Université Paris Cité, CNRS, Paris, France, 4Department Of Pathology, AP‐HP. Centre‐ Université Paris Cité, Hôpital Necker‐Enfants Malades, Paris, France, Paris, France, 5Department Of Pathology, AP‐HP. Centre‐ Université Paris Cité, Hôpital Cochin, Paris, France, Paris, France, 6Department Of Gastroenterology, AP‐HP. Centre‐ Université Paris Cité, Hôpital Cochin, Paris, France, Paris, France, 7Bioinformatic Platform, Institute of Genetic Diseases, INSERM UMR1163, Imagine, Université Paris‐Cité and Structure Fédérative de Recherche Necker, 75015 Paris, France, Paris, France, 8Genomics Core Facility, Institut Imagine‐Structure Fédérative de Recherche Necker, INSERM U1163 et INSERM US24/CNRS UAR3633, Paris Cite University, Paris, France, Paris, France, 9Université Paris‐Cité, iPSC Core Facility, Institut Imagine, INSERM U1163, 75015 Paris, France, Paris, France, 10Université Paris Cité, CNRS, Unité de Biologie Fonctionnelle et Adaptative, 75013, Paris, France, Paris, France, 11Department Of Genomic Medecine Of Rare Diseases, AP‐HP. Centre‐ Université Paris Cité, Hôpital Necker‐Enfants Malades, Paris, France, Paris, France, 12Service De Gastro‐entérologie Et Nutrition Pédiatrique, AP‐HP. Centre‐ Université Paris Cité, Hôpital Necker‐Enfants Malades, Paris, France, Paris, France
Objectives and Study: WNT2B deficiency was recently identified as a cause of congenital diarrhea. WNT2B signals through the β‐catenin pathway, crucial for stem cell proliferation.
Methods: P1 and P2, two female patients, presented with severe neonatal diarrhea and failure to thrive, requiring parenteral nutrition. Methods used include exome sequencing, quantitative RT‐PCR, immunofluorescence, and generation of intestinal organoids from induced pluripotent stem cells.
Results:
P1 carried compound heterozygous variants c.409 C>T;p.Arg137* and c.794 T>C;p.(Leu265Pro) and P2 a homozygous variant c.681 G>As; p.Thr227= in WNT2B. Confirming loss of WNT2B signalling, mRNA levels of WNT2B gene targets, OLFM4, LGR5, and AXIN2, were almost undetectable in gastric biopsies. P1 and P2 presented severe gastric atrophy and partial duodenal villous atrophy, with severely decreased plasma citrulline levels. Impaired stem cell proliferation and atrophy do not fully explain the malabsorption in WNT2B‐deficient patients. P1 showed significant nitrogen malabsorption. Selective inhibition of NHE3 drastically reduces peptide uptake. Accordingly, duodenal expression of NHE3 and DRA was almost undetectable in both patients. Other epithelial differentiation abnormalities were found: paneth cells mislocalization in both patients, prominent antral metaplasia in P1, and defective 3D structures with fewer single lumen in intestinal organoids from both patients. At age 9, an endoscopy in P1 incidentally revealed a pre‐pyloric adenoma with metaplasia and high‐grade dysplasia. Paired somatic‐germline exome sequencing revealed a pathogenic variant in CTNNB1 encoding for β‐catenin. CTNNB1 somatic variant affected a key phosphorylation site, Ser37, which stabilizes β‐catenin and reactivates the WNT/β‐catenin signaling pathway. Accordingly, OLFM4, LGR5 and AXIN2 expression was increased in the precancerous lesion compared to non‐dysplastic antrum, giving CTNNB1‐mutant cells a proliferative advantage.
Conclusions: WNT2B is critical for proliferation but also for differentiation of intestinal epithelial cells. Our report help anticipate adverse effects of in‐development WNT antagonists for cancers treatment and stresses the need to monitor WNT2B‐deficient patients for malignant transformation.
Contact e‐mail address: fabienne.charbit-henrion@inserm.fr
G‐RF076. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF076.1. 2′‐FL AND LNNT AMELIORATE GUT BARRIER DYSFUNCTION INDUCED BY EARLY WEANING IN MICE
Ru Chen, Lu Jiang, Wei Cai
Division Of Pediatric Gastroenterology And Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, Shanghai, China
Objectives and Study: Early weaning is a common practice among young mothers and is associated with an increased risk of gastrointestinal disorders. Human milk oligosaccharides (HMOs) play a critical role in maintaining gut barrier integrity and have been increasingly applied in infant formulas. However, the mechanisms of HMOs in maintaining gut function remain unclear. This study aimed to assess the effects of 2′‐fucosyllactose (2′‐FL) and Lacto‐N‐neotetraose (LNnT) in a mouse model of early weaning.
Methods: Fourteen‐day‐old mouse pups were randomly assigned to five groups: (1) control (normal suckling); euthanized at postnatal day (PND) 21; (2) early weaning (EW; weaned at PND 15); (3) EW+HMOs (2′‐FL+LNnT); (4) EW + 2′‐FL; (5) EW+LNnT. Body weight and energy intake were monitored, and intestinal permeability and inflammation‐related markers were assessed post‐euthanization. The fecal levels of Bifidobacterium were analyzed by qPCR. RNA sequencing of jejunal samples was conducted to investigate the transcriptomic profiles.
Results: At PND 21, no significant difference in body weight or food intake was observed among the five groups. Histopathological evaluation showed no evidence of intestinal injury or epithelial mucosal barrier impairment in jejunum, ileum, or colon sections. However, mice in the early weaning (EW) group exhibited increased intestinal permeability, as indicated by qPCR and immunofluorescence staining for zonula occludens (ZO)‐1. This increase was alleviated by supplementation with HMOs or LNnT. Fecal levels of Bifidobacterium were significantly reduced in the EW group but were restored following HMOs or LNnT supplementaton alone. Notably, RNA‐seq analysis revealed enrichment of the PPAR signaling pathway in the EW group compared to both the control and EW+HMOs groups, suggesting a role for PPAR signaling in HMO‐mediated improvements in intestinal permeability.
Conclusions: Our study demonstrates that early weaning increases intestinal permeability and reduces Bifidobacterium levels, while HMO supplementation offers potential benefits, likely through the regulation of PPAR signaling.
Contact e‐mail address:
G‐RF077. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF077.1. THE EFFECT OF EARLY TREATMENT WITH MACROLIDES ANTIBIOTICS IN CAMPYLOBACTER ENTERITIS
Ho Jung Choi, In Hyuk Yoo
Department Of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of
Objectives and Study: Azithromycin is widely recommended as the first‐line treatment for pediatric Campylobacter enterocolitis in various clinical guidelines. However, supporting evidence is limited, and studies evaluating the efficacy of other macrolide antibiotics are lacking. This study aims to assess the effectiveness of initiating macrolide therapy within three days of symptom onset in pediatric patients with Campylobacter enterocolitis. By addressing the gap in evidence, this research seeks to provide a broader understanding of the therapeutic potential of macrolides in managing this condition.
Methods: During the study period, pediatric patients under 19 years of age with a new diagnosis of Campylobacter enterocolitis were enrolled and randomly assigned to receive macrolide antibiotic treatment with either azithromycin or clarithromycin in a 1:1 ratio. Additionally, a historical cohort of pediatric patients diagnosed with Campylobacter enterocolitis prior to the study period, who did not receive macrolide antibiotics, was retrospectively reviewed for comparison. This dual approach allowed for evaluation of the effectiveness of macrolide therapy against untreated cases.
Results: The study included 27 patients in the macrolide group and 37 patients in the no macrolide group. There were no statistically significant differences in baseline characteristics between the two groups. However, the macrolide group showed significantly shorter durations of fever (p < 0.001), diarrhea (p < 0.001), illness (p < 0.001), and hospital admission (p = 0.002) after treatment initiation compared to the no macrolide group (Table 1). In multivariate analyses of factors associated with symptom resolution, macrolide use was identified as a significant factor.
Conclusions: The use of macrolide antibiotics within three days of symptom onset in pediatric patients with Campylobacter enterocolitis is effective in reducing the duration of fever, diarrhea, illness, and hospital stay.
Contact e‐mail address: yoohymn@naver.com
G‐RF078. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF078.1. EFFICACY OF DIFFERENT POST‐BIOTIC PREPARATIONS AGAINST OXIDATIVE STRESS INDUCED BY SPIKE PROTEIN OF SARS‐COV‐2 IN HUMAN ENTEROCYTES
Valentina Cioffi 1, Chiara Fulgione1, Antonietta Tarallo1,2, Carla Damiano1,2, Giancarlo Parenti1,2, Alfredo Guarino1, Marco Poeta1
11 department Of Translational Medical Science, Section Of Pediatrics, University of Naples Federico II, Naples, Italy, 2Telethon Institute of Genetics and Medicine, Napoli, Italy
Objectives and Study: The Spike protein of SARS‐CoV‐2 acts as an enterotoxin by inducing chloride secretion and an increase in reactive oxygen species (ROS) in human enterocytes. Probiotics are recommended for treatment of acute gastroenteritis. We tested the efficacy of different post‐biotic preparations against oxidative stress induced by Spike protein in human enterocytes.
Methods: Oxidative stress was analyzed in terms of ROS (DCFDA), lipid peroxidation (TBARS) and GSH levels (DNTB) after Spike protein addition to Caco‐2 cells. The same experiments were performed 1‐hour after cell pre‐treatment with post‐biotic preparations of Lacticaseibacillus rhamnosus (LGG), Saccharomices boulardii (Sb) and Limosilactobacillus reuteri (LR). Sodium Arsenite (ARS) and N‐acetylcysteine (NAC) were used as positive and negative controls, respectively.
Results: Spike induced a 2‐fold increase of ROS (p < 0.0001), a 3.5‐fold increase in lipid peroxidation (p < 0.0001), and a reduction in GSH (p < 0.0001) with a toxic effect similar to ARS. Pretreatment with post‐biotic preparations significantly reduced ROS (p < 0.001), lipid peroxidation (p < 0.001) and GSH levels (p < 0.001), with an antioxidant effect similar to NAC. No differences were found in terms of efficacy among the 3 different post‐biotics (p > 0.05).
Conclusions: The different post‐biotic preparations prevented the oxidative stress induced by Spike protein. Efficacy is comparable among post‐biotics, suggesting that different probiotic strains act on the same intracellular pathways, thereby providing the opportunity to identify specific post‐biotic products with antioxidant effects.
Contact e‐mail address:
G‐RF079. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF079.1. EPSTEIN BARR VIRUS INFECTION IN CHILDREN WITH IBS AND FAP WITH OR WITHOUT AUTISM. A STUDY ON PLASMA CYTOKINE RESPONSE AND EBER‐RNA ON INTESTINAL BIOPSIES
Karl Anders Dahlstrom 1, Helen Pavis1, Thom Lawson2, Paul Ashwood3
1Pediatric Gastroenterology, STANFORDCHILDREN'SHEALTH, Pebble Beach, United States of America, 2Lawson & Associates, El Cerrito, United States of America, 3Immunology, UC DAVIS, DAVIS, United States of America
Objectives and Study: IBS and FAP, WHICH CAN BE CAUSED BY EBv‐INFECTION, IS COMMON IN AUTISTIC CHILDREN. HIGH LEVELS OF TNF‐a, INDICATING AN ABNORMAL IMMUNE RESPONSE, HAVE BEEN REPORTED IN AUTISTIC CHILDREN. THE OBJECTIVES OF THIS STUDY WERE TO COMPARE POSITIVE EBV‐SEROLOGY WITH (1) PLASMA‐CYTOKINE LEVELS AND (2) EBER‐ISH EBV‐RNA INSITU HYBRIDIZATION FROM INTESTINAL BIOPSIES FROM CHILDREN.
Methods: WITH PARENTAL CONSENT, BLOOD AND STOOL TESTS WERE PERFORMED IN 34 CHILDREN WITH IBS/FAP (ROME III‐CRITERIA); 20 NON‐AUTISTIC (40% MALE) AND 14 AUTISTIC (100% MALE). BLOOD ANALYSES INCLUDED FULL EBV‐SEROLOGY FOR EARLY (IgM/EA) AND PAST(IgG/EBNA) INFECTION. EGD AND COLONOSCOPIES WERE PERFORMED ON ALL EBV‐POSITIVE CHILDREN. 20/34 CHILDREN HAD CYTOKINE PLASMA ANALYSIS (1)(LUMINEX, UC DAVIS, CA) COMPLETED.15/34 PATIENTS HAD EARLY‐RNA TRANSCRIPTS WITH IN SITU HYBRIDIZATION, USING EBER‐ISH‐RNA (2)(VENTANA MEDICAL SYSTEMS, L.A.,CA) ON INTESTINAL BIOPSIES.
Results: ALL BLOOD AND STOOL TESTS WERE WNL, BUT EBV‐SEROLOGY WAS POSITIVE IN 15/34 CHILDREN, THE MAJORITY WITH PAST INFECTION.THERE WAS NO STATISTICAL DIFFERENCE IN EBV‐SEROLOGY OR CYTOKINE LEVELS BETWEEN THE GROUPS, EXCEPT FOR ELEVATED TNF‐a IN THE AUTISTIC GROUP. THE EGD AND COLONOSCOPY BIOPSIES WERE ALL WNL, EXCEPT 3 EGDs SHOWED DUODENAL‐HYPERPLASIA AND 2 COLONOSCOPIES SHOWED TI‐LYMPHOID HYPERPLASIA.Of THE 15 EBER‐ISH/RNA INSITU‐TESTS, 7 WERE POSITIVE FOR EBV‐INFECTED B‐CELLS AND 5 NEUROENDOCRINE CELLS ALSO TESTED POSITIVE FOR EBV.
Conclusions: PAST EBV INFECTION IS COMMON IN CHILDREN WITH IBS/FAP. SOME BIOPSIES FROM DUODENUM AND T.I. TISSUES SHOWED THE PRESENCE OF LYMPHOID HYPERPLASIA, AN INDICATION OF INFECTION OR INFLAMMATION. GUT ASSOCIATED LYMPHOID TISSUE HAS BEEN SHOWN TO CONTROL INTESTINAL MOTILITY WHICH MAY BE AFFECTED BY THE EBV INFECTED B‐CELLS. THE NEUROENDOCRINE CELLS HAVE BEEN SHOWN TO CONTROL INTESTINAL MOTILIY, WHICH CAN BE ALTERD BY INFECTION OR INFLAMMATION. OUR FINDINGS DEMONSTRATE THAT EBV INFECTIONS MAY INTERFERE WITH INTESTINAL MOTILITY AND ARE ASSOCIATED WITH, AND POSSIBLY CAUSE, IBS/FAP IN CHILDREN.
Contact e‐mail address: andersdahlstrom3@hotmail.com
G‐RF080. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF080.1. EFFECTS OF IBP‐9414, A LIVE BIOTHERAPEUTIC PRODUCT, ON NECROTIZING ENTEROCOLITIS, FULL ENTERAL FEEDING, AND MORTALITY IN VERY LOW BIRTH WEIGHT INFANTS: CONNECTION STUDY RESULTS
Josef Neu1, Teresa Del Moral 2, Scott Guthrie3, Mark Hudak4, Flavia Indrio5, Jae Kim6, Anders Kronström7, Camilia Martin8, Neena Modi9, Jonas Rastad7, Rachana Singh10, Staffan Strömberg7, Hania Szajewska11, Marcus Thuresson7, Michael Caplan12
1University of Florida, Gainesville, United States of America, 2Miller School of Medicine, Florida, United States of America, 3Vanderbilt University School of Medicine, Nashville, United States of America, 4University of Florida College of Medicine, Jacksonville, United States of America, 5Department of Experimental Medicine, University of Salento, Lecce, Italy, 6Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America, 7Infant bacterial therapeutics, Stockholm, Sweden, 8Weill Cornell Medicine, New york city, United States of America, 9Imperial College London, London, United Kingdom, 10Tufts University School of Medicine, Boston, United States of America, 11Department Of Paediatrics, Medical University of Warsaw, Warsaw, Poland, 12Endeavor Health/University of Chicago, Pritzker School of Medicine, Chicago, United States of America
Objectives and Study: The Connection Study is a prospective, randomized phase 3 trial conducted under US IND and EU Clinical Trial Exemptions in 95 neonatal intensive care units to evaluate the efficacy and safety of IBP‐9414 for VLBW infants born between 23‐ and 32‐weeks gestational age.
Methods: 2117 VLBW infants were randomized 1:1 to treatment with IBP‐9414 (L. reuteri) or placebo, receiving an initial dose of study drug within 48 hours of birth, then one dose daily until a postmenstrual age of 346/7 weeks. Primary efficacy endpoints were prevention of NEC and time to sustained feeding tolerance (SFT). Secondary endpoints included NEC confirmed at laparotomy or autopsy and all‐cause mortality.
Results: Treatment with IBP‐9414 did not reach statistical significance for the primary endpoints of NEC (p = 0.25) and time to SFT (p = 0.07). Analysis on events occurring after 14 days of treatment, however, showed a significant reduction (p = 0.046) of NEC with intestinal necrosis verified through laparotomy or autopsy. All‐cause mortality was significantly reduced by IBP‐9414 (relative risk: 0.73, p = 0.04) and the relative risk was 0.54 (p = 0.02) for deaths by any cause occurring after 14 days of treatment (Fig. 1). The mortality effect was consistent across birth weight and gestational age subgroups. IBP‐9414 was not associated with imbalances in adverse and serious adverse events. No blood cultures were positive for IBP‐9414.
Fig.1. Kaplan‐Meier survival curves for IBP‐9414 and placebo treated infants.
Conclusions: IBP‐9414 treatment was associated with significant reduction in all‐cause mortality. The efficacy findings coupled with a favorable safety profile support a positive benefit‐risk profile for IBP‐ 9414 in VLBW infants.
Contact e‐mail address: neuj@peds.ufl.edu
G‐RF081. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF081.1. A RARE CASE OF HETEROTOPIC PANCREAS IN A PATIENT WITH PERFORATED DUODENAL ULCER
Andra Diaconu, Roxana Matran, Andreea Iordache, Oana Neagu, Orlando Marinescu, Cristina Becheanu
Grigore Alexandrescu Emergency Hospital for Children, Bucharest, Bucharest, Romania
Objectives and Study: Heterotopic pancreas (HP) is infrequently reported in the pediatric population, unlike in adults. Most patients are asymptomatic and the detection of HP is often incidental during histopathological examination. In symptomatic patients, the clinical presentation depends on the location of this structure.
Methods: We report the case of a 13‐year‐old patient with no significant medical history who was admitted in May 2023 to our Pediatric Surgery Department.
Results: He presented in the emergency room with a sudden onset of symptoms, including hematemesis and melena. On admission, he had severe anemia. The abdominal ultrasound revealed a thickened wall in the antrum‐pyloric region. Intravenous fluids, proton pump inhibitors (PPIs), hemostatic agents, blood transfusions were administered. The endoscopic intervention was performed 48 hours after admission, during which a large blood clot was identified in the stomach, and an adherent clot was found in the duodenum I. On the eleventh day of hospitalization, the patient experienced hemodynamic instability, expelling fresh red blood through the nasogastric tube, necessitating an immediate exploratory laparotomy. Loss of wall integrity with active bleeding was observed on the posterior aspect of the duodenum I. The histopathological examination revealed HP in the submucosa with both acinary cells and Langherhans islets. The recovery was slow but favorable. He underwent two additional endoscopic reevaluations in October 2023, when another ulcer was observed on the remaining duodenum and another in December 2023 when a normal appearing duodenum was revealed after treatment with PPIs, sucralfate.
Duodenal wall ‐ acinary cells, Langherhans islets, HE, 100x.
Conclusions: Gastrointestinal bleeding is a potentially life‐threatening presentation of HP. Resection of the HP is advisable. Recurrence of the symptoms impose vigorous searching for other sites of possible heterotopy. The use of video capsule endoscopy (VCE) may represent an option for some patients, given its high sensitivity and specificity in detecting sources of gastrointestinal bleeding.
Contact e‐mail address: diaconuandramihaela@yahoo.ro
G‐RF082. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF082.1. EFFECTIVENESS OF SACCHAROMYCES BOULARDII CNCM I‐745 IN PEDIATRIC ACUTE INFECTIOUS DIARRHEA: 2024 UPDATED META‐ANALYSIS
Ener Dinleyici
Department Of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
Objectives and Study: Acute infectious diarrhea is still a predominant cause of morbidity and hospitalization. The impact of probiotics in acute diarrhea is specific to the strain used. Saccharomyces boulardii CNCM I‐745 (Sb)is among the most extensively researched probiotics in randomized controlled trials and is widely endorsed in clinical guidelines. We assessed the impact of Sb on acute diarrhea in children in this study.
Methods: We conducted a systematic review and meta‐analysis on the efficacy of S. boulardii CNCM I‐745 in treating acute infectious diarrhea, utilizing pertinent studies sourced from medical databases up to December 2024. We assessed the impact of Sb in comparison to a placebo, no intervention, or alternative probiotics.
Results: This meta‐analysis encompassed 21 studies including Sb, with 1254 children in the Sb cohort and 1178 children in the control cohort, resulting in a total of 2432 participants. Sb markedly decreased the duration of diarrhea by roughly 21.2 hours (95% CI ‐23.8 to ‐18.7; p < 0.0001; substantial heterogeneity [I2 = 76%]). Sb also reduces the duration of hospitalization. Effects of Sb on diarrhea started at an early period of intervention, and significant reduction has been reported at Day 3. Sb was well tolerated, with no major side effects reported. Two studies showed beneficial effects of Sb on the gut microbiota composition. Most studies exhibited an uncertain or high risk of bias.
Conclusions: This systematic review and meta‐analysis regarding the efficacy of S. boulardii CNCM I‐45 in treating acute infectious diarrhea indicates that Sb was well tolerated, and robust evidence persists supporting the clinically important benefits. With the widespread use of the rotavirus vaccines during the last 10‐15 years and changing epidemioological sitiuation during the post‐pandemic era, it is imperative to conduct meticulously structured randomized placebo‐controlled trials incorporating microbiota analysis to further investigate the impact of Sb on children with acute infectious diarrhea.
Contact e‐mail address:
G‐RF083. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF083.1. PRO‐INFLAMMATORY MECHANISMS OF SARS‐COV‐2 ON THE INTESTINAL MUCOSA
Chiara Fulgione 1, Mariantonia Maglio1,2, Antonella Marano1, Valentina Cioffi1, Marco Poeta1, Andrea Lo Vecchio1, Alfredo Guarino1, Valentina Discepolo1,2
11 department Of Translational Medical Science, Section Of Pediatrics, University of Naples Federico II, Naples, Italy, 2European Laboratory for the Investigation of Food Induced Diseases (ELFID), University Federico II of Naples, Naples, Italy, Naples, Italy
Objectives and Study: SARS‐CoV‐2 infects the intestine upon binding to ACE‐2 receptor on intestinal epithelial cells, possibly leading to digestive symptoms. The infection may cause intestinal damage and increase of intestinal permeability. Aim of this study was to explore the pro‐inflammatory effects of SARS‐CoV‐2 on colonic mucosa ex vivo.
Methods: Human colonic mucosal samples were exposed to heat‐inactivated SARS‐CoV‐2(SARSi) (1 µg/ml) or Spike protein alone (1 µg/ml) in an organ culture system for 24 hours. Treated fragments were embedded in optimal cutting temperature medium (OCT) and processed by immunohistochemistry to assess Ki67 + ,CD3 + ,CD25+ cells density, and IL‐15 cytokine expression; PAS staining was performed to highlight goblet mucin‐secreting cells (FGBs); hematoxylin‐eosin (H&E) staining to evaluate eosinophils density. These parameters were evaluated in the colonic epithelium, crypts, and lamina propria.
Results: In vitro Spike protein significantly increased the number of activated immune cells CD25+ (Mean±DS:83,17 ± 39,20; P < 0,05) and CD3 + (368,0 ± 218,0; p < 0,05) in the lamina propria compartment compared to both Medium (50,00 ± 39,31; 182,7 ± 86,55) and SARSi (85,00 ± 101,9; 278,7 ± 232,5). Both Spike and SARSi led to an increased density of Ki67+ proliferating cells in the crypts (29,50 ± 3,391; 23,22 ± 5,150, respectively p < 0,05) and eosinophils in the lamina propria (159,8 ± 96,59; 139,8 ± 78,24; respectively p < 0,05) in comparison with only Medium (75,00 ± 59,19). Both treatments led to a reduction in FGBs cells in the crypts (Spike: 2,945 ± 1,844; SARSi: 2,812 ± 1,42; p < 0,05) compared to Medium (16,25 ± 4,911). No changes in CD3+IELs density or in IL‐15 expression were observed in the three analyzed compartments.
Conclusions: Our data indicated that SARS‐CoV‐2 Spike protein promotes inflammation of the human colonic mucosa, leading to increasd eosinophils, CD25+ and CD3+ cells in the lamina propria, along with a reduction of goblet cells in the epithelium, and increased mucus secretion, underscoring the potential of SARS‐CoV‐2 to disrupt barrier integrity and promote intestinal inflammation.
Contact e‐mail address:
G‐RF084. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF084.1. PREVALENCE AND RISK FACTORS OF FEEDING DIFFICULTIES IN CHILDREN WITH ESOPHAGEAL ATRESIA: A PARENT‐REPORTED MULTICENTER STUDY
Tut Galai 1, Shlomi Cohen1, Batia Weiss2, Ari Silbermintz3, Ron Shaoul4, Hadar Moran‐Lev1
1Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel aviv, Israel, 2Division Of Pediatric Gastroenterology And Nutrition, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel‐Hashomer, Ramat Gan, Israel, 3Pediatric Gastroenterology, Schneider Children's medical center, Petach Tikva, Israel, 4Pediatric Gastroenterology, Rambam Health Care Campus, Haifa, Israel
Objectives and Study: Feeding disorders are common in children with tracheoesophageal fistula (TEF) and esophageal atresia (EA), but the nature of these difficulties and their associated factors are not well understood. This study aimed to characterize parent‐reported feeding difficulties in children born with EA and assess factors associated with their development
Methods: Parents of children operated on for EA or TEF in four tertiary hospitals in Israel (2005‐2022) were recruited via social media and completed a structured questionnaire. Pediatric feeding disorder (PFD) was diagnosed based on Montreal children's hospital feeding scale, and was divided to four types according to the new unifying diagnostic definition
Results: seventy‐five children with EA/TEF were included, with a median age (IQR) of 40 months (17‐100). Sixty‐four percent were male, and the majority had atresia type C (84%). Associated anomalies were present in 62.7% of patients, with 15% having a complete VACTERL association. The median age (IQR) of the first oral feed was 14 days (2‐30). Only 53.3% of children received regular follow‐up from speech therapists or dietitians. Fifty‐seven parents (76%) reported on feeding difficulties and were categorized as PFD. Among them, 30 parents (52.6%) have noted that these feeding difficulties have developed during the first months of life. Lower gestational age [37, IQR (34‐38.75) vs. 39, IQR (38‐40) p = 0.001] and birth weight [2130 g IQR (1525‐ 2971) vs. 3084 g IQR (2650‐ 3450) P = 0.001] were significantly associated with PFD. Early oral feeding was protective against PFD [14 days IQR (2‐30) vs. 10 days IQR (2‐14), p = 0.05]. Feeding difficulties were attributed to feeding skill dysfunction (42%), nutritional dysfunction (28%), and medical dysfunction (17%).
Conclusions: Feeding difficulties are common in children with EA, with feeding skills disturbance being the most common type. Many affected children do not receive adequate follow‐up, highlighting the need for better long‐term multidisciplinary management
Contact e‐mail address: tootgalai@gmail.com
G‐RF085. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF085.1. ISOLATED SMALL BOWEL ENTEROPATHY IN JUNCTIONAL EPIDERMOLYSIS BULLOSA WITH PYLORIC ATRESIA
Lynette Goh, Kong Boo Phua, Veena Logarajah, Christopher Ho, Lay Queen Ng, Charanya Rajan, Sarah Wong, Tessa E‐Lin Ong, Fang Kuan Chiou
KK Women's and Children's Hospital, Singapore, Singapore, Singapore
Objectives and Study: Junctional epidermolysis bullosa with pyloric atresia (JEB‐PA) has been associated with severe protein losing enteropathy, requiring regular albumin as well as immunoglobulin replacement infusions. The extent of gastrointestinal involvement in these cases has not been well characterized with no previous details reported. We describe a case of JEB‐PA with minimal skin involvement and complete endoscopic mapping showing isolated small bowel enteropathy.
Methods: An 8‐year‐old girl initially presented in the neonatal period with persistent diarrhea and vomiting. She was diagnosed with pyloric atresia and underwent excision of atresia and gastroduodenostomy. Due to the presence of a few skin blisters, genetic analysis was performed that revealed heterozygous mutations in the ITGB4 gene encoding integrin β4 protein, consistent with JEB‐PA. She was started on parenteral nutrition but managed to be weaned off at 22 months of age. However, she had persistent hypoalbuminemia and hypogammaglobulinemia. Esophagogastroduodenoscopy, colonoscopy and video capsule endoscopy (VCE) was performed.
Results:
Upper and lower endoscopy with biopsies were macroscopically and microscopically normal. VCE showed significant small bowel enteropathy with mucosal denudation and bleeding. This correlated with stool calprotectin of >1000 ug/g, positive stool occult blood, serum albumin level of 10 g/L and IgG level 0.6 g/L. She was started on mycophenolate mofetil and has since managed to maintain normal serum albumin levels but still requires intravenous immunoglobulin supplementation.
Conclusions: This highlights the utility of VCE in investigating protein losing enteropathy and supports the hypothesis that there is differential expression of ITGB4 in human tissues and even within the same organ system.
Contact e‐mail address: lynette.goh.s.h@singhealth.com.sg
G‐RF086. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF086.1. EVALUATION OF ARTIFICIAL INTELLIGENCE IN PAEDIATRIC GASTROENTEROLOGY: CAN CHATGPT MATCH SEGHNP PROTOCOLS?
Silvia Gómez Anca, Pedro Luis Pérez Hernández, Camila Allende Chaves, Cristina María López García, Javier Artero López, Antonio García Jiménez, Marta Sarria Visa, Lorena Magallares García, Eva Martínez‐Ojinaga, Jesús Sarria Osés, Manuel Molina Arias
Pediatric Gastroenterology, Hospital Universitario La Paz, Madrid, Spain
Objectives and Study: Functional gastrointestinal disorders in children, such as cyclic vomiting (CV), functional dyspepsia (FD), and irritable bowel syndrome (IBS), pose diagnostic and therapeutic challenges. Artificial intelligence (AI) tools like ChatGPT (ChatGPT4o, o1‐mini, o1‐preview models) are emerging as potential aids in clinical decision‐making. This study evaluates and compares the quality of ChatGPT‐generated responses for managing these disorders against the guidelines of the Spanish Society of Paediatric Gastroenterology, Hepatology, and Nutrition (SEGHNP).
Methods: Using a quantitative approach, responses generated by ChatGPT for the three disorders were compared with SEGHNP protocols. Responses were tokenised to focus on clinically relevant terms, and cosine distance was applied to evaluate similarity, producing values between 0 and 1 (higher values indicate greater similarity). Additionally, word count was analysed to compare content extent between ChatGPT and SEGHNP guidelines.
Results: Cosine similarity was variable between disorders. For Cyclic Vomiting (CV), the o1‐mini model demonstrated the highest similarity to SEGHNP (0.24), followed by ChatGPT4o (0.22) and o1‐preview (0.19). In the case of Functional Dyspepsia (FD), o1‐preview achieved the highest similarity score (0.16), with ChatGPT4o and o1‐mini showing moderate values (0.14 and 0.15, respectively). For Irritable Bowel Syndrome (IBS), ChatGPT4o achieved the highest concordance with SEGHNP (0.26), while both o1‐mini and o1‐preview scored below 0.22. Word count varied significantly across all conditions, with AI responses tending to be longer than those of SEGHNP.
Conclusions: Although o1‐mini and o1‐preview aligned more closely with SEGHNP for specific disorders (such as CV and FD), ChatGPT4o demonstrated strong concordance in select areas, notably in IBS. These findings highlight variability in alignment across versions, suggesting that while AI platforms like ChatGPT4o can provide valuable information, they should be regarded as complementary to established clinical sources in pediatrics, especially given the inconsistency among versions.
Contact e‐mail address: silvia.g.anca@gmail.com
G‐RF087. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF087.1. MACROSCOPICALLY VISIBLE BIOFILMS IN THE ILEO‐COLON OF PAEDIATRIC PATIENTS: A PROSPECTIVE STUDY OF THEIR CHARACTERISATION AND DISTRIBUTION IN DIFFERENT DISEASE GROUPS
Karin Hammer 1, Denise Aldrian2, Georg Vogel2, Christa Kuderna3, Johann Hammer4
1St. Anna Kinderspital, Vienna, Austria, 2Department Of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria, 3Klinik Donaustadt, Vienna, Austria, 4Medizinische Universität Wien, Wien, Austria
Objectives and Study: Intestinal biofilms are microbiological colonies that colonize biotic and abiotic interfaces, occurring in various adult diseases like IBD, IBS, and CRC. This study investigates the occurrence and characteristics of visible biofilms in the colon of paediatric patients across different disease groups undergoing colonoscopy, aiming to record frequency, location, extent, and adherence in relation to diagnoses and intestinal sections.
Methods: The prospective, multicentre observational study included 157 paediatric patients undergoing ileocolonoscopy for diagnostic purposes. The presence, extent, and adherence of visible biofilms were documented using high‐resolution white light endoscopy. Biofilms, defined as yellow‐greenish adherent layers, were classified by extent (small, medium, large) and adherence (weak, medium, strong), then subdivided by diagnostic categories and colonic segments. 43 endoscopies with a Boston Bowel Preparation Score (BBPS) < 6 were excluded. Individual diseases that could not be assigned to these patient groups accounted for 7% (n = 8).
Results: Biofilms were found in 86.7% of patients with systemic disease and normal colonoscopy, 84.6% with ulcerative colitis, 72.7% with Crohn's disease, 85.7% with IBS, and 87.5% with colorectal polyps. There was a decreasing trend in extent and adherence from proximal to distal bowel segments across all groups. The caecum had the highest adherence and extent in all groups, while the rectum had the lowest. No significant differences in biofilm occurrence and characteristics between disease groups were observed. However, biofilms were significantly more common in proximal bowel segments (ileum, caecum, ascending colon).
Conclusions: Macroscopically visible biofilms are frequently detected in paediatric patients across various diagnoses, showing a predilection for proximal bowel segments. Particularly, patients with IBD, systemic diseases, and IBS are predisposed to biofilms, supporting the hypothesis that biofilms play a pathophysiological role in gastrointestinal diseases. These findings highlight the need for systematic investigation of biofilms in paediatric GI disease diagnosis and treatment.
Contact e‐mail address: johann.hammer@meduniwien.ac.at
G‐RF088. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF088.1. IDENTIFICATION AND DEFINITIVE DIAGNOSIS OF ‘ORPHAN SYMPTOMS’ IN PAEDIATRIC GASTROENTEROLOGY USING THE PSAGIS QUESTIONNAIRE, EXEMPLIFIED BY DYSPHAGIA
Karin Hammer 1, Barbara Majcher1, Johann Hammer2
1St. Anna Kinderspital, Vienna, Austria, 2Medizinische Universität Wien, Wien, Austria
Objectives and Study: 'Orphan symptoms' in pediatric gastroenterology are rare and challenging to diagnose and manage. These symptoms often require a more individualized approach. The Pediatric Structured Assessment of Gastrointestinal Symptoms (pSAGIS) questionnaire systematically evaluates GI symptoms in pediatric outpatients, providing a standardized method for symptom assessment.
Methods: Between February 2016 and January 2023, 1481 new patients at the outpatient GI clinic of St. Anna Kinderspital, Vienna, underwent standard diagnostics. Concurrently, the validated pSAGIS, comprising 21 GI‐related questions about symptom presence and severity in the past week, was completed by patients or their caregivers before their pediatric consultation. Dysphagia, defined as "difficulty swallowing or pain while swallowing," was classified as severe or very severe in 0.7% of patients, marking it as an orphan symptom. This data was then analyzed to understand the prevalence and implications of dysphagia.
Results: Of the patients, 40 reported severe/very severe dysphagia (mean age±SEM: 9.2 ± 0.3 years). Presenting symptoms included dysphagia (in 11 patients), upper GI tract symptoms (9 patients; including abdominal pain, loss of appetite, heartburn, nausea), lower GI tract symptoms (5 patients; including diarrhea, constipation, meteorism), sore throat (1), and fatigue (1). Final diagnoses were as follows: dysphagia (8 patients), gastroesophageal reflux disease (9), eosinophilic esophagitis (1), achalasia (1), functional GI disorder (8 patients, including functional nausea, functional dyspepsia, IBS, constipation, abdominal pain), celiac disease (5), Helicobacter pylori gastritis (1), Crohn's disease (1), lactose intolerance (1), and non‐GI diseases (5).
Conclusions: Severe dysphagia is an orphan symptom frequently associated with other GI symptoms and may not always be the primary presenting symptom. This wide range of diagnoses highlights the complexity and varied presentation of dysphagia in pediatric patients. The pSAGIS is an effective tool for identifying and monitoring a broad spectrum of GI symptoms in pediatric patients and can highlight symptoms that might otherwise be overlooked.
Contact e‐mail address: johann.hammer@meduniwien.ac.t
G‐RF089. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF089.1. EFFECTIVENESS OF BACILLUS CLAUSII PROBIOTICS FOR THE MANAGEMENT OF GASTROINTESTINAL SYMPTOMS: A SYSTEMATIC REVIEW AND META‐ANALYSIS
Mohammed Hasosah 1, Eylem Ulas2, Hossam Saleh3, Mohamed Al Boraei4, Mohamed Alzahry5, Mohamed Hussin6, Rola Sleman7, Said Al Dib8, Sirin Guven9, Zainab Malik10, Reham Medhat11
1Pediatric Gastroenterology, King Saud bin Abdulaziz University for Health Sciences. King Abdullah International Medical Research Center (KAIMRC), National Guard Hospital, Jeddah‐ Saudi Arabia, Saudi Arabia, 2Professor of Pediatric Emergency Deputy Chief Physician in Ege University Faculty of Medicine, istanbul, Turkey, 3Consultant Gastroentrology‐Dr. Sulaiman Habib Med. Group ‐Dubai, Dubai, United Arab Emirates, 4President of the Egyptian Foundation for Helicobacter and Microbiota., Cairo, Egypt, 5Professor of Gastroentrologyin Cairo University ‐Gastroentrology Consultant, Cairo, Egypt, 6Consultant of Pediatrics, Head of Neonatal Intensive Care Unit Ain Shams University, Egypt, Cairo, Egypt, 7Pediatric Consultant and former head department at Dr. Sulaiman Al Habib Medical Group Rayyan Hospital, Dubai, United Arab Emirates, 8Consultant Neonatologist, SEHA Network, Pure Health Group, Yas Hospital ‐UAE, Dubai, United Arab Emirates, 9Professor at University of Health Sciences, Head of Department of Pediatrics at Sancaktepe Training and Research Hospital, Istanbul, istanbul, Turkey, 10Consultant Pediatric Infectious Diseases Adjunct Clinical Associate Professor of Pediatrics Mohammed Bin Rashid University of Medicine and Health Sciences. Dubai, UAE, Dubai, United Arab Emirates, 11Africa, Middle East &Turkey Zone Medical Lead ‐Opella ‐Sanofi, Jeddah, Saudi Arabia
Objectives and Study: Global burden disease (GBD) 2019 reported 7.32 billion incidents and 2.86 billion prevalent cases of gastrointestinal disorder (GI) worldwide, resulting in 8 million deaths and 277 million disability‐adjusted life years (DALYs) lost. Among these, diarrhea, the most common GI disorder, led to 443,833 deaths in children under 5 years of age in 2021. Probiotics, such as Bacillus clausii (B. clausii), are known for restoring gut health and managing GI disorders. Although previous reviews have predominantly focused on randomized controlled trials (RCTs), real‐world evidence on their effectiveness and patient outcomes is limited. This study aimed to assess the effectiveness of B. clausii in alleviating GI symptoms, its immunomodulatory effects, its impact on patient outcomes, and trends in its usage.
Methods: A systematic review with meta‐analysis was conducted, including RCTs and observational studies published between January 2000 and March 2024. Due to heterogeneity in outcome measures, treatment durations, and variations in comparators, the meta‐analysis was supported by the Synthesis Without Meta‐analysis (SWiM) approach.
Results: A total of 37 studies on B. clausii were included in this study. B. clausii was effective in reducing diarrheal duration (‐8.73 hours) and hospital stay (‐15.48 hours) and showed comparable effects to other probiotics and placebo in reducing stool frequency (‐0.22) (Figure 1). SWiM analysis showed that B. clausii improved stool consistency, gastroenteritis, inflammatory bowel syndrome, rotavirus infections in children, and acute diarrhea and GI discomforts in adults. It was well‐tolerated, with fewer side effects, lower costs, and high patient satisfaction, though prescribed with antibiotics only in 22.4%–32.5% of the cases.
Conclusions: The review supports B. clausii as an adjunctive therapy for GI conditions, particularly pediatric acute diarrhea. The study also underscores the overall safety of B. clausii both in children and adults.
Contact e‐mail address:
G‐RF090. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF090.1. FOREIGN BODY INGESTION IN CHILDREN: A 7‐YEAR RETROSPECTIVE ANALYSIS ENCOMPASSING THE COVID‐19 PANDEMIC
Johannes Hilberath 1, Thamer Albarjas1, Steffen Hartleif1, Toni Illhardt1, Christoph Slavetinsky2, Christoph Werner3, Hans Joachim Kirschner2, Jörg Fuchs2, Ekkehard Sturm1
1Paediatric Gastroenterology And Hepatology, University Children's Hospital Tübingen, Tübingen, Germany, 2Paediatric Surgery And Urology, University Children's Hospital Tübingen, Tübingen, Germany, 3Section Of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology And Geriatrics, Department Of Internal Medicine I, University Hospital of Tübingen, Tübingen, Germany
Objectives and Study: Foreign body ingestion (FBI) in children is a frequent and potentially serious cause of paediatric emergency department (ED) visits. An increase in FBI cases during the COVID‐19 pandemic has been attributed to containment measures, including lockdowns [Festa, 2021]. However, an increase in FBI cases has also been noted before the pandemic [Speidel, 2020], and a post‐pandemic decline in ingestion has not yet been confirmed. This study analysed the frequency and characteristics of emergency presentations in children with suspected FBI (sFBI) between 2017‐2023 at the University Hospital of Tübingen, Germany.
Methods: This was a 7‐year retrospective, single‐centre chart analysis of all children (0‐17 years) presenting with suspected FBI at our ED. This study was approved by the local institutional ethics board (491/2020BO).
Results: While sFBI encounters increased during the pandemic in 2020, the total number of paediatric ED visits decreased (Table 1). In addition, a significant rise in button battery ingestion was observed. Post‐pandemic (2021‐2023), sFBI per 1.000 ED visits dropped yet remained elevated compared to pre‐pandemic levels (Figure 1). Table 1.
| 2017‐2023 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | |
| ED visits [n] | 115.463 | 14.861 | 15.934 | 16.709 | 14.791 | 16.530 | 19.080 | 17.558 |
| sFBI cases [n] | 602 | 66 | 64 | 65 | 110 | 99 | 96 | 102 |
| sFBI cases per 1.000 ED visits [n] | 5.21 | 4.44 | 4.02 | 3.89 | 7.44 | 5.99 | 5.03 | 5,81 |
| Age [years, mean (range)] | 3.47 (0.08‐17) | 2.7 (0.2‐10) | 3.3 (0.6‐16) | 3.4 (0.6‐14) | 3.0 (0.4‐13) | 3.9 (0.42‐15) | 4.1 (0.58‐17) | 3,7 (0.08‐17) |
| Button batteries [n (%)] | 75 (12,5%) | 6 (9,1%) | 3 (4,7%) | 5 (7,7%) | 22 (20,0%) | 16 (16,2%) | 15 (15,6%) | 8 (7,8%) |
Conclusions: Our data confirms an increasing trend in FBI, including potentially hazardous button batteries, with a significant peak during the COVID‐19 pandemic. The post‐pandemic reduction in FBI cases substantiates an additional pandemic‐driven effect, likely due to the restrictions imposed. Preventive measures are urgently needed, particularly during pandemics.
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G‐RF091. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF091.1. PEDIATRIC GASTRIC INTESTINAL METAPLASIA: THE ASSOCIATION WITH HELICOBACTER PYLORI AND OTHER GASTROINTESTINAL DISEASES
Assaf Hoofien, Sergei Ikher, Michal Kori
Paediatric Gastroenterology, Kaplan medical center, Rehovot, Israel
Objectives and Study: Objectives: Gastric intestinal metaplasia (GIM), the replacement of gastric epithelium with intestinal‐type epithelium, is considered precancerous. Helicobacter pylori (H. pylori) is the major risk factor in adults, pediatric data is limited. We aimed to explore the clinical characteristics, association with H. pylori and other gastrointestinal diseases in children.
Methods: Methods: A retrospective review of pediatric patients diagnosed with GIM based on histopathology reports between 1.2015 – 6.2024. Baseline data; demographics, symptoms, laboratory data, macroscopic and histopathologic findings. Follow‐up data; treatment and repeat EGD results when performed.
Results: Results: GIM was identified in 17/2140 (0.8%) patients undergoing esophagogastroduodenoscopy (EGD) with gastric biopsies, 10 (58.8%) female, mean age 14.6 ( ± 2 SD) years. Symptoms; gastrointestinal 11/17 (64.7%), iron deficiency anemia 4/17 (23.5%) and growth delay 2/17 (11.8%). Associated disease: celiac disease 6 (35.3%), Eosinophilic esophagitis 2 (11.8%) and Congenital Intestinal Pseudo‐Obstruction 1 (5.9%). Gastric findings; normal 5 (29.4%), erythema 3 (17.6%), nodularity 3 (17.6%), erosions 7 (41.2%), ulcer 1 (5.9%) polyp 1 (5.9%). Histopathology; GIM in the antrum in all, accompanied by acute and chronic gastritis. H. pylori was positive in 3 (17.6%). Follow‐up was available for 14 (82.4%) children; maximal time 60 months (mean 14.7 ± 15 SD months). Four children (23.5%) had a repeat endoscopy; GIM was not identified in any of the gastric biopsies.
Conclusions: Conclusions: GIM is rare in children and is usually an incidental histopathologic finding when investigating other diseases. H. pylori was present in the minority of cases. GIM regressed in all patients, suggesting a less ominous prognosis in children.
Contact e‐mail address: Laerites@gmail.com
G‐RF092. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF092.1. INFLUENCE OF RENAL PRESERVATION STRATEGY ON THE PREVALENCE OF NEPHROCALCINOSIS IN CHILDREN WITH PEDIATRIC INTESTINAL FAILURE
Inna Spector Cohen 1,2, Christina Belza3, Dianna Yanchis3,4, Glenda Courtney‐Martin3,4, Yaron Avitzur3,5
1Pediatric Gastroenterology & Nutrition Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel, 2Bruce Rappaport Faculty Of Medicine, Technion ‐ Israel's institute of technology, Haifa, Israel, 3Group For Improvement Of Intestinal Function And Treatment (gift), The Hospital for Sick Children, Toronto, Canada, 4Research Institute, The Hospital for Sick Children, Toronto, Canada, 5Division Of Gastroenterology, Hepatology And Nutrition, The Hospital for Sick Children, Toronto, Canada
Objectives and Study: Nephrocalcinosis is a common complication in pediatric intestinal failure (PIF). To minimize nephrocalcinosis development we adopted a renal preservation strategy (RPS), which included extended infusion length of parenteral nutrition (PN), reduced PN calcium, increased PN vitamin K, corrected metabolic acidosis, and oral calcium and bicarbonate supplementation. We aimed to evaluate the impact of RPS on the prevalence of nephrocalcinosis in PIF.
Methods: Sonographically reported nephrocalcinosis was assessed in PIF patients, at least 1 year on home PN, before (2006‐2014) and after implementing RPS (2015‐2020). Fluid, nutritional treatment, and renal complications were compared at the end of follow up.
Results: Thirty‐three patients (cohort 1, 10 females, median age 4 y) were followed before and 26 (cohort 2, 11 females, median age 3.5 y) after RPS implementation for a median of 3 years. Less patients in cohort 2 had nephrocalcinosis (11% vs 24%; P = 0.32) and nephrolithiasis (0 vs 6%; P = 0.5). Serum urea was comparable between the two cohorts (5.35 mmol/L vs 5 mmol/L; P = 0.85), but serum creatinine was lower in cohort 2 (21 umol/L vs 26 umol/L; P = 0.02). Total intravenous fluid infusion was comparable between the cohorts (117 ml/kg/day for cohort 2 vs 123 ml/kg/day for cohort 1; P = 0.64, respectively), as were the PN infusion hours (14 hours/day vs 13.5 hours/day; P = 0.41). Patients in cohort 2 required less PN calcium (0.32 mg/kg/day vs 0.58 mg/kg/day; P < 0.01) and acetate (2.25 mg/kg/day vs 5.2 mg/kg/day; P < 0.01) and experienced fewer episodes of low serum bicarbonate per year (HCO3 < 20 mmol/L – 0 episodes vs 1 episode; P = 0.05). Fewer patients in cohort 2 experienced any dehydration episodes in the previous year (20% vs 58%; P = 0.007) and had high urine calcium/creatinine ratios (57% vs 78%; P = 0.3).
Conclusions: The RPS appears to reduce the rates of nephrocalcinosis and may prevent long‐term kidney damage in children with PIF and prolonged PN dependency.
Contact e‐mail address:
G‐RF093. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF093.1. ANXIETY AND FUNCTIONAL CONSTIPATION IN MOTHERS OF INFANTS WITH DEFECATION DISORDERS
Aysel Ünlüsoy Aksu 1, Esra Akbulut2
1Pediatric Gastroenterology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey, 2Pediatrics, Ankara City Hospital, Ankara, Turkey
Objectives and Study: This study investigated the relationship between defecation disorders in infants under one year of age without organic disease and their mothers' anxiety and functional constipation.
Methods: Between March 2023 and March 2024, 350 mothers were interviewed using a questionnaire consisting of 39 questions. Demographic data, characteristics of the infant's bowel movements, nutritional status, iron supplementation, medication use, and history of defecation disorders in siblings were compared based on the presence of maternal anxiety and functional constipation. Pearson Chi‐square test or Fisher's Exact Probability Test was used to assess statistical significance, and the relationship between maternal anxiety and functional constipation was determined using Spearman's rho correlation coefficient.
Results: Among 350 infants, maternal anxiety was observed in 125 infants (35.7%), functional constipation in 87 infants (24.8%), and irritable bowel syndrome with predominant constipation in 5 infants (1.4%). Maternal anxiety was significantly more frequent in cases where the infant was 2 months old or older, lacked anal fissures, and had not received iron supplementation, probiotics, and lactulose for constipation management in the past (P < 0.05). Additionally, infants who were soothed by the sound of a car, vacuum cleaner, or hair dryer and those with siblings who had a history of constipation were associated with higher rates of maternal anxiety and functional constipation (P < 0.05). Notably, maternal anxiety was linked to functional constipation in 35.8% of cases.
Conclusions: Maternal anxiety and functional constipation are associated with defecation disorders in infants. Moreover, maternal anxiety is further exacerbated when the infant is 2 months or older, lacks anal fissures, does not receive iron supplementation, probiotics, or lactulose, is soothed by the sound of a car, vacuum cleaner, or hairdryer, and when the infant's siblings have a history of constipation.
Contact e‐mail address: ayselun@gmail.com
G‐RF094. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐RF094.1. ROUTINE PROBIOTICS AND NECROTIZING ENTEROCOLITIS IN INFANTS BORN PRETERM – A MULTICENTER CONTROLLED PRE‐POST ANALYSIS
Ceren Imren1, Vivian Jongejans2, Jasper Been1,3, Claudia Keyzer‐Dekker4, Wes Onland2, Anton Van Kaam2, Sinno Simons1, Jos Twisk5, Chris Van Den Akker 2, Marijn Vermeulen1
1Department Of Neonatal And Pediatric Intensive Care, Division Of Neonatology, Erasmus Medical Center ‐ Sophia Children's Hospital, Rotterdam, Netherlands, 2Department of Pediatrics‐Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, Netherlands, 3Department of Obstetrics and Gynaecology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands, 4Department Of Pediatric Surgery, Erasmus MC ‐ Sophia Children's Hospital, Rotterdam, Netherlands, 5Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands
Objectives and Study: Effectiveness of probiotics in preventing necrotizing enterocolitis (NEC) in preterm infants remains widely debated. We evaluated the effect of implementing routine multi‐strain probiotics (ProPrems®) on NEC incidence in two Dutch NICUs in a real‐time clinical setting. We hypothesized probiotics would reduce NEC.
Methods: A retrospective, controlled pre‐post study was conducted comparing NEC incidence (Bell≥stage 2) before and after implementing probiotics. Probiotics were routinely administered to infants born <30 weeks’ GA or <1000 g birth weight (BW). Infants born at 30‐32 weeks’ GA and 1000‐1500 g BW, who per‐protocol never received probiotics, were included to analyze NEC trends over time in the absence of probiotics. NEC incidence beyond seven days postnatally was compared between pre‐implementation (January 2018 – October 2020/March 2021) and post‐implementation (October 2020/March 2021 – June 2024) periods. Generalized additive regression models were applied to flexibly model nonlinear effects, while controlling for pre‐existing trends and confounding factors (GA, BW‐z‐score, gender, postpartum antibiotics, perinatal factors, and seasonality).
Results:
We assessed 2195 infants: 921 infants pre‐implementation (n = 602 < 30 weeks; n = 319 > 30 weeks GA) and 1274 post‐implementation (n = 822 < 30 weeks; n = 452 > 30 weeks GA). Baseline characteristics, including GA (median 29 + 1 weeks) and BW (median 1,155 g), were comparable across epochs. No significant pre‐existing temporal trends in NEC incidence or mortality were observed. After probiotic implementation, NEC odds were 62% lower among infants born <30 weeks’ GA (adjusted OR: 0.38, 95%‐CI: 0.16‐0.93, p = 0.03). A consistent relative risk reduction was observed in all infants receiving probiotics. (Figure 1). Similarly, secondary analysis showed lower odds of surgical NEC (aOR: 0.33, 95%‐CI: 0.13‐0.85, p = 0.02), whereas medical and fatal NEC odds remained unchanged.
Conclusions: Routine probiotic implementation was associated with a significant reduction in NEC risk, particularly for surgical NEC, with a consistent effect across all GAs in infants who received probiotics. These findings support routine use of probiotics in high‐risk preterm populations.
Contact e‐mail address: c.imren@erasmusmc.nl
G‐RF095. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF095.1. EXTERNAL VALIDATION OF POPULATION SPECIFIC FORMULAS FOR ESTIMATION OF FAT MASS COMPARED WITH DEXA MEASUREMENTS IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE
Ludovica Frezzati1, Luisa Abbattista 1, Annalisa De Silvestri2, Francesca Penagini1, Laura Gianolio1, Lorenzo Norsa1, Dario Dilillo1, Giulia Rendo1, Lucia Cococcioni1, Valeria Calcaterra1,3, Gian Vincenzo Zuccotti1,4
1Pediatrics, Vittore Buzzi Hospital, Milan, Italy, 2Biostatistic And Clinical Center Trial, Fondazione IRCCS Policlinico San Matteo, pavia, Italy, 3Internal Medicine, Paediatric and Adolescent Unit, Pavia University, Pavia, Italy, 4Biomedical And Clinical Science, Luigi Sacco Hospital, Milan, Italy
Objectives and Study: Children with inflammatory bowel disease (IBD) exhibit distinct body composition alterations compared to healthy peers. Dual‐energy X‐ray absorptiometry (DEXA) remains the reference standard for body composition assessment, but it is not universally available in clinical settings. Population‐specific predictive formulas (PF) based on anthropometric data were devised in 2021 to estimate fat mass percentage (FM%) in children with IBD. This study aimed to validate these formulas by comparing their accuracy compared to DEXA measurements.
Methods: From September 2023 to March 2024, pediatric IBD patients were recruited at V. Buzzi Children's Hospital. Anthropo‐plicometric measurements and DEXA scans were conducted for all participants. The study employed Bland‐Altman analysis and percentage error (PE) calculations to evaluate discrepancies between FM% values derived from PF and those obtained via DEXA.
Results: The study included 29 participants, comprising 21 with Crohn's disease and 8 with ulcerative colitis. The mean PE was as follows: 10.4% (95% CI: 6.4–15.5) for BMI‐based PF, 12.1% (95% CI: 5.4–18.4) for triceps skinfold PF, 12.3% (95% CI: 6.4–14.4) for two‐skinfold PF (biceps, triceps), and 5.9% (95% CI: 4.4–9.6) for four‐skinfold PF (triceps, biceps, subscapular, suprailiac‐ SF4). SF4 demonstrated the narrowest agreement range in Bland‐Altman analysis, with lower and upper limits at ‐6.2 (95% CI: ‐8.2 to ‐4.3) and 4.6 (95% CI: 2.6–6.5), respectively.
Conclusions: The four‐skinfold formula proved to be the most precise for FM% estimation in children with IBD, showing the lowest PE and optimal agreement with DEXA. This method presents a practical, effective alternative for assessing and tracking nutritional status in clinical practice, in particular when DEXA is not available.
Contact e‐mail address:
G‐RF096. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF096.1. MICROBIOME SIGNATURE IN PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Manoj Kumar1, Mohamed Djekidel1, Marwa Saadaoui2, Duaa Elhag2, Mohamed Rahal3, Nazira Ibrahim2, Khaled Abouhazima4, Fatma Almudahka2, Anthony Akobeng2, Mamoun Elawad2, Souhaila Al Khodor 3
1Research, Sidra Medicine, Doha, Qatar, 2Pediatric Gastroenterology, Sidra Medicine, Doha, Qatar, 3Perinatal And Reproductive Health Division, Sidra Medicine, Doha, Qatar, 4Gastroenterology, Sidra Medicine, Doha, Qatar
Objectives and Study: Inflammatory Bowel Disease (IBD) is a chronic disorder characterized by dysregulated mucosal immunity, influenced by factors such as diet, medication, family history, and the gut microbiome. Pediatric IBD presents distinct clinical manifestations compared to adult‐onset disease. Clinically, IBD is categorized into Crohn's disease (CD), Ulcerative colitis (UC), and IBD‐unclassified (IBDU). While gut microbiome alterations are well‐documented in adult IBD patients, pediatric studies remain limited. This study investigates microbial profile changes in pediatric IBD patients compared to healthy controls.
Methods: Stool samples were collected from pediatric patients with CD (n = 110), UC (n = 64), IBDU (n = 23), and healthy controls (n = 42). The gut microbiome composition was assessed using 16S rRNA gene sequencing and analyzed via the QIIME2 pipeline. Differential abundance analysis was performed to identify differentially abundant bacterial taxa among the study groups.
Results: The predominant phyla across all groups were Bacteroidota and Firmicutes. Microbial diversity was significantly reduced in IBD patients compared to controls, leading to significant microbial dysbiosis in patients. Differentially abundant taxa in IBD patients included Ruminococcus bicirculans, Bacteroides caccae, and Alistipes shahii in CD and UC patients compared to controls. Additionally, an increased abundance of opportunistic bacteria such as Veillonella in CD and Enterobacteriaceae in UC was observed.
Conclusions: Pediatric IBD is associated with reduced gut microbiome diversity and an enrichment of opportunistic bacteria, such as Veillonella in CD and Enterobacteriaceae in UC. This imbalance likely contributes to IBD development, underscoring the potential of microbiome signatures as biomarkers for pediatric IBD and their role in disease pathogenesis and progression
Contact e‐mail address: salkhodor@sidra.org
G‐RF097. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF097.1. IS METHOTREXATE STILL A VALID OPTION IN PEDIATRIC IBD? THERAPEUTIC INDICATIONS, LONG‐TERM EFFICACY AND TOLERABILITY
Rossana Albano 1, Massimo Martinelli2, Caterina Strisciuglio3, Annamaria Staiano2, Erasmo Miele2
1University of Naples "Federico II", Naples, Italy, 2Department Of Translational Medical Science, Section Of Pediatrics, University of Naples Federico II, NAPOLI, Italy, 3Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy
Objectives and Study: The objective of our study was to assess the use of methotrexate (MTX) and to evaluate its efficacy and tolerability in a cohort of children affected by IBD.
Methods: This was a retrospective, single center study. We enrolled children newly diagnosed with IBD between January 2019 and January 2024 starting therapy with MTX with a minimum follow‐up of 6 months. Data at diagnosis, therapeutic and clinical history were collected.
Results: One‐hundred‐four children [median age at MTX starting: 13.6 years (range 6.9‐17.7); CD/UC: 80/24; M/F: 70/34] were enrolled.
The median lag time for MTX starting from diagnosis was 2 months (range 0‐98) for CD patients and 18 months (0‐118) for UC children (p < 0.001). Overall, 94 children (90.4%) MTX started as monotherapy, while in 10 patients (9.6%) MTX was used in combination with anti‐TNFα. MTX was administered intramuscularly in all the cases with a median induction dose of 14.7 mg/m2 (8.5‐18.5) and a median maintenance dose of 10 mg/m2 (7‐14.1). The median duration of MTX therapy was 24.5 months (1‐93) with 70/104 (67.3%) still undergoing MTX at the last follow‐up. The number of children in combination therapy was significantly higher at follow‐up [24/70 (34.3%) vs Baseline 10/104 (9.6%)] p < 0.001)]. The overall efficacy of MTX monotherapy in terms of clinical remission was 44.2%, without significant difference between CD and UC children [CD: 35/80 (43.7%) vs UC: 11/24 (45.8%), p = 1]. Therapy was discontinued in 34 patients: 17 (50%) for side effects/intolerance/patient's will, 7 were for deep remission reach (20.6%) and 10 for therapeutic failure (29.4%).
Conclusions: MTX is still a valid therapeutic option in pediatric IBD with a good profile of efficacy and tolerability both as monotherapy or in combination with biologics.
Contact e‐mail address: albano.rossana9@gmail.com
G‐RF098. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF098.1. FREQUENCY OF BIOLOGIC SWITCHING AND OUTCOMES OF MULTIPLE BIOLOGICS SWITCHING IN CHILDREN AND YOUNG PEOPLE WITH INFLAMMATORY BOWEL DISEASE: MAJOR CENTRE EXPERIENCE
Rose Alhaleem 1, Sian Copley2
1Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, United Kingdom, 2Royal Manchester Children's hospital, Manchester, United Kingdom
Objectives and Study: Information is limited about biologics switching patterns in children and young people (Age <=18 years) with inflammatory bowel disease (IBD) in an era of many biologics therapies. The best choice of biologics to use if the first biological infliximab is not beneficial is also unclear. This study aimed to quantify and describe biologics switching patterns in children and young people with IBD, and to compare the effectiveness of using a second tumor necrosis factor inhibitor(TNFi) versus non‐TNF failure of a frist biologics TNFi in routine clinical practice.
Methods: This is a retrospective observational cohort study. Patients with two or more successive biologic switches were identified. Biologic treatment sequence was analyzed descriptively. Baseline demographic and clinical characteristics were collected retrospectively from the electronic medical records. Treatment failure was defined as the composite of IBD related hospitalization, new prescriptions of oral/IV corticosteroids or any IBD related surgery or the need to switch to a third biologic agent.
Results: Total 229 patients were identified whom received tumor necrosis factor a antagonist (anti TNF a) treatment followed by another anti‐TNFa treatment or Vedolizumab then Ustekinumab. Median age at diagnosis was 8 years. We found that (40 %) switched to a different biologic after a median of 2 years after diagnosis. In total thirty six of total 229(15%)percent of patients received 3 or more biologics. The most common reason for switching from antiTNF was poor clinical response in (50%) followed by antibodies and one patient was switched due to difficult access. Three out of total 229 patients with ileocolonic fistulating phenotype showed poor response to Ustekinumab and required IBD related surgery.
Conclusions: Vedolizumab was the most common second line biologic regardless of phenotype; patients with ileocolonic/perianal disease showed poor response. Ustekinumab may be more suitable as second line in ileocolonic or perianal disease.
Contact e‐mail address: rose.alhaleem@mft.nhs.uk
G‐RF099. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF099.1. NOVEL USE OF RISANKIZUMAB IN CHILDREN WITH REFRACTORY CROHN'S DISEASE : CASE SERIES
Ali Alsarhan, Christos Tzivinikos
Pediatrics Gastroenterology, Aljalial children's specialty hospital, DUbai, United Arab Emirates
Objectives and Study: Pediatric Inflammatory bowel disease (IBD) is generally more aggressive and difficult to treat compared to adulthood IBD. The only biological agent approved for use in this population is Anti‐TNF medications (Adalimumab and Infliximab). Other medications such as anti IL‐23 and/or IL‐12 antibodies are not officially approved, yet the adult literature showed efficacy even in refractory cases priorly exposed to biologics. Given the delay of new medications approval in children, we present the novel use and real world experience of Risankizumab which is a p19 anti IL‐23 antibody in children with refractory Crohn's disease.
Methods: We present 5 cases of Crohn's disease who have failed at least 1 biological agent, including Adalimumab, Infliximab, Ustekinumab, Azathioprine and methotrexate. All of them developed pharmacodynamic loss of response to Anti‐TNF and one patient developed neutralizing antibodies. MR enterography was showing active ileal disease prior to commencing Risankizumab. One Patient had developed Pyoderma gangrenosum, and another patient underwent pan‐endoscopy which showed inflamed mucosa. C‐reactive protein and ESR did not correlate with disease activity or response to the medication.
Results: Risankizumab was administered as per the protocol. After 1‐year follow up, all patients were in clinical remission with normal calprotectin. Bedside intestinal Ultrasounds was done and showed normal bowel wall thickness. Pyoderma gangrenosum improved significantly as well. Only one patient had MR enterography after 1 year which was unremarkable. No side effects were observed within the follow up period. Risankizumab could be used after Adalimumab, Infliximab or even Ustekinumab. Despite lack of approval, cautious use of new biological agents might be the only choice to avoid surgical resection in refractory Crohn's disease.
Conclusions: Over 1‐year follow up, Risankizumab was a safe and effective choice in pediatric Crohn's disease patients who have lost response to other biological treatment and who had surgical resection as well.
Contact e‐mail address: dr.ali.sarhand@gmail.com
G‐RF100. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF100.1. REAL‐WORLD EXPERIENCE WITH UPADACITINIB IN PEDIATRIC IBD
Ali Alsarhan 1, Balaji Krishnamurth2, Ajmal Kader3, Ehsan Malik4, Christos Tzivinikos5
1Pediatrics Gastroenterology, Aljalial children's specialty hospital, DUbai, United Arab Emirates, 2Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates, 3Pediatric Gastroenterology, Al Jalila children's hospital, dubai, United Arab Emirates, 4Aljalial children's specialty hospital, DUbai, United Arab Emirates, 5Department Of Pediatric Gastroenterology, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
Objectives and Study: Pediatric Inflammatory Bowel Disease (IBD) is a complex condition often requiring advanced therapies beyond conventional treatments. While Upadacitinib, a selective Janus kinase 1 (JAK1) inhibitor, has been approved by the FDA for use in adults with moderate‐to‐severe ulcerative colitis and Crohn's disease, its efficacy and safety in pediatric patients are still under studies. With limited therapeutic options available for children who fail biologics, JAK inhibitors represent a potential alternative. However, real‐world data on their use in pediatrics is scarce. Here, we report our experience with Upadacitinib in pediatric patients with refractory IBD, highlighting both its potential benefits and safety concerns.
Methods: Twelve pediatric patients (nine with Crohn's disease, two with ulcerative colitis, and one IBD‐undetermined) who had failed multiple biologic therapies were treated with upadacitinib at a starting dose of 45 mg daily. The age at initiation ranged from 11 to 18 years, and all were symptomatic. After eight weeks, inflammatory markers were assessed, with most patients showing a decrease in CRP and improvement of albumin levels. Three patients had no response and required a change in therapy, while three others had partial response. Eight patients received concomitant steroids. The treatment was generally well tolerated, with one case of hyperlipidemia as the only reported side effect.
Results: These findings indicate that upadacitinib may provide benefit in pediatric patients with refractory IBD, though response rates varied. The decline in inflammatory markers in most cases suggests potential efficacy, but the partial or absent response in some necessities other therapy modalities. The frequent use of steroids complicates the assessment of upadacitinib's independent effect. Despite this, the favorable safety profile observed supports its consideration in this population.
Conclusions: Upadacitinib shows agood response rate and a favorable safety profile in pediatric patients with refractory IBD. Further studies are neededto identify predictors of response and evaluate long‐term outcomes.
Contact e‐mail address: Dr.Ali.sarhand@gmail.com
G‐RF101. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF101.1. PREDICTING THE SPEED AND DURABILITY OF THE EFFECT OF INFLIXIMAB IN PAEDIATRIC CROHN'S DISEASE USING ENDOSCOPIC AND HISTOLOGICAL SCORES AT DIAGNOSIS
Marleen Bouhuys, Willem Lexmond, Patrick Van Rheenen
Paediatric Gastroenterology, University Medical Center, University of Groningen, Groningen, Netherlands
Objectives and Study: A significant proportion of children with Crohn's disease (CD) does not respond to infliximab or loses response within a year of initiation. Predicting whether a patient will reach sustained remission on infliximab is an unmet need as existing prediction models fail to achieve sufficient accuracy. We hypothesized that the Modified Multiplier Simple Endoscopic Score for CD (MM‐SES‐CD) and the Nancy histological Index (NHI) at time of diagnosis predict (1) the time to first in‐range faecal calprotectin (FC) on infliximab and (2) sustained remission on infliximab.
Methods: We used routinely collected electronic healthcare data in a consecutive series of children and adolescents with CD treated with infliximab (diagnosed between 2015 and 2023). A multivariable Cox proportional hazards model was created to predict time to first in‐range FC, which was our primary endpoint. The secondary endpoint was sustained clinical and biochemical remission between week 30 and 52 of infliximab therapy. We used logistic regression analysis to construct a multivariable prediction model for sustained remission.
Results: Eighty‐one children were included, of which 49 (61%) had at least one in‐range FC on infliximab. Median time to first in‐range FC was 21 weeks. 37 (46%) patients achieved sustained remission on infliximab. There were no statistically significant differences in demographics and clinical and biochemical parameters at diagnosis or infliximab initiation between children with and without sustained remission. We did develop a statistically significant prediction model for time to first in‐range FC, but MM‐SES‐CD and NHI were not retained in this model. In the multivariable logistic regression analysis, no statistically significant predictors were identified.
Conclusions: In our study, neither endoscopy (MM‐SES‐CD) nor histology (NHI) predicted time to first in‐range FC or responsiveness to infliximab. This study highlights the fact that clinical variables at time of diagnosis or infliximab initiation on the whole are poor predictors for sustained remission.
Contact e‐mail address: m.bouhuys@umcg.nl
G‐RF102. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF102.1. COMPARISON OF INTESTINAL ULTRASOUND SCORES TO ASSESS DISEASE ACTIVITY IN PAEDIATRIC ULCERATIVE COLITIS: A SINGLE CENTRE PROSPECTIVE STUDY
Viola Carzaniga 1, Sara Massironi2, Giacomo Mulinacci3, Giovanna Zuin4, Lorena Pirola5, Francesco Medici1, Nicola Zucchini6, Marco Emilio Dinelli3, Marta Maino3
1Paediatric Residency, University of Milano‐Bicocca, Monza, Italy, 2Gastroenterology And Endoscopy Department, Vita e Salute San Raffaele University, Istituti Ospedalieri Bergamaschi, Milan, Italy, 3Endoscopy Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy, 4Paediatric Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy, 5Gastroenterology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy, 6Pathology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
Objectives and Study: Intestinal ultrasound (IUS) is increasingly used as a point‐of‐care tool for patients with ulcerative colitis (UC). The Milan Ultrasound Criteria (MUC), Ulcerative Colitis Intestinal Ultrasound Score (UC‐IUS), and Civitelli score are promising tools for real‐time assessment of disease activity, potentially reducing reliance on invasive procedures like endoscopy at least during the follow‐up. Our aim is to evaluate the correlation and diagnostic efficacy of MUC, UC‐IUS, and Civitelli scores in assessing disease activity in paediatric UC patients, with endoscopic findings as the comparative gold standard.
Methods: Paediatric patients with UC at diagnosis or during follow‐up underwent ileocolonoscopy from January to June 2024 and were prospectively enrolled. IUS was performed within a 7‐day interval, with no therapeutic changes between procedures. Endoscopic disease activity was assessed with Mayo endoscopic subscores; for IUS studies MUC, UC‐IUS and Civitelli scores were calculated. Diagnostic accuracy was determined using receiver operating characteristic (ROC) curves, with endoscopy as the reference standard.
Results: The study included 34 paediatric UC patients (median age: 14.7 years; 65% male) with different disease severities and durations (median PUCAI: 30; median duration: 12.6 months). Bowel wall thickness (BWT) significantly correlated with all IUS scores; however, no correlation was observed between BWT and baseline Mayo endoscopic disease activity. The area under the curve (AUC) was 0.528 (CI: 0.348–0.704) for MUC, 0.602 (CI: 0.418–0.768) for UC‐IUS, and 0.572 (CI: 0.388–0.742) for the Civitelli score, indicating moderate diagnostic accuracy. While differences among scores were not statistically significant, UC‐IUS demonstrated the highest accuracy.
Conclusions: Both MUC, Civitelli, and UC‐IUS scores provide moderate diagnostic accuracy in assessing pediatric UC, though potentially less effective than in adult populations. UC‐IUS seems to offer enhanced sensitivity in paediatric patients. A larger sample of patients is needed to confirm these data.
Contact e‐mail address:
G‐RF103. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF103.1. EFFECTIVENESS OF TOFACITINIB IN PEDIATRIC INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND SINGLE‐ARM META‐ANALYSIS
Carolina Chaloub 1, Letícia Campos2, Angélica Nau3
1CUF Sintra Hospital, Sintra, Portugal, 2Ribeirão Preto University, Ribeirão Preto, Brazil, 3Federal University of Santa Catarina, Florianópolis, Brazil
Objectives and Study: Managing moderate‐to‐severe inflammatory bowel disease (IBD) in pediatric patients presents significant challenges due to limited therapeutic options. Tofacitinib, a nonselective Janus kinase (JAK) inhibitor, has demonstrated promising efficacy in adults. This study aimed to evaluate the effectiveness of tofacitinib as a novel treatment option for pediatric patients with IBD.
Methods: We systematically searched Medline, Embase, and Cochrane Central for studies involving pediatric IBD patients treated with tofacitinib. Efficacy outcomes included corticosteroid (CS)‐free status after induction, remission with CS‐free maintenance, and colectomy rates at the latest follow‐up. Baseline characteristics were recorded. We performed a single‐arm meta‐analysis using OpenMeta.
Results: We screened 615 studies. Five retrospective studies comprising 144 patients (140 ulcerative colitis, 4 Crohn's disease) with a mean age of 13.1 years were included. Pancolitis was reported in 80.6% of patients, with a mean disease duration of 24.1 months until tofacitinib initiation. Most patients (81%) had severe disease (30/37, 3 studies) with a mean Pediatric Ulcerative Colitis Activity Index (PUCAI) score of 51.4 (2 studies, n = 107). All patients had prior anti‐tumor necrosis factor α (anti‐TNF) exposure; 60.4% had used vedolizumab, and 27.9% had used ustekinumab. At induction, 59.7% (86/144) were on CS therapy. The mean follow‐up was 9.3 months. CS‐free status after induction was achieved in 70.4% (85/125; 95% CI 59.4%–81.3%), while remission with CS‐free maintenance occurred in 54.5% (40/123; 95% CI 26.5%–82.5%). Colectomy occurred in 19.8% (27/120; 95% CI 11.0%–28.5%). (see Figure 1).
Conclusions: Tofacitinib appears to be associated with a high corticosteroid (CS)‐free status following induction, although colectomy rates remain significant. Despite this, it seems a promising therapeutic option for pediatric patients with IBD. Further research is necessary to confirm these findings and refine its use in this population.
Contact e‐mail address: carolinachaloub@gmail.com
G‐RF104. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF104.1. TWO INTRAVENOUS IRON FORMULATIONS IN PEDIATRIC INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND SINGLE‐ARM META‐ANALYSIS
Carolina Chaloub 1, Letícia Campos2, Angélica Nau3
1CUF Sintra Hospital, Sintra, Portugal, 2Ribeirão Preto University, Ribeirão Preto, Brazil, 3Federal University of Santa Catarina, Florianópolis, Brazil
Objectives and Study: Iron deficiency anemia is a common extraintestinal manifestation of pediatric inflammatory bowel disease (IBD). This systematic review and single‐arm meta‐analysis evaluated the safety and efficacy of intravenous iron supplementation in pediatric IBD patients.
Methods: A systematic search in Medline, Embase, and Cochrane identified studies involving pediatric IBD patients from 0 to 21 years, treated with intravenous iron sucrose (IS) or ferric carboxymaltose (FCM). Efficacy outcomes included hemoglobin (Hb) changes at follow‐up (≥4 weeks) overall and by formulations. Safety outcomes were assessed through adverse events (AEs). Baseline characteristics were recorded. Statistical analysis was performed using OpenMeta.
Results: Eleven studies, including one randomized controlled trial, analyzed 717 patients who received IS (51%) or FCM (49%). Mean age was 13.7 years, and follow‐up ranged from 1 week to 40 months. Diagnoses included Crohn's disease (n = 404), ulcerative colitis (n = 162), and indeterminate colitis (n = 23). Mean PCDAI and PUCAI scores were 11.5 and 14.7, respectively. Mean baseline Hb was 10.4 g/dL, 10 g/dL, and 10.5 g/dL for overall, IS and FCM subgroups, respectively. Efficacy outcomes were evaluated for follow‐up duration, with mean Hb levels of 12.1 g/dL (95% CI 11.2–13.0) at 4–8 weeks and 11.6 g/dL (95% CI 11.0–12.1) at 12–16 weeks. By formulation, mean Hb levels reached 11.6 g/dL (95% CI 11.0–12.2) with IS and 12.2 g/dL (95% CI 11.5–12.9) with FCM. AEs prevalence was 5.6% (95%CI 1.8‐9.4) for FCM and 4.5% (95%CI 1.3‐7.8%) for IS, with infusion site, mild cardiovascular, and mild urticaria most common reactions. Only one severe AE (anaphylactic reaction) was documented (see Figure 1).
Conclusions: Intravenous iron therapy increases mean Hb levels within 4‐8 weeks and 12‐16 weeks compared to baseline, and both formulations demonstrate a favorable safety profile, with rare serious AEs, in pediatric IBD patients. This supports its role as a safe and effective treatment option in this population.
Contact e‐mail address: carolinachaloub@gmail.com
G‐RF105. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF105.1. ACCURACY OF A NON‐INVASIVE APPROACH IN MONITORING PEDIATRIC INFLAMMATORY BOWEL DISEASE: INTERIM‐ANALYSIS OF A PROSPECTIVE MULTICENTER ITALIAN STUDY
Giulia D'Arcangelo1, Alessandro Gravina1, Antonio Colucci 2, Tonia Raso1, Marianna Casertano2, Martina Milano2, Sabrina Cenni2, Francesca Maccioni3, Alfonso Reginelli4, Giusy Russo1, Danila Volpe1, Cosimo Ruggiero1, Caterina Strisciuglio2, Salvatore Oliva1
1Maternal And Child Health Department, Sapienza University of Rome, Rome, Italy, 2Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy, 3Department Of Radiology, Sapienza University of Rome, Roma, Italy, 4Department Of Woman, Child And General And Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
Objectives and Study: To provide less invasive monitoring capsule endoscopy (CE) and ultrasound (US) have been developed. We aimed to evaluate the accuracy of these non‐invasive techniques in monitoring pediatric IBD.
Methods: Interim analysis of the prospective multicenter protocol GR‐2019‐12370621. Consecutive children with IBD were enrolled. At baseline, 6 and 12 months, UC children underwent ileocolonoscopy (IC), CE and US, while CD children underwent IC, MRE, CE and US. For the terminal ileum in CD and the colon in UC and CD, IC was the gold‐ standard. For the SB (jejunum, proximal and mid‐ileum) MRE was the comparator to assess the presence of active disease. Sensitivity (Se), specificity (Sp), negative and positive predictive value (NPV and PPV) and accuracy of CE and US were determined for CD and UC.
Results: Fifty‐nine patients (29 CD and 30 UC) were enrolled (retrieval date 04/11/2024). For UC, 71 IC, 71 CEs and 66 US were performed, while in CD, 78 IC, 66 CEs, 47 US and 73 MREs were available. In UC, CE an accuracy of 92.6%. The accuracy of US was 65.6%. The combination of CE and US increased accuracy to 93.7%. For CD: the combined accuracy of CE and US was 100% for the terminal ileum, 94.7 % for the jejunum, 93 % for the proximal ileum, and 95.1% for the mid ileum. The accuracy of CE for the colon in CD was 87.7% (Table 1).
Conclusions: Compared to endoscopy, non‐invasive monitoring achieves an accuracy of 93.7 % in UC. For CD, it demonstrates excellent accuracy for the terminal ileum (100%) and good accuracy for the colon (87.7%) and the small bowel (93‐95% compared to MRE). The low PPV of the CE, particularly for jejunum and mild ileum, could be attributed to the detection of mucosal lesion not visible with the comparator (MRE).
Contact e‐mail address: giuliadarcangelo87@gmail.com
G‐RF106. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF106.1. ESTABLISHING A GASTROENTEROLOGY COMMERCIAL RESEARCH PORTFOLIO SPECIALISING IN PAEDIATRIC INFLAMMATORY BOWEL DISEASE, AT A UK SPECIALIST PAEDIATRIC NHS FOUNDATION TRUST
Aimee Corcoran, Amy Burrow, Akshay Kapoor
Clinical Research Facility, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
Objectives and Study: The incidence of paediatric inflammatory bowel disease (pIBD) is rising. There is an unmet need to understand disease causation and match disease phenotypes to efficacious drugs. Unfortunately, new drug trials in pIBD have lagged adults, as a consequence of which only two biologics are licensed for pIBD in a majority of countries. Some of the new generation biologics and oral small molecules are only available off‐label on a case‐by‐case basis. Sheffield Children's NHS Foundation Trust (SCH) has developed a growing portfolio of clinical research trials in commercial Clinical Trial Investigational Medicinal Product (CTIMP) trials in 2024. More than seven studies have opened or are in the later stages of set‐up, leading the UK's paediatric gastroenterology IBD‐specific research portfolio. Trials range from oral to intravenous medications for both Crohn's Disease and Ulcerative Colitis, sponsored by a range of pharmaceutical companies. SCH has accumulated many first patient recruitments in both the UK and Europe, whilst also maintaining its status as the lead paediatric IBD centre in the North of England. Our aim is to perform a stakeholder analysis, involving the trust, research team, pharmaceutical company, patient and families, to understand the interplay of various factors, roadblocks and putative solutions in establishing an IBD research portfolio within SCH.
Methods: A qualitative study design was utilised, whereby the study team members, principal investigator, and patients/families discussed the barriers and obstacles to initiation and management of an extensive portfolio of commercial IBD clinical trials within a specialist paediatric NHS trust. Related concepts were consolidated to achieve a consensus.
Results:
See image attached.
Conclusions: It is hoped that other paediatric and adult services in the NHS, as well as healthcare services more globally, can exchange knowledge and experiences to improve the management of similar portfolios of complex commercial trials, to further enhance treatment and outcomes for children with this debilitating condition.
Contact e‐mail address: aimee.corcoran@nhs.net
G‐RF107. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF107.1. COMPARATIVE ANALYSIS OF CLINICAL ACTIVITY, ENDOSCOPIC AND HISTOLOGICAL FEATURES IN VERY EARLY ONSET VERSUS LATER ONSET PEDIATRIC INFLAMMATORY BOWEL DISEASES
Irene Dalpiaz 1, Patrizia Alvisi2, Jessica Naso Onofrio3, Arianna Bedeschi1, Luca Scarallo1, Vincenzo Villanacci4, Paolo Lionetti1
1Gastroenterology And Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy, 2Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy, 3Residency School of Pediatrics, University of Bologna, Bologna, Italy, 4Pathology, Institute of Pathology, ASST Spedali Civili, University of Brescia, Brescia, Italy
Objectives and Study: To describe clinical, endoscopic, and histological features of children with non‐monogenic very early onset inflammatory bowel diseases (VEO‐IBD, <6 years of age at disease onset) compared to children with later onset (LO) inflammatory bowel diseases (>6 years).
Methods: A multicenter retrospective observational study was conducted at Meyer's Children Hospital, Florence, and Maggiore Hospital, Bologna. Clinical, endoscopic and histological data were collected.
Results: 53 children with VEO‐IBD (42 ulerative colitis (UC), 11 Crohn's disease (CD)) and 68 with LO‐IBD (44 UC, 24 CD) were retrospectively identified. Considering disease extension, a difference was noted between VEO and LO diseases, with a higher rate of isolated colonic disease in VEO‐CD group (p = 0.002) and of pancolitis in VEO‐UC group (p = 0.057). Considering clinical activity, no differences emerged between VEO and LO‐IBD, both in UC and CD. Regarding histology, goblet cells depletion, active inflammation, and crypt architectural distortion, were significantly more frequent in patients with LO‐UC compared to VEO‐UC (83.7% vs. 61.9%, p = 0.021, 100.0% vs. 73.8%, p < 0.001, 86.4% vs. 66.7%, p = 0.028), while in CD skip lesions and small intestine villous blunting were more frequently reported in LO‐CD than in VEO‐CD (83.3% vs. 45.5%, p = 0.031; 60.9% vs. 9.1%, p = 0.005).
Conclusions: While VEO‐IBD and LO‐IBD appear endoscopically and clinically similar, except for disease localization, certain histological features differ between the two groups. Surprisingly, younger children with UC exhibit a lower histological burden than those with LO‐UC. Furthermore, some typical characteristics of CD, such as skip lesions and small intestine villous blunting, were infrequently observed in children with VEO‐CD, while they were commonly reported in LO‐CD. Although these findings may be related to the earlier disease onset, it would be of interest to investigate the immune‐phenotype at the histological level to better characterize the lower histological burden of disease activity in VEO‐UC.
Contact e‐mail address: irene.dalpiaz@unifi.it
G‐RF108. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF108.1. STOOL AND BLOOD METABOLOME AND MICROBIOTA OF A PEDIATRIC IBD COHORT UNDERGOING ANTI‐TNF
Juliette Bardet1, Ludivine Lobraico2, Aubin Souche3, Céline Petit4, Aurore Rozieres4, Thomas Loppinet5, Nicolas Caron2, Sophie Heissat2, Pierre Poinsot2, Lioara Vanstraelen2, Noel Peretti2, Aurélie Portefaix5, Sophie Trouillet‐Assant6, Sophie Jarraud7, Karim Chikh8,9, Nicolas Benech2,10,11,12, Rémi Duclaux‐Loras 2,13
1Lyon Hospital, LYON, France, 2Hepato‐gastroenterology Department, Hôpital De La Croix‐rousse, Hospices civils de lyon, lyon, France, 3Infectious Diseases, Hospices civils de Lyon, Lyon, France, 4Autophagy, Infection, Immunity, Centre International de Recherche en Infectiologie, Inserm U1111, Lyon, France, Lyon, France, 5Pediatric Clinic Investigation Center, Hospices civils de Lyon, BRON, France, 6Joint Research Unit Civils Hospices Of Lyon‐biomérieux, Hospices civils de lyon, Lyon, France, 7Centre National De Référence Des Légionelles, Hospices civils de Lyon, Lyon, France, 8Department Of Biochemistry And Molecular Biology, Hospices civils de Lyon, Lyon, France, 9Laboratoire CarMeN, Inserm U1060, INRAE U1397, Lyon, France, 10French Faecal Transplant Group, Lyon, France, 11Lyon GEM Microbiota Study Group, Lyon, France, 12Claude Bernard Lyon 1 University, CRCL, Lyon, France, 13Team "autophay, Infection, Immunity", Centre International de Recherche en Infectiologie, Lyon, France
Objectives and Study: Deep characterization of the metabolome and microbiota in inflammatory bowel diseases (IBD) patients is a valuable tool for identifying essential factors, paving the way for the development of personalized treatments and predictive markers of therapeutic response. The aim of the study was to characterize the gut microbiota and the gut and blood metabolome in pediatric IBD patients undergoing anti‐TNFα therapy.
Methods: We prospectively recorded clinical and biological data at inclusion (V0), 6 months (V1), and 12 months (V2) in a cohort of pediatric IBD where anti‐TNFα therapy was initiated. 16S sequencing of microbiota from stool and multi‐targeted metabolomics analysis of blood and stool were performed at each visit.
Results: Nineteen patients were included, 15 with Crohn's disease and 4 with ulcerative colitis. 74% were in remission at one year of anti‐TNFα therapy. In blood, a multi‐targeted metabolomic revealed in plasma, 67 metabolites decreased (mainly triglycerides and polyamines) and 14 increased (including 6 plasmalogen phosphatidylethanolamines) 6 month and/or one year of anti‐TNFα therapy. In stool, 26 metabolites are decreased; including amino acids, acylcarnitines and lysophosphatidylserine, and 4 metabolites are increased including one plasmalogen PE and sphingosine d18:0. A combination of 15 stool metabolites, including 1 sphingamine and 3 sphingosines, predicted clinical response with an AUC of 0.93 (sensitivity/specificity > 90%). In blood, a combination of 10 metabolites predicted clinical response with an AUC of 0.85. 16S sequencing revealed a shift in bacterial community composition from V0 to V1, with a decrease in Enterobacteriaceae and an increase in Bacteroidaceae. However, α‐diversity remained unchanged at V0, V1, and V2. Community composition (β‐diversity) evolved over the follow‐up period (p = 0.01). Metabolites predicting response to anti‐TNF correlated strongly with anti‐inflammatory (Faecalibacterium) and pro‐inflammatory (Escherichia_Shigella) taxa.
Conclusions: Our study identified reliable bacterial species and metabolites, highlighting the potential of the sphingosine pathway as biomarkers of anti‐TNFα response in pediatric IBD.
Contact e‐mail address: remi.duclaux-loras@chu-lyon.fr
G‐RF109. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF109.1. PROSPECTIVE EVALUATION OF CROHN'S DISEASE EXCLUSION DIET AND ITS COMPARISON WITH ENTERAL EXCLUSIVE NUTRITION AS AN INDUCTION THERAPY
Jana Duskova, Ondrej Hradsky, Kristýna Zárubová, Katarina Mitrova, Jiri Bronsky, Tereza Lerchova
Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
Objectives and Study: Crohn's Disease exclusion diet (CDED) has shown positive clinical outcomes in inducing remission in pediatric Crohn's disease (CD). However, most studies have either lacked a control group or have been conducted retrospectively. We aimed to prospectively compare the clinical outcomes of CDED and exclusive enteral nutrition (EEN) induction regimens.
Methods: CDED was introduced at our center in 2020 to induce remission in all newly diagnosed luminal CD patients with pediatric Crohn's disease activity index (PCDAI) ≤ 40. Children treated with EEN (2014–2017) were included as a reference group, with similar maintenance therapy in both groups. The primary outcomes, clinical response (PCDAI decrease of ≥12.5 or <10 points) and mucosal healing (MINI index <8 points), were assessed at week 6. The secondary outcome, clinical relapse within the first year, was defined as the need for therapy change or two consecutive fecal calprotectin (fCPT) levels >500 µg/g after remission induction. Logistic regression and Cox proportional hazard regression model were used to estimate the odds ratio and hazard ratio, and 95% confidence interval (CI). Covariate adjustment included patient age, disease location, PCDAI, and fCPT at diagnosis (aOR, aHR).
Results: This study included 66 patients, 33 (50%) in each group. Clinical response, observed in 27/33 children (82%) induced with EEN and in 25/33 (76%) children receiving CDED, yielded an aOR of 0.56 (95% CI = 0.08–3.50) for CDED versus EEN. Mucosal healing was achieved in 11/33 (33%) children on EEN and in 16/33 (48%) CDED patients, and was not associated with type of induction (aOR=1.74 [95% CI = 0.51–6.13]). Individuals induced with CDED had lower risk of clinical relapse compared to children after EEN induction; HR = 0.56 (95% CI = 0.32–0.99). However, this association did not remain after adjustment (Figure 1).
Conclusions: CDED was associated with favorable clinical outcomes in inducing remission in pediatric CD.
Contact e‐mail address: jancapavelcova@seznam.cz
G‐RF110. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF110.1. FUNCTIONAL PROFILING OF MICROBIOTA GENES IN PEDIATRIC ULCERATIVE COLITIS IN SAUDI ARABIA
Mohammad El Mouzan 1, Ahmed Al Sarkhy1, Dana Walsh2, Badr Alsaleem3, Mohammad Al Mofarreh4, Asaad Assiri1, Abdullah Almasoud1
1Pediatrics, King Saud University, Riyadh, Saudi Arabia, 2Microbiome Sciences, Cmbio, Germantown, United States of America, 3Pediatrics, King Fahad Medical City, Riyadh, Saudi Arabia, 4Al Mofarreh Polyclinics, Riyadh, Saudi Arabia
Objectives and Study: The association of microbiota with inflammatory bowel disease is well known. However, the functional profile of microbial genetic sequences has rarely been reported. The objective of this study was to describe the microbial functional profiles in a cohort of children with ulcerative colitis (UC) and controls.
Methods: DNA was extracted from fecal and mucosal samples of children with newly diagnosed and untreated children with UC and non UC controls and sequenced by whole genome shotgun methods. The resulting gene sequences were then annotated using MetaCyc and Gene Ontology (GO) functional database to reconstruct and quantify metabolic pathways. Differences in functional pathways were compared between the groups using alpha and beta diversity metrics as well as differential enrichment with DESeq feature selection using the Boruta algorithm and ROC curve analysis to determine pathways predictive of UC.
Results: We identified 334 and 1349 GO functions and 37 MetaCyc pathways that were significantly enriched in fecal and mucosal samples of UC, suggesting their possible roles in predicting the diagnosis of UC. These included integral components of the membrane, the cytoplasm with all subcellular structures, and RNA and DNA binding.
Conclusions: While most of the findings represent normal biologic functions essential for cellular metabolism, those significantly enrished in UC samples imply a role in the pathogenesis of UC beyond beyond the level of microbial composition. Further studies with larger sample sizes identifying microbiota species specific pathways may clarify the metabolic basis of the role of microbiota in the pathogenesis and early diagnosis of ulcerative colitis.
Contact e‐mail address: drmouzan@gmail.com
G‐RF111. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF111.1. ROLE OF SALIVARY LYMPHOCYTES AS A POTENTIAL NON‐INVASIVE DIAGNOSTIC MARKER IN PEDIATRIC INFLAMMATORY BOWEL DISEASE (PIBD)
Stefania Giampetruzzi 1, Paola Gaio1, Alessandra Falda2, Nicole Contran2, Giulia Musso2, Luca Bosa1, Giovanna Faggian1, Andrea Padoan2, Daniela Basso2, Mara Cananzi1
1Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Department of Women's and Children's Health, Padova, Italy, 2Laboratory Medicine, University Hospital of Padova, Padova, Italy
Objectives and Study: This pilot study explores the detection of salivary lymphocytes in Pediatric Inflammatory Bowel Disease (PIBD) and their potential as innovative non‐invasive biomarkers of disease activity
Methods: A prospective study was conducted involving children (≤18 years) diagnosed with PIBD and a control group of healthy subjects. Saliva samples were collected using E‐saliva and Salivette® devices. Flow cytometry quantified lymphocyte populations and assessed their activation through HLA‐DR expression. Clinical data included disease type, activity scores (PCDAI/PUCAI), and laboratory markers such as complete blood counts, inflammatory markers and lymphocytes activation parameters. Comparative and correlation analyses were performed, with p < 0.05 as the significance threshold.
Results: 37 PIBD patients (15 females, median age 15.2 years) were enrolled. 13 (35%) tested positive for salivary lymphocytes (pL + ), while 24 (65%) were negative (pL‐). None of the 23 healthy controls had detectable salivary lymphocytes. The pL+ group showed a significantly higher prevalence of Crohn's disease (CD) (84% vs. 50%, p = 0.004). Notably, 30% of pL+ patients had active disease, while 70% were in remission, with 46% having experienced active disease within three months prior to saliva collection. Flow cytometry revealed a predominance of activated CD4+ lymphocytes (median CD4/CD8 ratio: 2.25) with 57.38% HLA‐DR expression in CD3 DR+ cells. Salivary lymphocyte counts correlated significantly with ESR (rho=0.7857, p = 0.0362) and activity scores (rho=0.5752, p = 0.0397), but not with blood lymphocyte activation (rho = ‐0.169, p = 0.290).
Conclusions: Salivary lymphocytes, particularly activated CD4+ cells, are detectable in children with PIBD, especially in CD. Their significant correlation with ESR and disease activity indices, alongside their presence during clinical remission, suggests their utility in monitoring immune responses across all disease phases. These results highlight the promising potential of salivary lymphocytes as non‐invasive biomarkers. Further studies are needed to validate their role in PIBD management.
Contact e‐mail address: stefania.giampetruzzi@gmail.com
G‐RF112. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF112.1. SCHOOL‐RELATED CHALLENGES FOR PAEDIATRIC INFLAMMATORY BOWEL DISEASE PATIENTS AND THE ROLE OF PATIENT ASSOCIATIONS: RESULTS FROM A NATIONAL SURVEY OF OVER 350 ITALIAN PAEDIATRIC PATIENTS
Laura Gianolio 1, Valentina Silvera1, Melania Quaglia2, Valeria Brazzoduro2, Francesca Penagini2, Dario Dilillo2, Enrica Previtali3, Salvatore Leone3, Gian Vincenzo Zuccotti1,4, Lorenzo Norsa2
1Department Of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy, 2Department Of Paediatrics, Vittore Buzzi Children's Hospital, Milan, Italy, 3AMICI Italia Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy, 4Department Of Biomedical And Clinical Sciences, University of Milan, Milan, Italy
Objectives and Study: Quality of life (QoL) is a fundamental long‐term therapeutic target. Given the significant role that school plays in pediatric IBD patients daily lives, understanding its impact on patients' QoL is crucial. Our study aimed to evaluate patients' perspectives on school environment and identify improvement areas.
Methods: An anonymized survey was distributed (02/2020‐11/2024) to all pediatric IBD patients and families registered with the Italian patient association AMICI. Data collected included disease type, sex, school grade along with disease awareness and responses to a 20‐item questionnaire evaluating various aspects of school experience.
Results: Overall, 362 patients (54% females; median age 16 years, IQR:13‐18) responded to the survey, with the majority attending secondary‐school/college (326/362, 90%). Most respondents reported being aware of their disease (327/362, 90%; 38% with Crohn's disease, 48% with ulcerative colitis) and its chronicity (311/362, 86%). While the majority (269/362, 74%) expressed a positive attitude towards school and had disclosed their condition to at least 1 person at school (286/362, 79%), challenges were identified. Concerning empathy, only 25% (91/362) and 23% (84/362) felt often understood by teachers and peers, respectively. Toilet access was problematic, with 48% (172/362) reporting unrestricted access and 62% (225/362) expressing fear of using school bathrooms (Figure1). Additionally, 25% (91/362) reported being teased due to their condition, while 22% (80/362) experienced physical/verbal bullying. Almost half (172/362, 48%) attended school despite feeling unwell to avoid criticism, with a minority having access to support teachers (54/362, 15%). Patients’ suggestions were training programs to educate teachers/peers (108/362, 29%) and improvements in bathroom access/organization and absences management (51/362, 14%).
Conclusions: Despite existing awareness campaigns, national/international initiatives to educate school staff/peers and foster understanding should be implemented to ensure a more inclusive school environment. Patient associations can play a pivotal role by identifying patients' daily needs and facilitating collaboration between healthcare providers, educators and policymakers.
Contact e‐mail address: laura.gianolio@unimi.it
G‐RF113. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF113.1. INFLAMMATORY BOWEL DISEASE IN PEDIATRIC INTESTINAL PSEUDO‐OBSTRUCTION: THREE CASES WITH DIVERGENT OUTCOMES
Silvia Gómez Anca 1, Cristina María López García1, Pedro Luis Pérez Hernández1, María Allende Chaves1, Javier Artero López1, Alida Alcolea Sánchez1, Eva Peña Saínz‐Pardo1, Ana Maria Castro Millán2, Ruth García Romero3, Rocío González Sacristán1, Francisco Hernandez‐Oliveros4, Esther Ramos Boluda1
1Pediatric Gastroenterology, Hospital Universitario La Paz, Madrid, Spain, 2Hospital Universitario de Canarias, La Laguna (Tenerife), Spain, 3Pediatric Gastroenterology, Hospital Infantil Miguel Servet, Zaragoza, Spain, 4Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain
Objectives and Study: Secondary inflammatory bowel disease (SIBD) is a multifactorial condition that mimics classic IBD, complicating diagnosis and treatment. This study explores SIBD in pediatric patients with chronic intestinal pseudo‐obstruction (PIPO), emphasizing clinical features and pathophysiology.
Methods: Epidemiological, clinical, therapeutic, and outcomes variables were analyzed in three patients with PIPO presenting with clinical, endoscopic, and histological findings consistent with inflammatory bowel disease.
Results: All patients were in intestinal failure requiring home parenteral nutrition at the time of diagnosis. Patient 1: A 20‐year‐old male with Berdon syndrome (heterozygous ACTG2 mutation) and polyarthritis, and high ileostomy output (3–4 liters daily), elevated CRP (10.6–33.9 mg/L), and fecal calprotectin (582 μg/g), causing nutritional impairment. Endoscopy showed ulcerative ileitis with acute inflammation. Initially he was treated with Adalimumab every 4 weeks for polyarthritis. It was intensified to weekly for 2 months, achieving clinical and analytical improvement. Patient 2: A 10‐year‐old female with increased intestinal losses, CRP (34–78 mg/L), and fecal calprotectin (724–977 μg/g). Initial treatment with Budesonide improved symptoms, but relapse occurred after corticosteroid withdrawal. Azathioprine and infliximab (IFX) were initiated however, IFX was discontinued due to anaphylaxis and replaced with Adalimumab. She is currently on biweekly Adalimumab, with fecal calprotectin reduction (311 μg/g) and clinical improvement. Patient 3: A 12‐year‐old female (homozygous ACTG2 mutation) presenting with rectal bleeding and pancolitis with deep ulcerations (CRP: 128–174 mg/L; calprotectin: 87–155 μg/g). Partial improvement was observed with topical corticosteroids, with further clinical stabilization achieved using Etanercept for polyarthritis.
Conclusions: ‐ PIPO may be associated with SIBD, requiring endoscopic and histological evaluation in unexplained cases of bleeding, increased losses, or inflammation. ‐ Treatment should be individualized, and potential autoimmune arthropathy associations investigated. ‐ Further research is essential to clarify its incidence, causes, and impact of SIBD in PIPO patients.
Contact e‐mail address: silvia.g.anca@gmail.com
G‐RF114. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF114.1. CHANGES IN MMP‐9 AND TIMP‐1 LEVELS DURING THE COURSE OF ULCERATIVE COLITIS ‐ A PRELIMINARY STUDY
Gabriela Gronowicz, Katarzyna Zdanowicz, Dariusz Lebensztejn, Urszula Daniluk
Department Of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology And Pulmonology, Medical University of Bialystok, Bialystok, Poland
Objectives and Study: Abnormal serum levels of matrix metalloproteinase‐9 (MMP‐9) and tissue inhibitor of metalloproteinase‐1 (TIMP‐1) have been demonstrated in children with ulcerative colitis (UC) at the time of diagnosis. However, there are no data on changes in concentrations of MMP‐9 and TIMP‐1 under treatment. The purpose of our study was to evaluate the serum concentrations of MMP‐9 and TIMP‐1 in children with UC at diagnosis or exacerbation (T0) and after 3 (T1) and 6 (T2) months of follow‐up.
Methods: 15 children with UC and 10 controls (Ctr) with functional gastrointestinal disorders were included in the study. The diagnosis of UC was based on the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines, including endoscopic and histological criteria. The type of therapy used (5‐aminosalicylic acid, steroid, infliximab) depended on disease activity as assessed by the Pediatric Ulcerative Colitis activity index (PUCAI) and endoscopic Mayo score.
Results: The study group included 9 children with newly diagnosed UC and 6 children with exacerbation of the disease. All children with UC had significantly higher MMP‐9 and TIMP‐1 levels at T0 compared to Ctr. ANOVA analysis showed a significant decrease in MMP‐9 and TIMP‐1 levels during follow‐up. 6/15 patients had an increase in MMP‐9 at T2 and 4 of them had treatment intensification (3 at T2 and 1 before measurement at T3). Next, the study group was divided in terms of PUCAI and fecal calprotectin (fCal) values assessed at T2. There were no significant differences in MMP‐9 and TIMP‐1 concentrations at T0, T1 and T2 in the study group divided by PUCAI and fCal.
Conclusions: MMP‐9 and TIMP‐1 concentrations decrease under effective treatment in children with UC. However, data are lacking to consider them as markers in predicting PUCAI and fCal values 6 months after the applied therapy.
Contact e‐mail address:
G‐RF115. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF115.1. DIETARY HABITS OF ULCERATIVE COLITIS PATIENTS UNDER FOLLOW‐UP IN A PEDIATRIC INFLAMMATORY BOWEL DISEASE UNIT
Marta Herrador‐López 1, Rafael Martín‐Masot1, Chen Sarbagilli2, Víctor Manuel Navas‐López1
1Pediatric Gastroenterology And Nutrition, Hospital Regional Universitario de Málaga, Málaga, Spain, 2The E.Wolfson Medical Center and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Objectives and Study: A Western dietary pattern may contribute to ulcerative colitis (UC) pathogenesis. Poor dietary habits can worsen symptoms and cause nutrient deficiencies, yet data on pediatric dietary practices and needs remain limited. This study aimed to evaluate dietary intake and habits in pediatric UC patients at a Spanish tertiary hospital.
Methods: This prospective observational study included dietary assessments of pediatric UC patients using the KIDMED questionnaire (adherence to the Mediterranean diet, MD) and a 3‐day dietary survey. Food processing levels were analyzed with the NOVA classification system.
Results: Forty‐seven patients (mean age 11.9 ± 3.3 years, 57% female) were followed for a median of 2.8 ± 5.4 years. Mean caloric intake was 1919.07 ± 292.8 kcal, meeting 96.7 ± 21.3% of energy needs. Protein (2.13 ± 0.8 g/kg, 239.06% of RDI) and saturated fat (31.65 ± 7.9% of total fat) intake exceeded recommendations. However, fiber (13.44 ± 2.9 g, 75.1 ± 24.7% of RDI), calcium (457.7 ± 239.3 mg, 41.6 ± 26.2% of RDI), and iron (8.3 ± 3.4 mg, 75.3 ± 37.2% of RDI) intake were inadequate. The average KIDMED score was 6.2, with only 31.9% of patients showing high MD adherence. Most (55.3%) needed dietary improvement, and 12.7% had very low diet quality. According to NOVA, energy intake came from unprocessed/minimally processed foods (40.09 ± 13.5%), processed culinary ingredients (7.9 ± 3.2%), processed products (25.06 ± 12.3%), and ultra‐processed products (27.1 ± 12.03%).
Conclusions: Despite family concerns, pediatric UC patients showed suboptimal dietary quality, with significant variability and unnecessary restrictions. Integrating specialized dietitians into multidisciplinary care teams and further exploring diet‐UC relationships are essential.
Contact e‐mail address: victor.navas@gmail.com
G‐RF116. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF116.1. THE PHARMACOKINETIC PATTERNS (INFANT TO MATERNAL RATIOS) OF THE DIFFERENT BIOLOGICS USED DURING PREGNANCY IN MOTHERS WITH INFLAMMATORY BOWEL DISEASE
Pia Homan 1, Darja Urlep2, Saša Čučnik3, Bor Vratanar4, Matjaž Homan5
1University Clinical Centre, Ljubljana, Slovenia, 2Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia, 3Immunology Laboratory, University Clinical Center, Ljubljana, Slovenia, 4Institute For Biostatistics And Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia, 5Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
Objectives and Study: Evidence on the safety of newer biologics during pregnancy is limited. In addition, data regarding the pharmacokinetics of the biologics are scarce. Therefore, we aimed to assess the placental transfer of different biologics during pregnancy and delivery.
Methods: We conducted a retrospective, single‐center study in consecutive pregnant women with inflammatory bowel disease exposed to infliximab (IFX), adalimumab (ADL), ustekinumab (UST) and vedolizumab (VDZ) during pregnancy and their newborns at the Division of Obstetrics and Gynaecology, University Medical Center in Ljubljana. Drug levels were assessed in maternal and cord blood at delivery.
Results: We included 41 pregnant (mean age 31.3, sd=4.4)) women exposed to biologics during the entire pregnancy. Out of them, 9 were treated with IFX, 17 with ADL, 8 with UST, and 7 with VDZ, respectively. The median ratio of infant:mother drug concentration at birth was 1.11 for IFX (95% confidence interval (CI),1.00; 2.69), 1.17 for ADL (95% CI,1.00;1.54), 1.14 for UST (95% CI, 0.62; 1.61), and 0.51 for VED (95% CI,0.25; 0.63), respectively. Figure 1: Comparison of drug concentrations between infant and mother for ADL, IFX, UST, and VDZ. The dashed line indicates the presence of ceiling or floor effects.
Conclusions: Placental transfer differed between the biologic drugs, with UST having similar and VDZ having an inverse infant‐to‐maternal ratio of drug levels compared with anti‐TNF drugs. VDZ demonstrated different placental pharmacokinetics, even though it is an IgG1 molecule as other aforementioned biologics and was expected to have similar active transport through the placenta by Fc receptor.
Contact e‐mail address: piaa.homan@gmail.com
G‐RF117. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF117.1. EVALUATING THE IMPACT OF THERAPEUTIC DRUG MONITORING STRATEGIES ON CLINICAL OUTCOMES IN PAEDIATRIC INFLAMMATORY BOWEL DISEASE: A COHORT STUDY OF THE CEDATA_GPGE REGISTRY
Karlotta Hubert, Sebastian Stricker, Jan De Laffolie
Department Of General Paediatrics And Neonatology, Justus‐Liebig University, Gießen, Germany
Objectives and Study: The rising incidence of Inflammatory Bowel Disease (IBD) in paediatric populations underscores the need for effective management strategies. Anti‐TNF‐α agents such as Infliximab (IFX) and Adalimumab (ADL) are effective drugs for inducing and maintaining remission, but many patients eventually lose response over time. Currently, there is limited data on how to perform therapeutic drug monitoring (TDM) to optimize anti‐TNF therapy, especially in the paediatric population. Henceforth, we compared the influence of proactive and reactive TDM on clinical outcomes and Anti‐TNF pharmacokinetics in a paediatric IBD cohort.
Methods: We conducted a retrospective multicenter study of 391 children with IBD (diagnosed 2014‐2023) from the CEDATA_GPGE registry. Patients were grouped into proactive and reactive TDM cohorts, which was performed at the discretion of the participating center. Clinical outcomes, IFX and ADL dosing, drug levels, and anti‐drug antibody development were compared.
Results: Proactive TDM was associated with higher rates of remission (50 vs 24 %; p < 0,0001). In CD (Crohn's disease) patients receiving proactive TDM, we observed a reduced wPCDAI (22; 10‐25 vs 26; 15‐33; p < 0.0001). Hospitalization rates were significantly lower in the proactive TDM group (17 vs 39 %; p < 0.0001). Proactive TDM was associated with significantly higher IFX levels (8.5; 2.9‐9.7 vs 7.2; 3.0‐7.8 µg/ml, p < 0.05), lower levels of anti‐drug antibodies (35; 2‐20 vs 54; 10‐57 U/ml, p < 0.0001) and less frequent switches of the biologic therapy.
Conclusions: Our data indicate that proactive TDM is associated with better clinical outcomes and lower hospitalization rates in paediatric IBD. Regarding IFX, proactive TDM significantly improved pharmacokinetics, further supporting the implementation of this monitoring strategy in paediatric IBD management.
Contact e‐mail address: karlotta.hubert@gmx.de
G‐RF118. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF118.1. LONGITUDINAL OBSERVATION OF BLASTOCYSTIS SP. AND DIENTAMOEBA FRAGILIS IN CHILDREN AND YOUNG PERSONS: A VERY RARE OCCURRENCE IN CHRONIC DISEASES WITH GUT DYSBIOSIS
Jakub Hurych 1, Jolana Havlova1, Vit Neuman2, Karolina Litosova1, Klara Hubackova1, Michal Kubat2, Ondrej Hradsky2, Jiri Bronsky2, Kaija‐Leena Kolho3, Paivi Saavalainen4, Hana Malcova5, Dita Cebecauerova5, Pavel Drevinek1, Zdenek Sumnik2, Ondrej Cinek1
1Dept Of Medical Microbiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic, 2Dept Of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic, 3Department of Paediatric Gastroenterology, Children's Hospital, HUS and University of Helsinki, Helsinki, Finland, 4Translational Immunology Research Program and Department of Medical and Clinical Genetics, Faculty of Medicine, University of Helsinki, Helsinki, Finland, 5Dept Of Adult And Paediatric Rheuamatology, Motol University Hospital, Prague, Prague, Czech Republic
Objectives and Study: Blastocystis sp. (BL) and, to some extent, Dientamoeba fragilis (DF) are increasingly viewed as indicators of diverse gut microbiomes rather than pathogens. However, longitudinal data on their presence and stability remain limited. This study aimed to assess their presence and stability in longitudinal series of faecal samples from children with inflammatory bowel disease (IBD) and cystic fibrosis (CF), contrasting these with gut‐healthy children with type 1 diabetes (T1D), juvenile idiopathic arthritis (JIA), and healthy controls.
Methods: Stool samples were collected at tertiary centres in Czechia and Finland. Internally controlled real‐time PCR was used to detect and quantify Blastocystis; Czech samples were similarly tested also for Dientamoeba. Massively parallel amplicon sequencing was used to determine Blastocystis subtypes (18S rDNA partial sequence) and bacteriome profiles (16S rDNA, V3‐V4 amplicon).
Results: A total of 372 subjects (mean age 13.9, 47% female) and their 1884 stool samples were analysed: 135 subjects with IBD (597 samples) and 22 with JIA (96 samples) from anti‐TNF therapy studies, 116 with T1D from interventional dietary studies (626 samples), and 45 subjects with CF from a study on CFTR modulator therapy (237 samples). BL and DF subject‐wise positivity rates were significantly lower in IBD (BL 5.9%, DF 6.5%) as well as in CF (none positive) than in healthy controls (BL 26.7%, DF 23.5%), T1D (BL 16.8%, DF 28.0%), or JIA (BL 9.1%, DF 26.9%), corrected P values < 0.01. Simultaneous positivity of the two protists was common, with nine individuals showing long‐term co‐colonization (≥4 samples; examples in Figure). Figure
Conclusions: Blastocystis sp. and Dientamoeba fragilis were frequently detected in gut‐healthy individuals (T1D, JIA, healthy), including asymptomatic long‐term co‐colonization in some cases. In contrast, these protists were rare in IBD and entirely absent in CF, likely reflecting their severely dysbiotic, inhospitable, low‐diversity microbiomes. Notably, this pattern persisted despite clinical improvement with anti‐TNF therapy in IBD or the initiation of CFTR‐modulating therapy in cystic fibrosis.
Contact e‐mail address: jakub.hurych@lfmotol.cuni.cz
G‐RF119. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF119.1. PHYSICAL ACTIVITY AND HANDGRIP STRENGTH IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE
Emese Kasznár 1,2, Dorina Bajzát1,2, Ágnes Tímár1,2, Dóra Dohos2, Eszter Gombos3, Anna Karoliny3, András Szabó3, Judit Szentannay3, Katalin Eszter Müller3,4
1Centre For Translational Medicine, Semmelweis University, Szeged, Hungary, 2Heim Pal National Pediatric Institute, Budapest, Hungary, 3Gastroenterology And Nephrology Department, Heim Pal National Pediatric Institute, Budapest, Hungary, 4Department Of Family Care Methodology, Semmelweis University, Budapest, Hungary
Objectives and Study: Approximately 15‐20% of patients with inflammatory bowel disease (IBD) are diagnosed in childhood. Sarcopenia is known to be a poor prognostic factor for the disease: it increases the length of hospital stay, surgical complications and worsens response to medication. We know that 1/3 of adult IBD patients have sarcopenia, but data on paediatric patients are limited. Our aim was to assess and compare the physical activity and handgrip strength of healthy children with paediatric patients with IBD treated at the Heim Pal National Paediatric Institute, Budapest.
Methods: Single‐centre, non‐interventional case‐control study. Anthropometric data, sex and age of healthy children and pediatric IBD patients were recorded. Hand grip strength and physical activity were assessed using the JAMAR hydraulic hand dynamometer and PAQ‐C.
Results: We compared data from 75‐75 children, 33 with Crohn's disease, 40 with ulcerative colitis and 2 with IBD‐U. 82.7% of the patients were in remission. The proportion of girls was 42.5%. The mean age was 15.46 ± 1.87 years in children with IBD and 15.45 ± 1.86 years in healthy subjects. The BMI z‐score was 0.17 ± 1.59 in children with IBD and ‐0.16 ± 0.84 in healthy subjects. 24% of the children with IBD needed increased muscle strength development and 39% needed slight improvement, compared to 33% of the healthy population. The total PAQ‐C score was 2.42 ± 0.61 in healthy subjects and 2.07 ± 0.6 in IBD patients.
Conclusions: The results show that children with IBD have a higher prevalence of muscle strength in need of improvement and a lower rate of physical activity compared to healthy children, even though more than three quarters of them are in remission.
Contact e‐mail address: kasznar.emese@stud.semmelweis.hu
G‐RF120. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF120.1. ZONULIN AS BIOMARKERS OF INTESTINAL BARRIER LEAKAGE IN THE DIAGNOSIS AND ASSESSMENT OF INFLAMMATORY BOWEL DISEASE PROGRESSION
Zilola Khadjieva 1,2, Malika Kurbonalieva3, Hilola Ubayxodjaeva2
1Medical Sc, Central Asian University, Tashkent, Uzbekistan, 2Pediatric Gastronterology, Republican Specialized Scientific Practice Medical Center of Pediatrics, Tashkent, Uzbekistan, 3Pediatrics, Defactum kids, Tashkent, Uzbekistan
Objectives and Study: Inflammatory bowel disease demonstrate a loss of tight junction barrier function, increased pro‐inflammatory cytokine production, and immune dysregulation. Zonulin is a protein that increases permeability in the epithelial layer of the small intestine by reversibly modulating the intercellular tight junctions. The aim of this study was to investigate fecal ZRP and fecal calprotectin in pediatric IBD patients as well as its correlation with disease activity.
Methods: In 2022–2024 years single‐center prospective study was conducted on 60 children aged 1 to 16 years with IBD. A stool specimen was collected the day before the visit to the hospital, then fecal ZRP and fecal calprotectin was tested using the ELISA test. The median age at diagnosis was 11 years. The normal zonulin reference range was set at 61 ± 46 ng/mL.
Results: All children included in the study were divided into 2 groups: 50 with UC and 10 with CD. Zonulin levels were significantly elevated in IBD patients compared to the normal range, indicating disrupted intestinal barrier integrity. The mean zonulin level for CD patients was 129.5 ± 34.2 ng/mL, while for UC patients, it was 104.8 ± 29.7 ng/mL, p < 0.05. Calprotectin levels were elevated in both groups, with higher levels in UC patients (mean 890 ± 120 µg/g) than in CD (mean 780 ± 110 µg/g; p < 0.05). Zonulin with CD patients showing higher levels, reflecting more severe barrier dysfunction. Both biomarkers were positively correlated with disease severity and progression.
Conclusions: Zonulin is a valuable biomarker for diagnosing and monitoring intestinal barrier leakage in pediatric IBD. The strong positive correlation between zonulin and calprotectin levels with disease severity supports the utility of zonulin as a novel, non‐invasive biomarker for assessing intestinal permeability and IBD progression. Further research is warranted to validate its role and explore its potential in therapeutic monitoring.
Contact e‐mail address: zkhadjieva@gmail.com
G‐RF121. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF121.1. INTEGRATIVE ANALYSIS OF HOST MOLECULAR INFLAMMATORY STATE AND ITS MUCOSA‐ASSOCIATED MICROBIOTA IN ULCERATIVE COLITIS
Patricia Khoo 1,2, Linden Gearing2,3, Sean Solari2,3, Samuel Forster2,3, Edward Giles1,2
1Department Of Paediatrics, Monash University, Clayton, Australia, 2Centre For Innate Immunity And Infectious Diseases, Hudson Institute of Medical Research, Clayton, Australia, 3Department Of Molecular And Translational Sciences, Monash University, Clayton, Australia
Objectives and Study: Inflammatory bowel disease (IBD) is caused by an aberrant immune response in genetically susceptible individuals to the environment, including their microbiota. A recent explosion in microbiome research in IBD has yet to change diagnostic algorithms nor resulted in new treatments. Most studies have focused on stool samples, hence lacking the representation of mucosa‐associated microbiota and the characterisation of host‐microbiota interaction at the mucosal interface. We therefore performed paired measurement of site‐specific host transcriptional response along with its mucosa‐associated microbiota.
Methods: Rectal biopsies were obtained from adults with ulcerative colitis(UC) and controls. Four mucosal samples were obtained from each patient, at the site of inflammation if observed. Two biopsies were sent for histological review. Matched mucosal culturing of mucosa‐associated bacteria and RNA sequencing of host transcriptional profiling were performed. RNA sequencing and microbial analysis were performed in R (v4.3.2). Expam, a clade‐based metagenomic analysis was performed to identify biologically relevant clades.
Results: Samples were collected from 98 patients: 52 with UC and 46 controls. The mean age of UC patients was 36.3 years (21‐75), and 42.3% were female. The mean age of control patients was 36.4 years (18‐56), and 54.3% were female. Principal coordinate analysis plot was generated using the Hallmark Inflammatory Response gene set. It demonstrated a cluster of molecularly inflamed samples, which comprised mostly of the histologically inflamed UC samples but there are some histologically inflamed samples that did not belong to the molecularly inflamed cluster. Sparse Partial Least Squares was performed to assess the correlations between the Hallmark gene set scores and the microbial species‐level clade abundance, identifying potential functionally distinct clades.
Conclusions: This unbiased site‐specific combination analysis of host inflammatory response and bacteria allows identification of clades potentially driving damage in IBD. Future work involves validation of our candidate bacteria using ex vivo models and analysis of publicly availabale datasets.
Contact e‐mail address: wei.khoo@monash.edu
G‐RF122. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF122.1. ASSESSMENT OF MUCOSAL HEALING AFTER EXCLUSIVE ELEMENTAL DIET USING SMALL BOWEL CAPSULE ENDOSCOPY IN PAEDIATRIC CROHN'S DISEASE
Yeong Eun Kim 1, Jooyoung Jang2, Seak Hee Oh2, Kyung Mo Kim2
1Department Of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, Republic of, 2Department Of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea, Republic of
Objectives and Study: Exclusive elemental nutrition (EEN) is an effective treatment for induction of remission in children with active luminal Crohn's disease (CD). Endoscopic or mucosal healing is associated with long‐term outcomes, but it is difficult to perform repeated colonoscopies in children. This study aimed to evaluate the improvement of small bowel mucosal lesions using small bowel capsule endoscopy (SBCE) in paediatric CD patients treated with EEN as induction therapy.
Methods: We retrospectively reviewed data from patients under 18 years of age who were newly diagnosed with CD and commenced EEN as induction therapy between May 2018 and April 2023. Among these patients, we included those who completed EEN for more than 6 weeks and underwent SBCE at both the time of diagnosis and within 2 weeks of completion of EEN. We compared the results of SBCE, laboratory tests, and BMI z‐score before and after EEN using the paired t‐test.
Results: A total of 71 patients (57 males, 14 females) were included with a mean age of 13.3 ± 2.27 years. After 6 to 8 weeks of EEN, 64 patients (90.1%) showed improvement in ulcers on follow‐up SBCE, including 35 patients (49.3%) with complete disappearance of ulcers and 29 patients (40.8%) with partial disappearance of ulcers. Seven patients (9.9%) showed no improvement. The Lewis score was significantly decreased (p < 0.001). In addition, mucosal healing, defined as the Lewis score < 135, was achieved in 28 patients (38%). Blood tests and fecal calprotectin showed significant improvement after EEN (p < 0.001). However, BMI z‐score was not improved after EEN (p = 0.46).
Conclusions: SBCE is a useful tool to evaluate mucosal healing after EEN in paediatric Crohn's disease. Most patients showed improvement in ulceration on SBCE after EEN. Additionally, improvements in blood test and fecal calprotectin levels were noted following EEN.
Contact e‐mail address:
G‐RF123. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF123.1. ROUTINE PRE‐MEDICATIONS AND PROLONGED INFUSIONS DO NOT REDUCE INFLIXIMAB INFUSION REACTIONS
Michael Lane 1,2,3, Ahmad Almaiman1,2, Karen O'Driscoll1, Rita Mackey1, Beth Meaney1, Megan Boys1, Rachael Burke1, Grace Alexander1, Séamus Hussey3,4,5
1Hepatology, Gastroenterology And Nutrition, CHI Crumlin, Dublin, Ireland, 2Royal College of Physcicians, Ireland, Dublin, Ireland, 3Royal College of Surgeons Ireland, Dublin, Ireland, 4National Children's Research Center, Dublin, Ireland, Dublin, Ireland, 5University College Dublin, Dublin, Ireland
Objectives and Study: Whether premedications with steroids and anti‐histamines, or slower infliximab infusions reduce allergic reactions is unclear. In 2020, our centre reduced infusion times, ceased routine premedication and reduced post‐infusion monitoring to 15 mins. The primary objective of this study was to assess whether this change increased infusion reactions.
Methods: This retrospective study compared two 6‐month eras, in 2019 and 2023. Data collection included characteristics (age, gender, diagnosis, BMI, allergies), infusion details (duration, induction/maintenance, post‐infusion observations), disease activity, antibody levels and premedication use. Reactions were classified according to the Common Terminology Criteria for Adverse Events v5.0 Grade 1‐5 (mild, moderate, severe, anaphylaxis, death). Reactions and infusion durations were compared separating induction durations (2.5hrs vs 2hrs) and maintenance durations (90 min vs 60 min). Statistical analysis employed Chi‐square, Fisher's Exact, and t‐tests, using Jamovi© Software.
Results: A total of 366 patients (125[2019]; 241[2023]) had 1075 infusions (342[2019]; 733[2023]); 269 (73.5%) had Crohn's disease, 82 (22.4%) Ulcerative Colitis and 15 (4.1%) IBD‐U. The era cohorts were comparable for age (mean 13.4 y vs 13.9 y, p= .467), gender M:F (n = 81:44 vs 144:97, p = .347), IBD subtype (p = .611), BMI (mean=19.5 vs 20.2, p = .091) and prior allergy (n = 6 vs 14, p = .687). There were proportionately more inductions in 2023 (7.3% vs 11.1%, p = .029). The reaction rate was 1.2/100 infusions, or 3.6/100 patients. Reactions included five grade 1, seven grade 2, and one grade 4, all occurring during infusions. Premedication neither reduced reaction rates (1% vs 1.5%, p = .565) nor anti‐drug antibody development (any stage [p = .565], patients completing induction [p = .327]). Reactions were more likely during induction (p = .001) but not in patients with higher‐titre anti‐drug antibodies (p = .476). Shorter infusions did not increase reactions (p = .521, p = 1).
Conclusions: Premedication and slower infusion rates do not reduce infliximab infusion reaction rates, and are unnecessary. Premedications do not decrease antibody levels. Short post‐infusion observation periods adequately meet safety needs following infliximab infusion.
Contact e‐mail address: michael.lane1@hse.ie
G‐RF124. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF124.1. HUMAN MILK‐DERIVED LACTOBACILLUS FERMENTUM CECT5716 MITIGATES EXPERIMENTAL NECROTIZING ENTEROCOLITIS VIA REGULATE GLUTATHIONE METABOLISM
Fan Zhang, Juyi Zhao, Xiaohui Chen, Shushu Li, Shuping Han
Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
Objectives and Study: Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in newborns. Studies have confirmed that colonization and homeostasis of gut flora in early life are associated with the development of NEC. Lactobacillus fermentans CECT5716, isolated from human milk, has many health effects such as improving immunity, relieving infant intestinal discomfort, treating infant eczema and even mastitis. In this study, we aimed to investigate whether Lactobacillus fermentans CECT5716 attenuates experimental NEC and to explore its potential mechanism.
Methods: In this study, the intervention effect of Lactobacillus fermentans CECT5716 on NEC was verified by constructing a NEC mouse model, and the protective effect of Lactobacillus fermentans CECT5716 on intestinal mucosal integrity in NEC was explored by the intestinal organoids.
Results: showed that Lactobacillus fermentosus CECT5716 significantly alleviated NEC symptoms in mice and promoted the proliferation of intestinal stem cells. Importantly, Lactobacillus fermentosus CECT5716 could directly improve LPS‐induced morphological damage of intestinal organoids and increase the number of intestinal stem cells, which was validated in mice. During repair, an increase in the number of Lgr5+ cells in intestinal organoids and mouse intestines was promoted by Lactobacillus fermentosus CECT5716. Gallic acid is a metabolite of Lactobacillus fermentosus CECT5716, which can activate the GSH system and inhibit ROS production, thus activating the Wnt/β‐catenin pathway and promoting intestinal stem cell regeneration.
Conclusions: This study demonstrates that Lactobacillus fermentans CECT5716 is effective at maintaining intestinal stem cell regeneration and homeostasis as well as at repairing intestinal damage after pathological injury and is thus a promising alternative therapeutic method for NEC.
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G‐RF125. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF125.1. BEYOND THE BOWELS: RARE EXTRAINTESTINAL MANIFESTATION OF PULMONARY NECROBIOTIC NODULES IN ULCERATIVE COLITIS WITH AUTOIMMUNE HEPATITIS‐PRIMARY SCLEROSING CHOLANGITIS OVERLAP SYNDROME
Tessa E‐Lin Ong 1, Fang Kuan Chiou1, Khurshid Merchant2, Sarah Wong1,3
1Gastroenterology, Hepatology And Nutrition, KK Women's and Children's Hospital, Singapore, Singapore, Singapore, 2Pathology And Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore, Singapore, 3KK Women's and Children's Hospital, Singapore, Singapore, Singapore
Objectives and Study: Pulmonary necrobiotic nodules (PNNs) are rare extraintestinal manifestation of inflammatory bowel disease (IBD). We present a patient with known ulcerative colitis (UC) and autoimmune hepatitis‐primary sclerosing cholangitis overlap syndrome (AIH‐PSC) who presented with haemoptysis and found to have bilateral pulmonary necrobiotic nodules.
Methods: Case report of a sixteen‐year‐old female with known UC and AIH‐PSC on Tacrolimus who presented with acute haemoptysis and fever. She had no chest pain, dyspnoea, constitutional or gastrointestinal symptoms. She had stable vital signs and normal respiratory examination. Investigations showed that UC and AIH‐PSC were quiescent.
Results: Chest radiograph revealed bilateral pulmonary opacities and chest Computed tomography (CT) scan showed bilateral well‐defined fluid‐filled lesions (Image 1). She was treated with empirical antibiotics and underwent extensive investigations which returned negative. Tissue samples obtained via CT‐guided lung biopsy showed necro‐inflammatory tissue comprising of degenerate cells in background of haemorrhage, fibrin and necrotic material, and inflamed fibrocollagenous tissue core (Image 2). There were no features of vasculitis or malignancy. Immunohistochemistry stains for microbiological organisms were negative. Steroid therapy was considered but held off in view of previous complications of raised intra‐ocular pressure. There has been no recurrence of respiratory symptoms, and serial chest radiographs show that the nodules have remained stable.
Conclusions: PNNs are a rare but recognized phenomenon in IBD. However, to our knowledge, it has not yet been reported in paediatric patients with both UC and co‐existing predominant AIH‐PSC. Given the overlapping immunopathogenesis of these conditions, a proposed pathophysiology of PNN in this context is a heightened dysregulated immune response in the gut‐liver‐lung axis, with antigenic cross‐talk and overproduction of pro‐inflammatory cytokines not confined to primary sites of disease. While there remains no clear guidelines on treatment and follow‐up imaging, this case contributes towards steps in gaining clarity in this rarity of presentation.
Contact e‐mail address: tessa.ong.e.l@singhealth.com.sg
G‐RF126. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF126.1. THE RELATIONSHIP BETWEEN OXIDATIVE STRESS MARKERS, ANTIOXIDANT SYSTEM AND INFLAMMATORY BOWEL DISEASE IN BULGARIAN PEDIATRIC PATIENTS: A CONTROLLED CLINICAL INVESTIGATION
Marlena Panayotova 1, Kamelia Petkova‐Parlapanska2, Mariana Penkova3
1Pediatrics, Trakia University, Stara Zagora, Bulgaria, 2Chemistry And Biochemistry, Trakia University, Stara Zagora, Bulgaria, 3Gastroenterology, Trakia University, Stara Zagora, Bulgaria
Objectives and Study: Inflammatory bowel diseases (IBD) are chronic, idiopathic, and complex disorders of the gastrointestinal tract. The main diagnostic tool remains endoscopy, an invasive and expensive procedure often unacceptable to patients, especially children and adolescents. Oxidative stress (OS), defined as an imbalance between prooxidants and antioxidants, is closely related to the inflammatory response in IBD. The search for new non‐invasive diagnostic methods is of great importance. The aim of our study was to determine whether oxidative disturbances—including the accumulation of reactive oxygen and nitrogen species (ROS/RNS) and changes in antioxidant system activation—impact the inflammation observed in pediatric IBD patients.
Methods: We included 21 children and young adults aged 14–25 years (mean age ~18.1) with IBD and 22 healthy controls (mean age ~17.6). Nine (42%) patients were male and twelve (58%) were female. Seven patients had Crohn's disease and 14 had ulcerative colitis. All patients underwent histological assessment. We investigated levels of carbonylated proteins (PCC), oxidized 3‐nitrotyrosine (3‐NT), albumin SH‐modification (5‐MSL), nitric oxide (NO), ROS peroxidation, pro‐inflammatory cytokines (TNF‐α, IL‐1β, IL‐6), and antioxidant enzymes in blood samples from IBD patients and healthy controls.
Results: The results showed a significant increase in PCC (p < 0.005), 3‐NT (p < 0.005), 5‐MSL (p < 0.001), NO levels (p < 0.003), and ROS peroxidation (p < 0.0001). There was also an elevation in pro‐inflammatory cytokine levels (p < 0.001) associated with Th1 and Th17 immune responses compared to controls. In contrast, the levels of antioxidant enzymes in blood were reduced.
Conclusions: Oxidative stress (ROS/RNS radicals) and inflammatory markers were moderately increased in the IBD group compared to healthy individuals. The accumulation of OS markers and oxidative damage play an essential role in the pathophysiology of IBD. This highlights the need for future research into managing IBD and improving the quality of life for patients with this complex and costly disease.
Contact e‐mail address: marlenapanayotova@gmail.com
G‐RF127. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF127.1. USTEKINUMAB THERAPY IN PEDIATRIC IBD: A MONOCENTRIC EXPERIENCE
Antonio Pizzol 1, Simone Bellucca2, Michele Pinon1, Laura Giugliano1, Anna Opramolla1, Caterina Rigazio1, Pier Luigi Calvo1
1Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Turin, Italy, 2Pediatrics, Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Turin, Italy
Objectives and Study: Ustekinumab (UST), an anti‐IL12/IL23 monoclonal antibody, is increasingly used as a rescue therapy in pediatric IBD patients refractory to first‐line anti‐TNF treatment. This study evaluates the real‐life effectiveness of UST in a monocentric cohort.
Methods: Eighteen pediatric IBD patients (7 CD, 10 UC, 1 IBD‐U) treated with UST between February 2018 and June 2024 at a tertiary level pediatric hospital, were retrospectively analyzed. All patients had failed at least one anti‐TNF therapy. UST was administered intravenously for induction, followed by subcutaneous maintenance every 4 to 12 weeks. Clinical, biochemical, and endoscopic outcomes were evaluated, with therapy escalation as needed.
Results: Sixteen patients (89%) achieved clinical response, defined as >30% reduction in disease activity scores, within four weeks. Biochemical remission (CRP normalization) was observed in 89% (16/18) of patients, including 100% of CD cases. Endoscopic remission was achieved in 43% (3/7) of patients undergoing follow‐up endoscopy, with mucosal healing in 29%. Therapy optimization was required in 33% of cases. By the one‐year mark, 80% (12/15) of patients remained on therapy in clinical remission. Four patients (22%) discontinued UST due to lack of efficacy or loss of response, two of whom required surgery.
Conclusions: The results of our study proved to be comparable, or even better, than the data already present in the literature. UST demonstrated high rates of clinical and biochemical remission in pediatric IBD patients refractory to anti‐TNF therapy, with moderate endoscopic outcomes. However, endoscopic monitoring data may suffer from a selection bias. These findings support UST as an effective rescue therapy in this population. Further research is warranted to refine its role and its definitive approval for the use in pediatric IBD.
Contact e‐mail address: pizzol.antonio@gmail.com
G‐RF128. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF128.1. SAFETY AND EFFICACY OF ADALIMUMAB 40 MG EVERY 3 WEEKS IN PEDIATRIC‐ONSET CROHN'S DISEASE
Yotam Elimeleh1, Anat Yerushalmy‐Feler2, Rula Taha Badarni3, Avishay Lahad4, Firas Rinawi 3
1Institute Of Gastroenterology And Liver Diseases, Emek medical center, Afula, Israel, 2Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel aviv, Israel, 3Emek Medical Centre, Afula, Israel, 4Emek Medical Center, Afula, Israel
Objectives and Study: Dose de‐escalation of biologic therapies such as adalimumab (ADA) has the potential to reduce healthcare costs and mitigate adverse events. However, evidence supporting this approach in pediatric populations is limited, with existing studies primarily focused on adult cohorts. This study aimed to evaluate the safety and efficacy of ADA dose de‐escalation in children diagnosed with Crohn's disease (CD).
Methods: We conducted a retrospective cohort study involving pediatric CD patients from two inflammatory bowel disease (IBD) units in Israel. All patients were in stable steroid‐free clinical and biochemical remission for at least 12 months on a standard ADA regimen of 40 mg every 2 weeks. Following this period, ADA was de‐escalated to 40 mg every 3 weeks. Clinical, biochemical, endoscopic and imaging outcomes were assessed, including rates of disease exacerbation, re‐escalation, or discontinuation of ADA therapy.
Results: Fourteen pediatric CD patients were included, with a median follow‐up duration of 12.5 months post de‐escalation (range 7 to 20 months). During follow‐up, 2 patients (14%) experienced disease exacerbation, 3 patients (21%) required re‐escalation to ADA 40 mg every 2 weeks, including1 patient (7%) who required subsequent escalation to 40 mg weekly. One patient (7%) discontinued ADA therapy due to sustained deep remission. Notably, no patients were hospitalized, developed new‐onset abscesses or fistulas, required steroid therapy, or switched to alternative therapies.
Conclusions: ADA dose de‐escalation to 40 mg every 3 weeks appears to be a safe and effective strategy for pediatric CD patients in sustained clinical and biochemical remission. Larger, randomized prospective trials are warranted to further validate these findings and to identify potential predictors of successful dose de‐escalation.
Contact e‐mail address: Yotamelime@gmail.com
G‐RF129. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF129.1. NUTRITIONAL STATUS AND BONE MINERAL DENSITY IN CHILDREN WITH CROHN'S DISEASE
Elena Roslavtseva 1, Karina Zenkova1, Vera Skvortsova1, Ina Sokolov1, Alexander Potapov2, Tatiana Borovik1
1Healthy And Sick Child Nutrition Laboratory, National Medical Research Center for Children's Health, Moscow, Russian Federation, 2Gastroenterology, National Medical Research Center for Children's Health, Moscow, Russian Federation
Objectives and Study: Dietary restrictions, inflammatory activity of Crohn's disease (CD) and the use of certain drugs can lead to bone and muscle mass loss in children with CD. The aim of study was to evaluate the frequency and association between pathological changes in body composition and bone mineral density (BMD) decrease in children with CD.
Methods: The study included 145 children with CD, aged 7 to 17 years. Anthropometric parameters were measured with subsequent calculation of BMI. Body composition indices, including bone mineral mass (BMM), were assessed using bioelectrical impedance analysis. BMD was measured using dual‐energy X‐ray absorptiometry of the lumbar spine.
Results: Decreased BMD was detected in 34 children (23.4%), among whom 29 (85.3%) had various degrees of nutritional deficiency. In patients with decreased BMD body composition and BMI indices were significantly lower (p < 0.001): median Z‐score BMI/age was ‐1.91 [IQR:‐2.51 to ‐1.51] vs ‐0.79 [IQR:‐1.04 to ‐0.53]; median Z‐score fat‐free mass/age was ‐1.95 [IQR:‐2.35 to ‐1.54] vs. 0.62 [IQR:‐0.81 to ‐0.42]; median Z‐score skeletal muscle mass/age was ‐1.57 [IQR:‐1.94 to ‐1.21] vs. ‐0.37 [IQR:‐0.55 to ‐0.19]. A strong positive correlation was found between the Z‐score of fat‐free body mass and BMD (p < 0.001, Rs=0.612). Additionally, a positive correlation was observed between BMM measured by bioimpedance analysis and BMD measured by X‐ray densitometry (p < 0.001, Rs=0.610).
Conclusions: The findings demonstrate a high frequency of reduced BMD in line with pathological changes in body composition, including fat‐free and skeletal muscle mass loss, in children with CD. These changes increase the risk of pathological fractures and subsequent limitations in physical activity, necessitating close monitoring of BMD parameters. The positive correlation between bone mineralization parameters measured by X‐ray densitometry and bioimpedance analysis suggests that bioimpedance is a promising, radiation‐free alternative for further study and potential clinical implementation.
Contact e‐mail address: roslikea@gmail.com
G‐RF130. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF130.1. EVALUATION OF THE EFFICACY OF JAK INHIBITORS IN BIOTHERAPY‐REFRACTORY IBD PEDIATRIC PATIENTS
Lisa Torelli, Christine Martinez‐Vinson, Jérôme Viala
Department Of Pediatric Gastroenterology And Nutrition, Robert Debré Hospital, PARIS, France
Objectives and Study: Although the advent of anti – Tumor Necrosis Factor (anti‐TNF) has revolutionized the treatment of both adult and pediatric inflammatory bowel diseases (IBD), up to 30% of patients are primary non‐responders and about 10‐20% per year become secondary non‐responders. Tofacitinib (TOFA) and Upadacitinib (UPA), Janus kinase (JAK) inhibitor, have demonstrated efficacy and safety in adults IBD, but data are limited in children. This study aimed to evaluate the clinical and biological efficacy of TOFA or UPA in pediatric patients with biologic‐refractory IBD.
Methods: This single‐centre retrospective study included patients with an established diagnose of IBD, who started TOFA or UPA under the age of 18 for refractory disease. Clinical activity scores, biochemical response, growth, and adverse events were compared at baseline and at the first and last follow‐up visit after anti‐JAK initiation.
Results: Twenty subjects were included, 12 with ulcerative colitis (UC), 7 with Crohn's disease (CD), 1 with IBD‐undetermined. Thirteen received UPA, 8 TOFA (1 patient received both). At the last follow‐up, 75% UC patients and 80% of CD patients achieved clinical remission under UPA, and 80% of UC and 67% of CD under TOFA. Both drugs led to significant reduction in PUCAI and PCDAI, and to a significant amelioration in weight and height. Albumin levels significantly increased, while non‐significant decrease in C reactive protein occurred. Two patients registered adverse events (acne, Cushingoid syndrome and Herpes zoster reactivation), with no severe side effects.
Conclusions: In this cohort, UPA and TOFA induced rapid and significative clinical response, with a low rate of adverse events. Larger, robust, prospective studies are needed.
Contact e‐mail address:
G‐RF131. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF131.1. "EVALUATION OF THE EFFICIENCY OF NON‐INVASIVE APPROACH IN MONITORING THERAPEUTIC MODIFICATIONS IN PEDIATRIC INFLAMMATORY BOWEL DISEASES (IBD): A MULTICENTER PROSPECTIVE ITALIAN STUDY"
Viviana Vela 1, Martina Milano2, Giulia D'Arcangelo3, Sossio Vitale1, Alessandro Gravina4, Giuseppina Russo1, Tonia Raso3, Anna Russo1, Alfonso Reginelli1, Francesca Maccioni5, Salvatore Oliva4, Caterina Strisciuglio6
1Department Of Woman, Child And General And Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy, 2Department Of Woman, Child And General And Specialized Surgery, University of Campania Luigi Vanvitelli, Napoli NA, Italy, 3Department Of Maternal And Child Health, Sapienza University, Paediatric Gastroenterology Unit, Rome, Italy, 4Pediatric Digestive Endoscopy, Pediatric Gastroenterology And Liver Unit, University Hospital Umberto, Sapienza University of Rome, Rome, Italy, 5Department Of Radiology, Sapienza University of Rome, Roma, Italy, 6Department Of Woman, Child And General And Specialized Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy
Objectives and Study: Ileocolonoscopy with biopsies is the gold standard for diagnosing and monitoring IBD, particularly mucosal inflammation and guiding treatment. However, its invasiveness, cost and compliance issues limit practicality in children. Non‐invasive alternatives like videocapsule endoscopy (VCE), intestinal ultrasound (US), and magnetic resonance enterography (MRE) offer detailed small bowel evaluation and promise for disease monitoring. This study evaluates a non‐invasive approach combining lab‐tests, US, VCE, and MRE for guiding pediatric IBD treatment and their role in achieving clinical and endoscopic remission.
Methods: This multicenter longitudinal study (2020–2024) based on protocol GR‐2019‐12370621, enrolled 57 pediatric IBD patients (aged 6–18 years) to evaluate non‐invasive diagnostic approaches. Patients were assessed at diagnosis (T0), 26 weeks (T26), and 52 weeks (T52) using clinical indices (PCDAI, PUCAI), laboratory markers (ESR, CRP, FC), radiological techniques (US, MRE), and videocapsule endoscopy (VCE), alongside traditional ileocolonoscopy. The primary goal was to detect mucosal inflammation and guide therapy adjustments based on clinical, radiological, and histological evaluations, with unchanged therapy in remission cases. Secondary analysis examined the correlation between clinical remission—defined as symptom resolution and normalization of laboratory and radiological markers—and endoscopic remission at T52 following therapeutic adjustments based on non‐invasive methods.
Results: For the first objective, 58 pediatric IBD patients (30 with Crohn's Disease and 28 with Ulcerative Colitis) were evaluated. Fifty‐one (86.8%) demonstrated clinical, laboratory, and non‐invasive diagnostic findings (US, VCE, MRE) indicative of active disease, leading to therapy adjustments. For the second objective, the effectiveness of non‐invasive methods in achieving clinical and endoscopic remission was analyzed in 45 patients who completed the study. Metrics are included in the table
Conclusions: These findings demonstrate that non‐invasive methods effectively identify patients in clinical remission and reliably predict the absence of remission while minimizing reliance on invasive procedures such as ileocolonoscopy. However, the relatively lower NPV highlights the need for further refinement to reduce false negatives.
Contact e‐mail address:
G‐RF132. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF132.1. EQUITY AND SPECIALIZATION IN PEDIATRIC INFLAMMATORY BOWEL DISEASE CARE IN SPAIN: INSIGHTS FROM A NATIONAL SURVEY
Gemma Pujol‐Muncunill1, Rafael Martín‐Masot2, Marta Velasco Rodríguez‐Belvis 3, Laura Palomino Pérez4, Víctor Manuel Navas‐López2, Javier Martín‐De‐Carpi1
1Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain, 2Pediatric Gastroenterology And Nutrition, Hospital Regional Universitario de Málaga, Málaga, Spain, 3Pediatric Nutrition, Hospital Infantil Niño Jesús, Madrid, Spain, 4Department of Pediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
Objectives and Study: Specialized and multidisciplinary approaches in Pediatric Inflammatory Bowel Disease (P‐IBD) have been shown to improve clinical outcomes, suggesting that this model should be generalized. Our objective was to analyze the current state of P‐IBD care in Spain.
Methods: Data on care processes and hospital structures were collected through a specific questionnaire developed for this purpose and disseminated through the working group of the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition.
Results: Out of 134 hospitals contacted (42 regions in Spain), 99 responded (73.8%, CI 95% 65‐80). Among them, 7 have a dedicated Pediatric IBD Unit, 61 have an Adult one with integrated pediatric care and 31 without specialized IBD Unit. The median number of P‐IBD patients attended per center was 35 (range: 1‐320), with 35 centers managing fewer than 20 patients (18 of which share care with a reference center). The median number of new diagnoses was 4 per year (range: 1‐60). Resoruces available included Endoscopy Unit in 91% (63% performed by pediatricians, 37% by adult gastroenterologists or surgeons). MRE in 96% of centers, and biological therapies in 96%. Only 18% have a specialized nurse, 9% offer clinical psychology, 23% with dietitian and 51% with specialized surgery. Colectomy with ileoanal pouch creation is possible in 35% of centers (annual average of 0‐1 patient/year). Email contact was available in 44% of centers, and phone lines in 22%. Quality indicators show 81% of centers have updated protocols, 20% offer specialized IBD outpatient clinic and 61% have rapid‐response protocols for suspected IBD cases. One‐third have multidisciplinary meetings and 58% have standardized transition protocols.
Conclusions: The management of pediatric IBD patients varies significantly, with up to 30% of these patients receiving care in centers without IBD Unit and limited resources. Identifying barriers in each center and region is essential to ensure equitable care for P‐IBD patients.
Contact e‐mail address:
G‐RF133. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF133.1. FIVE‐YEAR FOLLOW‐UP OF FIRST‐LINE INFLIXIMAB TREATMENT COMPARED TO CONVENTIONAL THERAPY IN PAEDIATRIC MODERATE‐TO‐SEVERE CROHN'S DISEASE – RESULTS FROM THE TISKIDS RANDOMIZED CONTROLLED TRIAL
Stephanie Vuijk 1, Maria Jongsma1, Martinus Cozijnsen1, Merel Van Pieterson1, Tim De Meij2, Obbe Norbruis3, Michael Groeneweg4, Victorien Wolters5, Herbert Van Wering6, Iva Hojsak7, Kaija‐Leena Kolho8, Thalia Hummel9, Janneke Stapelbroek10, Cathelijne Van Der Feen11, Patrick Van Rheenen12, Michiel Van Wijk2, Sarah Teklenburg3, Johanna Escher1, Lissy De Ridder1
1Paediatric Gastroenterology, Erasmus Medical Centre ‐ Sophia Children's hospital, Rotterdam, Netherlands, 2Paediatric Gastroenterology, Emma Children's hospital, Amsterdam UMC, VU University, Amsterdam, Netherlands, 3Paediatric Gastroenterology, Isala Hospital, Zwolle, Netherlands, 4Paediatric Gastroenterology, Maasstad Hospital, Rotterdam, Netherlands, 5Paediatric Gastroenterology, Wilhelmina Children's hospital, UMC Utrecht, Utrecht, Netherlands, 6Paediatric Gastroenterology, Amphia Hospital, Breda, Netherlands, 7Paediatric Gastroenterology, Children's Hospital Zagreb, Zagreb, Croatia, 8Paediatric Gastroenterology, University of Helsinki, Helsinki, Finland, 9Paediatric Gastroenterology, Medical Spectrum Twente, Enschede, Netherlands, 10Paediatric Gastroenterology, Catharina Hospital, Eindhoven, Netherlands, 11Paediatric Gastroenterology, Jeroen Bosch Hospital, 's‐Hertogenbosch, Netherlands, 12Paediatric Gastroenterology, University Medical Center, University of Groningen, Groningen, Netherlands
Objectives and Study: Previous results of the TISKids study showed that first‐line infliximab (FL‐IFX) treatment (5 infusions) with azathioprine was more effective for achieving clinical remission without treatment escalation at week 52 compared to conventional induction treatment (CONV) with azathioprine in children with moderate‐to‐severe Crohn's disease (CD)1. We aimed to investigate the effects at 5‐year follow‐up.
Methods: The TISKids study is a multicentre, open‐label randomised controlled trial, in which untreated, newly diagnosed CD patients (3–17 years old; wPCDAI >40) were included. Patients were randomised to FL‐IFX (5 IFX infusions, after which infusions were stopped) or CONV (exclusive enteral nutrition or prednisolone). Both treatment groups received azathioprine maintenance. The primary outcome was clinical remission (wPCDAI<12.5, CDAI < 150 or PGA remission) without additional CD‐related therapy ((re)start of additional biological, systemic corticosteroids, or ileocaecal resection) at 5 years. Secondary outcomes were time to (re)start of additional biological and the proportion of patients with ileocaecal resection until 5 years.
Results: In total, 100 patients were randomised, 6 patients were lost to follow‐up, 49 patients received FL‐IFX, and 45 CONV. At 5 years, 6/49 (12%) FL‐IFX and 2/45 (4%) CONV treated patients were in clinical remission without additional CD‐related therapy (p = 0.27). Time to (re)start of additional biological was shorter for patients in the CONV group (32 weeks 95%CI 22‐58) compared to FL‐IFX (median 63 weeks 95%CI 52‐122), p = 0.051 (Figure 1). Five/49 (10%) FL‐IFX and 7/45 (16%) CONV treated patients had an ileocaecal resection within 5 years (p = 0.64).
Conclusions: In this unique randomised controlled trial, the first year benefit of FL‐IFX was not maintained until 5 years of follow‐up. However, there was a borderline not significant longer time to (re)start of additional biological in the FL‐IFX group. To optimize IFX treatment, further research is required to identify in which patient and when IFX is optimally started and may be stopped. References: Jongsma et al.Gut.2020.PMID:33384335
Contact e‐mail address: s.a.vuijk@erasmusmc.nl
G‐RF134. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF134.1. ALTERATIONS IN GUT MICROBIOTA AMONG CHINESE CHILDREN WITH NEW‐ONSET CROHN'S DISEASE
Ying Wang 1, Ting Ge2, Qingqing Wu1, Weihui Yan1, Haixia Feng1, Jinling Wang1, Pei Xiao2, Lu Jiang1
1Division Of Pediatric Gastroenterology And Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, Shanghai, China, 2Shanghai Children's Hopsital, China, Shanghai, China
Objectives and Study: The gut microbiota is crucial in the pathogenesis of pediatric Crohn's disease (CD), but most studies focus on Western populations. This study aimed to characterize the gut microbiota in Chinese children with newly diagnosed with CD.
Methods: In this study, we extracted DNA from fecal samples from 43 children with CD and 21 healthy children. Metagenomic next‐generation sequencing was performed to evaluate changes in the gut microbiota profiles of the cohort. Mediation and multivariate logistic regression analyses were used to explore the relationship between altered bacteria and clinical outcomes. Furthermore, we investigated the influence of disease severity, sex, and the presence of perianal lesions on the gut microbiota profile.
Results: Children with CD exhibited a significant reduction in microbial diversity. Notably, Fusicatenibacter saccharivorans, Blautia wexlerae, and Bacteroides uniformis were less abundant in the CD group. Correlation analysis indicated negative associations between B. wexlerae levels and fecal calprotectin, interleukin‐1β (L‐1β), IL‐6, and IL‐8. Mediation analysis identified 44 linkages mediating microbial associations with body mass index (BMI) and Pediatric Crohn's Disease Activity Index (PCDAI), primarily through inflammatory and nutritional markers. A multivariate logistic regression model incorporating F. saccharivorans, B. wexlerae, and B. uniformis achieved an area under the curve of 0.909 (95% CI, 0.829‐0.988) for identifying patients with CD. Male children with CD showed distinct gut microbiota profiles linked to disease severity. Additionally, Klebsiella and Clostridium abundance was higher in patients with perianal lesions.
Conclusions: This study reveals a distinct gut microbiota profile in Chinese children with CD. We developed a model based on F. saccharivorans, B. wexlerae, and B. uniformis, that could accurately identify patients with CD in clinical settings.
Contact e‐mail address: xujuan66@sjtu.edu.cn
G‐RF135. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐RF135.1. INTESTINAL EPITHELIAL PIEZO1 DERIVED TGF‐Α FACILITATES MACROPHAGE‐MYOFIBROBLAST TRANSITION THROUGH ACTIVATING THE PKA/NF‐ΚB P65 SIGNALING PATHWAY IN CROHN'S DISEASE
Jing Yang, Jinyan Jing, Min Yang
Department Of Pediatrics, Guangdong Provincial People's Hospital Affiliated to Southern Medical University, Guangzhou, China
Objectives and Study: PIEZO1 plays a crucial role in fibrotic diseases. However, if intestinal epithelial PIEZO1 plays a role in intestinal fibrosis remains unclear. Recent studies have revealed that macrophage‐to‐myofibroblast transition (MMT), typically observed in renal fibrosis, also occurs in intestinal fibrosis. It is still uncertain whether PIEZO1 in intestinal epithelial cells (IECs) is involved in this process. Our previous research found that PIEZO1 is enriched in the colonic mucosal epithelial cells of CD patients. In this paper, we attempt to explore whether intestinal epithelial PIEZO1 can influence intestinal fibrosis by regulating the MMT.
Methods: Western blotting, real‐time PCR and immunofluorescence were used to detect the relationship between PIEZO1 in IECs and MMT in vivo and in vitro. CO‐Immunoprecipitation, RNA‐seq and Enzyme‐linked immunosorbent assay (ELISA) were performed to identify the mechanism through which PIEZO1‐activated IECs modulated MMT.
Results: We found that activation of PIEZO1 in IECs promotes the MMT. Conversely, knockdown of PIEZO1 inhibits this process. Mechanistically, the deletion of PIEZO1 in intestinal epithelial cells suppressed PKA phosphorylation and its interaction with P65 to blocking the PKA/NFκB p65 signaling pathway and ultimately affecting the progression of MMT. Additionally, P65 activator reverses the inhibitory effect of PIEZO1 on MMT. In a DSS‐induced chronic colitis mouse model, compared to the control group, Villin‐PIEZO1‐/‐ mice exhibited reduced intestinal fibrosis. More importantly, we found that the downregulation of TGF‐α expression in PIEZO1 knockdown IECs is a key factor contributing to the observed results.
Conclusions: These findings extended the novel insight of PIEZO1 in intestinal epithelial cells through the production of TGF‐α contributed to MMT to enhance intestinal fibrosis, which could be a promising strategy to patients with CD.
Contact e‐mail address: yangjing233005@163.com
G‐RF136. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF136.1. TRANS‐ANAL IRRIGATION (TRAI) – MANAGEMENT OF CONSTIPATION IN DIFFERENT SUBGROUPS OF NEURODIVERGENT CHILDREN; A SINGLE CENTRE EXPERIENCE FROM THE UNITED KINGDOM
Tushar Kanti Banerjee, Antima Banerjee
Paediatrics, United Lincolnshire Teaching Hospital NHS Trust, Boston, United Kingdom
Objectives and Study: Effectivity of TRAI in constipation with soiling, recurrent faecal impaction and Quality of Life (QoL) in different subgroups of neurodivergent children.
Methods: In this prospective observational study, 25 children (5‐10 years) were selected with a diagnosis of Autism (n = 15), Autism with Attention Deficit Hyperactive Disorder(ADHD) (n = 7) and ADHD (n = 3) alone. These children fulfilled the Rome IV criteria for functional constipation with poor therapeutic compliance, frequent faecal impaction and recurrent soiling, leading to poor parent‐reported QoL and school activities. There were eighteen boys and seven girls. The follow‐up period was 12 months. The data was collected for acceptance, compliance, tolerance, side effects and response to treatment; the endpoint for response to treatment is a parent‐reported reduction of the soiling frequency and faecal impaction with perceived QoL improvement.
Results: More than 80% of ADHD and ADHD with Autism did not continue TRAI for more than 3 months without achieving a sustained improvement in the frequency of soiling, faecal impaction and QoL. In contrast, most children with Autism alone (90%) tolerated the procedure well. Parents reported a lasting reduction in soiling without incidents of faecal impaction among those who successfully tolerated TRAI, consequently leading to an improved QoL. There were no reported procedure‐related complications.
Conclusions: Most parents report that children with ADHD often experience fidgetiness and difficulty concentrating. These children frequently struggle to sit still during procedures, and their inability to stay seated on the toilet is a significant factor leading to TRAI withdrawal. One major limitation of this study is its small sample size. A similar study with a larger sample could provide valuable insights into the best approaches for managing constipated children with ADHD. Understanding the differences in behavioural patterns of children with ADHD and autism may provide crucial insights into the best strategy for managing difficult constipation in different subgroups of neurodivergent children.
Contact e‐mail address: bnrjt07@gmail.com
G‐RF137. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF137.1. ULTRASOUND RECTAL MEASUREMENTS AS PREDICTIVE INDICATORS OF CONSTIPATION IN CHILDREN
Corina Cercel 1, Corina Pienar1,2, Pop Laurentiu1,2, Laura Savu1, Daniela Popescu3, Cristina Jura3,4
1Pediatrics, 2nd Pediatrics Clinic, “Pius Brinzeu” Emergency County Hospital, Timisoara, Romania, Timisoara, Romania, 22Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania, timisoara, Romania, 33Department of Obstetrics‐Gynecology and Neonatology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania, Timisoara, Romania, 4Neonatology, 4Medici's MedLife Hospital, Timisoara, Romania, Timisoara, Romania
Objectives and Study: Aim: Our objective was to create age and gender‐specific ultrasound (US) rectal measurement curves to assist in predicting constipation in children.
Methods: We conducted a prospective study in our outpatient clinic from January 2023 to November 2024. Parents and/or children were asked to classify the child's stool pattern using the Bristol Stool Chart (BSC). During the same appointment, we obtained transabdominal measurements of the rectum.
Results: Our cohort consisted of 1169 children (age range 2 months to 18 years, mean age 7.54 ± 4.95 years, 47.47 % girls). Non‐constipated children had lower rectal measurements (2–2.5 cm), whereas constipated children tend to have significantly higher values (2.5–3.5 cm), p‐value < 2.2×10 ‐16 , 95% CI: [−0.71, − 0.45]. The logistic regression model shows that for every 1 cm increase in rectal measurement, the odds of constipation nearly double. In constipated children, boys had slightly higher rectal measurements than girls (3.1–3.2 cm versus 2.7–2.8 cm). Probability curves also showed that boys reached higher probabilities of constipation at lower rectal measurements (Figure 1). Additionally, constipation thresholds tend to decrease with age (Figure 1). However, our results indicate that rectal measurements can vary even among identical self‐reported BSC stool types. Figure 1. Age and gender‐specific ultrasound rectal measurement constipation prediction curves The x‐axis represents rectal measurements. The y‐axis shows the predicted probability of constipation. Colored lines indicate specific age groups. Shaded areas signify risk levels: green indicates low risk (<30% probability); yellow, moderate risk (30–60%); blue, high risk (>60%). Vertical dashed lines mark clinical thresholds for girls and boys: 3.3 and 3.0 cm (moderate risk) and 3.8 and 3.5 cm (high risk), respectively.
Conclusions: Based on these findings, gender and age‐specific thresholds for predicting constipation using US rectal measurements were established. The overlap in measurements between constipated and non‐constipated children suggests that self‐reported BSC might not effectively predict constipation.
Contact e‐mail address: cercelmaria01@yahoo.com
G‐RF138. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF138.1. CLINICAL SPECTRUM OF CHILDREN WITH FUNCTIONAL GASTROINTESTINAL DISORDERS AND THEIR IMPACT ON PSYCHOSOCIAL STATUS OF CAREGIVERS
Sangeeta Dahiya 1, Praveen Kumar2, Preeti Singh2, Om Sai3
1Pediatrics, Lady Hardinge Medical College, Delhi, India, 2Department Of Pediatrics, Lady Hardinge Medical College, New Delhi, Delhi, India, 3Department Of Psychiatry, Lady Hardinge Medical College, New Delhi, New Delhi, India
Objectives and Study: Background: Functional gastrointestinal disorders (FGIDs) are common in children. These conditions significantly affect the quality of life of patients and impose a psychological burden on their primary caregivers, often leading to stress, anxiety, and depression. Despite the high prevalence of FGIDs, data on their clinical spectrum and caregiver psychosocial impact, particularly in India, are limited. Aim: To evaluate the clinical spectrum of FGIDs in children and adolescents using Rome IV criteria and to assess the psychosocial status of their primary caregivers using the Patient Health Questionnaire‐9 (PHQ‐9).
Methods: This prospective observational study was conducted from May 2023 to November 2024 in Delhi. Children aged 1 month to 16 years with symptoms meeting Rome IV criteria for FGIDs were included. Management strategies offered included dietary modifications, such as low‐FODMAP and high‐fibre diets, along with medical management and psychiatric intervention whenever needed. Primary caregivers were assessed for psychosocial stress using PHQ‐9. Clinical outcomes, caregiver mental health, and school absenteeism were analyzed after three months of management.
Results: Of 188 enrolled children, 150 were analyzed. Symptoms such as hard stools (40.7%) and recurrent abdominal pain (40%) were most common. Functional constipation (54.7%) was the most common diagnosis, followed by irritable bowel syndrome (22%) and functional abdominal pain (6%). Other diagnoses included functional dyspepsia (2%) and cyclic vomiting syndrome (2%). Among caregivers, 40% showed mild to severe depression. Caregivers of children with severe or multiple FGIDs reported higher psychosocial distress. Over three months, 58% of children reported improvement, and school absenteeism decreased by 46%. Caregivers also showed a modest reduction in depression scores.
Conclusions: FGIDs represent a significant dual burden, affecting both children and their caregivers. Comprehensive management strategies addressing both physical and psychosocial aspects are essential for improved outcomes. This study highlights the need for increased awareness and integrated care approaches to paediatric FGIDs.
Contact e‐mail address: pkpaed@gmail.com
G‐RF139. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF139.1. MICROBIOTA AND BEHAVIOR IN CHILDREN: EMERGING DATA FROM A SYSTEMATIC REVIEW
Gaia Dellea 1, Francesca Brambilla1, Thomas Gestels2, Yvan Vandenplas2, Massimo Agosti1, Silvia Salvatore1
1Neonatal And Pediatric Unit, University of Insubria, Varese, Italy, 2KidZ Health Castle UZ Brussel, Brussels, Belgium
Objectives and Study: There is growing interest on the relationship between the gut microbiota and behavior. The aim of this study is to provide updated and practical insights of existing literature data in children.
Methods: This is a systematic review performed following the PRISMA method, using PubMed, Web of Science and Cochrane database, Microbiota AND Behavior MESH terms, including original studies, limited to children (0‐18 years) and English language. The literature search was updated to April 2024.
Results: Out of the 631 search results, 22 eligible articles were included and analyzed. Most studies had a cross‐sectional observational design. Recent studies showed a cluster‐specific association between the gut microbiota/metabolomics and behavioral and neurodevelopmental outcomes in different pediatric ages. There is also preliminary evidence of psychotropic effects of certain probiotic strains and detrimental impact of early antibiotic exposure. However, inconsistency and discrepancy across studies were found related to heterogeneity of microbiota detection techniques, of population recruited and of multiple variables involved in behavioral outcome. In autistic and attention‐deficit/hyperactivity disorders dysbiosis and β‐diversity were reported, showing reduced Faecalibacterium and Prevotella and increased Bacteroides. However, α‐diversity, patient selection, intervention, outcome measures and microbiota assessment methods appeared different across studies.
Conclusions: Our systematic review highlights that alterations in the gut microbiota are frequently reported in children with neurodevelopmental and mood disorders. However, several discrepancies are present among the included studies, observational findings and specific (dietary or probiotic) interventions are currently inconsistent and not yet supporting causal inferences between microbiome changes and behavioral outcomes.
Contact e‐mail address: gaiaroberta.dellea@gmail.com
G‐RF140. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF140.1. PYLORIC BOTOX INJECTION IN PEDIATRICS: DOSE‐DEPENDENT OUTCOMES AND CLINICAL IMPLICATIONS
Lev Dorfman 1,2,3, Omar Brijawi3, Khalil El Chammas3,4, Lin Fei5, Ajay Kaul3,4
1Sackler Faculty Of Medicine, Tel‐Aviv University, Tel Aviv, Israel, 2Institute Of Gastroenterology, Nutrition And Liver Disease, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, 3Gastroenterology, Hepatology And Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America, 4Department Of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, United States of America, 5Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America
Objectives and Study: Intra pyloric Botox injection (IPBI) is a commonly utilized intervention in pediatric patients presenting with upper gastrointestinal (GI) symptoms such as dyspepsia, functional nausea, and gastroparesis. The injection facilitates pyloric muscle relaxation and may exert a central effect by influencing the gastric branches of the vagal nerve. Dosing strategies vary, with some centers employing weight‐based calculations and others using empirical doses of 100 or 200 units. This study aims to evaluate the clinical effects of 100‐unit versus 200‐unit pyloric Botox injections in pediatric patients with upper GI symptoms
Methods: Electronic medical records were reviewed to collect demographic data, symptoms, adverse events and follow‐up information for pediatric patients treated with pyloric Botox injection and balloon dilation for upper GI symptoms. Clinical response, based on patient‐reported outcomes, was categorized as worsening, no change, improvement, or resolution of symptoms.
Results: A total of 460 patients who had IPBT with simultaneous pyloric balloon dilation met inclusion criteria (median age: 16, IQR 14‐17, 349 (75.8%) females). The most common indications for IPBT were nausea/vomiting [n = 152,33%], gastroparesis [n = 98;21%], and abdominal pain [n = 83;18%]. Median follow up time was 2 months. Symptom resolution was noted in n = 56 (12%), improvement in n = 212 (46%), no change in n = 157 (34%) and worsening in n = 35 (8%). No significant adverse events were noted. In comparison between the 100‐units (n = 418) and the 200‐units group (n = 42) using a multivariate analysis, the 200‐unit dose group had significantly better probability of favorable outcomes (OR = 2.7). Additionally, males were more likely to have favorable response (OR = 2.1). The dose effect was similar between male and female patients after controlling for age.
Conclusions: Pediatric patients receiving a 200‐unit dose of IPBI demonstrated superior outcomes without an increase in adverse events. Our findings suggest that a 200‐unit dose may provide improved symptom resolution and should be considered when treating pediatric/adolescent patients with similar clinical presentations.
Contact e‐mail address: lev.dorfman@clalit.org.il
G‐RF141. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF141.1. MITOCHONDRIAL NEUROGASTROINTESTINAL ENCEPHALOMYOPATHY (MNGIE), RECURRENT ABDOMINAL ABSCESSES WITH A NOVEL TYMP GENE MUTATION
Fatma Eren Kurtipek 1, Hakan Öztürk1, Ayşe Can1, Cem Kaya2, Ramazan Karabulut2, Gülsüm Kayhan3, Buket Dalgiç1, Odul Egrıtas Gurkan1
1Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 2Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey, 3Medical Genetics, Gazi University Faculty of Medicine, Ankara, Turkey
Objectives and Study: Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive disorder caused by mutations in the TYMP gene, leading to thymidine phosphorylase deficiency. Clinical features include gastrointestinal dysmotility, neurological dysfunction, and severe malnutrition.
Methods: We present an unusual presentation of MNGIE case, diagnosed with a novel genetic mutation.
Results: A 12‐year‐old girl presented with a chronic abdominal pain, intermittent diarrhea and constipation, and recurrent intraabdominal abscesses. She was referred with a presumed diagnosis of Crohn's disease. Endoscopic and colonoscopic examinations were unremarkable, showing no significant pathology. Medical history revealed that she has sensorineural hearing loss since at age four. Her family history was notable for consanguinity and familial Mediterranean fever (FMF) in her paternal relatives. On physical examination, she had severe malnutrition (body mass index of 11 kg/m2), exhibited generalized abdominal tenderness, hypertrichosis. Laboratory tests showed elevated acute‐phase reactants. Tests for FMF and Behçet disease were negative. Imaging identified multiple abscesses in the left abdomen. Initial management included antibiotics and abscess drainage. However, six months later, she developed another intraabdominal abscess with intestinal perforation, requiring emergency surgery. Intraoperatively, extensive jejunoileal diverticulosis was observed. Subsequent genetic testing revealed a novel homozygous c.1128_1153dup (p.Ala385Glyfs*?) mutation in the TYMP gene, confirming MNGIE. This mutation, previously unreported in population databases or literature, was deemed pathogenic based on clinical findings.
Conclusions: Gastrointestinal motility disorders are a hallmark of MNGIE, often resulting in complications such as jejunoileal diverticulosis. These diverticula, typically asymptomatic, can cause bacterial overgrowth, malabsorption, and life‐threatening complications like perforation and abscess formation.
In our patient, the novel TYMP mutation highlights the importance of genetic testing in suspected cases. This case emphasizes the need to consider MNGIE in the differential diagnosis of unexplained gastrointestinal and neurological symptoms, especially in the presence of growth failure or diverticulosis in young patients.
Contact e‐mail address: ffatmaeren@gmail.com
G‐RF142. Topic: AS01. GASTROENTEROLOGY/AS01 h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF142.1. CRYING BEHAVIOUR IN 2574 PRESUMED HEALTHY INFANTS
Koen Huysentruyt 1, Rosan Meyer2, Katerina Bajerova3, Christophe Dupont4, Mikael Kuitunen5, Anna Nowak‐Wegrzyn6, Carmen Ribes‐Koninckx7, Silvia Salvatore8, Raanan Shamir9, Annamaria Staiano10, Hania Szajewska11, Carina Venter12, Yvan Vandenplas13
1KidZ Health Castle, UZ Brussel, Brussels, Belgium, 2Department Dietetics, Winchester University, Winchester, United Kingdom, 3Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic, 4Clinique Marcel Sembat, Ramsay Group, Boulogne‐Billancour, France, 5Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, 6Hassenfeld Children's Hospital, New York, United States of America, 7La Fe University, Valencia, Spain, 8Department of Medicine and Technological Innovation, Pediatrics, Hospital "F. Del Ponte", University of Insubria, Varese, Italy, 9Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 10University of Naples "Federico II", Naples, Italy, 11Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland, 12Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, United States of America, 13KidZ Health Castle UZ Brussel, Brussels, Belgium
Objectives and Study: Crying occurs in healthy infants, but is often a cause for concern. This study aims to establish crying behavior in presumed healthy infants.
Methods: Original data of prospective studies investigating Cowʼs Milk‐related Symptom Score (CoMiSS) values in presumed healthy infants (≤12 months) were pooled. The crying subscore (range 0‐6) categorizes crying into ≤1h, 1‐1.5 h, 1.5‐2 h, 2‐3 h, 3‐4 h, 4‐5 h, ≥5 per day. The 50th, 90th and 97th centiles of crying scores were modeled using GAMLSS (generalized additive models for location, scale and shape) using Lower Aikake Information Criteria (AIC) in R v4.1.3. Excessive crying was defined as >3 h per day (scores 4‐6). Binomial regression model investigated the relation of age and sex with excessive crying, including country as a random effect.
Results: CoMiSS was collected from 2,574 infants (52% boys; difference between countries: p = 0.476) from Belgium (n = 300), Brazil (n = 101), Bulgaria (n = 60), Czech Republic (n = 206), Egypt (n = 808), Indonesia (n = 286), Italy (n = 200), Mexico (n = 106), Poland (n = 366) and Spain (n = 141). The overall median (Q1;Q3) age was 5.2 (2.6;8.7) months, with a significant difference (p < 0.001) between countries. Solid feeds were started in 60.5% of the 1,976 infants without missing data. Excessive crying was not uncommon in the first 4 months (±4% with a peak at 6% between 1‐2 months) but rare (<1.5%) thereafter (Figure 1). Age, but not sex was a significant predictor of excessive crying (OR 0.78, 95% CI 0.68;0.89). Using a Negative Binomial type I distribution, respectively 61.9%, 92.5% and 98.5% of the observed data fell below the 50th, 90th and 97th crying score centile.
Conclusions: Excessive crying was not uncommon in the first 4 months (±4% with a peak at 6% between 1‐2 months) but rare (<1.5%) thereafter. This understanding of “normal” crying patterns will help reassure parents and avoid unnecessary investigations or treatments.
Contact e‐mail address: yvan.vandenplas@uzbrussel.be
G‐RF143. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF143.1. FUNCTIONAL GASTROINTESTINAL DISORDERS PREDICTORS IN NEONATES AND TODDLERS: A MACHINE LEARNING APPROACH TO RISK ASSESSMENT
Flavia Indrio 1, Elio Masciari2, Enea Vincenzo Napolitano2, Flavia Machese3, Antonio Di Mauro4, Arianna Aceti5
1Department Of Experimental Medicine, University of Salento, Lecce, Italy, 2Dipartimento Di Ingegneria Elettrica E Delle Tecnologie Dell'informazione, University Federico II, Naples, Italy, 3Department Of Medical And Surgical Science Pediatric Section, University of Foggia, Foggia, Italy, 4ASL BARI, BARI, Italy, 5Università di Bologna, Bologna, Italy
Objectives and Study: FGIDs can pose a great burden on affected children, their families, and the healthcare system. Due to the lack of knowledge about the precise pathophysiology of FGIDs, a proper identification of children at risk to develop FGIDs has never been attemped. The research aims to identify early‐life risk factors for FGIDs such as infantile colic, regurgitation, and functional constipation, within the first year of life.
Methods: This prospective observational cohort study enrolled both term and preterm infants from a tertiary care university hospital between January 1, 2020, and December 31, 2022. The study employed both traditional statistical methods and artificial intelligence techniques, specifically a random forest classification model, to identify key risk factors associated with the development of Functional Gastrointestinal Disorders (FGIDs). Based on these findings, an AI‐based predictive model will be developed, along with a user‐friendly, web‐based interface designed for practical risk assessment.
Results: 6060 infants were enrolled. 8.1% were born preterm. According to conventional statistics and random forest classification model by artificial intelligence, birth weight (BW), cord blood pH, and maternal age were the most relevant variables linked to development of FGIDs in the first year of life.
Conclusions: For the first time conventional statistics and machine learning allowed to identify BW, cord blood pH and maternal age as important variable for risk prediction of FGIDs in the first year of life. This practical risk assessment tool would help clinicians to identify infants at risk of FGIDs who would benefit from a tailored preventive approach.
Contact e‐mail address: flaviaindrio1@gmail.com
G‐RF144. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF144.1. ACHALASIA CARDIA IN INFANTS – BOTH UNDERDIAGNOSED AND MISDIAGNOSED
Deepa Janakiraman 1, Nirmala Dheivamani2, Sindhuja Thatti Audikesavalu3, Senthilkumar R1, Winston Thomas S3
1Department Of Paediatric Gastroenterology, INSTITUTE OF CHILD HEALTH AND HOSPITAL FOR CHILDREN, MADRAS MEDICAL COLLEGE, CHENNAI, India, 2Paediatric Gastroenterology, INSTITUTE OF CHILD HEALTH, CHENNAI, India, 3Department Of Paediatric Gastroenterology, MADRAS MEDICAL COLLEGE, INSTITUTE OF CHILD HEALTH, CHENNAI, India
Objectives and Study: Achalasia cardia(AC) is an extremely rare primary motor disorder of the esophagus in infants and often misdiagnosed as Gastro Esophageal Reflux Disease(GERD). As data on infants with AC is limited, this study was done to highlight the need for early diagnosis of infantile AC.
Methods: Retrospective review of children diagnosed as AC between 2018‐2023 was performed.
Results: Out of 24 children diagnosed as AC during the study period, 17patients(70%) were symptomatic from infancy and were included. Clinical Profile and outcome of Infantile Achalasia Cardia is given in Table1.
Figure 1.Flow diagram of Achalasia Cardia cases.
Table 1: Clinical Profile and outcome of Infantile Achalasia Cardia
| Boys: Girls | 9: 8 |
|---|---|
| Age at Onset of symptoms | 6 months (birth ‐1 year) |
| Symptom Duration at Diagnosis | 10 months (2 weeks‐ 10 years) |
| Age at diagnosis | 16 months (4 months – 11 years) |
| Average duration delay in diagnosis | 10 months |
| Vomiting/Regurgitation | 100%(17) |
| Failure to Thrive | 100%(17) |
| Pneumonia/Respiratory Tract infection | 29%(5) |
| Height Z score | ‐1.4 (‐2.4 to 1.45) |
| Weight for Height Z score | ‐3.6 (‐4.2 to ‐3.2) |
| Barium swallow suggestive of AC | 100%(17) |
| Endoscopy‐ Dilated esophagus, Absence of peristalsis | 100%(17) |
| LES pressure (mmHg) | 41.46 (23‐82) |
| IRP (mmHg) | 23 (15.5‐50) |
| Median age at surgical intervention | 16 months (4 months – 11 years) |
Conclusions: This is the largest case series of infantile onset achalasia cardia till date in literature. Achalasia cardia, an important differential diagnosis of GERD in infants requires high index of suspicion for establishing early diagnosis.While existing literature suggests a later onset, majority of our patients demonstrated symptoms from infancy. Type II AC was the most prevalent subtype, possibly due to earlier recognition and diagnosis, as well as the concept of Type II progressing to Type I AC over time. Laparoscopic cardiomyotomy with fundoplication is a safe and effective treatment option for infantile onset Achalasia Cardia.
Contact e‐mail address: rdherdhe9@gmail.com
G‐RF145. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF145.1. AGREEMENT BETWEEN BALLOON EXPULSION TEST AND HIGH‐RESOLUTION ANORECTAL MANOMETRY IN DIAGNOSIS OF DYSSYNERGIC DEFAECATION IN CHILDREN
Aleksandra Janiga 1, Barbara Skowronska1, Magdalena Dobrowolska2, Tomasz Janiga1, Marcin Banasiuk1
1Department Od Paediatric Gastroenterology And Nutrition, Medical University of Warsaw, Warsaw, Poland, 2Department Of Surgery And Orthopedics, Children Warsaw Hospital "KOPERNIK", Warsaw, Poland
Objectives and Study: Dyssynergic defecation (DD) is one of the frequent causes of functional constipation (FC) in pediatric population. Three‐dimensional high resolution anorectal manometry (3D‐HRAM) and ballon expulsion test (BET) may be useful in the diagnosis of DD. The aim of the study was to evaluate the agreement between HRAM and BET in diagnosis of DD.
Methods: Children diagnosed with FC based on Rome IV criteria were prospectively enrolled into the study. The diagnosis of DD assessed in 3D‐HRAM was defined as absence of an adequate pressure drop in the anal canal during the bear‐down maneuver. BET was performed using the Foley's catheter filled with 50 ml of warm water. Different thresholds were considered positive for DD. Agreement between the tests was assessed using Cohen's kappa.
Results: We included 100 children (median age 9 years; age range 5 – 17; 58 boys). Majority of patients (59‐74%) needed more than 1 minute to successfully expel rectal balloon. Clinical characteristics of subjects are summarized in Table 1. The children who successfully expelled balloon were significantly older than those who didn't (10.7 vs 8.6 y.o., p = 0.003). Analysis of agreement between BET and 3DHRAM revealed substantial agreement in children >10 y.o. (k = 0.62), while only moderate in those less than 10 y.o. (k = 0.5). Logistic regression analysis revealed that the only manometric parameter positively correlated with successful expulsion of rectal balloon was percent of anal relaxation (OR = 1.04; 95%CI: 1.01; 1.08; p = 0.020). Other manometric variables evaluated during bear‐down maneuver, i.e. residual anal pressure, intrarectal pressure and recto‐anal pressure differential have no significant correlation with positive BET (p = 0.495, p = 0.075 and 0.622, respectively). Cut‐off value of 22 percent of anal relaxation has the best prediction of successful expulsion based on ROC analysis (Figure 1).
Conclusions: There is moderate to substantial agreement between diagnosis of DD made by3DHRAM and BET. BET has worse performance in younger patients.
Contact e‐mail address:
G‐RF146. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF146.1. COMPARISON OF THE THERAPEUTIC EFFICACY OF MACROGOL 3350 VS BIOFEEDBACK IN PEDIATRIC PATIENTS WITH DYSSYNERGIC DEFECATION DIAGNOSED WITH HIGH RESOLUTION ANORECTAL MANOMETRY
Vasiliki Maria Karagianni 1, Vasiliki Karava2, Eirini Chantzi3, Konstantina Dimakou1, Rogalidou Maria1, Panayota Kafritsa2, George Karamanolis4, Alexandra Papadopoulou1
1Division Of Gastroenterology And Hepatology, First Department Of Pediatrics, University Of Athens, Agia Sofia Children's Hospital, Athens, Greece, 2First Department Of Pediatrics, University Of Athens, Agia Sofia Childrens' Hospital, Athens, Greece, 3Pediatric Centre for Anorectal and Urogenetic Disorders, Athens, Greece, Athens, Greece, 4Academic Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
Objectives and Study: Functional constipation's main subtypes are normal transit constipation, slow transit constipation and outlet obstruction. A common form of outlet obstruction is dyssynergic defecation (DD).The inability to perform a coordinated movement of defecation represents the key pathophysiologic abnormality in DD.According to Rao's criteria there are 4 types of DD and anorectal manometry is essential for it's diagnosis. The aim of the study is to compare the efficacy of osmotic laxatives with biofeedback therapy in the treatment of children with DD.
Methods: Over a 24‐month period, high‐resolution anorectal manometry was performed in 71 children aged 4‐17 years with functional constipation, after written parental consent for disclosure of possible DD. A questionnaire to measure specific symptoms of constipation (PAC‐SYM questionnaire) was used to assess the severity of constipation. Moreover, Bristol Stool Scale Score and presence of soiling and retentive behaviour were estimated. Patients diagnosed with DD, according to Rao's criteria, were randomly assigned to treatment with Macrogol 3350 or biofeedback.
Results: 48 patients (67%) were diagnosed with dyssynergic defecation; 22 with type 3 and 26 with type 1DD. Their median age was 6,5 (4‐17) years. The majority of patients with DD were males and 60% presented with soiling. Seventeen patients were randomized to macrogol 3350 treatment and 26 to biofeedback, while 5 patients did not complete the treatment protocol.The median percentage of score reduction after treatment was 59 %(33% ‐100%) overall: 70% (33%‐100%) improvement of PAC‐ SYM score with biofeedback therapy VS 48% (16%‐90%)improvement after macrogol treatment (p = 0,023)
Conclusions: Biofeedback therapy is more effective than the common macrogol treatment in the subgroup of pediatric patients with functional constipation that present dyssynergic defecation in high resolution anorectal manometry. The superiority of biofeedback therapy is statistically significant.
Contact e‐mail address: villy85@gmail.com
G‐RF147. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF147.1. PREVALENCE AND CLINICAL PREDICTORS OF FUNCTIONAL DYSPHAGIA IN CHILDREN: A RETROSPECTIVE COHORT STUDY
Veronica Lazzaretto 1, Gabriele Lazzari1, Viola Ceconi1, Manuela Giangreco2, Grazia Di Leo2, Matteo Bramuzzo2, Egidio Barbi1,2, Sara Lega2
1University of Trieste, Trieste, Italy, 2Pediatrics, Institute For Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
Objectives and Study: Functional dysphagia (FD) is poorly described in pediatrics, with limited guidance on its diagnosis and management. This study aims to describe the frequency of FD in children without neurologic impairment who present with difficulty swallowing, and to identify current diagnostic approaches and clinical characteristics suggestive of FD.
Methods: In this single‐center retrospective cohort study, children aged 0‐18 presenting with dysphagia between 2008‐2024, were identified. Patients with neurologic impairment or congenital anomalies were excluded. Data collected included demographics, symptoms, trigger events, comorbidities, diagnostic assessments.
Results: Among the 184 patients included, 126 (68%) were diagnosed with FD. Of these, 102 patients (81%) underwent at least one diagnostic test (47% barium swallow, 51% endoscopy, 35% FEES). Compared to those with an underlying organic condition (78% eosinophilic esophagitis, 7% achalasia, 15% gastritis), patients with FD were more frequently female (44% vs. 22%; p = 0.0051) and had an earlier onset of symptoms (median 9 years [IQR 6‐12] vs. 11 years [IQR 8‐14]; p < 0.001). FD more often followed a trigger event (38% vs. 2%; p < 0.0001; PPV 98%) and was more frequently associated with pharyngeal pain (44% vs. 19%; p = 0.0009; PPV 84%) and food avoidance (49% vs. 2%; p < 0.0001; PPV 98%).
Conclusions: In our cohort, children presenting with dysphagia were commonly diagnosed with FD, often determined by excluding other causes. Pharyngeal pain, food avoidance, and a history of trigger events were identified as significant predictors of FD and could aid in making a positive diagnosis. Developing specific algorithms tailored for children could enhance clinical decision‐making in children presenting with dysphagia.
Contact e‐mail address:
G‐RF148. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF148.1. THE STUDY ON THE FODMAP DIET REGULATING VISCERAL HYPERSENSITIVITY IN WATER AVOIDANCE STRESS IBS MODEL OF MICE THROUGH THE 5‐HT PATHWAY AND ITS RELATED MECHANISMS
Chenmin Hu, Rui Guo, Ziyu Liu, Fei Gao, Mizu Jiang
Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
Objectives and Study: IBS causes chronic pain, bowel changes, and visceral hypersensitivity, influenced by infection and stress.The low FODMAP diet (LFD) can alleviate symptoms like pain and bloating, but its mechanisms are unclear. This study investigates the impact of FODMAP diets on intestinal motility, behavior, 5‐HT signaling, and microbiota changes in animal model.
Methods: Male C57/BL6 mice were used to establish an IBS model via chronic water avoidance stress (WA) and fed customized FODMAP diets. Visceral hypersensitivity, anxiety, and intestinal phenotypes were evaluated through reflex tests, open‐field tests, and electron microscopy. Colon 5‐HT expression was analyzed by ELISA and immunofluorescence, while microcirculation was assessed using laser speckle imaging. Tryptophan hydroxylase inhibitor LX1032 was used to alter 5‐HT levels, and microbiota and short‐chain fatty acids were analyzed by 16S RNA and GC‐MS.
Results: During WA and dietary interventions, no significant differences in weight or feed consumption were observed. Visceral hypersensitivity decreased in the WA‐HF group. Fecal moisture and 2‐hour fecal count increased, and intestinal transit time decreased in the WA‐RF, WA‐HF, and WA‐MF groups, but LFD intervention reversed these effects. Anxiety‐like behaviors were alleviated by LFD. Electron microscopy showed impaired intestinal barrier function in the WA‐HF and WA‐MF groups, improved by LFD. Serum 5‐HT levels and colon 5‐HT expression were elevated in the WA‐RF and WA‐HF groups, with TPH1 expression increasing with HFD and decreasing with LFD. Colonic microcirculation was reduced in WA groups but restored with LFD. TPH inhibitor LX1032 reduced 5‐HT levels and improved visceral hypersensitivity. Fecal microbiota analysis revealed significant differences, showing FODMAP's impact on microbial diversity and biosynthesis.
Conclusions: HFD increased visceral hypersensitivity, reduced intestinal transit time, and induced anxiety, while LFD improved these symptoms. The FODMAP diet regulates 5‐HT synthesis via TPH1, alters colonic microcirculation, and affects gut microbiota, with bacteria like Akkermansia and Bifidobacterium influencing 5‐HT metabolism and SCFAs.
Contact e‐mail address: mizu@zju.edu.cn
G‐RF149. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF149.1. PREVALENCE AND FACTORS ASSOCIATED WITH INFANT REGURGITATION IN THAILAND: INSIGHTS FROM THE ROME IV CRITERIA
Areewan Soontornsook 1, Palittiya Sintusek2, Tanawan Noicharoen2, Duc Long Tran2
1Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 2Pediatrics, Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology., BANGKOK, Thailand
Objectives and Study: Regurgitation is the most common Functional Gastrointestinal Disorder (FGIDs) in infants. This study aims to evaluate the prevalence of regurgitation in Thai infants using the validated Thai version of Rome IV diagnostic questionnaire for FGIDs and to explore the factors associated with infant regurgitation.
Methods: A prospective cohort study was performed among full‐term healthy infants born at King Chulalongkorn Memorial Hospital, Thailand, between March and May, 2024. All infants were followed up at age 1, 2, 3, 4 and 6 months. The validated Thai version of Rome IV diagnostic questionnaire and symptom diaries were used to assess regurgitation symptoms. Regurgitation symptom was defined as one episode per day and infant regurgitation was diagnosed according to the Rome IV criteria.
Results:
A total of 160 infants has completed the study. Regurgitation symptom peaked at 90.9% at 2 months and declined significantly with age, dropping to 65.2% at 3 months, 38.9% at 4 months, and finally to 12.1% at 6 months. Using the ROME IV criteria, the prevalence peaked at 21.4% at 3 months, followed by a significant decrease. Infant aged 4 months with a body weight above the 90th percentile had a significantly higher risk of regurgitation (50% vs. 17%; RR = 2.94, p = 0.021). No significant associations were observed with delivery method, birth order, family smoking, maternal education, family income, or type of feeding (breast milk or formula).
Conclusions: The prevalence of regurgitation in Thai infants differs from that observed in Western infants. Regurgitation symptoms peaked at 2 months, while infant regurgitation based on the Rome IV diagnostic criteria peaked at 3 months and declined significantly by 6 months. Overweight was identified as a significant factor associated with infant regurgitation.
Contact e‐mail address: areewan.ming@gmail.com
G‐RF150. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF150.1. CHRONIC INTESTINAL PSEUDO‐OBSTRUCTION: THE IMPACT OF GENETIC AND HISTOLOGICAL ANALYZES ON IMPROVING PATIENT DIAGNOSIS, PROGNOSIS, AND TREATMENT STRATEGIES
Minh‐Chau Ta 1, Dominique Cazals‐Hatem1, Lore Billiauws1, Aurélien Amiot2, Marc Bellaiche3, Dominique Berrebi4, Benoit Coffin5, Olivier Corcos1, Emmanuelle Ecochard‐Dugelay3, Olivier Goulet6, Florence Lacaille7, Cécile Lambe8, Yann Nadjar9, John Rendu10, Cécile Talbotec11, Fabienne Charbit‐Henrion12, Francisca Joly1
1Beaujon University Hospital, Clichy, France, 2Department Of Gastroenterology, Hopitaux Universitaires Bicêtre, AP‐HP, Université Paris Saclay, INSERM, Centre for Research in Epidemiology and Population Health, Le Kremlin‐Bicêtre, France, 3Department Of Pediatric Gastroenterology, Robert Debré Hospital, Paris, France, 4Department Of Pathology, AP‐HP. Centre‐ Université Paris Cité, Hôpital Necker‐Enfants Malades, Paris, France, Paris, France, 5Department Of Gastroenterology, Louis Mourier Hospital, Colombes, France, 6Department Of Pediatric Gastroenterology, Necker Hospital, Paris, France, 7Hepatology Unit, Pediatric Hospital Necker Enfants malades, Paris, France, 8Service De Gastro‐entérologie Et Nutrition Pédiatrique, AP‐HP. Centre‐ Université Paris Cité, Hôpital Necker‐Enfants Malades, Paris, France, Paris, France, 9Department Of Neurology, Pitié‐Salpêtrière Hospital, Paris, France, 10Department Of Molecular Genetics, Grenoble University Hospital, La Tronche, France, 11Gastroenterology And Nutrition Unit, Pediatric Hospital Necker Enfants malades, Paris, France, 12Genetic Department, Pediatric Hospital Necker Enfants malades, Paris, France
Objectives and Study: Chronic Intestinal Pseudo‐Obstruction (CIPO) represents significant challenges in terms of diagnosis and management. Little is known about the contribution of genetics and histopathology in a large CIPO population. The aim of this study was to assess whether these methods could provide valuable information for diagnosis and management.
Methods: Data from 130 patients with CIPO followed in the Gastroenterology Department of Beaujon Hospital (Clichy, France) between January 1, 2007 and December 1, 2023 were analyzed. Genetic testing and histological analyzes were performed in 112 and 96 patients, respectively.
Results: Our cohort included 55 males and 75 females, with ages ranging from 19 to 74 years at enrollment. The use of genetics and histopathology characterized 82% of the patients (genetic diagnosis: n = 65/112, 58%; histological diagnosis: n = 73/96, 76%). Combining clinical, genetic and histological data allowed classifying all patients into six groups with distinct clinical characteristics, histopathological patterns, therapeutic responses, and prognoses: Monogenic Myopathy (n = 42, 32%); Mitochondriopathy (n = 19, 15%); Unspecified Myopathy (n = 26, 20%); Autoimmune Myopathy (n = 8, 6%); Neuropathy (n = 9, 7%); and Others (n = 26, 20%). Patients in the monogenic myopathy group showed significant improvement rates after enterectomy (odds ratio: 23.16; 95% CI: 4.20‐435.06; p = 0.0033) and favorable survival in adulthood (hazard ratio: 0.02, 95% CI: 0.00‐0.11; p < 0.001). Among them, 29 patients with an ACTG2 mutation were extensively described for the first time with genotype‐phenotype correlations.
Conclusions: This study highlighted the importance of genetics and histopathology in patients with suspected CIPO, as the results could improve diagnostic and decision‐making processes.
Contact e‐mail address: minhchau.ta@proton.me
G‐RF151. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF151.1. SINGLE‐CELL RNA SEQUENCING AND SPATIAL TRANSCRIPTOMICS REVEAL THE PROGRESSION CHARACTERISTICS OF HIRSCHSPRUNG DISEASE
Ying Wang 1, Min Yang2,3
1Department Of Pediatrics, Guangdong Provincial People's Hospital Affiliated to Southern Medical University, Guangzhou, China, 2Department Of Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China, 3Guangdong Provincial People's Hospital Affiliated to Southern Medical University, Guangzhou, China
Objectives and Study: To reveal the changes in the cellular atlas of full‐thickness intestinal tissues in children with Hirschsprung disease (HSCR) and explore the loss of ganglion cells and functional alterations in the ganglionic intestinal segments.
Methods: Single‐cell RNA sequencing was performed on paired intestinal samples from 7 HSCR patients, as well as proximal and distal full‐thickness surgical colon samples from 3 control patients with ileostomies. Bioinformatics analysis was employed to demonstrate changes in the composition and function of parenchymal and immune cells in different sample groups. Our findings were validated using spatial transcriptomics.
Results: We analyzed 99,867 single cells and observed an increased proportion of glial cells and T cells in the normal segments. Among the glial subpopulations, the largest one, Glial_Stress, was significantly enriched in the normal segments. Marker gene and GSVA analyses revealed metabolic reprogramming within this subpopulation, suggesting its active role in oxidative stress response, neuronal injury repair, and immune responses. Spatial transcriptomics analysis revealed that neurons in the normal colon segments expressed high levels of the death receptor TNFRSF1B, while its major ligand, TNF, was significantly upregulated in the Treg_IL2RA cell population in the normal segments. Pathway enrichment analysis further indicated that this CD4 + T cell subset in the normal segment was predominantly enriched in the IL6‐STAT3 signaling pathway, accompanied by enhanced activity of the transcription factors RELA and NFKB1.
Conclusions: Given the expression of death receptors on neurons in the normal segments, the metabolic reprogramming and functional changes in glial cells, and the local immune alterations, we propose that subtle pathological changes, including neuronal damage, glial cell repair, and immune activation, may exist in the normal segments of the colon in HSCR. These findings provide new insights into the pathogenesis of the disease and potential avenues for therapeutic evaluation.
Contact e‐mail address: wydsmu@163.com
G‐RF152. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐RF152.1. EFFECTS OF ALLERGIC DISEASES ON SOCIAL‐EMOTIONAL DEVELOPMENT IN CHILDREN AT 12 MONTHS OF AGE: A PROSPECTIVE COHORT STUDY
Xiaodan Yu
Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Objectives and Study: The link between allergic diseases and deficits in children's neurodevelopment has been suggested, but it remains unclear regarding the allergy‐related effects on social‐emotional development in early life. Our study aimed to explore the association between allergic diseases and social‐emotional development during infancy using a prospective study.
Methods: 937 infants at 6 months were recruited from two community hospitals in Shanghai, of which 805 infants followed up at 12 months. The outcome was social‐emotional concern, defined by Ages&Stages Questionnaire: Social‐Emotional and personal social domain from Ages&Stages Questionnaire with established cutoffs. Allergic diseases were assessed using modified International Study of Asthma and Allergies in Childhood core questionnaire. Allergy patterns were classified based on time of onset and persistence as “Never”, “Transient” (allergy at age of 0‐6 months only or 7‐12 months only), “Persistent” (allergy at age of 0‐6 and 7‐12 months).
Results: 8.45% of 12‐month infants exhibited social‐emotional concerns. Infants had increased risk of social‐emotional concerns at 12 months who suffered allergic diseases during 0‐12 months (adjusted odd ratio [aOR], 2.22; 95% confidence interval [CI], 1.33‐3.70), 7‐12 months (aOR[95%CI]: 2.07 [1.21, 3.57]) and 0‐6 months (aOR[95%CI]: 1.90 [1.12, 3.21]). Additionally, infants with persistent allergy had a 161% higher risk of social‐emotional concern (aOR[95%CI]: 2.61 [1.29, 5.28], P = 0.008) compared to infants without allergy (P for trend=0.001).
Conclusions: Allergic infants were more likely to experience social‐emotional concerns, particularly for those with persistent allergy. To optimize social‐emotional development, we highlight regular monitoring of mental health and effective management of allergy during infancy.
Contact e‐mail address:
G‐RF153. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐RF153.1. THE SYNERGISTIC EFFECT OF COLLOIDAL BISMUTH CITRATE WITH CLARITHROMYCIN WAS ENHANCED WITH THE INCREASE OF THE MINIMAL INHIBITORY CONCENTRATION OF CLARITHROMYCIN IN CLINICAL CHILDREN
Chunmeng He 1, Ying Zhou1, Liangdong Lyu2, Ying Huang1
1Children's Hospital of Fudan University, Shanghai, China, 2Key Laboratory Of Medical Molecular Virology Of The Ministry Of Education/ministry Of Health, Department Of Medical Microbiology And Parasitology, School Of Basic Medical Sciences, Fudan University, Shanghai, China
Objectives and Study: Due to the increasing drug resistance of Helicobacter pylori (H. pylori), in 2024, Espghan/Naspghan no longer recommends the use of clarithromycin‐containing therapy (including triple therapy and quadruple therapy) for children without clarithromycin susceptibility testing. At present, there are fewer antibiotics for children, especially those ≤8 years old. Vonoprazan are still not allowed in children. So, checkerboard experiments were performed to investigate the interaction between colloidal bismuth citrate and clarithromycin and metronidazole in clinical isolates, and to find out the interaction.
Methods: We collected specimens from patients with H. pylori infection who underwent gastroduodenoscopy at the Department of Gastroenterology, Children's Hospital of Fudan University from May to August, 2024. The specimens were inoculated and the monoclonal clones were used for proliferation. Broth microdilution method was used to determine the minimal inhibitory concentration (MIC) of colloidal bismuth citrate (CBS), clarithromycin (CLA) and metronidazole (MET) in clinical isolates. A standard checkerboard broth micro‐dilution test was carried out to test the synergistic effects of the combined antibacterial agents and calculated the fractional inhibitory concentration (FIC) index (FICI). The growth of each well was depicted using heat maps for all checkerboard experiments.
Results: In this study, 20 clinical samples were tested for MIC of CLA, and 13 samples were resistant to CLA, and the MIC(CLA) of all the samples was ≥16 µg/ml, indicating that the strains were highly resistant to CLA. All of them had A2143G mutation. However, in the samples with high clarithromycin resistance, CBS and CLA showed synergistic effect, and the synergistic effect was gradually enhanced with the increase of MIC(CLA). Four clinical samples and 1 standard strain resistant to MET were also measured, and the results showed that there was no clear synergistic effect between CBS and MET.
Conclusions: CBS may have an inhibitory effect on the high degree of clarithromycin resistance of H. pylori.
Contact e‐mail address:
G‐RF154. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐RF154.1. IS THE PREVALENCE OF H.PYLORI IN CHILDREN DECREASING IN TURKEY? A TERTIARY CENTER EXPERIENCE
Melike Ozcicek 1, Sınan Sarı1, Hakan Öztürk1, Odul Egrıtas Gurkan1, Betul Ogut2, Buket Dalgiç1
1Division Of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 2Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
Objectives and Study: This study aimed to investigate changes in the prevalence of Helicobacter pylori in childhood over the past 16 years and its relationship with peptic ulcers.
Methods: The study included 8,700 pediatric patients aged 0–18 years who underwent upper gastrointestinal endoscopy between 2008 and 2024 at the Pediatric Gastroenterology Department of Gazi University, one of Turkey's reference endoscopy centers. Patient records were retrospectively reviewed to determine the frequency of biopsy‐proven H. pylori and peptic ulcers, as well as their association over time. Causes of peptic ulcers unrelated to H. pylori were also documented.
Results:
The prevalence of H. pylori and peptic ulcers was 21.6% and 7.6%, respectively. The frequency of peptic ulcers was significantly higher in H. pylori‐positive patients compared to H. pylori‐negative patients (16.1% vs. 6.4%; p < 0.001). A significant decline in the prevalence of both H. pylori and peptic ulcers was observed from 2008 to 2024 (Fig). When analyzed in 4‐year intervals, the prevalence of H. pylori decreased from 31% to 10.3%, while the prevalence of peptic ulcers declined from 9.8% to 7%. Non‐H. pylori causes of peptic ulcer accounted for 60.9%. Over the 16‐year period, the proportion of peptic ulcers attributed to H. pylori decreased from approximately 50% to 30%.
Conclusions: Although the prevalence of H. pylori has significantly declined over the 16‐year study period, it remains one of the most important causes of peptic ulcers in Turkish children.
Contact e‐mail address: melikeozcicek@hotmail.com
G‐RF155. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐RF155.1. IMPACT OF PROTON PUMP INHIBITORS ON GASTRIC PH AND BIOPEPTIDE PROFILES FROM HUMAN MILK
Belén Pastor‐Villaescusa 1, Francisco Amil‐Ruiz2, Carlos A. Fuentes‐Almagro3, Katherine Flores‐Rojas1, Mercedes Gil‐Campos1, Lucía Izquierdo‐Palomares4, Angel Gil5, José Luis Gómez‐Chaparro Moreno1
1Metabolism In Childhood, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain, 2Bioinformatics Unit, Central Research Support Service (scai), University of Cordoba, Cordoba, Spain, 3Proteomics Unit, Central Service For Research Support (scai), University of Cordoba, Cordoba, Spain, 4Pediatrics Radiology Section, Radiodiagnostic Service, Reina Sofia University Hospital, Cordoba, Spain, 5Department Of Biochemistry And Molecular Biology Ii, University of Granada, Granada, Spain
Objectives and Study: Proton pump inhibitors (PPIs) are commonly prescribed for infants to manage complications such as gastroesophageal reflux disease. By increasing gastric pH, PPIs can alter the activity of gastric enzymes, potentially altering the biopeptides (protein‐derived peptides with inherent biological activity) produced during the digestion of human milk (HM). This study aimed to simulate the pH alterations associated with PPI administration to explore their potential changes in the biopeptides derived from HM.
Methods: An in‐silico proteomic analysis was performed to simulate gastric digestion under PPI administration. The PeptideCutter tool was used to model digestion at varying gastric pH levels (pH <2 (physiological), pH 2 (PPI use), and pH 5 (long‐term PPI use)). HM minor lactoserum proteins, identified through a ProteoMiner and liquid chromatography‐tandem mass spectrometry pipeline, were analyzed. These proteins represented all lactation stages and neonates with birthweights ranging from 550 g to 3900 g. The analysis considered the effects of increased pH on pepsin activity and its role in protein breakdown. Furthermore, the BIOPEP‐UWM database was employed to evaluate the biological activity of the milk‐derived biopeptides.
Results:
A total of 22 biological activities were identified from 150,025 peptides (Figure 1). Different biopeptide patterns were observed between physiological gastric conditions and the simulated conditions associated with PPI use, including long‐term PPI treatment. Among the identified biopeptides, those with antithrombotic and chemotactic activities were detected under pH 2, whereas long‐term PPI treatment conditions yielded biopeptides with antioxidant and antibacterial activities. The biopeptide pattern observed under physiological gastric conditions differed from those found under PPI treatments.
Conclusions: This in‐silico analysis indicates that PPIs use alters gastric pH, leading to changes in the biopeptides derived from HM and their associated biological activities. Further evidence is needed to clarify the changes induced by PPIs administration and to better understand their physiological implications and effects on infant development.
Contact e‐mail address: belen.pastor@imibic.org
G‐RF156. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐RF156.1. EVALUATION OF PROFESSIONAL PRACTISE ON HELICOBACTER PYLORI IN PAEDIATRICS: A PAN‐EUROPEAN STUDY
Marta Tavares 1, Angelika Kindermann2, Claudio Romano3, Anatoly Khavkin4, Yaşar Doğan5, Camille Jung6, Antal Dezsofi‐Gottl7, Amit Assa8, Alexandru Privan9, Vaidotas Urbonas10, Javier Martín‐De‐Carpi11, Olena Nyankovska12, Jiri Bronsky13, Ivan Milovanovic14, Veselinka Djurisic15, Staffan Berglund16, Ricardo Ferreira17, Orjena Žaja18, Rene Scheenstra19, Carsten Posovszky20, Mariam Ghughunishvili,21, Anne Olin22, Ieva Pukite23, Gayane Amaryan24, Vinod Kolimarala25, Matjaž Homan26
1Centro Materno Infantil do Norte, Porto, Portugal, 2Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands, 3Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital "G. Martino", Messina, Italy, 4Moscow Regional Center of Pediatric Gastroenterology and Hepatology, Moscow, Russian Federation, 5Pediatric Gastroenterology, Hepatology And Nutrition, Fırat University, Elazığ, Turkey, 6Department of pediatrics‐ university paris Est, Creteil, France, 7Pediatric Center, Semmelweis University, Budapest, Hungary, 8The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel, 92 Department of Pediatrics II, „Iuliu Hati eganu“ University of Medicine and Pharmacy, Cluj‐Napoca, Cluj‐Napoca, Romania, 10Medical Faculty Of Children's Diseases, Vilnius University, Vilnius, Lithuania, 11Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain, 12Danylo Halytsky Lviv National Medical University, Lviv, Ukraine, 13Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic, 14University Children's Hospital, Belgrade, Serbia, 15Institute for Children Disease, Clinical Center of Montenegro, Podgorica, Montenegro, 16Department Of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden, 17Hospital Pediátrico de Coimbra, Coimbra, Portugal, 18University Clinical Hospital Center "Sestre Milosrdnice", Zagreb, Croatia, 19Division Of Paediatric Gastroenterology And Hepatology, Department Of Paediatrics, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 20Universitats‐Kinderspital, Zurich, Switzerland, 21Tbilissi State Medical University, Tbilissi, Georgia, 22Hvidovre hospital, Copenhagen, Denmark, 23University Children's Hospital, Riga, Latvia, 24Pediatric Gastroenterology Service; Department Of Pediatrics, Arabkir MC ‐ICAH; Yerevan State Medical University, Yerevan, Armenia, 25Maidstone Hospital, Kent, United Kingdom, 26Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
Objectives and Study: Recent guidelines provide insightful information on the diagnosis and treatment of Helicobacter pylori (Hp) infection, but the current knowledge of European pediatric gastroenterologists (PedGP) is unknown. The aim of our study was to assess the knowledge of about Hp infection in European countries.
Methods: National Societies Representatives from ESPGHAN were enrolled in the study and invited their members to complete a web‐based questionnaire. Descriptive analysis was performed.
Results: The questionnaire was completed by 462 PedGP from 33 countries, 60% were paediatric gastroenterology specialists, 81% of respondents were hospital based and out of them were 49% from University hospitals. We found that in 139 cases (30%) of cases the prevalence of Hp was unknown.The main indications for screening were duodenal or gastric erosions (85%), iron‐refractory anaemia (56%), but also dyspeptic complaints (48%), halitosis (12%), immune thrombocytopenic purpura (27%) and positive family history for non‐cardiac gastric cancer in only 192 of cases. An invasive test was requested 56% of physicians, 29% ordered stool antigen test (SAT) and 13% urea breath test (UBT) for the diagnosis of infection. 205 clinicians consider to “test‐and‐treat” and 8,2% do it by local policy. 65% of pediatric practices have access to culture and antibiotic susceptibility testing (AST), but only 34% have access to molecular tests. The majority (47,7%) considered adding clarithromycin to empirical treatment and more than half of responders added a probiotic to treatment, more common at the test and treat strategy users.
Conclusions: The practise among PedGP regarding Hp infection management does not follow entirely the guidelines, regarding indications to screening and the choice of empiric treatment regimens. The unknown local prevalence and the local policies may be the cause. It would be beneficial to create a homogeneous awareness activity around all Europe to increase the literacy and practise update.
Contact e‐mail address: mdtavares@gmail.com
G‐RF157. Topic: AS01. GASTROENTEROLOGY/AS01j. Polyposis
G‐RF157.1. DEFINING THE PICTURE OF DESMOID DISEASE IN CHILDREN AND ADOLESCENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS
Benjamin Zare1, Warren Hyer 1, Steve Erdman2, David Rudnick3, Marcus Auth4, Wenly Ruan5, Ramit Magen Rimon6, Thomas Attard7, Ivana Copova8, Andrew Latchford1, Shlomi Cohen9
1St Mark's Hospital, London, United Kingdom, 2Division Of Gastroenterology Hepatology And Nutrition, Department Of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Ohio, United States of America, 3Departments Of Pediatrics And Developmental Biology, Washington University School of Medicine, Missouri, United States of America, 4Paediatric Gastroenterology, Hepatology And Nutrition, Alder Hey Children's NHS Foundation Trust & Liverpool University, Liverpool, United Kingdom, 5Division Of Pediatric Gastroenterology, Hepatology And Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, United States of America, 6Pediatric Gastroenterology And Nutrition Institute, Ruth Children's Hospital of Haifa, Rambam Medical Center, Faculty of Medicine, Haifa, Israel, 7The University Of Missouri In Kansas City School Of Medicine, Division Of Gastroenterology, Hepatology And Nutrition, Children's Mercy Hospital, Kansas City, United States of America, 8Department Of Pediatric Gastroenterology, Hepatology And Nutrition, University Hospital Motol and 2nd Faculty of Medicine, Prague, Czech Republic, 9Dana‐ Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Objectives and Study: Within the paediatric population, there is a dearth of literature on the burden and picture of desmoid disease in familial adenomatous polyposis (FAP), alongside the outcomes of treatment. We aimed to begin to address this knowledge gap.
Methods: Anonymised data of children with FAP‐associated desmoid disease were compiled from eight centres via an international paediatric polyposis registry granted by ESPGHAN. Demographic, clinical, genetic, desmoid phenotype and treatment data were collected. Local R and D approval was granted for each site.
Results: The cohort comprised 30 children/adolescents (20 female (66%)). The median age at desmoid diagnosis was 15 (IQR 4) years. While 19/30 (63%) had a family history of desmoid, high‐risk genotype (3′ of codon 1450) was observed in 13/30 (43%). There was no preceding abdominal surgery in 20/30 (67%). The anatomic distribution of desmoids was as follows: intra‐abdominal 14/30 (47%), extra‐abdominal 9/30 (30%), abdominal wall 5/30 (17%), and unknown in 3/30 (10%). In total, 10 desmoids developed after prophylactic colonic surgery; 7/10 (70%) colectomy with ileorectal/distal sigmoid anastomosis, and 3/10 (30%) restorative proctocolectomy. The median interval from surgery to desmoid diagnosis was 3 (IQR 1) years. Management strategies are outlined in Table 1. Pharmacotherapy was largely ineffective. Surgical excision was successful in both cases of abdominal wall desmoid where it was performed.
Conclusions: In children and adolescents with FAP, desmoid disease is predominantly not a post‐operative phenomenon but does seem to share the other risk factors of adult disease – family history, far 3′ pathogenic variant. Further work is needed to determine the burden of desmoid disease and its treatment (both surgical and medical) in the paediatric FAP population. * Benjamin Zare and Warren Hyer should be equally acknowledged as joint first authors .11
Contact e‐mail address: b.zare@nhs.net/warren.hyer@nhs.net
G‐RF158. Topic: AS01. GASTROENTEROLOGY/AS01j. Polyposis
G‐RF158.1. GALLBLADDER ABNORMALITIES IN METACHROMATIC LEUKODYSTROPHY: A TOOL FOR EARLY DIAGNOSIS?
Salvatore Recupero 1,2, Agnese Solmi3, Vera Gallo1,2, Sara Locatelli1, Marcella Facchini1, Alessandra Clerici1, Maria Pia Cicalese1,2, Maria Ester Bernardo1,2,3, Francesca Ferrua1,2, Federica Barzaghi1,2, Maddalena Migliavacca1,2, Francesca Tucci1,2, Giulia Consiglieri1,2, Sabina Cenciarelli1,2, Mery Cardarelli4, Michele Colombo5, Chiara Gritti5, Alessandro Aiuti2,3, Francesca Fumagalli1,2,6, Valeria Calbi1,2
1San Raffaele Telethon Institute for Gene Therapy (SR‐TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy, 2Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy, 3Vita‐Salute San Raffaele University, Milan, Italy, 4Pediatric Surgery Unit, Ospedale Maggiore Policlinico, Milan, Italy, 5Department of Radiology and Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy, 6Neurology & Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
Objectives and Study: Metachromatic leukodystrophy (MLD) is a fatal lysosomal storage disorder due to sulfatide accumulation. MLD is characterized by rapid neurological decline, especially in early‐onset variants, where hematopoietic stem cell gene therapy is the only effective treatment if administered before the onset of neurological symptoms. Gallbladder abnormalities are common in MLD but are extremely rare in the general pediatric population. This study investigates the relationship between gallbladder abnormalities and the onset of neurological symptoms in MLD patients.
Methods: MLD pediatric patients followed at our center were evaluated for gallbladder abnormalities. Serial abdominal ultrasounds were performed to assess gallbladder abnormalities at various stages of the disease, in accordance with standard care. Clinical histories were reviewed to identify any gallbladder symptoms prior to the MLD diagnosis.
Results: The study includes 50 pediatric MLD patients (median age 54 months, range 7‐186 months), 44 having early‐onset variants (24 late‐infantile and 20 early‐juvenile), and 6 with the late‐juvenile (LJ) variant. Among the early‐onset patients, 34 (77%) showed gallbladder abnormalities, with the most frequent being gallbladder wall thickening (33). Other findings included polyps and biliary sludge in 4 and 6 patients respectively. Notably, 29 patients (85%) of those with gallbladder abnormalities were pre‐symptomatic for neurological symptoms, including 3 with polyposis. Among the late‐juvenile patients, 3 (50%) had gallbladder abnormalities. In one LJ case, gallbladder polyposis and associated symptoms required cholecystectomy. This event and the histological findings enabled MLD diagnosis two years before any neurological symptoms, allowing early access to treatment.
Conclusions: Gallbladder abnormalities, including polyposis, can precede neurological symptoms in MLD. Detection of such abnormalities could serve as an early indicator for MLD, improving the likelihood of early diagnosis and treatment and better clinical outcomes.
Contact e‐mail address: recupero.salvatore@hsr.it
G‐EV001. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV001.1. CHALLENGES IN DIAGNOSING CELIAC DISEASE IN T1 DIABETES MELLITUS: SENSITIVITY AND SPECIFICITY OF INITIAL HIGH ANTIBODY LEVELS
Abdul Samet Ala 1, Talip Sayar2, Ali Islek2, Gokhan Tumgor2
1ÇUKUROVA UNIVERSITY, ADANA, Turkey, 2Pediatric Gastroenterology, ÇUKUROVA UNIVERSITY, ADANA, Turkey
Objectives and Study: Celiac disease (CD) is a chronic enteropathy characterized by a hypersensitivity to gluten. Its prevalence is significantly higher in individuals with type 1 diabetes mellitus (T1DM), ranging from 1% to 10%. Notably, seropositivity for celiac‐related antibodies is known to spontaneously resolve in some cases following the initial diagnosis. In this study, we evaluated celiac serology in T1DM patients.
Methods: We retrospectively analyzed 954 children with T1DM. Patients with positive celiac serology were categorized into two groups: those diagnosed with CD and without a formal diagnosis. Endoscopic biopsy was required for the diagnosis of CD.
Results: Anti‐TTG was positive in 27 patients (44.2%) at the time of diagnosis. Among these, anti‐TTG levels were >10 times the upper limit of normal (ULN) in 11 patients, 2 times ULN in 1 patient, and 4.5 times ULN in 1 patient, leading to a diagnosis of celiac disease. In 14 of the 27 patients, with anti‐TTG levels elevated 2–7 times ULN, the autoantibodies spontaneously normalized without a diagnosis of celiac disease. Additionally, during follow‐up, anti‐TTG positivity was observed in 34 more patients, 20 of whom were diagnosed with celiac disease. In these patients, anti‐TTG levels were 4 times ULN in 1 patient, 5 times ULN in 1 patient, and >10 times ULN in the remaining cases. The autoantibody levels in the 14 patients who were not diagnosed with celiac disease were <3 times the ULN.
Conclusions: Current guidelines lack a universally accepted consensus, it is generally suggested to postpone the decision for endoscopy unless specific criteria are met, such as antibody levels exceeding 7 times the upper limit of normal, a family history of celiac disease, or the presence of symptoms. This study demonstrated that an anti‐TTG level exceeding 10 times the upper limit of normal (130.5 U/ml) is a significant predictor for the diagnosis of celiac disease.
Contact e‐mail address:
G‐EV002. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV002.1. THE FREQUENCY OF MEFV GENE MUTATIONS AND FAMILIAL MEDITERRANEAN FEVER IN ARMENIAN CHILDREN WITH COELIAC DISEASE
Gayane Amaryan 1, Tatevik Shahinyan2, Siranush Pashinyan3, Armen Abrahamyan3, Ruzan Davtyan3, Tamara Sarkisian4, Artashes Tadevosyan5, Christian Braegger6
1Pediatric Gastroenterology Service; Department Of Pediatrics, Arabkir MC ‐ICAH; Yerevan State Medical University, Yerevan, Armenia, 2Pediatric Gastroenterology Service, Department Of Pediatrics, Arabkir MC ‐ICAH; Yerevan State Medical University, Yerevan, Armenia, 3Pediatric Gastroenterology Service, Arabkir MC ‐ICAH, Yerevan, Armenia, 4Department Of Medical Genetics, Centre of Medical Genetics and Primary Health Care; Yerevan State Medical University, Yerevan, Armenia, 5Department Of Public Health And Health Care Organization, Yerevan State Medical University, Yerevan, Armenia, 6Nutrition Research Unit, University Children's Hospital Zurich, Zurich, Switzerland
Objectives and Study: Coeliac Disease (CD) and Familial Mediterranean Fever (FMF) have some common symptoms: abdominal pain, diarrhea, arthralgia/arthritis. They are genetically determined immunologically mediated diseases, associated with other inflammatory and autoimmune diseases. There is high frequency of MEFV gene mutation carriers (1:3 ‐ 4) and FMF prevalence in Armenia. We investigated the frequency of MEFV mutations and FMF in Armenian children with CD and their influence on CD clinical course.
Methods: We observed 86 children with CD (35 boys, 51 girls, aged from 3 to 16 years). Diagnosis of CD was determined according to the New ESPGHAN Guidelines. Diagnosis of FMF was based on Tel – Hashomer criteria and genetic analysis for the 12 most common MEFV mutations in Armenia. The statistical analysis included descriptive statistics, calculation of rates, and one group z‐test.
Results: MEFV mutations were identified in 40.7% (35) of CD patients. The most common mutations were V726A, followed by M694V, E148Q (15.1%, 13.9%, 13.9% respectively). The symptoms and course of CD were identical in mutation carriers and non‐carriers. Most of mutations had heterozygous state (24/35), predominantly‐ V726A/N (8), M694V/N (7). E148Q/N (6). FMF was diagnosed in 12.8 % (11) of CD patients. Nine were compound‐heterozygotes with mild to moderate FMF course and had long‐term abdominal pain, arthralgia/arthritis, headache. The E148Q mutation was more frequent (6), followed by V726A (5), P369S (4), M680I (3). Two patients with E148Q/P369S genotype carried a third mutation (V726A or M680I). Patients with mild FMF phenotypes had low penetrance E148Q and P369S mutations (6). Two M694V homozygotes had moderate to severe FMF activity.
Conclusions: MEFV mutation frequency in Armenian CD patients (40.7%) was significantly higher than in general population (p < 0.0015). FMF was diagnosed in 12.8 % of the patients. MEFV mutation testing is recommended for Armenian CD patients with chronic abdominal pain, recurrent arthritis/arthralgia, headache despite adequate treatment.
Contact e‐mail address: gayaneamaryan@yahoo.com
G‐EV003. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV003.1. GUT CHECK: A CROSS‐SECTIONAL STUDY TO CORRELATE INTESTINAL FATTY‐ACID BINDING PROTEIN AND HISTOLOGICAL EVALUATION OF DUODENAL BIOPSIES FOR MONITORING GLUTEN‐FREE DIET COMPLIANCE IN CELIAC PATIENTS
Milena Ascani 1, Chiara Monachesi1, Francesca Di Sario1, Anil Verma2, Tiziana Galeazzi1, Dorina Pjetraj1, Elisa Franceschini1, Simona Gatti1, Carlo Catassi1, Maria Elena Lionetti1
1Department Of Pediatrics, Marche Polytechnic University, Ancona, Italy, 2Department Of Medicine Farncombe, Family Digestive Health Research Institute, McMaster University, Hamilton, Canada
Objectives and Study: The histopathologic evaluation of small intestinal tissue plays a crucial role in the diagnosis and management of patients with celiac disease (CD). The availability of effective, non‐invasive biomarkers remains an unmet need to evaluate mucosal normalization and compliance to the gluten‐free diet. The aim of this study is to identify a possible correlation between morphometric analysis results and serum levels of intestinal fatty acid‐binding protein (I‐FABP).
Methods: This ongoing prospective cross‐sectional study aims to enroll 40 patients with CD on a gluten free diet (GFD) by at least 1 year, attending medical follow‐up visit. The morphometric analysis of small intestinal mucosa, including villus height, crypt depth and intraepithelial lymphocytes (IELs) count, was performed. Plasma levels of I‐FABP were measured using the HK406 HUMAN I‐FABP ELISA test (Hycult® Biotech, Netherlands). Additionally, serum levels of anti‐tissue transglutaminase IgA (IgA anti‐tTG), IgG anti‐deamidated gliadin peptide (IgG anti‐DGP), and ferritin were assessed. Adherence to GFD and quality of life were evaluated using validated questionnaires.
Results: To date, 23/40 patients have been enrolled, including 16 females and 7 males, with a median age of 40 years. A significant negative correlation was observed between I‐FABP and villus height to crypt depth ratio (p = 0.032). No significant correlations were found between I‐FABP levels and IELs (p = 0.594), IgA anti‐tTG (p = 0.414), or adherence to GFD (p = 0.785). Conversely, a significant negative correlation was found between I‐FABP levels and quality of life (p = 0.009).
Conclusions: The preliminary results suggest that I‐FABP levels are associated with mucosal status. Further research and definitive results are needed to draw conclusive insights into its clinical utility.
Contact e‐mail address: milenascani23@gmail.com
G‐EV004. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV004.1. PREVALENCE OF PEDIATRIC GLUTEN‐RELATED DISORDERS IN UZBEKISTAN (COHORT PROSPECTIVE STUDY)
Gulnoza Azizova 1, Zulkhumor Umarnazarova2, Dilrabo Abdullaeva2, Svetlana Geller3, Noiba Azimova3, Kamola Usmanova3, Altinoy Kamilova3
1Gastroenterology, Akfa Medline, Tashkent, Uzbekistan, 2RSSPMC of Pediatrics, Tashkent, Uzbekistan, 3Gastroenterology, RSSPMC of Pediatrics, Tashkent, Uzbekistan
Objectives and Study: Gluten‐related disorders (GRDs) are increasing around the world, but their prevalence remains unknown in Central Asian countries. Our aim was to determine the incidence of gluten‐related disorders among children with gastrointestinal symptoms.
Methods: A prospective cohort study was conducted from 2021 to 2022, including 336 children aged 1–16 years with suspected gluten intolerance. In the first phase, 206 children were selected using a validated questionnaire. Of these, boys were 100 (48.5%) and girls‐106 (51.4%). The average age of the children was 63.1 ± 3.21 months. Diagnostic tests included antibodies to tissue transglutaminase IgA (and IgG, IgM in IgA‐deficient cases), total and specific IgE to wheat/gluten, HLA class II genotyping, and histological examination of duodenal biopsies when indicated. Non‐celiac gluten sensitivity (NCGS) was diagnosed using the Salerno criteria.
Results: The incidence of GRDs was 17.5% (36 children), among these celiac disease (CD) was in 11 cases(5.2%), wheat allergy (WA)‐15 (7.3%) and NCGS 10 (4.9%). The mean age of children with CD, WA, and NCGS was 7.31 ± 1.63 years, 5.27 ± 0.93 years, and 5.34 ± 0.95 respectively. The most common symptoms of CD were abdominal pain (72.7%), flatulence (81.8%), and diarrhea (54.5%). In most children wiith CD Marsh grade was 3 A (63,6 %). The leading extraintestinal symptom of NCGS was headache. Children with WA had allergic rash combined with abdominal pain.
Conclusions: This is the first study to evaluate GRDs incidence among children in Central Asia, showing that CD and WA are common diseases, while the incidence of NCGS is consistent with the average data published in the literature.
Contact e‐mail address: geller_svetlana@mail.ru
G‐EV005. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV005.1. HEMATOLOGIC ALTERATIONS AT THE ONSET OF CELIAC DISEASE IN PEDIATRIC PATIENTS: RETROSPECTIVE ANALYSIS IN A THIRD LEVEL PEDIATRIC CENTER
Mariachiara Bagnato, Silvia Altran, Sebastiano Salaorni, Giorgio Piacentini, Marco Deganello Saccomani, Claudia Banzato
Paediatric Gastroenterology, Woman's & Child's University Hospital of Verona, Italy, Verona, Italy
Objectives and Study: Celiac disease is a chronic autoimmune condition that affects the small intestine in response to gluten intake in genetically predisposed individuals. Although the classic presentation involves gastrointestinal symptoms, increasingly, the onset of the disease occurs with extra‐intestinal symptoms, including various hematological disorders. Among these, the most frequent are iron‐deficiency anemia, thrombocytosis, and IgA deficiency. The aim of this study is to analyze the frequency of hematological alterations at the onset of celiac disease in pediatric patients, to evaluate their progression during follow‐up, to identify any correlations with anthropometric and biochemical parameters.
Methods: This is configured as a retrospective observational study. We analyzed the clinical and laboratory parameters of pediatric patients with celiac disease followed at the Woman's & Child's University Hospital of Verona. Data related to the onset were collected, including symptoms, family history, weight, height, and laboratory parameters (complete blood count, TGA, transaminases, thyroid hormones), and their progression over time was evaluated by assessing the same parameters at follow‐up 6‐9 months later.
Results: We included in the study 157 patients (106 F/51 M). The average age at diagnosis was 7 ± 3.5 years. The complete blood count (CBC), was abnormal for at least, one parameter in 61% of the subjects. The incidence of anemia was 15% and the incidence of thrombocytosis was 17%. A detailed analysis of individual parameters revealed a correlation between age at diagnosis and CBC abnormalities, with younger children showing more alterations, and a correlation between CBC values and TGA levels, where children with higher initial TGA levels exhibited greater CBC abnormalities. At the follow‐up visit, after starting a gluten‐free diet, a significant improvement in most CBC values was observed.
Conclusions: Our study found a high incidence of blood count abnormalities in the pediatric population, with a higher frequency in young children and those with high TGA values at diagnosis.
Contact e‐mail address: bagnatomariachiara@yahoo.it
G‐EV006. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV006.1. THE IMPACT OF THE INTRODUCTION OF THE “NO BIOPSY” PROCEDURE FOR THE DIAGNOSIS OF CELIAC DISEASE – SINGLE‐CENTER OBSERVATIONS OVER 11 YEARS
Joanna Bierła 1, Marta Cyba2, Beata Oralewska1, Grzegorz Oracz1
1The Children Memorial Health Institute, Warsaw, Poland, 2The Childrens MEmeorial Helath Institute, Warsaw, Poland
Objectives and Study: The introduction of ESPGHAN diagnostic recommendations for the diagnosis of celiac disease in 2012 was a revolution of sorts. At that time, the possibility of diagnosing CD “no biopsy” was also allowed. However, the introduction of diagnostic recommendations does not mean their immediate introduction to clinical work. Therefore, the aim of our study was to follow the implementation of the “no biopsy” procedure during the implementation period, identifying potentially beneficial effects for clinical work.
Methods: The study analized medical records of the Institute of Children's Health in Warsaw (Poland) in the years 2013‐2023, with the consent of the local bioethics committee. On this basis, a database was created, including the results of diagnostic tests of patients, such as: concentration of antibodies anti‐tTG2 IgA, anti‐endomysium, the result of the histopathological examination, the result of the genetic test.
Results: The analysis used the medical records of 497 IPCZD patients who were diagnosed with celiac disease in the years 2013‐2023. The analysis of the data showed the successive implementation of the "no biopsy" diagnosis method. Initially, in 2013, out of 44 patients, the procedure without biopsy was used in only 1 patient out of 23 who met the conditions of the recommendation. In 2014, out of 54 CD diagnoses, 6 patients were diagnosed "no biopsy" out of 36 who met the conditions of the ESPGHAN recommendation. The growing trend continued in subsequent years, constituting in 2015 ‐9 CD diagnoses "without biopsy"/25; 2016 ‐ 5/21; 2017‐ 19/33; 2018 ‐ 8/18; 2019 ‐31/35; 2020 ‐ 21/21; 2021 ‐ 37/37; 2022 ‐ 30/32; 2023 ‐ 29/29 respectively.
Conclusions: The introduction of the "no biopsy" procedure was not radical, but occurred gradually over 6 years. It was not until 2019 that the "no biopsy" procedure covered the majority of patients meeting the criteria for diagnosis.
Contact e‐mail address: j.bierla@ipczd.pl
G‐EV007. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV007.1. IS A GLUTEN‐FREE DIET ALWAYS FOLLOWED CORRECTLY? HOW TO HELP PATIENTS WITH CELIAC DISEASE USING TESTS TO DETECT GLUTEN PEPTIDES IN URINE – PRELIMINARY STUDY
Joanna Bierła, Ewa Konopka, Ilona Trojanowska, Beata Oralewska, Bozena Cukrowska
The Children Memorial Health Institute, Warsaw, Poland
Objectives and Study: In 2022, ESPGHAN issued recommendations describing the principles of monitoring pediatric patients after the introduction of GFD. However, these recommendations do not provide clear indications for the use of tests determining the concentration of immunogenic gluten peptides (GIP). Despite the proven usefulness of detecting GIP in stool, patients consider this type of testing too unpleasant or complicated to perform. Therefore, tests based on the detection of GIP in urine seem more useful. Available tests allow for the detection of even a single gluten intake at a dose of 50 mg (the lowest daily dose considered harmful to patients with CD). Their only drawback is the relatively short detection time, as the presence of GIP in urine is detected within 0.5 h to 48 h after gluten ingestion, while in feces it is possible for up to 5 days. The aim of our study was to determine the usefulness of tests based on the detection of GIP in urine of pediatric patients with CD during GFD.
Methods: Urine samples from pediatric patients with CD, declaring adherence to GFD, subject to routine check‐ups in the Gastroenterology Clinic or during hospitalization at the Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, IPCZD were used for the study. For the tests urine was used a cassette test (Biomedal), and blood serum – concentration of antibodies against tissue transglutaminase type 2 in the IgA anti‐tTG2 IgA class (Phadia 100, Thermo Fisher).
Results: 56 patients with CD (31 girls) were included in the study. Abnormalities in GFD were detected in 18 patients (32%). In addition, 2 samples with negative GIP results were collected too late during hospitalization (after 48 h of strict GFD), and in‐depth interview revealed non‐adherence to GFD.
Conclusions: The results indicate the usefulness of tests detecting GIP in urine in CD patients in correcting GFD.
Contact e‐mail address: j.bierla@ipczd.pl
G‐EV008. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV008.1. MEAN PLATELET VOLUME AS A BIOMARKER FOR DIETARY COMPLIANCE IN CELIAC DISEASE
Sila Camur, Semih Sandal, Edanur Acarel, Mehmet Akif Yıldıran
General Paediatrics, ANKARA TRAINING AND RESEARCH HOSPITAL, Ankara, Turkey
Objectives and Study: To investigate whether changes in the mean platelet volume (MPV) may reflect inflammation, dietary compliance, and be used possibly as a biomarker in follow‐up of CD.
Methods: 150 children with CD were retrospectively included as study group and 110 children as control group. Demographic, laboratory and histopathological findings at onset were recorded.The Ig A tTG antibody and EMA levels were used to define the laboratory assesment for dietary compliance. Laboratory findings at 12th months of study group after gluten free diet (GFD) were also recorded.
Results: The mean age, gender, body weight, height, and BMI z‐scores did not differ between groups. The IgA tTG antibody levels lowered significantly after 12 months of GFD (median 124.0 (47,5‐300,0) at onset vs median 16.9 (4,5‐57,4) at 12 month; P < 0.001) (Table 1). The mean platelet count was significantly higher and the MPV levels were significantly lower at presentation. A significant increase in the MPV were demonstrated at the 12 months of GFD (p < 0.001) (Table 1).
Table 1. Comparison of complete blood count values of CD at onset and follow‐up
| Onset | 12th month | ||||
|---|---|---|---|---|---|
| Median | IQR 25‐75 | Median | IQR 25‐75 | p value | |
| WBC (/mm 3) | 7000 | 6065‐9130 | 7095 | 5830‐8412 | >0.05 |
| HGB (g/dL) | 12.6 | 11.6‐13.3 | 13.0 | 13.0‐13.7 | >0.05 |
| MCV (fL) | 79.5 | 74.8‐82.4 | 80.5 | 77.8‐82.4 | >0.05 |
| PLT (/mm 3) | 336000 | 292500‐401000 | 304000 | 260250‐351750 | <0.001 |
| MPV (fL) | 9.6 | 9.0‐10.4 | 9.8 | 9.3‐10.6 | <0.001 |
| DtIgA (AU/ml) | 124.0 | 47.5‐300.0 | 16.9 | 4.5‐57.4 | <0.001 |
Conclusions: MPV may be used as a biomarker for the monitoring of dietary compliance in CD for its low cost and easy access.
Contact e‐mail address: misra.sila.camur.37@hotmail.com
G‐EV009. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV009.1. CELIAC DISEASE COEXISTENCE IN TYPE 1 DIABETIC CHILDREN: A STUDY OF OVERLAPPING AUTOIMMUNITY
Tatiana Chisnoiu 1,2, Adriana Balasa2, Cristina Mihai1,2
1Ovidius University, Faculty of Medicine, Pediatric Department, Romania, Constanta, Romania, 2Constanta Clinical Emergency Hospital, Pediatric Department, Romania, Constanta, Romania
Objectives and Study: Celiac disease (CD) and type 1 diabetes (T1D) are autoimmune disorders that frequently co‐occur in pediatric populations, sharing a common genetic predisposition and immunopathogenic mechanisms. The perspective of CD in the context of T1D in children in this study could be approached in an original way by exploring the following aspects: prevalence, clinical and metabolic impact, early diagnosis and screening, integrated management, psychosocial aspects and quality of life.
Methods: We conducted a study between 2011‐2021 on a cohort of 182 children with T1D. They were screened for CD using serological markers (anti‐tissue transglutaminase antibodies, anti‐endomysial antibodies) and confirmed by duodenal biopsy in positive cases
Results: The prevalence of CD was found to be 8.79% (16 patients). Patients with T1D without CD (n = 166) were compared with T1D patients who also had CD (n = 16) according to the prevalence of complications involved in both the T1D and CD. Patients with CD and T1D had a more affected metabolic profile than those who were only diagnosed with T1D. Regarding insulin requirements at the onset of diabetes, those with CD and T1D had a lower insulin requirement compared to the control group (p < 0.01) Patients in T1D and CD group were more than four times more likely to experience weight loss (p < 0.01). While, only in patients with CD, concern has been raised about weight gain when the diet is based on excluding gluten from the diet, normal growth patterns in children and adolescents with T1D and CD, with body mass index and standard deviation of height scores only marginally but not significantly higher in the control group (non‐celiac) than the study group and similar to subjects with CD, with good adhesion.
Conclusions: A tailored, multidisciplinary approach is essential to optimize outcomes and improve quality of life in these children with dual autoimmune disorders.
Contact e‐mail address: Yes
G‐EV010. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV010.1. SHARED GENETICS, SHARED CHALLENGES: FAMILIAL CLUSTERING OF TYPE 1 DIABETES AND CELIAC DISEASE
Cristina Mihai1,2, Tatiana Chisnoiu 1,2, Adriana Balasa1,2
1Ovidius University, Faculty of Medicine, Pediatric Department, Romania, Constanta, Romania, 2Constanta Clinical Emergency Hospital, Pediatric Department, Romania, Constanta, Romania
Objectives and Study: The coexistence of type 1 diabetes mellitus (T1DM) and celiac disease (CD) in families underscores the shared genetic and immunological underpinnings of these autoimmune conditions.
Methods: We present a case series involving three families, each with multiple members diagnosed with both T1DM and CD, illustrating the hereditary and environmental factors contributing to this overlap.
Results: Family 1 includes a 3‐year‐old boy diagnosed with T1DM. His sister was diagnosed at the age of 4 with CD. Their father has psoriatic arthritis with biological treatment. At the age of 8 years and 3 months, she presented with an acute respiratory episode, which turned out to be Influenza Type A, at which time she was diagnosed with T1DM according to the ADA criteria, with a positive genetic predisposition for T1DM ‐DR3‐DQB1*02:01. Family 2 includes a girl aged 5 years and 7 months diagnosed with T1DM with inaugural ketoacidosis and CD confirmed genetically and histopathologically from the onset. Screening in the family, in the 1st degree relatives, revealed the presence of CD in the sister aged 3 years and 8 months and in the mother. Family 3 features monozygotic twins diagnosed simultaneously with T1DM and CD, emphasizing the genetic predisposition at the age of 7, presenting with polyuria, weight loss, and chronic diarrhea. Clinical challenges include the management of dual autoimmune conditions, adherence to gluten‐free diets, and achieving glycemic control. Genetic testing revealed associations with HLA‐DQ2 and HLA‐DQ8 alleles in all cases. Family screening facilitated early detection and intervention, preventing complications.
Conclusions: This case series emphasizes the importance of familial screening for CD in T1DM patients and vice versa, particularly in first‐degree relatives. The findings support the need for a multidisciplinary approach to optimize outcomes and enhance quality of life in affected families.
Contact e‐mail address: Yes
G‐EV011. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV011.1. LIVING WITH TWO CHRONIC CONDITIONS: QUALITY OF LIFE IN PEDIATRIC CELIAC DISEASE AND TYPE 1 DIABETES
Tatiana Chisnoiu 1,2, Cristina Mihai1,2, Adriana Balasa2
1Constanta Clinical Emergency Hospital, Pediatric Department, Romania, Constanta, Romania, 2Ovidius University, Faculty of Medicine, Pediatric Department, Romania, Constanta, Romania
Objectives and Study: Children who have both type 1 diabetic mellitus (T1DM) and coeliac disease (CD) have particular difficulties that might affect their quality of life (QoL). The purpose of this cross‐sectional study was to assess the quality of life (QoL) of paediatric patients with both CD and T1DM to those with T1DM alone
Methods: A total of 32 children (16 with both conditions and 16 with T1DM only) aged 1–18 years were assessed using validated QoL questionnaires tailored for chronic diseases. The study also examined the influence of dietary adherence, glycemic control, and family support on QoL scores.
Results: The findings showed that children with CD and T1DM had substantially poorer quality of life (QoL) levels than children with T1DM alone, especially in the social and emotional areas (p < 0.05). Further reductions in quality of life were linked to poor dietary adherence and inadequate glycaemic management, highlighting the combined cost of maintaining two chronic diseases. One important element in reducing these difficulties has been identified as family support.
Conclusions: In order to improve the quality of life for children navigating the difficulties of CD and T1DM, our findings emphasise the need of multidisciplinary treatment that integrates nutritional counselling and psychological support. This emphasises how specific actions are needed to address how various problems interact.
Contact e‐mail address:
G‐EV012. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV012.1. CLINICAL PRESENTATION IN CHILDREN WITH COELIAC DISEASE IN KOSOVO
Minire Çitaku 1, Jernej Dolinsek2, Petra Rižnik3, Bahtir Visoka4, Shkurte Çitaku5, Urata Beqa6, Violeta Uka6, Halim Toro6, Teuta Kamberi6, Vlora Jaha6, Leonore Zogaj6, Shqipe Kabashi6, Arrita Beqa7
1Gastroenterology, University Clinical Center, Childrens Hospital, Prishtinë, Kosovo, 2Gastroenterology, Hepatology And Nutrition Unit, Department Of Paediatrics, University Medical Centre Maribor, Maribor, Slovenia, 3University Medical Centre Maribor, Maribor, Slovenia, 4Biochemistry Clinic, University Clinical Center of Kosovo, Prishtinë, Kosovo, 5Family Medicine Center, Prishtine, Kosovo, 6Children's Hospital, University Clinical Center of Kosovo, Prishtine, Kosovo, 7University Clinical Center of Kosovo, Prishtinë, Kosovo
Objectives and Study: Background
Coeliac disease (CD) is a chronic autoimmune disorder triggered by gluten in genetically predisposed individuals. Its clinical presentation varies widely, especially in pediatric populations, where symptoms range from classic gastrointestinal complaints to extraintestinal manifestations. Limited data on the prevalence and clinical presentation of CD in children in Kosovo underscore the need for local research to guide diagnosis and management. Objective
To describe the clinical presentation, associated symptoms, and diagnostic findings in children diagnosed with coeliac disease in Kosovo.
Methods: This retrospective study, conducted as part of the CD SKILL project, analyzed pediatric patients diagnosed with coeliac disease in tertiary healthcare centers in Kosovo between 2022 and 2024. Diagnosis was based on serological markers, including tissue transglutaminase antibodies (tTG IgA/IgG) and anti‐endomysial antibodies (EMA). Clinical data—such as presenting symptoms, age at diagnosis, and comorbidities—were collected and analyzed.
Results: A total of 30 children were diagnosed with coeliac disease during the study period. The gender distribution was 66.67% female and 33.33% male. The leading presenting symptoms were: Abdominal pain (57.14%) Diarrhea (9.52%) Weight loss (9.52%) Anorexia (9.52%) Abdominal distension (4.76%) Growth retardation (4.76%) The median time from symptom onset to diagnosis was 12 months, indicating a delay in recognizing atypical presentations.
Conclusions: This study highlights that children with coeliac disease in Kosovo predominantly present with classic gastrointestinal symptoms, though extraintestinal manifestations also play a significant role. Delays in diagnosis, particularly in cases with atypical symptoms, remain a concern. Increased awareness among healthcare professionals is crucial to enable early diagnosis and prevent long‐term complications. Further research is needed to determine the true prevalence of CD in Kosovo's pediatric population and to develop effective screening strategies.
Contact e‐mail address: minire.citaku@gmail.com
G‐EV013. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV013.1. ANTIBIOTICS USAGE DURING INFANCY INCREASE THE RISK OF CELIAC DISEASE
Tal Cozacov 1, Michal Yackobovitch‐Gavan2, Vered Shkalim3, Noam Itzhaki Wygoda4, Anat Guz Mark1,3, Dror Shouval1,3, Raanan Shamir1,3
1The Institute Of Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center of Israel, Petah‐tikvah, Israel, 2Epidemiology And Preventive Medicine, School Of Public Health, Faculty Of Medicine, Tel Aviv University, tel aviv, Israel, 3School Of Medicine, Faculty Of Medical And Health Sciences, Tel Aviv University, Tel aviv, Israel, 4Data Scientist Research Data Center, Schneider Children's Medical Center of Israel, Petah‐tikvah, Israel
Objectives and Study: Celiac disease (CeD) occurs in genetically predisposed individuals with environmental factors also playing a role. Our primary aim was to evaluate if early exposure to antibiotics is associated with the development of CeD. The secondary aim was to analyze the effects of sociodemographic characteristics on this association.
Methods: This retrospective cohort study (2008–2023) utilized data from the Clalit Health Services (CHS) database, including children younger than 18 years exposed to antibiotics within their first year of life. Antibiotic exposure was categorized by prescription count and type, while CeD was defined by two positive serology tests (IgA‐TTG). Data included demographics, and socioeconomic position (SEP).
Results: Overall, 1,860,533 patient files were analyzed, with 8,546 (0.5%) diagnosed with CeD, predominantly females 5,393 (63.1%), median age 12 (IQR 8‐17) years, with the majority being Jewish, (7,529 [92.0%]) and (3,712 [47.2%]) having high SEP. Antibiotic exposure during the first year of life was observed in 57% of both CeD patients and controls, with an adjusted (to gender, SEP and ethnicity) hazard ratio (HR) for CeD of 1.090 95% CI (1.041–1.141), P < 0.001. Higher antibiotic exposure (59.9%) during the first was observed in lower socioeconomic levels (P = 0.003), and those of Arab ethnicity, 58.9% (P < 0.001). When stratified to sex, the adjusted (to SEP and ethnicity) HR for CeD was significant only in girls [girls: HR 1.139 95% CI (1.075,1.207), P < 0.001; boys: HR 1.009 95% CI (0.935,1.089), P = 0.820]. An increasing number of antibiotic prescriptions was linked to a higher risk of CeD, adjusted HRs of 1.076 CI 95% (P = 0.003) for 1–3 prescriptions, 1.120 (P = 0.003) for 4–9 prescriptions, and 1.426 (P < 0.001) for ≥10 prescriptions.
Conclusions: Early antibiotic exposure during the first year of life was associated with a higher risk of developing CeD, particularly with increasing prescription numbers and mainly in females.
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G‐EV014. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV014.1. EVALUATION OF NEUTROPHIL/LYMPHOCYTE RATIO, PLATELET/LYMPHOCYTE RATIO AND MEAN PLATELET VOLUME IN CELIAC PATIENTS
Fatma Demirbaş
Pedİatrİc Gastroenterology, BALIKESİR ATATÜRK CİTY HOSPİTAL, BALIKESİR, Turkey
Objectives and Study: Celiac disease (CD) is an autoimmune, systemic disease that develops in genetically predisposed individuals as a result of persistent sensitivity to dietary gluten.Neutrophils, lymphocytes, and platelets play a role in controlling inflammation.Studies have shown that mean platelet volume (MPV), neutrophil lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) can be an indicator of systemic inflammation and are associated with prognosis in many autoimmune diseases, cardiovascular diseases, malignancies, and chronic inflammatory diseases.Our aim in this study was to evaluate the relationship between mean platelet volume (MPV), neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) in CD.
Methods: Between March and October, 108 patients diagnosed with CD and 50 healthy children were included in the study.
Results: The study included 108 CD (55 girls, mean age at diagnosis 8.6 ± 2.37 years) and 50 healthy controls (31 girls, mean age 7.6 ± 2.37 years). In celiac patients, mean MPV was 9.1 ± 0.1, NLR was 1.92 ± 0.27 and PLR was 136.8 ± 6.7, while in the control group, mean MPV was 9.3 ± 0.3, NLR was 1.44 ± 0.14 and PLR was 123.5 ± 5.7.NLR and PLR values were found to be statistically significantly higher in celiac patients compared to the control group (p = 0.001, p < 0.001, respectively). This difference was more pronounced in CD with Marsh 3 c (p < 0.001, p < 0.001, respectively).There was no statistical difference between the groups in mean MPV levels (p = 0.236).
Conclusions: Our data support the role of neutrophils in the inflammatory cascade of celiac disease pathogens. This increase in NLR may be explained by the fact that inflammatory cytokines lead to increased neutrophil production in celiac disease as part of the inflammatory process.This study has shown that these easily applicable and inexpensive biomarkers can also be used in Celiac patients.
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G‐EV015. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV015.1. RETROSPECTIVE COHORT STUDY: ELEVATED TRANSAMINASES IN CHILDREN WITH NEWLY DIAGNOSED COELIAC DISEASE IN SLOVENIA
Lara Harmel1, Nuša Hozjan1, Petra Rižnik2, Tina Kamhi Trop3, Janez Zupancic4, Martina Klemenak2, Jernej Dolinsek 2
1Faculty of Medicine University of Maribor, Maribor, Slovenia, 2Gastroenterology, Hepatology And Nutrition Unit, Department Of Paediatrics, University Medical Centre Maribor, Maribor, Slovenia, 3Clinical Department Of Paediatric Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia, 4Paediatric Department, General Hospital Celje, Celje, Slovenia
Objectives and Study: It is known that children with Coeliac disease (CD) sometimes present with elevated levels of liver transaminases upon diagnosis. The current study aims to specify the exact proportion of these children in Slovenia.
Methods: Medical data of children were analysed as part of a multicenter study of The European Society for Paediatric Gastroenterology Hepatology and Nutrition, Celiac Disease Special Interest Group project, CD in Focus. A follow‐up of laboratory results, including alanine transaminase (ALT), aspartate transaminase (AST), gamma‐glutamyl transpeptidase (GGT), tissue transglutaminase antibody (tTG Ig) and endomysial antibodies (EMA), was conducted for Slovenian children newly diagnosed with CD since 2021.
Results: The study included data from 140 children with confirmed CD. At diagnosis 22 out of 86 patients with determination of liver enzymes had elevated ALT (25.6%), 23 out of 83 had elevated AST (27.7%) and 2 out of 78 had elevated GGT (2.6%). 34 out of 86 (39.5%) had an elevated level of at least one of the evaluated enzymes (AST or ALT or GGT). At first follow‐up 9 out of 63 (14.3%) had elevated ALT, 10 out of 63 (15.9%) had elevated AST and 3 out of 48 (6.3%) had elevated GGT.
Conclusions: The literature reports varying proportions of children diagnosed with CD to have elevated transaminases. In Slovenia the prevalence of elevated transaminases (ALT and/or AST and/or GGT) is present at a high proportion (39.5%). In the majority of patients this, however, is a transient finding and does not indicate serious liver injury.
Contact e‐mail address:
G‐EV016. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV016.1. COMPARATIVE ANALYSIS OF BIOCHEMICAL AND ANTHROPOMETRIC CORRELATIONS IN CELIAC DISEASE PATIENTS BEFORE AND AFTER TREATMENT
Yoana Dyankova 1, Maria Dzhogova2, Niya Rasheva2, Krasimira Koleva3, Rouzha Pancheva2, Miglena Georgieva3
1Dept. Of Pediatrics, St. Marina University Hospital, Medical University, Varna, Bulgaria, Varna, Bulgaria, 2Medicine, Medical University Prof Dr Paraskev Stoyanov Varna, Varna, Bulgaria, 3Medicine, Medical University, Varna, Bulgaria, Varna, Bulgaria
Objectives and Study: Celiac disease (CD) impacts metabolic and bone health through chronic malabsorption. This study explores the evolution of correlations between biochemical markers and anthropometric parameters in newly diagnosed and long‐term CD patients before and after six months on a gluten‐free diet (GFD), providing insights into recovery trajectories.
Methods: Correlations were assessed in two cohorts of CD patients treated at the Department of Pediatrics, St. Marina University Hospital, Varna, Bulgaria, between 2018 and 2021: newly diagnosed patients (Group A, n = 25) and long‐term patients (Group B, n = 54).Parameters included weight, height, calcium (Ca), magnesium (Mg), phosphorus (P), alkaline phosphatase (ALP), ferritin (Fe), hemoglobin (Hb), parathyroid hormone (PTH) and human osteoprotegerin (OPG). Data were analyzed at baseline and after six months of GFD using Pearson and Spearman correlation coefficients.
Results: Group A (7.28 ± 4.56 years, male n = 14(56%)) and Group B (8.15 ± 3.76 years, male n = 16 (29.6%), p = 0.376) were analyzed for growth and bone turnover. In Group A at baseline, weight strongly correlated with height (r = 0.893, p < 0.001), and bone turnover markers (OPG/ALP, r = 0.428) indicated active bone activity. After six months, correlations persisted, with OPG linked to calcium (r = 0.583, p = 0.002) and height (r = ‐0.542, p = 0.005), suggesting improved bone formation. In Group B, baseline OPG correlated with hemoglobin (r = ‐0.372, p = 0.006), ALP with calcium (r = 0.284, p = 0.037), and ferritin with OPG (r = 0.346, p = 0.010). After six months, stable weight/height correlation (r = 0.930, p < 0.001) and changes in OPG associations (ferritin, r = 0.301, p = 0.029; PTH, r = ‐0.491, p = 0.013) highlighted recovery and calcium regulation.
Conclusions: Newly diagnosed CD patients show marked improvements in bone turnover and anthropometric recovery, while long‐term patients exhibit subtler changes, especially in iron and calcium metabolism. OPG is maybe key biomarkers for monitoring recovery, underscoring the need for tailored interventions to optimize long‐term health outcomes.
Contact e‐mail address:
G‐EV017. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV017.1. RISK OF SELECTED MICRONUTRIENTS DEFCIENCY IN CHILDREN WITH COELIAC DISEASE: A SINGLE CENTRE EXPERIENCE
Nabil El‐Lababidi 1,2, Svatava Šímová1
1Department Of Paediatrics And Inherited Metabolic Disorders, General University Hospital in Prague, Prague, Czech Republic, 2Department Of Paediatrics And Inherited Metabolic Disorders, First Faculty of Medicine, Charles University, Prague, Czech Republic
Objectives and Study: Coeliac disease (CeD) is the most common primary malabsorption syndrome in children. ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) Position Paper recommends monitoring of complete blood count (CBC), iron metabolism, folic acid, vitamin B12 and vitamin D levels in these children. This study aims to evaluate the experience of a single centre in monitoring these parameters in children with CeD.
Methods: Retrospective analysis of prospectively collected data in children with CeD, followed between 11/2016 and 6/2024. Children with measurements of CBC, iron metabolism, folic acid, vitamin B12 and/or vitamin D levels were enrolled. The median, standard deviation, and percent of insufficient or deficient values in each category were evaluated. Analysis of variance (ANOVA) was used for evaluation between biopsy and non‐biopsy diagnosed cohorts. A P‐value ≤ 0.05 was regarded as significant. CeD diagnoses were established in concordance with ESPGHAN Guidelines.
Results: Two‐hundred and eleven children with a median age at diagnosis of 7.16 ± 3.70 years were enrolled. Females made 59,3 % of the cohort. Female to male ratio was 1.5:1. Non‐biopsy diagnostic criteria were met by 67,3 % of children. Haemoglobin (HGB) was measured 732xm, ferritin 592x, folic acid 577x, vitamin B12 512x and calcidiol 637x. Anaemia, defined as HGB < 110 g/l, was objectified in 3.28 %, ferritin levels <12 mg/l in 20.1 %, folic acid deficiency in 9.4 %, calcidiol deficiency in 20.6 % and insufficiency in 0.6 %. Vitamin B12 deficiency was not found. Comparing non‐biopsy and biopsy diagnosed cohorts found statistically significant difference only in calcidiol and folic acid levels in favour of the non‐biopsy group.
Conclusions: Due to the high incidence of low ferritin, calcidiol and folic acid, their levels should be assessed regularly in children with CeD. Measurement of vitamin B12 levels should be reserved for children with its low dietary intake, mainly in vegetarian and vegan children.
Contact e‐mail address: nabil.el-lababidi@vfn.cz
G‐EV018. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV018.1. ABSENCE OF INTESTINAL ARCHITECTURAL DAMAGE IN PATIENTS WITH SUSPECTED CELIAC DISEASE, POSITIVE FOR ANTI‐TRANSGLUTAMINASE AND NEGATIVE FOR ANTI‐ENDOMYSIUM ANTIBODIES: A CASE‐CONTROL STUDY
Chiara Esposito, Roberta Mandile, Lorenzo D'antonio, Alessandra Pasca, Riccardo Troncone, Renata Auricchio
Department Of Translational Medical Sciences ‐ Pediatrics Section, University of Naples Federico II, Naples, Italy
Objectives and Study: Anti‐endomysium antibodies (EMA) are more specific for Celiac Disease (CD) compared to anti‐tissue transglutaminase antibodies (anti‐TG2). These tests are often performed together in CD diagnostic assessment, despite current guidelines suggest searching for EMA only in case of high anti‐TG2 levels, to confirm diagnosis without biopsy. The aim of this work was to underline the utility of EMA test in the diagnosis of CD also in cases with low level of anti‐TG2.
Methods: In this retrospective study we analyzed patients referred to our center from January to November 2024 for suspected CD. From the entire cohort we identified cases group consisting of patients with anti‐TG2 positive and EMA negative antibodies who performed an esophagogastroduodenoscopy (EGDS). We selected a control group matched for age, sex and similar anti‐TG2 levels but with EMA positive antibodies. In these patients we evaluated clinical features and the status of the intestinal mucosa.
Results: Patients clinical features, both of cases and controls are shown in Table1. EMA negative patients always presented low to mild levels of anti‐TG2 antibodies(1,06‐3,82xULN). In the duodenal biopsies, no patient among cases showed an intestinal architectural damage, with a mean villous‐to‐crypt ratio (V/C) of 2.9: 4/11 had a completely normal mucosa (Marsh0), while 7/11 showed mild inflammatory changes (Marsh1). Vice versa, in the control group 4/15 patients showed a duodenal villous atrophy(VA) with a V/C < 2 (2 Marsh3a, 1 Marsh3b, 1 Marsh3c).
Conclusions: Our preliminary results suggest that patients with positive anti‐TG2 but negative EMA do not seem to show intestinal architectural damage. Vice versa patients with comparable levels of anti‐TG2 but positive EMA present intestinal damage in ~26% of cases. This suggests that EMA negativity points to a high probability for VA absence. Future studies on larger series are required to confirm our data and establish long‐term outcome of anti‐TG2 positive and EMA negative children.
Contact e‐mail address: esposito.chiara92@gmail.com
G‐EV019. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV019.1. DIAGNOSIS OF COELIAC DISEASE IN CHILDREN: A QUALITATIVE LONGITUDINAL STUDY WITH PARENTS
Christian Farrier 1,2, Marta Wanat2, Jennifer Hirst2, Anthony Harnden2
1Department Of Pediatrics, University of Calgary, Calgary, Canada, 2Nuffield Department Of Primary Care Health Sciences, Univeristy of Oxford, Oxford, United Kingdom
Objectives and Study: Coeliac Disease (CD) is chronic autoimmune condition affecting 1% of the population which often onsets in childhood. Due to its nonspecific symptoms and variable presentation, parents and children can experience difficulties in navigating care and in receiving a timely diagnosis with CD. Existing qualitative literature predominantly focuses on ‘living with CD’ rather than the experiences of parents/children surrounding diagnosis. This study aimed to explore parents’ experiences leading up to and following the diagnosis of CD in their children.
Methods: A qualitative longitudinal study using semi‐structured interviews with parents of children diagnosed in the preceding 6 months with CD from across the UK. Each parent was interviewed twice spaced 6 months apart. The interviews were recorded, transcribed and analysed using a combination of thematic analysis and trajectory approach.
Results: Thirty‐eight interviews were conducted with parents of 19 children. A maximum variation sample was obtained for geographic region in the UK, child sex and the age of child at diagnosis. Parents described the emotional distress resulting from the challenges navigating the healthcare system to receive a diagnosis, the period of limbo between having the first positive test and a confirmed diagnosis, and in adjusting to the many changes afterwards including the gluten free diet. Barriers included communication with care providers, healthcare system navigation, conflicting information and cost and accessibility of gluten free foods. Over time, families experienced a shift towards feeling more capable and comfortable managing CD.
Conclusions: The emotional impact of a diagnosis of CD is significant for the entire family. Families experience issues with healthcare system navigation, and how/when information is provided. They also experience challenges with adapting to a gluten‐free diet and with children feeling they are different. Provision of support and information at the time of initial testing and at diagnosis is crucial to facilitate adjustment to this lifelong diagnosis.
Contact e‐mail address: christian.farrier@ucalgary.ca
G‐EV020. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV020.1. CLINICAL PRESENTATION AND DIAGNOSIS TIMING IN PEDIATRIC CELIAC DISEASE: A RETROSPECTIVE STUDY
Laura Otilia Boca1, Gabriela Ghiga 1,2, Gabriela Paduraru1,2, Nicoleta Gimiga1,2, Otilia Iftinchi1, Lorena Manole1, Madalina Donos1, Laura Mihaela Trandafir1,2
1Department Of Mother And Child, Faculty Of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, iasi, Romania, 2“Saint Mary” Emergency Hospital for Children, iasi, Romania
Objectives and Study: This study aimed to analyze clinical characteristics, symptom onset, and diagnostic delays in pediatric celiac disease (CD) and evaluate associations between comorbidities and symptom onset.
Methods: We conducted a retrospective analysis of 40 pediatric CD patients diagnosed at the "Saint Mary" Clinical Emergency Hospital (2020–2023). Data on symptoms, comorbidities, age at onset, and diagnosis were analyzed. Descriptive statistics described symptom frequency, the mean age of onset was compared with the mean age at diagnosis and t‐tests assessed differences in diagnostic timing between patients with and without comorbidities.
Results: The mean age of diagnosis was 5.28 years (range 1–16), with an average delay of 0.68 years (8 months) between symptom onset and diagnosis. For half of the patients, diagnosis occurred promptly after symptom onset. Of the 40 patients, the most common symptoms at diagnosis were hypotrophy (47.5%), abdominal pain (35%), pallor (22.5%), diarrhea and abdominal bloating (17,5%). Decreased appetite, refractory anemia, constipation, short stature, vomiting, alternating diarrhea‐constipation, and irritability were observed in fewer cases. Atypical symptoms included arthralgia,recurrent intussusception, and dental enamel defects (2.5%). Comorbidities were identified in 23 patients (57.5%), most commonly Type 1 Diabetes (27.5%) and autoimmune thyroiditis (12.5%), followed by IgA deficiency, cystic fibrosis, and lactose intolerance (5% each). No significant differences in symptoms onset and diagnostic delays were found between patients with and without comorbidities.
Conclusions: Pediatric CD presents with diverse and occasionally atypical symptoms, emphasizing the importance of clinical vigilance for timely diagnosis. In our study, despite an average diagnostic delay of 8 months, over half of the patients were diagnosed promptly after symptom onset. Comorbidities, present in over half of the patients, did not impact diagnostic timing, underlining the need for awareness of CD in all pediatric cases, including those with atypical symptoms, to minimize diagnostic delays and improve outcomes.
Contact e‐mail address: ceocanlaura@gmail.com
G‐EV021. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV021.1. CLINICAL AND DEMOGRAPHIC CHARACTERISTICS OF PEDIATRIC PATIENTS WITH TYPE 1 DIABETES MELLITUS AND CELIAC DISEASE: A RETROSPECTIVE ANALYSIS
Gabriela Ghiga 1,2, Laura Otilia Boca1, Delia Bizim2, Carmen Oltean2, Elena Lia Spoiala1,2, Otilia Iftinchi1, Madalina Donos1, Lorena Manole1, Laura Mihaela Trandafir1,2
1Department Of Mother And Child, Faculty Of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, iasi, Romania, 2“Saint Mary” Emergency Hospital for Children, iasi, Romania
Objectives and Study: This study evaluates the clinical and demographic characteristics of pediatric patients diagnosed with both Type 1 Diabetes Mellitus (T1DM) and Celiac Disease (CD). The aim was to explore the relationship between the age of diagnosis for both conditions and assess other clinical features associated with these comorbidities.
Methods: A retrospective analysis was performed on 10 pediatric patients diagnosed with both T1DM and CD at the "Saint Mary" Clinical Emergency Hospital during a 7‐year period (2017‐2023). The ages at diagnosis for T1DM and CD were compared using paired t‐tests. Regression analysis examined the relationship between the ages at diagnosis, while descriptive statistics were used for clinical features, including autoimmune comorbidities, nutritional concerns, and glycemic control.
Results: • Mean age at T1DM diagnosis: 5.49 ± 3.21 years; mean age at CD diagnosis: 9.08 ± 3.22 years (p = 0.00296).
• Regression analysis showed a moderate positive correlation between the ages at diagnosis (Multiple R = 0.61, p = 0.056), indicating a trend that later T1DM diagnosis is associated with later CD diagnosis.
• Clinical findings: 30% had a family history of T1DM; 40% had autoimmune comorbidities.
• Laboratory results: 90% had antibody levels exceeding 10 times the normal limit, and all had Marsh III histology (III A‐C).
• Glycemia: Mean 161.5 mg/dL; median 163.5 mg/dL; range 69–320 mg/dL.
• HbA1c: Mean 9.04%; median 8.63%; range 5.9–14%.
• No significant difference in HbA1c values was found before and after the gluten‐free diet (p = 0.839).
Conclusions: CD was diagnosed later than T1DM, with a moderate correlation between diagnosis ages.The p‐value of 0.056 suggests a trend toward statistical significance, warranting further investigation with a larger cohort, therefore we plan to monitor newly diagnosed patients with both diseases. Elevated antibody levels and advanced Marsh III histology highlight the importance of regular screening for CD in children with T1DM.
Contact e‐mail address: ceocanlaura@gmail.com
G‐EV022. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV022.1. PEDIATRIC CASE STUDY: PRIMARY LYMPHANGIECTASIA DIAGNOSIS AND COELIAC DISEASE IN A COMPLEX CLINICAL PRESENTATION
Mariam Ghughunishvili 1, Merab Buadze2, Giorgi Burkadze3, Tinatin Tkemaladze4, Michael J. Lentze1,5
1Pediatric Gastroenterology, Tbilisi State Medical University, G. Zhvania Pediatric University Clinic, Tbilisi, Georgia, 2Pediatric Surgery, Tbilisi State Medical University, G. Zhvania Pediatric University Clinic, Tbilisi, Georgia, 3Tbilisi State Medical University, Tbilisi, Georgia, 4Department Of Genetics, Tbilisi State Medical University, Tbilisi, Georgia, 5Department Of Pediatrics, Children's Hospital Medical Center, University Bonn, Bonn, Germany
Objectives and Study: Celiac disease (CD) is an immune‐mediated inflammatory disease of the small intestine caused by sensitivity to dietary gluten and related proteins in genetically predisposed individuals. The primary intestinal lymphangiectasia (PIL) is a rare exudative enteropathy of unknown etiology that affects the lymphatic system. It causes lymphedema and malabsorption syndrome by the escape of the lymph and its elements into the intestinal lumen. Limited reports exist regarding the co‐occurrence of these conditions.
Methods: This case details a 5‐years‐old girl diagnosed with CD at age of 2, who presented with recurrent episodes of diarrhea and abdominal distention. Laboratory investigations revealed protein and albumin deficiencies, elevated TTG IgA >128 U/ml and normal total IgA levels. Despite strict gluten‐free diet, persistent diarrhea and protein‐deficiency edema were observed, primarily manifesting periorbital, abdominal, and in the upper limbs, notably the left hand. Requiring frequent hospitalizations and protein infusions, the patient's condition posed diagnostic challenges we excluded food protein‐induced enterocolitis syndrome, renal and cardiac‐related protein loss and C1, C4 complement deficiency‐induced edema. Continued exploration for comorbidities involved fecal alpha‐1‐antitrypsin determination with elevated levels (485 ng/g; N < 268 ng/g). Subsequent esophagogastroduodenoscopy revealed mucosal fold thickening and increased granularity in stomach and duodenum. Duodenal mucosa was covered with enlarged whitish, but normal structured villi and numerous lymphangitic follicles. Histomorphology identified dilated lymphatic vessels compatible with PIL (Picture: A)
Results: Additionally to strict GFD, patient was put on an exclusive diet with MCT oil as the sole source of fats. General condition improved, with a relative reduction in swelling that no longer necessitated protein transfusions. Whole genome sequencing tests were conducted, with normal results.
Conclusions: This case highlights the diagnostic and management challenges of celiac disease associated with PIL in a pediatric patient. It emphasizes the significance of a multidisciplinary approach in prolonged edema, along with diarrhea and protein loss
Contact e‐mail address: marighughu@yahoo.com
G‐EV023. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV023.1. COELIAC DISEASE PROGRESSION IS PRECLINICALLY MODULATED BY COCOA INTAKE
Marina Girbal Gonzalez 1,2, Soraia Mendes3, Arturo Rodríguez‐Banqueri4, Ulrich Eckhard4, Francesc Xavier Gomis‐Rüth4, Maria José Rodríguez‐Lagunas1,2, Àngels Franch1,2, Francisco J. Pérez‐Cano1,2
1Section Of Physiology, Department Of Biochemistry And Physiology, Faculty of Pharmacy and Food Science, Universitat de Barcelona, Barcelona, Spain, 2Research Institute of Nutrition and Food Safety (INSA‐UB), Santa Coloma de Gramenet, Spain, 3Proteolysis Laboratory, Department Of Structural Biology, Molecular Biology Institute of Barcelona (CSIC), Barcelona, Spain, 4Proteolysis Laboratory, Department Of Structural Biology, Molecular Biology Institute of Barcelona (CSIC), Barcelona, Spain
Objectives and Study: Cocoa intake has been linked to many health benefits, mainly due to its high content in polyphenols and fibre. The goal of this project was to assess the effect of cocoa powder consumption in a mouse model of coeliac disease (CD).
Methods: Transgenic DQ8‐Dd‐villin‐IL‐15 mice, genetically predisposed to CD, were divided in three groups (n = 14/group, 7 females/males) and followed for 25 days, a gluten‐free diet (REF), a gluten‐containing diet (GLI) or the latter with a supplementation of 5 mg/g of body weight of defatted cocoa powder 3 times/week (COCOA). Specific antibody levels were assessed by ELISA. For histological evaluation of the distal small intestine haematoxylin‐eosin staining was used. Intracellular levels of IL‐2 and IFN‐ɣ were quantified in mesenteric lymph node lymphocyte subpopulations by flow cytometry and profiling of the caecal microbiota was achieved through 16S rRNA sequencing.
Results: The CD model induced changes between the REF and GLI groups in the majority of the variables evaluated. Cocoa administration was able to prevent some of the changes associated to gliadin consumption, including the increase of anti‐gliadin IgA and IgG antibodies in gut wash and IgG in plasma. The male animals in COCOA group also exhibited lower plasma anti‐transglutaminase IgA levels and less faecal humidity compared to the GLI group. Cocoa intake also prevented the increase in villi width, as well as the decrease in blood lymphocytes and in the proportion of IL‐2 and IFN‐ɣ in various cell subpopulations, associated to gliadin intake. Sequencing of the caecal microbiota yielded differential β‐diversity and the administration of cocoa caused an increase of Akkermansia muciniphila and Alistipes inops, mucin‐ and short fatty acid‐producing species, respectively, which have been associated to gut health.
Conclusions: Cocoa administration was capable of preventing the development of some biomarkers indicative of CD progression, suggesting a potential immunomodulatory effect of cocoa in CD.
Contact e‐mail address: marinagirbal@ub.edu
G‐EV024. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV024.1. DOES ANTIBODY REACTIVITY TO AVENIN IN CHILDHOOD CELIAC DISEASE PATIENTS PREDICT AN OAT‐BASED PERSONALIZED GLUTEN‐FREE DIET?
Matěj Hrunka 1, Michaela Šťastná2, Lubomír Janda2, Adam Norek2, Tereza Pinkasová1, Kateřina Bajerová1, Eliška Hloušková1, Marek Jeřábek1, Martina Ambrozová1, Petr Jabandžiev1,3
1Department Of Pediatrics, University Hospital Brno, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic, 2Veterinary Research Institute, Brno, Czech Republic, 3Recetox, Faculty of Science, Masaryk University Brno, Brno, Czech Republic
Objectives and Study: A lifelong gluten‐free diet is the only therapeutic regimen for celiac disease (CD). Strict avoidance of wheat, rye, and barley is recommended. Current evidence suggests that most CD patients do not induce an autoimmune reaction to oats. Reactivity to avenin, an oat prolamin, however, may in some patients trigger an immune response similar to that of gliadin, a wheat prolamin. In this prospective study, we evaluate oat reactivity in pediatric CD patients. Based on the results, we aim to identify nonreactive individuals who may safely consume oats immediately after their initial diagnosis. This straightforward comparative analysis seeks to address the ongoing controversy regarding whether oats can be safely incorporated into the diet of CD patients, particularly given the persistent debate over their safety.
Methods: Quantification of IgA, IgG, and IgE antibodies (and their respective subclasses) binding to both native and recombinant avenins and gliadins was performed using multiplexed fluorescent ELISA (FLISA) and mass spectrometry (LC‐MS/MS) in parallel. Statistical analysis of 100 serum samples from CD patients obtained at a time of initial diagnosis and 50 samples from healthy controls.
Results: A subset of CD patients revealed significant reactivity to avenin, potentially limiting their ability to tolerate oats. FLISA and MS helped in identifying patients with low or no reactivity who may safely include oats into their diets. Antibody reactivity was analyzed together with comprehensive clinical data (human leukocyte antigen [HLA] typing, Marsh classification, symptoms, etc.) with the aim of patient risk stratification and predictor modelling. Detailed results and comprehensive clinical data will be presented at the conference.
Conclusions: This study aims to enhance our understanding of immunological tolerance to oat products in CD patients and provide a foundation for personalized dietary recommendations.
Contact e‐mail address: hrunka.matej@fnbrno.cz
G‐EV025. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV025.1. HEPATITIS B IMMUNE‐SEROCONVERSION STATUS OF CELIAC PATIENTS LIVING IN EASTERN ANATOLIA REGION
Belkıs Ipekçi
Pediatric Gastroenterology, Health Ministory Van State hospital, Van, Turkey
Objectives and Study: Türkiye is among the countries with a medium prevalence of HepatitisBvirus(HBV) carriers. The carrier prevalence of HBV in the Eastern and SoutheasternAnatolia regions is7%, which is quite high compared to others. HBVvaccine non‐response is distincly higher(50–70%) in celiac disease compared to nonceliacs, so we investigate the HBVimmunoconversion of celiac patients in EasternAnatolia in 2024.
Methods: The data of patients with celiac disease who applied to our pediatric gastroenterology outpatient clinic between October 2023‐October 2024 were retrospectively reviewed. Patients with known immune deficiency, congenital anomalies,diagnosed celiac disease without esophagogastroduodenoscopy were excluded. Celiac patients aged between 0‐18,whose Hbs Ag ant anti‐HbsAg levels could be obtained, were included. Patients who underwent esophagogastroduodenoscopy for non‐celiac reasons during the same period and whose HBSAg and anti‐HBSAg levels could be obtained were included as a control group. The immunresponse to the HBV vaccine is determined by assessing the concentration of neutralising antibody(anti‐HBsAg), and the optimum level required is ≥10 IU/L for responders and < 10 IU/ml for nonresponders. Statistical evaluation was performed using IBM SPSS 20.0 package program.
Results: Seventysix celiac(49 girls, 40 boys),and 76 nonceliac patients(40 girls,36 boys)were included. Age and gender distribution was similar between the groups. While anti‐HbsAglevels were >10 IU/l in 33 of the celiac and in 70 of the nonceliac patients(p = 0.001). Diet compliance was also found to be significantly higher in responder group. Anti‐HbsAg levels were found to be significantly increased in with low final anti‐tissuetransglutaminase IgA levels(p < 0.005). No significant relationship was found between the patients' age at diagnosis, white blood cell, neutrophil and lymphocyte counts, and anti‐HbsAg levels.
Conclusions: HBV is still a major public health problem and the most important way to prevent it is vaccination. While encouraging patients to comply with the diet, it can also be emphasized that it protects against HBV while nonresponders are mostly noncompliance to gluten‐free diet.
Contact e‐mail address: belkisipekci@hotmail.com
G‐EV026. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV026.1. PEDIATRIC CELIAC DISEASE IN MOROCCO: A TRIAD OF CLINICAL, IMMUNOLOGICAL, AND HISTOPATHOLOGICAL FEATURES
Mariam Lagrine 1,2, Rabiy Elquadiry2, Houda Nassih2, Aicha Bourrahouat2, Imane Aitsab2
1Gastrology And Hepatology Pediatric, University Hospital center of Marrakech, Marrakesh, Morocco, 2Child Health and developement Research Unit, CAdi Ayyad University Hospital, Marrakesh, Marrakesh, Morocco
Objectives and Study: ‐ Objectives : To investigate the correlation between clinical, immunological, and histopathological features in Moroccan children with celiac disease managed at the pediatric gastroenterology department at CHU Mohammed VI in Marrakech ‐ Study : A descriptive retrospective
Methods: A descriptive retrospective study was conducted over three years, from 2021 to 2023, involving 300 patients diagnosed with celiac disease at the pediatric service B of CHU Mohammed VI Study Design: Retrospective descriptive study. Study Population: 300 patients diagnosed with celiac disease at the pediatric service B of CHU Mohammed VI Data Collected: clinical sings, immunological profile, and histopathological features Data Analysis: Information was analyzed using Microsoft Excel
Results: The average age of the patients was 6.5 years, ranging from 1 to 15 years. There was a slight female predominance, with a sex ratio of 0.78. The most common gastrointestinal symptoms were diarrhea (41%) and abdominal pain (33%). Extra‐intestinal manifestations included growth retardation (62%) and pallor (40%). All patients underwent testing for IgA anti‐tissue transglutaminase antibodies. Histological evaluation using the modified MARSH classification revealed that 45% of patients had MARSH stage 0, while only 4.5% had MARSH stage 2. However, no significant correlation was observed between serological markers and biological signs of malabsorption.
Conclusions: The correlation between clinical, immunological, and histopathological features in children with celiac disease is complex, indicating the need for a deeper understanding of the disease and its manifestations. These findings highlight the importance of larger‐scale studies to further elucidate these relationships.
Contact e‐mail address: lagrine.mariam@gmail.com
G‐EV027. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV027.1. EVOLUTION OF BODY MASS INDEX IN CELIAC DISEASE CHILDREN ON GLUTEN FREE DIET ‐ COMPARISON BETWEEN TWO DECADES
Alexandra Palaga1, Dhea Macovei 1, Cristina Findrihan1, Diana Czika1, Alina Popp1,2
1"Alessandrescu‐Rusescu" National Institute for Mother and Child Health, Bucharest, Romania, 2"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
Objectives and Study: Celiac disease (CD) is a cause of malnutrition, gluten free diet (GFD) being the only treatment and having a beneficial impact on anthropometric indicators. We sought to see whether there is a difference in the body‐mass‐index (BMI) z‐score at diagnosis and on dietary treatment in children diagnosed with CD during two different decades.
Methods: This retrospective study comprised 42 CD children diagnosed between 2004‐2013 (group 1) and 78 children between 2014‐2023 (group 2). Anthropometric and serological data were collected from medical charts at diagnosis, after 2 years of GFD, and at last follow‐up. SPSS Statistics was used for data analysis.
Results: There was no significant difference between group 1 (73.8% biopsy‐proven diagnosis) and group 2 (35.8% biopsy‐proven diagnosis) regarding age and BMI z‐score at diagnosis. Mean GFD duration at last follow‐up fo in group 1 was 9.8 years and in group 2, 4.8 years. BMI z‐score at diagnosis (median ‐1.62) of children from group 1 was significantly improved after 2 years of GFD (median ‐0.51), (p = 0.038) and the last follow‐up (median ‐0.4), (p = 0.007), whereas group 2 had a significant improvement only at the last follow‐up (median ‐0.9), (p = 0.000). When comparing the BMI z‐score at diagnosis, after 2 years of GFD or long‐term treatment between the two groups, in neither girls nor in boys significant differences were seen. There was no significant correlation between BMI z‐score and anti‐transglutaminase antibodies at 2 years of GFD or at last follow‐up in group 1 and group 2, regardless of gender (Table 1).
Conclusions: Faster BMI z‐score improvement was seen in children diagnosed in the first studied decade. There was no difference in the evolution of anthropometric parameters between girls and boys overall when comparing the 2 groups. Children with CD diagnosed between 2004‐2013 and 2014‐2023 have no significant difference regarding BMI z‐score improvement on long term GFD.
Contact e‐mail address: alexandra.gita@rez.umfcd.ro
G‐EV028. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV028.1. NATURAL‐KILLER‐RECEPTORS PROFILE OF TCR‐ALFA‐BETA + CD8 + AND TCR‐GAMMA‐DELTA + INTRAEPITHELIAL LYMPHOCYTES IN DIFFERENT STAGES OF CELIAC DISEASE: A PROSPECTIVE STUDY
Antonella Marano 1, Sara Bruzzaniti2, Erica Piemonte3, Anna Mirra1, Maria Boccia1, Renata Auricchio1,4, Riccardo Troncone1,4, Mariantonia Maglio4, Mario Galgani3, Valentina Discepolo1,4
1Department Of Traslational Medical Science, University of Naples Federico II, Naples, Italy, 2Institute of Experimental Endocrinology and Oncology (IEOS), National Council of Research (CNR), Naples, Italy, Naples, Italy, 3Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples Federico II, Naples, Italy, Naples, Italy, 4European Laboratory for the Investigation of Food Induced Diseases (ELFID), University Federico II of Naples, Naples, Italy, Naples, Italy
Objectives and Study: Celiac disease (CD) is typically characterized by a small intestinal enteropathy and an increase of both TcRαβ+ and TcRγδ+ intraepithelial lymphocytes (IELs). Previous evidence suggest that a loss of NKG2A expression on TcRaβ + CD8+ IELs and of NKp46 in TcRγδ + Vd1+ IELs are typical of overt‐CD. In this study we characterized the natural‐killer‐receptors (NKRs) phenotype of both TcRaβ + CD8+ and TcRγδ + Vd1+ IELs in a wide cohort of CD patients at different disease stages.
Methods: IELs were isolated from duodenal biopsies of 22 controls (CTR),16 potential‐CD(PCD) and 15 active‐CD(ACD) patients. NKG2A and NKp46 expression in CD45 + CD3 + CD8b+ and CD45 + CD3+TcRγδ + VD1+ IELs was evaluated by flow cytometry.
Results: TcRaβ + CD8+ showed a dichotomic pattern of NKG2A expression in all groups of patients including CTR, suggesting that common inflammatory mediators may play a role in its downregulation in inflamed mucosa. Particularly, NKG2A loss was found in ACD with a higher degree of tissue damage as assessed by villous height to crypt depth ratio (Spearman r = 0.81; p < 0.001). On another hand, NKp46 expression on TcRγδ + Vd1+ IELs is gradually lost over the course of CD progression: decreased NKp46+TcRγδ + Vd1+ IELs percentage was observed in PCD and ACD compared to CTR (p < 0.05 and p < 0.0001,respectively) and in ACD compared to PCD (p < 0.001). Moreover, we evaluated the percentage of double positive/negative NKG2A and Nkp46 IELs finding a loss of NKG2A + NKp46+ and an increase of NKG2A‐NKp46‐ TcRaβ + CD8+ and TcRγδ + IELs in PCD and ACD compared to CTR (p < 0.05).
Conclusions: The progression of tissue damage in CD (from PCD to ACD) features specific NKRs phenotype changes of the two subpopulations of IELs (TcRaβ + CD8+ and TcRγδ + IELs), although the loss of NKG2A does not seem to be exclusive of CD, suggesting that both distinct and shared mechanisms of regulation of expression the two studied NKRs may play a role in the inflammatory process leading to tissue damage in CD.
Contact e‐mail address: antonellamarano.na@gmail.com
G‐EV029. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV029.1. QUALITY OF LIFE IN CHILDREN WITH CELIAC DISEASE: IMPLEMENTATION OF THE CELIAC DISEASE DUTCH QUESTIONNAIRE IN A COHORT OF ROMANIAN CHILDREN AND PARENTS
Georgiana Miu 1, Corina Pienar2, Mirela Mogoi2, Daniela Popescu3, Pop Laurentiu2, Laura Savu4, Anelise Szasz‐Capotescu5
12nd Pediatrics Clinic, “Pius Brinzeu” Emergency County Hospital, Timisoara, Romania, 2Pediatrics, 2nd Pediatrics Clinic, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Timisoara, Romania, 3Pediatrics, 3Department of Obstetrics‐Gynecology and Neonatology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania, Timisoara, Romania, 4Pediatrics, 2nd Pediatrics Clinic, “Pius Brinzeu” Emergency County Hospital, Timisoara, Romania, Timisoara, Romania, 5Pediatrics, 2nd Pediatrics Clinic, 'Pius Brinzeu' Emergency County Hospital, Timisoara, Timisoara, Romania
Objectives and Study: We aimed to assess how gluten‐free diet (GFD) impacts the quality of life (QoL) of children and adolescents with celiac disease (CD).
Methods: We used the Celiac Disease Dutch Questionnaire (CDDUX) in our CD cohort. Our analysis included demographic data, length and adherence to GFD, as well as type of diagnosis (serologic/endoscopic). The questionnaire addresses children and parents, and includes 3 categories: diet, communication, life with CD. The questions are assessed on an analogue‐visual scale. QoL was defined as follows: very bad (1‐20), bad (21‐40), neutral (41‐60), good (61‐80) or very good (81‐100).
Results: From the 43 CD children followed‐up in our clinic, 25 agreed to answer the questionnaire (aged between 3‐19 years, mean age 8.32 ± 4.15 years, 60% girls). 76% (19/25) of children live in an urban area. 21 children (84%) had a serological diagnosis. 56% (14/25) of the children have been on a GFD for less than one year. Our analysis showed a high adherence to GFD (96%, 24/25). We found a poor QoL in our study group, for both children and parents, overall and across categories (Table 1). Furthermore, our results show similarly poor QoL scores, according to gender, residence, type of diagnosis and length of GFD.
Table 1 CDDUX scores in the study group. CD denotes celiac disease; SD, standard deviation; p, the statistical significance of the paired t test.
Conclusions: The QoL of our CD children and their parents is poor. Our data show that the GFD itself is similarly difficult for both children and parents. On the other hand, communication about CD and having CD seem to be more of a burden for the parents. While we regularly assess adherence to GFD, growth, symptoms and possible complications, we never address QoL. Thus, we aim to implement the CDDUX in the follow‐up of our CD patients.
Contact e‐mail address: georgianna.vernicu@gmail.com
G‐EV030. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV030.1. SINGLE CELL TRANSCRIPTOMIC FOR DECIPHERING THE PATHOGENESIS OF CELIAC DISEASE
Giuseppe Molinario 1, Fabiana Ziberna2, Nicolò Gualandi3, Michelangelo Aloisio4, Elena Spinelli1, Giorgia Fontana2, Sara Lega2, Matteo Bramuzzo2, Grazia Di Leo2, Luigina De Leo2
1University of Trieste, Trieste, Italy, 2Pediatrics, Institute For Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy, 3University of Udine, Udine, Italy, 4IRCCS De Bellis, Castellana Grotte, Italy
Objectives and Study: Single‐cell RNA sequencing (scRNA‐seq) is a powerful tool to elucidate the complexity of gut at cellular resolution. It could provide novel insights into the pathogenesis of celiac disease (CD) and the recognition of new therapeutic targets and biomarkers.
Methods: In this prospective study intestinal samples will be collected from 10 pediatric patients (5 CD and 5 controls). Until now 8/10 were enrolled: 5 patients with CD (4F‐1M) and 3 controls (2F‐1M) with functional disorders. The gut samples were enzymatically and mechanically dissociated to obtain the single‐cell suspension and generated the scRNA libraries by using the GEXSCOPE kit (Singleron Biotechnologies). The libraries were then sequenced with the Illumina platform and raw data were analyzed with CeleScope and Seurat R‐package.
Results: In total 90,000 cells were sequenced and after quality control analysis (nFeature_RNA ≥ 250; nCount_RNA ≥ 250; Percent_mt ≤ 25) 60.000 cells with top‐notch quality data remained. Cluster analysis led to the identification of 16 clusters and cell types were manually annotated by using known make genes. Differential analysis showed an enrichment of immune cells (CD4 + and IgA plasma cells) and a reduction in epithelial cells (enterocytes and proliferative and transit‐amplifying) in the CD vs controls. Moreover, the annotated cellular populations showed a high number of genes differentially expressed in CD versus controls. However, the pathways in which these genes are involve have to be identified.
Conclusions: This study wants to add new pleces in the puzzle of CD pathogenesis. Preliminary bioinformatics analysis of these scRNA‐seq data confirm the loss of absorptive cells and activation of immune system. The patient's enrollment will be completed and further analysis will be performed to identify new up‐ or down‐ regulated pathways involved in CD and to understand the cell‐cell communication.
Contact e‐mail address: luigina.deleo@burlo.trieste.it
G‐EV031. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV031.1. SYMPTOMS EXPERIENCED BY CELIAC DISEASE PATIENTS ON A GLUTEN‐FREE DIET AFTER GLUTEN CONTAMINATION
Dorina Pjetraj, Denise Damiani, Chiara Monachesi, Simona Gatti, Carlo Catassi, Maria Elena Lionetti
Department Of Pediatrics, Marche Polytechnic University, Ancona, Italy
Objectives and Study: The prevalence of symptoms experienced by individuals with celiac disease (CD) following a gluten‐free diet (GFD) who unintentionally consume gluten‐contaminated meals has not been well‐documented. This study seeks to assess the occurrence of such symptoms through an online survey.
Methods: Medical data on 296 pediatric CD patients were collected at follow‐up from an online survey and medical records. Prevalence of symptoms associated with gluten ingestion was evaluated.
Results: Of the 296 pediatric celiac disease patients surveyed, 98 (33.1%) reported experiencing symptoms such as abdominal pain (56/98, 57.1%), diarrhea (42/98, 42.9%), and vomiting (31/98, 31.6%), headache (12/98, 12.2%), fatigue (14/98, 14.2%), nausea (7/98, 7%), constipation (7/98, 7.1%), urticaria (7/98, 7.1%), aphtous stomatitis (5/98, 5.1%) and arthropathy (5/98, 5.1%) after unintentionally consuming gluten‐contaminated meals while on GFD. Furthermore, 85.9% of the patients who experienced adverse effects reported that the symptoms manifested within less than 2‐3 hours. The contamination most commonly occurred when dining outside the home, particularly in restaurants and school cafeterias.
Conclusions: Real‐life exposures to gluten among individuals with celiac disease following a gluten‐free diet frequently result in the characteristic triad of abdominal pain, vomiting, and diarrhea. The prevalence of these symptoms is consistent with the range reported in the existing literature, where vomiting and nausea have been observed in 3‐46% of patients at the time of celiac disease diagnosis and in 13‐61% during gluten challenge tests
Contact e‐mail address:
G‐EV032. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV032.1. IMPACT OF GLUTEN‐FREE DIET ON THE LIPID PROFILE OF PEDIATRIC CELIAC DISEASE PATIENTS
Elpida Emmanouilidou‐Fotoulaki1, Maria Kavga2, Vera Karatisidou3, Fotini Sotiriadou 3, Olga Nikolaidou3, Maria Fotoulaki3, Kyriaki Papadopoulou‐Legbelou3
11st Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, 23rd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, 34th Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Objectives and Study: The increased cardiovascular risk in celiac disease patients is related to chronic inflammation, autoimmunity and lipid profile disorders, which lead to an acceleration of the atherosclerosis process. To date, the effects of gluten‐free diet on cardiovascular risk remain scarce and controversial. The aim of this study was to evaluate the impact of gluten‐free diet compliance on lipid profile of children/adolescents with celiac disease.
Methods: Lipid profile was assessed in 42 children/adolescents with celiac disease before (group A) and after having negative tTg‐IgA antibodies (group B), reflecting the adherence to the gluten‐free diet. Children with underlying diseases (diabetes mellitus, hypothyroidism) or children taking drugs that affect serum lipid levels were excluded.
Results: Mean follow‐up time was 4.02 ± 3.62 years. Mean age was 7.41 ± 3.93 years in group A and 11.27 ± 4.31 years in group B. Mean body mass index (BMI) and glucose levels were similar in both groups. Regarding lipid parameters, total cholesterol (TC), LDL‐cholesterol and triglyceride values did not differ between the two groups, while HDL‐cholesterol levels were significantly increased after negative tTg‐IgA antibodies were observed (p = 0.01). Moreover, TC/HDL ratio was decreased in group B patients (p < 0.01) (Table).
| Group A Mean (±SD) | Group B Mean (±SD) | p | |
| Age (years) | 7.41 (3.93) | 11.27 (4.31) | ‐ |
| ΒΜΙ (kg/m2) | 17.20 (3.49) | 18.90 (3.29) | 0.39 |
| Glucose (mg/dl) | 82.79 (13.15) | 82.15 (9) | 0.75 |
| Total cholesterol (TC) (mg/dl) | 151.39 (33.16) | 149.19 (26.59) | 0.61 |
| LDL‐C (mg/dl) | 93.69 (28.81) | 93.80 (26.03) | 0.98 |
| HDL‐C (mg/dl) | 45.67 (12.73) | 50.95 (9.55) | 0.01 |
| Median (IQR) | Median (IQR) | ||
| Triglycerides (mg/dl) | 68 (45.25) | 54.5 (25.25) | 0.15 |
| TC/HDL | 3.10 (1.59) | 2.90 (0.34) | <0.01 |
Conclusions: Lipid profile seems to be improved after adherence to gluten‐free diet (reflected by negative tTg‐IgA antibodies), by increasing HDL‐C levels and decreasing the TC/HDL ratio, which lead to the reduction in cardiovascular risk and delay in the atherosclerosis process.
Contact e‐mail address: eemma@auth.gr
G‐EV033. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV033.1. IGA ANTIBODIES AGAINST TRANSGLUTAMINASE AS A MARKER OF ADHERENCE TO GLUTEN‐FREE DIET IN CHILDREN WITH CELIAC DISEASE
Inês Mazeda1, Manuel Ferreira2, Joana Queirós3, Francisco Mourão3, Andreia Ribeiro4, Helena Silva3, Ermelinda Silva3, Marta Tavares 3, Rosa Lima3
1Pediatrics, ULS Póvoa de Varzim/Vila do Conde, Braga, Portugal, 2ULS Tâmega e Sousa, Penafiel, Portugal, 3Centro Materno Infantil do Norte, Porto, Portugal, 4ULS Gaia/Espinho, Gaia, Portugal
Objectives and Study: The role of celiac disease (CD)‐related serology in monitoring patients on a gluten‐free diet (GFD) remains controversial. While CD serological markers are reliable for diagnosis, their accuracy in monitoring diet adherence is less clear. This study evaluated the trajectory of immunoglobulin A anti‐tissue transglutaminase (IgA‐tTG) antibodies after diagnosis and assessed their effectiveness for long‐term GFD adherence.
Methods: A transversal study was conducted on pediatric patients diagnosed with CD between 2017 and 2023 at a Pediatric Gastroenterology Unit. The evaluation included IgA‐tTG serology results at diagnosis, 12 and 24 months following GFD initiation. Patients with over 24 months collected a sample at the time of the study. Current GFD compliance was assessed using a validated questionnaire for patients on the diet for over 24 months.
Results: A total of 90 children diagnosed with CD were included. Median age at diagnosis of 10 years (IQR = 8.3). The median IgA‐tTG concentration was 128 U/mL (IQR = 455.3) at diagnosis, 7.6 U/mL (IQR = 11.7) at 12 months and 4.6 U/mL (IQR = 8.5) at 24 months after starting GFD. IgA‐TG was positive (> 7 U/mL) in 51.1% of cases at 12 months and 25% at 24 months after GFD. Median IgA‐tTG concentration decreased significantly within 12 and 24 months after starting GFD (P < .0001). 77 patients (85.5%) patients completed the questionnaire. 68.8% reported good/excellent compliance with a GFD (negative predictive value 95.5%). The sensitivity and specificity of serology as a marker of adherence to the GFD was 58.3% and 77.3%, respectively, with a positive predictive value of 41% but a negative predictive value of 87.2%.
Conclusions: GFD is crucial for treating CD. Even with proper follow‐up, 25% of patients still had positive IgA‐tTG after 2 years. This study suggests IgA‐tTG tests help monitor diet adherence, but should not be the only tool. Standardized dietary questionnaires should complement them for assessing compliance.
Contact e‐mail address: ines.mazeda@gmail.com
G‐EV034. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV034.1. THE FREQUENCY OF COELIAC DISEASE IN SIBLINGS OF COELIAC PATIENTS
Ahmet Uzger 1, Ahmet Rauf Goktepe2, Yasin Sahin1
1Division Of Pediatric Gastroenterology, Gaziantep City Hospital, Gaziantep, Turkey, 2Pediatrics, Gaziantep City Hospital, Gaziantep, Turkey
Objectives and Study: The prevalence of coeliac disease (CD) is estimated to be approximately 1% in the world. The prevalence of CD was found to be 2.6‐11.9% in the first‐degree relatives of coeliac patients. In this study, we aimed to investigate the frequency of CD in siblings of coeliac patients.
Methods: This study was conducted between June and December 2024. The current study included 100 siblings of 42 coeliac patients. Firstly, tTG IgA and total IgA tests were performed. A second blood sample was taken from patients who met the ESPGHAN 2020 criteria for EMA test, and then patients with EMA positivity were diagnosed with CD without a biopsy. Esophago‐gastroduodenoscopy was performed on patients with positive tTG IgA who do not met the ESPGHAN 2020 criteria. At least four duodenal biopsies and two biopsies from bulbus were obtained from patients with positive tTG IgA.
Results: The mean age of 42 coeliac patients and their 100 siblings was 8.52 ± 3.12 years and 8.57 ± 4.40 years, respectively. 99 (99.0%) of them had no complaints. The median level of tTG IgA was 0.66 IU/L (IQR 1.28) and the mean total IgA level was 110.83 ± 56.19 mg/dl. Fifteen of them (15.0%) had positive tTG IgA antibody. 9 of them was diagnosed with coeliac disease with no‐biopsy approach according to the ESPGHAN guidelines in 2020. Esophago‐gastroduodenoscopy was performed in two of them. One of them was diagnosed with CD through biopsy. Four of them are waiting for endoscopy appointment.
Conclusions: 15 of 100 (15.0%) siblings of coeliac patients had tTG positivity. 10 of them (10.0%) was diagnosed with CD. The prevalence of CD in the siblings of coeliac patients was detected approximately 20 times higher than in the general population (0.47%). We recommend that serological screening tests for CD should be performed even if the siblings of coeliac patients are asymptomatic.
Contact e‐mail address: uzgerahmet@gmail.com
G‐EV035. Topic: AS01. GASTROENTEROLOGY/AS01a. Coeliac Disease
G‐EV035.1. RELATIONSHIP BETWEEN CELIAC DISEASE AND CHRONIC GASTRITIS: A RETROSPECTIVE ANALYSIS
Mehmet Akif Yıldıran, Semih Sandal, Sila Camur, Edanur Acarel
Pediatric Gastroenterology, ANKARA TRAINING AND RESEARCH HOSPITAL, Ankara, Turkey
Objectives and Study: Celiac Disease (CD) is a chronic autoimmune disorder triggered by gluten in genetically predisposed individuals. While primarily affecting the small intestine, recent studies have suggested that CD may also involve the stomach, leading to chronic gastritis. This study aims to evaluate the prevalence of chronic gastritis in pediatric CD patients, focusing on its potential immunopathological mechanisms and clinical significance.
Methods: This retrospective study included 186 pediatric patients (<18 years) who underwent both gastric and duodenal biopsies between January 2022 and January 2023. CD was diagnosed based on serological markers, including tissue transglutaminase antibodies and histopathological findings consistent with Marsh criteria. Chronic gastritis was confirmed by histopathological examination of gastric biopsies.
Results: Among the 186 patients included in the study, 47 (13.9%) were diagnosed with CD (29 girls and 18 boys, ages 4‐17 with a mean age of 11 ± 3.6 years) based on duodenal biopsy findings. All CD patients had histopathological changes consistent with Marsh 3 classification. Chronic gastritis was observed in 72.9 % of CD patients, suggesting a strong association between CD and gastric involvement. Interestingly, chronic gastritis was identified in CD patients independent of the presence or severity of villous atrophy. In the subgroup of CD patients with positive serology but without histopathological findings consistent with Marsh criteria, 10 cases (5.3%) exhibited chronic gastritis. Four cases showed normalization of serological markers during follow‐up, raising the possibility of false‐positive serology due to chronic gastric inflammation.
Conclusions: Chronic gastritis is a common finding in pediatric CD patients, with potential implications for diagnosis, symptom management, and long‐term outcomes.Celiac disease should also be kept in mind in complaints related to gastritis. Further research is needed to elucidate the mechanisms linking CD and chronic gastritis, including the role of dietary factors and immune pathways.
Contact e‐mail address: sandal.semih@gmail.com
G‐EV036. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV036.1. PANCREATITIS AS A COMPLICATION IN PEDIATRIC PATIENTS WITH ORGANIC ACIDEMIA: A CASE SERIES
Yasemin Sofu Oner1, Abdul Samet Ala 1, Talip Sayar1, Deniz Kor2, Halise Mungan3, Ali Islek1, Gokhan Tumgor1
1Pediatric Gastroenterology, ÇUKUROVA UNIVERSITY, ADANA, Turkey, 2Department Of Pediatric Metabolism And Nutrition, Cukurova University Faculty of Medicine, Adana, Turkey, 3Cukurova University Faculty of Medicine, Adana, Turkey
Objectives and Study: Organic acidemias (OAs) are rare inherited metabolic disorders that can lead to life‐threatening complications, including recurrent acute pancreatitis.
Methods: Out of 100 cases of organic acidemia followed in our clinic over ten years, six patients developed pancreatitis. This case series presents the clinical features, treatment strategies, and outcomes of these six patients, all diagnosed with either methylmalonic acidemia (MMA) or propionic acidemia (PA), highlighting the clinical challenges and management strategies required to address pancreatitis in OAs
Results: Pancreatitis is a rare but clinically significant complication in patients with OAs, such as MMA and PA. These metabolic disorders primarily present with metabolic acidosis, hyperammonemia, and neurodevelopmental challenges, but the occurrence of pancreatitis can complicate management and worsen outcomes. Our experience, based on six cases of pancreatitis among 100 OA patients, underscores the rarity of this complication, but it highlights its potential severity and association with increased morbidity. Pancreatitis in the context of metabolic disorders is clinically significant because it is often associated with poorer prognosis and worse overall outcomes. The presence of pancreatitis can exacerbate the challenges in managing OAs, emphasizing the need for heightened clinical awareness.
Conclusions: Early diagnosis and proactive management are essential in mitigating this risk. Clinicians should consider routine pancreatic enzyme monitoring in OA patients, particularly those experiencing frequent metabolic crises, as timely intervention may prevent the progression to chronic pancreatitis or other irreversible complications. Future research is needed to clarify the mechanisms by which organic acidemias predispose patients to pancreatitis and to develop tailored strategies to improve outcomes in these vulnerable patients.
Contact e‐mail address:
G‐EV037. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV037.1. RECURRENT AND CHRONIC ACUTE PANCREATITIS: RELATIONSHIP BETWEEN THE NUMBER OF EPISODES AND LONG‐TERM OUTCOMES IN A TERTIARY HOSPITAL
Jaime Alfaro‐Bolaños, Yunuen Rivera‐Suazo, Ana Quesada‐Tortoriello, Miguel Gallardo‐Luna
Paediatric Gastroenterology, National Medical Centre 20 de Noviembre ISSSTE, Mexico City, Mexico
Objectives and Study: Recurrent and chronic acute pancreatitis in children represents a significant clinical challenge due to its potential for long‐term complications. Understanding the progression and impact of multiple episodes is crucial for guiding effective management strategies. To determine the relationship between the number of episodes of recurrent and chronic acute pancreatitis in paediatric patients from 2014 to June 2024 and long‐term outcomes through a retrospective observational study.
Methods: We retrospectively analysed the records of 20 paediatric patients with recurrent and chronic acute pancreatitis. We evaluated the frequency of episodes, complications, treatments, and long‐term outcomes using descriptive statistics and logistic regression analysis to calculate odds ratios.
Results:
50% of the patients had more than 3 episodes. Patients with more than 3 episodes presented with pancreatic duct stenosis (60%) and chronic pancreatitis (40%). The risk of developing chronic pancreatitis was significantly higher in patients with high recurrence (OR: 4.5, 95% CI, p = 0.303), meaning that patients with more than 3 episodes of pancreatitis are 4.5 times more likely to develop complications compared to those with fewer episodes. Male patients accounted for 60% of the cases and 70% of severe complications. Female patients accounted for 40% of the cases and 30% of severe complications.
Conclusions: High recurrence of pancreatitis episodes (more than three) in children is significantly associated with complications and the development of chronic pancreatitis. However, the p‐value of 0.303 indicates that this is not statistically significant, which may be due to the small sample size but should be considered for future studies. Additionally, we believe it is crucial to implement early and aggressive management in these patients to improve long‐term outcomes and reduce complications.
Contact e‐mail address: je.gastropedia@gmail.com
G‐EV038. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV038.1. CYSTIC FIBROSIS AND GASTROINTESTINAL MANIFESTATIONS IN CHILDREN: 10 YEAR‐EXPERIENCE AT A UNIVERSITY HOSPITAL IN MEDELLÍN (COLOMBIA)
Monica Maria Contreras Ramirez 1, Isabel Zuluaga Aristizabal2, Angelica Rivera Cermeño3, Diana Galeano Tamayo4, Jorge Donado Gomez5
1Gastroenterology, Hospital Pablo Tobon Uribe, Medellin, Colombia, 2CES University, Medellin, Colombia, 3Pontificia Bolivariana University, Medellin, Colombia, 4Antioquia University, Medellin, Colombia, 5Hospital Pablo Tobon Uribe, Medellin, Colombia
Objectives and Study: Cystic fibrosis (CF) is a progressive, genetic, multisystemic disease and can affect any aspect of the gastrointestinal (GI) tract, including the esophagus, stomach, small intestine, colon, pancreas, liver, and gall bladder. The aim is to describe the sociodemographic, clinical, and laboratory characteristics at the gastrointestinal level of paediatric patients with CF treated at a University Hospital in Medellín, Colombia.
Methods: A retrospective cohort study of 63 patients with CF was conducted. The study included patients under 18 years of age with active follow‐up at a multidisciplinary CF program in Medellin, Colombia from January 2012 to December 2022. Nutritional status was classified according to World Health Organization (WHO) child growth standards. Categorical variables were presented as number (percentages) and continuous variables were presented as median (IQR).
Results: 63 patients were included, 58.7% male, median age 10 months (IQR: 4‐48) and 63.6% were homozygous for F508Del mutation. 98.4% of the patients presented pancreatic insufficiency, 20.9% rectal prolapse, 11.1% constipation, 7.9% Distal Intestinal Obstruction Syndrome (DIOS), 7.9% meconium ileus, 3.2% intussusception, and 3.2% Pseudo‐Bartter syndrome. Among the hepato‐biliary manifestations, fatty liver was the most frequent 38.1%, followed by Cystic Fibrosis Liver Disease (CFLD) 20.6%, cholelithiasis 3.2%, cholestasis 1.1%, and portal hypertension with varices in 1.6% of patients. Most common Vitamin Deficit encountered was Vitamin D in 31.7% of patients, followed by Vitamin A 14.3% and vitamin E 11.1%. There was a high malnutrition and risk of malnutrition status (according to WHO child growth standards) at admission to the program, that diminished during follow‐up. Median follow‐up of patients was 1504 days (IQR 734‐3052).
Conclusions: This study highlights the frequency of digestive, hepatic, and nutritional manifestations in a Colombian paediatric CF population. Recognition of these manifestations are important and availability of multidisciplinary teams for CF in Latin America should be a priority to appropriately care for these patients.
Contact e‐mail address: mcontreras@hptu.org.co
G‐EV039. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV039.1. A NOVEL CFTR MUTATION FOR SEVERE PANCREATITIS IN TWO SIBLINGS
Ilksen Demir 1, Halil Sagir1, Celal Özkaya1, Gozde Celiksoz1, Betül Aksoy1, Sinem Kahveci1, Suleyman Gunay2, Yeliz Cagan Appak1, Gokhan Koyluoglu3, Maşallah Baran1
1Paediatric Gastroenterology, Izmir Katip Celebi Univercityİzmir City Hospital, izmir, Turkey, 2Gastroenterology, Izmir Katip Celebi Univercity, Izmir, Turkey, 3Pediatric Surgery, Izmir Katip Celebi Univercity, Izmir City Hospital, Izmir, Turkey
Objectives and Study: It is relatively uncommon for children to experience severe pancreatitis, although it is a condition that affects adults quite frequently.
Methods: We report the management and hereditary component of a 13‐year‐old male patient and 16‐year‐old girl who presented with severe acute pancreatitis and a novel CFTR (cystic fibrosis transmembrane conductance regulator) gene mutation.
Results: Case1:A 13‐year‐old male patient was admitted with his first attack of acute pancreatitis.During follow‐up ultrasonography revealed a psodocyst.Total parenteral nutrition(TPN) was started because the patient couldn't tolerate feeding.Recurrent sepsis developed.The cyst did not regress.After 8 weeks of maturation of the cyst wall,cystogastrostomy(figure1)was performed.Lipase values returned to normal.The cyst didn't recurred,but the patient was given pancreatic enzyme replacement due to exocrine insufficiency.In the genetic examination,a homozygous mutation was detected in the CFTR gene(NM_000492.4(CFTR):c.1210‐11 T > G).SPINK1, PRSS1 gene was normal. Case2: A 16‐year‐old girl presented with her first attack of acute severe pancreatitis.At 48th hour, early enteral nutrition was started, but TPN was started because of inadequate nutrition.The patient is followed up in the gastroenterology department.Octreotide infusion is given due to elevated enzymes.The findings of both patients are summarised in the table 1.
Table 1:
| Case 1 | Case 2 | |
|---|---|---|
| Age At Presentation (year) | 13 | 16 |
| Gender | Male | Girl |
| Height | 170 cm(89p¹,1.25SDS²) | 166 cm(73p¹,0.6SDS²) |
| Weight | 63 kg(83p¹,0.95SDS²) | 43 kg(1p¹,‐2,35SDS²) |
| Previously Known Disease | No | No |
| Complaints at the time of application (day) | 2 | 9 |
| Complaint Component | Weakness,Stomachache | Nause,Womiting |
| Family History | History OfPancreatitis | in theUncle |
| Peak lipase level | 1420 IU/L³ | 2562 IU/L³ |
| Stool Elastase Result | 71,3 mg/mL⁴ | <1 mg/mL⁴ |
| Octreotid İnfussion | Yes | Yes |
| Kistogastrostomi | Yes | Not Yet |
| Duration of Hospital Stays (weeks) | 9 | 2 (she's still hospitalised) |
(¹percentile,²standartdeviationscore,³international unite/litre,⁴microgram/milliliter) figure1.
Conclusions: This variant has been reported in association with congenital absence of the vas deferens and cystic fibrosis.Since our patients presented with severe pancreatitis attack in adolescence for the first time without pulmonary findings, these cases are presented.
Contact e‐mail address: drilksendemir@gmail.com
G‐EV040. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV040.1. HEREDITARY PANCREATITIS IN CHILDREN ‐ A 3 YEARS EXPERIENCE IN A TERTIARY CENTER IN BUCHAREST, ROMANIA
Corina Dragu 1,2, Alexandra Coroleuca1,2, Roxana Smadeanu1,2, Irina Dijmarescu1,2, Cristina Becheanu1,2, Daniela Păcurar1,2
1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, 2Pediatrics, Emergency Hospital for Children Grigore Alexandrescu, Bucharest, Romania
Objectives and Study: Hereditary Pancreatitis (HP) is an important cause of acute pancreatitis (AP), acute recurrent pancreatitis (ARP), and chronic pancreatitis (CP) in pediatric populations, characterized by significant morbidity and complications.
Methods: This retrospective study analyzed 10 pediatric patients hospitalized at the "Grigore Alexandrescu" Children's Emergency Clinical Hospital in Bucharest over three years. All patients met the INSPPIRE diagnostic criteria for pancreatitis and were confirmed to have genetic mutations through comprehensive genetic testing. The cases of pancreatitis were categorized as mild, moderately severe, or severe based on the guidelines proposed by the NASPGHAN Pancreas Committee.
Results: The average age of onset was 9.6 years (range: 3–17 years), with a male‐to‐female ratio of 1.25:1. The genetic mutations identified included PRSS1 (50%), CFTR (30%), SPINK1 (20%), and CPA1 (10%), with one patient carrying mutations in both SPINK1 and CFTR. Disease severity varied, with severe pancreatitis in 50% of cases, mild in 40%, and moderate in 10%. PRSS1 was associated with severe and mild cases, SPINK1 exclusively with severe cases, CFTR with mild cases, and CPA1 with a single case of moderate severity. Half of the patients had a positive family history of biliary‐pancreatic disorders, predominantly paternal (60%), linked to pancreatic conditions, while maternal history (40%) involved biliary pathology. PRSS1 mutations were strongly associated with positive paternal history, while SPINK1 and CFTR mutations were unrelated to family history. Complications were prevalent, with 50% developing pancreatic necrosis, and 80% carrying PRSS1 mutations. Anatomical mutations of the Wirsung duct were observed in two PRSS1‐positive patients, requiring duct stenting. Chronic pancreatitis progression was observed in 70% of cases, with PRSS1 detected in 57% of these patients.
Conclusions: These findings highlight the critical role of PRSS1 in severe phenotypes and complications, emphasizing the need for genetic profiling to guide management and predict outcomes in pediatric HP.
Contact e‐mail address: bujor.corina08@gmail.com
G‐EV041. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV041.1. MULTICENTRIC COMPARATIVE ANALYSIS OF ABDOMINAL SYMPTOMS IN PATIENTS WITH CYSTIC FIBROSIS AND PATIENTS WITH INFLAMMATORY BOWEL DISEASE – EARLY RESULTS
Samira Dabelow1,2, Franziska Duckstein1, Carlos Zagoya1, Anton Barucha1,2,3, Carsten Schwarz4, Patience Eschenhagen4, Stefan Trenkel5, Gabor Dunay 2,6, Jochen Mainz1,2
1Cystic Fibrosis Centre, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany, 2Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus‐Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Potsdam, Germany, 3Gastroenterology, Internal Medicine, Brandenburg Medical School (MHB), University, Brandenburg an der Havel, Germany, 4Cystic Fibrosis Centre, Klinikum Westbrandenburg, Health and Medical University, Potsdam, Germany, 5Pediatric Gastroenterology, Klinikum Westbrandenburg, Health and Medical University, Potsdam, Germany, 6Pediatric Gastroenterology, Brandenburg Medical School (MHB), University,Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
Objectives and Study: Cystic fibrosis (CF) is an inherited life‐limiting multisystemic disease primarily affecting airways and the gastrointestinal (GI)‐tract. Recently introduced highly effective CFTR‐modulator therapy (HEMT) with the combination of elexacaftor/tezacaftor/ivacaftor (ETI), improves chloride channel function and life expectancy. Research focus thus shifted to abdominal manifestations of the disease. We therefore assessed similarities and differences in abdominal symptoms (AS) of people with CF (PwCF) and inflammatory bowel disease (PwIBD).
Methods: AS in children and adults with CF (PwCF n = 31, <18 y: 45%), IBD (PwIBD n = 27, <18 y: 74%) and healthy controls (HC n = 16, <18 y: 0%) were quantitatively assessed and compared. Study participants completed the CFAbd‐Score, the first CF‐specific GI‐PROM developed and validated following FDA‐guidelines as well as the IBD‐specific IBDQ‐32 questionnaires. Higher scores in CFAbd‐Score and lower scores for IBDQ represent increased burden of symptoms. The analysis included retrospective data of 12 PwCF prior to ETI‐initiation.
Results: At submission, 31 PwCF, 27 PwIBD and 16 HC were included. PwCF, of whom 65% were receiving ETI, found their AS to be less intensive than PwIBD and HC (total CFAbd‐Score: PwIBD: 19.6 [IQR:11.4‐24.3]; PwCF: 6.6 [2.9‐15.5]; HC: 7.9 [1.4‐12.9]). Retrospective data of 12 PwCF before ETI yielded a total CFAbd‐Score of 10.8 [5.9‐14.3] which decreased significantly to 4.9 [1.4‐7.9], p = 0.03 during ETI. PwIBD had the lowest health‐related quality of life (HRQOL) as measured by IBDQ‐32 (178 [160‐198.5]), followed by PwCF (205 [191‐214]) then HC (212 [198.8‐219]). Bloating, flatulence, abdominal pain and painful stools were the most prevalent AS in both PwCF and PwIBD. While more PwCF suffer from foul smelling stools and fatty stools, PwIBD demonstrated a significantly higher rate of everyday symptoms and psychological disease burden.
Conclusions: The burden of AS is generally lower in PwCF than in PwIBD. Abdominal pain symptoms and frequency of defecation were more pronounced in PwCF before ETI and improved substantially under ETI.
Contact e‐mail address: gadunay@protonmail.com
G‐EV042. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV042.1. AUTOIMMUNE PANCREATITIS IN CHILDREN
Svetlana Drozdova, Elena Kornienko
Department Of Pediatrics Them. Professor I.m. Vorontsov Af And Dpo, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation
Objectives and Study: To specify clinical and pathological features of autoimmune pancreatitis in children.
Methods: The study included 11 patients (5 girls and 6 boys); the mean age at the time of making the diagnosis was 12.5 (range 3‐16) years. All patients met AIP INSPPIRE criteria.
Results: Stomachache was the most frequent manifestation, it was characteristic for all patients. Jaundice was reported in 4 children. Pancreatic enzymes were increased in 10 patients, and serum immunoglobulin G4 ‐ in 4 ones. According to ultrasound scanning 10 patients had diffuse changes of pancreas and its size enlargement. Magnetic resonance imaging demonstrated the pancreas head enlargement in 1 patient and general enlargement of the pancreas in 7 patients. The pancreas biopsy was performed in 1 patient. All patients were administered corticosteroids (prednisolone), and 4 ones azathioprin as well. Due to the therapy all patients had positive dynamics. Autoimmune pancreatitis was associated with Crohn's disease in 7 patients, and with ulcerative colitis in 2 ones.
Conclusions: The most frequent manifestation of AIP in children and adolescents with AIP is stomachache, jaundice in combination with diffuse enlargement of pancreas or signs of mass formation in pancreas found at visualization examination is identified less often. All this experience unambiguously demonstrates that examination of pediatric patients with probable AIP requires taking into account endoscopic ultrasound examination or endoscopic biopsy of pancreas lesions.
Contact e‐mail address: s.drozdova@mail.ru
G‐EV043. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV043.1. SHWACHMAN‐DIAMOND SYNDROME: THREE CASES WITH DISTINCT CLINICAL COURSES
Fatma Özlem Koseoglu 1, Hakan Öztürk2, Sınan Sarı1, Odul Egrıtas Gurkan2, Buket Dalgiç2
1Division Of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 2Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey
Objectives and Study: Shwachman‐Diamond syndrome (SDS) is the second most common genetic cause of exocrine pancreatic insufficiency (EPI) in children. Here, we present three patients with SDS based on EPI and/or neutropenia.
Methods: Case presentation
Results: Case 1. An 18‐month‐old male presented with steatorrhea and severe malnutrition. His parents were consanguineous. Other clinical and laboratory findings included abdominal distension, attention deficit and autism spectrum disorder, retinitis pigmentosa, dental and skeletal abnormalities, mild transaminase elevation, hypolipidemia, and deficiencies in vitamins D and E. Genetic analysis revealed a homozygous EFL1 mutation (c.277 F>C, p.Ser93Pro). After three years, the patient developed neutropenia and thrombocytopenia with recurrent respiratory tract infections. Case 2. A 2.5‐year‐old male, a cousin of the first patient, presented with intermittent steatorrhea. He had a history of perinatal asphyxia. Clinical findings included mental retardation, attention deficit, unilateral hearing loss, bilateral hypermetropia, strabismus, neutropenia, anemia, recurrent infections, dental and skeletal abnormalities. The same EFL1 mutation identified in his cousin was detected in this patient. Case 3. A 5‐month‐old male presented with malnutrition, elevated transaminase levels, vitamin D deficiency, and steatorrhea. Other clinical and laboratory findings included hepatosplenomegaly, pectus excavatum, and pancytopenia. The patient with a heterozygous SDS mutation (c.258+2 T > C) was diagnosed with SDS based on clinical and laboratory findings. With fat‐soluble vitamins, enteral feeding enriched with medium‐chain fatty acids, and pancreatic enzyme replacement therapy, diarrhea and malnutrition improved in all cases diagnosed with EPI based on fecal elastase levels <100 μg/g.
Conclusions: SDS is a hereditary multisystem disorder typically characterized by the triad of EPI, cytopenia, and skeletal anomalies. The diagnosis is confirmed by identifying biallelic pathogenic variants in SBDS, DNAJC21, or EFL1, or a heterozygous pathogenic variant in SRP54. As observed in our patients, approximately half of genetically confirmed SDS cases may not present with classical features, or the clinical manifestations may evolve over time.
Contact e‐mail address: fatma.ozlem.gencturk@gmail.com
G‐EV044. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV044.1. ACUTE PANCREATITIS IN PAEDIATRIC POPULATION: CAUSES AND CONSEQUENCES
Etna Masip 1, Sara García1, M Angeles Calzado1, Begoña Polo1, Carmen Ribes‐Koninckx2, Ester Donat1
1Hospital Universitari i Politecnic La Fe, Valencia, Spain, 2Celiac Disease And Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe. Hospital Universitario y Politécnico La Fe, Valencia, Spain
Objectives and Study: Acute pancreatitis (AP) of diverse etiology, in children, is increasing. The majority of cases evolve satisfactorily, but some present acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP).The objective is to describe symptoms and evolution after a first AP episode.
Methods: Retrospective cross‐sectional study carried out including pediatric patients followed in a tertiary center in the last 10 years (2013‐2023). Demographic data, clinical manifestations, treatment and follow‐up are collected, including complications and subsequent evolution. Definitions of AP, ARP and CP are in accordance with INSPPIRE recommendations.
Results: 14 patients were included, 57% women. Median age of first AP was 4 years (2‐15). In 64% abdominal pain was the main symptom, followed by vomiting (21%); one patient showed spontaneous biliary perforation. Mean hospital stay was 6.3 days. Overweight was not observed: median weight 15.3 kg (11‐75) and height 99 cm (85‐180). 64% had mild pancreatitis. Immediate complications occurred in 21%: portal thrombosis and pancreatic collection‐pseudocyst, with the mean stay of these patients prolonged up to 13.7 days, being statistically significant (p = 0.018). As late complications, 21% developed pancreatic insufficiency. Single AP episode (43%): one patient with ulcerative colitis and concomitant COVID infection, other with cystic fibrosis after starting CFTR modulators, and a patient with encephalopathy and ileostomy. ARP or CP in subsequent follow‐up (57%). Among CP patients (28%): one had pancreas divisum requiring pancreaticojejunostomy, the other 3 had a SPINK1 mutation. Patients who developed ARP (28%): one had CPA1 genetic mutation, other was MCADD, another with Crohn's disease diagnosed after 2 AP episodes, and the last case had hyperlipoproteinemia A.
Conclusions: Pediatric AP is associated with short and long term morbidity. Although many of the isolated cases of pancreatitis are idiopathic, underlying diseases must be assessed. In cases of chronic and recurrent pancreatitis, it is mandatory to investigate genetics and rule out anatomical abnormalities.
Contact e‐mail address: masip_etn@gva.es
G‐EV045. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV045.1. EFFECTS OF PROTON PUMP INHIBITORS ADMINISTERED IN ACUTE PANCREATITIS AMONG THE PAEDIATRIC POPULATION: BENEFIT OR COMPLICATION?
Diana Mate 1, Otilia Marginean1,2, Laura Olariu1,2, Adina Craciun1, Alexandra Todor1, Alexandra Spaimoc1, Anda Beca1, Iuliana Sirbu1, Oana Belei1,2
1Paediatrics Section Iii, "Louis Țurcanu" Children's Emergency Hospital, Timișoara, Romania, Timisoara, Romania, 2First Pediatric Clinic, Disturbances Of Growth And Development On Children Research Center, Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania, Timisoara, Romania
Objectives and Study: The use of proton pump inhibitors (PPIs) in acute pancreatitis (AP) in children is very controversial, as there is insufficient data to justify their effect in the paediatric population (PP). The aim of this study is to analyze the effects of PPIs administered in AP among the PP from a hospital in western Romania.
Methods: A retrospective cohort study was conducted over a 3‐year period, including 70 patients diagnosed with AP according to INSPPIRE criteria out of a total of 106. The patients included in the study were divided into a group that received PPIs and another group with no PPIs treatment and were analyzed.
Results: 35 patients with no PPIs treatment (20 mild, 15 with moderate forms of AP) were studied; 24 of them had rapid remission and favourable clinical and biological evolution; 11 patients presented complications (recurrences 73%, Systemic Inflammatory Response Syndrome (SIRS) 9%, pancreatic necrosis (PN) 18%). 45 patients received PPIs (18 mild forms, 19 moderate, and 8 severe forms of AP) associated with standard treatment or other medication depending on the etiology of AP. Of the patients who received PPIs, 32 had rapid remission and favourable clinical and biological evolution; 13 of the 45 treated with PPIs presented complications (recurrences 69%, SIRS 8%, and PN 23%). p > 0.05 was obtained, with no significant differences between PPIs and no PPIs administration regarding the occurrence of subsequent complications.
Conclusions: The administration of PPIs in PP with AP can improve the clinical condition, but there are no significant differences from not using them. The severe complications that occur may also be correlated with the etiology or the medication associated with the determining cause of AP.
Contact e‐mail address: m.dianadenisa@gmail.com
G‐EV046. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV046.1. COMPARISON OF NECROTIZING PANCREATITIS TO MILD ACUTE PANCREATITIS IN THE PEDIATRIC POPULATION
Ashley Polachek 1, Carla Viesca1, Alex Jeker2, Megha Mehta1
1University of Texas Southwestern ‐ Children's Medical Center Dallas, Dallas, United States of America, 2Fordham University, Bronx, NY, United States of America
Objectives and Study: Pediatric necrotizing pancreatitis (NP) is a rare, poorly understood disease process with limited research. Our study aims to compare clinical and biochemical variables between patients diagnosed with mild acute pancreatitis (MAP) and NP.
Methods: This is a single‐center retrospective analysis of patients diagnosed with NP from 2012‐2022. This cohort was then compared to an established 2‐year cohort of patients diagnosed with MAP. Demographic information, etiologies, and hospital course were compared using statistical methods (t‐tests, chi‐square, Mann‐Whitney U).
Results: A total of 286 cases were included: 229 with MAP and 57 with NP. A significant difference was found in race/ethnicity distribution with positive correlation of Hispanic white with NP (57.9%) and non‐Hispanic white with MAP (38.4%) (p = <0.01). NP cases had significantly higher BMI percentile (median 93.7 IQR 75.7‐98.8 vs 79.5 37.4‐95.8, p = <0.001). More NP cases had no prior history of pancreatitis (87.7%) where almost half of MAP had underlying recurrent or chronic pancreatitis (46.7%, p < 0.001). NP had significantly longer hospital length of stay (median 14 IQR 10‐37 vs 4 2‐8 p = <0.001) and ICU requirement (59.6% vs 13.1% p = <0.001). From a laboratory perspective, NP was significantly associated with a higher white blood cell (WBC) count (p = <0.01), C‐reactive protein (CRP) level (p = <0.01) and a lower albumin level (p = <0.05), but no difference was observed in lipase/ULN ratio or BUN. While there was no significant difference seen in rates of biliary/structural, drug‐induced, infection or trauma risk factors for pancreatitis, hereditary pancreatitis (p = <0.001) and systemic risk factors (p = <0.001) were more associated with MAP and idiopathic pancreatitis (p = <0.05) was more associated with NP.
Conclusions: NP is significantly different when compared to MAP, notably with higher proportion of overweight and obesity as well as Hispanic white race/ethnicity. NP is also more likely to present in a sentinel event of pancreatitis and seen in idiopathic pancreatitis, but less likely in hereditary or systemic induced pancreatitis.
Contact e‐mail address: Ashley.Polachek@UTSouthwestern.edu
G‐EV047. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV047.1. RISK FACTORS FOR ACUTE RECURRENT AND CHRONIC PANCREATITIS IN CHILDREN – A SINGLE CENTER EXPERIENCE (PRELIMINARY RESULTS)
Yunuen Rivera‐Suazo, Jaime Alfaro‐Bolaños, Miguel Gallardo‐Luna, Ana Quesada‐Tortoriello
Paediatric Gastroenterology, National Medical Centre 20 de Noviembre ISSSTE, Mexico City, Mexico
Objectives and Study: The study aims to build a profile in acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP) for paediatric patients, considering the increasing incidence of these conditions in our country.
Methods: We performed a retrospective study in which we included children diagnosed with ARP and CP during a period of 10 years (2013‐2024). We analysed demographic profiles, risk factors, and management.
Results: Our cohort included 22 children with ARP (n = 11) and CP (n = 11) diagnosed based on the INSPPIRE definition. The mean age at diagnosis was 11.3 years, 54.5% of the patients were girls and the mean of episodes was 7.9. Clinical presentation was abdominal pain with vomiting in 68% (15/22), abdominal pain in 22.7% (5/22), and abdominal pain with vomiting, fever and jaundice in 1 patient (choledochal cyst type IV). The risk factors identified in ARP group were: idiopathic (54.5%), lithiasic (45.4%), pancreatitis malformations (9%, pancreaticobiliary malunion); 9% had multiple risk factors (lithiasis and pancreaticobiliary malunion). The risk factors identified in CP group were: idiopathic (36.3%), lithiasic (36.3%), dislipidemic (9%), genetic (9%, PRSS1) and obstructive (18.1%, pancreaticobiliary malunion and sphincter of Oddi dysfunction); 18.1% had multiple risk factors (microlithiasis+hypertriglyceridemia and lithiasis+pancreaticobiliary malunion). Cholecystectomy was performed in 7 patients (31.8%), sphincterotomy in 4 patients (18.1%) and pancreatic stent was inserted in 3 patients (13.6%). Except for one patient, genetic testing was not performed.
Conclusions: The aetiology remains undiscovered in 45.4% of patients. Efforts should be made to lower the prevalence of idiopathic cases by conducting genetic analyses of mutations and stopping disease progression. Despite pancreatitis being an increasing pathology in our hospital, our unit does not have access to genetic panel as a routine diagnosis approach.
Contact e‐mail address: rivera.suazo@outlook.com
G‐EV048. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV048.1. STUDY OF THE EFFECT OF THE PANCREATIC ENZYME REPLACEMENT THERAPY EN311 ON TWO ANIMAL MODELS OF PANCREATIC INSUFFICIENCY IN VIVO
Jessica Tran, Cloé Fabre
Eneapharm, Labège, France
Objectives and Study: Biological studies have been conducted to evaluate the efficacy of EN311, an experimental enzyme replacement therapy, in restoring exocrine pancreatic function in two rodent models of induced pancreatic insufficiency.
This condition is artificially induced in mice and rats through partial ligation of the pancreatic duct (PDL), leading to impaired enzymatic digestion and nutrient absorption, particularly of lipids. The study aims to determine whether EN311, by supplying exogenous pancreatic enzymes, can restore digestive function in these models.
Methods: The PDL rodent model involves a surgical procedure in which the main pancreatic duct is located and ligated in the neck region of the pancreas. A second ligature is placed close to the first to ensure lobe separation, and a third ligature is applied near the duodenum. The organs are then repositioned, and the abdominal cavity is closed with continuous and discontinuous sutures.
1)The effectiveness of EN311 treatment on the restoration of intestinal lipasic capacities was evaluated on mice model.
2)The comparison of therapeutic efficacy of EN311 and the market reference treatment CREON® was evaluated on rats.
Results: 1) Studies show that PDL mice treated with the EN311 formulation fully recover to a pseudo‐healthy phenotype. Additionally, the treatment protects against hypotrophy caused by pancreatic duct ligation.
2) The EN311 formulation has been validated for its effectiveness in restoring a quasi‐healthy phenotype in treated PDL rats. Moreover, at a concentration ten times lower than CREON®, EN311 is twice as effective in promoting intestinal lipid absorption in PDL rats.
Conclusions: EN311 formulation restores the pancreatic function in mice and is 18 times more effective than CREON® at an equivalent dose for the treatment of induced pancreatic insufficiency in rats.
Contact e‐mail address: j.tran@eneapharm.com
G‐EV049. Topic: AS01. GASTROENTEROLOGY/AS01b. Cystic Fibrosis and Pancreatic Disorders
G‐EV049.1. THE POLYMORPHISM OF CLINICAL MANIFESTATIONS IN PEDIATRIC PATIENTS WITH CYSTIC FIBROSIS FROM EASTERN ROMANIA
Madalina Donos1,2, Dana Teodora Anton Paduraru1,2, Alina Marinela Murgu1,2, Laura Otilia Boca1,2, Otilia Iftinchi1,2, Elena Lia Spoiala1,2, Lorena Manole1,2, Laura Mihaela Trandafir 1,2
1“Saint Mary” Emergency Hospital for Children, Iasi, Romania, 2Department Of Mother And Child, Faculty Of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, iasi, Romania
Objectives and Study: Cystic Fibrosis (CF) is a multisystemic genetic disorder primarily characterized by respiratory and digestive symptoms, which significantly affect nutritional status and overall quality of life.
This retrospective study analyzed a cohort of 77 pediatric patients (aged 0–18 years; 33 females and 44 males) monitored between 2015 and 2024 at the Regional Cystic Fibrosis Monitoring Center within the “Sfânta Maria” Children's Hospital in Iași, Romania. Objectives: The study aimed to evaluate the spectrum of digestive and extra‐digestive clinical features (including pulmonary, nutritional, otorhinolaryngological (ENT), cardiac, and endocrine symptoms) to determine their prevalence among pediatric patients in the Eastern region of Romania. The goal was to provide valuable epidemiological insights to support the optimization of multidisciplinary management strategies for CF care.
Methods: Patients were evaluated through anamnesis, clinical examination, anthropometric measurements, routine laboratory tests, intestinal inflammation markers, inflammatory markers, pancreatic function assessment, bacteriological examination, and fibrosis staging (abdominal ultrasound and hepatic elastography).
Results: Among the 77 patients, 65 (84.42%) were underweight, 19 (24.68%) had metabolic disorders (hepatic steatosis, obesity), 51 (66.23%) had hepatic involvement (cytolysis syndrome, hepatic fibrosis, cirrhosis, hepatosplenomegaly), 15 (19.48%) had intestinal involvement (celiac disease, inflammatory bowel diseases, meconium ileus, subocclusive syndrome), 18 (23.38%) had cardiac involvement, 22 (28.57%) had ENT involvement, and 62 (80.52%) had pulmonary involvement (bronchial hyperreactivity, bronchial asthma, recurrent respiratory infections, bronchiectasis, pleural empyema, pulmonary atelectasis, pulmonary emphysema).
Conclusions: Understanding the diverse clinical manifestations of cystic fibrosis is crucial for accurate diagnosis and timely intervention, particularly in Romania, where neonatal screening has been implemented for only three years.
Contact e‐mail address:
G‐EV050. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV050.1. ADVERSE OUTCOMES OF DIAGNOSTIC COLONOSCOPIES IN CHILDREN: A SYSTEMATIC REVIEW
Aderonke Ajiboye 1, Renee Yee Ting Tse1, Shiyao Liu2, Amirreza Nanaei1, Vasiliki Sinopoulou1, Morris Gordon1, Tim De Meij3
1School Of Medicine And Dentistry, University of Central Lancashire, Preston, United Kingdom, 2University of Central Lancashire, Preston, United Kingdom, 3Amsterdam UMC, Amsterdam Zuidoost, Netherlands
Objectives and Study: Diagnostic colonoscopies are routinely performed in children to identify a wide range of gastrointestinal disorders. Although the procedure is generally considered safe, complications may still occur. Most studies in the literature investigating adverse outcomes and complications following diagnostic colonoscopies are retrospective observational studies, and a comprehensive systematic report on the procedural risk is lacking. The only available systematic review of adverse events in paediatric colonoscopies included both diagnostic and therapeutic colonoscopies. Since therapeutic colonoscopies typically carry a higher risk of complications due to their interventional nature, including them in the study could have skewed the findings, limiting their applicability to purely diagnostic settings.
Methods: In November 2024, we searched, MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) with no language or date limitations. We included studies reporting adverse events from diagnostic colonoscopies performed in children (< 18 years old), regardless of diagnostic indications. Studies reporting complications of therapeutic colonoscopies were excluded from the review.
Results: Our search identified 3852 studies and 171 were eligible for full text screening. 142 studies were included in the review and 29 excluded with reasons. One death was reported in a study from 2006 which reviewed diagnostic endoscopy in children after hematopoietic stem cell transplantation. This death was recorded in 1 of the 18 (5.5%) children who underwent lower colonoscopy in the study.
Conclusions: This is the first detailed synthesis of the risks of diagnostic colonoscopy procedures in children, as well as the risks associated with bowel preparation and anaesthesia. These findings can be helpful for clinicians, guideline developers and for communicating to and consenting families. It can also aid shared decision making when balancing risk and benefits.
Contact e‐mail address: aajiboye@uclan.ac.uk
G‐EV051. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV051.1. RECURRENT GASTROINTESTINAL BLEEDING IN A CHILD POST LIVER TRANSPLANT: NOT THE USUAL SUSPECT
Rayna Alamurova 1, Natalia Nedelkopoulou1, Priya Narula1, Prithviraj Rao2, Arun Urs3, Shishu Sharma1, Dominique Schluckebier3, Zuzana Londt2, Mike Thomson2, Akshay Kapoor3
1Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom, 2Sheffield Children's Hospital, Sheffield, United Kingdom, 3Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
Objectives and Study: Obscure gastrointestinal (GI) bleeding may cause refractory anaemia, requiring repeated endoscopic evaluations. GI bleeding in children with previous abdominal surgery is often associated with anastomotic ulcers, requiring endoscopic intervention. Blue rubber bleb nevus syndrome (BRBNS) is an uncommon vascular disorder characterized by multiple venous malformations affecting primarily the skin and GI tract. Lesions can affect the distal small bowel, causing melena or occult blood loss.
Methods: We describe the case of a 10 ‐year‐old boy, who had a liver transplant for cryptogenic liver disease at age 2. He presented with multiple episodes of melena for 7 years, requiring numerous endoscopies to delineate the cause.
Results: The patient had multiple pan‐enteric endoscopic assessments, of which the first was normal. A relook endoscopy identified an angioectatic lesion in the second part of the duodenum to which argon plasma coagulation was applied. Double balloon enteroscopy (DBE) was planned during an episode of acute GI bleeding with a precipitous fall in haemoglobin to3.5 g/dl. Multiple angioectatic lesions were identified close to the Roux‐en‐Y anastomosis; however, haemostasis could not be achieved using clips or thermal coagulation. The patient underwent laparotomy with resection and re‐fashion of Roux‐en‐Y anastomosis. An on‐the‐table, lap‐assisted enteroscopy revealed no additional lesions. The histology of the bleeding area of the resected segment showed multiple dilated vascular channels in the submucosa, which appear to be venous in nature; the endothelium is unremarkable. There has been no further bleeding in a 2‐year follow up.
Conclusions: The diagnosis of BRBNS lesions can be challenging, especially in children with previous abdominal surgery and no cutaneous stigmata. DBE during an acute episode can be useful to localise the lesion and treat it endoscopically. There are no guidelines for the management of BRBNS with GI involvement. Treatment is determined by the severity of the intestinal involvement. Therapeutic options include interventional endoscopy, surgery, and angiogenesis inhibitors.
Contact e‐mail address:
G‐EV052. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV052.1. A RARE CAUSE OF OBSCURE BLEEDING AND SEVERE RECURRENT IRON DEFICIENCY ANAEMIA
Hristo Naydenov1,2, Emilia Nedeva‐Dobreva2, Alexander Petkov3, Petyo Hadzhiyski1,2, Petar Nikolov2, Mila Baycheva 1,2
1Paediatrics, Medical University of Sofia, Sofia, Bulgaria, 2Department Of Gastroenterology And Hepatology, University Children's Hospital, Sofia, Bulgaria, 3NeoClinic Private Practice, Sofia, Bulgaria
Objectives and Study: The most common causes of gastrointestinal (GI) bleeding in children are infections, food allergy, polyps, inflammatory bowel disease, and other. Bleeding episodes leading to severe anaemia can be very challenging and in 5% of all cases, it is difficult to identify the source of bleeding. The use of different diagnostic techniques is important to establish the correct diagnosis.
Methods: It is a clinical case of obscure bleeding and severe recurrent iron deficiency anaemia.
Results: A 7‐year‐old girl with unremarkable early life history, presented at the age of 2, 5, and 6 years with severe recurrent iron deficiency anaemia – haemoglobin level 65; 59; 72 g/L, iron level 1.4; 3.5 mmol/L, normal liver and renal functional tests. She received blood transfusions. The faecal occult blood test was negative on multiple occasions. At the age of 7 years, the girl was referred to our centre for evaluation. During the physical examination, we found multiple vascular lesions in the skin suggestive for cutaneous venous malformations. Blood test results showed anaemia with haemoglobin level of 97 g/L, haematocrit 30%, and iron level of 3.4 mmol/L. We have performed an initial screening for GI causes of iron deficiency anaemia – tissue transglutaminase, faecal calprotectin, and abdominal ultrasound were all normal. We proceeded with performing gastroscopy, colonoscopy and video capsule endoscopy – multiple venous malformations of the gastrointestinal tract suggestive for blue rubber bleb nevus syndrome (BRBNS) were found. The additional computer tomography of the head, neck and chest revealed a vascular conglomerate on the left side of the neck. After a research of the available therapeutic approaches, we started treatment with the mTOR inhibitor rapamycin with excellent results.
Conclusions: Recurrent severe iron deficiency anaemia and obscure bleeding in children should be thoroughly investigated. We show the importance of using all spectrum of instrumental imaging methods for detecting an active bleeding.
Contact e‐mail address: mila.baycheva@gmail.com
G‐EV053. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV053.1. ANTIBIOTIC PROPHYLAXIS IN ENDOSCOPY FOR PAEDIATRIC PATIENTS WITH CENTRAL LINES ON HOME PARENTERAL NUTRITION
Celia Bueno Suárez 1, Michelle Themalil2, Sophie Montgomery‐Stuart2, Hannah Littlechild2, Susan Hill2, Jutta Koeglmeier2, Rulla Al‐Araji2
1Hospital Universitario 12 de Octubre, Madrid, Spain, 2Department Of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
Objectives and Study: There are no established guidelines for antibiotic prophylaxis in children with central venous catheters (CVCs) on Home parenteral nutrition (HPN), leading to inconsistent practices. Children with intestinal failure may face higher bacteraemia risks due to anatomical and functional factors, biofilm formation, and central line use during procedures. Considering reported bacteraemia rates of up to 8% in upper and 25% in lower endoscopy in adults without central lines, prophylactic antibiotics may be justified for this high‐risk group.
Methods: We conducted a five‐year review (November 2019–November 2024) of paediatric HPN patients undergoing endoscopy in our centre, where the local protocol recommends considering antibiotic prophylaxis for patients with CVCs. Post‐procedure infections and associated risk factors were analysed, comparing infection rates between groups that received and did not receive antibiotics.
Results: A total of 33 patients on HPN underwent 63 endoscopic procedures, categorized as 20 upper, 3 lower, 23 combined upper and lower, and 17 combined upper, lower, and ileoscopy. Antibiotic prophylaxis was administered in 41 of the 63 procedures (65%), while the remaining 22 procedures (35%) did not receive prophylaxis, serving as a reference group for comparison. Ciprofloxacin and metronidazole were the primary antibiotics used. Confirmed infection rates remained at 0% up to 28 days post‐procedure in both groups, indicating no statistically significant differences in outcomes between those who received prophylaxis and those who did not.
Conclusions: This study is the first to investigate post‐endoscopy infection rates in paediatric patients on HPN. This study found no statistically significant relationship between antibiotic prophylaxis and infection rates in paediatric patients on HPN undergoing endoscopy. However, the infection rates observed were lower than those reported in adults. These findings highlight the need for further research to assess the clinical necessity of prophylactic antibiotics and to establish evidence‐based guidelines for patient safety.
Contact e‐mail address: cbuenos@salud.madrid.org
G‐EV054. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV054.1. CASES OF CHILDREN PRESENTING WITH LEECH INGESTION: POSSIBLE COMPLICATIONS AND THE IMPORTANCE OF ENDOSCOPY
Ilksen Demir 1, Serenay Alaca1, Kardelen Akın1, Halil Sagir1, Celal Özkaya1, Senay Onbası Karabag1, Betül Aksoy1, Kamer Polatdemir2, Tuğçe Nalbant3, Yeliz Cagan Appak1, Maşallah Baran1
1Pediatric Gastroenterology, Katip çelebi university,İzmir city hospital, izmir, Turkey, 2Pediatric Gastroenterology, Izmir city hospital, izmir, Turkey, 3Pediatric Emergency Medicine, Katip çelebi university,İzmir city hospital, izmir, Turkey
Objectives and Study: Swallowing foreign objects is most common in children between 6 months and 4 years of age.However,swallowed objects may vary depending on regional and cultural differences.
Methods: We present two cases of children who swallowed leeches provided by their parents for medical use.
Results: Case1:It was learnt that the leeches provided by his mother for skin dermatitis were kept in a water bottle and accidentally drunk with water by a 13‐year‐old male patient.They said that of the four leeches in the bottle, three could have been drunk.The patient had no active complaint and physical examination was normal.Hematemesis and melena were not observed during follow‐up.Hemogram,biochemistry and coagulation tests were within normal limits.No leeches were seen in upper gastrointestinal endoscopy, and mucosa was normal.There were no additional problems in follow‐up. Case2:It was learnt that the leeches kept in a water bottle by his mother for application around her eyes due to decreased visual acuity were accidentally drunk by the 8‐year‐old male patient.It was reported that there were six leeches in the bottle and one of them may have been swallowed by the patient(figure1).Physical examination was normal and the patient had no active complaints.Hemogram,biochemistry and coagulation tests were within normal limits.No foreign body was found in the upper gastrointestinal endoscopy. figure1: leech in the water bottle
Conclusions: Leeches are used by people in some diseases,as they are thought to increase blood flow and secrete anticoagulant substances.Due to its widespread use in recent years, its accessibility by children may increase.Cases of leeches detected in the gastrointestinal tract after swimming in polluted waters are reported in the literature. In these cases, endoscopic procedures performed on patients with anemia, hematemesis and melena revealed the presence of leeches in the etiology.In light of the potential for these complications, we promptly performed an upper gastrointestinal endoscopy and initiated clinical follow‐up.
Contact e‐mail address: drilksendemir@gmail.com
G‐EV055. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV055.1. THE ROLE OF ENDOSCOPY IN MANAGING CORROSIVE SUBSTANCE INGESTION IN CHILDREN
Duygu Demirtas Guner 1,2, Hatice Altug Demirol2
1Department Of Pediatrics, Division Of Pediatric Gastroenterology, Hepatology And Nutrition, Dr. Behçet Uz Children's Hospital, Izmir, Turkey, 2Department Of Pediatrics, Division Of Pediatric Gastroenterology, Hepatology And Nutrition, Van Training and Research Hospital, Van, Turkey
Objectives and Study: Corrosive substance ingestion is a significant pediatric health issue in Eastern Anatolia. This study aims to evaluate the clinical characteristics and management of children with corrosive substance ingestion, managed early by pediatric gastroenterologists in the absence of surgical endoscopy at our center.
Methods: We retrospectively analyzed data from pediatric patients hospitalized for corrosive ingestion at Van Training and Research Hospital between October 2021 and October 2023.
Results: Thirty‐four patients [21 females (61.8%) and 13 males (38.2%)] were included, with a median age of 2.1 years (IQR 1.5–3.5). Fourteen patients (41.2%) were asymptomatic. The most common symptoms were vomiting (32.4%), oropharyngeal lesions (23.5%), and coughing (8.8%). Drain cleaners were the most common ingested substances (41.2%). Upper endoscopy was performed in 67.6% of patients, with pathological findings in 73.9%. Two patients had grade 1, four had grade 2 A, and one had grade 2B esophagitis. Among five asymptomatic patients with pathological findings, two had grade 2 A esophagitis and gastric erosion. Among six patients with normal endoscopy findings, two had vomiting, and one had lip burns. Total parenteral nutrition was administered to 8.8% of patients: one with tongue burns and two with gastric necrosis observed during endoscopy. During hospitalization, 32 patients (94.1%) received intravenous pantoprazole, 28 patients (82.4%) sodium alginate, 15 patients (44.1%) sucralfate, and 10 patients (29.4%) antibiotics. Two patients were evaluated with control endoscopy before discharge. All patients were advised to have a visit to the pediatric surgery clinic.
Conclusions: The role of endoscopy in asymptomatic children who have ingested corrosive substances remains controversial. Our study highlights that significant injuries may occur without symptoms, and endoscopic evaluation is essential to identify cases requiring treatment. Conversely, identifying normal findings on endoscopy in symptomatic patients can prevent unnecessary prolonged fasting and facilitate timely and appropriate management, particularly in pediatric patients.
Contact e‐mail address: duygudemirtas@gmail.com
G‐EV056. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV056.1. ENDOSCOPY FOR GASTROINTESTINAL FOREIGN BODIES IN CHILDREN: A SINGLE‐CENTER RETROSPECTIVE STUDY
Duygu Demirtas Guner 1,2, Hatice Altug Demirol2, Busra Bilim Turkcan3
1Department Of Pediatrics, Division Of Pediatric Gastroenterology, Hepatology And Nutrition, Dr. Behçet Uz Children's Hospital, Izmir, Turkey, 2Department Of Pediatrics, Division Of Pediatric Gastroenterology, Hepatology And Nutrition, Van Training and Research Hospital, Van, Turkey, 3Department Of Pediatrics, Van Training and Research Hospital, Van, Turkey
Objectives and Study: Foreign body ingestion is common in children. This study evaluates the clinical and endoscopic findings of pediatric patients who underwent esophagogastroduodenoscopy (EGD) for foreign body ingestion.
Methods: This retrospective study included patients who underwent EGD for foreign body ingestion at the Department of Pediatric Gastroenterology, Van Training and Research Hospital, between September 2021 and August 2023.
Results: A total of 42 patients [27 males (64.3%)] with a median age of 3 years (IQR 1.6–5.7) were included. The most common reason for admission was a witnessed or suspected ingestion reported by a caregiver. One patient was diagnosed on a radiograph obtained for vomiting. While 39 patients (92.9%) were asymptomatic, three presented with vomiting. Commonly ingested objects included button batteries (26.2%), coins (11.9%), safety pins (9.5%), and sewing needles (7.1%). Other ingested objects included magnets, hairpins, screws, glass, nails, bracelets, AA batteries, thumbtacks, water beads, and leeches. Foreign bodies were not observed on EGD in 2 patients due to food residue and in 12 (28.6%) due to migration. Foreign bodies were removed in 28 patients (66.7%): 13 from the fundus, 4 each from the duodenum and antrum, 3 from the corpus, and 2 from the esophagus. Extractions were performed using a netted snare in 19 patients (67.9%), rat‐tooth forceps in 6, and alligator forceps in 3. Nine patients with no foreign body observed on EGD passed it in stool. Two patients who ingested glass and one each who ingested water beads and a leech remained asymptomatic. One patient with a syringe needle embedded in the colonic wall required surgical intervention.
Conclusions: Most children with gastrointestinal foreign bodies are asymptomatic. In children presenting with vomiting, foreign body ingestion should be considered. Migration is possible even if the object is visible on radiographs. However, removal is highly successful when the foreign body is observed during EGD.
Contact e‐mail address: duygudemirtas@gmail.com
G‐EV057. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV057.1. DIAGNOSTIC YIELD OF WIRELESS CAPSULE ENDOSCOPY IN CHILDREN
Davide Esposito 1, Maria Teresa Fioretti1, Massimo Martinelli1, Caterina Strisciuglio2, Annamaria Staiano1, Erasmo Miele1
1Translational Medical Science, Section Of Pediatrics, University of Naples ‘Federico II’, Napoli, Italy, 2Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy
Objectives and Study: Wireless Capsule Endoscopy (WCE) is a non‐invasive diagnostic technique that allows the generation of images from the small bowel and it could be use in children. Traditional endoscopic techniques are unable to visualize the small bowel. The aim of our study was to evaluate the diagnostic performance, the safety and the treatment impact of WCE.
Methods: We collected data regarding the mode administration (ingestion or release via special device), gastric and intestinal transit times, presence of complications and treatment impact in children undergoing WCE.
Results: Twenty‐three children [13 male (56.5%) and 10 female (43.5%); median age 11.4 years (3.4‐ 16.6 years)] were enrolled. WCE was placed in 16 patients (69.6%) endoscopically through the use of a device; in 7 patients (30.4%) it was swallowed. The diagnostic yield was 56.5% (13/23). Positive outcome was observed in 3/10 cases (30%) in which the indication was anemia, in 2/5 cases with rectorrhagia (40%), in 2/4 cases with diarrhea (50%) in 1/3 children with positive fecal occult blood (33.3%), and in all patients with melena, weight loss, and oral aphthae (n. cases= 2, 2, 2, respectively) (100%). Complications were found in 2/23 patients (8.7%). The device use is linked to a lower age (p = 0.007). In all cases of Crohn's disease, WCE has optimized therapy, as showed in Table.
| Diagnosis | N° of patients | Intervention | N° of patients undergoing intervention(%) |
|---|---|---|---|
| Crohn disease | 7 | Optimisation medical therapy (7) | 7/7 (100) |
| Obscure GI bleeding | 3 | Octreotide long active release + Propranolol (1) | 1/3 (33.3) |
| Polyposis syndrome | 1 | Polyp removal(1) | 1/2 (50) |
| Intestinal Lymphangiectasia | 1 | Diet and nutritional changes(1) | 1/1 (100) |
Conclusions: WCE is important for detecting localized disease, especially in the small bowel. Its diagnostic yield is superior to conventional endoscopic investigations, making it a safe and widely‐used tool in pediatric clinics.
Contact e‐mail address: davide.esposito05@gmail.com
G‐EV058. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV058.1. CASE OF OESOPHAGEAL EPIPHRENIC DIVERTICULI
Michał Kolejwa 1,2, Natalia Lwow1, Anna Socha‐Banasiak1, Elzbieta Czkwianianc1
1Gastroenterology, Allergology And Pediatrics, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland, 2Department Of Pediatrics, Immunology And Nephrology, Medical University of Lodz, Lodz, Poland
Objectives and Study: Esophageal diverticulum is a rare condition, especially in children, that involves herniation of the esophageal mucosa or even the entire parietal structure outside the esophageal wall. Patients with such disorder usually develop dysphagia as a main syndrome. An esophageal diverticulum can be categorized based on location as pharyngeal (Zenker) diverticula, mid‐esophageal diverticula, and epiphrenic diverticula. Epiphrenic diverticula are usually false diverticula located in the distal part of the esophagus.
Methods: Case report with analysis of diagnosis and treatment.
Results: A 12‐year‐old boy was admitted to the hospital with increasing dysphagia from a year. During last 6 months weight loss of 5 kg was observed. He was not treated from any chronic diseases, nor allergies. In the physical examination no abnormalities were observed. CT scan of the chest also did not revealed any cause of such symptoms. X‐ray with contrast agent showed separated lumen of the oesophagus by the longitudinal loss of contrast just above the cardia (presumably mucosal fold). Beneath that change fissure‐shaped band connecting oesophagus with stomach was revealed. During gastroscopy at the depth of 35 cm from the tooth a scaring lesion and three shallow diverticuli was found. In the fundus of one of them fissure‐shaped passage to the stomach was visualised. Despite using neonatal endoscope it was not possible to get thorough the stenosis. Patient undergone four endoscopies during which the narrowed oesophagus was dilatated by a balloon dilatator to 16,5 mm. After second dilatation patient stopped complaining about dysphagia and weight gaining was observed.
Conclusions: Symptoms such as dysphagia and weight loss should prompt the doctor to enhance the diagnostics. In special cases, it should be radiological and endoscopic diagnostic tools, which may help find some rare causes of such symptoms. Further management will be established in the nearest future ‐ after dilatating oesophagus to at least 18 mm diameter.
Contact e‐mail address: kolejwam@icloud.com
G‐EV059. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV059.1. CLINICAL EXPERIENCE OF ENDOSCOPICALLY GUIDED TRANSPYLORIC FEEDING TUBE INSERTION IN LOW BIRTH WEIGHT INFANTS
Yeoun Joo Lee, Shin Yun Byun, Narae Lee, Mun Hui Jung, Seung Hee Jeong
Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea, Republic of
Objectives and Study: We report our experience with endoscopic transpyloric(TP) tube insertion in in low body weight infant (LBWI) weighing less than 2.5 kg.
Methods: We retrospectively reviewed the medical records of patients who underwent endoscopic TP tube insertion in LBWI. Endoscopy was performed using an Olympus GIF‐XP260N gastroscope, and a 6Fr feeding tube with a guide wire passed through the end hole was inserted under the endoscopic field of view. Age, weight, indications at the time of endoscopy, change in amount of enteral nutrition before and after the endoscopy, and complication and prognosis were investigated.
Results: From April 2017 to March 2024, endoscopic TP tube insertion was performed on a total of 12 LBWIs. The average gestational age was 31 weeks and 2 days, the average birth weight was 1258 ± 495 g. The average age at the time of the procedure was 39 ± 19 days, the average body weight was 1961 ± 273 g (range: 1410‐2460 g), and 5 patients weighed less than 2000 g. All patients underwent endoscopic TP Tube insertion because of GERD, and two of them were patients who underwent surgery for congenital diaphragmatic hernia and congenital jejunal atresia. Before TP tube insertion, only 3/12 patients were fully feeding and were enteral feeding an average of 44.2±62cc/kg, but one week after TP tube insertion, one additional patient reached full feeding and was enteral feeding an average of 92±54cc/kg. Two weeks after endoscopy, 9 patients achieved full feeding. No procedural failures or complications were observed, but one patient died two weeks after the procedure due to underlying disease.
Conclusions: Endoscopic transpyloric feeding tube insertion can be performed safely even in LBWIs. Endoscopic TP tube insertion can be performed to achieve successful EN in LBWIs up to 1500 g.
Contact e‐mail address:
G‐EV060. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV060.1. DEVELOPMENT OF AN AI‐BASED SMALL BOWEL CAPSULE ENDOSCOPY SEVERITY SCORING ALGORITHM: A PRELIMINARY STUDY HIGHLIGHTING THE NEED FOR AI IN OBJECTIVE SCORING
Yeoun Joo Lee 1,2, Tae Hyeong Kim3, Hansol Kim1, Juwon Hwangbo2, Haejin Lee2
1Department Of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea, Republic of, 2Seoreu Co., Ltd., Yangsan, Korea, Republic of, 3Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea, Republic of
Objectives and Study: Current guidelines recommend severity scoring during Crohn's disease (CD) capsule endoscopy (CE), but this process is time‐consuming and labor‐intensive, with potential variability in practitioner judgment. This study analyzed CE severity scores in pediatric small bowel CD (SBCD) patients to assess their impact on treatment decisions and compared AI‐generated severity scores with those from specialists of varying experience levels.
Methods: We analyzed 30 CEs obtained from 30 pediatric and adolescent SBCD patients conducted between January and July 2023. The CE‐CD score evaluates four key parameters: ulcer count, the maximum ulcer size, surface involved, and stenosis presence. These parameters are calculated separately in each third of the small intestine and combined for total score. An AI CE‐CD score was developed using CAPTOS software (Seoreu, Co, Ltd.). The CE‐CD scores were calculated by AI and three specialists. We examined medication changes before and after CE in patients with follow‐up data. Spearman coefficients compared the AI and specialist interpretation.
Results: The patients included 17 newly diagnosed and 13 follow‐up CDs, with a mean age at diagnosis of 13.3 ± 2.6 years. Follow‐up studies were conducted a median of 20 months post‐diagnosis. Initially, five patients used biologics, and eight received conventional treatment. Post‐examination, five additional patients began biologics, while three remained on conventional treatment, with mean CE‐CD scores of 18.7 ± 2.5 and 8.1 ± 9.3, respectively. The mean CE‐CD scores from the three specialists and AI were 13.8 ± 6.9 and 14.4 ± 5.5. We found a very strong correlation between the specialists' mean scores and AI (Spearman's r = 0.800, p < 0.0001). One specialist and AI showed a very strong correlation (r = 0.88, p < 0.0001). Each expert correlated strongly with each other (r = 0.73, p < 0.0001 and r = 0.72, p < 0.0001).
Conclusions: CE severity scoring influences treatment decisions in pediatric CD. AI scoring offers a more objective alternative to manual specialist scoring, potentially enhancing consistency and efficiency in clinical practice.
Contact e‐mail address: moonmissing@gmail.com
G‐EV061. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV061.1. IMPACT OF ENDOSCOPIC SLEEVE GASTROPLASTY ON MASLD IN SEVERELY OBESE CHILDREN: A FIRST EXPERIENCE IN 3 CHILDREN
Eberhard Lurz 1,2, Mathias Kurz3, Tobias Ninke3, Ursula Weise4, Daniel Kotlarz4
1Department Of Pediatrics, University Hospital, LMU Munich, Munich, Germany, 2Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany, 3Klinik Für Anaesthesiologie, University Hospital, LMU Munich, Munich, Germany, 4Department Of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig‐Maximilians‐Universität Munich, Munich, Germany
Objectives and Study: Pediatric obesity is a world wide increasing burden associated with several co‐morbidities. More than 1/3 of obese children also have metabolic associated steatotic liver disease (MASLD). Bariatric surgeries such as Roux en Y or sleeve gastrectomy ares established in severly obese children (BMI > 40 kg/m2, or 35 ‐ 40 kg/m2 + co‐morbidity), and by the current EASL MASLD guideline supported, treatment options in adults with severe obesity and MASLD. An endoscopic sleeve gastrectomy (ESG) might be a less invasive bariatric option for children and adults but warrants further analysis especially in children. We hypothesize that an ESG is a feasible and safe bariatric treatment option for children with severe obesity and MASLD.
Methods: A retrospective case analysis of children with severe obesity and MASLD undergoing ESG in an acadamic pediatric university hospital. All procedures were performed by the same pediatric gastroenterologist.
Results: 3 children underwent an ESG at our institution since May 2024. All 3 children wer treatment refractory to either ambulatory or inpatient obesity treatment programs or both. One 17 year old boy with biopsy proven MASH, 163 kg and a BMI of 50 kg/m2. Within 3 months post ESG he lost about 10 % of total body weight and AST and ALT normalized. One 13 year old boy with MASLD and a BMI of 40.3 kg/m2. Within 3 months he lost about 8 % of total body weight and AST and ALT improved. A 14 year old girl with MASLD and a BMI of 41 kg/m2. Within 3 months she lost about 9 % of total body weight and AST and ALT normalized. No acute complication occured post ESG.
Conclusions: This case series is a first proof of concept for ESG in children with MASLD. In the short term no relevant complications occured and liver values normalized or improved significantly.
Contact e‐mail address: Eberhard.Lurz@med.uni-muenchen.de
G‐EV062. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV062.1. UPPER GASTROINTESTINAL BLEEDING IN CHILDREN: A 5 YEAR RETROSPECTIVE STUDY IN SINGAPORE
Eric Ma 1, Sarah Wong2, Charanya Rajan2, Lay Queen Ng2, Lynette Goh2, Veena Logarajah2, Fang Kuan Chiou2, Christopher Ho2
1Paediatrics Medicine, KK Women's and Children's Hospital, Singapore, Singapore, 2Gastroenterology, Hepatology And Nutrition, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore, Singapore
Objectives and Study: This study aims to analyse the clinical presentation and endoscopy findings of upper gastrointestinal bleeding in children.
Methods: A 5‐year retrospective study from 2018 to 2022 was performed on children aged 0‐18 years presenting with upper gastrointestinal bleeding (UGIB) and undertaken oesophagogastroduodenoscopy (OGD) from a tertiary paediatric centre in Singapore. Data collected and analysed included patient demographics, clinical presentation, endoscopy findings and clinical outcomes of patients with UGIB.
Results: Out of 1216 OGDs performed from 2018 to 2022, we identified a total of 72 OGDs (5.9%) that were performed for UGIB. This involved 65 patients with a median age of 8.4 years (range 4 months‐17 years old). 54 patients (75%) presented with hematemesis followed by malena in 12 (17%) and both haematemesis and malena in 6 patients (8%). Mean Hb of patients who presented with haematemesis was 11.2 g/dL, malena at 8.8 g/dL and both haematemesis and malena at 7.9 g/dL. 23 cases (32%) required blood transfusion. The most common causes of UGIB among all patients were erosive pangastritis (36%), oesophageal varices (17%), gastric ulcers (13%), duodenal ulcer (8.3%). No cause could be ascertained in 4 cases (5.6%): 2 cases were elective OGD performed 2 weeks after UGIB, 1 case for suspected oesophageal foreign body with acute UGIB, 1 for episodic haematemesis of 3 days. Mean Hb of these 4 cases was 13.5 g/dL. Most common endoscopy interventions performed were haemostatic spray (19.4%), variceal band ligation (12.5%), adrenaline injection (8.3%) and clipping (2.8%). There were 2 cases of rebleeding: 1 haemorrhagic erosive gastritis with underlying eosinophilic gastritis requiring repeat endoscopy and 1 rebleeding of oesophageal varices treated conservatively.
Conclusions: This study identified that erosive pan‐gastritis followed by variceal bleeding were the most common cause of upper gastrointestinal bleeding in our centre. Source of bleeding was identified in 94.4% of cases, with a low rebleeding rate of 2.8%.
Contact e‐mail address: eric.ma@mohh.com.sg
G‐EV063. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV063.1. GASTROINTESTINAL BLEEDING RELATED TO MTOR INHIBITOR: A RARE PAEDIATRIC CASE
Sunita Amar Rajani, Arun Urs, Akshay Kapoor, Mike Thomson, Natalia Nedelkopoulou
Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
Objectives and Study: Gastric antral vascular ectasia (GAVE) associated with mTOR inhibitors has been reported in adult literature but there is no published data in paediatric patients.
Methods: We present a case of Everolimus‐ associated gastrointestinal bleeding in a paediatric patient.
Results:
15‐year boy with Tuberous sclerosis, cardiac rhabdomyoma, seizures presented with a life‐threatening gastrointestinal bleed. He had been on Everolimus trial since 2014 for cardiac rhabdomyoma. Whilst in hospital for a lower respiratory infection, he developed hematemesis requiring blood transfusion. Had OGD with banding of vascular lesions in his stomach by adult gastroenterologists. He developed further melena, hence was transferred to us on octreotide. In view of on‐going melena repeat endoscopy revealed generalised oozing in gastric antrum requiring haemospray. His haemoglobin dropped 75 g/L. He needed high dependency as neurological and respiratory status worsended. He required blood transfusion and parenteral nutrition. Computed Tomography scan of the abdomen ruled out vascular anomalies. Detailed review led to literature search on Everolimus and its association with gastrointestinal bleeding. Everolimus was withheld. As he had tolerated the mTOR inhibitor for 10 years, the neurology team were keen to restart it. 72 hours after restarting Everolimus, he dropped his haemoglobin. Everolimus was discontinued. Endoscopy done once stable showed vascular lesions and two band ligators(7 mm) were applied distally to proximally in gastric antrum. Octreotide was stopped. No gastrointestinal bleeding in the next 6 months.
Conclusions: We successfully treated GAVE(post Everolimus) with band ligation in a paediatric patient. GAVE is associated to mechanical stress caused by altered gastric motility and gastric dysfunction that leads to submucosal fibromuscular hyperplasia and dilation of mucosal capillaries. Everolimus increases the gastric motility which may contribute to GAVE. We aim to raise the awareness of this rare adverse effect which can be a challenging cause of severe gastrointestinal haemorrhage in children.
Contact e‐mail address: sunita.rajani@nhs.net
G‐EV064. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV064.1. THE COIN THAT STAYED, FOR HALF A YEAR DELAYED – HOW IGNORING SYMPTOMS IN CHILDREN CAN HAVE SERIOUS EFFECTS – A CLINICAL CASE
Mariusz Olczyk 1,2, Michał Kolejwa3,4, Elzbieta Czkwianianc3, Marcin Tkaczyk1, Wiesław Konopka5, Anna Piaseczna‐Piotrowska5
1Department Of Pediatrics, Immunology And Nephrology, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland, 2Gastroenterology, Allergology And Paediatrics, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland, 3Gastroenterology, Allergology And Pediatrics, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland, 4Department Of Pediatrics, Immunology And Nephrology, Medical University of Lodz, Lodz, Poland, 5Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
Objectives and Study: Foreign body ingestion is a common gastrointestinal issue in pediatric patients. The management approach varies depending on the type of object ingested. However, the event of ingestion can often go unnoticed by parents, and a lack of awareness by healthcare professionals regarding the clinical symptoms can lead to severe consequences.
Methods: This clinical case report involves a 2.5‐year‐old patient who ingested a 19.5 mm diameter coin, which remained lodged in his esophagus for six months.
Results: The case began with hospitalization for a respiratory infection, during which a chest X‐ray was not performed. Over the following six months, the child gradually refused to eat solid foods. During a hospital visit, an X‐ray revealed the foreign body in the esophagus. An endoscopy showed the coin embedded in the swollen and hypertrophied mucosa at a depth of 8‐10 cm from the teeth. The decision was made not to remove it at that time. A subsequent CT scan confirmed the metallic foreign body at the level of T4 and T5 vertebrae, with narrowing of the left main bronchus. An attempt was made to remove the coin endoscopically with surgical and cardiothoracic assistance. However, due to significant tissue swelling, a thoracotomy was performed, successfully removing the foreign body from the esophagus. Follow‐up endoscopy led to a series of esophageal dilation procedures, ultimately resolving the issue.
Conclusions: Foreign bodies in the gastrointestinal tract, when unnoticed despite clinical symptoms, can pose a significant health risk to children. Timely recognition and appropriate management are critical to avoid severe complications.
Contact e‐mail address:
G‐EV065. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV065.1. NON‐INVASIVE DIAGNOSTIC TEST FOR HELICOBACTER PYLORI INFECTION IN CHILDREN
Tonia Raso 1, Giulia D'Arcangelo1, Naire Sansotta2, Caterina Strisciuglio3, Sabrina Cenni3, Selene Del Vespa4, Sara Renzo5, Elisa Salvadoretti6, Francesca Bravin7, Matteo Bramuzzo8, Salvatore Oliva1
1Department Of Maternal And Child Health, Sapienza University, Paediatric Gastroenterology Unit, Rome, Italy, 2Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 3Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy, 4university of florence, florence, Italy, 5Gastroenterology And Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy, 6Pediatrics, Woman's & children university hospital of Verona, Verona, Italy, 7Uo Pediatria Universitaria, Azienda Ospedaliero Universitaria Pisana, scuola di specializzazione in pediatria, pisa, Italy, 8Institute for Maternal and Child Health‐IRCCS "Burlo Garofolo", Trieste, Italy
Objectives and Study: We investigated the role of non‐invasive tests [urea breath test (UBT) and stool antigen test (SAT)] in children with suspected Hp infection.
Methods: Retrospective, multicenter study including children with suspected HP infection undergoing endoscopy with or without noninvasive tests. Primary aim was to evaluate diagnostic accuracy of UBT and SAT. Secondary aim was to describe the demographic and clinical features of patients with a confirmed Hp infection.
Results: Of 256 patients 150 (58.6%) had HP infection. SAT was more sensitive [94% (0.87–0.97) vs 87% (0.64‐0.98)], less specific than UBT [55% (0.45 – 0.64) vs 67% (0.39‐0.86)], with a lower PPV [64% (0.55–0.72) vs 78% (0.55‐0.91)], higher NPV [91% (0.81–0.96) vs 80% (0.49‐0.96)] and comparable likelihood ratio (2.1 vs 2.6). Compared to those without, children with Hp infection were characterized by higher age at diagnosis (P = 0.002), non‐Caucasian ethnicity (p < 0.0001), family history (p = 0.002) and a previous HP infection (p = 0.04). Heartburn (p = 0.03) and anemia (p = 0.03) were the symptoms statistically related to the infection. Multivariate analysis showed that family history [OR 4.4 (1.5–14.7), p = 0.008] and a positive SAT [OR 16.29 (5.15– 66.13), p < 0.0001] were independent risk factors for HP infection. Excluding children with previous Hp infection, non‐Caucasian ethnicity was also an independent risk factor for a positive endoscopy [OR 4.3 (1.37–15.7), p = 0.01].
Conclusions: Our study reported a good performance of SAT, especially in terms of sensibility and NPV in children with symptoms of suspected HP infection. Such results may allow to exclude HP infection and avoid endoscopy in the presence of a negative result.
Contact e‐mail address: toniaraso@gmail.com
G‐EV066. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV066.1. PORTAL CAVERNOMA AND ITS IMPACT ON PEDIATRIC GASTROINTESTINAL BLEEDING: A RARE AND CRITICAL DIAGNOSIS
Alessandra Maria Ricci 1, Francesca Rea2, Giulia Angelino2, Renato Tambucci2, Filippo Torroni2, Simona Faraci2, Erminia Romeo2, Chiara Imondi2, Monica Malamisura2, Anna Chiara Contini3, Tamara Caldaro3, Valerio Balassone3, Paola De Angelis2
1Gastroenterology and Nutrion Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy, 2Gastroenterology And Nutrition Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy, 3Digestive Endoscopy And Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
Objectives and Study: Upper gastrointestinal (UGI) bleeding is a common clinical condition in pediatric patients, with causes ranging from mild to severe. This study aims to present the case of a child with severe acute UGI bleeding, investigate its underlying cause, and discuss the implications of portal cavernoma, a rare manifestation of portal vein thrombosis, which can lead to severe esophageal varices and acute bleeding.
Methods: We report the case of a 3‐year‐old Caucasian girl admitted to the Emergency Department after two episodes of hematemesis and one of melena. Diagnosis was established through clinical, laboratory, and instrumental examinations, including esophagogastroduodenoscopy (EGD), abdominal ultrasound with Doppler imaging, and abdominal CT scan. The patient's clinical history, including preterm birth and corrective surgery for a vascular ring, contributed to the diagnosis.
Results: The patient presented with mild anemia (Hb 10.8 g/dl) and thrombocytopenia (99,000/mm³), while renal and hepatic function were normal, though liver enzymes were slightly elevated. EGD revealed grade III esophageal varices with red signs and one grade II varix, which was treated with ligation. Abdominal ultrasound showed splenomegaly and the presence of a portal cavernoma, confirmed by abdominal CT. A subsequent portography confirmed portal hypertension, suggesting the need for a meso‐Rex shunt.
Conclusions: Portal cavernoma is a rare but serious condition that can present with acute variceal bleeding in children, even in the absence of common risk factors such as umbilical vein catheterization. This case emphasizes the importance of considering portal vein thrombosis and portal hypertension as potential causes of UGI bleeding in pediatric patients. Early diagnosis and prompt treatment, including the management of esophageal varices, are crucial to prevent severe complications. The case also highlights the need for a multidisciplinary approach in managing rare and complex conditions like portal cavernoma.
Contact e‐mail address: alemaria.ricci@gmail.com
G‐EV067. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV067.1. REFRACTORY ESOPHAGEAL STENOSIS: WHEN TREATMENT FAILS
Luís Rodrigues 1,2, Mariana Reis1,3, Ana Fernandes1,2, Sara Azevedo1,2, Paula Mourato1,2, João Lopes4, Helena Loreto1,2, Ana Isabel Lopes1,2
1Pediatric Gastroenterology, Hepatology and Nutrion Unit, Department of Pediatrics, Hospital de Santa Maria, ULS‐Santa Maria, Lisboa, Portugal, 2Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal, 3Pediatrics Department, ULS Algarve ‐ Faro, faro, Portugal, 4Gastroenterology Service, Hospital de Santa Maria, ULS‐Santa Maria, Lisboa, Portugal
Objectives and Study: Introduction: Refractory esophageal stenosis in pediatric patients is a complex condition that requires a demanding therapeutic approach. It is defined as the inability to maintain an adequate esophageal lumen after five dilation sessions performed at two‐week intervals. Management is challenging due to its significant impact on nutrition, growth, and patients' quality of life, as well as the risk of complications.
Methods: Case Description:
Results: We present the case of an 11‐year‐old child from Guinea with a history of accidental caustic soda ingestion at six months of age, resulting in the development of a 2‐cm simple esophageal stricture. Initial treatment in Dakar involved six sessions of endoscopic dilation. The patient was later evacuated to Portugal at the age of 4 and enrolled in an endoscopic dilation program at a tertiary center. Due to refractoriness to dilations, including intralesional triamcinolone injection, a fully covered metallic stent (Micro‐Tech©) was placed at the age of 6 but was subsequently removed due to repeated migrations. At the age of 7, a gastrostomy was performed, and the patient continued endoscopic dilations. At 8 years old, topical mitomycin C was administered without success. At 10 years of age, an esophageal stent (Dynamic Stent©) was placed and maintained for 21 weeks, resulting in good adaptation and oral tolerance. However, following stent removal, progressive recurrence of symptoms was noted. Twelve weeks post‐removal, upper gastrointestinal endoscopy confirmed re‐stenosis. Currently, the patient is awaiting surgical intervention and continues to undergo endoscopic dilations every four weeks.
Conclusions: This case underscores the challenges in managing refractory esophageal stenosis in pediatric patients and highlights the need for innovative therapeutic strategies. Despite various interventions, including advanced techniques, they proved ineffective in this case.
Contact e‐mail address: luisnorterodrigues@gmail.com
G‐EV068. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV068.1. SURGICAL COMPLICATIONS FROM FOREIGN BODY (FB) INGESTION IN PAEDIATRIC AGE: AN ITALIAN RETROSPECTIVE MULTICENTRE STUDY
Alessia Salatto 1, Maria Boccia1, Cristina Bucci2, Francesco Cirillo2, Sara Isoldi2, Maria Giovanna Puoti2, Rossella Turco2, Andrea Chiaro3, Francesca Destro4, Maria Teresa Illiceto5, Paolo Orizio6, Filippo Torroni7, Paolo Quitadamo2
1Department Of Translational Medical Sciences (dismet), Section Of Pediatrics, University Federico II, Naples, Italy, 2Pediatric Gastroenterology and Hepatology Unit, Santobono‐Pausilipon Children's Hospital, Naples, Italy, Naples, Italy, 3Pediatric Gastroenterology and Endoscopy Unit, Institute Giannina Gaslini, Genoa, Italy, 4Pediatric Surgery Department, V. Buzzi" Children's Hospital, Milan, Italy, 5Pediatric Gastroenterology And Digestive Endoscopic Unit, Department Of Pediatrics, "Santo Spirito" Hospital of Pescara, Pescara, Italy, 6Department Of Pediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy, 7Gastroenterology And Nutrition Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
Objectives and Study: Foreign body (FB) ingestion is one of the most common endoscopic emergencies in paediatric patients. In some cases, FBs cannot be removed endoscopically and may lead secondary complications that require surgical intervention. This study aims at describing the clinical data of patients with surgical complications from FB ingestion and at assessing the actual risk posed by various FBs by providing a detailed characterization of the associated surgical complications.
Methods: The study was conducted from March 2024 to October 2024 at the Santobono‐Pausilipon Pediatric Hospital in Naples. Clinical data of patients aged 0 to 18 years with surgical complications from FB ingestion over the past 30 years were retrospectively collected from major Italian Paediatric Gastroenterology and Surgery Departments. Surgical complications included intestinal perforation, intestinal obstruction, and prolonged intestinal retention. A comprehensive medical record was completed for all enrolled patients.
Results: Data were collected from 40 children hospitalized due to surgical complications following FB ingestion. Of these, 30/40 (75%) presented with perforation, 5/40 (12.5%) suffered from intestinal obstruction, and the remaining 5/40 (12.5%) experienced prolonged FB retention requiring surgical removal. Among the ingested foreign bodies, 17/40 (42.5%) were magnets (multiple magnetic beads, geomag, or multiple magnets), 7/40 (17.5%) were sharp objects (pins, pine needles, metal wires, fish bones), 7/40 (17.5%) were button batteries, and 3/40 (5%) were bezoars. Lastly, 5/40 (12.5%) involved various objects such as an orthodontic splint, a wooden nut, an earring, a video capsule, and packing tape.
Conclusions: Our study represents the largest reported collection of surgical complications from FB ingestion in paediatric patients. The findings provide a better understanding of the epidemiology of FBs causing severe intestinal complications. Additionally, assessing the actual risk associated with various FB types, particularly identifying subgroups for which endoscopic removal is indicated, will support more effective patient management.
Contact e‐mail address: alessiasalatto1@gmail.com
G‐EV069. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV069.1. SINGLE CENTRE REVIEW OF THE CLINICAL APPLICATION OF VIDEO CAPSULE ENTEROSCOPY IN PAEDIATRIC PATIENTS
Kirn Sandhu, Enes Coskun, Chaman Urooj, Babu Vadamalayan
Paediatric Gastroenterology Department, King's College Hospital, London, United Kingdom
Objectives and Study: Video Capsule enteroscopy (VCE) is a non‐invasive tool for assessment of small bowel disease in inflammatory bowel disease (IBD), obscure gastrointestinal bleeding, iron deficiency anaemia and chronic unexplained abdominal pain. We aim to share insights into its safety, feasibility and effectiveness based on our experience.
Methods: We retrospectively reviewed all patients who underwent VCE over one year (November 2023 to November 2024).
Results: 48 patients underwent a VCE over the one‐year period with 50% of them males. The median age was 13.06 ± 4.07 years (19 months to 17.7 years). 25% of patients had VCE placed endoscopically under general anaesthetic. The most common indication for VCE was reassessment in patients with known IBD (Figure 1). 4 patients in whom IBD was suspected had incomplete scope, VCE was helpful in disease mapping. In 14 patients (29.2%) study was incomplete, 1 was unable to swallow the capsule, 2 were technical failures, in 11 patients, capsule was not seen to exit the caecum, so an abdominal X‐ray was done to ensure it was passed. No patients had retained capsule and there were no procedure related complications. 6 patients had patency capsule prior to VCE. Positive findings were noted in 37.5% of patients. In 12 patients there was a change in management, 6 with IBD who had an escalation of treatment based on VCE results. 85% of patients underwent an MRE (magnetic resonance enterography) prior to VCE. We found in 9 patients in whom the MRE was reported as mild inflammation in ileum had normal VCE result.
Conclusions: Our data shows that VCE is a safe and effective procedure in paediatric patients. It allows disease mapping in patients with IBD which can guide treatment strategy. VCE provides a non‐invasive method for assessment of small bowel disease especially in IBD patients which can aid treatment escalation.
Contact e‐mail address: kirn.sandhu3@nhs.net
G‐EV070. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV070.1. CURRENT STATUS OF GASTROINTESTINAL ENDOSCOPY FOR SEVERE MOTOR AND INTELLECTUAL DISABILITIES IN PEDIATRIC SPECIALIST MEDICAL FACILITIES
Ryutaro Saura, Shin‐Ichiro Hagiwara, Tatsuya Ishikawa, Yuki Yamano, Ayaha Hata, Takatoshi Maeyama, Yuri Etani
Department Of Pediatric Gastroenterology, Nutrition And Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
Objectives and Study: Endoscopic procedures are occasionally performed for gastrointestinal symptoms in severely disabled children and adults. However, challenges such as airway complications and scoliosis are often significant barriers to these procedures.Examining the usefulness and safety of gastrointestinal endoscopy (GE) in children and adults with severe physical and mental disabilities.
Methods: This retrospective study was conducted using the medical records of pediatric gastroenterologists who performed GE at our hospital from April 2015 to September 2024.
Results: Among 37 identified patients, 95 examinations, including repeat procedures, were analyzed (median age: 9.5 years [5.1–18.5], median BMI: 14.3 [13.2–15.3]). Upper GE was performed in 54 examinations (57%), colonoscopy in 27 (28%), endoscopic retrograde cholangiopancreatography (ERCP) in 4 (4%), and other procedures in 10 (11%). General anesthesia administered by pediatric anesthesiologists was used in 93 procedures (98%). Bloody stools were the most common symptoms found during GE. In total, 32 patients (86%) had endoscopic findings that could have caused the symptoms, and 5 patients underwent endoscopic treatment. There were 27 patients with scoliosis, making it difficult to change their position; therefore, the procedure was performed in the supine position. Adverse events occurred in four patients, with mucosal damage due to contact with the scope in three patients and poor oxygenation after the procedure in one; however, all symptoms improved promptly, and no serious adverse events were observed. In two patients, the patency capsule did not pass beyond the pharynx, and the procedure could not be performed.
Conclusions: In this study, GE was performed safely in children and adults with severe physical and mental disabilities, and endoscopic findings were used to identify the potential causes of symptoms in 86% of the cases. Therefore, GE should be considered in children and adults with severe physical and mental disabilities who present with gastrointestinal symptoms.
Contact e‐mail address:
G‐EV071. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV071.1. SEVERE CHEST PAIN AND DYSFAGIA IN AN ADOLESCENT: DRUG‐INDUCED ESOPHAGITIS
Ertug Toroslu
Pediatric Gastroenterology, Hepatology And Nutrition, Batman Education and Research Hospital, Batman, Turkey
Objectives and Study: Introduction:Drug or pill‐induced esophagitis is cause by direct caustic effects of the drugs through the esophageal mucosa. Frequently reported in older populations, who have motility problems due to connective tissue problems and/or autonomic neuropathy. Hereby, it's reported that a healthy adolescence who had an acute severe chest pain with a drug‐induced esophagitis.
Methods: Case:A seventeen‐year‐old girl was admitted to the outpatient clinic with severe chest pain described as an 8/10 with severe dysphagia. She described vomiting 4 times during the last 12 hours. On medical history she had no co‐morbidities, unless she was prescribed doxycycline 100 mg per twice a day due to acne therapy 2 days before chest pain. On physical examination was unremarkable. Chest X‐ray was within normal limitation. Cardiac enzymes and pancreatic enzymes were totally normal. Electrocardiography was almost normal. An upper gastrointestinal (GI) endoscopy showed nearly 3 cm superficial ulcerations roundly over %50 of lumen surface in the middle of the esophagus segment (Figure I).
Results: Result: She was ordered to intravenous proton pump inhibitor as pantoprazole per a day and oral sucralfate 4 times per a day. The patient was followed non‐peroral for 5 days till the chest pain resolved. After the chest pain resolved at the 6.day, she was allowed to swallowed liquids. On the 7th day of follow‐up, the patient was able to swallow soft foods. Then control chest X‐ray was unremarkable on the 7th day without perforation, the patient was discharged with PPI and oral sucralfate prescriptions. On the 4th week control upper GI endoscopy was totally normal with biopsy‐proven normal esophageal tissue.
Conclusions: Discussion: Whilst rarely can cause life‐threatening events drug‐induced esophagitis; a typical history, clinical presentation, and endoscopic view can easily help the diagnosis of drug‐induced esophagitis. Biopsy is generally unrecommended in this unless unclear different
Contact e‐mail address: ertugtoroslu@hotmail.com
G‐EV072. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV072.1. CAUSTIC INGESTION IN CHILDREN, 26 CASES IN A TERTIARY HOSPITAL CENTER
Meskini Toufik, Hagar Berrani, Mouna Sabib, Mariam Akhrif, Said Ettair
Rabat Children's Hospital, Rabat Mohammed V University, Rabat, Morocco
Objectives and Study: Characteristics of accidental caustic ingestion in children in a tertiary hospital center in Morocco. Observational study
Methods: Children under 15 years of age. Admitted for caustic ingestion. Endoscopy performed. Evolution noted. From January 2023 to March 2024. Analyzed parameters : caustic product type, Consultation time, symptoms presented, clinical, endoscopic and management data. outcome data are analyzed in correlation with the endoscopic stage of the digestive injuries.
Results: 26 cases was included. 15 boys, 11 girls. mean age is 2 years. from 12 month to 3 years. Liquid caustic product in 22 cases, bleach 10 cases, Alkalin drain unblockers 4 cases. Hydrogen peroxide 4 cases, hydrochloric acid 3 cases, hydrofluoric acid 2 cases, unknown 3 cases. Time between ingestion and admission from hours to 60 days. Dysphagia 9 cases, oral ulcers 8 cases. Vomiting 6 cases. Abdominal pain 6 cases, Asymptomatic 3 cases. Time of first upper endoscopy varies from 24 hours to 60 days. Endoscopy according to Zagar grading classification found caustic gastritis in 4 cases. caustic esophagitis stage 1 in 3 cases. stage 2b (2 cases), stage 3a (1 case), esophageal esophageal narrowing in 8 cases. In 9 cases endoscopy is normal. Caustic esophagitis is managed according to its stage. First 24 hours, an initial interruption of oral feeding in all cases. Parenteral corticosteroid therapy, antisecretory drugs and antibiotics administered when stage 2b and stage 3. Outcome is favorable for caustic gastritis. favorable for caustic esophagitis at stage 1. 6 cases of stenosis noticed in average period of 30 days. 4 cases of tight esophageal stenosis required dilation, 2 cases required a gastrostomy, 2 patients died.
Conclusions: Caustic ingestion is a source of serious morbidity and mortality, Prevention is the best management strategy. Manufacturers must respect the packaging standards for dangerous substanes, Media must inform the public and parents must remain vigilant.
Contact e‐mail address: ok
G‐EV073. Topic: AS01. GASTROENTEROLOGY/AS01c. Endoscopy
G‐EV073.1. A CASE OF INGESTION OF TWO COINS MIMICKING AS A BUTTON BATTERY
Liesbet Verbrugghe 1, Annika Herrtwich2, Hannes Devos2, Bruno Hauser1
1Paediatric Gastro‐enterology Department, UZ Brussel, Jette, Belgium, 2Radiology Department, UZ Brussel, Jette, Belgium
Objectives and Study: Background: Foreign body ingestion is a frequent indication for upper gastro‐intestinal endoscopy in children. History as well as imaging are both important tools to determine urgency of removal. Ingestion of button batteries are always a cause for urgent removal, as they may cause significant morbidity and mortality.
Methods: Case report
Results: Case presentation: We report on a 5‐year‐old boy presenting to the emergency room with a four day history of sore throat and difficulty swallowing solid feeds. The day of presentation the patients brother confessed that the boy swallowed a coin. An X‐ray was performed to determine the location of the foreign object and showed a round dense foreign body located medially between the claviculae. There was uncertainty about a halo sign, so an X‐ray in lateral view was performed showing a step‐off, fitting with the radiographic image of a button battery. CT scan, performed to exclude proximity to major vessels, showed no inflammation or perforation of surrounding tissues. An urgent upper gastro‐intestinal endoscopy was performed revealing two stacked coins of 50 and 20 eurocents, which were removed without complication. Two ulcers were visualised were the coins had been blocked.
Conclusions: We present this case, demonstrating the diagnostic difficulty to distinguish between multiple coins and button batteries radiographically. However because of the possible severe complications associated with button battery ingestion, an urgent endoscopy should always be considered in similar cases.
Contact e‐mail address: Liesbet.Verbrugghe@UZBrussel.be
G‐EV074. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV074.1. CLINICAL AND NUTRITIONAL CHARACTERISTICS OF NON‐EOE EGID PAEDIATRIC PATIENTS, A SINGLE CENTRE RETROSPECTIVE STUDY
Giovanna Alfano 1,2, Lucy Jackman3, Karen Aris1, Osvaldo Borrelli4, Leanne Goh1, Edward Gaynor1
1Paediatric Gastroenterology, Division Of Allergy And Mucosal Immunity, Great Ormond Street Hospital NHS Trust, London, United Kingdom, 2Département Femme‐mère‐enfant, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, 3Department Of Dietetics, Great Ormond Street Hospital NHS Trust, London, United Kingdom, 4Paediatric Gastroenterology, Division Of Neurogastroenterology And Motility, Great Ormond Street Hospital NHS Trust, London, United Kingdom
Objectives and Study: Eosinophilic gastrointestinal disorders (EGIDs), with/without eosinophilic esophagitis (EoE), represent a heterogeneous group of conditions. We aimed to analyse clinical and nutritional characteristics associated with remission in patients with paediatric EGIDs.
Methods: We reviewed all patients diagnosed between 2014 and April 2024 with EGIDs, with/without EoE, based on the current joint ESPGHAN/NASPGHAN guidelines. For each patient we have collected weight, height, BMI and their Z‐scores, albumin, FBC and ferritin. The delta Z‐score of weight/BMI were calculated as the difference between the Z‐scores at diagnosis and at remission or last follow‐up. Analyses were stratified based on: i. complete remission (defined as histological remission from all non‐EoE EGIDs for >6 months without changes in treatment); ii. oesophageal involvement; iii. single or multiple organ involvement.
Results: A total of 21 patients were included, with a mean age of 8.1 years (SD 4.1); 71% male. Sixteen patients (76%) had multisite EGID (2 sites 52%, 3 sites 14%); gastric involvement was observed in 43%, duodenal 29%, ileal 19%, colonic 29%. Fifteen patients (71%) had associated oesophageal involvement, predominant in males (93.3%). Complete remission occurred in 81% of patients during the follow‐up period, with a median time to remission of 11.4 months (IQR 8.6;20.5). All patients who did not achieve remission presented with eosinophilic gastritis (EoG), which was statistically significant when comparing active and remission groups (p = 0.05). There was a statistically significant difference in the delta Z‐score of BMI between active and remission groups (median ‐1.1 [IQR(‐1.5;‐0.6)] vs ‐0.01 [IQR(‐0.4;0.3)]; p = 0.049). No significant difference was observed in the Z‐scores for weight/BMI at diagnosis between patients with single/multi‐site involvement. Finally, no significant difference was found regarding other biomarkers.
Conclusions: Patients with persistently active EGIDs, particularly EoG, show significant impairment in BMI over time. Early identification/treatment, including dietetic support, are crucial to achieving remission and mitigating nutritional impact.
Contact e‐mail address: giovanna.alfano@gosh.nhs.uk
G‐EV075. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV075.1. CAREGIVER BURDEN AND QUALITY OF LIFE IN PEDIATRIC EOSINOPHILIC ESOPHAGITIS
Cigdem Arikan, Pinar Arikan, Ozlem Unsal, Romina Markaroglu, Arzu Baygül
KOC UNIVERSITY HOSPITAL, PEDİATRIC HEPATOLOGY AND NUTRITION, ISTANBUL, TURKEY, ISTANBUL, Turkey
Objectives and Study: Chronic pediatric conditions place significant emotional and psychological strain on caregivers, particularly mothers. Eosinophilic esophagitis (EoE) poses unique challenges, including repeated endoscopies, prolonged disease management, and complex dietary interventions. This study compares the caregiver burden in EoE to celiac disease and healthy controls, identifying contributing factors.
Methods: This cross‐sectional survey included 182 mothers divided into three groups: children with EoE (n = 28), celiac disease (n = 42), and healthy controls (n = 112). We used validated Zahir Caregiver Burden questionnaires, short‐form Psychological Resilience, anxiety, and QoL surveys. Statistical analyses were performed by SPSS 25.
Results: Mothers of children with EoE reported the highest burden, with a mean burden score of 72.4 ± 10.3 compared to 36.8 ± 8.5 in the celiac group and 18.7 ± 7.2 in healthy controls (p < 0.05). Psychological resilience scores were significantly lower in the EoE group (25.6 ± 6.8) compared to the celiac (48.3 ± 7.4) and control groups (62.5 ± 8.1) (p < 0.05). QoL scores were also worse in the EoE group (38.1 ± 9.7) compared to celiac (55.2 ± 8.2) and controls (72.8 ± 8.6) (p < 0.05). A positive correlation was found between caregiver burden and anxiety (r = 0.424; p < 0.01) as well as depression (r = 0.243; p < 0.01). Families with lower income levels showed higher caregiver burden scores (p < 0.01). The absence of additional caregivers in the family significantly increased the burden (p < 0.01). Mothers receiving education about their child's disease reported lower anxiety scores (p < 0.05). Burden levels rose with prolonged caregiving duration, repeated endoscopic procedures, living far from centers, having other children, and no additional caregivers.
Conclusions: Mothers of children with EoE endure significant caregiver burdens. Enhancing support systems can help reduce their stress and improve their quality of life.
Contact e‐mail address: cigdemarikanmd@yahoo.com
G‐EV076. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV076.1. HIGH RATE OF SUSTAINED REMISSION OF COMBINED THERAPY IN PAEDIATRIC EOSINOPHILIC ESOPHAGITIS
Rita Bianchi De Aguiar 1, Ana Miguel Silva1, Francisco Pinto Brás2, Francisco Mourão2, Helena Silva2, Rosa Lima2, Marta Tavares2
1Pediatria, Centro Materno‐Infantil do Norte ‐ Porto, Porto, Portugal, 2Centro Materno Infantil do Norte, Porto, Portugal
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic immune‐mediated esophageal disorder. Single therapy has a declining remission rate over time and
atopy/environmental exposure may trigger relapses even under strict food eviction or medication. Combined therapy has been used in adults but there is no data regarding the paediatric population. This study aims to analyse clinical, endoscopic, histological and therapeutic data of patients under combined therapy.
Methods: Retrospective data from 2010 to 2024 included 52 patients.
Results: They were predominantly male (69%), with a mean age of symptoms onset at 9.5 years and diagnosis at 11 years. Multiple allergic comorbidities were present in 17 (32%) patients. Dysphagia was the most frequent symptom (65%), followed by food impaction (50%) and abdominal pain (27%). 67% of the patients had a diagnostic delay over 12 months. 6% of the patients had no endoscopic changes at diagnosis but esophageal striations were present in 42 patients (80.8%) and stenosis in 8 cases (15.4%). Therapy comprised food elimination (overall low compliance of
42.9%), PPI and swallowed corticosteroids (SCT). Combined therapy (SCT plus PPI/diet or both) has been used in 20 cases (38.4%) versus monotherapy in 32 patients (61,5%), 5 with SCT, 25 with PPI and 2 with diet. Overall clinical improvement was reported in 48 patients (92,3%) and sustained histologic remission was observed in 81.6% during follow‐up (62,5% on single therapy vs 93,1% combined therapy). Only 2 out of 8 stenotic phenotype patients required esophageal dilation, and 2 refractory cases were proposed to dupilumab. No statistical significance was seen between demographic, clinical, endoscopic and allergic data at diagnosis and the need for combined therapy.
Conclusions: This study highlights the personalised therapeutic of paediatric EoE. Combined therapy is described and associated with a high rate of sustained remission over time. Prospective studies are needed to support this data.
Contact e‐mail address: rita.bianchi.aguiar@gmail.com
G‐EV077. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV077.1. STENOTIC PHENOTYPE IN PAEDIATRIC EOE: CHILDREN ARE NOT SMALL ADULTS
Ana Miguel Silva1, Rita Bianchi De Aguiar 1, Ana Margarida Matias1, Francisco Mourão2, Helena Silva2, Rosa Lima2, Marta Tavares2
1Pediatria, Centro Materno‐Infantil do Norte ‐ Porto, Porto, Portugal, 2Centro Materno Infantil do Norte, Porto, Portugal
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic inflammatory esophageal condition characterized by inflammation and remodeling. In adults, the stenotic pattern of EoE is typically managed with dilation as the standard of care. In pediatrics, however, the stenotic phenotype may be reversible. This retrospective study aimed to analyze associations between clinical characteristics and therapeutic responses in stenotic EoE cases.
Methods: Chi‐square tests were used to evaluate associations between disease severity and variables such as age at diagnosis, proton pump inhibitor (PPI) doses, comorbidities, and the need for esophageal dilation.
Results: Data from 52 patients, predominantly male (69%), were analyzed from 2010 to 2024, including 8 stenotic phenotype cases. Male gender was significantly associated with stenosis (57%, p = 0.019). Stenosis was also significantly correlated with higher PPI doses (≥40 mg; p = 0.004). Other clinical features, including age at diagnosis, comorbidities (e.g., asthma and rhinitis) and gastrointestinal diseases, showed no significant associations with disease severity (p = 0.653, p = 0.838, and p = 0.959, respectively). Similarly, age at symptom onset (mostly 7–14 years) and response to initial induction treatment did not demonstrate statistical significance (p = 0.976 and p = 0.383, respectively). The rate of stenosis reversal was high (75%). Corticosteroids were beneficial and elemental diets achieved the highest histological remission rates, particularly in rescue therapy, with individualized approaches improving response rates from 65% to 80%. Only 2 patients (25%) required dilations.
Conclusions: This study highlights the role of tailored rescue treatments for severe EoE. Male patients and those requiring higher PPI doses or esophageal dilation may represent a subset with more severe disease. Unlike adults, most pediatric patients achieved remission with medical treatments, reducing the need for dilation.
Contact e‐mail address: amsousasilva.silva@gmail.com
G‐EV078. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV078.1. LINKING ALLERGEN SENSITIZATION, SYMPTOMS, AND ENDOSCOPIC FINDINGS IN PEDIATRIC EOSINOPHILIC ESOPHAGITIS: A COLOMBIAN STUDY
Natali Gonzalez1, Michelle Higuera2, Ailim Carias 3, Juan Riveros4, Jose Fernando Vera3, Catalina Ortiz5, César Augusto Moreno Serrano6, Wilson Daza6, Carlos Timossi‐Baldi7, Estefania Peña8, Carlos Cuadros9, Jhon Camacho‐Cruz10, Otto Calderon11, Adriana Prada12, Juanita Higuera12, Pablo Vasquez‐Hoyos13
1Universidad de Pamplona, Cúcuta, Colombia, 2Universidad Nacional de Colombia, Bogota, Colombia, 3Fundación Santa Fe de Bogotá, Bogotá, Colombia, 4Universidad el Bosque, Bogotá, Colombia, 5Universidad CES, Medellin, Colombia, 6Universidad El Bosque, Bogota, Colombia, 7Departamento de Investigación y Desarrollo, Mexico City, Mexico, 8Fundacion Hospital de la Misericordia, Bogota, Colombia, 9Hospital Internacional de Colombia, Bucaramanga, Colombia, 10Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud (FUCS), Sociedad de Cirugía de Bogotá‐Hospital San José, Fundación Universitaria Sanitas, Clínica Reina Sofía Pediátrica y Mujer Colsanitas, Universidad Nacional de Colombia (UNAL), Bogota, Colombia, 11Clinica Imbanaco, bogota, Colombia, 12Universidad El Bosque, BOGOTA, Colombia, 13Intensivista Pediatra, Epidemiólogo Clínico. Jefe Unidad Cuidado Intensivo Pediátrico. Jefe de Investigación departamento de Pediatría. Departamento de Pediatria, Sociedad de Cirugia de Bogota Hospital de San Jose. Fundacion Universitaria de Ciencias de, Bogota, Colombia
Objectives and Study: To evaluate the relationships between allergen sensitization, clinical symptoms, and endoscopic findings in pediatric eosinophilic esophagitis (EoE) in Colombia.
Methods: A multicenter retrospective study was conducted across 11 pediatric gastroenterology centers in Colombia. Patients with a confirmed diagnosis of EoE based on endoscopic and histological criteria were included. Data on clinical symptoms, endoscopic findings, and allergen sensitization profiles were collected. Analysis included descriptive statistics (frequencies, proportions, and measures of central tendency) and inferential methods using paired McNemar chi‐square tests and relative risk calculations to explore associations between allergens, symptoms, and endoscopic findings.
Results: The study included 141 patients, with a median age of 92 months (interquartile range, 56–144), and 66% were male. Diagnosis was delayed by more than six months in 59.4% of cases. The most common symptoms were abdominal pain (67.1%), nausea (60.1%), vomiting (46.2%), regurgitation (42.7%), and heartburn (37.1%). Dominant endoscopic findings included longitudinal furrows (71%) and esophageal edema (50%). Sensitization to cow's milk (56.6%), casein (37.2%), and egg white (38.1%) was frequent. Significant associations were observed between casein sensitization and heartburn (60%, p = 0.049) and vomiting (69.4%, p = 0.003). Almond sensitization was linked to vomiting (88.9%, p = 0.009p), and wheat sensitization was correlated with food impaction (81.8%, p = 0.042). Regurgitation was associated with cow's milk (86.7%, p < 0.001) and casein (80.9%, p < 0.001). Endoscopic findings revealed associations between cow's milk sensitization and edema (65.2%, p = 0.007), exudates (86.4%, p < 0.001), and longitudinal furrows (87.9%, p < 0.001). Wheat sensitization was linked to the crepe paper appearance (94.1%, p = 0.033).
Conclusions: This study demonstrates significant links between allergen sensitization, clinical symptoms, and endoscopic findings in pediatric EoE. These findings highlight the importance of evaluating sensitization profiles to better understand the clinical and endoscopic presentation of EoE, providing valuable insights for diagnosis and management strategies.
Contact e‐mail address: michellehiguera@yahoo.com
G‐EV079. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV079.1. ALLERGEN SENSITIZATION AND THERAPEUTIC OUTCOMES IN PEDIATRIC EOSINOPHILIC ESOPHAGITIS: INSIGHTS FROM A MULTICENTER COLOMBIAN STUDY
Michelle Higuera1, Natali Gonzalez2, Ailim Carias 1, Juan Riveros3, Jose Fernando Vera4, Catalina Ortiz5, César Augusto Moreno Serrano6, Wilson Daza6, Carlos Timossi‐Baldi7, Estefania Peña8, Carlos Cuadros9, Jhon Camacho‐Cruz10, Otto Calderon11, Adriana Prada12, Juanita Higuera12, Pablo Vasquez13
1Universidad Nacional de Colombia, bogota, Colombia, 2Universidad de Pamplona, Cúcuta, Colombia, 3Universidad el Bosque, Bogotá, Colombia, 4Fundación Santa Fe de Bogotá, Bogotá, Colombia, 5Universidad CES, Medellin, Colombia, 6Universidad El Bosque, Bogota, Colombia, 7Departamento de Investigación y Desarrollo, Mexico City, Mexico, 8Fundacion Hospital de la Misericordia, Bogota, Colombia, 9Hospital Internacional de Colombia, Bogota, Colombia, 10Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud (FUCS), Sociedad de Cirugía de Bogotá‐Hospital San José, Fundación Universitaria Sanitas, Clínica Reina Sofía Pediátrica y Mujer Colsanitas, Universidad Nacional de Colombia (UNAL), Bogota, Colombia, 11Clinica Imbanaco, bogota, Colombia, 12Universidad El Bosque, BOGOTA, Colombia, 13Universidad Nacional de Colombia, BOGOTA, Colombia
Objectives and Study: To determine the relation between allergen sensitization, clinical and endoscopic findings, and therapeutic outcomes in pediatric eosinophilic esophagitis (EoE) in Colombia.
Methods: A multicenter retrospective study was conducted across 11 pediatric gastroenterology centers in Colombia. Patients with a confirmed diagnosis of eosinophilic esophagitis (EoE) based on endoscopic and histological criteria were included. Data on demographic characteristics, clinical presentations, endoscopic findings, histological findings, allergen sensitization profiles, and treatment approaches were collected. Analysis included descriptive statistics (frequencies, proportions, and measures of central tendency) and inferential methods using paired McNemar chi‐square tests and relative risk calculations to explore associations between allergen sensitization and therapeutic outcomes.
Results: The study included 141 patients, predominantly male (66.4%), with a history of formula feeding (62.2%), personal atopy (54.6%), and allergic rhinitis (34.3%). Endoscopic findings revealed longitudinal furrows (70.8%) and esophageal edema (50.4%). Histological analysis showed eosinophilic infiltration across all esophageal segments. Serum allergen testing identified cow's milk (56.6%), casein (37.2%), and egg white (38.1%) as the most frequent IgE‐mediated triggers. Regarding treatment, 95% of patients received proton pump inhibitors (PPIs), and 41.8% underwent dietary management, including elemental formulas (40.7%) and targeted elimination diets (94.9%). Follow‐up endoscopy after a median of 5 months (interquartile range, 3–10 months) demonstrated significant reductions in longitudinal furrows (34.5%; RR 2.10; p < 0.001) and edema (30.6%; RR 1.42; p = 0.019). Histological remission, defined as an eosinophil count <15 per high‐power field, was achieved in 25.3% of cases. Treatment escalation was required in 47.3% of patients due to suboptimal response, and 26.7% required stricter dietary restrictions.
Conclusions: This study highlights the critical interplay between allergen sensitisation and therapeutic strategies in paediatric EoE. Targeted dietary and pharmacological interventions achieved clinical and endoscopic improvements, although challenges remain in optimising histological remission. These findings underscore the need for personalised approaches to EoE management.
Contact e‐mail address: michellehiguera@yahoo.com
G‐EV080. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV080.1. INVESTIGATING THE ROLE OF AUTOPHAGY AND OXIDATIVE STRESS IN EOSINOPHILIC OESOPHAGITIS: PRELIMINARY FINDINGS
Sohail Aziz1, Mara Creoli2, Anna Valanzano3,4, Antonietta Tarallo3,4, Antonia Assunto3,4, Carla Damiano3,4, Martina Milano2, Diego Torre2, Antonio Colucci 2, Claudia Chiantese5, Marianna Casertano5, Giancarlo Parenti3,4, Caterina Strisciuglio2
1Department Of Experimental Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy, 2Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy, 3Telethon Institute of Genetics and Medicine, Napoli, Italy, 4Department Of Translational Medical Science, University of Naples "Federico II", Napoli NA, Italy, 5Department Of Translational Medical Science, Section Of Pediatrics, University of Naples "Federico II", Napoli NA, Italy
Objectives and Study: Eosinophilic Esophagitis (EoE) is a chronic immune‐ and antigen‐mediated clinicopathological condition with complex aetiology. Autophagy plays a critical role in maintaining cellular redox balance and homeostasis, particularly following exposure to the inflammatory environment of EoE. Present study focuses on evaluating the role of autophagy and oxidative stress in paediatric EoE patients.
Methods: Esophageal biopsies were obtained during upper endoscopy, which was performed according to standard clinical protocols for the diagnosis of EoE. Non‐EoE controls were subjects with upper gastrointestinal symptoms who had normal endoscopic and histological findings, with a conclusive diagnosis of functional dyspepsia. Medial oesophagus biopsies were used for evaluating autophagic and oxidative stress markers via western blots and microscopic evaluation. Furthermore, apoptosis and inflammatory markers were also evaluated in this cohort of patients and controls. Statistical analysis was performed using SPSS version 27. P‐values < 0.05 were considered statistically significant.
Results: This pilot study included five EoE patients at diagnosis and five controls. The oxidative stress marker P‐p38 and phospho‐ERK were both underexpressed in EoE patients in comparison to control, and this was statistically significant for P‐p38 (p = 0.034). Conversely, LC3 and p62 autophagy markers were highly expressed in EoE patients in comparison to controls, and the difference was statistically significant (p < 0.001) for both markers. Furthermore, we observed an overexpression of the apoptotic marker Caspase9 in EoE patients, although it did not reach statistical significance. We are further investigating the levels of oxidative stress by standard tests that evaluate ROS levels (2′,7′‐dichloro dihydrofluorescein, DCFDA); lipid peroxidation (Thiobarbituric Acid Reactive Substances, TBARS); and GSH levels (5,5′‐dithiobis‐2‐nitrobenzoic acid, DTNB).
Conclusions: These preliminary findings offer valuable insights into the role of autophagy in the pathogenesis of EoE. Autophagy over‐expression appears to function as a compensatory and cytoprotective mechanism, helping to preserve epithelial redox balance and homeostasis under the stress associated with EoE‐related inflammation.
Contact e‐mail address: caterina.strisciuglio@unicampania.it
G‐EV081. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV081.1. NEW‐ONSET IGE MEDIATED REACTIONS IN EOSINOPHILIC ESOPHAGITIS ASSOCIATED ELIMINATION DIETS (NIMREEDS)‐ A MULTICENTER STUDY
Shiri Cooper 1, Francesca Rea2, Salvatore Oliva3, Gloria Domínguez‐Ortega4, Cigdem Arikan5, Tzippora Shalem6, Shishu Sharma7, Monica Malamisura2, Raanan Shamir1,8, Noam Zevit1,8
1Institute Of Gastroenterology, Nutrition, And Liver Diseases, Schneider Children's Medical Center of Israel, petach tikva, Israel, 2Gastroenterology And Nutrition Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy, 3Pediatric Digestive Endoscopy, Pediatric Gastroenterology And Liver Unit, University Hospital Umberto, Sapienza University of Rome, Rome, Italy, 4Hospital Universitario Niño Jesús, Madrid, Spain, 5Koc University School of Medicine, Istanbul, Turkey, 6Shamir Medical Center, Zriffin, Israel, 7Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom, 8Faculty Of Medicine & Health Sciences, Tel‐Aviv University, Tel‐Aviv, Israel
Objectives and Study: Empiric Elimination diets(ED) remain a cornerstone of treatment for eosinophilic esophagitis (EoE). Although new‐onset IgE‐mediated reactions in EoE associated elimination diets (NIMREEDs) during the food reintroduction phase are uncommon, these poorly understood adverse events raise concerns for both patients and physicians.
Methods: A multi‐center, retrospective study collected data of children with NIMREEDs. Data included demographics, medical and atopic history, EoE diagnosis and treatment, NIMREED event characteristics, and outcomes.
Results: Between 2023‐2024, 16 NIMREEDs were reported (69% males). The median age(IQR) was 7.25 (3.3‐12) years at the time of the reaction. Fifteen patients (93.7%) reported additional atopic conditions. Clinical and histological improvement on ED were reported in 13 (81%) and 5 (31%) patients respectively. The median time interval between initiation of the ED to the first exposure to the food which caused a NIMREED was 18 (9‐22.5) months. The NIMREED occurred in response to milk in the majority of patients (13, 81.25%), eggs (2, 12.5%), and soy (1, 6.25%), following the first attempt at resuming the eliminated food in 9 (56%), the second attempt in 4(25%) and in later attempts in 3(19%). The definitive reactions included: rash or hives (81.25%), angioedema (31.25%), respiratory symptoms (18.75%), and anaphylaxis (6.25%). Allergy tests were positive in 9/9 patients prior to food re‐introduction. At last follow‐up, nine patients (56.2%) were still avoiding causative food, allergy spontaneously resolved in five (31.25%), one successfully completed oral immunotherapy and one was still undergoing oral immunotherapy.
Conclusions: This is the largest cohort to date of NIMREEDs which are rare yet concerning adverse event for patients undergoing ED in the treatment of EoE. Most patients have additional atopic conditions. Positive allergy tests prior to reintroduction may help predict the risk of developing NIMREEDs. This poorly recognized phenomenon should be discussed with patients during the shared decision‐making process while choosing treatments for EoE.
Contact e‐mail address: shirabe61@gmail.com
G‐EV082. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV082.1. ELIMINATION DIET RESPONSE IN EOSINOPHILIC ESOPHAGITIS PATIENTS WITH OR WITHOUT IGE‐MEDIATED FOOD ALLERGY
Marcela D'alessandro 1, Marta Freixas Bermejo2, Saray Mesonero Cavia2, Marina Alvarez Beltran2, Judith Raya Muñoz2, Vanessa Cabello Ruiz2, Susana Redecillas Ferreiro2, Oscar Segarra Canton2
1Pediatric Department, Pediatric Gastroenterology and Nutritional Support Unit Vall d'Hebron Barcelona Hospital Campus., Barcelona, Spain, 2Hospital Universitari Vall d'Hebrón, Barcelona, Spain
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease characterized by symptoms of esophageal dysfunction and an eosinophil infiltration on histology. Food antigens are the most commonly trigger implicated on their immune mechanism pathology. Although six‐food elimination diet (SFED) induces remission in the majority of patients with EoE, a step‐up approach and empiric individualized diet is recommended.
Methods: A retrospective descriptive study including patients with EoE who underwent an elimination diet treatment between 2014 and 2024. Sex, age at diagnosis, atopic disease, IgE‐mediated food allergy (IgE‐FA) and lipid transfer protein (LTP) syndrome history were collected. Patients were classified into 2 groups according to food allergy history or not. Moreover, IgE‐FA group was subclassified into LTP positive or negative. Diet approach consisted in elimination of 2, 4, 6 or prick test‐guided foods. Treatment response was verify based on clinical, endoscopic and histology features before and after diet approach.
Results: A total of 41 patients (90.25% male) with a median age at diagnosis of 10 years (range 6.2‐ 14.6). IgE‐FA group (21/41) had a 90.5% of atopic history, however, non‐IgE‐FA group (20/41) only 35%. The 65% (13/20) in non‐IgE‐FA group achieved remission. Food involved was cow milk (CM) (7/13), wheat (2/13), legumes (1/13). In 3/13 of them, the offending food was not able to find. Only 33.3% (7/21) in IgE‐FA group achieved remission (4/7 was LTP positive). Food involved was CM (7/7), wheat (1/7) and egg (1/7). No patient who underwent a prick test‐guided diet elimination (0/2) achieved remission.
Conclusions: Food allergy and atopic history are common risk factors associated in EoE patients but in this study we observed a worse response in food eliminated diet than in non‐IgE FA group (65% vs 33.3%). Surprisingly, our LTP positive group achieved a better remission (57%).
Contact e‐mail address: marcela.dalessandro@gmail.com
G‐EV083. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV083.1. PARENTAL PREFERENCES AND CONCERNS REGARDING EOSINOPHILIC ESOPHAGITIS TREATMENTS: A CROSS‐SECTIONAL SURVEY STUDY
Adi Eindor 1, Vered Richter2, Efrat Broide2, Maya Granot3, Eytan Damari4, Tzippora Shalem2
1Shamir medical center, Zeriffin, Israel, 2Shamir Medical Center, Zriffin, Israel, 3Pediatric Gastroenterology Unit, Edmond & Lily Safra Children's Hospital, Sheba Medical Center, Ramat‐Gan, Faculty of Medicine, Tel‐Aviv University, Tel Aviv, Israel, 4Assuta Ashdod, Ashdod, Israel
Objectives and Study: Eosinophilic Esophagitis (EoE) affects children's quality of life and places a significant burden on their families. Available first‐line induction therapies include empiric elimination diets, daily oral proton pump inhibitors (PPIs), and oral topical steroids, with no evidence favoring one treatment over another. Dupilumab, an anti‐IL‐4/IL‐13 antibody administered subcutaneously (SC) once weekly, has shown efficacy in treating EoE and other atopic conditions, such as asthma, atopic dermatitis, and nasal polyposis. This study aimed to explore parental preferences regarding EoE treatment options and assess their concerns about the disease and its management.
Methods: This cross‐sectional, multicenter survey study invited parents of children with EoE to complete an online questionnaire addressing disease characteristics, treatment preferences, and parental concerns.
Results: Fifty‐two parents participated; 88.46% were female, with a median age of 41 years. Children's median age at diagnosis was 7 years, with a median of 2 years since diagnosis. Comorbid atopic conditions were present in 78.85%. Current treatments included PPIs (51.92%), topical steroids (55.77%), elimination diets (19.23%), and biologic therapy (9.61%). Most parents (69.23%) preferred oral treatments, though 19% favored weekly SC injections. If SC injections were more effective than oral therapies, 30.77% preferred them as first‐line treatment, and 51.92% favored SC biologics if they addressed multiple atopic conditions. Concerns included chronic medication dependency (80.76%) and side effects (61.53%), though fewer parents expressed worry about the disease's direct impact on their child's well‐being (63.46%) or future quality of life (36.54%).
Conclusions: While oral treatments were preferred, many parents were receptive to SC biologics if they provided enhanced efficacy or addressed multiple atopic conditions. Despite concerns about medication dependency and side effects, fewer parents worried about the disease's direct impact on their child's quality of life.
Contact e‐mail address: adiei@shamir.gov.il
G‐EV084. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV084.1. VARIABILITY OF FORMULATION AND USE OF SWALLOWED TOPICAL CORTICOSTEROIDS IN PAEDIATRIC EOSINOPHILIC ESOPHAGITIS IN SPAIN
Tamara Arauzo Otero1, Alejandro García Díaz 2, Pilar Guadalupe Tena García1, Sonia Fernández Fernández3, Gloria Domínguez‐Ortega4, Víctor Vila Miravet5, Roger García Puig6, Carolina Gutiérrez Junquera2, Eoe Working Group (Seghnp)7
1Hospital Severo Ochoa, Leganés (Madrid), Spain, 2Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain, 3Hospital Universitario Svereo Ochoa. Leganés, Madrid, Spain, 4Hospital Universitario Niño Jesús, Madrid, Spain, 5Hospital Sant Joan de Deu, Barcelona, Spain, 6Hospital Mutua Terrassa, Barcelona, Spain, 7SEGHNP, Madrid, Spain
Objectives and Study: The absence of specific topical swallowed corticosteroids (STC) for treatment of Eosinophilic Esophagitis (EoE) in Paediatrics leads to the use of a variety of drugs and formulations in clinical practice. Our aim is to describe the prescription patterns of topical corticosteroids in Paediatric EoE in Spain.
Methods: An online survey was developed using the RedCap platform and distributed to all Spanish Pediatric Gastroenterology Society members, requesting one response per Hospital. The surveys were analyzed two months later using descriptive statistics.
Results: The survey was answered by 82 professionals from 14 autonomous communities. The majority of the respondents (62.2%) treat around 10‐50 patients with EoE. The 50% of physicians prescribe SCT as treatment, usually as a second‐line treatment. The most commonly used corticosteroid is oral viscous budesonide (BOV) (90%), followed by nasal fluticasone (24.3%), inhaled fluticasone (4.9%) and budesonide in vials for nebulization (5%). The most commonly used BOV formulation is a magistral formulation prepared in non‐hospital pharmacies (62%), followed by home‐preparated formulation (24%) and hospital pharmacies (13%). The concentrations of budesonide used varied among 0.5 mg/ml (54.7%), 0.25 mg/ml (46.7%), 0.2 mg/ml (18.4%) and 0.1 mg/ml (5.3%). In terms of composition, five formulations have been reported, the two main excipients were methyl cellulose or xanthan gum. In home preparations, the excipients used are dextrinomaltose (78,9%) and sucralose (21,1%). Eleven patients (13.3%) were treated with orodispersible budesonide, 81.8% were older than 10 years old, 72.7% were refractory to treatment and 27.3% with fibrostenotic phenotype.
Conclusions: BOV is the most commonly used formulation. Although the magistral formula prepared in pharmacies is the most commonly used, there are differences in terms of concentration and composition. The results show a wide variability in the use of SCT, highlighting the need for standardization of this treatment.
Contact e‐mail address: tamaraarauzo.med@gmail.com
G‐EV085. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV085.1. IS PASSED INFANTILE COW'S MILK PROTEIN ALLERGY IS MORE COMMON IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
Nelgin Gerenli 1, Fulden Coskuner1, Tugce Ibis1, Ebru Zemheri2
1Pedlatrlc Gastroenterology, University of health sciences/umraniye research hospital, Istanbul, Turkey, 2Pathology, University of health sciences/umraniye research hospital, Istanbul, Turkey
Objectives and Study: Cow's milk protein allergy (CMPA) is a common food allergy, especially in infancy CMPA (often non‐IgE mediated), which alleviates beyond two years of age. Cow's milk protein is one of the major food triggers for development of eosinophilic esophagitis (EoE) in children. Compared to other children, infants with CMPA are prone to functional gastrointestinal disorders and inflammatory bowel diseases as shown in many recent studies. The exact link between passed CMPA and EoE predisposition later in life has not been investigated. Our aim is to evaluate the association of passed infantile CMPA and EoE, comparing this association in patients with non‐eosinophilic esophagitis (Non‐EoE).
Methods: Patients with definitive diagnosis of EoE and non ‐EoE between 2000‐2005 were recruited. Demographic data of both groups were obtained from hospital charts. EoE was diagnosed according to clinical symptoms, endoscopic and histologic findings, with a esophageal mucosal count ≥ 15 eosinophils/high power field. Patients with peptic complaints and esophagitis with no eosinophilic infiltration on histopathological assessment were assigned as comparison group. Patients’ history for passed CMPA was recorded according to health system chards and verbal parenteral statement.
Results:
Findings of 31patients (23 males) with definitive EoE diagnosis without other eosinophilic diseases (like gastritis, enteritis or colitis) were compared to 32 Non‐EoE patients (21 males). The demographic, clinical and laboratory characteristics of EoE and Non‐EoE patients are shown on Image‐1. Number of patients with history of infantile CMPA were significantly higher in EoE group than in the non‐EoE group (7:1 respectively).
Conclusions: EoE is a multifactorial esophageal inflammation that includes IgE‐mediated and nonmediated food allergies. Milk is one of the major food triggers for development of EoE. History of infantile CMPA may also play role in development of EoE in later life.
Contact e‐mail address:
G‐EV086. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV086.1. CHARACTERIZATION OF A PEDIATRIC POPULATION WITH EOSINOPHILIC ESOPHAGITES – A SINGLE CENTER EXPERIENCE
Cláudia P. Gonçalves 1, Ana João Fernandes1, Diana Rita Oliveira1,2, Joana Vilaça1,2, Filipa Neiva1,2
1Pediatric Department, Local Health Unit of Braga, Braga, Portugal, 2Pediatric Gastroenterology, Hepatology And Nutrition Department, Local Health Unit of Braga, Braga, Portugal
Objectives and Study: Eosinophilic esophagitis (EOE) is a chronic inflammatory disease of the esophagus. The aim of our study is to describe the pediatric population with EOE in a tertiary‐level center, including demographic data, presented symptoms, treatment options and outcomes.
Methods: Retrospective, observational study that included all pediatric patients diagnosed with EOE in our center, between January 1st 2014 and December 1st 2024.
Results: A total of 26 patients were included, 85% males. Mean age at diagnosis was 10 years, mean follow‐up was 45 months. Regarding comorbidities, one patient underwent an esophageal atresia correction, one patient had type 1 diabetes and 54% had atopic conditions. A family history of allergies was present in 58% of patients. At diagnosis, 92% presented with more than one symptom, choking being the predominant complaint (69%), dysphagia (54%) and food impaction (50%). The most common finding at the first endoscopy was the presence of longitudinal striae (38%), however 19% had a normal macroscopic appearance; histologically, 8% met additionally the criteria for eosinophilic duodenitis. Mean number of endoscopies performed per patient was 4 (range 1‐8). Monotherapy was the first‐line treatment in 58% of cases (31% started on proton bomb inhibitors and 19% on swallowed topical steroids), followed by dual therapy (35%) and triple‐modality treatment (8%). During follow‐up, 62% of patients required treatment adjustments and 35% admitted non‐compliance with treatment. One patient is awaiting approval to initiate Dupilumab. Histological remission was achieved in 27%.
Conclusions: EOE is a demanding disease primarily due to the clinical‐histological dissociation reported, but also because there is still no ideal steroid formulation to achieve optimal therapeutic results. The final purpose of our study is to optimize the follow‐up, both at a therapeutic level and in terms of educating caregivers, in order to achieve better treatment compliance and higher remission rates.
Contact e‐mail address:
G‐EV087. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV087.1. RELATIONSHIP BETWEEN DISEASE ACTIVITY AND ABSOLUTE EOSINOPHIL COUNT AND SERUM IGE LEVEL IN PEDIATRIC PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
Burcu Güven, Semra Atasoy Yilmaz, Zeynep Sağnak Yilmaz, Ismail Saygin, Serdar Karakullukçu, Murat Çakir
Pediatric Gastroenterology, Karadeniz Technical University, Trabzon, Turkey
Objectives and Study: Clinical improvement does not reflect mucosal healing in the evaluation of response to treatment in eosinophilic esophagitis (EoE), and thus repeated endoscopies and eosinophil count on esophageal biopsy are still needed. Given that endoscopy is an invasive, risky, and costly method, noninvasive biomarkers that could practically indicate inflammation are needed to evaluate the treatment response.
Methods: The study included pediatric patients aged 0‐18 years diagnosed with EoE. Age, gender, presenting complaints, comorbid allergic diseases, absolute eosinophil count (AEC), serum total IgE, and specific IgE (sIgE) levels were recorded retrospectively. All endoscopic examinations were performed by the same two experienced pediatric gastroenterologists. Biopsy samples were re‐evaluated by two experienced pathologists.
Results: The study included 30 patients comprising 25 (83.3%) boys and 5 (16.7%) girls with a mean age of 6.93 ± 4.47 (range, 2‐16) years. Esophageal eosinophilic density established no significant correlation with total IgE level (p = 0.75), while it was correlated with AEC (p = 0.005, r = 0.248). Both IgE (1843.1 kU/L vs. 420.8 kU/L, p < 0.05) and AEC (1073.8/µL vs. 436.3/µL, p < 0.05) were found to be significantly higher in patients with eosinophilic microabscess. In ROC analysis, AEC was found to have a predictive value in the diagnosis of EoE (AUC: 0.609, 95% CI: 0.51‐0.71, p = 0.022) at a cut‐off value of 395/µL, with a sensitivity, specificity, PPV, and NPV of 58.1%, 64.2%, 47.5%, and 53.5%, respectively.
Conclusions: Although AEC appears to be a usable parameter in the follow‐up of the patients, it is not sufficient as a biomarker alone for the prediction of EoE.
Contact e‐mail address:
G‐EV088. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV088.1. RELATIONSHIP BETWEEN DISEASE ACTIVITY AND ABSOLUTE EOSINOPHIL COUNT AND SERUM IGE LEVEL IN PEDIATRIC PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
Burcu Güven, Semra Atasoy Yilmaz, Zeynep Sağnak Yilmaz, Ismail Saygin, Serdar Karakullukçu, Murat Çakir
Pediatric Gastroenterology, Karadeniz Technical University, trabzon, Turkey
Objectives and Study: Clinical improvement does not reflect mucosal healing in the evaluation of response to treatment in eosinophilic esophagitis (EoE), and thus repeated endoscopies and eosinophil count on esophageal biopsy are still needed. Given that endoscopy is an invasive, risky, and costly method, noninvasive biomarkers that could practically indicate inflammation are needed to evaluate the treatment response.
Methods: The study included pediatric patients aged 0‐18 years diagnosed with EoE. Age, gender, presenting complaints, comorbid allergic diseases, absolute eosinophil count (AEC), serum total IgE, and specific IgE (sIgE) levels were recorded retrospectively. All endoscopic examinations were performed by the same two experienced pediatric gastroenterologists. Biopsy samples were re‐evaluated by two experienced pathologists.
Results: The study included 30 patients comprising 25 (83.3%) boys and 5 (16.7%) girls with a mean age of 6.93 ± 4.47 (range, 2‐16) years. Esophageal eosinophilic density established no significant correlation with total IgE level (p = 0.75), while it was correlated with AEC (p = 0.005, r = 0.248). Both IgE (1843.1 kU/L vs. 420.8 kU/L, p < 0.05) and AEC (1073.8/µL vs. 436.3/µL, p < 0.05) were found to be significantly higher in patients with eosinophilic microabscess. In ROC analysis, AEC was found to have a predictive value in the diagnosis of EoE (AUC: 0.609, 95% CI: 0.51‐0.71, p = 0.022) at a cut‐off value of 395/µL, with a sensitivity, specificity, PPV, and NPV of 58.1%, 64.2%, 47.5%, and 53.5%, respectively.
Conclusions: Although AEC appears to be a usable parameter in the follow‐up of the patients, it is not sufficient as a biomarker alone for the prediction of EoE.
Contact e‐mail address:
G‐EV089. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV089.1. AN UNUSUAL PRESENTATION OF AN EOSINOPHILIC OESOPHAGITIS IN AN ADOLESCENT
Bruno Hauser 1, Pieter Jan Poortmans2, Liesbet Verbrugghe1, Koen Huysentruyt1
1Paediatric Gastroenterology, Hepatology And Nutrition, KidZ Health Castle Universitair Ziekenhuis Brussel, Brussels, Belgium, 2Gastroenterology, Universitair Ziekenhuis Brussel, Brussels, Belgium
Objectives and Study: Eosinophilic oesophagitis (EoE) generally presents with symptoms of oesophageal dysfunction.
Methods: Case report.
Results: A 14‐year‐old boy presented to the emergency department (E.D.) with thoracic pain since one day. He had been diagnosed with EoE at the age of 9 years presenting with food impaction but was lost to follow‐up after his initial diagnosis. At the E.D. he also presented with 2 episodes of hematemesis of which the second emesis contained a large blood cloth of +/‐ 10 cm in length for which an urgent upper gastrointestinal endoscopy (UGIE) was performed. The UGIE showed a long mucosal tear of about 10 cm in length in the mid‐oesophagus with some oozing medially and a bleeding vessel distally in the defect (figure 1a: white arrow: tear, black arrow: furrows). Coagulation with hot biopsy forceps was performed at both sites, obtaining haemostasis. Both sites were then successfully clipped using through‐the‐scope clips. At further inspection, furrows of the oesophagus were seen, raising the suspicion of underlying EoE. Oesophageal biopsies confirmed the diagnosis of EoE with peak eosinophil counts of 250, 350 and 240 eosinophils/mm² respectively at the distal, medial and proximal oesophagus (normal < 60 eosinophils/mm²). A treatment was started with high‐dose proton pump inhibitors (PPI). A control UGIE that was performed one month later showed a healed scar in the oesophagus but furrows of the oesophagus remained present (figure 1b). Oesophageal biopsies showed however a marked decrease in peak eosinophil counts of 90, 70 and 30 eosinophils/mm² respectively at the distal, medial and proximal oesophagus. He was continued on high‐dose of PPI and remains asymptomatic to date.
Conclusions: We present a case of an adolescent with an EoE who presented with hematemesis due to a large oesophageal mucosal tear. Local endoscopic treatment was needed for hemostasis. There was no recurrent hematemesis afterwards on high‐dose PPI.
Contact e‐mail address: bruno.hauser@uzbrussel.be
G‐EV090. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV090.1. INCREASING INCIDENCE OF EOSINOPHILIC ESOPHAGITIS AT A TERTIARY CARE PEDIATRIC CENTER IN FINLAND DURING THE YEARS 2004‐2023
Maria Jansson 1, Laura Merras‐Salmio2, Kaija‐Leena Kolho3
1Pediatric Gastroenterology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, 2Childrens Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, 3Department of Paediatric Gastroenterology, Children's Hospital, HUS and University of Helsinki, Helsinki, Finland
Objectives and Study: Primary Eosinophilic Esophagitis (EoE) has for unproven reasons been increasingly diagnosed in the pediatric population. This retrospective study aims to describe the EoE incidence and presentation of patients diagnosed and treated at our tertiary pediatric center in southern Finland during the past twenty years.
Methods: In this single‐center study, we used hospital endoscopy and histology records to identify patients between the ages of 2 and 18 who were diagnosed with and/or treated for EoE at HUS New Children's Hospital in Helsinki, Finland, from 2004 to 2023.
Results: We identified 61 patients meeting the criteria for EoE during the 20 years. The median age at diagnosis was 6 years (IQR 3‐12 y) and 70 % (n = 43) were male. There were 31 patients (51%) in the preschool (2‐6 y) age group, 16 (26%) in the school age (7‐12 y) group, and 14 (23%) in the adolescent (13‐18 y) group. In our urban catchment area of 320 000 children (ages 2‐18 y), the median incidence over the years 2004‐2013 was 0.17/100 000 children and 1.43/100 000 children over the years 2014‐2023 (Figure 1). The median incidence over the last 5 years was 1.55/100 000 children, 2.46/100 000 and 0.65/100 000 for males and females, respectively. Figure 1 The incidence of EoE over time.
Conclusions: The incidence of EoE has increased during the last decades. Boys are affected more often than girls. Surprisingly, EoE was frequent in the youngest age group.
Contact e‐mail address: maria.jansson@hus.fi
G‐EV091. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV091.1. EOSINOPHILIC GASTRITIS ASSOCIATED WITH NON‐IGE‐MEDIATED COW'S MILK PROTEIN ALLERGY IN INFANTS: A RETROSPECTIVE ANALYSIS
Tarek Kasri 1, Hocine Sklab2, Amel Benferchouli3, Hassina Ahmane3
1Private pediatric gastroenterology center, Bejaia, Algeria, 2Private Pathology Laboratory center, Bejaia, Algeria, 3Department Of Pediatrics, Centre hospitalo‐universitaire Khelil amrane, Bejaia, Algeria
Objectives and Study: Gastrointestinal symptoms of cow's milk protein allergy (CMPA), such as esophagitis and gastritis, are known, but data on gastritis specifically caused by CMPA remain limited. This study investigates the symptoms, endoscopic findings, histology, and clinical outcomes in infants with CMPA‐induced eosinophilic gastritis.
Methods: We retrospectively analyzed infants referred for upper gastrointestinal endoscopy due to hematemesis from 2020 to 2023. Eosinophilic gastritis was diagnosed by finding more than 30 eosinophils per high‐power field (HPF). CMPA was confirmed through oral food challenge (OFC) or symptom resolution after cow's milk protein (CMP) exclusion. Data on demographics, medical history, endoscopic and histological findings, IgE levels, and outcomes were reviewed.
Results: Eleven infants, including 9 females, were included in this study. Hematemesis was observed in all cases (100%), accompanied by vomiting in 4 cases (36.4%), failure to thrive in 4 cases (36.4%), and gastroesophageal reflux disease in 1 case (9.1%). Symptoms began at a median of 5 months (range: 1–11 months) after the introduction of cow's milk formula. Milk‐specific IgE was negative in all cases, indicating a non‐IgE‐mediated mechanism. Endoscopic findings revealed erosive gastritis in 10 cases (90.9%) and erythematous gastritis in 1 case (9.1%). Histopathological examination confirmed eosinophilic gastric infiltration in all patients (Figure 1), with additional eosinophilic bulbitis in 3 cases (27.3%). All infants were managed with an extensively hydrolyzed cow's milk protein formula, resulting in rapid symptom resolution. Oral food challenges conducted after 4 weeks of CMP exclusion in 6 patients (54.5%) yielded positive results. Following continued CMP exclusion, 10 patients (90.9%) acquired tolerance at a median of 8 months (range: 6–17 months). One patient progressed to an IgE‐mediated form of CMPA.
Conclusions: This study underscores the importance of recognizing non‐IgE‐mediated CMPA as a cause of eosinophilic gastritis. Early diagnosis and milk exclusion are essential for rapid improvement and long‐term tolerance.
Contact e‐mail address:
G‐EV092. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV092.1. ASSESSMENT OF THE QUALITY OF LIFE IN PEDIATRIC PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
Farah El Yaakoubi, Julie Nguyen, Assaad Salame, Eleni Iliadis, Patrick Bontems, Kallirroi Kotilea
Pediatric Gastroenterology, Hopital Universitaire des Enfants Reine Fabiola. Hopital Universitaire de Bruxelles., Brussels, Belgium
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic immune‐mediated inflammatory disease of the esophagus. Its prevalence is rising, and its pathophysiology is increasingly understood. Despite advances in management strategies, including pharmacological and dietary interventions, the long‐term impact of EoE on patients' quality of life (QoL) is poorly studied. This study seeks to fill this gap by evaluating the QoL of children and adolescents with EoE and exploring the factors that influence their well‐being.
Methods: This prospective, monocentric study was conducted in a tertiary pediatric gastroenterology clinic in Brussels, Belgium, involving children and adolescents aged 2 to 18 years, diagnosed with EoE. QoL was assessed using two validated questionnaires: One specific to EoE symptoms: Pediatric Eosinophilic Esophagitis Symptom Scores (PEESS v2.0) and one generic: Pediatric Quality of Life (PedsQL v3.0).
Results: The cohort consisted of 51 children. 34 patients (66.7%) with a history of allergic conditions and 17 patients (33.3%) with additional gastrointestinal disorders (GERD, Crohn's disease, celiac disease, esophageal atresia). Among the patients, 32 (62.7%) achieved endoscopic remission, and 25 (49%) achieved histological remission. The median PEESS score was 17/80, while the median PedsQL score was 80.16/100. Importantly, no significant correlation between these scores and endoscopic or histological remission status was found, highlighting the complexity of EoE's impact and follow‐up. On average, patients underwent five endoscopies throughout their treatment.
Conclusions: This study represents a step in understanding the broader implications of EoE beyond histological remission. While the clinical scores (PEESS and PedsQL) show promise in assessing QoL, they underscore the need for a comprehensive approach to patient care that includes not just symptom control but also emotional and social support. Our findings emphasize that endoscopic, histological, clinical, and quality of life assessments remain essential in the follow up of EoE patients and should be conducted concomitantly.
Contact e‐mail address: kalliroy.kotilea@ulb.be
G‐EV093. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV093.1. TOLERABILITY OF GOAT MILK PROTEIN IN EOSINOPHILIC ESOPHAGITIS PATIENTS WITH COW MILK PROTEIN TRIGGER – INTERIM RESULTS
Oren Ledder 1, Raffi Lev‐Tzion2, Dotan Yogev3, Esther Orlanski‐Meyer3, Eyal Shteyer4, Luba Plotkin3, Shira Stefansky4, Noam Zevit5
1The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel, 2The Juliet Keidan Institute Of Paediatric Gastroenterology Hepatology And Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel, 3Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Jerusalem, Israel, 4The Juliet Keiden Institute Of Pediatric Gastroenterology And Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel, 5Institute Of Gastroenterology, Nutrition, And Liver Disorders, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
Objectives and Study: Milk is the most frequent dietary trigger for Eosinophilic Esophagitis (EoE). Restrictive diets are often challenging for patients and contribute to a reduced quality of life. There is limited data on the cross‐reactivity of milk from other species. We aim to assess tolerability and safety of goat's milk in patients with EoE in whom cow's milk has been confirmed to be a trigger food for their disease.
Methods: Prospective, multi‐center trial includes patients with EoE who were confirmed to have cow's milk as a trigger. Baseline symptom profile (measured by Pediatric Eosinophilic Esophagitis Symptom Score (PEESS v2.0)) and esophagoscopy with routine biopsies (assessed by Eosinophilic Esophagitis Reference Score (EREFS) and Eosinophilic Esophagitis Histology Scoring System (EoEHSS)), were assessed. Goat milk containing diet was commenced with ≥1 serving daily until week 12, and then ad lib. Repeat symptom profile at 6, 12 and 52 weeks and repeat esophagoscopy at 12 and 52 weeks.
Results: Interim results from nine patients; median age 5 years (IQR 2‐9); 8 (78%) male. Baseline PEESS 11.25 (IQR 7.9‐17.5), EREFS 0 (0‐1), EoEHSS 0 (0‐0.01). At week 12, 7/9 (78%) had unchanged or improved PEESS. Amongst these seven patients, six (67% overall) had unchanged or improved EREFS, and five (56%) had unchanged EoEHSS with only minor increased score two. Three patients followed to 52 weeks with further drop in PEESS in all, and normal EREFS and EoEHSS in the two who repeated endoscopy.
Conclusions: Goat milk protein was tolerated in at least 56% of patients with EoE in whom dairy was a confirmed trigger. A further 22% of patients had subtle elevation of EoEHSS of uncertain significance. This is novel data which may improve quality of life for EoE patients on restricted diet. Recruitment for this study is ongoing and the full results will be published.
Contact e‐mail address: orenl@szmc.org.il
G‐EV094. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV094.1. EVALUATION OF THE USE OF ORODISPERSIBLE BUDESONIDE FOR EOSINOPHILIC OESOPHAGITIS IN A SINGLE TERTIARY PAEDIATRIC CENTRE
Elizabeth Morrisroe, Sian Copley, Rachel Wood, Afreen Mushtaque
Royal Manchester Children's Hospital, Manchester, United Kingdom
Objectives and Study: Eosinophilic oesophagitis (EOE) is an antigen mediated inflammatory disorder of the oesophagus; defined by symptoms of oesophageal dysfunction and histological findings of eosinophilic infiltration.1 Management include dietary eliminations, proton pump inhibitor (PPI) therapy and topical steroids. Oral viscous budesonide (OVB) is most commonly used but is often associated with difficulties in administration due to preparation with artificial sweetener.2 Orodispersible budesonide (ODB) is an alternative but is only licensed in over 18 years.2 The aim of this study was to evaluate management strategies in patients with EOE in a single tertiary paediatric centre. Specifically comparing the use of ODB in the paediatric cohort compared with more traditional treatment strategies (PPI, dietary exclusion, OVB or combination therapy).
Methods: A retrospective review of patient records identified 45[SC1] patients diagnosed with EOE between 2012 and 2024 (41 male, 4 female) with age ranging from 2 to 16 years at presentation. Data was collected on symptoms at presentation, histological findings, therapeutic management and clinical remission status.
Results: 13 patients were treated with monotherapy (PPI, ODB, OVB or dietary exclusion) and 32 received combination therapy. 9 patients were treated with dietary exclusion‐ 1 with exclusion alone; 8 with combination medical/dietary therapy. 6/9 patients (85%) who received ODB/PPI were in clinical remission (the remaining patient yet to be reassessed). The 2 patients receiving ODB monotherapy were awaiting reassessment. 13/17 (76%) patients who received OVB/PPI were in clinical remission. 2/4 (50%) patients treated with PPI/OVB/dietary[SC1] exclusion were in clinical remission.
Conclusions: The numbers remain small; but this study reflects slightly improved clinical remission rates in patients using ODB. This study also highlights the inconsistent implementation of elimination diets based on patient reported symptoms and specific IgE allergy testing. Orodispersible budesonide seems to be a promising option but more data needs to be collected on clinical and histological outcome.
Contact e‐mail address:
G‐EV095. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV095.1. HELICOBACTER PYLORI AS A POTENTIAL CAUSE OF REVERSIBLE ESOPHAGEAL EOSINOPHILIA
Nimrod Moss Ophir, Adi Eindor‐Abarbanel, Efrat Broide, Tzippora Shalem, Netanel Agajany
Pediatric Gastroenterology, Hepatology And Nutrition, Shamir Medical Center, Zeriffin, Israel
Objectives and Study: Helicobacter pylori (HP) infects up to half the world's population, though its prevalence is declining due to improved hygiene and eradication therapies. In contrast, eosinophilic esophagitis (EoE) incidence is rising globally, linked to genetic and environmental factors, including the hygiene hypothesis. Several studies suggest an inverse relationship between HP and EoE. However, esophageal eosinophilia (EE) may have various causes, including infections. HP infection should be considered in the differential diagnosis of gastrointestinal eosinophilia. To date, no published studies have examined the relationship between HP and EE or the effect of HP eradication.
Methods: We conducted a retrospective observational study of children aged 1‐18 diagnosed with EE ( > 15 eosinophils/HPF on esophageal biopsy) from 2000 to 2024 at Shamir Medical Center, Israel. Gastric biopsies confirmed HP infection, followed by HP eradication therapy and repeat endoscopy. Data included patient demographics, medical history, endoscopic and histologic findings.
Results: Among 71 children with EE, 23 (32.4%) were diagnosed with concomitant gastric HP infection. HP eradication therapy was recommended for 15 (65.2%), with successful eradication documented in 9 (39.1%). EE resolved in 3 (33.3%) characterized by younger age (6 years, IQR 6‐8, Vs 14 years, IQR 11‐15.5), absence of food impaction (0% Vs 37.5%), and no macroscopic EoE findings (0% vs. 75%). In this sub‐group the maximal eosinophil count was observed in the mid‐esophageal biopsies with a median of 26 eosinophils per HPF (IQR 23.5‐29), lower than for all patients (35, IQR 25‐50) or for patients with concomitant HP infection with no resolution after HP eradication (41, IQR 27.5‐50).
Conclusions: HP infection may cause reversible EE in some children. HP diagnosis and eradication should be considered before establishing EoE diagnosis, especially in younger patients with mild esophageal eosinophilia and no macroscopic EoE findings. Gastric acid hypersecretion during early HP infection may trigger esophageal barrier injury and eosinophilic inflammation.
Contact e‐mail address: yes
G‐EV096. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV096.1. DOES FOOD IMPACTION AFFECT OVERALL HEALTH PERCEPTION IN ADOLESCENTS WITH EOSINOPHILIC ESOPHAGITIS? INSIGHTS FROM A PEDIATRIC CENTER
Alessandra Maria Ricci 1, Francesco Milo2, Renato Tambucci3, Monica Malamisura4, Maria Cristina Artesani5, Sara Urbani6, Paola De Angelis4, Francesca Rea4
1Gastroenterology and Nutrion Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy, 2Clinical Psychology Unit, Bambino Gesù Children's Hospital, Rome, Italy, 3Gastroenterology And Nutrition, Bambino Gesù Children's Hospital, Rome, Italy, 4Gastroenterology And Nutrition Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy, 5Allergy Unit, Bambino Gesù Children's Hospital IRCCS, rome, Italy, 6Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic, inflammatory condition of the esophagus that can cause progressive dysphagia and food impaction, often leading to significant social and emotional burdens. These events may also present as endoscopic emergencies. The aim of this study was to evaluate the impact of food impaction (FI) on the overall perceived health of pediatric patients with EoE.
Methods: We conducted a single‐center case‐control study (1:3) comparing pediatric EoE patients over 11 years of age with at least one episode of food impaction (FI) to those without FI.Health outcomes were assessed using several measures: the Health‐Related Quality of Life (HRQoL) score (PedsQL), anxiety and depression symptoms (HADS), perceived symptoms score (PEESS), and the endoscopic severity score (EREFS).
Results: A total of 82 pediatric patients (mean age 14.96 years ± 4.95; 64% male) were included, with 21 having experienced FI and 61 not. In terms of treatment, 39% were on Budesonide, 1.2% on dupilumab, 24.4% on PPI, 4.9% on PPI and Budesonide, and 30.5% were off therapy. We found no significant differences between the two groups regarding HRQOL (85.8 vs 83.7; p = 0.68), anxiety (5 vs 4.5; p = 0.54), depression (3 vs 2.5; p = 0.95), PEESS (10 vs 6; p = 0.48), or EREFS (2 vs 2; p = 0.35). However, anxiety symptoms were independently associated with increased PEESS scores, both in patients with and without FI (B = 1.3; p = 0.01 vs B = 2.5; p < 0.001).
Conclusions: These findings suggest that perceived health in pediatric EoE patients who experience food impaction is similar to those without such episodes. This may indicate that the chronicity of symptoms plays a more significant role in determining perceived health than isolated, severe events like food impaction.
Contact e‐mail address: alemaria.ricci@gmail.com
G‐EV097. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV097.1. UNUSUAL PRESENTATIONS OF DE NOVO FOOD ALLERGIES FOLLOWING PEDIATRIC LIVER TRANSPLANTATION: TWO CASE REPORTS
Mouna Sabib, Said Ettair
Department Of Pediatric Hepatogastroenterology And Nutrition, hôpital d'enfants de Rabat, RABAT, Morocco
Objectives and Study: Food allergies are common in pediatric liver transplant recipients, affecting up to 54.3% of patients. Common allergens include eggs, cow's milk, soy, wheat, and peanuts. These cause IgE‐mediated reactions, ranging from mild skin symptoms to anaphylaxis. Gastrointestinal symptoms, such as abdominal pain and diarrhea, are frequent. Rectal bleeding and pancreatic exocrine insufficiency as initial symptoms are rare. This case report highlights two cases with these exceptional and atypical presentations.
Methods: We report on two pediatric patients who received liver transplantation due to cirrhosis secondary to biliary atresia. Both children were on tacrolimus post‐transplantation.
Results: Case 1: A 12‐month‐old girl, transplanted at 9 months, presented with recurrent diarrhea and rectal bleeding two months post‐transplant. Given a history of facial redness and pruritus after egg consumption, an allergic cause was considered after ruling out common causes, including infections. Specific IgE and prick tests were positive for milk and egg. An oral food challenge (OFC) with egg reproduced the skin symptoms, while the OFC with milk led to increased stool frequency and late onset of rectal bleeding. An elimination diet excluding eggs and cow's milk proteins resulted in significant clinical improvement. Case 2: A 3‐year‐old boy, transplanted at 11 months, presented at 2.5 years with weight stagnation and steatorrhea. Laboratory tests revealed malabsorption and reduced fecal elastase levels. Imaging ruled out structural abnormalities. Allergy testing identified IgE‐mediated hypersensitivity to cow's milk and eggs, and duodenal biopsies showed eosinophilic infiltration. Clinical improvement and normalization of fecal elastase were achieved with dietary exclusion of allergens.
Conclusions: These cases highlight the importance of considering food allergies in pediatric liver transplant recipients, even with atypical manifestations, as seen in our patients. They emphasize the need for systematic allergological evaluations and multidisciplinary care, including personalized dietary management, to optimize outcomes and quality of life.
Contact e‐mail address:
G‐EV098. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV098.1. BLOODY DIARRHEA, VOMITING, AND WEIGHT STAGNATION IN A WELL‐APPEARING NEWBORN WITH NEONATAL TRANSIENT EOSINOPHILIC GASTROENTEROCOLITIS
Bernat Servitje‐Verdaguer, Carmen‐María Sánchez‐Molina, Joana Díaz‐Font, Joan‐Carles Ferreres‐Piñas, Núria Torre‐Monmany, Clara Comalrena‐De‐Sobregrau‐Martínez, Diana García‐Tirado
Pediatrics, Parc Taulí University Hospital, Sabadell, Spain
Objectives and Study: This study aims to report a novel case of a well‐appearing newborn who presented with immediate postnatal hematochezia. Differential diagnoses included non‐IgE‐mediated gastrointestinal food allergies, along with neonatal transient eosinophilic colitis (NTEC), a recently described neonatal condition with a similar presentation but lacking allergic evidence. However, clinical, analytic, and histologic findings were inconsistent with both hypotheses, and a diagnosis of neonatal transient eosinophilic gastroenterocolitis (NTEGEC) was finally attained.
Methods: Case report.
Results: A male neonate born at 35 weeks and 5 days from a vegan mother presented with bloody mucous diarrhea in the first hour, before oral intake. He was well‐appearing, and his physical examination was unremarkable. Blood tests only revealed hypereosinophilia (7,940/mm3). Microbiologic and imaging tests ruled out infection, necrotizing enterocolitis, and other severe conditions. Endoscopy on day 7 showed widespread inflammation, erythema, and ulcers, with marked eosinophilic infiltration (120‐200 eosinophils/HPF) in the stomach, duodenum, colon, and rectum. He first received parenteral nutrition, progressing to enteral nutrition with an amino acid formula. He developed vomiting and weight stagnation during week 2, but both symptomatology and eosinophilia gradually resolved. Initial suspicion centered on neonatal FPIAP due to possible in‐utero sensitization to soy. However, this was incompatible since an oral challenge test with breast milk was negative and growth and development were satisfactory. NTEC was debated as a plausible diagnosis but was also rejected due to extensive eosinophilic involvement alongside upper digestive symptoms. This led to the proposed diagnosis of NTEGEC.
Conclusions: To our knowledge, this is the first reported case to identify NTEGEC as a neonatal eosinophilic gastrointestinal disorder, resembling NTEC but with both upper and lower digestive tract involvement. Although some data may suggest an early‐onset, rapidly remitting allergic background due to in‐utero food sensitization, this remains debated, as eosinophilic responses in newborns might also stem from stressors unrelated to allergy.
Contact e‐mail address: bernatservitje@gmail.com
G‐EV099. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV099.1. EOSINOPHILIC ESOPHAGITIS AND AUTISM SPECTRUM DISORDERS: A POTENTIAL ASSOCIATION REQUIRING FURTHER INVESTIGATIONS
Valentina Silvera 1, Laura Gianolio1, Raffaella De Santis1, Miriam Acunzo1, Cecilia Mantegazza1, Cristina Cocuccio1, Enza D'Auria1, Lorenzo Norsa1, Elena Pozzi1, Gian Vincenzo Zuccotti1,2
1Department Of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy, 2Department Of Biomedical And Clinical Sciences, University of Milan, Milan, Italy
Objectives and Study: Eosinophilic esophagitis (EoE) is a chronic, immune‐mediated disorder of the esophagus characterized by eosinophilic infiltration. Recent literature suggests a potential link between EoE and Autism Spectrum Disorder (ASD). It has been postulated that both conditions may share common pathophysiological mechanisms, particularly the involvement of type‐2 allergic inflammation. Our aim was to assess the prevalence of ASD in our single‐center pediatric EoE population and describe EoE symptoms at diagnosis.
Methods: We conducted a retrospective analysis of a single‐center cohort of pediatric patients who received a EoE diagnosis between 03/2019‐11/2023 and followed‐up until 11/2024. Data collection encompassed demographic information, characteristics of EoE and associated clinical manifestations, as well as ASD diagnosis and its related clinical features.
Results: Among 35 pediatric patients diagnosed with EoE, 4(11.7%) were also diagnosed with ASD. All patients were male. Median age at EoE diagnosis was 7.5years (range:2‐11) and at ASD diagnosis was 6years(range:4‐10). Two patients with high‐functioning ASD presented with classic EoE symptoms, including chest pain and heartburn in one case, and solid food dysphagia and heartburn in the second; both experienced episodes of food impaction. A third child, with more severe ASD and limited verbal communication, presented with reduced appetite and difficulty swallowing food, requiring water to aid food ingestion. The fourth child, diagnosed with ASD in the context of a neurodevelopmental disorder (9q34.11 microdeletion) determining psychomotor and speech delays, ataxia, and hypotonia, exhibited EoE symptoms such as prolonged chewing, frequent vomiting after meals, refusal to eat, and food aversion.
Conclusions: Our analysis suggests a higher prevalence of ASD in pediatric patients with EoE compared to the general pediatric European population (11.7%vs.0.8‐1.4%,respectively). These findings underscore the importance of a low threshold for investigating EoE in children with ASD, particularly those with verbal impairments or feeding difficulties, to avoid under‐recognition. Multicentric studies are needed to further investigate this potential association.
Contact e‐mail address: valentina.silvera@unimi.it
G‐EV100. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV100.1. COEXISTENCE OF EOSINOPHILIC ESOPHAGITIS AND CELIAC DISEASE: A SINGLE CENTER EXPERIENCE
Ozlem Sumer Cosar 1, Fatma Eren Kurtipek1, Fatma Özlem Koseoglu1, Ayşe Can1, Ozgur Ekıncı2, Hakan Öztürk1, Hacer Ilbılge Ertoy Karagol3, Sınan Sarı1, Buket Dalgıc1, Arzu Bakırtas3, Odul Egrıtas Gurkan1
1Division Of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 2Division Of Medıcıne Pathologhy, Gazi University Faculty of Medicine, Ankara, Turkey, 3Division Of Pediatric Allergy And Immunology, Gazi University Faculty of Medicine, Ankara, Turkey
Objectives and Study: The coexistence of eosinophilic esophagitis (EoE) and celiac disease (CD) has rarely been reported in the literature; however, its clinical implications remain unclear. This study aimed to investigate the clinical, laboratory, endoscopic, and histopathological characteristics of patients with concurrent EoE and CD.
Methods: This study was conducted on patients who underwent endoscopic biopsy between 2008‐2024. In patients diagnosed with celiac disease, a biopsy was taken from the esophagus in patients who suggested esophageal dysfunction, such as a feeling of stuckness, vomiting, and inability to swallow, and evaluated for eosinophilic esophagitis. For the diagnosis of EoE, an eosinophil count of >15 in the esophagus was accepted. Celiac disease was diagnosed by biopsy according to the Marsh classification. Celiac disease was not diagnosed in our unit without a biopsy.
Results: A total of 7082 patients were included in this study. A total of 138 patients were diagnosed with EoE infections. Five patients were diagnosed with EoE and celiac disease. The study included five patients (three males and two females) with a mean age of 9.5 years (range: 4–13 years). Clinical symptoms include growth retardation, abdominal pain, anorexia, dysphagia, and diarrhea. All the patients received a gluten‐free diet (GFD). Clinical improvement was noted in three patients, while two patients showed nonadherence to the GFD.
Conclusions: According to the literature, although there are fundamental differences in the pathophysiological mechanisms involved in EoE and CD, these conditions may coexist, and their prevalence is higher than expected. We highlight the importance of obtaining routine duodenal biopsies for the diagnosis of EoE in children undergoing endoscopy.
Contact e‐mail address: dr.ozlemcosar@gmail.com
G‐EV101. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV101.1. PREDICTORS OF PPI RESPONSE IN PEDIATRIC EOSINOPHILIC ESOPHAGITIS: A LONGITUDINAL COHORT STUDY
Ozlem Sumer Cosar 1, Fatma Özlem Koseoglu1, Hakan Öztürk1, Kenan Çetin2, Ozgur Ekıncı3, Sınan Sarı1, Hacer Ilbılge Ertoy Karagol2, Avnıye Kubra Baskın2, Buket Dalgıc1, Arzu Bakırtas2, Odul Egrıtas Gurkan1
1Division Of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 2Division Of Pediatric Allergy And Immunology, Gazi University Faculty of Medicine, Ankara, Turkey, 3Division Of Medıcıne Pathologhy, Gazi University Faculty of Medicine, Ankara, Turkey
Objectives and Study: Proton pump inhibitors (PPIs) are commonly used as the primary treatment for eosinophilic esophagitis (EoE). However, responses to PPIs vary among patients. This study compared clinical, endoscopic, and laboratory characteristics between PPI‐responsive and non‐responsive pediatric EoE patients.
Methods: This study retrospectively analyzed data from 5,779 patients who underwent endoscopic esophagial biopsies between 2014 and 2024. Among these, 146(%2) patients were diagnosed with EoE. After excluding 46 patients due to incomplete data. The final analysis included 100 patients. The final cohort consisted of 44 patients initially treated with first and only PPI monotherapy. Patients were divided into PPI‐responsive (n = 24) and PPI‐non‐responsive (n = 20). Demographic data, medical history, clinical presentations, endoscopic findings, and laboratory results were compared between the groups.
Results: Of the 44 patients included, 77% were male, with a mean age of 101 months. The mean age was higher in the PPI‐responsive group (111 months) compared to the non‐responsive group (90 months) (p = 0.15). Patients aged >5 years were significantly more common in the responsive group (p = 0.02). Endoscopic findings revealed that exudates (p = 0.008) and EREFS scores (p = 0.01) were significantly higher in the PPI‐non‐responsive group, indicating more severe endoscopic involvement. Eosinophil counts (576 vs 461 cells/µL), and IgE levels (434 vs 305 IU/mL) were higher in the non‐responsive group, though not statistically significant. The mean follow‐up duration in the group initially treated with PPI was 45 months. Among the 24 PPI‐responsive patients, 18(%75) achieved clinical and histopathological remission. However, 2 patients experienced recurrence on their second follow‐up endoscopy.
Conclusions: PPI‐responsive pediatric EoE patients tend to be older and show less severe endoscopic findings, as indicated by lower EREFS scores and fewer exudates than non‐responsive patients. This study highlights the importance of identifying predictive markers for PPI response in pediatric EoE.
Contact e‐mail address: dr.ozlemcosar@gmail.com
G‐EV102. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV102.1. FREQUENCY OF GENETIC MUTATIONS AND THEIR EFFECTS ON THE CLINICAL COURSE IN EOSINOPHILIC ESOPHAGITIS
Ipek Ulkersoy 1, Eymen Pinar2, Ahsen Colakoglu2, Ece Kuduban2, Erkan Akkus1, Oguzhan Tin1, Nursena Kologlu Ates1, Khusan Khodzhaev3, Hilal Keskin Karakoyun3, Ceyhan Sayar4, Nuray Kepil5, Kanay Yararbas6, Omer Beser1, Haluk Cokugras7, Fügen Çullu Çokuğraş8
1Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 2Department Of Pediatrics, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 3Department Of Molecular Biology And Genetics, Sapiens Genetics Diagnostic Center, Istanbul, Turkey, 4Department Of Medical Genetics, Sapiens Genetics Diagnostic Center, Istanbul, Turkey, 5Department Of Pathology, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 6Department Of Medical Genetics, Demiroglu Bilim University, Faculty of Medicine, Istanbul, Turkey, 7Department Of Pediatric Allergy And Immunology, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 8Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Demiroglu Bilim University, Faculty of Medicine, Istanbul, Turkey
Objectives and Study: Eosinophilic esophagitis (EoE) is a disorder whose pathophysiology is associated with strong heritability and esophageal‐specific genetic variants. It has been hypothesized that patients with esophageal atresia (EA) may be at higher risk of developing EoE considering the recently discovered genetic similarities between these disorders. We aimed to identify genetic mutations that could cause EoE and potentially explain susceptibility to accompanying EA and to determine the relationship between genetic mutations, clinical course and response to treatment.
Methods: We performed “whole exome sequencing” in DNA of patients diagnosed with EoE/EA to identify potential genomic regions increasing the risk of these disorders. The screening process was expanded with globally used genetic databases, aiming to identify potential candidate genes.
Results: A total of 35 cases (74% male) with the mean age at diagnosis 5,4 years were included. In 7 of EoE cases, there was accompanying EA. Pathogenic mutations were detected in genes known to cause EoE in 2 cases while likely pathogenic variants in 5. No polymorphisms were detected in 5 cases. Variants of uncertain significance (VUS) were detected in genes previously associated with EoE in 18 cases and in candidate genes in 7. Patients with VUS had a high percentage of associated EA, increased rates of atopy and quite high response to treatment. The duration of clinical response was longer in individuals without gene mutations (p‐value:0.006). Among isolated EoE cases, 50% had mutations in gene variants previously associated with EoE, while in EoE + /EA+ cases, this rate increased to 71,4%, indicating that there is a higher risk of genetic mutation in cases with accompanying EA.
Conclusions: Our study presented the role of genetic mutations in the etiology of EoE, consistent with other studies in the literature. The identification of new gene variants and potential insights into the etiopathogenesis are expected to enhance diagnosis, screening and treatment strategies.
Contact e‐mail address: ipekulkersoy@gmail.com
G‐EV103. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV103.1. ESOPHAGEAL STRICTURE SECONDARY TO EOSINOPHILIC ESOPHAGITIS IN THREE PEDIATRIC PATIENTS: A CASE SERIES
Kathalina Puerto1, Angie Vanessa Vergara Espitia1, Jose Fernando Vera 2, Andres Montaño Rozo3
1GastroenterologÍa PediÀtrica, FUNDACION SANTA FE DE BBOGOTÁ, BOGOTÁ, Colombia, 2GastroenterologÍa PediÀtrica, FUNDACION SANTA FE DE BOGOTÁ, BOGOTÁ, Colombia, 3Fundacion Santa Fe de Bogota, bogota, Colombia
Objectives and Study: To describe the clinical characteristics of pediatric patients who developed stricture due to Eosinophilic Esophagitis (EoE) treated at Fundación Santa Fe de Bogotá from 2022 to 2024.
Methods: An observational cross‐sectional study was performed with data retrospectively collected from 2022 to 2024 from the HIS‐ISIS and MedSys v.5 clinical registry software from patients with a diagnosis of EoE (esophageal dysfunction with esophageal eosinophilia: >15 eos/hpf) and endoscopic evidence of esophageal stricture.
Results: Among the fifty‐three patients with EoE, three patients (all male, mean age of diagnosis: 14 years) were diagnosed with esophageal stricture, all of them dysphagia, abdominal pain or feeding problems and just one of them presented with food impaction. All patients required endoscopic dilation, one of them with a pre‐treatment of systemic corticosteroids. One of the patients continued management with proton pump inhibitors, and two with swallowed steroids demonstrating clinical improvement and remission.
Conclusions: The frequency of esophageal stricture among pediatric patients with EoE treated in Fundación Santa Fe de Bogotá was 5.6%, all of them treated with esophageal dilation with improvement and current remission.
Contact e‐mail address:
G‐EV104. Topic: AS01. GASTROENTEROLOGY/AS01e. Eosinophilic Gastrointestinal Disorders
G‐EV104.1. COEXISTENCE OF EOSINOPHILIC ESOPHAGITIS AND CELIAC DISEASE: IMPACT OF GLUTEN‐FREE DIET ON EOSINOPHILIC INFILTRATION IN PATIENTS WITH POSITIVE ANTI‐TG2 ANTIBODIES
Carla Ziello, Roberta Mandile, Chiara Esposito, Renata Auricchio
Transaltional Medical Sciences, University Of Naples Federico Ii, Policlinico Federico II, Napoli, Italy
Objectives and Study: Eosinophilic esophagitis(EoE) is a chronic inflammatory disorder of the esophagus characterized by eosinophilic infiltrate in the esophageal mucosa(>15HPF), excluding other causes of esophageal eosinophilia, including celiac disease(CD). Our study aims to evaluate whether the esophageal hypereosinophilia in CD patients is attributable to CD and therefore reversible after gluten‐free diet(GFD), or if it represents an independent condition of EoE
Methods: We enrolled 10 patients between 2018 and 2024 with suspected CD, based on positive anti‐transglutaminase antibodies(anti‐TG2). Due to oesophagus macroscopical changes in all patients (columnar/trachealized appearance), additional esophageal biopsies (2proximal, 2middle, 2distal) were performed. In all cases, a marked eosinophilic infiltrate (>15HPF) was histologically documented. Five patients were diagnosed with overtCD(positive anti‐TG2, villous atrophy), while five were diagnosed with potential celiac disease(PCD, positive anti‐TG2 without villous atrophy). As first‐line therapy, CD patients started GFD for 6 months, while those with PCD received proton pump inhibitors(PPIs) for 8 weeks, with GFD proposed if PPI alone failed. The efficacy of each therapeutic trial was histologically documented with a reduction of eosinophilic infiltration <15HPF
Results: Among 5 patients with CD, one was lost to follow‐up, 2/5 (40%) didn't respond, and 2/5 are still undergoing treatment. Among 5 PCD patients, 2/5 (40%)went into remission after 8 weeks of PPI therapy, while the remaining 3/5 (60%)added GFD to PPI, and all went into remission.
Conclusions: Our preliminary results show that in patients who present both a positive anti‐TG2 and eosinophilic hypereosinophilia, GFD improves eosinophilia in approximately 43% of total cases. The persistence of eosinophilic inflammation in a subset of patients with CD despite following a GFD suggests that EoE may be an independent, coexisting condition rather than a manifestation of CD at least in a subset of patients. Further studies are needed to clarify the mechanisms underlying the coexistence of these two conditions and to establish optimal treatment strategies.
Contact e‐mail address: carlaziello94@gmail.com
G‐EV105. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV105.1. CHARACTERISTICS AND MANAGEMENT OF UPPER GASTROINTESTINAL BLEEDING (UGIB) IN A TERTIARY PAEDIATRIC GASTROENTEROLOGY CENTRE: A RETROSPECTIVE REVIEW
Catherine Acton, Loveday Jago, Virginia Chatzidaki, Adnaan Kala, Chai Lee, Maureen Lawson, Andrew Fagbemi, Sian Copley
Royal Manchester Children's hospital, Manchester, United Kingdom
Objectives and Study: UGIB is a potentially life‐threatening event (1). This study examined the aetiology and management of UGIB in children presenting to a tertiary paediatric gastroenterology centre over 18 months. Management was compared to UK guidelines (2).
Methods: Electronic patient discharges and handover lists were searched for ‘upper gastrointestinal bleed’, ‘upper gastrointestinal haemorrhage’, ‘haematemesis’, ‘coffee ground vomit’ or ‘melaena’. Patients aged under sixteen with signs of UGIB were included; those with only fresh rectal bleeding were excluded.
Results: 35 children were identified. 19 presented to the tertiary centre or were current inpatients. 15/35 transferred from district general hospitals (DGH). 18/35 had bleeding requiring transfusion. The majority had documented A‐to‐E assessments and received intravenous omeprazole but investigations differed. 33/35 had no consideration of button battery ingestion. 19/35 have undergone endoscopy, 3 required endoscopic intervention including adrenaline, polypectomy and flouracil with balloon tamponade.
| Significant GI pathology | 8 | |
| Portal hypertension | 1 | |
| Other acute illness | 2 | |
| Post endoscopy | 2 | |
| Irritation from gastro‐jejunal tube | 2 | |
| Gastritis | H pylori positive | H pylori negative |
| 2 | 8 | |
| Mallory‐Weiss tear | 4 | |
| Other | 6 | |
Table one – causes for UGIB Significant GI pathology included gastrointestinal stromal tumour (1), Meckel's diverticulum (2), Peutz‐Jegher polyposis (1), gastric ulcer (1), duodenal ulcer (2), severe oesophagitis (1).
Conclusions: Limitations were the retrospective nature and small numbers. Education is vital to support DGH paediatricians in the stabilisation of UGIB. Consideration of button battery ingestion is vital due to high morbidity and mortality. 18/35 (51%) had significant bleeding requiring transfusion. Although rare, significant GI pathology remains in the differential. As need for endoscopic intervention is uncommon, adult Gastroenterology and surgeons may be required to support endoscopic therapy. 1. Galos F et al. Trends in Upper Gastrointestinal Bleeding in Children: The Impact of Helicobacter pylori Infection and Non‐Steroidal Anti‐Inflammatory Drug Use. Antibiotics 2024;13(8). 2. BSPGHAN. GI bleeding pathway. 2018.
Contact e‐mail address: sian.copley@mft.nhs.uk
G‐EV106. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV106.1. LONG‐TERM CLINICAL OUTCOMES AND MANAGEMENT OF PEDIATRIC INTESTINAL PSEUDO‐OBSTRUCTION FROM A TERTIARY CENTER IN TURKEY
Kardelen Akın 1, Serenay Alaca1, Betül Aksoy1, Senay Onbası Karabag1, Sinem Kahveci1, Yeliz Cagan Appak1, Cezmi Karaca2, Maşallah Baran3
1Pediatric Gastroenterology, Katip çelebi university,İzmir city hospital, izmir, Turkey, 2Surgery, Acıbadem Kent Hospital, izmir, Turkey, 3Pediatric Gastroenterology, Izmir Katip Celebi Univercity, Izmir City Hospital, Izmir, Turkey
Objectives and Study: Pediatric Intestinal Pseudo‐obstruction(PIPO) is a rare, severe, disabling gastrointestinal motility disorder characterized by repetitive episodes or continuous symptoms and signs of bowel obstruction absence of mechanical obstructing cause. This study aimed to evaluate the management and follow‐up results of patients with PIPO.
Methods: The cases of 27 patients with PIPO were reviewed retrospectively. Demographic data, clinical features, etiologies, management of treatment, nutrition, and small bowel transplantation(SBT) were assessed.
Results: The median follow‐up was 15.5 months(1–130). The median age of the patients at initial presentation was 2.75 month(1 day‐13.3 years). 55.5%patients were female and,7.4% patients with PIPO had a preterm delivery history. The clinical symptoms were manifested in 29.6%patients at neonatal period. All the patients had complained of vomiting, constipation,and abdominal distantion.Twenty‐one(77%) patients were underwent surgical procedures to exclude mechanical obstruction and 15(55.4%)patients were performed either ileostomy or colostomy. Gastrostomy was applied to 9(33.3%) patients and gastrostomy decreased the clinical symptoms during the abdominal distension period. Gastrostomy was used for gastric decompression and enetral feeding in 33.3%of patients. 29,6%patients tolerated full enteral feeding. Five(18%) patients were depend on parenteral nutrition(PN) and three of them were following with partial home PN. Isolated SBT has been performed in 14.8%of the patients and one patient has been followed up for 9 years without any problems. One patient is still on the transplant list
MMIH:megacystis microcolon intestinal hypoperistalsis IND:intestinal neuronal dysplasia WS:Waardenburg EA:enteric anendocrinosis ACTG‐2:actg‐2 mutation NF‐1: neurofibromatosis type1 GN:ganglioneuroma AMSAN:acute motor and sensory axonal neuropathy
Conclusions: PIPO is a rare disease with a wide range of clinical symptoms that are difficult to diagnose and treat. It is important to clarify the etiological causes in these patients. While some patients remain dependent on PN and may require SBT, others may benefit from other therapies. Therefore, it is important that each patient with PIPO is assessed and managed individually.
Contact e‐mail address: akinkardelen@gmail.com
G‐EV107. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV107.1. LONG TERM NEED FOR VASCULAR ACCESS AND ASSOCIATED COMPLICATIONS IN CHILDREN WITH INTESTINAL FAILURE
Serenay Alaca1, Betül Aksoy1, Sinem Kahveci2, Senay Karabag Onbası2, Ilksen Demir1, Kardelen Akın 1, Gozde Celiksoz1, Yeliz Cagan Appak1, Onur Isık3, Muhammed Akyüz3, Maşallah Baran1
1Pediatric Gastroenterology, Katip çelebi university,İzmir city hospital, izmir, Turkey, 2Paediatric Gastroenterology, Izmir City Hospital, Izmir, Turkey, 3Paediatric Cardiac Surgery, Izmır Cıty Hospital, izmir, Turkey
Objectives and Study: Intestinal failure (IF) is defined as a condition where gut function is insufficient to absorb essential macronutrients, water, electrolytes to sustain health and support growth.Long‐term parenteral nutrition (PN) and vascular access puts these children at increased risk for complications related to central venous catheters. We aimed to determine the incidence of central venous catheter complications and share our clinical experience.
Methods: We performed a retrospective database analysis of all children diagnosed with IF at our center between 2014 and 2024.
Results: A total of 35 patients with intestinal failure 57.1% were female. The mean follow‐up period of the patients in our clinic was 20.9 months. The causes of intestinal failure among the patients were as follows: 57.1% had short bowel syndrome, 34.3% had intestinal motility disorder, and 8.6% had congenital enteropathy. The most common catheter‐related complication we observed was central line‐associated bloodstream infections (CLABSI). Six patients (17.1%) had superior vena cava syndrome during follow‐up. One of our patients required the use of a femoral port due to vascular access challenges. Two patients (5%) experienced subcutaneous necrosis as a result of PN solution leaking under the skin. These patients required surgical intervention including debridement to remove necrotic tissue.
Conclusions: In our retrospective study, which included a rare and special patient group followed with a multidisciplinary approach, we observed that complications such as CLABSI, damage to central venous blood vessels, central venous thrombosis and subcutaneous leakage due to long‐term central catheter use in patients with intestinal failure may jeopardize the maintenance of life‐saving vascular access.
Contact e‐mail address: drserenaycetinoglu@gmail.com
G‐EV108. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV108.1. A CASE OF MEDIAN ARCUATE LIGAMENT SYNDROME IN A 14‐YEAR‐OLD GIRL PRESENTING WITH CHRONIC ABDOMINAL PAIN
Yusuf Aydemir, Çiğdem Öztunalı, Pari Khalilova, Zeren Barış, Hüseyin Ilhan
Pediatric Gastroenterology, Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Gastroenterology, Eskişehir, Turkey, Eskişehir, Turkey
Objectives and Study: Median arcuate ligament syndrome (MALS) is a rare disorder that affects approximately 2 per 100,000 people. It is believed to be caused by the constriction of the celiac artery and the celiac plexus by the median arcuate ligament (MAL). Although primarily reported in adults, MALS can present in adolescents with nonspecific symptoms, making diagnosis challenging.
Methods: We present a case of a 14‐year‐old girl with chronic abdominal pain eventually diagnosed with MALS.
Results: A 14‐year‐old girl was referred to our pediatric gastroenterology clinic with a two‐month history of persistent epigastric pain. Her pain was described as sharp, worsening after meals, and relieved by sleeping. She denied experiencing vomiting, diarrhea, or any weight loss. Physical examination revealed mild epigastric tenderness without palpable masses. Initial laboratory investigations, including complete blood count, acute phase reactants, biochemical panel including lipase, and urine and stool analysis were unremarkable. Abdominal ultrasound examination showed no abnormalities. Due to persistent findings, upper gastrointestinal endoscopy and ileocolonoscopy were performed and found to be normal. Abdominal computed tomography revealed normal finding. Doppler ultrasound for suspected MALS showed normal lumen diameter and normal contours of the celiac trunk at its origin from the abdominal aorta. However, in the supine position during normal respiration, peak systolic flow velocity increased to 295 cm/s with aliasing artifact. During deep inspiration, the velocity rose to 300 cm/s, while deep expiration measurements averaged 165 cm/s. The patient underwent laparoscopic surgery for suspected MALS. Postoperative recovery was uneventful, and she experienced marked improvement in abdominal pain.
Conclusions: This case highlights the importance of considering MALS in the differential diagnosis of chronic abdominal pain in pediatric patients. Multidisciplinary management involving pediatric gastroenterologists, radiologists, and pediatric surgeons is essential for optimal patient outcomes.
Contact e‐mail address: dryusufaydemir@yahoo.com
G‐EV109. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV109.1. THE USE OF POINT‐OF‐CARE ULTRASONOGRAPHY IN EVALUATING THE EFFECTIVENESS OF CONSTIPATION TREATMENT IN CHILDREN – A PRELIMINARY REPORT
Marta Drabik, Martyna Laskowska, Anna Jarzumbek, Katarzyna Bąk‐Drabik
Faculty Of Medical Science In Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
Objectives and Study: The purpose of this study is to evaluate the usefulness of POCUS in assessing the effectiveness of treatment for chronic constipation in children. Using this method directly at the patient's treatment site significantly reduces the time needed to make a therapeutic decision. The parameters used in the assessment of constipation are rectal dilatation >30 mm, a crescent‐shaped hyperechoic area in the rectum, the presence of an acoustic shadow behind a sickle‐shaped, hyperechoic area indicating hard stool retention, fecal mass retention in the colon
Methods: The study included 37 children (21 boys) aged 2.0‐14.4 (mean age 5,57) diagnosed with chronic constipation who reported a second follow‐up visit to the Gastroenterology Clinic between 01.01 and 01.12.2024. Each patient underwent a complete abdominal ultrasound examination before or during the first visit to the Clinic, while during the second visit, only POCUS assessment was performed. One experienced gastroenterologist‐ultrasonographer performed the examination using a convex probe with a 2‐9 MHz frequency.
Results: The average rectal ampulla diameter was 30,5 mm (18‐60 mm). In 78% of the patients, hard stool was retained in the rectal ampulla, manifested by a characteristic white crescent with a visible acoustic shadow. In 40% of the children, hard fecal masses were also observed in the sigmoid. In most children (64%), it was decided to intensify the treatment after POCUS. In 2 patients, based on the image, a decision was made to hospitalize.
Conclusions: POCUS is a fast, efficient, and noninvasive method that provides an objective evaluation of the rectal ampulla's filling level, retention of fecal masses in the large intestine, and the degree of hardness of the retained fecal masses. This method helps assess treatment effectiveness and optimize therapy.
Contact e‐mail address:
G‐EV110. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV110.1. INTESTINAL FAILURE‐ASSOCIATED LIVER DISEASE IN CHILDREN: A TERTIARY‐CARE‐CENTER EXPERIENCE FROM TURKEY
Gozde Celiksoz 1, Senay Onbası Karabag2, Betül Aksoy1, Serenay Alaca3, Kardelen Akın4, Ilksen Demir5, Sinem Kahveci6, Yeliz Cagan Appak7, Maşallah Baran8
1Pediatric Gastroenterology, Izmir Katip Celebi Univercity, Izmir City Hospital, Izmir, Turkey, 2Pediatric Gastroenterology, Izmir City Hospital, izmir, Turkey, 3Pediatric Gastroenterology, Hepatology And Nutrition, Izmir City Hospital, Izmir, Turkey, 4Pediatric Gastroenterology, İzmir city hospital, izmir, Turkey, 5Paediatric Gastroenterology, Izmir Katip Celebi Univercityİzmir City Hospital, izmir, Turkey, 6Pediatric Gastroenterology, Izmir City Hospital, Izmir, Turkey, 7Pediatric Gastroenterology, Katip çelebi university,İzmir city hospital, izmir, Turkey, 8Pediatric Gastroenterology, İzmir City Hospital, İzmir, Turkey
Objectives and Study: Intestinal failure‐associated liver disease(IFALD) is a progressive liver disease that complicates intestinal failure(IF) and is multifactorial, depending not only on long‐term parenteral nutrition therapy but also on different aetiologies of intestinal failure. In this study, we aimed to evaluate the outcomes of patients diagnosed with IFALD in our centre.
Methods: Data from patients diagnosed with IFALD between 2010 and 2024 were retrospectively reviewed.Demographic data, clinical features, laboratory parameters, treatments and intestinal transplantation(IT) were assessed.
Results: Short bowel syndrome was present in 41(62%) patients, congenital enteropathies in 11(16.6%) and motility disorders in 14(21%) in the aetiology of IF.IFALD was observed in 14(21%) of the 66 patients.The characteristics of the patients are shown in Table.Liver biopsy was performed in 4(28.5%) patients.Chronic hepatitis and cholestasis were detected in 2 and 2 patients, respectively. Intestinal transplantation was performed in 2(14.2%) patients. The 2(14.2%) patients with IFALD died due to liver failure.
| Patient Number | Diagnosis | ALT/AST/GGT(U/L) | Total/Direct Bilirubin(mg/dl) | INR | Ultrasound |
|---|---|---|---|---|---|
| 1 | SBS | 143/89/14 | 0,61/‐ | 1,22 | Normal |
| 2 | SBS | 60/100/154 | 2,9/2,3 | 1,66 | Gallstones |
| 3 | SBS | 70/217/151 | 12,1/10,5 | 1,00 | Increased periportal echogenicity, Sludge in the gallbladder |
| 4 | SBS | 140/248/160 | 9,3/5,2 | 1,38 | Normal |
| 5 | Motility disorder | 71/110/28 | 7,3/4,6 | 2,08 | Normal |
| 6 | SBS | 215/179/141 | 5,7/3,6 | 1,32 | Normal |
| 7 | Motility disorder | 256/430/96 | 12,4/6,5 | 2,38 | Normal |
| 8 | SBS | 21/30/11 | 2,5/1,6 | 1,10 | Normal |
| 9 | SBS | 124/55/100 | 0,5/0,1 | 1,10 | Hepatosteatoz |
| 10 | SBS | 109/59/287 | 2,4/1,4 | 1,03 | Normal |
| 11 | Motility disorder | 13/14/36 | 2,3/1,8 | 1,10 | Hepatosteatosis, Gallstones |
| 12 | SBS | 242/271/214 | 6,4/3,4 | 1,40 | Polyp in the Gallbladder |
| 13 | SBS | 150/144/129 | 0,5/0,2 | 1,32 | Gallstones |
| 14 | Motility disorder | 51/114/122 | 5,6/4,7 | 1,34 | Normal |
Conclusions: IFALD is one of the major factors limiting long‐term survival in patients with IF.Recommendations such as cyclic parenteral nutrition infusion, management of bacterial overgrowth, promotion of enteral nutrition and reduction of catheter‐induced sepsis should be followed to prevent the development of IFALD. Patients should be closely monitored for IFALD.
Contact e‐mail address: celiksozgozde@gmail.com
G‐EV111. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV111.1. PNEUMATOSIS INTESTINALIS IN PAEDIATRIC PATIENTS WITH NEURODISABILITY: A CASE SERIES
Roshan Woods1, Elena Cernat 2, Lilianne Gomez Lopez1
1Paediatrics, Leeds General Infirmary, Leeds, United Kingdom, 2Leeds General Infirmary, Leeds, United Kingdom
Objectives and Study: Patients with neurodisability can lack the capacity to communicate their symptoms. Understanding the natural history and implications of Pneumatosis Intestinalis (PI) in this group of patients could help refine diagnostic and therapeutic strategies, potentially sparing unnecessary surgical interventions
Methods: A retrospective keyword search of a radiology database identified patients diagnosed with PI via imaging over a 10 year period (2014‐2024). Exclusion criteria were applied, selecting paediatric patients 6 months to 16 years of age with PI and neurodisability. Patient notes were analysed to identify: 1) subtle or atypical signs that may be present despite lack of clear symptoms 2) patients management 3) patient outcomes in form of clinical resolution and recurrence of PI. Five patients were identified (Table 1)
Results:
All 5 patients were managed conservatively, with all but one having resolution of PI noted on imaging. In the absence of any specific surgical intervention, only one patient experienced recurrent PI. Despite this, the patient remained asymptomatic from a gastrointestinal perspective on each subsequent episode.
Conclusions: These cases demonstrate that a conservative approach to management can be effective and should not be ruled out in favour of surgical management.
Contact e‐mail address: roshan.woods@nhs.net
G‐EV112. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV112.1. PROSPECTIVE COHORT STUDY OF NEONATAL ENTEROCOLITIS BASED ON OLINK PROTEOMICS
Yu Dai, Kedi Xi, Jianyu Feng, Juyi Zhao, Xiaohui Chen, Shushu Li, Shuping Han
Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
Objectives and Study: Neonatal enterocolitis (NEC), the most prevalent gastrointestinal emergency in newborns, is associated with a high incidence of morbidity and mortality.
Methods: A prospective study design was employed to collect serum samples from preterm infants with a birth gestational age of less than 32 weeks or a birth weight of less than 1500 g. The control group, which corresponded to the NEC group, was matched in a 1:1 ratio according to the age at blood sampling, birth weight, and birth gestational age. Olink proteomics was employed to screen the various proteins, and hierarchical clustering analysis was conducted to identify the "central" protein markers that are closely related to the pathogenesis of NEC. The clinical data, CRP, WBC, NEUT, and differential proteins screened by Olink proteomics were also subjected to statistical analysis in the enrolled children. Furthermore, as NEC is an intestinal disease, discarded intestinal tissues resected by intestinal surgery for NEC or congenital gastrointestinal malformations were also collected from our hospital and explored for centrin expression by H&E staining, immunohistochemistry, and immunofluorescence. To elucidate the expression of centrin in diverse tissues, an animal model of NEC was established, and tissue samples were procured from the heart, liver, kidney, brain, and intestine. The expression of FGF5 was determined through the use of PCR and ELISA.
Results: The differential proteins exhibited high efficacy in predicting NEC, with FGF5 (AUC = 0.8476), TRANCE (AUC = 0.7619), GDNF (AUC = 0.7381), and uPA (AUC = 0.7095) demonstrating particularly strong performance. The LASSO regression analysis and cross‐validation of elevated serum FGF‐5 levels demonstrated the capacity to predict the risk of NEC within the subsequent two weeks. Furthermore, FGF5 was predominantly expressed in brain tissues.
Conclusions: Serum FGF‐5 levels may serve as a valuable predictor of NEC risk in preterm infants. Additionally, the pathogenesis of NEC may be associated with the brain‐gut axis.
Contact e‐mail address:
G‐EV113. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV113.1. EVALUATION OF TREATMENT IN ACUTE GASTROENTERITIS: A COMPARATIVE STUDY
Fatma Demirbaş 1, Gülşen Yalçın2, Fatma Bacalan3
1Pedİatrİc Gastroenterology, BALIKESİR ATATÜRK CİTY HOSPİTAL, BALIKESİR, Turkey, 2Pediatric Emergency, diyarbakır children hospital, diyarbakır, Turkey, 3Infection Disease, diyarbakır children hospital, diyarbakır, Turkey
Objectives and Study: To compare the efficacy of only dietary recommendations, zinc, probiotics and combination therapies in children admitted with acute gastroenteritis.
Methods: The comparative, prospective, double‐blind, placebo‐controlled study was conducted from October 2020 to April 2021 at the Paediatric Emergency Service after approval from the ethics review committee of Diyarbakir Gazi Yasargil Training and Research Hospital, Turkey, and comprised infants with a diagnosis of acute gastroenteritis who were divided into four groups. Only appropriate dietary recommendations were given to the control group 1, while group 2 was given a single probiotic containing bifidobacterium breve, bifidobacterium bifidum, bifidobacterium infantis and bifidobacterium longum strains. Group 3 was given zinc and group 4 was given probiotics and zinc. Demographic data of the patients, admission complaints, physical examination findings, dehydration degrees, and laboratory findings were recorded and analysed.
Results: Of the 132 subjects, 79 (59.8%) were males. The overall mean age was 27.5 ± 3.6 months. There were 22 (16.7%) patients in group 1, 34 (25.8%) in group 2, 28 (21.2%) in group 3, and 48 (36.4%) in group 4. The mean duration time to diarrhoea termination was 84.5 ± 10.7 hours (range: 79‐89 hours) in group 1, 73.05 ± 6.8 hours (range: 70.5‐75.4 hours) in group 2, 80.1 ± 10.3 hours (range: 76‐84 hours) in group 3, and 43.5 ± 9.6 hours (range: 46‐48 hours) in group 4. Group 4 outcome was statistically significant (p < 0.001).
Conclusions: The efficiency of combined treatment with probiotics and zinc was found to be significantly better in the treatment of childhood acute gastroenteritis.
Contact e‐mail address:
G‐EV114. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV114.1. CLINICAL FINDINGS AND FOLLOW‐UP RESULTS OF PEDIATRIC SPLENIC CYSTS: A SINGLE‐CENTER STUDY
Neslihan Ekşi, Busra Sahiner Caliskaner, Gülin Hizal, Burcu Berberoğlu Ateş, Selim Dereci, Şamil Hızlı
Pediatric Gastroenterology, Hepatology And Nutrition, Bilkent City Hospital, Ankara, Turkey
Objectives and Study: Splenic cysts are rare benign lesions of the spleen in children.These cysts are often discovered incidentally on physical examination or during imaging studies for unrelated conditions. As they are often asymptomatic,they may be detected through abdominal pain or a palpable mass and may cause additional morbidity if not appropriately monitored.In this study,we aimed to collect the data of our splenic cyst patients,present their follow‐up results,and raise awareness about this issue.
Methods: A retrospective review of pediatric patients with splenic cysts was carried out, between 2019 and 2024,in Bilkent City Children Hospital.We analyzed demographics,including age,gender,cyst diameter,cyst localization,along with their follow‐up and management of the patients.
Results: Thirty‐two patients with splenic cysts were included in the study. The median follow‐up time was 5 months. The median age was 4.5 (IQR 1.25‐12 years),59.4% were male, and the median cyst size was 12 mm(range: 4‐78 mm) (Table 1). Three patients had multiple cysts. The results of the indirect hemagglutination test for screening hydatid disease were all negative.The clinical findings varied and included incidental finding (n = 29), abdominal pain(n = 6),vomiting(n = 4),constipation(n = 2),restlessness (n = 1)and palpable mass(n = 1).Only the symptoms of three patients(size >5 cm, 2 abdominal pain, and 1 palpable mass) were related to the cyst.Imaging studies revealed:fatty liver (n = 5),nephrolithiasis(n = 2),hydronephrosis (n = 1),renal agenesis(n = 1),vesicoureteral reflux(n = 1),bifid pelvis(n = 1),congenital cystic adenomatoid malformation(n = 1),diaphragmatic hernia (n = 1),polysplenia (n = 1)and lung cyst(n = 1).One patient underwent percutaneous aspiration. Two patients required surgical resection.Surgical procedures included laparoscopic cystectomy and partial splenectomy. One had recurrence after one year of the operation(5 cm cyst in the upper pole).Twenty‐eight patients(87.5%)had follow‐up ultrasound examinations. During the follow‐up visits, ultrasound examinations revealed no splenic cysts in four patients.
Conclusions: Although pediatric splenic cysts are commonly detected incidentally, they should be monitored appropriately due to the potential risk for increasing in size,risk of infection,and need for intervention.The risk of recurrence should be acknowledged for patients undergoing surgery. Our results underscore the importance of follow‐up.
Contact e‐mail address: neslihaneksi@hotmail.com
G‐EV115. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV115.1. THERAPEUTIC EFFECT OF ADALIMUMAB IN THE TREATMENT OF INTESTINAL BEHCET'S DISEASE
Tianjiao Gao, Ying Fang, Yanan Han, Xiaoxia Ren, Fengfan Wang
Xi'an Children's Hospital, Xi'an, China
Objectives and Study: To investigate efficacy and safety of Adalimumab in the treatment of intestinal Behcet's disease in children.
Methods: Retrospective analysis of clinical data of children with intestinal Behcet's disease treated with Adalimumab at Xi'an Children's Hospital from January 2021 to December 2023, analyzing the improvement of symptoms and endoscopic ulcer healing.
Results: There were a total of 8 children with intestinal Behcet's disease, including 4 males and 4 females, with an average age of 11.9 ± 1.4 years and a course of 10.5 (6.75, 22.5) months. Among the 8 children, 7 presented with abdominal pain (3 with diarrhea), 1 with vomiting, and 3 with intestinal obstruction (including 1 with intestinal perforation). CT scans of 7 children showed local intestinal wall thickening and strengthening. There were ileocecal ulcers in all 7 cases, and only terminal ileal ulcers in 1 case. After treatment with Adalimumab, the symptoms of all 8 patients improved and ulcers gradually healed. Before treatment with Adalimumab, the erythrocyte sedimentation rate was 44.63 ± 43.48 mm/h and C‐reactive protein was 43.87 ± 39.10 mg/dl. After treatment with Adalimumab, the erythrocyte sedimentation rate was 10.50 ± 7.65 mm/h and C‐reactive protein was 0.96 ± 0.67 mg/dl, both significantly decreased compared to before treatment, with statistically significant differences (P = 0.046 and P = 0.017, respectively).
Conclusions: Adalimumab is safe and effective in treating intestinal Behcet's disease for children.
Contact e‐mail address: 574048744@qq.com
G‐EV116. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV116.1. MICROSCOPIC COLITIS PREVALENCE IN A SINGLE CENTER PEDIATRIC POPULATION
Valentina Giorgio 1, Ludovica Iezzi2, Gaia Margiotta2, Giuseppe Stella1, Marina Greco3, Francesco Proli2, Fabiana Rita Guida2, Francesca Viozzi2, Pietro Pisano2, Marco Pulselli2, Niccolò Chirico2, Camilla Pietrantoni2, Bianca Mazzoli2, Maria Elena Riccioni4, Antonio Gasbarrini5
1Department Of Woman And Child Health And Public Health, Uoc Pediatria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, 2Department Of Woman And Child Health And Public Health, Uoc Pediatria, Fondazione Policlinico Universitario Agostino Gemelli Irccs, Rome, Italy, Policlinico Universitario Agostino Gemelli, Roma, Italy, 33. Università Cattolica del Sacro Cuore, Roma, Italy, Rome, Italy, 4Dipartimento Di Scienze Medico‐chirurgiche E Gastroenterologiche, Fondazione Policlinico Universitario A. Gemelli Irccs, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy, Rome, Italy, 5Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy, rome, Italy
Objectives and Study: Microscopic colitis (MC) is a pathological condition characterized by chronic watery diarrhea, in the absence of endoscopic and radiological alterations of the large bowel. The diagnosis is histological. Criteria for diagnosis of Collagenous colitis (CC) is thickened subepithelial collagenous band ≥10 mm. Criteria for Lymphocytic colitis (LC) are an increased number of IELs ≥20 per 100 surface epithelial cells. Both should be combined with an increased inflammatory infiltrate in the lamina propria. In recent years, several studies have explored MC incidence and prevalence in adults, highlighting a significant increase in its incidence. No studies are available in pediatrics. The aim of this study is to analyze the prevalence of pediatric MC in a single tertiary care center.
Methods: Clinical charts of children who underwent colonoscopy between January 2015 and December 2024 were reviewed. Those presenting with chronic diarrhea but no clinical or laboratory suspicion of inflammatory bowel disease were selected.
Results: 366 charts of children who underwent colonoscopy were reviewed (mean age 15,2 years ± 3,8; 56,8% males; 43,2% females). 47 children (12,8%) met the inclusion criteria and 8 (2,2%) were identified as having MC. Further investigations were conducted on these 8 children (mean age 16,8 years ± 2,55; 62,5% males; 25% had CC; 75% had LC) including fecal calprotectin which was always negative (mean 43 ± 3 mg/kg).
Conclusions: The prevalence of pediatric MC was 2,2%; CC prevalence was 0,5% vs LC prevalence of 1,6%. Prevalence appears to be lower than that of adults but still considerable. Larger multicenter studies and population‐based studies are needed to analyze the incidence and overall prevalence of MC in the pediatric population. This is a condition that is difficult to diagnose but has a significant impact on the quality of life of children.
Contact e‐mail address: valentina.giorgio@policlinicogemelli.it
G‐EV117. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV117.1. NOVEL USE OF DUPILUMAB FOR TRICHO‐ENTERO‐HEPATIC SYNDROME ASSOCIATED HYPOGAMMAGLOBULINEMIA
Lynette Goh, Christopher Ho, Kong Boo Phua, Veena Logarajah, Lay Queen Ng, Charanya Rajan, Sarah Wong, Tessa E‐Lin Ong, Fang Kuan Chiou
KK Women's and Children's Hospital, Singapore, Singapore, Singapore
Objectives and Study: The current management for tricho‐entero‐hepatic syndrome (THES) mainly involves parenteral nutrition and immunoglobulin supplementation. This case report aims to describe the novel use of dupilumab to treat hypogammaglobulinemia due to THES.
Methods: A 12‐year‐old curly haired girl initially presented in the neonatal period with chronic diarrhea, liver dysfunction, hypogammaglobulinemia and failure to thrive. Whole‐exon sequencing revealed TTC37 mutation consistent with THES. She was initially started on parenteral nutrition but managed to be weaned off at 10 months of age. However, even with the improvement of her diarrheal symptoms, she was dependent on regular intravenous immunoglobulin (IVIG) infusions to maintain clinically adequate IgG levels of >9 g/dL. Endoscopy showed large ulcers throughout her colon and histology showed an irregular epithelial luminal surface with crypt architectural distortion. She also had concomitant severe atopic dermatitis. Dupilumab is a monoclonal antibody that has been proven to be effective for the treatment of eczema. She was started on subcutaneous dupilumab 300 mg every 4 weekly.
Results:
Results Improvement in her trough monthly IgG levels were seen after 3 months and her monthly IVIG requirements were halved from 1.3 g/kg to 0.65 g/kg in 6 months. She also showed improvement in her skin. No adverse side effects of dupilumab were reported.
Conclusions: Tetratricopeptide repeat domain‐containing 37 (TTC37) encodes proteins involved in RNA processing and degradation. THES causing immunodeficiency without diarrhea has been reported but the underlying mechanism and pathophysiology is still unknown. The successful use of dupilumab in reducing IVIG requirements in THES suggests that there may be underlying Th2‐driven inflammation and IL‐4 and IL‐13 may be involved in this process.
Contact e‐mail address: lynette.goh.s.h@singhealth.com.sg
G‐EV118. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV118.1. INGESTED FOREIGN BODIES IN CHILDREN
Tuğba Gürsoy Koca 1, Halil Kocamaz2, Beyza Iscil3, Osman Uzunlu4
1Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Pamukkale University Hospital, DENIZLI, Turkey, 2Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Dicle University Hospital, Diyarbakır, Turkey, 3Pediatrics, Pamukkale University Hospital, DENIZLI, Turkey, 4Pediatric Surgery, Pamukkale University Hospital, DENIZLI, Turkey
Objectives and Study: Foreign body ingestion in children is one of the most common reasons for visits to the emergency department. In this study, we evaluated the pediatric patients who presented to our hospital with the complaint of ingestion of foreign body.
Methods: The records of children admitted to our pediatric emergency department with complaints of foreign body ingestion between January 2017 and December 2023 were retrospectively reviewed. Data on age, gender, type of ingested foreign body, presenting complaints, urgency of endoscopy, and, if endoscopy was performed, the location of the foreign body removal were collected. 4o
Results:
A total of 296 patients with a mean age of 4.3 ± 3.7 years (7 months to 17 years), including 128 females (43.2%), were evaluated. The most commonly ingested foreign bodies were coins (35.5%), sharp/penetrating objects (17.2%), and button batteries (9.8%). Among sharp/penetrating objects, the most frequent were safety pins (22.4%) and glass fragments (18.4%). Endoscopy was performed in 68 cases (33.0%). The most common site for foreign body removal within the gastrointestinal system was the upper third of the esophagus, accounting for 31 cases (45.6%). In 5 cases (7.4%), no foreign body was detected during the endoscopic procedure. In one case involving the ingestion of a needle, the foreign body could not be located endoscopically. The patient, who was under observation for spontaneous passage, developed bowel perforation, and the foreign body was removed laparoscopically. Another case, involving the ingestion of 32 magnets and 1 button battery, required emergency surgery due to bowel perforation. 4o
Conclusions: Coins are the most frequently ingested foreign objects. Foreign bodies in the stomach and intestines are observed to pass spontaneously more often compared to other parts of the gastrointestinal system. To avoid complications, batteries and sharp objects should be removed immediately, while other foreign bodies can be monitored for spontaneous passage.
Contact e‐mail address: tgkoca@gmail.com
G‐EV119. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV119.1. EVALUATION OF THE DEVELOPMENT OF FUNCTIONAL GASTROINTESTINAL DISEASES IN CHILDREN BETWEEN 4‐18 YEARS OF AGE DIAGNOSED WITH COW'S MILK PROTEIN ALLERGY
Nur Kevser Özyurt, Merve Kişioğlu, Burcu Güven, Nalan Yildiz, Fazil Orhan
Pediatric Gastroenterology, Karadeniz Technical University, trabzon, Turkey
Objectives and Study: Cow's milk protein allergy (CMPA) is one of the most common food allergies that occurs in early childhood. It is thought that CMPA may play a role in the pathophysiology of functional gastrointestinal diseases (FGIH) in the long term. In this study, our aim is to question the gastrointestinal symptoms in the long‐term follow‐up of patients with CMPA diagnosis, to recognize and gain awareness of frequently encountered FGIH.
Methods: : Our study includes patients diagnosed with CMPA, whose treatments were finalized and whose current ages were between 4 and 18. The control group consisted of 250 healthy children of similar age group who were not diagnosed with CMPA. The patients were administered the Pediatric Gastrointestinal Symptoms Questionnaire including Rome IV criteria. Laboratory findings of the children (skin prick test, total IgE, complete blood count) were obtained from hospital system records.
Results: In our study, the mean age of the CMPA patient group was 5.6 ± 2.0 (age±SD) years, 107 (42.8%) of the patients were diagnosed with IgE‐mediated CMPA. Functional GIS disease was observed in 70 (28%) of the patients with CMPA and in 76 (30.4%) of those without CMPA (p = 0.623). FGIH was observed in 36 (33.6%) patients with IgE‐mediated CMPA and in 34 (23.8%) patients with non‐IgE‐mediated CMPA. Functional abdominal pain, irritable bowel syndrome and encopresis were significantly more common in patients without CMPA (p = 0.009, p = 0.016, p = 0.01, respectively).Functional dyspepsia, functional abdominal pain and irritable bowel syndrome were observed more frequently in patients with IgE‐mediated CMPA (p = <0.001, p = 0.001, p = 0.002, respectively).
Conclusions: Although the frequency of FGID development does not increase significantly in the long term in patients diagnosed with CMPA, functional dyspepsia, functional abdominal pain, and irritable bowel syndrome are considerably higher. It appears that the development of FGID has multifactorial causes, and especially IgE‐mediated CMPA may be an important risk factor for them.
Contact e‐mail address:
G‐EV120. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV120.1. DIAGNOSTIC AND PROGNOSTIC VALUE OF FC MEASUREMENT IN PATIENTS WITH CMPA
Niga Hama Rashid
DR.JAR pediatric teaching hospital, Sulaimanya, Iraq
Objectives and Study: Cow's milk protein allergy (CMPA) is one of the most common food allergies with increasing prevalence rates in pediatric populations and its most common clinical manifestation is allergic colitis. Given the need for reliable, non‐invasive diagnostic tools for CMPA, this study aims to evaluate the diagnostic and prognostic value of fecal calprotectin (cytosolic protein released by neutrophils during inflammation)in patients with CMPA.
Methods: This research was constructed as a longitudinal cohort study. Collection of samples took place between February 2024 and November 2024, at the Pediatric Clinic of the Royal Hospital‐Sulaimanyah,Iraq. The study population included infants, children and adolescents between 1 and 18 years of age who presented with clinical symptoms suggesting cow's milk protein allergy using CoMISS score. Exclusion criteria for enrolment were the diagnosis of inflammatory bowel disease (IBD), coeliac disease (CD), and carbohydrate maldigestion or malabsorption. After a month on a strict dairy‐free diet, parents were asked to reintroduce dairy into the child's diet and report their observations via a CoMISS score. If the child exhibited symptoms after consuming dairy CoMISS score>10 following a symptom‐free period on the elimination diet, a diagnosis of cow's milk protein allergy was confirmed.
Results: 62 cases were analyzed, 9 cases (14.52%) did not meet the enrollment criteria. A total of 53 patients participated in the study [25 (47.17%) females and 28(52,83%) males, mean age: 2.34 years]. There was significant difference in FC levels between baseline and after 3‐month elimination diet [102.98 μg/g and 48.11 μg/g, respectively, p = 0.0331].
Conclusions: The study revealed significantly elevated fecal calprotectin levels in patients with (CMPA). However, these levels decreased after successfully implementing a cow's milk‐free diet, highlighting the correlation between calprotectin and intestinal inflammation. Consequently, the most effective method to prevent recurrence of symptoms is the strict avoidance of all cow's milk protein‐containing products
Contact e‐mail address: nigashafiq1988@gmail.com
G‐EV121. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV121.1. PAEDIATRIC GASTROINTESTINAL IGA VASCULITIS (GI‐IGAV) IN SOUTHEAST ASIA: A CLINICAL SPECTRUM OF SEVERITY
James Guoxian Huang 1,2
1Paediatrics, National University Singapore, Singapore, Singapore, 2National University Health System, SINGAPORE, Singapore
Objectives and Study: IgA vasculitis (IGAV) is a common childhood vasculitis with the highest prevalence in Asians. There is a lack of literature describing the clinical spectrum of paediatric GI‐IGAV, hence we aim to review a case series of Southeast Asian children presenting solely with acute abdominal symptoms in the absence of the classic IGAV tetrad.
Methods: A retrospective case‐record review was conducted between 2017‐2024: the inclusion criterion were children with IGAV ≤ 18 years of age, and whose clinical presentation were solely acute abdominal symptoms +/‐ contemporaneous purpura.
Results: 6 patients were identified (mean 10.2 [range 4‐16] years’ age at onset; 5 male/1 female). All had an acute abdomen: severe abdominal pain, bilious vomiting and reduced bowel output. Cutaneous purpura was contemporaneous in 2/6; delayed between 2‐11 days post onset of abdominal symptoms in 3/6; absent in 1/6 (endoscopic evidence of GI purpura). None had arthritis nor renal involvement. 4/6 had elevated IgA levels; ESR and CRP were elevated in 2/6 and 4/6 respectively. Intestinal sonography were performed in all 6 patients with marked mural thickening at various bowel sites (duodeno‐jejunum (2/6)); ileum (3/6; 1 had ileo‐ileal intussusception) and ascending colon (1/6). GI endoscopy was done in 2/6: gastric purpura/superficial ulcers and superficial ileal ulcers were seen. All 6 were initially treated with steroids: 3/6 had no further recurrence. 1/6 had a second relapse further complicated with nephropathy, requiring mycophenolate and multiple pulsed steroids. This patient also developed ileocolonic Crohn's 7 years post onset of GI‐IGAV. 1/6 had multiple GI‐IGAV relapses requiring high dose pulsed steroids. 1/6 was steroid‐refractory and developed an ileal perforation requiring surgical resection.
Conclusions: GI‐IGAV typically presents as an acute abdomen with non‐contemporaneous purpura, warranting a high index of suspicion; outcomes can be highly varied depending on initial steroid response and subsequent steroid‐dependence.
Contact e‐mail address: paehgj@nus.edu.sg
G‐EV122. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV122.1. EVALUATION OF COW'S MILK PROTEIN ALLERGY DEVELOPMENT IN CHILDREN WITH FORMULA FEEDING IN THE FIRST THREE DAYS POSTPARTUM
Halil Sagir, Betül Aksoy, Yeliz Cagan Appak, Sinem Kahveci, Senay Onbası Karabag, Ozlem Gulpinar Aydin, Serenay Alaca, Celal Özkaya, Maşallah Baran
Pediatric Gastroenterology, Hepatology And Nutrition, İzmir city hospital, İzmir/Turkey, izmir, Turkey
Objectives and Study: Cow's milk protein allergy(CMPA) is the most common food allergy. Initial breastfeeding and colostrum are very important in the delivery room. Cow's milk based formula(CMBF) is used in patients born by caesarean section due to insufficient breast milk. Therefore, in our study we investigated the relationship between the use of CMBF in the first three days and CMPA.
Methods: Fifty‐seven patients diagnosed with CMPA and 55 healthy children as controls were included in this study. Children with chronic diseases, eosinophilic enteropathy and inflammatory bowel disease were excluded from the study. Questionnaires were used to ask individuals about their retrospective history of CMBF use during the first three days. Even if there was a single meal of CMBF use, this was recorded.
Results: A significant difference was found between the patients and the control group in terms of the presence of a family history of allergy(p < 0.000). In the patient group, 30(70%) children received CMBF within the first 3 days(Table 1).A significant difference was found for the presence of allergic family members in all cases receiving formula during the first three days (p < 0.003).
Table1.Study‐data
| Patient | Control | Total | p‐value | |
|---|---|---|---|---|
| Sex( %Female) | 50,9% | 40,1% | 100% | 0.438 |
| Age(month)(Median)(min‐max) | 12,4(1‐40) | 14,2(3,7‐37) | 12,4(1‐40) | |
| Initial Symptoms and Signs at Presentation‐n(%) Bloody‐stool Mucouid‐stool Vomiting/Constipation Eczema/Diarrhe Anaphylaxis | 22(38,6) 14(24,6) 5(8.8)‐5(8,8) 7(12,3)/3(5,3) 1(1,8) | |||
| Allergic individual in the family‐n(%) Yes/No | 28(49,1)/29(50,9) | 9(16,4)/46(83,6) | 37(33)/75(67) | 0,000 |
| Other‐n (%) 1.Neonatal‐intensive‐care‐hospitalization Yes/No 2.Term/Preterm 3.Saesarean/Vaginal route | 12(21,1)/44(78,9) 50(87,7)/7(12,3) 42(73,7)/15(26,3) | 12(21,8)/43(78,2) 46(83,6)/9(16,4) 42(76,4)/13(23,6) | 24(21)/88(79) 96(85)/16(15) 84(75)/28(25) | 0,974 0,537 0,746 |
| Formula use in the first three day‐ n ( % ) Yes/No | 40(70,2)/17(29,8) | 35(63,6)/20(38,4) | 75(66,9)/37(33,1) | 0.462 |
Conclusions: Family history of allergy, CS, CMBF use in the first three days were high in CMPA and may have been trigger factors. The fact that the study was based on retrospective medical history may have limited the study.
Contact e‐mail address: dr.hllsgr@gmail.com
G‐EV123. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV123.1. A RARE CAUSE OF CHRONIC DIARRHEA IN CHILDHOOD: DUODENOCOLIC FISTULA
Elif Çivit, Selen Şimşek, Ferda Hosnut, Asuman Nur Karhan
Ankara Etlik City Hospital, Ankara, Turkey
Objectives and Study: Duodenocolic fistula is an extremely rare that can develop in adulthood following colon cancer, Crohn's disease, diverticula or H. pylori(HP) associated duodenal ulcer. In children, to exclude common causes such as inflammatory bowel disease and duodenal ulcer is crucial. To date, two cases described in the literature and we describe a patient with chronic diarrhea due to duodenocolic fistula.
Methods: Fistula image.
Results: CASE REPORT A 14‐years‐old girl admitted with watery, bloodless, mucus‐free diarrhea 4‐5 times a day for three years. Physical examination, anthropometric measurements were normal. Blood (CRP) and stool tests were normal, celiac was negative. In oesophagogastroduodenoscopy (OGD), a wall defect of approximately 1.5 cm in diameter was observed in second part of duodenum, opposite to papilla vateri, with normal mucosa. During procedure, patient had abdominal distention with low oxygen. End of OGD, abdominal distention decreased, oxygen saturation improved. Colonoscopy, histopathological examination was normal, HP negative. Contrast graphy of small bowel showed a thin fistula tract between duodenum part 2 and hepatic flexure, as well confirmed with CT. The fistula was closed with an endoscopic coil treatment, patient's diarrhea completely resolved after closure.
Conclusions: Duodenocolic fistula has been reported in two cases in childhood; one after safety pin aspiration, other was due to HP ulcer. Normal mucosa, suggested fistula in first case, as in our patient can be congenital. Intact mucosal integrity at site of fistula is a good predictor for spontaneous closure, defect size greater than 1 cm is a poor prognostic criterion for spontaneous closure. Although rare, structural defects should be considered, especially in cases of chronic diarrhea in which acute phase reactants and other etiological investigations are normal. Endoscopic closure methods should be preferred to invasive surgical procedures, especially in cases where mucosal integrity is preserved
Contact e‐mail address: asunurkar83@gmail.com
G‐EV124. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV124.1. EFFICACY OF MESALAZINE IN SOLITARY RECTAL ULCER SYNDROME IN CHILDREN: A PROSPECTIVE STUDY
Tarek Kasri 1, Hocine Sklab2
1Private pediatric gastroenterology center, Bejaia, Algeria, 2Private Pathology Laboratory center, Bejaia, Algeria
Objectives and Study: Solitary rectal ulcer syndrome (SRUS) is a rare and easily misdiagnosed pediatric condition characterized by rectal bleeding, abdominal pain, and altered bowel habits. Prolonged toilet sitting with excessive straining is commonly associated with SRUS. Anti‐inflammatory agent, such as corticosteroid enema, shows promise in managing SRUS. We prospectively evaluate the clinical, endoscopic, and histological outcomes of mesalazine therapy in six pediatric SRUS cases.
Methods: Six children (4 males, 2 females; mean age: 10.6 years) diagnosed with SRUS, confirmed by colonoscopy and histopathology, were prospectively followed between July 2022 and October 2024. During this period, they received mesalazine suppositories (20‐25 mg/kg/day) and were evaluated every three months.In two cases, oral mesalazine was added at a dose of 50 mg/kg/day for 3 months to enhance treatment efficacy. Clinical presentations included rectal bleeding (6/6), abdominal pain (4/6), constipation (1/6), diarrhea with mucus (1/6), and anemia (1/6). All patients exhibited prolonged straining during defecation. Endoscopic and histological assessments were performed pre‐treatment and post‐treatment (12‐18 months) in five cases.
Results: Clinical: Complete remission was achieved in 5/6 patients (83%) by 3 months; 1 (17%) showed partial improvement. Endoscopic: Pre‐treatment, 5 patients (83%) had one ulcer, and 1 (17%) had two ulcers. Post‐treatment, normal mucosa was observed in 3/5 patients (60%), and persistent ulceration was seen in 2/5 (40%) (1 with partial improvement). Histological: Complete healing occurred in 3/5 cases (60%), while ulceration persisted in 2/5 (40%). Safety: Mesalazine was well tolerated with no adverse effects.
Conclusions: Mesalazine demonstrated significant clinical and endoscopic efficacy in SRUS, achieving rapid symptom resolution and sustained remission.The persistence of symptoms in one patient highlights the potential role of associated factors, such as constipation, in limiting treatment success. These findings support mesalazine as a promising treatment, warranting further investigation in larger cohorts.
Contact e‐mail address: tarekkasri@gmail.com
G‐EV125. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV125.1. ILEAL LACTOBEZOAR: A RARE CAUSE OF INTESTINAL OBSTRUCTION IN EXTREMELY PREMATURE INFANTS. CASE PRESENTATION
Natalia Kelaidi 1, Maria Christina Siouli1, Iro Apostolopoulou1, Konstantina Dimakou2, Natasa Dimopoulou1, Aggeliki Krikri1
1Pediatric Surgery, General Pediatric Hospital "Agia Sofia", Athens, Greece, 2Paediatric Gastroenterology, General Pediatric Hospital "Agia Sofia", Athens, Greece
Objectives and Study: Ileal lactobezoar, defined as the pathological conglomeration of milk, is a rare gastrointestinal complication. However it is mostly reported in stomach, it can be found in any part of the intestinal tract. In premature infants it presents as abdominal distention, abdominal wall erythema, apnea, and desaturation and usually occurs 14 days after milk fortifiers are introduced in the diet. Although pathogenesis is multifactorial, an immature gastrointestinal function is of critical importance. Diagnosis is made mostly intraoperatively during surgical investigation for intestinal obstruction or perforation. If diagnosed preoperatively, lactobezoars are treated conservatively with bowel rest, Intravenous nutrition, gastric lavage and gastrografin enemas.
Methods: We present a case of ileal lactobezoar, in an extremely premature infant, which had already treated surgically for intestinal obstruction and perforation due to Ladd bands and intestinal duplication.
Results: At the fourteenth week of life, while the infant was in total enteric nutrition and 48 hours after changing of milk formula that was given, abdominal distention and bilious emesis occurred. Five days later exploratory laparotomy was performed due to serious abdominal obstruction failed to be treated conservatively by bowel rest and gastrografin enemas. Three huge masses of lactobezoar were removed from ileum by enterotomy. Postoperatively, reduced bowel motility was confirmed via imaging studies, and the patient was treated with azithromycin for 6 weeks. Total enteric feeding was achieved on the 35th postoperative day and on the 58th postoperative day the patient was discharged.
Conclusions: Intestinal lactobezoar poses a diagnostic challenge. Its higher incidence the last two decades is due to the increased number of extremely preterm infants worldwide. Despite that it's presentation appears to be mostly later in life, the complications of a lactobezoar such as intestinal obstruction and perforation are usually misinterpreted as necrotizing enterocolitis or other common gastrointestinal neonatal pathologies leading to misdiagnosis and inappropriate management.
Contact e‐mail address: kelaidinatalia@gmail.com
G‐EV126. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV126.1. HEAVY METAL: CHRONIC LEAD POISONING MIMICKING PORPHYRIA AND POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES)
Franziska Lammert 1, Moritz Muschaweck1, Jens Rengelshausen2, Jens Bertram2, Thomas Kraus2, Tobias Wenzl1, Norbert Wagner1
1Department Of Pediatrics, University Hospital RWTH Aachen, Aachen, Germany, 2Institute For Occupational, Social And Environmental Medicine, University Hospital RWTH, Aachen, Germany
Objectives and Study: A 10‐year‐old boy presented with colicky abdominal pain, constipation and postprandial vomiting for two months, weight loss of 7 kg, and general weakness. Diagnostic laparoscopy in an external hospital was inconspicuous. He had undergone appendectomy two years ago and had been a healthy boy. During the stay he developed visual impairment, headaches and abdominal pain crises necessitating treatment with opioids. He showed psychotic behavior, but our psychiatrist found no evidence for somatization disorder.
Methods: Case report.
Results: Blood tests showed slightly elevated aminotransferases (AST 62 U/l, ALT 76 U/l), g‐GT (62 U/l) and hypochromic microcytic anemia (Hb 6.4 g/dl, MCV 73.7 fl, MCH 24.9 pg). Blood smear detected basophilic spots. X‐ray and MRI of abdomen were normal. Urine testing for porphyria confirmed elevated levels of porphobilinogen (PBG; 3.9 mg/24 h (<1.7 mg/24 h)) and d‐aminolaevulinic‐acid (ALA; 49.6 mg/24 h (<6.4 mg/24 h)), consistent with rare ALA‐dehydratase deficiency (Doss‐porphyria). cMRI showed lesions consistent with posterior reversible encephalopathy syndrome (PRES). Hence, we suspected previously described porphyria‐induced PRES. As differential diagnosis, lead intoxication was considered, impacting ALA‐dehydratase activity, elevating ALA more than PBG. Surprisingly, high blood lead levels were found (581 µg/l (<22 µg/l)). We started chelation therapy with dimercapto‐propanesulfonic‐acid, resolving all symptoms within 48 hours. As lead source could not be identified, family members were tested, showing no elevated levels of lead. Despite of chelation therapy, lead concentration in blood remained high, indicating persistent lead exposure at home after discharge. After seven weeks, the boy's grandmother identified the lead source: a lead chain serving as curtain weight that the boy had regularly put in his mouth for months while computer gaming. After the exposure ended, blood lead levels slowly but steadily decreased.
Conclusions: Lead intoxication must be considered as potential differential diagnosis, notwithstanding the declining incidence. Furthermore, lead poisoning might mimic porphyria, whereas lead encephalopathy resembles PRES in cMRI, both complicating diagnosis.
Contact e‐mail address: flammert@ukaachen.de
G‐EV127. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV127.1. QUALITY OF LIFE IN GASTROINTESTINAL DISEASES: CHILDREN VERSUS PARENTS’ VIEW – COMPARATIVE SURVEY
Julia Leszkowicz 1, Wojciech Nazar2, Magdalena Dettlaff‐Dunowska1, Katarzyna Plata‐Nazar1, Agnieszka Szlagatys‐Sidorkiewicz1
1Department Of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University Of Gdańsk, Medical University of Gdańsk, Gdańsk, Poland, 2Laboratory Of Experimental And Translational Allergology, Division Of Allergology Department Of Pulmonology & Allergology, Medical University of Gdańsk, Gdańsk, Poland
Objectives and Study: Burden of gastroenterological diseases in children is a significant public health concern, impacting physical, emotional, and social aspects of life. We aim to compare the quality of life of children reported by themselves and by‐proxy by their caregivers.
Methods: 100 children and 100 parents of children aged 5‐18 y.o. with gastroenterological diseases (functional disorders such as abdominal pain, nausea, constipation, diarrhea; inflammatory bowel disease; gastroesophageal reflux, dysphagia, gastritis, pancreatitis, coeliac disease; anorexia) were evaluated with the Polish version of PedsQL™ Gastrointestinal Symptoms Module. Patients were divided into 3 age groups (5‐7;8‐12;13‐18 years old). They were patients of a tertiary pediatric gastroenterology ward in Gdańsk, Poland.
Results: Out of surveyed children, 56% were females, mean age of 10,8 (range 5‐18) years. Out of surveyed parents, 84% were females. The scores were converted to a scale ranging from 0 to 100, based on the following rules: 0 to 100, 1 to 75, 2 to 50, 3 to 25, and 4 to 0. Higher scores indicated lower severity of gastrointestinal disease symptoms. The transformed scores from the questionnaires were treated as continuous variables. In general, the answers were similar. The differences in individual symptoms (> 4, bolded in Tab.1) were most visible in the group of teenagers, where parents often assessed the symptoms as less severe than their children. The difference in mean of all questions between children and parents were: 0 in 5‐7 y.o. group; 0,8 in 8‐12 y.o. group; 2,9 in 14‐18 y.o. group. Tab.1. Quality of life in individual age groups (Mean, Confidence Intervals 95%).
Conclusions: The discrepancy in assessment of the quality of life between children and parents by‐proxy increases with the age of the child.
Contact e‐mail address: julia.leszkowicz@gumed.edu.pl
G‐EV128. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV128.1. DYSENTERY AS A GASTROINTESTINAL MANIFESTATION OF COVID‐19 IN CHILDREN: CASE REPORT AND ANALYSIS
Armen Malekiantaghi, Kambiz Eftekhari
Pediatric Gastroenterology, Tehran University of medical sciences, Tehran, Iran
Objectives and Study: Introduction COVID‐19, primarily recognized for respiratory symptoms, can also cause gastrointestinal (GI) symptoms like diarrhea, vomiting, and abdominal pain. Dysentery, a rare GI manifestation characterized by blood and mucus in the stool, has been reported in children with COVID‐19. This study explores dysentery as a distinctive GI symptom in pediatric COVID‐19 patients.
Methods: Twelve pediatric patients with confirmed COVID‐19 presented with dysentery. All tested positive for SARS‐CoV‐2 via RT‐PCR, and none had underlying health conditions or recent travel. Three children had overt dysentery, while others had stool samples positive for red and white blood cells. Stool cultures were negative for bacterial pathogens, parasites, and Clostridium difficile toxin.Abdominal ultrasonography and echocardiography were normal, ruling out multisystem inflammatory syndrome in children (MIS‐C). Stool tests confirmed no bacterial or parasitic infections.
Results: All patients received supportive care, including zinc supplementation, probiotics, and intravenous fluids for dehydration. All patients fully recovered and were discharged in stable condition. No GI complications were observed during follow‐up.
Conclusions: Dysentery in pediatric COVID‐19 cases is a rare but significant presentation. It may result from direct viral invasion of the gastrointestinal tract via ACE2 receptors or an immune‐mediated inflammatory response. Though self‐limiting, dysentery requires careful monitoring for dehydration and complications. Recognizing dysentery as a COVID‐19 manifestation can help differentiate it from other viral GI infections and guide treatment. Dysentery is a rare but important GI manifestation of COVID‐19 in children. It is typically self‐limiting and does not require invasive procedures or antiviral treatment. Further research is needed to explore the mechanisms behind GI symptoms and long‐term effects in pediatric COVID‐19 patients.
Contact e‐mail address:
G‐EV129. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV129.1. PHENOTYPIC VARIABILITY IN SYNDROMIC CONGENITAL SODIUM DIARRHOEA
Athina Mamatsiou, Keith Lindley, Jutta Koeglmeier
Paediatric Gastroenterology, Great Ormond Street Hospital, London, United Kingdom
Objectives and Study: Syndromic Congenital Sodium Diarrhoea (CSD; SPINT2¹ mutations) presents with sodium rich intractable diarrhoea and is associated with choanal/intestinal atresias, corneal erosions and tufting enteropathy. Symptoms start in utero; life‐threatening dehydration, electrolyte abnormalities and metabolic acidosis occur if untreated.
Methods: We present three male Kuwaiti cousins: Syndromic CSD, variable clinical presentation.
Results:
| Case 1 | Case 2 | Case 3 | |
| polyhydramnios | absent | absent | present |
| gestation | term | term | premature 32/40 |
| Birth weight | 3.6 Kg | 3.0 Kg | 1.8 kg |
| Passage of meconium | yes | yes | no |
| dysmorphism | face | face | face |
| Other features | no | no | Choanal atresia |
| Severe diarrhoea and dehydration | day 20 | day 10 | from birth |
| Transfer to London | Aged 11 months Minimal oral AA formula feeds, partial parenteral nutrition (PN) Malnourished: 3.9 kg (z‐7.68) | Aged 3 months Oral AA formula feeds Malnourished: 2.85 kg (z‐ 5.00). PN started | Aged 4 months On total PN Malnourished: 2.35Kg (z‐ 7/16). |
| Cessation of diarrhoea on fasting | no | no | no |
| 1 st Urine sodium | < 5 mmol/L | < 5 mmol/Kg | < 5 mmol/Kg |
| Stool sodium | 113 mmol/L | 127 mmol/ml | 136 mmol/Kg |
| Upper GI endoscopy | tufting enteropathy | tufting enteropathy | tufting enteropathy |
| EpCAM | retained | retained | retained |
| Genetics | homozygous SPINT2 gene variant | pending | homozygous SPINT2 gene variant |
| At present | 16 months Achieved some catch‐up growth (weight 6.84 Kg, z ‐4.10) Stable on PN (160 ml/Kg, sodium 10 mmol/Kg) Small amount of oral diet Home PN advised | 10 months Good weight gain (8.47 kg, 25th centile) On PN (210 ml/Kg, sodium 18 mmol/Kg) Supplementary oral foods/milk Home PN advised | 5 months Gaining weight (3.16 Kg, z – 6.46) On PN (120 ml/Kg, sodium 10 mmol/Kg) plus replacement of stool losses ml for ml with 0.9% NaCL and 10 mmol KCL per 500 ml fluid bag On trophic AA feeds |
Conclusions: Syndromic CSD is clinically heterogeneous, antenatal polyhydramnios not always present. Diarrhoea can begin later. PN, fluid and electrolyte replacement are essential.
Contact e‐mail address: athina.mamatsiou@gosh.nhs.uk
G‐EV130. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV130.1. INTESTINAL INFLAMMATION AND IMMUNE‐MEDIATED DISEASES IN A COHORT OF OBESE CHILDREN
Anna Mirra1, Antonella Marano 1, Autilia Boccia1, Maria Barca1, Maria Boccia1, Mariantonia Maglio2, Valentina Discepolo1,2
1Department Of Translational Medical Science, Section Of Pediatrics, University of Naples Federico II, Naples, Italy, 2European Laboratory for the Investigation of Food Induced Diseases (ELFID), University Federico II of Naples, Italy, Naples, Italy
Objectives and Study: High daily caloric intake and obesity have exponentially increased in the last decades, paralleling the incidence of immunemediated diseases including allergy and autoimmunity. Compelling evidence suggests a role for metabolic pressure in immune dysregulation. Whether unhealthy dietary habits promote immune responses via enhancing intestinal inflammation needs to be elucidated. To test this hypothesis, we designed a proof‐of‐concept study to assess the prevalence of immune‐mediated diseases in a pediatric cohort of obese children presenting or not with signs of intestinal inflammation.
Methods: We prospectively enrolled 106 paediatric patients with a BMI above the 90th percentile, hospitalised at the Paediatric Section of the University Federico II of Naples between April 2021 and June 2024. Patients were stratified into two groups: with(GI + ) or without(GI‐) signs of intestinal inflammation, defined as positive calprotectin and/or complain of gastrointestinal symptoms and/or gastrointestinal comorbidity. We compared the prevalence of immune mediated diseases in 19 GI+ and 87 GI‐ patients and the rate of obesity‐related complications in the two groups upon collecting the following data: total and fractionated cholesterol, systolic and diastolic blood pressure, C‐reactive protein, transaminases, blood glucose during OGTT, liver steatosis and sleep apnoea.
Results: GI+ patients had a higher prevalence of autoimmune (21% vs 10%, p < 0.05) and allergic diseases (41% vs 26%, p < 0.05) than GI‐ patients. Looking at obesity‐related complications/comorbidities, we found a higher rate of sleep disorders (OSAS 38% vs 22%,p < 0,05), but not of other metabolic complications in the GI+ group.
Conclusions: Our data show an increase prevalence of immune‐mediated diseases (both autoimmune and allergic) in obese patients with signs of intestinal inflammation, underlying its potential role in promoting immune dysregulation related to obesity. Upon validation of in a wider cohort, mechanist studies will follow to address how dietary metabolic overload impacts gut and systemic inflammation.
Contact e‐mail address: mirranna.1989@gmail.com
G‐EV131. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV131.1. TUBERCULOSIS OF THE PSOAS MUSCLE PRESENTING AS RECURRENT CONSTIPATION IN CHILDREN: A RARE CASE REPORT
Afiffa Mardhotillah, Raden Handidwiono, Falentina Pandjaitan, Rika Oktarina
Child Health (pediatric), University of Indonesia, Jakarta Pusat, Indonesia
Objectives and Study: Abdominal pain and recurrent constipation are common in children, typically managed per constipation guidelines. However, rare causes like psoas tuberculosis (TB) abscess may go undetected based on clinical features alone. Computed Tomography (CT) imaging and histopathology enable timely diagnosis, potentially reducing morbidity. We present a rare case of abdominal pain with constipation as the primary symptom of a complicated TB infection in a left psoas muscle.
Methods: Case: A 10‐year‐old boy presented with a month‐long history of left lower abdominal pain and recurrent constipation, accompanied by nausea and occasional low‐grade fever, but without cough, night sweats, or weight loss. Initial treatment with enemas and lactulose was ineffective for his abdominal pain. Physical examination after fecal disimpaction revealed a palpable mass in the left lower abdomen, suggesting a non‐typical cause of constipation.
Results: An abdominal ultrasound showed a large cystic mass, and CT imaging revealed a cystic, multiloculated lesion extending from the left psoas muscle to the proximal left femur, with a sclerotic defect from vertebrae T11 to L2. The patient underwent lumbotomy and abscess drainage, yielding 1000 cc of pus, followed by a drain that collected 10 cc/day over three days. Gram staining showed numerous white blood cells without bacteria, and TB‐PCR of the aspirated pus was positive. The patient started on antituberculosis treatment and was discharged after 7 days, continuing Anti‐TB medications for 12 months.
Conclusions: Psoas muscle TB in children is rare and may present as recurrent constipation. Early diagnosis is critical to prevent serious complications, emphasizing the importance for healthcare providers to consider this rare diagnosis in cases of persistent abdominal symptoms.
Contact e‐mail address:
G‐EV132. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV132.1. GASTROINTESTINAL MANIFESTATION IN PATIENTS WITH GAIN‐OF‐FUNCTION MUTATIONS IN PIK3CD
Pesah Melnik 1, Dror Shouval2, Raz Somech3, Batia Weiss1,3
1Division Of Pediatric Gastroenterology And Nutrition, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel‐Hashomer, Ramat Gan, Israel, 2Institute Of Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center, Petach Tikva, Israel, 3School Of Medicine, The Faculty Of Medical And Health Sciences, Tel Aviv university, Tel Aviv, Israel
Objectives and Study: Gain‐of‐function mutations in PIK3CD gene is the cause of activated phosphoinositide 3‐kinase δ syndrome (APDS), a rare primary immunodeficiency with a variable phenotype. The disease includes respiratory, hematological, rheumatic, renal and gastrointestinal (GI) symptoms such as bloody diarrhea, abdominal pain and failure to thrive. The endoscopic findings are colonic nodules or even polyps, resulting from lymphoid hyperplasia. Sirolimus is an mTor inhibitor used to treat lymphatic lesions and recently used in cases of APDS with GI involvement. The objective of this study is to characterize the gastrointestinal manifestations of children with APDS and assess response to sirolimus therapy.
Methods: A retrospective case series conducted in the pediatric gastrointestinal unit at Sheba Medical Center. Clinical, endoscopic and histological data prior to and after sirolimus treatment, as well as long‐term follow up data were retrieved.
Results: Four patients (two males) with a gain‐of‐function PIK3CD mutation leading to APDS syndrome were included. The age at diagnosis ranged from 3.5‐6.5 years, and the length of follow‐up was 3‐12 years. All patients had recurrent sinus‐pulmonary infections and chronic diarrhea (including a single patient with bloody stools). Endoscopic evaluation revealed severe and diffuse lymphoid hyperplasia of the small and large intestine, while a lymphoproliferative disease was ruled out. While IVIG therapy alone had no effect on clinical symptoms and endoscopic appearance, the addition of sirolimus led to a significant improvement in all aspects. Sirolimus therapy was overall safe, but one patient developed eosinophilic esophagitis.
Conclusions: Sirolimus is effective in ameliorating the gastrointestinal manifestations of APDS. However, long‐term follow‐up is required, especially since these patients are at risk of developing lymphoproliferative disorders.
Contact e‐mail address: pesahmelnik@gmail.com
G‐EV133. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV133.1. FECAL CALPROTECTIN DETERMINATION IN CHILDREN WITH COW'S MILK ALLERGY: AN UPDATE OF OUR COHORT STUDY
Filippo Mondi' 1, Caterina Anania1, Giulia Brindisi1, Alessandra Spagnoli2, Daniela De Canditiis3, Arianna Gesmini1, Lavinia Marchetti1, Alessia Fichera1, Maria Grazia Piccioni1, Annamaria Zicari1, Francesca Olivero4
1Department Of Maternal, Infantile And Urological Sciences, Sapienza University of Rome, Rome, Italy, 22department Of Public Health And Infectious Diseases, Sapienza University of Rome, Rome, Italy, 33Institute of Applied Calculus‐CNR, Rome, Italy, 4Independent Researcher, Rome, Italy
Objectives and Study: Cow's milk allergy (CMA) is the most common food allergy in the pediatric age. It can be IgE, non‐IgE‐mediated or mixed type. The oral food challenge (OFC) remains a mainstay of its diagnosis, especially for non‐IgE‐mediated CMA; this test can be risky and time‐consuming. Hence, the need to identify biomarkers. Fecal calprotectin (FC) showed variable results: few studies compared FC before and after an elimination diet in CMA patients, proposing it as a diagnostic biomarker. Our aim was to evaluate the application of FC as a biomarker of bowel inflammation in CMA patients, testing it before and after an elimination diet, and to correlate it to Cow's Milk Related Symptom Score (CoMiSS).
Methods: In this prospective study we enrolled 76 children (age 5‐18 months) with CMA‐related gastrointestinal and cutaneous symptoms following ESPGHAN guidelines. Clinical assessments included history, physical examination, SPT, and IgE assays. The percentage of IgE and non‐IgE‐mediated CMA patients was similar (51% vs 49%). FC levels and CoMiSS were measured in 51 patients pre‐ (T1) and post‐diet (T2), with a subgroup analysis of 15 patients with elevated baseline FC ( > 50 mg/kg).
Results: FC levels significantly decreased after an elimination diet (median 30 mg/kg at T1 vs. 16 mg/kg at T2; p < 0.001). In the subgroup with higher FC levels, median values dropped from 90 mg/kg to 33 mg/kg (p = 0.007). CoMiSS also improved (median 8.50 at T1 vs. 3.00 at T2; p < 0.001). Linear regression analysis showed no correlation between FC values and CoMiSS at T1 and T2.
Conclusions: The reduction of FC value after an elimination diet suggests that it could be considered a possible biomarker of bowel inflammation in CMA patients. Further studies are necessary to confirm these data and to evaluate and standardize the use of FC for diagnosis and follow‐up of CMA.
Contact e‐mail address: filippo.mondi94@gmail.com
G‐EV134. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV134.1. BIFIDOBACTERIUM LACTIS AND SACCHAROMYCES BOULARDII IN THE TREATMENT OF GREEK CHILDREN WITH FUNCTIONAL CONSTIPATION
Tatiani Moudiou, Eleni Tsotridou, Lilian Adamidou, Assimina Galli‐Tsinopoulou
2nd Department Of Pediatrics, Ahepa Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Objectives and Study: The prevalence of pediatric constipation ranges from 0.7 to 29.6% across different countries. Functional constipation (FC) accounts for 95% of chronic constipation cases. Probiotics have rendered promising results in the treatment of FC, but guidelines regarding the choice of agent and the dosage regimen are still lacking. The aim of the current study was to compare the efficacy of two probiotic supplements in pediatric patients with FC.
Methods: 173 Greek children diagnosed with FC according to the Rome IV criteria were enrolled in the study. Organic reasons for constipation were excluded. Two treatment group were formed, namely Group A: Saccharomyces boulardii (2 billion cfu, 15days/month) +Laxative ± Soluble Fiber and Group B: Bifidobacterium lactis (500 million cfu, daily for 30 days followed by one week break)+Laxative±Soluble Fiber. Τherapy was accompanied with toilet training, dietary and physical activity instructions. We assessed the differences of the required therapy duration between groups A and B.
Results: Our sample comprised of 93 males (53.8%) and 80 females (46.2%) with a median age of 6.5 years (range 0.5‐16). Group A included 37 males and 36 females, and Group B 26 males and 22 females with a median age of 5.75 and 6.5 years respectively. Therapy duration was significantly lower in group B (mean Group A 5.76 ± 1.55 months versus mean Group B 3.34 ± 1.04 months, Welch test p‐value = 0.036).
Conclusions: Bifidobacterium lactis reportedly reduces intestinal transit time by increasing the production of short chain fatty acids and modulating the gut–brain axis. Our results suggest that Bifidobacterium lactis is superior to Saccharomyces boulardii when combined with a laxative independently of adding soluble fiber in children with FC.
Contact e‐mail address: tmod@auth.gr
G‐EV135. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV135.1. ROLE OF MICROBIOTA IN GRAFT‐VERSUS‐INTESTINAL HOST DISEASE (GVHD) IN ALLOGENEIC HEMATOPOIETIC PRECURSOR TRANSPLANTATION (HSCT)
María Muñoz Fernández 1, Sergio George2, Mariana Izquierdo2, Roberto Ovalle2, Natalia Gonzalez3, Jorge Miranda4, Constanza Payeras4, Álvaro Vega1, Daniela Lecaros1, Mauricio Farfan2
1Gastroenterology, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile, 2Pediatrics, University of Chile, Santiago, Chile, 3Oncology, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile, 4Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
Objectives and Study: Background. GVHD affects 50‐70% patients after HSCT. Some studies point modification of gut microbiota with the loss of about 30% on average of alpha diversity compared to pre‐transplant samples. The aim of this study was describe the gut microbiota of children with allogeneic HSCT before and after transplantation and relate it to the development of intestinal GVHD.
Methods: Material and methods: An observational study of children with indication for HSCT was carried out at Dr. Luis Calvo Mackenna Hospital between November 2018 ‐ November 2020. Patients had 3‐4 stool samples taken for intestinal microbiota study (Admission, 60 and 100 days after the transplant, and additional samples due to suspicion of GVHD. Samples were preserved to be processed at the end of the study. The composition of the intestinal microbiota, amplification of the V3‐V4 regions of the gene that encodes 16S ribosomal RNA (16S rDNA), sequencing were carried out using Illumina platform on the NextSeq1000 equipment using 2 x 300 bp kit. paired end. The sequences obtained were processed in the RStudio program, following the DADA2 pipeline, those results were used to analyze alpha and beta diversity, as well as relative abundance at different taxonomic levels. The data were analyzed in the statistical program Stara v.14.0. Statistical significance with p < 0.05 was considered.
Results: Result: Eighteen children participated (61% male, median age 6 years). Most had oncological diagnoses (77.7%). Regarding HSCT 44% received bone marrow, 27.7% cord blood, and 27.7% peripheral blood. 38.8% developed intestinal GVHD. Alpha diversity (Shannon index) significantly decreased at 60 (p < 0.01) and 100 days (p < 0.001) post‐transplant with Proteobacteria dominating post‐transplant samples.
Conclusions: Conclusion: Our data showed changes in the gut microbiota in our group and could be related to the development of intestinal GVHD. Restitution of gut microbiota after HSCT might be an alternative treatment to prevent GVHD.
Contact e‐mail address:
G‐EV136. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV136.1. ETHNICITY IS ASSOCIATED WITH THE EPIDEMIOLOGY OF FOREIGN BODY INGESTION IN CHILDREN
Nadine Abboud1,2, Nitzan Abelson1,2, Leon Qarawani1,2, Gadi Howard1,2, Galina Ling1,2, Baruch Yrushalmi1,2, Raouf Nassar 1,2
1Faculty Of Health Sciences, Ben‐Gurion University of the Negev, Beer‐Sheva, Israel, Beer Sheva, Israel, 2Pediatric Gastroneterology, Hepatology, And Nutrition Unit, Saban Children Hospital, Soroka University Medical Center, Beer Sehva, Israel
Objectives and Study: Foreign body ingestion (FBI) is a challenging problem in children that may cause complications and needs an immediate medical evaluation. The most frequent cases are among children under six years old, most of which are incidental and involve common objects found in the house. The study aims to determine the epidemiology of FBI among children in southern Israel and to compare the two major populations in this area: Jewish and Bedouins (Muslim Arabs).
Methods: A retrospective study investigating the epidemiology and management of FBI among children who were admitted to the pediatric emergency room (PER), between the years 2022‐2023 at Soroka University Medical Center, which is the only tertiary medical center in southern Israel that provides pediatric gastroenterology services.
Results: A total of 479 children were admitted to the PER with FBI; 258 (53.9%) were males. The proportion of males among Jews was higher than Bedouins (63% vs. 49%, p‐value = 0.04, respectively). The median age was 6.13 years (+/‐4.3), and 66% of the cases were Bedouins. The prevalence of FBI was 15:10,000 children; the prevalence was higher among the Bedouins (19:10,000 vs.10:10,000 children, p‐value < 0.05, respectively). Blunt bodies were the most common ingested FB (48.5%), followed by sharp bodies (26.7%). The FB was mostly located in the stomach (32%), followed by the small intestine (22%). Bedouin children ingested more sharp objects compared to Jewish children (OR = 2,p‐value = 0.02), while the magnets were more frequent among the Jews (OR = 5, p‐value < 0.05). Furthermore, the hospitalization rate was higher among the Bedouins (OR = 1.6,p‐value = 0.04). Noticeably, the socioeconomic status was lower among the Bedouins.
Conclusions: The prevalence of FBI and hospitalization rate were higher among Bedouin children, which can be explained by their low socioeconomic status. The higher proportion of Bedouin females compared to the Jewish can be explained by the "Hijab" pin ingestion, which can also explain the higher rate of sharp body ingestion among the Bedouins.
Contact e‐mail address: Raouf.n@gmail.com
G‐EV137. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV137.1. THE METALLIC SCARS: TO WORRY OR NOT TO WORRY? A CASE REPORT OF A RARE COMPLICATION POST SINGLE STAGE BUTTON GASTROSTOMY BUTTON PLACEMENT
Wuthinan Nivatvongs, Sunita Amar Rajani, Dominique Schluckebier, Cathryn Ellison, Laura Solway, Katie Beattie, Prithviraj Rao
Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
Objectives and Study: T‐fasteners are preloaded suture anchor systems consisting of small metal bars attached to a suture. They have been widely used to effectively anchor the stomach to the abdominal wall ahead of placing a single stage percutaneous button gastrostomy in our Tertiary Paediatric Gastroenterology Centre for the last 10 years. We report a case of a child with a retained T‐fasteners with a literature review.
Methods:
A 7‐year old male presented with persistent mild redness and swelling around site 2 of T‐fastener sites 4 weeks post uncomplicated single stage PEG insertion. The indication for PEG insertion in our case was for ARFID (Avoidant/Restrictive Food Intake Disorder) and under nutrition. His co‐morbidities included Autism Spectrum Disorder. Examination of the site revealed erythema and granulation around 2 separate sites around the previously placed T‐fasteners. An ultrasound examination was done which excluded any sub cutaneous collection. Abdominal X‐ray revealed 2 small metal clips in‐situ which was radio opaque (reference picture). On his 6 weeks follow up, he had a fibrotic scar tissue over the 3mm T‐fasteners lodged within the skin, but is asymptomatic otherwise.
Results: Retention of the T‐fasteners are an uncommon complication of PEG insertion. Clinical presentation can range from an asymptomatic incidental finding/mildly symptomatic (as reported in our case) to recurrent infections requiring removal.
Conclusions: Clinicians should be aware of this uncommon complication of T‐fastener retention. In cases with minor symptoms, we recommend close monitoring and safety netting for signs of infections from the retained metallic foreign body. In addition, abdominal X‐rays and closer review of them can be necessary to identify these small foreign bodies.
Contact e‐mail address: w.nivatvongs@nhs.net
G‐EV138. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV138.1. RENAL AND URINARY COMPLICATIONS IN CHILDREN WITH INTESTINAL FAILURE, A 15‐YEAR SINGLE CENTER EXPERIENCE
Senay Onbası Karabag 1, Betül Aksoy1, Eren Soyaltın2, Sinem Kahveci1, Selen Güler1, Ilksen Demir1, Serenay Cetinoglu1, Kardelen Akın1, Gozde Celiksoz1, Yeliz Cagan Appak1, Halil Sagir1, Celal Özkaya1, Maşallah Baran1
1Pediatric Gastroenterology, Katip çelebi university,İzmir city hospital, izmir, Turkey, 2Pediatric Nephrology, Katip çelebi university,İzmir city hospital, izmir, Turkey
Objectives and Study: Comorbidities have become prominent in pediatric intestinal failure patients with increased survival. Data on renal function in these patients are limited in the literature. The aim of our study was to evaluate patients with intestinal failure in terms of renal dysfunction.
Methods: Ocak 2010‐Kasım 2024 tarihleri arasında bağırsak yetmezliği tanısı ile takip edilen hastaların verileri retrospektif olarak incelendi. Başlangıç ve son başvurudaki serum kreatinin değeri, renal ultrasonografik (USG) bulgular kaydedildi ve Schwartz formülü kullanılarak eGFR (tahmini GFH) hesaplandı.
Results: Altmış üç hasta çalışmaya dahil edildi; Hastaların 35′i (%56) kız, 28′i (%44) erkek olup, yaş ortalaması 7,5 ay (0,5‐219 ay) ve ortalama takip süresi 15 ay (1‐133 ay) idi. Barsak yetmezliği nedenleri 37 hastada (%59) kısa barsak sendromu, 14 hastada (%22) pediatrik intestinal psödoobstrüksiyon ve 12 hastada (%19) konjenital ishal idi. Hastaların dokuzuna ince barsak nakli yapıldı. Yirmi altı hastada (%41) böbrek fonksiyon bozukluğu vardı. Bu hastaların 7′sinde (%27) başlangıçta düşük eGFR, 2′sinde (%8) kronik böbrek yetmezliği, 2′sinde (%8) prerenal akut böbrek hasarı (ABH), 3′ünde (%11) ilaca bağlı tubulopati ve 12′sinde (%46) çoklu organ yetmezliğine bağlı ABH vardı. Böbrek fonksiyon bozukluğunun en sık nedeni çoklu organ yetmezliğiydi. Böbrek fonksiyon bozukluğu olan hastaların tamamı TPN'ye bağımlıydı ve bu hastaların %50′si (13 hasta) kaybedildi. Ölen hastaların sekizi nakil alıcısıydı. Ultrasonografi bulgularında 14 hastada (%22) anormal bulgular (nefrokalsinozis, hidronefroz, artmış ekojenite) saptandı. Pediatrik intestinal psödoobstrüksiyonu olan 7 hastada nörojenik mesane tanısı konuldu. Bu hastalardan ikisine vezikostomi gerekti.
Conclusions: Patients with pediatric intestinal failure are at significant risk for renal dysfunction. In our study, renal dysfunction was common in these patients, but most of them recovered. Those who were irreversible were all TPN‐dependent patients. Small bowel transplantation in particular was associated with significant renal dysfunction due to intensive immunosuppressant use. Renal complications are an important cause of mortality in patients with intestinal failure.
Contact e‐mail address: senayonbasikarabag@gmail.com
G‐EV139. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV139.1. FUNGI, BACTERIA AND PARASITES ARE ASSOCIATED WITH AUTISM? INCIDENCE IN COLOMBIA ‐ SOUTH AMERICA
Margaret Ordonez‐Smith
Microbiology, Microbiology Institute of Colombia "IMICOL", Bogota, Colombia
Objectives and Study: It is estimated that 1.0% of the global population suffers from Autism Spectrum Disorder (ASD), and its pathogenesis remains unclear. According to the World Health Organization, approximately one in 160 children is affected by ASD, with a notable increase over the past 50 years. Our aim is to emphasize the importance of studying the microbiota of individuals with ASD, focusing on the presence of bacteria, fungi, and/or parasites, as several studies have shown associations between these microorganisms and ASD.
Methods: Different etiologies were investigated in fecal samples, including parasites, fungi, and bacteria such as Yersinia, Klebsiella, Morganella, Salmonella, Proteus, Pseudomonas, Shigella, and Serratia. The samples were collected and processed within one to two hours after collection. Feces were cultured on MacConkey agar, EMB (Eosin Methylene Blue) agar, CLED (Cystine‐Lactose‐Electrolyte Deficient) medium with Andrade Indicator and selective media for Campylobacter. Fungal cultures were grown on Sabouraud Dextrose Agar or Potato Dextrose Agar. All cultures were incubated at 22°C for fungi and 37°C for bacteria.
Results: A total of 117 cases were analyzed, with 23% female and 77% male participants, between the ages of 2 and 11. The most frequent parasites identified were: 59.4% Entamoeba histolytica, 29.7% Strongyloides stercoralis, and 8.9% Ascaris lumbricoides. Fungi identified, included 47.9% Candida. The most prevalent bacterial species were: 48.8% Escherichia coli and 18.0% Yersinia enterocolitica, among others.
Conclusions: This study highlights the importance of early detection of dysbiosis in children with ASD. Our findings indicate that multiple etiologies may be involved, and the study supports the relationship between the gut microbiome and their symptoms and behavior. In a follow‐up survey conducted with parents after treatment, 88% reported significant improvements. Plus, it can reduce the autism cost in US, since ASD is increasing each year.
Contact e‐mail address: institutodemicrobiologia@yahoo.com
G‐EV140. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV140.1. CHILDHOOD LUPUS‐ASSOCIATED PROTEIN‐LOOSING ENTEROPATHY (LUPLE): A CASE REPORT
Ozlem Sumer Cosar1, Hakan Öztürk 1, Ayşe Can1, Denız Gezgın Yıldırım2, Batuhan Kucukalı2, Buket Dalgıc1, Ayse Dursun3, Odul Egrıtas Gurkan1
1Division Of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 2Division Of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey, 3Division Of Medıcıne Pathologhy, Gazi University Faculty of Medicine, Ankara, Turkey
Objectives and Study: Protein‐losing enteropathy (PLE) is a rare condition characterized by clinical findings such as edema, ascites, pleural effusion and diarrhea due to excessive protein loss from the gastrointestinal system. Although systemic lupus erythematosus (SLE) is rare in childhood, PLE can be the first presenting feature; this condition is referred to as lupus‐associated protein‐losing enteropathy (LUPLE).
Methods: Case Report
Results: Our case shows that PLE can be the initial presentation of SLE, which is a rare manifestation in childhood. PLE, a rare complication of lupus, tends to be more severe in children, and the diagnostic process can be challenging. This case report presents a seven‐year‐old girl who presented with abdominal distension, generalized edema, chronic diarrhea, and weakness. Despite treatment, the recurrence of symptoms and the addition of new joint findings led to further investigations, which revealed positive anti‐dsDNA and low complement levels, resulting in a diagnosis of systemic lupus erythematosus. The patient's clinical condition improved with steroid, azathioprine, and hydroxychloroquine treatments.
Conclusions: This case highlights the importance of considering SLE in the differential diagnosis of PLE and underscores the significance of recognizing the rare presentations of childhood lupus.
Contact e‐mail address: dr.ozlemcosar@gmail.com
G‐EV141. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV141.1. USE OF GERDQ AND QOLRAD QUESTIONS IN CHILDREN WITH OVERLAP GERD AND FD AS ALTERNATIVES TO A VISIT TO A DOCTOR
Natalia Pavlenko 1, Konstantin Voloshyn2, Olena Shutova1, Irina Solodovnichenko1, Olena Babadzhanyan1, Juli Karpushenko1, Lidiia Voloshyna1
1Department Of Pediatrics 3 And Neonatology, Kharkiv National Medical University, Kharkiv, Ukraine, 2Department Of Pediatrics, V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
Objectives and Study: Dyspeptic symptoms in children are quite common and are a frequent reason for referral to both the primary care physician (family doctor, pediatrician) and the gastroenterologist. One third of children with such symptoms have an overlap of GERD and functional dyspepsia (FD), which leads to frequent repeat visits. Objective: To assess the feasibility of using the GERDQ and QOLRAD questionnaires in children with overlap of GERD and FD for dynamic monitoring of symptoms, treatment effectiveness, and quality of life of patients in conditions of limited access to a doctor's visit.
Methods: 54 children aged 7‐18 years with overlap of GERD and FD were under observation. The diagnosis was verified by means of a questionnaire (GERDQ and QOLRAD questionnaires) and the use of fibrogastroscopy, endoscopic pH‐metry. The results were recorded in the developed individual patient card and statistically processed.
Results: The preliminary diagnosis established using the GERDQ questionnaire (adapted for school‐age children) in 90% of patients with overlap of GERD and FD was identical to the diagnosis established objectively and using upper endoscopy. During the treatment and after its completion during repeated questioning (GERDQ and QOLRAD questionnaires), the analysis of the patients' responses allowed to correctly objectify dyspeptic complaints by 100%, pain by 82%, psychoemotional sphere and general well‐being by 96% and overall quality of life by 100%.
Conclusions: Scoring questionnaire responses allows us to objectify the dynamics of complaints and symptoms in patients with overlap of GERD and FD, the effectiveness of treatment, and the quality of life of children even in the absence of a direct visit to a doctor, which is especially helpful in wartime.
Contact e‐mail address:
G‐EV142. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV142.1. PREVALENCE AND CHARACTERISTICS OF GASTROINTESTINAL ISSUES IN BULGARIAN CHILDREN WITH AUTISM SPECTRUM DISORDER AND CEREBRAL PALSY
Yana Petkova 1, Rozalina Braykova2, Rositsa Chamova2, Albena Toneva2, Silviya Nikolova3, Dimitar Marinov2, Stanislava Hadzhieva2, Nikoleta Yoncheva4, Stefka Tsvetanova4, Rouzha Pancheva2
1Department Of Hygiene And Epidemiology, Medical University of Varna, Varna, Bulgaria, 2Department Of Hygiene And Epidemiology, Medical University Prof Dr Paraskev Stoyanov Varna, Varna, Bulgaria, 3Department Of Social Medicine And Healthcare Organization, Medical University Prof Dr Paraskev Stoyanov Varna, Varna, Bulgaria, 4Karin Dom Foundation, Varna, Bulgaria, Varna, Bulgaria
Objectives and Study: Gastrointestinal (GI) issues are common comorbidities in children with neurodevelopmental disorders, significantly affecting their health and quality of life. Children with autism spectrum disorder (ASD) and cerebral palsy (CP) often exhibit a range of GI symptoms that exacerbate existing health challenges and create unique caregiving demands. This study explores the prevalence and characteristics of common GI symptoms, including gastroesophageal reflux disease (GERD) and constipation, in children with ASD and CP in Bulgaria.
Methods: A cross‐sectional study was conducted with 146 children (ASD: n = 102, 81.4% male; CP: n = 44, 54.5% male). Demographic data and GI symptoms (hypersalivation, rumination, GERD, and constipation) were analyzed. Comparisons between groups were made using cross‐tabulation and Fisher's exact test, with statistical significance set at p < 0.05.
Results: Hypersalivation was significantly more prevalent in CP (47.8%) than in ASD (10.4%, p < 0.001), with girls more affected than boys (33.3%, p = 0.022). Rumination was higher in CP (22.7%) compared to ASD (1.2%, p = 0.001). GERD was more common in CP (21.2%) than in ASD (5.3%, p = 0.013). Constipation affected 23.8% of children with ASD and 51.2% with CP (p = 0.003). Hard stools (77.8%, p < 0.001) and effortful defecation (60%, p < 0.001) were prevalent among children with defecation every two days. Constipation treatment was initiated currently or previously in 38.6% of children with ASD and 56.7% of those with CP (p < 0.001). Among treated children, 27.8% still reported pain during defecation (p = 0.002). Additionally, GERD was observed in 58.3% of children with constipation (p = 0.044).
Conclusions: GI symptoms, particularly GERD and constipation, significantly impact children with CP and ASD, with notable differences in their prevalence. Effective interventions addressing these symptoms are essential to improve nutritional outcomes, prevent complications such as malnutrition, and enhance health and development in these vulnerable populations.
Contact e‐mail address: yana.petkova17@gmail.com
G‐EV143. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV143.1. UNVEILING THE UNEXPECTED: THREE UNUSUAL CASES OF NEONATAL DIARRHEA
Dr. R. Bhanu Vikraman Pillai 1, Anju S Nair2, Anila Kn3, Seetha Lakshmy Kd2, Uday Kumar R2, Sudhindran Surendran3, Saraswathy S Nair3
1Department Of Paediatric Gastroenterology, Amrita Institute of Medical Sciences & Research center, Kochi, India, 2Department Of Pharmacy Practice,amrita School Of Pharmacy, Amrita Institute of Medical Sciences & Research center, Kochi, India, 3Department Of Solid Organ Transplantation, Amrita Institute of Medical Sciences & Research Centre, Kochi, India
Objectives and Study: Neonatal‐diarrhea is a complex condition requiring extensive, multidisciplinary evaluation. While CMPA is a common cause, manageable with dietary modifications like hydrolyzed or amino acid‐based formulas, other rare etiologies need advanced diagnostic mechanisms, including genetic testing. Despite these advances, outcomes vary depending on the underlying condition.We report three cases of neonatal chronic‐diarrhea, each with distinct genetic findings Case 1: A 2‐month‐old male, born of fourth‐degree consanguinity, had severe diarrhea from 2‐weeks of age, failure to thrive, and intermittent sepsis‐like symptoms. He underwent comprehensive evaluation, comprising endoscopy and EM, with no conclusive findings. Despite partial response to amino acid‐based formula, the infant succumbed to sepsis and refractory shock at 3‐months. Posthumous genetic testing revealed a homozygous SKIV2Lmutation (c.3540+2 T > C) causing trichohepatoenteric‐syndrome and a heterozygous PERCC1 mutation (c.701 C>T, p.Pro234Leu) of uncertain significance. Case 2: A 2‐month‐old male, born to third‐degree consanguineous parents, presented with chronic‐diarrhea and fat malabsorption. Endoscopic biopsies revealed eosinophilia, and floating fat globules were noted in the colon. Management included amino acid‐based formula and pancreatic enzyme replacement therapy, resulting in symptom improvement. Genetic testing revealed a homozygous PCSK1 mutation (c.818 A>T, exon 7) linked to proprotein‐convertase 1/3 deficiency. The infant succumbed to an intercurrent illness at 6 months. Case 3: A female infant with diarrhea from birth and a sibling history of similar fatal symptoms. Genetic testing confirmed a homozygous SLC5A1 mutation (chr22:c.1370 A>G) causing congenital glucose‐galactose malabsorption and a heterozygous CYP24A1 mutation (chr20:c.477_481delGAGTG) of uncertain significance. Managed with carbohydrate‐free formula and supplemental fructose, she thrived by 3‐months. These cases highlight the essential role of genetic analysis in diagnosing and tailoring management for neonatal diarrhea, with significant implications for outcomes.
Methods: Retrospective case‐analysis
Results: Identified 3 unusual genetic causes of neonatal diarrhea
Conclusions: All these 3‐cases demonstrate the importance of early, multidisciplinary evaluation of chronic‐diarrhea in the newborn and need a conclusive diagnosis for effective management.
Contact e‐mail address: bhanupillai@yahoo.com
G‐EV144. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV144.1. HIGH OUTPUT ENTEROSTOMY INCREASES THE RISK OF PERIOPERATIVE MORTALITY AFTER ENTEROSTOMY FORMATION IN CHILDREN
Himawan Rahman, Muzal Kadim, Yogi Prawira, Klara Yuliarti, Teny Sari, Badriul Hegar
Department Of Pediatrics, Faculty of Medicine, Universitas Indonesia ‐ Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Objectives and Study: Enterostomy formation surgery in children is at risk of complications, including mortality. Perioperative mortality (≤30 days postoperatively) might be influenced by the patient's condition before surgery, surgical technique, and postoperative complications. This study aims to examine factors that influence perioperative mortality after enterostomy surgery.
Methods: his study was conducted retrospectively on all pediatric patients (≤18 years) who underwent enterostomy (jejunostomy/ileostomy) and were treated at a tertiary referral hospital in Indonesia during the period October 2019 ‐ December 2023. We looked for preoperative and perioperative factors that might be associated with perioperative mortality. We used multivariate analysis in the analysis.
Results: This study involved 64 subjects, with the largest age group being neonates (44%). Infant age (≤1 year), emergency surgery, presence of bacteremia, and presence of high output stoma (HOS) episodes were included in the multivariate test (p = 0.027, 0.148, 0.213, and 0.001, respectively). In the multivariate test, only the occurrence of HOS was shown to be significantly associated with perioperative mortality (p = 0.003, RR 12.96 95%CI 2.42 ‐ 69.49).
Conclusions: The presence of HOS episodes increased the risk of perioperative mortality after enterostomy formation.
Contact e‐mail address: himawan.rahman@gmail.com
G‐EV145. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV145.1. DIARRHEA AND ITS ASSOCIATED FACTORS AMONG YOUNG IRANIAN CHILDREN: A CROSS‐SECTIONAL STUDY
Mohammad Bagher Rahmati 1, Tahere Maddah2
1Pediatrics, Hormozgan University of Medical Sciences, BND, Iran, 2Hormozgan University of Medical Sciences, BND, Iran
Objectives and Study: Introduction:
Acute diarrheal diseases remain a major cause of morbidity and mortality worldwide, particularly among young children in resource‐limited settings. Objective:
This study aimed to investigate the potential risk factors associated with diarrhea in young children.
Methods:
A descriptive cross‐sectional study was conducted on 250 children admitted to Bandar Abbas Children's Hospital between September 2017 and March 2018. Participants were divided into two groups: children with diarrhea (cases) and children without diarrhea (controls). Data were collected using a structured checklist.
Results:
Among the 250 participants, an equal distribution of males and females was observed (50% each). Diarrhea cases were more prevalent in winter, among children aged 1 to 3 years (with a 3.26‐fold higher risk compared to those over 3 years), and in children attending kindergarten.
Conclusions: Conclusion:
This study highlights significant associations between the incidence of diarrhea and factors such as age, maternal education level, kindergarten attendance, preterm birth, and the consumption of raw fruits and vegetables.
Contact e‐mail address: mbrahmati@gmail.com
G‐EV146. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV146.1. USE OF FERRIC CARBOXIMALTOSE IN PATIENTS FROM A PEDIATRIC INTESTINAL REHABILITATION UNIT, INCLUDING INFANTS
María Allende Chaves1, Cristina María López García2, Alida Alcolea Sánchez2, Silvia Gómez Anca2, Pedro Luis Pérez Hernández2, Javier Artero López2, Cristina Jiménez Núñez3, Rocío González Sacristán2, Eva Peña Saínz‐Pardo2, Pilar Serrano Fernández2, Esther Ramos Boluda 2
1Pediatric Gastroenterology, La Paz University Hospital, Madrid, Spain, 2Gastroenterología Pediátrica, Hospital Universitario La Paz, Madrid, Spain, 3Pharmacology, Hospital Universitario La Paz, Madrid, Spain
Objectives and Study: Iron deficiency is the most common nutritional deficiency in pediatric patients with intestinal failure due to multiple factors. Ferric carboxymaltose is the intravenous iron formulation that has demonstrated the greatest efficacy in resolving iron deficiency anemia, with a good safety profile, although its technical data sheet does not recommend its use in children under 1 year. The objective is to describe the profile and outcomes of patients who received intravenous ferric carboxymaltose in an Intestinal Rehabilitation Unit.
Methods: A retrospective descriptive analysis is performed of patients who received ferric carboxymaltose in an Intestinal Rehabilitation Unit for 4 years and 10 months (December 2019 to October 2024).
Results: A total of 134 ferric carboxymaltose infusions were administered to 68 patients. The median age was 7 years, the youngest being 2 months old. Of the 68 patients, 34 had intestinal failure (IF) due to short bowel syndrome, 18 were recipients of a multivisceral transplant, and 16 had IF due to other causes, such as intestinal pseudo‐obstruction, DGAT‐1 deficiency, microvillus inclusion disease, or tricho‐hepato‐enteric syndrome. The indication was for iron deficiency both with and without anemia. The maximum number of infusions received by the same patient was 14. Fourteen infusions were performed in children under 12 months. Dosing was between 15 and 20 mg/kg (maximum dose per infusion of 840 mg).
None of the patients reported adverse effects related to the infusion.
Conclusions: Paediatric patients with intestinal failure often require intravenous iron therapy. There are few data on the formulation and optimal dose of intravenous iron in patients requiring intestinal rehabilitation. We have not recorded any adverse effects secondary to ferric carboxymaltose infusion, even in children under 12 months, although further studies should be carried out to evaluate the safety profile in this age range.
Contact e‐mail address: mariacamila.allende@salud.madrid.org
G‐EV147. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV147.1. PREVALENCE OF GASTROINTESTINAL SYMPTOMS AND ADHERENCE TO THE MEDITERRANEAN DIET IN A COHORT OF CHILDREN WITH DOWN SYNDROME FROM SOUTHERN ITALY
Roberta Rotondo 1,2, Gerardo Farina2, Claudia Cuomo2, Mariantonia Maglio2,3, Maria Vittoria Barone2,3, Iris Scala4, Renata Auricchio2,3
1Department Of Medicine And Surgery, Pediatric Clinic, University of Parma, Parma, Italy, 2Department Of Translational Medical Science, Section Of Pediatrics, University of Naples Federico II, Naples, Italy, 3European Laboratory For The Investigation Of Food Induced Diseases (elfid), Department Of Translational Medical Science, Section Of Paediatrics, University of Naples Federico II, Naples, Italy, 4Department Of Maternal And Child Health, Section Of Pediatrics, University of Naples Federico II, Naples, Italy
Objectives and Study: Children with Down Syndrome (DS) are at a higher risk of comorbidities across various areas, including gastroenterology. Recent analyses of literature have revealed that more than half of children with DS experience gastrointestinal symptoms, with functional constipation and irritable bowel syndrome being the most common. Considering the prevalence of gastrointestinal symptoms in the U.S. cohort of DS patients previously analyzed, our study aims to evaluate the frequency of these disorders in a cohort of Southern Italy DS children, in relation to their adherence to the Mediterranean diet.
Methods: Our study included 44 DS children aged between 3 and 18 years, followed at the Federico II University Hospital in Naples. Along with clinical evaluations, were administered the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire to assess the presence of gastrointestinal symptoms the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED) to evaluate adherence to the Mediterranean diet.
Results: From the analysis of data from 44 patients (19 males, 25 females with a mean age of 11.5 years ± 4.3), evaluated between March and May 2024, it emerged that 97% of the patients did not present gastrointestinal symptoms significant enough to cause notable discomfort in daily life. The most frequently reported gastrointestinal disorder was chronic constipation (6.8%), a lower percentage compared to the literature. From a nutritional perspective, 88.6% of the cohort showed adherence to the Mediterranean diet (29.5% high adherence, 59% medium adherence).
Conclusions: Our study showed absence of significant gastrointestinal symptoms in children with DS living in our region and adhering to the Mediterranean diet compared to the U.S. cohort. The main components of the Mediterranean diet, such as extra virgin olive oil (unsaturated fatty acids and polyphenols), legumes (flavanols that regulate metabolism), fruits, vegetables, and omega‐3‐rich fish, may have a protective role, promoting gastrointestinal well‐being and reducing the likelihood of gastrointestinal symptoms.
Contact e‐mail address: robertarot.97@gmail.com
G‐EV148. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV148.1. MODERATE TO SEVERE PANCREATITIS, RESTRICTED DIET AND NEURODIVERGENCE ‐ A CASE SERIES AT CHILDREN'S HEALTH IRELAND AT CRUMLIN(CHI)
Deirdre Ryan 1, Husnain Mahomed2, Mairead O'Meara3, Roisin Mccaffrey3, Séamus Hussey1,4, Emer Fitzpatrick1
1Paediatric Gastroenterology, Hepatology & Nutrition, CHI Crumlin, Crumlin, Ireland, 2Chi Crumlin Gastroenterology And Hepatology, 1 Hermitage Close Rathfarnham Dublin, Dublin, Ireland, 3Nutrition & Dietetics Department, Childrens Health Ireland at Crumlin, Dublin, Ireland, 4University College Dublin, Dublin, Ireland
Objectives and Study: Acute pancreatitis (AP) is a challenging diagnosis in certain paediatric groups, given reliance on 2 of 3 clinical, laboratory or radiology parameters for diagnosis. Its aetiology is often enigmatic. Our national service was recently referred a series of AP cases, made more challenging due to related underlying comorbidities, which may be of interest to clinical teams with similar presentations.
Methods: A retrospective chart review was carried out of six cases of AP admitted to Crumlin Hospital, Dublin between July and November 2024. Each case fulfilled the diagnostic criteria and was assigned severity grading per the 2018 NASPGHAN guidelines for AP. Characteristics gathered included age, sex, comorbidities, AP severity; clinical, radiology and laboratory data, treatments and clinical outcomes.
Results: All patients had comorbid neurodivergence, restricted dietary intake consuming less than 10 food groups daily, micronutrient deficiency and moderate to severe episodes of pancreatitis requiring admission to hospital for an average of 34 days. Four of the cases were male. The youngest patients were aged 2 years (female) and 3 years (male), and all others were aged 13‐15 at time of diagnosis.
Table 1.
Conclusions: Individuals with autism may have dietary or gastrointestinal health challenges in addition to communication difficulties, which may compound typical disease presentations. Micronutrient deficiency secondary to restrictive intake may increase the risk of AP, if not severity. The potential for progressive AP should be considered in neurodiverse patients presenting with AP. Further research is required to elucidate potential associations between pancreatitis and autism.
Contact e‐mail address: deirdreryan500@gmail.com
G‐EV149. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV149.1. BONE MINERALIZATION IN PARENTERAL NUTRITION DEPENDENT CHILDREN IN MICROVILLOUS INCLUSION DISEASE: A RETROSPECTIVE COHORT STUDY
Rana Salman 1, Buthaina Murbati2, Martin Bitzan3, Muhamed Zulficar4, Eman Elyyan2, Hesham Obaidat5, Ajmal Kader2
1General Pediatrics, Al Qassimi Women and children's hospital, sharjah, United Arab Emirates, 2Pediatric Gastroenterology, Al Jalila children's hospital, dubai, United Arab Emirates, 3Pediatric Nephrology, Al Jalila children's hospital, dubai, United Arab Emirates, 4Pediatric Endocrinology, Al Jalila children's hospital, dubai, United Arab Emirates, 5General Pediatrics, Al Jalila children's hospital, dubai, United Arab Emirates
Objectives and Study: Microvillous inclusion disease (MVID) is a rare genetic disorder with intestinal failure and are dependent on parenteral nutrition (PN). Long term PN is associated with several complications including poor bone mineralization (BM). Literature search did not reveal any relevant articles on BM in children with MVID. Objective is to assess BM in a cohort of children with MVID over a 5‐year period and identify possible factors that may adversely affect BM.
Methods: Study design: Retrospective cohort study. Data collected manually from electronic medical records. Participants: Inclusion criteria: Children over 4 years with a genetically confirmed diagnosis of MVID. Exclusion criteria: Primary skeletal anomalies. Primary Outcome: Bone mineralization status Secondary Outcome: Renal tubular loss of bone minerals and effect on serum bone profile.
Results: Period between 2013 and 2025, Five patients of Arab ethnicity with mutation on MYO5B were identified, four met inclusion criteria. All are on daily PN since neonatal period. Data collected between 1st January 2020 to 28th February 2025. Table summarizes relevant baseline features and Bone parameters.
Conclusions: In this cohort, etiology of poor BM and short stature is likely to be multifactorial. Although, no fractures were noted, varying degrees of poor BM is very common in all PN dependent children with MVID. Increased urinary loss of calcium and phosphates due to renal tubulopathy appears to be an important contributory factor. However, the reliability of the urinary as well as serum parameters performed on spot samples in the setting of continuous PN infusion may need further validation in larger multi‐center study.
Contact e‐mail address: ranaaladhami@gmail.com
G‐EV150. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV150.1. A FIFTEEN‐YEAR RETROSPECTIVE STUDY AMONG PEDIATRIC PATIENTS DIAGNOSED WITH DOLICHOCOLON IN A TERTIARY HOSPITAL IN METRO MANILA, PHILIPPINES: A PRELIMINARY STUDY
Laurice San Jose, Portia Menelia Monreal, Rebecca Abiog‐Castro, Caroline Anne Castro‐Ador
University of Santo Tomas Hospital, Manila, Philippines
Objectives and Study: To review the clinical profile and various diagnostic modalities conducted among patients diagnosed to have dolichocolon.
Methods: A retrospective, case series chart review with analytical component, that determined the association of Dolichocolon and patient demographics, constipation history, possible risk factors (dietary history) and initial presentation (chief complaint and physical examination) at diagnosis. Pediatric patients aged 29 days old to less 18 years old at the University of Santo Tomas Hospital with barium enema between 2008 to 2023 were included. It reviewed the different imaging modalities and the barium enema findings.
Results: A total of 399 charts were reviewed. The most common age of diagnosis was between 2‐5 years old (48.1%). Female predominance at 54.65%. Majority of the patients did not have a family history of constipation. Constipation (60.40%) was the most common chief complaint among all ages and most symptoms were experienced intermittently for more than a month, but less than a year (49.87%). Abdominal dullness was noted at 81.45%. Plain abdominal radiographs, ultrasound and CT scans were insignificant to the diagnosis of dolichocolon. Contrast study of the colon, Barium Enema, confirmed colon redundancy. Sigmoid colon redundancy was found at 91.22%, with female predominance. Redundancy of the sigmoid was seen in the 2 to 5‐year age group. Constipation and abdominal pain were mostly seen with sigmoid colon redundancy. Cross tabulation with chi‐square test (pValue < 0.04) revealed an association between the following: 1) presence of sigmoid colon redundancy and females; 2) presence of hepatic flexure redundancy in the 6‐10 age group; 3) presence of ascending colon redundancy in the 2‐5 age group and 4) Abdominal distention with descending colon or ascending colon redundancy.
Conclusions: This study has demonstrated that the clinical features mainly: constipation, abdominal pain, and abdominal distention, found among the adult population, were also documented among our patients. Barium enema, was the diagnostic modality of choice to confirm dolichocolon.
Contact e‐mail address: lauricesanjose@gmail.com
G‐EV151. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV151.1. HERBST TRIAD ‐ A RARE CLINICAL PRESENTATION OF GASTROESOPHAGEAL REFLUX DISEASE
Elena Savvidou 1,2, Maria Argyrou2, Athina Chrysodonta3, Zacharias Zachariou4
1Pediatric Liver, Gi And Nutrition Centre, Archbishop Makarios III Hospital, Nikosia, Cyprus, 2Archbishop Makarios III Hospital, Nikosia, Cyprus, 3Pediatric Surgical Department, Archbishop Makarios III Hospital, Nikosia, Cyprus, 4Medical School, University of Cyprus, Nikosia, Cyprus
Objectives and Study: Herbst triad is an under‐diagnosed manifestation of GERD with iron deficiency anemia, hypoalbuminemia or protein‐loosing enteropathy and digital clubbing. Although the pathophysiology of this entity is still unknown, it should be part of the differential diagnosis of the above conditions. The aim of this study is to present a clinical case of a pediatric patient presenting with recurrent abdominal pain and vomiting, stunting growth and digital clubbing.
Methods: The patient, a 5 year old immigrant boy from Syria, presented with vomiting since infancy, stunting growth and excessive digital clubbing.
Evaluation from multiple pediatric subspecialties lead to extensive investigation, including full blood count, biochemical studies, stool studies including Calprotectin and a‐antitrypsin, Coeliac antibodies, specific RAST for food allergies, thyroid function tests, cardiological evaluation, Sweat test/Genetics for CF, HRCT‐Chest and MRI CNS. The above investigation revealed iron deficiency anemia, hypoalbuminemia and vitamin D Deficiency. Due to clnically possible GERD he was treated with PPIs 1 mg/kg/d for 2 months, without significant improvement of his vomiting and unfortunately further weight loss. The patient was non‐cooperative regarding a 24h‐Impedance‐pH Study.
Results: Subsequently he underwent an upper GI series and he was reported to have severe stricturing of the lower esophagus. An endoscopy was performed which verified the stricturing at the area of the lower esophagus and the patient underwent succesfully four sessions of endoscopic balloon‐dilatations. Biopsies while pre‐treated with PPIs remained unremarkable. Genetical investigations showed no pathological findings. We considered the esophageal stricturing a result of long‐standing GERD and after sucessful dilatations the patient's gastrointestinal symptoms relieved and his growth recovered.
Conclusions: We present a case report of Herbst's triad, an under‐diagnosed manifestation of GERD with iron deficiency anemia, hypoalbuminemia and excessive digital clubbing. High suspicion is needed for early diagnosis and treatment, especially regarding patients without classic clinical presentation of GER.
Contact e‐mail address: esavvidougastro@gmail.com
G‐EV152. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV152.1. PHARMACOKINETICS AND SAFETY OF INTRAVENOUS PANTOPRAZOLE IN A HOSPITALIZED PEDIATRIC POPULATION
Nancy Sherman 1, Kevin Wolter1, Elena Soto2
1Pfizer Inc, New York, United States of America, 2Pharmacometrics And Systems Pharmacology, Pfizer Research and Development, Sandwich, Kent, United Kingdom
Objectives and Study: Pantoprazole is a proton pump inhibitor (PPI) licensed in the US for the short‐term treatment of conditions including gastroesophageal reflux disease and a history of erosive esophagitis in adults and pediatric patients ≥3 months old. Intravenous (IV) pantoprazole is a treatment option for hospitalized patients or for whom oral administration of PPI therapy is not suitable. This study aimed to characterize the pharmacokinetics and safety of IV pantoprazole in hospitalized pediatric participants (1–16 years), who were candidates for acid suppression therapy.
Methods: In this non‐randomized, open‐label, multicenter, phase 4 study (NCT02401035), the primary objective was to characterize the pharmacokinetics (PK) of IV pantoprazole in pediatric participants in two age cohorts: Cohort 1, 1 to <2 years; Cohort 2, 2–16 years. Secondary objectives included: safety, tolerability, and assessment of the CYP2C19 metabolizer status. Participants received IV pantoprazole sodium (10–40 mg) once daily for 4–7 days, based on body weight.
Results: Eighteen participants received study drug and completed the study (Cohort 1 n = 2; Cohort 2 n = 16). Twelve participants (63.2%) were male and all were white. CYP2C19 metabolizer phenotypes were intermediate (n = 7), extensive (n = 7), rapid (n = 2), and ultra‐rapid (n = 2). The median (range) duration of study treatment was 4.0 (4–7) days in both cohorts. Clearance and volume of distribution values (geometric mean) were higher in Cohort 2 (4.7 L/hr and 5.6 L, respectively) than in Cohort 1 (1.9 L/hr and 1.6 L).
Conclusions: Pantoprazole exposures were comparable between the two cohorts for both single and multiple doses. Pantoprazole plasma concentration time profiles and PK parameters were comparable following single and multiple IV administration, indicating no accumulation following multiple dosing. No new safety concerns were raised. Acknowledgments: This study was funded by Pfizer and medical writing support was provided by Sarah Moore, MSc, of Engage Scientific Solutions.
Contact e‐mail address: Nancy.Sherman@Pfizer.com
G‐EV153. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV153.1. PNEUMATOSIS CYSTOIDES INTESTINALIS IN A PEDIATRIC PATIENT WITH SCLERODERMA AND SIGNS OF SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE REPORT
Maria Christina Siouli, Natalia Kelaidi, Eirini Chronopoulou, Grigorios Iordanoglou, Rogalidou Maria, Aggeliki Krikri
General Pediatric Hospital "Agia Sofia", Athens, Greece
Objectives and Study: Pneumatosis cystoides intestinalis (PCI) is described as the presence of gas‐filled cysts within the bowel wall. This entity is extremely rare in children and is highly correlated with acquired immunodeficiency due to a variety of underlying conditions such as rheumatoid diseases. PCI in the pediatric population poses a diagnostic challenge due to the variety of symptoms and the usually alarming findings on imaging. In the majority of cases, the diagnosis is made incidentally after a CT scan which reveals gas bubbles within the intestinal wall and/or pneumoperitoneum. It is usually a benign disease which can be managed conservatively.
Methods: In this presentation, we are describing a case of a 15‐year‐old female adolescent, with medical history of scleroderma and systemic lupus erythematous treated with high‐dose corticosteroids, who presented in the emergency department with long‐term stool retention and no other clinical or laboratory findings.
Results: Imaging studies (abdominal x‐ray and CT) revealed pneumoperitoneum. Based on these findings, the patient underwent exploratory laparotomy. Intraoperatively, no intestinal perforation was apparent, however a significantly dilated ileus with numerous gas‐filled cysts intramurally was found. Intestinal full thickness biopsy of the affected intestinal part was obtained.
Conclusions: Pneumatosis cystoides intestinalis constitutes a diagnostic riddle due to its rarity in the pediatric population but also due to its subclinical presentation. PCI with underlying scleroderma is extremely rare in the pediatric population. The aim of our case presentation is to raise awareness about this rare condition and to underline that surgical intervention should be reserved only when clinical and radiological signs and symptoms of peritonitis are established.
Contact e‐mail address: s.kristi1711@gmail.com
G‐EV154. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV154.1. CLINICAL AND ETIOLOGICAL PROFILE OF LOWER GASTROINTESTINAL BLEED IN CHILDREN IN A TERTIARY REFERRAL CENTRE
Viswanathan Melarcode Sivaramakrishnan 1, Rine Benson2, Iyyappakumar R3
1Paediatric Gastroenterology, Apollo Children's Hospital, CHENNAI, India, 2Paediatrics, Apollo Children's Hospital, Chennai, India, 3Paediatric, Apollo Children's Hospital, Chennai, India
Objectives and Study: To study the clincial and etiological profile of lower gastrointestinal bleeding (LGIB) in children aged 1 month to 16 years.
Methods: STUDY DESIGN Prospective observational study carried out in a tertiary referral centre PARTICIPANTS Children with LGIB aged 1 month to 16 years over 1 year period INTERVENTION Detailed history/clinical examination done. Complete blood count, stool analysis and ultrasound abdomen were done initially and further investigations as needed.
Results:
A total of 75 children in the age group of 1 month to 16 years presented with LGIB, 64% males and 36% females. Infants were 16%, preschool children 25.3%, young children 36% and 22.7% were adolescents. At presentation 92% had bright red colour stool. Bleeding was painful in 37.3% and painless in 62.7%. A history of constipation was found in 29.3% children and all had anal fissures. Fever in 10.7%, weight loss in 5.4%, mouth ulcers in 2.67%, joint pain in 1.3%. and 4% children had a history of atopy/wheezing. None had history of jaundice. Eight out of twelve (8/12) patients in less than 2‐year age group, were formula fed. A family history of atopy was noted in 6.7%, and 20% were malnourished (Z score <‐2SD). On presentation except for one child (1.3%), all were hemodynamically stable. On clinical examination 5.3% were pale, 4% had skin rash, 29.3% had anal fissures, and 2.67% had perianal tags. Investigations revealed 25.33% children with low haemoglobin (<11 gm%) & colonoscopy was indicated in 62.6% children. LGIB etiology is listed in table: 1.
Conclusions: Etiology of Lower GI bleed varies across the different age groups. Anal fissure is an important cause of low‐volume rectal bleeding in all age groups. Allergic proctocolitis is an important cause of LGIB in children < 2 years of age. Young Children and adolescents with rectal bleeding need to be evaluated for juvenile polyps and IBD.
Contact e‐mail address: drmsv21@gmail.com
G‐EV155. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV155.1. CLINICAL SPECTRUM OF GASTROINTESTINAL AND HEPATOBILIARY DISORDERS IN OVERWEIGHT & OBESE CHILDREN IN A TERTIARY REFERRAL CENTRE
Viswanathan Melarcode Sivaramakrishnan 1,2, Sravanthi Kosuri3
1Paediatric Gastroenterology, Apollo Children's Hospital, Chennai, India, 2Paediatric Gastroenterology, Apollo Children's Hospital, CHENNAI, India, 3Paediatrics, Apollo Children's Hospital, Chennai, India
Objectives and Study: To find out the clinical spectrum of various gastrointestinal and hepatobiliary disorders in overweight and obese children aged 2 to 18 years attending our hospital outpatient or inpatient departments.
Methods: This prospective descriptive study was conducted at a tertiary children's hospital in south India between June 2022 and April 2023. We included children aged 2 to 18 years who were overweight and obese based on BMI and weight for length (for < 5 years), with gastrointestinal and hepatobiliary symptoms. Data was collected from parents and children through a predesigned questionnaire, clinical examination, and investigations. The data was analysed by suitable statistical analysis.
Results:
Out of 129 children with gastrointestinal and hepatobiliary symptoms, 77 (59.7%) were obese, and 52 (40.3%) were overweight. Male gender predominance (59.7%) was noted as compared to females (40.3%). The prevalence of functional constipation (FC), non‐alcoholic fatty liver disease (NAFLD), functional dyspepsia (FD), irritable bowel syndrome (IBS), functional abdominal pain not otherwise specified (FAPNOS), gastro‐oesophageal reflux disease (GERD), cholelithiasis, and pancreatitis was 77 (59.7%), 69 (53.5%), 30 (23.2%), 8 (6.2%), 10 (7.8%), 14 (10.8%), 5 (3.8%) and 3 (2.3%) respectively (Table 1). Some of our patients had more than one diagnosis. We found 30.4% of children with NAFLD had higher ALT values (p value < 0.001) than the non‐NAFLD group. In the NAFLD group, a significant association with elevated triglycerides (p value < 0.001) was observed in 37.6% when compared to the non‐NAFLD group.
Conclusions: It would be advisable for general paediatricians to actively evaluate for gastrointestinal and hepatobiliary diseases/disorders in overweight and obese children. We would suggest particularly looking for functional constipation, NAFLD, and Functional dyspepsia, as they occur more frequently in them. Early referral to the paediatric gastroenterologist would be advisable, particularly if there are any clinical manifestations of gastrointestinal and hepatobiliary disorders, so that an optimal outcome could be achieved.
Contact e‐mail address: drmsv21@gmail.com
G‐EV156. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV156.1. FOOD PROTEIN INDUCED ENTEROCOLITIS SYNDROME (FPIES): A RETROSPECTIVE STUDY OF AN ITALIAN CENTER
Francesco Paolo Spano 1, Francesca Olivero2, Filippo Mondì1, Anna Maria Zicari1, Caterina Anania1
1Department Of Maternal, Infantile And Urological Sciences, Sapienza University of Rome, Rome, Italy, 2Independent researcher, Rome, Italy
Objectives and Study: Food protein‐induced enterocolitis syndrome (FPIES) is a delayed, non‐IgE‐mediated gastrointestinal food‐induced hypersensitivity, poorly known and generally underdiagnosed. We aimed to describe the clinical presentation of FPIES in our center.
Methods: An observational retrospective single‐center study was conducted, including children with acute FPIES referring to the Pediatric Allergy Unit of the Maternal and Child Health Department, Sapienza University of Rome, between June 2021 and November 2024. Oral food challenges (OFC) were performed in seven patients to test achievement of tolerance after 18 months from diagnosis.
Results: Ten patients (7 boys and 3 girls; 60% had a family history of atopy) were included. Food triggers were egg (30%), fish (30%), cow's milk (20%), rice (10%) and honey (10%), with a mean age of onset respectively of eight, twenty, four, six and twelve months. Atypical FPIES was found in one case (triggered by egg); 60% of cases had early onset acute FPIES. Mean time between onset and diagnosis was almost 13 months. Symptoms were typical in all patients. Three patients had an acute onset of FPIES characterized by severe dehydration, requiring emergency room care and intravenous rehydration, one of them was hospitalized. We performed OFC in 7 patients, mean age at OFC was 31 months, 3 did not reach tolerance (43%, triggered by egg, fish and honey) and ondansetron was administered in one case, due to repetitive emesis, lethargy and pallor during observation.
Conclusions: Our findings show that the diagnosis of FPIES is often delayed, especially fish‐triggered FPIES, that had the highest mean age of onset. The food triggers described were those most commonly reported in the Mediterranean region, except for honey, which is not reported as FPIES trigger in the literature. FPIES onset seems to be associated with the timing of food introduction: foods introduced later cause FPIES presentation to occur at a later age.
Contact e‐mail address: francesca_ol@hotmail.it
G‐EV157. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV157.1. CAN WE DO LESS? REDUCING DISCARDED BLOOD VOLUME IN LABORATORY TEST WITHDRAWALS FROM CENTRAL VENOUS CATHETERS IN PEDIATRIC INTESTINAL FAILURE PATIENTS
Yochai Frenkel1, Worood Matanis1, Or Kobi2, Marielle Kaplan3,4, Halima Dabaja‐Younis4,5, Inna Spector Cohen 4,6
1Pediatrics A, Ruth Rappaport Children's Hospital, Rambam healthcare campus, Haifa, Israel, 2Pediatrics B, Ruth Rappaport Children's Hospital, Rambam healthcare campus, Haifa, Israel, 3Clinical Biochemistry Laboratory, Rambam healthcare campus, Haifa, Israel, 4Bruce Rappaport Faculty Of Medicine, Technion ‐ Israel's institute of technology, Haifa, Israel, 5Pediatric Infectious Diseases Unit, Ruth Rappaport Children's Hospital, Rambam healthcare campus, Haifa, Israel, 6Pediatric Gastroenterology & Nutrition Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
Objectives and Study: Central venous catheters (CVCs) play a crucial role in managing pediatric intestinal failure (PIF) patients reliant on parenteral nutrition (PN). These patients require frequent blood draws from CVCs. Current protocols typically recommend discarding 5 mL of blood prior to collecting samples for laboratory analysis. However, this practice often exceeds the actual CVC dead‐space volume, leading to unnecessary blood loss. This study aimed to assess the reliability of blood test results when discarding smaller volumes compared to the standard 5 mL discard, with considerations for catheter size.
Methods: This prospective cohort study included 20 PIF patients with single‐lumen tunneled Hickman CVCs. Blood samples were obtained during routine clinical care, and laboratory parameters analyzed included hemoglobin, white blood cell count, platelets, sodium, potassium, glucose, and creatinine. Results from samples collected after discarding 1, 2, 3 and 4 mL of blood were compared to those obtained using the traditional 5 mL discard. Additionally, patients were stratified into subpopulations based on CVC size: small (2.7–6.6 Fr) and large‐bore (9.6 Fr).
Results: A total of 125 blood draws were analyzed. Across the entire cohort, a 2 mL discard volume yielded results comparable to 5 mL discard. For patients with larger CVCs, samples obtained after discarding 2 mL provided comparable results to samples after discarding 5 mL, while for smaller CVCs, discarding 1 mL was sufficient. Although some laboratory parameters showed statistically significant differences, these were clinically insignificant, indicating that reducing discard volume does not compromise clinical decisions.
Conclusions: Reducing discarded blood volume to 2 mL in 9.6 Fr CVCs or 1 mL for smaller CVCs (2.7‐6.6 Fr) preserve diagnostic accuracy while minimizing blood loss in PIF patients, potentially mitigating iatrogenic anemia. Further research is warranted to validate these findings for additional laboratory parameters, such as coagulation studies, and across different CVC types.
Contact e‐mail address: yochaif9@gmail.com
G‐EV158. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV158.1. EPIDEMIOLOGY OF ROTAVIRUS‐ASSOCIATED GASTROENTERITIS AMONG TOGOLESE YOUNG CHILDREN THROUGH THE SURVEILLANCE FOR CHILDHOOD DIARRHEA AT TWO SENTINEL SITES IN LOME THE CAPITAL CITY, 2008‐2023
Enyonam Tsolenyanu 1, Mawussi Godonou2, Djatougbe Akolly3, Mawuse Guedenon3, Novissi Tsogbale2, Amevegbé Boko4, Dadja Landoh5, Yawo Agbobli6, Lawe Okoumi7, Anoumou Dagnra2, Adama Gbadoe7, Joseph Biey8, Amadou Diallo9, Koffi Djadou10
1Paediatrics, Sylvanus Olympio Teaching Hospital, Ministry of Health/Medical school in University of Lome, Lome, Togo, 2Laboratory Of Microbiology, Sylvanus Olympio Teaching Hospital, Lome, Togo, 3Paediatrics, Sylvanus Olympio Teaching Hospital, Lome, Togo, 4Immunization, Ministry of Health, Lome, Togo, 5Country Office, Immunization, World Health Organization, Lome, Togo, 6Managing Director, Sylvanus Olympio Teaching Hospital, Lome, Togo, 7Paediatrics, Be Hospital, Lome, Togo, 8West African Inter‐country‐team, World Health Organization, Ouagadougou, Burkina Faso, 9Country Office, World Health Organization, Lome, Togo, 10Paediatrics, Medical school in University of Lome, Lome, Togo
Objectives and Study: Gastroenteritis is common in young children and remains the cause of nearly half a million child deaths per year worldwide. Rotavirus is still the leading cause of gastroenteritis and death‐associated in this age‐group. A rotavirus vaccine was introduced into the Togolese immunization schedule in 2014. We presented the epidemiology of gastroenteritis before and after the vaccine introduction.
Methods: Active surveillance for gastroenteritis is conducting at 2 sentinel sites in Lome, using the generic protocol developed by the Word Health Organization (WHO). We confirmed the diagnosis of rotavirus infection by Enzyme Linked Immunosorbent Assay (ELISA) in stool samples. We received technical assistance from the regional reference laboratory (RRL) in Pretoria (South Africa, 2008) and now from the RRL in Accra (Ghana, 2010) for ELISA test quality control and genotyping of rotavirus strains.
Results: Over a 15‐year sentinel surveillance period (2008–2023), we enrolled 2,221 children hospitalized with all‐cause gastroenteritis. The whole prevalence for rotavirus‐associated gastroenteritis was 43%. Boys represented 56% of enrolled cases; and 47% of them had confirmed rotavirus infection. More than 81% of all‐cause gastroenteritis cases and about 80% of rotavirus‐associated cases were infants. We enrolled 55% of all‐cause gastroenteritis cases and 60% of rotavirus‐associated cases from December to March. The overall prevalence of rotavirus gastroenteritis in this rotavirus season was 50%. We observed a median annual reduction of 63% in rotavirus‐associated gastroenteritis during the post‐rotavirus vaccination period (range: 16‐86%) compared to pre‐vaccination data (figure 1). The overall case fatality rate associated to all‐cause gastroenteritis was 1%. The most common genotypes combinations were G12P[8], (20%), G1P[8] (17%), G1P[6] (16%), and G3P[6] (10%).
Conclusions: We observed a higher non‐significantly number of boys with gastroenteritis; and the rotavirus vaccine has changed the whole epidemiology of childhood diarrhea in Togo. Acknowledgement to patients, Togo's Ministry of health, WHO, GAVI/Alliance and the rotavirus reference laboratories.
Contact e‐mail address: tsolenyanu_enyonam@yahoo.fr
G‐EV159. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV159.1. ULTRASONOGRAPHY FOR THE POSITIONING OF ESOPHAGEAL MULTICHANNEL INTRALUMINAL IMPEDANCE/PH‐METRY CATHETER IN NEWBORNS: A PROSPECTIVE STUDY AND COMPARISON WITH CONVENTIONAL TECHNIQUES
Dario Ummarino 1,2, Francesca Cinelli3, Carmine De Angelis4, Antonino Ciunfrini1, Antonietta D'Aniello1, Sara Alfano1, Maria Giuseppa Scala1, Angelina Grammegna5, Silvia Salvatore6, Roberto Cinelli1
1Department Of Neonatal Intensive Care Unit, hospital Saint Leonard, Castellammare di Stabia, Italy, 2Department Of Neonatal Intensive Care Unit, hospital Sait Leonard of Castellammare di Stabia, Castellammare di Stabia, Italy, 3UNICAMILLUS international Medical University, Rome, Italy, 4University of Naples Luigi Vanvitelli, Naples, Italy, 5Department Of Pediatric, hospital De Luca e Rossano, Vico Equense, Italy, 6Department of Medicine and Technological Innovation, Pediatrics, Hospital "F. Del Ponte", University of Insubria, Varese, Italy
Objectives and Study: To assess the use of ultrasound to visualize and determine the correct position of a multichannel intraluminal impedance‐pH probe (MII‐pH).
Methods: This is a monocenter prospective study recruiting newborns who underwent MII‐pH for suspicious of gastroesopahegal reflux disease (GERD). Catheter position was based on Strobel's formula and ultrasonography and was confirmed by X‐ray. The ultrasonography was performed using (US) system Alpinion‐eCube‐i7® in B‐mode with linear and convex probe. Ultrasound was used to evaluate the correct positioning of the MII‐pH catheter before the beginning and during the MII‐pH registration to evaluate any changes of the position. The results were also compared with retrospective cases collected in our center in previous years.
Results: Thirty‐six newborns were included Ultrasound allowed to visualize the esophageal probe in all the newborn tested. Ultrasound based positioning was correct in 100% of patients considering an error acceptance of 1 cm, and 66,7% with an error acceptance of 0,5 cm, compared to X‐ray. The median duration of the US was 3.2 minutes (range 2.5‐5.78 minutes), with prolonged time in crying babies. In two neonates the MII‐pH was accidentally removed during the registration and it was repositioned by using ultrasound. Previous cohort consisted of 35 newborns who underwent MII‐pH: one patient had the probe in the respiratory tract and six patients needed new positioning of the MII‐pH probe and second X‐ray control because of bad positioning or accidental removal of the probe during the registration.
Conclusions: Ultrasound seems to be a valid alternative for the assessment of the MII‐pH probe position and the identification of the pH sensor and the lower esophageal sphincter inreal time. However, ultrasound expertise is needed to provide accurate results.
Contact e‐mail address: dario.ummarino@hotmail.it
G‐EV160. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV160.1. GELATIN TANNATE IN PEDIATRIC INFECTIOUS GASTROENTERITIS
Yvan Vandenplas 1, Koen Huysentruyt2
1KidZ Health Castle UZ Brussel, Brussels, Belgium, 2KidZ Health Castle, UZ Brussel, Brussels, Belgium
Objectives and Study: Acute infectious gastroenteritis (AGE) causes impairment of the gastro‐intestinal mucus and epithelium. Adjuvant treatment to oral rehydration solution (ORS) is recommended to shorten the diarrhea duration. Gelatin tannate (GT) is a promising intestinal barrier modulators.
Methods: Data from MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials were analyzed.
Results: In a Romanian study, GT was more effective than other medications and decreased diarrhea duration (29.0 vs 45.4 hours, p < 0.0001) with more children with normal stool consistency at 72 h (87.0 vs 30.4%; p = 0.026). The difference was already apparent after 12 hours. A Polish randomized controlled trial (RCT) evaluated GT (n = 36) or placebo (n = 36) in addition to ORS showing a similar diarrhea duration in both groups (75.6 ± 27.8 vs 75.5 ± 29.0 hours, respectively). A Turkish RCT compared ORS plus GT (103 patients) with ORS plus placebo (100 patients) in children (3 months ‐ 12 years), reporting a lower incidence of watery stools in the GT than in the placebo group after 12 hours (59.2% vs. 77.0%; p = 0.01). The same was true for stool frequency (mean 2 vs. 3 stools; p < 0.01). Another Turkish RCT concluded that GT resulted in a decreased stool frequency after 12 hours, resulting in a better weight gain. An Italian RCT included 60 patients (3‐72 months old) with AGE: 29 received ORS and 31 ORS plus GT. The mean duration of diarrhea was significantly shorter in the ORS and GT than in the ORS only group (76.8 ± 19.2 vs. 108 ± 24.0 h; p < 0.0001). In another pediatric trial GT was associated with a greater decrease stools after 12 hours. In yet another trial testing a different tannate, diarrhea duration was 2.0 + /‐ 0.27 days vs 3.75 + /‐ 0.30 days (p < 0.001).
Conclusions: GT has a fast onset of action, is effective and safe in AGE in children.
Contact e‐mail address: yvan.vandenplas@uzbrussel.be
G‐EV161. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV161.1. BURDEN OF COW MILK ALLERGY IN THE POPULATION WITH CMA PERSISTENT ‐ A SYSTEMATIC LITERATURE REVIEW
Sarah Rodrigues1, Mayra Lemos2, Jady Vidal 1
1DANONE BRAZIL, SAO PAULO, Brazil, 2Lemos Health Reviews LTDA, SAO PAULO, Brazil
Objectives and Study: Cow's milk allergy (CMA) is one of the most common food allergies in the world and occurs when the immune system reacts to the proteins present in the cow's milk. Though the high prevalence among children, there is a lack of evidence on the long‐term impact of the condition in the patients’ lives. This study aims to analyze the current evidence on the burden of CMA in the population above 1 year‐old and identify the main knowledge gaps on this topic.
Methods: A comprehensive search was performed in the databases MEDLINE (Pubmed), COCHRANE, Lilacs and Embase retrieving an initial sample of 2.187 studies which after a selection process following the guidelines of screening and data extraction indicated by the PRISMA resulted in a final sample of 44 studies.
Results: A total sample of 1.880 patients were analyzed in this qualitative review. Patient's age ranged from 1 to 6 years old. The selected studies comprehended only cross‐sectional/observational designs focusing mostly on anthropometric measures, nutritional status and food intake. Most of the research opted to investigate the impact of cow milk free diets as comparators to evaluate the impact of CMA in the UpAge population. The use of hypoallergenic formulas represented only 22% of the final sample of studies with good results to all the populations studied. All the studies that covered a restrictive diet on cow's milk derivatives found a mild‐to‐moderate impact in the anthropometric/nutritional components of the patients.
Conclusions: There is a lack of long‐term prospective studies focusing on the follow‐up of CMA population. Nevertheless, the evidence retrieved in this analysis indicates that CMA have a lasting impact mainly regarding to the nutritional status of the children who presented the condition.
Contact e‐mail address: sarah.rodrigues@danone.com
G‐EV162. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV162.1. PROFILING OF VOLATILE ORGANIC COMPOUNDS IN CLINICAL ISOLATE CULTURES AND STOOLS FROM CHILDREN WITH CLOSTRIDIOIDES DIFFICILE INFECTION BY HS‐SPME‐GC‐MS
Xiaolu Li, Yizhong Wang, Pei Xiao
Shanghai Children's Hopsital, China, Shanghai, China
Objectives and Study: Bacterial volatile organic compounds (VOCs) has been investigated as a non‐invasive approach for infectious diseases diagnosis. Here, we aimed to explore potential diagnostic markers by profiling VOCs in cultures of unique clinical Clostridioides difficile (C. difficile) isolates and stool samples from pediatric C. difficile infection (CDI) patients.
Methods: VOCs were measured using headspace solid‐phase microextraction coupled with gas chromatography combined with mass spectrometry (HS‐SPME‐GC‐MS).
Results: A total of 106 individual compounds were detected in 39 C. difficile isolates cultures, of which, 1‐Hexanol, ethanol, and 4‐Methylvaleric acid were detected in all bacterial cultures, 2‐methyl‐Butanoic acid, 1‐Pentanol, 2‐Methyl‐1‐Propanol, p‐Xylene, and 6‐Methyl‐2‐Heptanone were found in 38 (97.4%), 37 (94.9%), 34 (87.2%), 34 (87.2%), and 32 (82.1%) isolates cultures, respectively. The most abundant compound was 4‐Methylvaleric acid (14.71, IQR 11.73, 16.38). Fecal VOCs patterns between the CDI and healthy children were significant different. Higher levels of 1‐Propanol, 6‐Methyl‐2‐Heptanone, Phenylethyl Alcohol, 2‐Octanone, Phenol, and Ethanol were detected in fecal samples of CDI children. Receiver‐operating characteristic (ROC) analysis showed 1‐Propanol, 6‐Methyl‐2‐heptanone, Phenylethyl Alcohol, and Ethanol presenting the highest discrimination value for differentiating feces of CDI children from healthy children.
Conclusions: Our data indicated that fecal 1‐Propanol, 6‐Methyl‐2‐heptanone, Phenylethyl Alcohol, and Ethanol may be used as potential biomarkers for CDI diagnosis.
Contact e‐mail address:
G‐EV163. Topic: AS01. GASTROENTEROLOGY/AS01f. Gastroenterology Other (including Enteropathy other than Coeliac; GI Infections; Esophageal Atresia)
G‐EV163.1. EXPLORING THE SUSCEPTIBILITY OF INFANTILE MICE WITH DIFFERENT FUT2 GENOTYPES TO ENTEROHEMORRHAGIC E.COLI O157:H7 INFECTION
Xiaoming Zhang 1, Qidi Xue1, Zerong Lu2, Feitong Liu2, Ming Li1
1College Of Basic Medical Science, Dalian Medical University, Dalian, China, 2Health And Happiness (h&h) Group, China Research and Innovation Center, GuangZhou, China
Objectives and Study: Glycans on intestinal mucosa, in particular the α1,2‐fucosylated terminal glycan chains catalysed by the fucosyltransferase 2 (FUT2), can be recognised and utilised by a wide range of enteropathogenic bacteria to colonize and iniciate infection. But the susceptibility of different FUT2 genotypes, i.e. secretion types, to bacterial infections remains unclear. Here, we compared the susceptibility of infantile mice with different FUT2 genotypes to Enterohemorrhagic E. coli (EHEC) O157:H7 infection, and to explore the underlying mechanisms.
Methods: FUT2 gene‐deficient mice were constructed by CRISPR‐Cas9 gene editing technology, and EHEC O157:H7 was given to infantile mice with different FUT2 genotypes by oral gavage for 10 days after antibiotic treatment. The susceptibility of infantile mice with different FUT2 genotypes to EHEC O157:H7 was investigated by detecting the degree of infection, mucosal barrier, immune function, and intestinal microbiota composition.
Results: After infection, compared to FUT2 gene‐deficient infantile mice, the wild‐type infantile mice showed weight loss, significant shortening of the colon, more severe pathological damage to the colon and disruption of the integrity of the intestinal barrier, as well as the increased intestinal EHEC O157:H7 colonization and translocation to the liver, suggested a higher severity of infection. Interestingly, FUT2 gene‐deficient infantile mice harbor higher abundance of Akkermansia muciniphila (A. muc). in their gut compared to the wild‐type infantile mice, which also provided a basis for the subsequent unravelling of the relationship between glycan metabolism of A. muc and EHEC O157:H7 in the gut.
Conclusions: Our results confirm that wild‐type infantile mice have a higher severity of infection and are more susceptible compared to FUT2 gene‐deficient infantile mice. These results provide a basis for understanding the relationship between FUT2 genotypes and infectious diseases.
Contact e‐mail address: vivianmarat@163.com
G‐EV164. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV164.1. THE EFFECTS OF ANTI‐TNFΑ TREATMENT ON ANTHROPOMETRIC PARAMETERS AND BODY COMPOSITION IN IBD CHILDREN: A 2‐YEAR PROSPECTIVE STUDY
Luisa Abbattista 1, Raffaella De Santis1, Laura Gianolio1,2, Lucia Cococcioni1, Lorenzo Norsa1, Dario Dilillo1, Francesca Penagini1, Gian Vincenzo Zuccotti1,2
1Paediatrics, Buzzi Children's Hospital, University of Milan, Italy, 2Biomedical And Clinical Sciences, University of Milan, Milan, Italy
Objectives and Study: Paediatric inflammatory bowel disease (PIBD) is associated with reduced fat‐free mass (FFM) compared to healthy controls. Moreover, anti‐TNFα treatment may lead to increases in body mass index (BMI) and fat mass (FM). Overweight patients face a higher risk of losing response (LOR) to anti‐TNFα therapy. This study aimed to evaluate variations of anthropometric measures and body composition over time in PIBD patients receiving anti‐TNFα therapy.
Methods: Between May 2020 and January 2024, we prospectively enrolled 24 anti‐TNFα‐naïve IBD children (6‐18 years; 10 males). We recorded anthropometric parameters (body weight ‐BW‐, height, BMI) and body composition (FM%, FFM%) via bioelectrical impedance analysis at baseline (first anti‐TNFα dose) and at 6, 12, 18, 24 months of therapy.
Results: Overall, 16/24 PIBD patients completed the 24‐months follow up (14 Crohn's Disease, 1 ulcerative colitis, 1 IBD unclassified). ‐ From baseline to 12 months a statistically significant increase of BW (43.7 Kg vs 53.7 Kg, p = 0.05) and BMI (17.6 vs 21.9, p = 0.02) was detected. ‐ Height also increased but difference did not reach statistical significance (p = 0.22). ‐ At 24 months, the increase of BW and BMI persisted with a statistically significant difference from baseline (BMI p = 0.002, BW p = 0.009) but non‐significant difference between 12 and 24 months. ‐ At 24 months an increase of FM% (21% vs 26.8%, p = 0.15) and a decrease of FFM% (79% vs 71.5%, p = 0.06) were observed. Difference was not statistically significant compared to baseline.
Conclusions: Our findings highlight a significant increase in BW and BMI with a trend toward altered body composition (increased FM and decreased FFM) in PIBD patients during anti‐TNFα treatment. This effect could be related to gut healing, but also to increased adipogenesis mediated by anti‐TNFα drugs. Regular nutritional assessments are critical to identify patients at risk of overweight and its potential impact on treatment efficacy.
Contact e‐mail address: luisa.abbattista@unimi.it
G‐EV165. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV165.1. NUTRITIONAL STATUS AT DIAGNOSIS IN PAEDIATRIC IBD: RISK FACTORS FOR UNDERWEIGHT IN CROHN'S DISEASE AND ULCERATIVE COLITIS
Luisa Abbattista 1, Laura Gianolio1,2, Francesca Gaboardi1, Donato Martella3,4, Francesca Penagini1, Giulia Rendo1, Lucia Cococcioni1, Dario Dilillo1, Alessandra Bosetti5, Elvira Verduci1, Gian Vincenzo Zuccotti6,7, Lorenzo Norsa1
1Paediatrics, Buzzi Children's Hospital, University of Milan, Italy, 2Biomedical And Clinical Sciences, University of Milan, Milan, Italy, 3Statistics And Quantitative Methods, University of Milano‐Bicocca, Milan, Italy, 4Unit Of Epidemiological And Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy, 5Department Of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy, 6Biomedical And Clinical Science, Luigi Sacco Hospital, Milan, Italy, 7Pediatrics, Vittore Buzzi Hospital, Milan, Italy
Objectives and Study: Paediatric inflammatory bowel disease (PIBD) is characterized by chronic intestinal inflammation, which can lead to severe malabsorption, resulting in significant weight loss. This study aimed to investigate the prevalence of underweight at PIBD diagnosis and its association with variables such as disease type, severity, extent, and age.
Methods: We retrospectively analyzed the BMI distribution of all patients newly diagnosed with PIBD at our Paediatric Gastroenterology Unit between 01/2013 and 12/2024. Patients were classified into categories based on their BMI z‐scores: <‐2 SD underweight (UW), >‐2 SD and <+1 SD normal weight (NW), >+1 SD overweight (OW), and >+2 SD obese (OB). Clinical records at diagnosis were reviewed, collecting disease type (Crohn's disease (CD) or ulcerative colitis (UC)), disease activity index (weighted‐PCDAI for CD and PUCAI for UC), and age of presentation (3 categories: ≤6 years, >6 to ≤12 years, and >12 years).
Results: We enrolled 123 PIBD patients (mean age 12.3, SD 3 years; 56 CD, 67 UC). At diagnosis 12/123 (10%) were underweight, 91/123 (74%) were NW, 14/123 (11%) were OW and 6/123 (5%) were OB. A lower BMI z‐score was observed in older PIBD patients (>12 years), with a statistically significant difference compared to younger ones (≤12 years ‐ p = 0.038). Additionally, CD was associated with a higher risk of underweight (p = 0.042) compared to UC. A severe PUCAI in UC correlated with a lower BMI z‐score, showing a statistically significant difference when compared to mild and moderate forms (p = 0.003), while a severe weighted‐PCDAI did not increase the risk of underweight (p = 0.196).
Conclusions: At diagnosis, most children were of normal weight; however, 10% had a low BMI. As anticipated, underweight was more common in CD patients with older age at diagnosis. Severe disease presentation in UC was an additional risk factors for low weight.
Contact e‐mail address: luisa.abbattista@unimi.it
G‐EV166. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV166.1. COMPLICATIONS AFTER COLECTOMY IN CHILDREN WITH ULCERATIVE COLITIS: A RETROSPECTIVE ANALYSIS
Paweł Rucinski, Katarzyna Akutko, Tomasz Pytrus
2nd Department Of Paediatrics, Gastroenterology And Nutrition, Faculty Of Medicine, Wroclaw Medical University, Wrocław, Poland
Objectives and Study: According to published data, 20‐45% of patients with ulcerative colitis (UC) will require surgical intervention during the course of the disease. Colectomy can be an effective treatment option for UC refractory to drug therapy; however, in most cases, it can lead to complications. In 50‐75% of children with UC, there is a significant risk of complications within 10 years after colectomy with ileal pouch‐anal anastomosis (IPAA). This study aimed to describe the impact of colectomy on the course of UC in children under the care of the Second Department of Pediatrics, Gastroenterology, and Nutrition in Wroclaw, Poland.
Methods: A cohort of children who underwent colectomy for drug‐resistant UC between 2018 and 2023 in University Hospital (UH) in Wroclaw was retrospectively analyzed.
Results: Eight patients with UC required colectomy, 4/8 with ileo‐anal anastomosis, 1/8 with ileo‐anal anastomosis with loop ileostomy and 3/8 with ileostomy. The median age at diagnosis was 13.03 years (SD 3.89). The median PUCAI score at colectomy was 55 points (SD 16.76). The mean time from diagnosis to colectomy was 2.12 years. 7/8 patients had surgical indications due to therapy resistance, 1/8 had urgent surgical indications due to bowel perforation. 7/8 patients prior to colectomy were treated with min. 1 biologic drug. Complications were noted in 7/8 patients. The median time from colectomy to complications was 9 months (SD 8.81). Among patients with ileo‐anal anastomosis, pouchitis was observed in 3, inflammation of the rectal stump in 1, fecal incontinence in 3, and no complications were observed in 1. Among patients with ileostomy, small bowel mucositis was observed in 2 and ulcerative inflammation of the rectal stump in 1.
Conclusions: Inflammation of the intestinal pouch (pouchitis) was the most common complication in children with restored gastrointestinal continuity. The cohort showed a similar incidence of complications compared to the existing literature.
Contact e‐mail address:
G‐EV167. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV167.1. MULTI‐OMICS OF MICROBIAL AND HOST FACTORS FOR A BETTER UNDERSTANDING OF INFLAMMATORY BOWEL DISEASE
Manoj Kumar1, Mohamed Djekidel1, Marwa Saadaoui2, Duaa Elhag2, Mohamed Rahal3, Nazira Ibrahim2, Khaled Abouhazima4, Fatma Almudahka2, Anthony Akobeng2, Mamoun Elawad2, Souhaila Al Khodor 5
1Research, Sidra Medicine, Doha, Qatar, 2Pediatric Gastroenterology, Sidra Medicine, Doha, Qatar, 3Perinatal And Reproductive Health Division, Sidra Medicine, Doha, Qatar, 4Gastroenterology, Sidra Medicine, Doha, Qatar, 5Director ‐ Perinatal And Reproductive Health Division, SIdra Medicine, DOHA, Qatar
Objectives and Study: Inflammatory Bowel Disease (IBD) is a chronic inflammatory disorder characterized by complex pathophysiology. Recent studies indicate that an abnormal immune response to environmental factors disrupts intestinal balance, triggering inflammation. To explore these factors, we devised a method to combine blood immune responses to innate stimuli at the transcriptional level with microbial profiling during disease flare and remission in children with IBD, comparing these profiles with those of healthy controls.
Methods: In this prospective longitudinal study conducted at Sidra Medicine's IBD clinic, we collected blood, saliva, and stool samples from IBD patients across a minimum of five visits, encompassing periods of disease flare and remission. Blood samples underwent multidimensional stimulation assays to assess immune signatures at both transcriptome and proteome levels. While, salivary and stool samples were analyzed to characterize microbiome composition and diversity. Comprehensive demographic, clinical, and phenotypic data were collected from both patients and control subjects. By integrating various omics approaches, our aim is to identify potential biomarkers crucial for understanding disease progression and treatment response in IBD.
Results: In this study, distinct gene expression and microbial signatures were identified for each subtype of IBD, showing clear differences during disease flare compared to remission or healthy controls. Analysis of immune transcriptome and proteomics data revealed specific correlations with relapses episodes and periods of remission. Based on these findings, a machine learning (ML) classifier was developed to predict markers indicative of each disease stage.
Conclusions: Taken together, our findings highlight distinct immune patterns and dysbiotic microbiota observed during disease relapse compared to remission in IBD. This comprehensive understanding of the dysfunctional immune system in IBD pathogenesis may unveil novel mechanisms and innovative therapeutic targets. The integration of our results with the ML classifier holds promise to augment current treatments for IBD patients
Contact e‐mail address:
G‐EV168. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV168.1. ASSESSING KNOWLEDGE, SELF‐MANAGEMENT, AND TRANSITION READINESS IN ADOLESCENTS WITH INFLAMMATORY BOWEL DISEASE: A MULTICENTER STUDY
Francesca Zucconi1, Francesco Graziano2, Matteo Bramuzzo3, Naire Sansotta4, Caterina Strisciuglio5, Giovanna Zuin6, Elvira Difrancisca7, Enrico Felici8, Michele Citrano2, Giulia D'Arcangelo1, Manuela Distante1, Silvia Rotulo1, Marina Aloi 9
1Department Of Maternal And Child Health, Sapienza University, Paediatric Gastroenterology Unit, Rome, Italy, 2Pediatric Unit, Villa Sofia Cervello Hospital, Palermo, Italy, 3Institute for Maternal and Child Health‐IRCCS "Burlo Garofolo", Trieste, Italy, 4Paediatric Hepatology, Gastroenterology And Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy, 5Department Of Woman, Child, General And Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli NA, Italy, 6Paediatric Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy, 7Division of Pediatric gastrointestinal Diseases, G. Di Cristina Hospital, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy, 88Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e C. Arrigo, Alessandria, Italy, 9Department Of Pediatric Gastroenterology, Hepatology, Transplantation, And Cystic Fibrosis, University of Milan, Milan, Italy
Objectives and Study: Transitioning to adult care can be a challenging phase for adolescents with chronic conditions such as inflammatory bowel disease (IBD). Many adolescents lack the necessary "readiness" for transition, which can lead to poor therapy adherence and an increased risk of missed follow‐ups. This study aimed to evaluate knowledge about IBD, self‐management (as reported by both adolescents and their parents), and readiness for transition in adolescents with IBD. Additionally, the study sought to explore correlations between these factors and patient demographics.
Methods: This multicenter, cross‐sectional study is part of a larger case‐control prospective study. Adolescents aged 14 to 17 years who had been diagnosed with IBD at least 60 days prior were enrolled from eight centers affiliated with the Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition. The IBD‐KID2 test was used to assess knowledge, the IBD‐STAR questionnaire measured self‐management, and the TRAQ was administered to determine readiness.
Results: A total of 163 patients and their caregivers participated. The average IBD‐KID2 score was 8.66 out of 15, with no significant demographic correlations found. The average IBD‐STAR score was 27.01/36 and higher scores correlate with older age (p0.002). The average TRAQ was 66.69/100, which is below the readiness threshold of 90. Higher TRAQ scores were associated with older age (p0.003). Additionally, higher scores on all three tests were linked to female gender (p0.0001, p0.01, p0.01, respectively). A significant correlation was identified between knowledge and self‐management (p < 0.0001), knowledge and readiness (p0.002), and self‐management and readiness (p < 0.0001). Parent‐reported self‐management showed a strong correlation with patients' self‐reports (p < 0.0001).
Conclusions: The median readiness at transition to the adult care among Italian adolescents with IBD is low. Females generally demonstrate higher knowledge, self‐management, and readiness. While self‐management and readiness improve with age, the overall level of transition readiness remains inadequate.
Contact e‐mail address: francesca.zucconi@uniroma1.it
G‐EV169. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV169.1. DURABILITY OF SECOND‐ AND THIRD‐LINE ADVANCED THERAPY IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE
Giulia D'Arcangelo1, Ludovica Fede1, Ramina Darabi1, Sara Curto1, Rosangela Grieco1, Miriam D'Orsi1, Marina Aloi 2,3
1Maternal And Child Health Department, Sapienza University of Rome, Rome, Italy, 2Department Of Pediatric Gastroenterology, Hepatology, Transplantation, And Cystic Fibrosis, University of Milan, Milan, Italy, 3Pediatric Gastroenterology, Hepatology And Cystic Fibrosis Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
Objectives and Study: Choosing the optimal sequence of biological and advanced therapies is crucial as it may affect treatment effectiveness. We analyzed the real‐world sequences of biological treatments in children with Inflammatory Bowel Disease and the persistence of each biological therapy after anti‐TNF failure.
Methods: Retrospective, observational cohort study conducted from January 1, 2014, to June 1st, 2024, including children with Crohn's Disease (CD) and ulcerative colitis (UC) treated with at least two successive biologics. The first‐ and second‐line biologics' treatment sequences from the index date (the beginning of the first biologic) up to a follow‐up of five years were captured. The primary aim was to assess and compare the persistence of each advanced therapy used as second and third‐line treatment in CD and UC.
Results: 119 children were enrolled (44% CD and 56% UC) were included. Infliximab was the initial biologic for 98 children (82%) (61.5% CD and 98.5% UC, p < 0.0001). Adalimumab was the first therapy in 20 children with CD (38.5%) and 1 with UC. Among those with CD, the prevalent treatment sequences included infliximab to adalimumab (n = 31 [59.6%]), adalimumab to infliximab (n = 13 [25%]), and adalimumab to anti‐IL12/23 (n = 6 [11.5%]); for UC, the sequences were infliximab to adalimumab (n = 37 [55.2%]) and infliximab to vedolizumab (n = 24 [35.8%]). Figure 1 shows the time to switch or discontinuation for each second and third‐line advanced treatment in the entire cohort (Figures 1 A and 1B). Survival under treatment was longer in CD vs. UC for second‐line therapy (Log‐rank p = 0.008), while no difference was observed for the third line (p = 0.055) (Figure 1 C and 1D).
Conclusions: All second‐line biologics and advanced therapies demonstrate similar durability. However, vedolizumab and anti‐JAK show greater persistence than adalimumab when used as third‐line therapies.
Contact e‐mail address: giuliadarcangelo87@gmail.com
G‐EV170. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV170.1. INCIDENCE OF CLOSTRIDIUM DIFFICILE INFECTION AND ENTERIC PATHOGENS AS A CAUSE OF PEDIATRIC INFLAMMATORY BOWEL DISEASE FLARE UP, RETROSPECTIVE STUDY IN THE UNITED ARAB EMIRATES
Kaltham Al‐Shaibah1, Reham Jasem2, Ali Alsarhan 1, Christos Tzivinikos1
1Pediatrics Gastroenterology, Aljalial children's specialty hospital, DUbai, United Arab Emirates, 2Medical Affairs, Dubai medical college, DUbai, United Arab Emirates
Objectives and Study: Pediatric patients with IBD are at increased risk of Clostridium difficile infection, which can trigger disease flare‐ups. Since treatment for flares and infections differs, identifying the infection and causative microorganism is crucial. There is limited data on the frequency of CDI in pediatric IBD patients in our region. This study aims to assess its incidence and identify possible risk factors.
Methods: We conducted a retrospective cross‐sectional study from October 2017 to May 2024, which included 144 encounters of pediatric IBD patients who presented with exacerbation of GI symptoms suggestive of flare up and underwent stool testing (PCR, C.difficile toxin detection (ELISA), and culture). We analyzed the association between categorical variables using the Chi‐square test to identify the predictors of CDI. All tests were considered significant with a P‐value < 0.05.
Results: Stool PCR was positive in 45 encounters, with E.coli (11.8%) and C. difficile (10.4%) [a] being the most common pathogens. Other pathogens detected were Salmonella, Campylobacter, Norovirus, and Adenovirus. Patients with Crohn's Disease had a higher rate of CDI than Ulcerative Colitis patients (17.2 vs 8.5%, P = 0.151). Patients on biological therapies were significantly at a higher risk of developing CDI compared to patients who were not (17.9% vs 6.9%, P = 0.042). We documented a higher rate of CDI in non‐stricturing, non‐fistulizing [b]CD patients. Additionally, we observed an increased rate of CDI in patients using azathioprine and corticosteroids, [c]though these findings were not statistically significant. Among patients hospitalized for flare‐up symptoms, one‐third were confirmed to have CDI.
Conclusions: CDI was common among pediatric IBD patients with flare‐ups, particularly in those with Crohn's disease, non‐stricturing, non‐fistulizing[d] disease, on biologics, and those hospitalized for their symptoms. Early detection of CDI and other enteric pathogens is essential to guide appropriate management and prevent the harmful use of immunosuppressants during acute infections.
Contact e‐mail address: dr.ali.sarhand@gmail.com
G‐EV171. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV171.1. MANAGING PARADOXICAL BIOLOGIC‐INDUCED CUTANEOUS MANIFESTATIONS IN PAEDIATRIC INFLAMMATORY BOWEL DISEASE
Muhammad Anjum 1, Nicholas Croft2,3, Ahmed Kadir2, Sabrina Barr2, Protima Deb2, Sandhia Naik2,3
1Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, United Kingdom, 2Department of Paediatric Gastroenterology, Barts Health NHS Trust, The Royal London Children's Hospital, London, United Kingdom, 3Queen Mary University of London, Centre for Immunobiology, The Blizard Institute, London, United Kingdom
Objectives and Study: Biologic therapies, particularly anti‐tumour necrosis factor alpha (anti‐TNF) agents such as infliximab and adalimumab, are effective in managing paediatric inflammatory bowel disease (IBD). However, cutaneous manifestations, paradoxically triggered by these therapies, are a significant concern and can complicate the management of IBD. This study aims to investigate the prevalence, characteristics, and management of biologic‐induced skin manifestations in paediatric IBD patients.
Methods: A retrospective cohort study of paediatric IBD patients at the Royal London Hospital (RLH) was conducted and patients receiving infliximab or adalimumab were identified. Only those who developed skin conditions after the initiation of biologic therapy were included. Data collected included patient demographics, IBD subtype, biologic treatment history, the type and timing of skin manifestations and their management strategies.
Results: 201 paediatric IBD patients were included in the study, 155 received infliximab, and 46 received adalimumab. Eight patients (4%) (seven with Crohn's disease, one with ulcerative colitis) developed skin manifestations, including psoriasis (n = 4), pyoderma gangrenosum (n = 2), psoriasiform eruptions (n = 1), and erythema nodosum (n = 1). Skin manifestations typically appeared between 4 months and 2 years after initiation of biological therapy. Six patients (75%) were treated with topical therapies alone. One (12.5%) patient required a switch in biologic therapy and one patient (12.5%) discontinued biologic treatment due to severity of the skin reaction. On average, skin manifestations resolved within 3‐4 months after initiation of dermatological treatment.
Conclusions: Cutaneous manifestations are a relatively common complication of biologic therapy in paediatric IBD patients but can often be managed conservatively with topical therapies without the need to discontinue biologic treatment. Early dermatological intervention and a multidisciplinary approach is essential to ensure effective management without compromise of IBD control. Further studies are required to develop evidence‐based management guidelines for biologic‐induced skin manifestations.
Contact e‐mail address:
G‐EV172. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV172.1. OUTCOMES OF ACUTE SEVERE COLITIS IN CHILDREN WITH ULCERATIVE COLITIS: A SINGLE‐CENTER EXPERIENCE
Yusuf Aydemir, Neslihan Üstün, Elif Muğlalı, Zeren Barış
Pediatric Gastroenterology, Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Gastroenterology, Eskişehir, Turkey, Eskişehir, Turkey
Objectives and Study: This study aimed to evaluate outcomes in children with acute severe colitis (ASC) managed at our center.
Methods: We retrospectively reviewed pediatric patients with ulcerative colitis (UC) and inflammatory bowel disease‐unclassified (IBD‐U) admitted between 2020 and 2024. Patients with a pediatric UC activity index (PUCAI) > 65 were included. Data collected included demographics, laboratory findings, PUCAI scores at admission and on days 3 and 5, treatments, and outcomes.
Results: Of 70 UC patients, 8 had ASC at diagnosis, while 6 developed ASC later. Median age at onset was 11.8 ± 3.8 years, with a male‐to‐female ratio of 1.33:1. Disease location included E3 (2 patients), E2 (1), and E4 (the rest). Steroid response was better in patients with ASC at diagnosis (7/8) than those developing ASC later (4/7). The average steroid response time was 3.9 vs. 4.9 days, respectively. Four patients were steroid‐refractory; three responded to infliximab. One infliximab‐refractory patient declined surgery and achieved remission with third‐line therapy. No predictive factors for steroid response were identified, including gender, age, CRP, ESR, albumin, hemoglobin, or disease location. Infections included Entamoeba histolytica (2 cases), C. difficile (1), enteropathogenic E. coli (1), and CMV (1). One patient presented with cerebral venous sinus thrombosis.
Conclusions: Prompt recognition and tailored management of ASC in pediatric UC/IBD‐U are vital. First‐line steroid and second‐line infliximab therapies were effective in most patients. For those unresponsive to these treatments, third‐line therapies can be life‐saving. Screening for infections is crucial in steroid‐refractory cases.
Contact e‐mail address: dryusufaydemir@yahoo.com
G‐EV173. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV173.1. ADVANCED DUAL THERAPY IN PAEDIATRIC INFLAMMATORY BOWEL DISEASE
Federico Barooty, Fevronia Kiparissi
Gastroenterology Department, Great Ormond Street Hospital, London, Uk, GOSH, London, United Kingdom
Objectives and Study: This monocentric study aimed to evaluate the effectiveness and safety of dual therapy in paediatric patients with inflammatory bowel disease (IBD).
Methods: Were retrospectively included children with IBD who underwent combinations of biologic agents or biologic and small molecule therapy for at least 3 months at GOSH. Demographic, clinical, laboratory and endoscopic data were collected. Adverse events were recorded. Clinical response was assessed by the PGA score.
Results: 7 children (5 Crohn's disease, 1 ulcerative colitis; 1 IbdU), with median age at time of diagnosis of 10 years and median age at time of ADT 15 years and 10 episodes of DAT (1 children had 3 and 1 had 2 episodes of DAT) were included. They had all failed previous biologic therapies, and 4 (57%) failed at least 2 biologic agents. The DAT episodes included were: 3 Infliximab and Vedolizumab, 1 Infliximab and Ustekinumab, 1 Adalimumab and Ustekinumab, 1 Adalimumab and risankizumab, 2 Vedolizumab and ustekinumab, 1 Upatacitinib and Vedolizumab, 1 Upatacitinib and Risankizumab. Clinical response at 3 months was observed in 6/10 DAT episodes. CRP normalised in all DAT episodes (2/2) in which there was raised inflammatory markers at induction. None children sustained adverse events.
Conclusions: Advanced dual therapy may be effective in children with refractory IBD. The potential efficacy should be weighed against the risk of serious adverse events.
Contact e‐mail address:
G‐EV174. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV174.1. VEDOLIZUMAB USE IN PAEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE – A TERTIARY SINGLE CENTRE EXPERIENCE
Hristo Naydenov1,2, Petar Nikolov2, Emilia Nedeva‐Dobreva2, Petyo Hadzhiyski1,2, Mila Baycheva 1,3
1Paediatrics, Medical University of Sofia, Sofia, Bulgaria, 2Department Of Gastroenterology And Hepatology, University Children's Hospital, Sofia, Bulgaria, 3Gastroenterology And Hepatology, University Children's Hospital, Sofia, Bulgaria
Objectives and Study: Inflammatory bowel diseases (IBD) are complex and multifactorial, characterized by immune dysregulation and chronic gastrointestinal inflammation. In children, the two main groups Crohn's disease (CD) and ulcerative colitis (UC) tend to have more aggressive phenotype and severe disease progression. Vedolizumab, a humanized α4β7‐integrin antagonist, is well established treatment in adults with UC and CD. In paediatric patients, despite being off‐label prescribed, there is an increasing evidence of safety and effectivenes of vedolizumab. The objective of our study was to evaluate the vedolizumab use in a cohort of children with IBD.
Methods: It is a single centre retrospective study including all IBD patients treated with vedolizumab in the period 2020‐2024.
Results: Seventeen children (10 female and 7 male) aged 2–17 years (median, 11 years) were included in the study. The cohort consist of 5 CD and 12 UC patients. Clinical activity scores and relevant laboratory parameters were obtained at infusion visits. The indication to start treatment was mild to moderate disease in anti‐tumour necrosis factor α antagonists (anti‐TNF) naïve patients (6/17) and also severe disease in patients who have failed convenional and anti‐TNF treatment (11/17). In the CD group: 4/5 patients achieved complete remission at week 14; 1/5 patients needed intensification schedule every 4 weeks to respond. In the UC group: a complete clinical remission was achieved at week 14 in 8/12; 3/12 patients discontinued therapy due to primary non‐response or loss of response; and 1/13 patients had a intensification schedule every 4 weeks but did not respond. Weight gain and increased haemoglobin levels were observed in both diagnostic groups. Adverse drug reactions and allergic reactions were not observed in any of the children.
Conclusions: These results demonstrate that vedolizumab can be an effective treatment for paediatric patients with IBD and is also safe and well tolerated.
Contact e‐mail address: mila.baycheva@gmail.com
G‐EV175. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV175.1. MICROBIOME INFLAMMATORY SIGNATURES CORRELATED WITH ENVIRONMENT AND DISEASE SEVERITY IN PEDIATRIC INFLAMMATORY BOWEL DISEASE: INSIGHTS FROM THE INITIAL BENCHMARK DATA COLLECTION OF A PEDIATRIC STUDY
Oana Belei 1, Laura Olariu1, Adrian Goldis2, Radu Dragomir3, Marina Mercioni4, Ileana Enatescu5, Otilia Marginean1
1First Pediatric Clinic, Disturbances Of Growth And Development On Children Research Center, Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania, Timisoara, Romania, 2Department Of Gastroenterology And Hepatology, Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania, Timisoara, Romania, 3Department Of Obstetrics And Gynecology, Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania, Timisoara, Romania, 4Applied Electronics Department, Faculty of Electronics, Telecommunications and Information Technologies, Politehnica University Timișoara, Timișoara, Romania, Timisoara, Romania, 5Twelfth Department, neonatology Clinic, Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania, Timisoara, Romania
Objectives and Study: The microbiome plays a pivotal role in the pathogenesis of pediatric Inflammatory Bowel Disease (IBD), comprising Crohn's Disease (CD) and Ulcerative Colitis (UC).The gut ecosystem dysbiosis is linked to epithelial barrier dysfunction and inflammatory responses. By integrating clinical, perinatal and dietary data, we aimed to elucidate the multifactorial contributors to disease pathogenesis and identify potential targets for therapeutic intervention.
Methods: This study applied advanced shotgun metagenomics and a specific Microbiome Intelligence Technology Platform to analyze the microbial composition, functional pathways, and inflammatory signatures in a cohort of 30 pediatric IBD patients aged 4–18 years.
Results: Cesarean delivery accounted for 67% of the cohort, significantly exceeding general population rates. C‐section births correlated with reduced microbial diversity and SCFA‐producing genera, including Bifidobacterium and Lactobacillus spp., leading to increased susceptibility to dysbiosis‐associated inflammation. Formula feeding (75%) was associated with early‐life microbial imbalances, characterized by over‐representation of pathobionts (Clostridium difficile, Escherichia coli) and reduced anti‐inflammatory taxa such as Faecalibacterium prausnitzii. Frequent fast‐food consumption (≥3 times/week, 40% of patients) correlated with a depletion of protective species, including Akkermansia muciniphila, and enrichment of inflammatory pathobionts (Clostridium difficile). Higher consumption of fruits (≥5 servings/week) and vegetables (≥7 servings/week) supported the growth of beneficial taxa like and Roseburia spp.,mitigating inflammatory responses. The prevalence of Bacteroides fragilis, particularly enterotoxigenic strains, correlated with heightened inflammatory markers and higher disease activity. Unique inflammatory signatures were identified, marked by the over‐representation of pathobionts (Escherichia coli, Clostridium difficile) and functional disruptions, including elevated oxidative stress pathways and reduced anti‐inflammatory species.
Conclusions: These findings underscore the complex interplay of environmental factors, microbiome composition, and functional disruptions in pediatric IBD, advocating for microbiome‐targeted interventions using cutting‐edge technologies.
Contact e‐mail address: oana22_99@yahoo.com
G‐EV176. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV176.1. SPLENIC NODULES IN A PEDIATRIC CROHN'S PATIENT: ASEPTIC ABSCESS SYNDROME
Gulin Eren1, Sevim Çakar 2, Duygu Demirtas Guner1, Mehmet Önder3, Safak Pelek4, Mehmet Coskun5, Cigdem Omur Ecevit3, Ozlem Bekem3
1Department Of Pediatrics, Division Of Pediatric Gastroenterology, Hepatology And Nutrition, Dr. Behçet Uz Children's Hospital, Izmir, Turkey, 2Pediatric Gastroenterology, Dokuz Eylül University, Izmir, Turkey, 3Pediatric Gastroenterology, Hepatology And Nutrition, University of Health Sciences Izmir Dr. Behçet Uz Children's Hospital, Izmir, Turkey, 4Pediatric Gastroenterology, Hepatology And Nutrition, University of Health Science Izmir Dr. Behcet Uz Children Hospital, Izmir, Turkey, 5Interventional Radiology, University of Health Sciences Izmir Dr. Behçet Uz Children's Hospital, Izmir, Turkey
Objectives and Study: Splenic nodules are seen rarely in the general population. Although an infectious etiology is usually found, they can be seen in the course of noninfectious diseases, including malignancies, autoimmune and autoinflammatory disorders.
Methods: Case: Previously diagnosed 16 years old Crohn's patient admitted to the pediatric emergency department with left flank pain for last two days. In her disease history, she got the diagnosis of Crohn's disease 4 years ago. Due to steroid dependent course of the disease infliximab was started. The patient was in remission for approximately 20 months. In her last admission to hospital with left flank pain, imagination studies showed multiple splenic nodules. The patient underwent detailed further examination for malignancies and infectious etiology. Broad‐spectrum antibiotics were given for 3 weeks with close laboratory and radological follow‐up. At this time IFX blood level was very low and IFX antibody was positive. Colonoscopic evaluation showed multiple milimetric linear ulcers in the terminal ileum and through entire colon. Splenic tissue evaluation was necessary for diagnosis so the patient underwent splenic biopsy by interventional radiologist. The histopathologic examination of the spleen sample revealed no evidence of infectious etiology or malignancy.
Results: After the exclusion of infections and malignancies, it was thought that the existing spleen nodules may be due to Crohn's activation (aseptic abscess). The treatment was switched to Adalimumab, and prenisolone was added during the first 2 months of treatment. After the first month of ADA treatment the patient's spleen nodules completely disappeared.
Conclusions: Spleen nodules are not common in children with inflammatory bowel disease. Splenic tissue evaluation is necessary for definitive diagnosis, but splenectomy should be avoided in this patient group in order not to create even deeper immune suppression. Fine needle aspiration biopsy should be considered first as it is a safer option for obtaining splenic tissue.
Contact e‐mail address: gulinerdemir@yahoo.com
G‐EV177. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV177.1. THROMBOPROPHYLAXIS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN PEDIATRICS. IS IT NECESSARY?
M Angeles Calzado 1, Etna Masip1, Begoña Polo1, Raquel Simó2, Sara Izquierdo1, Bienvenida Argiles1, Ester Donat3
1Hospital Universitari i Politecnic La Fe, Valencia, Spain, 2Hospital Dr Peset, Valencia, Spain, 3Pediatric Gastroenterology And Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
Objectives and Study: Inflammatory bowel disease (IBD) is an independent risk factor for thromboembolism. Current guidelines (ECCO‐ESPGHAN 2018) recommend antithrombotic prophylaxis in pediatric patients with severe acute colitis who have risk factors such as smoking, contraceptive use, central venous catheters, immobilization, obesity, significant infections, known prothrombotic alterations and personal or family history of thromboembolic events. Our aim is to highlight that these recommendations should be reconsidered/updated
Methods: Four pediatric cases with ulcerative colitis (UC) are shown. None of them received thromboprophylaxis due to the absence of risk factors with normal prothrombotic study.
Results: A girl diagnosed at age 5, treated with oral mesalazine. At age 7, she had a severe flare‐up (PUCAI 70) requiring hospitalization and intravenous corticosteroids. One month later, she developed cerebral thrombosis of the right transverse sigmoid and partial sinus. A girl diagnosed at age 9, treated with adalimumab. At age 15, she had ovarian torsion requiring surgery and afterwards had a moderate flare‐up treated with intravenous corticosteroids. She developed thrombosis of the iliac, splenic, mesenteric, right portal and suprahepatic veins. A girl diagnosed at age 12, treated with mesalazine. At age 13, she had a severe flare‐up requiring intravenous corticosteroids, followed by Infliximab due to corticosteroid refractoriness. While undergoing induction treatment, she developed thrombosis of cortical veins in the left parietal lobe, intracranial venous sinuses and thrombosis of the bulb and jugular vein. A girl diagnosed at age 2, treated with mesalazine and azathioprine. At age 5, she had a moderate flare‐up treated with oral corticosteroids. She developed Labbé's vein thrombosis
Conclusions: In publications based on incidence studies and expert opinion, the use of systemic corticosteroids and parenteral nutrition are incorporated as risk factors. With these considerations, our patients would have been benefited from thromboprophylaxis. Our series support the need for an update of management guidelines in children with inflammatory bowel disease.
Contact e‐mail address: geles.calzado@gmail.com
G‐EV178. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV178.1. ACUTE PANCREATITIS IN PAEDIATRIC PATIENTS WITH ULCERATICE COLITIS: ONE‐YEAR RETROSPECTIVE STUDY
Beatriz Pedreira1, Marta Figueiredo2, Filomena Cardosa3, Sofia Bota3, Cristina Campos Goncalves 3, Isabel Afonso3
1Paediatric Unit, Hospital Central do Funchal, Funchal, Portugal, 2Paediatric Unit, Hospital de São Francisco Xavier, Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal, 3Paediatric Gastroenterology And Hepatology Unit, Paediatric Hospital Dona Estefânia, Unidade Local de Saúde São José, Lisboa, Portugal
Objectives and Study: Acute pancreatitis (AP) in pediatric patients with ulcerative colitis (UC) is a relatively rare condition. Both UC flare‐ups and drugs are suspected triggers, with medications like mesalazine, azathioprine, and antibiotics being frequently implicated. The incidence of AP in Inflammatory Bowel Disease patients is thought to be higher than in the general population, and the clinical course tends to be milder. We report a small case series highlighting the potential causes of AP in UC patients.
Methods: A retrospective, descriptive study was conducted including paediatric patients with UC diagnosed with AP at a tertiary care center, over one‐year (from 1/10/2023 to 1/10/2024).
Results: Three patients with UC were included, two of them were male. The median age was 11 years. In these 3 patients, during the study period, 6 episodes of AP were observed (2 episodes in one patient and 3 in another). All episodes were mild AP. All the episodes occurred alongside with an UC flare. In 3 episodes of 2 patients, a new drug was recently started (mesalazine and ciprofloxacin). One patient had a positive stool culture for Yersinia enterocolitica during one episode. Management in all patients included fluid resuscitation, pain management, and discontinuation of possible causative medications (mesalazine in 4 episodes; ciprofloxacin in 2 episodes and azathioprine in 1 episode).
Conclusions: The etiological diagnosis of acute pancreatitis in patients with inflammatory bowel disease is challenging, as multiple triggers can be involved, including drugs, disease flares and infections. In the presented cases, the hypothesis of drug‐induced pancreatitis and extra‐intestinal manifestation of UC were considered as all the episodes occurred alongside with a UC flare and 2 patients had recently started a new drug for UC.
Contact e‐mail address: beabopedreira@gmail.com
G‐EV179. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV179.1. DUAL BIOLOGIC THERAPY IN PEDIATRIC IBD PATIENTS – EXPERIENCE OF A TERTIARY CENTRE
Filomena Cardosa, Mariana Duarte, Sofia Bota, Cristina Campos Goncalves, Isabel Afonso
Paediatric Gastroenterology And Hepatology Unit, Hospital Dona Estefânia, Unidade Local de Saúde São José, Lisbon, Portugal
Objectives and Study: Anti‐TNF agents are an effective treatment for moderate to severe pediatric inflammatory bowel disease (pIBD). However, a significant proportion of patients experience loss of response, require treatment escalation, or develop side effects. Although there are other available options (vedolizumab, ustekinumab and tofacitinib), some pIBD patients remain refractory to these therapies. Dual biologic therapy (DBT) is an emerging option for the most severe cases. Nevertheless, additional studies are required to compare different biologic combinations and their safety profiles.
Methods: Exploratory study with retrospective data collection of patients under 18 years old with IBD who started DBT for refractory disease, since 2022.
Results: Five patients were included with a female predominance (60%) and a median age of 8,6yo at diagnosis (2,1‐14,6) and 12,3yo (3,2‐ 15,8) at the beginning of DBT. Two patients had a very early onset disease, specifically the infantile form (<2yo). Four patients (80%) had ulcerative colitis and one (20%) Crohn's disease. Before DBT, all the patients were treated with a combination of an immunomodulator and an anti‐TNF. The most frequent DBT (60%) was an anti‐TNF plus vedolizumab. A decrease in the average C‐reactive protein (CRP) was noted from 48,5 mg/L, at the beginning of DBT, to 9,8 mg/L after six months. There was also a significant decrease in the average value of fecal calprotectin after three months (from 1919 to 362 μg/g) with two patients (40%) reaching values under 100 μg/g after six months. Three patients are still in the first six months of DBT. One patient maintained clinical and laboratory remission for over two years and no adverse effects were reported.
Conclusions: Our preliminary findings suggests that DBT may be an effective option for refractory pIBD. Despite the results, more studies with longer follow‐up and larger cohorts are required to further assess the efficacy and safety of these therapeutic approaches.
Contact e‐mail address: filomena.cardosa@gmail.com
G‐EV180. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV180.1. EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS OF PAEDIATRIC INFLAMMATORY BOWEL DISEASE IN A TERTIARY REFERRAL CENTRE IN HONG KONG
Chi Ying Jaime Chiu, Po‐Yee Leung, Chung Mo Chow
Deapartment Of Paediatrics, Prince of Wales Hospital, Shatin, Hong Kong PRC
Objectives and Study: To study the demographics and clinical characteristics of PIBD in the past 18 years in Prince of Wales Hospital
Methods: Clinical, biochemical, endoscopic and radiological data at diagnosis were extracted between 1 Jan 2006 to 31 Dec 2023. Demographics, presenting symptoms, time period of disease onset to diagnosis, biochemical results and endoscopic findings, disease progression, treatment modalities and complications of treatment were analysed. Disease phenotypic characteristics were classified as per the Paris classification system.
Results: The incidence of PIBD in NTEC showed an increasing trend from 2006‐2022. The mean age was 13.69 years old and the peak incidence was at 10‐16 years old. A high incidence of perianal disease and growth failure was noted. Patients with Crohn's disease were noted to present with more constitutional symptoms and anemia, higher ESR, higher CRP and hypoalbuminemia than those with ulcerative colitis. The trend of using nutritional therapy was increasing. Younger age and perianal disease were associated factors for the use of biologics. Around 7.8% of patients with Crohn's disease progressed to stricturing disease. Common treatment complications include leukopenia, infection, deranged liver function and drug induced pancreatitis due to thiopurine use.
Conclusions: There is a rising trend of incidence of PIBD in NTEC in Hong Kong. A higher proportion of patients with growth failure and perianal symptoms were observed. Immunomodulators remained as the mainstay of treatment. Nutritional therapy and biological therapy played a more important role as maintenance treatment. 26% of patients with Crohn's disease required surgical treatment.
Contact e‐mail address:
G‐EV181. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV181.1. RENAL MANIFESTATIONS IN INFLAMMATORY BOWEL DISEASE: SINGLE CENTRE EXPERIENCE IN SINGAPORE
Mae Chua, Sarah Wong, Charanya Rajan, Lay Queen Ng, Lynette Goh, Christopher Ho, Fang Kuan Chiou, Kong Boo Phua, Veena Logarajah
Gastroenterology, Hepatology And Nutrition, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore, Singapore
Objectives and Study: Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD), ulcerative colitis (UC) and IBD‐unclassified, is a chronic inflammatory disorder primarily affecting the gastrointestinal tract. Renal involvement though uncommon may occur as an extra‐intestinal manifestation or medication‐related complications of IBD. This study aims to examine the spectrum of renal involvement in paediatric IBD patients at a tertiary hospital in Singapore.
Methods: Chart review of patients 5‐18 years of age with IBD on follow‐up from 2015‐2024 was conducted. The range of renal involvement included haematuria, proteinuria and abnormal renal function tests.
Results: Among 345 paediatric IBD patients, 6 were identified. Five had CD and one had UC. Median age at presentation was 10.5 years (range 5‐15). Presenting characteristics included chronic abdominal pain (n = 5), diarrhoea (n = 4), and vomiting (n = 3). Haematuria was most frequent renal manifestation (n = 5). Underlying causes include renal calculi (n = 3), nutcracker syndrome (n = 1), and hypercalciuria (n = 1). Biochemical characteristics at time of renal manifestation are summarised in Table 1. One CD patient developed acute renal failure during his index admission (creatinine peaked at 487 umol/L) due to bilateral vesico‐ureteric junction obstruction from urolithiasis, requiring dialysis. He was also hypertensive (systolic blood pressure peaked at 134, >95th + 12 centile). Renal function normalised with diuresis during admission, and remained normal after CD remission, with exclusive enteral nutrition and mesalazine for induction and azathioprine for maintenance. The remaining five patients were normotensive throughout. The UC patient with nutcracker syndrome had significant weight loss from disease activity due to treatment non‐adherance. This resolved with disease control following medication compliance.
Conclusions: Renal manifestations of IBD are subtle and uncommon. A high index of suspicion is essential in patients presenting with renal signs and symptoms especially during periods of high IBD activity to ensure timely management for optimal clinical outcome.
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G‐EV182. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV182.1. ASSESSMENT OF HYPERAMYLASAEMIA IN PAEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Tracy Coelho 1,2, Pranav Kesavan3, Fernando Vazquez Lopez4, Elena Kurteva2, James Ashton4, Bhumita Vadgama5, Jacqueline Allotey5, Akshay Batra2, Nadeem Afzal2, Lynn Win1, Mark Beattie2, Sarah Ennis4
1Paediatric Gastroenterology, University Hospital Southampton, SO YD, United Kingdom, 2Paediatric Gastroenterology, University Hospital Southampton, YD, United Kingdom, 3Human Development And Health, Faculty Of Medicine, University Hospital Southampton, YD, United Kingdom, 4Human Development And Health, Human Genetics And Genomic Medicine, University of Southampton, YD, United Kingdom, 5Histopathology, University Hospital Southampton, YD, United Kingdom
Objectives and Study: A small proportion of patients with paediatric IBD (pIBD) present with hyperamylasaemia, which could be an indicator of ongoing pancreatic inflammation. The causes and outcomes of hyperamylasaemia in pIBD are not well understood. In this study, we aim to identify pIBD patients with hyperamylasaemia, explore potential causes and assess clinical outcomes over a minimum of two‐year follow up period.
Methods: This is an observational cohort study including pIBD patients, ≤18 years of age, diagnosed from 2015 to 2022 at a specialist paediatric gastroenterology centre. Laboratory results, clinical course, anthropometry, disease location, radiology (ultrasound/MRCP) and histopathology reports were retrospectively reviewed and analysed.
Results: The study cohort included 334 patients, 61.4% male, with a median age at diagnosis of 13.42 years; CD (62.6%), UC (27.5%), and IBDU (9.9%). Hyperamylasaemia was observed in 62 patients (18.6%) from diagnosis to the specified follow up period, with 18 patients (29%) presenting at diagnosis. Most patients (79%) had amylase levels < 2x ULN (upper limit of normal), 12.9% between 2 x ULN to < 3x ULN and 8.1% exceeded 3x ULN. A statistically significant association for hyperamylasaemia was detected with the younger age (p = 0.0444), non‐European ethnicity (p = 0.0039), and BMI > 91st centile (p = 0.0467). No significant association was identified with gender, disease phenotype or disease location. Follow‐up data were not available in nine patients with hyperamylasaemia. Hyperamylasaemia resolved in 41 out of 53 (77%) of which 6 patients needed medication withdrawal (thiopurines 4, 5‐ASA 1, systemic steroids 1). Ten patients (19%) continued to have fluctuating hyperamylasaemia, one patient developed acute pancreatitis, while another patient with ansa pancreatica on MRCP developed recurrent pancreatitis.
Conclusions: Hyperamylasaemia is common in pIBD and is significantly associated with younger age, non‐European ethnicity and overweight BMI. Most cases resolve spontaneously without any intervention.
Contact e‐mail address: tracy.coelho@uhs.nhs.uk
G‐EV183. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV183.1. EXCLUSIVE ENTERAL NUTRITION FOR INDUCTION OF REMISSION IN PAEDIATRIC CROHN'S DISEASE: A SINGLE TERTIARY CENTRE EXPERIENCE
Sian Copley, Nathan Boydell, Rebecca Foulkes, Lisa Charlton, Virginia Chatzidaki, Adnaan Kala, Chai Lee, Loveday Jago, Maureen Lawson, Rachel Wood, Osarugue Otabor, Andrew Fagbemi
Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, United Kingdom
Objectives and Study: Exclusive enteral nutrition (EEN) with whole protein feed is recommended first line for remission induction in paediatric Crohn's disease. Remission is induced in up to 80%, providing a nutritionally complete feed with minimal side effects. Literature is limited on individual products. We evaluated outcomes of the standard EEN formulation used in our centre.
Methods: 69 patients receiving first course of EEN were identified over an 18‐month period from the departmental IBD database, data collected included demographics, diagnosis, anthropometrical parameters, days to target volume, length of stay (LOS), EEN completion and remission rates.
Results: Mean age at diagnosis: 12.07 years. Disease distribution: 3/69 ileal, 25/69 ileocolonic, 23/69 upper gastrointestinal (UGI) + ileocolonic, 4/69 colonic + UGI, 14/69 colonic. 11/69 had percentage median BMI (%mBMI) < 80; 11/11 ileal or UGI disease. 30/69 were high refeeding risk. 68/69 were admitted to commence: 32/68 from endoscopy, 20/68 electively, 16/68 urgently prior to endoscopy. Modal days to target volume was 3 (range 2–11). Modal LOS was 4 days (range 2–42). Prolonged stay: 11/68 nutritional rehabilitation, 4/68 nasogastric tube (NGT) training, 1/68 to meet target, 11/68 other management. 9/68 required oral electrolyte replacement; none required IV. 8/9 (88%) were identified as high refeeding risk. 52/69 (75%) completed EEN (35/52 orally, 17/52 NGT. Discontinuation reasons: no response (10/69), vomiting (3/69), erythema nodosum (3/69), patient choice (1/69). 19/69 continued nutritional supplements. 39/69 were analysed further (30/69 excluded: top‐down treatment 12/30; early cessation 17/30, alternative feed 1/30). 37/39 achieved clinical remission at completion, 3 months: 32/39, 6 months: 26/39, 12 months: 16/22. 9/39 later commenced biologics
Conclusions: EEN is well tolerated and effective. Most complete orally reaching target by day 3. Remission rates are 95% at completion, 82% at 3 months. 67% and 72% sustained remission at 6 and 12 months. None required IV electrolyte replacement. Home EEN may be safe and effective.
Contact e‐mail address: sian.copley@mft.nhs.uk
G‐EV184. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV184.1. REFEEDING SYNDROME IN PATIENTS RECEIVING EXCLUSIVE ENTERAL NUTRITION FOR PAEDIATRIC CROHN'S DISEASE ‐ A SINGLE CENTRE EXPERIENCE
Sian Copley, Nathan Boydell, Rachel Wood, Osarugue Otabor, Rebecca Foulkes, Lisa Charlton, Virginia Chatzidaki, Chai Lee, Adnaan Kala, Loveday Jago, Maureen Lawson, Andrew Fagbemi
Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, United Kingdom
Objectives and Study: Crohn's disease (CD) is an inflammatory disease of the gastrointestinal tract associated with weight loss or faltering growth. Patients with restricted intake or malnutrition are at risk of developing refeeding syndrome (RFS). The presence of hypophosphataemia is the hallmark of RFS but other biochemical shifts are recognised during the early stages, including low potassium and magnesium levels. RFS can have life‐threatening consequences. Exclusive enteral nutrition (EEN) is recommended as first line induction of remission therapy. With this increase in nutritional intake, patients may be at increased risk of RFS. We evaluated RFS rates and treatment needed for electrolyte disturbance in children with newly diagnosed CD who underwent EEN as initial induction treatment.
Methods: 60 patients over a 14‐month period were identified from the departmental IBD database. Data collected included demographics, anthropometry, EEN treatment, cardiovascular observations, potassium, phosphate and magnesium levels, and electrolyte replacement. 7/60 were excluded due to nutritional supplementation prior to EEN, 5/60 for insufficient biochemistry data. The remaining 48 were divided into two risk groups based on percentage median Body Mass Index, weight loss and dietary intake.
Results: 19/48 (39.6%) had electrolyte disturbance following initiation of EEN. 13/48 needed electrolyte replacement (13/48 phosphate, 1/48 magnesium), no patients needed IV replacement. 22/48 were low risk. 5/22 (22.7%) had electrolyte disturbances and 1/22 (4.5%) required oral replacement. 3/22 had self‐resolving bradycardia (no ECG abnormalities). 26/48 were high risk. 14/26 (53.8%) had electrolyte disturbances, 12/26 (46.2%) needed electrolyte replacement. 2/26 had self‐resolving bradycardia (no ECG abnormalities); 3/26 orthostatic blood pressure changes. No patients were admitted to critical care.
Conclusions: RFS syndrome incidence was 39%, increased if scored as high risk (53.8% compared to 22.7%). No patients required IV electrolyte replacement regardless of initial refeeding risk group. Community based EEN with blood monitoring, dietetic input and clinician oversight may be safe.
Contact e‐mail address: sian.copley@mft.nhs.uk
G‐EV185. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV185.1. DESCRIPTIVE ANALYSIS OF METHOTREXATE IN THE TREATMENT OF PAEDIATRIC INFLAMMATORY BOWEL DISEASE: A SINGLE CENTRE STUDY
Rebecca Macduff, Rebecca Foulkes, Lisa Charlton, Virginia Chatzidaki, Loveday Jago, Adnaan Kala, Maureen Lawson, Chai Lee, Andrew Fagbemi, Sian Copley
Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, United Kingdom
Objectives and Study: Methotrexate is used for immunomodulation in paediatric IBD, typically second line to thiopurines. This study aimed to describe reasons for methotrexate use, outcomes of treatment and tolerance at a tertiary referral centre.
Methods: A retrospective analysis of records from IBD diagnosis until December 2024 was performed for all paediatric IBD patients currently or previously using methotrexate.
Results: 35 patients were identified and included. Their diagnoses were Crohn's disease (30/35), UC (3/35), IBDU (2/35), and VEOIBD (7/35). 28/35 used thiopurines prior to methotrexate. They were switched for failure of disease control (5/28) or adverse effects of thiopurines (23/28), including pancreatitis (11/23), myeloid suppression (4/23), out‐of‐range metabolites (3/23) and hepatotoxicity (3/23). 7/35 started methotrexate as their first immunomodulator, principally for low TPMT (4/7), or rheumatological co‐pathology (2/7). 28/35 also use biologics, with 17/35 having tried more than one biologic. Where results available, there was improvement in at least 2/3 serum inflammatory markers (CRP, ESR, orosomucoid) at three months (21/29) and six months (18/28). Faecal calprotectin improved after 3‐12 months in 9/17. 8/35 had endoscopic reassessment within 12 months. 6/8 had significant active disease. However, these may have been selected for reassessment due to ongoing symptoms, potentially biasing findings. Of note, two patients were switched to methotrexate due to severe Crohn's disease on their fourth biologic and had improvement in symptoms and inflammatory markers. One had endoscopic re‐evaluation which showed some improvement. 24/35 continue to take methotrexate. 19/24 tolerate this subcutaneously while 5/24 take orally. 11/35 have had their methotrexate discontinued, principally for deranged liver function (5/11), or nausea/vomiting (4/11).
Conclusions: Methotrexate is a viable alternative to thiopurines. Switch from subcutaneous to oral methotrexate can alleviate associated nausea and vomiting. Switch of immunomodulator may be beneficial in patients who have failed multiple biologics with thiopurines. Endoscopic re‐evaluation is important for full assessment of response to treatment.
Contact e‐mail address:
G‐EV186. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV186.1. EVALUATION OF VEDOLIZUMAB LEVELS AND RESPONSE TO TREATMENT ADJUSTMENTS IN PAEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD)
Enenimiete Woha, Rebecca Foulkes, Lisa Charlton, Zain Butt, Virginia Chatzidaki, Chai Lee, Adnaan Kala, Loveday Jago, Maureen Lawson, Andrew Fagbemi, Sian Copley
Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, United Kingdom
Objectives and Study: Vedolizumab is an anti‐integrin antibody used to treat moderate‐severe paediatric inflammatory bowel disease (PIBD). It is used when TNF‐alpha inhibitors fail, are intolerable, or are contraindicated. Limited data exists on vedolizumab monitoring compared to anti‐TNF. Suggested levels are 37.1 mg/L at week 6, 18.4 mg/L at week 14, and 12.7 mg/L during maintenance. This retrospective cohort study evaluates serum vedolizumab levels and the impact on treatment decisions and clinical response.
Methods: Patients receiving vedolizumab were identified from the IBD Database, with data collected on diagnosis, age at diagnosis, previous treatments (use of biologics, azathioprine, methotrexate, anti‐TNF agents, and Ustekinumab), initiation date of vedolizumab, inflammatory markers, clinical symptoms, and endoscopic findings.
Results: 23 patients were identified: mean age at diagnosis was 9 years (range 2‐15). 16/23 had Crohn's disease (CD) (luminal), 5/23 CD with perianal disease, and 2/23 had ulcerative colitis. 17/23 were stepped up to biologics,21/23 patients had undergone anti‐TNF therapy before switching to vedolizumab. Levels were taken for 21/23, 6/21 during induction (8‐14 weeks) and 15/21 during maintenance (> 14 weeks). Mean levels were 15.28 mg/L (median: 11.5 mg/L, range:4.5‐27.9) during induction (40% in therapeutic range), and 17.9 mg/L (median: 8.2 mg/L, range 3.5‐80.9) during maintenance (45.5% in therapeutic range). Treatment adjustments based on levels were made in 52.3%, Changes done included adjusting frequency as well as dosing. 5 out of 12 with lower inflammatory markers had trough levels within the recommended therapeutic range. 3/5 showed improved endoscopic appearances with 2/3 with trough levels within recommended range.
Conclusions: Most escalated to vedolizumab after failing immunomodulators and anti‐TNF. Standard dosing was ineffective in 61.9%, some requiring adjustments based on trough levels. While higher levels didn't always correlate with reduced inflammation, therapeutic drug monitoring might optimize outcomes. Further research is needed to define the relationship between vedolizumab levels and clinical response in the paediatric population.
Contact e‐mail address: Eneniefebo@yahoo.com
G‐EV187. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV187.1. OPTIMISING CARE IN THE INFLAMMATORY BOWEL DISEASE MULTIDISCIPLINARY TEAM CLINIC: A COMPREHENSIVE EVALUATION OF PAEDIATRIC PATIENT SERVICES AT A UK SPECIALIST NHS FOUNDATION TRUST
Aimee Corcoran, Nick Delnero, Akshay Kapoor
Clinical Research Facility, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
Objectives and Study: The IBD Multidisciplinary Team (MDT) Clinic at Sheffield Children's Hospital (SCH) plays a pivotal role in delivering comprehensive care to patients and provides the leading paediatric IBD centre in the North of England. The MDT team comprises specialised IBD team members, including physicians, nurses, dietitians, pharmacists, and psychologists. The evaluation of this clinic's patient services is crucial to optimize the quality‐of‐care provided, enable a refined service delivery and mitigate potential risks associated with managing IBD patients. The primary objective of this evaluation is to enhance the patient experience, quality of care, patient outcomes within the IBD MDT Clinic. By reviewing patient services, we aim to identify areas of improvement and potential risk factors. This analysis will enable us to make data‐driven decisions to refine and streamline service delivery, ultimately resulting in an enhanced patient experience and improved clinical outcomes.
Methods: This retrospective quantitative analysis utilised a 15‐item questionnaire administered to families and patients at the IBDGA clinic. During a six‐month period, 49 questionnaires were collected for service evaluation. Non‐identifiable data was encoded on a likert scale of numerical values, with potential scores ranging from ‐98 to +98, the latter representing the most favourable outcome. An objective of 82.5% was pursued in accordance with the trust's current guidelines.
Results:
Please see graph attached for main results.
Conclusions: Overall patient satisfaction with IBDGA exceeds guidelines, exhibiting predominantly positive feedback, with no aspects receiving negative evaluations. Scores pertaining to appointment duration, professionalism and friendliness and resource clarity all fulfilled and surpassed the trust's standards. Nevertheless, aspects requiring enhancement were identified, including the ease of appointment scheduling, waiting times and confidence of IBD management. Targeted interventions will be guided by the insights obtained from this evaluation, which will enable data‐driven decisions to refine and streamline service delivery, as identified in the current analysis, which requires improvement.
Contact e‐mail address: aimee.corcoran@nhs.net
G‐EV188. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV188.1. DOES CHECKING THIOGUANINE LEVELS ADD TO THE TREATMENT OF PAEDIATRIC IBD PATIENTS?
Enes Coskun, Kirn Sandhu, Harween Dogra, Kushila Rupasinghe, Babu Vadamalayan
Paediatric Gastroenterology Department, King's College Hospital, London, United Kingdom
Objectives and Study: Azathioprine is commonly used for maintenance treatment of inflammatory bowel disease (IBD) but often requires dose adjustments or discontinuation due to adverse effects. While monitoring 6‐TGN and 6‐MMP metabolites could optimize paediatric IBD therapy and assess compliance, this practice is not yet routinely implemented despite its potential benefits.
Methods: Paediatric patients with IBD who have been started on Azathioprine between 01.04.23 and 31.10.24 are enrolled in the study. Diagnosis date, dose and start date of Azathioprine and Thiopurine methyl transferase levels (TMPT) levels were recorded. 6TGN and MMP levels were checked approximately in 3 months.
Results: In total, 42 patients were enrolled in the study. Mean age of the patients were 12.81 ± 2.97 years and 42% (18) were female. The percentage of the patients with Crohn's, Ulcerative Colitis and IBD‐ U were 64.3%, 28.6% and 7.1%, respectively. TPMT levels of 35 out of 42 patients were found to be low in 4 (11.4%), within normal range in 26 (74.3%) and high in 5 (14.3%) patients. The average time for checking 6‐TGN were 88.68 ± 45.3 days. The thioguanine levels were available in 27 out of 42 patients which were below therapeutic range in 33.3% (9), above the range in %26.9 (8) within range in and 37% (10).
Conclusions: Azathioprine metabolite monitoring is standard in adult IBD management, where therapeutic ranges improve outcomes and reduce adverse effects. In paediatrics, it is less established but supported by emerging evidence. In our cohort, 33.3% (n = 9) of patients had thioguanine nucleotide (TGN) levels below the therapeutic range; three underwent dose increases, and the rest were evaluated for compliance. Monitoring TGN metabolites in paediatric IBD can optimise treatment by preventing toxicity, guiding dose adjustments, and addressing non‐compliance, a common issue in adolescents. This approach enhances personalised care, improving treatment efficacy and supporting adherence in this challenging patient population.
Contact e‐mail address: enes.coskun@nhs.net
G‐EV189. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV189.1. COLLABORATION WITH ADULT SERVICES THROUGH TRANSITION OF CARE ENHANCES PATIENT ENGAGEMENT
Kay Crook, Jitka Adio, Warren Hyer
St Mark's Hospital, Ibd Unit, London North West University Healthcare NHS Trust, London, United Kingdom
Objectives and Study: Many documents detail how to transition of care from paediatrics to adults i.e. ‘The Inbetweeners’ (NCEPOD) (2023). We report on the need to ensure Adolescent and Young people's IBD (AYP) services evolve to meet the patient/parent needs by reviewing the current processes and identifying barriers to young people accessing timely support. The transition process starts at first contact in paediatrics, with transition to adult services following their 16th birthday, after exams have been completed, enabling 2 years within the AYP service with paediatric and adult nursing support. The initial clinic occurs in a multidisciplinary clinic with adult and paediatric Consultants and Nurses, tailoring the future clinic requirements according to the AYP needs. Subsequent AYP clinics are led by the Adult IBD Link nurse until the AYP naturally moves into a regular clinic.
Methods: AYP identified through a variety of methods and a database was developed. AYP lost to follow up, or challenges and barriers to engagement highlighted to inform service improvement projects.
Results: 293 AYP identified though adviceline, clinics, transition lists.
| Changes to AYP Clinics | ||
|---|---|---|
| Service changes | Why | Outcome |
| Variety of consultation methods available. | Inaccesibility of service opening times. | ‐ Reduced DNA rates ‐ Empowerment |
| LUSCII app introduced during transition process | Reluctance to access telephone/email adviceline due to minimal experience of these methods. LUSCII meets 4 of the top 10 most important questions from JLA Digital Technology for Adolescents and Young persons with IBD. | ‐ 77/112 AYP active |
| Pre‐clinic questionnaires | AYP liked the idea of pre‐writing relevant information | Aborted questionnaires not returned or brought to clinic |
| All newly transitioned/diagnosed AYP contacted least 3 monthly | Concern being 'lost in the system' | ‐ Reduced disengagement ‐ 3/143 with no contact in 12 months |
Conclusions: The co‐location of paediatric & adult IBD nurses within the same nursing team enhances the evolution of the transition in to adult services process.
Contact e‐mail address: kaycrook@nhs.net
G‐EV190. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV190.1. PANCREATITIS AS ONSET MANIFESTATION OF IBD IN CHILDREN
Lorenzo D'antonio 1,2, Valerio Balassone1, Paola De Angelis1, Filippo Torroni1, Luca Cristiani3, Federico Alghisi3, Simona Faraci1
1Gastroenterology, Endoscopy And Surgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy, 2Department Of Translational Medical Sciences ‐ Pediatrics Section, University of Naples Federico II, Naples, Italy, 3Pediatric Pulmonology & Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
Objectives and Study: The inflammatory bowel diseases(IBD) are multisystem diseases,associated with extraintestinal manifestations in up to 50% of patients. Pancreatic involvement includes a wide heterogenic group of disorders and abnormalities of the pancreas and range from mild self‐limited diseases to severe disorders,but remains a less recognized associations and poorly understood. In literature few case reports describe pancreatitis as the onset manifestation of IBD. The aim of our study is to determine how pancreatitis in children can anticipate the onset of IBD as extraintestinal manifestation. The findings may improve early recognition of IBD.
Methods: This is an observational retrospective study on pediatric patients diagnosed with IBD and pancreatitis,presenting to our tertiary pediatric center over the past four years. We included children presenting history of pancreatitis first of IBD diagnosis. Demographic variables,clinical presentation,laboratory findings,imaging results,endoscopy and subsequent IBD classification (Crohn's disease/CD, ulcerative colitis/UC, unclassified‐IBD/U‐IBD) were collected.
Results: 312 pediatric patients with IBD were identified(101 CD, 192 UC, 7 U‐IBD). Among them 20(6,4%) have had pancreatitis in their medical history. All patient presented abdominal pain and pancreatic enzymes were over 3 times normal value. Pancreatitis preceding the diagnosis of IBD was found in 11 of 312(3,5%). All these patients presented calprotectin over 250 mg/kg and underwent endoscopy with a diagnosis of IBD. Median time between onset of first episode of pancreatitis and diagnosis of IBD was 77 weeks(range 0‐366). Data of patients in figure 1.
Conclusions: In pediatric patients it is important to include IBD in differential diagnosis of pancreatitis, which can anticipate the onset of IBD, as described in adult patient. Therefore, we suggest to test fecal calprotectin levels in pancreatic work up, both during the initial evaluation and throughout the follow‐up. Further studies are needed to demonstrate, as already established in adults, that such pancreatic manifestations may be underpinned by an autoimmune mechanism, which if often misdiagnosed.
Contact e‐mail address: simona.faraci@opbg.net
G‐EV191. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV191.1. INCREASED LEVELS OF PROTEIN GLYCATION PRODUCTS IN SERUM OF CHILDREN WITH ULCERATIVE COLITIS – A PRELIMINARY STUDY
Katarzyna Zdanowicz1, Mateusz Maciejczyk2, Kamil Lulko3, Dariusz Lebensztejn1, Malgorzata Zendzian‐Piotrowska2, Anna Zalewska4, Urszula Daniluk 1
1Department Of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology And Pulmonology, Medical University of Bialystok, Bialystok, Poland, 2Department Of Hygiene, Epidemiology And Ergonomics, Medical University Of Bialystok, Medical University of Bialystok, Bialystok, Poland, 3Students’ Scientific Club “biochemistry Of Civilization Diseases” At The Department Of Hygiene, Epidemiology And Ergonomics, Medical University of Bialystok, Bialystok, Poland, 4Department Of Conservative Dentistry, Medical University of Bialystok, Bialystok, Poland
Objectives and Study: The pathogenesis of ulcerative colitis (UC) remains unclear. In particular, the involvement of protein glycation in UC progression is unknown. Therefore, the aim of our study was to determine the Amadori products (AP) and advanced glycation end products (AGE) levels in children with UC compared to controls.
Methods: 40 children (20 suffering from UC and 20 control subjects with functional gastrointestinal disorders) were included in the study. The diagnosis of UC was based on the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines, including endoscopic and histological criteria. Serum levels of AP were measured using the colorimetric method, while serum levels of AGE were measured using the fluorometric method.
Results: The study group included 15 children with newly diagnosed UC and 5 children with exacerbations of the disease. Serum levels of AP and AGE were significantly higher in patients with UC compared to the control group (respectively 2.157 umol/mg vs 1.903 umol/mg, p = 0.028; 49.96 AFU/mg vs 41.45 AFU/mg, p = 0.038). AGE and AP was found to be a good discriminator between UC and Ctr groups with the area under curve (AUC) of 0.711 (p = 0.01) and AUC of 0.704 (p = 0.01) respectively. The only significant correlation was observed between AGE and red blood cells (R = 0.65, p = 0.002). In contrast, significant negative correlations were noted between AP and platelet (PLT) (R = ‐0.58, p = 0.008), AP and PLT/albumin ratio (R = ‐0.49, p = 0.03), and positive correlation between AP and body mass index (R = 0.59, p = 0.007).
Conclusions: Our preliminary study demonstrates the potential association of protein glycation with pediatric UC. Understanding the interactions between protein glycation, inflammation, and the immune response can provide beneficial insights for potential therapeutic interventions that may impede the progression of UC.
Contact e‐mail address:
G‐EV192. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV192.1. ANTI‐TNF‐ALPHA BIOSIMILAR CROSS‐ AND REVERSE‐SWITCHING IN PEDIATRIC IBD: PRELIMINARY REAL‐WORLD DATA FROM THE SIGENP IBD WORKING GROUP
Valeria Dipasquale 1, Lorenzo Fioretti2, Rossella Morello1, Saverio Pochesci2, Luca Scarallo2, Francesco Graziano3, Michele Citrano3, Paolo Lionetti2, Claudio Romano1
1Pediatric Gastroenterology and Cystic Fibrosis Unit, University Hospital “G. Martino”, Messina, Italy, 2Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Florence, Italy, 3Pediatric Unit, Villa Sofia Cervello Hospital, Palermo, Italy
Objectives and Study: Multiple switching between anti‐tumor necrosis factor alpha (anti‐TNF‐alpha) biosimilars is not yet officially recommended. A multicenter, nationwide retrospective study to determine the safety and effectiveness of multiple switching is currently underway within the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) Inflammatory Bowel Disease (IBD) Working Group.
Methods: Data from pediatric IBD patients who made one or more switches from one anti‐TNF‐alpha biosimilar to another (cross‐switch) or from one biosimilar to the originator (reverse‐switch) from 2013 to present have been collected. Safety was the primary objective. These data are preliminary.
Results: To date, three centers have collected data on 89 patients who underwent at least one cross‐ or reverse‐switch 13.7 months (7‐23.5) after starting biologic therapy: 51 with infliximab (IFX) (more for ulcerative colitis (UC) and inflammatory bowel disease‐unclassified (IBDU) patients than Crohn's disease (CD) patients, p < 0.01) and 38 with adalimumab (ADL) (more in CD than in UC/IBDU patients, p < 0.01). Twenty‐one (23.6%) patients were switched twice, four (4.5%) three times, at 5.2 months (2‐14.7) and 16.4 months (5.1‐18.7), respectively, since the previous switch. 84 were cross‐switches and 5 were reverse‐switches. The switch was non‐medical in most cases (n = 86, 89%) and medical in the remaining cases (due to adverse events). An acute infusion reaction occurred in 6/89 (6.7%), 1/21 (4.8%) and 1/4 (25%) patients after the first, second and third switches, respectively. Multiple switching was followed by a relapse in 2/89 (2.2%) and 2/21 (9.5%) after the first and second switching, respectively. No between‐group differences in reactions or flares were noted between IFX and ADL.
Conclusions: Multiple switching is a reality in pediatric IBD. This practice does not appear to have any effect on the course of the disease, but further data are pending.
Contact e‐mail address: dipasquale.va@gmail.com
G‐EV193. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV193.1. KONO‐S ANASTOMOSIS FOR PEDIATRIC CROHN'S DISEASE: THE EXPERIENCE OF A TERTIARY REFERRAL CENTER
Valeria Dipasquale 1, Carmelo Romeo2, Pietro Impellizzeri2, Angela Simona Montalto2, Giuseppe Navarra3, Claudio Romano1
1Pediatric Gastroenterology and Cystic Fibrosis Unit, University Hospital “G. Martino”, Messina, Italy, 2Pediatric Surgery Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital “G. Martino”, Messina, Italy, 3Surgical Oncology Division, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital “G. Martino”, Messina, Italy
Objectives and Study: Kono‐S anastomosis is designed to reduce the risk of anastomotic recurrence after resection for Crohn's disease (CD). Some studies have reproduced these outcomes in adults. To date, only two pediatric studies are available. This study examines the outcomes of the Kono‐S anastomosis two years after its introduction in a tertiary referral center for pediatric inflammatory bowel disease.
Methods: This retrospective study included all consecutive pediatric CD patients who underwent resection with a Kono‐S anastomosis in a tertiary referral center for pediatric inflammatory bowel disease.
Results: A total of 11 Kono‐S anastomoses have been performed since January 2022 in 11 pediatric CD patients, including 7 females (63.6%), with a mean age at surgery of 14.7 years (range 11–18). The majority of anastomoses were ileocolic (n = 10), while there was one small bowel‐to‐small bowel anastomosis in a patient who had undergone a previous resection for CD. All patients underwent minimally invasive surgery. Indications for surgery were represented by strictures (n = 6), abdominal abscesses (n = 3), and both (n = 2). Locations for strictures were the ileum (n = 4), the ileocecal valve (n = 2), and the ileum and the cecum (n = 1). Surgery was elective in 9 cases and urgent in two cases (bowel obstruction). No postoperative complications were recorded during the study period, with a mean follow‐up of 21.3 months (range 3–35). Currently, a total of nine patients have undergone follow‐up endoscopic surveillance at 1 year (Rutgeerts score grade 0, n = 8; grade 1, n = 1). All patients were started on post‐operative prophylaxis with anti‐tumor necrosis factor (TNF)‐a after a mean of 10.4 weeks (range 4–20).
Conclusions: Kono‐S anastomosis appears to be safe and feasible in CD children. No postoperative complications were observed. The present findings suggest that this technique is promising in pediatric patients too.
Contact e‐mail address: dipasquale.va@gmail.com
G‐EV194. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV194.1. DEVELOPMENT OF AN INTERACTIVE WEB‐BASED TRANSITION ROADMAP TO SUPPORT YOUNG ADULTS THROUGH THE JOURNEY OF TRANSITIONING FROM PEDIATRIC IBD TO ADULT CARE
Alana Carter, Karen Frost, Melanie Watson, Usha Chauhan
Canibd, Canadian Nurses in IBD Group, Toronto, Canada
Objectives and Study: The transition from pediatric to adult services for young adults with chronic diseases, such as inflammatory bowel disease (IBD), requires careful planning and coordination. Comprehensive care is essential to address clinical,and psychosocial needs. IBD, a lifelong condition increasingly affecting children, necessitates a structured transition to adult care. In Canada, the national incidence of IBD was estimated at 29.9 per 100,000 in 2023. This transition is critical as young adults must develop self‐management skills to navigate healthcare effectively. Transferring care to an adult gastroenterologist around age 18 can be stressful, with heightened expectations for independent decision‐making. Challenges include poor therapy adherence, anxiety, depression, low self‐efficacy, and differences between pediatric and adult care models.
Methods: To address these challenges, Canadian IBD nurses (CANIBD) collaborated with adult and pediatric IBD nurses to develop an interactive web‐based Transition Roadmap (www.transitionibd.ca). This tool enhances readiness for transition by equipping young adults with the knowledge and skills necessary for independent disease management. The roadmap addresses barriers like therapy adherence and self‐efficacy while fostering communication between young adults and healthcare providers. It allows users to set health goals, access self‐care tips, and explore supportive resources. Initially created as a cardstock version in 2021, the roadmap was adapted into an interactive web‐based format in 2024 based on feedback. Features include quizzes, goal‐setting tools, and interactive rewards.
Results: Evaluations are planned to assess the roadmap's effectiveness in improving transition readiness, self‐management skills, and reducing negative outcomes. The ultimate goal is to foster a successful transition, enhancing patient engagement for young adults with IBD.
Conclusions: The web‐based Transition Roadmap supports young adults transitioning from pediatric to adult IBD care by promoting self‐management, identifying knowledge gaps, and encouraging active participation.This initiative aims to reduce hospitalizations, improve therapy adherence, and increase confidence, reflecting CANIBD's commitment to high‐quality care and collaboration.
Contact e‐mail address: karen.frost@sickkids.ca
G‐EV195. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV195.1. EXPLORING PATIENT PERSPECTIVES ON NON‐MEDICAL SWITCHING FROM ORIGINATOR TO BIOSIMILAR IN PEDIATRIC INFLAMMATORY BOWEL DISEASE PATIENTS ON ADALIMUMAB MAINTENANCE THERAPY
Francesca Gaboardi1, Laura Gianolio 1, Valentina Silvera2, Lucia Cococcioni2, Dario Dilillo2, Francesca Penagini2, Lorenzo Norsa2, Gian Vincenzo Zuccotti2,3
1Paediatrics, Buzzi Children's Hospital, University of Milan, Italy, 2Department Of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy, 3Department Of Biomedical And Clinical Sciences, University of Milan, Milan, Italy
Objectives and Study: Biosimilars are increasingly used in paediatric IBD care, offering significant cost reductions within the healthcare system. This study aimed to evaluate paediatric IBD patients’ experience with the switch from adalimumab (ADA) originator to ADA biosimilar while on ADA maintenance therapy.
Methods: We conducted a single‐center prospective cohort study between November 2023 and June 2024. Paediatric IBD patients on maintenance ADA therapy were switched from originator to biosimilar regardless of disease activity. Patient experiences with the switch were assessed using a study‐specific survey administered 8–12 weeks post‐switch.
Results: Thirteen patients (12 with Crohn's disease, 1 with ulcerative colitis; 10 males, 3 females) were included, with a median age of 16.7 (IQR: 13.7–17.4) years at the time of the switch. Post‐switch, 8/13 patients (62%) reported increased apprehension about self‐administering the drug, and 6/13 patients (46%) noted changes in the administration modality. Most patients (11/13, 85%) experienced increased pain at the injection site (median NRS scale: 6, IQR: 3). No significant increases in local itchiness, erythema, or swelling were observed. Despite educational efforts, only 6/13 patients (46%) expressed satisfaction with the switch, while 9/13 patients (69%) desired modifications to the injection device.
Conclusions: Fewer than half of the paediatric IBD patients in this study were satisfied with the switch to ADA biosimilar, reporting increased apprehension and injection‐site pain despite pre‐switch education. Beyond safety, efficacy, and economic considerations, delivery devices should be evaluated to ensure drug compliance and long‐term success when implementing non‐medical switches for subcutaneous biosimilars.
Contact e‐mail address: francesca.gaboardi@unimi.it
G‐EV196. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV196.1. UNDERNUTRITION AND ITS IMPACT ON PAEDIATRIC INFLAMMATORY BOWEL DISEASE OUTCOMES
Carla Maria Grimaldi 1, Chiara Cesari2, Matteo Motta3, Viola Carzaniga1, Alessandro Rinaldi1, Lorenzo D'antonio2, Giovanna Zuin4, Naire Sansotta3
1Paediatric Residency, University of Milan‐Bicocca, Monza, Italy, 2School of medicine, University of Milan‐Bicocca, Bergamo, Italy, 3Paediatric Hepatology, Gastroenterology And Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy, 4Paediatric Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
Objectives and Study: Malnutrition is common in paediatric inflammatory bowel disease (IBD), impacting quality of life and treatment outcomes with higher prevalence in Crohn's disease (CD, 60%) than ulcerative colitis (UC,35%). Our aim was to investigate the impact of undernutrition on IBD clinical course.
Methods: We included children diagnosed with UC or CD with at least 6‐months follow‐up at 2 IBD Paediatric Referral Centers. Clinical, biochemical, endoscopic and anthropometric data were collected at diagnosis and follow‐up. Undernutrition was defined as BMI <5th percentile.
Results: One hundred patients (M/F: 57/43, UC/CD: 48/52) with a mean age at diagnosis of 12.9 years were included. Undernutrition at diagnosis was found in 40% of our population. It was slightly higher in CD (48%, 25/52) than UC (45%, 15/33), with no statistical significance (p = 0.08). Age at diagnosis, diagnostic delay, extension and localization of disease was not found to be significant in undernourished children as compared with normal or overweight group (respectively p = 0.9, p = 0.6, p = 0.9, p = 0.1). After a mean follow‐up of 27.4 months, out of 40 underweight children at diagnosis, 28 (70%) had normal BMI while 12 (30%) remained undernourished. Remarkably, three children with normal BMI at diagnosis developed undernutrition and one of them presented with refractory disease. Use of biological therapy and rate of relapses were not significantly different between underweight children as compared with normal/overweight group (both p = 0.6).
Conclusions: Undernutrition does not seem to negatively impact paediatric IBD course in terms of biologic therapy use, rate of relapses and disease prognosis. However, more than a quarter of patients remained underweight at follow‐up despite the disease treatment and a small portion of patients developed undernutrition at follow‐up.
Contact e‐mail address: c.grimaldi8@campus.unimib.it
G‐EV197. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV197.1. CROHN'S DISEASE EXCLUSION DIET (CDED): EXPERIENCE OF THE USE AND PERSPECTIVE OF THE FAMILIES FROM A MULTIDISCIPLINARY TEAM OF A PUBLIC HOSPITAL
Rocio Viollaz1, Luciana Guzman 2, Lorena Menendez3, Paula Borobia3, Florencia Recalde1
1Buenos Aires, Sor Maria Ludovica Children' s Hospital, La Plata, Argentina, 2hiaep sor maria ludovica, LA PLATA, Argentina, 3Sor Maria Ludovica Children's hospital, La Plata, Argentina
Objectives and Study: Objective: describe the experience of the patients with IBD and their families with the CDED. How feasible was, what was the response to the different diagnoses of IBD and the use of other formulas than Modulen, the difficulties they had, and their suggestions for the medical team.
Methods: We sent the families a Google form questionnaire. We collected the results and analyzed them with Excell. Inclusion criteria: families of patients with IBD who are on the CDED or were on it.
Results: 25 families received the questionnaire. 100% responded. The average age when starting the CDED was 11 years (3‐15 y). Diagnosis: Ulcerative Colitis 56%, Crohn's Disease 32%, and indeterminate 12%. Regarding treatments 61,5% were taking Mesalazine, 61,5% steroids, 38,5% Azathioprine, 31% biologic, 11,5% antibiotics, 11,5 % others, and 4% nothing. Regarding adherence, 16% did not finish Phase 1. 86% of the patients who completed Phase 1 and Phase 2 reported following the instructions every day. 64% of patients used another formula or milk than ModulenⓇ, of which 81% improved the symptoms, and the other 19% did not have changes. Concerning the 36% of the patients that used MODULEN, 67% improved the symptoms, and 33% reported no changes in the symptoms. Regarding the facility of following the diet, 60% considered it difficult or very difficult, and 40% easy or very easy. 68% of the families reported that the CDED is very important for IBD. When we asked for suggestions for the medical team, the families resalted: daily menu options (69%), food recipes (58%), cooking classes (50%), and more consultation with the dietitian (50%).
Conclusions: Most of the patients improved their symptoms with the CDED in combination with other treatments and used another formula than Modulen, with good adherence.It is worth highlighting the role of the dietitian from the beginning of treatment.
Contact e‐mail address: rviollaz@gmail.com
G‐EV198. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV198.1. PREDICTING THE PERSISTENCE OF BIOLOGICS THERAPY FOR PEDIATRIC CROHN'S DISEASE: TOWARDS PRECISION MEDICINE
Toya Hattori 1,2, Ryusuke Nambu1, Kana Honda2, Masashi Yoshida1, Tomoko Hara1, Hirokazu Ikeda2, Itaru Iwama1
1Division Of Gastroenterology And Hepatology, Saitama Children's Medical Center, Saitama‐city, Japan, 2Department Of Pediatrics, Showa University Northern Yokohama Hospital, Yokohama‐city, Japan
Objectives and Study: In recent years, novel biologics (Bio) for Crohn's disease (CD) has been approved. With the increase in treatment options, precision medicine is required. We explored the predictors of persistent use of each Bio for pediatric CD.
Methods: We included patients who received infliximab (IFX), adalimumab (ADA), and ustekinumab (UST) for CD at two hospitals in the last 12 years. The Kaplan–Meier method was used to assess the rate of Bio treatment persistence, and the log‐rank test and Cox proportional hazard analysis (CPHA) were used to evaluate the predictors.
Results: We included 81 patients (54 boys). The average age at diagnosis was 11.5 ± 2.5 years. IFX was used to 38 patients, ADA to 47, and UST to 30. The 1‐year (3‐year) cumulative persistence rate for IFX, ADA, and UST was 63% (41%), 78% (54%), 73% (73%), respectively. The log‐rank test determined that the following variables were significant predictors of early treatment termination: age <6 years at diagnosis for IFX (p < 0.00001) and ADA (p < 0.005), and CRP ≧1.7 mg/dL at start of Bio therapy for ADA and UST (p < 0.05). IFX also significantly led to early termination when used as the 2nd‐line therapy. There was no difference in persistence rates of UST whether it was used as the 2nd‐ or 3rd‐line therapy. CPHA revealed that age <6 years at diagnosis (HR, 14.5; 95%CI 3.12‐65.3; p < 0.01) of IFX and CRP ≧1.7 mg/dL at start Bio therapy (HR, 7.0; 95%CI 1.17‐42.5; p < 0.05) of UST were independent predictors of early termination.
Conclusions: Age at diagnosis of CD and CRP levels at start of Bio therapy may provide a help to select Bio therapy.
Contact e‐mail address: t-hattori@med.showa-u.ac.jp
G‐EV199. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV199.1. POSTNATAL CLEARANCE OF ADALIMUMAB IN INFANTS BORN TO MOTHERS WITH INFLAMMATORY BOWEL DISEASE
Pia Homan 1, Darja Urlep2, Saša Čučnik3,4, Bor Vratanar5, Matjaž Homan6
1University Clinical Center, Ljubljana, Slovenia, 2Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia, 3University Clinical Centre, Ljubljana, Slovenia, 4Immunology Laboratory, University Clinical Center, Ljubljana, Slovenia, 5Institute For Biostatistics And Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia, 6Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
Objectives and Study: The data about in utero exposure to and postnatal clearance of anti‐tumor necrosis factor (anti‐TNF) agents in infancy is scarce. Therefore, we aimed to assess the infant's time of clearance for adalimumab (ADL).
Methods: We conducted a retrospective, single‐center study in infants born to mothers with inflammatory bowel disease on biologic therapy from July 2016 to September 2024, and therefore exposed in utero to ADA. The children were evaluated at the Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital in Ljubljana. Biologics levels were obtained in the cord blood at the delivery and then every 3‐months until the drug was undetectable.
Results: Overall, 12 infants exposed in utero to ADL were included in the study. In Figure 1, we illustrate the drug concentrations slowly decreasing with time. The maximum time of drug clearance in our group was 5 months. Moreover, we also showed the estimated probability of infants exposed in utero to ADL having detectable drug concentrations in the blood over time. The median value of 3.84 months indicates that, after this period, 50% of the infants had drug concentrations below the detection threshold. A ‐ Points represent the observed drug concentrations in infants, while lines show the one‐compartment model‐predicted concentrations for each infant. Unique colors are used to denote the same infants in both observed and predicted data. B ‐ Estimated probability of detectable drug concentrations over time.
Conclusions: In a study of infants born to mothers who were treated during pregnancy with ADL, we estimated that half of the infants had drug concentrations below the detection threshold after approximately 4 months. Infants should probably not be vaccinated with live attenuated vaccines before 5 months of age, because the maximum time of drug clearance in our group was 5 months.
Contact e‐mail address: piaa.homan@gmail.com
G‐EV200. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV200.1. DIFFERENTIAL GENE EXPRESSION IN GUT EPITHELIAL CELLS STIMULATED WITH FECAL SAMPLES FROM IBD PATIENTS: INSIGHTS INTO ANTI‐TNF TREATMENT RESPONSE
Jarno Honkanen 1, Rebecka Ventin‐Holmberg1, Katarzyna Leskinen1,2, Heli Pessa1,2, Anmol Kumar1, Hanne Salmenkari1, Markku Lehto1, Katri Korpela3, Schahzad Saqib4, Seppo Virtanen3, Eija Nissilä2, Anja Eberl4, Taina Sipponen4, Anne Salonen4, Paivi Saavalainen1,2
1Folkhälsan Research Center, Helsinki, Finland, 2Translational Immunology Research Program, University of Helsinki, Helsinki, Finland, 3Human Microbiome Research Program, University of Helsinki, Helsinki, Finland, 4Department Of Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Objectives and Study: Intravenous anti‐TNF blockers are used to treat patients with inflammatory bowel disease (IBD). However, up to 50% of patients fail to respond to this treatment. Current clinical, serological, microbiological, and immunological markers show limited and inconsistent ability to predict anti‐TNF response in IBD patients. Mucosal tolerance breakdown against gut microbes and luminal antigens is considered as a key event in disease pathogenesis. In this pilot study we aimed to characterize gut epithelial responses to fecal samples from patients with ulcerative colitis (UC) who respond or do not respond to anti‐TNF treatment.
Methods: In the current study, colonic epithelial cells (Caco‐2 cell line) were stimulated with fecal extracts from UC patients, including responders (n = 4) and non‐responders (n = 3). Fully differentiated Caco‐2 cells were exposed to fecal supernatant for six hours and then lysed for bulk RNA sequencing. Differentially expressed genes (DEG) were analyzed using Qlucore Omics Explorer (v3.10) with DESeq2 integration. TMM‐normalized read counts were used for the analysis and FDR < 0.1 was considered significant.
Results: A total of 677 DEGs were identified with FDR < 0.1. Pathway and gene ontology analysis linked these genes to TNF/NfκB signaling, cell junctions, and energy metabolism.
Conclusions: Caco‐2 cells stimulated with fecal extracts from anti‐TNF responders showed distinct gene expression compared to those from non‐responders. This may reflect differences in fecal microbial composition and the gut microbiota's role in modulating gut barrier function in IBD patients with varying clinical outcomes. Our results may provide new diagnostic marker for identification of IBD patients who would benefit from anti‐TNF treatment. Further research with larger sample size and advanced metabolomics and lipidomics analysis is warranted.
Contact e‐mail address:
G‐EV201. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV201.1. RELATIONSHIP BETWEEN VITAMIN D LEVELS AND THE SEVERITY OF INFLAMMATORY BOWEL DISEASE IN PEDIATRIC PATIENTS
Karen Ignorosa Arellano, Eimy Lucía Tribouillier Espinoza, José Cadena León, Flora Zarate Mondragon, Erick Toro Monjaraz, Ericka Montijo Barrios, Roberto Cervantes Bustamante, Jaime Ramírez Mayans
Gastroenterology And Nutrition, Instituto Nacional de Pediatría, Coyoacán, Mexico
Objectives and Study: Introduction: Inflammatory bowel disease (IBD) such as Crohn's disease (CD) and ulcerative colitis (UC) are chronic diseases affecting the gastrointestinal tract. The pathogenesis and etiology are not fully understood and are believed to involve environmental, genetic, and immunological factors. Additionally, IBD patients often have deficiencies in micronutrients especially vitamin D. Recent studies suggest an important role for vitamin D in immunomodulation and pathogen response. However, the relationship between low vitamin D levels and IBD activity, risk of hospitalization, and surgeries remains unclear. Some studies support vitamin D as a severity predictor, while others do not find an association. Sufficient vitamin D levels are classified as greater than 30 ng/ml, insufficient as 20‐30 ng/ml, and deficient as less than 20 ng/ml. Objective: To establish the relationship between vitamin D levels and the severity of ulcerative colitis flare‐ups.
Methods: Analytical, observational, cross‐sectional, and retrospective study. A total of 36 patients diagnosed with IBD at the IBD clinic were included between 2018 and 2024. 5 patients with CD were excluded, resulting in 31 patients with UC.
Results: Of a total of 31 patients diagnosed with UC the average age of 132 months and vitamin D levels of 21.9 ng/ml. The rest of results are presented in image 1, include descriptive statistics and the association analysis, this was performed using post hoc Bonferroni tests, showing no statistically significant differences between vitamin D values and PUCAI severity groups.
Conclusions: In IBD patients, it is important to consider vitamin D levels at diagnosis and during flare‐ups because, regardless of severity, they often present decreased levels. In this study, patients with mild flare‐ups tended to have a wider range of vitamin D levels compared to moderate and severe. There is no statistically significant difference between vitamin D levels and the severity of ulcerative colitis flare‐ups in the studied population.
Contact e‐mail address: eimytr@gmail.com
G‐EV202. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV202.1. SAFETY PROFILE OF ANTI‐TNFΑ BIOLOGICS IN PEDIATRIC INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE TWO‐CENTER STUDY
Mara Ionescu 1,2, Andreea Ioan1, Catalin Boboc1, Luca Mirea1, Malina Anghel1, Alexandrina Constantinescu3, Felicia Galos1,4
1Department Of Pediatrics, Marie Curie Emergency Children's Hospital, Bucharest, Romania, 2Department Of Functional Sciences, Division Of Physiology —neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, 3Clinical Institute Fundeni, Bucharest, Romania, 4Department Of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Objectives and Study: Biologic therapies have significantly improved outcomes for pediatric inflammatory bowel disease (IBD) patients, yet they carry risks such as infusion reactions (e.g., immediate hypersensitivity), infections (increased susceptibility due to immunosuppression), autoimmune complications (e.g., lupus‐like syndrome, autoimmune hepatitis), and malignancy concerns (potential lymphoma risk, particularly in children). Given that pediatric patients may respond differently than adults, close monitoring of adverse events (AEs) is critical.
Methods: We conducted a retrospective, observational, two‐center study at Marie Curie Emergency Children's Hospital and Clinical Institute Fundeni, evaluating the safety profile of anti‐TNFα biologics (Infliximab, Adalimumab) in children with IBD. Clinical and safety data were collected from January 2021 to November 2024 for patients treated for at least three months, including immediate and delayed AEs, infections, and treatment discontinuation rates.
Results: A total of 123 patients (54 females [43.9%], 69 males [56.1%]; 40 UC [32.5%], 83 CD [67.5%]) were included. Among them, 66 patients (53.6%) required anti‐TNFα therapy for over three months (CD: 78.5%; UC: 23%). AEs were reported in 20 patients (30.3%), with immediate AEs observed in 10 patients (anaphylaxis: 2, bronchospasm: 4, rash: 3, headache: 2, nausea: 3, hypertension: 2). One patient developed delayed optic neuropathy, and 11 patients experienced severe infections, including recurrent Clostridium difficile (7/11), tuberculosis reactivation (3/11), and persistent infections (e.g., Rotavirus, Campylobacter, Candida). Some patients exhibited multiple AEs. Treatment discontinuation or switch was required in 14/20 patients (70%) due to AEs.
Conclusions: Anti‐TNFα biologics play a central role in pediatric IBD management, with 53.6% of patients requiring prolonged treatment. AEs occurred in 30.3% of cases, primarily immediate infusion reactions and severe infections, leading to therapy adjustments in many patients. The observed AE rates align with existing data, reinforcing the safety of biologics in children. However, vigilant monitoring remains essential to promptly identify and manage potential side effects, ensuring safe and effective treatment.
Contact e‐mail address: mara-ioana.ionescu@umfcd.ro
G‐EV203. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV203.1. SEROLOGICAL EVIDENCE OF VARICELLA‐ZOSTER VIRUS SUSCEPTIBILITY IN PAEDIATRIC IBD PATIENTS: RISK IMPLICATIONS REGARDLESS OF TREATMENT
Takashi Ishige, Ryusuke Yagi, Takuya Nishizawa, Yoshiko Igarashi, Maiko Tatsuki, Reiko Hatori, Takumi Takizawa
Department Of Pediatrics, Gunma University Hospital, Maebashi, Japan
Objectives and Study: Immunosuppression in inflammatory bowel disease (IBD) patients increases susceptibility to varicella‐zoster virus (VZV) complications. However, evidence regarding VZV risks in paediatric IBD patients remains sparse. This study evaluates VZV IgG antibody levels in paediatric IBD patients at diagnosis and during treatment, identifies factors influencing serostatus changes, and examines their association with herpes zoster occurrence.
Methods: We included IBD patients under 18 years diagnosed at our institution since April 2011 with documented vaccination and VZV disease history. VZV IgG titres were measured using sera collected at diagnosis and after at least one year of treatment. Clinical data, including varicella or herpes zoster history and IBD therapy, were retrieved from medical records.
Results: The study included 76 patients (Crohn's disease: 39; ulcerative colitis: 37). The age at diagnosis ranged from 3 to 15 years (median: 13 years). Vaccination was documented in 35% (n = 27), and 52% (n = 40) had a history of varicella. Following Japan's adoption of routine VZV vaccination in 2012, 10 patients were born. VZV IgG seropositivity, defined by a cutoff value of 4.0, was 63% at diagnosis. Varicella history (odds ratio [OR]: 27.0) and vaccination (OR: 9.7) were associated with seropositivity. Post‐treatment VZV IgG titres were assessed in 64 patients, and seroreversion to negativity occurred in 3 cases. Therapies included ustekinumab (n = 1), infliximab with azathioprine (n = 1), and 5‐aminosalicylic acid (n = 1). Herpes zoster developed in 4 patients, including 1 seronegative and 3 with low VZV IgG titres at baseline. Treatments associated with herpes zoster included infliximab (n = 3), ustekinumab (n = 1), and azathioprine (n = 2).
Conclusions: VZV IgG seroreversion may occur regardless of immunosuppressive therapy. Paediatric IBD patients, irrespective of treatment type, face a risk of herpes zoster. Proactive prevention strategies, including vaccination and serological monitoring, are essential in this vulnerable population.
Contact e‐mail address: ishiget@gunma-u.ac.jp
G‐EV204. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV204.1. COMPARISON OF MAGNETIC RESONANCE ENTEROGRAPHY AND INTESTINAL ULTRASOUND SCORES FOR THE ASSESSMENT OF CHILDREN WITH INFLAMMATORY BOWEL DISEASE – A PILOT STUDY
Tomasz Janiga 1, Przemysław Bombiński2, Aleksandra Banaszkiewicz1, Marcin Banasiuk1
1Department Of Paediatric Gastroenterology And Nutrition, Medical University of Warsaw, Warsaw, Poland, 2Department Of Pediatric Radiology, Medical Univeristy of Warsaw, Warsaw, Poland
Objectives and Study: Intestinal ultrasound (IUS) and magnetic resonance enterography (MRE) are noninvasive diagnostic tools in Inflammatory bowel disease (IBD). A simplified magnetic resonance enterography index (sMARIA) was developed and validated in children for Crohn's disease (CD). Bowel Ultrasound Segmental Activity Score (IBUS‐SAS) is a comprehensive tool proposed by an expert consensus with good reliability but its usefulness was not validated in children. The aim of this pilot study was to assess the correlation between IBUS‐SAS with validated sMARIA score in pediatric patients with IBD.
Methods: Children with newly diagnosed IBD were prospectively evaluated by MRE and IUS using sMARIA and pediatric IBUS‐SAS scores. Based on two scales several variables were evaluated and compared: bowel wall thickness (BWT), edema, fat stranding. Scores were compared using Pearson correlation coefficient (r). BWT measurements were compared using Wilcoxon signed rank test. Data are expressed as mean (±SD).
Results: 10 patients were included (mean age 13.7 years, range 7‐17; 4 boys), 6 diagnosed with ulcerative colitis and 4 with Crohn's disease. Activity of the disease was mild in 6, moderate in 3 and severe in 1 patient. Mean level of calprotectin, CRP and ESR were as follows: 52.5 µg/g (±362.20), 0.4 mg/dl (±0.97), 21.5 ( ± 15.11) mm/h, respectively. Mean sMARIA score was 7.4 ( ± 7.8), while mean IBUS‐SAS score equaled 37.2 ( ± 18.0). There was strong correlation between scores obtained from both scales (r = 0.77; p = 0.009; Figure 1). No significant differences between bowel wall thickness obtained by MRI and USG were found (Table 1). No significant correlation was found between calprotectin values and sMARIA or IBUS‐SAS scores (r = ‐0.49, p = 0.22 and r = ‐0.36, p = 0.39, respectively).
Conclusions: The IBUS‐SAS score correlated very well with sMARIA score. No correlations were found between scores and calprotectin but more reasearch with larger cohort is needed.
Contact e‐mail address: tomasz.janiga@uckwum.pl
G‐EV205. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV205.1. TRANSITION SERVICES IN PAEDIATRIC INFLAMMATORY BOWEL DISEASE: A SINGLE TERTIARY CENTRE EXPERIENCE
Priyanka Kamath, Rebecca Foulkes, Lisa Charlton, Maureen Lawson, Adnaan Kala, Loveday Jago, Virginia Chatzidaki, Chai Lee, Andrew Fagbemi, Sian Copley
Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, United Kingdom
Objectives and Study: Transition from paediatric to adult care is a critical phase for adolescents with inflammatory bowel disease (IBD). 20‐30% of patients are diagnosed before the age of 20, with paediatric‐onset illness associated with greater disease severity1,2,3. Literature regarding the process and approach is limited4,5,6. This study evaluated the IBD transition service at a single tertiary centre, identifying recurring themes and targets for service improvement.
Methods: 95 patients aged 16‐18 were selected from the departmental IBD database. Electronic patient notes were evaluated, data collected on age, sex, diagnosis and treatment. Thematic analysis using open coding identified transition‐related themes.
Results: Mean age was 16.3 years, 52/95 male and 43/95 female. 66/95 had Crohn's disease, 17/95 had IBD‐unclassified and 12/95 had ulcerative colitis. 69/95 were on thiopurines, 66/95 aminosalicylates and 40/95 biologics. 3/95 were on no maintenance therapy. 67/95 were in clinical remission. In 11/95 appointments the parent was present without the patient. 12/95 failed to attend at least 1 transition appointment. 9/95 did not feel ready for transition, most commonly due to active disease. Mental health issues affected 15/95; particularly anxiety and depression (8/95), autism (5/95) and eating disorders/poor self‐image (3/95). 15/95 reported school absences impacting academic progress. 16/25 expressed medication compliance issues when prompted, attributable to poor understanding and forgetfulness. One patient wished to switch from intravenous to subcutaneous biologic. 32/95 wanted to continue within the Trust's adult services, 30/95 at a local district general hospital (DGH) and 33/95 had not yet decided. Patients with active disease were more likely to favour continued care at the Trust.
Conclusions: Key issues at the time of transition include mental health, education, and medication. Incorporation of tools such as HEADSSS assessment7 can help clinicians structure these discussions. Patients’ views on barriers to clinic attendance and service design should be sought to ensure young people attend key clinic appointments.
Contact e‐mail address: kamath.priyanka97@gmail.com
G‐EV206. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV206.1. C‐REACTIVE PROTEIN TO ALBUMIN RATIO FOR DIAGNOSIS AND PREDICTING BEHAVIORAL PATTERN IN CROHN'S DISEASE COMPARED TO ULCERATIVE COLITIS IN PEDIATRIC INFLAMMATORY BOWEL DISEASE
You Ie Kim, Sang Yong Kim
Incheon St. Mary's hospital, Incheon, Korea, Republic of
Objectives and Study: Recently, the C‐reactive protein to albumin ratio (CAR) has been recognized as playing an important role in monitoring disease activity as a non‐invasive and cost‐effective biomarker in adult patients with inflammatory bowel disease (IBD). In our study, we aimed to evaluate the CAR as a non‐invasive biomarker reflecting the severity and prognosis of Crohn's disease (CD) compared with ulcerative colitis (UC) in pediatric patients.
Methods: We investigate clinical symptoms, laboratory findings including CAR and fecal calprotectin, endoscopic findings, treatments and the occurrence of relapse at the time of diagnosis and also one year afterward in pediatric patients diagnosed with IBD.
Results: A total of 97 patients were included: 78 with CD, and 19 with UC. Hemoglobin, erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), and CAR were significantly different between CD and UC (all P < 0.05). CAR revealed positive correlation with platelet, ESR, CRP, fecal calprotectin, clinical and endoscopic severity score, whereas negative correlation with hemoglobin and albumin in CD (all P < 0.05). In UC, similar trends were observed as in CD except for fecal calprotectin. In ROC curve, an AUC of 0.843 was obtained with cut‐off of 1.62, with a sensitivity of 85.9% and specificity of 73.7%. (Fig. 1). Furthermore, when comparing luminal CD and fistulizing CD, it was observed that CAR was statistically significantly higher in luminal CD compared to fistulizing C
D.
Conclusions: In this study, CAR is shown to be helpful in distinguishing between CD and UC in pediatric patients suspected IBD, and it appears to be a good predictor of behavior in CD as well.
Contact e‐mail address: ue28235@gmail.com
G‐EV207. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV207.1. DISEASE COURSE AND MANAGEMENT OF CHILDREN WITH VERY EARLY ONSET INFLAMMATORY BOWEL DISEASE
Shreya Kishore 1,2, Aruna Sethuraman1, Hiba Binomar3, Kevan Jacobson1,4
1Division Of Gastroenterology, Hepatology And Nutrition, British Columbia Children's Hospital, Vancouver, Canada, 2School Of Medicine And Dentistry, Griffith University, Southport, Australia, 3King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 4Faculty Of Medicine, The University of British Columbia, Vancouver, Canada
Objectives and Study: Background: Very early‐onset inflammatory bowel disease (VEO‐IBD), defined as IBD diagnosed before age 6, has a distinct phenotype with predominantly colonic involvement. However, there are limited studies describing the long‐term outcome of children with VEO‐IBD. Aims: To determine the long‐term outcome in children with VEO‐IBD and rates of corticosteroid free clinical remission (CFCR) and biochemical remission (BR).
Methods: A retrospective cross‐sectional chart review was conducted for all children with VEOIBD diagnosed between 1st January 2013 to 31st December 2022 with a minimum follow up of one year at British Columbia Children's Hospital (BCCH). Patients were identified from the BCCH pediatric IBD database. Demographic and relevant clinical data including IBD medications and response were collected. Data points at 3 months, 6 months, 1 year and then annually until 10 years from diagnosis were collected. CFCR was defined as being off steroids for ≥ 3 months at yearly follow up and a PUCAI score of < 10 or weighted PCDAI < 12.5. BR was defined as fecal calprotectin <250ug/g.
Results: 77 patients were identified. The mean age at diagnosis was 47.1 months (+ 22.6 months). The median follow‐up was 70.4 months (interquartile range 38.9 to 98.2 months). Of the 43 patients on biologics, the most common 1st, 2nd, 3rd and 4th line biologics were anti‐TNF (27/28), vedolizumab (6/10), ustekinumab (4/4) and vedolizumab (1/1) respectively. Fecal calprotectin was only available in 66 patients (85.7%) at last follow up. Of those, 34 (51.5%) achieved CFCR and BR. Figure 1: CFCR and BR at last follow up in VEOIBD patients
*IMM immunomodulator
Conclusions: Approximately 55% of our VEOIBD patients had moderate to severe disease requiring escalation to biologic therapy, which is similar to previously described outcomes in adolescent children. Similarly, in patients who escalated to biologic therapy, the first biologic was most effective at achieving CFCR and BR.
Contact e‐mail address: shreya_bhushan@hotmail.com
G‐EV208. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV208.1. OCCURRENCE AND AETIOLOGY OF ANAEMIA DURING THE FIRST YEAR OF INFLAMMATORY BOWEL DISEASE IN CHILDREN
Ilona Kozioł1, Julia Budzyńska2, Paulina Krawiec 3
1Independent Public Health Care Center in Świdnik, Świdnik, Poland, 2Specialist Medical Centre in Polanica‐Zdrój, Polanica Zdrój, Poland, 3Department Of Paediatrics And Gastroenterology, Medical University of Lublin, Lublin, Poland
Objectives and Study: Anaemia is one of the most common extraintestinal manifestations of inflammatory bowel diseases (IBD). There are limited longitudinal data on the prevalence of anaemia in children with IBD. The aim of the study was to assess the occurrence and aetiology of anaemia in children at IBD diagnosis, and at 3 and 12 months follow‐up.
Methods: We reviewed electronic medical records of patients with newly diagnosed IBD in a single gastroenterological department from 01/02/2021 to 23/02/2023. Anaemia was diagnosed according to the World Health Organization criteria. Statistical analysis was performed using the Statistica v.13.0 program. The study was approved by the local bioethical committee (KE‐0254/116/2020).
Results: A total of 55 children with newly diagnosed IBD were included in the analysis. In the study group 58.2% had ulcerative colitis, 36.3% Crohn's disease and 5.5% IBD unclassified. At the time of IBD diagnosis anaemia was diagnosed in 61.8% of patients, at 3 months follow‐up in 45.5%, and at 12 months follow‐up in 35.5% of patients (p = 0.02). There were no significant differences in the incidence of anaemia depending on the IBD subtype of IBD (p = 0.91) or the severity of disease activity (p = 0.20). Iron deficiency anaemia coexisting with anaemia of chronic diseases was the most common cause of anaemia at IBD onset (42.3% of all anaemic patients), while iron deficiency anaemia was the most common cause of anaemia at 3 months follow‐up (62.5% of all anaemic patients). Iron deficiency without anaemia was diagnosed in 18% of children at IBD onset and 3 months follow‐up and in 20% of children at 12 months follow‐up (p = 0.96).
Conclusions: Anaemia and iron deficiency are common manifestations of paediatric IBD that may occur regardless of the IBD subtype and activity. Decisive treatment approach Is needed to reduce the risk of anaemia in children with IBD.
Contact e‐mail address: paulina.krawiec@umlub.pl
G‐EV209. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV209.1. A PEDIATRIC APLAID SYNDROME WHO PRESENTED AS VEOIBD
Günsel Kutluk 1, Çiğdem Aydoğmuş2, Selami Ulaş2
1Pediatric Gastroenterology, Health Sciences University Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey, 2Pediatric Allergy And Immunology, Health Sciences University Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
Objectives and Study: The auto‐inflammation and phospholipase Cg2 (PLCg2)‐associated antibody deficiency and immune dysregulation (APLAID) syndrome is a very rare primary immunodeficiency caused by a mutation in the PLCG2 gene. The APLAID patients presented with early‐onset blistering skin lesions, iflammatory bowel disease (IBD), posterior uveitis and recurrent sinopulmonary infections caused by a humoral defect. Here we present a new pediatric APLAID patient who presented with very early onset inflammatory bowel disease (VEOIBD) and skin lesions.
Methods: CASE:A 2 years old girl was presented with bloody diarrhea. After endoscopic and histopathologic examination she was diagnosed as very early onset inflammatory bowel disease(VEOIBD) in form of ulcerative colitis(UC). At that time PUCAI score was 80 and remission induction was achieved with metylprednisolon.Mesalamin and azathiopurin was added to the therapy while tapering metylprednisolon.But she experienced recurrent attacks while on maintenance treatment and therefore Infliximab was initiated after 10 months. Although UC symptoms were controlled with the current treatment,two months later,skin lesions appeared on the legs and scalp,so she had alopecia areata. While it was unclear whether skin lesions were an extraintestinal manifestation of IBD or a side effect of Infliximab treatment we had to discontinue Infliximab treatment.
Results: Because she had VEOIBD, genetic and immunological investigations were also conducted. No major immunological deficiency was detected, but she was found to have a missense variation in the PLCG2 gene,inherited from the father,identified in whole exome sequencing test, so she was diagnosed as APLAID and was switched to ustekinumab treatment.The patient has been receiving ustekinumab treatment for over a year, is in remission, and skin symptoms have also improved.
Conclusions: In VEOIBD cases, monogenic immune deficiencies that may predispose to the condition should be kept in mind, and detailed genetic and immunological analyses should be performed, especially in treatment‐resistant cases, for targeted therapy planning.
Contact e‐mail address: gekutluk@gmail.com
G‐EV210. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV210.1. HEPATOBILIARY MANIFESTATIONS IN ULCERATIVE COLITIS IN CHILDREN
Magda Łazinek, Agata Rocka, Elżbieta Pac‐Kożuchowska, Paulina Krawiec
Department Of Paediatrics And Gastroenterology, Medical University of Lublin, Lublin, Poland
Objectives and Study: Introduction: Ulcerative colitis (UC) is one of the type of inflammatory bowel disease (IBD), may progress with concomitant symptoms from other systems, including the liver and biliary tract. The current literature on the phenotype and the course of UC in children with concomitant hepatobiliary manifestations are limited. Aim of the study: The aim of the study was to evaluate the prevalence of biliary tract, gallbladder and liver diseases in children with ulcerative colitis.
Methods: We performed a retrospective review of medical records of patients with ulcerative colitis hospitalized in the Department of Pediatrics and Gastroenterology from 2009 to 2022. The following data were included in the analysis: age at diagnosis, gender, disease course, exacerbation, laboratory, imaging and histopathological findings
Results: In the studied period 207 patients were newly diagnosed with ulcerative colitis. The study group included 112 (54.11%) boys and 95 (45.59%) girls. At the time of diagnosis, the mean age of the children was 12.42 ± 4.03 years (median 13.25 years). The mean Pediatric Ulcerative Colitis Activity Index (PUCAI) at the time of diagnosis was 42.07 ± 19.31 points. In the study group, 19 (9.18%) patients had hepatobiliary manifestations. In 14 cases (6.76%) hepatobiliary manifestations were diagnosed at UC diagnosis, while in 5 (2.42%) after the diagnosis of UC. In the group of patients with UC and concomitant liver disease pancolitis was most often involved in the inflammatory process. The most common hepatobiliary manifestation in children with UC was autoimmune hepatitis (AIH)/primary sclerosing cholangitis (PSC) overlap syndrome (26.32%), followed by PSC (21.05%) and AIH (10.53%). Two patients presented features of hepatic steatosis. In 6 patients, the etiology of hepatopathy was not determined.
Conclusions: Hepatobiliary manifestations may occur independently of the time elapsed since the diagnosis of UC. It seems reasonable to routinely monitor liver function tests in children with UC.
Contact e‐mail address: magda.lazinek@gmail.com
G‐EV211. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV211.1. ANOTHER NIGHTMARE IN IBD: ABNORMAL LIVER FUNCTION TESTS
Ugur Can Leblebici
Pediatric Gastroenterology Hepatology Nutrition, ARTUKLU UNIVERSITY MARDIN STATE HOSPITAL, MARDIN, Turkey
Objectives and Study: Inflammatory bowel diseases (IBD) are disorders characterized by chronic inflammation of the gastrointestinal system and are often associated with abnormal liver function tests (LFTs). However, there are limited studies that demonstrate the relationship between IBD and abnormal LFTs. The aim of this study is to evaluate LFT abnormalities, their etiology, and the relationship with demographic and clinical factors in children diagnosed with ulcerative colitis (UC) and Crohn's disease (CD).
Methods: This is a retrospective, single‐center study that reviewed 29 children diagnosed with UC or CD at a pediatric gastroenterology clinic in 2024. Patients with indeterminate colitis were excluded from the study. Liver function tests and liver damage were analyzed.
Results: A total of 29 patients were included in the study, with 17 diagnosed with UC (7 male, 10 female; median age 9) and 12 with CD (7 male, 5 female; median age 11). A statistically significant difference in gender was observed among the CD patients (p = 0.049). The rate of abnormal LFTs was found to be 12% in UC patients and 28% in CD patients, with CD patients showing significantly higher abnormal LFTs compared to UC patients (p = 0.008). Additionally, a significant relationship was found between azathioprine use and LFT abnormalities in UC patients, with a higher rate of azathioprine use observed in patients with abnormal LFTs (p = 0.044).
Conclusions: The findings of this study suggest that children with IBD may exhibit abnormalities in liver function tests. Therefore, regular monitoring of liver function tests is recommended for these patients during follow‐up. Furthermore, the association between azathioprine use and abnormal liver function tests emphasizes the need for careful monitoring during treatment.
Contact e‐mail address: canleblebici@gmail.com
G‐EV212. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV212.1. MESALAZINE‐INDUCED EOSINOPHILIC PNEUMONIA: A CASE REPORT
Huey Miin Lee 1, Jane Standish2, Joanne Harrison3, Noel Cranswick2, Jenny Bracken4, Shaun Ho1
1Department Of Gastroenterology & Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia, 2Department Of General Medicine, Royal Children's Hospital, Melbourne, Australia, 3Respiratory And Sleep Medicine, Royal Children's Hospital, Melbourne, Australia, 4Medical Imaging Department, Royal Children's Hospital, Melbourne, Australia
Objectives and Study: Mesalazine is often used as a first‐line medication in ulcerative colitis (UC) to achieve and maintain disease remission. Mesalazine‐induced lung injury (MILI) is rarely reported. We present a case of mesalazine‐induced eosinophilic pneumonia, which is the most common form of MILI.
Methods: A 7.5‐year‐old girl with pancolitis UC on mesalazine for 19 months and azathioprine for 7 months presented with a one‐week history of fever, cough, exertional dyspnoea, itchy feet and intermittent abdominal pain. Her chest X‐ray (CXR) showed extensive bilateral patchy pulmonary opacities. In the seven weeks preceding this presentation, she was admitted to hospital twice with fever and abdominal pain. Serial CXRs showed bilateral interstitial and parenchymal opacities with progressive left lower zone opacification. She was treated with intravenous broad‐spectrum antibiotics and oral azithromycin on both admissions. She did not receive co‐trimoxazole during these admissions. She also had chronic peripheral eosinophilia up to 6.36x10e9/L, which pre‐dated the commencement of her azathioprine.
Results: In the setting of clinical and radiological progression, she underwent chest computed tomography which showed bilateral panlobular interstitial, airspace abnormalities, diffuse irregular septal thickening and mild patchy ground‐glass opacification bilaterally. Bronchoalveolar lavage (BAL) contained abundant eosinophils (>200 per x10 high power fields) but no fungal elements, viral inclusions or malignant cells. BAL culture was negative and no parasites were detected. Mycobacterium tuberculosis, cytomegalovirus and Pneumocystis jirovecii nucleic acids were not detected in BAL. She underwent endoscopic reassessment of her ulcerative colitis during this admission, which showed patchy Mayo 1 pancolitis. Mesalazine and azathioprine were ceased, and she was commenced on oral corticosteroids at 1 mg/kg for one week with a planned taper. Her MILI recovery is under assessment.
Conclusions: Mesalazine‐induced lung injury should be considered in patients who are on mesalazine treatment and present with unexplained recurrent fever and respiratory symptoms.
Contact e‐mail address: leehueymiin82@yahoo.com
G‐EV213. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV213.1. GENETIC RISK VARIANTS ARE COMMON IN NATIVE‐BORN AND IMMIGRANT PEDIATRIC INFLAMMATORY BOWEL DISEASE PATIENTS FROM MINORITIZED BACKGROUNDS
Shagun Sharma1, Shazaib Khan1, Melissa Ramirez Escobar1, Anne Levine 2
1SUNY Downstate Health Sciences University, Brooklyn, United States of America, 2Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, United States of America
Objectives and Study: Introduction: Inflammatory bowel diseases (IBD) are chronic immunologically‐mediated disorders with a significant genetic component. Over 200 risk genes have been identified. However, most genetic studies draw from populations with few non‐Caucasian patients. At our center, most IBD patients are of Afro‐Caribbean descent, and many are immigrants. Although the genetics of IBD in patients of African descent resembles that of Caucasians, some risk alleles are ethnicity‐specific, and others exert different effect sizes. Thus, we aimed to describe the frequency and significance of a limited number of risk alleles in our population.
Methods: We conducted a retrospective chart review of individuals aged 0‐21 diagnosed with IBD at SUNY Downstate Medical Center between 2009‐2024. Data included demographics, including ethnicity and immigration status (where available), clinical characteristics, and laboratory results, including the Prometheus Laboratories SGI panel, which reports genotypes for risk variants in ATG16L1, ECM1, NKX2‐3, and STAT3. Pediatric patients with histologically confirmed IBD were included.
Results: Results: Nineteen patients had sufficient data for analysis. Four were native‐born Americans (21.1%), 3 first‐generation immigrants (15.8%) and 12 second‐generation immigrants (63.2%). Ten were African‐American (52.6%), 2 Hispanic (10.5%), and 7 from other ethnicities (36.8%). There were no Caucasians. There was high frequency of disease‐associated variants in ATG16L1 and STAT3, with less frequency in ECM1 and NKX2‐3. Second‐generation immigrants and African‐Americans exhibited the highest diversity across all genes, particularly with variants in ATG16L1 and STAT3 (Table 1).
Conclusions: These genes are widely reported as disease risk alleles for IBD in Caucasian populations. Less is known about the frequency and effect size of these risk alleles in our unique and diverse patient population. Our data shows that they are common in patients of Afro‐Caribbean descent, though the degree of effect is unclear. More research is needed to identify the contribution of these markers to genetic risk in non‐Caucasian populations.
Contact e‐mail address: annie.levine@downstate.edu
G‐EV214. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV214.1. REVIEWING THE PSYCHOLOGICAL NEEDS OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE STUDY WITHIN A PAEDIATRIC GASTROENTEROLOGY PSYCHOLOGY SERVICE
Louise Maclean, Cathryn Evans, Wendy Walker, Veena Zamvar
Paediatric Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
Objectives and Study: Psychological support for children and young people (CYP) with Inflammatory Bowel Disease (IBD) is integral to supporting optimal wellbeing. CYP with IBD comprise a significant proportion of referrals to the Specialist Gastroenterology Psychology Service. This study aimed to provide a retrospective analysis of referrals to identify key reasons for referral, consider patterns of referral and better understand the need for psychology support.
Methods: A review of psychology referrals made between October 2023 and October 2024 was undertaken.
Results: 66 CYP with IBD were referred, with most (76%) being outpatient referrals. They represented 38% of referrals during this period, with an additional 16% of CYP referred who did not engage after referral. For CYP who did engage, there was an average wait of 59 days. The wait for inpatient support was shorter, between 3‐18 days. Average age at referral was 11 years. The number of treatment sessions ranged between 2 and 16 sessions, with an average of 4 sessions. The most common reasons for outpatient referral were for support with adjustment to diagnosis, high anxiety and treatment adherence. In terms of inpatient referrals, the most common referrals were for support with adjustment to diagnosis, procedural distress and surgical preparation, high anxiety and low mood. The data suggests inpatient support required longer and more frequent sessions to best support families.
Conclusions: Psychology support is vital in managing CYP with IBD in this service. Clinical psychology service provision should be developed with the different needs of the CYP groups in mind. For outpatients, investigation of barriers to engagement should be considered. Additionally, groups supporting adjustment and adherence could maximise effectiveness with limited psychology resource.With inpatients, the need for fast responses to referrals coupled with the need for more intensive support suggests that practical strategies, such as having a nominated clinician with protected time, could provide optimal support.
Contact e‐mail address: Louise.maclean3@nhs.net
G‐EV215. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV215.1. THE IMPACT OF CHILDHOOD ADVERSITY ON THE DISEASE COURSE IN PAEDIATRIC‐ONSET IBD, LIVER DISEASE AND IMMUNE‐MEDIATED INFLAMMATORY DISEASES: A POPULATION‐BASED LIFE‐COURSE STUDY
Mikkel Malham 1,2,3,4, Christoffer Sejling5, David Wilson1, Vibeke Wewer3, Matthew Fox6, Naja Rod2
1Department Of Paediatric Gastroenterology And Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, 2Copenhagen Health Complexity Center, University of Copenhagen, Copenhagen, Denmark, 3Department Of Paediatric And Adolescent Medicine, Copenhagen University Hospital – Hvidovre, Copenhagen, Hvidovre, Denmark, 4Copenhagen Center For Inflammatory Bowel Disease In Children, Adolescents, And Adults, Copenhagen University Hospital – Hvidovre, Hvidovre, Denmark, 5University Of Copenhagen, Section of Biostatistics, Department of Public Health, Copenhagen, Denmark, 6Boston University, Departments of Epidemiology and Global Health, Boston, United States of America
Objectives and Study: In a population‐based cohort study, we aimed to estimate the effect of childhood adversities on developing a severe disease course in paediatric‐onset IBD (pIBD), autoimmune liver disease (pALD) and when grouped with common immune‐mediated inflammatory diseases (pIMID).
Methods: Using the Danish registries, we identified all individuals born between 1981 and 2001 who were diagnosed with pIMID before age 18 (defined as IBD [most common pIMID], pALD, juvenile idiopathic arthritis, systemic lupus erythematosus, or vasculitis). We used nationwide health and socioeconomic registries to model childhood adversity from ages 0 to 15. We divided it into 5 trajectories according to the timing and characteristics of the adversity. The trajectories were modelled based on poverty, unemployment, death or severe illness, parental drug or alcohol abuse, maternal separation, or foster care. The outcome was developing a severe disease course as defined by requiring biologics, steroid dependency, surgery, hospitalisation (>5 days), and complications indicative of disease progression. We used Cox regression to estimate sex‐adjusted hazard ratios (aHR) with age as the underlying timescale. Person time started at pIMID diagnosis and ended at the earliest of the outcome, emigration, death, or 31 DEC 2021. The low adversity trajectory was used as comparator for all analyses.
Results: Of 5,847 incident pIMID patients, 3,829 (65%) developed a severe disease course. Figure 1 presents aHR and the cumulative risks of developing a severe disease course. Patients with persistent material deprivation were more likely to develop steroid dependency, require surgery and prolonged hospitalisation, and develop complications. Patients with persistent material deprivation and high adversity were less likely to receive biologics.
Conclusions: Persistent material deprivation is associated with developing a severe disease course in pIMID, indicating substantial social inequality. It should be investigated whether this effect represents physiological changes or is mediated through socioeconomic factors such as poor family support.
Contact e‐mail address: mikkel.malham.knudsen.01@regionh.dk
G‐EV216. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV216.1. EXPLORING INTESTINAL ULTRASOUND AS A NEW TOOL FOR PEDIATRIC IBD
Ana Martin Adrados 1, Marta Velasco Rodríguez‐Belvis2, Laura Palomino2, Olga Maria Suarez Traba2, Amalio Fernández Leal3, Marianna Di Campli Zaghlul3, Carmen Martín Fernández2, Sara Arozamena Aguayo2, Rosa Ana Muñoz Codoceo2
1Hospital Fundación Alcorcón, Madrid, Spain, 2Pediatric Nutrition, Hospital Infantil Niño Jesús, Madrid, Spain, 3Hospital Infantil Niño Jesús, Madrid, Spain
Objectives and Study: Magnetic resonance enterography (MRE) is commonly used in the diagnosis and monitoring of pediatric inflammatory bowel disease (IBD). However, it has limited availability in certain healthcare settings and it can supose a challenge to perform the procedure in children as oral contrast ingestion may be a challenge. In contrast, intestinal ultrasound (iUS) is a less expensive, more accessible technique that may serve as a promising alternative to MRE.
Methods: A prospective study was conducted in 2024, including pediatric IBD patients under the age of 18 who underwent both iUS and MRE. The patients were divided into two groups: those with normal ultrasound findings (normal iUS) and those with any abnormal findings (abnormal iUS).
The results of the ultrasound were compared with those of MRE. Data analysis was performed using SPSS software (version 25).
Results: Seventeen patients were included, with a mean age of 12.8 years ([maximum age 7 ‐ minimum age 17]). The cohort consisted of 64.7% males and 35.3% females. Most patients (76.4%) had Crohns disease, while 2 patients had ulcerative colitis, and 2 were suspected of having IBD. Of the 17 patients, 7 had normal iUS results (41.1%), and in all of them the MRE was also normal. Findings were concordant in 100% of the cases. In contrast, 10 patients had abnormal intestinal ultrasound findings (58.8%). Among these, in 8 patients (80%) MRE was also reported as abnormal. In 2 cases, MRE was reported as normal, whereas the radiologist identified slight wall thickening in a small bowel segment on the iUS.
Conclusions: Our study suggests that iUS and MRE show concordant findings, so it may replace MRE in specific cases. Larger and more comprehensive studies are warranted to further define the role of iUS as an adjunctive tool in the management of pediatric IBD.
Contact e‐mail address: martinadradosana@gmai.com
G‐EV217. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV217.1. FOOD RELATED QUALITY OF LIFE IN CHILDREN WITH CHRONIC GASTROINTESTINAL DISORDERS: COMPARATIVE STUDY BETWEEN INFLAMMATORY BOWEL DISEASE AND FUNCTIONAL ABDOMINAL PAIN – WHICH IS WORSE?
Roxana Matran 1,2, Andra Diaconu1, Andreea Iordache1,2, Cristina Becheanu1,2
1Grigore Alexandrescu Emergency Children's Hospital, Bucharest, Romania, 2UMF Carol Davila Bucharest, Bucharest, Romania
Objectives and Study: Gastrointestinal disorders frequently involve nutritional management strategies. Inflammatory bowel disease (IBD) is an organic condition in which most of the patients experience frequent diet manipulation in order to obtain long term remission. Functional abdominal pain disorders are one of the most frequent chronic pathologies addressed to the pediatric gastroenterologist, with no specific treatment but with several equivocal dietetic interventions. We aimed to evaluate the comparative food‐related quality‐of‐life (FR‐QoL) in light of these dietary interventions between these two conditions.
Methods: This is a cross‐sectional study, involving children aged 7‐18 years diagnosed with IBD and functional abdominal pain (FAP). Assessment of this aspect was performed using the self‐reported FR‐QoL 29 questionnaire. For FAP questionnaires were modified with “FAP” instead of “IBD”.
Results: Fifty‐one patients were included, 17 in each subgroup (Crohn's disease (CD) ulcerative colitis (UC) and FAP), 22 boys (56.9%), median age (IQR) at inclusion 14 years (11.2‐16). The total FR‐QoL score was low, 68.3 ± 16.7. The FR‐QoL scores were similar across the three groups, p = 0.454. Underweighted patients had lower score when compared with those with a normal nutritional status (59.4 ± 15.5 vs. 71 ± 16.2, p = 0.03). For the IBD group, the scores were not influenced by disease activity.
Conclusions: The burden of dietary interventions is apparently similar between IBD, an organic condition and FAP. Nutritional status is a risk factor for decreased FR‐QoL while for the IBD group, disease activity seems to not influence the FR‐QoL.
Contact e‐mail address:
G‐EV218. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV218.1. THE USEFULNESS OF ULTRASOUND ELASTOGRAPHY IN THE DIAGNOSIS OF LIVER DISORDERS IN CHILDREN WITH CROHN'S DISEASE
Aleksandra Medyńska‐Przęczek, Aleksandra Zawartka, Anna Stochel‐Gaudyn, Andrzej Wędrychowicz
Department Of Paediatrics, Gastroenterology And Nutrition, Jagiellonian University Medical College, Kraków, Poland
Objectives and Study: In recent years, increased incidence of inflammatory bowel diseases in the pediatric population has been observed, including Crohn's disease (CD). Approximately 30% of pediatric patients with CD may experience liver function disorders of various etiologies and varying degrees of severity. Liver biopsy remains the gold standard in diagnosing these disorders. Due to the burdens associated with liver biopsy, less invasive methods for assessing liver are needed. The aim of our study was to assess the occurrence and severity of liver disorders in children with newly diagnosed CD using non‐invasive methods such as elastography.
Methods: The study included 44 patients with newly diagnosed CD (25 boys, 19 girls aged 3‐17.5 years, mean age 12.8 years). In this group of patients, the levels of liver parameters (ALT, AST, GGTP), calprotectin, CRP and ESR were assessed, and additionally, ultrasound liver elastography using the point shear wave elastography method was performed, the results of which were presented in kPa.
Results: In the study group, elevated ALT levels were observed in 5 patients (11%), and elevated AST levels in 8 patients (18%). Additionally, elevated GGTP levels were observed in 8 patients (18%). In 4 patients (9%) abnormal values of liver tissue stiffness in elastography were found (2 girls and 2 boys, 7.18‐13.84 kPa) ‐ in this group three patients also had abnormal values of transaminases and GGTP, ultimately two of them were diagnosed with autoimmune hepatitis, and one patient with primary sclerosing cholangitis. Statistical analysis showed a positive correlation between calprotectin concentration and elastography values (p = 0.011), it did not show a relationship between elastography values and transaminases or GGTP.
Conclusions: Patients with severe intestinal inflammation may have increased liver stiffness, but further studies are needed to assess whether increased elastography values in this group of patients may lead to the development of liver disease in the future.
Contact e‐mail address: aleksandramedynska@gmail.com
G‐EV219. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV219.1. ADHERENCE TO ESPGHAN GUIDELINES ON THE MONITORING OF VITAMIN D, FOLATE AND VITAMIN B12 IN PATIENTS WITH PAEDIATRIC CROHN'S DISEASE
Chloe Montagnon
Paediatric Dietetics, St Georges Hospital, London, United Kingdom
Objectives and Study: Due to increased risk of nutrient deficiency in paediatric Crohn's disease (CD), ESPGHAN guidelines recommend annual monitoring of folate, regular monitoring of vitamin D and annual monitoring of vitamin B12 in the case of active ileal disease or ileal resection. The aim of this audit was to determine if nutrients are monitored in accordance with guidelines, and to determine the micronutrient status of CD patients in the dietetic clinic.
Methods: Retrospective data collection of CD patients ≤18 years old that were seen in the dietetic IBD clinic at St Georges and St Helier Hospitals between 01.09.23‐01.09.24. Collected data included patient characteristics and all vitamin D, B12 and folate results across the patients’ disease course. This audit was registered with St Georges Clinical Audit Department.
Results: 84 patients were eligible and included. 64.7%, 26.0% and 36.8% had vitamin D, folate and B12 checked at diagnosis, respectively. 8.2%, 54.1% and 42.6% of patients had never had vitamin D, folate and B12 checked, respectively. Table 1. Rates of insufficiency and deficiency at diagnosis and across the disease course.
| Diagnosis | Across disease course | |||
|---|---|---|---|---|
| Insufficient | Deficient | Insufficient | Deficient | |
| Vitamin D | 49.1% | 20.0% | 38.0% | 23.0% |
| Vitamin B12 | 10.0% | 0.0% | 10.3% | 0.0% |
| Folate | 23.1% | 4.0% | 7.0% | 7.0% |
Conclusions: Vitamin D, folate, and vitamin B12 are not being monitored in line with ESPGHAN guidelines. Research suggests that vitamin D supplementation may improve infliximab efficacy in CD patients particularly when deficient, and folate deficiency may be associated with increased risk of colorectal cancers with supplementation playing a protective role. This audit highlights scope to improve micronutrient status, and insufficiency/deficiency is likely underestimated due to non‐adherence to guidelines. Improved monitoring and appropriate supplementation could reduce the risk of IBD complications whilst improving overall nutritional status. Local guidance, and the ability for dietitians to order nutritional bloods could improve blood monitoring going forward.
Contact e‐mail address: chloe.montagnon@stgeorges.nhs.uk
G‐EV220. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV220.1. SUPPORT FROM OTHERS AS PERCEIVED BY PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Ryusuke Nambu 1, Itaru Iwama1, Hirotaka Shimizu2, Shin‐Ichiro Hagiwara3, Yuri Etani3, Takuya Nishizawa4, Takashi Ishige4, Ken Kato5, Tatsuki Mizuochi5, Yusuke Hoshi6, Daiki Abukawa6, Koji Yokoyama7, Hideki Kumagai7, Keisuke Jimbo8, Takahiro Kudo8, Satoshi Ukai9, Tomomitsu Sado9, Mei Haruyama10, Katsuhiro Arai2
1Division Of Gastroenterology And Hepatology, Saitama Children's Medical Center, Saitama‐city, Japan, 2Center For Pediatric Inflammatory Bowel Disease, Division Of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan, 3Department Of Pediatric Gastroenterology, Nutrition And Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan, 4Department Of Pediatrics, Gunma University Hospital, Maebashi, Japan, 5Department Of Pediatrics And Child Health, Kurume University School of Medicine, Fukuoka, Japan, 6Department Of General Pediatrics And Gastroenterology, Miyagi Children's Hospital, Miyagi, Japan, 7Department Of Pediatrics, Jichi Medical University, Tochigi, Japan, 8Department Of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan, 9Department Of Pediatrics, Shinshu University School of Medicine, Nagano, Japan, 10Department Of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
Objectives and Study: Children and adolescents with inflammatory bowel disease (IBD) require support from the community beyond their families as they come to accept their disease and strive to attain independence. However, little is known about the everyday emotional support that they experience from their peers, schools, and communities.
Methods: We administered a questionnaire (the Respect IBD Study) to teenage patients treated at 9 medical facilities specializing in pediatric IBD, analyzing items involving how patients perceived support offered by their surroundings. Based upon the results, a group discussion was held with 27 pediatric IBD patients attending an IBD Children's Camp (March 23‐24, 2024) about support that they would like to receive at their schools.
Results: A total of 573 patients were included (319 male; mean age, 14.5 years). Support from parents, teachers, school nurses, club activities, lessons, and friends was respectively felt to be “insufficient” by 2.8%, 14%, 12%, 11%, 9.1%, and 6.5% of respondents, with the 3 school‐related categories each involving over 10% of survey respondents. No difference in disease type, severity, or treatment was evident between the group answering “insufficient support” from school teachers and the group answering “sufficient support” or “no support needed.” The group that answered “insufficient” had significantly lower scores on IMPACT III than the group that answered “sufficient” or “no support needed” (P < 0.0001). Subjects answering “insufficient” were significantly more likely to feel that their teachers were “not knowledgeable about IBD” (P < 0.0001). In discussions based on these results, the specific support requested by children with respect to teachers typically involved eating, toileting, earning credits and taking tests, as well as acquisition and sharing of knowledge about IBD among teachers.
Conclusions: Pediatric IBD patients experiencing limited quality of life may feel that they lack support in school surroundings. Discussion of ways to provide better support and solutions is needed.
Contact e‐mail address: nambee1231@gmail.com
G‐EV221. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV221.1. NEED ASSESSMENT AND OPTIONS TO IMPROVE PEER SUPPORT FOR PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Ryusuke Nambu 1, Itaru Iwama1, Hirotaka Shimizu2, Shin‐Ichiro Hagiwara3, Yuri Etani3, Takuya Nishizawa4, Takashi Ishige4, Ken Kato5, Tatsuki Mizuochi5, Yusuke Hoshi6, Daiki Abukawa6, Koji Yokoyama7, Hideki Kumagai7, Keisuke Jimbo8, Takahiro Kudo8, Satoshi Ukai9, Tomomitsu Sado9, Katsuhiro Arai2
1Division Of Gastroenterology And Hepatology, Saitama Children's Medical Center, Saitama‐city, Japan, 2Center For Pediatric Inflammatory Bowel Disease, Division Of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan, 3Department Of Pediatric Gastroenterology, Nutrition And Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan, 4Department Of Pediatrics, Gunma University Hospital, Maebashi, Japan, 5Department Of Pediatrics And Child Health, Kurume University School of Medicine, Fukuoka, Japan, 6Department Of General Pediatrics And Gastroenterology, Miyagi Children's Hospital, Miyagi, Japan, 7Department Of Pediatrics, Jichi Medical University, Tochigi, Japan, 8Department Of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan, 9Department Of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
Objectives and Study: For pediatric patients with inflammatory bowel disease (IBD), peer support is important in fostering independence and acceptance of their chronic illness. The extent of this need is uncertain, as is adequacy of peer support through social networking and other media.
Methods: A questionnaire survey, was conducted among teenage Japanese IBD patients receiving care at 9 facilities in Japan that specialized in pediatric IBD (the Respect IBD Study). We analyzed replies to survey items relating to peer support.
Results: Surveyed adolescents numbered 573 (319 male; mean age, 14.5 years). Among them, 64% said that they would like to have some support from peers of their age; these included 18% who said that they wanted to talk, 32% who would like to talk a little, and 14% who did not want a conversation but would like to hear about others’ experiences. Among other respondents, 29% did not want to talk. Groups desiring some level of additional peer support had significantly lower IMPACT III scores than those who did not, especially with respect to emotional and social functioning. Logistic analysis detected significant differences in desire for additional peer support favoring female sex (odds ratio or OR, 2.0; P < 0.001), Impact III score < 147 (OR, 1.7; P = 0.001), and diagnosis less than 5 years before the survey (OR, 1.0; P = 0.02. Disease and treatment types had little influence on desire for peer support. Face‐to‐face meetings were the most preferred form of peer support (40% of responses), followed by social networking without revealing names or faces (25%), and online media such as Zoom, YouTube, or others (24%).
Conclusions: As more than 60% of pediatric IBD patients desired peer support and patients seeking peer support tended to have a lower quality of life, more peer support options are needed to meet their needs.
Contact e‐mail address: nambee1231@gmail.com
G‐EV222. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV222.1. CLINICAL FEATURES OF VERY EARLY ONSET INFLAMMATORY BOWEL DISEASE AT THE CHILDREN'S MEMORIAL HEALTH INSTITUTE IN WARSAW: A RETROSPECTIVE SINGLE‐CENTER STUDY
Anna Orlowska‐Wojcicka 1, Piotr Socha1, Daniel Kotlarz2, Maciej Dądalski1, Jaroslaw Kierkus1, Maja Klaudel‐Dreszler1
1Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 2Department Of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig‐Maximilians‐Universität Munich, Munich, Germany
Objectives and Study: Very early onset inflamatory bowel disease (VEO‐IBD) is defined as the occurrence of inflammatory bowel disease (IBD) before the age of 6. In the group of children with VEO‐IBD, compared to patients with later onset of the disease, there is a higher likelihood of monogenic etiology related to inborn errors of immunity.
Methods: A retrospective review of data from 55 patients diagnosed with VEO‐IBD hospitalized in 2006‐2024 was conducted ‐ 18 girls (33%) and 36 boys (67%).
Results: In 11 patients an inborn error of immunity was molecularly confirmed, among them 5 (45%) were initially diagnosed with Crohn's disease (CD) and 6 (55%) with unclassified type (IBD‐U). In the remaining group of patients ulcerative colitis (UC) was diagnosed in 24 patients, CD in 14 patients, and IBD‐U in 7 patients. The average age of patients at the time of diagnosis was 28.56 ± 5.24 months. The most common initial symptoms were: diarrhea (77%), blood in the stool (75%), abdominal pain (59%), failure to gain weight or weight loss (16%). Perianal lesions occurred in 3 patients (30%) with an inborn error of immunity and in 3 patients (7%) without confirmed error of immunity. In the group of patients with an inborn error of immunity 5 patients (45%) required total parenteral nutrition, in the second group ‐ 12 patients (27%). The number of patients who received biological treatment in both groups was 4 (36%) and 30 (68%) patients respectively. In the group with an inborn error of immunity 4 patients (36%) required surgical treatment, in the group of patients without an immune defect – 10 patients (23%). 6 (60%) patients with inborn error underwent hematopoietic stem cell transplantation (HSCT).
Conclusions: In patients with VEO‐IBD a quick diagnosis of an inborn error of immunity is of great importance due to the potential decision to perform HSCT.
Contact e‐mail address: a.orlowska@ipczd.pl
G‐EV223. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV223.1. ROLE OF USTEKINUMAB IN MANAGING ANTI‐TNF EXPOSED PEDIATRIC INFLAMMATORY BOWEL DISEASE (IBD): A REAL WORLD SINGLE CENTRE EXPERIENCE
Nitin Reddy Patlolla 1, Dominique Schluckebier2, Zuzana Londt2, Priya Narula3, Arun Urs4, Prithviraj Rao4, Natalia Nedelkopoulou4, Shishu Sharma2, Mike Thomson2, Akshay Kapoor2, Sunita Amar Rajani2
1Gastroenterology, SHEFFIELD CHILDRENS HOSPITAL, Sheffield, United Kingdom, 2Sheffield Children's Hospital, Sheffield, United Kingdom, 3Department Of Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom, 4Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
Objectives and Study: Ustekinumab(UST) is an anti‐IL12/23 inhibitor, licensed in adults for moderate to severe Crohn's disease(CD) and Ulcerative Colitis(UC) who have not responded to/lost response to anti‐TNFs. However, its efficacy and safety in children is emerging. We aimed to evaluate our center's experience in terms of effectiveness and safety in pediatric patients.
Methods: We conducted a retrospective review of all children treated with Ustekinumab from 2020 onwards.
Results: Our cohort included 20 children treated with Ustekinumab with minimum follow up of 1 year. Of these,18 were aged 8–14 years at the time of IBD diagnosis,one was 3 years old(VEO‐IBD).14 had Crohn's,5 had UC and 1 has IBD‐U. 13 children(65%) responded to Ustekinumab based on patient reported outcomes/clinical and biomarker response.Corticosteroid free response was 100%.Efficacy was higher in UC subgroup(80% vs 57%).Dual therapy with immune‐modulators was required in 15% of patients with Crohn's disease.
| Total 20 | Responded : 13 | Not Responded : 7 |
|---|---|---|
| Crohns Disease : 14 | Phenotypes: L3 p : 1 L3 L4a : 6 L1 L4 ab: 1 | Phenotypes: L 1:1 L3 :2 L3 p: 2 L3 L4ab p :1 |
| Ulcerative colitis : 5 | E4 S1 : 3 E4 S0 :1 | E4 S1:1 |
| IBD‐U : 1 | 1 | ‐ |
Among the 20 patients treated, all got Anti TNF medications, 7 had Infliximab,5 had adalimumab and 7 had both. Of the 13 patients who responded to Ustekinumab, three previously failed Vedolizumab, and one failed Upadacitinib. Among the seven non‐responders to Ustekinumab,subsequent treatments included adalimumab desensitization, Upadacitinib and Risankizumab. 10% of the patients required re‐induction to capture response.Dose optimisation to 4 weekly maintenance was required in 45% of the patients.
Conclusions: Our experience has shown UST to be an effective second line drug for anti‐TNF failures.Coupled with a favourable safety profile, low immunogenicity and ease of administration,it has shown its utility in difficult disease phenotypes as well.
Contact e‐mail address: nitin.patlolla@nhs.net
G‐EV224. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV224.1. EVALUATION OF INFECTIOUS AGENTS IN DISEASE ACTIVITY OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Safak Pelek 1, Mehmet Önder2, Deniz Ergun3, Duygu Demirtas Guner4, Cahit Baris Erdur2, Vecihe Dursun2, Gulin Eren2, Ilker Devrim3, Cigdem Omur Ecevit4, Ozlem Bekem1
1Pediatric Gastroenterology, Hepatology And Nutrition, University of Health Science Izmir Dr. Behcet Uz Children Hospital, Izmir, Turkey, 2Pediatric Gastroenterology, Hepatology And Nutrition, University of Health Sciences Izmir Dr. Behçet Uz Children's Hospital, Izmir, Turkey, 3Pediatric Infectous Diseases, University of Health Science Izmir Dr. Behcet Uz Children Hospital, Izmir, Turkey, 4Department Of Pediatrics, Division Of Pediatric Gastroenterology, Hepatology And Nutrition, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
Objectives and Study: Inflammatory bowel diseases (IBD) are a group of chronic, exacerbated autoimmune diseases that are increasingly prevalent in childhood. Disease activations may be caused by the nature of the disease itself or may be triggered by infectious causes due to diseased mucosa and impaired microbiota. The objective of our study is to evaluate the infectious causes that trigger disease activation.
Methods: A study of 20 patients with IBD hospitalized for severe colitis was conducted between 2022 and 2023 at Dr. Behçet Uz Children's Hospital. The following data were recorded at admission: age, gender, endoscopy findings, CRP, sedimentation, complete blood count, microscopic stool examination, stool culture, PUCAI or PCDAI parameters. The presence of E. coli, Clostridium difficile, Campylobacter jejuni, Salmonella, Vibrio cholerae, Entamoeba histolytica, Giardia lamblia, Adenovirus F40/41, Astrovirus, Norovirus and Rotavirus was determined by stool PCR.
Results: The study included 20 patients: 11 men and 9 women. 15 patients had ulcerative colitis; 5 had Crohn's disease. PCR tests showed pathogenic microorganisms in nine patients, but not in the remaining 11. Two patients had C. difficile, six had E. coli, and one had both Norovirus and Rotavirus. Stool cultures were obtained from all patients, and no positive culture was observed in any of them. There was no significant difference between the laboratory findings, PUCAI and PDCAI scores of patients with positive stool cultures and those with negative stool cultures.
Conclusions: IBD patients are prone to infections due to gut dysbiosis and weak mucosal defenses. This study identified Escherichia coli as the most common bacterial strain, and found no Entamoeba histolytica infections. These results do not prove a cause‐and‐effect relationship between enteric infections and symptom flare‐ups. PCR tests cannot distinguish between active infections and colonization. Larger pediatric studies are needed to confirm these findings.
Contact e‐mail address: safakpelek@hotmail.com
G‐EV225. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV225.1. THE QUALITY OF LIFE AND LEVEL OF SATISFACTION WITH TREATMENT EFFECTS OF PEDIATRIC PATIENTS SUFFERING FROM INFLAMMATORY BOWEL DISEASES AND THEIR PARENTS
Agata Pieńkowska 1, Agnieszka Szlagatys‐Sidorkiewicz2, Zuzanna Barańska1, Małgorzata Lipińska1, Michał Brzeziński1
1Department Of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University Of Gdańsk, Medical University of Gdańsk, Gdańsk, Poland, 2Paediatrics, Paediatric Gastroenterology, Allergology And Nutrition, Medical University of Gdansk, Gdansk, Poland
Objectives and Study: Inflammatory bowel disease (IBD) are diagnosed with increasing frequency in children. Young patients often experience a severe and drug‐resistant course of the disease, which reduces their quality of life, interferes with their psycho‐social development and extremly involves their parents in their care. As part of a polish nationwide pilot project, a survey was conducted among children and parents at the Kopernik Hospital in Gdańsk.
Methods: Standardised and translated quality of life questionnaires for patients and their carers were used in the study: the IMPACT ‐ III, IBD Control, EQ‐5D‐Y, Stanford Presenteeism Scale (SPS‐6) and Zarid Burden Interview. We analysed the results of 142 questionnaires (89 patients + 53 dyad of parents and children).
Results: Young patients with ulcerative colitis (UC), on the scale from EQ‐5D‐Y questionnaire, rated their health status on average at 69.8% (SD 25.7) and those with Crohn's disease at 78.7% (SD 14.5). Parents rated their children's health status at 59.5% (SD 22.1) for UC and 66.3% (SD 15.4) for Crohn's disease. There is a statistically significant correlation (p < 0.05) between the frequency of abdominal pain, difficulties in daily activities and patient's fear of exacerbation. 37% of IBD patients are disturbed by daily medication use. Morover, 57% of IBD patients indicated they didn't need to modify their treatment in the last 2 weeks. 29.7% of parents reported that their health had suffered due to necessity to care for a sick child.
Conclusions: The results show that the perspective of the disease between the patient and their carer differs. Inflammatory bowel disease not only significantly reduces the quality of life of patients, but also of their families. Moreover a significant proportion of patients, despite treatment, do not perceive that their disease is satisfactorily controlled. The study is currently being conducted in 13 paediatric gastroenterology departments in Poland.
Contact e‐mail address: apienk@gumed.edu.pl
G‐EV226. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV226.1. MESALAMINE‐ ASSOCIATED PERICARDITIS: UNCOVERING A RARE ADVERSE REACTION
Dr. R. Bhanu Vikraman Pillai 1, Seetha Lakshmy Kd2, Anju S Nair2, Anila Kn3, Sudhindran Surendran3, Uday Kumar R2, Saraswathy S Nair3
1Department Of Paediatric Gastroenterology, Amrita Institute of Medical Sciences & Research center, Kochi, India, 2Department Of Pharmacy Practice,amrita School Of Pharmacy, Amrita Institute of Medical Sciences & Research center, Kochi, India, 3Department Of Solid Organ Transplantation, Amrita Institute of Medical Sciences & Research Centre, Kochi, India
Objectives and Study: A 12‐year‐old male was referred to hospital diagnosed with Ulcerative colitis on colonoscopy, when he presented with blood in stools and started on tablet mesalamine 2 weeks earlier. Now presented with breathing difficulty, lethargy & high grade fever with 1‐day duration. He was tired, pale, tachycardic and had pericardial rub on examination. Laboratory investigations showed raised inflammatory markers: increased ESR 98 mm/hr (reference range 8‐20 mm/hr) & increased CRP levels 99.09 mg/dl (reference range 0‐5 mg/dl). Cardiac markers slightly elevated HsTropT was 0.087(reference range 0.0127 ‐ 0.025 ng/ml) & CK MB 0.492 (reference range 0.0 ‐ 4.94 ng/ml). Haematological investigations showed haemoglobin 4.8 (reference range 13.0 ‐ 17.0 g/dl) & RBC count 2.70 (reference range 4.5 ‐ 5.5 M/uL) Ultrasound abdomen shows splenomegaly & bilateral minimal pleural effusion. Clinical features showed severe anaemia with ulcerative colitis & pericardial effusion. ECHO shows moderate pericardial effusion with good LV function. He had further extensive work up to find out aetiology of this presentation, and ruled out malignancy, autoimmune disease, viral or bacterial infection. Because of the possible aetiology of pericarditis from mesalamine, it was discontinued and Inj methyl prednisolone started. He was treated with IV fluids, 2 units of PRBC transfusions, 20% albumin was also given to treat shock. Started to improve by day 3 and by day 9, he had clear improvement and ECHO was normal. The boy was discharged, corticosteroid therapy was weaned, and azathioprine therapy was started, and the patient remained asymptomatic at the subsequent outpatient routine checks.
Methods: Retrospective case analysis
Results: Identifed a rare adverse effect of mesalamine
Conclusions: This case highlights the importance of including pericarditis as a differential for IBD patients on mesalamine, especially within the first month of initiating medication as drug cessation usually leads to immediate clinical improvement.
Contact e‐mail address: kvseethalakshmy@gmail.com
G‐EV227. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV227.1. CLOSTRIDIOIDES DIFFICILE INFECTION IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE ‐ A 10 YEARS STUDY
Daniela Pop 1, Radu Pop1, Georgiana Dragomir2, Camelia Molnar2, Sabina Trifa2, Bogdan Andrei2, Christiana Mândrilă2, Dorin Farcău3
13rd Pediatric Discipline, ”Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj‐Napoca, Romania, 2Emergency Hospital for Children, Cluj‐Napoca, Romania, 3Nursing Discipline, ”Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj‐Napoca, Romania
Objectives and Study: Children with inflammatory bowel diseases (IBD) have a high risk of associating Clostridioides difficile infection. This study aimed to evaluate the number of episodes of infection with Clostridioides difficile in children diagnosed with IBD and the risk factors associated with these episodes.
Methods: Material and method. All patients diagnosed with IBD between 2015 and 2024 were included in the study. Clinical picture, investigation results, diagnosis at onset, number of episodes of infection with Clostridioides difficile, and treatment were retrospectively evaluated.
Results: In our medical unit, in the past 10 years, 31 patients were diagnosed with IBD (mean age 10.9 ± 4.8 years), 12 children with Crohn's disease, 15 with ulcerative colitis, and 2 with indeterminate colitis. Eight/31 (25.8%) patients with IBD had at least one episode of infection with Clostridioides difficile. Six patients with Crohn's disease (50%) had at least one episode of infection with Clostridioides difficile, and two of them were diagnosed with early‐onset disease. These two patients had 7 and 11 episodes of infection with Clostridioides difficile, respectively. Five children with Crohn's disease had antibiotic therapy before the infections, 4 had corticosteroid treatment, four patients had immunosuppressive treatment, and 3 had biological treatment. Two/15 (13.3%) children with ulcerative colitis had an infection with Clostridioides difficile, each with only one episode.
Conclusions: A quarter of the patients diagnosed with IBD in the past 10 years associated at least one episode of infection with Clostridioides difficile. Patients with early onset IBD had the highest number of episodes of infection with Clostridioides difficile.
Contact e‐mail address: pop.daniela@umfcluj.ro
G‐EV228. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV228.1. SINGLE CENTER PROSPECTIVE OBSERVATIONAL STUDY: BODY COMPOSITION AND CLINICAL OUTCOMES IN PEDIATRIC‐ONSET CROHN'S DISEASE TREATED WITH CDED AND BIOLOGICS
Sara Isoldi1, Flavia Ricevuti2, Francesco Russo2, Massimo Verdicchio3, Maria Giovanna Puoti 1, Maria Grazia Carbone2, Cristina Bucci1, Michele Dinardo2, Paolo Quitadamo1, Rossella Turco1, Elisabetta Cesarano2, Alfredo De Michele2, Giovanni Messere2, Salvatore Morra2, Armando Scognamiglio2, Mariano Caldore1, Nicola Cecchi2
1Pediatric Gastroenterology and Hepatology Unit, Santobono‐Pausilipon Children's Hospital, Naples, Italy, Naples, Italy, 2Clinical Nutrition Unit, Santobono‐Pausilipon Children's Hospital, Naples, Italy, 3Pediatric Department, University of Salerno, Salerno, Italy
Objectives and Study: This study examines the impact of the Crohn's Disease Exclusion Diet (CDED) in combination with biologics on body composition and clinical outcomes in pediatric‐onset Crohn's disease (CD). Conducted as a single‐center prospective observational study, the research focused on assessing changes in body composition, and disease activity over a 12‐month period. Preliminary findings indicate that the integration of CDED with biologics significantly improves nutritional status and achieves high rates of disease remission.
Methods: This prospective observational study was conducted at a specialized Pediatric Gastroenterology and Hepatology division.
All patients were treated with biologic therapy administered in accordance with standard dosing protocols for Crohn's disease management. This was combined with CDED, a structured dietary protocol implemented in phases to reduce gut inflammation by excluding pro‐inflammatory foods while providing balanced nutrition. Primary outcomes: Change in Pediatric Crohn's Disease Activity Index (PCDAI) and serum C‐reactive protein (CRP) levels. Secondary outcomes: Growth parameters, body composition and fecal calprotectin levels
Results: Fifthteen pediatric patients (mean age: 12; 67,7% male) were included. Impaired growth (Paris Classification G1) is reported in 60% of the patients (9 out of 15) Primary Outcomes: ‐ PCDAI scores decreased significantly from 35,87 ± 10,15 at baseline to 7,08 at 6 (p < 0.01). ‐ CRP levels dropped from a mean of 60,8 ± 78,9 mg/L to 5.9 ± 5.6 mg/L (p < 0.01). Secondary Outcomes: ‐ Growth parameters improved ‐ FC levels showed a reduction from 720 ± 733 µg/g to 122 ± 112 µg/g (p < 0.05)
Conclusions: This study highlights the potential of combining dietary interventions with biologics as a comprehensive therapeutic approach for pediatric CD. However, limited evidence exists regarding the effects of CDED on body composition and its interaction with biologics in pediatric populations. This research aims to fill this gap by evaluating the clinical and nutritional impacts of these interventions.
Contact e‐mail address: fricevuti@gmail.com
G‐EV229. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV229.1. MILK MATTERS: DAIRY CONSUMPTION TRENDS IN EARLY CHILDHOOD NUTRITION IN ALGERIA
Nada Boutrid1,2, Hakim Rahmoune 2,3, Oussama Kadded2
1EHS El Eulma, Setif, Algeria, 2Medicine, University of Setif 1, Setif, Algeria, 3University Hospital of Setif, Setif, Algeria
Objectives and Study: The Middle East and North Africa (MENA) region is witnessing shifts in dietary habits among children, influenced by socio‐economic factors and cultural dynamics. These changes raise concerns about nutrition and health outcomes in this vulnerable population. Understanding actual dietary patterns is crucial for developing effective public health strategies to enhance nutrition and prevent childhood obesity. This study investigates dairy consumption as a key component of children's diets in El Eulma, Setif, Algeria, aiming to inform dietary recommendations and public health initiatives.
Methods: The study targeted children under 6 years of age in El Eulma (Setif, Algeria) and employed a semi‐quantitative survey method. Data was gathered through a combination of in‐person interviews and online surveys. Collected data was imported for analysed by R programming language.
Results: ‐ The average child under 6 years of age lives in a family of three, with a middle‐income status and both parents holding bachelor's degrees. ‐ Children from middle‐income families consume four more portions of dairy weekly compared to those from high and low‐income families; however, this difference is not statistically significant. ‐ Parents' education level, family size, preference for fermented milk, and breastfeeding decisions are significantly correlated (p < 0.05) with the choice between processed and artisanal dairy products. ‐ Consumption of fermented milk among children under 6 years is significantly associated (p < 0.05) with mother's professional status, age at which diet diversification begins, total dairy product consumption, regular milk consumption, and whether parents select dairy products based on nutritional value.
Conclusions: The insights from this study underscore the necessity for targeted nutritional interventions and educational programs to promote healthy dietary choices among young children in the MENA region. Addressing factors such as parental education and socio‐economic status through public health initiatives can improve nutrition and health outcomes for this vulnerable population.
Contact e‐mail address: rahmounehakim@gmail.com
G‐EV230. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV230.1. USTEKINUMAB AS RESCUE THERAPY IN INFLAMMATORY COLITIS WITH X‐LINKED LYMPHOPROLIFERATIVE SYNDROME
Aathira Ravindranath 1, Rajkumar Wadhwa2
1Pediatric Gastroenterology, Apollo BGS Hospital, Mysore, India, 2Gastroenterology, Apollo BGS Hospital, Mysore, India
Objectives and Study: To assess the efficacy of Ustekinumab in achieving remission in inflammatory colitis with underlying inborn errors of immunity (IEI).
Methods: Children with inborn errors of immunity have to deal with dual problems of immune deficiency and autoimmunity. Among the autoimmune manifestations inflammatory colitis has a significant impact on quality of life. Control of the gut inflammation also plays an important role in reducing the risk of graft versus host disease after hematopoietic stem cell transplant in IEI. A 10 year old boy was diagnosed with X‐linked lymphoproliferative syndrome [hemizygous ‐ chrX:123040931 G > A(GRCh37); c.1394 G>A (HEMI); (p.Cys465Tyr)] at the age of 8 years. He had developed disseminated tuberculosis which was treated with anti‐tubercular therapy at 7 years of age. For the past 1 year he developed bloody diarrhoea which on evaluation was suggestive of Crohn's‐like colitis. Oral steroids induced clinical remission however, on tapering he relapsed despite being on optimum dose of azathioprine. Since he had history of disseminated tuberculosis Infliximab could have flared up tuberculosis and predispose to other infections. Hence, Ustekinumab was considered as the next option to induce steroid‐free remission.
Results: Before initiating Ustekinumab, Pedaitric Crohn's disease activity index was 72.5, simple endoscopic score for crohn's disease (SES‐CD) was 40. He was administered induction dose of 3 mg/kg intravenous followed by 2 mg/kg maintenance subcutaneously 8 weeks later. Steroids could be tapered and stopped. At the end of 16 weeks, he was reassessed. PCDAI reduced to 20 and SES‐CD decreased to 22. Since the gut inflammation reduced significantly, he underwent HSCT successfully after which PCDAI reduced to 5.
Conclusions: Ustekinumab is a safer option in children with IEI and Crohn's‐like colitis as it is a more selective immunosuppressant compared to infliximab and will reduce chances of severe infections.
Contact e‐mail address: aathira.r@gmail.com
G‐EV231. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV231.1. TOFACITINIB BEYOND ACUTE SEVERE COLITIS IN CHILDREN ‐ ROLE IN STEROID DEPENDENT ULCERATIVE COLITIS
Aathira Ravindranath 1, Rajkumar Wadhwa2
1Pediatric Gastroenterology, Apollo BGS Hospital, Mysore, India, 2Gastroenterology, Apollo BGS Hospital, Mysore, India
Objectives and Study: Evidence for the role of tofacitinib in pediatric acute severe colitis is expanding. There is limited information about the effect of tofacitinib in steroid dependent ulcerative colitis (UC) which this study aims to explore.
Methods: All patients who were diagnosed with ulcerative colitis were treated with the standard methods of induction and maintenance as per the ECCO‐ESPGHAN guidelines. Patients who achieved remission with steroids but relapsed on tapering steroids were included. Azathioprine was added to 5‐amino salicylic acid (5‐ASA) for maintenance but again relapsed on tapering steroids. None of these patients could afford biologicals. Hence, tofacitinib was initiated. Immediate and long‐term response were assessed.
Results: Five patients (3 boys, 2 girls) aged 10.4 years (5 – 14) were included. Three had E4 and 2 had E2 ulcerative colitis, PUCAI was between 40‐60. Induction was initiated with oral prednisolone after which all 5 responded with a reduction in PUCAI < 10, 5‐amino salicylic acid was used for maintenance. However, on tapering prednisolone to 5 mg, PUCAI increased between 40‐55. After adding azathioprine for 8 weeks steroid tapering was re‐attempted but again caused a relapse. Hence, tofacitinib was initiated at a dose of 5 mg twice a day in 1 patient (age:5 years) and 10 mg twice a day in 4. PUCAI reduced to <10 by day 12 (10‐16) and steroids could be tapered and stopped. One patient developed nausea and vomiting in the first week of tofacitinib that settled with anti‐emetics. There were no other adverse events. Over a period of 16.8 months (12‐20) all 5 patients remained in remission.
Conclusions: Role of tofacitinib in acute severe colitis in children is increasing. However, effect of tofacitinib in steroid dependent UC is unexplored and this study helps to expand the role of tofacitinib beyond acute severe colitis.
Contact e‐mail address: aathira.r@gmail.com
G‐EV232. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV232.1. SEVERE HEMOPHILIA AND CROHN'S DISEASE IN A TEN‐YEAR‐OLD BOY: A DANGEROUS COMBO
Mariana Reis 1,2, Luís Rodrigues1, Ana Fernandes1, Sara Azevedo1, Helena Loreto1, Paula Mourato1, Ana Isabel Lopes1,3
1Pediatric Gastroenterology Unit, Department of Pediatrics, Hospital Santa Maria, Unidade Local de Saúde Santa Maria, Lisboa, Portugal, 2Pediatrics Department, ULS Algarve, Faro, Portugal, 3Pediatric University Clinic, Medical School, University of Lisbon, Portugal, Lisboa, Portugal
Objectives and Study: The association of hemophilia A (HA) and inflammatory bowel disease (IBD) is extremely rare, posing important diagnostic and therapeutic challenges. We describe an illustrative case of IBD diagnosed in a pediatric patient with severe HA.
Methods: A 10‐year‐old boy with a prenatal diagnosis of severe HA (FVIII < 1%) with the development of inhibitors against factor VIII early after recombinant FVIII therapy, and currently under treatment with emicizumab, presented in the emergency department (ER), with acute abdominal pain, vomiting, and diarrhea with bright red blood that evolved to severe hematochezia. On admission, he appeared pale, with abdominal tenderness, and laboratory tests showed acute anemia (hemoglobin 6.9 g/dL). Meckel's diverticulum was excluded, and abdominal ultrasound revealed terminal ileal thickening. Initial GI bleeding was temporarily controlled with rFVIIa and tranexamic acid. The child was again admitted in the ER, nine days later with abundant melena and hypovolemic shock. Workup showed elevated fecal calprotectin (5147 µg/g) with no other significant abnormalities. Ileocolonoscopy suggested Crohn's disease (terminal ileitis). Total enteral nutrition was initiated while awaiting histology, which later revealed nonspecific inflammation, but bleeding persisted. No response was obtained with intravenous steroid treatment prompting the initiation of Infliximab therapy (10 mg/kg), with control of the intestinal bleeding. The patient was discharged after 24 days on infliximab maintenance therapy. At an 8‐month follow‐up, he remains stable with close outpatient monitoring, maintaining therapy with infliximab and emicizumab.
Results: This case highlights the challenges of diagnosing and managing IBD in a pediatric patient with a severe hemorrhagic disorder. It emphasizes the risk of life‐threatening bleeding and the need for early diagnosis and effective treatment.
Conclusions: There are no targeted therapeutic options effective in both conditions therefore it is of utmost importance to maintain good disease control and to achieve deep healing, as an IBD flare may be severe and potentially life‐threatening.
Contact e‐mail address:
G‐EV233. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV233.1. RARE BUT CRUCIAL: EARLY RECOGNITION AND MULTIDISCIPLINARY MANAGEMENT OF VENOUS THROMBOEMBOLISM IN PEDIATRIC INFLAMMATORY BOWEL DISEASE
Alessandra Maria Ricci 1, Francesca Rea2, Chiara Imondi2, Erminia Romeo2, Simona Faraci2, Giulia Angelino2, Daniela Knafelz2, Fiammetta Bracci2, Sabrina Cardile2, Tamara Caldaro3, Matteo Luciani4, Paola De Angelis2
1Gastroenterology and Nutrion Unit, Bambino Gesù Children's Hospital, Rome, Italy, 2Gastroenterology And Nutrition Unit, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy, 3Digestive Endoscopy And Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy, 4Pediatric Hematology Bambino Gesù Children's Hospital, Rome, Italy
Objectives and Study: Venous thromboembolism (VTE) is a rare but serious complication of inflammatory bowel diseases (IBDs), particularly during the active phase of the disease. Although the absolute risk in the pediatric population is lower compared to adults, it should not be underestimated. The clinical presentation can be insidious, often involving unusual venous sites, and early recognition is crucial for effective management. We present two pediatric cases of severe acute colitis with thrombotic complications to highlight the importance of rapid and accurate diagnosis and treatment.
Methods: A 7‐year‐old Caucasian girl with a diagnosis of VEO‐IBD, RCU‐like phenotype, undergoing treatment with anti‐TNF alpha and azathioprine, was hospitalized for severe acute colitis. During hospitalization, she developed left periorbital headache and dizziness; CT scan revealed transverse sinus thrombosis. She was initially treated with enoxaparin and later switched to rivaroxaban. A 14‐year‐old Caucasian girl with ulcerative colitis, receiving anti‐TNF alpha therapy, developed pain and paresthesia in the left lower limb during hospitalization for disease relapse. An ultrasound Doppler study revealed deep venous thrombosis (DVT) of the iliac‐femoral axis, and treatment was initiated with enoxaparin, followed by aspirin.
Results: Both patients showed significant clinical improvement following optimization of biological therapy, with resolution of gastrointestinal symptoms. Coagulation testing revealed elevated levels of factor VIII and MTHFR mutations (heterozygous in the first case and homozygous in the second). Anticoagulant therapy resulted in a reduction in thrombotic defect extension, as demonstrated by brain MRI and venous Doppler ultrasound.
Conclusions: These cases emphasize the need for prompt, multidisciplinary management of life‐threatening IBD complications. Early diagnosis is crucial, and new neurological symptoms should be taken seriously. These cases emphasizes the potential synergy between anti TNF alfa therapy and heparin in managing VTE in pediatric IBD patients, offering an innovative approach to optimize both inflammatory control and thrombotic complications.
Contact e‐mail address: alemaria.ricci@gmail.com
G‐EV234. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV234.1. CONVERSION OF THE DIAGNOSIS OF ULCERATIVE COLITIS TO CROHN'S DISEASE IN CHILDREN
Agata Rocka, Magda Łazinek, Elżbieta Pac‐Kożuchowska, Paulina Krawiec
Department Of Paediatrics And Gastroenterology, Medical University of Lublin, Lublin, Poland
Objectives and Study: The two most commonly diagnosed inflammatory bowel diseases (IBD) in children are ulcerative colitis(UC) and Crohn's disease(CD). In UC, the inflammatory process is limited to the mucosa, involving the large intestine. In Crohn's disease, inflammatory lesions may involve the entire thickness of the gastrointestinal wall, localizing throughout the gastrointestinal tract. There is limited work in literature that address the conversion rate of IBD diagnosis.The aim of the study was to evaluate the frequency of conversion of an ulcerative colitis to Crohn's disease in children.
Methods: We performed a retrospective review of medical records of patients with ulcerative colitis hospitalized in the Department of Pediatrics and Gastroenterology from 2009 to 2022. The following data were included in the analysis: age at diagnosis, gender, course of the disease, severity of the disease, and number of exacerbations.
Results: In the studied period 221 patients were initially diagnosed with ulcerative colitis. The study group included 119 (53.85%) boys and 102 (46.15%) girls. At the time of diagnosis, the mean age of the children was 12.33 ± 4.10 years. The mean Pediatric Ulcerative Colitis Activity Index (PUCAI) at the time of diagnosis was 41.97 ± 19.38 points. In 14 (6.33%) patients, the diagnosis of UC was converted to Crohn's disease at an average of 15 ± 33.32 months after the initial diagnosis. The mean age of UC recognition in this subgroup was 10.95 ± 4.90 years.
Conclusions: The recognition of IBD subtype may not be ultimate in childhood. Conversion of the diagnosis should be considered, particularly in cases of therapeutic failures. There is a need to identify predictive factors of diagnosis conversion.
Contact e‐mail address:
G‐EV235. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV235.1. CHALLENGING MANAGEMENT OF VEO‐IBD PATIENTS IN SEVERE DYSKERATOSIS CONGENITA
Pejman Rohani 1, Mahya Haghipanah2, Mehdi Totonchi2, Maryam Sotoudeh Anvari3, Nima Parvaneh3, Mohammad Shahrooei4
1Pediatrics, Pediatric Gastroenterology and Hepatology Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran, Teheran, Iran, 2Molecular Genetics, Tarbiat Modares University, Tehran, Iran, 3Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran, Teheran, Iran, 4Molecular Genetics, Dr.Shahrooei Lab, Tehran, Iran
Objectives and Study: Epithelial cell defects have been identified as a cause of monogenic IBD, like IKBKG deficiency, kindler syndrome and dyskeratosis congenita. In patients with dyskeratosis congenita and inflammatory bowel disease, treatment of inflammatory bowel disease with immunosuppressive drugs is challenging due to the presence of bone marrow failure (BMF) and increased susceptibility to opportunistic infections. Bone marrow transplantation may be ineffective. This study aims to investigate two cases of dyskeratosis congenita and IBD patients with distinct clinical presentations: enterocolitis and chronic colitis.
Methods: In this study, we included two patients with dyskeratosis congenita and colitis. Clinical data were collected, and whole exome sequencing was performed.
Results: Patient P1 indicated X‐linked dyskeratosis congenita and infantile enterocolitis. Genetic analysis revealed a hemizygous mutation in the DKC1 (NM_001363, c.C1058T, p.Ala353Val) gene. This patient underwent esophageal balloon dilatations due to esophageal stenosis. Patient P2 presented with AR dyskeratosis congenita and chronic colitis. Genetic studies identified a homozygote mutation in the RTEL1 (NM‐001283009.2:c.2869 C>T:p.Arg957Trp) gene. Clinical and histopathological signs are indicated in Table 1. These patients were initially treated with corticosteroids and azathioprine, but their treatment was stopped due to CMV infection. Following the use of infliximab, patient P1 did not respond to the drug and unfortunately died due to BMF and septicemia, and patient P2 had thrombocytopenia. Following the administration of three vedolizumab doses to patient P2, the medication level rose to 8 mcg/mL, and no antibody was generated. Ultimately, this patient also died due to BMF and septicemia.
Conclusions: The study of these two patients showed that in patients with dyskeratosis congenita and inflammatory bowel disease, treatment of inflammatory bowel disease with immunosuppressive drugs is challenging due to the presence of BMF and increased susceptibility to opportunistic infections. In these patients, the use of biological drugs in the treatment of inflammatory bowel disease was also not beneficial.
Contact e‐mail address: rohanipejmanmd@gmail.com
G‐EV236. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV236.1. EXPERIENCE WITH UPADACITINIB IN CHILDREN WITH CROHN'S DISEASE
Elena Roslavtseva 1, Anna Vinokurova2, Alexander Potapov2, Olga Usolceva2
1Healthy And Sick Child Nutrition Laboratory, National Medical Research Center for Children's Health, Moscow, Russian Federation, 2Gastroenterology, National Medical Research Center for Children's Health, Moscow, Russian Federation
Objectives and Study: Upadacitinib (UPA) is a new selective Janus kinase inhibitor approved for the treatment of IBD in adults but in children still remains off‐label. The aim of our study was to evaluate the efficacy of UPA in pediatric Crohn's disease (CD).
Methods: The study included 12 patients with CD aged 2‐18 years with ineffectiveness of anti‐TNF and vedolizumab therapy. The induction course of UPA was 12 weeks: 7 patients received 45 mg, 4 ‐ 30 mg due to severe weight deficit and 2 years old boy received 15 mg. Endoscopic and clinical activity was assessed using the SES‐CD, PCDAI scale. The results of general and biochemical blood tests, fecal calprotectin were analyzed. Differences were considered statistically significant at p < 0.05.
Results: Before therapy, high clinical activity was observed in 2 children (16.7%), moderate in 10 (83.3%). Leukocytosis observed in 2 (16.6%), thrombocytosis in 8 (66.6%), anemia in 5 (41.7%), increased CRP in 5 (41.7%), ESR in 6 (50%) and fecal calprotectin in 7 (58.3%) patients. Moderate endoscopic activity was observed in 5 (83%) and remission in 1 (17%) children. Assessment SES‐CD in the remaining 6 children was impossible due to previous surgery. After 3 months of therapy clinical remission was achieved in 25% patients, while the rest showed decrease in activity. A decrease in leukocytes (p = 0.003) and platelets (p = 0.022) was observed in all patients, ESR decreased in 83% (p = 0.052), CRP ‐ in 72% (p = 0.035) of observations. The level of fecal calprotectin normalized in 9 (50%) patients. In 4 out of 5 patients (p = 0.03), endoscopic activity changed from moderate to minimal.
Conclusions: The use of UPA allowed achieving clinical and laboratory remission of the disease and reducing endoscopic activity in children with CD with ineffectiveness of previous biologic therapy. Results obtained indicate UPA effectiveness in children and require further study.
Contact e‐mail address: roslikea@gmail.com
G‐EV237. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV237.1. DEVELOPMENT OF THE NONINVASIVE INDEX OF INFLAMMATION OF THE MUCOUS IN ULCERATIVE COLITIS IN CHILDREN (MINIUC)
Elena Roslavtseva 1, Anna Vinokurova2, Alexander Potapov2, Olga Usolceva2
1Healthy And Sick Child Nutrition Laboratory, National Medical Research Center for Children's Health, Moscow, Russian Federation, 2Gastroenterology, National Medical Research Center for Children's Health, Moscow, Russian Federation
Objectives and Study: To develop an index of noninvasive diagnosis of mucosal inflammation in ulcerative colitis (UC) in children based on clinical and laboratory parameters.
Methods: : 200 children aged 7 to 18 years with the UC were examined 2021 to 2023 period. The endoscopic activity of UC was assessed using the UCEIS index. Clinical criteria of the patients; results of blood tests and fecal calprotectin (FC) were analyzed. Using Spearman's rank correlation coefficient, laboratory parameters with significant (p < 0.05) closeness of association according to the Cheddock scale were selected, as well as clinical criteria with significant differences (p < 0.001), calculated using the Kraskell‐Wallis criterion.
Results: Among the laboratory parameters, platelets (Rs 0.899, p < 0.001), FC (Rs 0.749, p < 0.001), and among the clinical criteria rectal bleeding and stool consistency (p < 0.001) had significant changes. ROC analysis identified threshold values of platelets and FC for the corresponding level of endoscopic UC activity. With an increase of the endoscopic activity by UCEIS, there was a significant (p < 0.001) increase in blood amount in stools and changes of stools consistency. The results of the performed calculations and MINIuc score scale in children are presented in Table.
| Variable | Points | |
|---|---|---|
| Platelets, 109/L | <353 | 0 |
| 354‐507 | 1 | |
| >508 | 2 | |
| Fecal calprotectin, µg/g | <401 | 0 |
| 402‐1109 | 1 | |
| >1110 | 2 | |
| Rectal bleeding | none | 0 |
| <50% | 1 | |
| >50% | 2 | |
| Stool consistency | formed | 0 |
| partially formed | 1 | |
| completely unformed | 2 |
Degrees of mucosal inflammation activity according to the MINIuc index: 0‐2 points – remission\mild activity, 3‐5 – moderate activity, 6‐8 – high activity. The minimum score is 0, the maximum is 8. The presented scoring system has a sensitivity of 76.3% and a specificity of 73.8%.
Conclusions: The proposed index allows for a non‐invasive assessment of the mucosal condition and to determine indications for endoscopic examination in children with UC with inconsistent clinical and laboratory signs of activity.
Contact e‐mail address: roslikea@gmail.com
G‐EV238. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV238.1. CLINICAL AND GENETIC SPECTRUM OF VERY EARLY ONSET INFLAMMATORY BOWEL DISEASE ‐ A SINGLE CENTRE INDIAN EXPERIENCE
Megha Rustagi, Karunesh Kumar, Smita Malhotra, Yaja Jebaying
Pediatric Gastroenterology, Indraprastha Apollo Hospital, Delhi, India
Objectives and Study: Children presenting with very early onset inflammatory bowel disease (VEOIBD) may have a monogenic basis, predominantly disorders of immunodeficiency or immune dysregulation. Next generation sequencing (NGS) is helpful in finding out monogenic diseases. To describe the clinical presentation, IBD phenotypes, response to treatment, and underlying monogenic mutations in patients with VEOIBD in a single Indian centre.
Methods: It is a retrospective descriptive study. Data was collected from outpatient and inpatient records. Demographic information, clinical presentation, biochemical parameters, and histopathology findings were collected. The phenotype– ulcerative colitis(UC), crohn's disease(CD) and IBD‐unclassified(IBD‐U) were noted. Treatment given and response, need for specific therapy including hematopoietic stem cell transplantation(HSCT) were noted. The data was recorded in a pre‐designed proforma in Microsoft Excel and analysed.
Results: We report 19 children under 6 years of age with VEOIBD naive to treatment (one third of our total IBD cohort) (Fig 1). Mean age of presentation was around 2 years. All had diarrhea at presentation along with bloody diarrhea(37%), vomiting(42%), recurrent fever(37%), growth failure(74%) and anemia(84%). Thirteen were diagnosed as monogenic IBD (Table 1). Four (2 were monogenic) needed biologics. Three underwent HSCT, are alive and healthy. Three succumbed during medical treatment, two had disorder of immune dysregulation indicating poor prognosis. Third one had non‐monogenic IBD. FIGURE 1
TABLE1‐ Subtypes of Monogenic IBD and identified genetic mutations
| MONOGENIC DEFECTS | TOTAL 13 |
|---|---|
| Phagocytic defects | 4 (CYPBA, CYPBB, SLC37A4) |
| Disorders of immunedysregulation | 3 (FOXP3, CTLA4) |
| Hyperinflammatory and Autoinflammatory disorders | 3 (NLRC4, PLCG2) |
| Epithelial barrier dysfunction | 2 (TGFB1, TTC7A) |
| T‐cell and B‐cell dysfunction | 1 (RAG1) |
Conclusions: One third of new onset IBD can be labelled as VEOIBD. Timely Whole exome sequencing(WES) is a valuable tool in prognostication and management of VEOIBD as many monogenic IBD may have an aggressive clinical course warranting specific therapy including HSCT. IBD‐U is identified more than CD followed by UC.
Contact e‐mail address: drmeghagastro@gmail.com
G‐EV239. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV239.1. PEDIATRIC CROHN'S DISEASE INVOLVING ESOPHAGOGASTRODUODENUM: IS THERE ANY PHENOTYPICAL DIFFERENCE?
Bilge Sahin Akkelle, Engin Tutar, Deniz Ertem
Pediatric Gastroenterology, Hepatoloy And Nutrition, Marmara University School of Medicine, Istanbul, Turkey
Objectives and Study: Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) that can affect every segment of the gastrointestinal tract (GIT). Esophagogastroduodenal involvement (EI) is reported in 30‐60% of pediatric patients with CD. The aim of this study was to evaluate the phenotypic characteristics of pediatric CD (PCD) with EI.
Methods: Pediatric patients with CD, who were followed in our pediatric IBD center were retrospectively reviewed for diagnostic and follow‐up features. Monogenic IBD cases were excluded. Patients were classified according to the Paris classification; disease activity was assessed by using the Pediatric Crohn's Disease Activity Index (PCDAI). Characteristics of patients with and without EI were compared.
Results: In this cohort of 78 PCD patients, EI was present in 34 patients at diagnosis (43.6%). The mean age at diagnosis and gender distribution were comparable between patients with or without EI. The most commonly affected segment was the duodenal bulb (70.5%), and there was inflammation in more than one part of the upper GIT. In this PCD cohort, EI was most commonly associated with ileocolonic involvement (47%), isolated EI was found in 2 (2.6%) patients. There was no significant difference in extraintestinal manifestations between cases with and without EI (p = 0.09). Patients with EI had a higher frequency of moderate‐severe CD at diagnosis (p = 0.02). There was no significant difference in the frequency of surgical interventions between cases with and without EI (p = 0.56); however, the use of biological agents was significantly higher in cases with EI (81.2% versus 55.8%; p = 0.02).
Conclusions: In this study, EI in PCD was most commonly observed in the duodenal bulb. It was demonstrated that CD patients with EI had more severe disease, more extensive gastrointestinal involvement at onset, and required biological agents at a higher rate during follow‐up. These findings suggest that EI may be a poor prognostic indicator in PCD.
Contact e‐mail address:
G‐EV240. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV240.1. UNVEILING GENETIC CAUSES IN A TURKISH COHORT WITH PEDIATRIC INFLAMMATORY BOWEL DISEASE
Elif Saraç 1, Sinem Kocagil1, Yusuf Aydemir2, Zeren Barış2
1Medical Genetics, Eskişehir Osmangazi University, Faculty of Medicine, Department of Medical Genetics, Eskişehir, Turkey, Eskişehir, Turkey, 2Pediatric Gastroenterology, Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Gastroenterology, Eskişehir, Turkey, Eskişehir, Turkey
Objectives and Study: Monogenic defects, often involving genes associated with primary immunodeficiencies, autoinflammatory diseases, and epithelial barrier defects, are increasingly recognized mostly in patients with very early‐onset inflammatory bowel disease (VEO‐IBD) and aggressive phenotypes. Our study aimed to identify monogenic IBD causes in pediatric patients followed in our center.
Methods: Inclusion criteria was early‐onset IBD ( < 10 years) or features such as family history of IBD, refractory disease, or atypical presentation for those diagnosed between 10–18 years among the patients followed up in our center between 2016‐2024. Singleton/trio whole exome sequencing (WES) was performed to evaluate variants in genes associated with IBD.
Results:
WES was performed in 22 of 130 pediatric IBD patients followed in our center. Trio‐WES was conducted for 14/22 patients. The cohort included 16 patients with early‐onset IBD and six with other risk factors. The median age of onset was 7.5 years (min=1/max=17/IQR = 5–11.5), with a female‐to‐male ratio of 1.44:1. Diagnoses included ulcerative colitis (10/22), IBD‐unclassified (7/22), and Crohn's disease (5/22). Parental consanguinity was observed in five patients. Pathogenic variants and/or variants of uncertain significance (VUS) were identified in 50% of patients (11/22). Pathogenic variants were detected in CARMIL2, PEPD, XIAP, TNFRSF13B and MEFV genes, associated with immunodeficiency‐58, prolidase deficiency, X‐linked lymphoproliferative syndrome‐2, common variable immunodeficiency‐2 and familial Mediterranean fever, respectively. 27% of the cohort (6/22) and 30% of VEO‐IBD patients (3/10), all with infantile‐onset disease, had monogenic IBD VUS in IBD‐related genes were detected in eight patients (36,4%).
Conclusions: WES is critical for identifying monogenic IBD, particularly in VEO‐IBD as well as in patients with atypical/refractory disease course, especially in populations with high prevalence of consanguinity. Early genetic diagnosis can inform prognosis and facilitate tailored therapies, potentially improving outcomes in pediatric IBD patients.
Contact e‐mail address: dryusufaydemir@yahoo.com
G‐EV241. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV241.1. DUAL BIOLOGIC THERAPY IN PAEDIATRIC CHRONIC INFLAMMATORY BOWEL DISEASE ‐ A RETROSPECTIVE SINGLE‐CENTRE ANALYSIS
Merle Claßen1, Alexander Schnell 2, Adrian Regensburger3, André Hoerning2
1Department Of Pediatrics, Universitätsklinikum Erlangen, Erlangen, Germany, 2Pediatric Gastroenterology, Hepatology And Endoscopy, Department Of Pediatrics And Adolescent Medicine, University Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, Erlangen, Germany, 3Pediatric Gastroenterology, Hepatology And Endoscopy, Department Of Pediatrics And Adolescent Medicine, University Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, erlangen, Germany
Objectives and Study: In patients with high disease activity, characterised for example by the development of perianal fistula formation and/or refractory IBD‐associated arthritis, and failure of at least one biologic, dual biologic therapy may be effective (Goyal & Bass, 2020; Penagini et al., 2023). The largest multicentre longitudinal study of 62 paediatric IBD patients (Yerushalmy‐Feler et al., 2024), observed clinical remission, measured by clinical scores, in 63% after one year.
Methods: The dual biologic therapy regime at our centre was evaluated. Retrospective data were collected from patients who received dual biologic therapy for at least one month. Demographic characteristics and the course of clinical scores and laboratory parameters are described.
Results: Dual biologic therapy has been practised in Erlangen since 2020 in eleven paediatric patients. Treatment was started in mean 75 months after diagnosis. The median duration of dual treatment was 18.5 months. On average, patients were 16 years old when dual biologic therapy was initiated and 63% were female. 50% of the patients had ulcerative colitis. 72.7% received a combination consisting of vedolizumab and another biologic (18% ADL, 18% IFX, 18% golimumab), the remaining 27.3% of patients received a combination with ustekinumab. After initiation of therapy, 63% of patients showed a reduction in calprotectin levels of more than 90%. Steroids could be discontinued in 50% of patients with steroid‐dependent disease. Clinical scores showed a significant reduction. Because of insufficient treatment response the combination of biologics had to be changed in 27%. No serious adverse drug reactions were reported.
Conclusions: Dual biologic therapy appears safe and effective as a treatment option for refractory paediatric inflammatory bowel disease. The most common combinations were vedolizumab with a TNF‐alpha inhibitor. The clinical response appears to be similar to the Europe‐wide multicentre sample. Larger studies are necessary to identify patients who benefit from dual biologic therapy and predictors of treatment response.
Contact e‐mail address:
G‐EV242. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV242.1. INFLIXIMAB IN VERY EARLY ONSET INFLAMMATORY BOWEL DISEASE (VEO‐IBD), DOSING AND OUTCOME: A RETROSPECTIVE CROSS‐SECTIONAL STUDY
Aruna Sethuraman 1, Shreya Kishore1,2, Hiba Binomar3, Kevan Jacobson1,4
1Division Of Gastroenterology, Hepatology And Nutrition, British Columbia Children's Hospital, Vancouver, Canada, 2School Of Medicine And Dentistry, Griffith University, Southport, Australia, 3King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 4Faculty Of Medicine, The University of British Columbia, Vancouver, Canada
Objectives and Study: VEO‐IBD patients are uniquely at risk of inadequate infliximab (IFX) exposure. Our primary aim was to study the rate of clinical remission with VEOIBD on IFX. We also wanted to note the association of body weight (BW) and body surface area (BSA) dosing.
Methods: A retrospective chart review was conducted for children with VEOIBD diagnosed between 1st January 2013 to 31st December 2022 with a minimum follow up of one year at a single centre. Clinical data, including IBD medication use and response were collected from the medical record. REB approval was obtained for this study.
Results: 77 patients were identified in our study with 32 (41.5%) exposed to IFX, with a mean follow up of 69.3 mo (+34.8mo). The mean age at diagnosis was 45.1 mo (SD + 18.07 m). Among them, 15 (46.9%) were with CD and 14 (43.7%) and 3 (9.4%) with UC and IBD‐U respectively. 62.5% patients were started on IFX below 6 yrs of age. The median time from diagnosis to IFX start was 9.5 mo. The median pre dose 3 and pre dose 4 IFX trough levels were 5.6 ug/mL and 5.2 ug/mL respectively with a mean IFX induction dose of 6.54 mg/kg (SD + 2.13 mg/kg) and 156.46 mg/m2 body surface area. 25% needed reinduction and 90.6% needed dose optimization at some point in their follow up. 53.1% were on concomitant therapy. 18/32 (56.2%) were in clinical remission with a mean IFX dose of 311.58 mg/m2 and 10.45 mg/kg at last followup. IFX failure occurred in 14/32 (43.7%) of patients. Among them,10 were exposed to a 2nd biologic, 5 to a 3rd biologic and 1 to a 4th biologic. Three patients required a colectomy and 1 underwent a bone marrow transplant.
Conclusions: Infliximab trough levels pre dose 3 and 4 are often low in VEO‐IBD patients and dose optimization is very common.
Contact e‐mail address: alairuna@gmail.com
G‐EV243. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV243.1. REAL WORLD USE OF BIOLOGICS FROM THE LARGEST COHORT OF PEDIATRIC INFLAMMATORY BOWEL DISEASE FROM INDIA – LESSONS FROM A RESOURCE LIMITED COUNTRY
Sahana Shankar 1, Srikanth Puttaiah Kadyada2
1Division Of Pediatric Gastroenterology, Department Of Medical Gastroenterology, Mazumdar Shaw Medical Center, Narayana Health, Bangalore, India, 2Pediatric Gastroenterology, Manipal Hospitals, Bengaluru, India
Objectives and Study: Use of biologics has transformed management of pediatric inflammatory bowel disease (PIBD). However, there is scant data regarding biologic use from India where the disease burden is rising. Lack of universal healthcare insurance, widespread prevalence of tuberculosis (TB) and limited or no access to newer biologics in India pose a significant barrier to use of biologics. Our objective was a) to describe use of biologics in a cohort of PIBD from a resource limited setting ‐ indications for use, top down versus step‐up approach, originator versus biosimilar use and adverse effects (AE) related to biologic use including TB reactivation and b) to describe the utility of therapeutic drug monitoring (TDM) during biologic therapy in PIBD‐ reactive versus proactive TDM.
Methods: Retrospective audit of PIBD patients who received biologics between 2019‐2024 in two tertiary care centers in South India was performed. Baseline demographics, IBD phenotype, distribution of disease, type of biologic use, top‐down or step‐up therapy, use of combination or monotherapy, TDM use, reactive or proactive and AEs were recorded. Outcomes were defined as steroid free clinical remission at 14 weeks and 52 weeks of biologic use.
Results: 160 children were diagnosed with IBD, of which, 38 (23%, Male 55%) received biologic therapy (see image below). 45% (5/11) of patients on adalimumab had to be switched to infliximab due to loss of response (4) and primary nonresponse (1). No cases of TB reactivation were noted. Elective discontinuation of therapy was done in 1 patient.
Conclusions: Infliximab was the most common biologic used followed by adalimumab biosimilar, high risk CD being the commonest indication. Top‐down therapy was used in 71% of cohort with steroid‐free clinical remission rate of 84% at 52 weeks.TDM was used in 65% of cohort with dose intensification in 44% of patients.Durability of response was better for infliximab compared to adalimumab biosimilar.
Contact e‐mail address: drsahanashankar@gmail.com
G‐EV244. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV244.1. MUSCLE MASS DETERMINED BY MRI AND RISK OF RELAPSE IN CHILDREN WITH CROHN'S DISEASE
Ivana Trivić Mažuranić, Sara Sila, Paola Ruška, Ana Močić Pavić, Zrinjka Mišak, Ana Tripalo Batoš, Iva Hojsak
Referral Center For Pediatric Gastroenterology And Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
Objectives and Study: We aimed to determine the effect of muscle mass determined on the MRI on the relapse risk in the first 6 months and during the follow‐up in children with Crohn's disease (CD).
Methods: Children with CD who had MRI enterography in the first year of diagnosis were included. Total psoas muscle area (TPMA) was measured, and psoas muscle index (PMI) was calculated. Factors including nutritional status, muscle mass, perianal disease, age, sex, disease location and antiTNF therapy were assessed as a risk for relapse.
Results: 92 children were included (mean age 13.7 ± 3.03 years, 60% male). Disease duration at the time of MR was 6.9 ± 16.3 months. The average TPMA was 810 ± 429 vs 631 ± 215 mm2 (p = 0.01), and the average PMI was 514 ± 228 vs 452 ± 140 mm2 (p = 0.113) for males and females, respectively. Six months after MRI, 27 (29%) children had relapsed, increasing to a total of 64 (70%) during the follow‐up time (mean 2.7 ± 1.6 years). Stunting was observed in only 4 (4%) and undernutrition in 24 (26%) children at the time of MRI. Binary logistic regression identified that only L1 compared to L3 location was associated with a lower risk of relapse 6 months after MRI (HR 0.140, 95% CI [0.03‐0.658], p = 0.013). During the follow‐up, the risk for relapse was higher amongst younger children, children with L3 compared to L1, and in children not treated with antiTNF (Table 1). None of the other risk factors, including TPMA and PMI, were associated with the risk of relapse.
Table 1. Relapse risk during the follow‐up (binary logistic regression, univariate)
| HR | 95% CI | p | |
|---|---|---|---|
| Age at diagnosis | 0.709 | 0.571‐0.880 | 0.002 |
| Localization of CD (L3 reference) L1 L2 | 0.207 0.306 | 0.073‐0.585 0.124‐1.923 | 0.003 0.489 |
| antiTNF therapy | 3.93 | 1.126‐13.713 | 0.032 |
Conclusions: Muscle mass determined my MRI was not associated with a relapse risk during the follow‐up of children with CD.
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G‐EV245. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV245.1. MESALAMINE‐INDUCED MYOCARDITIS AND PERICARDITIS IN PEDIATRIC INFLAMMATORY BOWEL DISEASE: EXPERIENCE FROM TWO ITALIAN TERTIARY CENTERS
Laura Rigotti1, Laura Gianolio1, Valentina Silvera 1, Giuseppe Stella2, Francesco Proli2, Lucia Cococcioni1, Dario Dilillo1, Valentina Giorgio2,3, Lorenzo Norsa1, Francesca Penagini1, Gian Vincenzo Zuccotti1,4
1Department Of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy, 2Department Of Woman And Child Health And Public Health, Uoc Pediatria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, 3Università Cattolica del Sacro Cuore, Rome, Italy, 4Department Of Biomedical And Clinical Sciences, University of Milan, Milan, Italy
Objectives and Study: Myocarditis and/or pericarditis are rare but severe adverse events associated with mesalamine (5‐ASA). The existing literature on this topic is scarce. We report a case series of pediatric inflammatory bowel disease (PIBD) patients with myocarditis, pericarditis and myopericarditis from two Italian tertiary centers.
Methods: We retrospectively analyzed clinical records of 271 PIBD patients followed at Buzzi Children's Hospital in Milan and Gemelli Hospital in Rome (01/2021 ‐ 11/2024). Cases with a history of cardiovascular involvement while on 5‐ASA were identified. Demographic, clinical, and treatment‐related data were collected.
Results: Cardiovascular involvement was documented in 3/271 (1.1%) PIBD on 5‐ASA. One patient with Crohn's disease (Paris classification A1aL3L4aB1G1) developed pericarditis and two with ulcerative colitis (Paris classification E1S0 and E4S0) experienced myocarditis and myopericarditis, respectively. All patients were male; median age at carditis onset was 13 years (range 9‐16) with a median time between IBD onset and carditis of 7 months (range 1‐12). All patients presented with chest pain, with two cases accompanied by fever. At the time of cardiovascular symptoms, the pericarditis patient had mildly active disease while on oral 5‐ASA, the myopericarditis case was in clinical remission on rectal 5‐ASA and the myocarditis one was in remission on oral 5‐ASA, infliximab (10 mg/kg every 4 weeks), and prednisone. Treatment included non‐steroidal anti‐inflammatory drugs (NSAIDs) for pericarditis and oral corticosteroids for myocarditis and myopericarditis. Cardioactive therapy was required only in the myocarditis case. All patients discontinued 5‐ASA and recovered fully without lasting sequelae.
Conclusions: Cardiovascular involvement during 5‐ASA therapy in PIBD is rare but represents a potential drug‐related adverse event. Clinicians should maintain vigilance and a low threshold for diagnosis in the presence of suggestive symptoms to ensure timely and effective management.
Contact e‐mail address: laura.rigotti@unimi.it
G‐EV246. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV246.1. DIFFICULTIES IN FINDING AN IDEAL DONOR IN FECAL MICROBIOTA TRANSPLANTATION; HIDDEN DANGERS
Elif Turkmen 1, Lutfiye Oksuz2, Zerrin Önal1, Zerrin Aktas2, Ozden Boral2, Burak Karacan3, Fatma Oguz4, Mustafa Oncu5, Ozlem Durmaz1
1Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul University Istanbul Medical Faculty, istanbul, Turkey, 2Medical Microbiology And Laboratory, Istanbul University Istanbul Medical Faculty, istanbul, Turkey, 3Medical Microbiology And Laboratory, Istinye University, İstanbul, Turkey, 4Medical Biology, Istanbul University Istanbul Medical Faculty, İstanbul, Turkey, 5Infectious Diseases And Clinical Microbiology, Istanbul University Istanbul Medical Faculty, İstanbul, Turkey
Objectives and Study: Dysbiosis plays an important role in the pathogenesis of inflammatory bowel disease (IBD). Therefore, fecal microbiota transplantation (FMT) has attracted great interest to provide normobiosis. Finding a healthy donor is the most important and difficult step of FMT. We wanted to highlight the difficulty of finding an age‐matched donor and its hidden danger.
Methods: Donor inclusion criteria is presented in Figure 1. Additionally, relatives and age‐matched donors were primarily preferred. FMT was performed three times for each patient, one month apart.
Results: A total of 21 healthy donor candidates were examined and only five age‐matched donor were detected after screening program. Of the eliminated donor candidates (n = 17), 9 had ESBL positive E.coli, two carbapenem resistant enterobacteriaceae and, insulin resistance, a history of animal caretaker and feeding, Giardia lamblia, Blastocystis hominis, Rotavirus in one patient each. It was observed that two candidates had decreased microbiota diversity (Table 2).
| Questionnaire | Laboratory results | |
|---|---|---|
| Donor 1 | N | Giardia lamblia |
| Donor 2 Donor 3 Donor 4 Donor 5 Donor 6 Donor 7 Donor 8 Donor 9 Donor 10 | N N N N N N N N N | ESBL ( + ) E.coli ESBL ( + ) E.coli ESBL ( + ) E.coli ESBL ( + ) E.coli ESBL ( + ) E.coli ESBL ( + ) E.coli ESBL ( + ) E.coli ESBL ( + ) E.coli + B. hominis ESBL ( + ) E.coli + Rotavirus |
| Donor 11 Donor 12 | N Animal caretaker‐feeding | Decreased diversity (after 2nd donation) ‐ |
| Donor 13 | Insulin resistant | ‐ |
| Donor 14 | N | Decreased diversity |
| Donor 15 Donor 16 | N N | Carbapenem resistant bacteria Carbapenem resistant bacteria |
Conclusions: An ideal donor is the most important factor affecting the success of FMT. Even in donor candidates are supposed healthy, they may be asymptomatic carriers for resistant bacteria and, dangerous for patients. Therefore, detailed laboratory investigation is crucial for the safety and effectiveness of the procedure. In our study, we determined that the most difficult stept is finding a healthy and suitable donor for FMT.
Contact e‐mail address: drturkmen61@gmail.com
G‐EV247. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV247.1. DISEASE ACTIVITY CLASSIFICATION BASED ON ROUTINELY COLLECTED BLOOD TESTS IN A PROSPECTIVE PEDIATRIC IBD INCEPTION COHORT
Rona Lujan1, Oren Ledder2, Tasia Maslov2, Dotan Yogev3, Raffi Lev‐Tzion2, Esther Orlanski‐Meyer3, Amit Assa3, Shira Yuval Bar Asher3, Dan Turner 4
1Shaare Zedek Medical Center, Jerusalem, Israel, 2Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel, 3The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel, 4The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
Objectives and Study: We have previously shown that disease‐activity clusters, based on routinely performed blood tests from administrative database of Crohn's disease (CD), are associated with long‐term disease outcome. Here we aimed to validate these findings on constructs of disease activity by applying similar methods to a well phenotyped prospective inception cohort.
Methods: Data from a prospective inception cohort of children with CD were used. Hierarchical clustering, an unsupervised machine learning method for partitioning patients' data into clusters where elements are grouped according to their similarities, was applied on blood tests available at the time of diagnosis. The order of the clusters, from mild to severe disease activity, was determined by observing the median values of the laboratory results. Disease‐severity validation constructs included wPCDAI, physician global assessment of disease activity and endoscopic scores.
Results: A total of 152 children with new‐onset CD were included. Three disease severity clusters were formed (1‐mildest to 3‐severe). In support of internal validity, there was a gradual worsening in the median of all laboratory values across the three disease‐severity clusters (Figure). In support of external validity, there was a stepwise increase in median constructs’ values across the clusters, including physician assessment (34 [IQR 20‐49], 55 [43‐72], 67 [55‐80]; p < 0.001), wPCDAI (35 [18‐49], 53 [35‐65], 65 [58‐78]; p < 0.001), and endoscopic score (8 [3‐12], 14 [9‐18], 16 [11‐25]; p < 0.001) (Figure).
Conclusions:
We showed that hierarchical clustering of routinely collected blood tests can reflect disease activity in CD.
Contact e‐mail address:
G‐EV248. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV248.1. PAPILLARY THYROID CANCER IN A PATIENT WITH PANCOLIC ULCERATIVE COLITIS ON ANTI‐TNFΑ TREATMENT
Massimiliano Turzi 1, Luisa Abbattista1, Virginia Rossi1, Alice Bianchi2, Lucia Cococcioni3, Laura Gianolio4, Lorenzo Norsa5, Dario Dilillo6, Francesca Penagini7, Gian Vincenzo Zuccotti6
1Buzzi Children's Hospital, Milano, Italy, 2Paediatrics, Buzzi Children's Hospital, Milan, Italy, 3Pediatrics, Vittore Buzzi Hospital, Milan, Italy, 4Biomedical And Clinical Sciences, University of Milan, Milan, Italy, 5Pediatric Department, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy, 6Paediatrics, Buzzi Children's Hospital, University of Milan, Italy, 7Department Of Paediatrics, Vittore Buzzi Children's Hospital, Milan, Italy
Objectives and Study: Inflammatory bowel diseases (IBD) are linked to a higher risk of gastrointestinal and extra‐intestinal cancers due to chronic inflammation and treatment‐induced immunosuppression. While IBD patients face increased risks of non‐melanoma skin cancers, Crohn's disease is associated with haematological, lung, cervical, prostate, renal, oral, and laryngeal cancers. Limited data exist on thyroid malignancies in IBD patients.
Methods: We report a case of a 17‐year‐old girl with pancolic ulcerative colitis (UC) who developed papillary thyroid carcinoma. A narrative literature review was conducted to explore potential associations between thyroid cancer and IBD.
Results: The patient was diagnosed at age 13 with acute severe pancolic UC refractory to intravenous corticosteroids. She received infliximab (IFX) 10 mg/kg (weeks 0‐1‐4) combined with azathioprine for 7 months, maintaining remission on IFX every 4 weeks for a year, later extended to 6‐8 weeks. After three years of treatment, a thyroid ultrasound performed for suspected parotitis revealed a solid, irregular, hypo/iso‐echoic lesion (10 × 10 × 14 mm) in the left thyroid lobe with microcalcifications and intense vascularization. Fine‐needle aspiration and histological analysis confirmed papillary thyroid carcinoma, and hemithyroidectomy was performed.
Conclusions: IBD patients are predisposed to gastrointestinal and extra‐intestinal malignancies, but available literature does not indicate an increased incidence of thyroid cancer in this population. Data on thyroid malignancies in paediatric IBD patients are particularly limited. Further research is necessary to clarify the risk and guide potential screening strategies.
Contact e‐mail address: massimiliano.turzi@unimi.it
G‐EV249. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV249.1. A SINGLE CENTER COHORT: EVALUATION OF INFLAMMATORY BOWEL DISEASE IN JUVENILE SPONDYLARTHRITIS PATIENTS
Ipek Ulkersoy 1, Umit Gul2, Arlin Tunc3, Sevval Ozyildirim3, Nergis Akay2, Oguzhan Tin1, Nursena Kologlu Ates1, Elif Kilic Konte2, Aybuke Gunalp2, Esma Aslan2, Mehmet Yildiz2, Ayse Kalyoncu Ucar4, Sezgin Sahin2, Nuray Kepil5, Kenan Barut2, Sebuh Kurugoglu4, Omer Beser1, Ozgur Kasapcopur2, Fügen Çullu Çokuğraş6
1Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 2Department Of Pediatric Rheumatology, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 3Department Of Pediatrics, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 4Department Of Pediatric Radiology, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 5Department Of Pathology, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 6Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Demiroglu Bilim University, Faculty of Medicine, Istanbul, Turkey
Objectives and Study: Since Juvenile spondylarthritis (JSpA) is an inflammatory rheumatic disease with shared genetic, immunopathogenic mechanisms and environmental background with pediatric inflammatory bowel disease (IBD), it is thought that the risk of IBD is increased in patients with JSpA. We aimed to evaluate IBD‐related symptoms in JSpA patients, conduct further investigations to determine the prevalence of IBD and assess the relationship between fecal calprotectin (FCP) levels and the presence of IBD in JSpA patients to improve diagnostic, treatment and follow‐up strategies.
Methods: A total of 75 JSpA patients were included. FCP levels were measured and patients with elevated FCP levels or 2 or more IBD‐related symptoms (chronic diarrhea, weight loss, abdominal pain, bloody or mucous stool) underwent ileo‐colonoscopy examination, histopathological assessment and radiological evaluation with MR enterography imaging for further investigations.
Results: 75 JSpA patients (males %72) with a mean age of 16,1 years were included. Among these 75 patients, 20 with high FCP levels (27%) (median:356,1 mcg/g) and 3 with IBD‐related symptoms (4%) underwent ileo‐colonoscopy examination and histopathological assessment. Among these 23 patients, 10 diagnosed with macroscopic and microscopic colitis (10/23,43,5%;10/75,13,3%) and 4 with only microscopic colitis (4/23,17,4%;4/75,5,3%) while remaining 9 patients (9/23,39%;9/75,12%) had normal histopathological assessment. A significant proportion of JSpA patients with elevated FCP levels presented without clinical symptoms of IBD (n = 20/75,27%). In patients with MRI‐confirmed sacroiliac joint involvement, FCP‐positivity was found to be statistically significantly higher (p‐value:0,001). There was no statistically significant difference between FCP‐positive and negative groups regarding acute phase reactants and JSPADAI/JADAS‐27 scores.
Conclusions: Since IBD‐related findings was confirmed in patients with high FCP levels, FCP may be used for screening of silent IBD, however, should be supported by ileo‐colonoscopy examination and histopathological assessment. These findings (preliminary results) suggest that FCP testing and gastrointestinal symptom monitoring should be considered in the early diagnosis and management of IBD in JSpA patients.
Contact e‐mail address: ipekulkersoy@gmail.com
G‐EV250. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV250.1. A VERY RARE COMBINATION: ULCERATIVE COLITIS, PYODERMA GANGRENOSUM AND ACNE FULMINANS
Bariş Kaygisiz1, Nazmiye Salici2, Hacer Aktürk3, Seçil Vural4, Nuray Uslu Kizilkan 5
1Department Of Pediatrics, Koç University Hospital, School of Medicine, İSTANBUL, Turkey, 2Department Of Dermatology, Koç University, Scdool of Medicine, İstanbul, Turkey, 3Department Of Pediatrics, Division Of Infectious Diseases, Koç University, İSTANBUL, Turkey, 4Department Of Dermatology, Memorial Hospital, İstanbul, Turkey, 5Department Of Pediatrics, Division Of Pediatric Gastroenterology, Koç University, İSTANBUL, Turkey
Objectives and Study: The coexistence of acne fulminans, pyoderma gangrenosum (PG), and ulcerative colitis (UC) is extremely rare. Such association has been termed as PAC (PG, acne and UC) syndrome, an entity included in the wider PAPA‐like spectrum of autoinflammatory disorders. Recognition of such rare presentations is important for the understanding of shared inflammatory mechanisms and management strategies.
Methods: A 16‐year‐old boy who has the diagnosis of UC for one year presented with nodulocystic acne lesions on the face with solid edema. There were also numerous painful, deep, purulent ulcerative lesions with undermined borders on the back, violaceous nodule with erythematous base on the left forearm and scattered pustular lesions on various parts of the body.(Figure 1) According to the history the lesions started and progressed in the last 2‐3 days. He had high‐grade fever of 41°C lasting for one day. Laboratory evaluation revealed anemia and signs of inflammation. Histopathological findings of ulcerative lesions on the back were consistent with PG and microbiological evaluation of tissue swab and biopsy were normal. Endoscopic evaluation was compatible with UC. The treatment included systemic corticosteroids, infliximab, with intensive wound care and also aggressive pain control. Also, intralesional corticosteoid injection has been applied for some lesions on face and forearm,. as the pustular lesions rapidly progressed to ulceration. At the end of the first month pain was relieved, and lesions were healing mostly with normal laboratory findings except anemia. Result of whole exome analysis is pending.
Results: A case report
Conclusions: This case serves as an illustration of the complex nature of PAPA‐like syndromes, clearly bringing into focus the requirement for a multidisciplinary diagnosis and treatment approach. Thus, in patients with inflammatory bowel disease who presented with severe acne and PG, overlapping autoinflammatory pathways should be taken into consideration.
Contact e‐mail address: nkizilkan@kuh.ku.edu.tr
G‐EV251. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV251.1. A RARE CASE REPORT OF VERY EARLY‐ONSET INFLAMMATORY BOWEL DISEASE ASSOCIATED WITH CARMIL2 MUTATION AND ESOPHAGEAL STENOSIS WITHOUT EOSINOPHILIC ESOPHAGITIS
Neslihan Üstün 1, Zeren Barış1, Yusuf Aydemir1, Elif Saraç2, Sinem Kocagil2, Deniz Nazire Çağdaş Ayvaz3
1Pediatric Gastroenterology, Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Gastroenterology, Eskişehir, Turkey, Eskişehir, Turkey, 2Medical Genetics, Eskişehir Osmangazi University, Faculty of Medicine, Department of Medical Genetics, Eskişehir, Turkey, Eskişehir, Turkey, 3Pediatric Immunology, Hacettepe University, Faculty of Medicine, Department of Pediatric Immunology, Ankara, Turkey, Ankara, Turkey
Objectives and Study: Very early‐onset inflammatory bowel disease (VEO‐IBD), defined as IBD onset before six years of age, is often associated with genetic factors, severe inflammation, and resistance to conventional therapies. CARMIL2 mutations are linked to immunodeficiency, VEO‐IBD, eosinophilic esophagitis, and lymphocytic esophagitis. This report describes a unique case of VEO‐IBD with esophageal stenosis due to a pathogenic CARMIL2 mutation.
Methods: A 2.5‐year‐old girl presented with chronic diarrhea and abdominal pain for three months. Her medical history revealed allergic asthma and consanguinity between parents. Initial investigations suggested celiac disease with histological findings of villous atrophy and intraepithelial lymphocytosis. Despite adherence to a gluten‐free diet, her symptoms worsened. Subsequent colonoscopy and histopathological evaluations revealed chronic inflammation, leading to a diagnosis of ulcerative colitis. During follow‐up, she experienced recurrent respiratory infections and chickenpox. During follow‐up, esophageal stenosis was identified with lymphocytic infiltration but no eosinophilia. Whole‐exome sequencing identified a homozygous nonsense mutation in the CARMIL2 gene (c.1109 C>A, p.Ser370Ter), confirming the diagnosis of CARMIL2 deficiency.
Results: Hematopoietic stem cell transplantation was planned, and infliximab therapy induced remission of colitis.
Conclusions: This case highlights the importance of considering monogenic causes like CARMIL2 mutations in VEO‐IBD patients with recurrent infections or gastrointestinal strictures. Early genetic diagnosis is crucial for personalized treatment and improved outcomes.
Contact e‐mail address: ustunneslihann@gmail.com
G‐EV252. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV252.1. FUNGAL GUT MICROBIOTA COMPOSITION IN INFLAMMATORY BOWEL DISEASE INTRODUCED TO INFLIXIMAB
Rebecka Ventin‐Holmberg 1,2, Jarno Honkanen2, Anja Eberl3, Taina Sipponen3, Paivi Saavalainen2,4
1Human Microbiome Research Program, University of Helsinki, Helsinki, Finland, 2Folkhälsan Research center, Helsinki, Finland, 3Department Of Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland, 4Translational Immunology Research Program and Department of Medical and Clinical Genetics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
Objectives and Study: Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastro‐intestinal tract growing rapidly in incidence and prevalence throughout the world. The gut microbiota is composed of various microorganisms including the fungal microbiota, called the mycobiota. The microbiota is associated with IBD. There is no cure for IBD, but the treatment aims for mucosal healing including conventional treatment and biological therapies such as infliximab (IFX). Moderate to severe IBD is treated successfully with anti‐tumor necrosis factor alpha (TNF‐α) infliximab (IFX) but up to half of the patients receiving IFX do not have a good long‐term response.
Methods: Fecal samples were collected from 70 patients with IBD (24 CD, 44 UC and 2 IBDU) before, during and after IFX treatment. The fungal microbiota composition was investigated by targeting the conserved ITS1 region in MiSeq sequencing and quantification by qPCR.
Results: The results show that the fungal gut microbiota differs during IFX treatment and this change was different between the responders and non‐responders to IFX. Additionally, the total fungal load was more stable in responders compared to non‐responders.
Conclusions: To conclude, the fungi might also play a role in the IFX treatment outcome.
Contact e‐mail address: rebecka.ventin-holmberg@helsinki.fi
G‐EV253. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV253.1. PREVALENCE AND CLINICAL FEATURES OF INFLAMMATORY BOWEL DISEASE ASSOCIATED WITH MONOGENIC VARIANTS: A SINGLE‐CENTER SURVEY IN A CHINESE COHORT
Lin Wang, Caiyun Long, Hailin Wu, Ying Huang
Children's Hospital of Fudan University, Shanghai, China
Objectives and Study: Over the past decades, the broader utilization of next‐generation sequencing techniques has facilitated the evaluation of a proportion of patients for single gene variants associated with IBD (monogenic IBD). Strong differences have been observed in proportions and features of monogenic IBD among ethnic populations. We aimed to investigate the prevalence and clinical features of monogenic disease in a cohort of pediatric IBD patients in China.
Methods: The pediatric patients diagnosed with IBD (aged 0‐18 years) between January 2015 and May 2024 were retrospectively reviewed. The patients who underwent clinical genetic testing by targeted panel sequencing, whole exome sequencing or whole genome sequencing were enrolled. The clinical manifestations, genetic profiles and treatment outcomes were included.
Results: A total of 357 patients (61.1% males and 38.9% females) with a median diagnosis age of IBD 17.9 months were enrolled. A total 195 of 357 (54.6%) patients with IBD were diagnosed as monogenic IBD, including IL10RA (74.4%, 145/195), TNFAIP3 (4.1%, 8/195), LRBA (2.1%, 4/195) and FOXP3 (2.1%, 4/195). These variants occurred in 78.9% (154/195) of children younger than 2 years, 91.3% (178/195) of children younger than 6 years and 8.7% (17/195) of children aged 6–18 years. Patients with monogenic IBD presented with higher rate of stricturing behavior, lower hemoglobin levels and higher C‐reactive protein (P < 0.05 for all). This group demonstrated higher rates of surgical intervention and higher mortality. Allogeneic hematopoietic stem cell transplantation was performed in 109 patients (55.9%) with IL‐10RA deficiency, 2 patients (1.0%) with FOXP3 mutation or other gene mutation (CARD11, XIAP, LRBA, WAS) as a curative treatment.
Conclusions: This high rate of monogenic defects with a broad spectrum of genes reiterates the importance of performing genetic testing among childhood‐onset IBD patients. Patients with monogenic IBD are at risk for more severe disease course.
Contact e‐mail address:
G‐EV254. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV254.1. BLAUTIA WEXLERAE ALLEVIATES DSS‐INDUCED COLITIS BY INHIBITING FERROPTOSIS VIA ACTIVATING NRF2/SLC7A11 PATHWAY
Ying Wang, Lu Jiang
Division Of Pediatric Gastroenterology And Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, Shanghai, China
Objectives and Study: Ferroptosis is involved in regulating the pathological mechanisms of colitis. Blautia wexlerae, a potential next‐generation probiotic, is significantly depleted in children with colitis. However, its protective role and the underlying mechanisms in pediatric colitis remain poorly understood.
Methods: Three‐week‐old juvenile mice were randomly divided into four groups: control (normal water), DSS (3% dextran sulfate sodium), DSS + B. wexlerae (1 × 109 CFU/day, oral gavage), and DSS + B. wexlerae + ML385 (Nrf2 inhibitor, 30 mg/kg/day, intraperitoneal injection). We assessed body weight, diarrhea, and hematochezia during 9 days’ intervention. We evaluated the effects of B. wexlerae on gut barrier function, inflammation, and intestinal ferroptosis. Gut microbiota was analyzed by metagenomic next‐generation sequencing (mNGS) using fecal samples.
Results: B. wexlerae improved body weight gain and colon length compared with DSS alone. Additionally, it alleviated DSS‐induced diarrhea and intestinal edema while reducing the spleen‐to‐body weight ratio. Regarding its effects on the intestinal barrier, it upregulated the expression of Occludin (Ocln) and Zonula Occludens‐1 (Zo‐1). Furthermore, it significantly reduced the serum levels of interleukin‐1β (IL‐1β), IL‐6, and tumor necrosis factor‐alpha (TNF‐α), demonstrating its efficacy in suppressing the expression of inflammatory factors. Importantly, DSS induced upregulation of intestinal ferroptosis, accompanied by reduced expression of Nrf2 and Slc7a11. These changes were effectively reversed following B. wexlerae treatment. Interestingly, injection of ML385, a Nrf2 inhibitor, partially reversed the beneficial effects of B. wexlerae in DSS‐treated mice, indicating the involvement of Nrf2/Slc7a11 pathway in its mechanism of action. Finally, metagenomic sequencing revealed that B. wexlerae increased microbial diversity and promoted the growth of beneficial bacteria.
Conclusions: B. wexlerae alleviates DSS‐induced colitis in juvenile mice by inhibiting ferroptosis through activating the Nrf2/Slc7a11 pathway.
Contact e‐mail address: xujuan66@sjtu.edu.cn
G‐EV255. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV255.1. ASSOCIATION BETWEEN SERUM IGF‐1 LEVELS AND SARCOPENIA IN CHILDREN WITH PAEDIATRIC CROHN'S DISEASE AT A TERTIARY HOSPITAL IN SHANGHAI, CHINA
Yuan Xiao, Mingyue Yin
Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
Objectives and Study: Sarcopenia and short stature are common complications in children with Crohn's disease (CD). However, few studies have examined the association between sarcopenia and insulin‐like growth factor 1(IGF‐1) levels in paediatric CD patients. This retrospective study investigated this association in Chinese paediatric CD patients at a tertiary hospital in Shanghai.
Methods: This study retrospectively collected pediatric CD patients with complete clinical information aged 6‐14 years old who were admitted to the Department of Paediatrics of Ruijin Hospital, Shanghai Jiaotong University School of Medicine from January 2018 to November 2023. The psoas major muscle area divided by the square of height yielded the psoas major muscle index (PMI). Patients were divided into four groups based on PMI. The clinical data, IGF‐1 levels, and other laboratory data were collected retrospectively. The factors associated probably with PMI were analyzed by correlation analysis and univariate and multivariate logistic regression.
Results: 81 patients were included in this study, of whom 59 (72.8%) were male. The study showed that PMI was significantly associated with BMI, BMI for age Z score, weight, albumin, creatine kinase (CK), hemoglobin (Hb), IGF‐1, IGF‐1 for age Z score, and Vitamin D (VD) levels positively. The PMI also negatively correlated with the PCDAI score, WBC, CRP, neutrophils count, platelets count, fibrinogen (Fg), and DD dimer. Univariate logistic regression analyses showed that patients in the lowest quartile of PMI had lower BMI, BMIz scores, levels of ALB, CK, Hb, IGF‐1, IGF‐1z scores, VD, and higher PCDAI scores, and WBC count, compared with patients in the highest quartile of PMI. Multivariate logistic regression analysis showed that BMI, IGF‐1 z score and WBC were independently associated with PMI (P < 0.05).
Conclusions: Lower IGF‐1 level is an independent correlate of sarcopenia in Chinese children with CD.
Contact e‐mail address:
G‐EV256. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV256.1. THE IMPACT ON AN UPPER GASTROINTESTINAL INVOLVEMENT ON THE CLINICAL OUTCOME OF PEDIATRIC INFLAMMATORY BOWEL DISEASE
Anat Yerushalmy‐Feler, Ofek Aloni, Shlomi Cohen
Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Faculty of Medical and Health Sciences, Tel aviv, Israel
Objectives and Study: The clinical implications of involvement of the upper GI (UGI) tract in pediatric inflammatory bowel diseases (IBD) are controversial. This study aimed to assess the impact of an UGI involvement on IBD outcomes in children.
Methods: A retrospective cohort study of children diagnosed with IBD at a tertiary referral center between 2010‐2023. Patients that underwent an UGI endoscopy at diagnosis of IBD and were followed for at least 12 months were included. Demographic, clinical, laboratory, endoscopic and histologic data were collected. The outcomes of the study included clinical remission (wPCDAI < 12.5 or PUCAI < 10), biomarker remission (C‐reactive protein < 5 mg/L and fecal calprotectin < 150 mcg/g), need for biologic therapy and IBD‐related hospitalizations.
Results: An UGI involvement was observed in 210 of 310 (67.7%) children, with a higher prevalence in Crohn's disease (CD) compared to ulcerative colitis (UC) (73% vs 57%, P = 0.004). Children with an UGI involvement had significantly lower probability to achieve clinical remission (HR = 0.756, 95% CI 0.587–0.981, P = 0.035) and biomarker remission (HR = 0.596, 95% CI 0.453–0.784, P < 0.001) and were more likely to initiate biologic therapy (HR = 1.769, 95% CI 1.243–2.517, P = 0.001). An UGI involvement did not significantly affect hospitalization rates. A subgroup analysis revealed that an UGI involvement was associated with reduced biomarker remission in both CD and UC, and it was related to increased need of biologic therapy in CD.
Conclusions: An UGI involvement in pediatric IBD is associated with a more severe disease course, characterized by a lower rate of clinical and biomarker remission and a higher rate of biologic therapy. These findings highlight the importance of early endoscopic evaluation of the UGI tract in pediatric IBD to guide monitoring and treatment strategies.
Contact e‐mail address: Yes
G‐EV257. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV257.1. SAFETY AND EFFECTIVENESS OF INDIGO NATURALIS FOR INDUCTION OF REMISSION IN CHILDREN WITH MILD TO MODERATE ULCERATIVE COLITIS: A PROSPECTIVE OPEN‐LABEL TRIAL
Dotan Yogev 1, Yael Weintraub2, Oren Ledder1, Manar Matar2, Alex Krauthammer2, Zivia Shavit‐Brunschwig1, Nir Salomon2, Amit Assa1, Dan Turner3, Esther Orlanski‐Meyer1, Dror Shouval2
1The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel, 2Institute Of Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center of Israel, Petha‐Tikva, Israel, 3The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
Objectives and Study: Indigo Naturalis (QingDai, QD) is effective in inducing remission in adults with Ulcerative Colitis (UC). However, data in pediatrics is limited and potential pulmonary hypertension and hepatitis remain a concern. In this prospective open‐label study, we aimed to evaluate the efficacy and safety of QD for pediatric UC.
Methods: Children (4‐18) with mild‐moderate UC (PUCAI 10‐60) on stable medication, and not receiving steroids or biologics, were treated with QD for 6 weeks. Initial doses were weight‐based (500/750/1000 mg/day for 20‐30/30‐40/40+ kg, respectively) with possible dose escalation at week 3. Echocardiography was performed at baseline and week 6. The primary outcome was corticosteroid‐free remission at week 6 defined as PUCAI < 10 and a ≥ 10‐point reduction in PUCAI. Results were analyzed using intention‐to‐treat.
Results: Twenty children were enrolled (age 13.6 ± 2.4 years, disease duration 7[3‐12] months, 50% female), all were treated at baseline with 5ASA. Two discontinued QD early (UC exacerbation, poor compliance), 18 completed the study and 9 required dose escalation at week 3. Clinical remission was achieved in 13 patients (65%). Calprotectin levels <250 mg/kg and <100 mg/kg were observed in 13 (65%) and 10 (50%), patients, respectively. Significant reduction compared to baseline were noted in both PUCAI (30 [15‐40] vs. 5 [5‐15], p < 0.01) and calprotectin (588 [305‐1,137] vs 97 [44‐438], p = 0.03). Adverse events included headache (4 patients), vomiting (1) and nausea (1) and did not lead to treatment discontinuation. Mild transient hepatitis was noted in a single patient at week 3, another had minimal ALT elevation at week 6. There was no evidence of pulmonary hypertension at week 6.
Conclusions: QD is effective in inducing remission in children with biologic‐naïve mild‐moderate UC. Headache was the most common adverse event; pulmonary hypertension was not observed. Additional efficacy and safety studies are required to determine whether QD can be used for maintenance.
Contact e‐mail address:
G‐EV258. Topic: AS01. GASTROENTEROLOGY/AS01g. Inflammatory Bowel Disease
G‐EV258.1. COMBINING UNTARGETED METABOLOMICS AND OXIDIZED LIPIDOMICS TO EXPLORE LIPID METABOLISM AND POTENTIAL PATHOGENESIS OF NECROTIZING ENTEROCOLITIS
Juyi Zhao, Shuping Han
Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
Objectives and Study: Combining untargeted metabolomics and oxidative lipidomics to explore the lipid metabolism and potential pathogenesis of necrotizing enterocolitis (NEC) in animal models.
Methods: (1) The animal model of NEC in neonatal rats was constructed by hypoxia and hypertonic milk powder feeding, and collected the intestinal tissues and intestinal contents from each group. (2) Using untargeted metabolomics to detect the metabolites of intestinal contents, explore the lipid metabolites of differential changes in NEC animal model and analyze the pathways of enrichment metabolites. (3) Detection of oxidized lipid levels in intestinal tissues by targeted oxidized lipid metabolomics. (4) The results of untargeted metabolomics and targeted oxidized lipid metabolomics were jointly analyzed.
Results: (1) The animal model of NEC in neonatal rats was constructed by hypoxia and hypertonic milk powder feeding, and collected the intestinal tissues and intestinal contents from each group. (2) Using untargeted metabolomics to detect the metabolites of intestinal contents, explore the lipid metabolites of differential changes in NEC animal model and analyze the pathways of enrichment metabolites. (3) Detection of oxidized lipid levels in intestinal tissues by targeted oxidized lipid metabolomics. (4) The results of untargeted metabolomics and targeted oxidized lipid metabolomics were jointly analyzed.
Conclusions: Untargeted metabolomics and oxidized lipidomics showes that the metabolic pathway and related metabolites involved in NEC are related to arachidonic acid metabolism.
Contact e‐mail address:
G‐EV259. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV259.1. EATING BEHAVIOUR IN CHILDREN (10 ‐16 YEARS) WITH SIGNIFICANT FUNCTIONAL GASTROINTESTINAL DISORDER (FGID) AND ITS EFFECT ON QUALITY OF LIFE (QOL)
Tushar Kanti Banerjee, Antima Banerjee
Paediatrics, United Lincolnshire Teaching Hospital NHS Trust, Boston, United Kingdom
Objectives and Study: To understand the effect of symptoms of significant FGID (Rome IV criteria) and its impact on eating behaviour and QoL in young persons.
Methods: This mixed‐method survey involved 120 pediatric patients from general and pediatric gastroenterology clinics. It examined children's eating behaviour related to FGID through structured open‐ended and closed‐ended questions.
Results: Over 80% of children prefer familiar foods and are hesitant to try new items, a phenomenon known as neophobia. While 40% want to eat the same foods as their peers in social situations, they worry that trying new foods may worsen their diarrhoea or abdominal pain. Older children tend to feel more anxious about the possibility of experiencing diarrhoea after eating unfamiliar foods. 70% of children report experiencing mild to moderate anxiety when eating out, and 30% prefer to eat at home due to significant food‐related anxiety. Factors contributing to food avoidance include food texture and unpleasant oral sensations caused by sticky, mashed, or granular foods. Other considerations include spiciness, colour, and flavour. 90% of children do not recognize that their food‐avoidance behaviours might compromise their nutrition. Interestingly, many children mistakenly use the terms "food intolerance" and "food allergy" interchangeably, and a small percentage (10%) are concerned about the risk of anaphylaxis. Additionally, 20% of children report experiencing bullying related to their food avoidance in school or community settings, and 40% struggle with low self‐esteem. Almost all children (92%) feel that their eating behaviour affects their quality of life.
Conclusions: Recognising individual dietary preferences and understanding the various eating habits of children with Functional Gastrointestinal Disorders are essential for effective nutritional management. To achieve better outcomes, a multidisciplinary team, including adequate psychological support, should address significant food‐related anxiety. This approach can help to reduce the risk of neophobia and the avoidance of unacceptable adverse eating behaviours in children with significant FGID.
Contact e‐mail address: bnrjt07@gmail.com
G‐EV260. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV260.1. CORRELATIONS BETWEEN GASTROINTESTINAL AND WELLBEING OUTCOMES FOLLOWING 8 WEEKS OF PROBIOTIC SUPPLEMENTATION WITH BIFIDOBACTERIUM LONGUM 35624 IN CHILDREN WITH IRRITABLE BOWEL SYNDROME
Katy Sorensen1, Lucy Upton2,3, Gillian Quinlan4, Mary Belov 5, Asker Brejnrod6, Eamonn Quigley7
1Clinical Development, Novozymes A/S (part of the Novonesis group), Bagsvaerd, Denmark, 2The Children's Dietitian Ltd, Stratford‐Upon‐Avon, United Kingdom, 3The Feeding Trust, Birmingham, United Kingdom, 4Department Of Dietetics, University Hospital Limerick, Limerick, Ireland, 5Department Of Primary Care Dietetics, HSE West & North West, Galway, Ireland, 6Data Science, Novozymes A/S (part of the Novonesis group), Bagsvaerd, Denmark, 7Lynda K And David M Underwood Center For Digestive Health, Houston Methodist Hospital, Houston, Texas, United States of America
Objectives and Study: Irritable bowel syndrome (IBS) impairs quality of life (QOL). Previous studies found Bifidobacterium longum 35624 improved IBS symptoms and QOL in adults. Fewer studies report effects in children. This real‐world study explored gastrointestinal and wellbeing outcomes following B. longum 35624 supplementation.
Methods: Children experiencing symptoms of IBS (n = 220; 6years 10months ± 3 years; 48.6% female; 100% recurrent abdominal pain, 84.5% associated bowel habit changes) received B. longum 35624 (1x108 colony‐forming units/day; 8 weeks). Baseline and Week‐8 data from online questionnaires measured frequency (days per week) and severity (1‐10 least‐most) of gastrointestinal symptoms (abdominal pain, bloating, diarrhoea, constipation, bowel urgency, incomplete evacuation, and flatulence); missed days (within last 8 weeks) of: school, parent/guardian work, extracurricular activities, and social activities; and overall wellbeing (1‐10; worst‐best). Correlations between gastrointestinal symptoms and QOL were explored.
Results: Probiotic responses After 8 weeks, there were significant reductions in frequency and severity of all gastrointestinal symptoms and missed days of school (0.40 ± 1.23 vs. 2.21 ± 3.58) (Figure), parent/guardian work (0.45 ± 1.39 vs. 1.98 ± 3.39), extracurricular (0.55 ± 1.75 vs. 2.62 ± 3.68) and social activities (0.55 ± 1.94 vs. 2.36 ± 3.18), with an increase in wellbeing (all p < 0.001). Relationships between symptoms and QOL measures At baseline, the QOL domains most impacted by gastrointestinal symptoms were missed days of extracurricular and social activities, and wellbeing. The symptoms which correlated most strongly and significantly to these QOL domains at baseline were: pain, diarrhoea and urgency. The observed improvements in these QOL domains significantly correlated to the reductions in frequency and severity of pain, diarrhoea and urgency. For example, wellbeing increased from 6.51 ± 1.88 to 8.22 ± 1.79 (p < 0.001) and significantly correlated to reductions in severity of pain (p < 0.001), diarrhoea (p = 0.004) and urgency (p = 0.005).
Conclusions: B. longum 35624 may provide parallel improvements in gastrointestinal symptoms and meaningful measures of daily function and wellbeing in children, with abdominal pain, diarrhoea and bowel urgency being important determinants of QOL.
Contact e‐mail address: kass@novonesis.com
G‐EV261. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV261.1. ASSESSMENT OF SLEEP QUALITY IN CHILDREN DIAGNOSED WITH CONSTIPATION
Buket Daldaban Sarica 1, Yunus Emre Dogan2
1Pediatric Gastroenterology, KAYSERI CITY HOSPITAL, Kayseri, Turkey, 2Pediatrics, ERCIYES UNIVERSITY SCHOOL OF MEDICINE, Kayseri, Turkey
Objectives and Study: This study aimed to evaluate the sleep quality of children aged 5‐18 years diagnosed with functional constipation (FC). Between October and December 2023,25 children diagnosed with FC (15 M) aged 5‐18 years, who were followed up in the Pediatric Gastroenterology outpatient clinic of Kayseri City Hospital, were included in the study. A control group of 23 healthy children without any chronic diseases or other health problems was also included. The diagnosis of FC was made based on the Rome IV criteria.To assess sleep‐related issues, a sleep questionnaire consisting of 72 items was utilized. The questionnaire included behaviors observed during the night and sleep time as well as daytime behaviors, rated on a scale of "yes,sometimes,and no,"corresponding to scores of 2, 1, and 0, respectively. Higher scores indicated the presence of sleep problems.
Methods: The data were analyzed using IBM SPSS V23 (Chicago, USA). The normality of data distribution was tested using the Shapiro‐Wilk test. Homogeneity of variances was evaluated using the Levene test. For comparisons of normally distributed variables between groups, independent samples t‐test was used, while the Mann‐Whitney‐U test was applied for non‐normally distributed data. The Chi‐square test was used to compare gender differences. Linear regression analysis was conducted to assess the relationship between sleep scores and other variables. Effect size results were presented as mean ± standard deviation and median (minimum‐maximum), with statistical significance set at p < 0.05.
Results: When comparing the FC group and the healthy controls, the median sleep scores were significantly different (p < 0.001; 94 vs. 64). A strong positive correlation was found between the duration of complaints and sleep score (r1 = 0.719;p < 0.001). Additionally, a strong negative correlation was observed between hemoglobin levels and sleep score (r1 = ‐0.663; p < 0.001).
Conclusions: It is important to evaluate children with FC for sleep disorders and initiate treatment promptly to address both gastrointestinal and sleep‐related issues.
Contact e‐mail address:
G‐EV262. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV262.1. CLINICAL CHARACTERISTICS, FOLLOW‐UP ASSESSMENTS AND TREATMENT OUTCOMES IN PEDIATRIC ACHALASIA: A SINGLE‐CENTER STUDY
Neslihan Ekşi, Naimi Ahmadli, Burcu Berberoğlu Ateş, Gülin Hizal, Selim Dereci, Şamil Hızlı
Pediatric Gastroenterology, Hepatology And Nutrition, Bilkent City Hospital, Ankara, Turkey
Objectives and Study: Esophageal achalasia is a rare primary disorder of esophageal motility and is considered an uncommon cause of dysphagia in children.It is often managed with frequent endoscopic dilatations or surgical interventions.Given the rarity of pediatric achalasia,our objective was to contribute clinical data,follow‐up assessments and treatment outcomes regarding our patients to the existing medical literature.
Methods: The data of the patients who were diagnosed with achalasia between 2022 and 2024 were included in the study.The demographic data of the patients,clinical findings and Eckardt scores in diagnosis and follow‐up,imaging studies were evaluated retrospectively.
Results: The study included 16 patients,68.7%were male.The median age was 13.5 years.The median follow‐up time was 7 months(6‐33 months).On admission,the median body weight Z‐score was ‐2.2(1 mild,4 moderate,5 severe malnutrated).The median value of body mass index Z‐score of 15 patients older than 5 years was ‐1.13.Clinical presentations are shown in Table 1.The median of the baseline Eckardt score was 6.All patients underwent barium esophagography before diagnosis.Endoscopic evaluation of the upper gastrointestinal tract was performed in 14(87.5%) patients.Nine(64.2%) had dilatation in the proximal part of the esophagus and resistance in the transition to the distal part.High‐resolution manometry(HRM) was performed in 12(75%)patients.Eleven balloon dilatation(BD) was performed on 8 patients.A decrease in Eckardt score was observed in 6(75%)patients who underwent BD.BD was performed for the second time in 3 patients.Per‐oral endoscopic myotomy(POEM) was performed as the first‐line treatment for 2 patients:one with type 3 and one with type 2 achalasia. Heller myotomy(HM) was performed as the first‐line treatment for 3 patients.
Conclusions: Consequently,in our study,the most frequent was type 2 achalasia,compatible with the literature.The presence of Triple A patients was particularly notable.Due to the Eckardt score,BD had 75% success in our study.While LHM and POEM are regarded as the preferred treatment modalities,BD treatment emerges as a significant treatment option,particularly due to its less invasive nature.
Contact e‐mail address:
G‐EV263. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV263.1. COMPARE THE BALLOON EXPULSION TEST (BET) IN SUPINE POSITION AND WHILE SITTING ON THE TOILET
Jamal Garah 1, Ron Shaoul2
1Pediatric Gastroenterology, Rambam Medical Center, Haifa, Israel, 2Pediatric Gastroenterology, Rambam Health Care Campus, Haifa, Israel
Objectives and Study: Defecatory disorders in children, including chronic constipation (CC) and fecal incontinence (FI), are common conditions worldwide and have a significant impact on children, their families, and the healthcare system. Anorectal manometry (ARM) is relatively novel tool for the assessment of anal sphincter function and rectal sensation and have contributed significantly to improving the understanding of the anorectum as a functional unit. ARM has been recognized as the investigation of choice for adults with symptoms of defecation disorders, including fecal incontinence (FI), evacuation difficulties, and constipation. An important part of ARM is to evaluate the effect of pushing (PUSH) in order to evaluate evacuation disorders. The balloon expulsion test (BET) is extensively used in adults with constipation and suspected pelvic outlet obstruction. BET is reported to be 88% sensitive and 89% specific for this diagnosis. We hypothesize that performing this test while sitting on the toilet, would better imitate the physiologic defecation process and therefore would be more reliable compared to supine position. The aim of our study to compare BET in supine position and while sitting on the toilet. The BET has been done along with ARM
Methods: Prospective study comparing BET in supine position and while sitting on the toilet. The BET has been done in 40 children, ages 5 to 17 years, with defecatory disorders. For BET, a 50‐mL balloon was used. Passage of balloon in 1 minute or less was considered normal.
Results: From the cohort of 40 patients, only one (2.5%) expelled the baloon within the allowed time in supine position compared to six (15%) in the toilet sitting position
Conclusions: The balloon expulsion test is used in patients with constipation and suspected pelvic outlet obstruction. Our study supports performing this test while sitting on the toilet, which better reflects normal physiologic position compared to supine position.
Contact e‐mail address: j_garah@rambam.health.gov.il
G‐EV264. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV264.1. HIGH RESOLUTION ANORECTAL MANOMETRY IN PATIENTS WITH ANORECTAL MALFORMATION: AN HELPFUL ALLAY TO SET A PERSONALIZED TREATMENT
Gaia Margiotta1, Francesco Proli2, Giuseppe Stella2, Alessia Cherubino2, Bianca Mazzoli2, Camilla Pietrantoni2, Claudia Rendeli2, Antonio Gasbarrini3, Valentina Giorgio 4
1Uoc Pediatria, Policlinico Universitario Agostino Gemelli, Roma, Italy, 2Department Of Woman And Child Health And Public Health, Uoc Pediatria, Fondazione Policlinico Universitario Agostino Gemelli Irccs, Rome, Italy, Policlinico Universitario Agostino Gemelli, Roma, Italy, 3Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy, rome, Italy, 4Department Of Woman And Child Health And Public Health, Uoc Pediatria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
Objectives and Study: Anorectal manometry (HRAM) is the most used device to analyse the anal sphincter complex, both in functional and anatomic disorders. Approximately 43% of children affected by anorectal malformation (ARM), despite surgical and medical therapy, continue to experience faecal incontinence (FI). HRAM may help clinicians to detect specific defecatory disorders in order to choose a personalized treatment. The aim of our study was to describe the manometric profile of the reconstructed anal sphincter in children with ARM. We also aimed to identify an eventual correlation between the manometric profile and the ARM subtype
Methods: This is a monocentric, prospective, pilot, interventional study enrolling children aged 4‐17 years with ARM (24 patients) or functional refractory constipation (FC) (28 patients). Both groups underwent 3D‐HRAM. A descriptive analysis of the demographics and clinical characteristics was performed.
Results: Anal atresia was the most common ARM subtype (58.3%). Comparing high ARM with low ARM groups, faecal incontinence was prevalent in the high‐ARM one (100%), while refractory constipation was more prevalent in the low‐ARM group (85.7%). As for manometric parameters, in FC group, average resting anal pressure was 48.8 mmHg, residual push pressure was 71.5 mmHg and maximum rectal compliance was 1.4 mmHg. In ARM group average resting anal pressure was 35.7 mmHg, residual push pressure was 55.0 mmHg, and maximum rectal compliance was 0.7 mmHg, therefore all these analysed values were lower in the ARM group. Moreover, patients with high‐ARM show lower pressure values compared to patients with low‐ARM, as the latter group seems to have FI while patients with low ARM may suffer more from refractory constipation.
Conclusions: Patients with ARM present a complex clinical picture with significant manometric differences compared to patients with FC, and between ARM subtypes, highlighting the need for personalized management strategies. Further studies are needed to increase the statistical significance of these results.
Contact e‐mail address: gaia.margiotta@gmail.com
G‐EV265. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV265.1. EVALUATION OF THE DEVELOPMENT OF FUNCTIONAL GASTROINTESTINAL DISEASES IN CHILDREN BETWEEN 4‐18 YEARS OF AGE DIAGNOSED WITH COW'S MILK PROTEIN ALLERGY
Nur Kevser Özyurt, Merve Kişioğlu, Burcu Güven, Nalan Yildiz, Fazil Orhan
Pediatric Gastroenterology, Karadeniz Technical University, trabzon, Turkey
Objectives and Study: It is thought that CMPA may play a role in the pathophysiology of functional gastrointestinal diseases (FGIH) in the long term. In this study, our aim is to question the gastrointestinal symptoms in the long‐term follow‐up of patients with CMPA diagnosis, to recognize and gain awareness of frequently encountered FGIH, and to compare the development of FGIH in IgE and non‐IgE CMPA patients.
Methods: Our study includes patients diagnosed with CMPA, whose treatments were finalized and whose current ages were between 4 and 18, who applied to Pediatrics Polyclinics. The control group consisted of 250 healthy children of similar age group who were not diagnosed with CMPA. The patients were administered the Pediatric Gastrointestinal Symptoms Questionnaire including Rome IV criteria. Laboratory findings of the children (skin prick test, total IgE, complete blood count) were obtained from patient files and hospital system records.
Results: The mean age of the CMPA patient group was 5.6 ± 2.0 (age±SD) years, and the mean age of patients without CMPA was 6.5 ± 3.1 (age±SD) years. 107 (42.8%) of the patients were diagnosed with IgE‐mediated CMPA. Functional GIS disease was observed in 70 (28%) of the patients with CMPA and in 76 (30.4%) of those without CMPA (p = 0.623). FGIH was observed in 36 (33.6%) patients with IgE‐mediated CMPA and in 34 (23.8%) patients with non‐IgE‐mediated CMPA. Functional abdominal pain, irritable bowel syndrome and encopresis were significantly more common in patients without CMPA (p = 0.009, p = 0.016, p = 0.01, respectively). Functional dyspepsia, functional abdominal pain and irritable bowel syndrome were observed more frequently in patients with IgE‐mediated CMPA (p = <0.001, p = 0.001, p = 0.002, respectively).
Conclusions: Although the frequency of FGID development does not increase significantly in the long term in patients diagnosed with CMPA, functional dyspepsia, functional abdominal pain, and irritable bowel syndrome are considerably higher, especially in those with IgE‐mediated ones.
Contact e‐mail address:
G‐EV266. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV266.1. EVALUATION OF TRANSCUTANEOUS INTERFERENTIAL ELECTRICAL STIMULATION IN THE TREATMENT OF CHRONIC CONSTIPATION IN CHILDREN: A PILOT STUDY
Hannelore Van Gool1, Elien Baert2, Inge Geraerts2, Marc Miserez3, Karen Van Hoeve4, Ilse Hoffman 4
1Department Of Pediatrics, University Hospitals, Leuven, Belgium, 2Department Of Physical Medicine And Rehabilitation, University Hospitals, Leuven, Belgium, 3Department Of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium, 4Department Of Pediatric Gastroenterology, Hepatology & Nutrition, Universital Hospitals Leuven, Leuven, Belgium
Objectives and Study: This study evaluated the effectiveness of interferential therapy (IFT) in children with therapy‐resistant pelvic floor dyssynergia‐type constipation (PFD).
Methods: Children with PFD were selected through baseline investigations. Data were collected using stool diaries, anal manometry and quality of life (QoL) questionnaires. IFT was administered using an interferential stimulator with four adhesive electrodes (two on the abdomen, two on the back). Therapy adjustments were made after three months based on the progress. Primary outcomes included achieving normal defecation frequency (3x/day – 3x/week), 50% reduction in soiling episodes, and improved stool consistency (Bristol Stool Chart scores of 3 – 5 for > 50% of movements). Secondary outcomes included reduced laxative use, improved rectal sensation and QoL. Follow‐up lasted one year.
Results: This pilot study included 15 children (6 girls, 9 boys, mean age 11.4 years) with PFD. After one year, defecation frequency increased (mean 6,1/week to mean 8,8/week, p = 0,06), stool consistency improved significantly (75% to 100% of patients achieving normal consistency, p = 0,01) and soiling episodes decreased (mean 2,4/week to mean 0,5/week, p = 0,22). Laxative use dropped significantly (75% to 45% of patients using laxatives, p = 0,05), with 45% of patients no longer requiring therapy. QoL scores improved significantly: gastrointestinal QoL scores increased from 69/100 to 82/100 (p = 0,01) for patients and from 65/100 to 82/100 (p = 0,01) for parents. General QoL scores rose from 64/100 to 78/100 (p = 0,00) for patients and from 58/100 to 76/100 (p = 0,00) for parents. Anal manometry revealed improved rectal sensation and defecation urge. No adverse events were reported.
Conclusions: IFT improved stool consistency, reduced laxative use, and enhanced QoL in children with PFD. It also improved rectal sensation and defecation urge. Adding IFT to standard treatment may reduce need for water enemas and enhance QoL for patients and families.
Contact e‐mail address: ilse.hoffman@uzleuven.be
G‐EV267. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV267.1. MANAGEMENT OF PEDIATRIC ACHALASIA PATIENTS :CLINICAL EXPERIENCE
Sinem Kahveci 1, Maşallah Baran2, Ilksen Demir3, Kardelen Akın3, Betül Aksoy2, Suleyman Gunay4, Senay Onbası Karabag5, Yeliz Cagan Appak2, Gokhan Koyluoglu6
1Pediatric Gastroenterology, Izmir City Hospital, Izmir, Turkey, 2Pediatric Gastroenterology, Izmir Katip Celebi Univercity, Izmir City Hospital, Izmir, Turkey, 3Pediatric Gastroenterology, Izmir Katip Celebi Univercity, Izmir City Hospital, izmir, Turkey, 4Gastroenterology, Izmir Katip Celebi Univercity, Izmir, Turkey, 5Pediatric Gastroenterology, Izmir City Hospital, izmir, Turkey, 6Pediatric Surgery, Izmir Katip Celebi Univercity, Izmir City Hospital, Izmir, Turkey
Objectives and Study: Achalasia is a rare neuromuscular disorder of the esophagus. Pediatric achalasia data are limited in pediatric case series.
Methods: We retrospectively evaluated the demographic data, clinical follow‐up, treatments applied of achalasia patients.
Results: Eighteen pediatric patients (9 male,9 female) were evaluated. The age at diagnosis was 10( ± 5.1) years and body weight Z score was 1( ± 1.2) standart deviation score(SDS). At the diagnosis Eckardt Score is 8.4( ± 2.6). The most frequent complaint at admission (%44.4) was a feeling of getting stuck while swallowing. Fluoroscopic imaging was performed in 17 patients (%94.4) and all patients were found to be compatible with achalasia. The most common finding in upper gastrointestinal system endoscopy was stenosis in the distal esophagus and dilatation in the proximal part of the esophagus. Manometry was performed in 9(% 50)patients.(8 patients type 2 achalasia, 1 patient type 1 achalasia). Balloon dilatation was applied to 17(94.4%) patients. Pain and pleurisy were observed in only 1 patient as complications, no need for treatment. Balloon dilatation was required for the second time in 12 patients (%66.7); and third repeat was performed in 4 patients (%22.2).Heller myotomy was performed in 3 patients and symptoms recurred later in 2 patients. Nifedipine and botulism injection were administered only 1 patient, but it was unsuccessful. Peroral endoscopic myotomi(POEM) was applied to 7 patients who were unresponsive to treatment or had recurrent symptoms. The Eckardt Score of the patients before POEM was 4 ( ± 1.4); after POEM was 0. Pneumoperitoneum was observed in 1 patient during the procedure. It regressed without treatment. The follow‐up period of patients was 27 (8‐156) days.
Conclusions: Achalasia presents with recurrent symptoms in children. Patients may need repeated endoscopic or surgical treatment. POEM is also a safe and effective approach for pediatric achalasia.
Contact e‐mail address: dr_skahveci@hotmail.com
G‐EV268. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV268.1. EVALUATION OF CHILDREN WHO UNDERWENT UPPER ENDOSCOPY DUE TO ESOPHAGEAL DYSPHAGIA
Selen Şimşek Pervane, Elif Çivit, Ferda Hosnut, Asuman Nur Karhan
Pediatric Gastroenterology, Hepatology And Nutrition, Ankara Etlik City Hospital, Ankara, Turkey
Objectives and Study: Swallowing difficulties may have serious consequences and endoscopic examination is very useful to differentiate organic pathologies from non‐organic ones. Swallowing difficulties are rarely encountered among children thus we aimed to evaluated the results of upper gastrointestinal endoscopies performed for swallowing difficulties to contribute to literature.
Methods: Pediatric patients who admitted to pediatric gastroenterology department in last two years due to esophageal dysphagia and underwent upper endoscopy were evaluated retrospectively. Patients with oropharyngeal dysphagia were excluded. Clinical features, endoscopic findings, treatments, and treatment responses were recruited.
Results:
38 patients underwent upper endoscopy due to esophageal dysphagia. The mean age was 11.8 years, M/F ratio was 63.1%, duration of dysphagia was 13.6 months. The main pathological results were, non‐specific esophagitis (n = 12, %31.6), eosinophilic esophagitis (n = 6, 15.8%) and candida esophagitis (n = 1, 2.6%) associated with inhaled corticosteroid use respectively. Esophageal strictures were found in three patients (7.9%); one patient diagnosed as achalasia via HR manometry remaining two had congenital strictures. One patient had aberran right subclavian artery detected with CT angiography. Seven patients (%18.4) had normal endoscopic and pathological findings with normal HR manometry results, so psychogenic dysphagia was considered. No statistically significant differences were found between finding an organic etiology in the endoscopic examination and age, sex, duration of symptoms, and presence of growth delay. PPIs treatment were given in 28 patients (%73.7). Three patients (%7.9) were referred to surgery. Seven patients (%18.4) psychogenic dysphagia received support from the child mental health department.
Conclusions: The etiology of dysphagia is diverse, and treatment involves a wide range of approaches. Our study revealed that frequency of organic pathology is high but there is also a remarkable number of patients with psychological problems. Thus, there is a need for extensive studies to identify diagnostic markers to make a non‐invasive diagnosis during the evaluation process.
Contact e‐mail address: asunurkar83@gmail.com
G‐EV269. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV269.1. THE RELATIONSHIP OF THE HYDROGEN‐METHANE BREATH TEST WITH CLINICAL EXAMINATION, THE MICROBIOTA OF THE SMALL AND LARGE INTESTINE IN CHILDREN WITH DIGESTIVE DISEASES
Aleksandr Shabalov1, Elena Kornienko 2, Alexandra Buntovskaya1, Alexandra Trandina1, Vyacheslav Kilimnik3
1Department Of Children's Diseases, Military medical academy of S.M. Kirov, Saint‐Petersburg, St. Petersburg, Russian Federation, 2Saint‐Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation, 3Department Of Biotechnical Problems, St. Petersburg State University of Aerospace Instrumentation, St. Petersburg, Russian Federation
Objectives and Study: To evaluate the relationship between the concentration of hydrogen and methane in exhaled air with clinical examination, the microbiota of the small and large intestine in children with the small intestinal bacterial overgrowth (SIBO).
Methods: 102 patients aged 10.6 ± 3.9 years (55 girls and 47 boys) with digestive diseases (functional dyspepsia, GERD, chronic gastroduodenitis) were examined. A hydrogen breathing test "Lactophan" and a hydrogen‐methane test "GastroCheck" with lactulose were performed to determine hydrogen‐induced (H2‐ SIBO) and methanogenic (CH4‐ SIBO), the area under the curve (AUC, H2 and CH4, ppm) for 0‐90 minutes. Microbiota in biopsies of the small intestine was studied in 17 patients, in 47 patients in feces by real‐time PCR.
Results: SIBO was diagnosed in 74 (72.6%) patients, of whom 62 (60.8%) had H2‐ SIBO, and 12 (11.8%) had CH4– SIBO. The duration of nausea (r = 0.774, p = 0.041), rapid satiety/severity after eating (r = 0.818, p = 0.047) correlated with CH4 for 60 minutes. studies and AUC, CH4 (0‐90 min.). A negative relationship was obtained between the H2 level for 30 minutes. respiratory test and the content in the small intestine of Bifidobacterium spp. (r =‐0.852; p = 0.078) and Faecalibacterium prausnitzii (r =‐0.821; p = 0.089). A reliable relationship between CH4 for 30‐60 minutes has been determined respiratory test and Acinetobacter spp. (r = 0.920; p = 0.027), Streptococcus spp. (r = 0.881, p = 0.049) and Escherichia coli (r =‐0.970; p = 0.006). CH4 level for 30‐90 min. The study correlated with the content of Methanobrevibacter smithii in faeces (r = 0.774, p = 0.041), and not in biopsies of the small intestine.
Conclusions: H2‐ and CH4‐ SIBO were characterized by a decrease in the content of bacteria with anti‐inflammatory properties and an increase in bacteria with pro‐inflammatory potential and contributing to damage to the barrier function of the small intestine. The level of methane correlated with the duration of a number of dyspeptic complaints, which requires timely diagnosis and therapy of SIBO.
Contact e‐mail address: Aleks-Shabalov2007@yandex.ru
G‐EV270. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV270.1. NO DIFFERENCE IN GASTROESOPHAGEAL REFLUX PREVALENCE BETWEEN INFANTS WITH CLEFT LIP AND THOSE WITH CLEFT PALATE: A 30‐YEAR, RETROSPECTIVE PH‐MONITORING STUDY
Martin Schils1, Kallirroi Kotilea 2,3, Diane Franck1
1Pediatric Surgery, Hopital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgium, 2Pediatric Gastroenterology, Hopital Universitaire des Enfants Reine Fabiola. Hopital Universitaire de Bruxelles., Brussels, Belgium, 3Faculte De Médecine, Universite Libre de Bruxelles, Brussels, Belgium
Objectives and Study: To assess whether infants with isolated cleft palate (CP) or cleft lip and palate (CLP) are at higher risk for acid gastroesophageal reflux compared to infants with isolated cleft lip (CL) without palate involvement. Retrospective case‐control study. The study was conducted at a tertiary care academic center between January 1988 and December 2017.
Methods: We included infants with isolated CP or CLP who underwent pH monitoring before primary surgery were included as cases. Age‐matched controls were infants with isolated CL who also underwent pre‐surgery pH monitoring. The primary outcome was the comparison of seven pH parameters, including the reflux index (RI), between groups. The prevalence of acid reflux was calculated and compared to previously published normal values for the pediatric population.
Results: The study included 52 CL controls and 182 cases (87 CP, 95 CLP). The prevalence of gastroesophageal reflux disease (GERD) was similar between CP/CLP cases and CL controls (p > 0.1). However, both groups showed significantly higher acid reflux prevalence than the normal pediatric population (p < 0.01) for all parameters except the total number of reflux episodes).
Conclusions: There was no significant difference in acid reflux occurrence between infants with CL and those with CP/CLP, suggesting that anatomical abnormalities of the palate may not be the primary cause of reflux. However, both groups exhibited higher acid reflux prevalence compared to non‐cleft infants. These findings suggest that a motility disorder of the esophagus could be a contributing factor to the increased GERD prevalence in infants with orofacial clefts, leading to a new hypothesis for further exploration.
Contact e‐mail address: kalliroy.kotilea@ulb.be
G‐EV271. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV271.1. "PIERRE ROBIN SEQUENCE: FAR FROM JUST A SIMPLE ANATOMICAL TRIAD"
Martin Schils1, Kallirroi Kotilea 2,3, Diane Franck1
1Pediatric Surgery, Hopital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgium, 2Pediatric Gastroenterology, Hopital Universitaire des Enfants Reine Fabiola. Hopital Universitaire de Bruxelles., Brussels, Belgium, 3Faculte De Médecine, Universite Libre de Bruxelles, Brussels, Belgium
Objectives and Study: To determine the prevalence of gastroesophageal reflux disease (GERD) in infants with Pierre Robin Sequence (PRS) and enhance understanding of preoperative feeding disorders, ultimately optimizing care before surgery. Retrospective case‐control study. The study was conducted at an academic tertiary care center including patients born from January 1988 to December 2017.
Methods: The study included 31 infants with PRS who underwent pH monitoring prior to primary surgery. Age‐matched controls included 86 infants with isolated cleft palate (CP), also monitored pre‐surgery. The primary outcome was the comparison of seven pH parameters, with the reflux index (RI) used to calculate the exact prevalence of GERD.
Results: Infants with PRS had a significantly higher prevalence of GERD (61%) compared to CP controls (16%). Significant differences between PRS and CP groups were found for two key parameters: the total reflux index (RI) and the number of reflux episodes lasting more than 5 minutes.
Conclusions: The prevalence of GERD in infants with PRS (61%) is notably higher than in children with isolated cleft palate (16%). These findings suggest that PRS involves more than just a triad of anatomical defects, with underlying esophageal motor dysfunction and swallowing coordination disorders possibly playing a crucial role. Therefore, close collaboration with a gastroenterologist is essential to ensure effective management of GERD and optimize preoperative care for these complex patients.
Contact e‐mail address: kalliroy.kotilea@ulb.be
G‐EV272. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV272.1. LOW SENSITIVITY OF THE CARBON‐13 BREATH TEST FOR LACTOSE MALABSORPTION DIAGNOSIS IN CHILDREN
Zina Kadiri1, Edmee Delmotte2, Patrick Bontems1, Kallirroi Kotilea 1,3
1Pediatric Gastroenterology, Hopital Universitaire des Enfants Reine Fabiola. Hopital Universitaire de Bruxelles., Brussels, Belgium, 2Nuclear Medicine, Brugmann University Hospital, Brussels, Belgium, 3Faculte De Médecine, Universite Libre de Bruxelles, Brussels, Belgium
Objectives and Study: This study compares the performance of the carbon 13 (13C) breath test to the hydrogen (H2) and methane (CH4) breath tests in diagnosing lactose malabsorption in a pediatric cohort. It explores potential clinical and demographic factors influencing test outcomes.
Methods: This diagnostic study analyzed data from 133 children who underwent H2/CH4 and 13C breath tests after ingesting 13C‐enriched lactose. The H2 and CH4 concentrations in exhaled air were directly measured using gas chromatography, while 13C levels were assessed using mass spectrometry. Samples for mass spectrometry were stored for 1–5 months. Demographic data were recorded, including age, weight, height, parental origin, and pre‐test symptoms.
Results: Demographic and clinical analyses revealed no significant differences in patient characteristics based on their results from the H2 and CH4 breath test, except for a lower Z‐score of the body mass index (BMI) in positive patients, with a median of 0.2 (‐0.95; 0.675). The Receiver Operating Characteristic (ROC) curve revealed poor diagnostic performance for the 13C test, with an area under the curve (AUC) of 0.528, indicating low sensitivity. The mean delta 13C value was 34.05. Restricting the analysis to samples measured within two weeks of collection yielded a marginally improved AUC of 0.548, but the diagnostic accuracy remained suboptimal.
Conclusions: The 13C breath test demonstrates low sensitivity for diagnosing lactose malabsorption in children and adolescents. Despite its ability to assess lactase activity directly, the test's diagnostic accuracy is limited by sample handling and variability in measurement over time. Its primary limitations include the inability to evaluate sample quality at the time of collection.
Contact e‐mail address: kalliroy.kotilea@ulb.be
G‐EV273. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV273.1. IMPACT OF POSTERIOR URETHRAL VALVE ABLATION ON CHRONIC CONSTIPATION IN CHILDREN: A PROSPECTIVE OBSERVATIONAL STUDY
Lara Limansky 1, Sara Isoldi1, Cristina Bucci1, Paolo Quitadamo1, Maria Giovanna Puoti1, Rossella Turco1, Francesco Cirillo1, Nicola Cecchi1, Vera Manganaro2, Chiara Santoro2, Agnese Roberti2, Alessandra Farina2, Di Iorio Giovanni2
1Pediatric Gastroenterology and Hepatology Unit, Santobono‐Pausilipon Children's Hospital, Naples, Italy, 2Pediatric Urology Unit, Santobono‐Pausilipon Children's Hospital, Naples, Italy
Objectives and Study: Urinary symptoms are frequently associated with constipation, possibly due to rectal distension compressing the bladder. However, the relationship between primary urological conditions and gastrointestinal disorders is currently underexplored. The present study aimed at evaluating the prevalence of constipation in children with posterior urethral valve (PUV) and at assessing the effects of therapeutic cystoscopy for PUV ablation on constipation symptoms.
Methods: This prospective observational study was conducted from January 2021 to March 2024 at the Santobono‐Pausilipon Children's Hospital in Naples, Italy. All pediatric patients (0–16 years) diagnosed with PUV were enrolled and both demographic and clinical data were collected. Patients were assessed for constipation symptoms at diagnosis and after PUV ablation according to Rome IV criteria.
Results: A total of 101 children were enrolled in the study (mean age: 10 months; age range: 10 days to 198 months). At diagnosis, constipation was present in 27% of patients. Following PUV ablation, constipation symptoms resolved in 55.5% of these cases (p: <0.01). Urinary symptoms improved in 68% of patients and resolved completely in 13%. No significant correlation was found between patient characteristics and constipation resolution.
Conclusions: The study reveals a high prevalence of constipation in children with PUV and demonstrates significant improvement in constipation symptoms following intervention of PUV ablation. These findings underscore the bidirectional relationship between urinary and gastrointestinal dysfunctions and highlight the importance of an interdisciplinary approach between pediatric urology and gastroenterology.
Contact e‐mail address: laralimansky@gmail.com
G‐EV274. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV274.1. EFFECTIVENESS OF INTERDISCIPLINARY, MULTIMODAL OUTPATIENT TREATMENT OF FUNCTIONAL ABDOMINAL PAIN DISORDERS IN ADOLESCENTS ‐ A RETROSPECTIVE ANALYSIS OF 8 YEARS OF DATA
János Major 1, Zsófia Havrán1, Adrienn Vargay2
1Institute Of Behavioural Medicine, Semmelweis University, Budapest, Hungary, 2Paediatric Pain Centre, Bethesda Children's Hospital, Budapest, Hungary
Objectives and Study: Functional abdominal pain disorders (FAPDs) affect approximately 12% of adolescents in Hungary. The treatment of these disorders of the gut‐brain interaction represents a significant challenge on a worldwide level. In the present study, we aimed to investigate patients aged 11 to 18 years with FAPDs who received interdisciplinary, multimodal pain therapy at the Bethesda Children's Hospital Paediatric Pain Centre and completed the assessment questionnaire between 06.02.2013 and 23.03.2021. We aimed to investigate changes in their detailed pain parameters and pain‐related disability as a result of treatment.
Methods: A retrospective analysis of self‐reported questionnaires completed by patients (N = 86) were analysed (before treatment and at 3 months). Mean agewas 14.3 years (SD 2.0, N = 60 girls). We measured the location, time of onset, frequency, duration of pain, the most severe, average pain in the last 4 weeks using numerical rating scale (NRS), the Paediatric Pain Disability Index (PPDI). The effectiveness of pain therapy was measured using a paired Wilcoxon test and paired sample t‐test for pain frequency, severity and PPDI (p < 0.05 was considered as statistically significant change).
Results: 26.7% of the sample reported pain in two body sites. The average duration of pain was 25.6 months (SD 29.2), 36.5% reported continuous pain. The mean pain score was 5.7 (SD 2.2) NRS, most severe pain was 7.2 (SD 2.1) NRS. In the control visit, the frequency of pain was statistically significantly reduced, as was the mean pain to 4.8 (SD 2.7, p = 0.009) and the most severe pain to 6.1 (SD 3.1) according to NRS,(p = 0.049). PPDI (from M = [32.4], SD = [11.6]) also showed a statistically significant reduction (M = [28.2], SD = [11.1]) at the second appointment (t(25) = 2.4, p < 0.02).
Conclusions: The potential efficacy of interdisciplinary, multimodal approaches in addressing functional abdominal pain disorders warrants further investigation.
Contact e‐mail address: major.janos@bethesda.hu
G‐EV275. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV275.1. ESOPHAGEAL ACHALASIA IN A 2‐YEAR‐OLD PATIENT: CASE REPORT
Jhoanna Valery Adauto Luizaga1, Maria Manin 1, Leandro Fanjul‐Regueira1, Mauricio Urquizo1, Emilia Cohen1, Veronica Busoni1, Andres Ditaranto2
1Buenos Aires, Hospital Italiano de Buenos Aires, CABA ‐ BUENOS AIRES, Argentina, 2Buenos Aires, Hospital Britanico, CABA ‐ BUENOS AIRES, Argentina
Objectives and Study: Achalasia is a rare neuromuscular disorder of esophageal motility. It is an exceptional condition in the pediatric population and extremely rare in children under 5 years old. The aim of this paper is to present the case of achalasia diagnosed in a 2‐year‐old patient.
Methods: The patient, initially presenting with nocturnal vomiting at 18 months, underwent normal primary investigations. Due to persistent symptoms, a gastroenterology evaluation was conducted, which included an upper gastrointestinal videoendoscopy with no significant findings and a pathological 24‐hour pH/impedance study, leading to a diagnosis of gastroesophageal reflux disease (GERD). Treatment was initiated but without adequate response. A follow‐up gastroduodenal series revealed material retention, impaired peristalsis and lack of lower esophageal esphincter (LES) relaxation, consistent with achalasia. High‐resolution manometry confirmed the diagnosis, showing a hypertensive LES and absent peristalsis. The patient was managed by a multidisciplinary team and began balloon dilations with an initial positive response. However, short symptom‐free periods and weight loss led to a decision for Heller myotomy and Dor fundoplication, with good postoperative recovery.
Results: Achalasia typically presents with an insidious onset and variable clinical manifestations, which can delay diagnosis and treatment. Although performing manometry in pediatric patients is challenging, conducting this study in a patient of this age was crucial for diagnosis. Pneumatic dilation and surgical myotomy are currently the treatment of choice for symptomatic achalasia. The selection of one over the other as the first treatment option depends on the experience of the center and the patient's characteristics.
Conclusions: Due to the rarity of the condition and the lack of experience at this age, there is often a delay in diagnosis and treatment. It is essential to include achalasia in the differential diagnosis, especially in patients who do not respond adequately to initial treatment.
Contact e‐mail address: jhoanna.adauto@hospitalitaliano.org.ar
G‐EV276. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV276.1. GASTROINTESTINAL MOTILITY AND AUTONOMIC NERVOUS SYSTEM FUNCTION IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE AND IRRITABLE BOWEL SYNDROME
Ana Močić Pavić 1, Paola Ruška1, Zrinjka Mišak1, Magdalena Krbot Skorić2, Mario Habek3, Iva Hojsak4
1Referral Center For Pediatric Gastroenterology And Nutrition, Children's Hospital Zagreb, Zagreb, Croatia, 2UHC Zagreb, ZAGREB, Croatia, 3Neurology, UHC Zagreb, ZAGREB, Croatia, 4Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia
Objectives and Study: Electrogastrography (EGG) is a noninvasive method for the measurement of gastric myoelectrical activity that uses abdominal surface electrodes. This study aimed to investigate the differences in gastric motility measured with EGG and its correlation with standardized autonomic nervous system tests in children with inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and healthy children (HC).
Methods: Sixty‐two children were enrolled: 18 in the IBD, 26 in the IBS, and 18 in the HC group. ANS symptoms were evaluated with the Composite Autonomic Symptom Score (COMPASS‐31). COMPASS31 > 7.913 was considered a clinically significant autonomic symptom burden. The severity and distribution of ANS function were quantitated using adrenergic, cardiovagal, and sudomotor indices of the Composite Autonomic Severity Scale (CASS). Gastric myoelectric activity was obtained from EGG in the preprandial and postprandial periods (standardized meal 300 kcal).
Results: There was no statistically significant difference in any of the EGG parameters between groups (all p > 0.05). Autonomic symptom burden measured with COMPASS‐31 score negatively correlated with postprandial period dominant frequency (PDF) (r = ‐0.316, p = 0.02). The gastrointestinal domain of the COMAPSS‐31 did not correlate with PDF (p > 0.05). However, the orthostatic intolerance domain of the COMAPSS‐31 negatively correlated with postprandial PDF (r = ‐0.364, p = 0.007). Children with clinically significant autonomic symptom burden had lower values of postprandial PDF (2.8 (IQR 0.19) vs 2.9 (IQR 0.23), p = 0.016). CASS and its indices did not correlate with any of the EGG parameters.
Conclusions: These findings indicate that children with higher and clinically significant autonomic symptom burden postprandially have lower levels of gastric activity.
Contact e‐mail address: ivahojsak@gmail.com
G‐EV277. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV277.1. COMPARISON OF EFFICACY, SAFETY & TOLERABILITY OF POLYETHYLENE GLYCOL 3350 + ELECTROLYTES VERSUS POLYETHYLENE GLYCOL 4000 FOR FECAL DISIMPACTION IN PAEDIATRIC FUNCTIONAL CONSTIPATION: A DOUBLE‐BLIND RANDOMIZED CONTROLLED‐TRIAL
Kalpana Panda 1, Jami Bikrant Prusty2, Mrutunjay Dash2, Prasant Saboth3, Mamata Mohanty3
1Division Of Pediatric Gastroenterology & Hepatology, Department Of Pediatrics, Institute of Medical sciences and SUM Hospital, Bhubaneswar, Odisha, India, 2Department Of Pediatrics, Institute of Medical sciences and SUM Hospital, Bhubaneswar, Odisha, India, 3Department Of Pediatrics, Institute of Medical Sciences and SUM Hospital, Bhubaneswaer, Odisha, India
Objectives and Study: Polyethylene glycol (PEG) is recommended first‐line laxative for faecal disimpaction in pediatric functional constipation. PEG 3350+Electrolytes (E) & PEG 4000 are most common available formulations. PEG 3350 + E and PEG 4000 have hypothesized benefits of lesser risk of dyselectrolaemia and better palatability, respectively. No head‐to‐head comparison has been conducted till date. This study was planned to compare efficacy, safety & tolerability of PEG 3350 + E versus PEG 4000 for fecal disimpaction in pediatric functional constipation.
Methods: This prospective double‐blind randomized controlled intention‐to‐treat trial was conducted from April 2024 to Nov 2024 (Trial registration number: CTRI/2024/03/063855). Pediatric patients having functional constipation (as per ROME IV) with faecal impaction were included. Those with organic constipation, h/o prior gastrointestinal surgery, already receiving PEG/lactulose had been excluded. Computer‐generated block randomization was done.Colorless liquid formulation of both study medications was provided by investigator (JBK) as per treatment allocation in identical opaque bottles @1.5 gm/kg/day x 6 days or till fecal impaction resolution (passage of clear liquid stool), whichever is earlier.
Results: 100 patients were randomized in 1:1 (50‐ each arm). Efficacy of PEG 3350 + E vs PEG 4000 was similar (84% vs 86%, p = 0.9) for fecal disimpaction. Likewise, no significant differences were observed in adverse event rates between the two. Abdominal discomfort and vomiting were the most common side effects with both. PEG 4000 had better palatability in comparison to PEG 3350 + E (p = 0.049). However, there was no significant difference in compliance rate.
Conclusions: PEG 3350 + E and PEG 4000 had similar efficacy for fecal disimpaction with minor side effects. PEG 4000 has a better palatability; however, both were well‐tolerable by children.PEG 3350 + E and PEG 4000 had similar efficacy for fecal disimpaction with minor side effects. PEG 4000 has a better palatability; however, both were well‐tolerable by children.
Contact e‐mail address: drkalpanapanda@gmail.com
G‐EV278. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV278.1. GUT MICROBIOTA COMPOSITION IN EARLY INFANCY REVEALS THE RISK OF NEUROPSYCHIATRIC CONDITION
Paulo Refinetti1, Anna Koskinen2, Emily Jamieson1, Meryam Ben Salem1, Marco Pane3, Samuli Rautava 4, Erika Isolauri2
1REM Analytics SA, Monthey, Switzerland, 2Department Of Pediatrics And Adolescent Medicine, Turku University Hospital, Turku, Finland, 3Research And Development, Probiotical s.p.a., Novara, Italy, 4Department Of Neonatology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
Objectives and Study: Deviant gut microbiota in early infancy is linked to the progressive increase in chronic immune‐mediated non‐communicable diseases (NCDs). We hypothesized that this list may be extended to NCDs linked to behavior and brain, which are connected to the gut by bidirectional exchange of endocrine, immune, and neural signals.
Methods: From an original population of 659 children participating in randomized controlled probiotic intervention studies with long‐term follow‐up, we identified 38 children with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) diagnosed by a Pediatric Neurologist, with fecal samples collected during their first 6 months of life. As controls, we selected 38 children with available fecal samples, matched for antibiotic and probiotic contact, the duration of pregnancy, mode of delivery, birth weight and breast feeding. The gut microbiota composition was analyzed in blinded fashion using BifidoZoom, a specific bifidobacteria‐focused assay (REM Analytics, Switzerland). It provides an accurate distinction between key Bifidobacterium species and sub‐species, measuring precise relative abundances.
Results:
Partial least squares discriminant analysis showed clear discrimination between children who developed or did not develop ASD or ADHD based on their fecal Bifidobacterium profile in the first 6 months of life. The area under the ROC curve was 0.7 (p < 0.001). The fecal abundances of Bifidobacterium breve, B. longum subspecies longum, B. bifidum and B. pseudocatenulatum were higher in controls while B. infantis was more prevalent in samples from infants later diagnosed with ASD or ADHD.
Conclusions: We identified a heightened risk of ASD and ADHD in children with specific Bifidobacterium profiles, long before any clinical manifestation, by deploying a targeted analytical approach with more granular resolution and precise quantification. These results provide evidence for Bifidobacterium as an important operator in children's development, and BifidoZoom may provide a tool for prediction and prevention or targeted therapeutic measures.
Contact e‐mail address: paulo.refinetti@remanalytics.ch
G‐EV279. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV279.1. PEDIATRIC INTESTINAL PSEUDO‐ OBSTRUCTION IN CHILDREN WITH HYPOPARATHYROIDISM‐ RETARDATION‐DYSMORPHISM SYNDROME
Rotem Shalve Shamay 1,2, Galina Ling1,2, Slava Kogan1,2, Gadi Howard1,2, Raouf Nassar1,2, Baruch Yrushalmi1,2
1Faculty Of Health Sciences, Ben‐Gurion University of the Negev, Beer‐Sheva, Israel, Beer Sheva, Israel, 2Pediatric Gastroneterology, Hepatology, And Nutrition Unit, Saban Children Hospital, Soroka University Medical Center, Beer Sehva, Israel
Objectives and Study: Chronic intestinal pseudo‐obstruction (CIPO) or pediatric intestinal pseudo‐obstruction (PIPO) is a rare disorder characterized by bowel dilatation without mechanical obstruction. Hypoparathyroidism‐retardation‐dysmorphism syndrome (HRD) is an autosomal recessive syndrome caused by mutations in the TBCE gene, leading to developmental delays and various clinical manifestations. This study explores the association between HRD and PIPO.
Methods: A retrospective cohort analysis was conducted at Soroka University Medical Center (SUMC) involving patients diagnosed with HRD who required long‐term parenteral nutrition. Clinical data, pathology, and radiology findings were extracted from electronic medical records following approval from the local Institutional Review Board.
Results: At SUMC, 68 patients with HRD syndrome have been identified. All of them were of Bedouin origin and carried the same mutation. This study focuses on five patients (7%) diagnosed with PIPO. The initial clinical presentations included abdominal distention and recurrent bilious vomiting, with radiological findings indicating pseudo‐obstruction emerging early in life. All patients required total parenteral nutrition (TPN) and faced significant challenges, including severe complications leading to hospitalizations. Notably, two patients succumbed to severe infections, while one patient experienced marked improvement with partial PN support. Despite the complexities associated with their conditions, those who received PN showed substantial weight gain, underscoring the importance of targeted nutritional support in managing PIPO in HRD patients.
Conclusions: This study highlights the emergence of PIPO as a significant complication in patients with HRD, likely due to electrolyte imbalances and impaired gastrointestinal motility associated with the TBCE gene mutation.
Contact e‐mail address:
G‐EV280. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV280.1. PREVALENCE, TEMPORAL PATTERN, AND FACTOR ASSOCIATION WITH INFANTILE COLIC USING ROME IV DIAGNOSTIC CRITERIA IN HEALTHY TERM INFANTS: A PROSPECTIVE COHORT STUDY IN THAILAND
Palittiya Sintusek, Tanawan Noicharoen, Areewan Soontornsook, Duc Long Tran
Pediatrics, Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology., BANGKOK, Thailand
Objectives and Study: Infantile colic is a common condition affecting healthy infants, characterized by excessive crying and fussing. The prevalence and diagnostic criteria for colic can vary across different populations. This study aims to evaluate the prevalence, and factor association with infantile colic among healthy term infants in Thailand, using the Thai‐validated Rome IV diagnostic criteria.
Methods: We conducted a prospective cohort study at King Chulalongkorn Memorial Hospital in Thailand, enrolling healthy term infants who were followed up until 6 months of age. Infants were assessed for colic using the Thai‐validated Rome IV criteria and daily crying time per week at age 1, 2, 3, 4 and 6 months.
Results: A total of 520 infants were included in the study and a total of 254 infants has completed the study, 54% were female. Using Rome IV criteria, the prevalence of infantile colic decreased over time from 5.7% at 1 months to 2.14% at 2 months, 0.3% at 3 months and none at 4 and 6 months of age. Overall reported that 93.6%, 5.1%, 0.6% of infants crying times were < 3 hours, 3‐6 hours and > 6 hours per day, respectively. First child (RR 2.37), stressful life events in family (RR 1.79) and feeding type (infant formula) (RR 3.21) were the significant independent factors associated with infantile colic (P < 0.05).
Conclusions: This study provides important insights into the temporal pattern and prevalence of infantile colic in Thai infants. First child, stressful life events and infant feeding type were identified as significant factors influencing crying duration and colic development.
Contact e‐mail address: palittiya.s@chula.ac.th
G‐EV281. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV281.1. CORRELATION BETWEEN ANAL POSITION INDEX AND CONSTIPATION IN THAI INFANTS: A LONGITUDINAL COHORT STUDY
Duc Long Tran 1,2, Arisa Ama2, Areewan Soontornsook2, Tanawan Noicharoen2, Palittiya Sintusek2
1Clinical Sciences program,Faculty of Medicine,Chulalongkorn University, Bangkok, Thailand, 2Pediatrics, Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology., BANGKOK, Thailand
Objectives and Study: Anteriorly displaced anus is associated with constipation in infants. The anal position index (API) serves as an useful tool for identifying this condition. This study aims to compare API values between Thai infants with and without constipation.
Methods: This longitudinal cohort study was conducted on full‐term neonates born at King Chulalongkorn Memorial Hospital. API was measured at 1 month of age by a physician. API was calculated as the distance from the vaginal/scrotal to the midpoint of the anus, divided by the distance from the vaginal/scrotal to the coccyx. All infants were followed at 1, 2, 4, and 6 months. Constipation was suspected if an infant met any of the following criteria: (1) defecation less than two times per week, (2) hard stools, or (3) large‐diameter stools.
Results: A total of 185 infants were enrolled in the study, including 101 boys (54.6%), with a mean age of 36.8 ± 17.4 days, mean birth weight of 3,071 ± 340.6 g, and mean length of 49.5 ± 1.5 cm. 39 (21.1%) infants were suspected with constipation. The distance from the vaginal/scrotal to the anus was 3.13 ± 0.56 cm in males and 2.11 ± 0.44 cm in females, while the distance from the vaginal/scrotal junction to the coccyx was 6.34 ± 0.69 cm in males and 4.94 ± 0.81 cm in females. API was significantly greater in males than females (0.49 ± 0.05 vs 0.42 ± 0.04, P < 0.01). No significant correlations were found between API and birth weight or length. In male infants, the API for those with constipation (0.49 ± 0.04) was similar to those without constipation (0.49 ± 0.06). In female infants, the API in those with constipation was shorter than in healthy infants (0.41 ± 0.05 vs 0.43 ± 0.04, P = 0.06).
Conclusions: In Thai infants, API was 0.49 in males and 0.42 in females. The measurement API should be performed in children with constipation to detect anterior displacement anus early.
Contact e‐mail address: palittiya.s@chula.ac.th
G‐EV282. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV282.1. MITOCHONDRIAL NEUROGASTROINTESTINAL ENCEPHALOPATHY: MUST INCREASE AWARENESS
Nuray Uslu Kizilkan 1, Serpil Eraslan2, Umut Altunoğlu3
1Department Of Pediatrics, Division Of Pediatric Gastroenterology, Koç University, School of Medicine, İSTANBUL, Turkey, 2Department Of Medical Genetics, Koç University Hospital, İSTANBUL, Turkey, 3Department Of Genetics, Koç University, School of Medicine, İSTANBUL, Turkey
Objectives and Study: Mitochondrial neurogastrointestinal encephalopathy (MNGIE) is a rare autosomal recessive multisystem disorder most commonly caused by biallelic variants in TYMP, leading to thymidine phosphorylase deficiency. This progressive disease mostly presents with gastrointestinal manifestations and degenerative neurologic symptoms. This case report aims to emphasize early‐onset sensorineural hearing loss (SNHL) as the initial symptom in a small subset of MNGIE patients.
Methods: A 13 1/2 year‐old boy patient presented to us because of ongoing nausea, vomiting, abdominal and stomach pain, heartburn, loss of apetite, and early satiety. Extensive neurological examination showed no pathological findings. He had an operation for gangrenous perforated appendectomy at the age of 2. He was diagnosed with SNHL when he was 4 years old and metachronously underwent bilateral cochlear implantation at 7 and 10 years of age. At age of 6, gastrointestinal symptoms of vomiting, abdominal pain, failure to thrive appeared. For ongoing symptoms nonresponsive to medical treatments he underwent a Nissen fundoplication at the age of 12.5 years. After the surgery, his symptoms worsened. On admission to our hospital we performed esophagsogastroduodenoscopy with normal results and the gastric emptying scintigraphic evaluation with Tc‐99m DTPA showed slightly delayed gastric emptying. We performed exome sequencing with a preliminary diagnosis of MNGIE, revealing two heterozygous, novel, likely pathogenic frameshift variants in the TYMP [NM_001257989.1] gene: c.90_100del, p.(Pro31Alafs89*) and c.978dup, p.(Ala327Argfs*) gene. Parental studies confirmed the compound heterozygous state of these variants, ascertaining the molecular diagnosis of MNGIE 1 (MIM# 603041).
Results: Case report
Conclusions: The order of appearance and the severity of symptoms of MNGIE disease is unpredictable. In our case, hearing loss has been observed as the earliest symptom. Awareness of the disease by medical subspecialties is essential to prevent delay of diagnosis, as establishing a correct, timely diagnosis may help avoid unnecessary exploratory abdominal surgeries, risks associated with anesthesia, and inappropriate therapies.
Contact e‐mail address: nkizilkan@kuh.ku.edu.tr
G‐EV283. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV283.1. SAFETY OF FECAL MICROBIOTA TRANSPLANTATION VIA COLONOSCOPY IN PEDIATRIC PATIENTS: A SINGLE‐CENTER RETROSPECTIVE STUDY
Dominykas Varnas, Lukrecija Jakelyte, Vaidotas Urbonas
Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Objectives and Study: Fecal microbiota transplantation (FMT) is an established treatment for Clostridium difficile infection and shows promising potential for conditions such as inflammatory bowel disease, autism spectrum disorder (ASD), and metabolic syndrome. Common delivery methods for FMT include colonoscopy, enema, nasogastric tube, and oral capsules. At our institution, colonoscopy is preferred due to higher success rates. This study aimed to evaluate the safety profile of FMT via colonoscopy in pediatric patients.
Methods: A retrospective, single‐center study was conducted, including all pediatric patients who underwent FMT at the Vilnius University Hospital Santaros Klinikos between 2017 and 2024. All the FMT procedures were conducted in accordance with the hospital's protocols. Data were collected from patient medical records.
Results: A total of 108 FMT procedures were performed on 73 patients (52 male, 21 female) with a median age of 8.8 years (range: 2.7–17.8 years). Indications included Clostridium difficile infection (n = 11, 10.2%), inflammatory bowel disease (n = 7, 6.5%), ASD (n = 84, 77.8%) and other conditions (n = 6, 5.6%). Among cases of Clostridium difficile infection, 81.8% were associated with underlying inflammatory bowel disease. No anesthesia or colonoscopy‐related complications were observed, and no serious adverse events occurred. Mild adverse events, such as transient diarrhea and abdominal discomfort, were recorded in 10 cases (9.3%). One patient (0.9%) developed fever and pharyngitis symptoms three days post‐procedure, likely unrelated to FMT.
Conclusions: In our center's experience, FMT via colonoscopy in pediatric patients demonstrated a favorable safety profile, with no severe adverse events and only occasional, self‐limiting mild adverse events. These findings support the safety of FMT as a therapeutic option in pediatric care.
Contact e‐mail address: varnas.dominykas@gmail.com
G‐EV284. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV284.1. APPLICABILITY OF TRANSANAL IRRIGATION IN THE MANAGEMENT OF PEDIATRIC BOWEL DYSFUNCTION
Natasha Woods Kreisler 1, Lucinda Bunce1, Mirella Barredo Maya2, Maria De Los Angeles Muñoz Miguelsanz2, Georgina Sanchis Blanco2
1Division Of Pediatric Gastroenterology, Hepatology And Nutrition, University Hospital Son Espases, Palma de Mallorca, Spain, 2Division Of Pediatric Surgery, University Hospital Son Espases, Palma de Mallorca, Spain
Objectives and Study: Pediatric bowel dysfunction (BD) presenting as true fecal incontinence or severe constipation is a condition that interferes with a child's normal life and causes social and emotional disturbances. Bowel management with transanal irrigations (TAI) is an effective therapy for this population. Our aim was to describe patient characteristics, underlying pathologies and outcomes in a single‐center pediatric cohort.
Methods: Pediatric patients (<18 years) treated with TAI (2012‐2024) at a tertiary center were reviewed retrospectively. Included refractory fecal incontinence despite standard surgical and medical therapies. Data included demographics, diagnostic tests, prior treatments, TAI parameters, autonomy level, and continence outcomes.
Results: Twenty‐six patients (73% male) were identified: 12% had recto‐sigmoid Hirschsprung's disease (HD), 12% functional constipation, 42% anorectal malformations (ARM) (4 recto‐urethral, 3 vestibular, 1 recto‐vesical, 1 cloaca, 1 colon pouch, and 1 anorectal diaphragm) and 42% neurogenic bowel (8 due to myelomeningocele, 1 lipomeningocele, 1 cerebral palsy and 1 congenital varicella). Among HD patients, one had an intact pectinate line, one lacked it, and one was partially intact. 82% of neurogenic bowel patients had spinal anomalies (55% tethered cord, 9% spinal regression, 9% low‐lying spinal cord). Contrast enemas were done in 62%, showing colon dilation in38%. Prior treatments included enemas (80%), PEG (69%), stimulant laxatives (19%), biofeedback (8%). TAI began at mean age 7.5 years (range 4‐14) and frequency 5.3 days/week (3‐7). Adjuvants included PEG (19%), glycerine (15%), loperamide (12%) and methylcellulose (8%). Regarding autonomy, 38% were caregiver‐dependent, 38% autonomous and 23% assisted. After TAI, 69% stays clean and31% had residual stool accidents[GS2] (2 daily, 3 weekly and 3 occasional).
Conclusions: In our pediatric BD cohort, TAI proved to be an effective treatment in patients with HD, ARM, neurogenic bowel and refractory constipation. It improves quality of life, encourages self‐management and fosters patient autonomy. TAI should be considered a valuable tool in managing pediatric BD.
Contact e‐mail address: natashawoodskreisler@gmail.com
G‐EV285. Topic: AS01. GASTROENTEROLOGY/AS01h. Neurogastroenterology, Motility and Gut‐Brain Interaction
G‐EV285.1. POST‐SURGICAL HIRSCHSPRUNG'S DISEASE: OUTCOMES AND QUALITY OF LIFE. A MULTICENTER STUDY
Maria Daniela Neder1, Maira Chazarreta Cifre1, Patricia Gavaise1, Cecilia Zubiri 2, Anabella Zosi2, Pablo Malagrino3, Florencia Biasoli3, Lidia Garcete Mañotti4, Roman Bigliardi5, Adriana Oviedo5, Ana Rocca1
1Hospital Garrahan, Capital Federal, Argentina, 2Hospital Sor Maria Ludovica de La pLata, Capital Federal, Argentina, 3Hospital Gutierrez, Capital Federal, Argentina, 4Hospital de Clinicas, Capital, Paraguay, 5Hospital Nacional Posadas, Capital Federal, Argentina
Objectives and Study: Objectives: To evaluate the long‐term outcome and quality of life of patients with HD and follow‐up at different centers in Latin America.
Methods: Material and Methods: Cross‐sectional analytical study of patients aged 6 to 17 years, operated on between 2012 and 2016, with at least one year since ostomy closure. Presence of postoperative symptoms was evaluated, and a continence score and a quality of life score (PedsQL) were applied. Statistical Method: Descriptive statistics were performed using cross‐tabulations and frequency distributions. Association between variables was assessed using multivariate linear regressions and partial correlations.
Results: 59 patients, median age 9 years (SD 2.8). Males 67% (39). Median age at diagnosis 3 months (±26.7 months). Disease extent: 38 had short‐segment disease (64%), 7 long‐segment, and 10 total colonic aganglionosis. Surgical techniques used were Georgeson in 29/51 cases (49%), Duhamel in 17, Soave in 3, de la Torre in 4, combined in 3, and unknown in 2. Median age at pull‐through surgery: 13.5 months (range 2‐134). 4 required reoperation. At the last follow‐up, 40 (68%) had post‐surgical symptoms: 21 incontinent, 9 constipated, 6 both, 4 with recurrent enterocolitis, and 26 (44.8%)nocturnal incontinence. Rintala score: 62% had a normal or acceptable score.Georgeson's technique was positively associated with higher Rintala score (beta = 2.6, p = 0.008), while Duhamel's technique showed non‐significant negative trend (p = 0.09). Higher age correlated with better Rintala and PedsQL scores. There was significant positive association between Rintala and PedsQL (p = 0.001) and negative association between treatment complexity and PedsQL (p = 0.008755)
Conclusions: This study found that post‐surgical symptoms were common. Older patients had better Rintala scores and quality of life, which were strongly correlated. In our population, patients who underwent Georgeson surgery showed better postoperative results. These findings emphasize the need for targeted treatment and multidisciplinary follow‐up to optimize long‐term outcomes and quality of life
Contact e‐mail address: nederdaniela@gmail.com
G‐EV286. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EV286.1. RELATIONSHIP BETWEEN CRP/ALBUMIN RATIO AND THE SEVERITY OF HELICOBACTER PYLORI‐ASSOCIATED GASTRITIS AND DISEASE COURSE AMONG CHILDREN
Hüdaverdi Kara1, Melike Arslan 1, Coşkun Özkeçeci1, Edibe Başaran1, Necati Balamtekin1, Bülent Ünay2
1Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Gülhane Training and Research Hospital, Ankara, Turkey, 2Department Of Pediatrics, Gülhane Training and Research Hospital, Ankara, Turkey
Objectives and Study: The aim of this study was to determine the relationship between the CRP/albumin ratio (CAR) and the clinical, endoscopic, and histopathological symptoms of the disease in Helicobacter pylori (H pylori) gastritis and to investigate whether CAR could be used as a marker in the diagnosis of H pylori.
Methods: This cross‐sectional retrospective study was performed on paediatric patients aged 1‐18 years who presented to the paediatric gastroenterology outpatient clinic with the complaint of dyspepsia and were diagnosed with H pylori, had no concomitant diseases, and whose CAR was calculated.
Results: The study included 121 paediatric patients, (age, mean ± standard deviation: 14.49 ± 2.83 years) and (66%) female. No significant difference was found between CAR and severity of gastric inflammation, gastritis activity and gastric H pylori colonisation (p = 0.735, p = 0.287, p = 0.318, respectively). The median CRP/albumin level was found to be higher in patients with significant gastric H pylori colonisation (0.21) compared to patients with mild/moderate gastric H pylori colonisation (0.15), but not significantly different (p = 0.744). In patients with significant gastric H pylori colonization, the cut‐off point for CAR was determined to be ≥ 0.208, and the sensitivity to be 51.9%, specificity to be 60.6%, and the area under the ROC curve ± standard error (AUC ± SE) to be 0.347 ± 0.611 (p = 0.744) (AUC < 0.70, p = 0.744).
Conclusions: The results obtained in this study show that CAR is not associated with H pylori colonisation rate and gastritis severity.
Contact e‐mail address:
G‐EV287. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EV287.1. ASSOCIATION OF H. PYLORI INFECTION WITH TREATED AND UNTREATED WATER USE IN CHILDREN AGED 2‐12: A DUAL CENTER CROSS‐SECTIONAL ANALYSIS
Shireen Qassim Bham 1, Farhan Saeed2, Nighat Aijaz3, Umer Hayat Ahmed Sharif4, Syed Humza Nasr5
1Pediatrics, FAZAIA RUTH PFAU MEDICAL COLLEGE, KARACHI, Pakistan, 2LIAQUAT COLLEGE OF MEDICINE & DENTITSTRY, KARACHI, Pakistan, 3Pediatrics, Sindh institute of Urology & Transplantion SIUT, KARACHI, Pakistan, 4Internal Medicine, DOW UNIVERSITY OF HEALTH SCIENCES, Karachi, Pakistan, 5Student, DOW UNIVERSITY OF HEALTH SCIENCES, Karachi, Pakistan
Objectives and Study: Objective: Infection with Helicobacter pylori is a global health concern. Developing nations are more likely to harbor H pylori organism. We investigated the incidence of symptomatic H. Pylori infection in our community and its correlation with treated/untreated water to provide recommendations for mitigating the incidence of this infectious disease.
Methods: Method: This is a multi‐center cross sectional study conducted for 6 months. Random sampling technique was used and children age 2 to 12years with upper Gastrointestinal sypmtoms were included. The demographic data included were age, sex, area of residence and parental education. Inquired the water source used for drinking like boiled, unboiled, mineral water branded/unbranded, filtered and RO Plant. Stool test for H. pylori antigen was performed on all participants. Association of H‐pylori was tested with risk factors using Fisher's exact test. Univariate analysis was done using binary logistic regression for risk factors of H‐pylori using Enter method, multivariate analysis was done using Forward LR method. P‐values less than 0.05 were considered significant.
Results: Results: The mean age among 209 children was 7.53 (SD = ± 2.80) years. H pylori antigen was detected in stool samples from 90 (43.1%) of the patients. Among the positive cases, the frequency of use of water from RO plant was 31 (34.4%), filter 18 (20%), 17 (18.9%) unboil water and mineral water, branded and unbranded were, 11 (12.2%) respectively. The most common symptoms noted were abdominal pain 99(47.7%) followed by abdominal pain with nausea and vomiting 38(18.6%). Regression analysis showed odds of acquiring H pylori infection increases 3 times with the use of filtered [OR = 3.25, CI(1.16‐9.07)], and unboil water [OR = 3.68,C.I(1.03‐13.1)] as compared to branded mineral [OR = 0.36,C.I(0.15‐0.90)]water.
Conclusions: Conclusion: Our research validates the notion that consuming untreated water raises the risk of H pylori infection; hence, it is best to promote the use of boiled or treated mineral water.
Contact e‐mail address: drshbham@yahoo.com
G‐EV288. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EV288.1. CAN NEXT GENERATION SEQUENCING BE A METHOD SUPPORTING ROUTINE DIAGNOSIS OF INFECTIONS CAUSED BY HELICOBACTER PYLORI AMONG PEDIATRIC PATIENTS?
Agnieszka Krawczyk 1, Tomasz Gosiewski2, Anna Szaflarska‐Popławska3, Tomasz Bogiel4
1Department Of Molecular Medical Microbiology, Jagiellonian University Medical College, Chair of Microbiology, Cracow, Poland, 2Laboratory Of Microbiome Research, Jagiellonian University Medical College, Chair of Microbiology, Cracow, Poland, 3Department Of Pediatric Endoscopy And Gastrointestinal Function Testing, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland, 4Microbiology Department, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
Objectives and Study: Bacterial culture of gastric biopsy samples is considered the „gold standard” for diagnostics of infections caused by Helicobacter pylori due to its 100% specificity. However, it is characterized by relatively low sensitivity, which is influenced by factors such as sample handling and previous use of medications by patients. Molecular methods, like PCR, offer high sensitivity (>95%) and enable the detection of H. pylori DNA and antibiotic resistance‐associated mutations, thereby accelerating diagnosis and improving treatment outcomes. Next‐generation sequencing (NGS) is an emerging method and a valuable tool for studying H. pylori infections patomechanisms, including virulence and antibiotic resistance, although its application in routine diagnostics remains insufficiently researched. This study aimed to compare the effectiveness of real‐time PCR (IVD certified kit) and NGS in detection of H. pylori DNA in gastric biopsy samples of pediatric origin.
Methods: The study analyzed gastric biopsy samples collected from pediatric patients, aged 2 to 17 years (n = 40). Patients were examined at the Department of Pediatric Endoscopy and Gastrointestinal Function Testing, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Torun, Poland. DNA was isolated from the samples. Subsequently, real‐time PCR (AmpliSens Helicobacter pylori‐FRT PCR kit) and NGS sequencing (MiSeq for V3‐V4 regions) were performed.
Results: H. pylori DNA was detected in 16 (40.0%) biopsy samples using real‐time PCR. The NGS methodology identified the presence of H. pylori DNA in 14 (35.0%) samples (summarized in Figure 1).
Conclusions: NGS is characterized by high sensitivity and specificity and, most importantly, provides reproducible and reliable results of H. pylori DNA detection. The NGS method appears to be a promising tool for the diagnosis of H. pylori infections, particularly when results from other methods are inconclusive.
Contact e‐mail address: agnieszka1.krawczyk@uj.edu.pl
G‐EV289. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EV289.1. DECADE‐LONG STUDY OF PEDIATRIC UPPER GASTROINTESTINAL BLEEDING: COVID‐19 PANDEMIC AND ITS EFFECT ON ETIOLOGICAL FACTORS
Luca Mirea 1, Mara Ionescu1,2, Catalin Boboc1, Andreea Ioan1,3, Malina Anghel1, Felicia Galos1,3
1Department Of Pediatrics, Marie Curie Emergency Children's Hospital, Bucharest, Romania, 2Department Of Functional Sciences, Division Of Physiology Ii—neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, 3Department Of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Objectives and Study: Upper gastrointestinal bleeding (UGIB) in children is an uncommon but potentially severe condition with diverse etiologies. This study aimed to evaluate the roles of Helicobacter pylori (H. pylori) infection and non‐steroidal anti‐inflammatory drug (NSAID) use in the etiology of UGIB over a 10‐year period, focusing on trends during the COVID‐19 pandemic. We performed a retrospective analysis on pediatric patients undergoing esophagogastroduodenoscopy (EGD) for UGIB, highlighting the prevalence and significance of these factors.
Methods: Patients aged 2 months to 18 years who underwent EGD for UGIB between January 2015 and December 2024 were included. Data were categorized into pre‐pandemic (before February 2020) and pandemic/post‐pandemic (February 2020 onward) periods for comparative analysis.
Results: A total of 98 patients with identified bleeding sources were included, with a median age of 12.4 years (SD = 5.61); 58.16% (57/98) were female. The pre‐ and post‐pandemic groups were comparable in age, sex, and urban‐rural origin. Hematemesis was the most frequent presentation, observed in 84.69% (83/98), followed by melena in 26.53% (26/98) and hematochezia in 4.08% (4/98). Gastric sources accounted for 55.1% (54/98) of bleeding cases, with erosive gastritis being the leading cause in 32.65% (32/98) cases. The prevalence of H. pylori infection remained stable, at 39.7% (23/58) pre‐pandemic and 35% (14/40) during the pandemic (p = 0.799). In contrast, NSAID‐related UGIB cases nearly tripled during the pandemic, increasing from 12.06% (7/58) pre‐pandemic to 32.5% (13/40) post‐pandemic (p = 0.027).
Conclusions: This study underscores the critical roles of H. pylori infection and NSAID use in pediatric UGIB, highlighting a marked rise in NSAID‐related cases during the pandemic. These findings emphasize the need for targeted clinical strategies to mitigate UGIB risk by monitoring and managing H. pylori infection and NSAID exposure in children.
Contact e‐mail address:
G‐EV290. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EV290.1. ANTIBOITIC RESISTANCE OF HELICOBACTER PYLORI AND ERADICATION RATES – SINGLE CENTER EXPERIENCE
Tena Matek1, Iva Hojsak2,3,4, Mario Mašić2, Ana Močić Pavić2, Mia Šalamon Janečić2, Zrinjka Mišak 2,3
11Health Care Center Zagreb‐West, Zagreb, Croatia, Zagreb, Croatia, 2Referral Center For Pediatric Gastroenterology And Nutrition, Children's Hospital Zagreb, Zagreb, Croatia, 3School Of Medicine, University of Zagreb, Zagreb, Croatia, 4School Of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
Objectives and Study: Antibiotic resistance is one of the main reasons for the eradication failure of Helicobacter pylori (H. pylori) infection. The aim of this study was to analyze the frequency of antibiotic resistance in H. pylori infected children and eradication rates.
Methods: This retrospective study included children who underwent endoscopy during the period from January 2011 to December 2022, and were diagnosed with H. pylori infection. Collected were results of antibiotic susceptibility testing (to amoxicillin (AMO), clarithromycin (CLA), and metronidazole (MET)) together with data on eradication.
Results: Out of a total number of 4989 children who during the observed period underwent endoscopy with antral biopsies analyzed for H. pylori, 220 (56.6% girls) were diagnosed with H. pylori infection (4.4%). Among H. pylori infected children 181 (82.3%) were treatment naïve and 39 (17.7%) were patients after the treatment failure. Results of antibiotic susceptibility testing and eradication rate are shown in Table 1. There were altogether 72 patients (32.7%) lost to follow‐up (63 of naïve patients), and 14 patients (6.4%) who were not treated (12 of naïve patients). Table 1.
| sensitive | resistant to AMO | resistant to CLA | resistant to MET | double resistance | eradicated | not treated | |
|---|---|---|---|---|---|---|---|
| naÏve(%) | 108 (65.5) | 0 | 39 (23.6) | 27 (16.4) | 12 (7.3) | 91 (85.8) | 12 (6.6) |
| not‐naÏve(%) | 11 (28.9) | 1 (2.6) | 19 (50.0) | 20 (52.6) | 14 (36.8) | 14 (70.4) | 2 (5.1) |
| p | <0.001 | <0.001 | <0.001 | <0.001 | NS | NS |
Conclusions: In conclusion, both single and double resistance were significantly more common in group of patients with previous treatment failure. However, the eradication rates did not differ significantly between the groups and did not reach 90% not even in treatment naïve group of patients. Therefore, additional efforts are needed to increase eradication rates and, as nearly one third of patients were lost to follow‐up, to improve monitoring after the treatment.
Contact e‐mail address:
G‐EV291. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EV291.1. CLINICAL SIGNIFICANCE AND PROGNOSIS OF GASTRIC INTESTINAL METAPLASIA IN CHILDREN AND ADOLESCENTS: PRELIMINARY SURVEY
Eell Ryoo, Myungyeon Lee, Hye Jung Cho
Gachon University, Gil Medical Center, Incheon, Korea, Republic of
Objectives and Study: Gastric intestinal metaplasia (GIM) is recommended for regular examination as precancerous lesions associated with increased risk of gastric cancer in adults, but there are few studies related to this in children and adolescents. We studied the clinical significance and prognosis of GIP in children and adolescents.
Methods: From 2001 to July 2024, patients who visited the pediatric gastrointestinal clinic due to gastrointestinal symptoms and performed gastric biopsy along with upper gastrointestinal endoscopy were analyzed retrospectively.
Results: Of total 7,979 patients (65,733 cases), 3,533 patients (7,707 cases; 39.3%) underwent upper gastrointestinal endoscopy and biopsy. Histologic examination revealed GIM in 31 cases (0.88%), of which 14 were male, mean age was 13.01 ± 3.70 years, and BMI was 19.2 ± 3.3 kg/m2. The chief complaints were chronic or recurrent abdominal pain (25), nausea and/or vomiting (4), abdominal discomfort (2). Endoscopic findings were as followed by 10 erosive gastritis, 6 hemorrhagic gastritis, 4 gastric and duodenal ulcer, 4 reflux esophagitis, 3 normal, 2 bile reflux gastritis, 1 polyp, and 1 nodular gastritis. Of these, H. pylori positive was 23% (7 cases). The final diagnosis was 9 acute gastritis, 7 H. pylori gastritis, 4 reflux esophagitis, 3 gastric and duodenal ulcer, 3 functional gastrointestinal disease, 2 Crohn's disease, 2 bile reflux gastritis, and 1 tubular adenoma. There were 15 patients who underwent follow‐up endoscopy, and in 2 of these patients, intestinal metaplasia persisted on follow‐up examination.
Conclusions: GIM is very rare in children and adolescents and seems to be highly related to H. pylori infection.
Contact e‐mail address: hiryoo@gmail.com
G‐EV292. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EV292.1. ERADICATION RATE OF HELICOBACTER PYLORI IN CHILDREN IN TUNISIA : A PROSPECTIVE STUDY
Nadia Siala, Nour Houda Gabsi, Jihene Ben Hefaiedh, Syrine Khelif, Haifa Ouerda, Ons Azzabi
Pdiatrics, Mongi Slim Hospital, La Marsa, Tunisia
Objectives and Study: The aim of this study was to evaluate the efficacy of the triple therapy Amoxicillin‐Metronidazole‐PPI as a first‐line treatment of H. pylori infection in Tunisian children.
Methods: Prospective longitudinal study over a period of four years (April 2020–April 2024) in the pediatric department of Mongi Slim Hospital, in Tunisia. We included children who underwent upper digestive endoscopy with biopsies confirming H. pylori infection, treated with a 14‐day triple therapy regimen Amoxicillin, Metronidazole and PPI and whose eradication was checked at least 8 weeks after achieving the treatment. Were excluded children who were lost to follow‐up and those who have not done the eradication check. Were not included children who received antibiotics or PPI in the last four weeks.
Results: Seventy patients were included. The average age was 9 years 10 months. The sex‐ratio was 0.7. Family history of digestive symptoms was reported in 28 children. The predominant symptom was recurrent epigastralgia in 71% (N = 50). The most common endoscopic finding was nodular appearance (43%) congestive gastritis (29%) and petechial gastritis (7%). No cases of gastric ulcer or metaplasia were noted. All children received triple therapy Amoxicillin (100 mg/kg/day), Metronidazole (30 mg/kg/day), and PPI (40 mg/day in two doses) for 14 days. Eradication rates were assessed using H. pylori detection via stool PCR. 50 patients (91%) were compliant with treatment. The eradication rate among compliant patients was 95.5% with improvement in clinicl symptoms. Eradication failure was noted in three children: two non‐compliant because of treatment‐related adverse effects, and one compliant child.
Conclusions: The eradication rate of H. pylori using triple therapy with Amoxicillin, Metronidazole, and PPI in children in this study was about 96%, showing the effectiveness of this therapeutic strategy. A larger‐scale study is needed to confirm these results. However, testing antibiotic sensitivity remains crucial for improving management in cases of treatment failure.
Contact e‐mail address: sialanad@gmail.com
G‐EV293. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EV293.1. PREVALENCE OF GASTRIC INTESTINAL METAPLASIA IN A LARGE COHORT FROM TURKEY
Ozlem Sumer Cosar 1, Melike Ozcicek1, Fatma Özlem Koseoglu1, Yelda Bozkurt2, Sınan Sarı1, Hakan Öztürk1, Odul Egrıtas Gurkan1, Onur Ertunc2, Buket Dalgıc1
1Division Of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 2Division Of Pathologhy, Gazi University Faculty of Medicine, Ankara, Turkey
Objectives and Study: Gastric intestinal metaplasia (GIM) is a pre‐malignant condition rarely reported in pediatric populations. The primary aim of this study is to determine the prevalence of GIM and identify potential risk factors associated with this condition.
Methods: This study was conducted through a retrospective analysis of data from 7,082 patients who underwent endoscopic gastric biopsy between the years 2008 and 2024. Gastric biopsies were assessed for gastritis, GIM, and the presence of Helicobacter pylori based on the criteria outlined in the Sydney classification.
Results:
The prevalence of GIM was found to be 0.35% (n = 25). Of these, 13 (52%) were female. The median age was 12.2 years (3–17 years). 21 patients (84%) were over 10 years old. The most common indications for endoscopy in patients with GIM were dyspepsia (48%) and abdominal pain (28%). Gastric erythema and nodularity were the most common endoscopic findings. Pathology revealed chronic inactive gastritis (72%), incomplete intestinal metaplasia (64%), H. pylori infection (24%) and glandular atrophy (8%) (Fig 1). The rate of GIM in H. pylori‐positive patients was not statistically different compared to H. pylori‐negative cases (0.39% vs. 0.34%; p = 0.95). No statistically significant association was found between the type of GIM and the presence of H. pylori. Among the eight patients who underwent surveillance with a median follow‐up of 24 months (range 3‐100), six demonstrated regression of GIM, while two continued to have persistent GIM. No dysplasia or malignancy was detected.
Conclusions: This large cohort study demonstrated that GIM is a rare condition in pediatric patients and shows no significant association with H. pylori infection. Because of GIM's malignant potential, long‐term surveillance studies should be performed.
Contact e‐mail address: dr.ozlemcosar@gmail.com
G‐EV294. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EV294.1. COMPARISON OF UPPER GASTROINTESTINAL ENDOSCOPY FINDINGS IN CHILDREN WITH DYSPEPTIC COMPLAINTS BEFORE AND AFTER THE COVID‐19 PANDEMIC
Hatice Ulusoy Kalkan 1, Nevzat Aykut Bayrak2
1Pediatrics, University of Health Sciences, Zeynep Kamil Women & Children's Training & Research Hospital, Istanbul, Turkey, 2Pediatric Gastroenterology, Hepatology And Nutrition, University of Health Sciences, Zeynep Kamil Women & Children's Training & Research Hospital, Istanbul, Turkey
Objectives and Study: During the COVID‐19 pandemic, significant lifestyle changes such as decreased adherence to healthy diet, physical inactivity, school absenteeism and strict adherence to hygiene norms were observed. In addition, viral upper respiratory infections increased after the COVID‐19 outbreak, despite a significant decrease during the pandemic. We aimed to determine whether changes in conditions and practices have led to changes in gastroscopy findings in children with dyspepsia.
Methods: All children who underwent gastroscopy for dyspeptic complaints in 2019 were classified as the pre‐pandemic group, and in 2023 as the post‐pandemic group. Demographics, symptoms, comorbidities, gastroscopy, histology and Helicobacter pylori (Hp) status were recorded from electronic medical records. Hp infection was considered positive if both the rapid urease test and histological evaluation were positive. Cases with antibiotic use in the previous three weeks, a history of gastroscopy, neurological, metabolic, renal, gastrointestinal or hepatobiliary disorders were excluded.
Results: Data from 703 of 974 patients who underwent gastroscopy and met the criteria were evaluated. The study population consisted of 376 cases (53.4%) from 2019 compared to 327 cases from 2023 (mean age: 10.79 ± 5.02 vs 10.96 ± 4.73, girls 60.8% vs 53.8%, p > 0.05). Esophagitis, gastritis and bulbitis were not significantly different between groups (p > 0.05). However, a significant decrease in the frequency of Hp infection (30.6% vs. 21.4%, χ2: 7.59, OR: 1.43, 95%CI: 1.11‐1.85, p < 0.01) and peptic ulcer (9.6% vs. 5.2%, χ2: 7.59, OR: 1.43, 95%CI: 1.11‐1.85, p < 0.05) was observed.
Conclusions: Our data showed a decrease in the frequency of Hp infection and peptic ulcer in children with dyspeptic complaints undergoing gastroscopy after the outbreak of COVID‐19 pandemic.
Contact e‐mail address: aykutbayrak@hotmail.com
G‐EV295. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EV295.1. HELICOBACTER PYLORI ERADICATION IN PEDIATRIC PATIENTS IN LATIN AMERICA: THE GAP BETWEEN GUIDELINES AND CLINICAL PRACTICE
Carolina Zambrano1, Jose Fernando Vera 1, Kathalina Puerto1, Mariana Vasquez Roldan1, Nataly Gonzalez1, Constanza Camargo2, Ailim Carias1, Juan Riveros3, Dianora Navarro4, Michelle Higuera‐Carillo5
1Fundación Santa Fe de Bogotá, Bogotá, Colombia, 2Hospital infantil Los Ángeles Pasto, pasto, Colombia, 3Universidad el Bosque, Bogotá, Colombia, 4Hospital Dr Miguel Pérez Carreño, Venezuela, Venezuela, 5Universidad Nacional de Colombia, Bogota, Colombia
Objectives and Study: Objectives/Study: To determine the adherence to recommendations for diagnosis and treatment in medical practice in Latin American countries according to the NASPGHAN/ESPGHAN and LASPGHAN adaptation guidelines.
Methods: Methods: An observational cross‐sectional study was performed with data retrospectively collected from 2018 to 2024. Forty‐eight centers in 9 Latin American countries submitted information from H. pylori‐infected patients to the "LatamPed‐Hp" registry via REDcap. The results were contrasted with the guidelines mentioned. All analyses were performed on Stata v.18.0.
Results: Results: A total of 488 records were completed. Histology was the diagnostic method in 453 (92.8%) patients, urease test in 88 (18%), PCR in 31 (6.4%) and culture in 19 (3.9%). Just 22.1% cases followed the recommendation of combining at least two positive tests for diagnosis. Erosions were found in 32.9% and ulcers in 6.4% of the patients. In 390 (79.9%) cases biopsies were performed with findings of nodular or follicular mucosa, which was one of the controversies described in the guidelines. Correct dosing according to weighted‐adjusted prescriptions (Group 1: 15‐24 kg, Group 2:25‐34 kg and Group 3: > 35 kg), was found for proton pump inhibitors in 76.8% of patients in Group 1, 33.7% in Group 2, and 69.5% in Group 3. For amoxicillin, 78.9% in Group 1, 59.7% in Group 2, and 82.5% in Group 3. For clarithromycin, 81% in group 1, 36.8% in group 2, and 84.8% in group 3. Regarding verification of eradication, urea breath test was performed in 49.2%, fecal antigen test in 39.4% and endoscopy with biopsy in 15.2%. Eradication was achieved in 82.6%.
Conclusions: Conclusions: Adequate weight‐adjusted dosing in the sample was between 33.7%‐84.8%, particularly low for PPIs and clarithromycin and in the group of patients between 25 to 34 kg. Improved eradication rates could be expected if accurate diagnosis, dosing and current NASPGHAN/ESPGHAN/LASPGHAN updated guidelines are followed.
Contact e‐mail address: jfvera1@gmail.com
G‐EV296. Topic: AS01. GASTROENTEROLOGY/AS01i. Peptic Disease and Helicobacter Pylori
G‐EV296.1. ACCURACY OF H. PYLORI ERADICATION THERAPY: ADHERENCE TO GUIDELINES IN A SYMPTOMATIC COLOMBIAN PEDIATRIC POPULATION
Carolina Zambrano1, Jose Fernando Vera 1, Kathalina Puerto1, Nataly Gonzalez1, Juan Riveros2, Ailim Carias1, Michelle Higuera‐Carillo3
1Fundación Santa Fe de Bogotá, Bogotá, Colombia, 2Universidad el Bosque, Bogotá, Colombia, 3Universidad Nacional de Colombia, Bogota, Colombia
Objectives and Study: Objectives and Study: This study aimed to determine the adherence to recommendations for diagnosis and treatment in medical practice in Colombia according to the NASPGHAN/ESPGHAN and the LASPGHAN adaptation guidelines.
Methods: Methods: An observational cross‐sectional study was performed with data retrospectively collected from 2018 to 2024. Twenty‐six centers in Colombia submitted information from H. pylori‐infected patients to the "LatamPed‐Hp" registry via REDcap. The results were contrasted with the guidelines mentioned. All analyses were performed on Stata v.18.0.
Results: Results: A total of 331 records were included. Histology as a diagnosis method 98.2% (325), urease test in 21.5% (71) and culture in 2.1% (7). Just 22.9% (76) cases combined at least two positive tests for diagnosis. Nodullar or follicular mucosa was found in 78.8% (261) cases. Amoxicillin and clarithromycin were used in 97% and 88%, respectively. To determine accurate dosing according to medication regimens, an analysis by weight groups was performed (Group 1: 15‐24 kg, Group 2:25‐34 kg and Group 3: > 35 kg). For proton pump inhibitors, accuracy was found in 82.1% in Group 1, 43% in Group 2, and 82.4% in Group 3. For amoxicillin, 79.2% in Group 1, 63.3% in Group 2, and 89.1% in Group 3. For clarithromycin, 84% in group 1, 40% in group 2, and 92.8% in group 3. Eradication was achieved in 81.9% and verified through urea breath test in 62.2%, fecal antigen test in 23.3% and endoscopy with biopsy in 16.3%.
Conclusions: Conclusions: The eradication rate was low: 81.9%. Precision in weight‐adjusted prescription in the sample ranged from 40% to 93%, with particularly low accuracy for PPIs and clarithromycin, especially in patients weighting 25 to 34 kg. The recommendation to perform at least two tests to confirm the diagnosis is not being followed. Strict implementation of the updated ESPGHAN/NASPGHAN/LASPGHAN guidelines could result in a higher eradication rate.
Contact e‐mail address: jfvera1@gmail.com
G‐EV297. Topic: AS01. GASTROENTEROLOGY/AS01j. Polyposis
G‐EV297.1. INFANTILE FAMILIAL ADENOMATOUS POLYPOSIS WITH POOR PROGNOSIS: WHEN CLINICAL GUIDELINES CANNOT BE FOLLOWED
Sofía Bassy Navarro1, Laura Palomino 2, Marta Velasco Rodríguez‐Belvis2, Paula Sánchez Llorente2, Rosa Ana Muñoz Codoceo3
1Paediatric Gastroenterology, Hepatology And Nutrition Section. Paediatrics, Hospital Niño Jesús, Madrid, Madrid (Spain), Spain, 2Hospital Infantil Universitario Niño Jesús and Instituto de Investigación Sanitaria Princesa (IIS‐Princesa), Madrid, Spain, 3Pediatric Nutrition, Hospital Infantil Niño Jesús, Madrid, Spain
Objectives and Study: Familial adenomatous polyposis (FAP) is a rare hereditary disorder marked by multiple malignant‐potential adenomas in the digestive tract. Typically asymptomatic in childhood, the 2019 ESPGHAN guidelines recommend colonic surveillance starting at age 12. Given the rarity of total colectomy in these patients, we aim to present a representative case.
Methods: Retrospective review of the patient's history, audiovisual test records, and relevant guidelines and literature on the subject.
Results: A 2‐year‐old girl presented with rectal bleeding unresponsive to a cow's milk exclusion diet. Her maternal uncle and mother were diagnosed with FAP at ages 16 and 20, respectively. Colonoscopy revealed multiple colonic polyps, and an APC mutation was confirmed. Due to persistent bleeding, anemia requiring IV iron, and endoscopic findings of countless polyps (Video 1), colectomy was performed at age 8, revealing a polyp with high‐grade dysplasia (Image 1). One year before the colectomy was done, her mother died at age 23 from a duodenal tumor.
Conclusions: Despite being one of the youngest patients to undergo colectomy for FAP in the literature, the presence of high‐grade dysplasia highlights the need to consider this type of invasive diagnostic and treatment techniques in patients with a positive family history of FAP and poor prognostic factors. FAP should be managed by multidisciplinary units with a personalized approach related to diagnostic procedures, early prophylactic surgery, and lifelong follow‐up.
Contact e‐mail address: sofiabassy18@gmail.com
H‐OP001. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP001.1. UNDERSTANDING THE CARE BURDEN IN FAMILIES OF CHILDREN WITH PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS
Cigdem Arikan 1,2, Pinar Arikan2, Ozlem Unsal2, Romina Markaroglu2
1KOC UNIVERSITY CENTER CENTER FOR TRANSLATIONAL MEDICINE (KUTTAM), KOC UNIVERSITY, ISTANBUL, TURKEY, ISTANBUL, Turkey, 2KOC UNIVERSITY HOSPITAL, PEDİATRIC HEPATOLOGY AND NUTRITION, ISTANBUL, TURKEY, ISTANBUL, Turkey
Objectives and Study: Caregivers of children with chronic diseases experience significant physical, emotional, and social burdens. This study aimed to evaluate caregiver burden, anxiety and depression, quality of life (QoL), and additional factors such as sleep quality and itching severity among caregivers of children with progressive familial intrahepatic cholestasis (PFIC), autoimmune hepatitis (AIH), and healthy controls.
Methods: This cross‐sectional study included 176 caregivers, with 32 caregivers of children with PFIC, 24 with AIH, and 120 healthy controls. Caregivers were assessed using the “Patient and Caregiver Information Form,” “Zarit Caregiver Burden Scale,” anxiety and depression scores, a validated Quality of Life (QoL) questionnaire, and assessments of sleep quality and itching severity. Statistical analyses included t‐tests, ANOVA, and Pearson correlation tests.
Results: Caregivers of children with PFIC had significantly higher burden scores (66.59 ± 12.6) than AIH (35.82 ± 10.3) and healthy controls (12.34 ± 5.6). QoL scores were lower in PFIC caregivers than other groups (p < 0.01). Sleep quality and itching severity were worse in PFIC caregivers compared to AIH and controls, with no differences between AIH and controls. Sleep disturbances and itching severity were key factors increasing burden and were positively associated with depression scores (p < 0.01). Caregiving burden correlated with anxiety (r = 0.62; p < 0.01) and depression (r = 0.64; p < 0.01) across all groups. Anxiety scores were higher in PFIC and AIH caregivers compared to controls (p < 0.05), but no significant differences were seen between PFIC and AIH. Depression scores were higher in PFIC caregivers with frequent hospitalizations (>4) compared to fewer hospitalizations (<4) (p < 0.05). Prolonged disease duration, comorbid conditions, and lack of support increased burden and depression in PFIC caregivers (p < 0.01). Families with multiple children and lower economic status also had higher burdens (p < 0.01). Education about the disease reduced anxiety and depression in AIH caregivers (p < 0.05) but not in PFIC caregivers.
Conclusions: Targeted psychosocial and educational support and addressing disease‐specific factors, is essential to improve caregiver well‐being.
Contact e‐mail address: cigdemarikanmd@yahoo.com
H‐OP002. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP002.1. CHARACTERIZING INFECTIONS IN PEDIATRIC ACUTE LIVER FAILURE: EPIDEMIOLOGY, TRENDS, RISK FACTORS, AND PROGNOSIS
Tamoghna Biswas 1, Bikrant Bihari Lal1, Vikrant Sood2, Pratibha Kale3, Vikas Khillan3, Rajeev Khanna1, Seema Alam1
1Department Of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India, 2Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, Delhi, India, 3Department Of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India
Objectives and Study: The present study aimed to explore the prevalence, characteristics, predictors and outcomes of infections in pediatric acute liver failure (PALF).
Methods: Data was retrieved from a prospectively maintained database of PALF patients admitted between January 2012 and June 2024. ‘Sepsis’ was defined as presence of systemic inflammatory response syndrome (SIRS) with suspected or proven infection. Patients with positive bacterial and/or fungal cultures were labelled as ‘culture‐positive sepsis’. Outcome measures included native liver survival (NLS) and overall survival (OS) at day 28.
Results: A total of 422 patients of PALF were included in the study of whom 195 (46.21%) fulfilled the criteria of sepsis and 71 (16.8%) had culture‐positive sepsis. Bronchoalveolar fluid (37/81, 45.7%) was the commonest site of culture positivity followed by blood (29, 35.8%). More than 80% of cultures grew gram negative organisms with high prevalence of carbapenem (77.1%) and multidrug (60%) resistance. These organisms were sensitive to colistin and newer beta‐lactam combinations. Intensive care unit (ICU) stay, mechanical ventilation, grade 3‐4 hepatic encephalopathy and use of extracorporeal liver support systems were associated with culture‐positive sepsis. Patients with culture‐negative sepsis had lower NLS and OS, while patients with culture‐positive sepsis had outcomes comparable to patients without sepsis. However, culture‐positive severe sepsis patients had significantly lowered NLS (33.3%) and OS (42.9%) at day 28.
Conclusions: There is high prevalence of carbapenem and multidrug resistant sepsis in PALF. ICU stay and use of extracorporeal support are factors independently associated with sepsis. While culture‐positive sepsis did not significantly affect survival, patients with severe sepsis had lower NLS and OS.
Contact e‐mail address: tamoghnab@gmail.com
H‐OP003. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP003.1. EXPLORING RELATIONSHIP BETWEEN INFLAMMATORY BOWEL DISEASE ACTIVITY AND PRIMARY SCLEROSING CHOLANGITIS OUTCOMES
Emma Broer 1, Rabia Khan2, Eileen Crowley3, Nidhi Rashmikant Suthar3, Mary Sherlock4, Mary Zachos4, Herbert Brill4, Ruchika Sharma4, Carolina Jimenez2, Juan Pablo Arab3, M. Khan3, Adrienne Abaya3, Rokhsana Mortuza3, Gurpret Mahli3, Neeraj Narula5, Zaki Alhashimalsayed5, Mohammed Alkhalifa5, Daniel Mulder6, Jennifer De Bruyn7, Matthew Carroll8, Nabiha Faisal9, Fariba Ishrar9, Julie Zhu10, Anthony Otley11, Sara Omar1, Sanjay Murthy12, Eric Benchimol1, Amanda Ricciuto1
1Toronto Hospital for Sick Children, Toronto, Canada, 2Children's Hospital of Eastern Ontario, Ottawa, Canada, 3London Health Sciences Centre, London, Canada, 4McMaster Children's Hospital ‐ Hamilton Health Sciences, Hamilton, Canada, 5Hamilton Health Sciences, Hamilton, Canada, 6Kingston Health Sciences Centre, Kingston, Canada, 7Alberta Children's Hospital, Calgary, Canada, 8Stollery Children's Hospital, Edmonton, Canada, 9Children's Hospital of Winnipeg, Winnipeg, Canada, 10Dalhousie University, Division of Digestive Care and Endoscopy, Halifax, Canada, 11IWK Health Centre, Halifax, Canada, 12The Ottawa Hospital, Ottawa, Canada
Objectives and Study: The relationship between inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) remains enigmatic. While data suggest that inactive IBD/colectomy protect against PSC recurrence post‐liver transplant (LTx), recent animal studies suggest that colitis may ameliorate cholestatic liver disease. We aimed to examine the association between IBD and PSC outcomes in a Canadian PSC‐IBD cohort.
Methods: CAN‐PSC‐IBD is a retrospective cohort including children/adults with PSC‐IBD at 13 centres across 4 Canadian provinces. We examined the association between IBD features and time to LTx (Kaplan‐Meier curve, Cox regression), unadjusted and adjusted for baseline PSC severity reflected by SCOPE index (low/medium/high risk).
Results: The cohort includes 259 paediatric‐onset and 450 adult‐onset PSC‐IBD patients (75% UC/IBD‐U; 65% male; median follow‐up 2.9 y in children, 11.6 y in adults; 17 LTx in children, 166 in adults). In univariate Cox regression in children, longer IBD duration at PSC diagnosis and moderate‐severe baseline endoscopic severity were protective for LTx, while higher ESR at IBD diagnosis was a risk factor. LTx did not differ by IBD type. After adjusting for SCOPE index, the direction of effect for endoscopic severity reversed though not significant. Adjusted estimates for IBD duration and ESR remained similar, though no longer significant. FigA/B suggest faster progression to LTx in children with milder clinical activity (PGA) at IBD diagnosis and persistently quiescent endoscopic disease. In adults, there was a trend toward UC/IBD‐U being a risk factor for LTx and anti‐TNF use was protective (unadjusted p = 0.07, 0.003).
Conclusions: Unadjusted analysis suggests an inverse association between IBD severity and LTx. However, the markedly different adjusted estimate for endoscopic severity highlights that PSC severity may be a confounder (severe IBD may trigger faster assessment and milder PSC at diagnosis). This underlines the challenges of unravelling the relationship between IBD and PSC activity and the importance of accounting for baseline disease characteristics.
Contact e‐mail address: amanda.ricciuto@sickkids.ca
H‐OP004. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP004.1. PATIENT‐SPECIFIC IPSC‐DERIVED HEPATIC ORGANOIDS AS MODEL FOR MRNA‐BASED GENE THERAPY IN FARNESOID‐X RECEPTOR (FXR) DEFICIENCIES
Tobias Cantz 1, Malte Sgodda1, Sebastian Hook2, Eva‐Doreen Pfister3, Verena Keitel‐Anselmino4, Ulrich Baumann3
1Translational Hepatology & Stem Cell Biology, Hannover Medical School, Hannover, Germany, 2Gastroenterology, Hepatology, Infectious Diseases & Endocrinology, Hannover Medical School, Hannover, Germany, 3Pediatric Gastroenterology And Hepatology, Hannover Medical School, Hannover, Germany, 4Otto‐von‐Guericke University Hospital Magdeburg, Magdeburg, Germany
Objectives and Study: Progressive familial intrahepatic cholestasis (PFIC) represents a group of rare disorders characterized by defective bile formation and account for 10‐15% of neonatal cholestasis. The underlying mechanism of intrahepatic cholestasis can be associated with mutations in hepatobiliary transport proteins or in nuclear receptors responsible for proper transcriptional control of these transporters. In our previous work we demonstrated that patient‐specific iPS cell lines can be differentiated into hepatic organoids for functional studies of the patients’ mutations.
Here, we aimed to investigate if such organoids could serve as model to assess effective mRNA‐based therapies.
Methods: First, we studied iPSC‐based organoids from two patients suffering from BSEP deficiency caused by mutations in the farnesoid‐X receptor (FXR) gene NR1H4. The NR1H4 gene encodes four different FXR variants whereas the FXR alpha‐2 variant is most abundant in the liver. We used one cell line carrying a homozygous variation in exon 7, resulting in a loss of substrate binding of FXR and therefore in a complete abrogation of downstream signal transduction. A second cell line carries a homozygous variation in intron 4 resulting in an exon‐skipping, which encodes the start codon for both FXR alpha‐1 and ‐2 variants, while transcription of the FXR alpha‐3 and ‐4 variants would be unaffected.
Results: We generated lipid nanoparticles (LNP) carrying mRNAs of the four different FXR variants as well as BSEP as a positive control. After treatment of the hepatic organoids with the different LNP, we were able to restore BSEP‐mediated hepatobiliary transport with all FXR variants. This indicates that even the gut‐associated FXR alpha‐3 and ‐4 variants are able to restore hepatic function and might be targetable to induce BSEP function in FXR alpha‐1 or ‐2 deficient patients.
Conclusions: However, as the different FXR variants are involved in several metabolic pathways, the global impact of this alternative activation needs further investigation.
Contact e‐mail address: cantz.tobias@mh-hannover.de
H‐OP005. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP005.1. CARDIAC AND VASCULAR MALFORMATIONS ARE COMMON IN SUBJECTS WITH EXTRAHEPATIC CONGENITAL PORTOSYSTEMIC SHUNTS
Isaline Chabbey 1, Nicolas Silvestrini2, Valeria Casotti3, Simona Korff4, Julier Wacker5, Riccardo Superina6, Laurent Savale7, Anne‐Laure Rougemont8, Dominique Debray9, Valérie Mclin4
1Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland, 2Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland, 3Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 4Swiss Pediatric Liver Center, Department of Pediatrics, University of Geneva, Geneva, Switzerland, 5Pediatric Cardiology Unit, Department of Pediatrics Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland, 6Division Of Transplant And Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, United States of America, 7Pulmonary Medicine, Hopital Bicetre, Paris, France, 8Pathology, Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland, 9National Reference Centre for Rare Pediatric Liver Diseases (Biliary Atresia and Genetic Cholestasis), FILFOIE, ERN RARE LIVER, Necker‐Enfants Malades Hospital, University of Paris, Paris, France
Objectives and Study: It has been reported that congenital portosystemic shunts (CPSS) are frequently associated with congenital malformations (CM), but the frequency of these associations is not known. Furthermore, it is unknown if CM differ according to anatomical shunt type. We hypothesized that CM are more common in patients with extrahepatic CPSS (EH CPSS). Therefore, our aim was to analyze CM in a large dataset of patients with CPSS.
Methods: CM and anatomical subtypes of CPSS were extracted from the IRCPSS. CM were categorized into cardiac, vascular, urological, gastrointestinal, brain, heterotaxy/situs inversus. Patients with two types of CPSS or missing information on shunt type were excluded. Statistics: descriptive analysis and chi‐square or Fisher tests to compare proportion of CM between IH and EH.
Results: By November 2024, 270 patients with at least one shunt were included in the registry. 112 patients had IH CPSS, while 149 patients had EH CPSS. 9 patients were excluded (5 with both IH and EH, 4 with missing information). 53% of patients were male and 41% diagnosed at 1 year of age or later. Table 1 summarizes the findings according to shunt type.
Conclusions: In patients included in the IRCPSS, there was an over‐representation of any malformation among subjects with EH CPSS, and a trend for these patients to present with more cardiac or vascular abnormalities than patients with IH forms. Patients with EH CPSS presented with situs abnormalities more commonly than the general population. These findings suggest that CPSS should be sought in patients with malformations of any kind.
Contact e‐mail address:
H‐OP006. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP006.1. SEBELIPASE ALFA IMPROVES LIVER AND LIPID PARAMETERS IN PATIENTS WITH LYSOSOMAL ACID LIPASE DEFICIENCY: RESULTS FROM THE INTERNATIONAL LAL‐D REGISTRY
Lorenzo D'Antiga 1, Don Wilson2, Jennifer Evans3, Florian Abel3, Emilio Ros4, William Balistreri5, Joe Pellegrino6
1Pediatric Hepatology, Gastroenterology And Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 2Cook Children's Medical Center, Fort Worth, United States of America, 3Alexion, AstraZeneca Rare Disease, Boston, United States of America, 4Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain, 5Uc Department Of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America, 6OPEN Health, Parsippany, United States of America
Objectives and Study: Liver transaminase abnormalities and dyslipidemia are common in patients with lysosomal acid lipase deficiency (LAL‐D). This study examined alanine and aspartate aminotransferase (ALT, AST) and low‐ and high‐density lipoprotein cholesterol (LDL‐C, HDL‐C) levels in pediatric patients to determine prevalence and severity of baseline abnormalities and to report results over 3 years follow‐up among those treated with sebelipase alfa enzyme replacement therapy.
Methods: This observational study included patients diagnosed with LAL‐D before 18 years of age who were enrolled in the International LAL‐D Registry (NCT01633489), excluding those who initiated treatment before 6 months of age. Baseline liver and lipid measures were assessed. A subanalysis was performed among patients with baseline data and 3 consecutive annual follow‐up assessments. Descriptive results are presented.
Results: As of October 2024, 99 patients were included (41% female, 94% White, 9.2 year median age at baseline). Baseline ALT and AST levels were above the upper limit of normal for most patients: 81/86 (94%) for ALT and 75/83 (90%) for AST. Baseline LDL‐C was >130 mg/dL (median: 210 mg/dL) for 69/80 (86%) patients. Baseline HDL‐C was below the lower limit of normal for 61/78 (78%) patients. Among 29 treated patients with baseline data and 3 consecutive annual follow‐up measures, few patients had ALT, AST, LDL‐C, and HDL‐C within normal limits at baseline (7%, 7%, 10%, 10%, respectively); results improved over the first year (45%, 45%, 35%, 28% of patients, respectively, had normal values), with benefits sustained over 3 years. Most patients (66%) had ≥1 adverse event; most AEs were mild/moderate. One death occurred during follow‐up (roadway accident).
Conclusions: Baseline liver and lipid measures were abnormal among most patients with LAL‐D diagnosed at <18 years of age. Liver and lipid parameters improved in a large proportion of patients receiving sebelipase alfa over 3 years.
Contact e‐mail address:
H‐OP007. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP007.1. DIGITAL STOOL COLOR SCREENING FOR BILIARY ATRESIA: A PROSPECTIVE FIELD STUDY USING A MOBILE APP FOR PARENTS
Thomas Darijtschuk 1, Severin Allmendinger1, Christoph Bührer2, Wolfgang Henrich3, Christan Hudert1, Christian Krumnow4, Björn‐Oliver Gohlke5, Lucas Griessmair1, Philip Bufler1
1Department Of Pediatrics, Division Of Gastroenterology, Nephrology And Metabolic Medicine, Charité ‐ Universitätsmedizin Berlin, Berlin, Germany, 2Department Of Neonatology, Charité ‐ Universitätsmedizin Berlin, Berlin, Germany, 3Department Of Obstetrics, Charité ‐ Universitätsmedizin Berlin, Berlin, Germany, 4Center For Biomedical Image And Information Processing (cbmi), HTW Berlin, Berlin, Germany, 5It Division, Charité ‐ Universitätsmedizin Berlin, Berlin, Germany
Objectives and Study: Early diagnosis of Biliary atresia (BA) improves native liver and overall survival. Leading symptom of BA is the occurrence of acholic stools. Our previous data indicate high accuracy of an AI‐based image algorithm in detecting acholic stools. Here we tested the acceptance and user experience of the digital stool color screening in newborns using a mobile app for parents (DiaperID) and evaluated the AI model's performance in comparison to expert assessment.
Methods: An ongoing (until April 2025) prospective field study including healthy newborns without prolonged hospitalization is conducted at the newborn wards of Charité university hospital Berlin. Participating parents complete a 5‐week study course, during which they are asked to take at least one stool photo per week. App usage and user rates are tracked pseudonymized. User experience is analyzed via an online questionnaire including the S‐MAUQ. Items are rated 1‐7 on a Likert scale, with 7 indicating best agreements. A pretrained AI model was selected for image analysis. Expert rating by two trained pediatricians is used as reference and feedback for parents.
Results: After 11 of 15 weeks 378 participants completed the study. 60,1% actively used DiaperID and 29,9% uploaded stool photos in four or more weeks. Parents rated their user experience with a mean of at least 5,8/7 throughout all 7 items of the S‐MAUQ. The AI model agreed with the expert assessment in 90,8%. No case of BA was detected during the current study period.
Conclusions: High acceptance and user experience ratings reflect the feasibility and serve as a proof‐of‐concept for a digital stool color screening in newborns. However, testing of an improved app version in larger populations is needed. Stool photos are used for further training of the AI model. Updated AI models for stool color analysis and final study results will be presented.
Contact e‐mail address: diaperid@charite.de
H‐OP008. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP008.1. LIVER‐DERIVED MESENCHYMAL STEM CELLS PROMOTE EPITHELIAL‐MESENCHYMAL TRANSITION IN A HEPATOCELLULAR CARCINOMA SPHEROID COCULTURE MODEL
Grégory De Bodt 1,2, Joachim Ravau1, Jonathan Evraerts1, Xavier Stephenne1,2, Mustapha Najimi1, Etienne Sokal1,2
1Pedi, Irec, UCLouvain, Woluwe‐Saint‐Lambert, Belgium, 2Division of Pediatric Gastroenterology and Hepatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium
Objectives and Study: Mesenchymal stem cells (MSC) play a highly debated role in cancer. Potent anti‐ and pro‐tumour properties have been shown in vitro and in vivo depending on the tumour studied and the MSC used. Here, we investigate the interaction between liver‐derived MSC and hepatocellular carcinoma (HCC). We postulate that this shared origin can lead to unique insights on the potential implication of MSC in carcinogenesis.
Methods: We established a 3D coculture spheroid model by combining Human Adult Liver Progenitor Cells (HALPC), liver‐derived mesenchymal stem cells described by our team, and one of three human hepatocellular carcinoma cell line (HuH7, HepG2, Hep3B). Cancer cell proliferation was studied through spheroid growth follow‐up, chemiluminescent measurement of ATP content and Ki67 immunostaining in light sheet fluorescent microscopy. Cancer cell invasiveness was investigated using transwell and spheroid invasion assays. Total RNA sequencing was conducted on HALPC and cancer cells extracted from control and coculture spheroids.
Results: HCC coculture with HALPC resulted in an inhibition of cancer cell proliferation (up to 66% reduction in Ki67‐positive cancer cells in coculture; p = 4.6x10‐5), while invasion studies demonstrated the induction of an invasive phenotype. Comprehensive transcriptomic analysis showed massive changes in expression levels in both HALPC and cancer cells following coculture. In cancer cells, gene set enrichment analysis revealed dysregulation of cancer hallmarks gene sets, with an important positive enrichment of the epithelial‐mesenchymal transition (EMT) gene set (Normalized Enrichment Score: + 2.7; p adj. = 1.1x10‐18).
Conclusions: We showed in a 3D coculture model that liver‐derived MSC decreased proliferation and induced invasiveness in several human HCC cell lines. This was associated with the induction of an EMT phenotype at the transcriptomic level, shedding additional light on the role of organ resident MSC in carcinogenesis. Ongoing work will confirm the EMT phenotype at the protein level and validate results in vivo.
Contact e‐mail address: gregory.debodt@uclouvain.be
H‐OP009. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP009.1. RELATIVE EXCHANGEABLE COPPER: VALIDATION OF A HIGHLY SPECIFIC AND SENSITIVE BIOMARKER FOR WILSON DISEASE DIAGNOSIS IN CHILDREN
Clement Desjardins1, Dominique Debray 1, Mickael Alexandre Obadia1, Djamila Rahli1, Nouzha Djebrani‐Oussedik2, Aurelia Poujois1
1Reference Center For Wilson Disease, Hôpital Fondation Adolphe de Rothschild, PARIS, France, 2Toxicology, Hôpital Lariboisière, PARIS, France
Objectives and Study: Evaluation of copper metabolism for diagnosis of Wilson disease (WD) includes total serum copper (Cu), ceruloplasmin and urinary copper. A direct measure of non‐ceruloplasmin‐bound copper, named exchangeable copper (CuEX), was developed in 2009 in France, and the ratio of CuEX to total serum Cu levels, i.e relative exchangeable copper (REC), was proposed as a diagnostic biomarker. This study aims to define REC cut‐off for WD diagnosis in children.
Methods: All individuals investigated in our centre from January 2009 to 2021 who underwent serum Cu, CuEX, and REC assessments, and genetic testing for ATP7B were included. The ROC curve analysis of the entire study population defined the REC cut‐off for the diagnosis of WD which was subsequently validated in two independent groups: children (<16 years old) and adult (≥16 years old).
Results: 623 individuals were included in the study: 192 patients (including 76 children) with genetically confirmed WD; 270 (including 115 children) healthy heterozygous (HTZ) carriers and 161 (including 49 children) healthy controls without ATP7B variants. Among controls, median total Cu levels did not differ by age group. Compared to adults, children had lower median CuEXC levels (0.78 μmol/L vs 0.89 μmol/L; p < 0.05) and lower REC values (4.9% vs 5.4%, p < 0.05). Based on the entire study population, REC cut‐off was set at 13.92% (95.8% sensitivity, 99.8% specificity). For children, the optimal threshold determined by the Youden method was 13.92% (94.7% and 99.3% respectively). Using this cut‐off, there were 4 false negatives (1 asymptomatic and 3 with slightly increased transaminase levels), and 1 false positive (HTZ carrier but 2 variants on the same allele).
Conclusions: REC is a robust diagnostic biomarker for WD, demonstrating high sensitivity and specificity in children as well as in adults, and should be included into routine clinical practice, potentially reducing the need for invasive liver biopsies to assess hepatic copper levels.
Contact e‐mail address: ddebray@for.paris
H‐OP010. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP010.1. PROTOCOL BIOPSY IN CHILDREN WITH AUTOIMMUNE LIVER DISEASE: PRELIMINARY RESULTS OF MONOCENTRIC STUDY
Angelo Di Giorgio 1, Lisa Licini2, Paola Tebaldi2, Michela Bravi3, Paola Stroppa3, Emanuele Nicastro3, Lorenzo D'antonio4
1Hospital Santa Maria Della Misericordia, Udine, Italy;, Pediatric Hepatology, Gastroenterology and Transplantation, Bergamo, Italy, 2Liver Pathology, Hospital Papa Giovanni XXIII, Bergamo, Italy, 3Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 4Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy; Department of Medicine and Surgery, University of Milano – Bicocca, Milan, Italy
Objectives and Study: In patients with autoimmune liver disease (AILD) transaminases are considered the best surrogate markers for histological remission. At our centre, we perform protocol liver biopsy (PLB) in children with autoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (ASC) to assess histological activity. Here we aim to define whether normal transaminases correlate with histological remission.
Methods: PLB was performed every 3 years after diagnosis in children with normal transaminase levels, between 2017‐2024. Liver specimens were retrospectively reviewed and scored by two pathologists. Histological remission was defined as modified Hepatitis Activity Index (mHAI) < 4/18; residual activity as mHAI 4‐5; moderate‐high inflammatory activity as mHAI ≥ 6/18. New course of steroids and/or switch to second‐third line immunosuppressive treatment were considered in children with mHAI ≥ 6/18.
Results: 101 children diagnosed with AILD according to standardized criteria were included (AIH n = 71; ASC n = 30). At diagnosis the median mHAI was 8 (IQR 5‐12); all were treated with immunosuppressive therapy (prednisone with or without azathioprine). At first PLB (n = 66 cases; AIH = 49, ASC = 17), 56% (37/66) of patients showed histological remission while 44% (29/66) had residual (13/29, 45%) or moderate‐high (16/29, 55%) histological activity. At second PLB (n = 36 cases; AIH = 23; ASC = 13), 78% (28/36) showed histological remission while 22% (8/36) had residual (5/8; 62%) or moderate‐high (3/8, 38%) histological activity. At third PLB (8 cases; AIH = 6; ASC = 2), 88% (7/8) had histological remission while 12% (1/8) had moderate‐high activity.
Conclusions: Preliminary results demonstrate that around 50% of patients with AILD show histological disease activity despite normal transaminase levels. This percentages gradually reduced at 2nd and 3rd PLB suggesting benefits from treatment changes. These results underline the need for new biomarkers of disease activity in children with AILD.
Contact e‐mail address: angelo.digiorgio@uniud.it
H‐OP011. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP011.1. SAFETY AND EFFICACY OF CARVEDILOL IN CHILDREN WITH PORTAL HYPERTENSION: A NATIONAL STUDY FROM THE 3 QUARTENARY UK CENTRES
Vangelis J Giamouris 1, Abdullah A Amin2, Marumbo Paul Mtegha3, Bethany Tucker1, Dimitrios Mourelatos1, Jane Hartley2, Girish L Gupte2, Lauren Johansen2, Joanne Crook1,4, Siti Bintiali1,4, Eirini Kyrana1,5, Robert Hegarty1, Vandana Jain1, Chayarani Kelgeri2, Tassos Grammatikopoulos1,5
1King's College Hospital NHS Foundation Trust, Paediatric Liver, GI & Nutrition Centre, Lodnon, United Kingdom, 2Paediatric Liver Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom, 3Paediatric Liver Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK, Leeds, United Kingdom, 4Pharmacy, Kings college hospital NHS Foundation Trust, London, United Kingdom, 5Roger Williams Institute Of Liver Studies, King's College London, London, United Kingdom
Objectives and Study: Carvedilol is a non‐selective beta‐blocker used in adults with portal hypertension (PHT), with limited evidence in children. This retrospective cross‐sectional study from the 3 UK paediatric liver centres evaluated the safety and efficacy of Carvedilol.
Methods: Clinical and laboratory data were collected from each unit's database. All children underwent endoscopic surveillance and interventions(banding and/or sclerotherapy) prior to Carvedilol therapy. Screening before commencing Carvedilol, dose and frequency of endoscopy followed trust protocols. The efficacy was evaluated by comparing number of interventions and bleeding episodes per year before(Group A) and after treatment(Group B) in patients who were followed up for at least one year. Results are reported as median and range.
Results: We included 63 children(57% male); age of 10.5years(1‐18). Primary diagnosis was portal carvenoma(PC) in 24(38%), biliary atresia(BA) in 19(30%), other aetiology in 20(31%). Carvedilol was tolerated in all except 3(4.7%), from which one showed major side effect (wheezing episode on a background of chronic lung disease) and 2 showed non‐adherence. Minor complaints were dizziness, night terrors, sleep disturbance and abdominal discomfort. The subgroup cohort to assess efficacy included 43 patients(51% male); age 12(3‐18). Number of interventions per year significantly decreased from 1.37(before carvedilol) to 0.67 after carvedilol treatment (Wilcoxon Test, p < 0.0001)(Figure 1). Treatment with carvedilol significantly reduced median bleeding episodes per year, from 0.1667 (before carvedilol) to 0.0 after carvedilol(Wilcoxon Test, p < 0.0001). Significant differences in age at diagnosis, carvedilol starting age, pre‐carvedilol interventions observed in different diagnoses: BA(n = 9), PC(n = 19), and other(n = 15)(table 1). In total 8 patients had liver transplant with median follow up 9 months (0‐13) and no child deceased.
Conclusions: Carvedilol seems a well‐tolerated and safe medication in children with PHT. We report a significant decrease of endoscopic intervention rates in children treated with carvedilol. Further longitudinal studies are required to assess long‐term efficacy in children.
Contact e‐mail address: e.giamouris@nhs.net
H‐OP012. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP012.1. GUT MICROBIOTA RESPONSE TO ILEAL BILE ACID INHIBITOR THERAPY IN CHILDREN WITH PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS
Kora Schulze1, Miriam Kramer1,2, Sabrina Woltemate1, Niyade Ouro‐Djobo2, Alina Poets1,2, Marius Vital1, Imeke Goldschmidt 2
1Institute For Medical Microbiology, Medizinische Hochschule Hannover, Hannover, Germany, 2Division Of Pediatric Hepatology And Liver Transplantation; Department Of Pediatric Liver, Kidney And Metabolic Diseases And Neuropediatrics, Medizinische Hochschule Hannover, Hannover, Germany
Objectives and Study: Progressive familial intrahepatic cholestases (PFIC) designates a number of hereditary cholestasis syndromes with variable defects in bile acid (BA) secretion. Treatment of PFIC with ileal BA transport inhibitors (IBATi) increases transport of primary BA to the colon, while liver transplantation (LT) is restores normal bile flow completely. Gut microbioata (GM) metabolize BA, but little is known on impact of PFIC treatment on GM composition and function. We explore GM composition in PFIC before and after treatment with IBATi or LT.
Methods: In 31 children (15 f, age 4.9 (0.4‐17.5) years (PFIC 1/2/3/5/6/other in n = 2/14/9/2/1/3), in total 63 fecal samples including therapy‐naïve PFIC (PFICnaïve) n = 13, established IBATi treatment (PFICIBATi) n = 14, and PFIC after LT (PFICLT) n = 13)) were analysed for GM composition and function using metagenomics and compared with 29 healthy controls (HC). Longitudinal changes in GM before and under IBATi were analysed in n = 9.
Results:
Bacterial cell‐counts were reduced in all patients compared to HC, while alpha‐diversity was almost normal in PFICLT (Fig 1a&b). GM function (median relative frequency of genes for ACCOA) was significantly reduced in PFICnative (6.9%) and PFICIBATi (15.6%) compared to both PFICLT (23.3%) and HC (30.1%,p < 0.01 respectively). The bai‐operon coding for metabolization of primary to secondary BA by GM was almost absent in PFICnaive. Although transport of BA to the colon is believed to increase in PFICIBATi, bai frequency did not (Fig1c). Longitudinal assessment of GM after initiation of IBATi showed gradual increase of diversity in some but not all patients. Change in beta‐diversity after initiation of IBATi appeared associated with response to therapy.
Conclusions: Patients with PFIC show severe GM dysbiosis compared to HC. GM capacity to metabolize primary bile acids does not increase under IBATi. LT almost normalizes GM in PFIC, while IBATi does not. Amelioration of GM after IBATi therapy is associated with response to therapy.
Contact e‐mail address:
H‐OP013. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP013.1. IMPROVEMENTS IN PRURITUS AFTER MARALIXIBAT TREATMENT ARE ASSOCIATED WITH IMPROVED HEALTH‐RELATED QUALITY OF LIFE FOR PATIENTS WITH CHOLESTATIC LIVER DISEASE
Emmanuel Gonzales 1, Alexander Miethke2, Binita Kamath3, Richard Thompson4, Douglas Mogul5, Tiago Nunes5, Jolan Terner‐Rosenthal5, Marshall Baek5, Pamela Vig5, Emmanuel Jacquemin1
1Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 2Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America, 3Children's Hospital of Philidelphia, Philidelphia, United States of America, 4Institute of Liver Studies, King's College London, London, United Kingdom, 5Mirum Pharmaceuticals, Inc., Foster City, California, United States of America
Objectives and Study: Alagille syndrome (ALGS) and Progressive Familial lntrahepatic Cholestasis (PFIC) are rare cholestatic liver diseases (CLD) associated with severe pruritus along with markedly reduced health related quality of life (HRQoL). Maralixibat, an IBAT inhibitor, is approved for the treatment of cholestatic pruritus in patients with ALGS ≥ 2 months and for the treatment of PFIC ≥ 3 months of age in the EU, respectively. This analysis assessed whether improvements in pruritus after maralixibat treatment are correlated with improvements in HRQoL.
Methods: Separate retrospective analyses of pruritus and HRQoL data from the ICONIC trial in ALGS and the MARCH trial in PFIC were conducted. Patients in both studies had moderate to severe pruritus (≥1.5 on ItchRO[Obs]; scale: 0=none to 4=very severe). HRQoL was assessed using the PedsQL (0‐100 scale, 100=best QoL), Physical Health (PH), Psychosocial Health (PSH), and Multidimensional Fatigue (MF) scales. In MARCH, a subset of questions from the exploratory diary questionnaire (EDQ) focused on sleep disturbance were assessed for their relationship to pruritus improvement. Spearman's (r) coefficients evaluated the relationship between pruritus improvements and HRQoL.
Results: A total of 31 patients with ALGS from ICONIC were included in the analysis. After 18 weeks of maralixibat treatment, there was a significant correlation between pruritus improvement and improvements in PedsQL (r ‐0.50 [p = 0.0074]), PSH (r ‐0.47 [p = 0.012]), and MF (r ‐0.71 [p = 0.0002]). In MARCH, 64 patients from the AII‐PFIC cohort (33 maralixibat, 31 PBO) were included in the analysis. Among maralixibat‐treated participants after 26 weeks of treatment, there was a significant correlation between pruritus improvement and improvements in PedsQL (r ‐0.53 [p = 0.003]), PH (r ‐0.50 [p = 0.0057]), PSH (r ‐0.47 [p = 0.01]), and sleep (r 0.96 [p < 0.0001]).
Conclusions: Irrespective of the CLD studied, improvements in pruritus after maralixibat treatment were strongly associated with improvements in HRQoL across multiple domains.
Contact e‐mail address:
H‐OP014. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP014.1. HEPATIC FORM OF DLD DEFICIENCY: PHENOTYPIC SPECTRUM, LABORATORY FINDINGS AND THERAPEUTIC APPROACHES IN 50 PATIENTS
Nicole Hammann 1, Christian Staufner1, Lea Schlieben2, Antal Dezsofi3, Johannes Häberle4, Norman Junge5, Vassiliki Konstantopoulou6, Robert Kopajtich7, Valérie Mclin8, Daisy Rymen9, Christoph Slavetinsky10, Ekkehard Sturm11, Johannes Mayr12, Matias Wagner7, Stefan Kölker1, Holger Prokisch2, Georg Hoffmann1, Dominic Lenz1
1Heidelberg University, Medical Faculty, Department Of Pediatrics I, University Children's Hospital, Heidelberg, Germany, 2Technical University of Munich, Munich, Germany, 3First Department Of Pediatrics, Semmelweis University, Budapest, Hungary, 4University Children's Hospital Zurich and Children's Research Center, Zurich, Switzerland, 5Division For Pediatric Gastroenterology And Hepatology, Department Of Pediatric Kidney, Liver And Metabolic Diseases, Hannover Medical School, Hannover, Germany, 6Department Of Pediatrics And Adolescent Medicine, Medical University of Vienna, Vienna, Austria, 7Institute of Human Genetics, Helmholtz Zentrum Munich, Neuherberg, Germany, 8Swiss Pediatric Liver Center, Department of Pediatrics, University of Geneva, Geneva, Switzerland, 9Departement Of Paediatrics, University Hospital Leuven, Center for Metabolic Diseases, Leuven, Belgium, 10Paediatric Surgery And Urology, University Children's Hospital Tübingen, Tübingen, Germany, 11Department Of Pediatric Gastroenterology And Hepatology, University Children's Hospital Tuebingen, Tuebingen, Germany, 12University Children's Hospital, Paracelsus Medical Universit, Salzburg, Austria
Objectives and Study: The hepatic form of dihydrolipoamide dehydrogenase deficiency (MIM 246900/DLDD) is an autosomal recessive mitochondrial disease leading to recurrent metabolic decompensations accompanied by hepatocytolysis. The aim of this study is to investigate in detail phenotype, laboratory findings and therapy of hepatic DLDD.
Methods: We conducted a multicentre observational study including individuals with elevated liver transaminases (ELT) or acute liver failure (ALF) and biallelic variants in DLD gene identified via whole exome sequencing (WES) and a literature study including previously published individuals with DLDD and a predominantly hepatic phenotype.
Results: Seven individuals were identified via WES and 43 additional individuals in literature. Overall, 50 individuals with DLDD and liver involvement (ELT and/or ALF) were included. Forty‐nine of the 50 individuals carried the p.G229C variant, of whom 37 were homozygous for this variant. Decompensations presented with nausea and vomiting (32/32), abdominal pain (14), hepatomegaly (22/25), hypoglycemia (27/35), and lactic acidosis (40/42) and were usually triggered by febrile illness (20/20) or fasting (10/14). In individuals homozygous for the p.G229C variant, there were typically no neurologic manifestations, whereas mild neurologic symptoms (8/12) were found in individuals carrying a second DLD variant in trans. During decompensation, specific plasma amino‐ and urinary organic‐acids were frequently ‐ however not consistently – elevated, and moreover, they were typically normal during the interval. Rescue therapy of decompensations was successful with intravenous dextrose. Maintenance therapy varied between centers, most often used was riboflavin, however, also thiamine and antioxidants (e.g. N‐acetylcysteine) were described to reduce frequency and/or severity of crises in single cases.
Conclusions: Hepatic DLDD leads to recurrent metabolic crises and liver involvement as severe as ALF. As there is no specific biomarker, early genetic testing in all children with unexplained ELT or ALF is useful to diagnose DLDD.
Contact e‐mail address: NicoleIrene.Hammann@med.uni-heidelberg.de
H‐OP015. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP015.1. LONGITUDINAL PATTERNS OF SERUM BILE ACID LEVELS AND PLATELETS COUNTS IN PATIENTS WITH BILE SALT EXPORT PUMP DEFICIENCY (PFIC 2) IN THE GLOBAL NAPPED REGISTRY
Pauline Huisman 1,2, Henkjan Verkade3, Alida De Groot4, Mark Nomden3, Antonia Felzen3, Emmanuel Gonzales5, Irena Jankowska6, Benjamin Shneider7, Etienne Sokal8, Richard Thompson9, Jian‐She Wang10, Liting Li10, Emmanuel Jacquemin5, Patryk Lipinski11, Piotr Czubkowski11, Tassos Grammatikopoulos12, Augustina Kadaristiana12, Henrik Arnell13, Bjorn Fischler14, Wendy Van Der Woerd15, Emanuele Nicastro16, Lorenzo D'antonio16, Seema Alam17, Mohammad Shagrani18,19, Dieter Broering18, Binita Kamath7,20, Aglaia Zellos21, Girish L Gupte22, Pier Luigi Calvo23, Enke Grabhorn24, Dominique Debray25, Mara Cananzi26, Mathias Ruiz27, Carolina Jimenez‐Rivera28, Kyung‐Mo Kim29, Loreto Hierro30, Gema Munoz Bartolo30, Ozlem Durmaz31, Georg Vogel32, Ekkehard Sturm33, Giuseppe Indolfi34, Alexandre Fabre35,36, Eyal Shteyer37, Marianne Hørby Jørgensen38, Jae Sung Ko39, Nathalie Rock40, Amer Azaz41, Yael Mozer ‐ Glassberg42, Sandra Ferreira43, Jernej Brecelj44,45, Gabriella Nebbia46, Ioannis Roilidis47, Antal Dezsofi‐Gottl48, Emna Barkaoui49, Christos Tzivinikos50, Geurt Jongbloed2, Paola Mian51, Bettina Hansen1,52,53, Pedro Miranda Afonso1
1Department Of Epidemiology And Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands, 2Department Of Applied Mathematics, Delft University of Technology, Delft, Netherlands, 3Pediatric Gastroenterology‐hepatology, University Of Groningen, University Medical Center Groningen, Groningen, Netherlands, 4Pediatric Gastroenterology‐hepatology, University Medical Center Groningen, Groningen, Netherlands, 5Pediatric Hepatology and Liver Transplantation Unit, National Reference Centre for Rare Pediatric Liver Diseases, FILFOIE, ERN RARE LIVER, Bicêtre Hospital, AP‐HP. Université Paris‐Saclay, Le Kremlin‐Bicêtre, and Inserm U1193, Hepatinov, University of Par, Orsay, France, 6Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, Children's Memorial Health Institute, Warsaw, Poland, 7Division Of Pediatric Gastroenterology, Hepatology, And Nutrition, Department Of Pediatrics, Baylor College of Medicine, Houston, United States of America, 8Pediatric Gastorenterology And Hepatology, Université Catholique de Louvain, Cliniques St Luc, Brussels, Belgium, 9Paediatric Liver, Gi And Nutrition Centre, King's College London, London, United Kingdom, 10Department Of Gastroenterology, Children's hospital of Fudan university, Shanghai, China, 11Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 12Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom, 13Pediatric Gastroenterology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, And Department Of Women's And Children's Health, Karolinska Institutet, Stockholm, Sweden, 14Pediatric Gastroenterology, Astrid Lindgren Children's Hospital, Karolinska University Hospital And Division Of Pediatrics, Clintec, Karolinska Institutet, Stockholm, Sweden, 15Pediatric Gastroenterology, Hepatology And Nutrition, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands, 16Pediatric Hepatology, Gastroenterology And Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 17Department Of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India, 18Liver & Sb Transplant & Hepatobiliary‐pancreatic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, 19Alfaisal University, College of Medicine, Riyadh, Saudi Arabia, 20Division Of Gastroenterology, Hepatology And Nutrition, The Hospital for Sick Children and the University of Toronto, Toronto, Canada, 21First Department Of Pediatrics, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece, 22Liver Unit (including Small Bowel Transplantation), Birmingham Women's and Children's Hospital, Birmingham, United Kingdom, 23Pediatic Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera Città Della Salute e Della Scienza University Hospital, Turin, Italy, 24Pediatric Hepatology And Liver Transplantation, University Medical Center Hamburg Eppendorf, Hamburg, Germany, 25Gastroenterology‐hepatology‐nutrition Unit, APHP‐Necker Enfants Malades University Hospital, Paris, France, 26Unit Of Gastroenterology, Digestive Endoscopy, Hepatology And Care Of The Child With Liver Transplantation, University Hospital of Padova, Padova, Italy, 27Service D'hépato‐gastroentérologie Pédiatrique, Centre De Référence De L'atrésie Des Voies Biliaires Et Des Cholestases Génétiques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France, 28Department Of Pediatrics, Children's Hospital Of Eastern Ontario, University of Ottawa, Ottawa, Canada, 29Department Of Pediatrics, Asan Medical Center Children's Hospital, Seoul, Korea, Republic of, 30Service Of Pediatric Hepatology And Transplantation, Children's Hospital La Paz, La Paz University Hospital, Madrid, Spain, 31Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul Faculty Of Medicine, Istanbul University, Istanbul, Turkey, 32Department Of Pediatrics I & Institute Of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria, 33Pediatric Gastroenterology And Hepatology, University Children's Hospital Tuebingen, Tuebingen, Germany, 34Meyer Children's, IRCCS, Florence, Italy, 35INSERM, MMG, Aix Marseille University, Marseille, France, 36Service de Pédiatrie Multidisciplinaire, Timone Enfant, Marseille, France, 37The Juliet Keiden Institute Of Pediatric Gastroenterology And Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel, 38Department Of Pediatrics And Adolescent Medicine, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark, 39Department Of Pediatrics, Seoul National University College of Medicine, Seoul, Korea, Republic of, 40Division Of Pediatric Gastroenterology, University Hospital of Geneva, Geneva, Switzerland, 41Pediatric Gastroenterology, Hepatology And Nutrition, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, 42Institute Of Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva, Israel, 43Maxillofacial Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, 44Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, University of Ljubljana, Ljubljana, Slovenia, 45Department Of Paediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia, 46Servizio Di Epatologia E Nutrizione Pediatrica, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy, 47Third Pediatric Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece, 48Pediatric Center, Semmelweis University, Budapest, Hungary, 49Department Of Pediatrics, Tunis Children Hospital, Tunis, Tunisia, 50Department Of Pediatric Gastroenterology, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates, 51Clinical Pharmacy And Pharmacology, University Of Groningen, University Medical Center Groningen, Groningen, Netherlands, 52Toronto Center For Liver Disease, University Health Network, Toronto, Canada, 53Ihpme, University of Toronto, Toronto, Canada
Objectives and Study: Bile Salt Export Pump (BSEP) deficiency, also known as Progressive Familial Intrahepatic Cholestasis type 2 (PFIC 2), is a rare genetic cholestatic liver disease. Treatments that reduce serum bile acid concentrations (sBA) are associated with a higher survival with native liver, whereas decreasing platelet counts (PLT) could indicate development of progressive fibrosis. We analyzed longitudinal patterns of sBA and PLT in patients with BSEP deficiency to assess possible heterogeneity.
Methods: Data were obtained from the NAtural Course and Prognosis of PFIC and Effect of biliary Diversion (NAPPED) Registry, a global PFIC patient database. We excluded participants treated with IBAT inhibitors and censored follow‐up at age 18 years, surgical biliary diversion, or liver transplantation. Two latent class mixed‐effects models were used to identify pattern subgroups of sBA (log‐transformed) and PLT. The optimal number of subgroups was determined using information criteria and requiring 10% of the study population per subgroup.
Results: We analysed data from 289 patients with BSEP deficiency (median follow‐up 3.8 years, IQR 1.3–9.3), encompassing 1,155 sBA and 1,612 PLT measurements. Each patient had at least one measurement for both markers (sBA: median 2, IQR1–5; PLT: median 4, IQR2–8). Longitudinal patterns of sBA and PLT (Figure 1) identified a large subgroup associated with a higher rate of liver transplantation (LTx, ≥89%) and surgical biliary diversion (SBD, ≥81%) than the two smaller subgroups with low rates of these surgeries. The four subgroups did not have overt differences in genetic categorization, historical use of ursodeoxycholic acid, or the clinical and biochemical characteristics of patients at first presentation.
Figure 1: Patterns of sBA and PLT. The crosstable shows the distribution of individuals (IDs) across subgroups.
Conclusions: This study identified distinct longitudinal patterns of sBA and PLT in BSEP deficiency. These patterns highlight heterogeneity in the disease and its evolution and could lead to trajectory‐specific management strategies.
Contact e‐mail address: p.huisman.1@erasmusmc.nl
H‐OP016. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP016.1. EVALUATION OF ADULT MAGNETIC RESONANCE IMAGING SCORES IN PREDICTING LONG‐TERM OUTCOMES IN CHILDREN WITH PRIMARY SCLEROSING CHOLANGITIS
Anna Jerregård Skarby 1, Evangelos Mourtos2, Thomas Casswall3, Lina Lindström1, Aristeidis Grigoriadis4
1Department Of Medicine, Karolinska Institutet, Stockholm, Sweden, 2Department of radiology, Karolinska University Hospital, Stockholm, Sweden, 3Division For Paediatrics, Department Clinical Interventions And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 4Division Of Radiology, Department Of Clinical Science, Intervention And Technology (clintec), Karolinska Institutet, Stockholm, Sweden
Objectives and Study: Objectives & Study : Primary sclerosing cholangitis (PSC) is a progressive liver disease with a variable clinical course and outcomes are difficult to predict. The role of magnetic resonance imaging (MRI) scores as prognostic tools for adult PSC seems promising, but their use in pediatric PSC is still unclear. Our aim was to assess the potential value of existing adult MRI‐scores to predict outcomes in children with large‐duct PSC.
Methods: Methods: We included all consecutive children (<18 years), diagnosed with PSC between Jan 2000 – Dec 2015 at the Pediatric Liver Unit, Karolinska University Hospital in Stockholm. MRI/MRCPs from date of diagnosis were reviewed by one adult and one paediatric radiologist in consensus. DiStrict score and ANALI score without gadolinium were calculated. Outcome was defined as liver transplantation, liver‐related death, complications of portal hypertension, and biliary complications. We generated Kaplan‐Meier curves and compared them with log‐rank test. Univariate Cox‐regression analysis was performed to evaluate the association between MRI scores and outcomes.
Results: Results: We included 104 children (56% boys) with a median age of 13 years (1.9‐17.8) at diagnosis. IBD was present in 91% (n = 95). Overlap with autoimmune hepatitis was present in 30% (n = 31). Under a median follow‐up time of 13 years (5.7‐21.6), 16 children (15%) were transplanted,15 (14%) developed complications of portal hypertension, one (1%) individual died from liver disease, and 29 (28%) developed biliary complications. Individuals with high DiStrict score (5‐8) and high ANALI score (3‐5) without gadolinium had worse overall survival compared to individuals with low DiStrict score (1‐4) and low ANALI score (0‐2), respectively (p < 0.05). However, in Cox‐analysis, only DiStrict score was significantly associated with outcomes (HR = 4.05, 95%CI; 1.64‐10.06, p = 0.002). ANALI score had a HR = 2.45 (95%CI; 0.99‐6.06, p = 0.052).
Conclusions: Conclusions: Adult MRI scores, mainly the DiStrict score, could predict long‐terms outcomes in children with PSC.
Contact e‐mail address: anna.jerregard.skarby@ki.se
H‐OP017. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP017.1. SIGENP BILIARY ATRESIA NETWORK : PRELIMINARY RESULTS OF TEN YEARS RETROSPECTIVE ANALYSIS OF ITALIAN BILIARY ATRESIA REGISTRY
Daniela Liccardo 1, Giusy Ranucci2, Alessandra Nardi3, Claudia Mandato4, Angelo Di Giorgio5, Daniele Alberti6, Jean De Goyet2, Giovanni Boroni7
1Hepatology and Liver Transplant Unit, Bambino Gesù IRCCS Children's Hospital, Rome, Italy, 2Department of Pediatrics Liver Transplant Center UPMC‐ISMETT, Palermo, Italy, 3Department Of Mathematics, University of Rome Tor Vergata, Rome, Italy, Rome, Italy, 4Pediatric Unit, University Hospital San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy, 5Department Of Medicine, University Of Udine; Pediatric Hepatology, Gastroenterology And Transplantation, Hospital Papa Giovanni Xxiii, Bergamo Italy, Hospital Santa Maria della Misericordia, Udine, Italy, 6Pediatric Surgery, University Department of Pediatrics, Children's Hospital, Spedali Civili, Brescia, Brescia, Italy, 7Pediatric Surgery, University of Brescia, Brescia, Italy
Objectives and Study: In 2018, supported by SIGENP, the Italian Biliary Atresia (BA) Network was established (13 centres, distributed throughout Italy) and an on‐line platform was created to analyse BA epidemiology in Italy and native liver survival (NLS); (website: https://avb-sigenp.org).
Methods: analysis of data acquired retrospectively by the registry (period 2011‐2021); results were compared with those reported by other European registries (A: France (1986‐2015); B: England/Wales (1999‐2019); C: Netherlands (1987‐2008); D: Denmark/Finland/Norway/Sweden (2005‐2016); E: Switzerland (1994‐2004).
Results: BA mean annual incidence in Italy is estimated around 1/14.850 live births (A:1/19.600; B:1/17.000; C:1/18.619; D: na; E: 1/17.800). In the 10‐year period of time (2011‐2021), the average new BA cases were 32/years on total of 326 BA diagnosis (A:1428, 47pts/y; B:867, 41pts/y; C:231, 10.5pts/y; D:158, 14pts/y; E:48, 4pts/y). Of 254 cases available for this preliminary analysis, 31 (12.2%) did not undergo Kasai procedure (KP) (A:6,2%; B:4,2%; C:7%; D:6,3%; E:10,4%), but primary liver transplant (mean Age first referral 118 days, IQR 92‐130). 223 KP were performed at median age of 69 days (IQR 51‐83) (A:59 d; B:51; C:59; D:64,; E:68) with 29 infants (11.4%) presented at age >100 days (B:5.6%). Five‐year post‐Kasai native liver survival (PKNLS) is 35.4% (A:41,2%; B:51,3%; C:46% at 4 y; D:55%; E:37,4%) and becomes 48.9 % when KP is done before 40 days of age
Conclusions: Discussion. PKNLS is lower compared to European series, likely due to late diagnosis and old age at KP. High proportion of infants were not candidates for KP in this cohort Early diagnosis and reducing the age at KP is mandatory to improve short and long term outcomes of BA infants in Italy.
Contact e‐mail address:
H‐OP018. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP018.1. POPULATION BASED STUDY ON INCIDENCE AND OUTCOMES OF BILIARY ATRESIA IN PRETERM VERSUS TERM INFANTS IN THE NORDIC COUNTRIES
Ulrika Liliemark 1,2, Runar Almaas3,4, Vibeke Christensen5,6, Nils Ekvall7, Hanna Elmi4, Vladimir Gatzinsky8, Thora Helt9, Maria Hukkinen10,11, Lars Johansen5, Erik Omling12,13, Mikko Pakarinen10,11,14, Jan Svensson14,15, Bjorn Fischler1,2
1Pediatric Gastroenterology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden, 2Clintec, Division Of Pediatrics, Karolinska Institutet, Stockholm, Sweden, 3Institute Of Clinical Medicine, Oslo University, Oslo, Norway, 4Department Of Pediatric Research, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway, 5Paediatric Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, 6Comparative Pediatrics And Nutrition, University of Copenhagen, Copenhagen, Denmark, 7Pediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden, 8Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden, 9Clinical Physiology And Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, 10Helsinki University Hospital, Helsinki, Finland, 11Pediatric Surgery Department, Helsinki University Children's Hospital, Helsinki, Finland, 12Pediatric Surgery, Skane University Hospital Lund, Lund, Sweden, 13Pediatrics, Lund University Clinical Sciences, Lund, Sweden, 14Women's And Children's Health, Karolinska Institutet, Stockholm, Sweden, 15Pediatric Surgery, Astrid Lindgrens Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
Objectives and Study: Biliary atresia (BA) is a severe cholangiopathy that, if untreated, leads to end‐stage liver disease and death before 2 years of age. The first line of treatment is Kasai portoenterostomy (KPE). Studies from the Netherlands and Taiwan suggest BA is more frequent in preterm infants, who also experience delayed KPE and poorer outcomes than term infants. This study aimed to determine the incidence of BA in preterm and term infants in the Nordic countries and analyze outcomes after KPE in both groups.
Methods: A retrospective study that used pseudonymized data from all tertiary units treating BA in Sweden, Finland, Norway, and Denmark. BA patients born between January 1, 2005, and December 31, 2020, were included. Data on patient characteristics, laboratory findings, and outcome parameters were collected. Information on gestational age for all births was obtained from national registries.
Results: 232 patients were included, with 205 term and 27 preterm infants. The incidence of BA was 0.47 per 10,000 births in term infants and 0.97 in preterm infants (p = 0.0012), resulting in an Odds Ratio of 2.05 (95% CI: 1.32‐3.07). Preterm infants had a median age at KPE of 70 days compared to 58 days for term infants (p = 0.183). Preoperative bilirubin levels were lower in preterm infants, median 136 µmol/L compared to 155 µmol/L in term infants (p = 0.014). NLS and clearance of jaundice (COJ) were similar between the two groups: NLS shown in Fig. 1, COJ (bilirubin <20 µmol/L within 6 months) was 54% in preterm and 61% in term (p = 0.60).
Conclusions: Preterm infants have a two‐fold incidence of BA compared to term infants. However, post‐KPE outcomes do not significantly differ between the groups indicating that preterm birth does not adversely affect the success of KPE. This study highlights the potential for improvements in the diagnostic work‐up for preterm neonates with jaundice.
Contact e‐mail address: ulrika.liliemark@ki.se
H‐OP019. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP019.1. SINGLE CELL SPATIAL TRANSCRIPTOMIC MAP OF BILIARY ATRESIA IDENTIFIES MECHANISMS OF HILAR INJURY
Jake Mann 1, Alba Bueno‐Jimenez1, Scott Davies2, Evelyn Ong1, Ye Oo2, Annabelle Schofield3, Khalid Sharif1, Christopher Shave4, Hector Vilca‐Melendez1, Girish L Gupte1
1Liver Unit (including Small Bowel Transplantation), birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom, 2Centre for Liver and Gastrointestinal Research, Institute of Biomedical Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom, 3University of Birmingham, Birmingham, United Kingdom, 4Birmingham Tissue Analytics, University of Birmingham, Birmingham, United Kingdom
Objectives and Study: Biliary atresia is characterised by neonatal obliteration of the extrahepatic biliary tree. 50% of children require liver transplantation at under 5 years, despite Kasai portoenterostomy. Multiple aetiological factors are implicated in the initial hit to the biliary system (e.g. polygenic, viral). It is not clear why some children need early transplant ‘rapid progressors’ and some remain stable long‐term. Here, our overall aim was to understand the interactions governing inflammation at the hilar plate in biliary atresia at single‐cell resolution. Specifically, we aimed to identify differences at the time of Kasai that predict need for early transplantation.
Methods: We performed CosMx single‐cell transcriptomic profiling (1000 genes) on hilar plate taken at time of Kasai from 4 patients with non‐syndromic biliary atresia. 2 patients were 'rapid progressors' ‐ transplant under 2 years old; and 2 were 'slow progressors' requiring transplant at 12‐15 years old. All patients had moderate (3/6) fibrosis at the time of Kasai. CellChat was used to calculate cell‐cell interaction signalling networks. Markers were validated using multiplex immunofluorescence and with immunohistochemistry in samples from n = 24 patients.
Results: Single‐cell spatial profiling identified 69,374 cells, after quality‐control. Hilar plate showed bile duct remnants, surrounded by fibroblasts (expressing ACTA2 and SOX9), accompanied by foci of Th2 inflammation: STAT6 + CD28 + CD4 T‐cells, B‐cells, type 2 dendritic cells (DC2), and plasma cells (Fig 1A‐B). CXCL12 secretion from fibroblasts mediated recruitment of CXCR4 + CD4 T‐cells (Fig 1D). ‘Rapid progressors’ had more IRF4 + DC2 (p.adj=1.4x10‐21), which drive Th2 and Th17 inflammation. They also had higher TNFSF9 (4‐1BBL) expression in DC2 (p.adj=1.9.x10‐42), which is needed for co‐activation of Th2 CD4 T‐cells. CellChat found CCL19 (from DC2 and fibroblasts) binding to CCR7 as a key mediator of Th2 inflammation (Fig 1E‐F).
Conclusions: At time of Kasai, patients who would need early transplant had more Th2‐polarised inflammation at the hilar plate, driven by DC2 phenotype.
Contact e‐mail address: j.p.mann@bham.ac.uk
H‐OP020. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP020.1. FONTAN‐ASSOCIATED LIVER DISEASE (FALD): CLINICAL AND EPIDEMIOLOGICAL IMPACT ON A LARGE COHORT IN THE UK, RESULTS FROM A MULTICENTER STUDY
Eleonora Munaretto 1,2, Hannah Bellsham‐Revell3, Nathalie Dedieu4, Aaron Bell3, Mara Cananzi1, Anil Dhawan2, Michael Quail4, Alastair Baker2
1Unit Of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology And Care Of The Child With Liver Transplantation, Department Of Women's And Children's Health, University Hospital of Padua, Padua, Italy, 2Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom, 3Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom, 4Paediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
Objectives and Study: As survival after the Fontan procedure improves, FALD prevalence is increasing; however, paediatric data remain limited. This study investigates FALD prevalence, its impact on survival, and risk factors for disease severity.
Methods: A retrospective multicenter cohort study was conducted across three UK tertiary care centers, including patients with univentricular hearts who underwent the Fontan procedure between 1987 and 2024. Liver disease severity was assessed using MELD‐XI and VAST scores.
Results: Among 729 patients, 53.5% (390) underwent liver assessment, with a median age of 13.1 years and median follow‐up of 12.8 years. FALD prevalence was 10.9% at 0‐5 years, 23.3% at 5‐10 years, 63.7% at 10‐15 years, 82.6% at 15‐20 years, 91% at 20‐25 years, and 100% at 25‐40 years. Cirrhosis was detected in 18.2% of imaging within 5 years, 29.9% at 5‐10 years, 37.7% at 10‐15 years, and 83.3% beyond 25 years. Hepatocellular carcinoma was present in 0.14%. Liver stiffness did not change over time nor correlated with disease severity, whereas VAST and MELD‐XI scores positively correlated with time post‐Fontan (p < 0.0005, p < 0.0001). Older age at Fontan, cardiac isomerism, and male sex correlated with MELD‐XI (p = 0.003, 0.004, 0.036). Univariate Cox regression identified liver injury pre‐Fontan (HR 3.74, p = 0.041), VAST (HR 2.93, p < 0.0005) and MELD‐XI (HR 1.17, p = 0.015) as significant mortality predictors. Multivariable analysis confirmed VAST (HR 3.15, p < 0.0005) and MELD‐XI (HR 1.21, p = 0.013) independent role. ROC analysis identified VAST > 1 (AUC 0.84) and MELDXI > 10 (AUC 0.92) as mortality predictors.
Conclusions: FALD progresses to advanced liver disease in nearly all patients over time, with up to 64% of patients developing FALD during childhood, including radiological cirrhosis in 38%. Pre‐Fontan liver injury, MELD‐XI and VAST scores are associated with mortality, while liver stiffness does not predict progression. We therefore advocate for initiating liver assessments within the first decade post‐Fontan to enable timely management of hepatic complications.
Contact e‐mail address: eleonora.munaretto@nhs.net
H‐OP021. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP021.1. RESOLUTION OF METABOLIC INJURY IN A HUMAN MASLD MODEL USING A COMPUTATIONALLY PREDICTED FLAVIN COFACTOR AS A THERAPEUTIC AGENT
Milad Rezvani 1, Julian Weihs2, Fatima Baldo3, Alessandra Cardinali3, Gehad Youssef3, Katarzyna Ludwik2, Harald Stachelscheid2, Nils Haep2, Peter Tang2, Igor Sauer2, Pavitra Kumar2, Cornelius Engelmann2, Quach Susanna2, Christan Hudert2, Philip Bufler1, Namshik Han3
1Department Of Pediatric Gastroenterology, Nephrology, And Metabolic Diseases, Charité Universitätsmedizin Berlin, Berlin, Germany, 2Charité Universitätsmedizin Berlin, Berlin, Germany, 3Milner Therapeutics Institute, University of Cambridge, Cambridge, United Kingdom
Objectives and Study: This preclinical study aimed to develop a drug‐repurposing strategy for Metabolic Dysfunction‐Associated Steatotic Liver Disease (MASLD) using computational tools in combination with a novel human stem cell‐based model of complex metabolic hepatocyte injury. Our pipeline considers common genomic polymorphisms and metabolic mediators outside the liver that determine hepatocyte injury, mitochondrial dysfunction and inflammation.
Methods: For the computational part, we first harnessed public analyses (reverse transcriptomic signature mapping, Weighted Gene expression analysis) to identify targets and pathways linked to MASLD. We validated the existence of these pathways in our own n = 70 pediatric MASLD proteomics dataset. We constructed a virtual biological network, filtered for critical “intersections”, and identified FDA‐approved drugs with known mechanisms. We established a MASLD model by exposing human induced pluripotent stem cell‐derived hepatocytes (iHeps) to a combination of free fatty acid excess and muscle‐derived myostatin and adipose‐derived resistin, with and without PNPLA3‐I148M gene variant, simulating compounded liver injury. We enhanced the model by co‐culture with peripheral blood mononuclear cells to model hepatitis. We ultimately tested the compound predicted by computational methods in iHeps.
Results: Our multi‐modal predictions independently suggested that Flavin adenine dinucleotide (FAD), a vitamin B2‐derivative, could be a therapeutic strategy for MASLD. Our proteomics dataset from pediatric MASLD confirmed a significant loss of FAD‐related pathways. In our human “multi‐hit” MASLD model, extrahepatic signaling through resistin and myostatin represented the most notable metabolic shift toward a mitochondrial dysfunction signature. Treatment with FAD effectively compensated for mitochondrial dysfunction, significantly reduced steatosis and improved functional mitochondrial coupling efficiency and membrane potential (all p > 0.05, n = 3).
Conclusions: We developed an effective drug repurposing strategy for complex metabolic pathophysiology by integrating computational predictions and human iPSC‐based cell models, identifying FAD‐ or FAD‐enhancing pathways as a therapeutic approach.
Contact e‐mail address: milad.rezvani@charite.de
H‐OP022. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP022.1. ANDROGEN DYSREGULATION IN ADOLESCENTS AND YOUNG ADULTS WITH LIVER DISEASE AND PORTAL HYPERTENSION
Marianne Samyn 1, Ritika Kapoor2, Sophie Cant1, Jeremy Nayagam3, Deepak Joshi3, David Taylor4
1Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom, 2Paediatric Endocrinology, King's college Hospital, London, United Kingdom, 3Institute Of Liver Studies, King's college Hospital, London, United Kingdom, 4Clinical Biochemistry, King's college Hospital, London, United Kingdom
Objectives and Study: Androgen dysregulation is described in adults with advanced liver disease, recovers after liver transplantation but is poorly explored in in adolescents and young adults (AYA). The objective was to analyse the hormone profile of AYA with chronic liver disease (CLD) and portal hypertension and its relationship with clinical phenotype, blood tests and radiological features.
Methods: Observational study in 72 AYA (22 M), median age 19 (IQR17‐23) years. Hormone profiles included serum and urine steroid profile (USP) and USP of 67 healthy controls.
Results: Fifty‐seven AYA had CLD [20 M] [autoimmune liver disease(24), biliary atresia(13), other(20)]. Fifteen [2 M] were diagnosed with extrahepatic portal vein obstruction (EHPVO). Platelet count <150 ×109/l [PLT < 150], was present in 49 [68%]. Elevated androstenetriol + /‐a‐cortolone, defined as abnormal USP, was found in 50% and more common in EHPVO [87%] than CLD [40%,p < .001] and in PLT < 150 than PLT > 150 [61%vs26%,p = .005] with no gender difference. Abnormal USP was characterised by higher bilirubin [23[14‐34]vs11[7‐19] umol/l,p < .001], testosterone [4.6[1.9‐16.5]vs1.2[0.4‐6.7] nmol/l,p = .011] and INR [1.1 [1.0‐1.3]vs1.0 [1.0‐1.1], p = .004] and lower white cell [4.1[3‐5]vs5.4[4.0‐6.8]×109/l, p = .011] and platelet [96 [67‐127]vs150[89‐244]×109/l,p = .007] count. The frequency of radiological features was: liver nodules (70%), varices (69%), right lobe atrophy (65%), lieno‐renal shunting (45%), umbilical vein patency (34%) and splenic artery aneurysms (20%). Varices, lieno‐renal shunting and right lobe atrophy were more present in EHPVO vs CLD [93%vs62%,p = .022, 80%vs36%,p = .002 and 87%vs59%,p = .020 respectively], PLT < 150 vs PLT > 150 [87%vs30%,p < .001, 60%vs13%,p < .001, 79%vs35%,p < .001 respectively] and abnormal vs normal USP [86%vs51%,p = .002, 64%vs26%,p = .001, 78%vs51%,p = .020 respectively]. Menstrual irregularities including irregular menses + /‐menorrhagia [n = 22,45%], amenorrhoea [n = 6,12%] and polycystic ovary syndrome/premature pubarche [n = 7,14%] were reported by 71% of females and associated with elevated serum testosterone levels [86%vs50%,p = .044] and the presence of varices on imaging [86%vs51%,p = .047]. Nine (8 F) had undetectable testosterone levels and 11/20 males had testosterone deficiency.
Conclusions: Androgen dysregulation is prevalent in AYA with EHPVO and CLD and associated with features of portal hypertension including extrahepatic porto‐systemic shunting.
Contact e‐mail address: marianne.1.samyn@kcl.ac.uk
H‐OP023. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP023.1. POSTOPERATIVE RECTAL BUDENOSIDE APPLICATION AFTER KASAI‐PORTOENTEROSTOMY IMPROVES LONG‐TERM SURVIVAL WITH NATIVE LIVER
Nagoud Schukfeh 1, Nathalie Pauer1, Eva‐Doreen Pfister2, Norman Junge2, Ulrich Baumann2, Omid Madadi‐Sanjani1, Claus Petersen1, Jens Dingemann1, Stefanie Langreen1
1Department Of Pediatric Surgery, Hannover Medical School, Hannover, Germany, 2Pediatric Gastroenterology And Hepatology, Hannover Medical School, Hannover, Germany
Objectives and Study: Biliary atresia (BA) remains the main indication for pediatric liver transplantation. The Kasai‐portoenterostomy (KPE) may delay or prevent liver transplantation. Adjuvant application of corticosteroids aims to prolong native liver survival after KPE. However, the efficacy of intravenous application on jaundice‐free native liver survival (jf‐NLS, bilirubin<20 µmol/l) has never been proven. We have shown improved short‐term jf‐NLS by off‐lable application of rectal Budenoside up to 2 years postoperatively. We now aimed to evaluate the impact of rectal Budesonide administration on long‐term jf‐NLS in BA‐patients undergoing KPE.
Methods: Ethical approval was obtained (No. 9429_BO_K_2020). Patients who underwent KPE from 2011‐2024 in our clinic received 2 mg/day adjuvant rectal Budenoside application as per our in‐house protocol (2 mg/day, from the 5th postoperative day for 3 months) and were retrospectively analyzed and compared to a historic control group of patients after KPE without steroid application (2000‐2020, including patients who refused Budenoside). Adverse effects of steroids were documented. Endpoint was long‐term jf‐NLS.
Results: 142 patients were included in the Budenoside group (40% male) and 118 (47% male) in the control group without steroid application. 16 patients (11%) in the study group and 15 (13%) in the control group had syndromal BA. Mean Age at KPE was 57 days in the Budenoside and 62 days in the control group (n.s.). Given our high follow‐up rate (95%), jf‐NLS in our control group was comparable literature. For the extended study period (‐2024), jf‐NLS was significantly higher in the Budenoside group at 6 months, 2, 5 and 10 years after KPE (Figure). No significant adverse effects of Budenoside were found.
Conclusions: Rectal application of Budenoside remains beneficial on the jf‐NLS not only in the short‐term, but also in the long‐term course 10 years after KPE without significant side effects. We recommend rectal Budenoside application as a standard adjuvant therapy in BA patients after KPE.
Contact e‐mail address:
H‐OP024. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP024.1. A CFCHIP‐SEQ LIQUID BIOPSY FOR THE DIAGNOSIS OF AUTOIMMUNE HEPATITIS IN CHILDREN
Gavriel Fialkoff1, Ami Ben Ya'akov2, Israa Sharkia1, Ronen Ronen1, Jenia Gutin1, Abed Khalaileh Khalaileh3, Rifaat Safadi4, Yael Milgrom4, Eisa Mouallem4, Naomi Gorelin4, Dasash Abata4, Hila Peretz4, Eithan Galun4, Nir Friedman1, Eyal Shteyer 5
1The Rachel And Selim Benin School Of Computer Science And Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel, Jerusalem, Israel, 2The Juliet Keidan Institute Of Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel, 3Department Of General Surgery And Transplantation Unit, Hadassah‐Hebrew University Medical Center, Jerusalem, Israel, 4The Liver Unit Institute Of Gastroenterology And Liver Diseases, Hadassah‐Hebrew University Medical Center, Jerusalem, Israel, 5Institute Of Gastroenterology, Nutrition And Liver Diseases, Shaare Zedek Medical Center, Jerusalem, Israel
Objectives and Study: Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease associated with morbidity and mortality. Diagnosis often requires a liver biopsy to confirm the condition and affirm subsequent remission. While advances in liquid biopsy techniques have shown promise in cancer diagnosis, their application in liver diseases has yet to be extensively investigated. Cell‐free DNA (cfDNA) in human plasma, a noninvasive liquid biopsy, offers molecular insights into the pathological processes of the organs of origin. These fragments reflect transcriptional activity within the dying cells. This study aims to evaluate the ability of chromatin immunoprecipitation and sequencing (cfChIP‐seq), which informs on gene transcription in dying cells, to differentiate AIH from other chronic liver diseases.
Methods: We applied cfChIP‐seq to analyze plasma samples from 95 children and adults with AIH, either at diagnosis or during biochemical remission, and a control group comprising 18 healthy individuals and 79 patients with various liver diseases including fatty liver, primary sclerosing cholangitis, viral hepatitis and metabolic disease.
Results: Comparative analysis of plasma samples identified immune‐related transcriptional processes uniquely active in the hepatocytes of AIH patients. Several significantly elevated genes were identified, including those linked to hepatic inflammation (CXCL9/10/11, GBP1, GBP5, UBD, TRIM31, HLA‐DOB, and HULC) and immune mediated liver pathology (FOXP3, IL32). These genes constituted an 'AIH score' that achieved an area under the curve (AUC) of 0.9 in a validation set, effectively distinguishing AIH from all other chronic liver diseases. RNA‐seq analysis of liver biopsies from the same patient cohort further confirmed, the AIH cfChip‐seq signature, of the differential expression of these genes.
Conclusions: Plasma cfChIP‐seq demonstrates potential as a non‐invasive diagnostic tool for AIH, offering an alternative to liver biopsy. This approach not only enhances diagnostic accuracy but also provides deeper insights into AIH pathogenesis, potentially transforming clinical management of the disease.
Contact e‐mail address: eyals@szmc.org.il
H‐OP025. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP025.1. PERFORMANCE OF SPLENIC STIFFNESS MEASUREMENT BY SPLEEN DEDICATED TRANSIENT ELASTOGRAPHY AS A NON‐INVASIVE TOOL FOR PREDICTING VARICES IN CHILDREN WITH CLINICALLY EVIDENT PORTAL HYPERTENSION
Janvi Sirwani, Aditi Kumar, Samarendra Mahapatro, Manas Panigrahi, Ranjan Patel
Department Of Pediatrics, AIIMS Bhubaneswar, Bhubaneswar, India
Objectives and Study: To assess the diagnostic accuracy of Splenic Stiffness Measurement(SSM) using spleen‐dedicated transient elastography(TE) for predicting varices in children with clinically evident portal hypertension(CEPH). Additional objectives included comparing SSM values between bleeders and non‐bleeders, stratify severity of varices based on their grade and identify optimal SSM cutoffs for detecting varices needing treatment(VNT) and predicting variceal bleeding in childhood portal hypertension(PHTN).
Methods: A cross‐sectional study conducted at a tertiary care referral centre from March 2023 to December 2024, included 87 children aged 6 months–14 years with CEPH. SSM was measured using TE ‘FibroScan 630 Expert with a spleen‐specific probe’. Esophagogastroduodenoscopy (EGD) served as the reference standard for varices detection and risk stratification. Diagnostic accuracy was derived using Receiver Operating Characteristic (ROC) analysis.
Results: SSM was significantly elevated in children with varices(p < 0.001). Furthermore, higher SSM suggested increasing severity of varices. A cutoff of 31 kPa for SSM predicted VNT with 88% sensitivity and 77% specificity and AUROC of 0.86. Bleeders had significantly higher SSM values compared to non‐bleeders(p < 0.001). (Table 1) The prehepatic PHTN group exhibited higher median SSM (47 kPa) than the hepatic group (32 kPa) (p < 0.001). The success rate of TE was 97%.
Table:1 Comparison of SSM based on presence of varices, VNT and predicting bleed(p < 0.001)
| Presence of Varices | Absent(n = 11) | 20.3 ± 8.9 |
| Present(n = 76) | 41.4 ± 19.7 | |
| VNT | Yes(n = 56) | 46.5 ± 19.8 |
| No(n = 31) | 24.5 ± 9.9 | |
| Bleeders | Yes(n = 45) | 50.6 ± 19.2 |
| No(n = 42) | 25.9 ± 10.5 |
Figure 1 depicting ROC curves for SSM based on presence of varices, VNT and predicting variceal bleed
Conclusions: SSM is a robust non‐invasive tool for predicting varices and stratifying bleeding risk in pediatric PHTN. Its high diagnostic accuracy and ease of use could reduce dependency on invasive EGD for screening pediatric PHTN. Further multicenter studies are warranted to validate these findings and establish standardized SSM cutoffs.
Contact e‐mail address: sirwanijanvi@gmail.com
H‐OP026. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP026.1. LET ESPGHAN SHINE INITIATIVE: HEPATIC ACCUMULATION OF OXLDL AND MYELOID‐DERIVED SUPPRESSOR CELLS IS ASSOCIATED TO LOX‐1 UPREGULATION IN BILIARY ATRESIA
Amelie Grieb1, Stefanie Dietz‐Ziegler2, Natascha Köstlin‐Gille2, Steffen Hartleif3, Johannes Hilberath3, Jörg Fuchs1, Ekkehard Sturm4, Christoph Slavetinsky 1
1Paediatric Surgery And Urology, University Children's Hospital Tübingen, Tübingen, Germany, 2Neonatology, University Children's Hospital Tübingen, Tübingen, Germany, 3Paediatric Gastroenterology And Hepatology, University Children's Hospital Tübingen, Tübingen, Germany, 4Department Of Pediatric Gastroenterology And Hepatology, University Children's Hospital Tuebingen, Tuebingen, Germany
Objectives and Study: Knowledge on the etiology and targeted therapy for biliary atresia (BA) is urgently needed, as most patients require early‐life liver transplantation. The lectin‐like oxidized LDL receptor 1 (LOX‐1) is crucial in arteriosclerosis due to macrophage activation via oxLDL and marker for immunosuppressive myeloid‐derived suppressor cells (MDSCs), which protect newborns from excessive inflammation. This study aimed to characterize LOX‐1′s role in BA and its correlation with clinical outcomes.
Methods: LOX‐1, TGFß, IL‐1ß, and IL‐8 expression were analyzed by qPCR in liver tissue from BA at early (at KPE; n = 36) and late (at LTX; n = 44) stages, age‐matched healthy livers (n = 6) and familial cholestatic disorders (FCD; n = 24). LOX‐1 expression was correlated with fibrosis (TGF‐ß, Ishak score), inflammation (IL‐1ß, IL‐8), and cholestasis markers (bilirubin) via regression analysis. LOX‐1+ cells were localized by immunohistochemistry, identified by immunofluorescence, and oxLDL liver levels measured by Western blot and ELISA. LOX‐1+ cells were isolated from blood and liver by CD66b MACS, and characterized via FACS and T‐cell suppression. Results were associated to native liver survival (Kaplan‐Meier estimator) and clearance of jaundice (ANOVA).
Results: LOX‐1 was upregulated in early and late BA, correlating with IL‐1ß and IL‐8 but not TGFß or histological fibrosis. LOX‐1+ cells localized in fibrous septa and co‐localized with CD15, identifying them as PMN‐MDSCs. BA liver tissue showed elevated levels of the major LOX‐1 substrate oxLDL compared to controls. Isolated CD66b+ cells from corresponding blood and liver samples of BA compared to controls expressed CD66b, CD11b, CD15, and LOX‐1, while lacking CD14 and HLA‐DR, and actively suppressed T cells, confirming them as PMN‐MDSCs. Higher LOX‐1 expression at KPE was linked to successful jaundice clearance and prolonged native liver survival.
Conclusions: LOX‐1 upregulation in BA is driven by PMN‐MDSC accumulation, linked to elevated oxLDL levels. As PMN‐MDSC accumulation correlates with better outcomes, LOX‐1 stimulation may offer a therapeutic target.
Contact e‐mail address:
H‐OP027. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP027.1. LOW BASELINE SERUM URIC ACID LEVELS AS A DIAGNOSTIC BIOMARKER FOR DIAGNOSIS OF WILSON DISEASE IN PEDIATRIC POPULATION
Sanjeevani Kaul, Vikrant Sood, Rajeev Khanna, Bikrant Lal, Seema Alam
Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, Delhi, India
Objectives and Study: Diagnostic dilemmas are common in clinical practice for Wilson disease (WD), despite the availability of standard criteria. Low serum uric acid (UA) is known to occur in WD due to proximal tubular dysfunction but has not been systematically evaluated. We aimed to evaluate the diagnostic value of UA as a simple diagnostic biomarker for WD.
Methods: In this retrospective analysis of prospectively maintained database divided into 2 cohorts [derivation, n = 199, 56 WD (till December 2017) and validation, n = 194, 56 WD (since January 2018)], we studied UA levels in 3‐18‐year‐old children and adolescents with chronic liver disease. Diagnoses were as per standard departmental protocol. Metabolic liver diseases, metabolic‐associated steatotic liver disease, acute kidney injury and genetic intrahepatic cholestasis were excluded. Cut‐off values of UA defined from the derivation cohort were tested in the validation cohort. We also correlated the UA levels with indices of liver dysfunction in children with WD.
Results: Mean UA levels were lower in WD than other CLD (1.77 + 0.79 mg/dL vs 3.55 + 1.32 mg/dL) (p < 0.001) in the derivation cohort. At a cutoff of 2.65 mg/dL, the sensitivity, specificity and positive likelihood ratio for diagnosis of WD was 87.5%, 81.1% and 4.63 with an AUROC of 0.908 (p < 0.001; figure 1). Applying this cut‐off to the validation cohort yielded a sensitivity, specificity and positive likelihood ratio of 85.7%, 69.6% and 2.82. UA levels correlated with New Wilson Index (r = ‐0.264, p = 0.005) and PELD (r = ‐0.302, p = 0.007), and improved after 3 months of chelation (1.89 + 0.76 to 3.46 + 0.66, p < 0.001).
Conclusions: Serum uric acid is a useful diagnostic marker and also correlates with severity of WD. The findings support further consideration of baseline serum UA levels as a simple biochemical test for screening diagnostic evaluation in any pediatric patient with suspected WD.
Contact e‐mail address: drvickyster@gmail.com; vsood@ilbs.in
H‐OP028. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP028.1. FUNCTIONAL CHARACTERIZATION OF VARIANTS OF UNKNOWN SIGNIFICANCE (VUS) IN THE ALAGILLE SYNDROME‐ASSOCIATED GENES JAG1 AND NOTCH2 IDENTIFIES IMPAIRED SIGNALING CAPACITY OF SOME VUS
Nicole Buhl1, Eva‐Doreen Pfister1, Daniel Oliveira2, Fabio Turetti2, Emma Andersson3, Ulrich Baumann1, Nataliya Di Donato4, Thomas Illig5, Eberhard Lurz6, Britta Skawran4, Jan Mašek2, Amelie Stalke 4
1Division For Pediatric Gastroenterology And Hepatology, Department Of Pediatric Kidney, Liver And Metabolic Diseases, Hannover Medical School, Hannover, Germany, 2Department Of Cell Biology, Faculty Of Science, Charles University, Prague, Czech Republic, 3Department Of Cell And Molecular Biology, Department of Karolinska Institute, Stockholm, Sweden, 4Department Of Human Genetics, Hannover Medical School, Hannover, Germany, 5Hannover Unified Bank (hub), Hannover Medical School, Hannover, Germany, 6Department Of Pediatrics, University Hospital, LMU Munich, Munich, Germany
Objectives and Study: Autosomal dominant Alagille syndrome (ALGS) primarily affects the liver, heart, kidneys, spine and eyes. Two genes in the NOTCH signaling pathway, JAG1 and NOTCH2, are associated with ALGS. Diagnosis is challenging due to incomplete penetrance and variable expressivity. Functional analysis of variants of unknown significance (VUS) may aid in diagnosis. This study aims to characterize 5 JAG1 and 3 NOTCH2 missense VUS identified in 9 patients with clinically confirmed or suspected ALGS. Phenotypes ranged from the full clinical spectrum of ALGS to isolated neonatal cholestasis and ALGS‐atypical abnormalities.
Methods: pcDNA3/pcDNA3.1 vectors were used to overexpress JAG1/NOTCH2 wild‐type (WT) protein. Site‐directed mutagenesis was used to introduce VUS as well as benign and pathogenic control JAG1/NOTCH2 variants. After transfection of HEK293T, HepG2 and/or Huh7 cells, JAG1/NOTCH2 expression was quantified by qRT‐PCR and Western blot. PNGase F digestion was performed to analyze glycosylation and a luciferase‐based assay was used to assess NOTCH pathway activation.
Results: All VUS showed mRNA overexpression. Western blots revealed a significantly lower protein level and reduced size for two JAG1 VUS compared to WT; PNGase F digestion confirmed the absence of glycosylation. This JAG1 VUS and a de novo NOTCH2 VUS both significantly reduced luciferase activity in the NOTCH signaling assay, while all other VUS showed WT activity.
Conclusions: Our functional analyses suggest pathogenic effects for two VUS, which are therefore likely to be the molecular cause of ALGS. Other JAG1/NOTCH2 VUS have not yet shown pathogenic effects. Further studies will explore alternative pathomechanisms, such as impaired splicing or effects masked by the overexpression system. Understanding of these mechanisms could lead to personalized therapies in the future. Funded by the German Federal Ministry of Education and Research (HiChol, grant no. 01GM2204B and the German Research Foundation (DFG) (project #433387263)
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H‐OP029. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP029.1. COUNSELLING YOUNG LIVER PATIENTS ON ALCOHOL USE IS MORE STRICT IN ADULT SERVICE: A SURVEY OF CLINICAL PRACTICES ACROSS EUROPE
Janne Suykens 1,2, Caren Ramien2,3, Ruth De Bruyne1,2, Helena Degroote2,4, Ansgar Lohse2,3, Marianne Samyn2,5, Jose Willemse2,6, Henriette Ytting2,7,8, Youth Panel2, Marianne Hørby Jørgensen2,9
1Department Of Internal Medicine And Pediatrics, Ghent University, Ghent, Belgium, 2European Reference Network on Hepatological Diseases, Hamburg, Germany, 3I. Medical Department, University Medical Centre Hamburg‐Eppendorf, Hamburg, Germany, 4Department Of Gastroenterology And Hepatology, University Hospital Brussels, Brussels, Belgium, 5Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom, 6Dutch Liver Patient Association, Rotterdam, Netherlands, 7Departments Of Medical Gasteroenterology And Hepatology, Hvidovre University Hospital and Rigshospitalet, Copenhagen, Denmark, 8Department Of Clinical Medicine, Faculty Of Health And Medical Sciences, Copenhagen University, Copenhagen, Denmark, 9Department Of Pediatrics And Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
Objectives and Study: Alcohol is part of young people's social interactions. With limited evidence on alcohol dosage and impact on liver disease, clinicians have poor guidance for counselling. This survey aimed to assess how young people with chronic liver disease are counselled across Europe and identify clinicians’ knowledge gaps and needs.
Methods: Within ERN RARE‐LIVER, we designed a survey on how clinicians counsel young patients (under the age of 25) with liver disease about alcohol intake. It was distributed via ESPGAN, EASL and ERN RARE‐LIVER mailing lists to both paediatric (PS) and adult services (AS).
Results: 142 clinicians from 27 countries participated (86 AS, 52 PS, 4 both). Most (71%) felt comfortable counselling about alcohol (69% PS, 74% AS), though 28% reported occasional uncertainty (31% PS, 26% AS). While 35% felt they had sufficient knowledge (26% PS, 39% AS), 56% identified some knowledge gaps (63% PS, 52% AS), and 8% lacked adequate knowledge (9% PS, 8% AS). Recommendations for patients with liver disease were stricter than for those without, ranging from complete abstinence to <40 units/week, with stricter limits as disease severity increased. PS were more likely than AS to set specific limits and less likely to recommend complete abstinence at all stages of liver disease (see table 1).
Conclusions: Across Europe, alcohol counselling for young adults and adolescents varies by physician, liver status, and service. Recommendations for complete abstinence increase with disease severity, fostering more agreement within and between services, though full consensus is never reached. PS are less likely to advise abstinence and more often recommend minimal alcohol intake, possibly recognizing social pressures and exploratory behaviours in this age group. This variability may cause confusion and inconsistencies in adherence, especially during transitions. While most clinicians feel confident, many highlight the need for additional clinical guidance, education, and patient materials.
Contact e‐mail address: janne.suykens@ugent.be
H‐OP030. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP030.1. THE RELATIONSHIP BETWEEN SERUM BILE ACIDS AND EVENT‐FREE SURVIVAL FOLLOWING THE USE OF MARALIXIBAT FOR PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS (PFIC): DATA FROM THE MARCH/MARCH‐ON TRIALS
Richard Thompson 1, Lorenzo D'antonio2, Simon Horslen3, Douglas Mogul4, Tiago Nunes4, Will Garner4, Pamela Vig4, Alexander Miethke5
1Institute of Liver Studies, King's College London, London, United Kingdom, 2Pediatric Hepatology, Gastroenterology And Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 3UPMC Children's Hospital of Pittsburgh, Pediatrics, Pittsburgh, Pennsylvania, United States of America, 4Mirum Pharmaceuticals, Inc., Foster City, California, United States of America, 5Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Objectives and Study: Maralixibat, an IBAT inhibitor, is approved in the EU for treatment of PFIC in individuals ≥3 months old. Prior analyses in ALGS demonstrated improved event‐free survival (EFS) following use of maralixibat associated with reductions in sBA. MARCH/MARCH‐ON, clinical trials of maralixibat in PFIC, demonstrated reductions in sBA. In this analysis, we evaluated the impact of sBA reduction on EFS.
Methods: First events (liver transplant, decompensation, surgical biliary diversion [SBD], or death) were identified for different PFIC types. For individuals with nt‐BSEP and FIC1, 2‐year EFS was calculated and stratified by sBA response at Week 26 (averaged over last 12 weeks) using thresholds developed by the NAPPED Consortium (BSEP: >75% reduction or <102 µmol/L; FIC1: <65 µmol/L).
Results: There were 5 events among 72 individuals with a median (Q1, Q3) follow‐up of 94 (68, 110) weeks. The overall EFS was 92%. Among individuals with nt‐BSEP, sBA response was achieved in 12 of 27 (44%), this group had no events yielding an EFS of 100%; an insufficient sBA response was observed in 15 (56%) and this group had 2 events for an EFS of 84%. Among FIC1 participants, sBA response was achieved in 3 of 12 (25%) and yielded an EFS of 100%; an insufficient sBA response was observed in 9 (75%); this group had 2 events for an EFS of 78%. When nt‐BSEP and FIC1 were analyzed together, sBA responders had an EFS of 100% whereas sBA non‐responders had an EFS of 81%. For the individual with MDR3 disease requiring a transplant, sBA reduction was 44%.
Conclusions: Consistent with sBA response thresholds from NAPPED that are associated with EFS, individuals who reduced sBA levels below the threshold did not have a clinically meaningful event. These data support the importance of sBA reduction in PFIC and maralixibat to potentially facilitate this biochemical change.
Contact e‐mail address:
H‐OP031. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP031.1. IMPROVEMENTS IN PRURITUS ARE ASSOCIATED WITH IMPROVEMENTS IN GROWTH IN PATIENTS WITH PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS: DATA FROM THE MARCH‐ON TRIAL
Alexander Miethke1, Amal Aqul2, Chuan‐Hao Lin3, Douglas Mogul4, Tiago Nunes4, Jolan Terner‐Rosenthal4, Marshall Baek4, Pamela Vig4, Richard Thompson 5
1Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America, 2University of Texas Southwestern Medical Center, Dallas, Texas, United States of America, 3Children's Hospital Los Angeles, Los Angeles, California, United States of America, 4Mirum Pharmaceuticals, Inc., Foster City, California, United States of America, 5Institute of Liver Studies, King's College London, London, United Kingdom
Objectives and Study: Progressive familial intrahepatic cholestasis (PFIC) is a group of disorders resulting in disrupted bile composition and cholestasis leading to debilitating pruritus, growth deficits, vitamin deficiency, and progressive liver damage. Maralixibat, an IBAT inhibitor, is approved in the EU for treatment of PFIC in individuals ≥3 months old. MARCH, a Phase 3 trial of maralixibat, achieved its primary and key secondary endpoints of pruritus and sBA reduction. Long‐term maintenance of effect, including growth, for up to two years was observed in MARCH‐ON, an open‐label extension. We report on the relationship between pruritus response and growth improvements in MARCH‐ON.
Methods: Pruritus response was defined as a participant having ≥1 point reduction in ItchRO(Obs) from baseline to the average of the final 3 week periods of MARCH (Weeks 15‐18, 19‐22, 23‐26). Height and weight Z‐scores were analyzed. Wilcoxon signed‐rank test and rank sum test were used to determine CFB significance within groups and between groups.
Results: Sixty participants from the All‐PFIC cohort in MARCH‐ON were included in the analysis. Baseline characteristics were well‐balanced between groups. Growth (mean [SE]) for the overall study population was stunted at Baseline (height z‐score: ‐2.11 [0.17]; weight z‐score: ‐1.50 [0.17]). Thirty‐seven participants met the pruritus responder criteria in the All‐PFIC population and 23 were non‐responders. Pruritus responders had a significant improvement in height (mean CFB [SE]: 0.42 [0.09]; P < 0.0001) and weight z‐scores (CFB: 0.44 [0.07]; P < 0.0001) at Week 26, sustained out to 70 weeks of MRX treatment in MARCH‐ON (height CFB: 0.51 [0.10]; P < 0.0001; weight CFB: 0.55 [0.15]; P = 0.0002). Significant differences between pruritus responders and non‐responders were sustained out to 70 weeks in height (CFB Δ: +0.63; P = 0.0049) and numeric improvements in weight (CFB Δ: +0.52; P = 0.11).
Conclusions: These consistent trends in growth for participants on maralixibat who were pruritus responders indicate a potential disease‐modifying effect of maralixibat treatment in PFIC.
Contact e‐mail address:
H‐OP032. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP032.1. CLINICAL SPECTURM OF GSD IV/GLYCOGEN BRANCHING ENZYME DEFICIENCY; AN EXPERIENCE FROM A TERTITARY CENTRE IN THE UK
Nirubhan Veeraraghavan 1, Roshni Vara2, Nedim Hadzic2
1Paediatric Metabolic Disorders, Evelina Children's Hospital, Guys and St Thomas Hospital NHS foundation trust, London, United Kingdom, 2Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom
Objectives and Study: Glycogen storage disease type IV (GSD IV) is caused by glycogen branching enzyme (GBE) deficiency. Clinical presentation is variable with primarily hepatic (progressive or non‐progressive) or neuro muscular symptoms with or without cardiac involvement. Limited literature exists on clinical phenotypes and outcomes.
Methods: A retrospective case series analysis of children with genetically confirmed GSD IV managed at a tertiary UK centre.
Results: We identified 6 children (4 male) with genetically confirmed GSD IV. Median age at diagnosis was 24 months (range 3‐39 months). 2 presented in the neonatal period with hypotonia, contractures, and feeding difficulties. 4 presented with elevated transaminases [median AST‐194 (17‐586)] and hepatomegaly. One child originally treated at another centre was managed with 3 hourly feeding to maintain normoglycemia. Failure to thrive, developmental delay, and hepatosplenomegaly was observed in 5/6 patients, while hypotonia was present in 3/6 (50%). Cardiomyopathy was absent in all patients. Diagnosis was established through molecular genetic testing (Table1) in all cases. 2 children were diagnosed based on the positive family history. 3 children with progressive hepatic cirrhosis underwent liver transplantation at a median age of 37 months (range 26‐44 months). All remain alive with normal graft function at median of 18 months (10‐24 months) follow up. One child with clinically non‐progressive cirrhosis remains under surveillance with normal AFP. 2 children with neuromuscular phenotype have normal liver function and both attend mainstream school with extra support.
Conclusions: This study highlights the phenotypic variability of GSD IV. Cardiomyopathy was not observed in our cohort. Liver transplantation appears to offer a favourable outcome for patients with progressive hepatic disease. Registries are needed to delineate the long‐term outcomes for those with neuromuscular and non‐progressive hepatic involvement.
Contact e‐mail address: nirubhan.veeraragavan@nhs.net
H‐OP033. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP033.1. BILE ACID SUBSPECIES ARE CORRELATED WITH PRURITUS AND BILIRUBIN IMPROVEMENT IN PFIC PATIENTS TREATED WITH MARALIXIBAT: DATA FROM MARCH AND MARCH‐ON
Henkjan Verkade 1, Alexander Miethke2, Simon Horslen3, Douglas Mogul4, Tiago Nunes4, Cory Kostrub4, Josephine Shelton4, Will Garner4, Pamela Vig4, Richard Thompson5
1(1) Beatrix Children's Hospital University Medical Center, Groningen, Netherlands, 2Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America, 3UPMC Children's Hospital of Pittsburgh, Pediatrics, Pittsburgh, Pennsylvania, United States of America, 4Mirum Pharmaceuticals, Inc., Foster City, California, United States of America, 5Institute of Liver Studies, King's College London, London, United Kingdom
Objectives and Study: Serum bile acids (sBA) have been implicated as an important pruritogen in cholestatic diseases. Maralixibat, an IBAT inhibitor, is approved in the EU for the treatment of Progressive Familial Intrahepatic Cholestasis (PFIC) in individuals ≥3 months. The drug has been shown to improve cholestatic pruritus and bilirubin in PFIC patients and this clinical response is strongly correlated with reductions in total sBA. Here, we evaluate the correlation of change in sBA subspecies with changes in pruritus and direct bilirubin (DB) for individuals with PFIC treated with maralixibat in the MARCH/MARCH‐ON trials.
Methods: Spearman correlation coefficients were determined for the percent change from Baseline to Week 26 (averaged over the last 8‐12 weeks) in total/subspecies sBA with change in ItchRO(Obs) and DB in the All‐PFIC and the nt‐BSEP deficiency cohorts.
Results: Analysis includes 60 individuals with PFIC. For the All‐PFIC cohort on maralixibat, a decrease in conjugated primary BA (GCDCA, TCDCA, GCA, TCA) and conjugated UDCA (GUDCA, TUDCA) was correlated with a decrease in both ItchRO(Obs) and DB (Table). An increase in CDCA was correlated with a decrease in ItchRO(Obs) and DB, while an increase in CA was correlated with a decrease in ItchRO(Obs). Nearly identical correlations were observed for the nt‐BSEP deficiency cohort receiving maralixibat. There were no significant correlations between BA subspecies with ItchRO(Obs) or DB in individuals on placebo.
Conclusions: This analysis further identifies changes in BA subspecies that are associated with both pruritus reduction and improvement in DB including positive correlations with conjugated primary BAs and negative correlations with unconjugated primary BAs. This pattern indicates either new BA synthesis in response to reduced BA levels in the liver or increased bacterial action on BAs in the colon. These data further elucidate the pathophysiology of how MRX may influence improvements in both pruritus and underlying liver health in patients with PFIC.
Contact e‐mail address:
H‐OP034. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP034.1. ODEVIXIBAT TREATMENT IN PATIENTS WITH FIC1 DEFICIENCY: SUSTAINED EFFICACY, PARTICULARLY IN PRURITUS, IN AN INTEGRATED ANALYSIS OF RESPONDERS (PEDFIC 1 AND PEDFIC 2)
Henkjan Verkade 1, Richard Thompson2, Reha Artan3,4, Pier Luigi Calvo5, Piotr Czubkowski6, Buket Dalgıc7, Lorenzo D'antonio8, Ozlem Durmaz9, Tassos Grammatikopoulos10, Girish L Gupte11, Winita Hardikar12, Binita Kamath13, Florence Lacaille14, Elke Lainka15, Kathleen Loomes16, Cara Mack17, Patrick Mckiernan11, Hasan Ozen18, Sanjay Rajwal19, Eyal Shteyer20, Etienne Sokal21, Nisreen Soufi22, James Squires23, Ekkehard Sturm24, Shikha Sundaram25, Mary Tessier26, Wendy Van Der Woerd27, Jennifer Vittorio28, Fatine Elaraki29, Alejandra Ramirez‐Santiago30, Quanhong Ni31, Emmanuel Gonzales32
1Pediatric Gastroenterology‐hepatology, Department of Paediatrics, University Medical Center Groningen, Beatrix Children's Hospital/University Medical Center Groningen, Groningen, Netherlands, 2Institute Of Liver Studies, King's College London, London, United Kingdom, 3Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden, 4Department Of Paediatric Gastroenterology, Akdeniz University, Antalya, Turkey, 5Pediatic Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera‐Città della Salute e della Scienza di Torino, Turin, Italy, 6Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 7Division Of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 8Department Of Paediatric Hepatology, Gastroenterology And Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy, 9Department Of Child Health And Diseases, Gastroenterology, Hepatology And Nutrition, Istanbul Faculty Of Medicine, Istanbul University, Istanbul, Turkey, 10Paediatric Liver, Gi And Nutrition Centre And Mowatlabs, King's College Hospital NHS Trust, London, United Kingdom, 11Liver Unit And Small Bowel Transplantation, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom, 12Department Of Gastroenterology And Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia, 13Division Of Gastroenterology, Hepatology And Nutrition, The Children's Hospital Of Philadelphia And Department Of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States of America, 14Pediatric Gastroenterology‐hepatology‐nutrition Unit, Hôpital Necker‐Enfants malades, Paris, France, 15Department Of Paediatric Gastroenterology, Hepatology, And Transplant Medicine, University Children's Hospital Essen, Essen, Germany, 16Department Of Gastroenterology, Hepatology And Nutrition, Children's Hospital of Philadelphia, Philadelphia, United States of America, 17Paediatrics Department, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, United States of America, 18Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Hacettepe University, Ankara, Turkey, 19Children's Liver Unit, Leed's Teaching Hospitals NHS Trust, Leeds Children's Hospital, Leeds, United Kingdom, 20Faculty Of Medicine, Juliet Keidan Department Of Paediatric Gastroenterology, Hebrew University of Jerusalem, Shaare Zedek Medical Centre, Jerusalem, Israel, 21Service De Gastroentérologie Et Hépatologie Pédiatrique, Université Catholique de Louvain, Cliniques St Luc, Brussels, Belgium, 22Paediatrics Department, Children's Hospital Los Angeles, Los Angeles, United States of America, 23Division Of Gastroenterology, Hepatology And Nutrition, The Children's Hospital of Pittsburgh, Pittsburgh, United States of America, 24Paediatric Gastroenterology And Hepatology, University Children's Hospital Tübingen, Tübingen, Germany, 25University Of Colorado School Of Medicine, Children's Hospital of Colorado, Aurora, United States of America, 26Department Of Paediatrics, Section of Paediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine−Texas Children's Hospital, Houston, United States of America, 27Department Of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands, 28Department Of Surgery, Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, United States of America, 29Ipsen Pharma, Boulogne‐Billancourt, France, 30Ipsen (at time of study), Cambridge, United States of America, 31Ipsen, Cambridge, United States of America, 32Hépatologie Et Transplantation Hépatique Pédiatriques, Centre de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, FSMR FILFOIE, ERN RARE LIVER, Hôpital Bicêtre, AP‐HP, Université Paris‐Saclay, Hépatinov, Paris, France
Objectives and Study: Long‐term data demonstrate improvements in pruritus, reductions in serum bile acids (sBA), and manageable safety with odevixibat (ODX) across progressive familial intrahepatic cholestasis (PFIC) types in the phase III PEDFIC 1 study (NCT03566238) and PEDFIC 2 open‐label extension study (NCT03659916). It is important to better understand outcomes and response dynamics for patients with different PFIC types. Therefore, we have now characterized the responders to ODX with FIC1 deficiency (PFIC 1), separately for sBA and pruritus.
Methods: Patients with FIC1 deficiency treated with ODX (40 or 120 µg/kg/day) in PEDFIC 1/2 who achieved a sBA response and/or a pruritus response at Week 24 of treatment were included in this post‐hoc analysis. sBA response was stringently defined as ≥70% reduction in fasting sBA from baseline (BL) or sBA ≤70 μmol/L. Pruritus response was defined as a ≥ 1‐point drop in observer‐reported (ObsRO) scratching score (0–4 scale) from BL. Here we report sBA and pruritus outcomes over time for these patients.
Results: 36 patients with FIC1 deficiency were enrolled; 34 remained on treatment at Week 24. At Week 24 of ODX treatment, 5 patients were sBA responders and 14 were pruritus responders, indicating that most patients had an improvement in pruritus, independent of a sBA response; 15 patients had either sBA or pruritus response, or both. Sustained reductions in sBA and/or pruritus were observed from BL to 96 Weeks (Table). Patient‐level data for these patients, including liver function tests and safety will be presented.
Conclusions: Patients with FIC1 deficiency who responded to ODX treatment at Week 24 experienced rapid improvements in pruritus and reductions in sBA that were sustained with long‐term treatment. Data demonstrate that most of these patients achieved a sustained, clinically relevant improvement in pruritus, without fulfilling the stringent criteria for a sBA response.
Contact e‐mail address: h.j.verkade@umcg.nl
H‐OP035. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP035.1. ROTATIONAL THROMBOELASTOMETRY VERSUS CONVENTIONAL HAEMOSTATIC TESTS IN CHILDREN WITH DECOMPENSATED CIRRHOSIS UNDERGOING INVASIVE PROCEDURES: A RANDOMIZED CONTROLLED TRIAL
Snigdha Verma 1, Seema Alam1, Bikrant Lal1, Rajeev Khanna1, Vikrant Sood1, Meenu Bajpayi2, Amar Mukund3
1Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India, 2Department Of Transfusion Medicine, Institute of Liver and Biliary Sciences, Delhi, India, 3Department Of Interventional Radiology, Institute of Liver and Biliary Sciences, New delhi, India
Objectives and Study: This randomized controlled trial (RCT) was conducted with the aim to evaluate the efficacy and safety of using ROTEM‐ based transfusion strategy in decompensated cirrhotic children with severe coagulopathy undergoing invasive procedures.
Methods: This was an open‐label, RCT which included (i) children 6 months ‐18 years of age with liver cirrhosis (ii) INR between 2.5 ≤ INR ≤ 3.5 for all invasive procedures and 2 to 2.5 for liver biopsy (iii) platelet count between 20 × 109/L and 50 × 109/L for all invasive procedures (iv) listed for invasive procedures. An interactive web response system was used to randomize the patient. Patients randomized to the ROTEM and conventional groups received blood component transfusion using predefined criteria.
Results: A total of 326 invasive procedures were screened for inclusion, of which 68 were randomized, 2 patients were excluded, as the procedure was cancelled for one and other one had withdrawn consent for the procedure. A total of 66 patients were included (33 in each group with comparable baseline parameters). The volume of total blood components, fresh frozen plasma (FFP) and platelets transfused was comparable between the two groups (OR: 1.68, p = 0.378). There was no difference in procedure‐ related bleed and transfusion‐ related complications between the two groups. In our study the costs incurred were higher in the ROTEM group.
Conclusions: ROTEM is not cost effective in cirrhotics with severe coagulopathy. Higher thresholds for ROTEM are needed in decompensated sick patients to try and bring down the component usage in the ROTEM arm.
Contact e‐mail address: dr.snigdha1@gmail.com
H‐OP036. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP036.1. PLASMA EXCHANGE IMPROVES SURVIVAL WITH NATIVE LIVER IN WILSON DISEASE WITH NEW WILSON'S INDEX ≥ 11 AND EARLY HEPATIC ENCEPHALOPATHY
Snigdha Verma 1, Seema Alam1, Bikrant Lal1, Tamoghna Biswas1, Vikrant Sood1, Rajeev Khanna1, Meenu Bajpayi2
1Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India, 2Department Of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
Objectives and Study: Decision about liver transplant is difficult in Wilson's disease (WD) with liver failure, especially with conflicting reports about New Wilson's index (NWI). Therapeutic plasma exchange (TPE) can provide survival with native liver (SNL) in WD. This study was done to see the effect of TPE on outcome and identify factors for SNL.
Methods: All cases of WD with liver failure (INR ≥ 2.5) from prospectively maintained data were included for propensity score matching (PSM) to select TPE (n = 48) and no TPE (n = 48) groups. Three sessions of TPE on three consecutive days were given to TPE group.
Results: 159 cases were included in the PSM with NWI & hepatic encephalopathy (HE) grading as predictors. SNL was comparable (26 versus 17 cases (OR 1.45, p = 0.05), but significantly improved in cases with no to early HE (OR = 1.70, p = 0.03). Kaplan Meier survival curves were significantly (Log Rank 0.019) improved in the TPE group when analysing in no to early HE. Lower INR (Adjusted OR = 0.47, 95%CI 0.28‐0.79, p = 0.005) and TPE administration (Adjusted OR = 3.12, 95%CI 1.10‐9.4, p = 0.032) at enrollment were independently associated with SNL. Lower NWI (Adjusted OR 0.686, 95%CI 0.53‐0.89, p = 0.005) at 96 hours was independently associated with SNL.
Conclusions: TPE improves SNL by 3 folds in early HE. Advanced HE should be offered immediate LT. Lower INR at enrollment can increase SNL by 50%. After 3 sessions of TPE, every unit decrease in NWI increases SNL by 32%.
Contact e‐mail address: dr.snigdha1@gmail.com
H‐OP037. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP037.1. HUMAN BILIARY ATRESIA EXTRAHEPATIC CHOLANGIOCYTE ORGANOIDS HAVE ELEVATED ER AND OXIDATIVE STRESS, ALTERED DRUG METABOLISM, AND ABNORMAL POLARITY
Orith Waisbourd‐Zinman 1,2, Adi Har‐Zahav2, Yara Hamody2, Raanan Shamir1, Michael Gurevich3, Keren Danan4, Irit Gat‐Viks4
1Pediatric Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center, Petach Tiqva, Israel, 2Faculty Of Medical And Health Sciences, Tel‐Aviv University, Tel‐Aviv, Israel, 3Pediatric Liver Kidney Transplant Unit, Schneider Children's Medical Center, Petach Tiqva, Israel, 4The Shmunis School Of Biomedicine And Cancer Research, George S. Wise Faculty Of Life Sciences, Tel‐Aviv University, Tel‐Aviv, Israel
Objectives and Study: Biliary atresia (BA) pathogenesis remains unknown. In order to gain a better understanding of mechanisms of cholangiocyte injury in the disease, we used BA‐derived human extrahepatic cholangiocyte organoids (HCOs). We previously showed that BA‐derived organoids morphologically have a different shape compared to control. We analyzed RNA sequencing (RNAseq) of BA‐derived HCOs vs. controls (obtained from transplants of patients with metabolic disease) and functionally validated the results.
Methods: RNA‐seq data were analyzed using enrichment score analysis and perturbation analysis to identify key pathways. Findings were validated using RT‐PCR, immunofluorescence (IF) staining, and electron microscopy (EM). To assess the role of cytochrome P450 enzymes, we inhibited CYP4A activity using HET0016.
Results: RNAseq analysis revealed significant differences in ER stress, unfolded protein response (UPR), cell adhesion, and drug metabolism between BA and controls. To validate the results functionally and to determine cell‐to‐cell adhesion, we used IF staining of the HCOs for E‐cadherin (cell membrane protein), RhoU (non‐canonical WNT signaling pathways gene), and Sox17 (transcription factor associated with cell polarity), all of which showed significantly different expression in BA patients compared to controls. Both RT‐PCR and IF stains showed elevated expression of BiP, PERK, and ATF4 in BA organoids, all suggestive of ER stress. RT‐PCR for SOD3, ERO1A, WFS1 and CHOP showed decreased expression in BA HCOs compared to controls. EM revealed dilated, irregular ER structures in BA‐derived HCOs. CYP4A isoform was highly expressed in BA organoids, and its inhibition with HET0016 reduced ER stress markers in BA organoids.
Conclusions: BA‐derived HCOs exhibit increased ER stress markers and disrupted cell polarity and epithelial integrity. Inhibiting cytochrome P450 enzymes attenuates ER stress. These findings provide insights into the mechanisms of cholangiocyte injury in BA and offer a foundation for developing targeted interventions to modify and improve epithelial integrity.
Contact e‐mail address: orithw@tauex.tau.ac.il
H‐OP038. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP038.1. EFFECT OF EXERCISE BASED REGIMEN ON FRAILTY IN CHILDREN WITH LIVER DISEASE‐A RANDOMIZED CONTROLLED TRIAL
Deepika Yadav 1, Vikrant Sood1, Seema Alam1, Rajeev Khanna1, Bikrant Lal1, Jaya Benjamin2, Sukriti Baweja3, Rakesh Kumar4
1Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, Delhi, India, 2Department Of Clinical Nutrition, Institute of liver and biliary sciences, New Delhi, India, 3Department Of Molecular And Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India, 4Department Of Physiotherapy, Institute of liver and biliary sciences, New Delhi, India
Objectives and Study: Cirrhosis reduces muscle mass, strength, and impacts quality of life. Resistance training and physical exercise may improve muscle mass and functional capacity in cirrhosis. This randomized controlled trial evaluates the impact of a 12 and 24‐week exercise‐based regimen versus standard medical therapy (SMT) on frailty scores, clinical outcomes, body composition, and myokines in children with cirrhotic liver disease (CLD).
Methods: Children (9‐18 years of age) with CLD and five fried frailty scores of>5 were randomly assigned to groups that received exercise training (n = 23) or SMT alone (n = 23). Exercise regimen included aerobic and resistance exercises for a total of at least 50 minutes/day for 3‐5 days per week for 24 weeks. Frailty assessment was done at baseline, 12 weeks, and 24 weeks while myokines/hepatokines levels and body composition analysis were evaluated at baseline and after 12 weeks.
Results:
At 12 and 24 weeks, the delta change in frailty scores was significantly greater in the exercise group compared to the SMT group (p < 0.001) (figure 1). By 12 weeks, 60% of patients in the exercise group became non‐frail (frailty score <5), increasing to 85% by 24 weeks. In the SMT group, 32% and 37% of patients achieved non‐frail status at 12 and 24 weeks, respectively. At 12 weeks, the exercise group showed a significant delta reduction in myostatin levels compared to the SMT group (p = 0.02), while no significant differences were noted for follistatin, decorin, or irisin levels. Significant improvements were observed in skeletal muscle mass and phase angle in the exercise group at 12 weeks.
Conclusions: In this pilot trial, exercise regimen significantly improved frailty scores and skeletal muscle mass compared to the SMT. Larger trials are warranted to further evaluate the long‐term benefits of exercise in pediatric cirrhotic population. ClinicalTrials.gov (NCT05770284)
Contact e‐mail address: deepikayadav2012mamc@gmail.com
H‐OP039. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐OP039.1. ACUTE HEMODYNAMIC RESPONSE TO CARVEDILOL IN CIRRHOTIC CHILDREN WITH CLINICALLY SIGNIFICANT PORTAL HYPERTENSION
Deepika Yadav 1, Rajeev Khanna1, Seema Alam1, Vikrant Sood1, Bikrant Lal1, Ankur Jindal2
1Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, Delhi, India, 2Department Of Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
Objectives and Study: Clinically significant portal hypertension (CSPH), indicated by hepatic venous pressure gradient (HVPG) >/= 10 mm Hg is associated with portal hypertension (PHT) complications and mortality in patients with liver disease. We studied the acute hemodynamic response to carvedilol, its predictors, and complications of PHT in cirrhotic children with CSPH.
Methods: Under‐18‐age cirrhotic children underwent HVPG via transjugular route. Those with CSPH were administered a single dose of carvedilol (0.2 mg/kg) via oral or nasogastric route. AHR was defined as a decrease in HVPG ≥ 20% from baseline or absolute HVPG value declining to ≤12 mm Hg, 90 min after carvedilol. The proportion of patients achieving the AHR and factors predicting it were studied.
Results:
Forty children (65% males) with a median age of 12.7 (11, 15) years) with CSPH were included. Autoimmune liver disease (49%) was the commonest etiology. Median PELD and Child‐Pugh scores of the cohort were 10 (IQR 2, 19) and 8(5,10) respectively. Half of the children had prior decompensation (52%)– 4 had variceal bleed; 19 (47%) had clinically significant varices. Median baseline HVPG was 17 mm Hg (IQR15, 22 mm Hg). Following 90 minutes of carvedilol, 21(52 %) patients had an AHR. On multivariate analysis, AHR in HVPG was predicted by portal vein size [Exp(B) = 2.38; 95% CI = 1.31‐4.30, P = 0.004] and serum sodium [Exp(B) = 0.65; 95% CI = 0.46‐0.92, P = 0.015] but not by other demographic, clinical, laboratory, or endoscopic variables. Children who did not achieve AHR had poor survival with native liver at 6 months (OR = 2.38; 95% CI 1.57‐3.60, p = 0.02) – there were 3 deaths and 3 liver transplant in non‐responders at 6 months of follow‐up.
Conclusions: More than half of the children achieved acute hemodynamic response following carvedilol. Larger portal vein diameter and lower serum sodium levels indicative of advance portal hypertension and liver disease predict non‐response to carvedilol.
Contact e‐mail address:
H‐OP040. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐OP040.1. UTILISATION OF THROMBOELASTOGRAPHY AND VONWILLEBRAND FACTOR ANTIGEN PROFILE IN CHILDREN WITH BLEEDING AND LIVER TRANSPLANT
Akshat Goel 1, Michael Avery1, Bethany Tucker1, Miriam Cerisuelo2, Lara Roberts3, Eirini Kyrana1,4, Anish Gupta5, Robert Hegarty1, Tassos Grammatikopoulos1
1Paediatric Liver, Gi & Nutrition Centre And Mowatlabs, King's College Hospital NHS Foundation Trust, London, United Kingdom, 2Liver Transplant Surgery, Institute Of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom, 3Department Of Haematological Medicine, King's Thrombosis Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom, 4Institute Of Liver Diseases, King's College Hospital NHS Foundation Trust, London, United Kingdom, 5Division Of Liver Transplant, Anaesthetic Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
Objectives and Study: Bleeding is a common perioperative complication associated with portal hypertension(PHT) and liver transplantation(LT). Thromboelastography(TEG) reflecting hemostatic status, and vonWillebrand Factor Antigen (vWFAg) a vascular endothelial activation marker can independently predict risk of bleeding and death in liver disease. Data is limited regarding use of TEG and vWFAg in LT children. We investigated use of TEG activated clotting time(TEG‐ACT), TEG‐R, and vWFAg in predicting the risk of overall bleeding perioperatively in children undergoing LT.
Methods: We carried out observational cohort study in children listed for LT at King's College Hospital between Jun2021‐Nov2024, and recorded TEG parameters, vWFAg, GPIbR, clinical and laboratory data including bleeding outcomes as per departmental protocol.
Results: Ninety‐six patients(male=51) underwent LT, median age 4 yrs(IQR 9.3 years). Diagnosis was biliary atresia(n = 34), acute liver failure(ALF) (n = 17), metabolic liver disease(n = 6), hepatoblastoma(n = 7), ciliopathy(n = 7), and others(n = 29). Median values of platelets, vWFAg, GPIbR and TEG‐ACT was 102 x109/L, 278.2IU/dL, 203.9IU/dL and 134.7 seconds, respectively. 32 children had bleeding episodes either whilst listed or peri‐operatively. TEG‐ACT and TEG‐R were significantly higher in children who bled (153.4 seconds vs 116.0 seconds, 1.1 minutes vs 0.7 minutes) (p 0.048 and 0.04, respectively); for TEG‐ACT, and in ALF subgroup vs chronic liver disease (CLD) (n = 59) subgroup (209.5 seconds vs 125.3 seconds, 1.7 minutes vs 0.8 minutes, respectively) (p < 0.0001 and 0.0001, respectively). vWFAg was not statistically significant. Platelets were lower in bleeders(94x109/L vs 134x109/L) (p 0.01) and ALF subgroup(46x109 vs 81x109/L) (p 0.01). TEG‐ACT, TEG‐R, platelets were not statistically significant in CLD subgroup.
Conclusions: To our knowledge this is the first study in children describing the utilization of TEG and vWFAg to co‐relate bleeding episodes in LT. TEG‐ACT and platelet count are statistically significant in those with bleeding events. Further studies with aetiological subgroup analysis are required to measure their potential as an independent predictor of bleeding.
Contact e‐mail address: akshat.goel@nhs.net
H‐OP041. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐OP041.1. KIDNEY AND/OR LIVER TRANSPLANT IN CHILDREN WITH AUTOSOMAL RECESSIVE POLYCYSTIC KIDNEY DISEASE‐ A SINGLE CENTER EXPERIENCE OVER 30 YEARS
Kavya Kurkal 1, Khalid Sharif1, Jane Hartley1, Chayarani Kelgeri1, Mordi Moruah2, Girish L Gupte3
1Paediatric Liver Unit (including Intestinal Transplantation), Birmingham Children's Hospital, Birmingham, United Kingdom, 2Paediatric Nephrology, Birmingham Children's Hospital, Birmingham, United Kingdom, 3Paediatric Hepatology, Birmingham Children's Hospital, Birmingham, United Kingdom
Objectives and Study: Data from the European Society for Paediatric Nephrology/European Renal Association‐ European Dialysis and Transplant Registry in 2016 suggested worse outcomes after combined liver‐kidney transplant (CLKT) for ARPKD. Criteria for CLKT and isolated Kidney transplant (IKT) have evolved in the last decade. Our objective was to describe trends and outcomes of IKT, isolated liver transplant (ILT) and CLKT from a single tertiary center.
Methods: All children with ARPKD (cwARPKD) < 18 years of age who had CLKT, IKT or ILT at Birmingham children's hospital (BCH) and/or who had regular follow up with the liver unit at BCH from January 1993‐ October 2024 were included. Variables are presented as proportions and medians with IQR.
Results: A total of 36 cwARPKD (56% males) had 44 transplants. Median follow up duration was 7.4 years (IQR 3.9).
| Primary CLKT | Primary IKT | |
|---|---|---|
| Transplant in cwARPKD; n (%) | 24 (67%) | 10 (28%) |
| Number between 1993‐2016 | 24 | 5 |
| Number between 2017‐2024 | 0 | 5 (100%graft and patient survival) |
| Baseline characteristics | ||
| Median age (years) (IQR) | 6.4 (6.3) | 7.8 (9) |
| Proportion with cholangitis Proportion with varices needing intervention | 42% 17% | 11% 20% |
| Outcome | ||
| Overall graft survival | 96% | 60% |
| Overall patient survival | 96% | 70% |
2 children had primary ILT of which 1 had sequential liver‐kidney transplants. Transplant related mortality was seen in 3 cwARPKD. Median time to death from transplant was 22 days (16‐39). 1, 5‐year renal graft (RG) survival after IKT was 90% and 60% respectively; whereas 1,5‐ and 10‐year RG survival after CLKT was 100%, 95% and 95% respectively (p = 0.004). Since 2017, 8 children have been assessed for CLKT but no child has needed CLKT; whereas 5 IKT have 100% graft and patient survival without significant progress of liver disease.
Conclusions: CLKT has excellent overall patient and graft outcomes compared to IKT, but should only be considered for a select subgroup of patients.
Contact e‐mail address: kavya.kurkal@nhs.net
H‐OP042. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐OP042.1. WHO IS THE IDEAL LIVER DONOR FOR MY PATIENT – INFLUENCE OF DONOR SPECIFIC VARIABLES ON PATIENT AND GRAFT SURVIVAL AFTER PEDIATRIC LIVER TRANSPLANTATION
Christoph Leiskau 1, Norman Junge2, Tobias Laue3, Clara Weigle4, Florian Vondran4, Eva‐Doreen Pfister2, Ulrich Baumann5
1Pediatric Gastroenterology, Hepatology And Liver Transplantation, Hannover Medical School, Hannover, Germany, 2Division For Pediatric Gastroenterology And Hepatology, Department Of Pediatric Kidney, Liver And Metabolic Diseases, Hannover Medical School, Hannover, Germany, 3Department of Pediatrics, Freiburg, Germany, 4General, Visceral And Transplant Surgery, Hannover Medical School, Hannover, Germany, 5Pediatric Gastroenterology And Hepatology, Hannover Medical School, Hannover, Germany
Objectives and Study: In times of organ shortage and mortality on the pediatric liver transplant waiting list, the task to find the ideal donor has become increasingly challenging. Thus, our aim was to identify donor‐specific risk factors for mortality and graft loss in our pediatric liver transplantation cohort to improve donor pre‐selection.
Methods: We analysed pediatric liver transplantations (pLTx) in our center within the EUROTRANSPLANT region from 1983 till 2021. Data were collected from patients' files and EUROTRANSPLANT data. Donor variables were correlated with patient and graft survival calculating hazard ratios by using JMP 16.0.
Results: 883 pLTx were performed in 727 patients(346 f). Main indications were biliary atresia (36.8%), PALF (11.6%) and PFIC subtypes (8.9%). 5‐year patient/graft survival improved from 64.1%/48.1% in Era 1 (1983‐1993) to 98.1%/90.1% in 2015–2021 (p < 0.001,each). 136 transplantations were performed as living related transplantations. Mean age (21.6 vs 33.1 years,p < 0.001) and BMI (20.5 vs. 23.7 kg/m2,p < 0.001) of the deceased donors was lower. Living related pLTx was associated with a lower risk of mortality and graft loss (HR = 0.26/0.47,p = 0.0005/0.0004). Cerebrovascular causes of death impaired patient/graft outcome (HR = 2.15/2.27,p < 0.001 each). A higher donor/recipient liver weight ratio was associated with impaired patient, but not graft survival (HR = 2.319,p = 0.009). Age, sex and BMI had no significant influence on patient/graft survival. Higher donor creatine showed a negative correlation to patient/graft survival (HR = 1.004/1.003, p = 0.0007/0.0018), whereas elevated liver function tests did not. CMV‐IgM positivity was a risk factor for mortality (HR = 2.58, p = 0.0278).
Conclusions: Preexisting renal disease, acute CMV infection and cerebrovascular cause of death in the liver donors impaired outcome after pLTx, whereas living related pLTx showed better outcome. Age and BMI of the donor and small for size grafts did not impair patient or graft survival. In times of organ shortage, extension of donor criteria (age, BMI) might be considered whereas infectious, vascular and renal disease should be monitored closely.
Contact e‐mail address: christoph.leiskau@med.uni-goettingen.de
H‐OP043. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐OP043.1. INCIDENCE AND HIGH‐RISK GROUPS OF HEPATIC ARTERY THROMBOSIS AND STENOSIS AFTER PEDIATRIC LIVER TRANSPLANTATION: PRELIMINARY RESULTS FROM A RETROSPECTIVE, OBSERVATIONAL, MULTICENTRIC STUDY
Weihao Li 1, Hermien Hartog2, Julia Minetto3, Marcelo Dip3, Sergio Sierre4, Florent Guérin5, Stéphanie Franchi‐Abella6, Emmanuel Gonzales7, Ane Andres8, Francisco Hernandez‐Oliveros8, Esteban Remacha9, Catalina Jaramillo10, Arielle Melen11, Norman Junge12, Ulrich Baumann12, Nicolas Richter13, Joseph Dinorcia14, Puja Patel14, Sander Florman14, João Seda Neto15, Eduardo Antunes Da Fonseca15, Carolina Magalhães Costa15, Martín De Santibañes16, Victoria Ardiles16, Jimmy Walker Uño16, Lucie Gonsorčíková17, Jiří Froněk18, Šimon Bohuš17, Girish L Gupte19, Khalid Sharif19, Simon Mcguirk20, Denise Aldrian21, Jonathan Seisenbacher21, Georg Vogel21,22, Barbara Wildhaber23, Ana Calinescu23, Alexis Ricoeur24, Mukesh Kumar25, Shaleen Agarwal25, Subhash Gupta26, Tingbo Liang27, Xueli Bai27, Wei Zhang27, Paolo Marra28, Lorenzo D'antonio29,30, Domenico Pinelli31, Marisa Beretta32, Francisca Van Der Schyff33, Cristina Ferreira34, Luiza Nader34, Marco Farina34, Jesus Quintero35, Maria Mercadal‐Hally35, Jose Andrés Molino‐Gahete35, Winita Hardikar36, Sue Bates36, Lynette Goh36, Dieter Broering37, Dimitri Raptis37, Kris Ann H. Marquez37, Amit Shah38,39, Bryanna Domenick38, Michael Acord39,40, Arti Pawaria41, Haritha Rajakrishnan42, Sudhindran Surendran42, Thomas Casswall43, Carl Jorns44, Martin Delle45, Muthukumarassamy Rajakannu46, Kumar Palaniappan46, Mohamed Rela46, Khaled Dajani47, Alessandro Parente47, Vidyadhar Mali48, Marion Aw49, Sonal Asthana50, Mallikarjun Sakpal50, Ashritha Avalareddy50, Marco Spada51, Lidia Monti52, Tommaso Alterio53, Marek Stefanowicz54, Julita Latka‐Grot54, Adam Koleśnik55, Yusuke Yanagi56, Hajime Uchida56, Ryuji Komine56, Riccardo Superina57, Juan Carlos Caicedo57,58, George Mazariegos59, Kyle Soltys59, Rene Scheenstra60, Rudi Dierckx61, Reinoud Bokkers1, Hubert Van Der Doef60
1Department Of Radiology, Medical Imaging Centre, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 2Department Of Surgery, Section Of Hepatobiliary Surgery & Liver Transplantation, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 3Division Of Liver Transplant, J. P. Garrahan Hospital, Buenos Aires, Argentina, 4Division Of Interventional Radiology, J. P. Garrahan Hospital, Buenos Aires, Argentina, 5Department Of Pediatric Surgery, Bicêtre Hospital, Bicêtre, France, 6Pediatric Radiology Department, Bicêtre Hospital, Bicêtre, France, 7Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 8Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain, 9Pediatric Hepatology Department, La Paz University Hospital, Madrid, Spain, 10Department Of Paediatrics, Division Of Paediatric Gastroenterology, Hepatology And Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, United States of America, 11University of Utah School of Medicine, Salt Lake City, United States of America, 12Division For Pediatric Gastroenterology And Hepatology, Department Of Pediatric Kidney, Liver And Metabolic Diseases, Hannover Medical School, Hannover, Germany, 13Department Of General, Visceral And Transplant Surgery, Hannover Medical School, Hannover, Germany, 14Recanati‐miller Transplantation Institute, Mount Sinai Hospital, New York, United States of America, 15Hepatology And Liver Transplantation, Hospital Sírio‐Libanês, São Paulo, Brazil, 16Hpb And Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 17Department Of Pediatrics, First Faculty Of Medicine, Charles University Prague and Thomayer University Hospital, Prague, Czech Republic, 18Department Of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic, 19Liver Unit (including Small Bowel Transplantation), birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom, 20Department Of Radiology, birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom, 21Department Of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria, 22Institute Of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria, 23Swiss Pediatric Liver Center, Division Of Child And Adolescent Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland, 24Swiss Pediatric Liver Center, Division Of Interventional Radiology, Geneva University Hospitals, University of Geneva, Geneva, Geneva, Switzerland, 25Centre For Liver And Biliary Sciences, Max Super Speciality Hospital, New Delhi, India, 26Liver Transplant Surgery, Centre For Liver And Biliary Sciences, Max Super Speciality Hospital, New Delhi, India, 27Department Of Hepatobiliary And Pancreatic Surgery, Liver Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, 28Department Of Radiology, ASST Papa Giovanni XXIII Hospital, University of Milano‐Bicocca, Bergamo, Italy, 29Department Of Paediatric Hepatology, Gastroenterology And Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy, 30Department Of Medicine And Surgery, University of Milan‐Bicocca, Bergamo, Italy, 31Department Of Organ Failure And Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy, 32Department Of Peadiatrics, Wits Donald Gordon Medical Centre, Johannesburg, South Africa, 33Department Of Surgery, Wits Donald Gordon Medical Centre, Johannesburg, Johannesburg, South Africa, 34Department Of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil, 35Pediatric Hepatology And Liver Trasplant Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 36Department Of Gastroenterology, Royal Children's Hospital, Melbourne, Australia, 37Organ Transplant Center Of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 38Division Of Gastroenterology, Hepatology And Nutrition, Department Of Paediatrics, Children's Hospital of Philadelphia, Philadelphia, United States of America, 39Perelman School Of Medicine, University of Pennsylvania, Philadelphia, United States of America, 40Department Of Radiology, Children's Hospital of Philadelphia, Philadelphia, United States of America, 41Department Of Pediatric Hepatology & Gastroenterology, Amrita Institute of Medical Sciences & Research Centre, New Delhi, India, 42Department Of Solid Organ Transplantation, Amrita Institute of Medical Sciences & Research Centre, Kochi, India, 43Division For Paediatrics, Department Clinical Interventions And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 44Department Of Transplantation Surgery, F82, Karolinska University Hospital, Department Clinical Science, Intervention And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 45Department Of Radiology, Karolinska University Hospital, Department Clinical Science, Intervention And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 46Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chromepet, Chennai, India, 47Department Of Surgery, Division Of Transplantation Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada, 48Department Of Paediatric Surgery, National University Hospital, Singapore, Singapore, 49Department Of Paediatrics, National University Hospital, Singapore, Singapore, 50Integrated Liver Care Department, Aster CMI hospital, Bengaluru, India, 51Division Of Hepatobiliopancreatic Surgery, Liver And Kidney Transplantion, IRCCS Bambino Gesù Children's Hospital, Rome, Italy, 52Gastrointestinal And Transplanted Liver Imaging Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy, 53Hepatology And Liver Transplant Unit, IRCCS Bambino Gesu' Children's Hospital, Rome, Italy, 54Department Of Pediatric Surgery And Organ Transplantation, Childrens Memorial Health Institute, Warsaw, Poland, 55Cardiovascular Interventions Laboratory, Childrens Memorial Health Institute, Warsaw, Poland, 56Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan, 57Division Of Transplant And Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, United States of America, 58Division Of Transplantation, Department Of Surgery, Northwestern University Feinberg School of Medicine, Chicago, United States of America, 59University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Hillman Center for Pediatric Transplantation, University of Pittsburgh, Pittsburgh, United States of America, 60Division Of Paediatric Gastroenterology And Hepatology, Department Of Paediatrics, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 61Department Of Nuclear Medicine And Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
Objectives and Study: Hepatic artery complications (HACs) such as thrombosis (HAT) and stenosis (HAS) cause significant morbidity and mortality after pediatric liver transplantation (pLT); however, their incidence and risk factors remain poorly defined. This study aimed to investigate the incidence of HACs after pLT and identify high‐risk groups.
Methods: We performed a retrospective, multicentric study from the HEPatic Artery stenosis and Thrombosis after liver transplantation In Children registry, which includes pLTs from 24 centers across 20 countries and six continents over a 20‐year period. We examined the onset of HACs after pLT and analyzed the incidence of HACs across subgroups defined by pLT indication, age at pLT, donor type, transplant era, and annual center volume.
Results: A total of 8,469 pLTs were identified with 406 HACs, yielding an overall incidence of 4.8% (HAT: 3.4%; HAS: 1.4%). HACs occurred predominantly within the first month post‐pLT (85.3%), with HAT peaking in the first week and HAS evenly distributed throughout the month. HAC incidence was higher after re‐transplantation (6.5%) compared to primary pLTs (4.7%, p = 0.04) and after deceased donor liver transplantation (DDLT) compared to living donor liver transplantation (LDLT) (6.2% vs. 3.4%, p < 0.01). Among biliary atresia (BA) patients under 1 year, HAC rates were higher following DDLT than LDLT (7.6% vs. 3.2%, p < 0.01) and higher with whole grafts compared to partial grafts in DDLT (12.2% vs. 5.9%, p < 0.01). HAC rates significantly increased over time, from 3.6% (2002–2012) to 5.5% (2012–2022), and were highest in low‐volume centers (11%, p < 0.01).
Conclusions: The overall incidence of HACs was 4.8%. Higher HAC incidence was observed in re‐transplantations, DDLT (particularly with whole grafts in BA patients under 1 year), recent decade (2012–2022), and low‐volume centers. Identifying these high‐risk groups can help guide improvements in the prevention, detection, and management of HACs after pLT.
Contact e‐mail address: l.weihao@umcg.nl
H‐OP044. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐OP044.1. POOR ONE‐YEAR OUTCOMES FOLLOWING HEPATIC ARTERY THROMBOSIS AFTER PEDIATRIC LIVER TRANSPLANTATION: RESULTS FROM AN INTERNATIONAL, MULTICENTER, REAL‐WORLD REGISTRY
Weihao Li 1, Hermien Hartog2, Julia Minetto3, Marcelo Dip3, Sergio Sierre4, Emmanuel Gonzales5, Florent Guérin6, Stéphanie Franchi‐Abella7, Ane Andres8, Francisco Hernandez‐Oliveros8, Esteban Remacha9, Catalina Jaramillo10, Leandra Bitterfeld11, Arielle Melen12, Norman Junge13, Ulrich Baumann13, Nicolas Richter14, Joseph Dinorcia15, Puja Patel15, Sander Florman15, João Seda Neto16, Eduardo Antunes Da Fonseca16, Carolina Magalhães Costa16, Martín De Santibañes17, Victoria Ardiles17, Jimmy Walker Uño17, Lucie Gonsorčíková18, Jiří Froněk19, Šimon Bohuš18, Girish L Gupte20, Khalid Sharif20, Simon Mcguirk21, Denise Aldrian22, Jonathan Seisenbacher22, Georg Vogel22,23, Barbara Wildhaber24, Ana Calinescu24, Alexis Ricoeur25, Mukesh Kumar26, Shaleen Agarwal26, Subhash Gupta26, Tingbo Liang27, Xueli Bai27, Wei Zhang27, Paolo Marra28, Lorenzo D'antonio29,30, Michela Bravi29, Domenico Pinelli31, Marisa Beretta32, Francisca Van Der Schyff33, Cristina Ferreira34, Luiza Nader34, Marco Farina34, Jesus Quintero35, Maria Mercadal‐Hally35, Jose Andrés Molino‐Gahete35, Winita Hardikar36, Sue Bates36, Lynette Goh36, Dieter Broering37, Dimitri Raptis37, Kris Ann H. Marquez37, Amit Shah38,39, Bryanna Domenick38, Michael Acord39,40, Arti Pawaria41, Haritha Rajakrishnan42, Sudhindran Surendran42, Thomas Casswall43, Carl Jorns44, Martin Delle45, Muthukumarassamy Rajakannu46, Kumar Palaniappan46, Mohamed Rela46, Khaled Dajani47, Alessandro Parente47, David Bigam47, Vidyadhar Mali48, Marion Aw49, Sonal Asthana50, Mallikarjun Sakpal50, Ashritha Avalareddy50, Marco Spada51, Lidia Monti52, Tommaso Alterio53, Marek Stefanowicz54, Julita Latka‐Grot54, Adam Koleśnik55, Yusuke Yanagi56, Hajime Uchida56, Ryuji Komine56, Riccardo Superina57, Juan Carlos Caicedo57,58, George Mazariegos59, Kyle Soltys59, Rene Scheenstra60, Rudi Dierckx61, Reinoud Bokkers1, Hubert Van Der Doef60
1Department Of Radiology, Medical Imaging Centre, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 2Department Of Surgery, Section Of Hepatobiliary Surgery & Liver Transplantation, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 3Division Of Liver Transplant, J. P. Garrahan Hospital, Buenos Aires, Argentina, 4Division Of Interventional Radiology, J. P. Garrahan Hospital, Buenos Aires, Argentina, 5Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 6Department Of Pediatric Surgery, Bicêtre Hospital, Bicêtre, France, 7Pediatric Radiology Department, Bicêtre Hospital, Bicêtre, France, 8Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain, 9Pediatric Hepatology Department, La Paz University Hospital, Madrid, Spain, 10Department Of Paediatrics, Division Of Paediatric Gastroenterology, Hepatology And Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, United States of America, 11Intermountain Primary Children's Hospital, Salt Lake City, United States of America, 12University of Utah School of Medicine, Salt Lake City, United States of America, 13Division For Pediatric Gastroenterology And Hepatology, Department Of Pediatric Kidney, Liver And Metabolic Diseases, Hannover Medical School, Hannover, Germany, 14Department Of General, Visceral And Transplant Surgery, Hannover Medical School, Hannover, Germany, 15Recanati‐miller Transplantation Institute, Mount Sinai Hospital, New York, United States of America, 16Hepatology And Liver Transplantation, Hospital Sírio‐Libanês, São Paulo, Brazil, 17Hpb And Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 18Department Of Pediatrics, First Faculty Of Medicine, Charles University Prague and Thomayer University Hospital, Prague, Czech Republic, 19Department Of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic, 20Liver Unit (including Small Bowel Transplantation), birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom, 21Department Of Radiology, birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom, 22Department Of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria, 23Institute Of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria, 24Swiss Pediatric Liver Center, Division Of Child And Adolescent Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland, 25Swiss Pediatric Liver Center, Division Of Interventional Radiology, Geneva University Hospitals, University of Geneva, Geneva, Geneva, Switzerland, 26Centre For Liver And Biliary Sciences, Max Super Speciality Hospital, New Delhi, India, 27Department Of Hepatobiliary And Pancreatic Surgery, Liver Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, 28Department Of Radiology, ASST Papa Giovanni XXIII Hospital, University of Milano‐Bicocca, Bergamo, Italy, 29Department Of Paediatric Hepatology, Gastroenterology And Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy, 30Department Of Medicine And Surgery, University of Milan‐Bicocca, Bergamo, Italy, 31Department Of Organ Failure And Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy, 32Department Of Peadiatrics, Wits Donald Gordon Medical Centre, Johannesburg, South Africa, 33Department Of Surgery, Wits Donald Gordon Medical Centre, Johannesburg, Johannesburg, South Africa, 34Department Of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil, 35Pediatric Hepatology And Liver Trasplant Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 36Department Of Gastroenterology, Royal Children's Hospital, Melbourne, Australia, 37Organ Transplant Center Of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 38Division Of Gastroenterology, Hepatology And Nutrition, Department Of Paediatrics, Children's Hospital of Philadelphia, Philadelphia, United States of America, 39Perelman School Of Medicine, University of Pennsylvania, Philadelphia, United States of America, 40Department Of Radiology, Children's Hospital of Philadelphia, Philadelphia, United States of America, 41Department Of Pediatric Hepatology & Gastroenterology, Amrita Institute of Medical Sciences & Research Centre, New Delhi, India, 42Department Of Solid Organ Transplantation, Amrita Institute of Medical Sciences & Research Centre, Kochi, India, 43Division For Paediatrics, Department Clinical Interventions And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 44Department Of Transplantation Surgery, F82, Karolinska University Hospital, Department Clinical Science, Intervention And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 45Department Of Radiology, Karolinska University Hospital, Department Clinical Science, Intervention And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 46Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chromepet, Chennai, India, 47Department Of Surgery, Division Of Transplantation Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada, 48Department Of Paediatric Surgery, National University Hospital, Singapore, Singapore, 49Department Of Paediatrics, National University Hospital, Singapore, Singapore, 50Integrated Liver Care Department, Aster CMI hospital, Bengaluru, India, 51Division Of Hepatobiliopancreatic Surgery, Liver And Kidney Transplantion, IRCCS Bambino Gesù Children's Hospital, Rome, Italy, 52Gastrointestinal And Transplanted Liver Imaging Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy, 53Hepatology And Liver Transplant Unit, IRCCS Bambino Gesu' Children's Hospital, Rome, Italy, 54Department Of Pediatric Surgery And Organ Transplantation, Childrens Memorial Health Institute, Warsaw, Poland, 55Cardiovascular Interventions Laboratory, Childrens Memorial Health Institute, Warsaw, Poland, 56Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan, 57Division Of Transplant And Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, United States of America, 58Division Of Transplantation, Department Of Surgery, Northwestern University Feinberg School of Medicine, Chicago, United States of America, 59University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Hillman Center for Pediatric Transplantation, University of Pittsburgh, Pittsburgh, United States of America, 60Division Of Paediatric Gastroenterology And Hepatology, Department Of Paediatrics, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 61Department Of Nuclear Medicine And Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
Objectives and Study: Hepatic artery thrombosis (HAT) after pediatric liver transplantation (pLT) is a severe complication that can lead to acute graft failure, often requiring urgent re‐transplantation. Despite its significance, the outcomes of HAT after pLT remain poorly characterized. This study aimed to determine the one‐year incidence of graft loss and mortality and to identify risk factors in patients who develop HAT after pLT.
Methods: We analyzed data from patients who developed HAT after pLT from the HEPatic Artery Stenosis and Thrombosis after Liver Transplantation in Children registry. This registry includes 8,469 pLTs from 24 centers across 20 countries and six continents, spanning a 20‐year period. Clinical characteristics were examined at three timeframes: pre‐transplant, immediate post‐transplant, and following HAT diagnosis. Risk factors for graft loss and mortality were identified through multivariate Cox regression analyses, with model assumptions verified using Schoenfeld residuals.
Results: HAT occurred in 3.4% of patients (n = 287, 53% female, median age 1.8 years). Following the diagnosis of HAT, the cumulative incidence of graft loss was 44% (95% CI 38–49) at one month and 56% (95% CI 50–62) at one year. Mortality rates were 15% (95% CI 11–19) and 23% (95% CI 18–28) at these respective timepoints. Multivariate Cox regression analysis identified three independent risk factors for one‐year graft loss: aspartate aminotransferase (AST) ≥ 1000 U/L, an international normalized ratio (INR) ≥ 2, and dialysis at HAT diagnosis (each p < 0.05). Independent risk factors for one‐year mortality included non‐cirrhotic primary diseases, living donor pLT, AST ≥ 1000 U/L, INR ≥ 2, and dialysis at HAT diagnosis (each p < 0.05).
Conclusions: Patients with HAT after pLT experience notably high rates of graft loss and mortality, particularly within the first month following diagnosis and with signs of graft and multi‐organ failure. Risk stratification at HAT diagnosis underscore the critical need for preventing graft loss and mortality after HAT.
Contact e‐mail address: l.weihao@umcg.nl
H‐OP045. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐OP045.1. ADHERENCE TO TACROLIMUS IN ADOLESCENTS WITH LIVER TRANSPLANTS: A STUDY OF BLOOD LEVELS AND SMAQ RESPONSES IN TRANSITION CARE
Paloma Martínez Campos 1, María Jesús Pascau González Garzón1, María Alós Díez1,2, Maria Dolores Lledin Barbancho2, Gema Munoz Bartolo3, María José Quilés Blanco2, Ana Martínez Pereira2, Esteban Remacha4, Loreto Hierro3
1Paediatric Hepatology, La Paz University Hospital, Madrid, Spain, 2Pediatric Hepatology, University Hospital La Paz, Madrid, Spain, 3Service Of Pediatric Hepatology And Transplantation, Children's Hospital La Paz, La Paz University Hospital, Madrid, Spain, 4Pediatric Hepatology Department, La Paz University Hospital, Madrid, Spain
Objectives and Study: Adherence to treatment is crucial for preventing graft loss in liver transplant recipients. No gold standard exists to measure adherence to immunosuppressive therapy, but variability in tacrolimus blood levels is linked to graft loss. This study assessed adherence to tacrolimus in adolescents (12–18 years) transitioning to adult care and compared the Medication Level Variability Index (MLVI) with the Self‐Reported Medication Adherence Questionnaire (SMAQ).
Methods: MLVI ( > 2 SD indicating non‐adherence) was compared to SMAQ scores in a cohort of 96 patients, after excluding 13 individuals: 1 patient not receiving immunosuppressive therapy, 6 on cyclosporine, 1 in critical condition, and 5 with infrequent follow‐up. Tacrolimus levels and SMAQ scores were monitored throughout 2024.
Results: In the statistical study, the contingency table shows an 8% false positive rate and a 22% false negative rate. According to Cohen's Kappa index (value 0.558, p < 0.001), the survey used shows a 56% agreement with the variability of tacrolimus levels, which represents moderate agreement.
Conclusions: While tacrolimus blood levels are generally considered a reliable indicator of adherence, the discrepancies between SMAQ and blood levels suggest that variations in tacrolimus levels may not always reflect true adherence. This indicates also that SMAQ alone is not sufficient to accurately assess adherence. However, nursing interventions, such as patient education and monitoring, can help prevent non‐adherence and improve treatment outcomes. Combining both objective blood level measurements and supportive nursing care could enhance adherence and graft survival in adolescent liver transplant recipients.
Contact e‐mail address: pmcampos@salud.madrid.org
H‐OP046. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐OP046.1. PREDICTORS OF LONG‐TERM OUTCOME AFTER PEDIATRIC LIVER TRANSPLANTATION – A CLINICAL FOLLOW‐UP FROM THE CHILSFREE STUDY
Hamoud Nasser 1, Niyade Ouro‐Djobo2, Evgeny Chichelnitskiy3, Lorenzo D'antonio4, Deirdre Kelly5, Valérie Mclin6, Dominique Debray7, Loreto Hierro8, Joanna Pawlowska9, Christine Falk10, Ulrich Baumann11, Imeke Goldschmidt11
1Clinic For Pediatric Kidney, Liver And Metabolic Diseases, Hanover Medical School, Hannover, Germany, 2Institute For Medical Microbiology, Medizinische Hochschule Hannover, Hannover, Germany, 3Department Of Transplantation Immunology, Medizinische Hochschule Hannover, Hannover, Germany, 4Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 5University of Birmingham, Birmingham, United Kingdom, 6Swiss Pediatric Liver Center, Department of Pediatrics, University of Geneva, Geneva, Switzerland, 7Gastroenterology‐hepatology‐nutrition Unit, APHP‐Necker Enfants Malades University Hospital, Paris, France, 8Service Of Pediatric Hepatology And Transplantation, Children's Hospital La Paz, La Paz University Hospital, Madrid, Spain, 9Department Of Gastroenterology, Hepatology, Nutritional Disorders, And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland., Warsaw, Poland, 10Department Of Transplantation Immunology, Hanover Medical School, Hannover, Germany, 11Division Of Pediatric Hepatology And Liver Transplantation; Department Of Pediatric Liver, Kidney And Metabolic Diseases And Neuropediatrics, Medizinische Hochschule Hannover, Hannover, Germany
Objectives and Study: Despite significant advancements in pediatric liver transplantation (pLT), predicting long‐term outcomes remains difficult. This study investigates clinical predictors of long‐term outcome after pLT within the multicentric international ChilSFree cohort study.
Methods: ChilSFree was a multicenter European cohort study that provided clinical and immunological assessments during the first year post‐pLT. In 221 children previously enrolled in ChilSFree, clinical outcome data at the last available visit were compared with clinical predictors obtained 12 months after pLT. The median follow‐up time was 7.7 (range 1–10) years. Transplant outcomes were evaluated based on the incidence of T‐cell mediated rejection (TCMR) and two surrogate outcome parameters designed to reflect stability over time: "Good Outcome" (normal liver function tests LFTs, i.e. AST, ALT, GGT, bilirubin) without prior TCMR, and "Optimal Outcome" (normal LFTs without any for‐cause biopsies).
Results: Overall survival was 93.4%. 60.2% never had TCMR. "Good" and "Optimal" outcomes throughout were achieved by 24.9% and 17.6%, respectively. The frequency of "Good" and "Optimal" outcomes increased to 33.5 % and 37.6%, respectively, if only time after the first year post‐pLT was considered. Normal AST at one‐year post‐pLT, immunosuppression at the last follow‐up, and treating transplant center were associated with outcome variables on univariate analysis. On logistic regression, only normal AST levels at one‐year post‐pLT (Exp(B) = 4.544, p = .026), and transplant center (Exp(B) = 27.188, p = .005 for "good"; Exp(B) = 95.600, p = .007 for "optimal") were independent predictors of favorable outcomes. No immunosuppressive regime independently predicted positive outcomes.
Conclusions: Normal AST but not ALT at 12 months post‐pLT predicts "optimal outcome" during long‐term follow‐up. The transplant center appears as an independent predictor irrespective of differences in immunosuppression. This highlights the influence of follow‐up care and individual practice and demands further research integrating clinical, immunological, and organizational parameters to optimize long‐term outcomes in pediatric liver transplantation.
Contact e‐mail address: nasser.hamoud@mh-hannover.de
H‐OP047. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐OP047.1. CYTOMEGALOVIRUS‐RNA ACCURATELY PREDICTS THE NEED FOR PREEMPTIVE THERAPY IN CHILDREN UNDERGOING LIVER TRANSPLANTATION: A PROOF‐OF‐CONCEPT STUDY
Emanuele Nicastro1, Eleonora Severi 1,2, Ilaria Passera3, Michele Totaro3, Lorenza Matarazzo1, Laura Fornataro3, Francesco Morotti1,4, Alessandra Tebaldi5, Ezio Bonanomi6, Michela Bravi1, Angelo Di Giorgio7, Samuele Covini8, Marta Dolci1, Domenico Pinelli9, Marco Enrico Giovanni Arosio3, Lorenzo D'antonio1,2
1Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 2Department of Pediatrics, University of Milan Bicocca, Milan, Italy, 3Microbiology and Virology, Hospital Papa Giovanni XXIII, Bergamo, Italy, 4Neonatology and Neonatal Intensive Care Unit, Spedali Civili Hospital, Brescia, Italy, 5Infectious Diseases, Hospital Papa Giovanni XXIII, Bergamo, Italy, 6Pediatric intesive Care Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy, 7Pediatrics, University of Udine, Udine, Italy, 8School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy, 93rd Surgery, Hospital Papa Giovanni XXIII, Bergamo, Italy
Objectives and Study: Preemptive therapy (PET) is safe and effective in controlling Cytomegalovirus (CMV) infection after pediatric liver transplantation (LT) and allows to observe the kinetics of quantitative CMV‐DNA viral load till it reaches the treatment thresholds. While an early detection of low‐to‐moderate CMV‐DNA levels may not indicate active viral replication, awaiting the viral load to exceed the treatment threshold may lead to viremic breakthroughs and CMV disease. We assessed the capacity of quantitative CMV‐RNA (UL21.5 mRNA) to identify active viral replication, and its accuracy in predicting the need for PET in LT children.
Methods: This is a prospective observational proof‐of‐concept study. Children were followed for 6 months after LT, and both CMV‐DNA and CMV‐RNA were determined once a week in the first 12 weeks and at +4, +5, +6 months. Children were treated with iv ganciclovir for PET and in case of CMV disease. Cut‐off for PET was CMV‐DNA ≥ 100,000 IU/mL (142,800 cp/mL) in low‐intermediate risk, and ≥ 50,000 IU/mL CMV‐DNA (71,400 cp/mL) in high‐risk children. PET or CMV disease were defined “complicated CMV”.
Results:
One‐hundred and forty‐four comparative quantitative CMV‐RNA and CMV‐DNA determinations were obtained from 12 children. Of 52 CMV‐DNA‐positive specimens, 17 (32%) were also CMV‐RNA‐positive, while CMV‐RNA was undetectable in CMV‐DNA‐negative specimens. CMV‐DNA was significantly higher in CMV‐RNA‐positive (56,499 ± 102,577 copies/mL) than in CMV‐RNA‐negative specimens (1,189 ± 1,382; P < 0.0001) (Figure, A). Children with complicated CMV had early detectable CMV‐RNA, peaking simultaneously to CMV‐DNA (median CMV‐DNA: 65,906 cp/mL; median CMV‐RNA: 767 cp/mL; Figure, C); conversely, none of those with persistently low DNAemia proved CMV‐RNA‐positive (Figure, B).
Conclusions: In this first pilot study, CMV‐RNA had 100% sensitivity and specificity in predicting the need for PET after pediatric LT. The early detection of CMV‐RNA marks significant CMV infection/reactivation, thus allowing to avoid unnecessary antiviral treatment.
Contact e‐mail address: enicastro@asst-pg23.it
H‐OP048. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐OP048.1. SAFETY AND EFFICACY OF PTA AND STENT PLACEMENT FOR PORTAL VEIN STENOSIS AFTER PEDIATRIC LIVER TRANSPLANTATION; FINDINGS FROM THE PORTAL REGISTRY
Lydia Sieben 1,2, Bader Alfares3, Guillermo Cervio4, Julia Minetto4, Sergio Sierre5, Piotr Kalicinski6, Malgorzata Markiewicz‐Kijewska6, Adam Koleśnik7, Stéphanie Franchi‐Abella8, Emmanuel Gonzales9, Florent Guérin10, Jai Patel11, Marumbo Paul Mtegha12, Raj Prasad13, Mureo Kasahara14, Seisuke Sakamoto14, Hajime Uchida14, Martín De Santibañes15, Victoria Ardiles15, Jimmy Walker Uño15, Paolo Marra16, Lorenzo D'antonio17,18, Domenico Pinelli19, Catalina Jaramillo20, Arielle Melen21, Leandra Bitterfeld22, Barbara Wildhaber23, Marisa Beretta24, Denise Aldrian25, Georg Vogel26,27, Valeria Berchtold28, Winita Hardikar29, Helen Evans30, David Duncan31, John Mccall32, Amit Shah33, Phoebe Wood34, Michael Acord35, Jesus Quintero36, Maria Mercadal‐Hally36, Mauricio Larrarte King37, Vidyadhar Mali38, Marion Aw39, Steffen Hartleif40, Ekkehard Sturm40, Thomas Casswall41, Greg Nowak42, Martin Delle43, Rajeev Khanna44, Viniyendra Pamecha45, Amar Mukund46, Ryan Fischer47, Bhargava Mullapudi48, Richard Hendrickson48, Rudi Dierckx49, Henkjan Verkade50, Ruben De Kleine51, Hubert Van Der Doef1, Reinoud Bokkers2
1Division Of Paediatric Gastroenterology And Hepatology, Department Of Paediatrics, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 2Department Of Radiology, Medical Imaging Centre, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 3Department Of Radiology, University Medical Center Groningen, Groningen, Netherlands, 4Division Of Liver Transplant, J. P. Garrahan Hospital, Buenos Aires, Argentina, 5Division Of Interventional Radiology, J. P. Garrahan Hospital, Buenos Aires, Argentina, 6Department Of Paediatric Surgery And Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland, 7Cardiovascular Interventions Laboratory, Childrens Memorial Health Institute, Warsaw, Poland, 8Pediatric Radiology Department, Bicêtre Hospital, Bicêtre, France, 9Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 10Department Of Pediatric Surgery, Bicêtre Hospital, Bicêtre, France, 11Department Of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom, 12Paediatric Hepatology, Leeds Children's Hospital, Leeds, United Kingdom, 13Department Of Surgery And Transplantation, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom, 14Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan, 15Hpb And Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 16Department Of Radiology, ASST Papa Giovanni XXIII Hospital, University of Milano‐Bicocca, Bergamo, Italy, 17Pediatric Hepatology, Gastroenterology And Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 18Department Of Medicine And Surgery, University of Milan‐Bicocca, Bergamo, Italy, 19Department Of Organ Failure And Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy, 20Department Of Paediatrics, Division Of Paediatric Gastroenterology, Hepatology And Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, United States of America, 21University of Utah School of Medicine, Salt Lake City, United States of America, 22Intermountain Primary Children's Hospital, Salt Lake City, United States of America, 23Swiss Pediatric Liver Center, Division Of Child And Adolescent Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland, 24Department Of Peadiatrics, Wits Donald Gordon Medical Centre, Johannesburg, South Africa, 25Department Of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria, 26Department Of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria, 27Institute Of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria, 28Department Of Visceral, Transplant And Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria, 29Department Of Gastroenterology, Royal Children's Hospital, Melbourne, Australia, 30Paediatric Gastroenterology And Hepatology, Starship Child Health, Auckland, New Zealand, 31Department Of Paediatric Radiology, Starship Children's Hospital, Auckland, New Zealand, 32Liver Transplant Unit, Starship Children's Hospital, Auckland, New Zealand, 33Division Of Gastroenterology, Hepatology And Nutrition, Department Of Paediatrics, Children's Hospital of Philadelphia, Philadelphia, United States of America, 34Department Of Paediatrics, Division of Gastroenterology, Hepatology and Nutrition, Philadelphia, United States of America, 35Department Of Radiology, Children's Hospital of Philadelphia, Philadelphia, United States of America, 36Pediatric Hepatology And Liver Trasplant Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 37Pediatric Hepatology And Liver Transplantation, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 38Department Of Paediatric Surgery, National University Hospital, Singapore, Singapore, 39Department Of Paediatrics, National University of Singapore, Singapore, Singapore, 40Paediatric Gastroenterology And Hepatology, University Children's Hospital Tübingen, Tübingen, Germany, 41Division For Paediatrics, Department Clinical Interventions And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 42Department Clinical Interventions And Technology Clintec, Division For Transplantation Surgery, Karolinska Institute, Stockholm, Sweden, 43Department Of Radiology, Karolinska University Hospital, Department Clinical Science, Intervention And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 44Department Of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India, 45Department Of Hepato‐pancreato‐biliary Surgery, Institute of Liver and Biliary Sciences, Delhi, India, 46Department Of Interventional Radiology, Institute of Liver and Biliary Sciences, New delhi, India, 47Children's Mercy Hospital, Kansas City, United States of America, 48Department Of Paediatric Surgery, Children's Mercy Kansas City, Kansas, United States of America, 49Department Of Nuclear Medicine And Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands, 50Division Of Pediatric Gastroenterology And Hepatology, Department Of Pediatrics, University Medical Center Groningen, Groningen, Netherlands, 51Division Of Hepatobiliary Surgery & Liver Transplantation, Department Of Surgery, University Medical Center Groningen, Groningen, Netherlands
Objectives and Study: Portal vein stenosis (PVS) is a serious complication after pediatric liver transplantation (pLT) requiring revascularization. While percutaneous transluminal angioplasty (PTA) and endovascular stent placement offer less invasive alternatives to surgery, their long‐term outcomes remain unclear. This study aims to determine their efficacy and safety.
Methods: The study analyzed PTA and stent procedures (n > 10) for PVS after pLT from the PORTAL registry, which comprises of a 20‐year cohort from 21 centers across 18 countries. Outcome measures included technical success, adverse events (<30 days postprocedural), and long‐term portal vein patency obtained with, and without adjuvant treatment.
Results: Among 239 patients with PVS, 207 underwent primary endovascular treatment (181 PTA, 26 stent), achieving technical success rates of 97% and 89% respectively (p = 0.089). Adverse events did not differ (p > 0.050), including bleeding (5%), thrombosis (3%), infection (4%), reintervention (2%), retransplantation (2%), death (4%) and other (3%). One‐year patency rates were 75% for PTA and 84% for stents. Adjuvant secondary treatment after PTA was performed in 56 patients (1 conservative, 5 surgical, 50 endovascular) and in 5 patients after stenting (1 conservative, 4 endovascular). After PTA, secondary treatment with re‐PTA achieved 78% one‐year patency (n = 35), while secondary stenting had a 100% patency rate (n = 12, p = 0.085). Over a 10‐year follow‐up, 97% of primarily PTA‐treated vessels, and 100% of primarily stented vessels maintained patency or had it restored with adjuvant treatment (p = 0.978).
Conclusions: PTA and stent placement demonstrate excellent safety and efficacy, even as reinterventions. Given its minimally invasive nature, PTA is a particularly favorable modality for addressing PVS after pLT.
Contact e‐mail address: h.p.j.van.der.doef@umcg.nl
H‐EP001. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP001.1. CORRELATION BETWEEN PLASMA LEVELS OF LIPOPOLYSACCHARIDE‐BINDING PROTEIN AND HEPATO‐METABOLIC IMPAIRMENT IN CHILDREN WITH MASLD
Antonella Mosca1, Nadia Panera2, Giulia Andolina2, Donatella Comparcola1, Mariarita Sartorelli1, Paola Francalanci3, Andrea Pietrobattista1, Anna Alisi 2
1Hepatology And Liver Transplant Unit, Children Hospital Bambino Gesù, Rome, Italy, 2Research Unit Of Genetics Of Complex Phenotypes, Children's Hospital Bambino Gesu, rome, Italy, 3Pathology, Children's Hospital Bambino Gesù, ROMA, Italy
Objectives and Study: Metabolic dysfunction‐associated steatotic liver disease (MASLD) covers a broad spectrum of hepatic and metabolic disorders where interwind between gut‐derived products (GDPs) and inflammatory response plays a pivotal role. Among GDPs, lipopolysaccharide (LPS) is considered the major trigger of systemic and hepatic inflammation in MASLD. However, the pattern of soluble lipopolysaccharide‐binding protein (LBP), the primary binding protein for identifying LPS in circulation, remains uncovered. Here, we aim to investigate the soluble levels of LBP and its role as potential biomarkers of a predictor of hepato‐metabolic impairment in children with MASLD.
Methods: Seventy‐five Caucasian adolescents with MASLD (12.6 ± 3.3 years; 49 males) were enrolled in the study. The presence of steatohepatitis (MASH) was defined by histopathology assessment according to the Delphi consensus algorithm. Plasma samples were used to assess the levels of LPS and LPB by enzyme‐linked immunosorbent assays.
Results: Our data highlighted that ALT levels (37.6 ± 17.8 vs. 25.1 ± 8, p = 0.001) and HOMA‐IR value (4.88 ± 2.8 vs. 2.97 ± 1.5, p = 0.048) values were significantly higher in patients with MASH (MASH) than in patients without MASH (Not‐MASH). Of note, MASH adolescents exhibited significantly lower LBP levels (9949.4 ± 3,719 vs. 13550.54 ± 5,022 ng/ml; p = 0.0005), but higher LPS levels (5.29 ± 6.8 vs. 3.5 ± 1.9, p = 0.02) than Not‐MASH adolescents. Moreover, univariate analysis showed that LBP values were negatively correlated with ALT levels (r = ‐0.25, p = 0.03), steatosis (r = ‐0.27, p = 0.048), but and fibrosis (r = ‐0.32, p = 0.04); while they were positively correlated with glucose (r = 0.29, p = 0.03) and triglycerides (r = 0.28, p = 0.02).
Conclusions: In conclusion, we demonstrated that low levels of soluble LBP are negatively correlated with hepato‐metabolic impairment in paediatric MASLD, thus suggesting the protective role of this molecule in LPS clearance and underlining the need for further investigation into therapeutic approaches that may promote hepatic LPB production.
Contact e‐mail address:
H‐EP002. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP002.1. DISSECTION OF CROSSTALK BETWEEN LIVER DAMAGE AND GUT MICROBIOTA IN A MURINE MODEL OF EARLY METABOLIC DYSFUNCTION‐ASSOCIATED STEATOTIC LIVER DISEASE
Giulia Andolina 1, Maria Rita Braghini1, Francesca Toto1, Federica Del Chierico1, Matteo Scanu1, Roberto Piciotti2, Cristiano De Stefanis1, Lorenza Putignani1, Anna Alisi1
1Bambino Gesù Children's Hospital and IRCCS, Rome, Italy, 2Privato, Rome, Italy
Objectives and Study: Metabolic dysfunction‐associated steatotic liver disease (MASLD) encompasses simple liver steatosis to advanced forms of liver damage, such as fibrosis and cirrhosis, even in children where dysmetabolism and gut dysbiosis play a crucial role. We investigated the crosstalk between liver damage and changes in gut microbiota composition in a murine model of MASLD with post‐natal induced insulin resistance.
Methods: A non‐genetic mouse model of early induced MASLD was generated by combining streptozotocin treatment with a high‐fat diet. Three groups of 8 mice each plus controls were fed for 6, 11 and 14 weeks to follow the disease progression by histological and biochemical analyses. Serum levels of lipopolysaccharides (LPS) and cytokines were analyzed by ELISA. Intestinal tight junctions (TJs) were analyzed by immunofluorescence and gene expression analysis. Metagenomic analysis was performed by the Illumina MiSeq™ platform
Results: Treated animals showed increased body and liver weight compared to the respective controls, rising throughout the progression of liver damage (steatosis, inflammation, ballooning and fibrosis). Correspondingly, all treatment groups exhibited elevated serum levels of ALT, glucose, TNFα, and LPS compared to controls, with a progressive increase of these parameters alongside the hepatic damage progression. These changes were coupled with the loss of intestinal barrier integrity demonstrated by the reduction of TJs gene and protein expression. Microbiota analysis revealed greater bacterial diversity in the control groups compared to the treated mice. Additionally, an increase in Clostridium T and Bifidobacterium_388775 was observed in treated mice compared to controls, while Turicibacter was enriched in fibrotic mice compared to their controls.
Conclusions: Our murine model reproduces the early onset and progression of hepato‐metabolic patterns of MASLD and highlights that the loss of intestinal barrier integrity and dysbiosis were associated with the severity of liver damage and inflammation thus underscoring a correlation between disease advancement and microbial dynamics.
Contact e‐mail address: anna.alisi@opbg.net
H‐EP003. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP003.1. LIVER ASSESSMENT IN CHILDREN WITH CYSTIC FIBROSIS BEFORE AND AFTER ELEXACAFTOR/TEZACAFTOR/IVACAFTOR THERAPY
Pilsu Andreea 1, Corina Pienar1,2, Laura Savu1, Popescu Alina3,4, Szasz‐Capotescu Anelise1, Ciuca Ioana‐Mihaiela1,2, Dediu Mihaela1,2, Mirela Mogoi1,2, Pop Laurentiu1,2
1Pediatrics, 2nd Pediatrics Clinic, “Pius Brinzeu” Emergency County Hospital, Timisoara, Romania, 2Department Of Pediatrics, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Timisoara, Romania, 3Gastroenterology, "PIUS BRÎNZEU" COUNTY EMERGENCY CLINICAL HOSPITAL, Timisoara, Romania, 4Gastroenterology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
Objectives and Study: We aimed to evaluate liver function, ultrasound (US) and transient elastography in cystic fibrosis (CF) children after the introduction of elexacaftor/tezacaftor/ivacaftor (ETI) therapy.
Methods: We conducted an observational study that included children followed‐up in the Romanian National CF Center, over 24 months (January 2022‐October 2024).We colected demograhipc data, serum transaminase and trombocytes levels and calculated the APRI score before, and after 3, 6 and 12 months of therapy. In addition, we performed liver US and transient elastography (Fibroscan©, Echosens, Paris) before and after 12 months of therapy.
Results: Our CF cohort consists of 66 children. 45 of them were initiated on ETI. Our final study group included 32 children that completed at least one year of treatment (age range 6 to 18 years, mean age 11.16 ± 4.1 years, 53.1% girls). We found significant lower levels of ALT and AST after ETI treatment (Table 1). The APRI score remained normal over the first year of treatment. A higher percentage of children had a normal liver on US at the end of the first year of ETI therapy (p = 0.79) (Table 1). Transient elastography quantified steatosis (CAP) was lower at 12 months of modulator therapy (p = 0.16), while liver stiffness measurements remained similar before and after treatment (Table 1). Table1 Characteristics of the study group at baseline and over the first year of ETI therapy. SD denotes standard deviation; US, ultrasound; CAP, controlled attenuation parameter; p, statistical significance of non‐parametric tests.
Conclusions: Our results show that ETI improves transaminase levels over the first year of treatment. In addition, our findings suggest that ETI may improve liver echogenity/steatosis during the first year of treatment. The APRI score has limited use in evaluating liver disease in CF children. Further studies are needed to confirm these results.
Contact e‐mail address: andreeapilsu@gmail.com
H‐EP004. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP004.1. EFFECT OF EXTRACORPOREAL LIVER SUPPORT THERAPIES ON CELLULAR BIOENERGETICS OF PERIPHERAL BLOOD MONONUCLEAR CELLS IN PATIENTS WITH HEPATITIS A VIRUS RELATED PEDIATRIC ACUTE LIVER FAILURE
Tamoghna Biswas 1, Bikrant Bihari Lal1, Anupam Kumar2, Deepanshu Maheshwari2, Ashish Maheshwari3, Meenu Bajpayi3, Vikrant Sood4, Rajeev Khanna1, Seema Alam1
1Department Of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India, 2Department Of Molecular And Cellular Medicine, Institute of Liver and Biliary Sciences, Delhi, India, 3Department Of Transfusion Medicine, Institute of Liver and Biliary Sciences, Delhi, India, 4Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, Delhi, India
Objectives and Study: We aimed to evaluate the effect of extracorporeal liver support therapies on cellular bioenergetics of peripheral blood mononuclear cells (PBMC) in patients with pediatric acute liver failure (PALF).
Methods: Eleven patients aged between 5‐18 years with hepatitis A virus (HAV)‐induced PALF undergoing therapeutic plasma exchange (TPE) were included. Oxygen consumption rate (OCR) of the isolated PBMC was measured using Mito Stress Test in Seahorse XFe24 Extracellular Flux Analyzer (Agilent Technologies, California, USA). Patient outcome was defined as survival with native liver or death by day 21. The primary outcome measure was comparison of OCR before and after TPE sessions while the secondary outcome measure was comparison of OCR between the survivors and the non‐survivors.
Results: Among the 11 patients included in the study, 5 (45.5%) survived with their native liver and 6 (54.5%) died awaiting LT. Nine patients (81.8%) received concomitant continuous kidney replacement therapy (CKRT). There was an increase in basal respiration (p = 0.003), ATP‐linked respiration (p = 0.004), and maximal respiration (p = 0.003) after 12 hours of TPE. While TPE led to increase in the basal, ATP‐linked, and maximal respiration in both survivors and non‐survivors, all these parameters were significantly higher in survivors both at baseline as well as post TPE. The spare reserve capacity of PBMCs of the survivors increased significantly post TPE (p = 0.043) while this difference was not apparent in the non‐survivors (p = 0.917).
Conclusions: Extracorporeal liver support therapies can significantly enhance cellular bioenergetics in pediatric patients with HAV‐induced ALF, which may correlate with improved survival outcomes.
Contact e‐mail address:
H‐EP005. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP005.1. PILOTING THE "MAKING MEDICINES WORK FOR YOU” ADHERENCE SCREENER IN CHILDREN WITH LIVER DISEASE
Assya Mol Veluthedathparambu Subair1, Joanne Crook 2, Tasniya Aktar1, Sarah Chapman1
1Faculty Of Life Sciences & Medicine, King's College London, London, United Kingdom, 2Pharmacy Dept., Kings College Hospital NHS Foundation Trust, London, United Kingdom
Objectives and Study: Sub‐optimal medication adherence continues to pose a significant challenge in chronic disease management, with up to 50% of long‐term medications not taken as prescribed.1 Medication adherence is particularly critical for children with liver disease, including those post post‐liver transplantation, in order to reduce the risk of organ transplant rejection and morbidity.2 There are no tailored tools enabling health care professionals (HCPs) to assess the risk of non‐adherence that addresses the unique needs of children and young people (CYP). This study aims to evaluate the acceptability of an adapted "Making Medicines Work for You" (MMWFU) adherence screener, currently used in adult practice for CYP with liver disease and their caregivers.3
Methods: A mixed‐methods, cross‐sectional service evaluation was conducted at a large UK paediatric liver centre over 6 months. Families of children aged 0–16years with liver disease were invited to complete a questionnaire exploring demographic and clinical characteristics, self‐reported adherence levels via Visual Analog Scale (VAS), and to assess screener acceptability using the Theoretical Framework of Acceptability (TFA).4
Results: 61 caregivers completed the evaluation, patients’ ages ranged from 5 months ‐ 16 years, the most frequently reported type of liver disease was Biliary atresia (31.1%), 52.5% of all patients had received a liver transplant. Self‐reported medication adherence was high, with a mean rate of 91.7%. The adherence screener was rated by families as "acceptable" or "completely acceptable" by 78.7% of participants, with an average acceptability score of 4/5. Participants highlighted its value in facilitating adherence discussions, suggested improvements included simplified language and a digital format.
Conclusions: The MMWFU screener was well‐received, demonstrating potential to support adherence in CYP with liver disease. Refinement and further studies are needed to validate its effectiveness and assess impact on long‐term outcomes. This work provides a foundation to develop tailored tools to improve medication adherence in CYP with chronic liver diseases.
Contact e‐mail address: Joanne.Crook2@nhs.net
H‐EP006. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP006.1. LONG‐TERM QUALITY OF LIFE OUTCOMES FOR PATIENTS WITH ALAGILLE SYNDROME TREATED WITH ODEVIXIBAT: POOLED RESULTS FROM PHASE III RANDOMIZED DOUBLE‐BLIND ASSERT AND OPEN‐LABEL ASSERT‐EXT STUDIES
Piotr Czubkowski 1, Madeleine Aumar2, Alastair Baker3, Philip Bufler4, Mara Cananzi5, Ozlem Durmaz6, Ryan Fischer7, Giuseppe Indolfi8, Wikrom Karnsakul9, Way Seah Lee10, Giuseppe Maggiore11, Mathias Ruiz12, Etienne Sokal13, Ekkehard Sturm14, Wendy Van Der Woerd15, Andrew Wehrman16, Fatine Elaraki17, Judy Zhu18, Alejandra Ramirez‐Santiago19, Henkjan Verkade20, Nadia Ovchinsky21
1Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 2Pediatric Gastroenterology, Hepatology, And Nutrition, Univ Lille, CHU Lille, Lille, France, 3Paediatric Liver Centre, King's College Hospital, London, London, United Kingdom, 4Department Of Pediatric Gastroenterology, Nephrology, And Metabolic Diseases, Charité Universitätsmedizin Berlin, Berlin, Germany, 5Unit Of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology And Care Of The Child With Liver Transplantation, Department Of Women's And Children's Health, University Hospital of Padova, Padova, Italy, 6Department Of Child Health And Diseases, Gastroenterology, Hepatology And Nutrition, Istanbul Faculty Of Medicine, Istanbul University, Istanbul, Turkey, 7Division Of Pediatric Gastroenterology, Hepatology, And Nutrition, Children's Mercy Hospital, Kansas City, United States of America, 8Meyer Children's Hospital, IRCCS, Florence, Italy, 9Division Of Pediatric Gastroenterology, Hepatology, And Nutrition, Department Of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America, 10Department Of Paediatrics, Faculty Of Medicine, University of Malaya, Kuala Lumpur, Malaysia, 11Hepatology And Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy, 12Hépatologie Gastro‐entérologie Et Nutrition Pédiatriques, Hospices Civils de Lyon, Hôpital Femme‐Mère‐Enfant, Bron, France, 13Service De Gastroentérologie Et Hépatologie Pédiatrique, Université Catholique de Louvain, Cliniques St Luc, Brussels, Belgium, 14Paediatric Gastroenterology And Hepatology, University Children's Hospital Tübingen, Tübingen, Germany, 15Department Of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands, 16Division Of Gastroenterology, Hepatology, And Nutrition, Boston Children's Hospital, Boston, United States of America, 17Ipsen Pharma, Boulogne‐Billancourt, France, 18Ipsen, Cambridge, United States of America, 19Ipsen (at time of study), Cambridge, United States of America, 20Pediatric Gastroenterology‐hepatology, Department of Paediatrics, University Medical Center Groningen, Beatrix Children's Hospital/University Medical Center Groningen, Groningen, Netherlands, 21Pediatric Gastroenterology And Hepatology, Hassenfeld Children's Hospital, NYU Langone, New York, United States of America
Objectives and Study: Patients with Alagille syndrome (ALGS) often have debilitating pruritus with associated sleep disturbances and reduced QoL.1
Robust long‐term data demonstrate sustained efficacy – including clinically significant improvements in pruritus – and tolerability for patients with ALGS remaining on odevixibat (ODX) for cholestatic pruritus after 72 weeks’ follow‐up in ASSERT‐EXT (NCT05035030). Here, we evaluate long‐term (≤96 weeks) pooled QoL data from ASSERT (NCT04674761) and ASSERT‐EXT.
Methods: Patients in ASSERT received 24 weeks of placebo or 120 µg/kg/day ODX and were eligible for ASSERT‐EXT (120 µg/kg/day ODX for 72 weeks). Endpoints included: sleep parameters (Observer‐Reported Outcome [ObsRO]) and caregiver‐assessed QoL (Pediatric Quality of Life Inventory [PedsQL]).
Results: 52 patients (median age: 5.7 years [1–15.5]) received ODX during ASSERT and ASSERT‐EXT. Patients had significant improvements in 6/7 ObsRO sleep parameters from baseline (BL) up to weeks 93 − 96 and a numerical reduction in days taking medication to induce sleep (Figure 1 A). PedsQL scores reported by caregivers also showed numerical improvements from BL up to week 96 with ODX (Figure 1B).
Conclusions: Long‐term ODX improved multiple sleep parameters and caregiver‐reported QoL in patients with ALGS up to 96 weeks; data support long‐term improvements in pruritus seen with ODX. The correlation between QoL outcomes and efficacy will be explored. 1. Ovchinsky N, et al. AASLD 2024. Abstract 50 (Oral)
Contact e‐mail address: p.czubkowski@ipczd.pl
H‐EP007. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP007.1. UNDERSTANDING TREATMENT EFFICACIES OF PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS VIA A PROSPECTIVE WORLD‐WIDE REGISTRY, TREATFIC
Alida De Groot 1, Mark Nomden1, Pedro Miranda Afonso2, Emmanuel Gonzales3,4, Verena Keitel‐Anselmino5, Ekkehard Sturm6, Richard Thompson7, Henrik Arnell8, Bjorn Fischler9, Mara Cananzi10, Antal Dezsofi‐Gottl11, Lorenzo D'antonio12, Angelo Di Giorgio12, Tassos Grammatikopoulos7, Giuseppe Indolfi13, Irena Jankowska14, Nathalie Rock15, Eyal Shteyer16, Georg Vogel17,18, Jian‐She Wang19, Bettina Hansen2,20,21, Paola Mian22, Henkjan Verkade1
1Pediatric Gastroenterology‐hepatology, University Of Groningen, University Medical Center Groningen, Groningen, Netherlands, 2Department Of Epidemiology And Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands, 3Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 4Inserm Umr‐s 1193, Paris‐Saclay University, Orsay, France, 5Otto‐von‐Guericke University Hospital Magdeburg, Magdeburg, Germany, 6Paediatric Gastroenterology And Hepatology, University Children's Hospital Tübingen, Tübingen, Germany, 7Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom, 8Pediatric Gastroenterology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, And Department Of Women's And Children's Health, Karolinska Institutet, Stockholm, Sweden, 9Pediatric Gastroenterology, Astrid Lindgren Children's Hospital, Karolinska University Hospital And Division Of Pediatrics, Clintec, Karolinska Institutet, Stockholm, Sweden, 10Unit Of Gastroenterology, Digestive Endoscopy, Hepatology And Care Of The Child With Liver Transplantation, University Hospital of Padova, Padova, Italy, 11Pediatric Center, Semmelweis University, Budapest, Hungary, 12Pediatric Hepatology, Gastroenterology And Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 13Meyer Children's Hospital, IRCCS, Florence, Italy, 14Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, Children's Memorial Health Institute, Warsaw, Poland, 15Division Of Pediatric Gastroenterology, University Hospital of Geneva, Geneva, Switzerland, 16The Juliet Keiden Institute Of Pediatric Gastroenterology And Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel, 17Department Of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria, 18Institute Of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria, 19Department Of Gastroenterology, Children's hospital of Fudan university, Shanghai, China, 20Toronto Center For Liver Disease, University Health Network, Toronto, Canada, 21Ihpme, University of Toronto, Toronto, Canada, 22Clinical Pharmacy And Pharmacology, University Of Groningen, University Medical Center Groningen, Groningen, Netherlands
Objectives and Study: Progressive familial intrahepatic cholestasis (PFIC) is a group of rare pediatric cholestatic liver diseases. Our retrospective “NAtural Course and Prognosis of PFIC and Effect of Biliary Diversion” registry allowed us to identify genotype‐phenotype relationships for FIC1‐ and BSEP‐deficiency. Recently, more PFIC subtypes have been characterized and ileal bile acid transporter inhibitors (IBATi) are increasingly used for treatment. Therefore, we initiated a prospective analysis of the treatment of PFIC, TreatFIC, in 2023. The objective of TreatFIC is to determine the natural history of all PFIC subtypes and collect real‐world data on the efficacy and safety of current treatments, including IBATi. Here, we provide the first update on TreatFIC.
Methods: This multicenter prospective registry includes genetic and clinical data from individuals with genetically confirmed PFIC subtypes. For each individual demographic and clinical characteristics were collected retrospectively and, after entering TreatFIC, prospectively every 6 months using REDcap.
Results: Since January 2023, legal procedures with 43 centers worldwide have started, of which 25 centers have full IRB approval and data transfer agreements as of November 2024. The average patient inclusion rate has increased from 2 to ~10 per quarter since May 2024. We included 84 individuals from 13 centers across Europe and Asia (Figure). Twenty‐nine individuals are using odevixibat, 4 individuals used odevixibat in the past, 9 individuals are using maralixibat and 42 individuals are not treated with an IBATi. The first analyses will be presented.
Conclusions: TreatFIC is rapidly expanding and provides prospective data on the treatments of individuals with PFIC and its efficacy. The number of included individuals has grown rapidly since its initiation in 2023. TreatFIC will allow to assess real‐world data on the current treatments for PFIC diseases. To further increase the impact of the registry, centers that treat children or adults with PFIC are invited to participate (pfic@bkk.umcg.nl).
Contact e‐mail address: pfic@bkk.umcg.nl
H‐EP008. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP008.1. THE ASSOCIATION BETWEEN GESTATIONAL AND CHILDHOOD FACTORS AND ALANINE AMINOTRANSFERASE LEVELS AS INDICATORS OF RISK FOR MASLD IN EARLY LIFE: A PROSPECTIVE, POPULATION‐BASED STUDY
Hanna De Ruyter 1, Linnea Aitokari1, Annum Iqbal2, Aino‐Maija Eloranta3, Anna Viitasalo3, Sonja Soininen3, Eero Haapala2, Heini Huhtala1, Jarmo Jääskeläinen2, Seppo Heinonen4, Timo Lakka2, Kalle Kurppa1
1Tampere University, Tampere Center for Child, Adolescent and Maternal Health Research, Tampere, Finland, 2University of Eastern Finland, Kuopio, Finland, 3Institute Of Biotechnology, University of Eastern Finland, Kuopio, Finland, 4University of Helsinki, University of Helsinki, Finland
Objectives and Study: Metabolic‐associated steatotic liver disease (MASLD) may begin already in childhood, but the factors associated with its development remain unclear. We investigated the associations between prenatal and childhood factors and the children's higher ALT levels as an early indicator of MASLD in a general population of children followed into adolescence.
Methods: Altogether 496 children aged 7‐8 years who underwent blood sampling for metabolic and nutritional biomarkers and assessments of diet, other lifestyle factors, and body composition were included. Follow‐up visits were conducted at ages 9‐11 (n = 431) and 15‐17 (n = 265). Prenatal data were obtained from registries and questionnaires. Linear regression models were used for the analyses, with P‐values < 0.05 considered significant.
Results: In total, 45.7‐48.7% of the participants were girls, and 17.7‐19.3% were overweight or obese. The prevalence of insulin resistance was 3.4‐5.5% and dyslipidemia 3.8‐12.8%. BMI‐SDS (standardized coefficient β = 0.188‐0.316), waist‐to‐height ratio (β = 0.204‐0.385) and visceral adiposity (β = 0.179‐0.405) were significantly associated with serum ALT levels in all ages, while insulin resistance (β = 0.281), triglycerides (β = 0.257), LDL cholesterol (β = 0.188), and HDL cholesterol (β = ‐0.264) were associated at 15‐17 years. Energy intake‐adjusted animal (β = 0.129) and dairy product (β = 0.121) consumption were associated with ALT at 9‐11 years, and protein intake (β = 0.298) and fish consumption (β = 0.161) at 15‐17 years. Serum phenylalanine (β = 0.169‐0.247) and branched‐chain amino acid levels (β = 0.134), specifically leucine (β = 0.139‐0.154), were associated with ALT at 7‐8 and 9‐11 years, and omega 3 (β = 0.188), omega 6 (β = –0.102 to 0.198), and saturated (β = 0.214), polyunsaturated (β = 0.206) and monounsaturated (β = 0.213) fatty acids at 15‐17 years. Prenatal factors, sleep, physical activity, carbohydrate intake, and vegetable or fruit consumption were not associated with ALT levels.
Conclusions: Visceral and central adiposity, dietary factors, and specific amino and fatty acids were associated with serum ALT levels, even in a general pediatric population. Supporting the link to MASLD, markers of metabolic syndrome were associated with ALT levels in adolescents.
Contact e‐mail address: kalle.kurppa@tuni.fi
H‐EP009. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP009.1. MALNUTRITION IN CHILDREN WITH LIVER DISEASE: NATIONWIDE SURVEY ON CURRENT CLINICAL PRACTICE ON BEHALF OF THE ITALIAN SOCIETY OF PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION (SIGENP)
Fabiola Di Dato 1, Teresa Capriati2, Rossella Colantuono3, Valeria Delle Cave1, Martina Mainetti4, Mara Cananzi5, Giuseppe Indolfi6, Angelo Campanozzi7, Irene Degrassi8, Paolo Gandullia9, Maria Immacolata Spagnuolo1, Federica Ferrari10, Pier Luigi Calvo11, Annalisa Madeo9, Michela Bravi12, Michele Pinon11, Maria Sole Basso2, Annamaria Sapuppo13, Silvia Iuliano14, Raffaele Iorio1, Lorenzo Norsa12, Claudia Mandato3
1Department of Translational Medical Sciences, Section of Pediatrics, University Federico II, Naples, Naples, Italy, 2Hepatology, Gastroenterology And Nutrition Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy, 3Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, Baronissi (SA), Italy, 4Department Of Pediatrics, Santa Maria delle Croci Hospital, Ravenna, Italy, 5Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Department of Women's and Children's Health, Padova, Italy, 6Meyer Children's Hospital, IRCCS, Florence, Italy, 7Department Of Medical And Surgical Sciences, Pediatric Unit, University of Foggia, Foggia, Italy, 8Pediatric Department, Buzzi Children's Hospital, Milan, Italy, 9Pediatric Gastroenterology And Digestive Endoscopy Unit, G.Gaslini Institute for Maternal and Child Health, IRCCS, Genova, Italy, 10Pediatric Unit, Sant'Eugenio Hospital, Rome, Italy, 11Pediatic Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera‐Città della Salute e della Scienza di Torino, Turin, Italy, 12Paediatric Hepatology, Gastroenterology And Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy, 13Unit Of Pediatrics And Pediatric Emergency Department, University Hospital Policlinico "G.Rodolico‐San Marco", Catania, Italy, 14Gastroenterology And Digestive Endoscopy Unit, University Hospital of Parma, Parma, Italy
Objectives and Study: Malnutrition is a frequent and extremely relevant problem in patients with liver disease, potentially impacting morbidity and mortality related to liver transplantation. Therefore, the diagnosis of malnutrition in these patients and an adequate therapeutic management are of fundamental importance. The aim of this study was to evaluate the diagnostic and therapeutic strategies used in Italy for malnutrition in pediatric patients with liver disorders.
Methods: The study was a multicenter cross‐sectional web survey conducted between September 2023 and December 2023 among members of the Liver and Nutrition areas of the Italian Society of Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP).
Results: 19 Italian second‐ and third‐level centers were represented. The contribution of the pediatric nutritionist was requested more frequently in cases of acute liver failure (7, 36.8%) and neonatal cholestasis (6, 31.6%). Surprisingly, 17 (89.5%) and 15 (78.9%) centers did not use screening tools for malnutrition in chronic liver disease or acute liver failure, respectively. Nutritional assessments were primarily based on auxological parameters in 16 (84.2%) centers and secondarily on upper arm circumference in 12 (63.1%). Biochemical monitoring with glycemia, albumin, lipid profile, IGF1, creatinine and fat‐soluble vitamins was performed in 18 (94.7%) centers. The frequency of nutritional assessment was not standardized but defined case by case in 12 (63.1%) centers. The most common nutritional interventions were medium‐chain triglyceride (MCT) supplementation (13, 68.4%), fat‐soluble vitamin supplementation (10, 52.6%) and increased caloric concentration (8, 42.1%). In 10 (52.6%) centers, fat‐soluble vitamin supplementation was prescribed based on serum levels, and in 12 (63.1%) cases the route of administration was decided based on the deficit recorded.
Conclusions: Diagnostic and intervention practices for malnutrition in pediatric hepatology vary across Italian centers. There is a potential need for standardization in malnutrition screening tools and therapeutic interventions to improve nutritional care in this patient population.
Contact e‐mail address: fabiola.didato@unina.it
H‐EP010. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP010.1. PREDICTING RESPONSE TO ODEVIXIBAT TREATMENT IN CHILDREN WITH DIFFERENT TYPES OF PFIC
Angelo Di Giorgio 1, Marco Sciveres2, Maurizio Fuoti3, Pier Calvo4, Mara Cananzi5, Ana Lleo6, Simona Gatti7, Giuseppe Indolfi8, Annalisa Madeo9, Claudia Mandato10, Federica Nuti11, Chiara Zanchi12, Carioli Greta13, Arianna Ghirardi13, Emanuele Nicastro14, Lorenzo D'antonio15
1Hospital Santa Maria Della Misericordia, Udine, Italy;, Pediatric Hepatology, Gastroenterology and Transplantation, Bergamo, Italy, 2Hepatology and Liver Transplant Unit, Bambino Gesù Children's Hospital, Rome, Italy, 3University Department Of Pediatrics, Children's Hospital, Spedali Civili, Pediatric Gastroenterology and Endoscopy Unit, Brescia, Italy, 4Azienda Ospedaliera‐universitaria Città Della Salute E Della Scienza, Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Torino, Italy, 5Dpt. For Women's And Children's Health, University Hospital Of Padova, Unit of Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Padova, Italy, 6Internal Medicine And Hepatology Unit, Department Of Gastroenterology, Irccs Humanitas Research Hospital, Rozzano, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy, Milano, Italy, 7Università Politecnica Delle Marche, Department of Pediatrics, Ancona, Italy, 8Meyer Children's Hospital, Firenze, Italy, 9Pediatric Gastroenterology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy, 10Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Pediatrics Section, University of Salerno, Baronissi, Salerno, Italy, 11Department of Paediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy, 12IRCCS Burlo Garofolo, Triieste, Italy, 13FROM Research Foundation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 14Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 15Department Of Medicine And Surgery, University Of Milano – Bicocca, Milan, Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy;, Bergamo, Italy
Objectives and Study: In our previous study we reported efficacy of odevixibat treatment (OT) in a real‐world cohort of children with progressive familial intrahepatic cholestasis (PFIC). Here we aim to identify the best cut‐off of sBA reduction predicting the response to OT at 6 months.
Methods: We reviewed data on children with PFIC treated with odevixibat for 6 months. ROC analysis was performed to calculate the best cut‐off of sBA reduction associated with improvements in pruritus scale of ‐1 point at 6 months (defined as pruritus responders).
Results: 24 patients [median age 6.6 years (3.7‐12.1), M/F = 11/13] were enrolled; 16 (67%) had classic PFIC types (PFIC‐1 = 2; PFIC‐2 = 11; PFIC‐3 = 3), 8 (33%) had rarer forms (PFIC‐4 = 5, PFIC‐5 = 1; PFIC‐6 = 1; PFIC‐9 = 1). At 6 months, 75% reduced sBA levels ≥ 70% from baseline value, 73% were pruritus responders. Reductions of sBA levels ≥48% from baseline value at 1 st month and ≥52% at 3 rd month were associated with improvements of pruritus scale (‐1point) at 6 months (pruritus responders) (1st month: ROC‐AUC 0.771; SE = 0.75, SP = 0.83; 3rd month: ROC‐AUC 0.885; SE = 0.81, SP = 1.00). Eighty‐five percent of patients who reduced sBA ≥ 48% at 1st month were pruritus responders at 6 months compared to 36% of patients who did not reach the cut‐off value (p = 0.033). At the 3rd month, 100% of patients who reduced sBA ≥ 52% were pruritus responders at 6 months (p = 0.033). Furthermore, patients who reduced sBA levels ≥46% from baseline value at 1rd month and ≥35% at 3rd month became sBA responders at 6 months.
Conclusions: In our cohort, reduction of sBA levels of around 50% from baseline value at 1 and 3 months is associated with a full response to OT at 6 months. This information can be useful to plan prosecution or prompt discontinuation of treatment after 6 months of odevixibat.
Contact e‐mail address: angelo.digiorgio@uniud.it
H‐EP011. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP011.1. TITLE: UNIQUE SERUM INFLAMMATORY PROTEIN SIGNATURE CORRELATES TO BLOOD CD8 PERFORIN EXPRESSION IN PAEDIATRIC ACTIVATED T‐CELL ACUTE LIVER FAILURE
Tamir Diamond 1, Catherine Chapin2, Sarah Mccuaig1, Caroline Diorio1, Sarah Henrickson1, Niansheng Chu1, Anna Banc‐Husu3, Jaime Chu4, M Jensen5, Daniel Leung3, Amrita Narang6, Katelyn Saarela7, Beth Carter8, Scott Elisofon9, Rima Fawaz10, Ryan Fischer11, Steven Lobritto12, Anna Peters13, Norberto Rodriguez‐Baez14, Rene Romero15, Philip Rosenthal16, David Rudnick17, James Squires18, Shikha Sundaram19, Kyla Tolliver20, Pamela Valentino7, Zemin Su21, Simon Horslen18, Kathleen Loomes1, Estella Alonso2, Edward Behrens1
1Pediatrics, University of Pennsylvania, Philadelphia, United States of America, 2Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States of America, 3Texas Children's Hospital, Houston, United States of America, 4Icahn School of Medicine at Mount Sinai, New York, United States of America, 5University of Utah, Salt Lake City, United States of America, 6Lucile Packard Children's Hospital, Palo Alto, United States of America, 7University of Washington, Seattle, United States of America, 8Keck USC School of Medicine, Los Angeles, United States of America, 9Boston Children's Hospital, Boston, United States of America, 10Yale University, New Haven, United States of America, 11Children's Mercy Hospital, Kansas City, United States of America, 12Columbia University Medical Center, New York, United States of America, 13Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America, 14UT Southwestern Medical Center, Dallas, United States of America, 15Emory University School of Medicine, Atlanta, United States of America, 16University of California, San Francisco, San Francisco, United States of America, 17Washington University Medical Center, St. Louis, United States of America, 18Children's Hospital of Pittsburgh, Pittsburgh, United States of America, 19Children's Hospital of Colorado, Aurora, United States of America, 20Indiana University School of Medicine, Indianapolis, United States of America, 21Medical University of South Carolina, Charleston, United States of America
Objectives and Study: Paediatric Activated T‐cell Acute Liver Failure (TC‐PALF) is the most common cause of PALF, in which livers are infiltrated by effector CD8 T cells (CTL) with high interferon gamma (IFNg) pathway protein signature. We found two phenotypically different groups in TC‐PALF that can be distinguished by the CTL expression of perforin in peripheral blood. Patients with high perforin expression (TC‐PALF High Prf) have an accentuated CTL response compared to those with normal levels (TC‐PALF Nl Prf). We hypothesize that TC‐PALF patients have a unique serum inflammatory protein signature compared to other causes of PALF(Oth‐PALF), and protein signatures will further differ between PALF High vs Nl Prf groups.
Methods: To test this hypothesis, we used a high‐parameter inflammatory protein screen, Olink 384 Inflammatory panel, in serum samples from PALF patients. Serum samples were utilized from the NIH funded TRIUMPH study (NCT04862221) prior to immunomodulation, PALF‐SG biorepository (UO1‐DK072146) as Oth‐PALF disease controls and healthy children (HC). 4 groups were compared: Oth‐PALF, TC‐PALF, indeterminate PALF (iPALF), and HC. TC‐PALF group was sub‐analysed according to CTL Perforin expression in blood flow cytometry (TC‐PALF High Prf vs. TC‐PALF Nl Prf)
Results: Analysis was performed in 55 Oth‐PALF, 13 TC‐PALF, 10 iPALF and 10 HC patients. Non‐biased nearest neighbour clustering did not find unique clusters that correlated with clinical phenotype, suggesting serum inflammatory mediators do not distinguishing aetiology of PALF. Sub‐analysis in patients with TC‐PALF showed enrichment in proteins associated with T‐cell activation and migration in TC‐PALF High Prf group compared to TC‐PALF Nl Prf (Figure).
Conclusions: Patients suffering from TC‐PALF High Prf, have a unique serum inflammatory signature when compared to those with TC‐PALF Nl Prf including proteins associated with lymphocyte activation and migration. This suggests serum biomarkers may be useful in categorizing TC‐PALF endotypes and can be used in conjunction with flow cytometry to classify these sub‐groups.
Contact e‐mail address: diamondt@chop.edu
H‐EP012. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP012.1. MOLECULAR PROFILE OF HEPATIC NODULES IN THE SETTING OF CONGENITAL PORTO‐SYSTEMIC SHUNTS
Paola Francalanci 1, Isabella Giovannoni1, Marta Maistri2, Marco Spada2, Silvia Scuderi1, Francesca Arienzo1, Andrea Pietrobattista3, Lidia Monti4, Gian Luigi Natali5, Rita Alaggio6
1Pathology, Children's Hospital Bambino Gesù, ROMA, Italy, 2Division Of Hepatobiliopancreatic Surgery, Liver And Kidney Transplantion, IRCCS Bambino Gesù Children's Hospital, Rome, Italy, 3Hepatology and Liver Transplant Unit, Bambino Gesù Children's Hospital, Rome, Italy, 4Gastrointestinal And Transplanted Liver Imaging Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy, 5Interventional Radiology Unit, Children's Hospital Bambino Gesù, ROMA, Italy, 6Pathology, Sapienza University, ROME, Italy
Objectives and Study: Congenital portosystemic shunts (CPSS), rare vascular malformations consisting of anomalous communications between the portal veins and the hepatic veins or the inferior vena cava system, are divided into extrahepatic shunts (EHS) and intrahepatic shunts (IHS). IHS have a higher chance of spontaneous closure, however in the natural history of both HIS and EHS there is the possibility of developing liver nodules. The aim of our study is to analyze the molecular profile of any type of nodule in CPSS.
Methods: Data were collected from children who were diagnosed with either EHS or IHS on sonographic screening and then underwent a liver biopsy. The subjects'medical information was collected including demographics, medical background, sonographic and clinical outcome. Blood test results including liver function tests and α‐fetoprotein were documented. Histology and immunohistochemistry (IHC) for β‐catenin and glutamine synthetase (GS) were reviewed. Targeted next generation sequencing (NGS), performed on the DNA of nodular lesions was applied.
Results: Four patients with multiple nodules were identified on imaging and the liver biopsy of the largest nodule in each one showed: 1 hepatocellular carcinoma (HCC) and 2 focal nodular hyperplasia (FNH) in EHS and 1 hepatocellular adenoma (HA) in IHS. On IHC, β‐catenin showed nuclear staining in all but 1 FNH and GS showed a diffuse heterogeneous staining in FNH and diffuse homogeneous in HA and HCC. Molecular analysis showed hotspot mutation on the CTNNB1 in 1 FNH as well as in HA and HCC.
Conclusions: Hepatocellular nodules are a known complication in CPSS. Lesions with diffuse GS pattern and nuclear β‐catenin labeling should be completed with NGS for CTNNB1. An adequate diagnostic workup is essential since lesions with β‐catenin activation present a potentially higher risk of malignant progression and require more careful follow‐up and a lower threshold for surgical indication, while asymptomatic benign lesions do not necessitate further treatment.
Contact e‐mail address: paola.francalanci@opbg.net
H‐EP013. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP013.1. LONG TERM EFFECTS OF CHOLIC ACID THERAPY IN CHILDREN WITH DEFECTS OF PRIMARY BILE ACID SYNTHESIS
Antoine Gardin 1, Mara Cananzi2, Bertrand Roquelaure3, Sophie Hillaire4, Valérie Mclin5, Anil Dhawan6, Andrea Pietrobattista7, Marco Sciveres7, Enke Grabhorn8, Jan Beime8, Cristina Padrós9, Grazia Bossi10, Dorothea Haas11, Thorsten Marquardt12, Ulrich Baumann13, Pier Luigi Calvo14, Stefano Martelossi15, Federica Mario15, Dalila Habes1, Emmanuel Gonzales1, Emmanuel Jacquemin1
1Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 2Unit of Pediatric Gastroenterology, Digestive Endoscopy and Hepatology, University Hospital of Padova, Padua, Italy, 3Unit of Pediatric Gastroenterology and Hepatology, Timone Hospital, Marseille, France, 4Internal Medicine Unit, Foch Hospital, Suresnes, France, 5Swiss Pediatric Liver Center, Department of Pediatrics, University of Geneva, Geneva, Switzerland, 6Pediatric Hepatology, King's College, London, United Kingdom, 7Hepatology and Liver Transplant Unit, Bambino Gesù Children's Hospital, Rome, Italy, 8Pediatric Hepatology and Gastroenterology Unit, University Eppendorf, Hamburg, Germany, 9Pediatric Hepatology And Liver Transplantation, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 10Department of Pediatrics, Policlinico San Matteo, Pavia, Italy, 11Heidelberg University, Child Medicine Center, Child Neurology and Metabolic Medicine, Heidelberg, Germany, 12Department of Pediatrics, University Hospital, Munster, Germany, 13Pediatric Hepatology and Gastroenterology Unit, MHH Hannover/University Magdeburg, Hannover, Germany, 14Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Turin, Italy, 15Pediatric Unit, Ca' Foncello Hospital, Treviso, Italy
Objectives and Study: To evaluate long‐term safety and efficacy of cholic acid (CA) therapy in 37 children with a 3β‐hydroxy‐C27‐steroid‐dehydrogenase/isomerase (3β‐HSD) deficiency and 9 with a Δ4‐3‐oxosteroid‐5β‐reductase (Δ4‐3‐oxoR) deficiency, included in a surveillance database (Orphabase).
Methods: The 46 patients (24 boys) were followed in 15 european centres. 3β‐HSD and Δ4‐3‐oxoR deficiencies were confirmed by mass spectrometry analysis of urinary bile acids and genotyping. All patients received oral CA (5‐15 mg/kg/day), with a dose adaptation according to biochemical/mass spectrometry profiles.
Results: Patients received CA for a median period of 9 years (Q1‐Q3: 6‐26, 660 patient‐year). Fifteen patients were treated > 20 years. One child experienced liver function worsening due to sepsis after few months of treatment and required liver transplantation. All the other patients were alive with their native live at last follow‐up. Before CA onset, median serum alanine aminotransferase (ALT), gamma‐glutamyl‐transferase (GGT) and total bilirubin levels were 85 U/L (Q1‐Q3: 47‐218), 27 U/L (Q1‐Q3: 16‐42), 25 µmol/L (Q1‐Q3: 12‐61) respectively. At last follow‐up with CA, median serum ALT and bilirubin levels were 24 U/L (Q1‐Q3: 21‐30) and 7.7 µmol/L (Q1‐Q3: 5.5‐10) repectively. Hepatomegaly/splenomegaly had disappeared or diminished. Total serum bile acid concentrations measured in 18 patients were normal. A dramatic decrease in abnormal urinary bile acid intermediates was observed (20 patients tested). Liver fibrosis assessed during follow‐up on liver biopsies in 14 children decreased in 13 and stabilized in one. Liver elastography performed in 16 patients was normal in 10 and slightly elevated in 6. All patients had a normal quality of life and 7 women have had 15 uneventful pregnancies. No serious adverse event was identified.
Conclusions: CA is safe and efficient to treat children with 3β‐HSD or Δ4‐3‐oxoR deficiency and enables them to reach adulthood with their native liver in almost all cases, with a normal quality of life.
Contact e‐mail address: antoine.gardin@aphp.fr
H‐EP014. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP014.1. CLINICAL BENEFITS OF MARALIXIBAT FOR PATIENTS WITH ALAGILLE SYNDROME ARE DURABLE THROUGH 7 YEARS OF TREATMENT: DATA FROM THE MERGE STUDY
Emmanuel Gonzales 1, Binita Kamath2, Deirdre Kelly3, Karen Murray4, Daniel Leung5, Douglas Mogul6, Will Garner6, Pamela Vig6, Emmanuel Jacquemin1
1Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 2Children's Hospital of Philidelphia, Philidelphia, Pennsylvania, United States of America, 3Odn, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom, 4Cleveland Clinic Children's Hospital and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, United States of America, 5Texas Children's Hospital, Houston, Texas, United States of America, 6Mirum Pharmaceuticals, Inc., Foster City, California, United States of America
Objectives and Study: Maralixibat, an IBAT inhibitor, is approved for the treatment of cholestatic pruritus in patients with Alagille syndrome (ALGS) ≥ 2 months of age in Europe. Improvements in pruritus, serum bile acids (sBA), and height have been demonstrated from prior maralixibat ALGS clinical trials. Participants could then enroll in MERGE for additional long‐term follow‐up (LTFU). We report on efficacy from MERGE up to 7 years.
Methods: All participants from maralixibat ALGS clinical trials were included in the analysis. Impact of maralixibat was assessed for pruritus [ItchRO(Obs)], sBA, growth, ALT, AST, total bilirubin (TB) and direct bilirubin (DB). Change from Baseline (CFB) was determined by comparing median (Q1, Q3) values from enrolment in the initial trial to data from the visit in MERGE that best aligned with an annual visit.
Results: Data were analyzed for 86 participants, with follow‐up to 1 year for 76, 4 years for 42, and 7 years for 23. Baseline mean (SD) ItchRO(Obs) was 2.65 (0.75) and clinically meaningful reductions with CFB of ‐1.57 (‐0.83, ‐2.14), ‐2.00 (‐1.43, ‐2.56), and ‐2.14 (‐1.43, ‐3.00) at 1, 4 and 7 years, respectively. Baseline sBA was 254 (207) µmol/L and decreased with CFB of ‐57 (8, ‐150) µmol/L, ‐62 (‐32, ‐152) µmol/L, and ‐105 (‐41, ‐266) µmol/L at 1, 4 and 7 years. Height improvements were observed, with Baseline z‐score of ‐1.7 (1.27) and CFB of 0.1 (‐0.1, 0.3), 0.3 (0.0, 1.0), and 0.7 (0.0, 1.2) at 1, 4 and 7 years while weight z‐scores were largely unchanged. Reductions in TB and DB were observed after maralixibat treatment and no clinically meaningful changes in ALT or AST were observed. There were no new safety signals.
Conclusions: The benefit of maralixibat in ALGS patients, including both improvements in clinical outcomes and sBA, persist through 7 years of treatment with no new safety signals.
Contact e‐mail address:
H‐EP015. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP015.1. EFFECTS OF MARALIXIBAT IN CHILDREN WITH ALAGILLE SYNDROME: A FRENCH REAL‐LIFE DATA ANALYSIS
Alice Thebaut1,2, Mathias Ruiz3, Nolwenn Laborde4, Muriel Girard5, Barbara Rohmer3, Oanez Ackermann1, Bertrand Roquelaure6, Dominique Caldari7, Frédéric Gottrand8,9, Marjorie Bonneton10, Patrick Borentain11, Mathilde Butori12, Marlène Chotard13, Eduardo Couchonnal3, Claire Dupont‐Lucas14, Alexandre Fabre6,15, Lydia Flaux16, Antoine Gardin1,2, Bogdan Hermeziu1, Noemie Laverdure3, Virginie Robert17, Béatrice Salman18, Emmanuel Jacquemin1,2, Emmanuel Gonzales 1,2
1Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 2Inserm Umr‐s 1193, Paris‐Saclay University, Orsay, France, 3Pediatric Gastroenterology Hepatology And Nutrition Unit, Bron Hospital, Hospices civils de Lyon, Bron, France, 4Pediatric Hepatology Unit, University Hospital of Toulouse, Toulouse, France, 5Pediatric Hepatology Unit, Hôpital Necker‐Enfants Malades, PARIS, France, 6Pediatric Gastroenterology, Hepatology And Nutrition Unit, Marseille University Hospital, Marseille, France, 7Department Of Pediatrics, CHU de Nantes, Nantes, France, 8Department Of Pediatric Gastroenterology Hepatology And Nutrition, Lille University Hospital, Lille, France, 9Clinical Investigation Center, Univ. Lille, Inserm, CHU Lille, U1286 ‐ INFINITE ‐ Institute for Translational Research in Inflammation, Lille, France, 10Pediatric Gastroenterology, Hepatology And Nutrition Unit, Nancy Hospital, Nancy, France, 11Hepatology Unit, Marseille University Hospital ‐APHM, Marseille, France, 12Department Of Pediatrics, Nice University Hospital‐ Hôpital LENVAL, Nice, France, 13Department Of Pediatrics, Besançon University Hospital, Besançon, France, 14Department of Paediatrics, Caen University Hospital, Caen, France, 15INSERM, MMG, Aix Marseille University, Marseille, France, 16Department Of Pediatrics, Angers University Hospital, Angers, France, 17Department Of Pediatrics, Pau Hospital, Pau, France, 18Department Of Pediatrics, Reims University Hospital, Reims, France
Objectives and Study: Alagille syndrome (ALGS) is often responsible for severe cholestasis, intractable pruritus, and elevated serum bile acids concentration (sBA). Maralixibat had been available in France in the setting of an Expanded Access Program (EAP) for treatment of pruritus in ALGS patients from January 2021 to May 2024. We report on clinical and biological data of ALGS patients started with maralixibat before February 2024 in the setting of this EAP.
Methods: Patients were treated with maralixibat at the target daily dose of 380 µg/kg.d. Clinical and biological data including sBA were prospectively collected at baseline and during the follow‐up (M1, M3, M6, then every 6 months). Pruritus was assessed by the child or his parents using a 0 to 10 Visual Analog Itching Scale (VAIS) and by the physician using a 0‐4 Clinical Skin Scratch Scale (CSS). Clinical response was defined as a ≥ 1 point decrease in CSS or a ≥ 3 points decrease in VAIS. Biological response was defined as a ≥ 30% decrease in sBA.
Results: 54 patients with a median (range) age of 3.6 years (0.7‐21) were included. At baseline, sBA, CSS and VAIS scores were 202 µmol/L (12‐626), 3 (0‐4), 5.5 (0‐10), respectively. The median duration of exposure to treatment was 12 months (0.1‐40). Treatment was interrupted before efficacy could be assessed in 8 patients. Among the 46 other patients, 26 were both clinical and biological responders, while 12 and 3 were only clinical or biological responders, respectively. Evolution of CSS scores and of sBA are provided in Figure 1. Diarrhea (n = 19) and abdominal pain (n = 20) were reported in 28 out of the 54 patients (52%) and led to definitive treatment discontinuation in 9 patients.
Conclusions: This real‐life study confirms the efficacy of maralixibat to decrease pruritus and sBA in ALGS patients with acceptable tolerability.
Contact e‐mail address: emmanuel.gonzales@aphp.fr
H‐EP016. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP016.1. FOLLOW UP QUESTIONNAIRE‐BASED STUDY BY THE ESPGHAN PORTAL HYPERTENSION SPECIAL INTEREST GROUP ON THE MANAGEMENT OF PORTAL HYPERTENSION
Tassos Grammatikopoulos 1,2, Maria Mercadal‐Hally3, Angelo Di Giorgio4,5, Hubert Van Der Doef6, Ruth De Bruyne7, Marumbo Paul Mtegha8, Marianne Hørby Jørgensen9, Toni Illhardt10, Oanez Ackermann11, Daniela Liccardo12, Emer Fitzpatrick13
1Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom, 2King's College London, Institute of Hepatology, School of Immunology and Mucosal Biology, London, United Kingdom, 3Pediatric Hepatology And Liver Transplantation, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 4Pediatric Hepatology, Gastroenterology And Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 5Pediatrics, University of Udine, Udine, Italy, 6Division Of Paediatric Gastroenterology And Hepatology, Department Of Paediatrics, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 7Department Of Internal Medicine And Pediatrics, Ghent University, Ghent, Belgium, 8Paediatric Hepatology, Leeds Children's Hospital, Leeds, United Kingdom, 9Department Of Pediatrics And Adolescent Medicine, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark, 10Paediatric Gastroenterology And Hepatology, University Children's Hospital Tübingen, Tübingen, Germany, 11Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 12Uoc Malattie Metaboliche Ed Epatologia Clinica Dei Trapianti Di Fegato, Ospedale Pediatrico Bambino Gesù, Roma, Italy, 13Paediatric Gastroenterology, Hepatolog & Nutritiony, Our Lady's Children's Hospital, Crumlin, Ireland
Objectives and Study: Introduction: Portal hypertension represents a significant clinical challenge in children with chronic liver disease(CLD) or portal vein thrombosis(PVT), with management approaches and clinical presentations varying considerably across different institutions Aim: To record current management strategies from individual ESPGHAN members.
Methods: Methods: During the annual ESPGHAN meeting members of the hepatology group were asked to complete a brief follow up online questionnaire that was agreed and compiled by the PHT SIG members.
Results: 26 hepatologists/gastroenterologists and 3 surgeons responded. All responders agreed on the definition of endoscopic surveillance, primary(PP) and secondary(SP) prophylaxis. Oesogastroduodenoscopy(OGD) was performed in CLD and PVT as both PP and SP by 97% and 83%, respectively. Endoscopic sclerotherapy for gastric varices was undertaken for both PP and SP by 17% of responders. Liver/spleen elastography is used as indirect marker of PHT by 65% responders. NSBB were used for prevention of GI bleeding (68%) from >2 yrs of age by 52%. Combination treatment with NSBB and EVL/Sclerotherapy in non‐responders(75%), bleeding gastropathy(64%) and when no surgical options available(68%). Grade 1(55%) or no(45%) varices were considered as eradication with 96% responders rescoping for confirmation, most within 1 year (68%). Transjugular venography(82%) and liver biopsy(72%) are usually performed in the management of PVT when considering Meso‐Rex‐Bypass(MRB). MRB would be considered by 59% in all patients in absence of PHT complications at a preferable age 2‐5 yrs(90%). Anticoagulation with prophylactic(74%) dose of LMWH(60%) for up to 6 months(57%) is used mostly. Radiological PV recanalization is considered if MRB is unattainable(43%) with variable age limitations. TIPSS is used for recurrent GI bleeding or high risk varices(100%) considering encephalopathy as primary risk(73%).
Conclusions: There is consensus in the definition/classification of PHT in children with variation in the management between individual centres. We are actively developing additional research and protocols to address the identified challenges to provide standardized guidance in diagnostics and management.
Contact e‐mail address:
H‐EP017. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP017.1. LONGITUDINAL FOLLOW‐UP OF SHEAR‐WAVE ELASTOGRAPHY FOR PREDICTING ADVANCED CYSTIC FIBROSIS LIVER DISEASE IN CHILDREN
Rishi Bolia, Silvia Gross, Laura Rishanghan, Charlton Noble, Sasha Mealing, Peter Lewindon
Department Of Gastroenterology, Hepatology And Liver Transplantation, Queensland Children's Hospital, Brisbane, Australia
Objectives and Study: Hepatobiliary manifestations of Cystic Fibrosis (CF) have a wide spectrum. A proportion develop features of advanced CF‐liver disease (aCFLD) in the form of multilobular cirrhosis and portal hypertension. Early identification and care of aCFLD can improve the morbidity and mortality associated with the condition. We evaluated the role of shear‐wave elastography (SWE) in identifying and predicting aCFLD.
Methods: Patients with CF (pwCF) underwent annual serial liver–stiffness measurements (LSMs) by SWE between Aug,2015‐Mar,2022. Baseline demographic data, LSM and corresponding ultrasound findings, liver function parameters, liver histology (if available) were recorded. Liver fibrosis indices– GGT‐to‐platelet ratio(GPR), AST‐to‐Platelet Ratio Index(APRI) and fibrosis‐4(FIB‐4) were calculated. aCFLD was defined as having one (or more) of the following: nodular liver, advanced fibrosis(F4), multilobular cirrhosis with or without portal hypertension.All these pwCF were followed up till Oct, 24.
Results: Total of 138 pwCF (74 males) with 386 LSMs were evaluated.Twenty‐seven (19.5%) had aCFLD at last follow–up with 5 requiring liver transplantation. Initial LSM values were higher in those who had or subsequently developed aCFLD 13.3(8.1)vs.7.2(3.3),p = 0.001, as compared to those with no aCFLD. Among non‐invasive liver fibrosis indices, SWE had highest AUROC [0.84 vs. 0.80(GPR) vs. 0.82(APRI) vs. 0.65(FIB‐4)] in predicting aCFLD. A cut – off of >9.25 kPa identified aCFLD with a sensitivity 81.5% specificity 74.6%. Ninety‐seven children had serial SWE readings (Increasing values n = 39). Increasing LSM values were associated with a higher risk of having aCFLD (14/22vs.25/75,p = 0.01). Elastography demonstrated concerning liver stiffness (Kpa > 9.25 and/or increasing Kpa) before a median 12 months before US changes confirmed aCFLD.
Conclusions: LSMs by SWE are an excellent tool for the assessment of liver disease in pwCF. They are superior to US and other non invasive indices for the identification and prediction of aCFLD in pwCF. Increasing serial LSMs identify patients progressing to aCFLD before ultrasound imaging by at least 1 years.
Contact e‐mail address: rishi.bolia@health.qld.gov.au
H‐EP018. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP018.1. CLINICAL IMPACT OF GENETICAL ANALYSIS IN THE DIAGNOSIS OF WILSON DISEASE
Zeynep Günal Türk 1, Ayça Dilruba Aslanger2, Tülin Ayşe Özden3, Lale Alıbaylı1, Aysel Majıdova1, Zerrin Önal1, Elif Turkmen1, Ozlem Durmaz1
1Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul University Faculty of Medicine, Istanbul, Turkey, 2Department Of Medical Genetics, İstanbul University Faculty of Medicine, Istanbul, Turkey, 3Gastroenterology And Trace Elements Laboratory, İstanbul University Faculty of Medicine, Istanbul, Turkey
Objectives and Study: Timely diagnosis and appropriate treatment can prevent cirrhosis and irreversible complications in Wilson Disease (WD). The aim of this study is to evaluate the role of genetic testing in the diagnosis of WD and to assess the impact of different genetic variations on clinical presentation of the disease.
Methods: A total of 71 patients (50 males, 21 females) followed at our center from 2009 on were included in the study. The Ferenci score with or without genetical data was used for diagnosis. Forty‐six of the patients had undergone genetic analysis. ATP7B gene analysis was performed as the initial genetical test and segregation analysis was conducted where appropriate. Patients were grouped according to clinical presentation and genetic zygosity pattern. Comparisons were made accordingly to show if any associations existed.
Results: Hepatic involvement (H) was present in 70, neurological involvement (N) in 16 patients (combined involvement in 15 patients and isolated in 1). All patients except four had a Ferenci score compatible with WD without adding the genetical data where available. Thus, genetical analysis had additional diagnostic impact in only 6% of our patients. Among the 46 patients with genetic analysis (45H & 7 N) ratios of homozygosity, heterozygosity and compound heterozygosity were 58.7%, 17.4% and 21.7% respectively. Overall, 25 different variants were detected; L1327V, R919W and M769Hfs26 were the most common mutated alleles. L1327V was also the most common homozygous mutation in children with hepatic presentation. Eight different mutated allels were revealed in 7 children with N. G1089E mutation existed in the only patient with isolated N. No pathogenic mutations were identified in 1 patient.
Conclusions: There is significant genetic heterogeneity in pediatric WD. Genetic testing adds little to other parameters of Ferenci score for diagnosis of symptomatic patients, though it is of value for a few uncertain cases and family screening.
Contact e‐mail address: zeynepgunal.08@gmail.com
H‐EP019. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP019.1. THE GENETIC BLUEPRINT OF LIVER DISORDERS
Deepa Janakiraman 1, Nirmala Dheivamani2, Sindhuja Thatti Audikesavalu3, Senthilkumar R1, Winston Thomas S1
1Department Of Paediatric Gastroenterology, INSTITUTE OF CHILD HEALTH AND HOSPITAL FOR CHILDREN, MADRAS MEDICAL COLLEGE, CHENNAI, India, 2Paediatric Gastroenterology, INSTITUTE OF CHILD HEALTH, CHENNAI, India, 3Department Of Paediatric Gastroenterology, MADRAS MEDICAL COLLEGE, INSTITUTE OF CHILD HEALTH, CHENNAI, India
Objectives and Study: Inherited or monogenic liver disorders have narrowed down the spectrum of cryptogenic liver disorders in the recent past. This study aimed to analyze the clinical and genetic spectra of inherited liver disease in children in a tertiary hospital.
Methods: In this ambispective study between May 2022 to October 2024 in a tertiary care centre in South India, a total of 150 patients were classified into four groups according to their clinical presentation: cholestasis (Group A), Chronic liver disease(Group B), and hepato/splenomegaly (Group C) and recurrent acute liver failure (Group D). Next‐generation sequencing (NGS) was performed on all patients recruited in this study.
Results: The median age at enrollment of the 150 patients was 13 months (IQR: 5.0, 43.5 months), with 59.3% males and 40.7% females 60% consanguinity. The overall diagnostic rate was 82.6% (124/150) in this group. We identified 46 genes related to different phenotypes, including 31 novel disease‐related pathogenic mutations and 25 mutations of uncertain significance but with phenotypic correlations. The diagnostic rates in the four groups: cholestasis (Group A), Chronic liver disease(Group B), and hepatomegaly/splenomegaly (Group C) and recurrent acute liver failure (Group D) were 73%(46/63), 69.6% (23/33), 96% (48/50) and 100% (4/4) respectively. AGL, PYGL and ATP7B were the top three genes related to monogenic liver disease in this study. Fig1. Diversity of genes in inherited liver disorders
Conclusions: This is the largest study till date in literature to report the huge diversity of genes involved in inherited liver disorders from a single centre. Systematic approach to narrow down to a suspicion of inherited liver disorders after ruling out all acquired causes significantly increases the yield of Next Generation Sequencing(NGS) in suspected monogenic cases. Compared to previous studies, this study reports the highest yield of NGS and highlights the importance of appropriate use of NGS in the algorithm to unravel the mystery behind cryptogenic cirrhosis.
Contact e‐mail address: rdherdhe9@gmail.com
H‐EP020. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP020.1. SCREENING AND DIAGNOSIS OF METABOLIC DYSFUNCTION‐ASSOCIATED STEATOTIC LIVER DISEASE IN CHILDREN WITH OBESITY IN PUBLIC HEALTHCARE
Lyydia Lahtinen 1,2, Pauliina Hiltunen1,3, Nina Vuorela1,3, Kalle Kurppa1,2,3,4, Linnea Aitokari1,2,5
1Tampere University, Tampere Center for Child, Adolescent and Maternal Health Research, Tampere, Finland, 2Tampere University, Celiac Disease Research Center, Faculty of Medicine and Life Sciences, Tampere, Finland, 3The Tampere University Hospital, Department of Pediatrics, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland, 4The University Consortium of Seinäjoki, Seinäjoki, Finland, 5Valkeakoski Social and Healthcare Center, Wellbeing Services County of Pirkanmaa, Valkeakoski, Finland
Objectives and Study: Childhood obesity and related metabolic dysfunction‐associated steatotic liver disease (MASLD) have emerged as major global challenges. Guidelines recommend screening for MASLD from children with overweight/obesity, but it remains unclear how this is actually realized. We investigated the implementation of screening and diagnosis of pediatric MASLD in healthcare.
Methods: Medical data of 926 children investigated due to overweight or obesity in primary (n = 350) and tertiary (n = 576) healthcare in 2002‐2020 were collected. Particular emphasis was paid to the methods used for screening and diagnosing MASLD and possible temporal changes.
Results: Median age of the patients was 11.6 years, 43% were girls and 87% obese. The screening included alanine aminotransferase (ALT) measurement in 83%, ultrasound imaging in 9% and no screening in 16.2%. It was more frequent among obese children and in specialized care. Altogether 81% underwent differential diagnostics for MASLD and 88% screening of abnormalities in glucose or lipid metabolism. ALT testing increased in tertiary care from 82.1% in 2002‐2011 to 91.7% in 2012‐2020 (p < 0.001) and exclusion of liver‐affecting conditions in primary (75.0% vs. 93.5%, p < 0.001) and tertiary care (79.5% vs 87.8%, p = 0.010). No temporal changes were seen in other tests. ALT 2x upper limit was seen in 16.7% and steatosis in 64.3% of those studied. Altogether, NAFLD was diagnosed by clinician for 7.2%, while 14.4% met the criteria retrospectively. Increasing trend was seen in prevalence of children receiving NAFLD diagnosis from a clinician (from 8% in 2006‐2008 to 11% in 2018‐2020, p = 0.159) and also in those fulfilling MASLD criteria applied retrospectively (12% to 19%, p = 0.731), although this was not significant. Liver biopsy was performed in four cases, with three showing steatohepatitis and early‐stage fibrosis.
Conclusions: The implementation of MASLD screening largely aligned with the recommendations. However, many patients may remain unrecognized, underscoring the need to improve guidelines for clinicians.
Contact e‐mail address:
H‐EP021. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP021.1. CAN METS‐IR AND SPISE BE CONSIDERED AS NEW BIOCHEMICAL‐ANTHROPOMETRIC INDICES OF INSULIN RESISTANCE IN CHILDREN WITH METABOLIC DYSFUNCTION‐ASSOCIATED STEATOTIC LIVER DISEASE AND METABOLIC SYNDROME?
Anna Lebensztejn, Kinga Trochimczyk, Anna Bobrus‐Chociej, Marta Flisiak‐Jackiewicz, Kamila Kwiatek‐Średzińska, Dariusz Lebensztejn
Department Of Paediatrics, Gastroenterology, Hepatology, Nutrition, Allergology And Pulmonology, Medical University of Bialystok, Białystok, Poland
Objectives and Study: Metabolic dysfunction‐associated steatotic liver disease (MASLD) is considered a hepatic manifestation of metabolic syndrome (MS) with underlying insulin resistance (IR). The traditionally used HOMA‐IR index does not have standardized reference values in children under 16 years old. Therefore, the aim of this study was to evaluate the usefulness of new surrogate biochemical‐anthropometric indices METS‐IR (metabolic score for IR) and SPISE (single point insulin sensitivity estimator) and compare them with other biochemical indices: triglyceride‐glucose index (TyG), triglyceride/cholesterol‐HDL ratio (TG/HDL‐C) and HOMA‐IR in children with MASLD and MS.
Methods: The retrospective study included a group of 222 obese/overweight children (aged 10 to16 years). MASLD was diagnosed according to the criteria developed by numerous scientific societies (JPGN 2024), and MS was diagnosed according to IDF. METS‐IR and SPISE were calculated according to the mathematical formulas. ROC analysis was performed to assess the power of the analyzed IR indicators in children with MASLD and MS.
Results: MASLD was diagnosed in 145 children (65,3%) and MS in 49 patients (22%). Children with MASLD had significantly higher levels of ALT, GGT, TG, uric acid and value of CAP on elastography and IR indices: TyG, TG/HDL‐C compared to the group of nonhepatopathic obese controls (n = 77). The most important indices in identifying MASLD were: TyG (AUC = 0.653, p < 0.0001, cut‐off=8.4, Se=58%, Sp=70%) and TG/HDL‐C (AUC = 0.65, p = 0.0001, cut‐off=2.6, Se=52%, Sp=78%). Moreover, the highest predictive values of MASLD and MS were found for TG/HDL‐C (AUC = 0.93, p < 0.0001, cuoff=3.4, Se=90%, Sp=88%), TyG (AUC = 0.917, p < 0.0001, cut‐off=8.8, Se=82%, Sp=92%), SPISE (AUC = 0.826, p < 0.0001, cut‐off=5.1, Se=84%, Sp=72%) and METS‐IR (AUC = 0.773, p < 0.0001, cut‐off=42.8, Se=84%, Sp=58%). HOMA‐IR had the lowest prediction value (AUC = 0.698, p < 0.0001).
Conclusions: METS‐IR and SPISE can be considered as useful indicators of IR in children with MASLD and MS, however, they are not superior in sensitivity and specificity to simple biochemical indicators: TyG and TG/HDL‐C.
Contact e‐mail address:
H‐EP022. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP022.1. LIVER DISEASE IN 230 PATIENTS WITH NBAS DEFICIENCY: CLINICAL COURSE, PROGNOSTIC FACTORS AND OUTCOME
Bianca Peters1, Lea Schlieben2, Heiko Brennenstuhl3, Cigdem Arikan4, Sarah Bedoyan5, Fatma Bulut6, Ellen Crushell7, Carlo Dionisi Vici8, Ada Drab9, Alexander Fichtner1, Aixa Gonzales10, Deanna Fry10, Sven Garbade1, Nicole Hammann1, Nedim Hadzic11, Robert Hegarty12, Marianne Hørby Jørgensen13,14, Martin Laass15, Elke Lainka16, Lina Leghlam1, Eberhard Lurz17, Halise Mungan6, Andrea Pietrobattista18, Begona Polo19, Piotr Socha20, James Squires21, Tian Sun1, Georg Vogel22, Holger Prokisch2, Stefan Kölker1, Georg Hoffmann1, Christian Staufner1, Dominic Lenz 1
1Heidelberg University, Medical Faculty, Department Of Pediatrics I, University Children's Hospital, Heidelberg, Germany, 2Technical University of Munich, Munich, Germany, 3Institute Of Human Genetics, Heidelberg University and University Hospital Heidelberg, Heidelberg, Germany, 4Koc University School of Medicine, Istanbul, Turkey, 5UPMC Children's Hospital of Pittsburgh, Pittsburgh, United States of America, 6Cukurova University Faculty of Medicine, Adana, Turkey, 7Childrens Health Ireland, Temple Street, Dublin, Ireland, 8Metabolic Diseasaes And Hepatology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy, 9The Children's Memorial Health Institute, Warsaw, Poland, 10University of Arkansas for Medical Sciences (UAMS) and Arkansas Children's Hospital, Arkansas, Germany, 11Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom, 12Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom, 13Department Of Pediatrics And Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark, 14Department Of Paediatric And Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark, 15Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany, 16Clinic For Pediatrics Ii, Department Of Pediatric Nephrology, Gastroenterology And Transplant Medicine, University Children's Hospital Essen, Essen, Germany, 17Department Of Pediatrics, University Hospital, LMU Munich, Munich, Germany, 18Hepatology and Liver Transplant Unit, Bambino Gesù Children's Hospital, Rome, Italy, 19Hospital Universitario y Politécnico La Fe, Valencia, Spain, 20Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 21Children's Hospital of Pittsburgh, Pittsburgh, United States of America, 22Department Of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
Objectives and Study: Since its identification in 2015, NBAS‐associated disease has emerged as a significant cause of paediatric acute liver failure (ALF). This study aims to investigate the variability in clinical presentation, genotype‐phenotype correlations, outcomes, and prognostic factors related to hepatic involvement in affected individuals.
Methods: We conducted an international observational study that included individuals with biallelic pathogenic variants in the NBAS gene, incorporating both newly identified and previously reported cases.
Results: Our analysis encompassed 230 patients, including 13 novel cases. The liver was identified as the most commonly affected organ, with 63.4% of participants experiencing liver involvement; notably, 41.3% suffered at least one episode of ALF. The median age at onset of liver symptoms was 0.9 years, while the median age at the last recorded ALF was five years, with the latest occurrence noted at 24 years. Liver crises were predominantly triggered by febrile infections and were characterized by significantly elevated hepatic transaminase levels. There was considerable variation in liver involvement across different subgroups: 91.7% of patients with infantile liver failure syndrome type 2 and 88.9% from the combined subgroup (variants affecting the β‐propeller domain) experienced ALF, whereas those with SOPH (stature, optic atrophy, Pelger–Huët anomaly) exhibited either no liver involvement (66.4%) or persistent transaminase elevation without ALF. The native liver survival rate was 83.9%, with 16 patients that underwent liver transplantation and 24 fatalities recorded.
Conclusions: Hepatic abnormalities are prevalent and represent the primary cause of mortality in NBAS‐associated disease. A distinct genotype‐phenotype correlation exists concerning liver involvement. While liver crises predominantly occur during infancy, prompt medical intervention during febrile illnesses is crucial across all ages. Although liver transplantation can avert ALF, careful consideration of its associated risks is essential given that the frequency and severity of liver crises tend to diminish with advancing age.
Contact e‐mail address: dominic.lenz@med.uni-heidelberg.de
H‐EP023. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP023.1. MICE WITH HUMANIZED FARNESOID X RECEPTOR EXHIBIT INCREASED SENSITIVITY TO OBETICHOLIC ACID ACTIVATION
Jinxiao Li 1, Hilde De Vries1, Sarah Falcone1, Rick Havinga1, Milaine Hovingh1, Niels Mulder1, Ellen Weersing2, Henkjan Verkade3, Folkert Kuipers2, Jan Freark De Boer1
1Department Of Pediatrics, University Medical Center Groningen (UMCG), Groningen, Netherlands, 2European Research Institute for the Biology of Ageing (ERIBA), Groningen, Netherlands, 3Division Of Pediatric Gastroenterology And Hepatology, Department Of Pediatrics, University Medical Center Groningen, Groningen, Netherlands
Objectives and Study: FXR is a bile acid (BA)‐activated nuclear receptor and therapeutic target for cholestatic/metabolic liver diseases. However, species‐specific differences have hampered the translation of preclinical findings to clinical applications. Notably, human FXR‐ligand binding domain (LBD) has been shown to display a stronger response to CDCA than mouse FXR‐LBD in vitro. Furthermore, CDCA‐derived FXR agonist OCA effectively activates FXR in humans while exhibiting limited efficacy in mice. Therefore, we developed a mouse model with ‘humanized’ FXR by replacing murine LBD with human LBD. Here, we characterized these mice and investigated the impact of FXR humanization on BA metabolism upon OCA administration.
Methods: FXR‐hLBD mice were generated, and the phenotype of adult male and female mice was characterized. In another experiment, FXR‐mLBD (CTRLs) and FXR‐hLBD mice were treated with either vehicle or OCA (40 mg/kg BW/day p.o.) for 7 days.
Results: FXR expression levels were comparable between FXR‐hLBD mice and CTRLs. Hepatic transcriptome analysis revealed no alterations in BA signaling between two groups under unstimulated conditions. Importantly, there were no indications of liver pathology in FXR‐hLBD mice. Upon OCA administration, however, notable differences in expression of FXR target genes became apparent. Hepatic Shp expression was significantly increased in OCA‐treated FXR‐hLBD mice compared to CTRLs, whereas Cyp7a1 expression was further suppressed. Notably, intestinal Fgf15 expression was elevated in FXR‐hLBD mice upon OCA administration, but not in CTRLs. OCA treatment reduced fecal BA secretion in both genotypes. Interestingly, OCA‐induced reductions in plasma cholesterol levels (LDL‐C and HDL‐C) were considerably more pronounced in FXR‐hLBD than in CTRLs.
Conclusions: We generated mice with ‘humanized’ FXR. Although phenotype of these mice is indistinguishable from CTRLs under basal conditions, FXR‐hLBD mice do show greater responsiveness to OCA. This mouse model may represent a useful tool for studying BA metabolism, and the response to pharmacological FXR modulators is in a more human‐relevant manner.
Contact e‐mail address: j.li02@umcg.nl
H‐EP024. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP024.1. EFFECTIVENESS OF ILEAL BILE ACID TRANSPORT INHIBITORS (IBATS) IN CHILDREN WITH ALAGILLE SYNDROME: A SYSTEMATIC REVIEW AND META‐ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Jonathan Lopes 1, Natalia Libonati2, Inês Martins Esteves3, Fátima Gomez Da Silva4, Angélica Nau5
1Faculdade de Ciências Médicas de São José dos Campos‐ HUMANITAS, São José dos Campos, Brazil, 2Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Brazil, 3School of Medicine and Biomedical Sciences, University of Porto, Portugal, Porto, Portugal, 4Medical Science Center ‐ Federal University of Paraíba (UFPB), João Pessoa, Brazil, 5Federal University of Santa Catarina, Florianópolis, Brazil
Objectives and Study: Objectives and Study: Alagille syndrome (ALGS), a rare genetic disorder, frequently leads to severe pruritus caused by cholestasis, significantly affecting the quality of life in pediatric patients. Ileal bile acid transport inhibitors (IBATs) have emerged as a potential treatment, but robust evidence on their efficacy is scarce. This systematic review and meta‐analysis evaluated the effectiveness of IBATs versus placebo in managing pruritus and bile acid levels in children with ALGS.
Methods: Methods: PubMed, EMBASE, and Cochrane databases were systematically searched for randomized controlled trials (RCTs) comparing IBATs (maralixibat and odevixibat) to placebo. Primary outcomes included changes in pruritus severity (measured by the ItchRO score) and serum bile acid levels. Data were pooled using a random‐effects model to calculate risk ratios (RR) and mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI). Statistical analyses were conducted using Review Manager software (version 5.4.1xyz).
Results: Results: Four RCTs involving 141 patients (ages 5.4–5.9 years; 52% male) were included. Baseline characteristics showed significantly elevated serum bile acids (≥3× the upper limit of normal) and moderate‐to‐severe pruritus (ItchRO[Obs] scores of 2.5–3.0). Compared to placebo, IBATs significantly reduced serum bile acids (MD ‐83.2 µmol/L; 95% CI: ‐126.7 to ‐39.7; p < 0.0002) and pruritus scores (SMD ‐0.99; 95% CI: ‐1.66 to ‐0.32; p < 0.004). Adverse events were mild, with gastrointestinal symptoms being the most common.
Conclusions: Conclusion:
This meta‐analysis demonstrates that IBATs significantly improve pruritus and reduce serum bile acid levels in pediatric ALGS patients compared to placebo. These findings highlight IBATs as a promising treatment option with good tolerability.
Contact e‐mail address: angel.l.nau@gmail.com
H‐EP025. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP025.1. INCREASED ALT ASSOCIATES WITH SPECIFIC ALTERATIONS IN LIPIDS AND DESATURASE ACTIVITY INDICES IN CHILDREN WITH OVERWEIGHT AND OBESITY
Judith Lubrecht 1, Robert Kleemann2, Tim Van Den Broek3, Martin Giera4, Gabriele Gross5, Janna Van Diepen5, Ivana Bobeldijk‐Pastorova2, Anita Vreugdenhil1
1Pediatrics, Maastricht UMC + , Maastricht, Netherlands, 2Metabolic Health Research, TNO, Leiden, Netherlands, 3Microbiology And Systems Biology, TNO, Leiden, Netherlands, 4Centre For Proteomics And Metabolomics, Leiden University Medical Centre, Leiden, Netherlands, 5Mead Johnson Nutrition Institute, Hoofddorp, Netherlands
Objectives and Study: Metabolic dysfunction‐associated steatotic liver disease (MASLD) is characterized by specific alterations in lipid species, that may differentiate between stages of the disease. In adults, certain accumulating hepatic lipids associated with lipotoxicity and hepatocellular damage. However, paediatric studies are limited. This study investigates associations of lipid species and desaturase activity indices with hepatocellular damage, defined by alanine aminotransferase (ALT), in children with overweight and (severe) obesity.
Methods: A cross‐sectional study was performed at Maastricht University Medical Centre. Comprehensive quantitative lipidomics analyses were performed in 182 plasma samples from 91 children with overweight and (severe) obesity, with and without hepatocellular damage and 25 plasma samples from lean children without hepatocellular damage. Associations between lipids, desaturase activity indices and ALT were evaluated, as well as potential differentiating lipids between groups.
Results: A total of 651 lipid species and 41 desaturase activity indices were assessed. Fatty acid desaturase‐1 and 2 (FADS1 and FADS2) activity indices for cholesteryl esters (CE), phosphatidylcholines (PC) and triglycerides (TG) were positively associated with ALT, while stearoyl‐CoA desaturase‐1 (SCD1) activity index for TG was negatively associated. Specific FADS2 and SCD1 activity indices for CE and 12 lipid species differentiated children with and without hepatocellular damage with balanced accuracy of 80%.
Conclusions: Hepatocellular damage in children with overweight and (severe) obesity is associated with specific alterations in desaturase activity indices and lipid species. These results provide important insights into the changes in lipid metabolism in the pathophysiology of MASLD in children with overweight and (severe) obesity and may facilitate targeted research into therapeutically relevant lipid metabolism pathways.
Contact e‐mail address: judith.lubrecht@mumc.nl
H‐EP026. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP026.1. A DESCRIPTIVE REPORT OF 12 YEARS OF EXPERIENCE ON AUTOIMMUNE HEPATITIS CHILDREN IN A ROMANIAN TERTIARY CARE CENTER
Bianca Mariș 1,2, Alina Grama1,2, Tudor Lucian Pop1,2
1Mother And Child, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj‐Napoca, Romania, Cluj‐Napoca, Romania, 2Second Pediatrics Clinic, Center Of Expertise In Pediatric Rare Liver Diseases, Emergency Clinical Hospital for Children, Cluj‐Napoca, Romania
Objectives and Study: Autoimmune hepatitis (AIH) is a rare disease but is of great interest due to the significant morbidity associated with delayed diagnosis. This study aims to describe AIH children diagnosed and followed up in a tertiary care center.
Methods: We analyzed all children with AIH diagnosed in our center between 2012 and 2024. Study data was obtained from medical records in our informational system with subsequent storage and analysis using an Excel database. Results were compared with ESPGHAN reports and medical literature.
Results: We identified 39 AIH patients, out of which 79.5% were AIH‐1, 15.4% were AIH‐2, and 5.1% were de novo AIH after liver transplant. About three‐quarters were females, and the mean age at diagnosis was 9.3 years. There was no difference between AIH‐1 and AIH‐2 in our patients, despite available ESPGHAN data of a younger age in AIH‐2. Most patients were asymptomatic at diagnosis or presented as acute hepatitis (around 30% each), while 15.4% were confirmed with liver cirrhosis. The mean ALT value was 587 U/L, while the mean IgG titer was 2744 mg/dl, with no significant differences regarding AIH subtype. Associated autoimmune diseases were present in 54% of patients, higher than data presented in medical literature (20% in children with AIH). Overlap syndrome was encountered in one‐third of patients, similar to ESPGHAN reports, while inflammatory bowel disease and coeliac disease were underrepresented, with only one case each. As of treatment, 28% were managed with corticoids alone, while in the majority of patients, supplemental immunosuppression, mainly azathioprine, was introduced.
Conclusions: Our AIH cohort exhibited clear female preponderance and mostly consisted of AIH‐1 cases. Most patients were diagnosed with incidental transaminitis, which outlines the importance of a high index of suspicion. Our patients displayed a high rate of polyautoimmunity, primarily overlap syndrome.
Contact e‐mail address: bianca.mateescu18@yahoo.com
H‐EP027. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP027.1. BIOCHEMICAL‐ANTHROPOMETRIC INDICES ASSESSING LIVER STEATOSIS IN CHILDREN WITH METABOLIC DYSFUNCTION‐ASSOCIATED STEATOTIC LIVER DISEASE
Aleksandra Motkowska 1, Anna Lebensztejn1, Bartosz Tuchliński1, Kinga Trochimczyk1, Marta Flisiak‐Jackiewicz1, Anna Bobrus‐Chociej1, Magdalena Rogalska2, Dariusz Lebensztejn1
1Department Of Paediatrics, Gastroenterology, Hepatology, Nutrition, Allergology And Pulmonology, Medical University of Białystok, Bialystok, Poland, 2Department Of Infectious Diseases And Hepatology, Medical University of Bialystok, Bialystok, Poland
Objectives and Study: Metabolic dysfunction‐associated steatotic liver disease (MASLD) is the most common cause of liver pathology in children and adolescents. Hepatic fat content can be assessed by a transient elastography but this method is not widely used. Therefore, the aim of this study was to evaluate the usefulness of a simple, surrogate biochemical‐anthropometric indexes of a liver steatosis: HSI (Hepatic Steatosis Index), LAP (Lipid Accumulation Product) and FLI (Fatty Liver Index) in children with MASLD.
Methods: The retrospective study included a group of 103 obese/overweight children (aged 7‐ 18 yrs., median 12 yrs.). MASLD was diagnosed according to criteria developed by numerous scientific societies (JPGN 2024). Liver steatosis (controlled attenuation parameter/CAP/) was assessed in elastography (FibroScan, Echosense, France). HSI, FLI and LAP were calculated according to the mathematical formulas. ROC analysis was performed to calculate the power of the studied indices in diagnostics of liver steatosis in children with MASLD.
Results: MASLD was diagnosed in 72 children (70%). Children with MASLD had significantly higher levels of ALT, AST, GGT, uric acid and value of SDS‐BMI, waist circumference, HOMA‐IR, CAP on elastography and indices: HSI, FLI, LAP compared to the group of nonhepatopathic controls (n = 31). HSI, FLI and LAP significantly correlated with CAP (r = 0.42, r = 0.42, r = 0.33 resp.) The most important indices in identifying MASLD were HSI (AUC = 0.683, p = 0.0006, cut‐off=39.9, Se=76%, Sp=24%), LAP (AUC = 0.66, p = 0.0037, cut‐off=43.8, Se=46%, Sp=87%) and FLI (AUC = 0.66, p = 0.0027, cut‐off=58.1, Se=49%, Sp= 76%). Moreover, the highest predictive values for identifying liver steatosis (CAP ≥ 250 dB/m) were HSI (AUC = 0.77, p < 0.0001, cut‐off=36.8, Se=78%, Sp=64.5%), FLI (AUC = 0.76, p = <0.0001, cut‐off=37.5, Se=71%, Sp=74%) and LAP (AUC = 0.68, p = 0.002, cut‐off=30.6, Se=71%, Sp=62%).
Conclusions: HSI, LAP and FLI can be considered to be useful biochemical‐anthropometric indicators of liver steatosis and MASLD in obese/overweight children.
Contact e‐mail address:
H‐EP028. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP028.1. DETECTION OF AAV2 IN SAMPLES OF ACUTE SEVERE HEPATITIS IN CHILDREN PREDATING THE 2022 OUTBREAK OF HEPATITIS OF UNKNOWN AETIOLOGY
Dimitrios Mourelatos 1, Bethany Tucker1, Li‐An Brown2, Oscar Enrique Torres Montaguth2, Julianne Brown3, James Burton3, Sofia Morfopoulou2, Anil Dhawan1, Nedim Hadzic1, Judy Breuer2, Tassos Grammatikopoulos1
1Paediatric Liver, GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Trust, London, UK, London, United Kingdom, 2Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom, 3Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Microbiology, Virology and Infection Control, London, United Kingdom
Objectives and Study: Background: In 2022, reports emerged of acute severe hepatitis and acute liver failure(ALF) in immunocompetent children across several countries. A co‐infection with Adenovirus‐F41(AdV) and/or AAV2, a dependoparvovirus, was identified as an association in UK children. No pre–2022 data exist on the association of AAV2 and acute severe hepatitis in children.
Aim: To investigate the presence of AAV2 in historical serum samples from cases of indeterminate acute severe hepatitis and/or ALF.
Methods: This single‐centre study identified cases of indeterminate ALF or acute severe hepatitis, from 2017‐ 2021 records. Indeterminate Hepatitis/ALF referred to cases where no definitive cause could be identified, despite extensive diagnostic investigations, including viral, autoimmune, metabolic, and genetic work up. Historical biobank plasma samples were retrospectively assessed for AAV2 presence for research purposes following consent. Real‐time PCR targeting a 62‐nt region of the AAV2 inverted terminal repeat sequence was performed.
Results: We identified samples from 10 patients (7 males, 3 females; mean age 7.7 years). Admission laboratory and demographic data were collected (Table 1). AAV‐2 was detected in 3/10 samples with one sample showing high‐level positivity and two samples exhibiting low‐level positivity. AdV was detected by PCR in 2 samples (20%), both co‐infected with AAV2. The third patient (AdV negative) with AAV2 positive serum sample was PCR positive for HHV‐6. All 3 patients required liver transplantation(LT), with no deaths reported. Both AdV‐positive patients were treated with cidofovir and became negative on the one month follow up post‐LT
Conclusions: This study confirms the presence of AAV‐2 in the plasma of children with indeterminate severe hepatitis/ALF, prior to the 2022 outbreak. These findings suggest a longstanding association of AAV2 with severe hepatitis resulting to LT, particularly in cases of co‐infection with AdV or HHV‐6. Screening for AAV2 co‐infection is recommended in cases of acute severe hepatitis.
Contact e‐mail address:
H‐EP029. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP029.1. ROLE OF CMV IN INFANTS WITH CHOLESTASIS: A BYSTANDER OR A CULPRIT?
Subhiksha Muralidhar 1, Bhagirathi Dwibedi1, Aditi Kumar1, Baijayantimala Mishra2, Susama Patra3
1Pediatrics, All India Institute Of Medical Sciences, Bhubaneswar, India, 2Microbiology, All India Institute Of Medical Sciences, Bhubaneswar, India, 3Pathology, All India Institute Of Medical Sciences, Bhubaneswar, India
Objectives and Study: Cytomegalovirus(CMV) infection in cholestasis‐of‐infancy(COI) remains an enigma regarding its association or causation.CMV is found in 10‐30% cases, though its prevalence in Indian population is unclear.The study aims to estimate the prevalence of CMV‐infection among the COI and evaluate response to antivirals in medical(MCOI) and surgical(SCOI) subgroups.
Methods: A cross‐sectional‐analytical study was conducted at a tertiary‐care‐referral centre in India. All COI‐cases were screened for CMV‐infection by IgM‐CMV‐ELISA, urine‐CMV‐PCR(qualitative)and liver‐biopsy for histopathological evidence. Infants were sub‐grouped as SCOI(those needing surgery) and MCOI. All CMV‐positive COI were treated with oral‐Valganciclovir for three‐months with viral clearance documented post‐treatment. Outcomes were compared between CMV‐positive and CMV‐negative COI. Unfavourable‐outcome was defined as decompensated‐liver disease or death.
Results: Total 147‐cholestatic infants (May2023‐October2024) were included. Sixty‐two(42.2%) cases were SCOI, of which 58/62(93%) cases were biliary‐atresia(BA) and 4/62(7%)choledochal‐cyst. MCOI included 85(57%) cases in which sepsis was the commonest cause 29(34%) followed by metabolic liver disease 26(30%). CMV‐positivity was found in 74 COI‐cases(50.3%) suggesting a high‐prevalence in our region. CMV‐positivity in SCOI was statistically significant compared to MCOI[40/62(64.5%)vs 34/85(40%);p = 0.003]. Significant proportion of CMV‐positive‐infants were small‐for‐gestational age(p < 0.05). Other clinical and biochemical parameters were comparable in the two groups including the incidence of advanced fibrosis(12/28 43%) on liver‐histopathology in the CMV‐positive versus CMV‐negative SCOI(12/28vs4/13 p‐value0.71).However, CMV‐positive SCOI had delayed presentation compared to CMV‐negative SCOI with the median‐age of Kasai portoenterostomy 97days vs 72days(p < 0.05). Response to Valganciclovir was documented in 67/74 CMV‐positive‐COI.Thirty‐eight completed treatment documenting viral clearance in 3‐months(Figure1).One‐fourth(21/85)of MCOI and 62.2%(38/61)SCOI had poor outcome irrespective of CMV‐status. Furthermore, poor‐outcome in CMV‐positive‐BA was 25/38(65.7%) and12/20(60%) in the CMV‐negative‐BA‐group was comparable(p‐value0.66). Interestingly, among CMV‐positive‐MCOI,14/34(41.1%) had an unfavourable outcome despite treatment compared to 7/51(14%) in CMV‐negative‐MCOI(p < 0.005).
Conclusions: CMV has a high‐prevalence in COI in India. Surgical‐COI shows higher CMV positivity, and outcomes remain dismal regardless of CMV status. CMV‐negative‐MCOI has a significantly better outcome than CMV‐positive‐MCOI cases.
Contact e‐mail address: drms2k15@gmail.com
H‐EP030. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP030.1. 1H‐NMR METABOLIC PROFILING IN PAEDIATRIC WILSON DISEASE
Moritz Niesert 1, Claire Cannet2, Isabelle Mohr3, Markus Großmüller1, Stephanie Cordts1, Dominic Lenz1, Georg Hoffmann1, Uta Merle3, Jürgen Okun1, Andreas Ziegler1, Alexander Fichtner1
1Department Of Pediatrics I, Heidelberg University, Heidelberg, Germany, 2Bruker BioSpin GmbH, Ettlingen, Germany, 3Medical Faculty, Department Of Internal Medicine Iv, Heidelberg University, Heidelberg, Germany
Objectives and Study: Wilson disease (WD) is a rare autosomal recessive disorder caused by mutations in the ATP7B gene. Impaired copper homeostasis in the whole organism leads to profound metabolic changes and tissue damage. Despite relevant advances in (genetic) diagnostics, diagnosis and treatment, management often remain difficult and individualised prediction of disease progression is virtually impossible.Metabolomics bears the potential to map the complex metabolic changes. We investigate the potential of 1H‐NMR metabolomics for the non‐invasive identification of paediatric patients with WD.
Methods: 1H‐NMR‐spectroscopy metabolic profiles were generated from plasma samples of 72 children and adolescents, including 12 patients with Wilson's disease, 39 patients with hepatic diseases (HEP) and 21 healthy controls (HC). Modelling was performed using the PCA/CA/k‐nn/MCCV algorithm, censoring known drug metabolites. For a more precise characterisation of the metabolic changes, a quantitative enrichment analysis of the annotated spectral components with the KEGG database was performed.
Results:
Plasma samples from 72 children and adolescents (age: WD: 11.8 y [7‐18 y]; HEP: 11.0 y [1‐18 y]) were included in the analysis. A machine lerning model was developed, correctly distinguishing between WD, HEP and healthy controls in 80.1% of cases (Fig. 1). Quantitative enrichment analysis revealed significant differences in the metabolism of individual amino acids despite small absolute changes.
Conclusions: Even with the limited number of patients, classification models can be established, discriminating with good accuracy between patients with WD, other liver diseases and healthy controls. Large parts of the areas contributing to the modelling are outside the annotated spectrum, although specific amino acid metabolisms are significantly altered in WD. The inclusion of a hepatological control cohort allows non‐specific changes to be excluded from the analysis. MEtabolic changes in WD are amenable 1H‐NMR spectroscopy‐based metabolomics analysis. Including additional patients is necessary to validate the models and assess the potential clinical benefits, particularly in disease monitoring and therapy management.
Contact e‐mail address:
H‐EP031. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP031.1. STOOL COLOR CARD: A SCREENING TOOL TO PREDICT BILIARY ATRESIA ‐ EXPERIENCE AT A TEACHING HOSPITAL IN PAKISTAN
Anjum Saeed 1, Huma Cheema2, Tehreem Fatima2
1Department Of Pediatric Gastroenterology, Hepatology & Nutrition, The Children's hospital & University of child health sciences, Lahore, Lahore, Pakistan, 2The Department Of Pediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & University of Child Health sciences, Lahore, Pakistan
Objectives and Study: To determine the diagnostic accuracy of Stool Color Card (SCC), as a screening tool in predicting Biliary Atresia (BA), in cholestatic infants up to 3 months (90 days) of age. Study Design: Prospective cohort study Place and Duration of Study: Department of Pediatric Gastroenterology and Hepatology, University of Child Health Sciences, Lahore; 1st Feb 2024 to 31st July 2024.
Methods: Infants up to 3 months of age, presenting with cholestatic jaundice, were enrolled. Mothers of these infants, were asked to fill the stool color card, by matching the stool color of their baby. These infants were divided into group A (abnormal stool color) and group B (normal stool color). Both groups were followed up and Infants who screened as true positive and true negative by the stool color card were noted; sensitivity, specificity of the stool color card was calculated.
Results: Out of total 56 patients enrolled, 33 were male and 23 were female. 46/56 infants had abnormal (acholic) stool color ‐ group A. Whereas, 10/56 babies had a normal (pigmented) stool color ‐ group B. It was found that 22/56 babies in group A were diagnosed as Biliary Atresia. All 10 patients in group B, did not have biliary atresia. Sensitivity of SCC was 47.8%, Specificity was 100%, PPV was 100% and NPV was 29.4% according to our study.
| Confirmed cases of BA* | Total | |||
|---|---|---|---|---|
| Positive | Negative | |||
| Stool color according to SCC | Acholic | 22 (47.8 %) | 24 (52.2 %) | 46 (100%) |
| Pigmented | 0 (0%) | 10 (100%) | 10 (100%) | |
| *By taking cholangiogram as a gold standard ** Sensitivity: 47.8%, Specificity: 100%, PPV: 100%, NPV: 29.4%, Prevalence: 39.3% | ||||
Conclusions: Stool color is most practical means of screening for biliary atresia in terms of its ease to use and its economic value. It requires little expertise for the screening purpose, while having a high specificity.
Contact e‐mail address: anjuj2002@gmail.com
H‐EP032. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP032.1. THE EXPERIENCE OF GENDER DIVERSE YOUNG PEOPLE IN A MULTI‐DISCIPLINARY LIVER CLINIC
Kat Wheatley1, Jemma Day2, Marianne Samyn 2
1South London & Maudsley NHS Foundation Trust, London, United Kingdom, 2Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom
Objectives and Study: To gain insight into the presence and experience of transgender, gender‐queer, and non‐binary (TGQNB) young adults with chronic liver disease (CLD) within a specialist multi‐disciplinary liver service.
Methods: A mixed‐methods design was implements. An anonymised online questionnaire was used to capture the gender identity of young people attending clinic. A focus group was implemented with self‐selected TGQNB young people to explore their experiences of clinic and care. Thirty‐five patients were recruited from King's College Hospital (KCH) Young Adults Liver Service (YALS). Thirty‐two took part in the online survey which was analysed using descriptive statistics. Three TGQNB young people participated in the focus group, which was analysed using thematic analysis and informed by the Gender Affirmation Framework, as recommended in the study of gender diversity in healthcare. Patient and Participant Involvement (PPI) was utilised throughout the design, data‐analysis, and development of recommendations.
Results: The online survey highlighted much higher reports of gender‐diversity than the general population (18.5% of participants described their gender TGQNB vs. 1% of 16‐24 year‐olds from the England and Wales Census in 2021). Key themes from the thematic analysis were: (1) Positive Experiences with YALS Clinicians (2) Mixed Experiences with the Wider System (3) Invisible Experiences (e.g. anxiety before 'coming out', preventing stigma, being treated holistically).
Conclusions: This study suggests an over‐representation of gender‐diversity in young people with CLD. This requires further exploration, alongside the growing literature regarding hormone profile differences in the same population. It highlighted a number of strengths in delivering gender‐affirming care, and wider areas for development, proposing enhanced clinician support to address the systemic and interpersonal stressors that TGQNB patients may face in healthcare settings.
Contact e‐mail address: Jemmaday1@nhs.net
H‐EP033. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP033.1. IMPACT OF ELEXACAFTOR/TEZACAFTOR/IVACAFTOR ON FECAL PANCREATIC ELASTASE IN CHILDREN WITH CYSTIC FIBROSIS AND PANCREATIC INSUFFICIENCY AGED 6‐17 YEARS: PRELIMINARY RESULTS FROM A SINGLE‐CENTER OBSERVATIONAL STUDY
Cristina Fevola1, Daniela Dolce1, Silvia Campana1, Erica Camera1, Michela Francalanci1, Valeria Galici1, Annasilvia Neri1, Giovanni Taccetti1, Luca Scarallo 2,3, Paolo Lionetti2,3, Vito Terlizzi1
1Cystic Fibrosis Regional Reference Centre, Meyer Children's Hospital, IRCCS, Florence, Italy, 2Gastroenterology And Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy, 3Neurofarba, University of Florence, Florence, Italy
Objectives and Study: The impact of elexacaftor/tezacaftor/ivacaftor (ETI) on pancreatic insufficiency (PI) recovery in children and adolescents with Cystic Fibrosis (CF) is still being studied. This single‐center retrospective observational study aimed to evaluate this effect on a cohort of children with CF (CwCF) on ETI, carrying at least one F508del variant, followed at the CF center of Florence, Italy.
Methods: Fecal pancreatic elastase (FE‐1; normal value > 100 µg/g) levels were retrospectively assessed in all CwCF with PI at diagnosis (FE‐1 < 15 µg/g). If more than one FE was available, the highest value was considered for analysis.
Results: Out of 72 subjects on ETI therapy, 57 (79.2%, males: 47.4%, median age at initiation of ETI: 10.9 y, range 6‐16.8 y) were PI, and enrolled in the study. FE‐1 was retrospectively evaluated on average after 20.6 months (range 5‐36 m) from the initiation of ETI therapy. While some improvement in FE‐1 levels was observed in 14 (24.6%) cases, a significant increase > 100 μg/g was noted in only 3 (5.3%) cases (Table 1). No differences in FE‐1 improvement were observed by comparing CwCF aged 6‐11 and 12‐17 years. No cases of pancreatitis on ETI were registered. No child stopped pancreatic enzyme replacement therapy (PERT).
Table 1. Change in fecal pancreatic elastase (FE‐1) in 3 CwCF in elexacaftor/tezacaftor/ivacaftor (ETI) therapy.
| Genotype | Sex | Age at ETI initiatin (Y) | FE‐1 pre ETI (µg/g) | |
|---|---|---|---|---|
| Age at FE‐1 analysis (Y) | Fe‐1 post ETI (µg/g) | |||
| Case 1 | F508del/F508del | F | 6.6 | <15 |
| 8.0; 8.2; 8.5 | 381; 148; 117 | |||
| Case 2 | F508del/L1065P | M | 14.1 | <15 |
| 16.6; 17.0 | 41; 190 | |||
| Case 3 | F508del/C276X | M | 6.1 | <15 |
| 7.4; 7.8 | 217; 70 |
Conclusions: Increase in FE‐1 values may occur in children aged 6‐17 on ETI therapy. The clinical implications need further investigation. Prospective data on large cohorts and guidance on timing of PERT discontinuation are needed.
Contact e‐mail address:
H‐EP034. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP034.1. LAPAROSCOPIC PERCUTANEOUS CHOLECYSTOSTOMY – A MINIMAL INVASIVE ALTERNATIVE TO PARTIAL EXTERNAL BILIARY DIVERSION IN ILEAL BILE ACID TRANSPORTER (IBAT)‐INHIBITOR‐RESISTANT PATIENTS
Stefanie Langreen1, Eva‐Doreen Pfister2, Ulrich Baumann2, Jens Dingemann1, Nagoud Schukfeh 1
1Department Of Pediatric Surgery, Hannover Medical School, Hannover, Germany, 2Pediatric Gastroenterology And Hepatology, Hannover Medical School, Hannover, Germany
Objectives and Study: The approval of Ileal bile acid transporter (IBAT) Inhibitors has significantly the improved treatment options for Progressive familial intrahepatic cholestasis (PFIC) and Alagille Syndrome. However, a subset of patients remain unresponsive to medical treatment and may require partial external biliary diversion (PEBD). We have previously introduced laparoscopic cholecystostomy as an innovative alternative to PEBD and improving upon that previous method, have developed an even simpler and less invasive approach.
Methods: For this surgical approach, the patient lies in supine position. A 5 mm transumbilical camera trocar is inserted. One or two additional working trocars are placed (right upper quadrant, epigastrium). The surgeon grasps and repositions the gallbladder fundus towards the abdominal wall using two transcutaneous holding sutures to secure it in position. A needle is used to puncture the gallbladder fundus, followed by guide wire insertion, needle removal and successive dilatation until Charrier size 10 is achieved. A CH‐10 Flowcare Gastrotube® is inserted and secured with a 1,2 ml aqua block. The holding sutures are fixed subcutaneously.
Results: Percutaneous cholecystostomy was successfully and safely performed in three patients (mean age 1 year) and immediate bile flow was achieved. Once healing is complete, the tube may be exchanged for a CH‐12 MIC‐Key® button for improved Patient comfort.
Conclusions: Laparoscopic percutaneous cholecystostomy facilitates bile flow and disrupts the enterohepatic bile acid circulation. This technique is safe and feasible and combines the principle of PEBD with the simplicity of a gallbladder drain, while preserving anatomical conditions.
Contact e‐mail address: langreen.stefanie@mh-hannover.de
H‐EP035. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP035.1. IS THERE OCCULT NEUROLOGICAL INVOLVEMENT IN HEPATIC WILSON DISEASE?
Moinak Sen Sarma 1, Neeraj Jain2, Amresh Mishra1, Abhay Kumar2, Amrita Mathias1, Ankit Agrawal1, Ujjal Poddar1, Jayantee Kalita3
1Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 2Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 3Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Objectives and Study: Progression of inapparent neurological involvement versus chelator‐induced neurotoxicity in Wilson disease (WD) is a therapeutic dilemma for clinicians. There is limited data on occult neurological involvement (ONI) in existing liver disease. We aimed to assess ONI by neuroimaging and neurodegenerative biomarkers in WD.
Methods: Newly diagnosed hepatic WD without neurological involvement (Unified Wilson's Disease Rating Scale=0) and overt hepatic encephalopathy were compared to controls (autoimmune hepatitis). All patients underwent magnetic resonance imaging(MRI), spectroscopy(MRS), neurofilament light chain(NfL), glial fibrillary acidic protein(GFAP), total serum copper(TSC) and serum exchangeable copper(ExCu) assessment. Severe (liver failure, decompensation) and stable (hepatitis, compensated cirrhosis) cases were compared and followed for 12 months.
Results: Significant MRS changes (table 1) were noted in the metabolite ratios between WD (n = 29) and control (n = 10).
| WD (n = 29) | Controls (n = 10) | P‐value | |
|---|---|---|---|
| Age (y) | 9.8(2.3) | 10.6(2.4) | 0.08 |
| Pediatric end‐stage liver disease score | 16(5.7) | 17(3.4) | 0.07 |
| NAA/Chol‐Short TE | 3.4(0.7) | 1.2(0.9) | 0.01 |
| NAA/Chol‐Intermediate TE | 2.8(0.7) | 2.5(0.4) | 0.03 |
| NAA/Chol‐Long TE | 4.5(0.8) | 2.1(0.7) | 0.01 |
| NAA/Cr‐Short TE | 3.2(0.2) | 1.1(0.2) | 0.02 |
| NAA/Cr‐Intermediate TE | 2.9(0.4) | 2.6(1.1) | 0.03 |
| NAA/Cr‐Long TE | 4.6(0.3) | 2.1(0.2) | 0.002 |
| Chol/Cr‐Short TE | 0.5(0.1) | 0.6 0.1) | 0.7 |
| Chol/Cr‐Intermediate TE | 0.6(0.2) | 0.5(0.2) | 0.9 |
| Chol/Cr‐Long TE | 1.8(0.4) | 0.8(0.4) | 0.09 |
| Values expressed as mean(SD). Metabolite ratios of N‐acetylaspartate(NAA), choline(Cho) were calculated with respect to creatine(Cr) TE:echo time (short:31 ms, intermediate:144 ms, long:288 ms) at basal ganglia |
13 WD (35%) had basal ganglia changes, higher NAA/Cr‐intermediate TE (2.8 ± 0.6 vs 2.0 ± 0.2, p = 0.03) higher NfL (28 ± 34 vs 21 ± 16 pg/mL, p = 0.02), GFAP (422 ± 244 vs 123 ± 24 pg/mL, p = 0.001, compared to normal MRI patients(n = 16). ΔTSC(3.6 ± 0.2µmol/L) and ΔExCu (2.8 ± 0.7µmol/L) increase was noted in 5/13 who progressed to florid neuroinvolvement in 3(1‐4) months on chelation therapy. 22/29 (76%) had native liver survival. Severe(n = 19) cases had higher NAA/Chol short TE and NAA/creat short TE than stable cases(n = 10).
Conclusions: ONI is already present at baseline in hepatic WD, especially in severe cases. Routine neuroimaging is recommended at presentation.
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H‐EP036. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP036.1. IMPACT OF CONTINUOUS GLUCOSE MONITORING SYSTEM IN IMPROVING GLYCEMIC CONTROL IN CHILDREN WITH GLYCOGEN STORAGE DISEASE
Moinak Sen Sarma 1, Arghya Samanta1, Preeti Dabadghao2, Anshu Srivastava2, Ujjal Poddar1
1Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 2Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Objectives and Study: Intermittent self‐monitoring of blood glucose (SMBG) may not sufficiently capture periods of asymptomatic hypoglycemia, particularly during sleep. A 24‐hour continuous glucose monitoring system (CGMS) is the standard of care in brittle diabetes. We aimed to study the impact of CGMS on glycemic control in children with glycogen storage disease (GSD).
Methods: Genetically proven hepatic GSDs with baseline hypoglycemia, prospectively underwent glycemic (14‐day CGMS, SBGM) and metabolic profile assessment at baseline. On day 15 of CGMS values, dietary modification (timing, dosage of corn‐starch) was implemented. Repeat glycemic and metabolic profiles were assessed at 3‐6 months. Glycemic indices such as time in range[TIR], below range[TBR], above range[TAR] were defined as blood sugar 70‐180 mg/dL,<70 mg/dL) and >180 mg/dL respectively.
Results: Thirty children (median age 4[IQR 2‐9] years, GSD I n = 11, GSD III n = 9, GSD VI n = 3, GSD IX n = 7) were evaluated. CGMS detected asymptomatic hypoglycemia in 58% of all readings, missed by SBGM. Pearson correlation analysis and Bland‐Altman curves showed poor correlation between CGMS and SBGM values at baseline(R = 0.29) and follow‐up(R = 0.38) [figure 1].
There was a statistically significant improvement in weight z‐score, TIR, TBR, aspartate aminotransferase, alanine aminotransferase, and secondary metabolic derangements after median 4.5 months (IQR4‐5) of CGMS‐guided dietary modification [table 1]. No major adverse events occurred.
| Parameters | At baseline | After CGMS‐guided dietary modifications | p‐value |
|---|---|---|---|
| Weight z‐score | ‐1.8(‐2.1 to ‐1.7) | ‐1.6(‐1.8,‐1.4) | 0.032 |
| Height z‐score | ‐2.3(‐2.4 to ‐2.1) | ‐2.2(‐2.3 to ‐2.1) | 0.73 |
| %Time in range[TIR],Median(IQR) | 55(45‐59) | 79(74,80) | 0.004 |
| %Time below range[TBR],Median(IQR) | 38(35‐43) | 17(15‐21) | 0.002 |
| %Time above range[TAR], Median(IQR) | 7(3‐9) | 4(2‐6) | 0.63 |
| Aspartate aminotransferase(U/L) | 315(156‐432) | 236.5(98‐312) | 0.004 |
| Alanine Aminotransferase(U/L) | 269(93‐321) | 215(64.5‐290) | 0.036 |
| Triglyceride(mg/dL) | 349(274‐385) | 215(167‐259) | 0.01 |
| Total cholesterol(mg/dL) | 223(180‐287) | 144(115‐177) | 0.04 |
Conclusions: CGMS is a novel and safe method to monitor wholesome glycemic control and has better yield for detecting asymptomatic hypoglycemia. CGMS‐guided dietary modifications have a positive impact on growth and metabolic profile in children with GSD.
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H‐EP037. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP037.1. LONG‐TERM EFFICACY AND SAFETY OF ODEVIXIBAT IN PATIENTS WITH ALAGILLE SYNDROME: POOLED RESULTS FROM PHASE III RANDOMIZED DOUBLE‐BLIND ASSERT AND OPEN‐LABEL ASSERT‐EXT STUDIES
Ekkehard Sturm 1, Madeleine Aumar2, Alastair Baker3, Philip Bufler4, Mara Cananzi5, Piotr Czubkowski6, Ozlem Durmaz7, Ryan Fischer8, Giuseppe Indolfi9, Wikrom Karnsakul10, Way Seah Lee11, Giuseppe Maggiore12, Mathias Ruiz13, Etienne Sokal14, Wendy Van Der Woerd15, Andrew Wehrman16, Fatine Elaraki17, Judy Zhu18, Alejandra Ramirez‐Santiago19, Henkjan Verkade20, Nadia Ovchinsky21
1Paediatric Gastroenterology And Hepatology, University Children's Hospital Tübingen, Tübingen, Germany, 2Pediatric Gastroenterology, Hepatology, And Nutrition, Univ Lille, CHU Lille, Lille, France, 3Paediatric Liver Centre, King's College Hospital, London, London, United Kingdom, 4Department Of Pediatric Gastroenterology, Nephrology, And Metabolic Diseases, Charité Universitätsmedizin Berlin, Berlin, Germany, 5Unit Of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology And Care Of The Child With Liver Transplantation, Department Of Women's And Children's Health, University Hospital of Padova, Padova, Italy, 6Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 7Department Of Child Health And Diseases, Gastroenterology, Hepatology And Nutrition, Istanbul Faculty Of Medicine, Istanbul University, Istanbul, Turkey, 8Division Of Pediatric Gastroenterology, Hepatology, And Nutrition, Children's Mercy Hospital, Kansas City, United States of America, 9Meyer Children's Hospital, IRCCS, Florence, Italy, 10Division Of Pediatric Gastroenterology, Hepatology, And Nutrition, Department Of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, United States of America, 11Department Of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia, 12Hepatology And Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy, 13Hépatologie Gastro‐entérologie Et Nutrition Pédiatriques, Hospices Civils de Lyon, Hôpital Femme‐Mère‐Enfant, Bron, France, 14Service De Gastroentérologie Et Hépatologie Pédiatrique, Université Catholique de Louvain, Cliniques St Luc, Brussels, Belgium, 15Department Of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands, 16Division Of Gastroenterology, Hepatology, And Nutrition, Boston Children's Hospital, Boston, United States of America, 17Ipsen Pharma, Boulogne‐Billancourt, France, 18Ipsen, Cambridge, United States of America, 19Ipsen (at time of study), Cambridge, United States of America, 20Pediatric Gastroenterology‐hepatology, Department of Paediatrics, University Medical Center Groningen, Beatrix Children's Hospital/University Medical Center Groningen, Groningen, Netherlands, 21Pediatric Gastroenterology And Hepatology, Hassenfeld Children's Hospital, NYU Langone, New York, United States of America
Objectives and Study: Robust long‐term data demonstrate sustained efficacy and tolerability for patients with Alagille syndrome (ALGS) remaining on odevixibat (ODX) for cholestatic pruritus after 72 weeks follow‐up in ASSERT‐EXT (NCT05035030), an open‐label, phase III study.1 Here, we evaluate the long‐term (96 week) pooled efficacy and safety data from ASSERT (NCT04674761) and ASSERT‐EXT.
Methods: Patients in the phase III, randomized, double‐blind ASSERT study received placebo or 120 µg/kg/day ODX for 24 weeks, and were eligible for the open‐label ASSERT‐EXT (120 µg/kg/day ODX for 72 weeks). Endpoints included change from baseline (BL) up to week 96 in pruritus score and serum bile acid (sBA). Liver parameters and long‐term safety were assessed throughout the 96 weeks.
Results: 52 patients (median age: 5.7 years [range: 1–15.5]) received ODX during ASSERT and ASSERT‐EXT. 44/50 patients completed ASSERT‐EXT, 6 patients discontinued (due to: AE of elevated bilirubin [n = 1], consent withdrawn [n = 3], liver transplant [n = 1], or medication change [n = 1]). Patients achieved rapid improvements in pruritus scores and reductions in sBA that were sustained with long‐term treatment (Figure A&B). Initial mean increases in ALT and AST levels reached a plateau or decreased through week 96. Improvements in pruritus scores were observed irrespective of baseline sBA and direct bilirubin levels (Table). Drug‐related treatment‐emergent AEs were reported in 36.5% of patients receiving ODX; the most common was diarrhea (17.3%; all events were non‐serious, and none led to discontinuation).
Conclusions: In ASSERT/ASSERT‐EXT – the only phase III study in patients with ALGS – patients treated with ODX achieved rapid improvements in pruritus and reductions in sBA levels that were sustained with long‐term treatment. Long‐term treatment with ODX was well tolerated, with no new or unexpected safety findings. 1. Ovchinsky N, et al. AASLD 2024. Abstract 50 (Oral)
Contact e‐mail address: ekkehard.sturm@med.uni-tuebingen.de
H‐EP038. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP038.1. GREATER IMPROVEMENTS IN BILIRUBIN WERE OBSERVED IN PRURITUS RESPONDERS AFTER MARALIXIBAT TREATMENT IN PATIENTS WITH PFIC: DATA FROM THE MARCH/MARCH‐ON TRIALS
Richard Thompson 1, Lorenzo D'antonio2, Nadia Ovchinsky3, Chuan‐Hao Lin4, Douglas Mogul5, Tiago Nunes5, Shannon Vandriel5, Cheng Chen5, Joanne Quan5, Pamela Vig5, Alexander Miethke6
1Institute of Liver Studies, King's College London, London, United Kingdom, 2Pediatric Hepatology, Gastroenterology And Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 3New York University Grossman School of Medicine, New York, New York, United States of America, 4Children's Hospital Los Angeles, Los Angeles, California, United States of America, 5Mirum Pharmaceuticals, Inc., Foster City, California, United States of America, 6Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Objectives and Study: Progressive familial intrahepatic cholestasis (PFIC) comprises a heterogeneous group of disorders linked to genetic defects in hepatocanalicular transporters. Prior data has demonstrated total bilirubin (TB) is associated with improved transplant‐free survival in this disorder. Maralixibat (MRX), an IBAT inhibitor approved for the treatment of PFIC in patients ≥3 months of age in the EU, has been shown to reduce TB. Here, we evaluate the relationship between pruritus response and changes in TB in MARCH and MARCH‐ON.
Methods: MARCH/MARCH‐ON have been previously described. Changes in TB were evaluated during the first 26 weeks of MRX treatment (average of weeks 18, 22, and 26). Pruritus was assessed with average morning ItchRO(Obs) severity score in week 15‐26 and response was defined as ≥1‐point reduction from baseline or having the average score ≤ 1 point. Differences between pruritus responders and non‐responders were analyzed using Wilcoxon signed‐rank test and Fisher's exact test.
Results: Fifty‐nine children were treated with MRX [PFIC1: n = 12 (20%); nt‐PFIC2: n = 28 (47%); PFIC3: n = 9 (15%); PFIC4: n = 7 (12%); PFIC6: n = 3 (5%)]. Pruritus response was observed in 37 (63%). Pruritus responders had lower Baseline TB compared to non‐responders (3.0 vs. 6.3 mg/dL, p < 0.01) and had greater reductions in TB following treatment (‐1.4 vs. ‐0.6 mg/dL, p = 0.048). Normalization of TB occurred more frequently in pruritus responders (Table, p < 0.01). In an age‐adjusted logistic regression model, patients with Baseline TB < 2.8 mg/dL (determined using ROC) were 4.74 times more likely to have a pruritus response (95% CI = 1.37‐16.43) compared to those with higher Baseline TB.
Conclusions: Changes in bilirubin and pruritus are linked in patients on MRX with greater reductions in bilirubin, an important marker of liver health, being observed in pruritus responders. People treated earlier in the course of disease (i.e., lower bilirubin) may have greater likelihood of improvement in pruritus.
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H‐EP039. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP039.1. ODEVIXIBAT TREATMENT IN PATIENTS WITH BILE SALT EXPORT PUMP DEFICIENCY: SUSTAINED EFFICACY IN AN INTEGRATED ANALYSIS OF RESPONDERS (PEDFIC 1 AND 2)
Richard Thompson 1, Henkjan Verkade2, Reha Artan3,4, Pier Luigi Calvo5, Piotr Czubkowski6, Buket Dalgıc7, Lorenzo D'antonio8, Ozlem Durmaz9, Tassos Grammatikopoulos10, Girish L Gupte11, Winita Hardikar12, Binita Kamath13, Florence Lacaille14, Elke Lainka15, Kathleen Loomes16, Cara Mack17, Patrick Mckiernan11, Hasan Ozen18, Sanjay Rajwal19, Eyal Shteyer20, Etienne Sokal21, Nisreen Soufi22, James Squires23, Ekkehard Sturm24, Shikha Sundaram25, Mary Tessier26, Wendy Van Der Woerd27, Jennifer Vittorio28, Fatine Elaraki29, Alejandra Ramirez‐Santiago30, Quanhong Ni31, Emmanuel Gonzales32
1Institute of Liver Studies, King's College London, London, United Kingdom, 2Pediatric Gastroenterology‐hepatology, Department of Paediatrics, University Medical Center Groningen, Beatrix Children's Hospital/University Medical Center Groningen, Groningen, Netherlands, 3Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden, 4Department Of Paediatric Gastroenterology, Akdeniz University, Antalya, Turkey, 5Pediatic Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera‐Città della Salute e della Scienza di Torino, Turin, Italy, 6Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 7Department Of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 8Department Of Paediatric Hepatology, Gastroenterology And Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy, 9Department Of Child Health And Diseases, Gastroenterology, Hepatology And Nutrition, Istanbul Faculty Of Medicine, Istanbul University, Istanbul, Turkey, 10Paediatric Liver, Gi And Nutrition Centre And Mowatlabs, King's College Hospital NHS Trust, London, United Kingdom, 11Liver Unit And Small Bowel Transplantation, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom, 12Department Of Gastroenterology And Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia, 13Division Of Gastroenterology, Hepatology And Nutrition, The Children's Hospital Of Philadelphia And Department Of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States of America, 14Pediatric Gastroenterology‐hepatology‐nutrition Unit, Hôpital Necker‐Enfants malades, Paris, France, 15Department Of Paediatric Gastroenterology, Hepatology, And Transplant Medicine, University Children's Hospital Essen, Essen, Germany, 16Department Of Gastroenterology, Hepatology And Nutrition, Children's Hospital of Philadelphia, Philadelphia, United States of America, 17Paediatrics Department, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, United States of America, 18Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Hacettepe University, Ankara, Turkey, 19Children's Liver Unit, Leed's Teaching Hospitals NHS Trust, Leeds Children's Hospital, Leeds, United Kingdom, 20Faculty Of Medicine, Juliet Keidan Department Of Paediatric Gastroenterology, Hebrew University of Jerusalem, Shaare Zedek Medical Centre, Jerusalem, Israel, 21Service De Gastroentérologie Et Hépatologie Pédiatrique, Université Catholique de Louvain, Cliniques St Luc, Brussels, Belgium, 22Paediatrics Department, Children's Hospital Los Angeles, Los Angeles, United States of America, 23Division Of Gastroenterology, Hepatology And Nutrition, The Children's Hospital of Pittsburgh, Pittsburgh, United States of America, 24Paediatric Gastroenterology And Hepatology, University Children's Hospital Tübingen, Tübingen, Germany, 25University Of Colorado School Of Medicine, Children's Hospital of Colorado, Aurora, United States of America, 26Department Of Paediatrics, Section of Paediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine−Texas Children's Hospital, Houston, United States of America, 27Department Of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands, 28Department Of Surgery, Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, United States of America, 29Ipsen Pharma, Boulogne‐Billancourt, France, 30Ipsen (at time of study), Cambridge, United States of America, 31Ipsen, Cambridge, United States of America, 32Hépatologie Et Transplantation Hépatique Pédiatriques, Centre de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, FSMR FILFOIE, ERN RARE LIVER, Hôpital Bicêtre, AP‐HP, Université Paris‐Saclay, Hépatinov, Paris, France
Objectives and Study: Long‐term data demonstrate improvements in pruritus, reductions in serum bile acids (sBA), and manageable safety with odevixibat (ODX) across progressive familial intrahepatic cholestasis (PFIC) types in the phase III PEDFIC 1 study (NCT03566238) and PEDFIC 2 open‐label extension (NCT03659916). It is important to better understand outcomes and response dynamics for patients with different PFIC types. Therefore, we aimed to further characterize responders to ODX in patients with bile salt export pump (BSEP) deficiency (PFIC 2).
Methods: Patients with BSEP deficiency treated with ODX (40 or 120 µg/kg/day) in PEDFIC 1/2 who achieved an sBA response at Week 24 were included in this post hoc analysis. sBA response was stringently defined as ≥70% reduction in fasting sBA from baseline (BL) or sBA ≤70 μmol/L. We report sBA and pruritus outcomes over time for these patients.
Results: 70 patients with BSEP deficiency enrolled; 69 remained on treatment at Week 24. At Week 24, 26 achieved an sBA response with ODX (BSEP 1, n = 6; BSEP 2, n = 20); 21 (80.8%) of these patients achieved both an sBA and pruritus response. For sBA responders, mean BL sBA was 248.06 μmol; reductions in mean sBA were seen by Week 4 and sustained over time (Figure 1a) and mean BL scratching score was 3.00 and improved over time (Figure 1b). sBA responders with BSEP 2 had higher mean BL sBA levels than BSEP 1 (272.30 and 167.25 µmol/L, respectively); both BSEP 2 and BSEP 1 responders achieved and sustained low sBA levels (mean sBA levels at Week 72 of 26.67 and 44.00 µmol/L, respectively).
Conclusions: In patients with BSEP deficiency, sBA responses to ODX were largely concordant with pruritus response. sBA responders had early and sustained reductions in sBA and pruritus. Patient‐level data and additional endpoints (including liver function tests and safety) will be presented.
Contact e‐mail address: richard.j.thompson@kcl.ac.uk
H‐EP040. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP040.1. IMPACT OF LONG‐TERM MARALIXIBAT TREATMENT ON CONCOMITANT MEDICATION USE FOR THE TREATMENT OF CHOLESTATIC PRURITUS IN ALAGILLE SYNDROME: REAL‐WORLD EXPERIENCE IN THE UNITED STATES
Tony Tokman 1, Jolan Terner‐Rosenthal1, Robin Howard1, Renee Shiota1, Wiktor Stopka2, Liz Turner1
1Mirum Pharmaceuticals, Inc., Foster City, California, United States of America, 2Beghou Consulting, LLC., Emeryville, California, United States of America
Objectives and Study: Maralixibat, an IBAT inhibitor, is approved to treat cholestatic pruritus in patients with Alagille syndrome (ALGS) ≥ 2 months of age in the EU and ≥3 months of age in the US. This study aimed to understand the long‐term real‐world concomitant use of medications at the start of maralixibat treatment and how it changes over time.
Methods: This analysis utilized pharmacy data from the Mirum Access Plus (MAP) program in the US. The MAP program is a single source specialty pharmacy and patient education program for patients receiving maralixibat. Patients were included in the analysis if they received their first commercial shipment of maralixibat by 4/1/2022 and have not discontinued maralixibat therapy in order to capture concomitant medication trends of up to 2 years of potential maralixibat use. Concomitant medication information was verified by MAP before each shipment of maralixibat.
Results: 178 US patients were included, with a median age at start of maralixibat treatment of 6 years. Median days on maralixibat therapy was 751 days. At the start of treatment, patients were receiving a median of 2 antipruritic medications and 1 nutritional/vitamin supplement. Baseline use of concomitant medications were as follows: choleretics (80%), pregnane X receptor (PXR) agonist (49%), antihistamine or allergy medication (49%), bile acid sequestrant (BAS) (7%), opioid antagonist (10%), SSRIs (2%) and a nutritional/vitamin supplement (72%). During maralixibat treatment, 43% of patients discontinued ≥1 concomitant medication, 21% discontinued ≥2 and 8% discontinued ≥3. 54% discontinued a BAS during maralixibat treatment, 44% discontinued a PXR agonist, 35% discontinued an opioid antagonist, 26% discontinued an antihistamine/allergy medication, 25% discontinued a SSRI, 12% discontinued a choleretic, and 22% discontinued a nutritional/vitamin supplement. Median days on concomitant medication until discontinuation was 309 days.
Conclusions: Consistent with previous findings, these data demonstrate that maralixibat can reduce polypharmacy burden long‐term in a real‐world setting.
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H‐EP041. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP041.1. BIOCHEMICAL AND IMMUNOLOGICAL MARKERS SHOW LIMITED ACCURACY IN PREDICTING HISTOLOGICAL REMISSION IN PAEDIATRIC AUTOIMMUNE HEPATITIS: RESULTS FROM A MULTICENTER STUDY
Francesca Trevisan 1, Eleonora Munaretto2, Claudia Mescoli3, Marco Bolzonella4, Claudio Palmeri4, Claudia Cozzolino4, Paola Gaio2, Luca Bosa5, Giovanna Faggian5, Vincenzo Baldo4, Maesha Deheragoda6, Marianne Samyn7, Mara Cananzi5
1Department Of Women's And Children's Health, University Hospital of Padua, Padova, Italy, 2Unit Of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology And Care Of The Child With Liver Transplantation, Department Of Women's And Children's Health, University Hospital of Padua, Padua, Italy, 34. Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University Hospital of Padova, Padova, Italy, 4Department Of Cardiac, Thoracic, Vascular Sciences, And Public Health, University of Padova, Padova, Italy, 5Unit Of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology And Care Of The Child With Liver Transplantation, Department Of Women's And Children's Health, University Hospital of Padova, Padova, Italy, 65. Institute of Liver Studies, King's College Hospital, London, United Kingdom, 7Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom
Objectives and Study: Paediatric autoimmune hepatitis (pAIH) responds well to immunosuppression, but relapse risk remains high upon treatment withdrawal. Whilst ongoing histological activity increases the likelihood of relapse, the role of liver biopsy to decide on discontinuation remains debated. This study explores the value of biochemical and immunological markers in predicting histological activity in pAIH.
Methods: We conducted a retrospective, observational study involving children diagnosed with pAIH per ESPGHAN criteria between 2000 and 2024, at the University Hospital of Padua and King's College Hospital. The endpoints for pAIH treatment evaluated using non‐invasive parameters ‐ biochemical response (BR; normal transaminases), immunological response (IR; normal immunoglobulin levels), complete biochemical response (CBR; normal transaminases and immunoglobulin levels), and serological remission (SR; negative autoantibodies) ‐ were compared with histological remission (HR), defined as a modified hepatitis activity index (mHAI) < 4. Concordance analysis was performed to assess agreement between invasive and non‐invasive outcome measures.
Results: 71 patients (58% female) diagnosed with pAIH (AIH‐1 77%, AIH‐2 21%, seronegative 2%) at a median age of 11 years, were included. Follow‐up biopsies were performed at a median age of 14 years after an average time of 5 years after diagnosis, with evaluating HR before discontinuing immunosuppression as most common indication (68%). Median mHAI was 2 (range 0–14). BR predicted HR in 80% of patients (accuracy 0.84, kappa test 0.64) and CBR in 81.6% of patients (accuracy 0.81, kappa test 0.6). IR and SR predicted HR in 68% and 80% of cases, but demonstrated poor concordance, with kappa values of 0.3 and 0.2, respectively.
Conclusions: BR and CBR are not reliable indicators of HR in pAIH, as 20% of patients with normal transaminases +/‐ immunoglobulin levels still exhibit active histologic disease. Despite the inherent limitations of this retrospective analysis, our findings underscore the importance of follow‐up liver biopsies for accurately assessing histological remission.
Contact e‐mail address: mara.cananzi@aopd.veneto.it
H‐EP042. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP042.1. PLATELET‐RELATED PARAMETERS IN CHILDREN WITH METABOLIC DYSFUNCTION‐ASSOCIATED STEATOTIC LIVER DISEASE
Bartosz Tuchliński, Aleksandra Motkowska, Anna Lebensztejn, Kinga Trochimczyk, Marta Flisiak‐Jackiewicz, Anna Bobrus‐Chociej, Dariusz Lebensztejn
Department Of Paediatrics, Gastroenterology, Hepatology, Nutrition, Allergology And Pulmonology, Medical University of Bialystok, Bialystok, Poland
Objectives and Study: Metabolic dysfunction‐associated steatotic liver disease (MASLD) is the most common cause of liver pathology in adults and children and may progress from simple steatosis to steatohepatitis, fibrosis and cirrhosis. Growing scientific evidence suggests that MASLD is a risk factor for cardiovascular disease. Platelet‐related parameters (P‐RP) are involved in the process of low‐grade systemic inflammation, liver fibrosis and the process of atherogenesis but results of studies in patients with MASLD are inconsistent. Therefore, the aim of this study was to evaluate the association between P‐RP and parameters of liver fibrosis and atherosclerosis in children with MASLD.
Methods: The retrospective study included 219 obese/overweight children (aged 7‐18 yrs., median 12 yrs.). MASLD was diagnosed according to criteria developed by numerous scientific societies (JPGN 2024). Platelets (PLT) and P‐RP (PCT, PDW, MPV, P‐LCR) were evaluated using an automated analyser (Sysmex‐XN). Intima media thickness (IMT) was assessed by ultrasound. AST to Platelet Ratio Index (APRI) and Fibrosis index (FIB‐4) were calculated according to the mathematical formulas. ROC analysis was performed to assess the power of the examined P‐RP in the diagnosis of MASLD.
Results: MASLD was diagnosed in 138 children (63%). Children with MASLD had significantly higher levels of PLT, PCT, ALT, AST, GGT, triglycerides, uric acid and value of waist circumference, HOMA‐IR, APRI and FIB‐4 compared to the nonhepatopathic controls (n = 81). The most important platelet‐related parameter in identifying MASLD was PCT (AUC = 0.62, p = 0.008, cut‐off=0.31, Se=56.5%, Sp=62%). We found a significant positive correlation between IMT and PDW (r = 0.28), MPV (r = 0.25) and P‐LCR (r = 0.26). PLT, PCT, PDW, MPV and P‐LCR significantly correlated with APRI (r = ‐0.6, ‐0.52, 0.3, 0.32, 0.3 respectively) and FIB‐4 (r = ‐0.73, ‐0.63, 0.4, 0.4, 0.4 respectively).
Conclusions: Selected platelet‐related parameters can be considered as useful markers of liver fibrosis and subclinical atherosclerosis in children with MASLD.
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H‐EP043. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP043.1. REPEATABILITY AND RELIABILITY OF HOME‐BASED SCREENING FOR BILIARY ATRESIA USING DIGITAL INFANT STOOL COLOUR CARDS IN NORTH INDIA
Piyush Upadhyay
Division Of Pediatric Hepatology And Gastroenterology, Department Of Pediatrics, Dr RML INSTITUTE OF MEDICAL SCIENCES, Lucknow, India
Objectives and Study: The aim of the study was to study the Reliability of Home‐Based Screening for Biliary Atresia Using Digital Infant Stool Colour Cards (dSCC), the factors affecting reliable interpretation of Stool colour charts at home and to assess the dSCC Response (SRR) and utilization rates(SUR)
Methods: A dSCC was distributed and taught to the families of newborns at birth. Families reported stool colour at the time of immunisation(6,10 weeks) or earlier by phone/in person in case of pale stools. Phone surveys to families was done, who did not return for vaccination, to estimate total card utilization rate(TCUR). Stool samples of each infant was evaluated by 3 family members, 3 paramedics, and 2 trainee doctors.
Results: Seven thousand five hundred and twenty nine eligible newborn(90.2%) were enrolled. However, only 6459 infants(85%)%) who turned up for the vaccination at 6 weeks got included, of these 4896 infants (65%) (77.9%) returned at 10 weeks. One case of Biliary atresia were identified which was labelled pale by doctors and paramedics but not by family members. The Spearman inter‐class correlation coefficient(ICC) showed poor correlation between family members and trainee doctors(0.26) and with paramedical staff(0.31), but good between doctors and paramedics(0.84). After counseling at 6 weeks, ICC improved to 0.77, 0.68 and 0.88 for the latter. Most common reason for false labelling was predisposition for non‐acceptance of disease at early age of child. Kasai portoenterostomy was done at 59 days, survived and successful. No significant difference in socio‐economic status was noted among these 8 infants. Stool Colour chart Response/Return Rate was 85.8). dSCC Utilization Rate (Conservative) was 90.6%. dSCC Utilization Rate (Optimistic) was 95.9%
Conclusions: Stool colour chart screening program in a developing country like India will fail despite high utilisation rate without widespread awareness program or screening needs to be carried out at the time of 1st routine vaccination
Contact e‐mail address: uppiyush@yahoo.com
H‐EP044. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EP044.1. THE INFLUENCE OF WAR‐RELATED ANXIETY ON FREE FATTY ACIDS CONTENT IN UKRAINIAN CHILDREN WITH METABOLIC‐ASSOCIATED STEATOTIC LIVER DISEASE
Natalia Zavhorodnia 1, Oksana Tatarchuk2, Inna Klenina2, Raisa Kislova3, Oksana Petishko2
1Pediatric Gastroenterology, SI Institute Gastroenterology of the NAMS of Ukraine, Dnipro, Ukraine, 2Research, SI "Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine", Dnipro, Ukraine, 3Mini‐invasive Endoscopic Interventions And Instrumental Diagnostics, SI "Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine", Dnipro, Ukraine
Objectives and Study: War in Ukraine has a negative impact on metabolic‐dysfunction‐associated steatotic liver disease course in children due to stress‐related eating disorders, social isolation, and restrictions on physical activity/Objective: to study the impact of anxiety on the content of serum free fatty acids (FFA) in children with МASLD during the war in Ukraine.
Methods: The study included 42 obese children with MASLD aged 6 to 17 years (averaged 12.00 ± 0.56 years). Determination of the presence of liver steatosis was performed by transient elastography with CAP measurement (FibroScan®502touch, Echosence, France). The presence of obesity was confirmed by bioimpedance analysis (TANITA MC‐780MA, Japan). Screening for anxiety disorders was performed using the Screen for Child Anxiety‐Related Disorders (SCARED) questionnaire. Depending on the presence of anxiety disorders, children with MASLD were divided into 2 groups: group I ‐ 12 children without anxiety disorders, group II ‐ 30 children with anxiety disorders. The control group consisted of 10 children of normal weight without anxiety disorders. The content of serum FFAs was determined by gas chromatography. The clusters of saturated fatty free fatty acids (SFA), monounsaturated free fatty acids (MUFA), and polyunsaturated free fatty acids (PUFA) were calculated separately.
Results: The total content of MUFA decreased in children of group II by 2.0 times, p < 0.05, compared to the control group. The median level of SFAs was significantly reduced by 1.9 times, p < 0.05, in children of group II. Children of group II had a higher frequency of detection of a decrease in the PUFA content (66.7% versus 50.0% in group I). Correlations were found between fat content and the ratio of omega 3/omega 6 PUFA (r = ‐ 0.30, p < 0.05).
Conclusions: Thus, the presence of war‐related anxiety in children with MASLD is accompanied by excessive oxidation of fatty acids, namely PUFA clusters, which could contribute to the MASLD progression.
Contact e‐mail address: nzavgorodni75@gmail.com
H‐EP045. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EP045.1. A LONG WAIT FOR THOSE WITH A SHORT GUT: THE IMPACT OF INCREASED WAITING TIME IN PAEDIATRIC INTESTINAL TRANSPLANTATION‐ A SINGLE CENTRE EXPERIENCE
Sinead Cunningham, Sergio Assia Zamora, Miriam Cortes Cerisuelo, Carly Bambridge, Nigel Heaton, Jonathan Hind, Anil Dhawan
Kings College Hospital NHS Trust, London, United Kingdom
Objectives and Study: Intestinal transplant (ITx) is the standard of care for intestinal failure (IF) where parental nutrition is no longer feasible‐ due to loss of vascular access, recurrent sepsis or intestinal failure associated liver disease (IFALD).
Methods: Retrospective case review of paediatric patients referred for consideration of intestinal transplant from 1998‐2024 at a single UK centre.
Results: 37 children from 1998‐2024, have been transplanted. 21 boys (57%), age range 7 months to 17 years‐old (mean 6.8, median 7). Grafts include: 13 isolated small bowel (SB) (31%); 9 SB and colon (22%); 6 liver and SB (14%); 9 multivisceral transplants (22%); 1 multivisceral plus colon and kidney (2%); 1 living donor SB (2%);1 living donor liver and SB (2%). 5 patients required retransplantation (14%). Median time on the waiting list was 215 days (range 13‐1248 days). Due to prolonged waiting times and severity of IFALD, a further 9 patients (24%), initially listed for small bowel and liver containing grafts, required an isolated liver transplant as a life‐saving measure while awaiting suitable organs, and a further 6 having died on the list in the last 24 months. Of those transplanted, the 1, 2, and 5 year survival is 93%, 86% and 71% respectively.
Conclusions: Recent innovations in paediatric intestinal transplantation (ITx) at our centre include the use of reduced liver and bowel grafts and living donor grafts, achieving satisfactory 1‐ and 5‐year survival rates with excellent quality of life for survivors. However, median waiting times in our cohort (215 days) were nearly four times longer than the UK adult population (54 days) (UK intestinal transplant registry 2012–2022). Isolated liver transplantation has become a critical lifesaving measure for patients with severe intestinal failure‐associated liver disease (IFALD) during extended waiting periods. To further improve outcomes, efforts are needed to increase the availability of paediatric donors and utilize more living‐related grafts.
Contact e‐mail address: sinead.cunningham3@nhs.net
H‐EP046. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EP046.1. NATURAL HISTORY OF ANTI‐BSEP ALLOIMMUNE DISEASE IN LIVER TRANSPLANTED PATIENTS FOR BILE SALT EXPORT PUMP DEFICIENCY
Antoine Gardin 1, Chiara Rubino2, Alice Michaut3, Géraldine Résin1, Charlotte Mussini3, Mathias Ruiz4, Teresa Antonini5, Bertrand Roquelaure6, Patrick Borentain7, Dominique Debray8, Xavier Stephenne9, Bogdan Hermeziu1, Thomas Falguières10, Giuseppe Maggiore11, Eleonora De Martin12, Emmanuel Gonzales1, Emmanuel Jacquemin1
1Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 2Liver Unit, Meyer Children's Hospital IRCSS, Florence, Italy, 3Pathology Unit, Bicêtre Hospital, Le Kremlin Bicêtre, France, 4Pediatric Gastroenterology and Hepatology Unit, Bron Hospital, Bron, France, 5Hepatology Unit, Croix Rousse Hospital, Lyon, France, 6Unit of Pediatric Gastroenterology and Hepatology, Timone Hospital, Marseille, France, 7Hepatology and Gastroenterology Unit, Timone Hospital, Marseille, France, 8Pediatric Hepatology Unit, Necker Hospital, Paris, France, 9Division of Pediatric Gastroenterology and Hepatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium, 10Inserm UMR_S 1193, University Paris‐Saclay, Orsay, France, 11Hepatogastroenterology and Liver Transplant Unit, Bambino Gesù Children's Hospital, Rome, Italy, 12Hepatology Unit, Paul Brousse Hospital, Villejuif, France
Objectives and Study: Patients with bile salt export pump (BSEP) deficiency may develop anti‐BSEP antibodies after liver transplantation (LT) because of an anti‐BSEP alloimmunisation (ABAI), but its frequency and risk factors are not precisely known.
Methods: A multicenter cohort of 35 patients who underwent LT for BSEP deficiency was extensively studied including screening for anti‐BSEP antibodies (immunodetection technique).
Results: Ten patients (29%) were screened positive for anti‐BSEP antibodies. All developed ABAI, in median 5 years after LT (range: 1.5‐14), characterized by cholestasis and pruritus (n = 10/10), jaundice (n = 6/10), elevated serum bile acid (n = 8/8). Graft histology revealed cholestasis and giant hepatocytes in 7 out of 9 patients and a reduced canalicular BSEP staining in 4 out of 7. Unusual C4d canalicular staining was identified in liver biopsy in 4 out of 5 patients. ABAI evolved toward cirrhosis/liver failure in 7 patients, 6 of whom (60%) received a second LT. With escalation of immunosuppression and additional therapies (gammaglobulins, rituximab, plasmapheresis or immunoadsorption), the disease was controlled in 3 of the 4 non‐retransplanted patients and in 4 of the 6 retransplanted patients. Three patients (30%) died because of uncontrolled ABAI. Among the 25 patients without ABAI, one died (4%) and another one was retransplanted (4%). While a severe ABCB11 genotype (biallelic truncating mutations) was significantly associated with ABAI (80% in patients with ABAI vs 28% in patients without ABAI, p = 0.008), absence of BSEP staining on native liver, post‐LT CMV infection, presence of biliary anastomosis strictures or graft rejection were not.
Conclusions: In patients with BSEP deficiency, ABAI is a frequent post‐LT complication that should be screened for, especially in patients with severe genotypes. Early diagnosis may improve patient outcome.
Contact e‐mail address: antoine.gardin@aphp.fr
H‐EP047. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EP047.1. POST‐TRANSPLANT LYMPHOPROLIFERATIVE DISORDERS IN PAEDIATRIC LIVER TRANSPLANT RECIPIENTS: SURVEY REPORT OF UK‐WIDE CENTRES
Sunitha Vimalesvaran1, Vandana Jain1, Kavya Kurkal 2, Sandra Lucas3, Hannah Spoor1, Natalie Bailey1, Bethany Tucker1, Sophie Cant1, Fernanda Monge Urrea1, Sinead Cunningham1, Chirag Shah1, Sanjay Rajwal3, Girish L Gupte2, Anita Verma1
1Paediatric Liver, Gi And Nutrition Centre And Mowat Labs, King's College Hospital NHS Foundation Trust, LONDON, United Kingdom, 2Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom, 3Paediatric Hepatology, Leeds Children's Hospital, Leeds, United Kingdom
Objectives and Study: Post‐transplant lymphoproliferative disease (PTLD) is associated with significant morbidity in paediatric liver transplant recipients (PLTR). In this UK‐wide survey we aim to characterise epidemiology, risk factors and treatment strategies for PTLD.
Methods: Histologically‐proven PTLD patients (<18 years of age) in PLTR cohort at UK Hepatology Centres (King's College Hospital, Birmingham and Leeds Children's Hospital) between January 2013‐December 2023, were identified, and standardised data collection was performed. For continuous variables, median [interquartile ranges] were calculated
Results: PTLD occurred in 78/2167 PLTR (3.6%) recipients. Histological categorisation included; early/non‐destructive (41%), polymorphic (28%), monomorphic (27%) and Hodgkin lymphoma‐type (3.8%). Time from transplant to PTLD was 10.2 months [4.8,21.2]. Recipient Epstein‐Barr Virus (EBV) sero‐negativity, cytomegalovirus infection and rejection episode(s) were present in 56%, 31% and 49% respectively. Ninety‐nine percent PTLD were EBV‐related. Immunosuppression (IS) at PTLD diagnosis; prednisolone and calcineurin inhibitor (100%) and a second agent [azathioprine/MMF/sirolimus] (24%). Clinical symptoms were present in 64%. Screening investigations included haemoglobin [73 g/dl(56,101)], albumin [27 g/L(17,39)] and lactate dehydrogenase [461 U/L(196,795]. Faecal occult blood was positive in 52% and diagnostic sensitivity for PTLD by CT chest/abdomen, endoscopy and bone marrow aspirate was 72%, 92% and 12% respectively. All patients underwent IS manipulation [cessation(73%);reduction(27%)]; 40% required no further treatment. Rituximab was administered to 53%; 7% received chemotherapy; 12.8% received cytotoxic T‐cells, and 3.8% underwent surgery. Acute rejection occurred in 41%; survival post‐PTLD was 97.4%.Table 1. Demographics and risk factors/treatment/complications stratified by histological classification of PTLD.
Conclusions: In this first UK‐wide PTLD survey, low incidence and low mortality of PTLD in PLTR was identified. High rejection rates pre‐ and post‐PTLD, were observed. Over half of PTLD cohort were EBV‐seronegative. Early/non‐destructive type was most common, and needs further characterisation to establish true PTLD from infectious mononucleosis or primary EBV infection. This valuable UK collaboration could help characterise predictive markers and stratify treatment in this heterogenous cohort.
Contact e‐mail address: vjain@nhs.net
H‐EP048. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EP048.1. ONE‐YEAR OUTCOMES OF HEPATIC ARTERY STENOSIS AFTER PEDIATRIC LIVER TRANSPLANTATION: RESULTS FROM AN INTERNATIONAL, MULTICENTER, REAL‐WORLD REGISTRY
Weihao Li 1, Hermien Hartog2, Julia Minetto3, Marcelo Dip3, Sergio Sierre4, Stéphanie Franchi‐Abella5, Emmanuel Gonzales6, Florent Guérin7, Ane Andres8, Francisco Hernandez‐Oliveros8, Esteban Remacha9, Catalina Jaramillo10, Leandra Bitterfeld11, Arielle Melen12, Norman Junge13, Ulrich Baumann13, Nicolas Richter14, Joseph Dinorcia15, Puja Patel15, Sander Florman15, João Seda Neto16, Eduardo Antunes Da Fonseca16, Carolina Magalhães Costa16, Martín De Santibañes17, Victoria Ardiles17, Jimmy Walker Uño17, Lucie Gonsorčíková18, Jiří Froněk19, Šimon Bohuš18, Girish L Gupte20, Khalid Sharif20, Simon Mcguirk21, Denise Aldrian22, Jonathan Seisenbacher22, Georg Vogel22,23, Barbara Wildhaber24, Ana Calinescu24, Alexis Ricoeur25, Mukesh Kumar26, Shaleen Agarwal26, Subhash Gupta26, Tingbo Liang27, Xueli Bai27, Wei Zhang27, Paolo Marra28, Lorenzo D'antonio29,30, Domenico Pinelli31, Marisa Beretta32, Francisca Van Der Schyff33, Cristina Ferreira34, Luiza Nader34, Marco Farina34, Jesus Quintero35, Maria Mercadal‐Hally35, Jose Andrés Molino‐Gahete35, Winita Hardikar36, Sue Bates36, Lynette Goh36, Dieter Broering37, Dimitri Raptis37, Kris Ann H. Marquez37, Amit Shah38,39, Bryanna Domenick38, Michael Acord39,40, Arti Pawaria41, Haritha Rajakrishnan42, Sudhindran Surendran42, Thomas Casswall43, Carl Jorns44, Martin Delle45, Muthukumarassamy Rajakannu46, Kumar Palaniappan46, Mohamed Rela46, Khaled Dajani47, Alessandro Parente47, David Bigam47, Vidyadhar Mali48, Marion Aw49, Sonal Asthana50, Mallikarjun Sakpal50, Ashritha Avalareddy50, Marco Spada51, Lidia Monti52, Tommaso Alterio53, Marek Stefanowicz54, Julita Latka‐Grot54, Adam Koleśnik55, Yusuke Yanagi56, Hajime Uchida56, Ryuji Komine56, Riccardo Superina57, Juan Carlos Caicedo57,58, George Mazariegos59, Kyle Soltys59, Rene Scheenstra60, Rudi Dierckx61, Hubert Van Der Doef60, Reinoud Bokkers1
1Department Of Radiology, Medical Imaging Centre, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 2Department Of Surgery, Section Of Hepatobiliary Surgery & Liver Transplantation, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 3Division Of Liver Transplant, J. P. Garrahan Hospital, Buenos Aires, Argentina, 4Division Of Interventional Radiology, J. P. Garrahan Hospital, Buenos Aires, Argentina, 5Pediatric Radiology Department, Bicêtre Hospital, Bicêtre, France, 6Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 7Department Of Pediatric Surgery, Bicêtre Hospital, Bicêtre, France, 8Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain, 9Pediatric Hepatology Department, La Paz University Hospital, Madrid, Spain, 10Department Of Paediatrics, Division Of Paediatric Gastroenterology, Hepatology And Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, United States of America, 11Intermountain Primary Children's Hospital, Salt Lake City, United States of America, 12University of Utah School of Medicine, Salt Lake City, United States of America, 13Division For Pediatric Gastroenterology And Hepatology, Department Of Pediatric Kidney, Liver And Metabolic Diseases, Hannover Medical School, Hannover, Germany, 14Department Of General, Visceral And Transplant Surgery, Hannover Medical School, Hannover, Germany, 15Recanati‐miller Transplantation Institute, Mount Sinai Hospital, New York, United States of America, 16Hepatology And Liver Transplantation, Hospital Sírio‐Libanês, São Paulo, Brazil, 17Hpb And Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 18Department Of Pediatrics, First Faculty Of Medicine, Charles University Prague and Thomayer University Hospital, Prague, Czech Republic, 19Department Of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic, 20Liver Unit (including Small Bowel Transplantation), birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom, 21Department Of Radiology, birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom, 22Department Of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria, 23Institute Of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria, 24Swiss Pediatric Liver Center, Division Of Child And Adolescent Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland, 25Swiss Pediatric Liver Center, Division Of Interventional Radiology, Geneva University Hospitals, University of Geneva, Geneva, Geneva, Switzerland, 26Centre For Liver And Biliary Sciences, Max Super Speciality Hospital, New Delhi, India, 27Department Of Hepatobiliary And Pancreatic Surgery, Liver Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, 28Department Of Radiology, ASST Papa Giovanni XXIII Hospital, University of Milano‐Bicocca, Bergamo, Italy, 29Department Of Paediatric Hepatology, Gastroenterology And Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy, 30Department Of Medicine And Surgery, University of Milan‐Bicocca, Bergamo, Italy, 31Department Of Organ Failure And Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy, 32Department Of Peadiatrics, Wits Donald Gordon Medical Centre, Johannesburg, South Africa, 33Department Of Surgery, Wits Donald Gordon Medical Centre, Johannesburg, Johannesburg, South Africa, 34Department Of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil, 35Pediatric Hepatology And Liver Trasplant Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 36Department Of Gastroenterology, Royal Children's Hospital, Melbourne, Australia, 37Organ Transplant Center Of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 38Division Of Gastroenterology, Hepatology And Nutrition, Department Of Paediatrics, Children's Hospital of Philadelphia, Philadelphia, United States of America, 39Perelman School Of Medicine, University of Pennsylvania, Philadelphia, United States of America, 40Department Of Radiology, Children's Hospital of Philadelphia, Philadelphia, United States of America, 41Department Of Pediatric Hepatology & Gastroenterology, Amrita Institute of Medical Sciences & Research Centre, New Delhi, India, 42Department Of Solid Organ Transplantation, Amrita Institute of Medical Sciences & Research Centre, Kochi, India, 43Division For Paediatrics, Department Clinical Interventions And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 44Department Of Transplantation Surgery, F82, Karolinska University Hospital, Department Clinical Science, Intervention And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 45Department Of Radiology, Karolinska University Hospital, Department Clinical Science, Intervention And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 46Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chromepet, Chennai, India, 47Department Of Surgery, Division Of Transplantation Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada, 48Department Of Paediatric Surgery, National University Hospital, Singapore, Singapore, 49Department Of Paediatrics, National University Hospital, Singapore, Singapore, 50Integrated Liver Care Department, Aster CMI hospital, Bengaluru, India, 51Division Of Hepatobiliopancreatic Surgery, Liver And Kidney Transplantion, IRCCS Bambino Gesù Children's Hospital, Rome, Italy, 52Gastrointestinal And Transplanted Liver Imaging Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy, 53Hepatology And Liver Transplant Unit, IRCCS Bambino Gesu' Children's Hospital, Rome, Italy, 54Department Of Pediatric Surgery And Organ Transplantation, Childrens Memorial Health Institute, Warsaw, Poland, 55Cardiovascular Interventions Laboratory, Childrens Memorial Health Institute, Warsaw, Poland, 56Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan, 57Division Of Transplant And Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, United States of America, 58Division Of Transplantation, Department Of Surgery, Northwestern University Feinberg School of Medicine, Chicago, United States of America, 59University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Hillman Center for Pediatric Transplantation, University of Pittsburgh, Pittsburgh, United States of America, 60Division Of Paediatric Gastroenterology And Hepatology, Department Of Paediatrics, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 61Department Of Nuclear Medicine And Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
Objectives and Study: Hepatic artery stenosis (HAS) after pediatric liver transplantation (pLT) can progress to hepatic artery thrombosis, biliary complications, graft failure, and death. However, there is a lack of robust studies investigating outcomes of HAS after pLT. This study aimed to determine one‐year graft and patient survival rates and identify risk factors associated with adverse outcomes in patients who develop HAS after pLT.
Methods: We analyzed data from patients who developed HAS after pLT from the HEPatic Artery stenosis and Thrombosis after liver transplantation In Children (HEPATIC) registry. This registry includes data from 24 centers across 20 countries and six continents, spanning a 20‐year period during which 8,469 pLTs were performed. Clinical characteristics were examined at three timeframes: pre‐transplant, immediate post‐transplant, and after HAS diagnosis. Risk factors for graft loss and mortality after HAS were identified using multivariate Cox regression analyses, with model assumptions verified using Schoenfeld residuals.
Results: HAS was reported in 119 patients (estimated 1.4%; 51% female; median age 4.2 years). The overall one‐year graft and patient survival rates after HAS diagnosis were 93% (95% CI: 89–98) and 97% (95% CI: 93–100), respectively. Multivariate Cox regression analysis identified dialysis requirement at HAS diagnosis as the sole independent risk factor for both one‐year graft loss (p < 0.01) and mortality (p = 0.01).
Conclusions: HAS after pLT is associated with favorable one‐year outcomes, with risk factors for unfavorable outcomes generally lacking. In patients requiring dialysis at the time of HAS diagnosis, other factors are more likely to contribute to multi‐organ failure and poor outcomes. Future studies are needed to identify best clinical practice and treatment strategies for pediatric patients with HAS.
Contact e‐mail address: l.weihao@umcg.nl
H‐EP049. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EP049.1. IMPLEMENTATION OF RAPID GENOME SEQUENCING FOR PAEDIATRIC ACUTE LIVER FAILURE ACROSS TWO TERTIARY PAEDIATRIC HEPATOLOGY CENTRES IN THE UNITED KINGDOM
Fernanda Monge Urrea 1, Joseph Valamparampil2, Miriam Cortes Cerisuelo3, Robert Hegarty1
1Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom, 2Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom, 3Adult And Paediatric Liver Transplantation, King's College Hospital, London, United Kingdom
Objectives and Study: The aim of this study was to evaluate the diagnostic yield and turnaround time of a national, rapid genetic sequencing service in paediatric acute liver failure (PALF) and to assess whether genetic results influenced therapeutic decision‐making.
Methods: An audit was conducted across two paediatric liver centres in the United Kingdom—King's College Hospital and Birmingham Children's Hospital—on PALF patients who underwent rapid whole exome/genome testing at Exeter Genomics Laboratory. Data was collected, since 2018 when rapid sequencing became available as a routine diagnostic tool, on patient demographics, clinical outcomes, genetic sequencing results, turnaround time and the impact of these results on treatment decisions.
Results: Twenty‐eight PALF patients were included, of which 64.2% (18/28) were male. The mean age at diagnosis of PALF was 28 months (range: 0 ‐ 168 months). Seven patients survived with their native liver (25%), while fourteen (50%) underwent a liver transplant. The diagnostic yield was of 21.4% (6/28). The average turnaround time from sample collection to results was 11.4 days (range: 6‐20 days). Therapeutic decision‐making may have been influenced had genetic results been available at the time of LT decision‐making and could have likely contraindicated LT in 3 neonates including those affected by biallelic variants in LARS1, POLG and MPV17. In all other positive cases, including those related to variants in TRMU and NBAS, having an earlier, molecular diagnosis would have helped refine treatment plans and prognostic discussions.
Conclusions: Despite the continued advances in genomics and availability of rapid sequencing technologies as first‐line investigation in PALF, the timeframe from sampling to results is still not quick enough to inform clinical decision‐making in LT. This study highlights both the potential and limitations of genomic diagnostics in PALF, emphasizing the need for improved genomic protocols and access to technology to better guide therapeutic decision‐making in LT.
Contact e‐mail address:
H‐EP050. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EP050.1. POST‐TRANSPLANT LYMPHOPROLIFERATIVE DISORDER (PTLD) AFTER PEDIATRIC LIVER TRANSPLANT: A 7‐YEAR SINGLE‐CENTER EXPERIENCE
Thanaporn Nilyaem 1, Chomchanat Tubjaroen2,3, Kanhatai Chiengthong4,5, Sutha Eiumkulbutr2,3, Voranush Chongsrisawat2,3
1Department Of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 2Division Of Pediatric Gastroenterology And Hepatology, Department Of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 3Excellence Center for Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 4Division Of Pediatric Hematology And Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 5Integrative and Innovative Hematology/Oncology Research Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Objectives and Study: This study aimed to evaluate the incidence, risk factors, and outcomes of post‐transplant lymphoproliferative disorder (PTLD) among pediatric liver transplant recipients (pLTRs) at King Chulalongkorn Memorial Hospital over a seven‐year period. PTLD is a serious complication of liver transplantation (LT), particularly in children, necessitating a better understanding of its predictive factors and outcomes to improve management strategies.
Methods: A retrospective cohort study was conducted involving pLTRs under 18 years of age between 2017 and 2023. Data on demographics, pre‐ and post‐LT EBV viral loads (VL), immunosuppressant (IS) regimens, and clinical outcomes were collected from electronic medical records. Logistic regression was employed to identify risk factors for PTLD, while Kaplan‐Meier analysis was used to estimate PTLD‐free survival rates.
Results: Among 81 patients, 18 (22.2%) developed PTLD, a rate higher than previously reported, possibly due to younger transplant ages and universal donor EBV seropositivity. Elevated EBV VL( ≥ 2000 copies/mL) within three months post‐transplant (adjusted hazard ratio [aHR]: 3.18) and tacrolimus dosages ≥0.5 mg/kg/day (aHR: 3.39) were identified as significant risk factors. Clinical presentations of PTLD included fever, watery diarrhea, and cervical lymphadenopathy, often accompanied by high EBV viremia and hypoalbuminemia. Treatment involving IS adjustments and rituximab‐based regimens led to remission in 83.3% of patients, with a low recurrence rate and a PTLD‐related mortality of 16.7%.
Conclusions: This study demonstrates a higher‐than‐expected incidence of PTLD among pLTRs with EBV VL and IS dosing identified as key risk factors. These findings underscore the importance of close monitoring of EBV VL and individualized IS management to mitigate PTLD risk and improve outcomes in this vulnerable group.
Contact e‐mail address:
H‐EP051. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EP051.1. ORAL MUCOSA LESIONS IN LIVER TRANSPLANTED CHILDREN AND THE ASSOCIATION WITH FOOD ALLERGY AND IMMUNOSUPPRESSION
María Alós Díez1, María José Quilés Blanco 1, Marta García Vega1, Maria Dolores Lledin Barbancho1, Gema Munoz Bartolo2, Lorena Fernández Tomé1, Cristina María López García1, Ana Martinez Pereira1, Esteban Frauca Remacha1
1Pediatric Hepatology, University Hospital La Paz, Madrid, Spain, 2Service Of Pediatric Hepatology And Transplantation, Children's Hospital La Paz, La Paz University Hospital, Madrid, Spain
Objectives and Study: Tacrolimus use in paediatric liver transplantation (LT) led to clinical findings of food allergy and lesions in lips and tongue in many children. The pathogenesis is still unknown. Aims Study to assess lip and tongue abnormalities in LT.
Methods: The study population consisted of 136 patients in outpatient visit. 90(66%) younger than 2 years at LT. Age at study was median=9 years, 39% adolescents. Immunosupresion (IS) consisted of tacrolimus granules (MODIGRAF™) plus steroids in 45(33%), tacrolimus‐XL (ADVAGRAF™) plus steroids in 50(37%), tacrolimus‐XL monotherapy in 17(12%), 15 combination with MMF, 4 cyclosporine, 1 sirolimus and 2 steroids. Forty‐nine (36%) had food exclusion due to allergy.
Results: Forty‐four (32%) had lip lesions (fissures, angular cheilitis) which were mild in 13, moderate in 24 and marked in 9. Tongue abnormalities (fissures, prominent papillae) were observed in 27(20%). 38% of children with cheilitis showed abnormal tongue. Cheilitis had a relationship with food allergy even on exclusion diet.Food allergy affected 36%, 59% of children with cheilitis and 70% of patients with abnormal tongue. (p < 0.0001) The prevalence of cheilitis was significantly lower in adolescents (19%) compared with children (41%).Prevalence of tongue disturbances did not modify by age. No difference in cheilitis was observed according to IS with tac‐XL or tac granules. However 36% reported improvement after switch to tac‐XL. Tongue abnormalities were less frequent with tac‐XL(p = 0.05) Age at LT influenced prevalence of food allergy, lip and tongue lesions. Food allergy occurred in 45% children less than 2 years old and 17% older at LT(p < 0.001).
Conclusions: The study shows again the association of food allergy with young age at LT, and the high prevalence of lip lesions in allergic children. We report lip and tongue lesions independent of food allergy, and in children undergoing LT at older ages. Prevalence decreased in adolescents, improvement was observed with conversion to tac‐XL in 36%.
Contact e‐mail address: maria.alos@salud.madrid.org
H‐EP052. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EP052.1. FRAILTY IN PEDIATRIC LIVER DISEASE IS ASSOCIATED WITH AN INCREASED INCIDENCE OF READMISSIONS AFTER PEDIATRIC LIVER TRANSPLANTATION
Saleh Alqahtani1, Michael Shpoliansky 2, Shannon Vandriel3, Fatema Johara3, Eberhard Lurz4, Caludia Quammie3, Estella Alonso5, James Daniel6, Vena Venkat7, Daniel Leung8, Julie Economides8, Evelyn Hsu9, Kathleen Loomes10, Nitika Gupta11, Dana Manino12, Jerome Menendez13, Vicky Ng3, Binita Kamath10
1Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, 2Health Sciences Center, Winnipeg, Canada, 3Hospital for Sick Children, Toronto, Canada, 4Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany, 5Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States of America, 6Children's Mercy Hospital, Kansas City, United States of America, 7UPMC Children's Hospital of Pittsburgh, Pittsburgh, United States of America, 8Texas Children's Hospital, Houston, United States of America, 9University of Washington‐Seattle Children's Hospital, Seattle, United States of America, 10Children's Hospital of Philidelphia, Philidelphia, United States of America, 11Children's Healthcare of Atlanta Emory University School of Medicine, Atlanta, United States of America, 12Nemours Children's Hospital Delaware, Wilmington, United States of America, 13Levine Children's Hospital Carolinas Health Care Center, Charlotte, United States of America
Objectives and Study: Frailty is a phenotype characterized by cumulative physiological decline, resulting in reduced physiologic reserve and increased vulnerability to stressors. In adults, frailty is associated with adverse outcomes following liver transplantation (LT), but its role in pediatric populations has not been studied extensively. A multicenter prospective study previously identified frailty in 46% of children with end‐stage liver disease (ESLD).
Methods: This multicenter study included pediatric participants from the original frailty study who subsequently underwent LT across 10 North American transplant centers. Clinical outcomes were tracked for up to one year post‐transplant. Participants were classified based on their pre‐transplant frailty status, defined by a frailty score of ≥6.0, and outcomes were compared between frail and non‐frail groups.
Results: Weakness, slowness, and fatigue were primary contributors to frailty, while the commonly used triceps skinfold (TSF) thickness was not a reliable marker for distinguishing frailty status. Among 28 pediatric LT recipients (60.7% female, 46.4% biliary atresia), 54% were categorized as frail (n = 15). Pre‐transplant frailty was significantly associated with failure to thrive (FTT) (33.3% vs. 0%, p = 0.044). Frail children experienced more hospital readmissions within one‐year post‐transplant (22 vs. 12, p = 0.034). Sensitivity analysis showed no significant relationship between pre‐transplant FTT and readmission rates. No correlations were observed between pre‐transplant MELD/PELD scores and outcomes assessed in the study.
Conclusions: This study demonstrates that pre‐transplant frailty is a valuable predictor of post‐LT morbidity in children, that is not captured by conventional laboratory investigations, particularly an increased frequency of rehospitalization. These findings suggest that frailty is distinct from anthropometric and sarcopenic measures, and highlight the potential for targeted pre‐habilitation strategies. We also introduce pre‐frailty in pediatric ESLD. This study paves the way for further research to incorporate frailty into pediatric LT evaluation, potentially supplementing organ allocation systems.
Contact e‐mail address: shpoliansky.michael@gmail.com
H‐EP053. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EP053.1. GRAFT AND OVERALL SURVIVAL IN PATIENTS WITH PORTAL VEIN STENOSIS AFTER PEDIATRIC LIVER TRANSPLANTATION; RESULTS FROM THE MULTICENTER MULTINATIONAL PORTAL REGISTRY
Bader Alfares1, Lydia Sieben 2,3, Guillermo Cervio4, Julia Minetto4, Sergio Sierre5, Piotr Kalicinski6, Malgorzata Markiewicz‐Kijewska6, Adam Koleśnik7, Stéphanie Franchi‐Abella8, Emmanuel Gonzales9, Florent Guérin10, Jai Patel11, Marumbo Paul Mtegha12, Raj Prasad13, Mureo Kasahara14, Seisuke Sakamoto14, Hajime Uchida14, Martín De Santibañes15, Victoria Ardiles15, Jimmy Walker Uño15, Paolo Marra16, Lorenzo D'antonio17,18, Domenico Pinelli19, Catalina Jaramillo20, Arielle Melen21, Leandra Bitterfeld22, Barbara Wildhaber23, Marisa Beretta24, Denise Aldrian25, Valeria Berchtold26, Georg Vogel25, Winita Hardikar27, Helen Evans28, David Duncan29, John Mccall30, Amit Shah31, Phoebe Wood32, Michael Acord33, Jesus Quintero34, Maria Mercadal‐Hally34, Mauricio Larrarte King34, Vidyadhar Mali35, Marion Aw36, Steffen Hartleif37, Ekkehard Sturm38, Thomas Casswall39, Greg Nowak40, Martin Delle41, Rajeev Khanna42, Viniyendra Pamecha43, Amar Mukund44, Ryan Fischer45, Bhargava Mullapudi46, Richard Hendrickson46, Rudi Dierckx47, Ruben De Kleine48, Henkjan Verkade49, Reinoud Bokkers3, Hubert Van Der Doef2
1Department Of Radiology, University Medical Center Groningen, Groningen, Netherlands, 2Division Of Paediatric Gastroenterology And Hepatology, Department Of Paediatrics, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 3Department Of Radiology, Medical Imaging Centre, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands, 4Division Of Liver Transplant, J. P. Garrahan Hospital, Buenos Aires, Argentina, 5Division Of Interventional Radiology, J. P. Garrahan Hospital, Buenos Aires, Argentina, 6Department Of Paediatric Surgery And Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland, 7Cardiovascular Interventions Laboratory, Childrens Memorial Health Institute, Warsaw, Poland, 8Pediatric Radiology Department, Bicêtre Hospital, Bicêtre, France, 9Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 10Department Of Pediatric Surgery, Bicêtre Hospital, Bicêtre, France, 11Department Of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom, 12Paediatric Hepatology, Leeds Children's Hospital, Leeds, United Kingdom, 13Department Of Surgery And Transplantation, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom, 14Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan, 15Hpb And Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 16Department Of Radiology, ASST Papa Giovanni XXIII Hospital, University of Milano‐Bicocca, Bergamo, Italy, 17Pediatric Hepatology, Gastroenterology And Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 18Department Of Medicine And Surgery, University of Milan‐Bicocca, Bergamo, Italy, 19Department Of Organ Failure And Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy, 20Department Of Paediatrics, Division Of Paediatric Gastroenterology, Hepatology And Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, United States of America, 21University of Utah School of Medicine, Salt Lake City, United States of America, 22Intermountain Primary Children's Hospital, Salt Lake City, United States of America, 23Swiss Pediatric Liver Center, Division Of Child And Adolescent Surgery, Geneva University Hospitals, University of Geneva, Geneva, Swaziland, 24Department Of Peadiatrics, Wits Donald Gordon Medical Centre, Johannesburg, South Africa, 25Department Of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria, 26Department Of Visceral, Transplant And Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria, 27Department Of Gastroenterology, Royal Children's Hospital, Melbourne, Australia, 28Paediatric Gastroenterology And Hepatology, Starship Child Health, Auckland, New Zealand, 29Department Of Paediatric Radiology, Starship Children's Hospital, Auckland, New Zealand, 30Liver Transplant Unit, Starship Children's Hospital, Auckland, New Zealand, 31Division Of Gastroenterology, Hepatology And Nutrition, Department Of Paediatrics, Children's Hospital of Philadelphia, Philadelphia, United States of America, 32Department Of Paediatrics, Division of Gastroenterology, Hepatology and Nutrition, Philadelphia, United States of America, 33Department Of Radiology, Children's Hospital of Philadelphia, Philadelphia, United States of America, 34Pediatric Hepatology And Liver Transplantation, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 35Department Of Paediatric Surgery, National University Hospital, Singapore, Singapore, 36Department Of Paediatrics, National University of Singapore, Singapore, Singapore, 37Paediatric Gastroenterology And Hepatology, University Children's Hospital Tübingen, Tübingen, Germany, 38European Reference Network on Hepatological Diseases, Hamburg, Germany, 39Division For Paediatrics, Department Clinical Interventions And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 40Department Clinical Interventions And Technology Clintec, Division For Transplantation Surgery, Karolinska Institute, Stockholm, Sweden, 41Department Of Radiology, Karolinska University Hospital, Department Clinical Science, Intervention And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 42Department Of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India, 43Department Of Hepato‐pancreato‐biliary Surgery, Institute of Liver and Biliary Sciences, Delhi, India, 44Department Of Interventional Radiology, Institute of Liver and Biliary Sciences, New delhi, India, 45Children's Mercy Hospital, Kansas City, United States of America, 46Department Of Paediatric Surgery, Children's Mercy Kansas City, Kansas, United States of America, 47Department Of Nuclear Medicine And Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands, 48Division Of Hepatobiliary Surgery & Liver Transplantation, Department Of Surgery, University Medical Center Groningen, Groningen, Netherlands, 49Division Of Pediatric Gastroenterology And Hepatology, Department Of Pediatrics, University Medical Center Groningen, Groningen, Netherlands
Objectives and Study: Portal vein stenosis (PVS) represents a significant complication following pediatric liver transplantation (pLT). While PVS can potentially compromise graft function and patient outcomes, its actual impact on survival remains poorly characterized. This study presents the first global registry‐based analysis of one‐year patient‐ and graft survival in post‐pLT PVS patients.
Methods: The study analyzed data from the Portal vein Obstruction Revascularisation Therapy After Liver transplantation (PORTAL) registry. This registry contains data from 21 centers, across 18 countries, 6 continents over a 20‐year cohort. Graft‐ and patient survival was determined for the first year following PVS‐diagnosis using the Kaplan‐Meier method and a Cox proportional hazards model.
Results: We included 239 patients (53% female; median age at pLT, 1.1 years) diagnosed with PVS. Median age at PVS‐diagnosis was 2.7 years, and the median pLT‐PVS interval was 5.8 months. The one‐year graft survival rate was 96%, and the one‐year patient survival rate was 99%. Multivariable analysis revealed several independent factors associated with decreased survival outcomes. The presence of a venous jump/interposition graft during pLT was associated with a reduced graft‐, as well as patient survival (p = 0.003 and p = 0.015, respectively). Additionally, early onset diagnosis (≤14 days after pLT, p = 0.017), age at pLT less than 1 year (p = 0.003) and male gender (p = 0.018) emerged as significant patient‐related risk factors to the occurrence of graft loss.
Conclusions: Patients with PVS after pLT have excellent graft‐ and patient survival. Several risk factors which lower patient outcome were identified. Long‐term outcomes could be enhanced by targeting these risk factors.
Contact e‐mail address: h.p.j.van.der.doef@umcg.nl
H‐EP054. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EP054.1. SARCOPENIA IN CHILDREN WITH INHERITED METABOLIC DISORDERS TREATED BY LIVER TRANSPLANTATION: A RETROSPECTIVE, SINGLE‐CENTER STUDY ON 45 PATIENTS
Silvio Veraldi 1, Maria Sole Basso1, Silvia Maria Bernabei2, Riccardo Cirelli3, Fabrizio Chiusolo4, Alessia Esposito2, Diego Martinelli2, Lidia Monti5,6, Rosanna Pariante4, Barbara Siri2, Giovanna Soglia6, Gionata Spagnoletti3, Roberta Taurisano2, Andrea Pietrobattista1, Marco Spada3, Carlo Dionisi Vici7
1Hepatology and Liver Transplant Unit, Bambino Gesù Children's Hospital, Rome, Italy, 2Division Of Metabolic Diseases, Bambino Gesù Children's Hospital, Rome, Italy, 3Division Of Hepatobiliopancreatic Surgery, Liver And Kidney Transplantion, IRCCS Bambino Gesù Children's Hospital, Rome, Italy, 4Anesthesia And Critical Care Medicine, Bambino Gesù Children's Hospital, Rome, Italy, 5Bambino Gesù Children's Hospital, rome, Italy, 6Gastrointestinal And Transplanted Liver Imaging Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy, 7Division Of Metabolic Diseases And Hepatology, Bambino Gesù Childrens Hospital IRCCS, Rome, Italy
Objectives and Study: To define the prevalence and features of sarcopenia in pediatric patients affected by intoxication type inherited metabolic disorders (IMDs) undergoing to liver transplant (LT).
Methods: Retrospective single‐center study involving IEM patients (0‐18 years) with organic acidemias (OA), urea cycle disorders (UCD) and maple syrup urine disease (MSUD), treated by LT (2016‐2024). Sarcopenia was defined as a total psoas muscle area z‐score ≤−2, measured at L4‐L5 on axial CT scan images.
Results: 45 patients, 22 OA, 12 UCD 12, 11 MSUD were evaluated pre‐LT [median age 44 months (22‐192)]. Daily protein intake was higher in MSUD [136% RDA (natural 34%)] vs UCD [92% RDA (natural 75.5%)] and OA [100% RDA (natural 78.6%)], which corresponded significantly different plasma levels of total essential aminoacids (umol/L): MSUD 1189, UCD 564, OA 590 (p < 0.001). MSUD patients had greater plasma leucine levels (163 umol/L vs. 77‐84, p < 0.001), while higher FGF‐21 levels (nv<200 pg/ml) were seen in OA (1733) and UCD (1667) compared to MSUD (649). Sarcopenia in the overall population was detected in 40% of patients, with higher prevalence in OA (54.5%) vs. UCD (33.3%) and MSUD (18.2%). Sarcopenic patients showed lower weight and height z‐score compared to those with normal muscle mass and more frequently required nutritional enteral support [70.6% vs 34.6% (91.6% in OA)]. In OA, patients with sarcopenia had lower glutamine (p.0.025) and insulin levels (p 0.016) compared to those without sarcopenia, while UCD patients with sarcopenia had lower leucine (p 0.01) levels. Considering the overall population, leucine was as an independent predictor of sarcopenia [OR 1.063 (CI 0.930‐1.214), p 0.016].
Conclusions: Sarcopenia is a common finding in OA and UCD while is rarer in MSUD. Differences in metabolic profiles within the three disease groups highlight the potential role of leucine in stimulating insulin secretion and its anabolic functions on muscle tissue.
Contact e‐mail address: silvio.veraldi@opbg.net
H‐EP055. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EP055.1. RECIPIENT AND DONOR GENETIC POLYMORPHISM IN PEDIATRIC LIVER TRANSPLANT RECIPIENTS AND THEIR INFLUENCE ON TACROLIMUS LEVELS AND GRAFT FUNCTION
Snigdha Verma 1, Rajeev Khanna1, Vikrant Sood1, Bikrant Lal1, Shvetank Sharma2, Viniyendra Pamecha3, Seema Alam1
1Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India, 2Department Of Molecular And Cellular Medicine, Institute of Liver and Biliary Sciences, New delhi, India, 3Department Of Hepatopancreaticobiliary And Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New delhi, India
Objectives and Study: Tacrolimus is the mainstay immunosuppression after Liver transplant (LT). It is bound to P‐Glycoprotein (ABCB1 gene) in the intestine, while its elimination occurs by CYP3A isoforms. Increased expression of CYP3A5 causes lower trough levels. We studied CYP3A5(donors) and ABCB1 polymorphisms (recipients) and their influence on tacrolimus levels and graft function.
Methods: Paediatric living donor LT recipients (6mo‐18years; follow up of 1 year) were studied. CYP3A5 genotype (slow CC: *3/*3 and fast metabolizer TC: *1/*3, TT: *1/*1) in their respective donors, and ABCB1 genotype (wild AA, mutant AT/AC/CC/AC) in the recipients was analyzed. Tacrolimus concentration divided by dose adjusted to weight (C/W‐D) ratios were determined at 1week, 4 weeks, 3months, 6months and 1year. Time to achieve ALT within 1.5 times ULN with respect to genotype and association of genotype, C/W‐D ratios, rejection and immunosuppression toxicity were studied.
Results: 60 donor‐recipient (73.3% males) pair were evaluated. CYP3A5(*3/*3) and ABCB1(AA) allele seen in 56.7% and 45% respectively. Median time to achieve ALT within 1.5times of ULN (60 IU/L) was 20 days. C/W‐D ratios were lower in CYP3A5 (*1/*1, *3/*1) in comparison to CYP3A5(*3/*3) at 4weeks (p < 0.001), 3months (p < 0.001), 6months (p < 0.001) and 1year (p = 0.004) post‐LT. 71.7% patients achieved ALT < 60 IU/L while 46.7 % achieved ALT < 40 IU/L within 4 weeks. A cut‐off of 4 week C/W‐D ratio of ≤ 34.9 predicted normalization of ALT with a sensitivity, specificity and positive likelihood ratio of 60.7 %, 71.9 % and 2.16 respectively. CYP3A5 did not effect rejection or toxicity. There was no influence of ABCB1.
Conclusions: CYP3A5 allele influences tacrolimus level. Fast metabolizers have lower tacrolimus levels although this did not effect normalization of transaminases.
Contact e‐mail address: dr.snigdha1@gmail.com
H‐RF002. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF002.1. ODEVIXIBAT THERAPY ALLEVIATES REFRACTORY PRURITUS IN PFIC 7 CAUSED BY USP53: A CASE REPORT
Abdul Samet Ala 1, Talip Sayar1, Yasemin Sofu Oner1, Mahmut Tuluce2, Cigdem Arikan3, Ali Islek1, Gokhan Tumgor1
1Pediatric Gastroenterology, ÇUKUROVA UNIVERSITY, ADANA, Turkey, 2Pediatric Gastroenterology, Hepatology And Nutrition, Şanlıurfa Training and Research Hospital, Sanliurfa, Turkey, 3Koc University School of Medicine, Istanbul, Turkey
Objectives and Study: Progressive Familial Intrahepatic Cholestasis Type 7 (PFIC 7) is an rare autosomal recessive disorder arising from homozygous or compound heterozygous mutations in the USP53 gene. It is primarily characterized by cholestasis, pruritus, elevated transaminase levels, and normal gamma‐glutamyl transferase activity. Odevixibat, a bile acid transport inhibitor, has demonstrated significant efficacy in ameliorating symptoms and reducing serum bile acid levels in cholestatic disorders accompanied by pruritus. Herein, we report a case of PFIC 7 effectively managed with odevixibat therapy, underscoring its therapeutic potential in this rare and challenging condition.
Methods: A 2.5‐month‐old female presented to our outpatient clinic with jaundice that had begun in the neonatal period. Physical examination revealed a soft, palpable liver extending 3 cm below the costal margin, while the spleen was non‐palpable. Laboratory investigations showed AST: 152 U/L, ALT: 123 U/L, total bilirubin: 5.9 mg/dL, direct bilirubin: 3.1 mg/dL, and GGT: 122 U/L. WES performed, which identified a homozygous USP53 mutation, confirming the diagnosis of PFIC 7. The patient was initially managed with UDCA, cholestyramine, rifampin. However, pruritus remained refractory to treatment. At 21 months of age, odevixibat was initiated. Remarkable clinical improvement was observed within two weeks, with complete resolution of pruritus. Serum bile acid levels demonstrated a significant reduction from 93.4 μmol/L (0–10) prior to treatment to 14.7 μmol/L after one month of therapy.
Results: At present, the patient is 31 months old and has been on odevixibat therapy for the past 10 months, demonstrating satisfactory growth, no progression of liver disease, and no clinical signs of hearing impairment.
Conclusions: This report documents the first case of PFIC Type 7 managed with odevixibat described in the literature. It highlights the remarkable efficacy of odevixibat in alleviating refractory pruritus and lowering bile acid levels in PFIC 7, while underscoring the critical need for uninterrupted access to therapy.
Contact e‐mail address:
H‐RF003. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF003.1. CORRELATING GENOTYPE‐PHENOTYPE IN PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS TYPE III, AND RESPONSE TO URSODEOXYCHOLIC ACID
Homoud Alhebbi, Sami Wali, Sarah Algubaisi, Awad Alqahtani, Faisal Alhafaf, Nour Alsaati
Prince Sultan Military Medical City, Riyadh, Saudi Arabia
Objectives and Study: To evaluate the outcome of 20 ABCB4 confirmed mutations, including nine novel mutations, in 80 patients and their response to ursodeoxycholic acid.
Methods: We revised the files of 80 patients whom their diagnosis of PFIC III was confirmed by genetic testing. For each mutation, the patients were divided into early presentation before the age of two years and later presentation. The response was compared in these two groups regarding liver function normalization, bile acid level, resolution of itching and the progression to portal hypertension or the need for liver transplantation.
Results: We identified nine missense mutations in 51 patients, five frameshift mutations in 9 patients, one nonstop mutation in 5 patients, one splice site mutation in 8 patients,one nonsense mutation in 2 patients and three mutations that were not elsewhere categorized in 5 patients. The overall response to ursodeoxycholic acid in the missense mutations was 45%. However, six patients (27%) of the respondents developed portal hypertension as they had late presentation. In contrast, all the patients who presented before the age of 2 years responded to ursodeoxycholic acid and only one developed portal hypertension. Furthermore, 7 out of 27 patients (26%) who did not respond had positive autoimmune markers. Five had elevated immunoglobulins, one had positive ANA and one had persistent high ESR. None of the patients who had nonsense, frameshift, or splice site mutations had responded. Only one out of five patients with a nonstop mutation responded, Some mutations (C.2906 G > A(P.ARG969HIS), C526 > T(P.ARG176TRP), C:965 T > C(P.L322P), and C:628‐643DEL(P.PHE210SERFS*5) are associated with autoimmune disorders. One had overlap syndrome, three celiac, three vitiligo, and one food and drug allergies.
Conclusions: Early diagnosis and introduction of ursodeoxycholic acid before age two significantly impact the course of the disease in the missense mutations category. The presence of high inflammatory markers has an overall negative predictive value for response to ursodeoxycholic acid.
Contact e‐mail address: hhhebby@hotmail.com
H‐RF004. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF004.1. NOVEL MUTATIONS IN FAMILIAL CHOLESTASIS‐RELATED GENES BEYOND PFIC1‐3 WITH VARIABLE PHENOTYPES AND OUTCOMES: RESULTS FROM A LARGE ARAB STUDY COHORT
Abdulrahman Al‐Hussaini 1, Razan Badr2, Areej Alsunaid3, Mohammed Alameer4, Meshari Alaifan5, Nagla Kamal6, Waleed Afashah7, Naif Almontashiri8, Yagoub Bintaleb9, Ahmed Alawfi10, Asrar Alshahrani1, Samah Almahjoub2, Bushra Jalodi2, Yaser Alrusaini11, Mousa Mobarki12
1Pediatric Gastroenterology And Hepatology, King Fahd Medical City, Riyadh, Saudi Arabia, 2Multi‐organ Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia, 3Department Of Pediatrics, Ministry of the National Guard ‐ Health Affairs ‐. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia, 4King Fahad Central Hospital, Jazan, Saudi Arabia, 5Division Of Pediatric Gastroenterology, King Abdulaziz University, Jeddah, Saudi Arabia, 6Pediatric Gastroenterology Division, Alhada Armed Forces Hospital, Kasralainy Faculty of Medicine, Riyadh, Saudi Arabia, 7Maternity & Children's Hospital in Almadinah Almunwarah, Riyadh, Saudi Arabia, 8Center for Genetics and Inherited Diseases, Faculty of Applied Medical Sciences, Taibah University, Almadinah Almunwarah, Saudi Arabia, Almadinah Almunwarah, Saudi Arabia, 9Department Of Pediatrics, Division Of Pediatric Gastroenterology, King Abdulaziz University, Jeddah, Jeddah, Saudi Arabia, 10Division Of Pediatric Gastroenterology, King Saud Medical City, Riyadh, Saudi Arabia, 11Pathology Department, King Fahd Medical City, Riyadh, Saudi Arabia, 12Pathology Department, King Fahad Central Hospital, Jazan, Saudi Arabia
Objectives and Study: Advancement in molecular technology has uncovered mutations in genes that are important for bile transport. We report new variants in several cholestasis‐related genes inducing various clinical phenotypes and different outcomes.
Methods: We retrospectively reviewed charts of 53 children with familial cholestasis beyond PFIC1‐3 [TJP2 = 13, NR1H4 = 1, MYO5B = 10, USP53 = 8, KIF12 = 4, TTC26 = 4, LSR = 1, WDR19 = 1, WDR35 = 5, VIPAS39 = 2, NPHP3 = 4] who presented with cholestasis to 9 tertiary care centers from different regions in Saudi Arabia. The clinical phenotype was categorized, based on the response of cholestasis and itching to treatment and ultimate outcome, into mild (complete response), intermediate (partial response, non‐progressive to advanced liver disease), and severe (progression to cirrhosis, portal hypertension, end‐stage liver disease, or intractable itching), over a median follow up time of 6.75 years (range, 0.2 – 15 years).
Results: We identified 34 biallelic mutations in the investigated genes (19 are novel): 6 splicing, 8 frameshift, 12 missense, and 8 nonsense. Variants in the TTC26, KIF12, WDR35, and NPHP3 genes resulted in high GGT cholestasis; the remaining variants led to normal/low GGT cholestasis. Variants in TTC26, USP53, WDR35, and NPHP3 were associated with kidney disease. The single missense variant in TJP2 led to mild phenotype while the remaining 12 TJP2 patients that harbored nonsense, frameshift, or splicing variants developed severe phenotype in the first 5 years of life. The founder MYO5B variant [c.946 G>A,p.(Gly316Arg)] in 6 patients caused liver disease with variable severity. All patients with TTC26, WDR35, R1H4, LSR, WDR19 and NPHP3 variants had severe phenotype. The 8 patients with USP53 variants had liver disease variable in severity.
Conclusions: Our data provide further expansion of the phenotypic spectrum and molecular diversity of variants in cholestasis‐related genes leading to a phenotypic continuum between mild, transient, non‐progressive disease and rapidly progressive, fatal, early‐onset phenotypes during early childhood.
Contact e‐mail address: aa_alhussaini@yahoo.com
H‐RF005. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF005.1. RITUXIMAB IN PAEDIATRIC ONSET AUTOIMMUNE LIVER DISEASE: A STANDARDIZED APPROACH BASED ON REGULAR EVALUATION OF CD19/CD20 TO GUIDE THE BEST TIMING FOR MAINTENANCE DOSES
Valentina Leone1, Elena Diprima2, Mihaela Danalache3, Emily Argento 3, Silvia Riva1, Jean De Ville De Goyet1, Giusy Ranucci4
1Department of Pediatrics Liver Transplant Center UPMC‐ISMETT‐IRCSS, Palermo, Italy, 2Policlinico Giaccone, palermo, Italy, 3ISMETT, Palermo, Italy, 4Department of Pediatrics Liver Transplant Center UPMC‐ISMETT, Palermo, Italy
Objectives and Study: B cell immune‐depletion to treat refractory autoimmune liver disease has been described in retrospective case series. We describe the first three patients treated according to a standardized protocol for the use of Rituximab we have developed.
Methods: Inclusion criteria were poorly controlled disease due to resistance/intolerance or non‐adherence to conventional treatments and/or steroid‐dependence. A cycle of Rituximab included 2 to 4 infusions at a dose of 375 mg/m2; the treatment was stopped if complete biochemical remission (normalization of transaminases and IgG levels) and CD19/CD20 depletion was achieved. Subsequent doses were given if evidence of biochemical relapse or CD19/CD20 re‐population. A frequent follow‐up regime was offered with planned weaning of steroids and other immune‐suppressors.
Results: Three female teenagers (mean age at treatment 16,6, range 15‐18) diagnosed with autoimmune hepatitis (type 1 in 2 and type 2 in 1 case) have been treated 4 to 12 years after disease onset. Steroids dependence was the main indication and all patients had been or were on azathioprine, cyclosporine and mycophenolate mofetil as well as prolonged steroids. All patients had and history of 4 to 5 previous relapses at steroids withdrawal attempt. Biochemical remission and immune‐depletion was achieved with 2 to 3 infusions. Retreatment at six months was undertaken in one patient because of increase of CD19/CD20 count. A mild infusion reaction was observed only in 1 patients at the second cycle of treatment.
Conclusions: We developed a standardized protocol to treat refractory patients monitoring the achievement of biochemical remission and CD19/CD20 immuno‐depletion and planning repeated doses according to either biochemical relapse and/or immuno‐repopulation. The aim is to reach steroids withdrawal and/or reduction of long term conventional immunosuppression in severe disease. Lower doses were used. Use of Rituximab seems a promising option in refractory patients. Longer follow‐up will be need to assess the safety and efficacy.
Contact e‐mail address: vleone@ismett.edu
H‐RF006. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF006.1. CIRRHOTIC CARDIOMYOPATHY AMONG CHILDREN WITH BILIARY ATRESIA AND GENETIC INTRAHEPATIC CHOLESTASIS: PREVALENCE, NATURAL HISTORY AND OUTCOMES
Tamoghna Biswas 1, Bikrant Bihari Lal1, Rajeev Khanna1, Vikrant Sood2, Vikas Kohli3, Jaswinder Maras4, Viniyendra Pamecha5, Seema Alam1
1Department Of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India, 2Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, Delhi, India, 3Delhi Child Heart Centre, Delhi, India, 4Department Of Molecular And Cellular Medicine, Institute of Liver and Biliary Sciences, Delhi, India, 5Department Of Hepato‐pancreato‐biliary Surgery, Institute of Liver and Biliary Sciences, Delhi, India
Objectives and Study: The present study aimed to explore the prevalence and progression of cirrhotic cardiomyopathy (CCM) among children with biliary atresia (BA) and genetic intrahepatic cholestasis (GIC) and its correlation with outcomes pre and post liver transplant (LT).
Methods: This was a prospective observational study. All children aged 0‐18 years and diagnosed with either BA or GIC were included in the study while those with structural congenital heart diseases were excluded. Transthoracic echocardiography including 2‐dimensional, color‐Doppler and motion modes was done for cardiac assessment. Left ventricular mass index (LVMI) ≥ 95 g/m2.7 and/or relative wall thickness (RWT) of left ventricle (LV) ≥ 0.42 was used for defining CCM.
Results: Prevalence of CCM in children with BA and GIC were 54% and 48% respectively. Among BA, CCM was present in 53% (n = 30), 69% (n = 13) and 45% (n = 20) of children with successful Kasai portoenterostomy (KPE), unsuccessful KPE and unoperated BA respectively albeit showing no significant difference. LVMI (g/m2.7) was significantly higher in children with unsuccessful KPE (p = 0.05 & p = 0.024) and unoperated BA (p < 0.001 & p = 0.002) compared to those with successful KPE and GIC. Serum bile acid levels were significantly (p = 0.037) higher among children with CCM. CCM was associated with a lower native liver survival (NLS) and overall survival (OS) at 12 months (NLS: CCM: 67.39% vs no CCM: 85.71%; Log Rank 4.24, p = 0.0039; OS: CCM: 78.26% vs no CCM: 95.24%; Log Rank 7.651, p = 0.006). There were no significant associations between presence of CCM and post‐LT mortality, time to extubation, duration of inotrope requirement or length of ICU stay. 75% children with CCM at pre‐LT evaluation had resolution of CCM within 3‐6 months post‐LT.
Conclusions: CCM is prevalent in almost half of patients with BA and GIC and is associated with decreased NLS and OS. Bile acids were significantly higher in those with CCM.
Contact e‐mail address: tamoghnab@gmail.com
H‐RF007. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF007.1. THE USE OF INTESTINAL BITE ACID TRANSPORTER INHIBITORS IN CHOLESTATIC LIVER DISEASE, A RETROSPECTIVE MULTICENTER COHORT STUDY
Rana Bitar 1,2, Balaji Krishnamurth3, Amna Alkhuzaei4, Christos Tzivinikos3, Mohamad Miqdady2
1College Of Medicine, Khalifa University, Abu Dhabi, United Arab Emirates, 2Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, 3Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates, 4Gastroenterology, Sidra Medicine, Doha, Qatar
Objectives and Study: Intestinal Bile Acid Transport (IBAT) inhibitors are approved in europe to treat cholestatic pruritis and reduce bile acid level in children with Progressive Familial Intrahepatic Cholestasis (PFIC) and Alagille Syndrome. They have demonstrated clear improvement in patient pruritis, and bile acid levels. We aim to retrospectively review the effect of IBAT inhibitors on pediatric patients with cholestatic liver diseases.
Methods: We retrospectively reviewed patients with cholestatic liver disease on IBAT inhibitors in three tertiary pediatric hospitals from January 2023 to December 2023. Data collected included; genetic result, pruritis score, bile acid, bilirubin, and Alanine Aminotransferase (ALT) levels. Pruritus was assessed using the Albireo observer‐reported outcome Precision instrument. Pruritis score was 0, 1, 2, 4, 4 for no scratching, a little scratching, medium scratching, a lot of scratching, and worst possible scratching respectively.
Results: 14 patients were identified with genetically confirmed disease. Six PFIC type 3, two ARC syndrome, two PFIC type 1, two episodic PFIC, and two Alagille syndrome. Median age of starting treatment was 6 years (range:6month‐16years). After 12 months of treatment there was improvement in ALT level (P = 0.07), but this did not reach statistical significance. However, bile acids significantly improved (P = 0.01). Additionally, bilirubin level didn't improve significantly (P = 0.38). Mean pruritis score was 3 prior to starting treatment and 0 at 12 months. (graph 1‐3). There were no reported adverse events.
Conclusions: IBAT inhibitors are the only treatment available targeted at reducing bile acids and thus controlling pruritis in children with PFIC and Alagille syndrome. This study reinforces the positive effect of IBAT inhibitors in real clinical practice in children with cholestatic liver disease with no reported side effects in our group. Long term data is awaited to evaluate the effect of this unique treatment on the progression of liver disease and patient overall survival with native liver.
Contact e‐mail address: drranab@doctors.org.uk
H‐RF008. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF008.1. LIVER ULTRASOUND SURVEILLANCE IN CHILDREN WITH CHRONIC HEPATITIS B INFECTION
Muhammad Asad Khan1, Chayarani Kelgeri2, Maxine Brown 2,3
1Liver And Small Bowel Transplant Unit, Birmingham Children's Hospital, Birmingham, United Kingdom, 2Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom, 3Liver Unit, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
Objectives and Study: International societies including WHO recommend 6 monthly liver Ultrasound (USS) and alpha fetoprotein (AFP) as surveillance for Hepatocellular Carcinoma (HCC) in Chronic Hepatitis B (CHB) patients with cirrhosis or presence of high‐risk factors.There are no recommendations for HCC surveillance in Children with CHB, the reported incidence of cirrhosis and HCC being 3‐5 % and 0.01%‐0.03% respectively. The aim of our study is to report the outcomes of Liver USS and utility of fibroscan in children with CHB at a paediatric liver centre.
Methods: This retrospective study involved 149 children (ages 6M‐18Y), with Chronic Hepatitis B treated in our centre between 2004 till 2023. A baseline Liver USS, AFP, Fibroscan and LFTs were offered at first consultation and thereafter in outpatient followup visits. All data was collected from the Liver Unit data base.
Results: All children had baseline Liver USS and 28.8 % had a repeat study equating to a total of 210 USS studies. The findings of USS are summarized in pi chart shown in the media below. No Hepatocellular Carcinoma was detected in sample. The mean interval of repeat Liver USS was 36.67 months(SD ± 29.63 months). 27(18%) patients had interval changes on repeat USS. A p‐value of 0.4 was noted concluding no impact of antivirals on interval sonological findings as shown in Table 1 of the media below. A Fibroscan reading >7Kpa was used as marker of “significant fibrosis” in accordance with WHO guidelines.A p‐value of.01 (p < .05) was obtained when USS findings were cross tabulated against corresponding Fibroscan data for 102 patients concluding that abnormalities of fibroscan correlate abnormalities of USS
Conclusions: We conclude that in children with CHB, only Fibroscan monitoring is a feasible surveillance option and USS liver may be reserved only for those with high AFP, high fibroscan readings or in presence of risk factors for HCC.
Contact e‐mail address: masaddalikhan@gmail.com
H‐RF009. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF009.1. ENGAGEMENT AND RETENTION OF YOUNG PEOPLE LIVING WITH CHRONIC HEPATITIS B IS LINKED TO SUCCESSFUL TRANSFER OF CARE TO ADULT HEALTH SERVICES
Maxine Brown 1, Jacqueline Logan1, Julie Taylor1, Catherine Stewart2, Joseph Valamparampil1, David Mutimer2, Chayarani Kelgeri1
1Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom, 2Hepatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
Objectives and Study: To determine the incidence of young people (YP) with chronic hepatitis B (CHB) who were successfully linked to adult health services (AHS) following transition from a dedicated paediatric viral hepatitis service (PVHS) and identify barriers contributing to non‐linkage.
Methods: A retrospective review of YP followed up at a PVHS liver centre in the United Kingdom who transitioned to AHS between 2018‐2023. Non linkage was defined as nonattendance of at least one of the two initial outpatient appointments in AHS after transitioning. Data was obtained from electronic records at PVHS and AHS sites.
Results: No YP were lost to follow up at PVHS. Of the 70 YP transitioned to AHS, 35 (50%) were during the SARS‐CoV‐2 lock down period. Sixty‐one YP (87%) were successfully linked to AHS. Mode of transmission was vertical in 44, horizontal in 4 and unknown in 22. Majority were Asians 42(60%). Of the 37 and 31 YP who were offered in person and virtual transition appointments respectively at the pediatric center, 23 attended in each group. 23 patients had received antivirals for CHB either for clinical reasons or as research study. Thirteen patients on antivirals (Entecavir or Tenofovir) at time of transition were successfully linked to AHS. All 16 YP with comorbidities were linked to AHS. Nine patients were not linked to AHS and the risk factors identified were ‐ 1 referral not received, 1 YP was asylum seeker, 1 had frequent nonattendance in PVHS, 2 not contactable and no clear cause identified in 4 (see Table 1).
Conclusions: The dedicated PVHS contributed to high rates of successful linkage to AHS. However, the lockdown period and other factors led to some being lost to follow‐up, suggesting the importance of in person consultations and engagement with YP.
Contact e‐mail address: chayarani.kelgeri@nhs.net
H‐RF010. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF010.1. A RARE CAUSE OF NORMAL GGT CHOLESTASIS: FAMILIAL HYPERCHOLANEMIA SECONDARY TO A MUTATION IN THE WDR83OS GENE
Ayşe Can 1, Hakan Öztürk1, Gülsüm Kayhan2, Sınan Sarı1, Odul Egrıtas Gurkan1, Buket Dalgiç1
1Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 2Medical Genetics, Gazi University Faculty of Medicine, Ankara, Turkey
Objectives and Study: Familial hypercholanemia (FHC) is a rare multisystemic condition characterized by elevated serum bile acids due to defects in bile acid transport. Here, we present a case of FHC characterized by cholestasis, dysmorphic features, and intellectual disability.
Methods: Case Report
Results: A 3‐year‐old boy presented with incidentally detected elevated transaminase levels. He was born at 35 weeks of gestation with a birth weight of 1800 grams and required 15 days of incubator care, during which an exchange transfusion was performed. The patient had a history of persistent pruritus for 2 years, accompanied by dysmorphic features, macrosomia, scoliosis, microcephaly, hepatomegaly, and developmental delays. Laboratory tests showed an AST level of 72 U/L and an ALT level of 87 U/L, with gamma‐GT, albumin, bilirubin, and INR levels within the normal range. Infectious and metabolic causes of cholestasis were ruled out. Fasting bile acid levels were elevated at 38.7 µmol/L, while postprandial bile acid levels were markedly increased at 202.9 µmol/L. Liver biopsy revealed normal hepatic microanatomy, hydropic degeneration, focal xanthomatous degeneration, and focal acinar transformation. Whole exome sequencing subsequently identified a homozygous c.156+1 G > A mutation in the WDR83OS gene, confirming the diagnosis of FHC.
Conclusions: FHC is one of the rare genetic causes of cholestasis, recently described in the literature. To date, 14 cases from 11 families have been reported with mutations in the WDR83OS gene. Patients typically present with pruritus, dysmorphic facial features, macrocephaly or microcephaly, intellectual disability, scoliosis, elevated serum bile acid levels, and normal serum GGT levels. Recent advancements in molecular and genetic research have identified pathogenic variants in pediatric cholestatic liver diseases, enhancing our understanding of cholestasis etiology and contributing to improved clinical management and genetic counseling.
Contact e‐mail address: aysegunescan@hotmail.com
H‐RF011. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF011.1. ILEAL BILE ACID TRANSPORTER INHIBITOR TREATMENT FOR BILE SALT EXPORT PUMP DEFICIENCY: TOWARDS UNDERSTANDING CLINICAL RESPONSIVENESS
Cristina Chiadò 1,2,3, Alida De Groot3, Pier Luigi Calvo4, Paola Mian5, Henkjan Verkade3
1Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Turin, Italy, 2University of Turin, Turin, Italy, 3Pediatric Gastroenterology‐hepatology, University Medical Center Groningen, Groningen, Netherlands, 4Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Turin, Italy, 5Clinical Pharmacy And Pharmacology, University Medical Center Groningen, Groningen, Netherlands
Objectives and Study: Ileal bile acid transporter inhibitor (IBATi) treatment can reduce cholestasis by inhibiting the intestinal reabsorption of bile acids. Two IBATi drugs, maralixibat and odevixibat, have been approved by regulatory agencies for the treatment of different types of Progressive Familial Intrahepatic Cholestasis (PFIC). Bile Salt Export Pump (BSEP) deficiency (PFIC 2) impairs bile acid secretion leading to cholestasis. Non‐truncating BSEP (nt‐BSEP) subtypes are more likely to have residual BSEP function. Nevertheless, not all nt‐BSEP patients respond to IBATi with a relevant decrease in serum bile acids (sBA) and pruritus. To better understand responsiveness to IBATi in BSEP‐deficiency patients, we analyzed published data on treatment with maralixibat and odevixibat in terms of pruritus and sBA.
Methods: We performed a systematic literature search in PubMed, Web of Science, EMBASE and Cochrane Library. Responder rates, pruritus and sBA levels were extracted from included reports. The study from which data were extracted defined sBA and pruritus responders and non‐responders.
Results: We included 18 reports from 4 clinical studies. Maralixibat and odevixibat treatment each reduced sBA and pruritus among fractions of nt‐BSEP patients up to 240 and 72 weeks, respectively (Table). Despite a correlation between pruritus and sBA response to each IBATi, some patients experienced relief of pruritus independent of sBA response (Table). With longer follow‐up, the rate of responders seemed to increase and the sBA to decrease, but this could be due to selection bias, as non‐responders are expected to discontinue treatment more readily (Table).
Conclusions: Maralixibat and odevixibat are approved IBATi treatments for patients with nt‐BSEP‐deficiency, but published data indicate that a significant proportion (32‐68%) of patients do not have a relevant response in terms of relevant sBA or pruritus decrease. More precise characterization of IBATi non‐responders may help to develop treatment strategies that are as effective as IBATi in responding patients.
Contact e‐mail address: cristina.chiado@unito.it
H‐RF012. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF012.1. ETIOLOGY OF STEATOTIC LIVER DISEASE IN CHILDREN‐A SINGLE CENTRE EXPERIENCE
Cristina Beatrice Chirileasa‐Tanasa 1, Alina Grama1, Tudor Lucian Pop2
12nd Pediatric Clinic, Emergency Clinical Hospital for Children, Cluj Napoca, Romania, 22nd Pediatric Discipline, Mother And Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj‐Napoca, Romania
Objectives and Study: Steatotic liver disease (SLD) in children is a pathology with increasing incidence all over the world. In the pediatric population, rapid recognition of fatty liver is important because, especially in younger children, it can have a genetic, endocrine or metabolic cause. Undiagnosed it can lead to long term complications like liver chirrosis, hepatocarcinoma and increased cardio‐vascular risk. Our study aimed to highlight the main causes of SLD in children.
Methods: We performed a retrospective study in which we included children diagnosed with SLD during a period of 2 years (2023‐2024). We analyzed the demographic profiles, risk factors, anthropometric parameters, the onset symptomatology and etiology.
Results: Our cohort included 32 children with SLD diagnosed based on the elevated alanine aminotransferase or imaging evidence of fatty liver loading. The mean age at diagnosis was 9,83 years, and 56,2% of the patients were girls. Regarding the initial symptoms, only 25% presented for abdominal pain, 15% for weight gain and 25% for the accidental discovery of a hepatocytolysis syndrome; the rest of the patients presented for evaluation of associated pathologies when SLD was revealed. Regarding the etiology of steatosis, we identified the following: metabolic associated steatotic liver disease (MASLD) in 46,8% of cases, MASLD associated with another pathology ‐ 21,8% of cases, hereditary fructose intolerance‐ 9,3%, Wilson disease in 6,2%, autoimmune hepatitis‐3,1%, secondary biliary cirrhosis‐ 3,1%, lysosomal acid lipase deficiency‐ 3,1% and idiopathic SLD‐ 6,2 %. From the group presenting MASLD associated with another pathology, we noted patients with acute EBV infection, endocrine pathology, Turner syndrome and Wilson's disease.
Conclusions: Approximately half of patients with SLD do not show symptoms at onset, the disease progressing to a subclinical level. It is important to recognize hepatic steatosis and evaluate its causes, in order not to miss a pathology that can be treated.
Contact e‐mail address: beatriceuu@yahoo.com
H‐RF013. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF013.1. GENETIC VARIANTS AND LONG‐TERM OUTCOMES IN KOREAN CHILDREN WITH PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS
Shinjie Choi, Jae Sung Ko, Jin Soo Moon, Kyung Jae Lee, Jeong Eun Ahn, Lia Kim, Yeji Kim, Sunwoo Park
Department Of Pediatrics, Seoul National University Hospital, Seoul, Korea, Republic of
Objectives and Study: This study aimed to elucidate the genetic variants associated with progressive familial intrahepatic cholestasis (PFIC), a rare class of disorders driven by pathogenic monogenic variants in bile acid transporters. Furthermore, the study sought to evaluate the long‐term clinical outcomes associated with these genetic variations in PFIC patients.
Methods: A retrospective cohort study was conducted at Seoul National University Hospital (SNUH) and included six pediatric patients diagnosed with PFIC and confirmed genetic diagnoses between January 2000 and October 2024. Genetic testing, encompassing either single‐gene testing or a neonatal cholestasis gene panel analyzing 34 genes, was performed for all patients.
Results: A total of six patients (three males) were identified, including five with PFIC type 2 and one with PFIC type 3. The age of symptom onset ranged from 20 days to 3 years, with a median onset at 3 months. The genetic analysis revealed no common known variants associated with PFIC; however, three novel variants were identified in the ABCB11 gene, including one frameshift variant (c.589dupG, p.Glu197GlyfsTer8) and two missense variants (c.3662 G>A, p.Arg1221Lys; c.3812 T>A, p.Ile1271Asn). All patients ultimately underwent liver transplantation, and two developed hepatocellular carcinoma (HCC). The median age at transplantation was 1.8 years, and the mean age at HCC diagnosis was 1.7 years. Postoperative complications were noted in three patients, including bile leakage, biliary stricture, and portal vein stenosis. Notably, all patients survived without recurrence after transplantation, with a mean post‐transplant follow‐up duration of 8.5 years.
Conclusions: This study represents the first documented case of PFIC type 3 in Korean children. Given the early diagnosis of HCC observed in some patients, routine surveillance for HCC is strongly recommended during the follow‐up of PFIC type 2 patients.
Contact e‐mail address: shinjie85@gmail.com
H‐RF014. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF014.1. DIAGNOSTIC YIELD OF NEXT‐GENERATION SEQUENCING IN MONOGENIC LIVER DISEASES IS HIGHER IN INFANTS WITH LOW‐GGT CHOLESTASIS: A SINGLE‐CENTRE RETROSPECTIVE STUDY
Franco Curci 1, Teresa Sarti2, Chiara Rubino3, Mariangela Stinco3, Simona Carrera3, Elisa Bartolini3, Giuseppe Indolfi1,3
1Department Neurofarba, University of Florence, Florence, Italy, 2Department Of Health Sciences, University of Florence, Florence, Italy, 3Paediatric and Liver Unit, Meyer Children's Hospital IRCSS, Florence, Italy
Objectives and Study: An increasing number of monogenic liver diseases have been identified over the last decade, driving the widespread adoption of genetic testing in clinical practice. This study aimed to assess the diagnostic yield of next‐generation sequencing (NGS) using a targeted gene panel in a cohort of children with liver disease.
Methods: Children (age < 18 years) who underwent genetic testing using NGS of a gene panel associated with liver disease at a single tertiary care hospital between April 2018 and August 2023 were included. The initial gene panel comprised 48 genes, which was expanded to 68 genes from May 2019. Demographic, clinical and genetic data were retrospectively collected from clinical records.
Results: Eighty‐three patients (49 males, 59%) were included. The indications for genetic testing were high‐gamma‐glutamyltransferase (GGT) cholestasis in 30 patients (36%), hypertransaminasemia in 21 (25%), low‐GGT cholestasis in 12 (15%), suspected Wilson's disease in 6 (7%), and other conditions in 14 (17%). A diagnosis of monogenic liver disease was established in 11 patients (13%). The highest diagnostic yield was observed in infants with low‐GGT cholestasis (43%). The median time from clinical presentation to the prescription of genetic testing was shorter in infants (28 days [IQR 5‐103]), compared to children aged 1‐5 years (177 days [IQR 43‐540]) and those over 5 years (143 days [IQR 28‐314]) (p = 0,016). A heterozygous mutation in the ATP Binding Cassette Subfamily B Member 4 (ABCB4) gene was identified in 6 patients (7%); one presented with a phenotype of sclerosing cholangitis, while the remaining 5 exhibited mild manifestations of liver disease.
Conclusions: Genetic testing through NGS constitutes a valuable tool in the diagnostic workup of children with liver disease. Accurate patient selection based on age and clinical characteristics is essential to optimize both time and resources.
Contact e‐mail address:
H‐RF015. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF015.1. DOSE‐RESPONSE RELATIONSHIPS OF MARALIXIBAT AND ODEVIXIBAT IN PATIENTS WITH ALAGILLE SYNDROME
Alida De Groot 1, Cristina Chiadò1,2,3, Paola Mian4, Henkjan Verkade1
1Pediatric Gastroenterology‐hepatology, University Of Groningen, University Medical Center Groningen, Groningen, Netherlands, 2University of Turin, Turin, Italy, 3Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Turin, Italy, 4Clinical Pharmacy And Pharmacology, University Of Groningen, University Medical Center Groningen, Groningen, Netherlands
Objectives and Study: Two selective reversible Ileal Bile Acid Transporter inhibitors (IBATi), maralixibat and odevixibat, are approved for treatment of cholestatic pruritus in patients with Alagille syndrome (ALGS). The optimal doses for these IBATi have not been determined, and the current literature reports a wide range of doses, with varying responses. We aimed to determine relationships between dose and efficacy in reducing pruritus and serum bile acid (sBA) based on available publications.
Methods: The impact of different doses on treatment outcomes was evaluated for maralixibat and odevixibat. We conducted a systematic search across PubMed, EMBASE, Web of Science and Cochrane Library of articles, oral presentations, poster presentations and abstracts up to July 29, 2024. We assessed sBA and pruritus from clinical studies, their long‐term extensions and retrospective studies.
Results: We included 25 reports in this review. The maralixibat maintenance doses ranged from 66.5 to 760 µg/kg/day, with variable results on dose‐response (Figure). For example, in maralixibat studies, increases in dose did not correlate with a decrease in mean pruritus score or sBA (Figure). The median decrease in sBA was less pronounced after 8‐10 weeks on maralixibat dose of 266 µg/kg/day than on 66.5 µg/kg/day (‐27 µmol/L vs ‐177 µmol/L). In contrast, in another study, sBA decrease was less pronounced at a lower than at higher dose (380 and 760 µg/kg/day, respectively). For odevixibat, doses ranged from 10 to 200 µg/kg/day. However, individual outcomes have only been reported for odevixibat 120 µg/kg/day, with similar results on pruritus and sBA across different studies.
Conclusions: Present reports on IBATi for patients with ALGS do not establish reliable dose‐response relationships for pruritus or sBA. We advocate to address optimization of dose regimens to enhance clinical efficacy at the lowest possible doses.
Contact e‐mail address: a.d.e.de.groot@umcg.nl
H‐RF016. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF016.1. AN UNUSUAL CASE OF TYPE 3 HEMOCHROMATOSIS IN AN ASYMPTOMATIC TODDLER: HOW AND WHEN TO TREAT?
Valeria Delle Cave, Fabiola Di Dato, Giusy Bernardo, Erasmo Miele, Raffaele Iorio
Department of Translational Medical Sciences, Section of Pediatrics, University Federico II, Naples, Italy
Objectives and Study: Hereditary hemochromatosis (HH) includes a group of genetic disorders characterized by progressive tissue iron overload which leads to organ damage. HH almost never begins clinically in the first decade of life.
Methods: To describe an early case of HH in a toddler and evaluate the applicability of the available therapeutic strategies used mainly for secondary hemochromatosis.
Results: A symptom‐free 2‐year‐old male was referred to our Pediatric Liver Unit for an incidental finding of hyperferritinemia (2624 ng/mL). Iron levels were 241 µg/dL, transferrin 184 mg/dL and transferrin saturation > 90%. Blood count and coagulation were normal. Liver enzymes were slightly increased (ALT 77 IU/L, AST 61 IU/L) with normal bilirubin and GGT. No history of drugs or blood transfusions was reported. Physical exam was unremarkable. Main causes of hyperferritinemia were excluded. Genetic analysis revealed a pathogenic homozygous mutation (splicing variant c.1270+1 G > C) in TFR2 gene, causative of HH type 3. Additionally, a homozygous missense variant in HFE gene (c.187 C>G) was identified, but this alone is not responsible for severe iron accumulation. To assess the extent of iron overload, abdominal and cardiac MRI‐T2* was performed; only hepatic severe iron accumulation was found (T2*1.9 ms, LIC 16.5 mg/g) despite the absence of hepatomegaly. After 6 months of observation, ferritin levels were slightly reduced (1670 ng/ml).
Conclusions: The exceptional early onset of HH type 3 was probably favored by the coexistence of homozygosity for missense variant in HFE gene.Despite severe iron overload on liver MRI, the patient showed slightly reduced ferritin values during the observation period. Although there is a clear indication for iron chelation especially based on cases of secondary hemochromatosis, the very young age of the patient, the possible side effects of chelators and the lack of specific data in literature pose the problem of how to carry out iron chelation and when to start it.
Contact e‐mail address: Yes.
H‐RF017. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF017.1. DIAGNOSTIC SCORING IN BILIARY ATRESIA
Sukru Gungor1, Fatma Varol1, Ebubekir Altundaş2, Emre Gok 1, Turan Yildiz2, Sevgi Demiroz Tasolar3
1Pediatric Gastroenterology, Hepatology And Nutrition, Inonu University, Malatya, Turkey, 2Pediatric Surgery, Inonu University, Malatya, Turkey, 3Radiology, Inonu University, Malatya, Turkey
Objectives and Study: This study aimed to create a diagnostic scoring model to aid the early detection of biliary atresia (BA) by assessing the need for intraoperative cholangiography in patients suspected of having the condition.
Methods: A retrospective analysis was conducted on 70 patients who underwent intraoperative cholangiography with a prediagnosis of BA between 2019 and 2024. Data from patients diagnosed with BA via intraoperative cholangiography were compared with those who were not diagnosed with BA. Scoring was based on three parameters: acholic stools, ultrasound findings suggestive of BA, and elevated GGT levels. ROC analysis was used to determine the optimal GGT cut‐off point for diagnosing BA. The diagnostic efficacy of the scoring system was evaluated.
Results: There were no significant differences between the BA and non‐BA groups regarding age and gender. Acholic stools were present in 51 (98%) of BA patients, while 46 (88.5%) had ultrasound findings indicative of BA. All patients had elevated GGT levels. ROC analysis determined that a GGT cut‐off of ≥366 provided 73% sensitivity, 77.8% specificity, 50% negative predictive value, and 90.5% positive predictive value for BA diagnosis. A biliary score ≥1.5 yielded 98% sensitivity, 83.3% specificity, 93.7% negative predictive value, and 94.4% positive predictive value.
Conclusions: The study offers a robust and sensitive diagnostic criterion to help clinicians determine the necessity of intraoperative cholangiography and/or the Kasai procedure in infants under three months with cholestasis. These results should be validated through prospective studies with larger sample sizes.
Contact e‐mail address: sukru.gungor@yahoo.com
H‐RF018. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF018.1. DEVELOPMENT OF PORTAL HYPERTENSION AND HIGH‐RISK ESOPHAGEAL VARICES IN PATIENTS WITH BILIARY ATRESIA AND SUCCESSFUL KASAI PROCEDURE: PROGNOSTIC VALUE OF EARLY SERUM BILE ACID LEVELS
Emilie Grimaud 1,2, Antoine Gardin2,3, Oanez Ackermann2,3, Dalila Habes2, Bogdan Hermeziu2, Alice Thebaut2, Solene Le Cam4, Stéphanie Franchi‐Abella4, Virginie Lambert4, Virginie Fouquet5, Lucas Pio5, Florent Guérin5, Mathier Duché2, Emmanuel Jacquemin2,3, Marion Almes2, Emmanuel Gonzales2,3
1Faculty Of Medecine, Sorbonne Université, Paris, France, 2Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 3Inserm Umr‐s 1193, Paris‐Saclay University, Orsay, France, 4Pediatric Radiology Department, Bicêtre Hospital, Bicêtre, France, 5Department Of Pediatric Surgery, Bicêtre Hospital, Bicêtre, France
Objectives and Study: Biliary atresia can lead to portal hypertension (PH), high‐risk esophageal varices (HRV) and liver transplantation, despite a successful Kasai procedure (KP). Serum bile acids (sBA) can reflect a residual cholestasis in patients with a successful KP. We investigated the predictive value of sBA measured during the first year post‐KP on the development of PH and HRV within 5 years post‐KP.
Methods: In this retrospective monocentric observational study, we included biliary atresia patients who underwent a successful KP, defined as a total serum bilirubin level of ≤ 25 µmol/L within 6 months post‐KP, and in whom sBA levels were measured during the first year post‐KP (n = 60). We collected clinical, biological, radiological, and digestive endoscopic data up to 5 years post‐KP to assess the occurrence of PH and HRV. The predictive values of sBA were analyzed using receiver operating characteristic curves.
Results: Serum bile acids, measured at a median time of 6 months (range: 4.5‐9) and of 11 months (range: 7‐13) post‐KP, predicted PH at 3 and 5 years post‐KP, with AUCs between 0.82 and 0.89 (p < 0.001). Serum bile acids measured at the same time predicted the occurrence of HRV before 5 years post‐KP with AUCs between 0.73 and 0.74 (p < 0.05). Serum bile acid thresholds of 26 μmol/L and 13 μmol/L at a median time of 6 and 11 months post‐KP, respectively, distinguished patients with PH at 3 and 5 years post‐KP, with a 100% sensitivity. Thresholds of 56 μmol/L and 30 µmol/L at a median time of 6 and 11 months post‐KP, respectively, predicted HRV within 5 years post‐KP with a sensitivity of 100%.
Conclusions: In biliary atresia patients with a successful KP, sBA level is an early biomarker predicting the development of PH and HRV within the first 5 years post‐KP.
Contact e‐mail address: emilie.grimaud@aphp.fr
H‐RF019. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF019.1. GLYCEROL‐3‐PHOSPHATE DEHYDROGENASE 1 (GPD1) DEFICIENCY – REDEFINING THE PHENOTYPE AS A CAUSE OF PERSISTENT HEPATIC STEATOSIS AND HYPERTRIGLYCERIDAEMIA
Michael Gunn 1, Dinusha Pandithan1, Nedim Hadzic2, Roshni Vara1,2
1Paediatric Inherited Metabolic Disease, Evelina London Children's Hospital, London, United Kingdom, 2Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom
Objectives and Study: GPD1 deficiency is a rare inherited metabolic condition which is reported as a cause of transient hypertriglyceridaemia in infancy, it can manifest with liver derangement, hepatomegaly and hepatic steatosis. The GPD1 gene encodes for glycerol‐3‐phosphate dehydrogenase 1, which has a role in carbohydrate and lipid metabolism. We describe 3 patients.
Methods: A retrospective review of medical notes of patients who presented to our centre with GPD1 deficiency.
Results: We identified 3 patients (2 male); presented at a median age of 2 years (range 1 – 3 years). 2 were from consanguineous parentage. All presented with hepatomegaly and 1 had failure to thrive. 2 patients were initially investigated for suspected glycogen storage disorder. All had evidence of hepatic steatosis on ultrasonography. At presentation, mean was ALT 101 U/L (51‐169 U/L), mean triglycerides 3.87 mmol/L (1.3‐7.36 mmol/L) and mean cholesterol 4.8 mmol/L (3.3‐6.9 mmol/L). All patients underwent investigation into hepatomegaly and metabolic dysfunction associated fatty liver disease (MAFLD). Liver biopsy demonstrated moderate‐to‐severe micro and macrovesicular steatosis in all and bridging fibrosis in 2. Genetic findings confirmed homozygous pathogenic GPD1 variants in 2 and a heterozygous GPD1 variant in 1. The mean BMI at follow up is 22.1 (12.5 – 27.5). All are advised to follow healthy eating and none are treated with lipid lowering agents at last review. At a mean follow up of 9 years (4‐14 years) all patients remain well with hypertriglyceridaemia with a mean value of 7.0 mmol/L (6.5‐7.7) and hepatic steatosis on imaging.
Conclusions: We present 3 cases of a rare cause of fatty liver disease and highlight the persistence of hypertriglyceridaemia and hepatic steatosis despite the previous ‘transient’ definition. We would recommend including genetic testing for GPD1 in any patient with unexplained hepatic steatosis.
Contact e‐mail address: roshni.vara@nhs.net
H‐RF020. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF020.1. TACROLIMUS IN CHILDREN WITH AUTOIMMUNE HEPATITIS
Amira Ali, Jane Hartley, Lauren Johansen, Girish L Gupte, Joseph Valamparampil
Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
Objectives and Study: The first line treatment for autoimmune hepatitis with Azathioprine and prednisolone is effective in 80‐90% children. Tacrolimus is used as second or third‐line agent in children with 75%‐ 94% attaining biochemical remission. The objective of the audit was to analyse the use of tacrolimus in management of autoimmune hepatitis and the clinical course and outcomes on follow‐up.
Methods: Retrospective audit on the use of tacrolimus in autoimmune hepatitis in children ≤16 years (2010‐24). Demographics, indications of tacrolimus use, clinical course, laboratory parameters, liver biopsies (fibrosis staged by Ishak fibrosis score), treatment response, complications and outcomes of therapy (remission, relapse or need for liver transplantation) were assessed. Biochemical remission was defined as alanine aminotransferase <40 IU/ml.
Results: Tacrolimus was used as second (n = 7) or third (n = 4) immunosuppressant in 11 children over 14 years. Tacrolimus was started at a median age of 14.5 (IQR 13‐ 16) years and interval between diagnosis of AIH and initiation of tacrolimus was 14 (9 ‐60) months. Indications for changing to tacrolimus were failure of first line therapy (n = 10), complications related to previous immune suppressive therapy (n = 5) and non‐compliance with therapy (n = 2). Progression of fibrosis stage was noted in 72% (n = 8) at the time of initiation of tacrolimus. Initial biochemical remission was attained in 55% (n = 6) and only 27% (n = 3) attained long term remission. The total duration of follow‐up on tacrolimus was 17 (IQR 11‐ 32) months. 5 (45%) were listed for liver transplantation while three children were started on biological therapy. There were no complications from the use of tacrolimus.
Conclusions: Tacrolimus is useful as alternative immunosuppressive drug in very select group of children with treatment failure, incomplete response, or intolerance to first‐line agents. Careful selection of patients is necessary as those with advanced liver disease is unlikely to respond, necessitating addition of biologics or need for liver transplantation.
Contact e‐mail address: joseph.valam@nhs.net
H‐RF021. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF021.1. ALTERED PLASMA AMINO ACID PROFILE IN CHILDREN WITH ACUTE LIVER FAILURE
Ida Handberg 1, Thilde Winther2, Allan Lund1, Flemming Wibrand3, Peter Nissen4, Marianne Hørby Jørgensen1, Mette Ørngreen1
1Department Of Paediatrics And Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, København Ø, Denmark, 2), Department Of Paediatrics And Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, København Ø, Denmark, 3Department For Clinical Genetics, Section 4062, Biochemical Genetics, Copenhagen University Hospital, København Ø, Denmark, 4Private gastroenterology and hepatology practice, København Ø, Denmark
Objectives and Study: Pediatric Acute Liver Failure (P‐ALF) is a rare, life‐threatening condition affecting approximately 10 children annually in Denmark. The liver has a crucial role in amino acid metabolism, and while studies of amino acids in adults with ALF has given metabolic insights, prognostic value, nutritional and therapeutic information, similar studies in children are scarce. This study aims to investigate amino acid profiles in P‐ALF.
Methods: This retrospective nationwide cohort study included Danish children diagnosed with P‐ALF between 2005 and 2023. Measurement of plasma amino acid assessment was done as diagnostic work up in all P‐ALF except those with established diagnosis at arrival. Data were extracted from the medical records.
Results: Among 64 children with P‐ALF, plasma amino acid profiles revealed significant deviations from reference ranges across all tested amino acids (P < 0.001). The overall survival after PALF over a mean follow up of five years period was 65.6% (n = 42), with six children undergoing liver transplantation (LTx) and a 50% survival rate among those transplanted. Adjusted regression analysis identified significant associations between Liver Injury Unit (LIU) scores (categorized as above or below 200) and abnormal concentrations, primarily elevated levels of asparagine, glycine, histidine, lysine, tyrosine and glutamine (Figure 1: OR: 1,03‐1,017, CI: 1,001‐1,033, P < 0,005). Additionally, the distribution of glycine, histidine, threonine, and tyrosine differed significantly with primary elevated levels observed in children especially with Gestational Alloimmune Liver Disease (GALD) compared to other diagnostic categories (P < 0.05).
Conclusions: Elevated amino acid levels were linked to acute liver failure, with six specific amino acids associated with LIU scores, reflecting poorer prognosis as outcome. The distributions of glycine, histidine, threonine, and tyrosine in children with especially GALD emphasize the value of metabolic and clinical markers for P‐ALF. These findings underscore valuable insights into metabolic derangements and may guide future research and clinical management in pediatric liver failure.
Contact e‐mail address: ida.elise.lindeberg.handberg.01@regionh.dk
H‐RF022. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF022.1. PRENATAL CHARACTERISTICS AND POSTNATAL OUTCOMES OF FETAL HEPATIC LESIONS: A RETROSPECTIVE COHORT STUDY
Sophia Heiman 1,2, Tal Weissbach1,3, Shayan Yousefi1,3, Simon Lassman1, Tal Elkan Miller1,3, Eran Kassif1,3, Batia Weiss1,2
1Faculty Of Medicine, Tel Aviv University, Tel Aviv, Israel, 2Division Of Pediatric Gastroenterology And Nutrition, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel‐Hashomer, Ramat Gan, Israel, 3Department Of Obstetrics And Gynecology, Sheba Medical Center, Tel Hashomer, Israel, Ramat Gan, Israel
Objectives and Study: Fetal hepatic lesions are rare findings on prenatal imaging, with variable clinical significance. This study aimed to evaluate the prenatal characteristics, associated anomalies, and postnatal outcomes of fetuses diagnosed with hepatic lesions.
Methods: A retrospective cohort study was conducted at a single tertiary center, including fetuses diagnosed with hepatic lesions via ultrasound between 2011 and 2023. Prenatal imaging data were analyzed, and postnatal outcomes were extracted from electronic medical records. Key variables assessed included lesion type, progression, associated anomalies, genetic abnormalities, and postnatal follow‐up.
Results: Among 65 cases, 55 (84.5%) presented with echogenic lesions, 7 (11%) were cystic, 2 (3%) were subcapsular hematomas, and 1 (1.5%) was a mixed lesion. Multiple lesions were noted in 38% of cases. Most lesions (76%) remained stable, and 15% resolved prenatally. Associated anomalies were observed in 24 fetuses (37%), and genetic abnormalities were identified in 18%. Fetal mortality or pregnancy termination occurred in 18% of cases, all associated with genetic abnormalities or intrauterine growth restriction (IUGR). Among 48 liveborn infants, 96% were healthy at discharge, while 10% were diagnosed with severe comorbidities during follow‐up. Overall, 63% of hepatic lesions resolved postnatally by a median age of 12 months (IQR 2–22 months), and routine liver function tests remained normal. Isolated echogenic hepatic lesions were strongly associated with a favorable outcome (p = 0.012), whereas cystic components were linked to significant health conditions (p = 0.006).
Conclusions: Isolated fetal hepatic lesions have a good prognosis, with most resolving postnatally and no long‐term hepatic sequelae. However, ongoing follow‐up is essential for patients with associated anomalies or cystic‐type lesions.
Contact e‐mail address: sophiaheiman1@gmail.com
H‐RF023. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF023.1. THE ROLE OF WAIST‐HIP RATIO IN PREDICTING NONALCOHOLIC FATTY LIVER DISEASE AMONG KOREAN PEDIATRIC PATIENTS
Sujin Jeong
CHA Bundang Medical Center, CHA University, seongnamsi, Korea, Republic of
Objectives and Study: Background: Pediatric nonalcoholic fatty liver disease (NAFLD) is increasing along with the explosive rise in pediatric obesity since the COVID‐19 pandemic. While body mass index (BMI) have been key indicators for pediatric obesity and its comorbidities, there is a need for markers to screen and detect NAFLD more rapidly. The study aimed to explore the potential of Waist‐Hip Ratio (WHR) as an early diagnostic tool for pediatric NAFLD in Korea.
Methods: Methods: Pediatric patients aged 10‐19 who visited the CHA pediatric gastrointestinal clinic with weight gain, or elevated liver function tests participated in this study during 2 years. Anthropometric measurements included height, weight, waist circumference, and hip circumference. The diagnosis of pediatric NAFLD was based on an alanine aminotransferase level exceeding 25 mg/dL with liver ultrasound findings.
Results: Results: In a study of 781 participants (460 boys, 321 girls, mean age 11.40 years), 309 (39.6%) had NAFLD, with boys more affected than girls (51.1% vs. 23.1%). Both boys and girls with NAFLD showed higher age, WHR, and BMI compared to non‐NAFLD children. WHR cut‐off values of 0.825 for boys and 0.875 for girls were identified using ROC curves, showing significant associations with NAFLD. More NAFLD patients had a WHR above the cut‐off value than a BMI percentile above the 95th percentile, indicating the potential importance of WHR in assessing NAFLD risk in children and adolescents.
Conclusions: Conclusions: The study suggests that using Waist‐Hip Ratio (WHR) cut‐off values may be more effective in screening for pediatric NAFLD risk compared to BMI percentile cut‐off values.
Contact e‐mail address: jinped@cha.ac.kr
H‐RF024. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF024.1. DIAGNOSTIC CRITERIA FOR PEDIATRIC AUTOIMMUNE HEPATITIS: COMPARATIVE EVALUATION OF AUTOANTIBODIES AND TESTING METHODS
Norman Junge 1,2,3, Theresa Kirchner4, Nicole Hennies4, Stephanie Loges4, Muhammed Yuksel5,6, Wojciech Janczyk7, Claudine Lalanne8, Kalliopi Zachou9, Ye H Oo10, Jerome Gournay11, Simon Pape12, Joost Ph Drenth13, Amedee Renand14, George Dalekos9, Luigi Muratori8, Piotr Socha7, Cigdem Arikan6, Yun Ma5, Heiner Wedemeyer3,4, Ulrich Baumann1,2,3, Bastian Engel3,4, Richard Taubert3,4
1Division For Pediatric Gastroenterology And Hepatology, Department Of Pediatric Kidney, Liver And Metabolic Diseases, Hannover Medical School, Hannover, Germany, 2ERN Transplantchild, Madrid, Spain, 3European Reference Network on Hepatological Diseases, Hamburg, Germany, 4Department Of Gastroenterology, Hepatology, Infectious Diseases And Endocrinology, Hannover Medical School, Hannover, Germany, 5Department Of Inflammation Biology, School Of Immunology And Microbial Sciences, Institute of Liver Studies, King's College Hospital, London, United Kingdom, 6Liver Immunology Lab, Koç University Research Centre for Translational Medicine, Istanbul, Turkey, 7Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 8Department Of Medical And Surgical Sciences, University of Bologna, Bologna, Italy, 9Department Of Medicine And Research Laboratory Of Internal Medicine, National Expertise Center Of Greece In Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece, 10Centre For Liver And Gastro Research, National Institute Of Health Research Birmingham Biomedical Research Centre, Institute Of Immunology And Immunotherapy, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom, 11Chu Nantes, Institut Des Maladies De L'appareil Digestif (imad), Hépato‐gastro‐entérologie, Inserm Cic 1413, Nantes Université, Nantes, France, 12Department Of Gastroenterology And Hepatology, Radboud University Medical Center, Nijmegen, Netherlands, 13Department Of Gastroenterology And Hepatology, Amsterdam University Medical Center, Amsterdam, Netherlands, 14Inserm, Center For Research In Transplantation And Translational Immunology, Nantes Université, Nantes, France
Objectives and Study: The diagnosis of pediatric autoimmune liver disease (pAILD = pediatric autoimmune hepatitis (pAIH) and autoimmune sclerosing cholangitis (AISC)) is still challenging. Autoantibodies, typically detected by immunofluorescence testing (IFT) and liver histology are the key features. Polyreactive immunoglobulin G (pIgG) has emerged as a complementary biomarker in pAILD(1,2). However, autoantibodies are common findings also in non‐pAILD‐liver‐ diseases (non‐pAILD‐LD) and the comparability for ELISA and IFT assessment is not analyzed in pAILD so far. This retrospective multicenter‐cohort‐study aimed to evaluate diagnostic value for these different methods and autoantibodies.
Methods: Blood sample of untreated patients with pAILD or with non‐pAILD‐LD were reanalyzed for autoantibodies by ELISA (ANA, F‐Actin, pIgG) and IFT (ANA, SMA). Autoantibody detection was performed locally using three commercial ANA‐ELISAs, one commercial F‐actin‐ELISA, one home‐made pIgG‐ELISA and IFT (rodent tissue sections and HEp‐2 cells). The diagnosis of pAILD was based on published scoring system and confirmed by disease behavior at follow‐up. The study was approved by ethics committee.
Results: 69 pAIH‐patients, 12 AISC‐patients and 124 non‐AILD‐LD‐patients were included. The median age wasr 12 years (2‐17) vs. 13 (6‐17) vs. 12 (0‐17); p = 0.978. The AUCs for the detection of pAIH for ANA ELISAs ranged from 0.646 to 0.764 and were comparable to those of IFT (HEp‐2 AUC: 0.762; rodent tissue AUC: 0.761). SMA IFT on rodent tissue showed an AUC of 0.742 (Figure 1 A + B). Specificity was increased to 100% by including the SMA staining pattern of vessels, glomeruli and tubules. ELISA‐based quantification of anti‐F‐actin (AUC = 0.855) and pIgG (AUC = 0.857) showed the highest AUCs. Anti‐F‐actin was found in most AISC patients (75%), while pIgG was less common (43%).
Conclusions: F‐actin and pIgG ELISAs showed the highest accuracy for predicting pAILD and may complement diagnostic criteria. ELISAs could provide reliable ANA detection comparable to IFT and specificity of SMA is depending on staining pattern.
Contact e‐mail address: junge.norman@mh-hannover.de
H‐RF025. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF025.1. SYSTEMATIC LITERATURE REVIEW OF THE CLINICAL AND HUMANISTIC BURDEN OF BILIARY ATRESIA
Emmanuelle Kaltenbach 1, Claudia Mighiu2, Sushma Pabbineedi2, Pushpa Hossain2
1Ipsen, London, United Kingdom, 2Prime HCD, Knutsford, United Kingdom
Objectives and Study: Biliary atresia (BA) is a rare, progressive fibroinflammatory cholangiopathy in infants. Primary treatment involves surgical intervention with Kasai portoenterostomy (KPE), aiming to reconstruct bile flow to prevent liver failure. However, many affected children will develop end‐stage liver disease, requiring liver transplantation. Despite improvement in diagnosis and management, BA is a major pediatric health issue worldwide, and no approved drug is available to slow or prevent complications. The aim of this systematic literature review (SLR) was to describe the clinical and humanistic burden of BA.
Methods: Databases were searched for interventional and observational studies (SLRs and meta‐analyses) published from 2014–2024, including articles reporting on patients of any age diagnosed with BA and receiving any or no intervention. This SLR focused on natural history of the disease, treatment patterns, and patient‐reported outcomes, describing health‐related quality of life (HRQoL).
Results: Number of included studies is presented in Figure 1. In studies reporting clinical outcomes, age at KPE varied with a mean of 45 days at the lower end, and most studies reported the procedure around 50–60 days. Native liver survival and graft survival were reported in 13 and 4 studies respectively, reported rates are described in Table 1. Twelve studies reported drug therapies using nutritional supplements, immunosuppressants, postoperative antibiotics, and steroid therapy. Studies indicated lower HRQoL in BA patients compared with healthy peers, with mean PedsQL scores of 80–90. Caregivers reported higher anxiety levels during hospitalization, with anxiety 36% higher compared with reference values.
Conclusions: Patients with BA undergo many interventions early in life and require continuous medication to manage symptoms and complications from surgery, contributing to a substantial humanistic and clinical burden for patients and caregivers. However, there is a gap in knowledge regarding the long‐term evolution of patients' HRQoL, and data on caregivers is scarce, highlighting the need for further research.
Contact e‐mail address: emmanuelle.kaltenbach@ipsen.com
H‐RF026. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF026.1. THE EFFECTIVENESS OF PARTIAL SPLENIC EMBOLIZATION IN HYPERSPLENISM AND VARICEAL BLEEDING IN CHILDREN
Fırat Kaya 1, Hülya Karaahmetoğlu2, Pinar Yamac Dilaver3, Erkan Akkus4, Ilgin Özden5, Özgür Kılıçkesmez6, Günsel Kutluk1
1Pediatric Gastroenterology, Health Sciences University Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey, 2Pediatric Gastroenterology, Health Sciences University Başakşehir Çam ve Sakura City Hospital, ISTANBUL, Turkey, 3Pediatric Gastroenterology, Health Sciences University Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey, 4Pediatric Gastroenterology, Hepatology And Nutrition, Health Sciences University Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey, 5General Surgery,hepatobiliary Surgery And Liver Transplantation Department, Health Sciences University Başakşehir Çam and Sakura City Hospital, ISTANBUL, Turkey, 6Radiology, Health Sciences University Başakşehir Çam and Sakura City Hospital, ISTANBUL, Turkey
Objectives and Study: Partial splenic artery embolization (PSAE) is a significant alternative for managing hypersplenism, preventing esophageal variceal bleeding, and avoiding the risks of splenectomy in cases where surgery is infeasible. This study aims to present the short‐ and long‐term outcomes of PSAE performed on 11 children.
Methods: Eleven patients, who were being followed up with a diagnosis of portal hypertension(PHT) and hypersplenism and underwent interventional splenic artery embolization, were included in the study.Demographic data,clinical courses and complications were evaluated. After being stabilized post‐procedure,the patients were monitored every three months with abdominal ultrasound (USG), blood counts, and liver function tests The children were followed for 1 to 48 months (median 25th‐75th percentile: 6‐36 months)
Results: Eleven patients(7 males)were included in the study.Ages ranged from 1 to 17 years (median age 5 years). All patients had hypersplenism and 8 patients had recurrent esophageal variceal bleeding. Underlying diseases included extrahepatic PHT in 7 patients(3 with portal vein thrombosis) and intrahepatic PHT in 4 patients due to biliary atresia,Wilson's disease, Gaucher disease and bile acid synthesis disorder Early complications commonly observed were minor issues such as fever and pain. The average hospital stay due to these complications was 22 days.No cases of severe sepsis or splenic abscess were observed following partial splenic artery embolization. Following PSAE,hematological values normalized in 10 of 11 patients with hypersplenism. Recurrence observed in only one patient. The frequency of esophageal variceal bleeding decreased from an average of 1.8 per year to 0.25 (p < 0.05). Some patients experienced no bleeding during follow‐up periods ranging from 4 to 40 months. Variceal bleeding significantly improved in patients with portal vein thrombosis.
Conclusions: This study demonstrates that PSAE is an important method in managing portal hypertension in selected patients, effectively managing hypersplenism and variceal bleeding while reducing the need for splenectomy.
Contact e‐mail address: firatkaya9296@gmail.com
H‐RF027. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF027.1. SUCCESSFUL TREATMENT OF CHOLESTATIC PRURITUS WITH ODEVIXIBAT IN VANISHING BILE DUCT SYNDROME: A NOVEL APPROACH
Thomas Kehler
University Children's Hospital Regensburg, University Hospital Regensburg, Regensburg, Germany
Objectives and Study: Vanishing Bile Duct Syndrome (VBDS) is a rare cholestatic liver disorder characterized by the progressive loss of intrahepatic bile ducts, leading to jaundice, pruritus, and elevated serum bile acids (sBA). Managing cholestatic pruritus is particularly challenging in pediatric patients. Odevixibat, an ileal bile acid transporter (IBAT) inhibitor, interrupts the enterohepatic circulation of bile acids and has demonstrated efficacy in other pediatric cholestatic conditions. This a case report about the successful treatment of cholestatic pruritus with Odevixibat in VBDS.
Methods: We report the case of an adolescent male with VBDS, likely secondary to Hodgkin's lymphoma. The patient presented with severe pruritus and markedly elevated sBA levels, refractory to standard therapies. An increased dose of ursodeoxycholic acid (UDCA) resulted in clinical worsening and higher sBA levels. Following the initiation of odevixibat, the patient experienced rapid improvement, with resolution of pruritus and a significant reduction in sBA levels, nearing normal ranges.
Results: This is the first documented use of odevixibat in VBDS. Its mechanism of action offers a targeted approach to managing cholestatic pruritus and reducing systemic bile acid levels. This case highlights the potential for IBAT inhibitors to address a critical unmet need in pediatric cholestatic liver diseases.
Conclusions: Odevixibat proved highly effective in resolving cholestatic pruritus in a pediatric VBDS patient, underscoring its potential as a novel therapeutic option. This case highlights the potential for IBAT inhibitors in addressing unmet needs in the management of rare cholestatic disorders. Further research is essential to evaluate its broader application and long‐term outcomes in cholestatic conditions.
Contact e‐mail address: thomas.kehler@ukr.de
H‐RF028. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF028.1. OCCURRENCE OF HEPATITIS E VIRUS INFECTION IN LIVER TRANSPLANTED PEDIATRIC PATIENTS AND IN PATIENTS WITH AUTOIMMUNE LIVER DISEASE
Gandom Kharrazi 1, Rickard Nordén2, Johan Westin2, Bjorn Fischler3
1Pediatric Gastroenterology, Astrid Lindgren Children's Hospital, Karolinska University Hospital and Division of Pediatrics, CLINTEC, Karolinska Institutet, Stockholm, Sweden, Stockholm, Sweden, 2Dept. Infectious Diseases/Clinical Microbiology, Gothenburg, Sweden, 3Pediatric Gastroenterology, Astrid Lindgren Children's Hospital, Karolinska University Hospital And Division Of Pediatrics, Clintec, Karolinska Institutet, Stockholm, Sweden
Objectives and Study: Hepatitis E virus (HEV) infection can lead to acute hepatitis, which usually resolves without complications in healthy individuals. However, chronic HEV infection can develop in immunosuppressed patients. Increased awareness of chronic HEV infection in various conditions is important, as there are reported data suggesting that the virus has significant clinical implications in these patients. Furthermore, such chronic HEV infection has been suggested to precipitate autoimmune liver disease in adults. The aim of this study may provide insights into whether HEV screening/monitoring of patients with autoimmune hepatitis or identified risk groups is indicated. Furthermore, the study aims to enhance knowledge about clinical manifestations that should prompt HEV testing in patients. Properly utilized resources can help identify potential cases of HEV infection, ensuring that affected individuals receive appropriate treatment.
Methods: Prospective testing for HEV serology was performed in all children with autoimmune liver disease (AILD) and in all Liver transplanted children attending annual check‐ups at Astrid Lindgren Children's Hospital during 2017. If any of the children showed serological signs of past or ongoing HEV infection, we concurrently requested permission to check existing frozen samples from the Department of Clinical Virology at Karolinska University Hospital, with PCR for HEV RNA.
Results: 70 patients were tested for HEV of whom 26 had AILD and 44 had been transplanted. There were 3 positive samples for HEV IgG of whom 2 had AILD.
Conclusions: HEV infection is unusal among pediatric patients with autoimmen hepatitis and liver transplanted in Sweden. Our data suggest that general screening for HEV infection in these groups may not be warranted, although patients with elevated transaminases of unknown cause need testing.
Contact e‐mail address: gandom.kharrazi@ki.se
H‐RF029. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF029.1. SECOND‐LINE THERAPY OF AUTOIMMUNE LIVER DISEASE IN CHILDREN AND ADOLESCENTS ‐SINGLE CENTER INCIDENCE AND EXPERIENCES OVER 10 YEARS‐
Marie Korell, Miriam Kramer, Alina Poets, Imeke Goldschmidt, Frauke Mutschler, Margarete Rathert, Reyna Rumenova Shentova‐Eneva, Hamoud Nasser, Eva‐Doreen Pfister, Ulrich Baumann, Norman Junge
Division Of Pediatric Hepatology And Liver Transplantation; Department Of Pediatric Liver, Kidney And Metabolic Diseases And Neuropediatrics, Medizinische Hochschule Hannover, Hannover, Germany
Objectives and Study: Pediatric Autoimmune hepatitis (pAIH) is a chronic or acute inflammation of the liver. First‐line‐treatment (FLT) of AIH involves prednisolone and azathioprine. If pAIH is left untreated or biochemical remission (BR) is not reached, liver cirrhosis can develop. Therefore, we aimed to compare the outcome under different second‐line therapies (SLT), third‐line therapies (TLT) or alternative first‐line therapies (aFLT) for pAIH.
Methods: We conducted a retrospective analysis at our center, including all cases of patients with pAIH or autoimmune sclerosing cholangitis (ASC) between 2014‐2024. All patients were diagnosed based on ESPGHAN guideline (REF)1.
Results: We could identify 128 patients with pAIH or ASC who were treated at our center between 2014 and 2024. Of these, 24 patients received at one point a therapy other than prednisolone and azathioprine (altT). SLT Reasons for change to SLT were primarily non‐BR in 80% (Figure‐1), which was co‐caused by non‐adherence in 5 cases (21,7%). While CSA was the most common SLT (Figure 1), proportionally, most patients with TAC and MMF achieved BR. TLT Of 23 SLT patients, 11 patients required TLT due to missing BR or side effects of SLT (Figure‐1). TAC was most frequently used as TLT, but TLT with MMF or infliximab led more frequently to a BR.
Conclusions: In our retrospective cohort analysis, 24 of 128 (18,75%) pAIH/ASC patients needed altT. Only 37.5% of SLT patients with MMF and 26.7% with CSA achieved BR. Infliximab, as TLT, reached a BR‐rate of 25% (potentially endorsed by controlled adherence due to intravenous application). We can conclude that BR rates for SLT and TLT are low (selection bias of difficult‐to‐treat patients) and that a clear advantage of a particular medication cannot be established based on our first analysis. 1) PMID: 29356770.
Contact e‐mail address: korell.marie@mh-hannover.de
H‐RF030. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF030.1. COGNITIVE FUNCTION AND QUALITY OF LIFE IN PEDIATRIC AUTOIMMUNE HEPATITIS
Miriam Kramer, Imeke Goldschmidt, Alina Poets, Niyade Ouro‐Djobo, Ulrich Baumann, Norman Junge
Division Of Pediatric Hepatology And Liver Transplantation; Department Of Pediatric Liver, Kidney And Metabolic Diseases And Neuropediatrics, Medizinische Hochschule Hannover, Hannover, Germany
Objectives and Study: Autoimmune hepatitis (AIH) is suspected to negatively influence cognitive function (cogF) and known to decrease health‐related quality of life (HRQoL). However, there are no data on cogF and only scarce data on HrQoL in children with AIH.
Methods: We prospectively investigated cogF and HRQoL in children with AIH using the PedsQL 4.0 (self and parent‐proxy report for subjective cogF and subjective HRQoL) and the children's colour trail test (CCTT) for objective estimation of cogF. Patients included a longitudinal cohort (pre‐treatment (PT) n = 18, 6 months treatment (T1) n = 14, age 12 y [6‐18]) and an additional cross‐sectional cohort on treatment (T2, n = 30, 15 y [6‐17]). Comparison was made with healthy children (HC, n = 296, 10 y [2‐18]) for CCTT and cogPedsQL, and with a published cohort of Varni et al for HRQoL (PMID 11468499).
Results: Pre‐treatment, patients’ subjective cogF did not differ from HC, while objective cogF trended worse compared to HC (p = 0.1). After 6 months of treatment, subjective proxy cogF improved (p = 0.07). Objective cogF decreased, albeit not significantly (p = 0.15). If both T1 and T2 were combined, lower objective cogF in patients compared to HC was confirmed (CCTT2 46[16‐66] vs 50[19‐63], p = 0.049). In HRQoL, physical health appeared reduced PT (patients’ self‐report 76.6 vs 80.2 (HC Varni). Patients physical health and psychosocial self‐report improved significantly from PT to T1 (physical HRQoL 76.6[25‐100] vs 91.4[41‐100], p = 0.028, psychosocial HRQoL 65 vs 77.5, p = 0.02, Fig.1).
Combined analysis of T1&T2 revealed higher parent‐proxy HRQoL and higher physical and overall self‐report HRQoL in patients compared to the Varni HC.
Conclusions: Objective cognitive functioning measured by CCTT2 is reduced in children with AIH. Self‐reported HRQoL improved after 6 months of treatment. While improvement in HRQoL might reflect response to treatment and strengthens treatment adherence, further research is required to investigate the consequences of reduction of objective cognitive functioning in AIH under treatment.
Contact e‐mail address: Kramer.Miriam@mh-hannover.de
H‐RF031. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF031.1. PRELIMINARY STUDY TO ASSESS THE UTILITY OF SHEAR WAVE ELASTOGRAPHY IN THE DIAGNOSIS OF PATIENTS WITH SUSPECTED BILIARY ATRESIA
Maria Dolores Lledin Barbancho 1, Monse Bret Zurita2, María José Quilés Blanco1, María Alós Díez1, Marta García Vega1, Lorena Fernández Tomé1, Gema Munoz Bartolo1, Ana Martinez Pereira1, Nelson Mauricio Buitrago Sánchez2, Esteban Frauca Remacha1
1Pediatric Hepatology, University Hospital La Paz, Madrid, Spain, 2Pediatric Radiologist, University Hospital La Paz, Madrid, Spain
Objectives and Study: Hepatic elastography (HE) is a non‐invasive, easy‐to‐perform technique that measures liver stiffness. Among the types of HE, shear wave elastography (SWE) has the advantage of an integrated probe, greater flexibility, and better evaluation of liver anatomy. It identifies vascular structures and focal lesions that may lead to errors. We aimed to establish its diagnostic value for patients with biliary atresia (BA).
Methods: Prospective single‐center study including, from April to December 2023, all patients evaluated for suspected BA and a control group without cholestasis. SWE (Canon i700 system) was performed with two transducers: a convex probe (i8Cx1‐8MHz) with greater penetration, and a linear probe (14 MHz) with lower penetration but higher image quality. Measurements were taken in the right hepatic lobe (RHL), left hepatic lobe(LHL), and spleen by the same radiologist. The association of the obtained values with age, analytical parameters, the diagnosis of atresia, the degree of fibrosis on liver biopsy during surgery, and the restoration of bile flow was analyzed.
Results:
Eighteen children aged 51 ± 18 days were included: 4 controls, 6 with cholestasis without BA, and 8 with BA. The convex probe yielded significant differences in the RHL between patients with BA vs. others (20.6 ± 13.3 KPa vs.7.0 ± 1.1 KPa, P = 0.006), as did the linear probe (23.1 ± 22.4 KPa vs.11.1 ± 2.9 KPa, P = 0.013). ROC curve analysis identified the best cutoff point at 9.25 KPa (Sensitivity=75%, Specificity=100%, AUC 0.896) to separate patients with BA from others. Two BA patients with values below the cutoff point restored bile flow after surgery. No differences were observed between controls vs. cholestasis without BA group (P > 0.05). No correlation was found with the degree of fibrosis, cholestasis parameters,or age.
Conclusions: SWE provides useful information in the differential diagnosis of BA. In our study, the best results were obtained with the convex probe and measurements in the RHL.
Contact e‐mail address: lolilledin@gmail.com
H‐RF032. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF032.1. ODEVIXIBAT RAPIDLY REDUCES PRURITUS AND SERUM BILE ACIDS IN CHILDREN WITH BILIARY ATRESIA AND RESIDUAL CHOLESTASIS FOLLOWING KASAI PORTOENTEROSTOMY
Emanuele Nicastro1, Angela Marino 2, Lorenza Matarazzo1, Valeria Casotti1, Fernanda Cristofori3, Ruggiero Francavilla3, Gabriella Nebbia4, Giulia Paolella4, Alessandro La Rosa5, Annalisa Madeo5, Antonio Marseglia6, Angelo Di Giorgio7, Lorenzo D'antonio1,2
1Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 2Department of Pediatrics, University of Milano‐Bicocca, Milan, Italy, 3Interdisciplinary Department of Medicine, Pediatric Section, Pediatric Hospital Giovanni XXIII, Bari, Italy, 4Intermediate Pediatric Care Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy, 5Pediatric Gastroenterology and Endoscopy Unit, IRCCS Giannina Gaslini, Genoa, Italy, 6Pediatrics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy, 7Pediatrics, University of Udine, Udine, Italy
Objectives and Study: Biliary atresia (BAtr) is a major cause of neonatal cholestasis, and the most common indication to pediatric liver transplantation. Children surviving with native liver after Kasai portoenterostomy (KPE) may present chronic cholangiopathy, residual cholestasis, and fibrotic progression. Ileal Bile Acid Transporter (IBAT) inhibitors have not been studied in these patients. We assessed safety and efficacy of Odevixibat in BAtr children with cholestatic pruritus.
Methods: Odevixibat was administered at a dosage of 40 μg/kg/d QD. Complete pruritus response was defined as a score ≤1 of the 0‐to‐4 points Pruritus Global Impression Scale (PGIS). Serum bile acid (sBA) response was defined as sBA decrease ≥50%, and was defined complete in presence of total sBA ≤75 mmol/L.
Results: Seven children [4 females, median age 7.5 years (range 1.1‐11.5), KPE performed at 67 (60‐95) days of life] were included. Five had liver fibrosis (≥12 kPa) at transient elastography, and 4 clinically evident portal hypertension; mean baseline bilirubin was 2.2 ± 1.3 mg/dL. All the patients had a complete pruritus response after a median time of 2 weeks, with a PGIS score decreasing from 2.8 ± 0.8 (baseline) to 1.1 ± 1 (week 2, p = 0.003), and 0.2 ± 0.4 (week 16, p < 0.001). Likewise, all had sBA response, which was complete in 6 of them. sBA decreased from 239 ± 115 (baseline) to 85 ± 122 (week 2, p = 0.005), and 57 ± 19 mmol/L (week 24, p = 0.052), with a median decrease of ‐75% (range: ‐55% to ‐86%). Transient grade 1 diarrhea was recorded in one patient.
Conclusions: This is the first report of Odevixibat in children with BAtr. Odevixibat is highly effective and safe in cholestatic pruritus in children with BAtr and residual cholestasis after KPE.
Contact e‐mail address: enicastro@asst-pg23.it
H‐RF033. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF033.1. DYSLIPIDEMIA IN ALAGILLE SYNDROME: PRELIMINARY RESULTS FROM THE MULTICENTER ALPACA STUDY (ALAGILLE SYNDROME LIPOPROTEIN PROFILE AND CHOLESTEROL ASSESSMENT)
Valentina Masenello 1, Alice Ossoli2, Lucia Belotti2, Emily Claire Argento3, Giusy Ranucci3, Alice Pozza4, Paola Gaio1, Laura Calabresi2, Mara Cananzi1
1Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, University Hospital of Padua, Padova, Italy, 2Centro Grossi Paoletti Niguarda Hospital, Milano, Italy, 3Department of Pediatrics Liver Transplant Center UPMC‐ISMETT, Palermo, Italy, 4University Hospital of Padova, Department of Women's and Children's Health, Padova, Italy
Objectives and Study: Background: Alagille Syndrome (ALGS) is a rare genetic disorder with multisystem involvement, including altered bile duct development. Hypercholesterolemia and xanthomas are hallmark features, but their pathogenesis and clinical impact remain poorly understood. The ALPACA study explores lipid/lipoprotein profiles in ALGS patients and their association with disease complications.
Methods: Methods: ALPACA is a multicenter, observational study enrolling ALGS patients of any age followed at the University Hospital of Padova and UPMC‐ISMETT Institute in Palermo (Italy). Data collection encompasses standardized clinical assessments, biochemical analyses, and instrumental evaluations such as carotid intima‐media thickness (IMT) and pulse wave velocity (PWV). Blood samples are processed centrally for lipid/lipoprotein analysis.
Results: Results To date, 25 ALGS patients (14 males; median age 13 years) have been enrolled. Among patients with native liver (20/25), lipid profiles revealed elevated total cholesterol (TC, 42%), free cholesterol (FC, 47.6%), phospholipids (52%), HDL (81%), and LDL‐C (33%) with low ApoB/LDL ratio. LpX was detected in 62% patients, associated with higher LDL‐C (125 mg/dL vs. 68 mg/dL, p = 0.004), FC/TC (0.29 vs. 0.24, p = 0.008) and HDL (78 mg/dL [55.8–121]). LpX detection correlated with cholestasis, including elevated conjugated bilirubin (p = 0.005), bile salts (p = 0.035) and GGT (p = 0.005), and with APRI index (p = 0.005). LCAT activity was reduced in LpX‐positive patients (median 18 U/L, IQR: 7.5–26.7). IMT and PWV exceeded the 95th%ile for age in 60% (9/15) and 83% (5/13) of patients. Notably, these vascular markers did not correlate with dyslipidemia or LpX detection.
Conclusions: Conclusions: Cholestatic ALGS patients present with a distinctive non‐atherogenic dyslipidemia, characterized by elevated LDL‐c, FC, HDL and phospholipids alongside LpX presence. This reflects disrupted cholesterol homeostasis, likely due to increased FC release by the cholestatic liver and reduced LpX clearance caused by low LCAT activity. These findings underscore the complexity of lipid metabolism in ALGS and highlight the need for further research to elucidate its clinical implications.
Contact e‐mail address: valentina.masenello@gmail.com
H‐RF034. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF034.1. THE USE OF FENOFIBRATE AS TREATMENT FOR CHOLESTATIC PRURITUS IN PEDIATRIC PATIENTS
Maria Mercadal‐Hally, Javier Juampérez, Cristina Padrós, Mauricio Larrarte King, Simone Mameli, Lis Vidal, Jesus Quintero
Paediatric Hepatology And Liver Trasplant Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Objectives and Study: Cholestatic pruritus is a prevalent and challenging symptom in patients with cholestatic disorders, difficult to quantify and manage. We aim to report our experience using fenofibrate in refractory cholestatic pruritus in pediatric patients.
Methods: Retrospective review of data collected from a prospective protocol on the use of fenofibrate in patients under 18 years old with moderate to severe pruritus (5D Itch score >15) refractory to UDCA, rifampicin, and cholestyramine due to fibrosing cholangiopathies. Patients were treated with fenofibrate at a dose of 100 mg/20 kg daily, with those weighing <20 kg receiving 10 mg/kg (maximum 100 mg). A good response was defined as a > 50% reduction in the 5D Itch score, while partial relief was defined as a 25‐50% decrease.
Results: A total of 25 patients were treated with fenofibrate from May 2017 to May 2023, with a median treatment duration of 24.2 months. Pruritus reduction was 36.8%, 52.2%, 53.6%, 57.1%, and 60.8% at 2 weeks, 1, 3, 6, and 12 months, respectively. At one year, 64% of patients (16/25) showed >50% improvement, while 16% (4/25) were partial responders. Fenofibrate also significantly decreased serum bile acids, AST, ALT, bilirubin, cholesterol, and triglycerides, though elastography was unaffected. No serious adverse events or discontinuations due to side effects were reported.
Conclusions: The results of our study underscore the potential therapeutic benefits of fibrates in managing pruritus in pediatric patients with cholestatic diseases. These findings warrant further investigation through randomized clinical trials to better assess their efficacy and safety.
Contact e‐mail address:
H‐RF035. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF035.1. INVESTIGATING CHOLESTASIS AND PRIMARY LIVER DISEASE IN A TERTIARY NEONATAL INTENSIVE CARE UNIT (NICU)
Zeba Moin 1, Amin Roberts1, Jonathan Bishop1, Mariam Buksh2, David Knight2, Robert Lopez1, Stephen Mouat1, Helen Evans1
1Paediatric Gastroenterology And Hepatology, Starship Child Health, Auckland, New Zealand, 2Starship Newborn Services, Starship Child Health, Auckland, New Zealand
Objectives and Study: Neonatal cholestasis has numerous aetiologies and occurs frequently in NICU through systemic illness, prematurity, and parenteral nutrition (PN). Invasive investigation in this cohort may be high‐risk and low‐yield. We retrospectively audited our NICU guidelines for evaluating cholestasis to refine them.
Methods: Babies born 2008‐2022, admitted to NICU, with conjugated bilirubin ≥ 20 µmol/L and fraction of total bilirubin ≥ 20% were identified from laboratory records. Investigations, risk factors, diagnoses and outcome data were obtained from clinical records. ‘Multifactorial cholestasis’ definition was ≥ two contributing aetiologies.
Results: Cholestasis developed in 208 (1.54% admissions) with median gestational age 27 weeks (IQR 25‐32 weeks) and birth weight 942 grams (IQR 730‐1478 grams). Specialist tests included 29 (13.9%) liver biopsies, 7 (3.4%) hepatobiliary scintigraphy and 1 (0.5%) percutaneous cholangiogram. Four (1.92%) infants had biliary atresia born 39, 37, 33 and 31 weeks; two term infants had heterotaxy or intrabdominal cysts on antenatal ultrasound and two preterm infants manifested cholestasis with acholic stools ≤ 1 month postnatal. All four received Kasai portoenterostomy within 8 weeks. One (0.48%) term infant with Alagille syndrome had dysmorphism and antenatally detected pulmonary stenosis. There was no late diagnosis of primary liver disease in NICU. ‘Multifactorial cholestasis’ was diagnosed in 85 (40.9%). Profound sepsis/hypoxia caused cholestasis in 17 (8.2%). Hypothyroidism was identified in 14 (6.7%). CMV infection was identified in 53 (25.5%). No cause was found in 19 (9.1%). None had inborn errors of metabolism. Only 31 (14.9%) of 99 (47.6%) infants with PN exposure ≥30 days had documentation. Intestinal failure‐associated liver disease (IFALD) definition (PN ≥ 60 days with hepatic dysfunction persisting without sepsis) was fulfilled by 40 (19.2%) infants but documented in 10 (4.8%).
Conclusions: All NICU infants with primary liver disease were readily identified. Guidelines can be refined to high‐yield testing by patient factors. Intestinal failure and IFALD is under‐recognised in NICU.
Contact e‐mail address:
H‐RF036. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF036.1. SUCCESS OF TRANSITION TO ADULT CARE IN PATIENTS WITH PEDIATRIC‐ONSET CHRONIC LIVER DISEASE
Sarah Mongbo 1, Valérie Canva2, Sébastien Dharancy2, Guillaume Lassailly2, Alexandre Louvet2, Philippe Mathurin2, Nassima Ramdane3, Frédéric Gottrand4, Madeleine Aumar4
1Service De Gastro‐entérologie, Hépatologie Et Nutrition Pédiatrique, Hopital Jeanne de Flandre, Lille, France, 2Service De Gastro‐entérologie Adulte, CHU de Lille, Lille, France, 3Unité Statistique, Évaluation Économique Et Data‐management, CHU Lille, Lille, France, 4Service De Gastroentérologie, Hépatologie Et Nutrition Pédiatriques, Lille Hospital, Lille Cedex, France
Objectives and Study: The transition of patients with pediatric‐onset chronic liver diseases (CLD) to adult care remains underexplored. This study aimed to evaluate the rate of successful transitions, their evolution over time, and factors associated with transition failure in a cohort of patients with CLD.
Methods: We conducted a retrospective, observational, single‐center study at a tertiary hospital. Ninety‐three patients followed in the pediatric hepatology clinic and transferred to adult care between 1997 and 2019, with at least two years of post‐transition follow‐up, were included. Data were extracted from medical records. Transition failure was defined as death, poor adherence to medical appointments, or complications due to therapeutic nonadherence within two years post‐transition.
Results: Transition failure was observed in 24% of patients, primarily driven by poor attendance (68%) and complications (32%); no deaths were reported. The failure rate decreased by nearly 80% over the study period. Significant risk factors for failure included a history of therapeutic nonadherence (odds ratio [OR]: 3.49; 95% confidence interval [CI]: 1.17–10.43, p = 0.03) and missed pediatric consultations in the year prior to transition (OR: 2.76; 95% CI: 1.06–7.15, p = 0.04). Although meeting an adult‐oriented hepatologist was not independently associated with transition outcomes, significantly more patients in the successful group had such meetings compared to those in the failure group (31% vs. 9.1%, p = 0.04). Age at transition, disease duration or stability, liver disease type, symptoms, and hepatologist experience were not significant predictors.
Conclusions: Successful transition was achieved in over 75% of patients, with outcomes improving over time. Adolescents with a history of therapeutic nonadherence or poor attendance require targeted interventions to optimize transition outcomes.
Contact e‐mail address:
H‐RF037. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF037.1. CURRENT PRACTICE IN PERINATAL MANAGEMENT OF CONGENITAL PORTOSYSTEMIC SHUNTS (CPSS) – ON THE ROAD FOR STANDARIZATION
Yael Mozer ‐ Glassberg 1, Stéphanie Franchi‐Abella2, Paolo Marra3, Henri Justino4, Hajime Uchida5, Narjes Ghali6, Jose Lipsich7, Max Zalcman8, Valérie Mclin9, Oanez Ackermann10, On Behalf Of Ircpss11
1Institute Of Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva, Israel, 2Pediatric Radiology Department, Bicêtre Hospital, Bicêtre, France, 3Department Of Radiology, ASST Papa Giovanni XXIII Hospital, University of Milano‐Bicocca, Bergamo, Italy, 4Rady Children's Hospital, San Diego, United States of America, 5Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan, 6Pediatric Intensive Care and Neonatal Medicine, AP‐HP Paris Saclay University, Bicetre Hospital, paris, France, 7Imaging Department, P. Garrahan Hospital, Buenos Aires, Argentina, 8CHIREC delta hospital, Brussles, Belgium, 9Swiss Pediatric Liver Center, Department of Pediatrics, University of Geneva, Geneva, Switzerland, 10Pediatric Hepatology And Pediatric Liver Transplant Department, Bicêtre Hospital, Bicêtre, France, 11IRCPSS, GENEVA, Switzerland
Objectives and Study: Awareness about CPSS has increased over the last decade, but there is still a lack of consensus regarding the confirmation of a prenatal diagnosis, the management of postnatal symptoms in infants with prenatal diagnosis, and which imaging findings or symptoms should trigger a workup for CPSS in newborns. We aimed to analyze current management trends using a multinational questionnaire.
Methods: During the ESPGHAN annual meeting 2024, the steering committee of the International Registry of Congenital Portosystemic Shunts (IRCPSS) distributed a digital questionnaire among participants at the Special Interest Group gathering and shared it electronically throughout the ESPGHAN community. Questions covered the following topics: multidisciplinary expertise and volume, diagnostic assessment and therapeutic interventions. The data was collected and analysed using SurveyMonkey.
Results: There were 63 responders who completed all questions. More than 90% of responders were hepatologists. In their respective institutions, 71% had a neonatal unit, 73% pediatric cardiologists, 55.5% interventional radiologists, 60% hepatobiliary surgeons, and 47% transplant service. Among participants, 80% had previously managed CPSS patients of all ages. Twenty‐two had seen 0‐5 patients in the last 10 years, 36 between 5‐50, and only 5 reported treating more than 50 patients over that period of time. There were wide variations concerning the imaging modalities used for postnatal diagnosis, biological work up, and in the timing of the assessment. There were further discrepancies regarding the approach to interventional closure for intrahepatic and extrahepatic CPSS during follow‐up.
Conclusions: Diagnosis and management of prenatal and post‐natal CPSS varied widely across centers. Access to multidisciplinary care was likely one of the factors underlying this diversity. How to harmonize care for these infants is an area for further study and development, which is currently being addressed by the IRCPSS.
Contact e‐mail address: yaelmozer@gmail.com
H‐RF038. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF038.1. GLECAPREVIR‐PIBRENTASVIR IMPLEMENTATION FOR CHILDREN AGED 3‐12 YEARS WITH CHRONIC HEPATITIS C: MULTICENTER REAL‐WORLD DATA
Raouf Nassar 1,2, Yaniv Faingelernt1,2, Orith Waisbourd‐Zinman3,4, Eyal Shteyer5,6, Baruch Yrushalmi1,2
1Pediatric Gastroneterology, Hepatology, And Nutrition Unit, Saban Children Hospital, Soroka University Medical Center, Beer Sehva, Israel, 2Faculty Of Health Sciences, Ben‐Gurion University of the Negev, Beer‐Sheva, Israel, Beer Sheva, Israel, 3Pediatric Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center, Petach Tiqva, Israel, 4Faculty Of Medical And Health Sciences, Tel‐Aviv University, Tel‐Aviv, Israel, 5The Faculty Of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel, 6The Juliet Keiden Institute Of Pediatric Gastroenterology And Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
Objectives and Study: Glecaprevir‐pibrentasvir (GLE/PIB), a pangenotypic direct‐acting antiviral (DAA), is the first‐line therapy for pediatric hepatitis C virus (HCV). Although real‐world results are promising in adults and adolescents, data for children aged 3‐12 are limited. This study reports national, multicenter outcomes for children treated with GLE/PIB, focusing on sustained viral response (SVR), adherence, and adverse events.
Methods: A multicenter retrospective analysis was conducted on children aged 3‐12 with chronic HCV treated with GLE/PIB in 2022‐2023. Data included demographics, liver assessments, adverse events, side effects, and SVR rates.
Results:
Ten children (5 males, 5 females; median age 6.8 years) were included. Five had genotype 1b, and the median pre‐treatment viral load was 1,171,178 IU/mL. GLE/PIB was administered as an 8‐week first‐line therapy, with good adherence reported. One child experienced a COVID‐19 infection during treatment, with no other adverse events. All achieved undetectable viral loads at 12 weeks post‐treatment, confirming SVR.
Conclusions: Our real‐world data support clinical trials, showing GLE/PIB to be effective and well‐tolerated for children aged 3‐12 with chronic HCV. Early treatment may help prevent liver damage and lower transmission rates.
Contact e‐mail address: Raouf.n@gmail.com
H‐RF039. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF039.1. REVOLUTIONIZING PEDIATRIC EXTRAHEPATIC PORTAL VEIN OBSTRUCTION MANAGEMENT: NEW INTERVENTIONAL RADIOLOGICAL BREAKTHROUGHS
Cristina Padrós 1, Dani Barnés2, Maria Mercadal‐Hally1, Mauricio Larrarte King1, Simone Mameli1, Jose Andrés Molino‐Gahete3, Gabriela Guillén3, Lucía Riaza4, Mercedes Pérez2, Jesus Quintero1
1Pediatric Hepatology And Liver Transplantation, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 2Interventional Radiology Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 3Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 4Pediatric Radiology Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
Objectives and Study: This study aims to detail the radiological management of pediatric patients with extrahepatic portal vein obstruction(EHPVO).
Methods: Single‐center retrospective cohort study (2021‐2024). We included patient's ≤18 years with EHPVO under a standardized management protocol since 2021. Patients with significant portal hypertension or hypersplenism underwent direct portography to assess the patency of intrahepatic and extrahepatic portal veins, evaluate the connection between portal branches and try to recanalize, if possible. Rex recess patency and the presence of portosystemic shunts was also assessed providing guidance for surgical management when necessary after radiological evaluation.
Results: Direct portography was performed in 19 patients (median age: 8.19 years [5,73‐11,32]; 63.16% male), with a median time since diagnosis of 2.65 years [1,92‐6,96]. EHPVO was linked to umbilical vein catheterization in 26.32% of cases. Access approaches included bilateral (52.63%), transhepatic (36.84%), and transsplenic (10.53%). Median irradiation dose was 29.55 Gy·cm² over 28.5 minutes. 9 patients presented complications, the majority of them were mild abdominal discomfort (7/9). Portal vein recanalization was achieved in 8 patients (42,10% through a collateral vein, 37.5% portal vein, 12.5% sharp recanalization), with one requiring stenting, and four undergoing shunt/varices embolization. Six patients maintained patency over a median follow‐up of 10.45 months [1,48‐21,3], with platelet normalization (5/6) and spleen size reduction in all of them (median: 150 mm [5,25‐32,25]). Post‐procedure management evolved from antiplatelet therapy (3/8) to oral anticoagulation. Two patients with prior upper gastrointestinal bleeding had complete resolution, with no post‐recanalization varices observed.
Conclusions: Several medical and surgical options are available for managing portal hypertension in these patients. Until now, the Rex shunt has been the only technique restoring physiological blood flow through the liver and preventing complications related to portal hypertension. Recanalization is an alternative treatment to surgery, aiming to restore normal blood flow early in life and prevent long‐term complications associated with portal hypertension.
Contact e‐mail address: daniel.barnes.idi@gencat.cat
H‐RF040. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF040.1. LIVER INVOLVEMENT IN HNF1B‐ASSOCIATED DISEASE: AN OBSERVATIONAL COHORT STUDY IN PEDIATRIC PATIENTS
Michele Pinon 1, Alessandro Gambella2,3, Luca Fabris4,5, Massimiliano Cadamuro6, Licia Peruzzi7, Silvia Kalantari8,9, Laura Giugliano1, Cristina Chiadò1, Giulio Frontino10, Sonia Toni11, Enza Mozzillo12, Petra Reinstadler13, Michela Trada14, Silvia Deaglio15, Pier Calvo1, Maurizio Delvecchio16
1Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Turin, Italy, 2Division of Liver and Transplant Pathology, University of Pittsburgh, Pittsburgh, PA, USA, Pittsburgh, Italy, 3Pathology Unit, Department of Medical Sciences, University of Turin, Italy, Turin, Italy, 4Department of Molecular Medicine, University of Padova, Padua, Italy, Padua, Italy, 5Liver Center, Digestive Disease Section, Department of Internal Medicine, Yale University, New Haven, CT, USA, Yale, Italy, 6School of Medicine and Surgery, University of Milan‐Bicocca, Milan, Italy, Milan, Italy, 7Pediatric Nephrology Unit, Regina Margherita Children's Hospital, Turin, Italy, Turin, Italy, 8Department of Molecular Medicine, University of Pavia, Pavia, Italy, Pavia, Italy, 9Medical Genetics Unit, Department of Diagnostic Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, Pavia, Italy, 10Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy, Milan, Italy, 11Unit of Diabetology and Endocrinology, Meyer Children Hospital, Florence, Italy, Florence, Italy, 12Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, University of Naples Federico II, Naples, Italy, Naples, Italy, 13Pediatric Department, Hospital of Bolzano, Italy, Bolzano, Italy, 14Pediatric Endocrinology Unit, Regina Margherita Children's Hospital, Turin, Italy, Turin, Italy, 15Immunogenetics and Transplant Biology Service, Azienda Ospedaliera‐Universitaria Città della Salute e della Scienza, Turin, Italy, Turin, Italy, 16Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy, L'Aquila, Italy
Objectives and Study: HNF1B deficiency is a well‐established cause of diabetes and kidney development disorders. Primary liver involvement, presenting as asymptomatic transaminases elevation or less frequently cholestatic liver disease, remains poorly understood. Considering the critical role of HNF1B in cholangiocyte development, this study, supported by the European Association for the Study of the Liver (EASL) Daniel Alagille Award, aimed to characterize liver involvement and assess genotype‐phenotype correlations in patients with HNF1B disease.
Methods: This retrospective observational study included 0‐18‐year‐old patients with HNF1B disease from Pediatric Nephrology and Diabetology Units in Italy. Histological and molecular profiles of available liver biopsies were analyzed to characterize disease hepatic phenotypes.
Results: Seventeen patients (12 males; median age 11.24 years, range 0.10–18.0) were included (median follow‐up: 5 years). Six out of 17 (35%) were small for gestational age, and 9/17 (53%) had congenital anomalies of the kidney and urinary tract (CAKUT), all with renal cysts or dysplasia and mild‐to‐moderate renal dysfunction. Insulin‐dependent diabetes was present in 11/17 (65%), and 2/17 (12%) had impaired exocrine function. No urogenital malformations were observed, and mild cognitive impairment occurred in one case. Five patients (29%) had liver involvement: one with persistent neonatal cholestasis (high GGT and ductopenia), one with hepatocellular carcinoma (syncytial giant cell subtype), one with primary sclerosing cholangitis, one with a hepatic lesion and associated splenomegaly, and one with persistent isolated transaminase elevation. Histological analysis of three liver samples showed marked ductopenia, hyperplasia of intrahepatic arteries, and features resembling Alagille Syndrome, though without intermediate hepatobiliary cells.
Conclusions: HNF1B has been increasingly recognized as a pivotal gene in the development of ciliopathies. Our study highlights its emerging role as a significant contributor to several cholangiopathy phenotypes. We endeavor to further investigate the pathogenic role of HNF1B via organoids and explore the therapeutic potential of ileal bile acid transporter (IBAT) inhibitors for HNF1B‐associated cholangiopathies.
Contact e‐mail address: michele.pinon@gmail.com
H‐RF041. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF041.1. CHRONIC HEPATITIS B INFECTION IN PEDIATRIC AGE: A MULTICENTER STUDY OF THE LIVER GROUP OF THE ITALIAN PEDIATRIC SOCIETY OF GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION (SIGENP)
Michele Pinon 1, Emanuele Nicastro2, Laura Giugliano1, Franco Curci3, Simona Carrera3, Chiara Rubino3, Mara Corpino4, Valentina Buccella5, Luca Castellazzi6, Giuseppe Indolfi3
1Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Turin, Italy, 2Pediatric Hepatology, Gastroenterology and Transplantation, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy, Bergamo, Italy, 3Pediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze, Italy, Florence, Italy, 4Gastroenterologia Pediatrica, Clinica Pediatrica e Malattie Rare, Ospedale Pediatrico Microcitemico A. Cao, ARNAS Brotzu, Cagliari, Italy., Cagliari, Italy, 5Unità Operativa Pediatrica, Ospedale S. Chiara, Trento, Trento, Italy, 6Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Milan, Italy
Objectives and Study: The treatment of children with chronic HBV infection is still not well‐established, and the therapeutic approach in Europe has often been conservative while awaiting new treatments and guidelines. The WHO aims to eliminate viral hepatitis as a public health threat by 2030, and its updated 2024 guidelines recommend treatment for all adolescents with elevated ALT levels and positive HBV DNA for at least six months. This study aimed to evaluate seroconversion rates, spontaneous viral clearance, and antiviral treatment outcomes in pediatric patients with chronic HBV infection.
Methods: This multicenter retrospective study analyzed patients diagnosed with chronic HBV infection before 18 years of age from January 1, 2006, to August 31, 2024, at six Italian centers.
Results: A total of 268 patients (162 males, 60.4%; median age 4.8 years, range 0.0 ‐ 17.2) were included, with a median follow‐up of 120 months. Ethnic distribution: 39.6% Caucasian, 35.4% Asian, 14.2% African, and 10.8% other/unreported. At the first visit, 83.2% were HBeAg‐positive, with 21.07% in the HBeAg‐positive infection phase and 19.7% in the HBeAg‐positive hepatitis phase. By the end of the observation period, 135 patients (50.3%) had HBeAg seroconversion, 55.5% of which occurred during the first decade of life. HBeAg‐positive patients with seroconversion had higher ALT levels and were more likely to be Caucasian. Only 5 patients showed seroconversion of both HBeAg and HBsAg. No patients developed HCC. Fifteen patients (5.6%) received antiviral therapy, of which 7 showed anti‐HBeAg seroconversion.
Conclusions: The benefits of current antiviral treatments in terms of HBeAg and HBsAg seroconversion rates remain debated. While the natural course of HBeAg infection often leads to spontaneous seroconversion, the potential benefits of early treatment in childhood—such as reducing viral DNA integration, preventing HCC, and increasing the likelihood of HBsAg loss—remain to be evaluated.
Contact e‐mail address: michele.pinon@gmail.com
H‐RF042. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF042.1. ORAL VANCOMYCIN IMPROVED HEPATOBILIARY OUTCOMES IN CHILDREN WITH PRIMARY SCLEROSING CHOLANGITIS – ULCERATIVE COLITIS
Laura Räisänen, Fariha Balouch, Christopher Burgess, Peter Lewindon
Queensland Children's Hospital, Brisbane, Australia
Objectives and Study: Primary sclerosing cholangitis–ulcerative colitis (PSC‐UC) involves inflammation of biliary tract and colon. Oral vancomycin therapy (OVT) is increasingly recognized as effective for managing colitis in children with PSC‐UC. We report hepatobiliary outcomes in a cohort of children with PSC treated with OVT for their colitis.
Methods: Between 2014‐2024, 34 children with confirmed PSC by MRCP or biopsy received OVT for at least 3 months for their colitis at Queensland Children's Hospital, Australia. Data on medical history, gamma‐glutamyl transpeptidase (GGT), and MRCP were obtained from medical records. Findings pre‐post OVT were compared.
Results: Median age at starting OVT was 11.9 (IQR 8.0‐14.3) years. Of the 34 children, 59% were male, 21% had history of autoimmune hepatitis (AIH). PSC was investigated with MRCP and liver biopsy in 21 (including 6 with AIH), MRCP only in 11, and biopsy only in 2 children (including 1 with AIH). Of the 32 MRCPs, 20 showed PSC (4 of them had normal baseline GGT). Post‐OVT, elevated baseline GGT in 30/34 children reduced from median 212 (IQR 127‐333) to 47 (IQR 21‐114) U/l (p < 0.001); 11/30 (37%) normalized. In 7 children with PSC‐AIH, GGT reduction after first OVT was not significant (from median 251 (IQR 145‐580) to 154 (IQR 90‐286) U/l, p = 0.173), none normalized. In 23 children with PSC without AIH, elevated baseline GGT significantly reduced from 211 (IQR 126‐312) to 35 (IQR 20‐80) U/l (p < 0.001). In 21 paired pre‐post OVT MRCP: 6 improved qualitatively (4 normalized), 3 remained normal, 6 were unchanged, and 6 worsened. Median reduction of GGT were 78% vs. 53% vs. 70% (p = 0.412) in children with improved/remaining normal, unchanged, or worsening MRCP – respectively.
Conclusions: OVT improved GGT and MRCP in children with PSC‐UC, with less efficacy in the presence of AIH history. MRCP outcomes were not always reflected by GGT.
Contact e‐mail address: laura.raisanen@tuni.fi
H‐RF043. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF043.1. MEDICAL EDUCATION SIGNIFICANTLY IMPROVES KNOWLEDGE OF THE BILE ACID CYCLE DISRUPTION IN ALAGILLE SYNDROME AND THE ROLE OF NEW IBAT INHIBITORS
S Christy Rohani‐Montez, Marinella Calle, Karen Reid
Medscape Education Global, London, United Kingdom
Objectives and Study: Physicians often manage Alagille syndrome (ALGS) with symptomatic treatments, however, targeting the disrupted bile acid cycle with newer therapies may better address symptoms and lead to overall improved outcomes. Through expert‐led education, we sought to improve physician knowledge of the disrupted bile acid cycle, and how new therapies restore bile acids in ALGS.
Methods: Physicians participated in a 30‐minute, video‐based, online CME activity with synchronized slides and clinical whiteboard animations (Thompson R. Connecting the Clinical Clues of Alagille Syndrome. Available at www.medscape.org/viewarticle/1000514). The effects of the education were assessed using a 3‐question, repeated pairs, pre‐assessment/post‐assessment study design. One question assessed confidence. Differences from pre‐ to post‐assessment were evaluated using the McNemar's test. P ≤ 05 is the significance level. The activity launched in March 2024 and, and data were collected through August 2024.
Results: Overall significant improvements were seen after participation for both gastroenterologists/hepatologists (correct response rate of 53% at pre‐assessment vs 73% at post‐assessment; P < .001, Cohen's d = 0.74, N = 32), and pediatricians (correct response rate of 61% at pre‐assessment vs 77% at post‐assessment; P < .001, Cohen's d = 0.78, N = 55). Specifically, significant improvements were observed in clinicians’ knowledge of the pathology leading to cholestasis in ALGS, the physiological consequences of cholestasis, and how IBAT inhibitors modulate the bile acid cycle in ALGS. After participating in the activity, 69% of gastroenterologists/hepatologists and 55% of pediatricians had measurable improved confidence related to explaining the mechanism of action of IBAT inhibitors in ALGS.
Conclusions: This study demonstrates the success of online, video‐ and animation‐based education in improving knowledge of the disrupted bile acid cycle in ALGS and mechanism of IBAT inhibitors. While significant improvements were shown, poor baseline knowledge suggests a need for continued education to reinforce the role of IBAT inhibitors in ALGS.
Contact e‐mail address: srohani@medscape.net
H‐RF044. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF044.1. DIFFICULTIES IN INTERPRETING WILSON DISEASE SCREENING TESTS IN CHILDREN
Elena Roslavtseva 1, Alina Komarova2, Alexander Potapov2
1Healthy And Sick Child Nutrition Laboratory, National Medical Research Center for Children's Health, Moscow, Russian Federation, 2Gastroenterology, National Medical Research Center for Children's Health, Moscow, Russian Federation
Objectives and Study: The diagnosis of Wilson disease (WD) is based on the Leipzig algorithm, which criteria reflect copper metabolism. Its use in children is limited because some tests may give false negatives. The aim of our study was to determine the informativeness of screening tests in children of different age groups.
Methods: The retrospective study included 103 children with genetically verified WD who were categorized into age groups (I (n = 12) under 5 years, II (n = 47) ‐ 5‐10 years, III (n = 44) ‐ 10 years and older). In all groups the levels of ceruloplasmin, 24‐hour urinary copper excretion and the presence of Kaiser‐Fleischer rings were assessed.
Results: The mean ceruloplasmin level in Group I was 9.4 ± 7.9 mg/dL, in Group II ‐ 12.1 ± 6.8 mg/dL and in Group III ‐ 11.1 ± 6.1 mg/dL, the differences were not significant (p = 0.437). While 24‐hour urinary excretion of copper was significantly lower in the group of young children compared to children older than 5 years (p = 0.047; p = 0.007) and amounted to 54 [5;213] mg/dL in Group I, 97 [24;431] mg/dL in Group II and 114 [2.4;1275] mg/dL in Group III. There was a significant low direct correlation between the daily urine level of copper and the age of patients (r = 0.298; p = 0.003). The occurrence of Kaiser‐Fleischer rings was independent of age (p = 1,000), as this sign was found with low frequency in all groups: in group I in 1/12 (8.3%) children, in group II ‐ 6/47 (12.8%), in group III in 6/44 (13.6%) patients.
Conclusions: The most age‐dependent diagnostic test is the 24‐hour urinary excretion of copper. A slight increase in 24‐hour copper excretion and absence of Kaiser‐Fleischer rings in a child, especially a young child, with reduced ceruloplasmin levels does not exclude WD and requires additional examination.
Contact e‐mail address: roslikea@gmail.com
H‐RF045. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF045.1. COMPARISON OF FERENCI SCORING IN SYMPTOMATIC WILSON PATIENTS AND DIAGNOSED THROUGH SCREENING CASES
Bilge Sahin Akkelle 1, Raziye Selcik2, Esra Polat3, Engin Tutar1, Deniz Ertem1
1Pediatric Gastroenterology, Hepatoloy And Nutrition, Marmara University School of Medicine, Istanbul, Turkey, 2Pediatrics, Marmara University School of Medicine, Istanbul, Turkey, 3Pediatric Gastroenterology, Hepatology And Nutrition, Sancaktepe Şehit Prof Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey
Objectives and Study: Wilson's disease (WD) is a genetic disorder that characterized by the consequences of copper accumulation in different organ/systems. The Ferenci scoring (FS), used in the diagnosis of WD includes clinical, biochemical, histological, and genetic parameters. In our study, we assessed the diagnostic value of FS in symptomatic (index) patients with WD and in cases diagnosed through sibling screening.
Methods: Pediatric patients who were diagnosed and followed‐up in our clinic with WD were included in the study. Clinical, laboratory findings of symptomatic patients and cases diagnosed‐through‐screening were reviewed according to the parameters used in FS.
Results: Of the 29 patients included in the study, 7 (24.1%) were diagnosed‐through‐screening. Serum ceruloplasmin levels were below normal in the majority of both symptomatic and diagnosed‐through‐screening cases (90.9% and 85.7%, respectively). In symptomatic cases, 22.7% had 24‐hour urinary copper excretion (UCE) within 1‐2x ULN, while 63.6% had levels >2x ULN. Among diagnosed‐through‐screening cases, only 1 had 24‐hour UCE above ULN. Liver biopsy revealed elevated tissue copper level (>250 mcg/g) in 14 out of 17 symptomatic and 2 out of 3 diagnosed‐through‐screening cases who underwent biopsy. In symptomatic patients, Kayser‐Fleischer ring and Coombs‐negative hemolytic anemia were found in 6.8%, and neuropsychiatric symptoms/brain MRI findings were observed in 13.7%. No extrahepatic involvement was detected in any case diagnosed‐through‐screening. When compared to symptomatic patients, the contribution of clinical, laboratory findings to the diagnosis were very limited in diagnosed‐through‐screening cases (86.3% vs. 14.3%). Ferenci scoring provided a diagnostic value of 85.7% in diagnosed‐through‐screening cases only after the demonstration of genetic mutations.
Conclusions: The diagnosis‐through‐screening in 25% of our WD cases emphasizes the importance of sibling screening in diagnosis of childhood WD. The results of our study suggest that genetic mutation analysis is the most crucial non‐invasive diagnostic tool for asymptomatic individuals screened for WD.
Contact e‐mail address:
H‐RF046. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF046.1. CLINICAL IMPACT OF LOW HDL LEVELS: INSIGHTS FROM THE SIGENP ITALIAN HYPERALT COHORT
Carmela Pia Senatore 1, Pietro Aliberti2, Angelo Di Giorgio3,4, Giusy Ranucci5, Lorenzo D'antonio6, Angelo Mazza7, Francesca Sbravati8, Maurizio Giuseppe Fuoti9, Andrea Colangelo2, Antonio Marseglia10, Serena Della Femina11, Annalisa Madeo12, Valentina Maffini13, Federica Ferrari14, Icilio Dodi13, Claudia Mandato2
1University of Salerno, Fisciano, Italy, 2Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Pediatrics Section, University of Salerno, Baronissi, Salerno, Italy, 3Pediatric Hepatology, Gastroenterology And Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 4Pediatrics, University of Udine, Udine, Italy, 5Department of Pediatrics Liver Transplant Center UPMC‐ISMETT, Palermo, Italy, 6Pediatric Hepatology, Gastroenterology And Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 7General Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, Italy, 8Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy, 9Pediatric Gastroenterology and Endoscopy Unit, University Department of Pediatrics, Children's Hospital, Spedali Civili, Brescia, Italy, 10Pediatria ‐ IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy, 11Residency School of Pediatrics, Department of Health Sciences, University of Florence, Florence, Italy, 12Pediatric Gastroenterology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy, 13General and Emergency Pediatric Unit ‐ "Pietro Barilla" Children Hospital, Parma, Italy, 14Pediatric Unit, Sant'Eugenio Hospital, Rome, Italy
Objectives and Study: This study investigated clinical characteristics of paediatric patients with HDL levels <30 mg/dL from the hyperALT cohort, comparing them with those having HDL ≥ 30 mg/dL.
Methods: Eighty‐six patients from the hyperALT multicenter cohort were classified into two groups: HDL < 30 mg/dL (n = 32) and HDL ≥ 30 mg/dL (n = 54). Demographic, clinical, and biochemical data, including age, sex, hospitalisation length, AST, ALT, haemoglobin, cholesterol, and liver disease family history, were collected. Statistical analyses included t‐tests and chi‐square tests.
Results: Patients with HDL < 30 mg/dL showed a distinct inflammatory profile, with significantly higher white blood cell and platelet counts, suggesting increased infection risk. Haemoglobin, cholesterol, and phosphorus levels were notably lower in this group. Abdominal ultrasounds detected abnormalities mainly in infants and older children. Male patients experienced longer hospital stays (p < 0.05). Clustering analysis revealed two subgroups within the HDL < 30 mg/dL cohort. Cluster 1 showed higher ALT levels (121.4 U/L), while Cluster 2 exhibited elevated LDH levels (802.8 U/L).
*,**,*** represent the significance at levels 5%,2% and 1% respectivily
Conclusions: The hyperALT paediatric cohort with HDL < 30 mg/dL displayed a more severe clinical profile, marked by increased inflammatory markers and prolonged hospital stays. Low HDL levels are associated with 2 distinct clinical profiles, allowing the identification of a patient cluster with liver involvement that requires tailored analysis and management.
Contact e‐mail address: c.senatore50@studenti.unisa.it
H‐RF047. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF047.1. TRANSAMINASE LEVELS IN CHILDREN ADMITTED TO GENERAL PAEDIATRICS WARDS: A STUDY FROM THE SIGENP HYPERALT COHORT
Pietro Aliberti1, Carmela Pia Senatore 2, Angelo Di Giorgio3,4, Giusy Ranucci5, Lorenzo D'antonio6, Francesca Sbravati7, Angelo Mazza8, Icilio Dodi9, Valentina Maffini9, Maurizio Giuseppe Fuoti10, Antonio Marseglia11, Federica Ferrari12, Annalisa Madeo13, Andrea Colangelo1, Serena Della Femina14, Claudia Mandato1
1Department Of Medicine, Surgery And Dentistry “Scuola Medica Salernitana”, Pediatrics Section, University of Salerno, Baronissi, Italy, 2University of Salerno, Fisciano, Italy, 3Department of Medicine, University of Udine, Udine, Italy, 4Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 5Department of Pediatrics Liver Transplant Center UPMC‐ISMETT, Palermo, Italy, 6Pediatric Hepatology, Gastroenterology And Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 7Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy, 8General Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, Italy, 9General and Emergency Pediatric Unit ‐ "Pietro Barilla" Children Hospital, Parma, Italy, 10Pediatric Gastroenterology and Endoscopy Unit, University Department of Pediatrics, Children's Hospital, Spedali Civili, Brescia, Italy, 11Pediatrics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy, 12Pediatric Unit, Sant'Eugenio Hospital, Rome, Italy, 13Pediatric Gastroenterology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy, 14Residency School of Pediatrics, Department of Health Sciences, University of Florence, Florence, Italy
Objectives and Study: Hypertransaminasaemia is common in paediatrics, but its prevalence in hospitalised children remains underexplored. This study aims to determine the prevalence of hypertransaminasaemia in children admitted for various reasons, comparing transaminase levels using standard laboratory cut‐offs and liver enzyme serum levels percentiles.
Methods: Data from 1652 patients aged 0 months to 17 years, hospitalised in 8 Italian paediatric centres, were analysed. Children with a previous diagnosis of liver or chronic diseases were excluded. Transaminase levels were assessed at admission and evaluated according to laboratory reference values and the 50th percentile proposed by Bussler 2018. Statistical analysis was performed using R software.
Results: The cohort comprised 53.27% males and 46.73% females. When applying laboratory cut‐offs, 55.72% of patients did not present elevated AST, ALT, or GGT levels. In contrast, using the 50th percentile from Bussler 2018, only 4.76% of patients fell within the normal range. Correlation analysis revealed significant associations: AST showed a moderate positive correlation with CPK, while AST and ALT were moderately correlated with hospital stay duration. A weak positive correlation was also observed between AST, ALT, GGT, and platelet count. Figure: Correlation plot between ALT, AST, GGT, CPK, Duration of the hospitalization, BMI, platelet and cholesterol.
Conclusions: The application of Bussler 2018 transaminase percentiles substantially reduces the number of patients classified as normal compared to standard laboratory cut‐offs. This discrepancy highlights the potential underdiagnosis of liver conditions in hospitalised children, emphasising the need for updated paediatric reference values in clinical practice.
Contact e‐mail address: p.aliberti20@studenti.unisa.it
H‐RF048. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF048.1. IN VITRO INFLAMMATORY RESPONSE OF PERIPHERAL MONONUCLEAR CELLS (PBMC) FROM ADOLESCENTS WITH NON‐ALCOHOLIC FATTY LIVER DISEASE (NAFLD) TO FECAL EXTRACTS
Natalia Zeber‐Lubecka1, Jacek Michalkiewicz2, Michalina Dabrawska3, Krzysztof Goryca3, Aldona Wierzbicka‐Rucińska4, Wojciech Janczyk5, Zbigniew Kulaga6, Jerzy Ostrowski1, Piotr Socha 5
1Department Of Gastroenterology, Hepatology And Clinical Oncology, Centre of Postgraduate Medical Education, Warszawa, Poland, 2Microbiology And Immunology, The Children's Memorial Health Institute, Warszawa, Poland, 3Department Of Genetics, Maria Sklodowska‐Curie National Research Institute of Oncology, Warszawa, Poland, 4Dep. Of Clinical Biochemistry, The Children's Memorial Health Institute, Warszawa, Poland, 5Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 6Public Health, The Children's Memorial Health Institute, Warszawa, Poland
Objectives and Study: NAFLD is characterized by chronic, systemic inflammation of low intensity. Pathogenesis seems to be related to immune cells which in turn are regulated by gut microbiota and its metabolites. Aim: To determine fecal extracts (FEs) effects on PBMCs gene expression profile.
Methods: 16 NAFLD (obesity and CAP on Fibroscan>250) and 14 control subjects aged 14‐18 yrs were studied. PBMCs obtained from patients and controls were induced by 18 hrs at 37 C in culture medium with or without methanol FE. Total RNA that was isolated from frozen PBMCs cultured with and without FEs. The whole transcriptome libraries were sequenced on the NovaSeq 6000 platform. Differentially expressed genes were selected using DESeq2 package. Overrepresentation of Gene Ontology, the Kyoto Encyclopedia of Genes and Genomes, and Reactome database was assessed with the Cytoscape platform in combination with the ClueGO plugin.
Results: We identified 97 and 151 differentially expressed genes (DEGs) in comparison of NAFLD vs controls, with and without FEs, respectively. Of these, 43 and 76 protein coding genes were more highly expressed in NAFLD with and without FEs stimulation. The top five DEGs most significantly differentiating between NAFLD and controls PBMCs include LAMP3, IPPK, COL6A1, LYRM7 and PTX3 for FEs and CCL4, CCL4L2, KANK1, CLDND1, CCL3 without stimulation. Among the protein coding DEGs identified in the comparisons, 49 were unique to PBMCs with FEs, 102 unique to PBMCs without FEs and 15 were shared. Moreover, we showed four (including lipid biosynthetic process) and 39 (including Toll‐like receptor signaling pathway) pathways unique to PBMCs and two (interleukin‐10 signaling and adipocytokine signaling) common in these comparisons.
Conclusions: DEGs differentiating NAFLD from controls and the activated pathways highlight the importance of inflammatory processes and metabolic disturbances in the pathophysiology of NAFLD. The findings suggest that FEs stimulation can reveal additional, specific aspects of immune cell responses in NAFLD.
Contact e‐mail address: p.socha@ipczd.pl
H‐RF049. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF049.1. RENAL MANIFESTATIONS AS PRESENTING FINDINGS IN PEDIATRIC CONGENITAL PORTOSYSTEMIC SHUNTS
Aditi Sinha1, Vikrant Sood 2, Snigdha Verma2, Paraselli Saiteja1, Adarsh Barwad3, Snehavardhan Pandey4, Manan Doshi5, Seema Alam2, Arvind Bagga1
1Pediatric Nephrology, All India Institute of Medical Sciences, New Delhi, India, 2Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India, 3Pathology, All India Institute of Medical Sciences, New Delhi, India, 4Pediatric Hepatology And Liver Transplantation, Sahyadri Hospital, Pune, India, 5Nephrology, Sahyadri Superspeciality Hospital, Pune, India
Objectives and Study: Congenital portosystemic shunts (CPSS) commonly present with hepatic, cardiopulmonary, and neurocognitive manifestations; however, index presentation with renal involvement is usually a rare phenomenon with limited world literature till date.
Methods: We hereby present four cases in whom renal manifestations were the presenting features that led to the primary diagnosis of CPSS.
Results: The four subjects (age range‐ 4 to 14 years, M:F‐ 1:1) presented with classical renal manifestations of anasarca, significant proteinuria/hematuria and membranoproliferative glomerulonephritis (MPGN) type of injury on histology (table 1). Shunt closure in one subject showed significant resolution of renal manifestations on 5 year follow up.
| Cases | Symptoms at presentation | Lab parameters | Outcome | Comments |
|---|---|---|---|---|
| 9 year old girl, Extrahepatic end‐to‐side portocaval shunt | Anasarca, Poor scholastic performance | Hyperammonemia, proteinuria, haematuria. Renal biopsy: Immune complex (IgA/G/M, C3 deposits) mediated membranoproliferative glomerulonephritis (MPGN) | Plug assisted obliteration of shunt; diuretics, angiotensin‐converting enzyme inhibitors (ACEI) use | 5 year follow up: Resolved anasarca; proteinuria improving; Improved Scholastic performance; repeat renal biopsy‐ resolved immune complex deposition |
| 14 years old girl, Extrahepatic side‐to‐side portocaval shunt | Anasarca, Hypertension | Hematuria, hypocomplementemia, Proteinuria; Renal biopsy: Immune‐complex mediated MPGN | ACEI, Intravenous cyclophosphamide use; Planned for shunt closure | |
| 4 years old boy, Extrahepatic shunt with splenic and superior mesenteric veins joining and draining into left renal vein | Gross haematuria, Hypertension | Urine R/M: Dysmorphic RBCs with sub‐nephrotic range proteinuria; Renal biopsy: focal membrane duplication, electron dense deposits in sub‐endothelium and mesangium with tubuloreticular inclusions. | ACEI use; Planned for shunt closure | |
| 14 years old boy, Extrahepatic end‐to‐side portocaval shunt | Pedal edema, Growth failure | Hypoalbuminemia; hyperammonemia; Proteinuria; Renal biopsy: Immune‐complex mediated MPGN | Supportive treatment only; planned for shunt closure | |
Conclusions: CPSS may have an index renal presentation and thus, it may be prudent to look for an underlying CPSS in cases of immune complex mediated MPGN after ruling out other commoner causes like lupus etc.
Contact e‐mail address: drvickyster@gmail.com; vsood@ilbs.in
H‐RF050. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF050.1. PREDICTORS OF TREATMENT WITHDRAWAL IN CHILDREN WİTH AUTOİMMUNE HEPATİTİS: SINGLE‐CENTER EXPERIENCE
Ozlem Sumer Cosar 1, Hakan Öztürk1, Ayşe Can1, Sınan Sarı1, Guldal Esendaglı2, Odul Egrıtas Gurkan1, Gulen Akyol2, Buket Dalgıc1
1Division Of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey, 2Division Of Medıcıne Pathologhy, Gazi University Faculty of Medicine, Ankara, Turkey
Objectives and Study: This study aimed to identify predictors of immunosuppressive treatment withdrawal in children diagnosed with autoimmune hepatitis (AIH) in our centre
Methods: The data of patients diagnosed with AIH in our clinic between 1999 and 2023 were recorded retrospectively. Clinical, laboratory, and histopathological factors affecting treatment withdrawal were examined. Values are given as medians.
Results:
A total of 102 patients with AIH diagnoses were evaluated in this study. Forty‐three patients were excluded from the study. The remaining 59 patients were classified into three groups:48 with type 1 AIH, six with type 2 AIH, and five with seronegative AIH (AIHsn). Immunosuppressive treatment was successfully withdrawn in seven patients(14%) with type 1 AIH and four (80%) with AIHsn.There were significant differences between AIHsn and type 2 AIH (p = 0.015) and between AHIsn and type 1 AIH (p = 0.005) in treatment withdrawal rates. The duration of treatment withdrawal was 77 months (31–111) for type 1 AIH and 40 months(27‐93) for AIHsn(p = 0.31). Patients with type 1 AIH were divided into two groups according to the withdrawal of treatment. There was no difference in immunosuppressive treatments between Group 1(treatment withdrawal) and Group 2(continued treatment). Significant differences were found between Group 1 and Group 2 in terms of age, INR, IgG, and fibrosis stage(Table 1). Multivariate analysis revealed that the only effective factor in treatment withdrawal was younger age (OR = 13.3 (2.6– 68.6), p = 0.002). During the follow‐up period, no relapse was observed among the patients whose treatment had been withdrawn.
Conclusions: Immunosuppressive treatment withdrawal rates are low, and relapse after treatment is frequent in children with AIH. Age, INR and IgG values, fibrotic stage, and type of autoimmune hepatitis may be predictive in patients for whom treatment withdrawal is planned. Prospective, multicenter, and long‐term studies are needed in this field.
Contact e‐mail address: dr.ozlemcosar@gmail.com
H‐RF051. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF051.1. MEASURING MMP‐7 LEVELS IN DRIED BLOOD SPOTS APPEARS NOT SUITABLE FOR NEWBORN SCREENING OF BILIARY ATRESIA
Marie Uecker 1, Björn Bulitta2, Nils Janzen2, Gertrud Vieten1, Jens Dingemann1, Claus Petersen1, Joachim Kuebler3, Christian Klemann4, Omid Madadi‐Sanjani5
1Pediatric Surgery, Medical School Hannover, Hannover, Germany, 2Screening Laboratory Hannover, Hannover, Germany, 3Klinikum Bremen‐Mitte, Bremen, Germany, 4University Hospital Leipzig, Leipzig, Germany, 5University Hospital Hamburg‐Eppendorf, Hamburg, Germany
Objectives and Study: Early diagnosis and treatment improve the prognosis in Biliary Atresia (BA). However, referal to treatment centers is still delayed in the vast majority of patients. Two studies reported high sensitivity and specificity of increased MMP‐7 levels in dried blood spots (DBS) for detection of BA. We aimed to assess whether MMP‐7 could be incorporated into the newborn screening (NBS) as a screening parameter for BA in Germany.
Methods: When infants with BA presented at our institution, their original DBS NBS cards were retrospectively collected from the respective screening laboratories at their place of birth. Healthy newborns from the screening laboratory Hannover served as controls. Samples were analyzed using a Quantikine ELISA Kit. MMP‐7 levels were correlated to clinical parameters at time of surgery (type of BA, clinical outcome, fibrosis score, bilirubin levels). ROC analysis was performed to evaluate test performance.
Results: BA patients showed significantly higher MMP‐7 levels than healthy controls (BA 22.80 ng/ml ± 12.28, HC 13.82 ng/ml ±2.97, p < 0.001), but ROC analysis did not yield satisfactory cut‐off values for screening purposes. No correlation of MMP‐7 levels at time of birth with clinical parameters was observed.
Conclusions: Although MMP‐7 is significantly elevated in the DBS of BA patients within 72 hours after birth, sensitivity and specificity are not high enough to allow incorporation into the NBS. Further efforts are needed to identify suitable screening options.
Contact e‐mail address:
H‐RF052. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF052.1. RED DICHROMATIC IMAGING (RDI) TECHNOLOGY BASED PREDICTION OF VARICEAL BLEED AND MONITORING OF CLINICALLY SIGNIFICANT VARICES(CSV): AN INNOVATION
Piyush Upadhyay 1, Gangadhar Rao2
1Division Of Pediatric Hepatology And Gastroenterology, Department Of Pediatrics, Dr RML INSTITUTE OF MEDICAL SCIENCES, Lucknow, India, 2Gastroenterology, Dr RML Institute of Medical Sciences, Lucknow, India
Objectives and Study: Current study was done with aim to develop an objective quantitative criterion to predict varices with imminent risk of bleed(VIRB) and monitor CSV using RDI technology.
Methods: Prospective study including children and adolescents of portal hypertension undergoing endoscopy on artificial intelligence based endoscopic system(EVIS X1; Olympus Co). Case Cohort(CC) consisted of patients having red colour sign(RCS) while control cohort A(CCA) consisted of patient not having RCS. Control cohort B(CCB) was same as CC but region of Interest(ROI) was non‐RCS area of the varix. ROI was selected by consensus between 2 examiners. The median colour scores on RDI in ROI in CC, CCA and CCB were compared using Adobe Photoshop Element 2024. Cut off was derived using AUROC to predict VIRB.
Results: Total 77 patients got included (33 in CC, 44 in CCA, bleeders were 22). The median luminosity(red), blue colour and green colour score in ROI in RCS area of CC cohort and in CC A control cohort were 57 ± 27.5(IQR 53‐82), 37 ± 19.3(IQR 32‐61.5), 52 ± 29.4(IQR 49‐81) and 198 ± 4.9(IQR 193‐199), 138 ± 4.6(IQR 133‐139), 166.3 ± 5.5(IQR 163‐165) respectively. Best cut off score as per commission International d'Eclairage(CIE) of < 66, <48.5 and <65.5(Figure 1) luminosity, blue colour and green colour predicted VIRB with perfect AUROC of 1.00, sensitivity and specificity of 100%. Four of the five patients who had scores less the predicted cut off and did not opt for endotherapy presented with bleed within 90 days despite beta blocker prophylaxis
Conclusions: RDI based prediction is an excellent tool for prediction of VIRB and monitoring of progression of CSV.
Contact e‐mail address: uppiyush@yahoo.com
H‐RF053. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF053.1. COMPARATIVE STUDY DEMONSTRATING THE SUPERIORITY OF DIRECT‐ACTING ANTIVIRALS OVER INTERFERON PLUS RIBAVIRIN IN ALBANIAN CHILDREN WITH CHRONIC HEPATITIS C
Virtut Velmishi
Mother Teresa Hospital, Tirana, Albania
Objectives and Study: The introduction of Direct Acting Antivirals (DAAs) has revolutionized the treatment landscape for chronic hepatitis C, especially in the pediatric population. This study aims to evaluate the efficacy, safety, sustained virologic response (SVR), side effects, and treatment duration of DAAs compared to traditional interferon plus ribavirin therapy in Albanian children diagnosed with chronic hepatitis C treated in our center.
Methods: This is a retrospective and comparative study that collected medical records of children diagnosed with chronic hepatitis C in our center from 2009 to 2024. The first group, comprising children aged 3 to 15 years (14 boys and 3 girls),[table 1] was treated with traditional Interferon/Ribavirin (Ifn/Rib) for 48 weeks, with SVR measured 24 weeks after treatment completion. The second group, comprising children aged 4 to 22*years (10 boys and 2 girls), [table 2]was treated with DAAs: half received HARVONI (Ledipasvir/Sofosbuvir) for 12 weeks, and the other half received MAVYRET (Glecaprevir/Pibrentasvir) for 8 weeks. We compared SVR,Side Effects and Treatment Duration.
Results: Children treated with DAAs achieved significantly higher SVR (100%) after 12 weeks compared to those treated with Ifn/Rib, whose SVR after 24 weeks was 83%[Fig 1]. There were no significant differences between the two DAA regimens (GLE/PIB and SOF/LVD). Seven patients (7/17) treated with Ifn/Rib experienced mild side effects, while two patients on the SOF/LVD regimen reported side effects such as headache and abdominal pain[Fig 2]. Furthermore, the DAA group had a significantly shorter treatment duration (8–12 weeks vs. 48 weeks).[Fig 3]
Conclusions: DAA regimens are highly effective and well‐tolerated compared to Interferon/Ribavirin. They resulted in fewer side effects and shorter treatment duration. These findings highlight the superiority of DAAs and support the WHO recommendations for treating adults, adolescents, and children as young as 3 years old.
Contact e‐mail address:
H‐RF054. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF054.1. RISING INCIDENCE OF PAEDIATRIC AUTOIMMUNE LIVER DISEASE –? AN IMMUNE MEDIATED POST‐COVID‐19 PHENOMENON
Suzan Warner 1, Marumbo Paul Mtegha1, Mariana Kostova2, Kavitha Jayaprakash1, Palaniswamy Karthikeyan1, Penny North‐Lewis3, Sanjay Rajwal1
1Paediatric Hepatology, Leeds Children's Hospital, Leeds, United Kingdom, 2Paediatric Surgery, Leeds Children's Hospital, Leeds, United Kingdom, 3Paediatric Pharmacist (hepatology), Leeds Children's Hospital, Leeds, United Kingdom
Objectives and Study: To compare the incidence and disease severity of children presenting with autoimmune liver disease (AILD) in the pre and post‐COVID‐19 pandemic time periods.
Methods: Retrospective study of the presenting characteristics and disease course in children with newly diagnosed AILD between 2015‐2024 from a UK quaternary liver specialist centre.
Results: Findings show a higher incidence of autoimmune hepatitis type 1 (AIH‐1), Primary sclerosing cholangitis (PSC) and Overlap/Autoimmune sclerosing cholangitis (ASC) in the post‐COVID‐19 time period (2020‐2024) compared to pre‐COVID (2015‐2019), with the greatest increase observed in the AIH‐1 cohort (p < 0.0001) (Figure 1). A higher age‐range for all three subgroups was seen but most notably in AIH‐1 (p = 0.0093). In contrast, minimal variation for incidence and age‐range was observed in AIH‐2 patients. A greater proportion of patients presenting with decompensated liver disease was observed in all subgroups post‐COVID‐19 but was most marked in Overlap/ASC (p = 0.0313). Higher rates of new‐IBD (≤1year of AILD diagnosis) was observed in PSC patients post‐COVID‐19 (p < 0.0001), specifically for Crohn's disease (p = 0.0030) and indeterminate colitis (p < 0.0001). Patient demographics were interrogated to identify possible associated factors; a marked rise in the incidence of African patients presenting with AIH‐2 (p = 0.0011) and Overlap/ASC (p = 0.0043) was observed post‐COVID‐19. The rate of concomitant viral infections including COVID‐19 was low in all subgroups; no patients experienced severe COVID‐19 or PIMS‐TS.
Conclusions: The higher incidence and greater disease severity observed in our newly diagnosed AILD patients and that reported in the literature for other autoimmune conditions maybe a post‐COVID‐19 pandemic phenomenon which has resulted from immune dysregulation in susceptible individuals following on from long‐periods of social isolation and the lifting of COVID lock‐down measures.
Contact e‐mail address: suzwong@doctors.org.uk
H‐RF055. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF055.1. BODY MASS INDEX (BMI) DETERMINES PRO‐INFLAMMATORY PROFILE OF STOOL EXTRACTS (SE) INDUCED PERIPHERAL MONONUCLEAR CELLS (PBMC) OF NAFLD, PH AND OBESITY
Aldona Wierzbicka‐Rucińska 1, Jacek Michałkiewicz2, Zbigniew Kułaga3, Jańczyk Wojciech4, Izabela Kubiszewska5, Anna Helmin‐Basa5, Lidia Gackowska5, Mieczysław Litwin6, Łukasz Obrycki6, Jerzy Ostrowski7, Piotr Socha4
1Dep. Of Clinical Biochemistry, The Children's Memorial Health Institute, Warszawa, Poland, 25 department Of Microbiology And Clinical Immunology, The Children's Health Institute, Warsaw, Poland, 3Public Health Department, The Children's Health Institute, Warsaw, Poland, 42 deparment Of Gastroenterology, Hepatology And Nutrition Disorders, The Children's Memorial Health Institute, Warsaw, Poland, 5Department Of Immunology, Faculty Of Pharmacy, Collegium Medicum, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland, 6Department Of Nephrology And Arterial Hypertension, The Children's Health Institute, Warsaw, Poland, 7Department Of Gastroenterology, Hepatology And Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
Objectives and Study: Background. Pathogenesis of low grade inflammatory syndromes NAFLD, PH, and simple obesity (SO) may at least partially be dependent on still unknown changes in the activation state of immune cells which in turn are regulated by actions of the gut microbiota and its metabolites. The aim of this study was to characterize the SEs ‐ induced immune profile of PBMC of the NAFLD, PM, and SO children/adolescents.
Methods: 43 NAFLD, 25 HP, 18 SO, and 25 control subjects aged 14‐18 yrs were studied. PBMC (1 x 106/ml) were induced by 18 hrs at 37 C in culture medium with SE in final concentrations of 1:100, 1:1000, 1: 10.000, or in medium alone (control). Cytokines levels (IL‐6, IL‐1 beta, TNF alfa and IL‐10) were determined in culture supernatants by ELISA method. The results were presented in pg/ml (after background subtraction). Microbiome and metabolomics characterization of stool samples were also performed.
Results: The SEs of NAFLD, PH and SO induced 2‐3 fold higher pro‐inflammatory activities in the PBMCs cultures than the SEs of the control, even at their very low concentrations. This effect was mediated especially by SEs of SO subjects who showed the highest responses to SEs induction (L‐6, IL‐1 beta and TNF alfa levels). Additionally, there were positive correlations between SEs (at concentration 1:1000, and 1:10.000)‐induced IL‐1 beta production by PBMCs; PBMC vs Z‐score BMI: r = 0.311, p = 0.035, and r = 0.326, p = 0.031, respectively. There were no significant differences between microbiome and metabolome characteristics within studied subjects.
Conclusions: Altogether, still unknown metabolites present in the SEs of NAFLD, HP and SO subjects differ in their abilities for immune profiles induction. Identification of metabolite components that differ simple obesity from other obesity related syndromes (here NAFLD and HP) should improve our knowledge about pathogenesis of obesity dependent syndromes.
Contact e‐mail address: a.wierzbicka-rucinska@ipczd.pl
H‐RF056. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF056.1. MACHINE LEARNING AND EXPERIMENTAL APPROACHES REVEAL MYBL2 AS A PROGNOSTIC MARKER AND MIR‐29A TARGET IN HEPATOCELLULAR CARCINOMA
Ya‐Ling Yang, Ying‐Hsien Huang
Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Objectives and Study: Hepatocellular carcinoma (HCC) presents significant challenges due to its multifaceted risk factors and poor treatment outcomes, underscoring the critical importance of early diagnosis and precision medicine approaches. While current interventions often prove insufficient, the medical community is intensively focused on identifying more effective, druggable targets to enable personalized treatment strategies and enhance patient prognosis.
Methods: In this study, we utilized a machine learning experimental approach to identify MYB proto‐oncogene like 2 (MYBL2) as a biomarker for diagnosis, development of improved prognostic model, response to immunotherapy and sorafenib, and a target for miRNA‐based treatment.
Results: The results identified MYBL2 as an excellent biomarker for differentiating normal tissue and tumors. Elevated MYBL2 levels were associated with unfavorable status, such as high‐grade tumors, high body mass index, microvascular invasion‐positive, HBV‐positive, nonresponse to transarterial chemoembolization, and poor survival outcomes. A nomogram scoring model integrating MYBL2 and AJCC stages showed superior predictive capability to the AJCC stage alone regarding 1‐, 3‐, and 5‐year survival probability. Furthermore, MYBL2 positively correlated with previously known predictive biomarkers, including AFP, MKI67, PCNA, and BIRC. Knockout in HCC cell lines confirmed the role of MYBL2 in maintaining cell viability. Pharmacogenetic analysis revealed that high levels of MYBL2 correlated with elevated sensitivity to sorafenib. Notably, HCC patients with high levels of MYBL2 were associated with a favorable response to anti‐PD‐L1 therapy and positively correlated with microsatellite instability (MSI). Bulk transcriptomics analysis revealed the involvement of MYBL2 in the immunosuppressive microenvironment. Integrated bioinformatics with an experimental approach unveiled the inhibitory effect of miR‐29a on translation via binding to MYBL2 3′UTR. miR‐29a‐overexpressing transgenic mice demonstrated a suppressing impact on tumorigenesis through diminished MYBL2 expression.
Conclusions: MYBL2 is a novel prognostic biomarker and shows promise in developing miRNA‐related therapy for HCC.
Contact e‐mail address: yhhuang123@yahoo.com.tw
H‐RF057. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF057.1. IN AUTOIMMUNE HEPATITIS IL‐18R + CXCR3 + FOXP3 + T REGS ARE ASSOCIATED WITH BETTER THERAPY RESPONSE
Katharina Yankouskaya 1, Ida Allabauer1, Naomi Richardson2, Grace Preece2, Amber Bozward2, Peter Dietrich3, Markus Neurath3, Joachim Woelfle1, Ye Oo2, André Hoerning1
1Pediatric Gastroenterology, Hepatology And Endoscopy, Department Of Pediatrics And Adolescent Medicine, University Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, Erlangen, Germany, 2Centre for Liver and Gastrointestinal Research, Institute of Biomedical Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom, 3Medicine Clinic 1, University Hospital Erlangen, Erlangen, Germany
Objectives and Study: Patients with autoimmune hepatitis (AIH) who do not achieve complete biochemical remission with current first‐line therapy have a worse prognosis. The objective of this study was to examine the role of CD4+T cells in AIH patients undergoing treatment, with a particular focus on therapy responders and non‐responders in AIH.
Methods: Liver derived lymphocytes and peripheral mononuclear blood cells (PBMCs) were freshly isolated from human liver explant samples of 4 patients (Primary Biliary Cholangitis (n = 1), Primary Sclerosing Cholangitis (n = 1), Alcohol‐related Liver Disease (n = 2)), and 3 donor explants as well as peripheral blood samples from 5 AIH responders and 5 AIH non‐responders undergoing treatment and 5 age matched healthy controls were analysed with Flow Cytometry. PBMCs were either analysed immediately, stimulated overnight with CD3/CD28, or stimulated with cytokines IL‐18, IL‐12 or both for 5 days and subsequently analysed.
Results: In unstimulated conditions, the number of IL‐18R+CXCR3+FOXP3+CD25+CD127low CD4+regulatory T cells (Tregs) in blood was higher in AIH than in controls (p = 0.01). Similarly, IL‐18R+FOXP3+ Tregs were more prevalent in disease livers. Following ex vivo stimulation of PBMCs with CD3/CD28, IL‐18R+CXCR3+FOXP3+ Tregs and tendentially IL‐18R+CXCR3+CTLA‐4+FOXP3+ Tregs were increased in AIH responders compared to non‐responders (p = 0.02 and p = 0.052). Upon stimulating T cells with IL‐18 and IL‐12, we observed an elevation in CD4+ IL‐18R+IFNy+FOXP3‐ and CD4+IL‐18R+IFNy+Tbet+ T cells in AIH non‐responders than in responders (p = 0.037 and 0.007), while CD4+IL‐18R+TIGIT+FOXP3‐ T cells were higher in responders than in non‐responders (p = 0.019).
Conclusions: We could show that in AIH the cytokine receptor IL‐18R seems to be involved in therapy response in these patients. Additionally, IL‐18R+CD4+ T cells appear to have different functions, depending on the T cell subset. Further research is needed to better understand the underlying mechanisms and possible involvement of these cells in a therapy refractory course.
Contact e‐mail address: katharina.yankouskaya@fau.de
H‐RF058. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF058.1. WAR‐RELATED ANXIETY AND LIPID AND CARBOHYDRATE METABOLISM IN UKRAINIAN CHILDREN WITH METABOLIC‐ASSOCIATED STEATOTIC LIVER DISEASE
Natalia Zavhorodnia 1, Oksana Tatarchuk2, Inna Klenina2, Raisa Kislova3, Oksana Petishko2
1Pediatric Gastroenterology, SI Institute Gastroenterology of the NAMS of Ukraine, Dnipro, Ukraine, 2Research, SI "Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine", Dnipro, Ukraine, 3Mini‐invasive Endoscopic Interventions And Instrumental Diagnostics, SI "Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine", Dnipro, Ukraine
Objectives and Study: Psychological stress as a result of the war in Ukraine harms children's health, leading to the exacerbation of existing diseases. Objective: to determine the impact of war‐related anxiety on lipid and carbohydrate metabolism in children with metabolic‐associated steatotic liver disease (MASLD).
Methods: The study included 42 children with MASLD aged 6 to 17 years. The presence of liver steatosis was confirmed by transient elastography (FibroScan®502touch, Echosence, France). Obesity was evaluated by bioimpedance analysis (TANITA MC‐780MA, Japan). Anxiety was screened using the SCARED questionnaire. Depending on the presence of anxiety children with MASLD were divided into 2 groups: Group I ‐ 12 children without anxiety, and Group II ‐ 30 children with anxiety. The control group consisted of 10 children of normal weight without anxiety. Insulin content was investigated by ELISA (Monobind Inc, USA), and HOMA‐IR was calculated. Lipid fractions were determined using Cormay kits (Poland). Low‐density lipoprotein cholesterol (LDL‐C), very low‐density lipoprotein cholesterol (VLDL‐C), and atherogenicity coefficient (AC) were calculated.
Results: In children of group I, a significant increase in the insulin level (2.1 times, p < 0.05) and the HOMA‐IR (2.7 times, p < 0.05) were found, in children of group II, a significant increase in the insulin level (2.1 times, p < 0.05) and the HOMA‐IR (2.8 times, p < 0.05) was found, compared to the control group. Children in group II had a higher frequency of elevation of these indicators, namely 43.3% compared to 33.3% in group I. An increase of AС in 1.2 times (p < 0.05) and the TG/HDL ratio 1.5 times (p < 0.05) in children of group I and in 1.2 times (p < 0.05) and 2.1 times (p < 0.05), respectively, in group II were found compared to the control group.
Conclusions: Thus, the presence of anxiety disorder in children with MASLD is accompanied by worsening of metabolic dysfunction, namely, dyslipidemia and insulin resistance.
Contact e‐mail address: nzavgorodni75@gmail.com
H‐RF059. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF059.1. ANALYSIS OF DIFFERENTIAL CHANGES IN GUT MICROBIOTA BETWEEN CHILDREN WITH BILIARY ATRESIA AND NON‐BILIARY ATRESIA CHOLESTASIS
Yajun Liu1, Ruochen Ji2, Muxia Li3, Yuan Zhang2, Lin Zhang 2
1The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, 2Hebei Medical University Third Hospital, Shijiazhuang, China, 3Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
Objectives and Study: By observing the changes of intestinal microecological characteristics and differential microbial species in children with biliary atresia (BA) and non‐BA cholestasis in infantile cholestasis (IC), to explore the roles of differential species in BA (without bile circulation) and IC (with bile circulation) during cholestasis.
Methods: Using 16S rDNA gene sequencing to analyze the variance in gut microbiota (GM) composition among three groups: infants with BA (BA group, n = 26), non‐BA cholestasis (IC group, n = 37), and healthy infants (control group, n = 50). Additionally, correlation analysis was conducted between GM and liver function‐related indicators.
Results: Among the three groups, the IC group had the highest intra group difference in gut microbiota and the highest GM diversity. In the gut microbiota structure, the BA group is mainly dominated by Actinobacteria, while the IC group is mainly dominated by Firmicutes and Proteobacteria. In the structure of intestinal microbiota, The top three co‐abundance groups that distinguish the IC group, and control group or BA group are CAG3, CAG5, and CAG10 (Fig. 1). relatively, the abundance of CAG3 and CAG10 in the IC group microbiota are higher, while the abundance of CAG5 is lower (Fig. 1), with Bifidobacterium longum dominating in CAG5. Higher levels of Bifidobacterium and Collinsella in CAG3 and CAG10. IC‐accumulated co‐abundance groups exhibited positive correlations with aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBiL), direct bilirubin (DBiL), and total bile acid (TBA) serum levels. These correlations were notably reinforced upon the exclusion of microbial samples from children with BA (Fig. 2).
Conclusions: The varying "enterohepatic circulation" status of bile acids in children with BA and non‐BA cholestasis contributes to distinct GM structures and functions. This divergence underscores the potential for targeted GM interventions tailored to the specific aetiologies of cholestasis.
Contact e‐mail address: lzhang_79@163.com
H‐RF060. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐RF060.1. MECHANISMS OF GUT MICROBIAL CHARACTERISTIC CHANGES IN REGULATING BILE ACID METABOLISM IN CHOLESTASIS MODEL MICE
Yajun Liu1, Ruochen Ji2, Muxia Li3, Yuan Zhang2, Lin Zhang 2
1The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, 2Hebei Medical University Third Hospital, Shijiazhuang, China, 3Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
Objectives and Study: To explore the characteristic changes in intestinal microecological imbalance and abnormal bile acid metabolism in cholestasis model mice, and to clarify the relationship between these changes, thereby elucidating the mechanism of the "microbial‐bile acid metabolism axis" in regulating bile acid metabolism during cholestasis.
Methods: A mouse model of cholestasis was established by bile duct ligation (BDL). Gut microbiota (GM) was sequenced by 16S rDNA. Fecal bile acid composition was analyzed using targeted metabolomics technology.
Results: GM composition showed differences between cholestasis model mice and healthy mice. The abundance of Ligilactobacillus, Candidatus_Saccharimonas, Desulfovibrio, Enterorhabdus, Parvibacter, Bilophila, and Candidatus_Stoquefichus decreased, while the abundance of Bacteroides, unidentified_Rumnococcaceae, [Eubacteria]_siraeum_group, UBA1819, Family_XIII_UCG‐001, Paludicola increased in cholestasis model mice. However, there was no significant difference in the GM diversity. Fecal bile acid metabolism was disrupted in cholestasis model mice, with decreased levels of nine unbound bile acids such as β‐MCA, DCA, LCA, and UDCA, etc. Correlation analysis revealed a significant link between differential intestinal microbial species and disordered bile acid metabolism components in cholestasis model mice (Fig. 1).
Conclusions: Imbalance of GM during cholestasis can result in bile acid metabolic disorders through characteristic microbial species, which are involved in the occurrence and development of cholestasis.
Contact e‐mail address: lzhang_79@163.com
H‐RF061. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF061.1. INCIDENCE, OUTCOME AND PROGNOSTIC FACTORS OF CHRONIC REJECTION IN A LARGE PEDIATRIC LIVER TRANSPLANTATION CENTER
Dalal Albogami 1, Aleyda Alexandra Aldana Grisales2, Kumar Kishwer2, Ali Syed Akhtarul Hassan2, Dieter Broering2, Mohammad Shagrani3
1Organ Transplant Center Of Excellence, Dept. Of Liver & Small Bowel Health Centre, Pediatric Hepatology & Transplant Hepatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 2Organ Transplant Center Of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 3Liver & Sb Transplant & Hepatobiliary‐pancreatic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
Objectives and Study: Chronic rejection (CR) after liver transplantation (LTx) is an ongoing immunological injury that commonly leads to permanent dysfunction and graft loss. Chronic rejection after pediatric LTx has decreased to currently~5 %(1).We aimed to characterize the risk factors and the outcomes of CR after pediatric LTx.
Methods: We analyzed all cases of CR in the period of 1‐10‐2010 to 30‐11‐2024 among the 837 children who undergone LTx in our center. We determined the incidence of CR, risk factors and its outcomes (remission, progression to a chronic allograft failure).To analyze risk factors for the outcome after CR, we compared patient and graft histology characteristics that were associated with CR, remission and progression to chronic allograft failure.
Results: We identified 30 patients with CR (30/837:3.6%).6 of the 30 patients (20%) achieved a stable remission by immunosuppressive adjustment or adding rescue therapies such as everolimus or single dose of basiliximab.None of these 6 patients had ductopenia in the liver biopsies.In 24 out 30 patients (80%).CR followed a progressive course, despite changing and intensifying immunosuppression, ultimately leading to chronic allograft failure and to retransplantation (19/24:79%) or death (5/24:21%). All patients in the latter group had shown interlobular bile duct loss and ductopenia in liver histology.
| CR total (n:30) | CR(remission) 6 Patients | CR (progression)24 patients |
|---|---|---|
| Mean Age at tx(months) | 45 | 39 |
| Mean time of CR after liver tx (months) | 50 | 28 |
| ALT/AST/GGT | 100 + /‐20 | 100 + /‐ 20 |
| ductopenia | 0/6 | 24/24 |
Conclusions: Our data indicate that ductopenia in liver histology predicts a low chance of reversal of CR upon adaptation of the immunosuppressive regimen. We propose that histological ductopenia in CR should lead to consider early retransplantation given the increased risk of sepsis and death during intensification of immunosuppression. 1Dike, Peace N.1; Schady, Deborah2; Himes, Ryan3; Goss, John A.4; Guffey, Danielle5; Cerminara, Dana1; Mysore, Krupa R.1 Liver Transplantation11
Contact e‐mail address:
H‐RF062. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF062.1. ISOLATED LIVER AND COMBINED LIVER‐PANCREAS TRANSPLANT IN CYSTIC FIBROSIS (CF): APPLICATIONS TO THE CF COMMUNITY IN AUSTRALIA AND NEW ZEALAND
Rishi Bolia 1, Mark Oliver2, Jonathan Bishop3, Helen Evans3, Kathe Holmes2, Peter Hopkins4, Robert Jones5, John Kanellis6, Tom Kotsimbos7, Peter Lewindon1, Avik Majumdar5, John Massie8, Silvana Marasco9, Chee Ooi10, Miranda Paraskeva11, Henry Pleass12, Paul Robinson13, Sheila Sivam14, Greg Snell11, Michael Stormon15, Caroline Tallis16, Anastasia Volovets17, Germaine Wong18
1Department Of Gastroenterology, Hepatology And Liver Transplantation, Queensland Children's Hospital, Brisbane, Australia, 2Department Of Gastroenterology And Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia, 3Paediatric Gastroenterology And Hepatology, Starship Child Health, Auckland, New Zealand, 4Queensland Centre For Pulmonary Transplantation And Vascular Disease, The Prince Charles Hospital, Brisbaane, Australia, 5Victorian Liver Transplant Unit, Austin Hospital, Melbourne, Australia, 6Department Of Nephrology, Monash Health and Centre for Inflammatory Diseases, Melbourne, Australia, 7The Alfred Hospital, Melbourne, Australia, 8Department Of Respiratory Medicine And Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Australia, 9Department Of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia, 10Pediatric Gastroenterology, Sydney Childrens Hospital, Sydney, Australia, 11Lung Transplant Service, Department Of Respiratory Medicine, The Alfred Hospital, Melbourne, Australia, 12Westmead Hospital, Sydney, Australia, 1314‐ department Of Respiratory And Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia, 14Department Of Respiratory And Sleep Medicine, The Alfred Hospital, Melbourne, Australia, 15Department Of Gastroenterology, Children's Hospital at Westmead, Sydney, Australia, 16Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Australia, 17Aw Morrow Gastroenterology And Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia, 18Centre For Transplant And Renal Research, Westmead Hospital, Sydney, Australia
Objectives and Study: There are concerns around transplant listing criteria, timing, waitlist management and graft selection in Cystic Fibrosis (CF) patients with advanced liver disease. A committee was assembled to formulate a systematic approach for isolated liver transplant (LT) and combined liver‐pancreas transplant (LPT) in this population.
Methods: A committee of 22 adult and paediatric transplant surgeons, hepatologists, gastroenterologists, pulmonologists, nephrologists and a transplant clinical nurse consultant devised questions regarding pre‐ and post‐transplant management including indications, contraindications and timing of LT and LPT in CF. PubMed literature search was performed for each question. Recommendations were voted using the Delphi process, with ≥70% agreement required to approve a recommendation.
Results: Thirty‐one questions were evaluated, from which 21 recommendations were approved. Broad consensus was that patients with CF‐related liver disease should receive priority on LT waiting lists because of the multi‐system nature of CF (16/22,73%). Prioritisation determined by consensus from the transplanting unit was considered the fairest approach (19/22,86%). The committee recommended combined LPT in all patients with CF–related diabetes being evaluated for LT (19/22,86%). Recommended indications for LT included hepatic synthetic dysfunction and advanced portal hypertension (20/22,91%); while uncontrolled systemic infection (21/22,95%), poor lung function [FEV1 < 40%] (17/22,77%) and severe Porto‐pulmonary hypertension (16/22,73%) were proposed as contraindications. Poor treatment adherence or psychosocial concerns were considered relative contraindications (17/22,77%). Quality of life should be factored in when considering LT (21/22,95%). Portosystemic shunt placement may bridge patients with intractable variceal bleeding to LT (20/22,91%). Aggressive pre–transplant nutritional optimisation (22/22,100%), individualised peri‐operative anti‐microbial prophylaxis (21/22,95%) and a post‐operative renal–sparing immunosuppression protocol for all (18/22,82%) were recommended.
Conclusions: These consensus recommendations provide criteria outlining indications, contraindications and timing for LT and LTP as well as CF‐specific transplant considerations in Australia and New Zealand. They are intended to be paired with published guidelines to reduce practice variability and improve patient care.
Contact e‐mail address: rishi.bolia@health.qld.gov.au
H‐RF063. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF063.1. EVALUATING ALPHA FETOPROTEIN AS PROGNOSTIC MARKER FOR LIVER TRANSPLANTATION IN PAEDIATRIC LIVER FAILURE
David Cairney 1,2, Hari Kanthimathinathan3, Sarah Heap4, Mary‐Jane Okpala1, Girish L Gupte1, Jane Hartley1, Khalid Sharif1, Chayarani Kelgeri1
1Paediatric Liver Unit (including Intestinal Transplantation), Birmingham Children's Hospital, Birmingham, United Kingdom, 2Department Of Paediatric Gastroenterology, Hepatology And Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, 3Picu, Birmingham Children's Hospital, Birmingham, United Kingdom, 4Clinical Chemistry, Birmingham Children's Hospital, Birmingham, United Kingdom
Objectives and Study: In paediatric acute liver failure (PALF), risk prediction models are unable to predict survival with native liver with certainty. Alpha fetoprotein (AFP) has been proposed as a promising prognostic biomarker and has been evaluated in neonatal and adult ALF but has not been assessed in PALF. We aimed to evaluate AFP as a prognostic marker for survival with native liver (SNL) in PALF and compare this to the previously validated CHLA‐acute liver failure (CHALF) score.
Methods: This was a single centre retrospective cohort study. Patients were identified from the departmental PALF database from 1/2022 to 8/2024 and included if they had at least one AFP measurement during their admission. Initial AFP, maximal AFP and initial:maximal AFP ratios were recorded. CHALF was calculated on admission or when sufficient biochemical values were available.
Results: 19 patients were included. Median (IQR) age was 3.5 (2.4‐4.2) years and 9 were female. 6 children had a single AFP measurement, others up to 10. 11 patients required LT and 1 died. Median first AFP was similar (SNL:53(26‐129), non‐SNL:50(16‐155); p = 0.87). Maximum AFP and median AFP ratio were higher in the SNL group (medians 583 vs 111, 7.70 vs 3.97) but this was not statistically significant. Median CHALF was significantly lower in the SNL group (35 vs 38, p = 0.02). First AFP, maximum AFP and AFP ratio performed poorly compared to the CHALF (Fig.1). Using univariate logistic regression, first AFP was combined into the CHALF (Fig.1).
Conclusions: This analysis shows that the CHALF performed better than AFP measurements. The inclusion of AFP into the CHALF may improve its performance. While maximal AFP and AFP ratio were higher in the SNL group, the differences were not significant. This cohort was small and should be considered hypothesis generating. AFP should be studied in a larger PALF cohort, measuring repeat AFP at consistent time points.
Contact e‐mail address: david.cairney@nhs.scot
H‐RF064. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF064.1. PREDICTORS OF RESPONSE TO STEROIDS IN CHILDREN AND ADOLESCENTS WITH TREATMENT NAÏVE SEVERE AUTOIMMUNE HEPATITIS
Samannay Das 1, Rajeev Khanna1, Vikrant Sood2, Anmol Anmol1, Tamoghna Biswas3, Bikrant Bihari Lal3, Archana Rastogi4, Chhagan Bihari4, Seema Alam3
1Pediatric Hepatology, ILBS, New Delhi, India, 2Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India, 3Department Of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India, 4Department Of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
Objectives and Study: Steroids are indicated in severe autoimmune hepatitis(AIH) to avert liver transplantation (LT). There is limited paediatric data on prediction of response to steroids. The present study was conducted to identify predictors of response to steroids in children and adolescents with severe AIH.
Methods: In this retrospective analysis of prospectively maintained database, children and adolescents below 18 years from January 2011 to May 2024 with severe AIH who received steroids were enrolled. Outcome was studied in terms of response to steroids which was defined clinically in terms of survival with native liver (SNL) or not (LT or death) by Day 28.
Results: Fifty children (31 females) with a median age of 11.9 (6.5, 15) years were studied. There were 9 deaths and 3 LT, while 38 (76%) had SNL. On Multivariate cox regression analysis, advance HE (HR 5.2, p = 0.024) and SURFASA score (HR = 1.2, p = 0.029) predicted poor response. SURFASA (AUROC 0.872) and AAPS scores (AUROC 0.827) were found to be superior to CLIF‐SOFA (AUROC 0.798) and PELD (AUROC 0.773). A cut‐off of SURFASA score of ‐2.3 differentiated patients with good or poor response.
| PARAMETERS | Univariate analysis HR (95% CI) | P value | Multivariate analysis HR (95% CI) | P value |
|---|---|---|---|---|
| Advanced HE | 10.350 (3.180‐33.600) | 0.001 | 5.153 (1.244‐21.351) | 0.024 |
| Number of organ failure | 3.674(1.890‐7.160) | 0.001 | ||
| Mechanical Ventilation | 21.975(5.998‐80.510) | 0.001 | ||
| INR | 1.717(1.290‐2.270) | 0.001 | ||
| Culture positive | 4.160 (1.116‐15.520) | 0.034 | ||
| Day 7 INR | 2.155(1.290‐3.600) | 0.003 | ||
| Simplified score | 0.585(0.350‐0.960) | 0.036 | ||
| CLIF Lung | 5.54(2.750‐11.710) | 0.001 | ||
| CLIF SOFA | 1.518(1.260‐1.830) | 0.001 | ||
| PELD | 1.12(1.049‐1.204) | 0.001 | ||
| SURFASA | 1.33(1.150‐1.550) | 0.001 | 1.436 (1.010‐2.030) | 0.042 |
| AAPS | 0.651 (0.502‐0.845) | 0.001 |
Conclusions: Response to steroids is seen in three‐fourths of children and adolescents with severe AIH. Advance HE and SURFASA score predicted poor response. SURFASA score >/= ‐2.3 help in identifying patients in urgent need for LT.
Contact e‐mail address:
H‐RF065. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF065.1. LIVER TRANSPLANTATION IN PATIENTS WITH WILSON'S DISEASE AND NEUROLOGICAL INVOLVEMENT: A STUDY OF 10 CHILDREN UNDER 18 YEARS OLD
Dominique Debray 1, Nathalie Dorison2, Céline Bellesme3, Fabienne Ory‐Magne4, Laurence Lion‐François5, Dalila Habes6, Mickael Alexandre Obadia1, Aurelia Poujois1
1Reference Center For Wilson Disease, Hôpital Fondation Adolphe de Rothschild, PARIS, France, 2Pediatric Neurology, Hôpital Fondation Adolphe de Rothschild, PARIS, France, 3Pediatric Neurology, Hôpital Bicêtre, Le KREMLIN‐BICETRE, France, 4Neurology, Hôpital PURPAN, TOULOUSE, France, 5Pediatric Neurology, Hospices Civils de Lyon, BRON, France, 6Pediatric Hepatology, Hôpital Bicêtre, Le KREMLIN‐BICETRE, France
Objectives and Study: Wilson's disease (WD) is a rare genetic disorder characterized by copper overload affecting multiple organs, especially the liver and brain. Children may present with neurological symptoms (neuroWilson) at diagnosis. These may worsen in nearly 20% of cases despite optimal medical treatment. Knowledge regarding the benefit of liver transplantation (LT) for improving neurological outcome is limited.
Methods: We report the outcome of 10 children (6 girls, 4 boys) who underwent LT at a mean age of 15.5 years for neurological deterioration. The diagnosis of WD was genetically confirmed at a mean age of 14.7 years. Initial neurological symptoms preceded the diagnosis of WD by an average of 7.6 months. All children presented with severe neurological involvement, which rapidly worsened in 9 children despite copper‐chelators, and in one who had stopped treatment.
Results: LT was performed at a mean of 7.5 months following the onset of neurological symptoms. At the time of transplantation, the UWDRS (Unified Wilson's Disease Rating Scale) score was on average 100. Main symptoms included dystonia (10/10); parkinsonian syndrome (7/10); psychiatric disorders (2/10); myoclonus (2/10); chorea (1/10).
A progressive and significant improvement in neurological symptoms was noted in 8 patients (mean follow‐up of 44 months [1.5 ‐ 158 months]; 1 patient showed no improvement; 1 patient died from sepsis 36 months after transplantation. The UWDRS score available at the last follow‐up (at least 1‐year post‐transplant) for 8 patients was 42. Improvement of brain MRI lesions was seen in 5 patients.
Conclusions: The observed neurological improvement suggests that LT allows satisfactory mobilization of copper from the central nervous system before irreversible apoptosis and cell necrosis. The indication for LT should be considered promptly after expert consultation in cases of neurological deterioration despite optimal medical treatment (chelators or zinc).
Conversely, neurological involvement should not contraindicate LT when indicated due to end stage liver failure.
Contact e‐mail address: ddebray@for.paris
H‐RF066. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF066.1. EFFICACY AND SAFETY OF PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY AND BIODEGRADABLE BILIARY STENT PLACEMENT IN CHILDREN WITH BILIARY STRICTURES
Paola Gaio 1, Giulio Bove1, Luca Bosa1, Giovanna Faggian1, Marco Bolzonella2, Annalisa Dolcet3, Enrico Gringeri3, Umberto Cillo3, Vincenzo Baldo2, Giulio Barbiero4, Michele Battistel4, Mara Cananzi1
1Unit Of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology And Care Of The Child With Liver Transplantation, Department Of Women's And Children's Health, University Hospital of Padova, Padova, Italy, 2Department Of Cardiac, Thoracic, Vascular Sciences, And Public Health, University of Padova, Padova, Italy, 3Hepatobiliary Surgery And Liver Transplantation Unit, Department Of Surgery, Oncology And Gastroenterology, University Hospital of Padova, Padova, Italy, 4Institute Of Radiology, Department Of Medicine‐dimed, University Hospital of Padova, Padova, Italy
Objectives and Study: Percutaneous transhepatic cholangiography (PTC) is a well‐established treatment for managing biliary strictures (BS) in adults. However, its application in children remains limited, particularly regarding the employment of biodegradable biliary stents (BBS). This study aimed to assess the efficacy and safety of PTC and BBS placement in a cohort of pediatric patients.
Methods: This retrospective study reviewed data from children treated with PTC for BS at the University Hospital of Padova between 2014 and 2024. Collected data included demographics, BS type, PTC procedure characteristics and complications. A PTC cycle consisted of the series of procedures required to address a single BS episode. PTC success was defined as the successful placement of the biliary drainage tube, while PTC efficacy as the absence of stricture recurrence at tube removal. The recurrence of significant BS impairing bile flow was assessed throughout the follow‐up period.
Results: Eighteen patients (55% males; median age 6 years; range 0.75‐18 years) were included. Fourteen subjects had undergone liver transplantation, while four had a native liver. The median follow‐up time was 21 months (range 3‐75). BS were categorized as anastomotic (10/18), intrahepatic (1/18), anastomotic and intrahepatic (1/18), complex (4/18), other (2/18). 86 procedures were performed and 19 cycles completed. Success and efficacy rates were 90.9% and 100%, respectively. BS recurrence occurred after 5 completed cycles (26.3%), with recurrence rates of 25% after the first cycle and 33.3% after the second. Cholangitis occurred after the 24% of procedures. Life‐threatening complications were rare, with sepsis and bleeding reported in 4.6% and 3% of patients, respectively.
Conclusions: PTC is an effective treatment for BS in children, achieving success rates of 90‐100%. Compared to recurrence rates of 50‐60% with standard PTC, BBS reduce the risk of restenosis to approximately 25%. Prospective studies with larger pediatric cohorts are required to confirm these findings.
Contact e‐mail address: paola.gaio@aopd.veneto.it
H‐RF067. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF067.1. BORTEZOMIB AS A TREATMENT MODALITY FOR RECURRENCE OF PFIC‐2 IN TRANSPLANT RECIPIENT
Rohan Grotra 1, Prasenjit Das2, Rajni Yadav2, Lalita Mehra2, Ashok Tiwari2, Rohan Malik3
1Division Of Pediatric Gastroenterology And Hepatology, Department Of Pediatrics, All India Institute of Medical Sciences, New Delhi, India, 2Pathology, All India Institute of Medical Sciences, New Delhi, India, 3Division Of Pediatric Gastroenterology And Hepatology, Department Of Pediatrics, All India Institute Of Medical Sciences, New Delhi, India
Objectives and Study: Progressive familial intrahepatic cholestasis type 2 (PFIC‐2) is caused by mutations in the ABCB11 gene, encoding the bile salt export pump (BSEP). Liver transplantation (LT) is offered to patients with end‐stage liver disease as curative therapy. Recurrence of PFIC‐2 in post‐transplant recipients is called as Autoimmune BSEP Disease (AIBD) which is mediated by Anti‐BSEP antibodies. There is no established protocol for treating AIBD. To date, several therapy options, including intensification of ongoing immunosuppression, plasmapheresis, immunoadsorption, and B‐cell depletion (rituximab), were considered effective in achieving remission of AIBD. Our case was refractory to these therapy options. We report a case of refractory AIBD, highlighting the complex behavior of AIBD and its successful management with Bortezomib therapy.
Methods: The patient developed normal GGT cholestasis along with severe pruritus 3 years after LT. Histopathological examination of liver biopsy showed canalicular cholestasis along with giant cell transformation. BSEP stain was retained on immunohistochemistry (IHC) indicating functional inhibition of BSEP protein. Indirect Immunofluorescence test was performed with purified patient's serum on liver biopsy as substrate which showed canalicular positivity for the Anti‐BSEP antibody (Dilution 1:160)
Image: Samples A to C show canalicular positivity for Anti‐BSEP antibodies. D and E (Post Treatment) negative for antibodies
Results: Aggressive treatment with plasmapheresis, immunoglobulins, and rituximab was initiated, showing a partial response in control of cholestasis. Despite the depletion of circulating Anti‐BSEP antibodies as evidenced by negative titres, cholestasis persisted. Bortezomib, a proteasome inhibitor, was used for active apoptosis of antibody‐producing plasma cells, following which complete resolution of cholestasis, pruritus, and transaminitis was achieved.
Conclusions: Autoimmune BSEP deficiency should be suspected in PFIC‐2 post‐transplant recipients who present with typical phenotype. Recurrence can be demonstrated with positive anti‐BSEP antibodies. Besides intensified immunosuppression and antibody treatment using plasmapheresis and rituximab, Bortezomib therapy can be used for refractory cases as demonstrated in this case.
Contact e‐mail address: dr.rohanmalik@gmail.com
H‐RF068. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF068.1. PERIOPERATIVE MANAGEMENT OF LIVER AND COMBINED LIVER‐KIDNEY TRANSPLANTATION FOR METHYLMALONIC AND PROPIONIC ACIDEMIA
Vickie Lacroix, Clothilde Marbach, Magali Gorce
Pediatric Hepatology, CHU TOULOUSE, Toulouse, France
Objectives and Study: Liver (LT) and combined liver‐kidney (LKT) transplantation for methylmalonic acidemia (MMA) and propionic acidemia (PA) involve a period of high catabolic risk, necessitating close perioperative monitoring. However, few studies have focused on perioperative metabolic management.
Methods: Between 2018 and 2024, six patients at Toulouse Hospital underwent LT (n = 2) or LKT (n = 4). Four patients were diagnosed with MMA, and two with PA. We retrospectively analyzed patient characteristics prior to LT or LKT, along with perioperative glycemia, lactate levels, specific plasma and urinary metabolic markers, and treatments. These data were compared with those from seven age‐matched patients who underwent LT for hepatobiliary causes.
Results: Except for one, all MMA and PA patients had normal blood glucose and lactate levels before transplantation. During surgery, all patients exhibited hyperglycemia followed by hyperlactatemia, but without lactic acidosis. Insulin therapy and a reduction in glucose infusion rate were administered to all patients. In the control group, the only patients who experienced complications during surgery showed hyperlactatemia, which resolved quickly. The median lactate level was 6.2 mmol/l for MMA and PA patients, compared to 3.1 mmol/l in the control group. Monitoring of urinary MMA and 3OHpropionate/propionylglycine levels showed a reduction of over 50% within 24 hours post‐transplant. None of the patients experienced neurological complications. To date, the overall patient and graft survival rates are both 100%.
Conclusions: LT and LKT present a particularly high‐risk catabolic situation for MMA and PA patients. Due to the perioperative protocol and the underlying metabolic conditions, all patients exhibited hyperglycemia and hyperlactatemia to a greater extent than the control group, but without complications. Further studies on perioperative data could help refine transplantation protocols for these high‐risk patients.
Contact e‐mail address:
H‐RF069. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF069.1. DONOR SPECIFIC ANTIBODIES MAY BE CONTRIBUTING TO GRAFT INJURY IN LONG TERM FOLLOW‐UP AFTER LIVER TRANSPLANTATION
Bharanikumar Ravikumar 1, Luke Foster2, Jane Hartley1, Chayarani Kelgeri1, Joseph Valamparampil1, Lauren Johansen1, Khalid Sharif1, Girish L Gupte1
1Liver Unit (including Small Bowel Transplantation), birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom, 2Nhsbt, Histocompatibility and Immunogenetics, BIRMINGHAM, United Kingdom
Objectives and Study: To understand the prevalence of Donor Specific Antibodies (DSA) in liver transplant (LTx) children attending for liver biopsy and correlate the association of DSAs with biochemical and histopathological findings.
Methods: A retrospective, observational study of LTx children undergoing liver biopsy between 2020 ‐2024. Outcomes measures included demographics, DSA status, liver biochemistry, Immunosuppression and biopsy findings
Results: 160 children (age – 9 months to 18 years, median ‐11 years, 87 male and 73 female) had DSA testing performed around the time of liver biopsy. 56/160 children (35%) had positive DSAs.There was no significant difference in liver function test and immunosuppression (single vs dual/triple and tacrolimus levels) between DSA+ve & DSA‐ve groups. 48/56 children (86%) had DSA against HLA class II, HLA DQ and its subtype DQA being the most prevalent (68%). 37/56 children had Mean Fluorescence Intensity (MFI) levels > 10000. There was no correlation between MFI levels and Acute cellular rejection (ACR)/antibody‐mediated rejection (AMR) within the DSA+ve group. Children with DSA‐ve were more likely to have normal liver biopsy (p = 0.018). There was no difference in the incidence of ACR and fibrosis between DSA+ve & DSA‐ve groups. 4 children had both ACR and AMR, among which 2 children presented <1 month post LTx with positive HLA class I DSA, and 2 children presented at 14 months and 16 years post LTx with positive HLA class II DSA (DQ). 3 children had chronic AMR with DSA against HLA DQ and/or DQA and their previous liver biopsy showed ACR with negative DSA. These patients were on dual or triple immunosuppression with normal liver function at the time of biopsy.
Conclusions: DSAs may be contributing to long term graft liver injury though their exact mechanism is uncertain and should always be interpreted in conjunction with histopathological changes on liver biopsy.
Contact e‐mail address: b.ravikumar2@nhs.net
H‐RF070. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF070.1. CYTOMEGALOVIRUS T‐CELL MEDIATED IMMUNITY ASSAYS IN PREDICTING VIROLOGIC CONTROL AFTER PAEDIATRIC LIVER TRANSPLANT: RESULTS OF THE TAILOR CMV STUDY
Emanuele Nicastro1, Eleonora Severi 2, Lorenza Matarazzo3, Francesco Morotti3, Matteo Consonni4, Ilaria Passera5, Andrea Francavilla4, Angelo Di Giorgio6, Marta Dolci3, Anna Paola Callegaro5, Alessandra Tebaldi7, Marco Enrico Giovanni Arosio5, Claudio Farina5, Ezio Bonanomi8, Paola Stroppa1, Michela Bravi9, Domenico Pinelli10, Lorenzo D'Antiga11
1Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 2Pediatric Hepatology, Gastroenterology, And Transplantation., Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 3Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 4Biostatistician FROM ‐ Fondazione per la Ricerca Ospedale di Bergamo ‐, Bergamo, Italy, 5Microbiology and Virology, Hospital Papa Giovanni XXIII, Bergamo, Italy, 6Hospital Santa Maria della Misericordia, Udine, Italy, 7Infectious Diseases, Hospital Papa Giovanni XXIII, Bergamo, Italy, 8Pediatric intesive Care Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy, 9Department Of Paediatric Hepatology, Gastroenterology And Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy, 10Department Of Organ Failure And Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy, 11Pediatric Hepatology, Gastroenterology And Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
Objectives and Study: T‐cell mediated immunity (CMI) is crucial in the response against Cytomegalovirus (CMV). This single‐centre prospective study evaluated the capacity of CMV‐CMI (T‐SPOT and QuantiFERON) assays in predicting complicated CMV infection after pediatric liver transplantation (LT).
Methods: Pediatric LT recipients were followed until 200 days after LT. Preemptive therapy (PET) with ganciclovir was initiated if i) ≥ 100.000 CMV‐DNA IU/mL or ii) ≥ 50.000 IU/mL CMV‐DNA in high risk patients. PET and CMV disease were defined as ‘complicated CMV’ (comCMV). QuantiFERON CMV (cut‐off: > 0.2 IU/mL), and CMV pp65/IE‐1 T‐SPOT (cut‐off: >15 SFU) were measured at baseline (t0), +2 and +4 weeks. Donor (D)‐to‐recipient (R) serological risk was classified as high (HR: CMV‐IgG D + /R‐), intermediate (MR: D(any)/R + ) and low (LR: D‐/R‐).
Results: 62 children (35 females) [median (IQR) age at LT of 3 years (0‐7)] were included. Seventeen remained uninfected (4 LR, 11 MR, 1 HR); 26 (24 MR, 2 HR) spontaneously controlled CMV (‘abortive infection’, aboCMV: median CMV‐DNA 1,961 IU/mL, IQR 720‐9,206); 19 (9 MR, 10 HR) had a comCMV (median CMV‐DNA 115,266 IU/mL, IQR 50,903‐185,912). QuantiFERON CMV at t0 was positive in 13 (34%) of the aboCMV and in 1 (5%) of the comCMV (p = 0.042); pp65 and IE‐1 T‐SPOTs were positive in 9 (24%) and 19 (51%) of the aboCMV, and in 0 and 2 (12%) of the comCMV group (p = 0.44 and p = 0.006, respectively). The CMV‐CMI tests had a negative predictive value as high as 94% (QuantiFERON CMV) and 100% (pp65/IE‐1 T‐SPOT). With ongoing infection at +4 weeks, the IE‐1 T‐SPOT/viremia ratio·10^3 was higher in aboCMV [8.1 (3.4‐33.9)] than in comCMV [0.9 (0.06‐7.9; p = 0.034).
Conclusions: CMV‐CMI assays have the highest negative predictive value towards complicated CMV after pediatric LT, identifying with unprecedented accuracy children at low risk, thus increasing the efficiency of PET.
Contact e‐mail address: eleonora.severi@virgilio.it
H‐RF071. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF071.1. KINETICS AND VARIABLES ASSOCIATED WITH DSA APPEARANCE DURING THE FIRST 2 YEARS AFTER PEDIATRIC LIVER TRANSPLANTATION
Côme Tissandier 1, Nathalie Rock1, Jean Villard2, Vladimir Cousin1, Antoine Poncet3, Julien Vionnet4, Sylvie Ferrari‐Lacraz2, Valérie Mclin1
1Swiss Pediatric Liver Center, Department of Pediatrics, University of Geneva, Geneva, Switzerland, 2Transplantation Immunology Unit And National Reference Laboratory For Histocompatibility, University of Geneva, Geneva, Switzerland, 3Clinical Research Center, University of Geneva, Geneva, Switzerland, 4Transplantation Center, University Hospital of Lausanne, Lausanne, Switzerland
Objectives and Study: Donor‐specific antibodies (DSA) in pediatric liver transplant (pLT) recipients are associated with graft inflammation and fibrosis, but the temporal relationship with DSA development is incompletely understood. This study aimed to analyze the onset of DSA and factors associated with their development during the first two years post‐LT.
Methods: After ethical approval, we retrospectively reviewed data from pediatric LT recipients focusing on preformed DSA (pfDSA) and de novo DSA (dnDSA) assessed at 1, 3, 6, 9, 12, 18, and 24 months using the Luminex assay. Donor and recipient data including HLA typing, the occurrence of T‐cell‐mediated rejection (TCMR) and tacrolimus levels were collected.
Results: Sixty‐six patients were included in the study. PfDSA and dnDSA were detected in 23% and 62% of patients, respectively. The most common dnDSA were anti‐DQ7 and anti‐DQ6, identified in 14 patients each, followed by anti‐DQ2 and anti‐DQ5, detected in 9 and 8 patients, respectively. Table 1 shows the timeline of onset of the 7 most‐frequents dnDSA. DnDSA development was associated with the presence of pfDSA (p = 0.04), but not with Pirche score or median tacrolimus levels at each follow‐up. Three main groups emerged based on occurence of dnDSA and TCMR: dnDSA + /TCMR+ (19/66), dnDSA + /TCMR‐ (21/66), and dnDSA‐/TCMR‐ (23/66).
Conclusions: Overall, 62% of patients developed dnDSA, and the presence of pfDSA was associated with dnDSA onset. Most dnDSA appeared in the first three months post LT. This suggests that early dnDSA are often persistent, and therefore that early monitoring may be clinically relevant. Although the relationship between TCMR and dnDSA remains to be defined, a subset of patients did not develop dnDSA or TCMR in the first 24 months, suggesting a distinct immunological profile. These findings suggest that early monitoring for DSA may inform management decisions.
Contact e‐mail address:
H‐RF072. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF072.1. THERAPEUTIC PLASMA EXCHANGE IN AMANITA PHALLOIDES‐INDUCED PEDIATRIC ACUTE LIVER FAILURE: INTERIM RESULTS OF THE AMANITA‐PEX STUDY
Klaus Stahl1,2, Bahar Nalbant2,3, Alejandro Campos‐Murguia1,2, Florian Von Borell 2,4, Tobias Laue2,5, Bente Utoft Andreassen2,6, Rainer Buescher7, Daniel Tegtmeyer2,8, Angelo Di Giorgio2,9, Geraldine Dahlqvist2,10, Isaure Breteau2,11, Dominic Lenz2,12, Tanja Fritz2,13, Eberhard Lurz14, Ekkehard Sturm2,13, Alexander Fichtner2,12, Erin Levesque2,11, Nicolas Lanthier2,10, Lorenzo D'Antiga2,9, Jun Oh2,8, Elke Lainka7, Marianne Hørby Jørgensen2,6, Ulrich Baumann2,5, Richard Taubert1,2
1Department Of Gastroenterology, Hepatology, Infectious Diseases And Endocrinology, Hannover Medical School, Hannover, Germany, 2European Reference Network on Hepatological Diseases, Hamburg, Germany, 3Department Of Respiratory Medicine And German Centre Of Lung Research (dzl), Hannover Medical School, Hannover, Germany, 4Department For Pediatric Cardiology And Intensive Care, Hannover Medical School, Hannover, Germany, 5Department Of Paediatric Kidney, Liver And Metabolic Diseases, Hannover Medical School, Hannover, Germany, 6Department Of Paediatric And Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark, 7Clinic For Pediatrics Ii, Department Of Pediatric Nephrology, Gastroenterology And Transplant Medicine, University Children's Hospital Essen, Essen, Germany, 8University Children's Hospital, Department Of Ped. Nephrology, Ped. Hepatology And Ped. Transplantation, University Medical Center Hamburg‐Eppendorf, Hamburg, Germany, 9Pediatric Hepatology, Gastroenterology And Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 10Service D'hépato‐gastroenterologie, Cliniques universitaires Saint‐Luc, Brussels, Belgium, 11Department Of Anesthesia And Intensive Care, University Hospitals of Tours, Tours, France, 12Heidelberg University, Medical Faculty, Department Of Pediatrics I, University Children's Hospital, Heidelberg, Germany, 13Department Of Pediatric Gastroenterology And Hepatology, University Children's Hospital Tuebingen, Tuebingen, Germany, 14Department Of Pediatrics, University Hospital, LMU Munich, Munich, Germany
Objectives and Study: Pediatric acute liver failure (PALF) is a rare, life‐threatening condition with a complex pathophysiology. Poisoning with Amanita species, though uncommon, can cause PALF with a rapidly deteriorating clinical course characterized by systemic inflammation, cerebral edema, and multi‐organ failure. Therapeutic plasma exchange (TPE) has emerged as a potential intervention, offering a bridge to recovery or liver transplantation (LTX). While its efficacy is recognized in adult acute liver failure (ALF) and its use has been proven to be safe in children. However, data on its role in Amanita‐induced PALF remain limited and clinical practice in applying this intervention varies between different transplant centers. This study aimed to evaluate 28‐day LTX‐free and overall survival in children treated with TPE compared to those without after Amanita poisoning.
Methods: This interim analysis is part of the multicenter, international, retrospective Amanita‐PEX study (NCT06187220), covering cases from 2013 to 2024. Pediatric patients meeting PALF criteria following Amanita poisoning were included. Outcomes in TPE‐treated and non‐TPE groups were compared.
Results: Nineteen pediatric patients were identified from 10 centers across five countries. All patients received N‐acetylcysteine, and 95% were treated with silibinin. Ten patients underwent adjunctive TPE (median age: 8.5), while nine served as controls (median age 7.0). The combined outcome of LTX or death was comparable between TPE and control groups (40% vs. 55.6%, p = 0.83). At 28 days, no TPE‐treated patients and 33% of non‐TPE patients had died (p = 0.17). LTX was performed in 40% of the TPE group and 25% of controls (Log‐rank p = 0.35). Secondary outcomes, including SOFA score, vasopressor requirement, and need of renal replacement therapy, were similar between groups.
Conclusions: This interim analysis, therefore most likely underpowered, suggests no significant benefit of TPE in improving transplant‐free survival in children with Amanita‐induced PALF. Further data are needed to clarify the potential role of TPE in this rare but critical condition.
Contact e‐mail address: borell.florian@mh-hannover.de
H‐RF073. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐RF073.1. LOW BILIARY COMPLICATION RATES AND COMPARABLE GRAFT & PATIENT SURVIVAL IN LDLT AND DBD‐LT PAEDIATRIC LIVER TRANSPLANT RECIPIENTS – A SINGLE CENTRE STUDY
Suzan Warner 1, Mariana Kostova2, Barbara Fiore3, Vivek Upasani3, Kavitha Jayaprakash1, Marumbo Paul Mtegha1, Palaniswamy Karthikeyan1, Sanjay Rajwal1, Dhakshina Vijayanand3
1Paediatric Hepatology, Leeds Children's Hospital, Leeds, United Kingdom, 2Paediatric Surgery, Leeds Children's Hospital, Leeds, United Kingdom, 3Paediatric Transplant Surgery, Leeds Children's Hospital, Leeds, United Kingdom
Objectives and Study: To compare the rate of biliary anastomotic stricture formation, intervention and outcomes in paediatric recipients of living donor liver transplantation (LDLT) with donation after brain death liver transplantation (DBD‐LT).
Methods: Retrospective study and data review of LDLT and DBD‐LT performed between 2013‐2024 from a UK supra‐regional paediatric liver transplant centre.
Results: LDLT (n = 56) paediatric recipients, median age 1.1years (IQR 0.2 – 12) (44.6% male) were compared with DBD‐LT patients (n = 60), median age 1.3 years (IQR 0.4 ‐11.4) (48.3% male). The most frequent indication for LT in both cohorts was end‐stage liver disease and the commonest underlying condition was biliary atresia. A greater proportion of children with biliary atresia underwent LDLT compared DBD‐LT (p = 0.0388). All LDLT recipients had either a pre‐existing or new Roux loop formation, compared with 76.7% of DBD‐LT recipients, the remainder of whom had duct‐to‐duct biliary anastomosis. Similar rates of biliary anastomotic strictures occurred in both cohorts; 14.3% (n = 8) in LDLT vs 15% (n = 9) in DBD‐LT recipients. Of these, 2xLDLT and 1xDBD‐LT had bile leaks in their immediate post‐transplant course. The onset of stricture formation, median total bilirubin and gamma‐GT levels, biliary stricture management and intervention (Figure 1) were comparable with no statistical difference identified between cohorts. Majority of LDLT patients, 62.5% (5/8) had resolution of their biliary pathology with one PTC procedure, compared to 33.3% (3/9) of the DBD‐LT cohort. No patients in the LDLT group needed re‐transplantation, and no patient deaths occurred in either cohort due to biliary complications.
Conclusions: Our study demonstrates low biliary complication rates in both LDLT and DBD paediatric liver transplant recipients. Importantly, preserved graft and patient survival following biliary stricture formation is marginally superior in the LDLT cohort. These findings support the LDLT safety outcomes and recommendations laid out by the A2ALL consortium given the current donor graft shortage and underutilization of LDLT in the UK.
Contact e‐mail address: suzwong@doctors.org.uk
H‐EV001. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV001.1. CLINICAL CHARACTERISTICS OF PEDIATRIC AUTOIMMUNE HEPATITIS IN KOREA
Jeong Eun Ahn 1, Jae Sung Ko1, Jin Soo Moon1, Yeoun Joo Lee2, Eun Joo Lee3, Hong Koh3, Ho Jung Choi4, Seak Hee Oh4, Kyung Mo Kim4, Ki Soo Kang5, Byung Ho Choe6, Seo‐Hee Kim7, Eun Sil Kim8, Mi Jin Kim9, Sun Young Kim9, Kyung Jae Lee1
1Department Of Pediatrics, Seoul National University Hospital, Seoul, Korea, Republic of, 2Department Of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea, Republic of, 3Department Of Pediatrics, Yonsei University College of Medicine, Seoul, Korea, Republic of, 4Department Of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea, Republic of, 5Department Of Pediatrics, Jeju National University College of Medicine, Jeju‐si, Korea, Republic of, 6Department Of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea, Republic of, 7Department Of Pediatrics, Chonnam National University Children's Hospital, Gwangju, Korea, Republic of, 8Department Of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of, 9Department Of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of
Objectives and Study: Autoimmune hepatitis (AIH) is a rare, chronic liver disease with limited data on long‐term outcomes, particularly in pediatric populations. This study aimed to investigate the clinical characteristics and prognosis of pediatric AIH patients in Korea.
Methods: We retrospectively reviewed the medical records of 44 patients diagnosed with AIH under 19 years of age between January 2007 and August 2023 at nine tertiary university hospitals in Korea. Biochemical remission, used to evaluate treatment outcomes, was defined as the normalization of serum transaminases and immunoglobulin G (IgG) levels. Overall survival was defined as survival regardless of liver transplantation during the follow‐up period.
Results: The median age at diagnosis was 12 years, with 25 patients (57%) being female. Type 1 AIH was the most common subtype, accounting for 91% of cases, and 11 patients (23%) had coexisting autoimmune diseases. The predominant clinical presentations included jaundice (36%) and asymptomatic transaminase elevation (30%). Cirrhosis was identified in 7% of patients at diagnosis, with no reported cases of acute liver failure. Median laboratory values included IgG at 1,952 mg/dL, aspartate aminotransferases at 372 IU/L, alanine aminotransferases at 371 IU/L, and total bilirubin at 1.7 mg/dL. All patients were seropositive for autoantibodies, with 93% testing positive for antinuclear antibodies. Corticosteroids were the most frequently administered initial treatment, while azathioprine became the primary agent after six months. More than 50% of patients were managed with immunosuppressant monotherapy, which remained the predominant regimen during follow‐up from six months to seven years. Complete biochemical remission at six months was achieved in 33% of patients. The ten‐year overall survival rate was 95%, while the native liver survival rate was 79%, and the clinical event‐free survival rate was 56%.
Conclusions: This study provides insights into the clinical characteristics, treatment responses, and long‐term prognosis of pediatric AIH in Korea, highlighting the need for precise diagnosis and tailored treatments to enhance outcomes.
Contact e‐mail address:
H‐EV002. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV002.1. GENETIC AND CLINICAL SPECTRUM OF PEDIATRIC INHERITED LIVER DISEASES IN OMAN
Safa Al Habsi 1, Al‐Qasim Al‐Bahlani2, Yusria Al Rawahi3
1Oman Medical Specialty Board, muscat, Oman, 2Pediatrics, Royal Hospital, muscat, Oman, 3Pediatrics, sultan Qaboos University, Muscat, Oman
Objectives and Study: This study aims to analyze the clinical and genetic spectrum of inherited liver diseases in Omani children with the goal of improving early diagnosis and targeted management strategies.
Methods: retrospective analysis was conducted using patient data collected from two major centers in Oman: Royal Hospital and Sultan Qaboos University Hospital. Data from patients diagnosed with inherited liver diseases between January 1,2006, and June1,2024.At the time of analysis, data from Royal Hospital were fully reviewed, while data collection from Sultan Qaboos University Hospital is ongoing.From this cohort, cases with a confirmed genetic diagnosis were identified for detailed analysis. Epidemiological details, clinical features, genetic diagnoses, and outcomes were collected and analyzed using SPSS software.
Results: The study consisted of74 patients with chronic liver disease, with a mean age at presentation of 28 months. Females constituted 59% of the cohort, and the majority of patients (25%) were from the Batinah North region. Jaundice was the most common clinical manifestation affecting 55.9% of patients, emphasizing its role as a key diagnostic feature. Other notable presentations included hypotonia (19.1%)and vomiting (16.2%),highlighting the diverse phenotypic spectrum of these disorders.Genetic testing confirmed diagnoses in 59%(n = 44) of patients, reflecting the importance of advanced diagnostics in this population. The most frequently identified mutation was ABCB4 identified in 18.18% (n = 8),followed by ATP8B1,TJP2 and MYO5B(each 4.5%).Consanguinity was observed in47% of cases and 33.8% had a family history of liver disease.
Conclusions: Inherited liver diseases in Oman exhibit a distinct clinical and genetic profile, with a high prevalence of consanguinity and family history pointing to a genetic predisposition within the population. These findings highlight the importance of early diagnosis and management, especially in Omani children.This preliminary data, gathered from a single center, ongoing data collection will expand the scope of the study, and by the time of the conference additional cases will be included.
Contact e‐mail address: safaalhabsi99@gmail.com
H‐EV003. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV003.1. FIRST PAEDIATRIC CASE OF POLYCYTHAEMIA VERA WITH BUDD‐CHIARI SYNDROME MANAGED WITH TIPS IN LATIN AMERICA
Jaime Alfaro‐Bolaños, Miguel Minero‐Hibert
Paediatric Gastroenterology, National Medical Centre 20 de Noviembre ISSSTE, Mexico City, Mexico
Objectives and Study: This case highlights the management of a 16‐year‐old female with polycythaemia vera (PV) and Budd‐Chiari syndrome (BCS), a rare paediatric complication associated with significant morbidity. The objective was to describe the clinical presentation, diagnosis, treatment strategies, and long‐term outcomes, emphasising the role of TIPS as a rescue therapy for refractory portal hypertension.
Methods: The patient presented with progressive abdominal pain, ascites, and signs of portal hypertension. Imaging studies, including Doppler ultrasound and abdominal CT, confirmed BCS and advanced chronic liver disease. Diagnosis of PV was supported by JAK2 mutation and bone marrow biopsy showing megakaryocytic hyperplasia. Initial management included therapeutic paracentesis, anticoagulation, diuretics, and beta‐blockers. Due to persistent symptoms and complications, a transjugular intrahepatic portosystemic shunt (TIPS) was performed to relieve portal hypertension and improve venous outflow.
Results: TIPS successfully restored venous circulation and resolved portal hypertension. At six months, the patient was asymptomatic with no recurrence of ascites, pleural effusion, or edema. Laboratory tests, including liver function and coagulation parameters, normalized. The patient remained on ruxolitinib to manage PV and rivaroxaban as ongoing anticoagulation therapy. Imaging studies showed a patent TIPS with no evidence of obstruction or disease progression.
Conclusions: This case demonstrates that TIPS is an effective treatment for managing severe portal hypertension due to BCS in paediatric PV cases. Early diagnosis and a multidisciplinary approach were critical in achieving favourable outcomes. Long‐term follow‐up is essential to monitor for complications, such as TIPS reocclusion, disease progression, or transformation of PV to myelofibrosis or acute leukemia. This report, the first of its kind in Latin America, provides valuable insights for managing complex thrombotic complications in children and underscores the importance of timely intervention to improve survival and quality of life.
Contact e‐mail address: je.gastropedia@gmail.com
H‐EV004. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV004.1. A CASE REPORT WITH VACTERL SYNDROME AND HEPATOCELLULAR CARCINOMA SECONDARY TO ABERNETHY MALFORMATION
Halil Sagir1, Betül Aksoy2, Ozlem Gulpinar Aydin3, Güleç Mert Doğan4, Birsen Gizem Ozamrak5, Yeliz Cagan Appak6, Murat Doğan7, Maşallah Baran 2
1izmir city hospital, izmir, Turkey, 2Pediatric Gastroenterology Hepatology And Nutrition Clinic, Izmir State Hospital, Izmir, Turkey, 3Pediatric Gastroenterology, Hepatology And Nutrition, Izmir City Hospital, Izmir, Turkey, 4Pediatric Radiology, izmir state hospital/izmir, Turkey, izmir, Turkey, 5Pathology, izmir state hospital/izmir, Turkey, İZMİR, Turkey, 6Paediatric Gastroenterology, Izmir Katip Celebi Univercityİzmir City Hospital, izmir, Turkey, 7General Surgery, izmir state hospital/izmir, Turkey, izmir, Turkey
Objectives and Study: Abernethy malformation is a rare congenital pathology, also defined as a congenital extrahepatic portosystemic shunt. This malformation is classified into type 1 that characterized by the complete absence of the portal vein, and type 2, characterized by a hypoplastic portal vein. Clinically, conditions such as hyperbilirubinemia, hyperammonemia, hepatopulmonary syndrome, hepatic encephalopathy, hepatocellular adenoma, hepatoblastoma, and hepatocellular carcinoma (HCC) may develop due to the portosystemic shunt. Here, a pediatric patient was presented who diagnosed with HCC secondary to type 1 Abernethy malformation.
Methods: case report
Results: The 14‐year‐old female patient referred with nausea and abdominal pain. The patient was diagnosed with VACTERL syndrome due to the presence of esophageal atresia, anal atresia and cardiac malformation in the neonatal period. The patient exhibited short stature, while other systemic examinations were unremarkable. Laboratory tests revealed alanine aminotransferase, aspartate aminotransferase, gamma‐glutamyl transferase at 41, 51, 443 U/L respectively. Other biochemical parameters, complete blood count, and coagulation profiles were within normal ranges.
The mass lesions with calcific foci, measuring 10 cm in the right lobe and 8 cm in the left lobe of the liver were identified with abdominal ultrasonography. Dynamic liver magnetic resonance imaging and contrast‐enhanced dynamic abdominal computed tomography showed the absence of the portal vein, consistent with Abernethy malformation. Histopathological examination of the liver lesion indicated well‐differentiated HCC. No distant metastases were found in the screening. The patient was scheduled for liver transplantation.
Conclusions: The early detection of Abernethy malformation, a rare condition that can lead to serious complications, is essential to prevent potential complications through appropriate monitoring and treatment. However, the coexistence of Abernethy malformation with VACTERL syndrome has not been previously reported in the literature.
Contact e‐mail address: dr.hllsgr@gmial.com
H‐EV005. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV005.1. LYMPHOPROLIFERATIVE DISEASES WITH PRIMARY LIVER INVOLVEMENT AND CHOLESTASIS – _A SERIES OF CLINICAL CASES
Georgi Bukov, Ivan Yankov, Neophit Spasov, Ivelina Neicheva, Maria Spasova, Hasan Burnusuzov
Pediatrics, UMHAT Sveti Georgi, Plovdiv, Bulgaria
Objectives and Study: Lymphoproliferative malignancies are common neoplasms of childhood. Involvement of the gastrointestinal (GI) tract, liver, biliary system, pancreas, and peritoneum is closely related and frequently occurs. In leukemias, lymphomas, and Langerhans& #39; histiocytosis (LCH), the manifestations are the result of infiltration, compression, an overburdened immune system, and chemotherapy‐ induced drug toxicity. These diseases are characterized by uncontrolled clonal proliferation of hematopoietic progenitor cells with subsequent infiltration of other tissues. The liver is part of the reticuloendothelial system and is therefore invariably involved, but rarely as primary place of origin.
Methods: We present a retrospective analysis of children with lymphoproliferative diseases with primary liver involvement who attended the clinic. Over a 10‐year period, 132 children with lymphoproliferative diseases attended the center, of which 2.3% (3 children) were diagnosed with Burkitt lymphoma with primary liver involvement, and 0.75% (1 child) was diagnosed with Langerhans& #39; histiocytosis with primary liver localization.
Results: We present 2 clinical cases – a patient with Burkitt lymphoma with primary hepatic localization and a patient with Langerhans& #39; histiocytosis and a formation involving the porta hepatis. Both attended the clinic due to jaundice and cholestasis and further clinical assessment revealed the diagnosis.
Conclusions: Hepatobiliary manifestations of hematolymphoid malignancies in children present with a variety of symptoms, ranging from subtle manifestations such as asymptomatic organomegaly to life‐threatening ones such as acute liver failure. The essence lies in identifying malignancy and distinguishing it from chronic infectious and inflammatory conditions. Early use of invasive procedures such as biopsy with X‐ray or ultrasound guidance, as well as endoscopic interventions, should be encouraged to avoid delay in initiating therapy in hematolymphoid malignancies with atypical onset.
Contact e‐mail address: yes
H‐EV006. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV006.1. IS LEAP‐2 A NEW TOOL IN THE DIAGNOSIS AND FOLLOW‐UP OF STEATOSIS IN MASLD IN ADOLESCENTS?
Sevim Çakar, Nur Arslan, Mehmet Ateş, Oya Sayın, Oğuzhan Akyaz, Tuğçe Tatar Arık, Rabia Ilgın, Nilay Danış
Pediatric Gastroenterology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
Objectives and Study: Liver‐expressed antimicrobial peptide 2 (LEAP‐2) positively associated with liver fibrosis and steatosis in patients with obesity. This peptide has been studied in adolescents to provide an easily accessible and non‐invasive technique for diagnosing and following steatosis in metabolic dysfunction associated steatotic liver disease (MASLD).
Methods: Prospectively, 51 adolescents aged 12‐18 years were divided into three groups. One diagnosed with a MASLD (confirmation of hepatosteatosis by imaging and at least one of the cardiometabolic criteria) (n = 19), the second with obesity (body mass index >2 SD) (n = 14) without any liver pathology, and the third was the healthy group (n = 18). The controlled attenuation parameter (CAP) of transient elastography (TE) was used to define steatosis and fibrosis using the FibroScan ® Mini+ 430 (Echosens SA, Créteil, France). The patients' serum LEAP‐2 and ghrelin levels were measured.
Results: LEAP‐2 and ghrelin levels between three groups were found to be similar (P = 0.148, P = 0.515). A positive correlation was found between LEAP‐2 level and CAP values in the MASLD and obesity groups (r = 0.379, P = 0.030). A single patient above the recommended CAP threshold of 240 dB/m was found in the healthy group; however, measurements in a total of 22 patients from the other two groups were above this value. When 240 dB/m is considered the cut‐off, the LEAP‐2 level in those above this value was med: 2.2 ng/ml and med: 1.37 ng/ml in those below this value (P = 0.021) which was found significantly different.
Conclusions: Interventional or imaging methods for the diagnosis and follow‐up of hepatosteatosis have taken their place in the literature. However, the fact that these tests are not available in all centres and are expensive leads to the search for other easily accessible diagnostic and follow‐up parameters.
Contact e‐mail address: sevim.cakar@deu.edu.tr
H‐EV007. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV007.1. PEDIATRIC AUTOIMMUNE HEPATITIS – A RETROSPECTIVE DESCRIPTIVE STUDY FROM ROMANIA
Nedelcu Calin 1, Irina Dijmarescu1,2, Patrascoiu Marina1, Daniela Păcurar1,2
1Paediatrics, "Grigore Alexandrescu" Emergency Children's Hospital, Bucharest, Romania, 2Paediatrics, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Objectives and Study: This study aims to evaluate the epidemiological, clinical and paraclinical features of Romanian children diagnosed with autoimmune hepatitis.
Methods: We included 35 patients diagnosed with autoimmune hepatitis (January 2019 to November 2024). Generic and history data were collected ‐ gender, age at presentation, living area, family and personal history of autoimmune diseases and triggers. Anthropometric parameters, clinical, laboratory and radiological data, type of presentation and complications were also analyzed.
Results: Average age at presentation was 9.08 years, 65.7% were female. Only 62.8% of patients presented with a normal weight, overweight or underweight being present equally (17,1% vs 20%). Regarding presentation types proposed by ESPGHAN, 31.42% had an acute presentation, 37.14% were diagnosed through incidental finding of elevated liver enzymes and 2,85% had fulminant hepatic failure. Positive autoimmune family history was identified in 28.57% of patients ‐ thyroiditis (11.42%) and diabetes (8.57%) being the most prevalent. Twelve patients (34.28%) associated other autoimmune diseases such as cholangitis (11.42%) or ulcerative colitis (11.42%). As possible triggers of the disease, the most important were Epstein‐Barr (31.42%), Cytomegalovirus (22.85%) and Varicella‐Zoster Virus (17.14%) infections and previous treatment with Albendazole (8.57%). Type 1 autoimmune hepatitis was the most prevalent (65.71%), with fewer cases of type 2 autoimmune hepatitis (14.28%). We had 4 seronegative patients (11.42%) and 3 patients (8.57%) with antibodies specific for both types. Most frequently we identified jaundice (37.14%), enlarged liver (34.28%) and splenomegaly (28.57%) on ultrasound and abdominal pain (25.71%). Only 45,71% performed a biopsy for diagnosis.
Conclusions: Autoimmune hepatitis benefits nowadays from an increasing awareness, even though there are still centers that cannot conduct all tests for diagnosis. Moreover, liver biopsy consent is still hard to obtain from parents, making the diagnosis even more challenging. Therefore, a consensus for an adapted diagnosis score for children is crucial.
Contact e‐mail address: nedelcu.calin24@gmail.com
H‐EV008. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV008.1. SEVERE VITAMIN D DEFICIENCY AND BONE COMPLICATIONS IN PFIC1: INSIGHTS FROM A SMALL CASE SERIES
Joana Vasconcelos1, Filomena Cardosa2, Sara Nobrega2, Marta Soares3, Paula Rocha1, Cristina Campos Goncalves 2, Isabel Afonso2
1Hospital Dona Estefânia, Lisboa, Portugal, 2Paediatric Gastroenterology And Hepatology Unit, Paediatric Hospital Dona Estefânia, Unidade Local de Saúde São José, Lisboa, Portugal, 3Hospital Algarve, Lisboa, Portugal
Objectives and Study: Progressive familial intrahepatic cholestasis type 1 (PFIC1) is a rare, autosomal recessive disorder characterized by chronic cholestasis, progressive liver damage, and complications such as growth failure and fat‐soluble vitamin deficiencies. Vitamin D deficiency is critical for bone mineralization and skeletal health. It is exacerbated by cholestasis‐associated malabsorption, increasing the risk of rickets, osteomalacia, and fractures. Altered bile acid metabolism in PFIC1 may further impair vitamin D bioavailability. Our study aims to characterize vitamin D status and bone metabolism in patients with PFIC1.
Methods: Demographic, clinical, and laboratory data related to bone metabolism were retrospectively collected from patients with clinical and genetic diagnoses of PFIC1.
Results: We analyzed four PFIC1 cases (50% male, median age at diagnosis: 7 months; median current age: 7.5 years). All patients exhibited severe fat‐soluble vitamin deficiencies, with undetectable vitamin D levels despite supplementation. Vitamin levels: Vitamin A (initial median: 47 µg/dL; maximum: 54 µg/dL; minimum: 37,5 µg/dL/actual median: 42,5 µg/dL; maximum: 50,6 µg/dL; minimum 5,3 µg/dL; normal: 20‐60 µg/dL), Vitamin D (initial median: 8 ng/mL; maximum: 12,4 ng/mL; minimum <4 ng/mL/actual median: 6 ng/mL; maximum: 11,2 ng/mL; minimum <3 ng/mL; normal: >10 ng/mL), Vitamin E (initial median: 250 µg/dL; maximum: 602 µg/dL; minimum 111,6 µg/dL/actual median: 439 µg/dL; maximum: 486 µg/dL; minimum 288,7 µg/dL; normal: 300‐900 µg/dL). PTH: Elevated in all cases (median: 359 pg/mL; maximum 444,6 pg/mL; minimum 122 pg/mL; normal: 11‐60 pg/mL), compatible with secondary hyperparathyroidism. Calcium and phosphate: Normal ranges All patients required high‐dose fat‐soluble vitamin supplementation, including calciferol, but normalization of vitamin D and PTH levels remained unattainable, despite normalization of levels of vitamin A and E. Two of the four patients experienced bone fractures from minor trauma.
Conclusions: Patients with PFIC1 exhibit severe vitamin D deficiency and secondary hyperparathyroidism despite high‐dose supplementation, with normalization proving challenging. These findings underscore the need for targeted management strategies and further research, as reports focusing on bone metabolism in PFIC1 remain scarce in the literature.
Contact e‐mail address: Joanaaavasconcelos@gmail.com
H‐EV009. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV009.1. PERCUTANEOUS TRANS‐SPLENIC ANGIOPLASTY FOR PORTAL HYPERTENSION DUE TO CAVERNOMATOUS TRANSFORMATION OF THE PORTAL VEIN
Filomena Cardosa 1, Cristina Campos Goncalves1, Sara Nóbrega1, Susana Nobre2, Sandra Ferreira2, Isabel Afonso1, Isabel Gonçalves2, Paulo Donato3
1Paediatric Gastroenterology And Hepatology Unit, Hospital Dona Estefânia, Unidade Local de Saúde São José, Lisbon, Portugal, 2Paediatric Hepatology And Liver Transplantation Unit, Unidade Local de Saúde de Coimbra, Coimbra, Portugal, 3Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
Objectives and Study: Cavernomatous transformation of the portal vein (CTPV) is a common pediatric cause of portal hypertension (PHT). When the Rex recess is patent, management relies on a meso‐portal bypass. In its absence, management with pharmacological and endoscopic therapy is usually chosen, with surgery reserved for refractory cases.
Methods: We report the case of a pediatric patient who underwent a transjugular intrahepatic portosystemic shunt (TIPS) combined with trans‐splenic portal angioplasty.
Results: A10‐year‐old boy from Guinea‐Bissau was evacuated due to recurrent hematemesis. On admission: pallor, systolic murmur, abdominal venous collateral circulation, splenomegaly, ascites and edema. Laboratory findings revealed pancytopenia (hemoglobin 3.3 g/dL, leukopenia 2420/uL, thrombocytopenia 81000/uL), INR 1.4, hypoalbuminemia (30.4 g/L) with normal bilirubin, liver enzymes, ammonia and lactate. Blood transfusion was performed. Imaging studies (Doppler ultrasound and CT angiography) confirmed CTPV, splenic and esophageal varices, splenomegaly and ascites. Esophagogastroduodenoscopy (EGD) revealed grade III esophageal varices and elastic band ligation (EVL) was performed. Liver biopsy was normal and retrograde portography showed no patency of the Rex recess. Subsequent treatment included diuretics, beta‐blockers, esomeprazole and repeated EVL. Despite these interventions, patient experienced worsening of PHT with severe gastropathy and recurrence of esophageal varices with extensive fibrosis. He underwent TIPS with portal angioplasty by percutaneous splenic vein access. The procedure achieved a significant reduction in portal vein pressure (29 to 16 mmHg). A transient subcapsular splenic hematoma was observed. One month after TIPS, a marked reduction in splenomegaly and thrombocytopenia was observed. One year later, the shunt is patent and EGD showed a complete regression of the esophageal varices.
Conclusions: The performance of TIPS is limited in the CTPV. This case highlights the potential of a novel endovascular approach, using trans‐splenic portal angioplasty. This option may reduce the need for surgical shunt or liver transplantation, with a significant impact on the morbidity and mortality of this condition in children.
Contact e‐mail address: filomena.cardosa@gmail.com
H‐EV010. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV010.1. PERSPECTIVES ON METABOLIC DYSFUNCTION‐ASSOCIATED STEATOTIC LIVER DISEASE (MASLD) AND POTENTIAL VALUE OF THE TRANSIENT ELASTOGRAPHY IN CHILDREN
Simona Carrera 1, Elisa Bartolini1, Chiara Rubino1, Giuseppe Indolfi1,2
1Liver Unit, Meyer Children's Hospital, IRCCS, Florence, Italy, 2University of Florence, Florence, Italy
Objectives and Study: Metabolic dysfunction‐associated liver disease (MASLD) is the most common cause of chronic liver disease in children. The gold standard method to evaluate hepatic steatosis and fibrosis is liver biopsy. Transient elastography (TE) is a non‐invasive technique used to assess liver fibrosis and steatosis through the liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), respectively. This study describes the experience of a tertiary care centre in the application of TE in the diagnosis and staging of MASLD.
Methods: This retrospective study included children who underwent TE for MASLD between 2020 and 2024. TE was performed with FibroScan (Echosens, Paris, France). CAP cut‐offs were the following: grade 1 > 248 dB/m; grade 2 > 268 dB/M; grade 3 > 280 dB/m. LSM cut‐offs of ≤5.0, 5.1‐9.0, and ≥9 kPa were used to define normal liver stiffness, significant fibrosis, and advanced fibrosis, respectively.
Results: 249 patients underwent TE for MASLD. Patients with higher grades of steatosis presented higher mean BMI, LSM, transaminases and HOMA‐IR index, and lower HDL‐cholesterol values. Significant positive correlations were found between CAP and BMI, between CAP and LSM, and between CAP and triglycerides. LSM was positively and significantly correlated with BMI, triglycerides, and HOMA‐IR index. The strength of these correlations was fair to moderate.
| Overall N = 249 | S0 N = 60 | S1 N = 34 | S2 N = 17 | S3 N = 138 | |
|---|---|---|---|---|---|
| Female, N | 67 | 9 | 11 | 2 | 45 |
| BMI, kg/m2 | 26.54 ( ± 4.6) | 24.26 ( ± 3.3) | 25.1 ( ± 3.8) | 24.7 ( ± 3.5) | 28.1 ( ± 4.8) |
| LSM (kPa) | 5.64 ( ± 2.2) | 4.56 ( ± 1.4) | 4.8 ( ± 1.7) | 5.09 ( ± 0.9) | 6.38 ( ± 2.3) |
| HOMA‐IR index | 5.5 ( ± 3.5) | 3.95 ( ± 2.9) | 4.02 ( ± 2.6) | 4.84 ( ± 2.2) | 6.4 ( ± 3.8) |
| HDL Cholesterol (mg/dl) | 46.1 ( ± 9.6) | 49.9 ( ± 10) | 47 ( ± 7.8) | 41.7 ( ± 9.7) | 44.8 ( ± 9.3) |
| ALT (UI/l) | 44 (25‐78) | 22.5 (17.7‐44.2) | 48 (20‐62) | 50 (29‐87.25) | 57.5 (36‐96.2) |
Conclusions: These findings highlight the multifactorial pathogenesis and the potential progressive natural history of MASLD.
Contact e‐mail address:
H‐EV011. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV011.1. TREATMENT OF CHRONIC HEPATITIS C VIRUS INFECTION WITH GLECAPREVIR/PIBRENTASVIR IN PEDIATRIC AGE ‐ THE REALITY OF A LEVEL III HOSPITAL
Luísa Castello‐Branco Ribeiro 1,2, Marta Pelicano1, Tong Yang1, Sara Nóbrega1, Cristina Campos Goncalves1, Isabel Afonso1
1Paediatric Gastroenterology And Hepatology Unit, Hospital Dona Estefânia, Unidade Local de Saúde São José, Lisbon, Portugal, 2Pediatrics Department, Hospital Professor Doutor Fernando Fonseca, Unidade Local de Saúde Amadora Sintra, Amadora, Portugal
Objectives and Study: Hepatitis C Virus (HCV) infection is rare in children across Europe. Most chronic cases remain asymptomatic, despite the risk of progression to cirrhosis and hepatocellular carcinoma. Glecaprevir/pibrentasvir (G/P), a pangenotypic antiviral combination, was approved in Europe in 2019 for chronic HCV in patients over 12 years. This retrospective study evaluates the efficacy and safety of G/P in pediatric HCV cases managed at a Pediatric Central Hospital between 2019 and 2024.
Methods: Clinical records were reviewed. Clinical, laboratorial, imagiological and histological data were analyzed. Data analysis was performed using Microsoft Excel®.
Results: Nine pediatric patients (six males) were included with a median age of 3 years and 1 month (range: 10 months to 15 years and 8 months) at initial evaluation. All infections resulted from vertical transmission and all patients were asymptomatic. One patient had previously received pegylated interferon and ribavirin without achieving sustained virologic responde (SVR). Pre‐treatment elevated ALT levels were noted in 8/9 patients (median: 62 U/L, range 30‐101 U/L) and liver steatosis was observed in two patients via abdominal ultrassound. Elastography (ARFI®in seven patients, FibroScan® in three) identified mild fibrosis (compatible with F1) in four patients. Liver biopsy was performed in one treatment‐experienced patient, showing moderate activity chronic hepatitis. G/P treatment was initiated at a median age of 13 years and 10 months (range: 12 years and 3 months ‐ 16 years and 8 months), with 8/9 patients receiving an eight weeks treatment and 1/9 for 16 week regimen due to prior treatment failure. No adverse effects were reported. Post‐treatment, one patient was lost to follow‐up. The remaining patients achieved undetectable viral loads and transaminase normalization four weeks after ending the treatment. At 12 weeks, SVR was confirmed in 8/8 patients.
Conclusions: Direct‐acting antivirals provide an opportunity to treat HCV at earlier ages with shorter regimens, achieving high cure rates and no side effects.
Contact e‐mail address: luisa.ribeiro@ulsasi.min-saude.pt
H‐EV012. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV012.1. A RETROSPECTIVE STUDY ON THE ROLE OF N‐ ACETYLCYSTEINE IN THE TREATMENT OF DENGUE‐ASSOCIATED ACUTE LIVER FAILURE
Shreya Chauhan 1, Karunesh Kumar1, Smita Malhotra1, Nameet Jerath2, Rohit Vohra2, Anupam Sibal1
1Department Of Paediatric Gastroenterology, Hepatology And Nutrition, Indraprastha Apollo Hospital, New Delhi, India, 2Pediatric Intensive Care Unit, Indraprastha Apollo Hospital, New Delhi, India
Objectives and Study: N‐acetylcysteine (NAC) as a therapeutic agent in pediatric acute liver failure (PALF) is still under evaluation barring some specific conditions. Few studies have explored its role as a promising therapeutic adjunct in the management of dengue‐associated acute liver failure (ALF) in the adult population. Data is scarce in the pediatric population despite dengue being a common cause of PALF in tropical countries. This study evaluates the effect of NAC on the outcome of dengue‐associated ALF.
Methods: It is a retrospective single‐center comparative study. Severe dengue patients fulfilling the PALF study group criteria in the last 8 years were included in the study. Enrolled patients were divided into two groups based on whether they received NAC or not. Data was collected on demographics, biochemical and clinical profile, and management outcomes. Statistical data analysis was performed using IBM SPSS Statistics version 29.0 Armonk, NY.
Results: Of 283 dengue patients admitted, 19% developed ALF. Mean duration of onset of ALF was 5.96 days after the onset of fever. NAC was given to 25 (46.3%) patients at 100 mg/kg/day. The median duration of NAC use was 3 days. Patients treated with NAC demonstrated improvements in biochemical outcomes, reducing AST levels by 35.8%, ALT by 45.9%, INR by 19.3%, and ammonia levels by 34.8%. Multiple organ involvement was common in 76% in the NAC group suggesting severity and necessitating NAC use. In the NAC group, 48% died while 52% recovered. In the non‐NAC group, 37% died and 62% recovered. NAC use did not have a statistically significant impact on the outcome (p‐value of 0.45).
Conclusions: NAC use may not alter the outcome of dengue‐associated ALF, especially in the presence of other confounding factors like multiple organ dysfunction. Further prospective and randomized controlled studies with a larger sample size are needed before discarding NAC as a useful therapeutic adjunct.
Contact e‐mail address: shreyachauhan294@gmail.com
H‐EV013. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV013.1. USE OF 50% DEXTROSE AS A SCLERO THERAPEUTIC AGENT FOR ESOPHAGEAL VARICES IN AN INFANT PRESENTED WITH HEMATEMESIS– A CASE REPORT WITH A VIDEO
Utpol Chowdhury
Paediatrics, Aga Khan University, Nairobi, Kenya
Objectives and Study: Sclerosing therapy of oesophegeal varices in infants is always a challanging task. Agent selection for sclerothrapy is also teadious. Many agents are used in adult (e.g ethanolamine oleate,polidocanol, 99% alccohol) but not suitable and effective in infants. Dextrose (50%) is effective but no large scale study done, only some discreate case reports were published. Our Patient was an 11 months old baby boy came with variceal bleed (Hematemasis and melena) with sever anemia (Hb% 5.5 gm%) and features of volume depletion. After initial management and stabilization (IV flid, PBC transfusion, FFP, Vitamin K), plan was taken to go for sclerotherapy to stop on going bleeding. General anathesia given, securing the airway. Oesophageal varices detected grade 4 with some bleeding sopts. Dextrose 50% was selected as a sclerosing agents and applied on three sites of oesophageal varices. No Gastric varices noted. After therapy bleeding stopped, no further transfusion was needed.
Methods: Life savingTherapeutic manuver
Results: Stopped variceal bleeding. No more hematemesis or melena noted. We are preparing patient for Living donar liver transplant.
Conclusions: Dextrose 50% works well as a sclerosing agents for bleeding oesophageal varices.
Contact e‐mail address: drutpol@gmail.com
H‐EV014. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV014.1. SUCCESFUL MANAGMENT OF DRUG‐INDUCED LIVER INJURY(DILI) WITH NON‐CONVENTIONAL REDUCED DOSING OF CFTR MODULATORS IN A CYSTIC FIBROSIS PATIENT
Margarita Suarez, Monica Maria Contreras Ramirez, Paula Roldan Cano, Gustavo Giraldo Ospina
Nutrition, Hospital Pablo Tobon Uribe, Medellin, Colombia
Objectives and Study: To present a clinical case using a non‐conventional CFTR Modulator dose in a Cystic Fibrosis patient that presented liver injury after treatment with regular dosing
Methods: clinical case report
Results: 13‐year‐old male patient with Cystic Fibrosis (homozygous F508). After 4 months of treatment with CFTR modulator, he presented elevated liver enzymes (Alanine transaminase/aspartate transaminase) twice the Normal upper limit (NUL) and skin lesions compatible with toxicodermia, the skin symptoms responded to topical management but liver enzymes persisted elevated more than six months. Infectious, anatomic and metabolic disease was ruled out. Liver biopsy reported mild steatosis and Grade 2 liver fibrosis. Treatment was stopped and liver chemistry improved but respiratory symptoms began, necessitating the initiation of modulator treatment at a reduced conventional dose. With this approach respiratory symptoms resolved but liver enzymes raised again with much higher values (> 10 NUL) but no evident coagulopathy. We decided to change to Non‐Conventional Reduced Dosing treatment, giving the modulator every other day. This resulted in improvement of liver enzymes and no respiratory deterioration.
Table 1. CFTR Modulator dose Recommendations
| Morning Dose | Evening Dose | |
|---|---|---|
| standard | Two tablets (elexacaftor 100 mg/tezacaftor 50 mg/ivacaftor 75 mg) One tablet of ivacaftor 150 mg | One tablet of ivacaftor 75 mg |
| Conventional Reduced Dosing | Day 1: two elexacaftor/tezacaftor/ivacaftor tablets • Day 2: one elexacaftor/tezacaftor/ivacaftor tablet | None |
| Non‐Conventional Reduced Dosing | Day 1: Two tablets (elexacaftor 100 mg/tezacaftor 50 mg/ivacaftor 75 mg) One tablet of ivacaftor 150 mg * Day 2: None | Day 1: One tablet of ivacaftor 75 mg * Day 2: None |
Conclusions: There is limited evidence on management of DILI after use of CFTR modulators in Cystic Fibrosis patients. With use of Non‐Conventional Reduced Dosing we demonstrated improvement of liver disease without affecting the respiratory function and this scheme can become an attractive alternative, although there is need more researches
Contact e‐mail address: mmsuarez@hptu.org.co
H‐EV015. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV015.1. BILIARY ATRESIA: LONG‐TERM OUTCOMES AND THE INFLUENCE OF EXTRAHEPATIC ANOMALIES IN A EUROPEAN SERIES
Mark Davenport 1, David Schwarz1, Rania Kronfli1, Erica Makin1, Guilia Lanfranchi1, Nedim Hadzic2
1King's College Hospital, London, United Kingdom, 2Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom
Objectives and Study: Biliary atresia (BA) has a known association with other anomalies and specifically the Biliary Atresia Splenic Malformation syndrome (BASM) in about 10‐20% of infants in Western series. We aimed to analyse the effect of BASM and other anomalies on long‐term outcome.
Methods: Single‐centre prospective database, using 2:1 isolated BA as contemporaneous controls. The effect of various sub‐groups (specifically cardiac) was also analysed. Clearance of jaundice (COJ) post Kasai‐portoenterostomy (KPE) was defined as <20 µmol/L. Overall survival (OS) and native liver survival (NLS) were calculated. Data were quoted as median (IQR) and non‐parametric comparisons (KW and MW tests) used throughout. P ≤ 0.05 defined significance.
Results: During the period 1990 – 2024 there were BASM (n = 95); BA and other anomalies (n = 61) and isolated BA (used as controls) (n = 250). Median follow‐up was 9.1, 8.9 and 10.4 yrs. respectively. There were no differences in age at KPE [51(40‐69) vs. 54(37‐ 67) vs. 54(43 – 69) days – P = 0.25)] or COJ [BASM – 58% vs. Anomalies – 59% vs. controls – 59%; P = 0.98]. Overall survival was significantly reduced in both BASM and Anomalies groups (vs. IBA P < 0.0001) (Fig 1a), though there was no significant difference in native liver survival (Fig. 1b) between the 3 groups (P = 0.14). The BASM and anomalies groups were then sub‐divided and NSL and OS calculated. Significant reduction in survival was only seen in the BASM + cardiac cohort (n = 19) (P < 0.0001) and not the Anomalies + cardiac cohort (n = 11) (P = 0.85).
Conclusions: ‐ Initial response (COJ) to KPE is excellent in all groups with comparable long‐term NLS. ‐There is a reduction in overall survival in both BASM and Non‐BASM Anomalies cohorts but only in the former is this due to cardiac anomlies.
Contact e‐mail address: markdav2@ntlworld.com
H‐EV016. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV016.1. PARTICIPATION AND QUALITY OF LIFE OF ADOLESCENTS WITH HEPATIC WILSON DISEASE: INSIGHTS FROM A SINGLE‐CENTER STUDY IN A LOW SOCIOECONOMIC CONTEXT
Duygu Demirtas Guner 1,2, Merve Cicek Kanatli3,4
1Department Of Pediatrics, Division Of Pediatric Gastroenterology, Hepatology And Nutrition, Dr. Behçet Uz Children's Hospital, Izmir, Turkey, 2Department Of Pediatrics, Division Of Pediatric Gastroenterology, Hepatology And Nutrition, Van Training and Research Hospital, Van, Turkey, 3Department Of Pediatrics, Division Of Developmental‐behavioral Pediatrics, Ankara Training and Research Hospital, Ankara, Turkey, 4Department Of Pediatrics, Division Of Developmental‐behavioral Pediatrics, Van Training and Research Hospital, Van, Turkey
Objectives and Study: This study aims to assess participation in activities of daily living and quality of life (QoL) in adolescents diagnosed with hepatic Wilson disease (WD). While WD primarily affects liver function, its impact on psychosocial and educational domains is underexplored, especially in low socioeconomic settings.
Methods: A single‐centre study was conducted with eight adolescents aged 10‐16 years diagnosed with hepatic WD. Participation was assessed using semi‐structured interviews with open‐ended questions based on the International Classification of Functioning, Disability and Health (ICF) framework. QoL was measured using the Pediatric Quality of Life Inventory™ (PedsQL™), focusing on both physical and psychosocial domains.
Results:
| Quality of life outcomes | ||||||||
|---|---|---|---|---|---|---|---|---|
| Patient no | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| Physical QoL score | 71.8 | 87.5 | 75 | 81.2 | 90.6 | 100 | 87.5 | 21.8 |
| Psychosocial QoL | 73.3 | 65 | 71.6 | 71.6 | 83.3 | 96.6 | 48.3 | 43.3 |
| Total QoL | 72.9 | 70.6 | 72 | 74 | 85.1 | 97.5 | 58.1 | 37.9 |
Eight adolescents aged 10‐16 years participated in the study. Significant participation limitations were observed:
• Education: Three adolescents dropped out or were at risk of dropping out of school due to liver failure.
• Social life: Adolescents with liver failure or transplant avoided social interactions, including meeting friends.
• Sports: Only one adolescent actively participated in sports, while another expressed a desire to participate but was limited by health concerns. Quality of life: •Physical QoL: Low scores were observed in one adolescent with ongoing liver failure.
• Psychosocial QoL (PS‐QoL): Scores were significantly lower in three adolescents who had dropped out of school or were at risk of dropping out.
Conclusions: Adolescents with hepatic WD face significant limitations in participation, especially in education and social activities, which profoundly affect their psychosocial QoL. A holistic, biopsychosocial approach is essential to improve their participation and overall QoL.
Contact e‐mail address: duygudemirtas@gmail.com
H‐EV017. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV017.1. TREATMENT WITH ILEAL BILE ACID TRANSPORTER INHIBITORS IN PATIENTS WITH RARE CHOLESTATIC LIVER DISEASES – FIRST BULGARIAN EXPERIENCE
Nadezhda Dolashkova 1, Emilia Nedeva‐Dobreva1, Hristo Naydenov1,2, Tihomir Todorov3, Albena Todorova3,4, Mila Baycheva1,2
1Department Of Gastroenterology And Hepatology, University Children's Hospital, Sofia, Bulgaria, 2Paediatrics, Medical University of Sofia, Sofia, Bulgaria, 3Genetic Medico‐Diagnostic Laboratory Genica, Sofia, Bulgaria, 4Medical University of Sofia, Sofia, Bulgaria
Objectives and Study: Rare cholestatic liver diseases are associated with impaired bile excretion and hepatobiliary dysfunction. Accumulation of bile acids (BA) in the liver leads to intensive pruritus, hepatocyte toxicity and cirrhosis. Inhibition of the ileal bile acids transporter (IBAT) blocks their intestinal reabsorption. Indications for treatment with IBAT inhibitors currently include progressive familial intrahepatic cholestasis (PFIC) and Alagille syndrome (ALGS). Aim is to present the first Bulgarian experience of treatment with IBAT inhibitors in patients with rare cholestatic liver diseases.
Methods: This is a data analysis within a prospective study in a specialized centre for the period December 2022 – May 2024.
Results: We present 4 patients, 2 siblings with PFIC type 6 and 2 children with ALGS, undergoing treatment with IBAT inhibitors. Patients with PFIC type 6 showed a significant reduction in pruritus and serum BA levels after initiation of therapy, one child needed a maximal dose of the drug for optimal effect. One patient with ALGS showed a rapid and significant effect in terms of pruritus, BA level and improvement in quality of life. The other patient, who has a severe form of multiorgan involvement in ALGS, showed a moderate positive effect of therapy, with fluctuating levels of BA. Changes in the liver enzyme levels, bilirubin, and markers of liver dysfunction were also analysed in all patients, and pruritus and quality of life assessment scales are presented for treated patients. No side effects of therapy are observed.
Conclusions: After the exclusion of biliary atresia, new exome sequencing methods lead to clarification of the cause of neonatal cholestasis in 80‐86%. Intensive pruritus and progressive liver injury in patients with PFIC and ALGS is an indication to initiate treatment with IBAT inhibitors. More real‐world data are accumulating on the effects of these drugs, and new indications are being developed in the field of cholestatic liver disease.
Contact e‐mail address: mila.baycheva@gmail.com
H‐EV018. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV018.1. PREVALENCE OF HEPATIC STEATOSIS IN CHILDREN WITH CELIAC DISEASE ON A GLUTENFREE DIET: PRELIMINARY REPORT OF A PROSPECTIVE CROSS SECTIONAL COHORT ANALYSIS
Marion Spilka1, Julia Eilenberger 1, Leo März1, Theresa Förg1, Lydia Barisic1, Alexander Ebner1, Daniel Kotlarz2, Eberhard Lurz1,3
1Department Of Pediatrics, University Hospital, LMU Munich, Munich, Germany, 2Department Of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig‐Maximilians‐Universität Munich, Munich, Germany, 3Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
Objectives and Study: Celiac disease (CD) is a chronic condition that primarily affects the gastrointestinal tract. Liver‐related complications in celiac disease can range from mild, temporary enzyme elevations to more severe conditions like chronic inflammation or scarring. In general, these abnormalities improve with adherence to a gluten‐free diet (GFD). However, adult studies indicate that the risk of hepatic steatosis is increased during GFD. We aim to investigate the risk for hepatic steatosis in children with CD adhering to GFD.
Methods: We conducted a prospective cross‐sectional study of children with CD at a tertiary university hospital in an urban socioeconomic setting. Anthropometric markers weight, length, bodymass index (BMI) and mid upper arm circumference (MUAC), serologic antibodies, liver function tests, and history of CD were documented. Fibroscan measurements were performed to screen for liver stiffness (kPa) and steatosis (decibel/m).
Results: In total 78 children with CD were included in the study, of whom 60.3% were female and 3 children were included at time of primary diagnosis. Mean age at evaluation was 11 years (SD 4.2). The duration of GFD was 3.5 (IQR 1.5;7) years. Median BMI was 17.3 (IQR 15.7;19.7) kg/m2 and MUAC was 20 (IQR 18;23.4) cm. Liver stiffness was 4.8 (IQR 4;5.5) kPA and grade of steatosis was 171 (IQR 154;203) dB/m. No correlation of BMI and grade of steatosis was seen (r = 0.18).
Conclusions: In this cohort of children with CD, no relevant liver steatosis and no correlation of BMI and grade of liver steatosis was seen. This might be due to the distribution within normal range of both values and a very careful complementary dietary support in our cohort of children with CD. Hence, we suggest to further analyze the grade of liver steatosis in children with CD in a broader socioeconomic environment to identify a potential risk of GFD for MASLD as shown in adults.
Contact e‐mail address: Eberhard.Lurz@med.uni-muenchen.de
H‐EV019. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV019.1. THE CHALLENGES IN NON‐RESPONSE TO HEPATITIS B VACCINATION AND IMMUNOGENECITY IN CHILDREN: SEROPREVALANCE STUDY IN COMMUNITY
Yudith Setiati Ermaya 1, Yunia Sribudiani2, Rd. Reni Majangsari1, Quak Seng Hock3, Dwi Prasetyo1
1Department Of Child Health, Faculty of Medicine Padjadjaran University ‐ Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, 2Department Of Basic Medical Sciences, Faculty of Medicine Padjadjaran University, Bandung, Indonesia, 3Department Of Paediatrics, National University Hospital, Singapore, Singapore
Objectives and Study: Hepatitis B Virus (HBV) is still a problem in the world, it can cause acute or chronic infections. Every child is expected to have immunity to HBV after Hepatitis B Vaccination (VHB). Antibodies directed against anti‐HBs after vaccination with three vaccine doses may be maintained over two decades. Anti‐HBs are associated with successful vaccination and recovery from acute infection. Indonesia, as the country with the second highest number of HBV infections in Southeast Asia, requires an eradication strategy starting from infancy and childhood this study aimed to determine the prevalence of Anti‐HBs seroprotection and immunogenicity.
Methods: Cross‐sectional research was conducted on communities in Bandung city, Indonesia. Blood samples were taken from baby at 7 months of age based on after complete primary VHB (0,2,3,4 age of months). Anti‐HBs examination was carried out using the Chemiluminescent Microparticle Immunoassay. They was assessed as non‐response to VHB if the Anti‐HBs level <10 mIU/mL. The analysis data is based on percentage and geometric mean concentration (GMC).
Results: The subjects were obtained from 308 infants aged 7 months. The GMC anti‐HBs in the GMC respectively <10, 10‐100, >100 mIU/mL average was 4.21, 44.32, and 442.23 mIU/mL with Immunogenicity seroprotection HBV 93.2% with average GMC level 196.27 mIU/mL. In this study, dominated by the group with a high response of 71.4% with a range GMC between 102.5‐ > 1000 mIU/mL, we found the prevalence of non‐response HB vaccination was 6.8%.
Conclusions: Elimination of HBV infection is very important. This can be achieved through universal HB immunization because there are still non‐responders to HB vaccination and provide recommendations for additional Hepatitis B vaccination to increase immunity.
Contact e‐mail address: udiths2016@gmail.com
H‐EV020. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV020.1. RESEARCH TRENDS AND HOTSPOTS OF OMICS IN DRUG‐INDUCED LIVER INJURY: A BIBLIOMETRIC ANALYSIS
Cai‐Xia Feng, Qing‐Wen Shan
Department Of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
Objectives and Study: In recent years, the investigation of omics in drug‐induced liver injury (DILI) has garnered considerable global attention. Despite this, there is a lack of a comprehensive bibliometric analysis to assess the research trends in this domain. This study endeavors to discern its evolving trends and hotspots, providing fundamental insights and potential avenues for further exploration.
Methods: Publications on omics and DILI, spanning from 1 January 2000 to 6 March 2024, were systematically retrieved from the Web of Science Core Collection database. VOSviewer, CiteSpace, and the online bibliometric platform "Bibliometrix" were utilized to extract and visualize the retrieved information.
Results: A total of 689 publications were collated, exhibiting a fluctuating annual publication trend. Notably, China made a significant contribution, accounting for 39.6% (273) of the total publications. Frontiers in Pharmacology stood out with the highest number of articles (37; 5.4%). Gonzalez Frank J. and Xiao Xiaohe emerged as leading authors, with Gonzalez Frank J. boasting the highest number of publications and Xiao Xiaohe holding the highest H‐index. Additionally, the Fifth Medical Center of Chinese PLA General Hospital was the most productive institution, contributing 30 articles (4.4%). Keyword analysis revealed metabolomics, hepatotoxicity, and proteomics as the most frequently occurring terms. Gut microbiota, network pharmacology, idiosyncratic DILI, traditional Chinese medicine, bile acid, inflammation, and lipidomics as dominant topics in the past five years. Notably, recent studies have demonstrated a growing focus on "inflammation" and "model", indicating shifting research interests.
Conclusions: Our findings offer a comprehensive overview of the evolving landscape of omics research in DILI, identifying key contributors, institutions, and research themes. This analysis provides valuable insights for researchers to gain a deeper understanding of the current trends and potential areas for future exploration in this critical field
Contact e‐mail address: fengcxdaydayup@163.com
H‐EV021. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV021.1. THE CLINICAL SPECTRUM OF PORTO‐SINUSOIDAL VASCULAR DISEASE IN PAEDIATRICS: A SINGLE CENTRE REVIEW
Sandra Fernandes Lucas, Marumbo Paul Mtegha, Kavitha Jayaprakash, Sanjay Rajwal, Jens Stahlschmidt, Palaniswamy Karthikeyan
Paediatric Hepatology, Leeds Children's Hospital, Leeds, United Kingdom
Objectives and Study: Porto‐sinusoidal vascular disease (PSVD) is a condition which affects the portal venules and sinusoids in the absence of cirrhosis. Knowledge about PSVD natural history is still limited. We aimed to describe the characteristics of children affected with PSVD, as well as their histological findings and clinical outcomes.
Methods: We performed a retrospective review of children with native liver biopsy samples suggestive of PSVD from January 2019 to October 2024.
Results: Forty‐eight patients fit the diagnostic criteria of PSVD with 64.6% (n = 31) having associated portal hypertension (PHT) and 35.4% (n = 17) without PHT. The median age age at presentation was 5 years (IQR 2.1, 11.6) and the median follow‐up was 2.4 years (IQR 1.6, 5.3). The most common reason for referral to hepatology was isolated elevated transaminases in the non‐PHT group, hypersplenism and portal hypertensive bleed in the PHT group. There were no significant differences between the histological features found on both groups, apart from a higher prevalence of perisinusoidal fibrosis in those with PHT (p = 0.018). The non‐PHT group had a higher median ALT of 61 (IQR 35, 213) at presentation when compared to the PHT group (p = 0.021). During the follow up period no significant adverse events were observed in non‐PHT group, while 2 children developed hepatopulmonary syndrome and 3 underwent liver transplantation in the PHT group. Of those with PHT, 16 had evidence of portal vein thrombosis (PVT) with cavernous transformation at presentation and 2 developed PVT during the follow up period.
Conclusions: PSVD is a condition with variable phenotypic presentation and disease course. Those without PHT, mostly presenting with isolated elevated transaminases, appear to have a milder disease course, while those with PHT can have poor outcomes. Prospective studies are required to improve our understanding of the disease course and identify those at risk of progressing to PHT and developing adverse outcomes.
Contact e‐mail address: sandra.lucas1@nhs.net
H‐EV022. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV022.1. CHARACTERIZATION, DIAGNOSIS, TREATMENT, AND OUTCOMES OF PEDIATRIC PORTAL CAVERNOMATOSIS IN CATALONIA
Diana García‐Tirado 1, Maria Mercadal‐Hally2, Cristina Padrós2, Cristina Molera Busoms3, Ines Loverdos Eseverri3, Víctor Vila Miravet3, Jesus Quintero2, Juan Carlos García Pagán4
1Pediatrics, Consorci Sanitari Parc Tauli, Sabadell, Spain, 2Pediatric Hepatology And Liver Trasplant Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 3Gastroenterology, Hepatology And Nutrition, Sant Joan de Déu, Barcelona, Spain, 4Liver Unit. Hospital Clinic. Idibaps And Ciberehd., Clinic Hospital, Barcelona, Spain
Objectives and Study: To describe the diagnostic characteristics, follow‐up, and outcomes of pediatric patients with extrahepatic portal vein obstruction (EHPVO) due to non‐cirrhotic portal vein thrombosis (PVT).
Methods: This multicentric, retrospective study included patients diagnosed with EHPVO between 2003 and 2023 in two referral centers in Catalonia. Data were collected using RedCap® and analyzed with R software (v4.3.0).
Results: Fifty‐four patients (61% male) were included, with a mean diagnostic age of 5.4 ± 4.6 years and an average follow‐up of 8 ± 4.7 years (range: 11 months–19 years). Diagnosis was incidental in 43% and related to hematemesis in 24%. Neonatal umbilical catheterization (38%) and undetermined causes (40%) were frequent associated factors. Prothrombotic studies (n = 33) identified mild antiphospholipid antibody elevation (n = 3), MTHFR C677T mutation (n = 1), and protein C and S deficiencies (n = 1). During follow‐up, 48% experienced gastrointestinal bleeding (median: 2 episodes, range: 1–12); 26 required interventions, including beta‐blockers (67%), endoscopic treatment (81%), surgical portosystemic shunts (SPSS) (50%), or angioplasty (19%). Eight patients received primary endoscopic prophylaxis, and primary SPSS were performed in three (Rex, n = 2). Bleeding was the only statistically significant factor associated with intervention (p = 0.0019). Liver transplantation was necessary in six cases due to severe complications such as hepatopulmonary syndrome, severe portopulmonary hypertension, encephalopathy, or refractory bleeding. No deaths occurred during the study period.
Conclusions: EHPVO was frequently linked to neonatal umbilical catheterization. Gastrointestinal bleeding affected nearly half of the cohort and was managed with secondary prophylaxis, mainly endoscopic and beta‐blockers. Liver transplantation was reserved for severe cases, with no mortality observed over the follow‐up period.
Contact e‐mail address: digartir@gmail.com
H‐EV023. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV023.1. DYNAMICS OF LIVER TESTS AND THE PROGNOSIS OF EVOLUTION IN ACUTE LIVER FAILURE IN CHILDREN AND ADOLESCENTS
Alina Grama 1,2, Alexandra Mititelu2, Gabriel Benta1,2, Tudor Lucian Pop1,2
12nd Pediatric Clinic, Center Of Expertise In Pediatric Rare Liver Diseases, Emergency Clinical Hospital for Children, Cluj‐Napoca, Romania, 22nd Pediatric Discipline, Mother And Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj‐Napoca, Romania
Objectives and Study: Acute liver failure (ALF) is a rare but severe condition with high mortality in children. The timely prediction of the unfavorable evolution using affordable parameters may help in referring these patients early to liver transplantation (LT). Our study aimed to evaluate the dynamic of the liver tests as possible prognostic factors in children with ALF.
Methods: We included in this study children with ALF of different causes, and we compared the liver tests on the admission day and their dynamic during the following days based on evolution (survival or fatal evolution, including the need for LT) and etiology. The maximum value and the increasing speed of transaminases, INR, and bilirubin levels were analyzed.
Results: We analyzed data of 121 children with ALF: 50.4% female, mean age 5.99 ± 6.08 years, 43.8% with fatal evolution. The etiology of ALF was infectious (33.88%), metabolic (23.14%), toxic (19.01%), autoimmune (12.40%), or unknown (11.57%). The maximum value of INR, total, and direct bilirubin serum level was higher in those with fatal evolution (5.13 vs. 3.11, p < 0.0001, 16.66 vs. 6.68 mg/dl, p < 0.0001, respective 12.69 vs. 5.15 mg/dl, p < 0001). Even though the speed of increase is higher for all parameters in patients with fatal evolution, only for the total bilirubin level, the speed is significantly higher (2.08 vs. 0.75 mg/dl/day, p < 0.01). The number of patients with decreasing values of studied parameters after admission is higher in patients with favorable evolution (p < 0.05 for transaminases, INR, and total bilirubin). No significant changes were found if analysis was done of specific etiologies.
Conclusions: Even though prognostic scores are used to predict the fatal evolution of ALF in children, early estimation of the dynamics of simple parameters such as INR or bilirubin level may be useful for early referral for LT without a delay that could influence survival.
Contact e‐mail address: tudorlpop@yahoo.com
H‐EV024. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV024.1. EXPLORING THE CLINICAL, GENOTYPIC, AND PHENOTYPIC SPECTRUM OF PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS
Rohan Grotra 1, Rajni Yadav2, Prasenjit Das2, Rohan Malik3, Devasenathipathy Kandasamy4, Manisha Jana4, Devendra Yadav5
1Division Of Pediatric Gastroenterology And Hepatology, Department Of Pediatrics, All India Institute of Medical Sciences, New Delhi, India, 2Pathology, All India Institute of Medical Sciences, New Delhi, India, 3Division Of Pediatric Gastroenterology And Hepatology, Department Of Pediatrics, All India Institute Of Medical Sciences, New Delhi, India, 4Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India, 5Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
Objectives and Study: Progressive familial intrahepatic cholestasis (PFIC) is a group of rare heterogeneous genetic disorders involving defective bile acid handling. It manifests with cholestasis, pruritus, and failure to thrive in early infancy/childhood which results in early end‐stage liver disease and death. Traditionally, PFIC was classified into 3 types. Advances in genetic testing have expanded the PFIC spectrum to include further subtypes with variable phenotypes and responses to management. This study intends to explore and analyze the PFIC subtypes, their clinical course, and outcomes.
Methods: This is a retrospective analysis of all genetically diagnosed PFIC patients in a tertiary care public health institution from December 2017 to October 2024. Diagnosis was made using clinical and laboratory parameters, histopathological examination of liver biopsies, and genetic testing. Genotype‐phenotype correlation was made, and patients were managed medically and surgically.
Results: We identified 37 cases of genetically confirmed PFIC. Among them, 22 had homozygous mutations, 14 heterozygous mutations and 1 had compound heterozygous mutation. The most common mutation was found in Multi‐Drug Resistant Protein (MDR3) n = 14 (37.8 %) followed by Bile Salt Export Pump deficiency (BSEP) n = 8 (21.6%), Familial Intrahepatic cholestasis 1 (FIC1) and Tight Junction protein 2 (TJP2), both n = 5 (13.5%). Other PFIC variants included NR1H4 gene (Farsenoid X Receptor, FXR) n = 1, Myosin VB (MYO5B) n = 2 (5.4%) and Ubiquitin‐Specific Protease 53 (USP53) n = 2 (5.4%). Histopathological examinations were done in n = 29 cases (78.4%). 3 (8.1 %) patients underwent biliary diversion of which 1 had liver transplant later. A total of 2 (5.4%) patients underwent liver transplant. Recurrence of PFIC‐2 post‐LT was seen in 1 case. Our native liver survival is 78.3% (n = 29) and with 21.6% (n = 8) mortality.
Conclusions: In this study, most children were managed medically, and biliary diversion improved pruritus in 2 cases. Early recognition and referral for transplant are crucial.
Contact e‐mail address: dr.rohanmalik@gmail.com
H‐EV025. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV025.1. BEYOND BILIARY ATRESIA: KIF12 MUTATIONS IN HIGH‐GGT NEONATAL CHOLESTASIS
Gulsah Unsal1, Ersin Gumus 1, Hayriye Hizarcioglu Gulsen1, Tulin Kurtul Demirhan1, Hulya Demir1, Inci Nur Saltik Temizel1, Diclehan Orhan2, Hasan Ozen1
1Pediatric Gastroenterology, Hacettepe University, Ankara, Turkey, 2Department Of Pathology, Hacettepe University, Ankara, Turkey
Objectives and Study: Genetic mutations contribute to 25‐50% of neonatal cholestasis cases. Progressive familial intrahepatic cholestasis type 8 (PFIC8) is an exceptionally rare cause of high gamma‐glutamyl transferase (GGT) cholestasis resulting from kinesin family member 12 (KIF12) pathogenic variants.
Methods: We report a case of KIF12‐associated PFIC8 diagnosed through advanced genetic testing.
Results: A 2‐month‐old baby was referred to our hospital due to progressive jaundice and acholic stools. Family history revealed parental consanguinity. Physical examination showed jaundice without hepatosplenomegaly. Laboratory findings indicated high GGT (562 U/L) cholestasis with moderate hypertransaminasemia. Synthetic liver function was preserved with normal albumin and INR levels. Following an inconclusive abdominal ultrasound for biliary atresia the patient underwent laparotomy and biliary atresia was ruled out by intraoperative cholangiography. Histopathology demonstrated intrahepatic cholestasis with septal fibrosis, bile duct proliferation and some degree of duct loss in some of the portal spaces. Diagnostic work‐up for treatable causes of neonatal cholestasis, including anatomical, metabolic, infectious, and endocrinological aetiologies, was negative. Genetic analysis for hereditary intrahepatic cholestasis was planned. Whole exome sequencing (WES) analysis revealed a homozygous KIF12 mutation (NM_138424.1; c.808+2 T > A, s1847120150), confirming the diagnosis of PFIC8. Genetic counselling was provided, and supportive management, including nutritional rehabilitation, fat‐soluble vitamin supplementation, and ursodeoxycholic acid, was continued. The patient remains clinically stable with gradual improvement in biochemical cholestasis.
Conclusions: KIF12‐associated PFIC8 is a rare but important consideration in high‐GGT neonatal cholestasis. Early use of genetic testing enables timely diagnosis, reduces unnecessary interventions, and facilitates appropriate management and prognosis estimation. WES is a powerful tool for uncovering rare and newly identified genetic causes, providing critical insights into complex neonatal cholestasis cases.
Contact e‐mail address: ersin.gumus@hacettepe.edu.tr
H‐EV026. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV026.1. PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS PATIENTS’ COHORT IN QATAR
Zahra Hejji 1, Hatem Abdulrahman2, Khaled Abouhazima1, Amna Alkhuzaei1, Rania Ilaria1
1Gastroenterology, Sidra Medicine, Doha, Qatar, 2Pediatric Gastroenterology, Sidra Medicine, Doha, Qatar
Objectives and Study: PFIC is a rare genetic disorder causing liver dysfunction, and progressive liver failure. Our institution has experienced a good number of patients, and with our multi‐disciplinary team approach we were successful in managing challenging complex cases. This poster highlights our experience and cohort pre‐ and post‐transplant. It is an overview of the pediatric cases in our institution who have been diagnosed with confirmed Progressive familial intrahepatic cholestasis (PFIC). It presents the clinical outcome and characteristics noted with an overview of the common subtypes in the region. As a results, it emphacizes successful transplanted cases, among which, some did not require medical treatment post‐transplant.
Methods: Retrospective study of qualitative data of PFIC cohort in Sidra Medicine institution from the year of 2000‐2024. It included patients who presented with neonatal cholestasis, elevated liver enzymes, or itchiness during this time period, and included the cases who were.confirmed PFIC by genetic testing.
Results:
Data provides quantitative and qualitative information of the cohort with outcomes of management.
Conclusions: Local institution cohort showed total number of thirty confirmed PFIC cases. The majority have been Qatari per nationality, and type III per subtypes. Among them 10 patients have been transplanted, and only 1 required medical treatment post‐transplant. The rest of the patient are being medically managed with standard treatment with no major complications. The outcomes of this study emphasize the great outcomes of clinical management of this rare disease our institution is dealing with in the clinical practice.
Contact e‐mail address: zhejji1@sidra.org
H‐EV027. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV027.1. THINK TWICE FOR CHOLESTASIS AND ACHOLIC STOOL
Gulsah Unsal1, Hayriye Hizarcioglu Gulsen 1, Burak Ardicli2, Diclehan Orhan3, Tulin Kurtul Demirhan4, Ersin Gumus1, Hulya Demir1, Hasan Ozen1, Inci Nur Saltik Temizel1
1Department Of Pediatric Gastroenterology, Hacettepe University, Ankara, Turkey, 2Department Of Pediatric Surgery, Hacettepe University, Ankara, Turkey, 3Department Of Pathology, Hacettepe University, Ankara, Turkey, 4Department Of Pediatric Gastroenterology, Hacettepe University, Çankaya, Turkey
Objectives and Study: Acholic stool is a pathognomonic finding for biliary atresia (BA) whereas Alagille syndrome, cystic fibrosis, MDR 3 deficiency, and alpha‐1‐antitrypsin (A1AT) deficiency may be mimickers.
Methods: A 78‐day‐old male patient was referred to our clinic from another hospital with cholestasis and acholic stools starting on postnatal 33rd day. In that center, high GGT cholestasis was determined. In the abdominal ultrasonography (USG) the choledochal duct could not be visualized, the gallbladder was hypoplastic, septate and no triangular cord sign was determined. Liver biopsy showed microvesicular steatosis and iron deposition, but no bile duct proliferation. Intraoperative cholangiography (IOC) was canceled after biopsy report. Metabolic investigations, vertebral X‐rays, echocardiography, and eye examination were normal. As A1AT level was low, the SERPINA gene mutation was sent and referred to our center.
Results: On admission jaundice, minimal hepatosplenomegaly, mild transaminase elevation (ALT: 90 U/L, AST:157 U/L) with high GGT cholestasis (ALP: 1444 U/L, GGT: 1086 U/L, total/direct bilirubin: 8.2/4.9 mg/dL) were found. No coagulopathy was shown. Abdominal USG was consistent with the previous findings. The sweat test was normal. A1AT level was low (0.334 g/L) for the second time. The SERPINA 1 gene analysis was announced the night before IOC and a pathogenic c.1096 G>A homozygous mutation was detected. However, IOC was performed to exclude BA and revealed atretic common bile duct, and small gallbladder, and portoenterostomy was performed. Liver biopsy showed severe calicular and hepatocellular cholestasis (positive MDR3 staining), fibrosis with nodule formation, bile duct proliferation, and macrovesicular steatosis with hepatocellular PAS‐positive staining. Two diagnoses of cholestasis, BA and A1AT deficiency, were identified. Two months after surgery, bilirubin levels returned to normal and GGT was significantly decreased.
Conclusions: The coexistence of A1AT deficiency and BA is rare, a few cases have been reported. BA should be excluded despite a genetic cholestatic disorder in case of discolored stool.
Contact e‐mail address: hayriyegulsen@gmail.com
H‐EV028. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV028.1. LATHOSTEROLOSIS: A RARE METABOLIC DISORDER CAUSING RECURRENT GASTRIC FUNDIC VARICEAL BLEEDING
Tulin Kurtul Demirhan1, Hayriye Hizarcioglu Gulsen 2, Ersin Gumus2, Bengi Ozturk3, Fatma Eldem4, Kismet Ciki5, Inci Nur Saltik Temizel6, Hasan Ozen6, Hulya Demir7
1Pediatric Gastroenterology, Hacettepe University Hospitals, ankara, Turkey, 2Pediatric Gastroenterology, hacettepe university hospitals, ankara, Turkey, 3Gastroenterology, hacettepe university hospitals, ankara, Turkey, 4Radiology, Hacettepe University Hospital, ankara, Turkey, 5Pediatric Metabolism, hacettepe university hospitals, ankara, Turkey, 6Pediatric Gastroenterology, Hacettepe University, Ankara, Turkey, 7Department Of Pediatric Gastroenterology, Hacettepe University, Ankara, Turkey
Objectives and Study: Tulin Kurtul Demirhan, Hayriye Hizarcioglu Gulsen, Ersin Gumus, Bengi Ozturk, Fatma Gonca Eldem, Kismet Ciki, Inci Nur Saltik Temizel, Hasan Ozen, Hulya Demir Lathosterolosis: A rare metabolic disorder causing recurrent gastric fundic variceal bleeding Objectives and Study Lathosterolosis is an extremely rare disorder of cholesterol biosynthesis caused by a deficiency of the enzyme ‘sterol C‐5 desaturase (lathosterol dehydrogenase)’ encoded by the SC5D gene. To our knowledge, a few cases have previously been reported. The diagnosis of lathosterolosis is based on plasma sterol analysis and demonstration of biallelic mutations in the SC5D gene.
Methods: Methods Here, we describe a 4.5‐year‐old girl born from a consanguineous marriage, with dysmorphic findings and developmental delay, who presented with hematemesis, melena and elevated transaminases during an infection.
Results: Results The patient had growth retardation, microcephaly, ptosis, downslanting palpebral fissures, long philtrum, high arced palate, micrognathia and cutaneous partial syndactyly of the second and third toes. Laboratory results showed elevated transaminases with normal platelets, bilirubin and INR. Hepatic‐portal Doppler ultrasound showed hypertrophy of the left lobe and caudate lobe with coarsened echotexture. Upper endoscopy showed isolated gastric (fundic) varices without esophageal varices. Computed tomography angiogram revealed splenorenal shunts. Whole exome sequencing, performed as part of work‐up for global developmental delay and dysmorphic features, revealed a homozygous mutation in SC5D gene (c.656 T>C p.Leu219Ser). Simvastatin treatment was started to decrease plasma lathosterol levels and to prevent progression of liver disease. The patient was listed for cadaveric liver transplantation (LT). After a successful coil and polidacanol embolization for gastric varices, the patient has been bleeding‐free for the last 6 months.
Conclusions: Conclusion Hepatic involvement of lathosterolosis can range from asymptomatic elevation of transaminases to intrahepatic cholestasis and portal fibrosis/cirrhosis. The coil and polidacanol embolization for gastric varices in this patient provided time for the patient waiting on the LT list.
Contact e‐mail address: tlnkrtl@gmail.com
H‐EV029. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV029.1. FAT‐SOLUBLE VITAMIN DEFICIENCY IN PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS PATIENTS WHO ARE TREATED WITH ODEVIXIBAT
Willemien Hof 1, Alida De Groot1, Henkjan Verkade1, Paola Mian2
1Pediatric Gastroenterology/hepatology, Dept. Of Pediatrics, University Medical Center Groningen, Groningen, Netherlands, 2Clinical Pharmacy And Pharmacology, University Medical Center Groningen, Groningen, Netherlands
Objectives and Study: Progressive familial intrahepatic cholestasis (PFIC) is a group of genetic disorders characterized by impaired bile formation and bile flow, leading to cholestasis. Due to fat malabsorption, these patients are at an increased risk of deficiencies in fat‐soluble vitamins A, D, E and K. The ileal bile acid transporter (IBAT) inhibitor odevixibat has been shown to reduce pruritus and cholestasis in PFIC patients, but may further decrease intestinal bile acid levels needed for fat and vitamin absorption. Here, we aimed to assess the effects of odevixibat on plasma levels of fat‐soluble vitamins in PFIC patients.
Methods: PFIC patients receiving odevixibat in our center between January 1st, 2021 and December 1st, 2024 were selected for this retrospective, descriptive study. Laboratory parameters for vitamins A, D, E and K plasma levels closest before and after the start of treatment were collected.
Results: Eleven PFIC patients (6 males; FIC1 deficiency, n = 3; BSEP deficiency, n = 4; MDR3 deficiency, n = 3; MYO5B deficiency, n = 1) had been treated with odevixibat in this time span. Their average age was 6.5 years (range, 5 mo. ‐ 27 yr). Serum levels of 6 patients indicated fat‐soluble vitamin deficiency, particularly A (n = 1) D (n = 3), E (n = 1) and K (n = 4) despite vitamin suppletion. No significant changes in laboratory values for vitamins A, D, E and K before and after the start of odevixibat treatment were found (P > 0.1; Figure 1). Within one year after the start of odevixibat treatment, vitamin suppletion doses were increased for 6 patients, remained unchanged for 4 patients and were decreased for 1 patient.
Conclusions: This study shows no significant association between odevixibat treatment and development of fat‐soluble vitamin deficiency in PFIC patients, while vitamin supplementation doses were on average increased after the start of odevixibat treatment. It remains therefore relevant to monitor fat‐soluble vitamin levels in PFIC patients to maintain adequate plasma levels.
Contact e‐mail address: w.f.j.hof@umcg.nl
H‐EV030. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV030.1. A PEDIATRIC CASE OF JAUNDICE, HEMOLYSIS, AND CHOLESTASIS: UNRAVELING THE DIAGNOSTIC CHALLENGES IN GLUCOSE TRANSPORTER 1 DEFICIENCY SYNDROME
Hahnbie Lee1, Da Jeong Lee2, Sook Won Ryu3, Jeana Hong 2
1Kangwon National University School of Medicine, Chuncheon, Korea, Republic of, 2Pediatrics, Kangwon National University Children's Hospital, Chuncheon, Korea, Republic of, 3Laboratory Medicine, Kangwon National University Hospital, Chuncheon, Korea, Republic of
Objectives and Study: Glucose transporter 1 deficiency syndrome (GLUT1DS) is a pediatric disorder caused by impaired GLUT1 transport at the blood‐brain barrier, typically presenting with intellectual disability, seizures, and hypoglycorrhachia, and responding well to the ketogenic diet. However, the clinical presentation can vary, and diagnosis may be challenging when associated with other conditions, such as anemia or pseudohyperkalemia. The phenotype of GLUT1DS with mild anemia due to chronic hemolysis is particularly rare. We present a Korean patient similar to this phenotype, who also exhibited jaundice and cholestatic hepatitis, highlighting the diagnostic challenges.
Methods: A 5‐year‐old boy with a history of neonatal jaundice, congenital cataracts, seizures, and developmental delay was referred for accidently confirmed elevated bilirubin levels from the emergency room. Initial lab results revealed mild indirect hyperbilirubinemia and splenomegaly. Genetic testing initially indicated a UGT1A1 mutation, suspected as Gilbert's syndrome. However, further testing identified a trinucleotide deletion in the SLC2A1 gene, confirming GLUT1DS. Despite this, the patient's mother declined the ketogenic diet.
Results: At age 9, the patient presented with jaundice, abdominal distension, and splenomegaly. Lab results showed mild anemia, reticulocytosis, and cholestatic hepatitis. A peripheral blood smear revealed hemolysis. Abdominal imaging confirmed splenomegaly and biliary obstruction due to gallstones. Treatment with ursodeoxycholic acid (UDCA) led to significant laboratory improvement, though reticulocytosis persisted. At age 11, he was readmitted with severe jaundice and abdominal pain. Imaging revealed worsened biliary obstruction and multiple gallstones. Follow‐up after ERCP and continued UDCA therapy showed improvement in serum levels of bilirubins and liver enzymes, but reticulocytosis remained.
Conclusions: This case highlights the diagnostic challenges of GLUT1DS with hemolysis, anemia, jaundice, and cholestatic hepatitis. Genetic testing confirmed GLUT1DS despite initial suspicion of Gilbert's syndrome, emphasizing the importance of comprehensive genetic and clinical evaluation. Further research is needed to explore the role of the ketogenic diet in such complex cases.
Contact e‐mail address: hahnbie.lee@gmail.com
H‐EV031. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV031.1. A WIDE COMBINATION OF AUTOANTIBODIES IN PEDIATRIC AUTOIMMUNE LIVE DISEASES
Bente Utoft Andreassen1,2, Marianne Hørby Jørgensen 1, Runar Almaas3, Gandom Kharrazi4, Vaidotas Urbonas5, Helene Kvistgaard6, Embjørg Wollen7, Christine Nilsson8, Thomas Casswall9, Bjorn Fischler10
1Department Of Paediatric And Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark, 2European Reference Network on Hepatological Diseases, Hamburg, Germany, 3Department Of Pediatric Researc, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway, 4Astrid Lindgren Childrens Hospital, Karolinska University Hospital, Stockholm, Sweden, 5Vilnius University Hospital Santariskiu Klinikos ‐ Childrens Hospital, Vilnius, Lithuania, 6Department Of Paediatrics And Adolescent Medicine, University Hospital, Aarhus, Åarhus, Denmark, 7Division Of Paediatric And Adolescent Medicine, Oslo University Hospital, Oslo, Norway, 8Department Of Clinical Immunology, Odense University Hospital, Odense, Denmark, 9Division For Paediatrics, Department Clinical Interventions And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 10Pediatric Gastroenterology, Astrid Lindgren Children's Hospital, Clintec, Karolinska Institutet, Stockholm, Sweden
Objectives and Study: Study: Paediatric Autoimmune liver disease (p‐AILD) is a rare chronic inflammatory liver disease by specific changes on biopsy and underlined by autoantibodies (aAB). p‐AILD are grouped according to aAB into Type I: SMA, ANA, ANCA, anti‐SLA/LP or seronegative, Type II:(LKM), and LC1, and ASC. This classification has been questioned, particularly in adult AILD. The data on the presence of aAB and combination in children are scarce, and the clinical features of the different combinations are unknown. Objectives: to describe the prevalence, numbers and combination of positive autoantibodies and correlation to presentation in Nordic children diagnosed with p‐AILD
Methods: Methods: Retrospective data on aAB measured within the first 3 months were collected in Pediatric patients (n = 157) with biopsy‐proven p‐AILD in five Centres. Additional data on presentation, liver biochemistry and other autoimmune diseases
Results: Results Twenty‐five combinations of autoantibodies were seen. The classic AIH type 1 was seen in 60.5% of the children: SMA + ANA (20.4%), SMA (19.7%), SMA + ANCA (11.5%) or SMA + ANCA + ANA (8,9%). SLA/LP (12,5%). AIH type 2 was seen in 33,1 %. LKM alone was positive in 5,7%. The combinations of LKM + SMA (1,9%), LKM + ANCA (1,9%) and LC1 5.2%, (Figure 1). Seronegative cases count for 6,4 %. SLA/LP and LC1 were always present with other aAB. No relation existed between type of presentation: IgG, INR > 2, Liver Injury Units admission values (aLIU), and the number of autoantibodies present. However, AIH type 2 does present with higher aLIU score and INR, while AIH type 1 present with higher IgG
Conclusions: Conclusion We found a high variability of aAB combination, the presence of more than 1 autoantibody in autoimmune liver disease in children is frequent. We did not find any impact on numbers of aAB, however differences between the classical subtype and presentation were confirmed. This justifies classification into type 1 and 2 AILD in the pediatric population
Contact e‐mail address:
H‐EV032. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV032.1. AUTOIMMUNE HEPATITIS AND IMMUNE DYSREGULATION: A CASE SERIES
Giulia Jannone, Clément Triaille, Fabien Touzot, Fernando Alvarez
CHU Sainte‐Justine, Montreal, Canada
Objectives and Study: To assess the presence of inborn errors of immunity (IEI) in a pediatric autoimmune hepatitis (AIH) cohort.
Methods: This retrospective study included all patients aged 0‐18 diagnosed with AIH in our center between 1995 and 2023 and concurrently followed by the immunology department for a clinical and/or molecular IEI diagnosis.
Results: Amongst the 83 patients followed in our center for AIH, six patients (7.2%) displayed signs of associated IEI. Two of those six patients had a genetic confirmation of IEI (SP110 and AIRE homozygous mutations), three patients displayed variants of uncertain significance in immunodeficiency‐related genes, and the last patient was not genetically tested. IEI‐related signs were recurrent infections (n = 4), immune‐mediated cytopenia (n = 4), immune‐mediated skin disease (n = 3), chronic diarrhea (n = 1) and autoimmune polyendocrinopathy (n = 1). Four patients were diagnosed with seronegative AIH and two patients with AIH type 2. All patients responded to AIH immunosuppressive therapy, except for the two AIH type 2 patients who underwent emergent liver transplantation for fulminant liver failure at diagnosis.
Conclusions: Our small case series highlights the need to look for signs of immune dysregulation in AIH patients. Conversely, as AIH can be atypical in IEI, the threshold should be low to perform a diagnostic liver biopsy in IEI patients suffering from chronic cytolysis. We believe that systematic genetic testing and immune phenotyping of AIH patients who display signs of dysimmunity will be crucial to better understand the close link between AIH and IEI.
Contact e‐mail address:
H‐EV033. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV033.1. PHENOTYPE AND GENOTYPE CORRELATION OF HEPATIC GLYCOGEN STORAGE DISEASE: A SINGLE CENTRE OBSERVATIONAL STUDY
Yaja Jebaying 1, Karunesh Kumar1, Smita Malhotra2, Anupam Sibal2
1Pediatric Gastroenterology, Indraprastha Apollo Hospital, Delhi, India, 2Department Of Paediatric Gastroenterology, Hepatology And Nutrition, Indraprastha Apollo Hospital, New Delhi, India
Objectives and Study: Glycogen storage diseases (GSDs) are inherited disorders of glycogen metabolism, that result from deficiency of enzymes or transporter proteins. The incidence is 1 in 20000 live births. Hepatic GSDs primarily include types 0, I, III, IV, VI, IX, and glucose transporter‐2 (GLUT2) defects. Often has fasting hypoglycemia and hepatomegaly, rarely cirrhosis. Our study aims to describe the clinical course, genotypic‐phenotypic correlation and outcome in hepatic GSD patients in our centre.
Methods: We retrospectively analysed all children with GSDs on definite genetic mutations, including homozygous, heterozygous, or compound mutations causing GSD, between 2015 to 2024. The clinical, and biochemical parameters and histopathological correlation with the disease outcome were studied. The details of medical interventions as per departmental protocol were recorded. The outcome variables, such as native liver survival, complications, other system involvement and mortality were studied.
Results: 25 cases of genetically diagnosed hepatic GSDs were identified. Affected males and females were 72%(n = 18) and 28%(n = 14) respectively. The mean age of diagnosis was 58.4 months. Consanguinity seen in 8 patients (3rd degree). The types and genes affected are given in Table 1. Most common was type III (AGL) in our study 44% (n = 11). Common clinical presentation was abdominal distension, hepatomegaly and hypoglycemia/seizure. Complications like renal calculi, portal hypertension, pancreatitis and diabetes mellites were seen in 4%, 8%, 4% and 4% respectively. Our native liver survival was 88% (n = 22), with 12% (n = 3) mortality and none of them required liver transplantation. Table 1.
| GSD Types | Gene affected | No of cases (n = 25) |
|---|---|---|
| Ia | G6PC/SLC37A4 | 2 |
| Ib | G6PC/SLC37A4 | 2 |
| IIIa | AGL | 7 |
| IIIb | AGL | 4 |
| IV | GBE1 | 1 |
| VI | PYGL | 4 |
| IXa | PHKA2 | 1 |
| IXb | PHKB | 2 |
| XI | GLUT2/SLC2A2 | 2 |
Conclusions: Early diagnosis and dietary management are the mainstay of treatment till gene therapy is readily available. Good metabolic control alleviates metabolic complications and a liver transplant is seldom needed.
Contact e‐mail address: dryaja18@gmail.com
H‐EV034. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV034.1. DIAGNOSTIC ASPECTS OF IRON OVERLOAD SYNDROME IN CHILDREN WITH CHRONIC HBV INFECTION
Flora Inoyatova, Khilola Kadirkhodjaeva, Gulnoza Inogamova, Nodira Ikramova, Feruza Abdullaeva, Nargiza Valieva
Hepatology, Republican Specialized Scientific Practical Medical center of Pediatrics, Tashkent, Uzbekistan
Objectives and Study: To study the diagnostic significance of markers of the iron metabolism transport system and the active forms of hepcidin‐25 in children with chronic HBV infection against the background of iron overload syndrome (IOS).
Methods: It were examined 100 children with chronic HBV infection with IOS aged 4‐18 years. The levels of FPN (ferroportin), HEPH (hephaestin), TfR‐2 (transferrin receptors‐2) and HPS‐25 (active form of hepcidin‐25) were measured by ELISA method in the blood serum (Cloud‐Clone Corporation, USA). The transferrin storage coefficient (TSC) was used in the diagnostics of IOS. All children were distributed depending on the degree of IOS: TSC < 0.2 ‐ severe (17.0% of children), TSC < 0.5 ‐ moderate (38.0%) and TSC > 0.5 ‐ mild (45.0%). Control ‐ 90 practically healthy children.
Results: The FPN values increased with the severity of IOS: TSC > 0.5 ‐ 2.48 ± 0.16 ng/ml,TSC < 0.5 ‐ 3.18 ± 0.32 ng/ml and TSC < 0.2 ‐ 3.56 ± 0.87 ng/ml, respectively, (p < 0.01 relative to the control (0.48 ± 0.13 ng/ml) and compared groups). Intragroup comparisons of TfR‐2 revealed the same trend: TSC < 0.5 ‐ 18.5 ± 1.3 ng/ml, TSC > 0.5‐ 13.5 ± 1.5 ng/ml relative to the values of children with TSC < 0.2 (25.6 ± 3.6 ng/ml, p < 0.001). The analysis of the HEPH level revealed significantly higher values in children with TSC < 0.2 (11.7 ± 1.3 ng/ml) in relation to the group with TSC < 0.5 (8.42 ± 0.9 ng/ml) and TSC > 0.5 (6.1 ± 0.4 ng/ml, p < 0.01) and the control (8.6 + 0.47 ng/ml,p < 0.001). The average HPS‐25 values were decreased depending on the degree of IOS: TSC > 0.5 ‐ 9.7 ± 0.40 ng/ml, TSC < 0.2 ‐ 8.6 ± 0.11 ng/ml and TSC < 0.5 ‐ 7.3 ± 0.14 ng/ml (p < 0.001) against the control values (12.5 ± 1.3 ng/ml, p < 0.001).
Conclusions: In conditions of chronic persistence of HBV in children, an increase in the level of FPN, HEPH, TfR‐2 and a decrease in HPS‐25 indicate a breakdown of the molecular mechanisms of the iron metabolism transport system at the level of enterocytes and hepatocytes, which can be used as a diagnostic marker in assessing the severity of IOS.
Contact e‐mail address: sshilola@mail.ru
H‐EV035. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV035.1. IMAGING CYTOMETRY REVEALS A DISTINCT LIVER MACROPHAGE LANDSCAPE IN CHILDREN WITH PORTAL‐PREDOMINANT METABOLIC DYSFUNCTION‐ASSOCIATED STEATOHEPATITIS
Laura Kalveram 1, Christoph Loddenkemper2, Florian Roßner3, Marlene Kohlhepp4, Yin Guo4, Natalja Amiridze4, Stephan Henning1, Susanna Wiegand5, Frank Tacke4, Philip Bufler1, Adrien Guillot4, Christan Hudert1
1Department Of Pediatric Gastroenterology, Nephrology And Metabolic Medicine, Charité ‐ Universitätsmedizin Berlin, Berlin, Germany, 2Gemeinschaftspraxis Für Pathologie Und Neuropathologie, PathoTres, Berlin, Germany, 3Department Of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany, 4Department Of Hepatology And Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany, 5Department Of Pediatric Endocrinology And Diabetes, Center For Social‐pediatric Care, Charité Universitätsmedizin Berlin, Berlin, Germany
Objectives and Study: Portal‐predominant zonation of steatosis is associated with more severe disease activity in children with metabolic dysfunction‐associated steatohepatitis (MASH). Expression of the scavenging receptor CD163 has been implicated in discriminating macrophage polarization state, with differing roles in inflammatory response, immune regulation and tissue repair. Here, we aim to characterize the macrophage populations in distinct zonal phenotypes of paediatric MASH.
Methods: Imaging cytometry (including 18 markers of parenchymal cells, immune cells and extracellular matrix components) of liver needle biopsies was performed in 37 children and adolescents (aged 10 to 17 years, 84% boys) with MASH. Expression data of IBA1 and CD163 in macrophages were analyzed. Data from digital image analysis and histological scoring were combined for unbiased, multiparametric analyses.
Results: The distribution of fibrosis stages was 29.7%, 21.6%, 21.6%, 27.0% for F0, F1, F2 and F3, respectively. Portal inflammation was significantly associated with increasing fibrosis stage and length of infiltrating septa (both p < 0.01). Portal zonation of steatosis was present in 16.2% of the patients and was associated with advanced fibrosis (F ≥ 3). Image cytometry revealed zonation specific changes in parenchymal and non‐parenchymal cells stratified to MASH disease activity. Total IBA1+ macrophage count was unaltered with respect to fibrosis stage and zonation of steatosis, while a reduced number of IBA1+CD163high macrophages was observed in patients with more advanced fibrosis (F ≥ 2, p = 0.016), as well as in patients with portal‐predominant steatosis (p = 0.023).
Conclusions: Our preliminary data indicate that paediatric patients with MASH exhibit distinct intrahepatic macrophage landscapes suggesting differing scavenging capacity. This observation may provide new insights into portal‐predominant disease activity.
Contact e‐mail address: christian.hudert@charite.de
H‐EV036. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV036.1. IS SERUM MATRIX METALLOPROTEINASE 7 A RELIABLE MARKER FOR DIAGNOSING BILIARY ATRESIA?
Fereshteh Karbasian 1, Seyed Mohsen Dehghani2, Maryam Ataollahi3
1Ali‐asghar children's hospital/Iran university of medical sciences, Tehran, Iran, 2Shiraz Transplant Center, Abu‐Ali Sina Hospital, Shiraz University of Medical Sciences, tehran, Iran, 3Shiraz Transplant Center, Abu‐Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
Objectives and Study: Researchers believe that matrix metalloproteinase 7 (MMP7) could be a useful tool for diagnosing biliary atresia (BA). This study focused on evaluating how accurately serum MMP7 can diagnose biliary atresia (BA) in people from the Middle East.
Methods: In this study researchers looked at newborns and infants with direct hyperbilirubinemia who were admitted to Namazi Referral Hospital in Shiraz Iran. When patients were admitted we collected their basic information medical details and blood samples. The level of MMP7 in the blood was tested using a kit called an enzyme‐linked immunosorbent assay from ZellBio GmbH.
Results: Our study involved 44 infants aged 65.59 days on average.13 cases of cholestasis were caused by BA, and 31 cases were caused by other etiologies.The serum MMP7 concentration was 2.13 ng/mL in the BA group and 1.85 ng/mL in the non‐BA group. There was a significant rise in MMP7 in those presenting with either dark urine or acholic stools.Based on receiver operating characteristic curve analysis, MMP7 had no statistically significant predictive capability in discriminating BA from non‐BA groups (area under curve: 0.6, 95% confidence interval: 0.45–0.75).At the optimal cut point of 1.9, the sensitivity and specificity were 84.6% and 45.1%, respectively. Further combination of MMP7 with gamma‐glutamyltransferase (GGT), alkaline phosphatase, direct and total bilirubin, and dark urine or acholic stool did not markedly increase the diagnostic accuracy of the test. Interestingly, at a cut‐off point of 230 U/L, GGT was 84.6% sensitive and 90.3% specific for BA.
Conclusions: Our results are not consistent with previous studies on this topic. It is recommended to consider more conventional and available tests, such as GGT, in addition to conducting future studies with larger samples and other geographical areas.
Contact e‐mail address: karbasian.md@gmail.com
H‐EV037. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV037.1. ONGOING BILIARY ATRESIA: A DIAGNOSTIC AND THERAPEUTIC CHALLENGE
Natalia Kelaidi 1, Ioannis Georgopoulos1, Emmanouil Kourakis1, Elissaios Kontis2, Lilia Lykopoulou3, Nikolaos Christopoulos1
1Pediatric Surgery, General Pediatric Hospital "Agia Sofia", Athens, Greece, 2General Surgery, General Oncologic Hospital of Piraeus "Metaxa", ATHENS, Greece, 3General Pediatric, General Pediatric Hospital "Agia Sofia", Athens, Greece
Objectives and Study: Biliary atresia (BA) is a rare but serious liver disease in infants, characterized by progressive inflammation and obstruction of the bile ducts. If left untreated, it inevitably leads to cirrhosis and liver failure. Diagnosing BA is particularly challenging due to its overlapping clinical features with other neonatal liver diseases. Timely diagnosis and surgical intervention, via the Kasai portoenterostomy, are critical for improving outcomes and delaying liver transplantation. However, the variability in disease progression, including rare presentations such as slowly progressive or cystic duct BA, complicates its management.
Methods: This report describes a challenging case of a female neonate who presented with cholestasis and fecal hypocholia first weeks of life. Baseline biochemical tests indicated cholestatic syndrome and abdominal ultrasound revealed the triangular cord sign, characteristics of biliary atresia. Operative cholangiography at one month of age did not show definitive obstruction or evidence of BA. Consequently, the surgical team performed a cholecystectomy and liver biopsy but opted not to proceed with the Kasai procedure.
Results: Further investigations over the following weeks excluded other potential diagnoses. Histopathological examination confirmed fibrotic obstruction of the cystic duct. Progressive liver dysfunction, including worsening elastography findings, escalating hyperbilirubinemia and signs of liver failure, prompted a second surgical exploration. During this procedure, biliary atresia was confirmed through direct visualization and operative cholangiography. A Kasai portoenterostomy was successfully performed. Despite the surgery, the infant developed liver cirrhosis and portal hypertension due to insufficient bile drainage and was ultimately referred for liver transplantation.
Conclusions: This case highlights the limitations of intraoperative cholangiography in diagnosing BA, particularly in cases with partial or atypical bile duct patency in ongoing atresia. It underscores the importance of maintaining a high index of clinical suspicion and utilizing complementary diagnostic tools. Early re‐evaluation is crucial when initial findings are inconclusive, to prevent irreversible liver damage and optimize patient outcomes.
Contact e‐mail address: kelaidinatalia@gmail.com
H‐EV038. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV038.1. HEPATITIS C (HCV) AND NEURODEVELOPMENTAL FACTORS AFFECTING TREATMENT IN CHILDREN AND YOUNG PEOPLE (C&YP) REFERRED TO PAEDIATRIC OPERATIONAL DELIVERY NETWORK (PODN) FOR HCV TREATMENT
Carla Lloyd1, Caroline Foster2, Dhamyanthi Thangarajah3, Deirdre Kelly 1,4
1Odn, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom, 2Imperial College Hospital, London, United Kingdom, 3Dept Of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, United Kingdom, 4University of Birmingham, Birmingham, United Kingdom
Objectives and Study: Chronic HCV infection is asymptomatic in C&YP. There has been little focus on neurodevelopmental data for CY&P living with HCV, who face exposure to both maternal infective & systemic inflammation in utero and to HCV & immune activation throughout the critical period of infant brain growth in the first 2 years of life with an increased risk of neurocognitive disorders in childhood. Infants born to women living with HCV are more likely to experience in utero substance use exposure, with potential for neurocognitive sequaelae associated with neonatal abstinence (NA) and foetal alcohol syndrome (FAS). This study compares treatment outcomes in C&YP, those who have no documented neurodevelopment issues (Group 1 ‐ NNI) against those with issues (Group 2‐NI) approved for HCV treatment
Methods: Treatment outcome review of C&YP referrals to pODN between 04/21 to 10/24 Data compared: •Clinical & demographic data; •Neurocognitive issues •Adherence; •DAA formulation; •Outcomes
Results: 143 HCV+ve were C&YP referred for HCV treatment Group 1 n = 113 (79%); Group 2 n = 30.(21%) There were no signfiicant differences in genotype; age; gender; ethnicity; transmission and DAA treatment Neurodevelopmental issues were reported in 30 C&YP, some reporting more than one NI; FAS (7); NA (6); Autistic spectrum disorder (12); Attention Hyperactivity Deficiency (9); Developmental delay (4); Behavioural difficulties (8) Treatment outcomes: Treatment refusals: Group 1: 2/113 (2%) v Group 2: 5/30 (17%) C&YP requiring more support from play specialists & therapists to facilitate taking treatment
Conclusions: Neurocognitive issues were reported in 21% pf C&YP compared to estimated rates of 2.5‐4% in the general UK school aged population. Children with NI exhibited more difficultyand refusals taking medication. The potential role of maternal‐infant HCV infection on neurocognitive outcomes requires elucidation for optimal timing of HCV therapy and to determine the risk benefit of maternal HCV clearance in pregnancy.
Contact e‐mail address: carla.lloyd1@nhs.net
H‐EV039. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV039.1. UTILITY OF NGS IN CHILDREN WITH UNCONJUGATED HYPERBILIRUBINEMIA
Hyun Jin Kim
Chungnam national university hospital, Daejeon, Korea, Republic of
Objectives and Study: Hyperbilirubinemia is the elevation of total serum bilirubin and severe elevation can cause neurologic complication. Next‐generation sequencing (NGS) is an effective tool for genomic screening and is widely used for the molecular diagnosis of pediatric diseases. This study aimed to evaluate clinical characteristics, utility of NGS, and prognosis of hyperbilirubinemia in children.
Methods: We retrospectively analyzed the medical records of patients aged <18 years who had unconjugated hyperbilirubinemia more than 3 moths between January 2015 and November 2024. Hyperbilirubinemia was defined as total bilirubin level exceeding 1.5 mg/dL. DNA was isolated from blood samples and panel‐based NGS of 98 genes was performed on each patient.
Results: Among 98 patients, NGS was performed in 30 (30.6%) patients and 12 (40%) patients were identified with pathogenic variants. Gilbert syndrome was most common (20%) and quite large patients were confirmed as hereditary spherocytosis (16.7%). One patients (3.3%) was diagnosed as rotar syndrome. Among patients with hematological disorder, only one patients showed elevated reticulocyte and anemia was not noted in all patients. The normalization of hyperbilirubinemia was observed in 34 (34.7%) patients with the median period of 6.6 months. Thirty‐five patients (35.7%) showed persistent unconjugated hyperbilirubinemia more than 1 year and severe hyperbilirubinemia (>5 mg/dL) was not observed in maximum follow‐up period. In multivariate analysis, peak bilirubin (OR, 1.65; 95% confidence interval: 0.087‐2.895) was significant factors related to abnormal NGS.
Conclusions: High diagnosis rate was obtained through NGS in hyperbilirubinemia and it can be used effectively. Also, we consider hemolytic disease as cause of unconjugated hyperbilirubinemia even if there is no anemia.
Contact e‐mail address:
H‐EV040. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV040.1. ERCP IN INFANTS
Jochen Kittel 1, Thomas Lang2, Dominic Brookman‐ Amissah2, Simone Hofmann3, Michael Melter1
1KUNO Kliniken Regensburg, Regensburg, Germany, 2Praxis Parsberg, Parsberg, Germany, 3BB Regensburg, Regensburg, Germany
Objectives and Study: ERCP in children over 3 years of age is a common procedure for the detection and treatment of congenital or acquired biliopancreatic diseases. For neonates/infants under 3 months of age, ERCP is a complex and challenging technique for the diagnosis or treatment of rare, mostly congenital diseases. Until today, there are insufficient data on diagnostic yield, therapeutic outcome and especially safety of ERCP in infants under 3 months of age.
Methods: We conducted from January 2019 to October 2024 81 ERCPs in 103 children. With a retrospective analysis we looked for indications, the diagnostic and therapeutic outcome. The rate of adverse events during and after the procedures were evaluated.
Results: Over a course of five years a total of 81 consecutive children underwent 113 ERCPs (mean age 32 months, median 2 months, 46% girls). 44 children (58%) were younger than 3 months, 29 children (29%) were between 3 months and 6 years and 8 children (13%) were older than 6 years. ERCPs in infants younger than 3 months were mainly carried out to congenital diseases such as biliary atresia or biliary hypoplasia. The question of biliary atresia accounted in 39 patients (90%) for the largest proportion of ERCP indications. In 13 infants, the ERCP was false positive with regard to biliary atresia and bile ducts were found intraoperatively after all. In children and adolescents, ERCP was mainly due to congenital and acquired diseases (gallstones, hereditary pancreatitis). Complications occurred in 9 cases (7.9 %): 2 pancreatitis after ERCP, 6 mild cholangitis, 1 endotracheal re‐intubation due to respiratory insufficiency after the procedure.
Conclusions: In our retrospective cohort study, pediatric ERCP is a feasible, effective and safe procedure, even in infants under 3 months of age.
Contact e‐mail address: jochen.kittel@barmherzige-regensburg.de
H‐EV041. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV041.1. LONG‐TERM FOLLOW‐UP OF PATIENTS AFFLICTED WITH GIANT CELL HEPATITIS ASSOCIATED WITH HEMOLYTIC ANEMIA‐ A SINGLE CENTER EXPERIENCE
Maja Klaudel‐Dreszler, Agnieszka Bakuła, Piotr Socha
Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
Objectives and Study: Giant cell hepatitis with autoimmune hemolytic anemia (GCH + AIHA) comprise a rare disease of children under 4 years of age. In most children conventional immunosuppressive treatment does not cause sustained remission. In such cases anti‐CD20 monoclonal antibody (Rituximab) should be considered. The aim of the study was to present the long‐term efficacy of Rituximab in such patients.
Methods: We present 6 girls and 5 boys with GCH + AIHA treated with Rituximab between 2006‐2024.
Results: Median age at disease onset was 8,9 months (range 2‐16 mo). The follow‐up lasted over 11 years in 5 patients, over 4 years in 4 children and 6 months in one. All children had positive direct Coombs’ test and giant cell transformation of hepatocytes confirmed by liver biopsy. 5 patients developed acute liver failure. All children received RTX due to ineffectiveness of steroids and azathioprine (AZA), in some cases also Cyclosporine, immunoglobulins (IVIg) or MMF. After 4 doses of RTX 8 patients achieved sustained remission of both anemia and hepatitis, 3 children required additional 1 or 2 doses of RTX. Aminotransferases normalized after 2‐8 months. In 8 children anemia resolved earlier than hepatitis, but in 2 we observed recurrence of AIHA, even 5 years later. Nobody has experienced the recurrence of GCH. RTX was followed by steroids in all cases, 8 children received also AZA or Cyclosporine. All patients experienced hypogammaglobulinemia caused by RTX, lasting for 8 months to 11 years. Despite IVIg 3 children developed severe infections including pneumocystosis; 3 suspected of primary immunodeficiency underwent genetic diagnostics. Finally, 10 children are free of symptoms; one died 2 months after RTX treatment due to acute respiratory insufficiency which could be caused by Rituximab‐associated lung injury (RALI).
Conclusions: In children affected with GCH with AIHA implementing RTX leads to sustained remission. Long‐lasting hypogammaglobulinemia after RTX treatment may suggest inborn error of immunity.
Contact e‐mail address: m.klaudel-dreszler@ipczd.pl
H‐EV042. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV042.1. LIVER TRAUMA IN CHILDREN –5‐YEAR‐EXPERIENCE OF A BULGARIAN REFFERAL CENTRE
Denitza Kofinova 1, Ivan Vasilevski2, Viliana Nansenova1, Zlatka Pesheva1, Milena Klingova1, Yanko Pahnev1, Stefan Stoilov1, Edmond Rangelov1, Nikolay Valchev1, Plamena Hristova3, Bogdan Mladenov3, Hristo Shivachev1, Petia Moutaftchieva1
1Pediatric Surgery, UMHATEM "N. I. Pirogov", Sofia, Bulgaria, 2Pediatric Surgery, UMHATEM “N. I. Pirogov”, Sofia, Bulgaria, 3Pediatric Intensive Care Unit, UMHATEM “N. I. Pirogov”, Sofia, Bulgaria
Objectives and Study: Blunt abdominal trauma is one of the leading causes for mortality due to trauma in children. Pediatric patients are prone to trauma because of their comparatively smaller body surface, larger visceral organs, less visceral fat and thin abdominal wall. Symptoms are unspecific and can be misleading. The objective of this study is to evaluate epidemiological, clinical features and outcome in Bulgarian pediatric patients with blunt abdominal liver trauma.
Methods: We present a retrospective review of the medical records of all patients treated for blunt abdominal liver trauma in our department for the period from January 2019 to October 2024.
Results: In total 285 medical records of hospitalized children with blunt abdominal trauma were evaluated. Seventeen (5.96%) children had liver trauma diagnosed by ultrasound and CT. The median age was 8 years (range: 1‐17 years). Seven (41.2%) were boys and ten (58.8%) were girls. The average number of patients with blunt abdominal trauma was 3.4 per year. Four children (23.52%) had bone fractures, four children (23.52%) had lung injury and two (11.7%) had combined trauma. All patients had abdominal pain, 3 ‐ nausea, 3 ‐ vomiting, 1 patient was febrile and 2 were unconscious. The most common mechanism of trauma was transport accidents in 70.6% (n = 12), falls in 29.4% (n = 5). Liver enzymes were elevated in all cases. In 10 cases (58.8%) involvement of two or more segments was found. Distribution by segments involved was: 8 children in 7th segment, 6 – in 6th, 5 – in 8th, 2 – in 4th and 5th and 1 in 3rd. Eleven (64.7%) children were treated conservatively. There was one fatal outcome. The average length of hospital stay for the conservatively treated patients was 7.9 days, and of the patients who underwent surgery ‐ 15 days.
Conclusions: Approximately 2/3 of patients with pediatric liver trauma can be treated conservatively.
Contact e‐mail address:
H‐EV043. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV043.1. ALAGILLE SYNDROME: A COMPREHENSIVE ANALYSIS OF CASES DIAGNOSED AND MANAGED OVER A DECADE AT A SINGLE CENTER
Aco Kostovski, Nikolina Zdraveska
Faculty of Medicine, University Ss Cyril and Methodius, Skopje, North Macedonia, Skopje, North Macedonia
Objectives and Study: Alagille Syndrome (ALGS) is a rare genetic multisystem disorder, with an incidence of 1 in 30,000 to 50,000 live births. It affects multiple organs, including the liver, heart, eyes, and bones, and is caused by mutations or deletions in the Jagged 1 gene, a key component of the Notch signaling pathway. Patients often experience refractory pruritus and progressive cholestatic liver disease, which may necessitate liver transplantation. The burdens of cholestatic pruritus and xanthomas significantly impair the quality of life. A new therapeutic option involving an ileal bile acid transport (IBAT) inhibitor has emerged to delay the progression of cholestatic liver disease potentially.
Methods: The study includes all cases of Alagille Syndrome (ALGS) that were diagnosed and followed at the University Children's Hospital in Skopje over the last ten years. Comprehensive analyses—encompassing clinical, biochemical, histological, and molecular evaluations—were conducted, along with an assessment of management approaches and clinical outcomes.
Results: Eight children diagnosed with Alagille syndrome (ALGS) were included in this study. The clinical presentation varied, ranging from subclinical symptoms and mild cholestasis (three patients managed symptomatically) to severe liver failure that necessitated liver transplantation. Recently, one patient with ALGS was started on an IBAT inhibitor, Maralixibat. After a 6‐month follow‐up, this patient showed notable improvements, including reduced pruritus and lower serum bile acid concentrations.
Conclusions: The availability of IBAT inhibitors for cholestatic liver disease marks a new era in the treatment of ALGS, potentially reducing the need for liver transplantation and enhancing the quality of life.
Contact e‐mail address:
H‐EV044. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV044.1. EPIDEMIOLOGICAL INSIGHTS AND CLINICAL IMPLICATIONS OF VIRAL HEPATITIS A IN PEDIATRIC DEPARTMENT OF UNIVERSITY HOSPITAL CENTER IN MARRAKESH
Mariam Lagrine 1,2, Rabiy Elquadiry2, Houda Nassih2, Aicha Bourrahouat2, Imane Aitsab2
1Gastrology And Hepatology Pediatric, University Hospital center of Marrakech, Marrakesh, Morocco, 2Child Health and developement Research Unit, CAdi Ayyad University Hospital, Marrakesh, Marrakesh, Morocco
Objectives and Study: ‐Objective : Evaluating the prevalence, socio‐economic factors associated with HAV in children presenting with febrile jaundice ‐ Study : A descriptive study conducted
Methods: Study Design: Retrospective descriptive study, During the period from December 2020 to January 2024 Study Population: 98 cases of acute onset febrile jaundice were recruited to with 77 cases were diagnosis as Hepatitis viral A Data Collected: Age at admission, family history of liver disease and similar case, socio economic level,clinical symptoms, severity of the hepatitis, and clinical features at admission. Data Analysis: Information was analyzed using Microsoft Excel.
Results: : 98 cases of acute onset febrile jaundice were recruited to. The average age was 6.75 years, with extremes from 18 months to 12 years. Among the 98 cases admitted for febrile jaundice, we identified: 77 cases had HVA. During the collection, the frequency of HVA was comparable for all months of the year, with a slight increase during the months of July, August and October. The majority of cases (53%) belonged to a low socioeconomic level, the children were in 60% of cases of urban origin. Most cases (90%) had a source of drinking water in their homes. Cases of jaundice were noted in the entourage of 18 children (25%). 04 children had a similar case at school and 14 cases had contagion in their families. Severe acute hepatitis was the most common form in 42 cases, followed by fulminant hepatitis in 33 cases. The progression to death was 34% in 2 cases. None of our children have benefited from a vaccination against HAV.
Conclusions: The study highlights the high prevalence of HAV among children with febrile jaundice, indicating its endemic nature in Marrakech. The findings underscore the need for improved vaccination coverage, public health education, and surveillance strategies to mitigate the disease's impact
Contact e‐mail address:
H‐EV045. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV045.1. COMBINATION OF SURGICAL BILIARY DIVERSION AND IBAT INHIBITION CAN TREAT CHOLESTASIS AND PRURITUS IN PFIC1 AND PFIC2 PATIENTS WHO PROVED UNRESPONSIVE TO EITHER TREATMENT ALONE
Willem Lexmond 1, Frank Bodewes1, Jan Hulscher2, Henkjan Verkade1
1Division Of Pediatric Gastroenterology And Hepatology, Department Of Pediatrics, University Medical Center Groningen, Groningen, Netherlands, 2Division Of Pediatric Surgery, Department Of Surgery, University Medical Center Groningen, Groningen, Netherlands
Objectives and Study: In approximately 40% of patients with FIC1 deficiency (PFIC1) or BSEP deficiency (PFIC2), cholestasis and pruritus can be alleviated by either partial external biliary diversion (PEBD) or intestinal bile acid transporter inhibitors (IBATi). While surgical and pharmacological diversion both interrupt the enterohepatic circulation of bile acids, it is unknown if combining both therapies increases therapeutic efficacy. We recently demonstrated that IBATi in PFIC2 patients increase the intestinal reabsorption of unconjugated bile acids (Gastroenterology 2023; 165:496‐98). Since PEBD prevents reabsorption, we hypothesized that surgical diversion could add efficacy to treatment with IBATi alone.
Methods: We combined IBATi and PEBD in three PFIC patients (ages 3‐14) with persistently elevated bile acids and pruritus after long‐term treatment with either IBATi (N = 2) or PEBD (N = 1) alone.
Results: Patient A (PFIC1) received IBATi for more than two years without improvement. Within days of his PEBD (while continuing IBATi), he became itch‐free with normal bile acid levels for a follow‐up of now six months. Patient B (PFIC1) had been symptom‐free for over a decade after PEBD, but was evaluated for liver transplantation upon recurrence of invalidating pruritus for two years. Within three months after co‐treatment with IBATi, his itch had disappeared and bile acid levels had normalized. Patient C (PFIC2) received IBATi for more than three years with no effect. PEBD in combination with IBATi has changed the disease to an episodic course, characterized by prolonged periods (8‐10 months) of complete biochemical and symptom resolution interspersed with periods of cholestasis triggered by viral infection.
Conclusions: We show proof‐of‐principle that the combination of pharmacological and surgical interruption of the enterohepatic circulation can effectively treat cholestasis and pruritus in patients with FIC1 or BSEP deficiency who proved unresponsive to either therapy alone. We believe combination therapy should be considered before committing these patients to liver transplantation.
Contact e‐mail address: w.s.lexmond@umcg.nl
H‐EV046. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV046.1. UNCONJUGATED BILIRUBIN CAN ADD COLOR TO ACHOLIC STOOLS IN BILIARY ATRESIA PATIENTS DURING THE FIRST WEEK OF LIFE AND DELAY DIAGNOSIS: A NOVEL HYPOTHESIS
Willem Lexmond, Henkjan Verkade
Division Of Pediatric Gastroenterology And Hepatology, Department Of Pediatrics, University Medical Center Groningen, Groningen, Netherlands
Objectives and Study: For infants with biliary atresia, optimal outcome hinges upon early detection of jaundice and acholic stools. To this end, stool color charts are increasingly implemented as screening tools within national healthcare systems. Nevertheless, most pediatric hepatologists will acknowledge that the interpretation of stool color may prove challenging and that the distinction between color 3 (abnormal) and 4 (normal) can sometimes be difficult to make with certainty. Moreover, parents of patients with biliary atresia may recall that the stools of their child seemed yellow initially, and only gradually lost color. Are these memories false? Multiple lines of evidence now indicate that complete obstruction of the biliary tree is already present in utero. Why, then, does it prove so difficult to detect these acholic stools in daily practice?
Methods: Here we present a novel hypothesis to explain this phenomenon and point out a caveat in the interpretation of the stool color chart for suspected biliary atresia.
Results: Physiological jaundice of the newborn results from accumulation of unconjugated bilirubin due to hemolysis of fetal erythrocytes and immaturity of hepatic conjugation. In contrast to conjugated bilirubin, unconjugated bilirubin is lipophilic and therefore diffuses readily across the lipid bilayer of cell membranes in a concentration‐dependent manner. The intestinal tract provides a large surface across which transport of unconjugated bilirubin can occur from the blood into the intestinal lumen, as demonstrated by early experiments with radioactive tracers in animals and humans with congenital hyperbilirubinemia (Schmid and Hammaker, 1963). In patients with biliary atresia, jaundice will initially be caused by unconjugated rather than conjugated hyperbilirubinemia, thus allowing for passive transport of bilirubin pigment into the intestinal lumen and, ultimately, the stool (Figure).
Conclusions: In biliary atresia patients, unconjugated bilirubin adds pigment to otherwise acholic stool, which affects read‐out of the stool color chart and therefore may delay diagnosis.
Contact e‐mail address: w.s.lexmond@umcg.nl
H‐EV047. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV047.1. BILE ACID PROFILES IN PEDIATRIC GASTROINTESTINAL, HEPATIC AND BILIARY DISEASES AND REFERENCE INTERVALS
Katja Linz, Felix Wachter, Merle Claßen, Alexander Schnell, Henriette Mandelbaum, André Hoerning, Joachim Woelfle, Jakob Zierk, Ferdinand Knieling, Manfred Rauh, Adrian Regensburger
University Hospital Erlangen, Erlangen, Germany
Objectives and Study: Bile acids (BA) are key drivers and prognostic biomarkers for hepatic disorders. The breakdown of bile acid profiles will add even more insights into pathophysiological processes in specific diseases. In this work we present reference values and indicatives values for gastrointestinal, hepatic and biliary pediatric diseases.
Methods: Routine assessed bile acid profiles from in‐ and outpatients of a tertiary care center for children and adolescents collected from October 2014 to April 2024 were analyzed. Bile acid profiles consists of 15 components. First, reference values for six age groups were calculated. Secondly, bile acid profiles for different diagnosis from gastrointestinal, hepatic and biliary diseases were analyzed.
Results: A total of 1906 bile acid profiles from 524 patients were analyzed, including 1341 profiles from 167 patients with gastrointestinal diseases, 220 profiles from 143 patients with hepatic diseases, and 269 profiles from 159 patients with biliary diseases. Standard values for total primary bile acids were found to be higher in younger compared to older children, with a notable increase in secondary BA with age. In gastrointestinal disease BA profiles were relatively normal, whereas significant alterations were observed in those with hepatic and biliary diseases. Characteristic changes included an increased ratio of primary bile acids compared to secondary bile acids compared to the control group, a reduced proportion of unconjugated bile acids in hepatic and biliary diseases and increased glycine to taurine conjugation ratio compared to gastrointestinal diseases.
Conclusions: We provide BA profile reference values for different pediatric age groups and an overview of altered BA profiles in different gastrointestinal, hepatic and biliary diseases. This work could serve as a framework for future studies in the field. Our findings emphasize the potential of bile acid profiling as a diagnostic tool in differentiating between various diseases states.
Contact e‐mail address:
H‐EV048. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV048.1. FAMILIAL HYPOBETALIPOPROTEINEMIA IN PEDIATRIC PATIENTS WITH FATTY LIVER‐ AN UNDERRECOGNIZED CAUSE?
Nurit Loberman Nachum 1,2, Eyal Shteyer3,4, Hofit Cohen1,5, Odelia Chorin1,6, Maya Granot1,2, Batia Weiss1,2
1School Of Medicine, The Faculty Of Medical And Health Sciences, Tel Aviv university, Tel Aviv, Israel, 2Division Of Pediatric Gastroenterology And Nutrition, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel‐Hashomer, Ramat Gan, Israel, 3Institute Of Gastroenterology, Nutrition And Liver Diseases, Shaare Zedek Medical Center, Jerusalem, Israel, 4The Faculty Of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel, 5Strassburger Lipid Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel, 6. The Danek Gertner Institute Of Human Genetics, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
Objectives and Study: Nonalcoholic fatty liver disease (NAFLD) in the absence of obesity and with low cholesterol levels may be associated with Familial Hypobetalipoproteinemia (FHBL). FHBL results from mutations in genes involved in lipoprotein assembly and secretion from the liver, leading to hepatic lipid accumulation, steatosis, and potential progression to fibrosis, cirrhosis, and hepatocellular carcinoma. The heterozygous form of FHBL is estimated to have a frequency of 1:1,000 to 1: 3,000. This study aims to present a case series of pediatric patients diagnosed with FHBL who presented with fatty liver.
Methods: We conducted a retrospective observational study of seven patients from three families, treated at two different medical centers. Clinical, laboratory, imaging, and genetic data were obtained from the patients' medical records.
Results: Four of the patients were males; the mean age at diagnosis was 15.3 years (range 4‐38 years). All index patients were children/adolescents presenting with fatty liver. The median follow up time was one year (0‐4.75 years). The median AST and ALT levels were 30IU/L (26‐40.75 IU/L) and 32 IU/L (24.5‐74 IU/L) respectively, and the median triglyceride (TG), low‐density lipoprotein (LDL) and Apolipoprotein B (ApoB) levels were 74 mg/dl(62‐125 mg/dl), 55.3 mg/dl (30‐84.5 mg/dl) and 39.5 mg/dl (35.2‐43 mg/dl) respectively. Genetic evaluation revealed a Missense or Stopgain mutation in the MTTP gene, and Nonsense or other mutation in the APOB gene.
Conclusions: FHBL is an important diagnosis to consider in lean patients with fatty liver and can co‐exist with other causes of fatty liver such as obesity. These patients should be long‐term monitored for disease progression to significant liver disease.
Contact e‐mail address:
H‐EV049. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV049.1. PRELIMINAR EXPERIENCE WITH ODEVIXIBAT – SIMILAR PATIENTS WITH DIFFERENT RESPONSES IN PATIENTS WITH PFIC1
Joana Jonet, José Maria Lupi, Sara Nobrega, António Campos, Cristina Campos Goncalves, Isabel Afonso
Paediatric Gastroenterology And Hepatology Unit, Paediatric Hospital Dona Estefânia, Unidade Local de Saúde São José, Lisboa, Portugal
Objectives and Study: Odevixibat (ODX), a selective inhibitor of the ileal bile acid transporter, is approved for the treatment of Progressive Familial Intrahepatic Cholestasis (PFIC) type 11. As a recently approved orphan drug, clinical experience remains limited.
Methods: We present three cases of children diagnosed with PFIC1 treated with ODX. Differences in treatment response were analyzed.
Results: Case 1: An 11‐year‐old girl from a consanguineous family was diagnosed at six months due to prolonged cholestasis with normal GGT and failure to thrive. She was also diagnosed with celiac disease and IgGF1 deficiency. A homozygous c.2854 C>T mutation in ATP8B1 was identified. Case 2: An 8‐year‐old girl was diagnosed at three months due to cholestasis with normal GGT and failure to thrive. Genetic test identified a homozygous c.697 G>A mutation in ATP8B1. Case 3: A 2‐year‐old girl was diagnosed at seven months due to cholestasis with normal GGT and severe malnutrition. Genetic testing revealed a homozygous c.697 G>A mutation in ATP8B1. Associated diagnoses included congenital heart disease and urogenital malformation. All children experienced refractory jaundice and pruritus with chronic lichenification lesions, unresponsive to ursodeoxycholic acid, cholestyramine, rifampicin, and hydroxyzine. ODX at 40 µg/kg/day was initiated. Cases 1 and 3 showed significant clinical improvement, including reduction in total and conjugated bilirubin levels (case 1: 18,1‐7,2 mg/dL; 11,6‐5,4 mg/dL,; case 3: 6,79‐2,49 mg/dL; 5,32‐1,85 mg/dL) and significant alleviation of pruritus. Case 2 showed no improvement in pruritus or total and conjugated bilirubin levels (6,33‐5,9 mg/dL; 4,6‐4,5 mg/dL). A co‐mutation in the ABCB11 gene was not identified in any case. No adverse effects were reported.
Conclusions: These cases align with the 44% improvement in pruritus and serum bilirubin levels reported in phase 3 study2. However, the dichotomous response to ODX observed in this small series underscore the need for further investigation.
Contact e‐mail address: joanajonet@gmail.com
H‐EV050. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV050.1. PEDIATRIC EXTRAHEPATIC PORTAL VEIN OBSTRUCTION: A 15‐YEAR RETROSPECTIVE ANALYSIS OF ETIOLOGY, MANAGEMENT AND OUTCOMES
José Maria Lupi, Joana Jonet, Filomena Cardosa, Sofia Bota, Sara Nobrega, Cristina Campos Goncalves, Isabel Afonso
Paediatric Gastroenterology And Hepatology Unit, Paediatric Hospital Dona Estefânia, Unidade Local de Saúde São José, Lisboa, Portugal
Objectives and Study: Introduction: Extrahepatic portal vein hypertension (EHPVO) is the leading cause of non‐cirrhotic portal hypertension in children, with distinct etiologies and management compared to adults. Objectives: Retrospective, descriptive revision of the pediatric EHPVO cases over 15 years at a pediatric central hospital.
Methods: Data was collected from medical records. Descriptive statistics was performed.
Results: Fifteen cases of EHPVO were identified: 8 boys; 7 girls, average age of 3 years at symptom onset and 5 years at diagnosis. Risk factors for EHPVO were identified in 12 patients: prematurity (9/15), umbilical vein catheterization (8/15) and neonatal sepsis (7/15). Deficits of protein C/S) were also common (3/15). Common presenting features were splenomegaly (12/15), cytopenias (11/15) and gastrointestinal bleeding (6/15). Diagnosis was confirmed by Doppler ultrasound in all cases with additional imaging (MRI, CT‐Angiography or Portography) in 12/15 patients. Upper gastrointestinal bleeding (UGIB) occurred in 7/15 patients, 3 at presentation. Upper endoscopy showed esophageal varices in 11/13 patients (median grade 3/3, 7/11 with red spots) and gastric varices in 7/13 cases. Management included beta‐blockers (7/15, 5 as secondary prophylaxis) and endoscopic ligation (4patients), with no UGIB recurrence post‐treatment. Rex recessus patency was observed in 4/11 patients and 3 underwent Mesorex bypass surgery. 1 achieved full recovery, 1 required shunt dilation with subsequent recovery and 1 experienced shunt thrombosis. Two patients underwent transjugular intrahepatic portosystemic shunt (TIPS) assisted with trans‐splenic access. One achieved complete variceal regression and the other required shunt dilation duo to persistent grade 3 varices. Two deaths occured: one due to hemoperitoneum, the other from respiratory and gastrointestinal tract bleeding of unknown origin. One patient experienced spontaneous EHPVO recanalization.
Conclusions: In pediatric EHPVO, neonatal factors are key etiological contributors. Definitive treatment includes anatomic resolution via Mesorex or, when unfeasible, TIPS/liver transplant. Meanwhile, beta‐blockers and/or endoscopic ligation proved effective in preventing UGIB recurrence.
Contact e‐mail address: jlupi@hevora.min-saude.pt
H‐EV051. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV051.1. CASE REPORT: ACUTE LIVER FAILURE FOLLOWING EXERCISE RELATED HEAT ILLNESS IN A BRITISH TEENAGER
Judwin Ndzo1, Siddharth Mahesh 2, Isaque Qureshi3, Sarah Heap2, Chayarani Kelgeri2
1Liver Unit, Birrmingham Children's Hospital, Birmingham, United Kingdom, 2Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom, 3Paediatrics, Nottingham University Hospital, Nottingham, United Kingdom
Objectives and Study: Exercise‐related heat illness (EHI) is uncommon in temperate regions. We report a case of EHI in a 15‐year‐old male who developed acute liver failure (ALF), acute kidney injury (AKI), and muscle injury after an hour of jogging on a warm, humid day (23°C, 55% humidity, 6 miles per hour wind).
Methods: A passerby finding him hot, doused him with water, and moved him to shade. Paramedics on arrival found him delirious and recorded a tympanic temperature of 39.1°C. He was intubated for transfer but extubated shortly after hospital arrival. Blood tests showed AKI and elevated troponins. Head imaging and toxicology were unremarkable.
Results: Repeat blood tests 48 hours later revealed ALF with an INR of 3.1 after parental Vitamin K, high bilirubin, liver enzymes, urea, creatinine, creatine kinase, and ammonia (350 mmol/l), indicating multiorgan injury. N‐acetylcysteine (NAC) infusion was started, and he was transferred to a specialized liver centre at 76 hours, where blood tests were still deranged but a normal ammonia was recorded (76 mmol/l). Genetic testing for malignant hyperthermia was negative. He subsequently made an uneventful recovery. Figure 1: Liver biochemical tests during course of illness Left axis: AST, ALT Right axis: INR, TB:Total serum bilirubin, DB:Direct bilirubin, NH3, CK: Creatinine Kinase
Conclusions: This case highlights the importance of early recognition, cooling, and blood test monitoring, as severe organ damage may not be evident initially. Ammonia levels can be inaccurately high when liver transaminases are elevated, especially with wet enzymatic assays. Ammonia testing in cases of elevated transaminases should include adequate sample blanking correction or use of dry chemistry method for accurate results to avoid unnecessary hemofiltration. The World Health Organization recommends NAC for heat stroke‐induced ALF. Genetic testing can help identify high risk individuals. Heat acclimatization and personalized prevention plans are essential to manage EHI risk, especially in the context of climate change.
Contact e‐mail address: judwin.ndzo@nhs.net
H‐EV052. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV052.1. ONASEMNOGENE ABEPARVOVEC (ZOLGENSMA) ASSOCIATED ACUTE LIVER FAILURE‐CHALLENGES FACED BY PEDIATRIC HEPATOLOGIST
Arjun Maria 1, Ratna Puri2, Sunita Bijarnia2, Anil Sachdev3, Nishant Wadhwa1
1Pediatric Gastroenterology, Sir Ganga Ram Hospital New Delhi, New Delhi, India, 2Medical Genetics, Sir Ganga Ram Hospital New Delhi, New Delhi, India, 3Pediatric Intensive Care, Sir Ganga Ram Hospital New Delhi, New Delhi, India
Objectives and Study: To describe a fatal case of acute liver failure associated with adeno virus associated vector therapy (zolgensma)
Methods: Description of zolgensma associated fatal ALF. This is the third case reported worldwide
Results: Male with spinal muscular atrophy type 1 received zolgesma at 21 months, weight 10 kg. He was on prednisolone at 1 mg/kg from day 1 of therapy. AST/ALT were monitored and 35 days post therapy AST/ALT increased to 1127/966 (IU/L). Other causes of hepatitis were ruled out and prednisolone dose was hiked to 2 mg/kg. Increasing trend of AST/ALT (2287/1398) continued with increase in INR to 1.96, thus, inj methyl prednisolone was started at 10 mg/kg. Following this AST/ALT showed improvement, however INR and ammonia continued to worsen.He was started on Tacrolimus and MPS dose was hiked to 30 mg/kg. INR continued to worsen and subsequently became unrecordably high with PT > 320 seconds with development of ascites and pleural effusion. Sirolimus was initiated, following which INR improved to 4.18. However, he developed hypertensive encephalopathy. Doppler showed left renal artery thrombosis and right renal artery partial thrombosis. Cause of arterial thrombosis was attributed to sirolimus, levels of which were found to be 23 ug/l. His CYP3A4/3A5 polymorphism showed that he was a slow metabolizer of sirolimus. Following stoppage of sirolimus and reduction of steroid, INR and bilirubin again showed a increasing trend, for which plasma exchange was done. His liver functions gradually stabilized; however he developed ventilator associated pneumonia, lower limb arterial thrombosis with gangrene requiring thrombectomy and expired due to sepsis with shock, 59 days after receiving zolgensma. Post mortem liver biopsy showed regenerative changes with ductular proliferation and pseudoglandular rosettes, with absence of massive hepatic necrosis, suggesting that the liver had recovered
Conclusions: There is lack of appropriate protocol for immunosuppression.High dose immnuosuppression in ALF is fraught with complications
Contact e‐mail address: arjunmaria0@gmail.com
H‐EV053. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV053.1. LYSOSOMAL ACID LIPASE DEFICIENCY: A DECADE OF SLOVENIAN EXPERIENCE IN SCREENING, DIAGNOSIS AND INSIGHTS INTO COHORT CHARACTERISTICS
Gaja Markovič 1, Jernej Brecelj1,2, Urh Grošelj2,3, Matej Mlinarič3, Anja Praprotnik Novak1
1Department Of Gastroenterology, Hepatology And Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia, 2Department Of Paediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia, 3Department Of Pediatric Endocrinology, Diabetes And Metabolic Diseases, University Children's Hospital Ljubljana, Ljubljana, Slovenia
Objectives and Study: Later onset form of lysosomal acid lipase deficiency (LAL‐D) is often underdiagnosed due to its variable presentation and overlap with familial hypercholesterolemia (FH) and metabolic dysfunction–associated steatotic liver disease, leading to delayed treatment. Patients are mostly asymptomatic with elevated lipids and transaminases. Our objective was to analyze the diagnostic pathways and cohort characteristics of Slovenian patients with later‐onset LAL‐D.
Methods: We retrospectively reviewed medical records of five LAL‐D patients diagnosed at the University Children's Hospital Ljubljana between 2014 and 2024.
Results: In 1995, Slovenia implemented universal FH screening from blood samples at age five, achieving 90% participation. Genetic testing for FH began in 2011, and an expanded dyslipidemia gene panel, including the LIPA gene for LAL‐D, was introduced in 2018 using next‐generation sequencing (NGS). Before 2018, LAL‐D patients were primarily identified through FH screening. Two were detected due to elevated cholesterol, and one through family cascade testing. All were asymptomatic, with normal BMI, but elevated total cholesterol, LDL, and transaminases. Diagnosis was confirmed using Sanger sequencing, leading to an average diagnostic delay of 3.3 years. The fourth patient referred for elevated transaminases and chronic diarrhea, was diagnosed using the NGS panel by a pediatric gastroenterologist, reducing diagnostic delay to 1.1 years. Genetic testing also confirmed the diagnosis in his brother. All patients had hepatomegaly due to fatty liver and reduced LAL enzyme activity. Genetic analysis identified the same pathogenic variant in all five patients. Sebelipase alpha treatment, initiated in three patients, improved cholesterol, transaminase levels, and liver steatosis.
Conclusions: LAL‐D should be considered in children with elevated transaminases and abnormal lipid profiles. Slovenia's successful FH screening program helped diagnose three presymptomatic patients with LAL‐D. Two additional patients were diagnosed outside the screening program, but by promptly using its NGS dyslipidemia gene panel, we significantly reduced diagnostic delays, enabling earlier treatment and improved outcomes.
Contact e‐mail address: anja.praprotnik.novak@kclj.si
H‐EV054. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV054.1. MUTATION IN THE SCRIBBLE GENE IN A CASE OF CHOLESTASIS: A CASE REPORT
Rosanna Masturzo 1, Carmen Campanile2, Melissa Iandolo2, Annalaura Milano2, Olga Lausi2, Annamaria Compagnone2, Annalisa Morelli2, Grazia Massa2, Rossella Colantuono3, Angelo Colucci2, Claudia Mandato2,3
1Department Of Medicine, Surgery And Dentistry "scuola Medica Salernitana", Pediatrics Section, University of Salerno, Baronissi (sa), Italy, 2Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, Baronissi (SA), Italy, 3Pediatric Unit, University Hospital S.Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
Objectives and Study: Neonatal cholestasis is a frequent condition with various underlying causes, including obstructive, infectious, metabolic, genetic or unknown. Recent improvements in next‐generation sequencing are a powerful tool for diagnosing the molecular causes of cholestatic liver diseases.
Methods: We present the case of a male infant with prolonged cholestasis. Born by twin cesarean section at 35 weeks of gestation, the infant had an uncomplicated clinical course until when he was twenty‐two days old when he showed jaundice and hypocolic stools. Laboratory tests revealed elevated conjugated bilirubin, γ‐GT, transaminases and serum bile acids. Abdominal ultrasound showed a normal liver size and morphology and no abnormalities in the biliary tract or gallbladder. He started ursodeoxycholic acid therapy with normalization of direct bilirubin levels, but γ‐GT, bile acides and transaminases remained elevated. We excluded all of known cholestasis causes, leading to whole exome sequencing for genetic testing.
Results: Whole exome sequencing identified a heterozygous mutation in the SCRIBBLE gene (c.3910‐2 A > C), classified as pathogenic, and a heterozygous mutation in the PKHD1 gene (c.5125 C>T), with uncertain pathogenicity. Scribble regulates cell polarity and its mutations could cause morphological changes in hepatic cells and contribute to cholangiocyte dysfunction, proliferation, and activation of inflammatory cells and myofibroblasts in the peribiliary area. Mutations in PKHD1 are associated with congenital hepatic fibrosis and previous studies have shown reduced or absent Scribble expression in hepatic tissue of affected individuals.
Conclusions: This case suggests that mutations in Scribble may contribute to the pathogenesis of cholestasis, showing a new involved gene in cholestasis’ diseases. It highlights the potential of whole exome sequencing in uncovering novel genetic causes of neonatal cholestasis, advancing our understanding of its pathogenic mechanisms.
Contact e‐mail address: rosannamasturzo97@gmail.com
H‐EV055. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV055.1. METABOLIC HEPATIC STEATOSIS: COMPARATIVE ANALYSIS OF ABDOMINAL ULTRASONOGRAPHY AND VIBRATION‐CONTROLLED TRANSIENT ELASTOGRAPHY (VCTE) IN PAEDIATRICS
Fernando Medina‐Monroy1, Maria Fernanda Medina 1, Natali Gonzalez2, Jorge Sanchez Plazas3, Michelle Higuera4
1Santander, UGANEP, BUCARAMANGA, Colombia, 2Universidad de Pamplona, Cúcuta, Colombia, 3Hospital Regional de Sogamoso, Sogamoso, Colombia, 4Universidad Nacional de Colombia, Bogota, Colombia
Objectives and Study: This study aimed to compare the effectiveness of abdominal ultrasonography (AUS) and vibration‐controlled transient elastography (VCTE) in evaluating metabolic hepatic steatosis (MHS) in paediatric patients. The analysis focused on identifying correlations between imaging findings and metabolic parameters, such as BMI and biochemical markers
Methods: A prospective, descriptive study was conducted at a paediatric gastroenterology centre in Colombia from February 2023 to October 2024. A total of 117 children with BMI > 30 kg/m² underwent anthropometric evaluations, biochemical testing, AUS, and VCTE using a FibroScan Compact 530. CAP (controlled attenuation parameter) was employed to quantify hepatic fat infiltration and stiffness. At least 10 successful VCTE measurements were required per patient. Statistical analysis was performed using STATA to assess the relationships between variables.
Results: The cohort had a mean age of 12.3 years (range: 3.88–18.33), with 65.79% males. Obesity was present in 53.98%, and 22.12% were diagnosed with NAFLD. The mean BMI was 25.1 kg/m², with 25% exceeding 29.4 kg/m². Biochemical markers showed mean ALT 52 U/L, AST 39 U/L, cholesterol 165 mg/dL, and triglycerides 153 mg/dL. AUS identified hepatomegaly in 33.63% and steatosis in 19.47%. VCTE revealed moderate‐to‐advanced fibrosis in 29.57%, with significant correlations between fibrosis grades and BMI (p < 0.01) and triglyceride levels (p < 0.05).
Conclusions: VCTE demonstrated greater accuracy in detecting hepatic fibrosis and steatosis compared to AUS, underscoring its utility in paediatric MHS evaluation. These findings support the integration of VCTE into diagnostic protocols to enhance early detection and guide multidisciplinary management of metabolic and hepatic abnormalities.
Contact e‐mail address: Famm1962@hotmail.com
H‐EV056. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV056.1. EXTENDED INFUSION ANTIBIOTIC THERAPY IN PATIENTS WITH LIVER DISEASE
Maria Mercadal‐Hally 1, Cristina Padrós1, Mireia Colas2, Simone Mameli1, Natalia Mendoza3, Susana Melendo4, Susana Celemente5, Lis Vidal1, Pere Soler4, Jesus Quintero1
1Paediatric Hepatology And Liver Trasplant Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 2Paediatrics Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 3Pediatric Hepatology And Liver Trasplant Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 4Paediatric Infectious Diseases Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain, 5Pharmacology Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Objectives and Study: Abdominal infections are common complications in patients with chronic liver disease. Treatment failure may occur in some cases due to limited antibiotic penetration in the context of advanced liver fibrosis. The aim of this study is to analyse the clinical experience with extended‐infusion antibiotic therapy in these patients.
Methods: Single‐centre retrospective review from January 2013‐November 2024, including patients aged 0 to 18 years with underlying liver disease or liver transplantation who received extended‐infusion antibiotic therapy.
Results: Thirteen patients were included, 61.5% of whom were female (8/13), with a median age at the time of treatment of 15 months (8–97.5). Biliary atresia was the most common underlying condition, present in 76% of patients (10/13). Twelve patients were treated for cholangitis, and one for an intra‐abdominal collection. Blood cultures were negative in 62% of cases (8/13). Among the positive blood cultures, three grew antibiotic‐resistant bacteria. The primary indication for extended‐infusion antibiotic therapy was a partial response to standard intravenous antibiotics (persistent fever, elevated acute‐phase reactants or other signs of infection). Ten patients presented with bile lakes or bile duct dilatation while one patient had a non‐drainable intra‐abdominal abscess. Meropenem (120 mg/kg/day, every 4‐6 hours, 3‐4 hour infusion) was the most commonly used antibiotic for extended‐infusion (69%, 9/13), typically following non‐extended‐infusion meropenem after initial piperacillin‐tazobactam therapy. The median time from starting antibiotic therapy to extended infusion initiation was 15 days (7–23), with a median duration of extended‐infusion treatment of 20 days (13.5–36.5). Clinical response occurred in 85% (11/13) of patients, 9 of whom continued therapy until liver transplantation. No adverse events were reported.
Conclusions: Extended perfusion antibiotic therapy effectively controlled cholangitis in most of our patients, including as a bridge to liver transplantation, with no adverse events.
Contact e‐mail address: mariamargaret.mercadal@vallhebron.cat
H‐EV057. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV057.1. SERUM CHOLINESTERASE LEVEL IN CHRONIC LIVER DISEASE AND ITS CORRELATION WITH SEVERITY OF THE DISEASE
Rahila Mitu
Department Of Paediatric Gastroenterology And Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
Objectives and Study: To estimate the level of serum cholinesterase in children with chronic liver disease (CLD).
Methods: This cross‐sectional descriptive study was conducted in the Department of Pediatric Gastroenterology and Nutrition at BSMMU, Dhaka. The duration of the study was one year. Total 45 diagnosed cases of CLD in children who fulfilled the inclusion and exclusion criteria were studied. Patients with CLD were classified by Child Pugh score (CP score) according to severity. Finally, the relationship between serum cholinesterase and the severity of CLD was analyzed. Statistical analysis was done using SPSS 26. P value of ≤ 0.05 was considered statistically significant.
Results: According to CP score, 4 patients (8.8%) were in class‐A, 16 patients (35.6%) were in class‐B, and 25 patients (55.6%) were in class‐C. The mean value of cholinesterase was 2703.96 ± 1178.31 U/L. Serum cholinesterase levels in different CP classes were 4018.50 ± 580.375 U/L (Child A), 3231.56 ± 1239.414 U/L (Child B), and 2155.96 ± 869.967 U/L (Child C). There was a substantial positive relationship between serum albumin and cholinesterase, while there was a non‐significant negative correlation between bilirubin and serum cholinesterase. There was no significant relationship between serum cholinesterase and ALT or INR. A negative correlation was found between serum cholinesterase levels and the severity of disease.
| Serum cholinesterase level in patients with CLD in different CP classes | |||
|---|---|---|---|
| n (%) | Serum Cholinesterase (Mean ± SD) | p value | |
| Child A | 4(8.8%) | 4018.50 ± 580.375 | < 0.005 |
| Child B | 16 (35.6%) | 3231.56 ± 1239.414 | < 0.005 |
| Child C | 25(55.6%) | 2155.96 ± 869.967 | < 0.005 |
| Total | 45(100%) | 2703.96 ± 1178.312 | |
Conclusions: Serum cholinesterase levels were low in children with CLD and gradually decreased with increasing severity of liver disease. Thus, serum cholinesterase levels may be used as a liver function test to assess the severity of liver dysfunction in children with CLD.
Contact e‐mail address: dr.rahila.begum@gmail.com
H‐EV058. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV058.1. HEPATOSPLENOMEGALY: SOMETIMES THE ONLY SIGN OF RARE DISEASES IN PEDIATRIC AGE
Melissa Iandolo1, Carmen Campanile2, Rosanna Masturzo2, Giovanni Ferrara2, Rossella Colantuono2, Angelo Colucci2, Annalisa Morelli 2, Annalaura Milano2, Olga Lausi2, Claudia Mandato2,3
1Department Of Medicine, Surgery And Dentistry "scuola Medica Salernitana", Pediatrics Section, University of Salerno, Baronissi (sa), Italy, 2Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, Baronissi (SA), Italy, 3Pediatric Unit, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
Objectives and Study: Hepatosplenomegaly can be the first and only clinical sign of various diseases in children, requiring thorough investigation to diagnose potentially severe (sometimes rare) conditions, such as the mucopolysaccharidosis (MPS) IIIB. In the literature the real incidence of hepatosplenomegaly as the first sign of rare diseases'clue is not known.
Methods: A literature review was conducted, analyzing articles from the past 10 years in PubMed, Scopus and Google Scholar using the keywords "Hepatosplenomegaly" and “Pediatric rare diseases”. The search identified 46 articles on PubMed, 25 on Scopus and 11 on Google Scholar. These studies were categorized into: 17 infectious causes, 27 storage diseases, 17 immune‐related causes, 10 inflammatory diseases and 11 oncohematological conditions. In addition, we reviewed our clinical experience with 16 pediatric patients presenting with hepatosplenomegaly. Of these, 4 had infectious causes, 4 had autoimmune hepatitis and 7 had metabolic disorders. A 14‐month‐old child with gastroenteritis, hepatosplenomegaly, coarse facies and elevated transaminases was diagnosed with MPS IIIB through enzymatic testing and genetic analysis in the preclinical phase, when motor and cognitive delays were not yet present.
Results: The literature of the last 10 years and our experience show how it's important to not understimate hepatosplenomegaly. Early diagnosis is crucial in rare and severe diseases, especially for progressive conditions, where prompt intervention can significantly improve clinical outcomes. In some cases, hepatosplenomegaly is the only sign of these rare conditions.
Conclusions: Clinicians must recognize hepatosplenomegaly as an early sign of serious and rare disease requiring immediate attention.
Contact e‐mail address: iandolomelissa2020@libero.it
H‐EV059. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV059.1. IDENTIFICATION OF CAUSES AND DIAGNOSTIC DIFFICULTY IN MANAGING PAEDIATRIC PANCREATITIS: EXPERIENCE AT A TERTIARY CARE CENTER OF RESOURCE‐CONSTRAINT COUNTRY
Khan Lamia Nahid
Pediatric Gastroenterology And Nutrition, BSMMU, Dhaka, Bangladesh
Objectives and Study: Here, we studied on causes and different diagnostic methods and diagnostic difficulties of pancreatitis in our center.
Methods: This cross‐sectional observational study was conducted in the Pediatric Gastroenterology and Nutrition Department at BSMMU. A total of 101 consecutive patients aged upto 18 years who fulfilled the criteria of pancreatitis were enrolled in this study from June 2016 to July 2019.The data were analyzed with the SPSS for Windows version 23.0.; the p‐value reached from the ANOVA test, and p < 0.05 was considered statistically significant.
Results: During the study period, a total of 101 cases of pancreatitis (42 [41.6%] AP, 26 [25.7%] ARP, and 33 [32.7%] CP) were managed in our department. The mean age of the study population was 10.38 ± 3.7 (range, 4–17) years, with a male to female ratio of 51:50 (1.02:1). The etiology of AP included biliary (9 [21%]: 2 gallstones, 5 choledochal cyst, 2 biliary ascariasis); viral infection (2 [4.8%]:1 Mumps, 1 Hepatitis A); drugs (3 [7.2%]: 2 L‐asparaginase, 1 vincristine); trauma (1 [2.3%]), Hypertriglyceridemia (1 [2.3%]), and idiopathic (26 [61.9%]). Local complications of all pancreatitis cases were acute fluid collections in 5 (4.95%), pseudocysts in 5 (4.95%), and pancreatic ascites in 3 (2.97%) cases. Almost half (11/26) of them had calcific pancreatitis, and the etiology of CP was tropical calcific pancreatitis in 11 (42.3%), SPINK1/PRSS gene mutation in 2 (7.2%). The etiology of ARP was biliary in 6 cases (18%; 1 choledochal cyst, 4 gallstones, 1 biliary ascariasis), Hypertriglyceridemia in 2 (6%), pancreas divisum in 1 (3%), and idiopathic in 24 (72.7%) cases.
Conclusions: Causes of acute pancreatitis were mostly idiopathic followed by biliary abnormality. There was no mortality in hospitalized patients of acute pancreatitis in our study. Half of chronic pancreatitis patients were calcific pancreatitis.
Contact e‐mail address: lamianahid@yahoo.com
H‐EV060. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV060.1. THE BIOCHEMICAL AND NUTRITIONAL EFFECTS OF ODEVIXIBAT IN PATIENTS WITH PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS (PFIC) AND ALAGILLE SYNDROME (ALGS)
Cho Zin Naing 1, Kavitha Jayaprakash2, Palaniswamy Karthikeyan2, Marumbo Paul Mtegha2, Sanjay Rajwal2, Kirsten Tremlett2, Penny North‐Lewis3
1Leeds Children's Hospital, EX, United Kingdom, 2Paediatric Hepatology, Leeds Children's Hospital, Leeds, United Kingdom, 3Paediatric Pharmacist (hepatology), Leeds Children's Hospital, Leeds, United Kingdom
Objectives and Study: This study presents a retrospective analysis of the nutritional and biochemical parameters of six patients diagnosed with PFIC (four) and ALGS (two) who received Odevixibat at a tertiary care centre from May 2022. The PFIC cohort included BSEP (ABCB11) missense mutations, MDR3 deficiency, FIC1 deficiency, and the BSEP (ABCB11) variant.
Methods: The average age of patients in the PFIC group was 4.25 years, 2.5 years in ALGS group. Within the PFIC cohort, one patient with a genetically confirmed BSEP (ABCB11) missense mutation required liver transplantation just 2.5 months after initiating Odevixibat therapy. Additionally, another patient with MDR3 deficiency underwent transplantation 6 months post‐initiation of treatment.
Results: The table below shows the median values for mid‐upper arm circumference (MUAC) taken by the same practitioner, alanine aminotransferase (ALT), gamma‐glutamyl transferase (GGT), and bilirubin levels.
| PFIC | Alagille | ||||
|---|---|---|---|---|---|
| Months | 0 | 6 | 0 | 6 | 12 |
| MUAC | 13.9 | 15.9 | 13.05 | 14.6 | 14.9 |
| ALT (<60iu/L) | 268.5 | 112.5 | 109 | 114 | 107 |
| GGT (<40iu/L) | 31 | 90 | 499 | 704 | 508 |
| Bilirubin(2‐21umol/L) | 51 | 126.5 | 170.5 | 120 | 162 |
| Albumin (30‐40 g/L) | 36 | 27.5 | 31.5 | 29 | 31 |
Conclusions: At 0 months all patients were placed on an MCT source. In the PFIC cohort, nutritional status improved at 6‐months post‐initiation of odevixibat. All carers reported improved quality of life. Subjectively all patients appeared to show improved growth rate compared to patients pre odevixibat era.Two patients required liver transplant before 6 months hence no improvement in biochemical parameters. In the Alagille cohort, nutritional improvements were observed at both the 6‐month and 12‐month evaluation after odevixibat treatment. One child has been listed for liver transplant with improved MUAC. In this cohort, we have identified that biochemical parameters do not necessarily improve after odevixibat, however nutritional status does improve which can be associated with better long‐term outcomes.
Contact e‐mail address:
H‐EV061. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV061.1. CHARACTERISTICS OF A PEDIATRIC COHORT OF PATIENTS WITH WILSON'S DISEASE MONITORED IN A TERTIARY HOSPITAL IN GREECE
Maria Natsiou 1, Afroditi Kourti2, Smaragdi Fessatou2, Ino Kanavaki2
1Gastroenterology, ATTIKON UNIVERSITY HOSPITAL, ATHENS, Greece, 2Department Of Paediatric Gastroenterology, Hepatology And Nutrition, 3rd Department Of Paediatrics, Attikon University General Hospital, Chaidari Attikis, Greece
Objectives and Study: This study focuses on the characteristics of pediatric patients with Wilson's disease monitored at the Pediatric Gastroenterology Unit at a university hospital in Greece.
Methods: We analyzed gender, age at diagnosis, origin, comorbidities, initial disease manifestation, and genetic mutations. We focused on pharmacological treatment, side effects, and the time required for the normalization of 24‐hour urinary copper levels and liver enzymes. Finally, we examined the results of abdominal ultrasound, liver biopsy, DEXA scan, brain MRI, ophthalmological, and neurological evaluations.
Results: Our cohort included 19 children (12 boys, 7 girls), with an average age at diagnosis of 6.79 years (range 3–14). All were permanent residents of Greece (15 natives and 4 from Albania). Comorbidities were present in 6 patients: 3 with dyslipidemia (1 developed obesity), 1 with precocious puberty, and 2 with elevated TSH and PTH levels. The most common initial manifestation was elevated liver enzymes, seen either during routine check‐ups or following viral infections. Three siblings were diagnosed through genetic testing due to family history. Urinary copper normalization occurred in 9 patients, ranging from 12 to 84 months, while hepatic enzyme normalization took 6 to 96 months in 9 patients. Abdominal ultrasound most commonly showed hepatic steatosis, followed by hepatomegaly, fibrosis, and splenomegaly. Neurologically, 2 children had a history of headaches, 3 were diagnosed with hyperactivity, and 1 with autism spectrum disorder. Brain MRI, DEXA scan, and ophthalmological evaluations were normal. Liver biopsy in 4 patients revealed steatosis, with one case showing nodular cirrhosis.
Table 1: Patient's pharmacological treatment and reasons for therapy modification
Conclusions: Wilson's disease is rare but can lead to severe health consequences. Pediatric data is limited. Larger studies are needed to better characterize the disease, establish diagnostic criteria, and ensure optimal care and outcomes for affected children.
Contact e‐mail address: inkan@med.uoa.gr
H‐EV062. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV062.1. NATURAL HISTORY AND PHENOTYPIC HETEROGENEITY IN PAEDIATRIC PATIENTS WITH ALAGILLE SYNDROME – A TERTIARY CENTRE EXPERIENCE
Emilia Nedeva‐Dobreva 1, Hristo Naydenov1,2, Tihomir Todorov3, Albena Todorova2,3, Petar Nikolov1, Mila Baycheva1,2
1Department Of Gastroenterology And Hepatology, University Children's Hospital, Sofia, Bulgaria, 2Medical University of Sofia, Sofia, Bulgaria, 3Genetic Medico‐Diagnostic Laboratory Genica, Sofia, Bulgaria
Objectives and Study: Alagille syndrome (ALGS) is an autosomal dominant genetic disorder characterized by liver involvement presenting with high γ‐glutamyltransferase cholestasis, variable multisystem abnormalities of the heart, skeleton, eyes and kidneys, and a specific facial dysmorphism. Mutations in JAG1 and NOTCH2 genes are responsible for more than 97% of the cases. At present, there are no well‐defined genotype‐phenotype correlations, some large cohort of patients are being published recently.
Methods: It is a single‐centre retrospective study of paediatric patients with ALGS for the period of 30 years 1994‐2024.
Results: We present 14 patients with ALGS (4 female, 9 male). The age of diagnosis ranges between birth and 10 years. All of them have hepatomegaly and splenomegaly at the time of diagnosis. One patient presents with mild mental retardation. Eleven patients have itching to varying degrees. Twelve patients have peripheral pulmonary stenosis or complex congenital heart malformation with pulmonary stenosis; 5 have structural abnormalities of the kidneys; 5 have typical vertebral anomalies. In eight patients diagnosed during the last 10 years, the diagnosis was confirmed by a genetic test – 7 have mutations in JAG1 and one in NOTCH2. All patients have been treated with ursodeoxycholic acid and fat soluble vitamins, 2 patients received ileal bile acids transporter inhibitor, 6 patients were referred for a liver transplantation.
Conclusions: In the case of combination of neonatal cholestasis and heart murmur, it is necessary to exclude the diagnosis of ALGS. Early treatment and monitoring prevent many complications and ensures normal growth and development. A small number of patients develop severe liver disease and require liver transplantation.
Contact e‐mail address: mila.baycheva@gmail.com
H‐EV063. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV063.1. FOLLOW‐UP RESULTS OF CASES DIAGNOSED WİTH AUTOIMMUNE HEPATITIS DURING THE COVID‐19 PANDEMIC PERIOD : RETROSPECTIVE ANALYSIS
Ezgi Oğuz 1,2, Miray Karakoyun2, Ezgi Kıran Taşcı3
1Ege Üniversitesi Çocuk Hastanesi, Ege Üniversitesi Tıp Fakültesi, İZMİR, Turkey, 2Pediatric Gastroenterology, Ege University Medical Faculty Hospital, İzmir, Turkey, 3Pediatric Gastroenterology, Hepatology And Nutrition, Ege University, Izmir, Turkey
Objectives and Study: We aimed to compare the patients who are followed up with Autoimmune Hepatitis in our clinic age at diagnosis,symptoms at the time of diagnosis,which immunosuppressant treatments used,which vaccine and how many doses they were vaccinated with,post‐vaccination and post‐infection symptoms and presence of disease activation according to these criteria
Methods: Our study is a single‐center retrospective cross‐sectional study.We have total of 24 patients who diagnosed under the age of 18.A case report form of a questionnaire was filled out.Statistical data were obtained by transferring the case report forms to SPSS format
Results: While 16.7 percent of the patients included in the study had Covid‐19 infection without any vaccination, 1 patient was observed to have Covid infection after vaccination. After vaccination, no disease reactivation was observed in any of our patients and no increase was detected in liver enzyme tests.It was observed that 3 of the 5 patients who had the covid‐19 infection were followed up without treatment, 1 patient received steroid and azathioprine treatment, and 1 patient received azathioprine treatment.While 10 (41.7%) of the patients received at least one dose of vaccine during the pandemic period, 14 (58.3%) were not vaccinated at all. No need for increased vaccine and infection‐related immunosuppression dose, hospitalization or acute exacerbation was detected in any of the 24 patients diagnosed with autoimmune hepatitis included in the study.It was observed that 3 of the 5 patients who had the infection were followed up without treatment,1 patient received steroid and azathioprine treatment,and 1 patient received azathioprine treatment.It has not been directly shown that immunosuppression therapy increases the risk of infection.
Conclusions: Attention was again drawn to the vaccine's protection against infection. However, since disease exacerbation was not detected in vaccinated and unvaccinated cases with Covid infection, the relationship between vaccination and infection and autoimmune hepatitis exacerbation could not be evaluated.
Contact e‐mail address:
H‐EV064. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV064.1. THE IMPACT OF PLASMAPHERESIS ROLE IN ACUTE/CHRONIC LIVER FAILURE
Sorin Păsărică1, Cătălin Lupu1, Alexandru Dinulescu1, Irina Dijmarescu1,2, Daniela Păcurar 1,2
1Paediatrics, "Grigore Alexandrescu” Emergency Children's Hospital, Bucharest, Romania, 2"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
Objectives and Study: Liver failure represents a severe impairment of liver function and is characterized by the presence of jaundice, coagulopathy, hepatic encephalopathy and ascites. Plasmapheresis is a therapeutic procedure involving plasma exchange, which can be beneficial in managing liver failure.
Methods: Our retrospective study (April 2022 to October 2024) included 8 patients with liver failure who underwent sessions of plasmapheresis.
Results: Out of the 8 patients, 4 had acute liver failure and 4 had previous chronic liver disease complicated with acute liver failure. Regarding the number of plasmapheresis sessions ‐ 1 patient had only 1 session, 4 patients had 2, 2 patients underwent 3, and 1 patient needed 4 sessions. After the first, second and third session the values varied as following: total bilirubin decreased by 61.18%, respectively 37.89% and 40.68% (absolute value decreasing by an average of 16.09 mg/dL, 6.96 mg/dL and 6.48 mg/dL); direct bilirubin decreased by 51.27%, respectively 45.41% and 25.6% (absolute value decreasing by an average of 5.53 mg/dL, 4.08 mg/dL and 1.17 mg/dL); ALT decreased by 82.06%, respectively 59.06%, but after the third session increased by 16.32% (absolute value decreasing by an average of 2371.85 UI/mL, respectively 430.66 UI/mL, subsequently increasing by 63 UI/mL); INR decreased by 19.2%, respectively 2.63% and 20.81% (absolute value decreasing by an average of 1.53, respectively 0.04 and 0.5). The average length of hospital stay was 29.75 days. Three out of four patients with acute on chronic liver failure had a bridge to liver transplantation benefit from plasmapheresis, while the patients with acute liver failure ended up not needing liver transplantation.
Conclusions: Plasmapheresis plays a potential role in the management of acute/chronic liver failure by removing toxic substances and improving hemodynamic stability in order to assure a bridge to either full healing or liver transplantation.
Contact e‐mail address: sorinalexandru94@gmail.com
H‐EV065. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV065.1. ALAGILLE SYNDROME IN ARGENTINA : CLINICAL FINDINGS AND INSIGHTS FROM 20 YEARS IN A TERTIARY HOSPITAL
Maria Belen Pallitto, Gustavo Boldrini, Victoria Fernandez De Cuevas, Maria Camila Sanchez, Lorena Cavalieri, Tatiana Bendersky, Daniel D Agostino, Guillermo Vera
Pediatric Gastroenterology, Hepatology And Liver Trasplant, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Objectives and Study: Alagille syndrome (ALGS) is a multisystem disorder characterized by chronic cholestasis with associated pruritus and extrahepatic anomalies. This study aimed to describe the baseline characteristics and natural history of liver disease in a cohort of children with ALGS in a Tertiary Hospital in Argentina
Methods: This was a retrospective study of children with a clinically and/or genetically confirmed ALGS diagnosis, between January 2000 and 2024. The medical records were retrospectively reviewed.
Results: Forty children with ALGS syndrome were included in the study.
| Male | 75% (30/40) |
| Genetically diagnoses, % | 20% (8/40) |
| Liver involvement | 87,5% (35/40) |
| Cardiac anomaly | 82.05% (32/40) |
| Facies | 78.3% (29/40) |
| Embryotoxon | 42% (16/40) |
| Butterfly vertebrae | 52.5% (21/40) |
| Renal anomaly | 30,7% (12/40) |
| Vascular involvement | 10% (4/40) |
| Median values | |
| Bile acids, μmol/L | 80.3 (36– 180) |
| TB, mg/dl | 10.9 (1.7–16.8) |
| CB, mg/dl | 6.35 (0.6–9.65) |
| ALT, IU/L | 184.5 (104‐233) |
| AST, IU/L | 175 (110 ‐ 242) |
| GGT, U/L | 197 (109‐368) |
| Cholesterol,mg/dl | 338 (186‐694) |
| Platelet | 282 (193‐380) |
Pruritus was reported in 82.5% (33/40) of children. The primary indications for LT were complications of cholestasis in 87.5% (21/24) and manifestations of PHT in 12.5% (3/24). In addition, 75% (8/24) of transplant recipients had more than one indication for LT. Median age for LT 34.8 months (19.7‐54.2). At 5,10,and 15 years, the rate of overall patient survival was 90%, 87,5%, and 80%, respectively. The median age of death was 42.3 months (18.2‐169.3).
Conclusions: This study provides insights into the baseline characteristics and natural history of liver disease in children with ALGS in Argentina. Our findings highlight the complex interplay between chronic cholestasis, pruritus, and extrahepatic manifestations of ALGS. Understanding these elements characterizing the disease's progression can aid in improving patient management and tailoring therapeutic approaches. Furthermore, our data may serve as a reference for future research in LATAM, fostering a better understanding of ALGS in diverse populations.
Contact e‐mail address: maria.pallitto@hospitalitaliano.org.ar
H‐EV066. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV066.1. HEREDITARY FRUCTOSE INTOLERANCE: AN OFTEN‐UNRECOGNISED CAUSE OF HEPATIC STEATOSIS
Dinusha Pandithan 1, Nedim Hadzic2, Radha Ramachandran3, Raphael Buttigieg3, Roshni Vara1,2
1Paediatric Inherited Metabolic Disease, Evelina London Children's Hospital, London, United Kingdom, 2Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom, 3Adult Inherited Metabolic Diseases, St Thomas' Hospital, L, United Kingdom
Objectives and Study: Hereditary fructose intolerance (HFI) is a rare autosomal recessive condition due to aldolase B deficiency. Clinical presentation is thought to commonly emerge when weaning from milk‐based nutrition in infancy. Exposure to fructose, sucrose and sorbitol can cause gastrointestinal symptoms, hypoglycaemia, liver dysfunction and renal tubular acidosis. Chronic exposure can lead to poor growth, hepatic steatosis, liver cirrhosis and chronic renal insufficiency. The literature consists predominantly of single case reports. We aim to describe a cohort of patients with HFI.
Methods: This is a multi‐centre retrospective review of paediatric and adult individuals with a confirmed diagnosis.
Results: We identified nine patients. Median age for paediatric diagnoses (n = 6) was 5.25 years (range 0.8–12 years) and median age for adult diagnoses (n = 3) was 29 years (range 17–54 years). One patient had a classical infant presentation. All individuals diagnosed after infancy had a history of aversion to sweet foods from childhood. Common clinical features otherwise were poor growth and hepatomegaly in paediatric diagnoses and, vomiting, diarrhoea and excess sweating in adults. At diagnosis all patients had hepatic steatosis on ultrasound and 3/9 had elevated liver transaminases and. A liver biopsy was performed in two patients (performed pre‐2011) demonstrating severe macrovesicular steatosis. A molecular diagnosis was confirmed in all patients. Median age at last follow‐up was 17 years (range 6.6–55 years) and all patients reported compliance with dietary restrictions. All patients had evidence of steatosis on hepatic imaging at last follow‐up and no evidence of renal involvement.
Conclusions: HFI is an important diagnostic consideration across all age groups in the evaluation of hepatic steatosis. A diet history plays a pertinent role in clinical evaluation. The role of liver biopsy has been superseded recently by genetic testing. We highlight the heterogenous presentation of a cohort of patients with HFI.
Contact e‐mail address: Roshni.Vara@gstt.nhs.uk
H‐EV067. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV067.1. SEVERE PHENOTYPE OF PAEDIATRIC DIABETIC KETOACIDOSIS‐ASSOCIATED ACUTE LIVER FAILURE IN THE POST‐COVID ERA; A CASE SERIES
Anneka Patel 1, Isadora Luling Feilding1, Emma Alexander1, Caroline Ponmani2, Pam D'silva3, Anil Dhawan1, Simon Chapman4, Akash Deep3, Vandana Jain1
1Paediatric Liver, Gi And Nutrition Centre And Mowat Labs, King's College Hospital NHS Foundation Trust, London, United Kingdom, 2Department Of Paediatric Emergency Medicine, Barking Havering and Redbridge University Trust, London, United Kingdom, 3Paediatric Intensive Care, King's College Hospital NHS Foundation Trust, London, United Kingdom, 4Department Of Child Health, King's College Hospital NHS Foundation Trust, London, United Kingdom
Objectives and Study: Reports highlight increasing incidence of Diabetic Ketoacidosis (DKA) since the COVID‐19 pandemic; increased viral susceptibility of the pancreas being a proposed mechanism. A series of DKA‐associated paediatric acute liver failure (ALF) cases have been observed in the post‐pandemic period.
Methods: Paediatric patients admitted to a hepatology unit, in ALF with an initial DKA presentation, between January 2010‐September 2024 were identified via a hospital database. Demographic, clinical and laboratory data were collected.
Results: Four patients presenting post‐2020‐2024 were identified. All presented with DKA; A:(pH7.27), B:(pH6.82), C:(pH6.90), D:(pH6.97) and normal liver and renal function on admission. DKA resolved by A:6, B:48, C:72, D:96 hours. Patients B and C were obese with a body mass index of 27 kg/m2 and 31 kg/m2 respectively. On day 4, they developed ALF with peak alanine transaminase (IU/L); A:3615, B:9984, C:4245 D:5113, peak international normalised ratio; A: > 15, B:4.4, C:3.0, D:4.7, metabolic acidosis and hyperlactatemia; peak lactate (mmol/L) A:19.8, B:23, C:7.9, D:7.9. Cardiovascular instability preceded ALF for patients B and C, but followed ALF in patients A and D. All patients required intubation and ventilation, escalating inotropic therapy and developed acute kidney injury; peak creatinine (µmol/L) A:81, B:86, C:100, D:400, necessitating haemofiltration. Viral, immune and metabolic ALF investigations were normal. They received therapeutic paracetamol dosing prior to ALF (paracetamol level (mg/L); A:60, B:24, C:16, D:15). Patient A, B and C had cardiac arrests on day 6. Patients A and B died. Liver autopsy revealed centriacinar necrosis and macro‐/micro‐vesicular steatosis in both. Patients C and D survived with normalisation of liver enzymes by day 64 and 37 respectively.
Conclusions: A concerning DKA‐hepatic phenotype is described post‐pandemic. Ischemic hepatitis ± drug‐induced injury in patients with metabolic susceptibilities are likely pathogenic factors. Earlier type 1 diabetes diagnosis and education/awareness of hepatic complications is essential to reduce morbidity and mortality in this burdensome disease pathogenesis. Mechanistic diabetes‐ALF studies are urgently needed.
Contact e‐mail address: vjain@nhs.net
H‐EV068. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV068.1. LIPID METABOLISM DISORDERS AND APOLIPROTEIN E POLYMORPHISM IN CHILDREN WITH CHOLELITHIASIS
Natalia Pavlenko, Olena Shutova, Olena Babadzhanyan, Irina Solodovnichenko, Lidiia Voloshyna
Department Of Pediatrics 3 And Neonatology, Kharkiv National Medical University, Kharkiv, Ukraine
Objectives and Study: Relevance. The incidence of cholelithiasis in Ukraine has increased from 0.1 – 1% to 5% or more in recent years. Rising incidence of cholelithiasis in childhood is obvious, but the reasons are not clear. The genetic factors of this disease in childhood are not well understood. Study objective. To research the associations of apoliprotein Е (ApoE) subclasses and parameters of lipid spectrum in children with cholelithiasis.
Methods: Materials and methods. 44 children (24 girls and 20 boys) at the age of 5 – 18 years with cholelithiasis were under supervision. The study involved patients with Stage I (n = 23) and Stage II (n = 21) cholelithiasis. Genotyping has been performed by ApoE alleles using PCR (analyzer and Termocycler test system). Lipid profile has been assessed in patients with different apoprotein E phenotypes. Statistical processing of results has been performed with use of software package “STATISTICA 6.0”.
Results: It has been found that LDL levels were significantly different in patients with E3/E4 and E4/E4 phenotype, pk‐w < 0.01. VLDL levels were significantly different in patients with E3/E3 and E3/E4 phenotype (pk‐w = 0.02). So, VLDL values in patients with E3/E4 phenotype were significantly higher than in patients with E3/E3 phenotype (0.89 ± 0.12 mmol/l versus 0.36 ± 0.06 mmol/l, pu <0.05). In patients with E4/E4 phenotype, AI was significantly higher (3.45 ± 0.34) than in patients with E3/E3 phenotype (2.17 ± 0.12, Pu <0.05) and E3/E4 phenotype (1.84 ± 0.24, pu <0.05).
Conclusions: Conclusion. Analysis of lipid spectrum in children with cholelithiasis and different Apo phenotypes gives an indication of genetic susceptibility to lipid metabolism disorders. Marker of increased risk for cholelithiasis development is E4/E4 phenotype.
Contact e‐mail address:
H‐EV069. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV069.1. QUALITY OF LIFE (QOL) AND PATIENT JOURNEYS IN ALAGILLE SYNDROME (ALGS)
Sebastian Schulz‐Juergensen1, Anna‐Lena Pentzlin 1, Mona Suck2, Laura Inhestern2, Jun Oh3
1Department Of Pediatrics, University Hospital Hamburg Eppendorf, Hamburg, Germany, 2Department Of Medical Psychology, University Hospital Hamburg Eppendorf, Hamburg, Germany, 3University Children's Hospital, Department Of Ped. Nephrology, Ped. Hepatology And Ped. Transplantation, University Medical Center Hamburg‐Eppendorf, Hamburg, Germany
Objectives and Study: ALGS is a genetically determined multisystem‐disease with variable penetrance involving liver, heart/blood vessels, kidney and other organ systems. While the clinical characterization is well described in the GALA study, QoL is only partially addressed, and the challenges of patients and families in the diagnostic and therapeutic process of a variable multisystem‐disease have not been addressed.
Methods: All patients with ALGS treated at the pediatric department and their caregivers were invited for a mixed‐methods study including questionnaires (a.o. PedsQLTM4.0) and semi‐structured interviews regarding their patient journeys. Clinical severity of ALGS manifestations was assessed by treating physicians. Group comparisons were analyzed using non‐parametric tests (Mann‐Whitney‐U‐/Kruskal‐Wallis‐test).
Results: 21/22 patient's families (16 mothers, 11 fathers) participated in the study. Median patient age was 11.2 years (range 0.2‐20.6), 14 male, 7 female. Overall QoL was reduced (M = 75.6, SD = 14.8) with particular reduction in psychosocial (M = 70.6, SD = 14.7) and emotional (M = 68.4, SD = 17.5) wellbeing as well as school functioning (M = 64.8, SD = 19.7). Fathers estimated higher scores for bodily and school functioning compared to mothers (p < 0.05). Clinicians’ assessment of severity was correlated with bodily and school functioning, but not with psychosocial and emotional wellbeing. Patient journeys ranged from smooth transfer to specialist treatment to a complex process including multiple steps to diagnosis. Parents’ needs were characterized by need for information, but also emotional uncertainty regarding prognosis and possible association of perceived symptoms with ALGS.
Conclusions: The limitations of QoL in ALGS are comparable to those in other chronic diseases, e.g. renal insufficiency. While there are variations in physical QoL correlating with different severity levels, all patients exhibit comparable reductions in psycho‐social and emotional QoL. The emotional uncertainty regarding prognosis and effects of ALGS on different aspects of life is a main factor reported in the patient journeys, besides the need for information. This underlines the importance of psychosocial and psychological support for ALGS families.
Contact e‐mail address: s.schulz-juergensen@uke.de
H‐EV070. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV070.1. DIFFERENCE IN CALORIC DISTRIBUTION IN THE DIETS OF OBESE CHILDREN WITH AND WITHOUT NON‐ALCOHOLIC FATTY LIVER DISEASE
Nopaorn Phavichitr, Ruangvith Tantibhaedhyangkul, Paweena Masoo
Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
Objectives and Study: Non‐alcoholic fatty liver disease (NAFLD) poses significant health risks to the liver and other organs. Its prevalence is rising among obese children. The pathogenesis is unclear and multifactorial, involving obesity, insulin resistance, dietary patterns, physical activity, genetics, socio‐economic and psychological factors, among others.
Methods: We conducted a cross‐sectional study at Phramongkutklao Hospital in 2024, enrolling obese children aged 10 to 18 years. Biochemical data and seven‐day dietary records were collected. Suspected NAFLD cases were identified based on elevated serum ALT levels (above 22 U/L in females and 26 U/L in males) after excluding other causes. Hepatic steatosis was confirmed by ultrasonography. The total caloric intake and macronutrient distribution were compared between participants with normal and abnormal ALT levels.
Results: Preliminary data from 21 obese children were analyzed: 9 had abnormal ALT levels, and 12 had normal levels. Demographic and biochemical parameters were comparable between the groups. Ultrasonography was done in 7 out of 9 children with abnormal ALT and confirmed fatty liver in those cases. Analysis of dietary records showed no significant differences between the groups in total daily caloric intake, protein, fat, carbohydrate, or sugar consumption. However, the abnormal ALT group had slightly higher caloric intake and sugar consumption compared to the non‐NAFLD group (2129.6 ± 326.9 vs. 1951.6 ± 234.6 kcal, p = 0.16; 59.0 ± 41.5 vs. 37.4 ± 24.3 g, p = 0.15). Accuracy of dietary records may be affected by participant compliance, and inaccuracies are common.
Conclusions: This preliminary study found no significant differences in caloric distribution between obese children with suspected NAFLD and those without it. Limitations include small sample size, potential inaccuracies in dietary records, and challenges with participant compliance. Further research is needed to identify additional risk factors and mechanisms underlying NAFLD in obese children.
Contact e‐mail address:
H‐EV071. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV071.1. CLINICAL PROFILE OF BILIARY ATRESIA FROM A TERTIARY CARE CENTRE IN KERALA, INDIA
Anupa Thomas1, Dr. R. Bhanu Vikraman Pillai 2
1Department Of Pediatric Gastroenterology And Hepatology, Amrita Institute of Medical Sciences, Kochi, India, 2Paediatric Gastroenterology, AMRITA INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTER, Kochi, India
Objectives and Study: To provide a comprehensive overview of the clinical profile of biliary atresia, focusing on its presentation, diagnosis, management strategies, and outcomes.
Methods: This was a retrospective analysis of patient's records of children with Biliary Atresia from 2010 to 2023
Results: 151 children were diagnosed with biliary atresia in the specified time period 47% were females & 53% were males. Median Age at onset of symptoms was from birth Median age at presentation to paediatrician was 45 days and pediatric gastro OPD was 65 days Mean age of Kasai's Porto Enterostomy (KPE) : 75 days Pale stools in 97% infants. Dark urine in 55% infants Jaundice reported in 85% infants Polysplenia in 2% VSD in 2 (1.8%) CMV ‐IgM was positive in 30%. 89% were term infants. Only 2 out of 151 children had consanguinity. After surgery, 30children were lost to follow up 67 out of 121 children (55%) received steroids post Kasai's 89% were term.
| Mean Bilirubin Value (Total/Direct | CMV IgM ‐ | CMV IgM + |
|---|---|---|
| Prior to Kasai | 10.4/6.59 | 14.8/7 |
| 2 months post Kasai | 7.4/5 | 8.9/4.9 |
Liver transplant was indicated in 76 out of 121 children (61%) 22% underwent liver transplant Fibrosis was present at time of Kasai in 95 out of 151 children (88%) Focal bile duct paucity (?co‐existing PFIC in 11 out of 151 children (10%)
Conclusions: *CMV IgM positive in 30%. *No statistical significance was seen in Bilirubin prior to Kasai in babies with CMV Infection compared to without CMV Infection. * 21% of children who did not receive steroids post Kasai's had bilirubin < 2 mg% at the end of 2 months while only 7.7% of children who received steroids had bilirubin <2 mg%. with p value of 0.035 (significant). The use of post operative steroids did not show a significant impact. * Liver transplant was indicated in 61% *88% had fibrosis at time of Kasai.
Contact e‐mail address: bhanupillai@yahoo.com
H‐EV072. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV072.1. SEVERITY OF GUT MICROBIOME DYSBIOSIS IS ASSOCIATED WITH IMPAIRMENT OF COGNITIVE FUNCTIONING IN CHILDREN WITH CHRONIC LIVER DISEASE
Alina Poets 1,2, Miriam Kramer1,2, Niyade Ouro‐Djobo1,2, Norman Junge1, Ulrich Baumann1, Kora Schulze2, Sabrina Woltemate2, Marius Vital2, Imeke Goldschmidt1
1Division Of Pediatric Hepatology And Liver Transplantation; Department Of Pediatric Liver, Kidney And Metabolic Diseases And Neuropediatrics, Medizinische Hochschule Hannover, Hannover, Germany, 2Institute For Medical Microbiology, Medizinische Hochschule Hannover, Hannover, Germany
Objectives and Study: The term gut‐brain axis describes the association of gut microbiota (GM) alterations with cognitive performance or mental health. In adult liver disease, it has primarily been linked to an association of GM dysbiosis with hepatic encephalopathy. We aimed to examine the possible association of GM dysbiosis with cognitive functioning in paediatric liver disease.
Methods: Cognitive performance was cross‐sectionally evaluated using the children colors trail test (CCTT1&2) and the PedsQL cognitive fatigue module (cogPedsQL) in four different pediatric liver disease cohorts: stable biliary atresia (BA, n = 32, age med(7.1[2.5‐15.5])), autoimmune hepatitis (AIH) before (AIHnativ, n = 10, age med(10.5[6‐16])) and on treatment (AIH‐T, n = 27, age med(13.7[6‐17])), and children after liver transplantation (pLT, n = 32, age med(11.9[5.3‐17.7])). Historic cohorts of healthy controls (HC) were used for comparison of CCTT/cogPedsQL data (n = 346) and GM data (n = 63). Fecal samples were analyzed using 16 s rRNA sequencing.
Results: Cognitive fatigue results did not differ between patients and HC. CCTT results were lower in pLT patients compared to HC (24.37 ± 25.71 vs. 42.59 ± 26.96, p = 0.02 (CCTT1); 30.6 ± 28.65 vs. 48.26 ± 23.84, p = 0.009 (CCTT2)), but did not differ to HC in BA and AIH. While HC showed higher GM alpha‐diversity compared to all patient cohorts (all p < 0.01), alpha‐diversity did not differ between the different patient groups. AIH‐T had lower levels of Bacteroidetes compared to BA, AIHnativ and pLT (all p ≤ 0.01). Overall performance in CCTT correlated with relative abundance of beneficial Firmicutes (r = 0.33, p = 0.007) and showed negative correlation with levels of Proteobacteria (r = ‐0.29, p = 0.017) and Enterobacteriaceae (r = ‐0.27, p = 0.027). Results in CCTT 1 correlated negatively with abundances of Sutterellacae (r = ‐0.29, p = 0.018) and Muribaculaceae (r = ‐0.29, p = 0.018). CogPedsQL correlated with Barnsiellaceae (r = 0.27, p = 0.02).
Conclusions: Dysbiosis in children with various chronic liver diseases and after pLT is associated with performance in cognitive functioning tests. Further research is necessary to identify the exact mechanisms of the gut‐brain axis contributing to these results.
Contact e‐mail address: poets.alina@mh-hannover.de
H‐EV073. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV073.1. PRESENTATION AND PROGNOSIS OF IDIOPATHIC NEONATAL CHOLESTASIS
Hilla Pyötsiä 1, Elisa Ylinen2, Mikko Pakarinen3, Laura Merras‐Salmio4
1Helsinki University Children's Hospital, Helsinki, Finland, 2Pediatric Organ Transplant And Nephrology Unit, Helsinki University Children's Hospital, Helsinki, Finland, 3Pediatric Surgery Department, Helsinki University Children's Hospital, Helsinki, Finland, 4Pediatric Gastroenterology Unit, Helsinki University Children's Hospital, Helsinki, Finland
Objectives and Study: The underlying pathophysiology of neonatal cholestasis (NC) remains often unclear. To rule out biliary atresia and other treatable cholestatic conditions, thorough diagnostics, including genetics, are increasingly performed. We aimed to elucidate the presentation and outcomes of NC in our tertiary referral center.
Methods: All patients with NC born between 1.1.2005 and 31.12.2020 were identified from our institutional registries. Cholestasis was defined as plasma conjugated bilirubin (BIL‐CJ) > 17 mmol/l. Since 2011, we have followed an institutional protocol to evaluate NC‐patients, including genetics from 2016 onwards.
Results: Of the 172 patients with a median follow‐up of 9 years, 54 (31%) had biliary atresia (BA), 35 (20%) parenteral nutrition associated cholestasis (PNAC), 38 (22%) other identified etiology, and 45 (26%) had eventually cholestasis of unknown etiology (idiopathic NC). Patients with idiopathic NC (INC) presented with lower BIL‐CJ compared to BA (median 39 vs. 104 mmol/l, Figure). In INC group, BIL‐CJ normalized in 41 (91%) patients after median 41 days by median age 2.8 (IQR 2.3‐4.0) months. One child with INC died, and two had liver transplants. Alagille syndrome, cytomegalovirus infection, choledochal malformations and immunization were most frequently identified other etiologies. Overall, 50 (60%) patients without BA or PNAC underwent genetic workup, which identified the cause of cholestasis in 13 (26%).
Conclusions: In 26% of cholestatic infants the underlying etiology remained unknown. INC was mostly transient, and did not recur after normalization of bilirubin. Genetic assessment established the cause of cholestasis in 26% of analyzed cases.
Contact e‐mail address: hilla.pyotsia@hus.fi
H‐EV074. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV074.1. METHOD FOR PROGNOSTICATING THE RISK OF PERINATAL HBV INFECTION IN CHILDREN BY DETERMINING THE SPIP‐ B PROBABILITY SCORE
Svetlana Liubarscaia, Tatiana Raba, Cristina Muscinschi, Victor Pântea, Ninel Revenco, Vergil Petrovici
”Nicolae Testemitanu” State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Moldova
Objectives and Study: Perinatal infection with hepatitis B virus (HBV) is one of the main routes of infection in children and represents a significant public health problem. Newborns and children under 5 years of age have up to a 90% risk of developing chronic HBV infection, which emphasizes the need for methods to identify the risk of infection early. We proposed a simple and non‐invasive method to estimate the risk of perinatal HBV infection in children. The aim of this method is to identify patients at high risk of perinatal HBV infection, especially those from vulnerable epidemiologic groups, in order to allow rapid implementation of early HBV prophylaxis measures. The method is based on the "Perinatal HBV infection probability score" developed by the authors.
Methods: The method uses discriminant analysis, based on certain indicators such as the child's age, family history of HBV infection, HBV vaccination status of the child and clinical signs (hepatomegaly, ALT elevation). A total score allowed classification of patients by infection risk of perinatal HBV infection.
Results: The study was performed in 2019‐2023 on 70 children at increased risk for perinatal HBV infection: 27 with chronic viral hepatitis B and 43 with hepatomegaly and cytolysis syndrome. The method showed a sensitivity of 96.3% for identifying high risk in patients with chronic viral hepatitis B and a specificity of 86.05% for correctly classifying low‐risk patients from other categories. The results of the application of this method demonstrate its effectiveness in quantifying the likelihood of perinatal HBV infection risk in children under 5 years of age.
Conclusions: The proposed SPIP‐B screening method is non‐invasive, simple to use and does not involve additional costs. It allows early identification of children at high risk of perinatal HBV infection, contributing to the early detection and supporting HBV prevention efforts and global strategies to eliminate HBV by 2030.
Contact e‐mail address:
H‐EV075. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV075.1. ROLE OF SARCOPENIA IN PAEDIATRIC METABOLIC DYSFUNCTION‐ASSOCIATED STEATOTIC LIVER DISEASE (MASLD)
Kavitha Jayaprakash1, Jonathan Wells2, Sanjay Rajwal 1, Jens Stahlschmidt1, Terry Humphrey1, Helen Woodley1, Eirini Kyrana3
1Paediatric Hepatology, Leeds Children's Hospital, Leeds, United Kingdom, 2Population Policy And Practice Department, Institute of Child Health, London, United Kingdom, 3Roger Williams Institute Of Liver Studies, King's College London, London, United Kingdom
Objectives and Study: Sarcopenia in adults with MASLD is associated with steatohepatitis and advanced liver fibrosis independent of age, sex, BMI and insulin resistance.
Methods: Children with MASLD undergoing liver biopsy had body composition by DXA scan and bioelectrical impedance(BIA), blood tests with HOMA‐IR and physical activity questionnaire score. Liver biopsies were assigned NAS score and fibrosis stage.
Results: Twenty children were recruited. Age 10‐16 years (16 M:4 F). Median z‐scores were for weight 2.69 (range 0.89‐ 3.46), height 0.86 (range ‐0.17‐ 2.87) and for BMI 2.31 (range 1.04‐ 3.56). Eighteen had whole body DXA, all had BIA. None of the children were sarcopenic as per definition of fat‐free mass index (FFMI) z‐score less than ‐2. All indices correlated with each other strongly (weight, BMI, total FMI, total FFMI, appendicular FMI and FFMI z‐scores). Biopsies with NAS equal or less than 3 were 'no MASH', over 3 'with MASH'. No children had fibrosis stage 4. Those with fibrosis stage 0‐1 were grouped as 'mild fibrosis', stage 2 and 3 were grouped as 'advanced fibrosis'. The children with MASH and those with advanced fibrosis had a higher cholesterol/HDL, but no significant anthropometric differences. In the advanced liver fibrosis group there was a tendency for more children to have a FFMI z‐score in the lower quartile (75% vs 25%) on liver biopsy. %Lean mass derived from the BIA correlated strongly with the FM indices from the DXA, implying that as fat mass increased the %LM was less, without necessarily an actual reduction in LM. HOMA‐IR had a significant negative correlation with total body FFMI z‐score ‐0.609.
Conclusions: In our cohort of patients with biopsy proven MASLD, HOMA‐IR had a significant negative correlation with FFMI z‐score and the group with the more advanced liver fibrosis had lean mass in the lower quartiles.
Contact e‐mail address: eirini.2.kyrana@kcl.ac.uk
H‐EV076. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV076.1. A CLINICAL PRACTICE REVIEW AGAINST THE 2018 ESPGHAN RECOMMENDATIONS OF A COHORT OF PEDIATRIC AUTOIMMUNE HEPATITIS
Valentina Leone1, Elena Diprima2, Eleonora La Sala2, Gabriela Vallejo3, Mihaela Danalache1, Jean De Goyet1, Giusy Ranucci 1
1Department of Pediatrics Liver Transplant Center UPMC‐ISMETT‐IRCSS, Palermo, Italy, 2Policlinico Giaccone, palermo, Italy, 3messina university, messina, Italy
Objectives and Study: We reviewed our clinical practice in managing pediatric autoimmune hepatitis seen at a single pediatric hepatology and transplantation center against the 2018 ESPGHAN recommendations.
Methods: We performed a retrospective chart review of pediatric autoimmune hepatitis cases treated at our tertiary referral hospital between 2005 and 2024.
Results: Out of the 45 patients seen at our centre over the last 20 years, 19 are still in follow up and were include in this study. At diagnosis, 16 had a type 1 serological profile and 2 had type 2. Sixteen patients achieved biochemical remission, with 12 remaining in remission on treatment and 4 after discontinuing treatment. At the last follow‐up, 8 patients were on monotherapy with Azathioprine, 2 on a combination of immunosuppressive agents and Rituximab, 1 on MMF and corticosteroids, and 1 on triple immunosuppressive therapy. Seven patients developed complications likely related to treatment, including one with portal hypertension. All children were followed according to ESPGHAN guidelines.
Conclusions: In our cohort, pediatric autoimmune hepatitis was managed according to the 2018 ESPGHAN guidelines. Although the majority of patients in this cohort achieved biochemical remission, most of them required combined immunosuppressive therapy. These findings highlight the need for personalized treatment strategies in managing pediatric autoimmune hepatitis. Further studies are necessary to optimize therapeutic approaches and minimize long‐term treatment‐related complications.
Contact e‐mail address:
H‐EV077. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV077.1. NOVEL PATHOGENIC VARIANT IN KIF12 GENE CAUSING RAPIDLY PROGRESSIVE CHOLESTATIC LIVER DISEASE: CASE REPORT AND REVIEW OF LITERATURE
Mariana Reis 1,2, Luís Rodrigues1, Ana Fernandes1, Sara Azevedo1, Rafael Cruz3, Helena Loreto1, Paula Mourato1, Ana Isabel Lopes1,4
1Pediatric Gastroenterology Unit, Department of Pediatrics, Hospital Santa Maria, Unidade Local de Saúde Santa Maria, Lisboa, Portugal, 2Pediatrics Department, ULS Algarve, Faro, Portugal, 3Department of Anatomical Pathology, Hospital Santa Maria, Unidade Local de Saúde Santa Maria, Lisboa, Portugal, 4Pediatric University Clinic, Medical School, University of Lisbon, Portugal, Lisboa, Portugal
Objectives and Study: Progressive familial intrahepatic cholestasis (PFIC) encompasses autosomal recessive disorders disrupting bile synthesis or transport. A recently identified gene, KIF12, is associated with hepatocellular transport abnormalities.
Methods: A Caucasian baby born to healthy unrelated parents presented with acute liver failure at 2 months and 20 days of age. The parents reported persistent jaundice and acholic stools since birth, which were not previously considered. Supportive therapy, including vitamin K, was temporarily effective. An extensive laboratorial and imaging investigation, including exclusion of biliary atresia trough cintigraphy, was unable to identify the etiology. Genetic testing for neonatal cholestasis identified a novel homozygous mutation in KIF12 (NM_138424.2)‐c.617 C>T(p.(Pro206Leu)). The patient remained under close follow‐up with progressive clinical and biochemical deterioration: liver function declined and GGT levels remained consistently elevated (with a maximum of 15 times above normal), while ultrasound and histology revealed progressive signs of hepatic fibrosis. At six months, she developed end‐stage liver disease with portal hypertension and refractory ascites, leading to liver transplantation at eight months of age. One‐month post‐transplant, she was admitted for elevated liver enzymes and diagnosed with cholangitis secondary to stenosis of the hepatojejunal anastomosis. Cholangiopancreatography and transanastomotic biliary drain placement were performed. Liver enzymes subsequently normalized, and she is currently awaiting drain removal.
Results: This is the 27th reported case of KIF12‐associated PFIC and one of the first from a nonconsanguineous European family. PFIC presentations range from mild liver abnormalities to severe liver dysfunction as seen in this case, one of the youngest with such rapid progression. This novel mutation adds to the diversity of known genetic mutations associated with cholestatic liver disease.
Conclusions: Rapid development of genetic sequencing techniques has allowed the identification of new mutations causing cholestasis, permitting earlier diagnosis and timely interventions that can significantly improve outcomes. Therefore, it is essential to periodically revisit unresolved cases of cholestasis.
Contact e‐mail address: mari.reis@sapo.pt
H‐EV078. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV078.1. IGG AS A SERUM BIOMARKER FOR HISTOLOGICAL ACTIVITY AND FIBROSIS IN CHILDREN WITH AUTOIMMUNE HEPATITIS (AIH) AT DIAGNOSIS
Yunuen Rivera‐Suazo 1, Jaime Alfaro‐Bolaños1, Carlos Flores Soriano2, Juan Suárez‐Cuenca3
1Paediatric Gastroenterology, National Medical Centre 20 de Noviembre ISSSTE, Mexico City, Mexico, 2Paediatrics, National Medical Centre 20 de Noviembre ISSSTE, Mexico City, Mexico, 3Department Of Clinical Investigation, National Medical Centre 20 de Noviembre ISSSTE, Mexico City, Mexico
Objectives and Study: AIH is a rare, necro‐inflammatory, progressive, immune‐mediated liver disease of unknown aetiology, characterised by specific circulating autoantibodies, elevated IgG concentrations and particular histopathology. Histopathologic findings from a liver biopsy are standard criteria for diagnosing AIH in children. Current serum biomarkers of liver injury in AIH that are used in practice include aminotransferases (AST and ALT) and IgG. There is a relative paucity of data about the role of IgG in the histological activity and fibrosis in children with AIH.
Methods: An analytical cross‐sectional study was conducted, including biopsies with a confirmed diagnosis of AIH based on simplified ESPGHAN 2018 criteria. Scheuer scoring system was used to evaluate necro‐inflammatory activity and histological changes. A score of 0 indicated absence of necroinflammation/fibrosis, 1‐2 represented mild necroinflammation/fibrosis, and 3‐4 severe necroinflammation/fibrosis. A 5‐point ROC curve was employed to establish the IgG cohort cut‐off with the highest performance and correlation with necro‐inflammatory activity and fibrosis. IgG values were those reported within the six months prior to biopsy.
Results: A total of 21 biopsies (21 patients) were analysed over a 5‐year period, all interpreted by the same pathologist. 16 biopsies were eligible for evaluation. Sensitivity was 87% and specificity was 62% for necro‐inflammatory activity, with a negative predictive value (NPV) of 0.83 in the cohort with IgG levels of 2000 mg/dL. Regarding fibrosis, sensitivity was 75% and specificity 90%, with an NPV of 0.90 in the cohort with IgG levels of 3000 mg/dL.
Conclusions: Elevated serum IgG levels are strongly associated with histological activity in paediatric patients with AIH. These findings suggest that IgG levels could serve as a useful marker for assessing disease activity and progression in liver disease. However, IgG should not be considered a standalone diagnostic criterion but rather used in conjunction with other clinical and histological biomarkers.
Contact e‐mail address: rivera.suazo@outlook.com
H‐EV079. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV079.1. CLINICAL PICTURE OF PATIENTS DIAGNOSED WITH GILBERT'S SYNDROME‐ SINGLE CENTRE STUDY
Sabina Wiecek1, Weronika Roesler‐Wilhelm 2, Natalia Leszczynska3, Klaudia Sobik3, Urszula Grzybowska‐Chlebowczyk4
1Department of Paediatrics, Medical University of Silesia, Katowice, Poland, 2University Of Opole, Doctoral School, Institute of Medical Sciences, Opole, Poland, 3Students’ Scientific Society, Department of Paediatrics, Faculty of Medical Sciences in Katowice, Katowice, Poland, 4Department of Gastroenterology and Pediatrics. Upper Silesian Children's Health Center, Katowice, Poland
Objectives and Study: Gilbert syndrome is characterised by mild, chronic, genetic unconjugated hyperbilirubinemia unrelated to any liver disease affecting 3‐12% of the population. In recent years, a number of risks (drug interactions, gallstones, haemolytic disease) and benefits (lower cardiovascular risk, cancer) occurring in patients with Gilbert's syndrome have been demonstrated. The aim of the study was to assess the clinical characterisation of the population of paediatric patients diagnosed with Gilbert's syndrome in the Department of Paediatrics, Medical University of Silesia in Katowice.
Methods: Retrospective analysis concerned 83 paediatric patients who were presented with Gilbert's syndrome diagnosis. The analysis has included: the age of a patient during the diagnostic process, clinical symptoms, medical history (including neonatal jaundice), laboratory test results (parameters of liver damage and cholestasis), result of UGT1A1 gene mutation and results of imaging tests, family history of liver/bile duct diseases as well as Gilbert's syndrome among relatives.
Results: In the study, 52/83 (63 %) patients were boys and 31/83 (37%) were girls. Analyses of the patients showed that the average age at diagnosis was 13,5 years. The clinical picture was dominated by: jaundice, increased bilirubin in random tests, chronic abdominal pain.17/83 (20%) patients haven't got any symptoms. 5/83 have positive familial history of Gilbert's syndrome. Blood tests revealed elevated total bilirubin with predominance of the unconjugated fraction. Older children (>10years) have higher level of total bilirubine. Ultrasound examination showed hepato‐ and splenomegaly in 11/83 patients. 8/83 of our patients have cholelithiasis. Concomitant gallstones occurred in 8/83 patients. 6/83 patients were cared for by a psychiatric clinic.
Conclusions: Gilbert's syndrome is a mild, unconjugated hyperbilirubinemia that usually causes no symptoms. It is important to remember that other diseases may more often coexist with this syndrome like hemolytic anemia and/or gallstones. Moreover, the occurrence of drug sensitivity is more frequent than in the population.
Contact e‐mail address:
H‐EV080. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV080.1. SENNA OCCIDENTALIS: A LIKELY CAUSE OF ACUTE LIVER FAILURE
Eugenia Voudouri, Vasiliki Avramidou, Konstantina Vasilaki, Ioannis Xinias, Ioannis Roilidis
Third Pediatric Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Objectives and Study: Introduction: Cassia occidentalis (or Senna occidentalis) is a plant that consists of seeds, leaves and yellow blossoms. It has been used as a pharmaceutical compound in the treatment of several diseases due to its high concentration of phytochemicals. However, the same plant, due to high concentration of anthraquinones, may cause fatal toxicity. Purpose: To report a case of Cassia occidentalis toxicity in a 3 year old girl in Greece, who developed acute liver failure (ALF) after consuming plant seeds.
Methods: Case: She presented in the emergency department with vomiting and lethargy, 4 days after accidental consumption of 2‐3Cassia occidentalis seeds. Blood tests showed elevated transaminases and coagulopathy suggestive of ALF. She was urgently admitted into the intensive care unit for further management, required intubation due to encephalopathy and neuroprotection measures were initiated. Treatment also included N‐acetylcysteine, vitamin K and prophylactic antibiotics and antifungals. During her hospitalization, other causes of acute liver failure were excluded including infections, metabolic causes and autoimmune dysregulation. After 9 days she was discharged with complete recovery from liver failure with improving transaminases.
Results: Discussion: ALF in up to 30% of children remains indeterminant. Toxicity from Cassia occidentalis hasn't previously been reported in Europe, however there are reports mainly in India. Upon presentation all children with ALF undergo urgent testing for viruses, metabolic conditions and autoimmune dysregulation to identify treatable causes. Obtaining a drug history up to six months prior is also important. In our case there was a timely correlation between consumption and development of symptoms.
Conclusions: Conclusion: This case report highlights a likely cause of acute liver failure, reported for the first time in Europe.
Contact e‐mail address: ioannis.roilidis@nhs.net
H‐EV081. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV081.1. TWO‐YEAR LONGITUDINAL ANALYSIS OF CFTR MODULATOR THERAPY ON LIVER FIBROSIS INDICES IN CHILDREN WITH CYSTIC FIBROSIS
Cristina Fevola1, Giuseppe Indolfi2,3, Chiara Rubino 3, Simona Carrera4,5, Zachary Sellers6,7, Vito Terlizzi1
1Cystic Fibrosis Regional Reference Centre, Meyer Children's Hospital, IRCCS, Florence, Italy, 2Department Neurofarba, University of Florence, Florence, Italy, 3Liver Unit, Meyer Children's Hospital, IRCCS, Florence, Italy, 4Department Of Health Sciences, University of Florence, Florence, Italy, 5AOU Meyer IRCCS, Florence, Italy, 6Department Of Pediatrics, Division Of Pediatric Gastroenterology, Hepatology, And Nutrition, Stanford University, San Francisco, United States of America, 7Sellers Research and Clinical Development Consulting, LLC, Newark, CA, United States of America
Objectives and Study: We prospectively evaluated liver fibrosis indices and liver tests in people with Cystic Fibrosis (pwCF) aged 6‐17 years on lumacaftor‐ivacaftor (Lum‐Iva) or elezacaftor/tezacaftor/ivacaftor (ETI) therapy, followed at the CF center of Florence, Italy.
Methods: AST‐to‐platelet ratio index (APRI), GGT‐to‐platelet ratio (GPR), fibrosis‐4 (FIB‐4), platelets, AST, ALT, GGT values were collected before and 12 months after Lum/Iva in F508del homozygous pwCF and 12 and 24 months after ETI in pwCF with at least one F508del variant.
Results: Seventy pwCF on ETI were enrolled: 22 homozygotes for the F508del variant (Group 1), were previously in Lum/Iva therapy; 48 were F508del/other variant. No statistically differences were observed in liver fibrosis indices and liver tests in any group over time, regardless of the presence of liver disease. A significant decrease in platelet values was observed in both groups (minimum value 130x10^3/μL), while AST values decreased only post Lum‐Iva.
Table. Effects of CFTR modulators on liver fibrosis indices and liver tests.
| Before CFTR modulators (N = 70) | After 12 months LUM/IVA (N = 21) | After 12 months ETI (N = 70) | After 24 months ETI (N = 53) | |||||
|---|---|---|---|---|---|---|---|---|
| No Liver Involvement (N = 40) | With Liver Involvement (N = 30) | No Liver Involvement (N = 15) | With Liver Involvement (N = 6) | No Liver Involvement (N = 50) | With Liver Involvement (N = 20) | No Liver Involvement (N = 37) | With Liver Involvement (N = 16) | |
| > ULN, N(%) | ||||||||
| ALT (U/L), ULN 36 U/L | 5(12.5%) | 15(50.0%) | 4(26.7%) | 2(33.3%) | 3(6.0%) | 4(20.0%) | 0 | 5(31.3%) |
| AST (U/L), ULN 30 U/L | 5(12.5%) | 15(50.0%) | 7(46.7%) | 3(50.0%) | 13(26.0%) | 4(20.0%) | 5(13.5%) | 5(31.3%) |
| GGT (U/L), ULN 20 U/L | 2(5.0%) | 10(33.3%) | 0 | 1(16.7%) | 2(4.0%) | 4(20.0%) | 0 | 4(25.0%) |
| APRI, ULN: 0,545 | 1(2.5%) | 3(10.0%) | 1(16.7%) | 2(4.0%) | 3(15.0%) | 3(8.1%) | 4(25.0%) | |
| GPR, ULN: 0,545 | 2(5.0%) | 6(20.0%) | 0 | 0 | 1(2.0%) | 2(10.0%) | 1(2.7%) | 3(18.8%) |
According to Sellers et al (PMID: 37934656)
Conclusions: Lum/Iva and ETI therapies decrease blood platelets in children and adolescents with CF, making it difficult to interpret liver fibrosis indices. Further investigation is needed
Contact e‐mail address:
H‐EV082. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV082.1. PANCREATITIS IN BANGLADESHI CHILDREN: AN EXPERIENCE WITH 72 CASES
Md. Rukunuzzaman
Pediatric Gastroenterology And Nutrition, BSMMU, Dhaka, Bangladesh
Objectives and Study: To observe the etiological, clinical, biochemical, and imaging profiles of acute, acute recurrent and chronic pancreatitis in children.
Methods: This cross‐sectional observational study was conducted in the Pediatric Gastroenterology and Nutrition Department at BSMMU. A total of 72 consecutive patients aged 3 to 18 years who fulfilled the criteria of pancreatitis were enrolled in this study from June 2017 to July 2020. The diagnosis of pancreatitis was based on INSPPIRE criteria for the diagnosis of pancreatitis. The data were analyzed with the SPSS for Windows version 23.0. p < 0.05 was considered statistically significant.
Results: Among the cases, 52.8% were male and 47.2% were female. The frequency of pancreatitis was higher in the 5‐10 years age group. The mean age was 10.27 ± 3.71years. Among all cases, 41.7% were acute pancreatitis (AP), 31.9% were chronic pancreatitis (CP), and 26.4% were acute recurrent pancreatitis (ARP). 54.1% pancreatitis was idiopathic. Each of the obstructive and genetic diseases was found to be the cause of pancreatitis in 19.4%. Characteristic abdominal pain was the presenting feature of all forms of pancreatitis. No significant difference is seen in the laboratory parameters among all three types of pancreatitis. Normal radiological findings were identified in most cases in plain X‐ray. On ultrasonography, MRCP, and abdominal CT, swollen pancreas was the most common finding in AP and ARP and irregular dilatation of the major pancreatic duct was the most common finding in CP.
Conclusions: Abdominal pain is the presenting feature of pancreatitis. The common age of pancreatitis is 5‐10 years. Genetic pancreatitis is quite common. Imaging studies revealed that swollen pancreas is the most common finding in AP and ARP and irregular dilatation of the major pancreatic duct Bangladesh, Children, Pancreatitis. is the common finding in CP.
Contact e‐mail address: dr.rukon@gmail.com
H‐EV083. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV083.1. HEPATIC BLOOD FLOW VELOCITY BEFORE AND AFTER KASAI HEPATOPORTO‐ENTEROSTOMY IS A PROGNOSTIC INDICATOR FOR NATIVE LIVER SURVIVAL IN BILIARY ATRESIA PATIENTS
Jan Sabo 1, Lukas Schipper2, Thanusiah Selvamoorthy1, Ines Moraleda Gudayol1, Ramsi Siaj1, Elke Lainka3, Kristina Kampmann3, Doris Franke4, Marie Uecker5, Ulrich Baumann6, Claus Petersen5, Jens Dingemann5, Michael Berger1, Omid Madadi‐Sanjani5
1Pediatric Surgery Department, Essen University Hospital, Essen, Germany, 2Institute For Medical Informatics, Biometry And Epidemiology, Essen University Hospital, Essen, Germany, 3Department Of Pediatric Gastroenterology, Hepatology, And Transplant Medicine, Essen University Hospital, Essen, Germany, 4Department Of Pediatric Kidney, Liver And Metabolic Diseases, Hannover Medical School, Hannover, Germany, 5Pediatric Surgery Department, Hannover Medical School, Hannover, Germany, 6Department Of Pediatric Gastroenterology, Hepatology And Liver Transplantation, Hannover Medical School, Hannover, Germany
Objectives and Study: Biliary atresia (BA) is a progressive neonatal cholangiopathy resulting in liver impairment, cirrhosis, and portal hypertension. Kasai portoenterostomy (KPE) attempts to restore biliary drainage in BA infants to achieve native liver survival (NLS), however, BA remains the main indication for pediatric liver transplantation. Consequently, indicators for KPE failure are essential. Therefore, we analyzed hepatic blood flow velocities and their predictive value for native liver survival in BA patients.
Methods: A retrospective chart review at two major German centers included patients diagnosed with BA from 2008 to 2023. Hepatic blood flow velocity was measured via standardized ultrasound before and 3 months after KPE. Systolic and diastolic blood flow velocity of the hepatic artery (HA), arterial resistivity index (ARI), and portal vein (PV) flow velocity were compared with liver function tests, liver fibrosis (according to Ishak), and NLS at 6 and 24 months post‐KPE.
Results: 163 BA patients were included. Postoperative NLS was 63.6% and 40% at 6 and 24 months following KPE, respectively. Systolic HA flow velocity significantly decreased in infants with postoperative NLS from diagnosis to 2‐year follow‐up (79.46 cm/s ± 32.14 vs. 56.85 cm/s ± 18.39; p = 0.002), while ARI significantly increased in patients with Kasai failure (0.76 ± 0.08 vs. 0.87 ± 0.14; p < 0.001). Furthermore, a significant difference was detected in PV flow velocity, with higher NLS rates at 6 months after KPE if initial flow velocities were increased at the time of diagnosis, with a cut‐off of 27 cm/s and above in favor of NLS (AUC 0.8371; p < 0.001). Multivariate analysis did not detect associations with liver fibrosis at KPE and liver function tests.
Conclusions: Hepatic blood flow velocities at the time of diagnosis and during follow‐ups may help to predict native liver survival in BA patients following KPE. The results need to be further validated in a prospective study.
Contact e‐mail address: jan.sabo@uk-essen.de
H‐EV084. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV084.1. PERFORMANCE OF CURRENT TESTS IN DIFFERENTIAL DIAGNOSIS OF BILIARY ATRESIA IN A REAL WORD SETTING: A PERSPECTIVE STUDY
Marco Sciveres 1,2, Giusy Ranucci3, Daniela Liccardo1, Filippo Parolini4, Paola Gaio5, Francesco Cirillo6, Valeria Casotti7, Daniele Serranti8, Michele Pinon9, Giuseppe Indolfi8, Daniele Alberti10, Mara Cananzi11,12, Lorenzo D'antonio7, Pier Luigi Calvo13, Angelo Di Giorgio14, Claudia Mandato15, Giuseppe Maggiore16
1Hepatology and Liver Transplant Unit, Bambino Gesù IRCCS Children's Hospital, Rome, Italy, 211Hepatology Study Group, Italian Society for Gaastroenterology, Hepatology and Nutrition, SIGENP, Italy, 3Department of Pediatrics Liver Transplant Center UPMC‐ISMETT, Palermo, Italy, 4Pediatric Surgery, University Department of Pediatrics, Children's Hospital, Spedali Civili, Brescia, Italy, Brescia, Italy, 5Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, University Hospital of Padua, Padova, Italy, 6Pediatric Gastroenterology and Hepatology Unit, Santobono‐Pausilipon Children's Hospital, Naples, Italy, Naples, Italy, 7Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy, 8Department of Pediatrics, Meyer Children's University Hospital, Firenze, Italy, 9Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera‐Città della Salute e della Scienza di Torino, Torino, Italy, 10Pediatric Surgery, University Department of Pediatrics, Children's Hospital, Spedali Civili, Brescia, Brescia, Italy, 11Unit Of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology And Care Of The Child With Liver Transplantation, Department Of Women's And Children's Health, University Hospital of Padova, Padova, Italy, 12Unit Of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology And Care Of The Child With Liver Transplantation, Department Of Women's And Children's Health, University Hospital of Padua, Padua, Italy, 13Pediatic Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera Città Della Salute e Della Scienza University Hospital, Torino, Italy, 14Hospital Santa Maria della Misericordia. Department of Medicine, University of Udine, Udine, Italy, 15Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Pediatrics Section, University of Salerno, Baronissi, Salerno, Italy, 16Hepatology And Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
Objectives and Study: Diagnostic work up for neonatal cholestasis (NC) is a difficult and time sensitive task. Biliary Atresia (BA) has to be confirmed or ruled out as early as possible. Every 10 children with NC only 2 have BA. Most reliable assesments are invasive and need sedation thus a number of non‐BA children undergo non‐conclusive invasive procedures. A bedside tool for a reilable first‐line screening could be useful
Methods: Within the framework of Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP), all italian third‐level hepatology Units joined to enroll a perspective, consecutive cohort of cholestatic children aged from 30 to 120 days. A total of 53 items including demographic, gravidic, clinical, laboratory, echographic end histological (if available) data were collected. A multi‐step statystical analysis is being performed.
Results: 182 children were enrolled, final diagnosis was BA in 95 and other cholestatic diseases in 86. To date only preliminary results on dicotomic variables are available and are partially shown in table.
| Sensitivity % | Specificity % | Positive Predictive Value % | Negative Predictive Value % | |
|---|---|---|---|---|
| Parenteral Nutrition | 96.8 | 20.0 | 57.2 | 85.0 |
| Acholic stools | 93.7 | 50.0 | 67.4 | 87.8 |
| Hepatomegaly | 83.2 | 45.3 | 62.7 | 70.9 |
| Splenomegaly | 58.9 | 81.4 | 77.8 | 64.2 |
| Triangular Cord | 49.5 | 97.7 | 95.9 | 63.6 |
| Gallbladder not found | 31.6 | 93.0 | 83.3 | 55.2 |
| Gallbladder Contractility | 92.7 | 76.9 | 80.9 | 90.9 |
| Subcapsular Flow | 47.7 | 83.8 | 78.8 | 55.9 |
| Polysplenia | 16.8 | 100.0 | 100.0 | 52.1 |
| Ductular Proliferation | 98.9 | 64.3 | 85.7 | 96.4 |
Conclusions: After preliminary analysis on dicotomic variables, triangular cord, non‐visualization of gallbladder, polysplenia are most specific items for a positive prediction of BA. A contractile gallbladder and no ductular proliferation at histology seems useful for a negative prediction. Next step will be to find optimal cut‐off for continuos variabile and finally to combine most performing items to obtain a diagnostic tool.
Contact e‐mail address: marco.sciveres@opbg.net
H‐EV085. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV085.1. SPLENIC ARTERY ANEURYSM IN A PATIENT WITH CIRRHOSIS
Lakshmi Selvarajan, Christine Spray, Ijeoma Chukwu
Bristol Royal Hospital For Children, Bristol, United Kingdom
Objectives and Study: A 16‐year‐old girl with known advanced cirrhosis, portal hypertension and polysplenia, secondary to biliary atresia post Kasai, presented with sudden onset left upper quadrant pain of one week duration aggravated on movement and required morphine. She was icteric, pyrexial, tender in left upper quadrant with otherwise stable splenomegaly, no haemodynamic disturbance. Commenced on IV Tazocin for possible cholangitis.
Methods: CRP 79 ( < 5); serum bilirubin 97 umol/L, ALT 48 (10‐40); GGT 56 ( < 38); ALP 168 (54‐130). She had thrombocytopaenia 106 (secondary to hypersplenism). Prothrombin time was increased 19.1, haemoglobin was stable, lipase and chest x ray were normal.
Results: An abdominal USS to look for possible splenic infarct showed splenic varices with patent portal vein. CT Angiogram of mesenteric artery showed multiple (7) splenic artery aneurysms (SAA) ranging from 7 mm to 27 mm with possible recent aneurysmal bleed. She had a further bleed 10 days later, had repeat CT scan, which showed pseudoaneurysm and was embolised by intervention radiology (IR) and had liver transplant assessment.
Conclusions: SAA occurs commonly in cirrhotic patients and are at heightened risk of rupture peri liver transplant with fatal consequences up to 57% mortality (1). However, there is no consensus regarding optimal management of asymptomatic SAA pre transplantation. A systematic review by Du Phan et al (2) reported 159 patients with SAA, of whom 121 had asymptomatic SAA, diagnosed pre liver transplant and subsequently underwent liver transplantation and concluded treatment should be considered regardless of aneurysmal size because of the risk of rupture post transplantation. 1 Gaglio PJ et al. a‐1 antitryspin deficiency and splenic artery aneurysm rupture: an association Am J of Gastroenteroly vol 95, June 2000 1531 – 1534. 2 Du Phan et al. Splenic Artery Aneurysm Management in the Cirrhotic Patient Listed for Liver Transplantation:a systematic review. Transplantation Proceedings Vol54, April 2022:706 – 714.
Contact e‐mail address:
H‐EV086. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV086.1. LARGEST INDIAN CASE SERIES OF NISCH SYNDROME: A NOVEL CAUSE OF LOW/NORMAL GGT NEONATAL CHOLESTASIS
Vaibhav Shah
Gujarat Superspeciality Clinic, Ahmedabad, India
Objectives and Study: Neonatal Icthyosis Sclerosing Cholangitis (NISCH) syndrome is an extremely rare disease, described in only 22 patients from 13 different families worldwide. We present the largest case series from India comprising 4 patients, each belonging to a different family.
Methods: Data was collected retrospectively of patients presenting to OPD clinic between November 2021 to November 2024. All patients with homozygous mutation in the CLDN1 gene were included.
Results:
All patients had Indian ethnicity, and presented with onset of jaundice in neonatal period, alongwith poor weight gain, hepatomegaly, hypotrichosis and icthyosis. Pruritus of varying severity, was observed in all patients, with onset around 4 months of age. Three patients were males. Single patient who expired at 7 months of age, was a female. All patients had a normal ultrasound of abdomen at the time of presentation. One patient was misdiagnosed initially as biliary atresia before presenting to us, and underwent Kasai portoenterostomy at 1.5 months of age. He has been posted for liver transplant at 9 months of age. Two patients showed complete regression of cholestasis with normalisation of liver function tests, without progression to chronic liver disease till date.
Conclusions: NISCH syndrome is one of the few causes of neonatal cholestasis with icthyosis. It should also be considered in the differential diagnosis of the tiny subset of low/normal GGT neonatal cholestasis. Further studies are required to establish genotype‐phenotype correlation and genotype‐outcome asociations.
Contact e‐mail address: drvsshah88@gmail.com
H‐EV087. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV087.1. PAEDIATRIC SARCOIDOSIS WITH HEPATIC INVOLVEMENT AS THE INITIAL PRESENTATION IN A TEENAGE GIRL
Viswanathan Melarcode Sivaramakrishnan 1, Priyadarshini M2, Mahesh Janarthanan3
1Paediatric Gastroenterology, Apollo Children's Hospital, CHENNAI, India, 2Paediatrics, Apollo Children's Hospital, CHENNAI, India, 3Paediatric Rheumatology, Apollo Children's Hospital, CHENNAI, India
Objectives and Study: Introduction Paediatric sarcoidosis is a rare systemic granulomatous disease. This case is presented to emphasise that hepatic involvement could be a primary presentation of paediatric sarcoidosis.
Methods: Case report: A thirteen year old girl of East African origin presented with complaints of weight loss & chronic abdominal pain, managed as autoimmune hepatitis elsewhere over last one year. Initial evaluation in our hospital revealed raised transaminases (ALT 123, AST 192),mild hyperbilirubinemia (Bilirubin ‐ Total 2.2, Conjugated 1.7), INR 1.28, GGT 435 and Albumin 3.9 (total protein 7.6). Autoimmune work up, serum ceruloplasmin & viral serology were unremarkable. Liver biopsy revealed a non‐caseating granulomatous inflammation, not suggestive of autoimmune liver disease (Figure:1). MRCP showed multiple discrete & conglomerate retroperitoneal lymphadenopathy and hepatosplenomegaly raising the suspicion of granulomatous inflammatory conditions and malignancy. Angiotensin converting enzyme was elevated ‐ 150 U/L (8‐52). Detailed evaluation: Immunological work up including HIV, infectious disease work up including tuberculosis & parasitic evaluation were unremarkable. A diagnostic laparoscopy with lymph node biopsy showed non‐necrotising granulomatous inflammation, confirming the diagnosis of sarcoidosis. Malignancy was ruled out. Pulmonary, cardiac, renal and eye evaluation was unremarkable. Rheumatologist opinion was sought, the girl was treated with Prednisolone, Mycofenolate Mofetil & other supportive management. At 6 months follow up, she is having good clinical and biochemical recovery.
Results: Discussion Paediatric Sarcoidosis is a diagnosis of exclusion. It is important to exclude hematological malignancies and infections like tuberculosis/parasites. Hepatic involvement is an uncommon initial presentation. Most cases of hepatic sarcoidosis are clinically silent, with only a few patients developing jaundice, chronic cholestasis, portal hypertension and/or Budd‐Chiari syndrome.
Conclusions: Hepatic sarcoidosis diagnosis requires histological confirmation of granulomatous inflammation, exclusion of all other granulomatous inflammation and evidence of at least one other organ involvement. Patients with markedly elevated liver enzymes, portal hypertension or unexplained hepatic decompensation should be considered for treatment.
Contact e‐mail address: drmsv21@gmail.com
H‐EV088. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV088.1. ETIOLOGY OF STEATOTIC LIVER DISEASE IN A TERTIARY PEDIATRIC GASTROENTEROLOGY CLINIC
Anelisa Socite 1, Corina Pienar2, Corina Cercel3, Pilsu Andreea4, Laura Savu3, Mirela Mogoi5, Pop Laurentiu6
1Pediatrics, 2nd Pediatrics Clinic, “Pius Brinzeu” Emergency County Hospital, Timișoara, Romania, 2Department Of Pediatrics, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Timisoara, Romania, 3Pediatrics, 2nd Pediatrics Clinic, “Pius Brinzeu” Emergency County Hospital, Timisoara, Romania, Timisoara, Romania, 42nd Pediatric Clinic, "PIUS BRÎNZEU" COUNTY EMERGENCY CLINICAL HOSPITAL, Timisoara, Romania, 5Pediatrics, 2nd Pediatrics Clinic, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Timisoara, Romania, 62Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania, timisoara, Romania
Objectives and Study: We aimed to evaluate the etiology of pediatric steatotic liver disease (SLD) in our Pediatric Gastroenterology Clinic.
Methods: We reviewed data of children diagnosed with liver steatosis on abdominal ultrasound between January 2021 and November 2024. We analyzed clinical features and serum markers used to establish etiology.
Results: We included 108 children (age range 1‐18 years, median age 11 ± 3.9 years, 63.6% boys). Liver steatosis severity ranged from mild (67.5%) to moderate (24.3%) and severe (8.2%). 73.14% of the children presented with at least one feature of metabolic associated SLD (MASLD). The most common associated MASLD feature was obesity (56.4%), followed by diabetes mellitus (9.3%). In 32.4% of the children (35/108) we found high serum transaminase levels. 73/108 children (67.5%) were diagnosed with MASH (metabolic associated steatohepatitis), presenting at least one metabolic feature. 4 children were further diagnosed with chronic viral liver infections (3 children present HBV infection and 1 has HCV infection). Another 14 (12.9%) children were tested to exclude cystic fibrosis, celiac disease, hypothyroidism, autoimmune hepatitis, Wilson disease, alpha‐1 antitrypsin deficiency, Gaucher or Niemann‐Pick disease. In 29/108 cases (26.85%), the etiology of hepatic steatosis remained unidentified.
Conclusions: MASLD is the most common etiology in our cohort of children with SLD. Among them MASH is frequent. We expand our etiology testing in a limited number of children.
Contact e‐mail address: anelisa.socite@gmail.com
H‐EV089. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV089.1. CARDIOMETABOLIC ABNORMALITIES AND ENDOCRINE PROFILE IN PEDIATRIC PATIENTS WITH NON‐ALCOHOLIC FATTY LIVER DISEASE: A RETROSPECTIVE ANALYSIS
Otilia Iftinchi1,2, Gabriela Paduraru2,3, Nicoleta Gimiga2,3, Elena Lia Spoiala1,2, Laura Otilia Boca1,2, Lorena Mihaela Manole1,2, Madalina Andreea Donos1,2, Laura Mihaela Trandafir 2,3
1“Saint Mary” Emergency Hospital for Children, Iasi, Romania, 2Department Of Mother And Child, Faculty Of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Iasi, Romania, 3“Saint Mary” Emergency Hospital for Children, iasi, Romania
Objectives and Study: Non‐alcoholic fatty liver disease (NAFLD) is increasingly prevalent in pediatric populations, particularly among children with obesity. This study aimed to evaluate the metabolic profile of pediatric patients with NAFLD and determine the prevalence of cardiometabolic and endocrine abnormalities.
Methods: A retrospective analysis was conducted on 32 pediatric patients diagnosed with NAFLD at the “Saint Mary” Clinical Emergency Hospital in Iași, Romania. The diagnosis of NAFLD was established according to the ESPGHAN criteria introduced in 2012. The patients, with an average age of 12.74 ± 0.64 years, were assessed for obesity, glucose metabolism abnormalities, dyslipidemia, and associated metabolic conditions.
Results: The cohort consisted of 62.5% males and 37.5% females, with a mean body mass index (BMI) of 29.87 ± 1.09 kg/m2. The BMI difference between boys and girls was not statistically significant (p = 0.579). Obesity was observed in 84.7%, and 15.6% were overweight. Lipid profile abnormalities included total cholesterol (161.41 ± 6.77 mg/dL), LDL (93.32 ± 4.54 mg/dL), HDL (43.26 ± 1.64 mg/dL), and triglycerides (129.25 ± 26.10 mg/dL), with significant dyslipidemia (12.5% hypercholesterolemia, 6.25% elevated LDL, 37.5% low HDL, 25% hypertriglyceridemia). Cardiometabolic abnormalities were observed, with 9.37% presenting with arterial hypertension, 12.5% diagnosed with type 2 diabetes, and 31.25% showing insulin resistance.
Conclusions: This study underscores the high prevalence of cardiometabolic abnormalities in pediatric NAFLD patients, including insulin resistance, dyslipidemia, hypertension and potential endocrine disturbances. While the small sample size (32 patients) limits statistical power and significant associations, it provides a foundation for future research. Notably, this marks the start of a broader investigation to which I will contribute by refining the study design to align with upcoming nomenclature and diagnostic criteria, and by expanding the cohort to strengthen findings and clinical relevance.
Contact e‐mail address: otilia.iftinchi@yahoo.com
H‐EV090. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV090.1. DETERMINATION OF SERUM ALT AND AST REFERENCE VALUES IN LATE PRETERM AND TERM INFANTS DURING THE NEONATAL PERIOD
Sezin Ünal 1, Lala Mahammadova2, Deniz Anuk Ince1, Ozden Turan1, Emil Akbarov1, Ayse Nur Ecevit1
1Pediatrics/division Of Neonatology, Baskent University Faculty of Medicine, Ankara, Turkey, 2Department Of Pediatrics, Ankara, Turkiye, Baskent University Faculty of Medicine, Ankara, Turkey
Objectives and Study: Serum ALT and AST reference values that were reported in textbooks in neonates are based on outdated studies; ALT: 6‐50 IU/L (0‐5 days), 1‐25 IU/L (1‐30 days) and AST: 35‐140 IU/L (0‐5 days), 20‐60 IU/L (1‐3 months). Few recent studies provide updated national data, and none exist from our country. We aimed to determine ALT and AST reference values in late preterm and term neonates.
Methods: Late‐preterm and term infants discharged between 2020‐2024 were included in this retrospective study. Their ALT and AST values were grouped (1st_day, 1st_week; and 2nd‐4th_weeks) within the first 28 days. Exclusion criteria; cord pH<7.20, APGAR score<7, preeclampsia, congenital heart disease, sepsis, inotropic drug use, liver injury, antibiotic use >7 days. Mann‐Whitney‐U test was used for group comparisons, Bonferroni correction was applied (p < 0.015) for pairwise comparisons among three time points. SPSS 25.0 was used.
Results: 450 neonates (253 term, 197 late‐preterm, 37 + 2 weeks, 2868 ± 578 g), 933 ALT and 818 AST values were analyzed. Mean ALT: 17 ± 10 U/L, AST: 47 ± 22 U/L. ALT levels were significantly lower in late‐preterm neonates. Median, 95p and 99p values are presented in Table. ALT levels were found to be lowest, and AST levels were found to be highest on the first day in both groups.
| 50p | 95p | 99p | p value | ||
|---|---|---|---|---|---|
| ALT | |||||
| 1st_day | Late‐PT Term | 10 14 | 24 33 | 66 43 | < 0.001 |
| 1st_week | Late‐PT Term | 12 17 | 30 35 | 51 44 | < 0.001 |
| 2‐4_weeks | Late‐PT Term | 13 18 | 32 39 | 83 91 | < 0.001 |
| AST | |||||
| 1st_day | Late‐PT Term | 53 59 | 95 107 | 143 144 | 0.032 |
| 1st_week | Late‐PT Term | 35 40 | 75 78 | 127 110 | 0.002 |
| 2‐4_weeks | Late‐PT Term | 32 34 | 57 62 | 102 216 | 0.101 |
Conclusions: Our study found that serum ALT and AST reference ranges are lower than previous values. Tracking time‐dependent changes in these enzymes may improve interpretation and help reduce unnecessary interventions.
Contact e‐mail address: sezinunal@gmail.com
H‐EV091. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV091.1. ETIOLOGICAL AND DIAGNOSTIC INSIGHTS INTO PROLONGED JAUNDICE IN TERM‐BORN INFANTS AGED 1‐3 MONTHS
Aysel Ünlüsoy Aksu 1, Büşra Yelgel2
1Pediatric Gastroenterology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey, 2Pediatrics, Ankara Bilkent City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
Objectives and Study: This study aimed to analyze prolonged jaundice in term‐born infants aged 1‐3 months, and to identify etiological variables, as well as to examine the frequency of hospital visits and the healthcare costs associated with variables that do not impact the diagnosis.
Methods: The patients with total bilirubin levels above 5 mg/dL were categorized into two groups: Group 1 consisted of infants diagnosed with a specific cause of prolonged jaundice, while Group 2 included those with idiopathic jaundice that resolved spontaneously. We reviewed the data retrospectively and compared the demographic characteristics, laboratory findings, and imaging results in the two groups. Student's t‐test was used, and the Mann‐Whitney U test was used if assumptions were not met.
Results: The mean age at the initiation of etiologic investigations was 26.9 ± 1.4 days in Group 1 (n = 109) and 31 ± 0.9 days in Group 2 (n = 257). Neonatal hospitalizations and phototherapy treatments were more frequent in Group 1 (p < 0.001). The age of jaundice onset, duration of jaundice, the number of visits to the pediatrics and the subspecialty clinics, and the age at which visits to subspecialty clinics were not different between the groups. However, pyuria in urine tests, positive urine cultures, elevated
Conclusions: In our study, the etiology of jaundice could not be determined in 70.2% of patients, and the jaundice resolved spontaneously, with these cases being classified as late‐type breast milk jaundice. The number of hospital visits and healthcare costs were substantial in both groups. By focusing on the most common diagnosis and associated tests, healthcare costs could be reduced.
Contact e‐mail address:
H‐EV092. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV092.1. NON‐CIRROTHIC PORTAL HYPERTENSION IN A PATIENT WITH ZNFX1 MUTATION
Aysel Ünlüsoy Aksu 1, Nesrin Turhan2, Betül Karaatmaca3, Sare Özlü4, Aynur Yavaş5, Banu Acar6, Meral Akdoğan7, Serdar Ceylaner8
1Pediatric Gastroenterology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey, 2Pathology, Ankara Bilkent City Hospital, Çankaya, Turkey, 3Pediatric Immunology, Ankara Bilkent City Hospital, Çankaya, Turkey, 4Pediatric Nephrology, Ankara Bilkent City Hospital, Çankaya, Turkey, 5Pediatric Metabolism, Ankara Bilkent City Hospital, Çankaya, Turkey, 6Pediatric Rheumatology, Ankara Bilkent City Hospital, Çankaya, Turkey, 7Gastroenterology, Ankara Bilkent City Hospital, Çankaya, Turkey, 8Intergen Genetics and Rare Diseases Diagnosis Center, Çankaya, Turkey
Objectives and Study: ZNFX1(NFX1‐type zinc‐finger‐containing) deficiency causes vulnerability to severe viral infections, multisystem hyperinflammation, and dysfunction. 28 patients with ZNFX1 mutations were reported leading recurrent viral and mycobacterial infections, monocytosis, thrombocytopenia, hepatosplenomegaly, and hemophagocytic lymphohistiocytosis (HLH) or HLH‐like manifestations. Here we describe a patient with non‐cirrhotic portal hypertension and resistant systemic hypertension.
Methods: A 16‐year‐old boy was admitted to the hospital for hematuria two years ago. He presented with systemic hypertension, and the laboratory tests revealed elevated blood urea, creatinine, and proteinuria. He was born to a consanguineous parent.
Results: Laboratory findings included: hemoglobin 10,7 g/dl, platelets 92000/mm3, absolute lymphocyte count 840/mm3, AST 61 U/L, ALT 67 U/L, urea 73 mg/dl, creatinine 1,23 mg/dl, albumin 37 g/L. GGT, bilirubin, and coagulation tests were normal. Abdominal ultrasound and magnetic resonance imaging (MRI) showed macro‐lobulated liver with heterogeneous parenchyma, caudate lobe hypertrophy, narrowing of portal vein branches in the right and left lobe, splenomegaly, and mild nephromegaly. Serum ferritin, cholesterol, and alpha‐1 antitrypsin levels were normal. Wilson's disease and systemic lupus erythematosus were excluded. Autoimmune hepatitis antibodies were negative. Comprehensive analyses of plasma amino acids, urine organic acids, and plasma carnitines were normal, and Fabry disease was excluded. He has concentric hypertrophy in the left ventricle wall on echocardiography, 1‐2 grade mitral insufficiency. Esophagogastroscopy revealed grade 2 esophageal varices. A liver biopsy showed mild hepatocellular injury, hepatic activity index/6, and fibrosis score of 1/6. The liver stiffness was 13.8 kPA. Renal biopsy revealed mild mesangial cellular proliferation. Immunoglobulin levels and lymphocyte subset analysis were normal. He had Legionella pneumophila, Bocavirus, Enteropathogenic E‐coli, Campylobacter infections, and esophagus varices hemorrhage three times in the previous two years. Whole exome sequencing was performed, and a ZNFX1 gene homozygous mutation was found.
Conclusions: Non‐cirrhotic portal hypertension is a rare condition, and ZNFX1 mutation should also be investigated in etiological evaluation.
Contact e‐mail address: ayselun@gmail.com
H‐EV093. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV093.1. REDEFINED APPROACH TO HIGH GGT NEONATAL AND INFANTILE CHOLESTASIS WITH PERCUTANEOUS CHOLECYSTOCHOLANGIOGRAPHY
Piyush Upadhyay 1, Abhishek Chauhan2, Tushant Kumar2, Nujhat Hussain3, Neha Nigam4, Dipti Agarwal5
1Division Of Pediatric Hepatology And Gastroenterology, Department Of Pediatrics, Dr RML INSTITUTE OF MEDICAL SCIENCES, Lucknow, India, 2Radiology, Dr RML Institute of Medical Sciences, Lucknow, India, 3Pathology, Dr RML Institute of Medical Sciences, Lucknow, India, 4Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India, 5Pediatrics, Dr RML Institute of Medical Sciences, Lucknow, India
Objectives and Study: The objective of this study was to evaluate the feasibility, safety, and role of percutaneous cholecystocholangiography (PCC) in changing the approach to high GGT neonatal cholestasis.
Methods: All consecutive infants with high GGT conjugated hyperbilirubinemia were included over a period of 24 months. Infants with significant ascites or clinically unstable were excluded. PCC was performed via the transhepatic route using 23‐g needle and iodixanol. PCC, ultrasound abdomen, complete liver function test and liver biopsy were done besides other baseline test and required tests in all cases. Liver biopsy was examined at 2 different centres by histopathologist with more than 10 years of experience in liver histopatholgy and blinded to each other.
Results: Fifty three infants (age range 35 days to 225 days) were evaluated. PCC was technically feasible in all. PCC demonstrated proximal and distal biliary patency in 35/50 (70%) infants (median age 45 days), thereby avoiding unnecessary laparotomy in them while suggestive of biliary atresia (BA) in 18 (mean age 152 days). Liver biopsy falsely labelled BA in 4/53 cases(diagnostic accuracy ‐DA 89.1%) and 5/53 cases(DA 88.5%) at center 1 and center 2 respectively. Ultrasound suggested BA in only 15 of the 18 cases (True Positive, Senstivity 83.3%) where PCC showed non patent biliary system and in 10 of the 35 cases(false positive,specificity 71.4%) where PCC showed patent Biliary system with DA of 74.5%. Kasai Portoenterostomy was feasible in only one case where PCC showed non patent biliary system, confirmed on laparotomy at age of 59 days, it was successful. One patient who showed patent biliary system with beading, later had resolving jaundice but progressive liver disease, genetic testing is planned. Thirty‐three patients had resolving jaundice without any evidence of liver disease progression. MDR3 stain was absent in 1 case.
Conclusions: Percutaneous Cholecystocholangiography has now redefined approach to high GGT neonatal cholestasis
Contact e‐mail address: uppiyush@yahoo.com
H‐EV094. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV094.1. BASELINE SERUM RETINOL LEVELS MAY PREDICT POOR OUTCOME OF PEDIATRIC ACUTE LIVER FAILURE OF INFECTIOUS ETIOLOGY: PROSPECTIVE OBSERVATIONAL STUDY FROM TERTIARY CARE CENTER NORTH INDIA
Sanjeev Verma 1, Stuti Shukla1, Kausar Ansari2, Amita Jain3
1Pediatrics, King George Medical University Lucknow, Lucknow, India, 2Toxicology, CSIR‐ Indian Institute of Toxicology Research, Lucknow, India, 3Microbiology, King George Medical University Lucknow, Lucknow, India
Objectives and Study: The Pediatric Acute Liver Failure Study (PALF) is devastating disease in children with poor outcome without liver transplant. Etiological profile varies as per prevalence of hepatotropic viral infection. Low retinol levels are linked with unpredictable inflammatory responses so this study aimed to determine etiological spectrum of PALF and investigate retinol levels as predictors of mortality in children with PALF.
Methods: ‐ A prospective observational study was done in the Pediatrics department of a tertiary care center in North India, focusing on children 6 months to 14 years age. Detailed histories and examinations were conducted for these children and assessed for viral, immunological, and metabolic disorders, along with retinol levels measured at admission.
Results: Total 72 children, Female (n = 43) were included in this study. Mean age of presentation is 6.00 ± 3.53 years. Among established etiology of PALF in 87.5% (63/72) cases, Hepatitis A were (66.7%) Hepatitis E (5.6%, n = 4), Hepatitis B (2.8%, n = 2), PALF‐CLD (5.6%, n = 4). Other causes include & other infection (4.2%, n = 3). Nine patients (12.5%) labelled as Indeterminate. 45 of them survived with native liver, PELD, INR, Bilirubin significantly worse in in children with poor outcome. Serum retinol levels were significantly lower in expired group compared to discharged group. (p = 0.006). Retinol values at presentation, at cut off of 0.048 mmol/l, predicts mortality with the sensitivity was 77.8% and specificity was 55.6%. Overall mortality accuracy was 62.5%.
Conclusions:
Hepatitis A is single most common etiology of PALF in North India. There is high risk of mortality among children with lower serum retinol levels.
Contact e‐mail address: drsanjeev78@gmail.com
H‐EV095. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV095.1. ACUTE HEPATITIS B TRIGGERING LIVER FAILURE IN A CHILD WITH UNDERLING MCAD DEFICIENCY HETEROZYGOSITY
Aikaterini Vourdoumpa 1, Ioanna Argyri1, Alexandros Panos1, Ariadni Neofytou1, Maria‐Evangelia Alyfanti1, Maria Tsolia1, Aglaia Zellos2, Angeliki Syggelou1, Lydia Kossiva1
1Second Department of Pediatrics, National and Kapodistrian University of Athens Medical School, P. & A. Kyriakou Children's Hospital, Athens, Greece, 2First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Aghia Sophia Children's Hospital, Athens, Greece
Objectives and Study: HBV infection remains a major global cause of morbidity and mortality. Early in life transmission typically occurs perinatally or in early childhood, often characterized by high viral replication, low‐grade inflammation, and normal or mildly elevated transaminase concentrations. This study aims to present a case of acute liver failure in a 4‐year‐old child due to HBV infection treated with entecavir, on the background of a heterozygous mutation in ACADM.
Methods: A 4‐year‐old unvaccinated girl presented with jaundice, diarrhea, and hepatomegaly. Family history revealed death of a 14‐month‐old sibling from acute liver failure, acidosis, and hypoglycemia.
Results: Evaluation revealed acute liver failure (ALT: 1619 U/L, AST: 1218 U/L, direct hyperbilirubinemia: 6.7 mg/dL, NH3: 47.9 μmol/L, INR: 1.67 despite vitamin K administration), along with acute hepatitis B of unknown transmission (HBsAg, total anti‐HBc, anti‐core HBV IgM, HBeAg: positive, anti‐HBe, anti‐HBs: negative, elevated serum HBV DNA: 103,600 IU/mL via Real‐Time PCR). Mother's HBV status showed recovery from past infection and immunity. On abdominal ultrasound, liver parenchyma was homogeneous and uniform in echogenicity and 2D shear wave elastography showed fibrosis graded F3‐F4. Antiviral therapy (entecavir: 0.5 mg/day) was initiated, resulting in successful HBeAg to HBeAb seroconversion, reduction in HBV DNA levels, and normalization of transaminases, gradually during a 6‐month follow‐up. Genetic testing (Whole Genome Sequencing) identified a heterozygous pathogenic variant [c.985 A>G (p.Lys329Glu)] in ACADM, which encodes a mitochondrial enzyme involved in fatty acid oxidation, causing medium‐chain acyl‐CoA dehydrogenase (MCAD) deficiency. A second ACADM mutation was not identified.
Conclusions: In cases of acute liver failure due to HBV, the prompt use of antiviral therapy improves liver function. Although a viral cause was identified, the patient's young age and family history led to genetic investigation, revealing heterozygosity for MCAD deficiency. Further studies are needed to clarify the genotype‐phenotype correlation between ACADM mutation carriers and deteriorating liver function upon hepatotropic infections.
Contact e‐mail address: katvourdouba@gmail.com
H‐EV096. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV096.1. TEN‐YEAR EXPERIENCE WITH NON‐SYNDROMIC MALFORMATIONS OF THE BILIARY TRACT: CLINICAL PRESENTATION, DIAGNOSIS AND OUTCOMES IN PEDIATRIC PATIENTS
Natasha Woods Kreisler 1, Antonio Rosell Camps1, Lucinda Bunce1, Georgina Sanchis Blanco2
1Division Of Pediatric Gastroenterology, Hepatology And Nutrition, University Hospital Son Espases, Palma de Mallorca, Spain, 2Division Of Pediatric Surgery, University Hospital Son Espases, Palma de Mallorca, Spain
Objectives and Study: To describe a ten‐year cohort of pediatric patients with non‐syndromic malformations of the biliary tract (BT), focusing on demographics, clinical presentation, diagnostics, complications, treatment and outcomes. It is crucial to maintain a high index of suspicion, as they can remain unnoticed and present as severe complications.
Methods: Pediatric patients (<15 years) diagnosed with non‐syndromic malformations of the BT at a tertiary center (2015‐2024) were retrospectively reviewed.
Results: Ten patients (60% female) were identified, with a mean diagnosis age of 10 months (prenatal to 4 years). Choledochal cysts (50%) were the most common (four Todani I, one Todani IVb), followed by gallbladder malformations (30%, one agenesia, one rudimentary gallbladder and one duplication), isolated anomalous pancreaticobiliary duct union (APBDU) and cystic biliary atresia (10% each). Two choledochal cyst cases (20%) involved also APBDU. Clinical presentation included: asymptomatic (60%), jaundice (30%), fever, vomiting, and irritability (20% each) and abdominal pain (10%). Two (20%) presented with spontaneous perforation of the BT. Diagnostic investigations included ultrasound (100%), MRCP (70%) and ERCP (30%). Pre‐surgical complications included: hypertransaminasemia (40%), cholestasis (30%), lithiasis (30%) and pancreatitis (20%). The surgical treatment included: resection and hepaticojejunostomy in choledochal cysts (50%), Kasai portoenterostomy in biliary atresia (10%), papillotomy and ductoplasty in isolated APBDU (10%) and no surgery in the gallbladder malformations (30%). Pathology showed no malignancy. With mean follow‐up of 3.6 years, post‐surgical complications included cholangitis (29%), pancreatitis (14%), and liver transplant (14%) (biliary atresia case).
Conclusions: Non‐syndromic biliary malformations in pediatric patients exhibit a wide spectrum of presentations, ranging from asymptomatic to severe complications. In our cohort, the most common presentation was asymptomatic followed by obstructive symptoms. However, due to the small sample size, the generalizability is limited. The lack of standardized pediatric clinical practice guidelines, poses challenges for long‐term management and follow‐up.
Contact e‐mail address: natashawoodskreisler@gmail.com
H‐EV097. Topic: AS02. HEPATOLOGY/AS02a. General Hepatology
H‐EV097.1. IMPACT OF WAR ON ANXIETY IN CHILDREN WITH METABOLIC‐DYSFUNCTION ASSOCIATED STEATOTIC LIVER DISEASE
Natalia Zavhorodnia 1, Yurii Stepanov2, Raisa Kislova3, Yulia Ocheretyanko1
1Pediatric Gastroenterology, SI Institute Gastroenterology of the NAMS of Ukraine, Dnipro, Ukraine, 2Director, SI "Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine", Dnipro, Ukraine, 3Mini‐invasive Endoscopic Interventions And Instrumental Diagnostics, SI "Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine", Dnipro, Ukraine
Objectives and Study: There is a need for investigation of war‐associated emotional disorders in Ukrainian obese children that may contribute to MASLD progression. Objective: To assess the anxiety in children with MASLD and to identify the psycho‐emotional features of MASLD children of military parents.
Methods: The study involved 45 patients aged 6 to 17 years (mean age 11.8 ± 1.5 years). The presence of obesity was evaluated using bioimpedance analysis (TANITA MC‐780MA, Japan). Liver steatosis was established by transient elastography (FibroScan®502touch, Echosence, France) with CAP measurement. Based on MASLD presence and relation of parents to the military, the children were divided into 3 groups: 1 group – 29 MASLD children of civilian parents, 2 group – 8 MASLD children of military parents, and 3 group (control) – 8 normal weight children of civilian parents. Screening for anxiety disorders was performed using the Screen for Child Anxiety‐Related Disorders (SCARED) questionnaire.
Results: An increased general level of anxiety was more frequently observed in children with MASLD compared to the control group (34.5% in 1 group (p˂0.05) and 37.5% in 2 group (p˂0.05) patients. Among children from military families, moderate anxiety disorders were more prevalent (25.0%, p˂0.05). Panic anxiety was also more common among children with MASLD (1 group – 31.0%, 2 group – 37.5%) compared to the control group (p˂0.05). Separation anxiety was predominant among all groups (1 group – 44.8%, 2 group – 50.0%, 3 group – 50.0%, p = 0.94). Children of military parents showed significantly higher rates of generalized anxiety disorder and school phobia.
Conclusions: During the war in Ukraine, separation anxiety, increased general anxiety, panic anxiety, and school phobias predominate in children with MASLD. Generalized anxiety disorders and school phobias are more prevalent among children of military parents, which should be considered for treatment program development for these patients.
Contact e‐mail address: nzavgorodni75@gmail.com
H‐EV098. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV098.1. NOVEL TECHNIQUE FOR MANAGEMENT OF POST‐TRANSPLANT REFRACTORY DIARRHOEA IN CHILDREN WITH PFIC TYPE 1
Abdullah A Amin 1, Girish L Gupte2, Ashita K Unny2, Khalid Sharif3
1Pediatric Gastroenterology, Birmingham Children's Hospital, Birmingham, United Kingdom, 2Liver Unit, Birmingham women's and children's NHS foundation trust hospital, Birmingham, United Kingdom, 3Liver Unit (including Small Bowel Transplantation), birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
Objectives and Study: Progressive familial intrahepatic cholestasis type 1 (PFIC1), or Byler disease, is a rare genetic disorder affecting bile flow in children [1]. Liver transplantation (LT) offers a curative option, but post‐LT complications such as chronic diarrhoea and hepatic steatosis due to bile acid malabsorption are common [2,3]. Surgical biliary diversion can alleviate symptoms, but not all patients require it post‐LT due to variability in complications and an unclear pathophysiology [4]. A novel technique was developed to mark the Roux loop during LT with radiopaque markers, enabling minimally invasive access for biliary diversion if needed. This retrospective study analyzed three pediatric PFIC1 patients who underwent LT with this marking technique
Methods: Retrospective study included three children, aged 2.5 years, 3 years, and 4.5 years, underwent LT for end‐stage liver disease. Two had pre‐transplant biliary diversion, one of whom required post‐transplant diversion.During LT, the Roux loop was marked with a radiopaque marker in the three cases to facilitate future minimally invasive biliary diversion if needed [4].
Results: One patient developed severe diarrhoea and hepatic steatosis post‐LT, requiring partial external biliary diversion via interventional radiology 7 months after a second LT. The marked Roux loop allowed minimally invasive intervention without major surgery [4]. Clinical improvements included reduced diarrhoea frequency, lower loperamide dose, and improved hepatic histology, with steatosis decreasing from severe to moderate and no fibrosis progression. Conversion to an internal/external biliary diversion further improved weight gain and reduced stool frequency. The other two patients, with mild diarrhoea and hepatic steatosis, did not require biliary diversion during the study.
Conclusions: Marking the Roux loop during LT in PFIC1 patients is a promising technique that facilitates minimally invasive management of post‐LT complications [5]. Larger studies are needed to confirm its benefits.
Contact e‐mail address: abdullah.amin@nhs.net
H‐EV099. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV099.1. CLINICAL OUTCOMES OF LIVER TRANSPLANTATION IN PEDIATRIC MAPLE SYRUP URINE DISEASE AND DOMINO LIVER RECIPIENTS AT KING FAISAL HOSPITAL AND RESEARCH CENTER‐ SAUDI ARABIA
Ali Akhtar 1, Wajiha Naz1, Zahida Khan1, Kumar Kishwer1, Hiba Binomar1, Dalal Albogami1, Bassam Ayoub1, Aleyda Alexandra Aldana Grisales1, Abubaker Sharif1, Massimo Malago2, Dieter Broering2, Mohamed Shagrani1
1Organ Transplant Center Of Excellence, Dept. Of Liver & Small Bowel Health Centre, Pediatric Hepatology & Transplant Hepatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 2Organ Transplant Center Of Excellence, Dept. Of Abdominal Transplant And Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Objectives and Study: Maple Syrup Urine Disease (MSUD) is a rare genetic disease affecting branched‐ chain amino acid metabolism in the liver. Treatment is primarily lifelong protein restriction to prevent devastating neurologic complications; however, compliance is difficult, and severe metabolic crises can still be triggered by acute illness. Elective liver transplantation offers a metabolic cure for classical MSUD patients. An additional benefit is that the explanted MSUD liver can subsequently be transplanted into a non‐MSUD patient, effectively curing the “domino” recipient's liver disease as well, since the enzymatic deficiency of the MSUD liver can be compensated by other organs in the recipient. The purpose of this retrospective study is to investigate the long‐term clinical outcomes of liver transplantation in pediatric MSUD patients and their domino recipients.
Methods: Data was collected retrospectively
Results: From September 2011 to August 2024, 31 pediatric MSUD patients underwent liver transplant at our center. Six (19%) of these patients developed ACR. Three (10%) developed vascular complications. One patient (3%) developed biliary stricture. Two patients (6%) required re‐transplantation. Pre‐ and post‐transplant serum BCAA levels were not consistently obtained in MSUD patients; most of them were transitioned to regular diet. However, not all of these patients normalized their BCAA levels after LT. Of the 31 explanted MSUD livers, 25 (80%) were utilized for domino transplant, 4 (16%) went to adult domino recipients. Four (16%) of the domino recipients developed ACR. Two (8%) domino recipients required re‐transplantation for graft failure, and 2 (8%) of the domino recipients did not survive. One pediatric domino recipient was lost‐to‐follow‐up. For the majority of domino recipients, post‐transplant BCAA levels were mildly elevated but later normalized. Further studies are ongoing on long‐term patient and graft outcomes.
Conclusions: Liver transplantation successfully prevents metabolic crisis in MSUD patients and domino MSUD livers are good source of grafts to expand the donor pool
Contact e‐mail address:
H‐EV100. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV100.1. OUTCOMES OF LIVER TRANSPLANTATION IN CHILDREN WITH ORGANIC ACIDURIAS(OA) SIX YEARS OF EXPERIENCE IN A TERCIARY CENTER IN KSA
Aleyda Alexandra Aldana Grisales 1, Dalal Albougami1, Kumar Kishwer1, Ali Syed Akhtarul Hassan1, Abubaker Sharif1, Zahida Khan1, Hiba Binomar2, Maximo Malago1, Dieter Broering2, Mohammad Shagrani1,3
1Organ Transplant Center Of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 2King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 3Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
Objectives and Study: Pediatric liver transplantation (LT) is increasingly used to treat organic acidemias (OA), a group of metabolic disorders characterized by enzyme deficiencies affecting amino acid metabolism. This study aims to describe the patterns and outcomes of liver transplants in children diagnosed with OA.
Methods: A retrospective analysis of transplant registries was conducted to gather data on pediatric patients with OA who underwent LT between Jan 2011 and Oct 2024. Data will include patient demographics, clinical outcomes, and survival rates
Results: Fourty 40 children were transplanted with diagnosis of OA Between 2011 and 2024 of a total 840. Half Female. Ninty percent were Propionic Acidemia and 10% Metilmalonic Acidemia. The median of age at transplant of 22,5 months (IQR 14‐37) and median weight 10 kg (IQR 8,7‐12,4). Their median stay in PICU after transplant was 5 days (IQR 3,7‐ 7) and total stay in hospital median 20 day (IQR 17‐29). With a 100% survive of life and graft after of following median 34 months. Just 19% of them developed Acute Celular Rejection all responded to steroids, 35% developed CMV viremia responded to gancyclovir. 33% of them has been free of any admition for infection, 34% have had 1 o 2 admission and the rest have had between 3 ande 8 admission for infeccion. We have not had any cardiac complication after LxTx, and no any upset of psiquiatric complication neither. Their neurological preform improved in 75% of the patients after transplant and at the time of LxTx 35% has significative malnourish while one year after LxTx just 12% of them had it
Conclusions: Liver Transplantation is a good therapeutical alternative for patients with confirm diagnosis of PPA or MMA. Behaiving after LxTx as standar patients. Keep in mind some special anesthetic managment and optimize all the support, in terms to physio and ocupational therapy.
Contact e‐mail address: aaldanagrisales@kfshrc.edu.sa
H‐EV101. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV101.1. PEDIATRIC LIVER RETRANSPLANTATION IN A TERCIARY CENTER IN RIYAD KSA
Aleyda Alexandra Aldana Grisales, Dalal Albougami, Kumar Kishwer, Ali Syed Akhtarul Hassan, Maximo Malago, Dieter Broering, Mohamed Shagrani
Organ Transplant Center Of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Objectives and Study: Pediatric liver retransplantation is a critical procedure with complex challenges. This study aims to describe the factors influencing outcomes and identifying key variables and relationships.
Methods: Retrospective descriptive analysis of the patients who went under Liver Retransplantation (LR) in our center between January 2011 and October 2024. The data were obteined from our register and files
Results: During the time observed, 847 Pediatric LT were preformed. We found 26 (3%) patients who required LR. There were not any third transplant. minimal predominance of girls (65%). The diagnosis because they were transplanted the fist time is summarized in the table 1. Most of them 88% were retransplanted from Living Donor, and 92% received ABO compatible. the median of age of the first LT was 41,2 months (IQR 13‐81) and the age at LR median 66 (IQR36‐117) The median of the months between the first and second LT was 8,1 (IQR 0,3‐30). the reason for require RT was in 46% Chronic rejection (CR) and 30% hepatic Artery Thrombosis (HAT) the rest were given for Budd Chiari, Portal vein Thrombosis and Recurrence of the primary disease (PSC). Watching for the patient with CR, there were a clinical correlation (even not stadistically significative p0,14) with the presence of Biliary Stenosis postLT. The Survival rate of the patients after Liver RT is showed in the table 2 and is considerable poorer than the First LT
Conclusions: The percentage of LR in the world series is most of the times superior than our, probably related to the large experience in our center in Living Donor LT, and its preponderance. Considering some avoidable situation, we recommend to give importance to the biliary complications and its early aproach because doing that we could prevent CR
Contact e‐mail address: aaldanagrisales@kfshrc.edu.sa
H‐EV102. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV102.1. RACIAL DISPARITIES IN LIVER TRANSPLANT IN PATIENTS OF SHORT BOWEL SYNDROME/OTHER CAUSES OF INTESTINAL FAILURE THROUGH ANALYSIS OF NATIONAL INPATIENT SAMPLE 2021
Janvi Bhavsar 1, Vivian Tang2
1General Pediatrics, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, United States of America, 2Pediatric Gastroenterology, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, United States of America
Objectives and Study: Objectives: 1) to identify, quantify, and understand the racial and socioeconomic disparities in the outcomes of pediatric liver transplantation and intestinal failure management, 2)To inform policy changes and develop targeted interventions aimed at reducing these disparities, ensuring equitable access to transplantation, and improving healthcare delivery and outcomes for all children, regardless of their racial, ethnic, or socioeconomic background.
Methods: We used the National Inpatient Sample 2021 to search for demographic distribution of pediatric patients using ICD codes for liver transplant and other intestinal malabsorption which included short bowel syndrome, whipple's disease, intestinal failure and other causes of intestinal malabsorption
Results: Our analysis of the National Inpatient Sample (NIS) 2021 identified 2105 pediatric patients with liver transplants and 6275 patients with short bowel syndrome. Pediatric patients who needed liver transplant due to intestinal malabsorption/short bowel syndrome were 130 in number. The demographic breakdown for race/Ethnicity was: 15% White, 35% Black, 35% Hispanic, 15% Other
he demographic breakdown for race/Ethnicity for liver transplant alone was: 40% White, 17% Black, 30% Hispanic, 13% Other
he demographic breakdown for race/Ethnicity for intestinal malabsorption/short bowel syndrome alone was: 40% White, 26% Black, 24% Hispanic, 10% Other On subgroup analysis for median household income, there was no racial disparity based on household income status, p value 0.33
Conclusions: The data highlight significant racial disparities in pediatric patients undergoing liver transplants due to short bowel syndrome, with Black and Hispanic patients being overrepresented in this group. However, advancements in IRPs and innovative treatments have improved survival rates and reduced the need for transplants. The analysis found no significant racial disparity based on median household income status (p value 0.33), suggesting that the observed disparities may not be solely due to economic factors but could be influenced by other systemic or healthcare access issues.
Contact e‐mail address:
H‐EV103. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV103.1. CHARACTERISTICS, MANAGEMENT AND OUTCOME OF PEDIATRIC PATIENTS WITH POST‐TRANSPLANT LYMPHOPROLIFERATIVE DISEASE FOLLOWING LIVER TRANSPLANTATION; A 10‐YEAR REVIEW
Doaa Zourob1, Manal Alkatheeri1, Eman Al Atrash1, Fatima Al Dhaheri2, Rana Bitar 1,3
1Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, 2Department Of Pediatrics, College Of Medicine And Health Science, United Arab Emarites University, Al Ain, United Arab Emirates, 3College Of Medicine, Khalifa University, Abu Dhabi, United Arab Emirates
Objectives and Study: Identifying and management of pediatric post‐transplant lymphoproliferative disease (PTLD) in liver transplant patients is challenging. We will review pediatric post liver transplant patients aiming to assess initial characteristics, likelihood to develop PTLD, PTLD therapy, and outcome.
Methods: A retrospective data review of children <18 years undergoing liver transplant in a tertiary pediatric hospital from Jan 2013 to 2023 was conducted. Data collected included patient demographics, age at transplant, Epstein‐Bar Virus (EBV) load, development of PTLD, type of tissue containing PTLD, WHO PTLD histology classification, treatment and patient outcome.
Results: 58 pediatric liver transplant patients were identified, 37 males, 44 living related. Median age at transplant was 1 year 8 months (range:3 weeks‐15 years), 38 (65.5%) developed EBV viremia, 28 (48%) developed chronic EBV viremia for > 6 months. 5 (8.6%) patients from the liver transplant patients developed PTLD. The PTLD group was further analyzed, median age of developing PTLD was 4.5 years (range: 3.5‐5), the patients developed PTLD within 2‐4 years from transplantation. All PTLD patients had EBV chronic viremia, median EBV viral load at diagnosis was 194300 (Range: 68,175‐221,250), median LDH at diagnosis was 258 (253‐1,473). In four patients PTLD was in the tonsils and in one patient it was in hilar lymph nodes and pleura. The four patients with tonsillar PTLD had florid follicular lymphoid hyperplasia and was localized and non‐destructive, they were treated with adenotonsillectomy and reduction of immunotherapy. The patient with hilar lymph and pleural involvement was diagnosed with Burkitt's B cell lymphoma with localized destructive disease, he was treated with cyclophosphamide, prednisone and rituximab. All patients with PTLD survived.
Conclusions: PTLD continues to cause major mortality post pediatric liver transplant in children. It can develop in up to 8.6% of patients. Regular monitoring of EBV viral load can aid early diagnosis and facilitating appropriate treatment and improved patient survival.
Contact e‐mail address: drranab@doctors.org.uk
H‐EV104. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV104.1. CHRONIC EPSTEIN‐BAR HIGH VIRAL LOAD AND RISK OF POST‐TRANSPLANT LYMPHOPROLIFERATIVE DISEASE IN PEDIATRIC POST LIVER AND MULTIVISCERAL TRANSPLANT; A 10‐YEAR TERTIARY CENTER REVIEW
Doaa Zourob1, Eman Al Atrash1, Manal Alkatheeri1, Fatima Al Dhaheri2, Rana Bitar 1,3
1Pediatric Gastroenterology And Hepatology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, 2Department Of Pediatrics, College Of Medicine And Health Science, United Arab Emarites University, Al Ain, United Arab Emirates, 3College Of Medicine, Khalifa University, Abu Dhabi, United Arab Emirates
Objectives and Study: Epstein‐Bar viral (EBV) infection is common in children post liver and multivisceral transplantation. Post‐transplant lymphoproliferative disease (PTLD) is associated with chronically high EBV viral load. We aim to review the incidence and outcome of chronic high viral load (CHL) in this group including risk of developing PTLD.
Methods: A retrospective patient record review of children undergoing liver and multiviscelar transplant in a tertiary pediatric hospital from Jan 2013 to 2023 was conducter. Data collected included patient demographics, age at transplant, Epstein‐Bar Virus (EBV) chronic high load (CHL) defined as carrying viral load >16000 genome copies/ml of whole blood for >50% of samples for greater than six months, development of PTLD, and patient outcome.
Results: 58 pediatric liver transplant and 6 multivisceral patients were identified, 38 males. Median age at transplant was 1 year 6 months (range: 3 weeks‐15 years), 28 (44%) developed chronic high EBV load. 5 out of the patients with CHL developed PTLD (17.9 %), no multivisceral transplant patient developed PTLD. In four patients PTLD was in the tonsils and in one patient it was in hilar lymph node and pleura with Burkitt's B cell lymphoma. Median EBV viral load at PTLD diagnosis was 194300 (Range: 68,175‐221,250). Both males and females were at risk of PTLD (P = 0.23), children transplanted at < 1 year were not more likely to develop PTLD (P = 0.12). As would be expected, patients with CHL were more likely to develop PTLD (P = 0.01). All patients with PTLD survived with 1‐10 year follow up.
Conclusions: EBV viral load monitoring is standard practice in children post liver and multivisceral transplant. There is an increased the risk of PTLD in post‐transplant children with CHL. Therefore, chronic high EBV viremia should prompt physicians to adjust immunomodulatory treatment to prevent the development of PTLD and to closely monitor patients and intervene early.
Contact e‐mail address: drranab@doctors.org.uk
H‐EV105. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV105.1. HEREDITARY TYROSINEMIA TYPE 1: SUCCESS AND CHALLENGES IN INDIAN SUBCONTINENT
Samannay Das 1, Vikrant Sood2, Tamoghna Biswas3, Deepika Yadav4, Snigdha Verma5, Bikrant Bihari Lal3, Rajeev Khanna3, Seema Alam3
1Pediatric Hepatology, ILBS, New Delhi, India, 2Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, Delhi, India, 3Department Of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India, 4Pediatric Hepatology, Institute of liver and biliary sciences, Delhi, India, 5Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
Objectives and Study: Tyrosinemia type 1 (HT1) is an entity secondary to FAH gene variations. Owing to lack of universal health care, the treatment of choice i.e. NTBC's availability is still limited in the Indian subcontinent. Due to limited literature from this part of the world, we aimed to analyze the presentation and outcome of Indian children with HT1.
Methods: Eighteen children with confirmed HT1 admitted from 2013 to 2024 were evaluated. Diagnosis was established either with elevated with urine succinylacetone (n = 11) and/or on exome sequencing (n = 7).
Results: Median age of symptom onset was 6 months (IQR 3.5‐18 months) with a median diagnostic delay of 4.5 months (IQR 2‐23 months). All had established cirrhosis at baseline with synthetic dysfunction in 88.9% and HCC in 27.8%. On follow up, new hepatic nodule formation observed in 9 cases: HCC (22.2%), regenerative nodule (22.2%) and dysplastic nodule (5.6%). Only seven children could be initiated on NTBC treatment. In the NTBC group (n = 7), 3 children underwent liver transplant, 3 (including 1 with HCC along with NTBC non compliance) died and there was only 1 surviving child with native liver. Among 11 children not receiving NTBC, 4 underwent LT (2 with HCC and 2 with decompensation) while 7 died (figure 1). Of the 7 children undergoing LT, at a median follow up of 38 months, the graft and patient survival was 100 % and 100 % without HCC recurrence.
Conclusions: The study highlights the difficulties faced by clinicians in managing HT‐1 cases in the developing world with limited logistics. Due to delayed diagnosis secondary to lack of newborn screening, majority of the children present with advanced liver disease with very high proportion of them developing HCC either at diagnosis or during follow up. In such cases, even initiation of NTBC may not be of adequate benefit.
Contact e‐mail address:
H‐EV106. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV106.1. PRIMARY IMMUNE THROMBOCYTOPENIA (ITP) IN CHILDREN WITH LIVER TRANSPLANTATION: A SINGLE CENTER EXPERIENCE OVER A 30‐YEAR PERIOD
Valeria Delle Cave, Fabiola Di Dato, Maria Immacolata Spagnuolo, Raffaele Iorio
Department of Translational Medical Sciences, Section of Pediatrics, University Federico II, Naples, Italy
Objectives and Study: Primary immune thrombocytopenia (ITP) has been reported anecdotally in children with liver transplantation (LT). To diagnose ITP, other more common causes of thrombocytopenia must be excluded.
Methods: A retrospective analysis of ITP in children following LT in a single center over 30‐year period was conducted.
Results: Among 120 children with LT, 8 patients (7 male), transplanted for biliary atresia, showed one or more episodes of ITP while on tacrolimus therapy. At onset, the patients had diffuse petechial skin lesions, a median age of 7.5 years (1‐14 years) and a median platelet count of 3.500/µL (range 1.000–15.000/µL). ITP occurred after a median of 5.8 years post‐LT (1–11 years). Bone marrow aspiration was consistent with ITP without evidence of blast cells, malignant infiltration, or storage disorders. PTLD was ruled out. Five patients had a single episode of ITP lasting 4‐6 months; while 3 patients experienced multiple relapses (2, 6, and 6 episodes over a period of 7,15 and 2 years, respectively). None achieved remission with intravenous immunoglobulin alone. Steroid was added after bone marrow aspiration in all cases, with good response in 6 patients. The remaining 2 patients had one episode of autoimmune hemolytic anemia lasting 2 months, in the intervals between ITP episodes, successfully treated with intravenous immunoglobulins and methylprednisolone. These 2 patients had also refractory ITP with platelet count stably below 10.000/μL associated to hemorrhagic manifestations, so treatment with Eltrombopag followed by Romiplostim was started without efficacy. Rituximab was avoided to prevent further immunosuppression. In both patients, switching from tacrolimus to sirolimus resulted in significant improvement and normalization of platelet counts over 4 years.
Conclusions: In this study, the incidence of ITP was 7%. Although the mechanisms underlying post‐LT ITP remain unclear, it occurs more frequently in patients receiving tacrolimus. In refractory or recurrent ITP, switching to alternative immunosuppressive regimens should be considered.
Contact e‐mail address: Yes
H‐EV107. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV107.1. PAEDIATRIC LIVER TRANSPLANTATION IN TIGHT JUNCTION PROTEIN 2 (TJP 2) DEFICIENCY
Shhilpa Dugar 1, Palaniswamy Karthikeyan2, Marumbo Paul Mtegha2, Kavitha Jayaprakash2, Joseph Hardwick3, Sanjay Rajwal4
1Paediatric Hepatology, Leeds General Infirmary, leeds, United Kingdom, 2Paediatric Hepatology, Leeds Children's Hospital, Leeds, United Kingdom, 3Leeds general Infirmary, leeds, United Kingdom, 4Children's Liver Unit, Leed's Teaching Hospitals NHS Trust, Leeds Children's Hospital, Leeds, United Kingdom
Objectives and Study: Homozygous and bi‐allelic compound heterozygous mutations in TJP2 protein results in TJP2 deficiency which is also known as PFIC42. There is little evidence on the outcomes of paediatric liver transplantation in TJP2 deficiency.1 In this retrospective review, we describe the clinicopathological features and posttransplant course of 6 paediatric Liver Transplant (LT) recipients with TJP2 genetic mutation. Data was collected on children who underwent LT between March 2008 to December 2023.
Methods: We identified 6 genetically confirmed TJP2 deficiency patients. 4/6 presented with neonatal jaundice. 1 presented with seizures aged 5 years, other one had pruritis. 3/6 had severe pruritus and 1 required external biliary diversion. 4/6 patients underwent liver transplant for end stage liver disease.
Results: The median age at transplantation was 11.5 years. 1 patient's care was transferred to another centre before liver transplantation. The remaining 3 patients recovered uneventfully after LT. 1 patient underwent a re‐transplant in 2017 due to recurrent cholangitis and died of multi‐organ dysfunction at 19 years. Table1: Pre and post LT course
| Variable | Patient 1 | Patient 2 | Patient 3 |
|---|---|---|---|
| Sex | F | M | F |
| Genetic mutation | TJP2: c.1099 C>T; p. (Arg367Ter) | homozygous c.813delC | homozygous c.813delC |
| Type of mutation | Stop gain change | pathogenic frameshift | pathogenic frameshift |
| Age at LT (years) | 1 | 10 | 14 |
| Post operative complications | Hypertension, Chylous ascites | Small bowel obstruction due to adhesions, Recurrent cholangitis | Splenic artery embolization for steal phenomenon, Hepatic vein anastomotic stricture |
| Graft Rejection | Yes | Yes | Yes |
| Retransplant | No | Yes | No |
Conclusions: There is limited documentation regarding paedaitric liver transplants in TJP2. Our small case series demonstrates that LT is linked to favourable outcomes in TJP2.
Contact e‐mail address: shilpa.dugar@nhs.net
H‐EV108. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV108.1. CMV, EBV INFECTIONS AND HAEMATOLOGICAL COMPLICATIONS IN LONG TERM FOLLOW UP AFTER LIVER TRANSPLANTATION
Ahmed Elhomosany1, Chaya Kelgeri2, Jane Hartely2, Lauren Johansen2, Joseph Valam2, Khalid Sharif2, Girish L Gupte 2
1Pediatric Hepatology, Assiut University children hospital, Assiut, Egypt, 2Liver Unit, Birmingham women's and children's NHS foundation trust hospital, Birmingham, United Kingdom
Objectives and Study: The long‐term outcome of pediatric liver transplantation (LTx) is determined by complications that occur both immediately post‐transplantation and in the long‐term.
Methods: Retrospective analysis on 300 children undergoing LTx in a tertiary liver center over 10 yrs (2013‐ 2023) and demographic details and medical records were reviewed in (week, 3 m, 6 m, 1 year, 5 yr, 10 yr) post‐transplant for hematologic and infectious complications.
Results: Anemia (81.9%), neutropenia (24.7%) and thrombocytopenia (55.3%) are highly prevalent pretransplant. There is a significant improvement in anemia (69.6% to 34.3%‐ p < 0.001*), neutropenia (28.3% to 16.3% p < 0.001*) and thrombocytopenia (87.3% to 20.7% p < 0.001*), from the first week to the first year respectively. There is a significant correlation between pre‐ and post‐transplant neutropenia and thrombocytopenia across all time points (p < 0.001*) but not in anemia. The highest incidence of EBV and CMV viremia is in the first 3 months post LTx which is about 46 (15.5%) for EBV and 42 (14%) for CMV. EBV disease is seen more frequently after 1st year post transplant mostly in gastrointestinal biopsies (+ve EBER cells), whilst CMV disease is seen n the first 3 months in liver biopsies (+ve CMV inclusions). 5‐year survival for CMV infection was (89%) and PTLD patients was (100%) as only one patient died long after CMV infection. Table 1 shows the infectious complications post‐transplant
Conclusions: Anaemia and cytopenia seen in pre‐transplant period resolve with liver transplantation. CMV and EBV viraemia occurs within the first year after transplantation and appropriate management would prevent development of CMV infection and progression to EBV disease and PTLD. Once diagnosed prompt treatment is associated with good long‐term outcome.
Contact e‐mail address:
H‐EV109. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV109.1. ANAEMIA AND PERITRANSPLANT BLOOD TRANSFUSION IN PAEDIATRIC LIVER TRANSPLANTATION: A RETROSPECTIVE OBSERVATIONAL STUDY
Siddharth Mahesh1, Michelle Cox2, Andrea Hughes2, Juliet Wheatley1, Khalid Sharif1, Jonathan Lancashire3, Chayarani Kelgeri 1
1Liver Unit (including Small Bowel Transplantation), birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom, 2Blood Bank, Birmingham Women's and Children's Hospital NHS Foundation trust, Birmingham, United Kingdom, 3Haematology, Birmingham Women's and Children's NHS Foundation trust, Birmingham, United Kingdom
Objectives and Study: Children receive red blood cell (RBC) transfusions in the liver transplant (LT) perioperative and intraoperative period to manage anaemia and blood loss. Transfusions increase sensitization risks, leading to adverse outcomes1,2. This retrospective study aimed to assess RBC transfusion incidence in children with CLD during the perioperative period at a UK LT centre. Since anaemia is common in these children3, a secondary aim was to evaluate screening and treatment for nutritional anaemia before transplantation.
Methods: The study included children with CLD undergoing LT between June 2021 and May 2024. Children listed for acute liver failure or hepatoblastoma were excluded. Data was collected perioperatively (from listing to surgery), intraoperatively (during surgery), and postoperatively (up to 28 days post‐LT). Screening for nutritional anaemia included iron studies, vitamin B12, and folic acid levels, with laboratory age‐specific reference ranges for haemoglobin and mean corpuscular volume. Data was obtained from medical and blood bank records.
Results:
Among 46 children analysed, the median wait time for LT was 58.5 days (range 1–270 days), with 48% (n = 22) being female. Biliary atresia was the most common indication for LT (60%, n = 28). Forty children were anaemic. RBC transfusions were needed in 20%(n = 8) preoperatively, 92% (n = 37) intraoperatively, and 65%(n = 26) postoperatively. None of the pre‐ or postoperative transfusions were due to bleeding. Of the eight children requiring preoperative transfusions, three were screened for iron deficiency anaemia. Of the with two found deficient,1 received iron supplements. Two patients were screened for vitamin B12 and folic acid deficiencies. Image 1 shows the results of nutritional anaemia screening and supplementation.
Conclusions: This study reports the incidence of RBC transfusions and insufficient nutritional anaemia screening in LT patients. Proper screening helps distinguish nutritional anaemia from chronic disease anaemia, enabling treatment with supplements to minimize perioperative PRBC transfusions.
Contact e‐mail address: s.mahesh@nhs.net
H‐EV110. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV110.1. OUTCOMES IN CHILDREN WITH BILIARY ATRESIA POST LIVER TRANSPLANT AT A HIGH‐VOLUME PEDIATRIC LIVER TRANSPLANT CENTER
Kishwer Kumar 1, Abubaker Sharif1, Ali Alsarhan1, Aleyda Alexandra Aldana Grisales1, Ali Syed Akhtarul Hassan1, Dalal Albougami1, Hiba Binomar2, Bassam Ayoub1, Zahida Khan1, Maximo Malago1, Dieter Broering1, Mohammad Shagrani1,3
1Organ Transplant Center Of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 2King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 3College Of Medicine, Alfaisal University, Riyadh, Saudi Arabia
Objectives and Study: Liver transplant (LT) has played a significant role in improving outcomes of children with Biliary Atresia. In Saudia Arabia, the lack of centralisation and awareness often leads to delays in presentation. There is no data on outcomes of post‐transplant patients with biliary atresia in Saudi Arabia. We aim to analyse our short and medium term outcomes post liver transplantation.
Methods: We performed a retrospective analysis of medical records of those patients that were transplanted for biliary atresia between 2011 ‐ 2024. Demographic data were collected and tabulated. Complications rates were analysed.
Results: Between January 2011 and December 2024 we performed a total of 845 liver transplants, of which 116 were for Biliary Atresia. Of these, Isolated BA was 88% (n = 90) and Syndromic Biliary Atresia (22%, n = 26). Majority were living related, 92% (with no donor mortality), Cadaveric 8% and Domino transplantation 3%. Recipients postoperative surgical complications consisted of hepatic artery thrombosis (1%, n = 2), Biliary strictures (10%, n = 12), Portal vein thrombosis (12%, n = 14), Hepatic vein stenosis (1%, n = 2). Retransplantation was performed in 2 patients. Two patients died in the early post operative period, due to TMA and uncontrolled bleeding. Sepsis was the most common cause of mortality in patients at peripheral hospitals. The 1, 5 and 10 year patient survival rates were 96%, 97% and 93% respectively.
Conclusions: Liver transplant outcomes among patients with BA are excellent in Saudia Arabia. There is a need to improve our network structure to post transplant patients living in remote and rural areas. Moreover, introduction of centralisation of care will certainly improve outcomes.
Contact e‐mail address:
H‐EV111. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV111.1. CLINICAL PRESENTATION, OUTCOMES, AND MANAGEMENT OF BSEP DEFICIENCY WITH TRUNCATED MUTATIONS: A COHORT STUDY OF PFIC2 PATIENTS AT A HIGH‐VOLUME PEDIATRIC LIVER TRANSPLANT CENTER
Kishwer Kumar 1, Ali Syed Akhtarul Hassan1, Sateesh Maddirevula2, Aleyda Alexandra Aldana Grisales1, Abubaker Sharif1, Dalal Albougami1, Hiba Binomar3, Maximo Malago1, Dieter Broering1, Mohammad Shagrani1,4
1Organ Transplant Center Of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 2Clinical Genomics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 3King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 4Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
Objectives and Study: Study aimed to evaluate the clinical presentation, laboratory findings, outcomes, and interventions in patients with Bile Salt Export Pump (BSEP) deficiency, specifically focusing on those with truncated founder variant in the ABCB11 (BSEP3).
Methods: The cohort consisted of 25 patients diagnosed between 2010 and 2023, with data on demographics, clinical features, biochemical results, and treatment outcomes. A comprehensive analysis of clinical symptoms, laboratory markers, and therapeutic interventions are performed to assess disease progression and management strategies.
Results: Cohort had a median birth year of 2018, with 48% male patients, all originating from consanguineous relationships. The median age at presentation was 3.05 years, with pruritus observed in 60% of patients. Laboratory findings revealed significantly elevated serum bile acids (median 190 µmol/L), bilirubin (median 151 µmol/L), and liver enzymes (ALT median 389 IU/L, AST median 386 IU/L). Notably, 16% of patients developed hepatocellular carcinoma (HCC), and there were notable deficiencies in fat‐soluble vitamins (D, A, and E). Liver transplantation was required for 80% of patients, with a median age of 1.9 years at transplantation. Post‐transplant mortality was low, but disease recurrence occurred in 10% of cases.
Conclusions: The findings highlight the aggressive nature of PFIC2 due to truncated BSEP mutations, with early liver transplantation being essential for survival. The study underscores the limited efficacy of current medical therapies, including IBAT inhibitors, for BSEP3 patients and emphasizes the importance of early intervention, close monitoring for HCC, and management of nutritional deficiencies. Despite successful liver transplantation, the risk of disease recurrence remains a significant challenge. Regular screening and tailored therapeutic strategies are crucial for improving long‐term outcomes.
Contact e‐mail address: kishwer.kumar@gmail.com
H‐EV112. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV112.1. COMPARISON OF PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS TYPE 2 (PFIC 2) BETWEEN EUROPEAN AND SAUDI ARABIAN COHORTS
Kishwer Kumar 1, Antal Dezsofi2, Henkjan Verkade3, Mohammad Shagrani1,4
1Organ Transplant Center Of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 2First Department Of Pediatrics, Semmelweis University, Budapest, Hungary, 3Pediatric Gastroenterology‐hepatology, University Medical Center Groningen, Groningen, Netherlands, 4College Of Medicine, Alfaisal University, Riyadh, Saudi Arabia
Objectives and Study: This study aims to compare the clinical presentation, genetic characteristics, and outcomes of patients diagnosed with Progressive Familial Intrahepatic Cholestasis Type 2 (PFIC 2) from European and Saudi Arabian cohorts.
Methods: A retrospective analysis of PFIC 2 patients was conducted using data from two cohorts: Europe (n = 19) and Saudi Arabia (n = 19). The parameters compared included consanguinity, clinical symptoms, hepatocellular carcinoma (HCC), liver transplantation outcomes, and genetic mutations.
Results:
1. Consanguinity:
◦ Europe: 1 patient (5.26%).
◦ Saudi Arabia: 10 patients (52.63%).
2. Clinical Features:
◦ Pruritus: Europe 19 patients (100%) vs. Saudi Arabia 10 patients (52.63%).
3. Hepatocellular Carcinoma (HCC):
◦ Europe: 1 patient (5.26%).
◦ Saudi Arabia: 3 patients (15.78%).
4. Liver Transplantation:
◦ Europe: 10 patients (52.63%) required transplantation.
◦ Saudi Arabia: All 19 patients (100%) required transplantation.
◦ Median age at transplantation was similar in both cohorts (2 years; range: 1–14).
5. Genetic Mutations:
◦ Europe: Compound heterozygous mutations were more common.
◦ Saudi Arabia: All patients had homozygous mutations.
6. Recurrence of Disease Post‐Transplantation:
◦ Europe: Data unavailable.
◦ Saudi Arabia: 2 patients (10.5%) experienced disease recurrence.
Conclusions: The Saudi Arabian cohort demonstrated a higher prevalence of consanguinity, homozygous mutations,
hepatocellular carcinoma, and universal need for liver transplantation compared to the Europeancohort. In contrast, compound heterozygous mutations were more common in the European cohort.
Pruritus, a hallmark of PFIC 2, was universally reported in the European cohort but less frequent in Saudi Arabia. These findings highlight regional differences in the genetic and clinical landscape of PFIC 2, which may reflect underlying genetic and environmental factors influencing outcomes.
Contact e‐mail address: kishwer.kumar@gmail.com
H‐EV113. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV113.1. CRYPTOSPORIDIUM INFECTION IN PEDIATRIC LIVER TRANSPLANT RECIPIENTS: CLINICAL CHALLENGES, IMPACT ON GRAFT FUNCTION AND THE IMPORTANCE OF EARLY DIAGNOSIS AND MANAGEMENT
Annalaura Milano 1, Annamaria Compagnone1, Olga Lausi1, Carmen Campanile1, Rosanna Masturzo1, Melissa Iandolo1, Angelo Colucci2, Rossella Colantuono2, Claudia Mandato2
1Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, Baronissi (SA), Italy, 2Pediatric Unit, Hospital S.Giovanni di Dio e Ruggi D'aragona, Salerno, Italy
Objectives and Study: This study explores the clinical challenges posed by Cryptosporidium infection in pediatric liver transplant recipients, focusing on its effects on graft function, immune suppression, and treatment strategies. Cryptosporidium, a protozoan parasite, is primarily contracted through contaminated water, food, or direct contact with infected individuals or animals.
Methods: A case involving a 9‐year‐old pediatric liver transplant recipient presenting with frequent episodes of diarrhea, alternating with periods of wellness, along with elevated liver enzymes, tacrolimus trough levels, and INR, was analyzed. Stool analysis confirmed the diagnosis of Cryptosporidium infection. Additionally, a review of relevant literature was conducted to evaluate the clinical impact and management approaches for this infection in immunocompromised children.
Results: The diagnosis of Cryptosporidium infection highlighted the parasite's role in causing persistent gastrointestinal symptoms, malabsorption, and dehydration in immunocompromised children. These complications were shown to exacerbate liver dysfunction, jeopardizing graft survival. Literature review corroborated that immunosuppressive therapy increases susceptibility to such infections, complicating disease management. The case also revealed that delays in diagnosis often lead to worsening symptoms and increased healthcare needs. Effective management involved antiparasitic treatment, such as nitazoxanide, and careful adjustments to immunosuppressive medications to strike a balance between infection control and rejection prevention. Regular monitoring of liver and renal function was vital to address potential nephrotoxic effects of the infection and associated treatments. Supportive care, including fluid replacement and nutritional support, proved critical in stabilizing the patient during treatment.
Conclusions: Cryptosporidium infection poses significant risks to pediatric liver transplant recipients, including severe dehydration and potential graft failure due to immunosuppression. Early diagnosis and tailored management strategies are essential to mitigate severe complications and ensure improved post‐transplant outcomes.
Contact e‐mail address: milanannalaura@gmail.com
H‐EV114. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV114.1. EVALUATION OF ALLOGRAFT FIBROSIS AFTER LIVER TRANSPLANTATION WITH LIVER ALLOGRAFT FIBROSIS SCORE (LAFSC): A SINGLE CENTRE EXPERIENCE
Rita Marchante Pita1, Rui Caetano2, Sandra Ferreira1, Isabel Gonçalves1, Susana Nobre 1
1Paediatric Hepatology And Liver Transplantation Unit, Unidade Local de Saúde de Coimbra, Coimbra, Portugal, 2Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
Objectives and Study: Allograft fibrosis is a common histological finding in liver biopsies following paediatric liver transplantation (LT). In 2012, Venturi et al. proposed the Liver Allograft Fibrosis Score (LAFSc) as a more precise method for assessing allograft fibrosis in children. This study aims to evaluate allograft fibrosis after LT through LAFSc and its progression in the Portuguese paediatric population.
Methods: Retrospective study of patients with LT between 2009‐2019. Liver biopsies at 6 months (M6), 1 year (Y1), and 5 years (Y5) post‐transplant (routine evaluation) were reviewed and allograft fibrosis assessed using the LAFSc. We excluded patients that were retransplanted or that died during follow‐up.
Results: Seventy‐two children were included (56,9% female), with a median age at LT of 4.4 years (0.4‐16.9). The main indication for LT was biliary atresia (48.6%), followed by metabolic diseases (16.7%). At M6, fibrosis was identified in 52/61 biopsies (85.3%), mild in 73.8% of cases, with a median LAFSc of 1.0 (0‐6). At Y1, fibrosis was documented in 31/43 biopsies (72.1%) and at Y5 there were fibrosis in 43/50 biopsies (86%; mild = 74%; moderate = 12%), with a median LAFSc of 2.0 (0‐6). No cases of severe fibrosis were observed. Fibrosis progression from M6 or Y1 to Y5 was assessed in 47 children, with an increase in LAFSc in 20 cases (42.5%; new fibrosis location in 11) and a LAFSc decrease in 11 cases (23.4%).
Conclusions: In this study, we found a M6 allograft fibrosis incidence of 85.3% and an Y5 incidence of 86%, mostly mild and with no cases of severe fibrosis. Over the 5‐year follow‐up, fibrosis progressed in 20 patients, mostly (55%) in new locations, and reduced in 11 patients, reinforcing the dynamics and reversibility of the fibrosis process in paediatric age.
Contact e‐mail address: ritacoelhopita@gmail.com
H‐EV115. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV115.1. PREVALENS AND RISK FACTORS OF SODIUM, POTASSIUM, AND CHLORIDE IMBALANCE IN CHILDREN POST LIVER TRANSPLANTATION AT DR. CIPTO MANGUNKUSUMO HOSPITAL, INDONESIA
Ramacil Afsan Notoprawiro 1, Hanifah Oswari2, Irawan Mangunatmadja3, Niken Puspaningtyas4
1Pediatric, Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia, 2Pediatric Gastroenterology & Hepatology, Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia, 3Pediatric Neurology, Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia, 4Pediatric Emergency Medicine, Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia
Objectives and Study: The complexity of liver transplantation surgery can lead to major electrolyte disturbances such as sodium, potassium, and chloride. Electrolyte disturbances can result in poor postoperative patient prognosis due to the association with morbidity events such as hemodynamic disorders, neurological disorders (encephalopathy, seizures, central pontine myelinolysis), and even death. There are no studies that describe the prevalence and risk factors of electrolyte disturbances in the pediatric population in Indonesia.This study was conducted to observe the prevalence and assess the risk factors for electrolyte disturbances in pediatric patients after liver transplantation at the Cipto Mangunkusumo Hospital Liver Transplant Center, Jakarta, Indonesia.
Methods: Retrospective cohort study conducted at a liver transplant center in Jakarta, Indonesia, involving all pediatric patients who underwent liver transplantation from December 2010 to December 2023. Bivariate and multivariate assessments were performed to evaluate the risk factors associated with post‐liver transplantation electrolyte disturbances.
Results: A total of 78 subjects met the inclusion criteria, with 79.5% experiencing electrolyte disturbances. The most common indication for liver transplantation surgery was biliary atresia (79.5%). The risk factors affecting electrolyte disturbances in pediatric patients after liver transplantation surgery were operation duration more than 12 hours (RR 1.46, 95% CI 1.21‐1.54) and serum creatinine (RR 0.64, 95% CI 0.27‐0.98) with a p‐value < 0.05.
Conclusions: Most pediatric patients undergoing liver transplantation experience electrolyte disturbances. An operation duration of more than 12 hours and an increase in serum creatinine levels are associated with the occurrence of electrolyte disturbances.
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H‐EV116. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV116.1. PRELIMINARY RESULTS OF HEPATITIS B VACCINE SEROPROTECTION IN CHILDREN WITH LIVER TRANSPLANTS AND THE EFFICACY OF REVACCINATION
Diego Pérez Salas, María Muñoz Fernández, Álvaro Vega, Daniela Lecaros, Milisen Vidal
Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
Objectives and Study: Infections are a frequent cause of complications in pediatric liver transplant recipients, and some (such as hepatitis B virus (HBV) infection), can be prevented through vaccination. Published data from previous studies have shown that protection from this vaccine may decrease after solid organ transplantation in children. The objective of this study is to measure the proportion of liver transplant patients who maintain seroprotection from this vaccine and their response to booster doses.
Methods: A retrospective analysis was conducted on demographic and clinical information, as well as HBV surface antigen antibody titers, from the medical records of patients under 18 years of age who had received a liver transplant between January 1, 2013, and December 31, 2022. Immunization data for each patient was obtained from the Chilean National Immunization Registry. A protective antibody level was defined as greater than 10 IU/L.
Results: After applying inclusion and exclusion criteria, 44 liver transplant recipients were analyzed. All patients had received at least 3 doses of the HBV vaccine prior to transplantation. The average time from transplantation to antibody measurement was 5.7 years. The proportion of patients with antibodies within the protective range was 6.8%. In five (5) cases, a booster vaccination was administered, achieving protective levels in all of them upon follow‐up.
Conclusions: Pre‐transplant vaccination protection against hepatitis B is lost in a high percentage of patients after liver transplantation but can be improved with booster vaccination. Serological monitoring of these patients is essential.
Contact e‐mail address: diegones3@gmail.com
H‐EV117. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV117.1. PAEDIATRIC LIVER TRANSPLANTATION IN INHERITED METABOLIC DISEASES – EVOLVING DEMANDS IN A SINGLE UK CENTRE
Roshni Vara 1,2, Colette Sadler2, Anil Dhawan2, Nigel Heaton2, Nedim Hadzic2
1Evelina London Children's Hospital, London, United Kingdom, 2Paediatric Liver, Gi And Nutrition Centre, King's College Hospital, London, United Kingdom
Objectives and Study: Liver transplantation (LT) is a well‐established treatment for inherited metabolic diseases (IMDs), accounting for 25‐30% of paediatric LTs globally. Improved outcomes have led to increasing referrals which has resulted in potentially longer waiting times for both metabolic and non‐metabolic indications. The premise of “the earlier, the better” has become the ideal and challenges have evolved with the increasing demands.
Methods: A retrospective review was conducted on paediatric LT for IMDs from 2013 to 2024. Data collected included demographics, waiting time, age at LT, and overall outcomes. The cohort was divided into 2 groups: Group 1 (2013‐2018) and Group 2 (2019‐2024).
Results: 52 paediatric patients with IMDs underwent LT, an overall institutional median of 52 performed transplants/year. The highest number of IMDs were performed in 2013 (8) and 2022 (9). Median waiting time for IMD patients was 106 days (range, 0 to 1834 days) compared to overall elective LT waiting time of 122 days (66‐178) Median age at LT for IMDs was 2.3 years (15 days –17.4 years). Indications in figure 1; those with GSD IV, MNGIE and arginase deficiency were all in Group 2. Thirteen patients received live‐related grafts (median waiting time 101 days) 4 received auxiliary transplants (median waiting time 1020 days), 2 underwent combined liver‐kidney transplants and 1 received a sequential liver‐kidney transplant. Four patients died (3 with propionic acidaemia, all in Group 1) and 2 lost to follow‐up. 54% of children had special educational needs post‐LT, ranging from mild to severe The median follow‐up post‐LT was 4.5 years, with median post‐LT age of 9.4 years.
Conclusions: We highlight the changing trends in the use of LT in IMDs emphasizing its growing role. Achieving early LT has become increasingly difficult due to expanding indications, waiting times, donor shortages, and competition with conventional LT indications.
Contact e‐mail address: roshni.vara@nhs.net
H‐EV118. Topic: AS02. HEPATOLOGY/AS02b. Transplantation
H‐EV118.1. PREDICTORS AND OUTCOME OF LATE ACUTE REJECTION IN PEDIATRIC LIVER TRANSPLANT RECIPIENTS
Snigdha Verma 1, Rajeev Khanna1, Vikrant Sood1, Ashray Patel2, Archana Rastogi3, Bikrant Lal1, Viniyendra Pamecha4, Seema Alam1
1Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India, 2Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, New delhi, India, 3Department Of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India, 4Department Of Hepatopancreaticobiliary And Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New delhi, India
Objectives and Study: Late acute rejection (LAR), seen in 8‐32% of pediatric liver transplant (LT) recipients, variably defined as that occurring after a duration of 3‐6 months post‐LT. LAR adversely affects graft and patient survival. We aimed to study the predictors, clinico‐histological profile and outcome of LAR in these children.
Methods: All under‐18‐aged pediatric LT recipients from September 2010 to June 2023 with a minimum 1‐year follow‐up (n = 104) were studied. LAR was diagnosed based on suggestive histology. Poor outcome was defined in terms of mortality, re‐transplantation, or persistent graft dysfunction.
Results: 19 (18.3%) (16 males) developed 28 episodes of LAR at a median time from transplant of 3.1 (1.5, 4.1) years. Median AST and ALT were 153 and 188 IU/L. Median Medication level variability index (MLVI) preceeding 6 months of LAR was 1.9 (0.9, 2.6). Histology revealed a median rejection activity index of 4 (3, 5). Monomorphic infiltrate, lymphocytic duct damage, duct atypia, central perivenulitis, perivenular fibrosis and periportal fibrosis were seen in 17, 16, 16, 12, 9, 4 biopsies. On multivariate binary logistic regression analysis, LAR was associated with previous episodes of acute cellular rejection (ACR) [Exp(B) = 13.88, p < 0.001]. and bacterial infections within first year of transplant [Exp(B) = 6.28, p = 0.011). Nine children had persistent graft dysfunction ‐ 3 developed chronic rejection (1 underwent re‐LT, 2 died awaiting re‐LT); 1 died of CNS aspergilloma. Poor outcome was associated with portal inflammation (HR = 2.08, p = 0.025) but not with other demographic, histological or patient variables.
| Independent Predictors of Late Acute Rejection | |||||
|---|---|---|---|---|---|
| variables entered | Variables in equation | Adjusted OR | 95% CI | P‐value | |
| Lower | Upper | ||||
| History of ACR | ACR | 13.88 | 4.47 | 43.16 | <0.001 |
| Infection | Infection | 6.28 | 1.54 | 25.64 | 0.011 |
| Graft recipient weight ratio (GRWR) | |||||
Conclusions: Late acute rejection is seen in 18% of pediatric LT recipients following previous ACR and infections. Poor outcome is difficult to predict, histology can be helpful.
Contact e‐mail address:
N‐OP001. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐OP001.1. IMPACT OF DIETARY LIPID DROPLET CHARACTERISTICS IN EARLY LIFE ON LATER LIFE ADIPOSITY OUTCOMES IN MURINE NUTRITIONAL PROGRAMMING MODELS: A META‐ANALYSIS
Marieke Abrahamse‐Berkeveld, Kelly Mulder, Ardy Van Helvoort, Louise Harvey, Lidewij Schipper
Danone Research & Innovation, Utrecht, Netherlands
Objectives and Study: Differences in growth and body composition development seem to contribute to observed differences in later life metabolic health of formula‐fed versus breast‐fed infants. One of the underlying factors could be the marked differences in supramolecular structure between human milk fat globules and lipid droplets in infant milk formula (IF). We investigated this hypothesis in mice using a nutritional programming model. Using an adapted production process, a Concept IF was developed containing large lipid droplets (mode diameter 3‐5 µm) coated with milk phospholipids and fat globule membrane fragments, more closely mimicking the size and surface characteristics of human milk fat globules. The current meta‐analysis evaluates the evidence‐base for the lasting impact of this Concept IF on later life adiposity.
Methods: We included published data from murine nutritional programming studies that examined effects of the Concept IF on adult adiposity. Despite variations in study design (e.g., physiological stressors, housing conditions, or adulthood diet), all studies involved early life exposure to a Concept vs Control IF‐based diet (from ~15 to 42 days of age) and assessed later life adiposity outcomes. Effect sizes (ES; Hedges’ g unbiased standardized mean difference) were calculated for a total of 14 relevant comparisons.
Results: The meta‐analysis demonstrated a substantial and significant inhibitory effect of early life exposure to Concept IF‐based diet on adult (excessive) fat mass accumulation (ES = ‐0.67, 95% CI ‐0.90, ‐0. 43, P < 0.01) with remarkably low heterogeneity (Q = 8.64, df=13, I^ = 0%).
Conclusions: This meta‐analysis reinforces scientific substantiation for the hypothesis that the size and surface characteristics of lipid droplets in the early life diet programs adiposity development. Remarkably, the effect of the Concept IF diet on adult adiposity was consistently observed across the different murine models of nutritional programming despite considerable variations in their design, indicative of the robustness of its impact on adiposity development.
Contact e‐mail address: marieke.abrahamse@danone.com
N‐OP002. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐OP002.1. IMPACT OF A NEW FORMULA ENRICHED WITH OSTEOPONTIN, GOS, HMOS & PROBIOTICS ON ATTENTIONAL NEURODEVELOPMENT IN HEALTHY INFANTS 1 YEAR OLD: THE EARLYTOLERA STUDY
Ana Nieto‐Ruiz1, Lucía Pérez‐Rodero2, Florian Herrmann3, Antonio Jerez3, José Antonio García‐Santos2, Roser De Castellar4, Maria Teresa Pérez‐Hernández4, Andrés Catena5, Cristina Campoy 3
1Department Of Methodology And Behavior Treatment, University of Granada, Granada, Spain, 2EURISTIKOS Excellence Centre for Pediatric Research, Granada, Spain, 3Department Of Pediatrics. School Of Medicine, University of Granada, Granada, Spain, 4Scientific Department, Laboratorios ORDESA, S.L., Barcelona, Spain, 5Experimental Psychology, University of Granada, Granada, Spain
Objectives and Study: Optimal attentional development during early postnatal stages is key to facilitate both social responsiveness and perceptual learning later in life. As part of EarlyTOLERA study (ClinicalTrials.gov ID: NCT04306263), current analysis is aimed to evaluate whether the enrichment of infant formula with some bioactive compounds, traditionally associated with immune system and gut microbiota development, could also have an effect on cognitive development up to 12 months of age, specifically regarding infant attentional neurodevelopment.
Methods: 231 healthy babies aged 0‐2 months participating in the EarlyTOLERA study (ClinicalTrials.gov ID: NCT04306263), were randomized to receive a standard infant formula (SF = 79) or experimental formula (EF = 75) enriched with Osteopontin, Galactooligosaccharides (GOS), Human Milk Oligosaccharides (HMOs) (2′FL) and probiotics (B. Infantis & L. Rahmnosus). Additionally, 77 breastfed infants (BF) were enrolled as reference group. Attention system was assessed at 12 months of age by eye movements via Tobii TX300® Eye Tracker (Tobii Technology, Stockholm, Sweden). Overall differences between EARLYTOLERA study groups were obtained from ANOVA and MANCOVA (adjusted by maternal educational level and paternal IQ). Differences between formula‐fed groups were obtained from Student's t‐Test. SPSS version 28.0.0 was used.
Results: No differences were found between EF or SF groups and BF regarding infants’ attentional development at 12 months of age (p > 0.05). However, formula‐fed infants showed significant differences in the time required to perform the first visual fixation; thus, EF infants showed a significant earlier first fixation than SF infants (1,04 ± 0,98 seconds vs 1,60 ± 1,99 seconds, respectively; p = 0.028).
Conclusions: Our data suggests that Osteopontin, GOS, HMOs & probiotics added to infant formula might improve its functionality, enhancing infants’ visual and attentional development compared to those fed with SF. Further studies are needed to understand the mechanisms underlying these differences and the long‐term consequences for cognitive development. Funding: Laboratorios Ordesa S.L. and TOLERA (CIEN Project)‐Spanish Ministry of Science, Innovation & Universities (IDI‐20170870).
Contact e‐mail address: ccampoy@ugr.es
N‐OP003. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐OP003.1. EFFECT OF A CHRONIC SUPPLEMENTATION WITH SIALYLATED MILK OLIGOSACCHARIDES ON INTESTINAL PHYSIOLOGY AND MICROBIOTA IN GROWTH‐RESTRICTED MICE PUPS
Laure Dubernat 1, Lucie Marousez1, Pauline Zarnitsky1, Bertrand Meresse1, Frédéric Gottrand2, Jean Lesage1, Delphine Ley2
1Institute For Translational Research In Inflammation, INFINITE ‐ U1286, Lille, France, 2Service De Gastroentérologie, Hépatologie Et Nutrition Pédiatriques, Lille Hospital, Lille Cedex, France
Objectives and Study: The World Health Organization (WHO) recommends exclusive breastfeeding for infants until 6 months of age, and its continuation until the age of 2 years alongside with a complementary feeding. Breast milk (BM) provides optimal nutrition and a high concentration of bioactive factors. Human milk oligosaccharides (HMOs), the third component of BM, are carbohydrates with prebiotic, immunomodulatory, anti‐infective, and anti‐inflammatory roles. However, their role in intestinal maturation is not fully characterized. Our goal was to assess the role of two sialylated HMOs on intestinal maturation in postnatally growth‐restricted (PNGR) mice pups and to explore the cellular mechanisms implicated using a murine intestinal organoid model.
Methods: At postnatal day 4 (PN4), large litters (15 pups/mother) were created to induce PNGR. Two sialylated HMOs (3′SL and 6′SL) were orally administered to PNGR pups from PN8 to PN21. Intestinal maturation was evaluated by assessing intestinal permeability using FITC‐dextran, histological and molecular approaches and RNA sequencing. The caecal microbiota content was analyzed by metagenomic sequencing. In vitro, murine intestinal epithelial organoids (IEOs) were cultured and exposed to 3′SL for 6 days, followed by RT‐qPCR analyses.
Results: From PN6 to PN21, PNGR pups had lower body mass and reduced ileal villous surface at weaning. Oral supplementation with 3′SL and 6′SL did not affect body mass or intestinal permeability at weaning but increased the caecal microbiota diversity and altered the ileal and colonic transcriptome. Gene expression of several factors implicated in the circadian rhythm machinery was altered by PNGR but not by HMOs supplementation. Preliminary data suggest that HMOs may directly promote cell proliferation in IEOs by increasing the expression of intestinal stem cell factors (Lgr5 and Ki67).
Conclusions: Our data indicate that sialylated HMOs supplementation during the lactation modulates the microbiota and intestinal transcriptome. These HMOs may also directly stimulate intestinal stem cell proliferation and reinforce the gut barrier.
Contact e‐mail address: laure.dubernat@inserm.fr
N‐OP004. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐OP004.1. THE IMPACT OF MATERNAL PROTEIN INTAKE AND LACTOFERRIN ON BREAST MILK COMPOSITION, HORMONAL REGULATION, AND INFANT METABOLIC OUTCOMES: INSIGHTS FROM RECENT STUDIES (2021–2024)
Sohair Elsiddig 1, Fawzia Alyafei2, Nada Alaaraj2, Noor Hamed1, Shayma Mohammed2, Ahmed Elawwa2, Ashraf Soliman2
1Paediatrics, Hamad Medical Corporation, Doha, Qatar, 2Pediatrics, Hamad Medical Corporation, Doha, Qatar
Objectives and Study: Maternal protein intake influences breast milk composition and infant growth outcomes. While protein is essential for growth, its effects vary based on quality, quantity, and timing. Recent studies from 2021 to 2024 provide critical insights into these relationships, especially regarding breastfeeding practices, hormonal regulation, and protein supplementation. Objectives:
This review synthesizes recent findings on maternal protein intake during pregnancy and lactation, focusing on its effects on breast milk protein composition, infant growth, and metabolic regulation.
Methods: Structured review of 20 studies published between 2021‐2024 was conducted, encompassing over 2,000 mother‐infant pairs globally. The studies included observational cohorts, randomized controlled trials, and cross‐sectional analyses, with a focus on protein quality, quantity, and their effects on infant growth outcomes.
Results: Protein Quantity: High maternal protein intake during pregnancy showed mixed outcomes, with excessive intake increasing the risk of preterm birth but not improving fetal growth. Protein‐enriched breast milk supported early weight and head circumference growth in preterm infants but showed diminishing returns for adiposity regulation over time. Protein Quality: High‐quality protein, such as lactoferrin, demonstrated neuroprotective and anti‐inflammatory effects, improving brain development in preterm infants. Animal‐based proteins showed stronger positive associations with infant growth compared to plant‐based proteins. Breastfeeding Practices and Metabolic Impacts: Breastfeeding with moderate protein levels improved growth trajectories while reducing obesity risks compared to formula feeding. Modified low‐protein formulas reduced insulin resistance in formula‐fed infants, better mimicking breast milk effects. Discussion:
The findings underscore the nuanced effects of protein quantity and quality. Excessive protein may hinder optimal growth, while high‐quality proteins and balanced breastfeeding practices enhance growth and neurodevelopment. Individualized maternal dietary strategies are essential to optimize infant health outcomes.
Conclusions: Maternal protein intake and breast milk composition are critical for infant growth. Emphasis on high‐quality protein and optimized intake levels can support healthy growth trajectories and long‐term health benefits.
Contact e‐mail address:
N‐OP005. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐OP005.1. HUMAN MILK MACRONUTRIENT INTAKE AND INFANT GROWTH
Maude Grant 1,2, Julie Lanigan2, Emma Sutton2, Andy Currie3, Jean‐Philippe Godin4, Sagar K. Thakkar4, Atul Singhal2
1Nestle Nutrition, West Sussex, United Kingdom, 2Ucl Great Ormond Street Institute Of Child Health, Childhood Nutrition Research Centre, London, United Kingdom, 3Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom, 4Nestle Research, Lausanne, Switzerland
Objectives and Study: Breastfed (BF) infants have a lower risk of obesity compared to those formula‐fed (FF), potentially due to differences in macronutrient intake and patterns of growth in infancy. This study aimed to investigate associations between human milk (HM) macronutrient intake (carbohydrate, fat, and protein) and infant growth in the first year of life.
Methods: Participants were a subset of exclusively breastfed infants (n = 28) that made up the HM group of a randomized controlled formula‐feeding trial. HM samples were obtained from full breast expression at 3 months. HM macronutrient composition was measured using a mid‐infrared HM analyzer, and volume of intake was determined using the deuterium “dose‐to‐mother” technique. Infant weight and length were measured at 3, 6, and 12 months of age. Linear regression models were used to assess the associations between macronutrient intake (g/day) and infant growth, adjusting for infant sex, birthweight, gestational age, and total energy intake (kcal/day).
Results: Carbohydrate (lactose) intake was positively associated with increases in weight‐for‐age Z‐scores between birth and 3 months of age (p < 0.001 in adjusted and unadjusted models). Fat intake was inversely associated with change in weight‐for‐age Z‐scores between birth and 3 months (p < 0.001) only after adjusting for energy. After adjusting for energy, protein did not show any significant associations with infant growth during the first year. By 6 months, no significant associations were observed between macronutrient intake and growth (Table 1).
Conclusions: Consistent with recent literature, carbohydrate intake was positively associated with growth during early infancy, independent of energy intake. In contrast to findings in FF infants, protein did not show significant associations with infant growth during the first year. These results contribute to the limited evidence on HM composition and infant growth, with further research needed to explore the mechanisms underlying these associations and their long‐term implications for child health.
Contact e‐mail address: maude.grant.17@ucl.ac.uk
N‐OP006. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐OP006.1. LOW‐DOSE IRON SUPPLEMENTATION IN HEALTHY BREASTFED INFANTS REDUCES BEHAVIORAL PROBLEMS AT 3 YEARS: RESULTS FROM A RANDOMIZED PLACEBO‐CONTROLLED TRIAL
Ludwig Kaloteka Svensson 1, Magnus Domellöf1, Cornelia Späth1, Anna Chmielewska1, Grzegorz Chmielewski2, Zofia Konarska3, Malgorzata Pieścik‐Lech3, Hania Szajewska3
1Department Of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden, 2Department Of Clinical Sciences, Obstetrics And Gynecology, Umeå University, Umeå, Sweden, 3Department Of Paediatrics, Medical University of Warsaw, Warsaw, Poland
Objectives and Study: Breastfed infants are at risk of iron deficiency, which has been associated with impaired neurodevelopment. While iron supplementation has been shown to reduce behavioral problems in certain risk groups, its effects on behavior in otherwise healthy infants remain unclear. This study investigated the effects of daily low‐dose iron supplementation, administered between 4 and 9 months of age, on behavioral outcomes at 3 years in exclusively or predominantly breastfed infants.
Methods: In a randomized double‐blinded, placebo‐controlled trial, 221 healthy full‐term exclusively or predominantly (>50% meals) breastfed infants were randomized to receive daily low‐dose iron supplementation (approximately 1 mg/kg/day) or placebo between 4 and 9 months of age. At 3 years, behavioral problems was assessed as a secondary outcome using the Child Behavior Checklist (CBCL).
Results: Caregivers of 133 participants (60%) completed the CBCL at 3 years. Iron supplementation compared to placebo significantly reduced mean total CBCL T‐scores (44.7 ± 8 vs. 47.7 ± 8.2, p = 0.014) and externalizing T‐score (45.6 ± 8.2 vs. 48.6 + . 8.9, p < 0.001) in intention‐to‐treat analysis. Participants receiving iron supplementation had significantly lower scores for withdrawn behavior, attention problems, and aggressive behavior compared to placebo (p = 0.017, 0.024, and 0.003, respectively). Exploratory post‐hoc analysis revealed that lower ferritin concentrations at 4 and 12 months were associated with higher behavioral problem scores at 3 years. Infants with ferritin concentrations below the lower quartile (18.6 μg/L) at 12 months had significantly higher scores for internalizing behavior (50.3 vs. 43.4, p = 0.003), anxious/depressed (2.7 vs. 1.3, p = 0.02) and somatic complaints (1.9 vs. 1.1, p = 0.05) compared to those above the lower quartile.
Conclusions: Low‐dose iron supplementation between 4 to 9 months of age significantly reduced behavioral problem scores at 3 years in predominantly breastfed healthy infants. Although promising, the findings warrant cautious interpretation until replicated.
Contact e‐mail address: Ludwig.Svensson@umu.se
N‐OP007. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐OP007.1. IMPROVING MACRONUTRIENT COMPOSITION IN DONOR HUMAN MILK POOLS BY USING MACHINE LEARNING AND OPTIMIZATION
Jacqueline Muts 1, Danée Knevel2, Dick Den Hertog2, Rachel Wong3, Timothy Chan3, Britt Van Keulen1, Johannes Van Goudoever4, Chris Van Den Akker5
1Pediatrics, Amsterdam UMC, Amsterdam, Netherlands, 2Business Analytics, University of Amsterdam, Amsterdam, Netherlands, 3Mechanical And Industrial Engineering, University of Toronto, Toronto, Canada, 4Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, Netherlands, 5Department of Pediatrics ‐ Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, University, Amsterdam, Netherlands
Objectives and Study: The macronutrient composition of donor human milk (DHM) can vary significantly due to factors such as maternal age, diet, and lactation duration. However, preterm infants require consistent macronutrient levels in DHM to support optimal growth. This study aims to stabilize the macronutrient quality of DHM by pooling milk from different donors by utilizing machine learning and optimization techniques.
Methods: The current pooling strategy at the Dutch human milk bank, which combines milk from different batches from a single donor, is compared with a new theoretical approach that pools milk batches from up to 5 donors. In current practice, the macronutrient content of each single donor pool is measured using a human milk analyzer (MIRIS®) as a quality indicator. For the new prediction model, we used the following variables: body mass index, the donor's diet (vegetarian or non‐vegetarian), maternal age, full‐term or preterm delivery, lactation stage, and volume pumped. These predictions are then used within an optimization model to create milk pools that minimise the deviations from the target macronutrient levels (1.0 g protein/100 mL and 70 kcal/100 mL).
Results: The prediction model is based on 2236 created single‐donor pools from 480 donors. Random forest regression models provided the most accurate predictions of macronutrient content. The new pooling strategy using multiple donors shows reduced deviations from target values compared to the current single‐donor approach (average total absolute deviation 0.402 versus 0.664).
Conclusions: This study proves the potential of data‐driven methods to improve operational efficiency in human milk banks, ultimately providing better nutritional support to preterm infants.
Contact e‐mail address: j.muts@amsterdamumc.nl
N‐OP008. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐OP008.1. MINOR WHEY PROTEIN PATTERNS ACROSS LACTATION STAGES IN HUMAN MILK FROM MOTHERS OF VERY LOW BIRTH WEIGHT NEWBORNS
Belén Pastor‐Villaescusa 1, Francisco Amil‐Ruiz2, Carlos A. Fuentes‐Almagro3, Katherine Flores‐Rojas1, Mercedes Gil‐Campos1, Lucía Izquierdo‐Palomares4, Angel Gil5, José Luis Gómez‐Chaparro Moreno1
1Metabolism In Childhood, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain, 2Bioinformatics Unit, Central Research Support Service (scai), University of Cordoba, Cordoba, Spain, 3Proteomics Unit, Central Service For Research Support (scai), University of Cordoba, Cordoba, Spain, 4Pediatrics Radiology Section, Radiodiagnostic Service, Reina Sofia University Hospital, Cordoba, Spain, 5Department Of Biochemistry And Molecular Biology Ii, University of Granada, Granada, Spain
Objectives and Study: Very low birth weight (VLBW) newborns require increased protein intake for adequate development. While it is well‐established that human milk (HM) from mothers with VLBW newborns contains higher protein levels than the term HM, the composition of minor whey proteins remains unclear. This study aims to explore these proteins, providing a detailed proteomic analysis of HM during lactation in this population.
Methods: This longitudinal study used HM samples from 35 mothers of VLBW newborns across three lactation stages: 1 ml of colostrum (0–48 hours), 1 ml of transitional (4–14 days), and 1 ml of mature HM (15–100 days). ProteoMiner protein enrichment was employed to identify minor whey proteins. Samples were analyzed using a high‐performance liquid chromatography system coupled with an Orbitrap Fusion mass spectrometer. Data were processed through Proteome Discoverer software. Statistical analysis was conducted using an in‐house R script (v3.5.3), with functional pathway and enrichment analyses performed through the STRING v11.0 database. The study followed the standards of the Declaration of Helsinki and was approved by the Ethics Committee of the participating hospital.
Results: Four clusters were identified, differentiating the HM proteome based on lactation stages (Figure 1). Cluster 1 (proteins involved in exocytosis, vesicle transport, and immunity) was predominantly overexpressed in colostrum, while Cluster 2 (proteins related to vesicle secretion, neutrophil activity, and fluid regulation) and Cluster 3 (proteins associated with antigen and immunoglobulin receptor binding) were overexpressed in transitional and mature HM, respectively. Cluster 4 (proteins implicated in lipid transport, and extracellular structure organization) exhibited underexpression in mature HM.
Conclusions: The proteomic patterns of HM vary across lactation stages, with certain protein groups overexpressed exclusively in colostrum, transitional, or mature HM. This likely reflects the specific protein requirements during each lactation stage for VLBW newborns. Understanding these profiles is crucial for customizing protein supplementation in HM banks to address their unique nutritional needs.
Contact e‐mail address: belen.pastor@imibic.org
N‐OP009. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐OP009.1. COGNITIVE OUTCOMES AFTER 12 MONTHS OF FEEDING AN INFANT FORMULA WITH 5 SPECIFIC HUMAN MILK OLIGOSACCHARIDES: A LARGE, RANDOMIZED, CONTROLLED TRIAL
Elizabeth Reverri 1, Menaka Yalawar2, Brian Leyshon3, Jeffery Oliver4, Rachael Buck3, Geraldine Baggs4
1Nutrition Science & Innovation, Abbott Nutrition, Columbus, United States of America, 2MARS Group Inc., Bloomington, United States of America, 3Gut, Immunity, & Brain Health, Abbott Nutrition, Columbus, United States of America, 4Medical Affairs & Research, Abbott Nutrition, Columbus, United States of America
Objectives and Study: Human milk (HM) is the gold standard of nutrition for infants. Observational studies have demonstrated positive associations between breastfeeding and cognitive outcomes during infancy and toddlerhood. Most infant formula studies with human milk oligosaccharides (HMOs) are short‐term and none have included cognitive assessments. The objective of this study was to investigate cognition at 12 months of age.
Methods: In this randomized, controlled trial, healthy, term infants received either study formula (SF) with 2.5 g/L of 5 HMOs (2′‐FL, 3‐FL, LNT, 3′‐SL, 6′‐SL) or control formula (CF) without HMOs but otherwise matched to SF through 12 months of age. Infants fed HM were also enrolled as a non‐randomized reference group. Cognition was assessed by MacArthur‐Bates Communicative Development Inventories and Bayley Scales of Infant and Toddler Development. Cognitive outcomes were analyzed using AN(C)OVA adjusted for covariates and a propensity score for being formula‐ or HM‐fed to account for potential confounding. Categorical variables were analyzed using Chi‐square or Fisher's exact test. P‐values ≤ 0.05 were considered statistically significant (SAS® Version 9.4).
Results: At 12 months of age, 354 infants were protocol evaluable: 123 fed CF, 130 SF, and 101 HM; evaluability was not significantly different among the 3 groups (P > 0.05). More infants fed SF imitated words when starting to talk, compared to CF (%Yes: 72.2% vs 52.3%, P = 0.0104). Infants fed SF, compared to CF, understood more everyday phrases (LSM ± SE: 10.97 ± 0.84 vs 13.65 ± 0.76, P = 0.0233) and had greater expressive communication scores (9.64 ± 0.23 vs 10.33 ± 0.21, P = 0.0452). Infants fed HM scored higher on adaptive behavior scores (99.20 ± 1.28 vs 103.61 ± 1.47, P = 0.0395), including socialization, interpersonal relationships, and play and leisure, compared to CF, with no significant differences for SF.
Conclusions: This clinical study showed for the first time that an infant formula with 5 specific HMOs supported cognitive development at 12 months of age (ClinicalTrials.gov NCT04957992).
Contact e‐mail address: Elizabeth.Reverri@abbott.com
N‐OP010. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐OP010.1. MUSCLE LOSS IN CRITICALLY ILL CHILDREN IS ASSOCIATED WITH INFLAMMATION
Zhang Yue 1, Yi Feng2
1Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, shanghai, China, 2Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
Objectives and Study: The main objectives of this study were to assess muscle wasting using point‐of‐care ultrasound (POCUS), as well as its association with nutritional delivery, inflammation, and clinical outcomes in PICU.
Methods: This study observed children over 1 year in our PICU from March 2023 to July 2024. Quadriceps femoris muscle thickness (QFMT) was measured three times: within 48 hours, day 7, and day 14. Muscle loss was defined as a 10% or more reduction in QFMT from admission. Factors associated with muscle loss were analyzed using multiple linear regression, with ∆QFMT% as the dependent variable. Independent variables included age, sex, disease, STRONGKids score, BMI‐z score, PCIS, nutritional support, caloric and protein intake deficit, inflammatory markers (CRP max, PCT max), sedative and hormone use, and outcomes like hospital stay, PICU hospital stay and mechanical ventilation time.
Results: 90 children with a mean age of 8 years (IQR 6‐11) were enrolled and male/female (51/39). Across the cohort, QFMT decreased in 45 cases (45/90, 50%) with a mean decrease of 4.0% (IQR = ‐21.0 to 18.5) at the first weekend and 18 cases (18/33, 54.5%) with 12% (IQR = ‐23.0 to 13%) at the second weekend. Nearly half of the children (44.4%) experienced muscle loss. After multiple linear regression analysis, ∆QFMT% = ‐0.108 + 0.054 PCT max.
Conclusions: In this cohort, muscle loss occured in nearly half of the critically ill children hospitalized for a long time by POCUS. After adjusting for confounding factors, it was found that muscle loss in the first week was closely related to PCT max during hospitalization.
Contact e‐mail address:
N‐OP011. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐OP011.1. MULTIDISCIPLINARY TEAM TREATMENT OF FEEDING DIFFICULTIES IN CHILDREN WITH AUTISM SPECTRUM DISORDER AND DOWN SYNDROME
Ines Pranjić, Anna Vestergaard Larsen, Tena Niseteo, Ivana Bukovina, Tihana Koren, Sara Sila
Referral Center For Pediatric Gastroenterology And Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
Objectives and Study: Children with autism spectrum disorder (ASD) and Down syndrome (DS) often experience feeding difficulties. The aim of this study was to determine outcomes of a multidisciplinary team (MDT) treatment for feeding difficulties.
Methods: This retrospective study included patients diagnosed with ASD and DS who were admitted to an MDT treatment program involving a nutritionist, occupational therapist, and psychologist. Data on age, sex, mode of feeding (tube‐feeding or oral feeding), calories from oral nutritional supplements (ONS), food selectivity (number of accepted foods, acceptance of different food textures, and food diversity defined as eating some foods from every food group), mealtime behaviours (family meals inclusion and eating meals at the table) and anthropometric data (body weight (BW) SDS, body height (BH) SDS and body mass index (BMI) SDS) were extracted at the first visit and at the last follow‐up to an MDT clinic.
Results: Forty six patients were included (71.7% ASD, 65.2% male, mean age 4.5 ± 3.3 years). Mean follow‐up time was 1.7 ± 1.5 years. Twenty seven (64.3%) patients attended sensory integration therapy. Ten (23.8%) patients required tube‐feeding at some point during the treatment, decreasing to 4 (8.7%) at the follow‐up (p = 0.031). A statistically significant improvement in food selectivity and mealtime behaviour was observed between first and last visit to an MDT (Figure 1). There was a statistically significant increase in intake of calories from ONS (mean 243.9 ± 290.4 at the first vs 405.6 ± 329.2 kcal at the last visit, p = 0.006). No significant differences were observed for BW SDS, BH SDS and BMI SDS between two time‐points. Figure 1. Changes in oral nutritional supplements (ONS) intake, food selectivity and mealtime behaviours between first visit and last follow‐up of an MDT.
Conclusions: Majority of children with ASD and DS remained dependant on ONS to meet their nutritional requirements. Nevertheless, significant improvement in mealtime behaviours and food selectivity were detected.
Contact e‐mail address:
N‐OP013. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐OP013.1. MECHANISMS OF THE FETAL REGULATORY B CELL INDUCTION BY 2′‐FUCOSYLLACTOSE SUPPLEMENTATION DURING PREGNANCY FOR ALLERGY PREVENTION
Marine Le Romancer 1,2, Carole Brosseau1, Barbara Misme‐Aucouturier1, Kristine Rothaus Christensen2, Sébastien Barbarot3, Marie Bodinier1
1Ur1268 Bia, INRAE, Nantes, France, 2DSM Firmenich, Hørsholm, Denmark, 3Service De Dermatologie, CHU Nantes, Nantes, France
Objectives and Study: Pregnancy is a critical period for the development and maturation of biological systems, including the immune system. During this period, several exchanges occur between the mother and fetus, including transfer of maternal cells, a phenomenon known as maternal microchimerism. We have previously shown that prenatal supplementation with 2′‐fucosyllactose (2'FL) abrogates food allergy symptoms by promoting a tolerogenic imprint in the fetus characterized by an increase of B10 regulatory cells. This tolerogenic imprint persists over time in the offspring. However, it remains unclear whether these tolerogenic cells originate from maternal microchimerism or are induced directly within the fetus. In this study, we specifically investigated the effects of the maternal 2'FL supplementation on maternal microchimerism.
Methods: Balb/c females (CD45.2 H2Dd/d) were mated with C57BL/6 Ly5.1 males (CD45.1 H2Db/b) to generate fetuses with a dual phenotype, CD45.1.2 H2Db/d to distinguish maternal, paternal, and fetal cells. Throughout gestation, females were supplemented with 2′FL. Non‐supplemented females were used as control. On day 18 of gestation, the frequency of B10 cells in feto‐maternal tissues was evaluated by flow cytometry.
Results: Gestational intake of 2'FL significantly increases the frequency of B10 cells in both maternal and fetal bone marrow (maternal: 0.61 ± 0.14% vs 0.73 ± 0.07%, p = 0.03; fetal: 1.66 ± 0.71% vs 2.81 ± 0.84%, p = 0.002), and in the placenta (0.93 ± 0.68% vs 1.74 ± 0.82%, p = 0.025). In the femur of fetuses from 2′FL‐supplemented mothers, both B10 cells with maternal and fetal phenotypes are significantly increased (maternal: 1.46 ± 1.71% vs 5.32 ± 3.76 %, p = 0.03; fetal: 3.32 ± 1.09% vs 7.16 ± 3.8%, p = 0.02).
Conclusions: Maternal 2'FL intake induced a tolerogenic environment in utero, partly explained by maternal microchimerism of B10 cells, potentially protecting offspring against food allergy. This study highlights a new mechanism by which 2′FL modulates the immune system, but further studies are needed to confirm of maternal B10 functionality in older offspring and fetal Breg cell induction mechanism.
Contact e‐mail address: marine.le-romancer@inrae.fr
N‐OP014. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐OP014.1. EFFECT OF CHRONOBIOLOGICAL FEEDING MODEL ON SLEEP AND PHYSIOLOGICAL PARAMETERS OF PRETERM INFANTS: A RANDOMIZED CONTROLLED TRIAL
Ebru Temizsoy 1, Neslihan Bozkurt2, Hüsnü Fahri Ovalı2, Gülzade Uysal3
1Istanbul Bilgi University, Üsküdar, Turkey, 2General Pediatrics, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey, 3Sakarya University, sakarya, Turkey
Objectives and Study: The preterm infants loses hormonal cues, normally received in utero, and is prematurely exposed to circadian synchronizers like daylight and enteral feeding. Recent evidence suggests that human milk can act as a Zeitgeber, as its composition varies throughout the day. Chrononutrition is a feeding model that adjusted to match each individual's biological clock. This study aimed to evaluate the effect of the chronobiological feeding model on the sleep and physiological parameters of preterm infants.
Methods: A prospective, randomized controlled trial was conducted in a tertiary neonatal intensive care unit between April 2023 and March 2024. Enrolled preterm infants were randomized to receive either chrononutrition (intervention group=30) or standard feeding (control group=30). Data were collected using the infant's follow‐up form.
Results: Among 60 neonates, the mean birth weight was similar in the intervention group (1985.4 ± 731.8 g) and the control group (1946.4 ± 545.7 g), with no statistically significant difference (p = 0.815). There was no statistically significant difference in demographical findings between the intervention and control groups (p > 0.05). The mean baseline deep sleep duration was similar between the intervention group (30.6 ± 33.3 minutes) and the control group (25.7 ± 20.9 minutes) (p = 0.504). The intervention group showed a significantly longer deep sleep duration at discharge (79.5 ± 46.4 minutes) compared to the control group (47.9 ± 20 minutes) (p = 0.002). The intervention group's sleep duration at discharge (271.3 ± 111.5 minutes) was significantly longer than the control group's (164.2 ± 82.2 minutes) (p < 0.001). There was no statistically significant difference between the two groups in crying durations and physiological parameters (p > 0.05).
Conclusions: The chronobiological feeding model affects the sleep characteristics of hospitalized preterm infants. Further studies needed to elucidate the effect of the chronobiological feeding model on various outcomes of preterm infants.
Contact e‐mail address: temizsoyebru@gmail.com
N‐OP015. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐OP015.1. LET ESPGHAN SHINE INITIATIVE: A STABLE ISOTOPE PILOT STUDY USING THE NATURAL ABUNDANCE VARIATION OF 13 C. EVIDENCE FOR INCORPORATION OF DIETARY LCPUFAS INTO PLASMA LIPIDS IN VERY PRETERM INFANTS
Ariadna Witte 1, Virgilio Carnielli2, Anna Sartori3, Manuela Simonato3, Patricia Álvarez García4, Alessio Correani2, Malaika Cordeiro4, Paola Cogo5, Miguel Sáenz De Pipaón4
1Neonatology, Biomedical Research Foundation of the La Paz University Hospital, Madrid, Spain, 2Department Of Odontostomatologic And Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy, 3Department Of Women's And Children's Health, University of Padova, Padova, Italy, 4Neonatology, La Paz University Hospital, Madrid, Spain, 5Department Of Medicine, Division Of Pediatrics, S. Maria della Misericordia University Hospital, University of Udine, Udine, Italy
Objectives and Study: Most studies have relied on plasma concentrations or percentages of fatty acids within lipid classes as proxies for bioavailability/absorption, and only a few have calculated absorption based on intestinal balance data. We used the natural variation of the 13C:12C ratio (δ 13C) in dietary lipids to assess the bioavailability LCP supplements (SLCP), namely their incorporation into plasma phospholipid LCPs (PLLCP) in preterm infants.
Methods: We studied 31 preterm infants born at less than 32 weeks of gestation. Eleven infants received standard of care (SOC) without SLCP, while 20 infants received SOC with oral supplementation of docosahexaenoic acid (SDHA) and arachidonic acid (SARA) from an algal source. Ten infants received 60 mg/kg SDHA and 120 mg/kg SARA, and 10 received 80 mg/kg SDHA and 160 mg/kg SARA. Supplements were initiated after birth as soon as enteral nutrition was tolerated and continued until 36 weeks corrected age (weeksCA). Plasma phospholipids and their fatty acid composition, including variations in the δ13C were measured using standard lipid techniques and Isotope Ratio Mass Spectrometry at three time points: immediately after birth (baseline), day 21 and 36 weeksCA.
Results: At baseline, there were no significant differences among groups neither in total plasma phospholipids nor in the δ13C of PLDHA and PLARA. The mol% values and δ13C of PLDHA and PLARA at 36 weeksCA are reported in table below. Differences were found in mol% and δ13C at 36 weeks between supplemented and SOC groups
Conclusions: This pilot study demonstrates that preterm infants who received SLCP containing both DHA and ARA had significantly higher plasma PLDHA and PLARA compared to SOC infants at 36 weeksCA, with no evidence of DHA‐ARA imbalance. Using a stable isotope technique, we showed that LCP‐60‐120 and LCP‐80‐160 schemes contributed approximately 42 and 56% to plasma PLDHA, and 48 and 59% to PLARA pools, respectively, by 36 weeksCA.
Contact e‐mail address:
N‐OP016. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐OP016.1. MEDITERRANEAN DIETARY PATTERN USING TWO DIFFERENT NUTRITIONAL ASSESSMENT TOOLS IN CHILDREN AGED 3‐6 YEARS IN FIVE EUROPEAN COUNTRIES PARTICIPATING IN THE CHILDHOOD OBESITY PROJECT
Julia Erhardt 1,2, Alexander Triebswetter1,2, Veit Grote1,2, Martina Totzauer1,2, Dariusz Gruszfeld3, Veronica Luque4, Annick Xhonneux5, Elvira Verduci6, Berthold Koletzko1,2
1Department Of Paediatrics, Division Of Metabolic And Nutritional Medicine, Dr. Von Hauner Children's Hospital, LMU University Hospital, Munich, Germany, 2German Center for Child and Adolescent Health, Munich, Germany, 3Neonatal And Nicu Department, Children's Memorial Health Institute, Warsaw, Poland, 4Pediatric, Nutrition And Development Research Unit, Universitat Rovira i Virgili. IISPV, Reus, Spain, 5Groupe Santé CHC, Liege, Belgium, 6Unit Of Metabolic Disease, Ospedale dei Bambini Vittore Buzzi, Milano, Italy
Objectives and Study: Our aim was to assess differences in dietary assessment tools to provide a score for adherence to Mediterranean Diet (MD), and to examine cross‐country variations in this score during young childhood.
Methods: 3‐Day Food Diaries (3‐DFD) and Food Frequency Questionnaires (FFQ) were assessed at 4 time points during the ages 3‐6 years across five European countries: Belgium, Germany, Italy, Poland, and Spain. These data were joint to form a combined KIDMED score. Specific diet score, country, and time point differences were examined. Individual diet score stability per country was determined using Intraclass Correlation Coefficient (ICC).
Results: Unifying 3‐DFD and FFQ resulted in a significant higher combined KIDMED score (3.75 ± 2.83) compared to FFQ (3.31 ± 2.33) and 3‐DFD score (1.77 ± 2.45) individually over the time period. The combined KIDMED score was higher in Mediterranean countries (Italy 5.00; Spain 4.54) than non‐Mediterranean countries (Belgium 1.96; Germany 3.13; Poland 1.65), as more children from Mediterranean countries consumed fruits, vegetables, fish, pulses, and olive oil (cf. Figure 1). There were no significant changes over time in the mean combined KIDMED score per country except for Poland between 3 and 4 years. Intra‐individual variability over time was poor to moderate (Germany: 0.620, Belgium: 0.604, Italy: 0.429, Poland: 0.564, and Spain: 0.493).
Conclusions: Combining FFQ and 3‐DFD led to a higher KIDMED score as more details of frequencies in food consumption were detected with a possible trend of overestimation of healthy food intake. Mediterranean countries exhibited higher adherence to the MD compared to non‐Mediterranean countries. Additionally, MD adherence remained moderately stable over time in early childhood, suggesting that dietary patterns established at a young age are likely to persist.
Contact e‐mail address: Berthold.Koletzko@med.uni-muenchen.de
N‐OP017. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐OP017.1. LIFESTYLE AND EATING BEHAVIOR IN EXTREMELY PRETERM CHILDREN AT TWO YEARS OF AGE: PRELIMINARY RESULTS FROM THE GENERATION P STUDY
Nina Frerichs 1,2, Rimke De Kroon1,2, Aranka Van Wesemael1,2, Chris Van Den Akker1,3, Willem De Boode4, Marijn Vermeulen5, Johannes Van Goudoever2, Aleid Leemhuis1,3, Berber Vlieg‐Boerstra6, Edgar Van Mil7, Angelika Kindermann2, Hendrik Niemarkt8,9, Tim De Meij2
1Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, Netherlands, 2Department Of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands, 3Department of Pediatrics ‐ Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, University, Amsterdam, Netherlands, 4Neonatal Intensive Care Unit, Amalia Children's Hospital, Radboud UMC, Nijmegen, Netherlands, 5Department Of Neonatal And Pediatric Intensive Care, Division Of Neonatology, Erasmus Medical Center, Rotterdam, Netherlands, 6Department Of Paediatrics, OLVG Hospital, Amsterdam, Netherlands, 7Department Of Pediatrics, Jeroen Bosch Hospital, 's‐Hertogenbosch, Netherlands, 8Department Of Neonatology, Maxima Medical Centre, Veldhoven, Netherlands, 9Department Of Electrical Engineering, Technical University Eindhoven, Eindhoven, Netherlands
Objectives and Study: Infants born extremely preterm continue to face unique challenges in their development following discharge from the neonatal intensive care unit (NICU), including potential long‐term impact on eating behaviors and lifestyle patterns. Our aim was to evaluate lifestyle and eating behaviors in this population at two years corrected age (CA).
Methods: The nationwide Generation P cohort study, performed in 8 NICUs in the Netherlands, aims to assess multiple childhood health outcomes at 2 years CA in extremely preterm infants (<28 weeks’ gestation). For this report, lifestyle and eating behavior outcomes were assessed at two years CA using parent‐completed health questionnaires containing two validated tools: the Dutch Fly‐Kids Questionnaire, a lifestyle screening tool that evaluates whether age‐specific recommendations on four lifestyle themes are met, and the Dutch Montreal Children's Hospital Feeding Scale (MCHFS), evaluating feeding behaviors and difficulties. The Fly‐kids questionnaire results were compared to recent outcomes in a term‐born healthy population (Krijger et al., 2023).
Results: 50 extremely preterm born infants have been included in the two year follow‐up (59%), with 44 completed questionnaires (88%). According to the MCHFS, 20% of infants were identified to have feeding difficulties. Furthermore, 7% of infants were still (at least partly) reliable on tube feeding. Preliminary findings from the Fly‐kids questionnaire reveals that these preterm infants show more unhealthy lifestyle behaviors compared to data on term‐born counterparts at two years CA (n = 201). Most evident differences were observed regarding unhealthy food intake (lower vegetable and higher snack consumption in ex‐preterm infants, p = 0.042 and p = 0.003, respectively), and insufficient sleep duration (p < 0.001) (Figure1).
Conclusions: These preliminary findings showed that extremely preterm birth is associated with ongoing feeding difficulties and unhealthy lifestyle behaviors at two years CA, which may further impact an already compromised development. These findings highlight the need for increased attention to lifestyle and feeding issues in this vulnerable population.
Contact e‐mail address:
N‐OP018. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐OP018.1. FOOD INSECURITY IN CHILDREN: IMPACT ON DIET QUALITY AND ACADEMIC ACHIEVEMENT
Aslı Hilal Güzelalp 1, Aysun Yüksel2
1Nutrition And Dietetic, Istanbul Rumeli University, İstanbul, Turkey, 2Nutrition And Dietetic, Istanbul Medeniyet University, İstanbul, Turkey
Objectives and Study: Food insecurity may influence children's diet quality and academic performance. This study aimed to assess children's experiences with food insecurity and investigate its effects on diet quality and academic achievement in a public secondary school.
Methods: The study included 168 volunteer children. The researcher collected descriptive data, food consumption frequency, and retrospective 24‐hour dietary intake records. Anthropometric measurements, including height, weight, waist, and arm circumference, were also taken. To assess food insecurity, children completed the Child Food Insecurity Experiences Scale. Their end‐of‐semester grades were obtained from the school principal. Diet quality was evaluated using the Healthy Eating Index (HEI‐20). Data analysis was performed using IBM SPSS Statistics 22, with statistical significance set at p < 0.05.
Results: showed that 76% of the children experienced food insecurity. Based on HEI‐20 scores, none of the participants had good diet quality. Saturated fat intake was significantly higher in food‐insecure children compared to their food‐secure peers (p = 0.042). Among girls, added sugar consumption was notably greater in those experiencing food insecurity. Additionally, the average mathematics, science, and overall end‐of‐semester grades were significantly lower in food‐insecure children than in food‐secure ones (p = 0.005, p = 0.0013, p = 0.007, respectively). A one‐point increase in food insecurity score was associated with a decrease of 1.877 points in mathematics, 1.094 points in science, 1.373 points in social sciences, and 0.918 points in the final grade (p < 0.05).
Conclusions: Ensuring children's access to nutritious diets is essential for supporting their academic performance. Therefore, school meal programs should be enhanced, and policies and interventions aimed at reducing food insecurity should be put into practice.
Contact e‐mail address: aslihilalguzelalp@gmail.com
N‐OP019. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐OP019.1. EFFECT OF IBP‐9414 ON TIME TO A STRICT DEFINITION OF SUSTAINED, FULL ENTERAL FEEDING IN VERY LOW BIRTH WEIGHT INFANTS: RESULTS FROM THE ‘CONNECTION STUDY’
Josef Neu1, Michael Caplan2, Teresa Del Moral3, Scott Guthrie4, Mark Hudak5, Jae Kim6, Anders Kronström7, Camilia Martin8, Neena Modi9, Jonas Rastad7, Rachana Singh10, Staffan Strömberg7, Hania Szajewska11, Marcus Thuresson7, Flavia Indrio 12
1University of Florida, Gainesville, United States of America, 2Endeavor Health/University of Chicago, Pritzker School of Medicine, Chicago, United States of America, 3Miller School of Medicine, Florida, United States of America, 4Vanderbilt University School of Medicine, Nashville, United States of America, 5University of Florida College of Medicine, Jacksonville, United States of America, 6Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America, 7Infant bacterial therapeutics, Stockholm, Sweden, 8Weill Cornell Medicine, New york city, United States of America, 9Imperial College London, London, United Kingdom, 10Tufts University School of Medicine, Boston, United States of America, 11Department Of Paediatrics, Medical University of Warsaw, Warsaw, Poland, 12Department of Experimental Medicine, University of Salento, Lecce, Italy
Objectives and Study: Achievement of full enteral feedings is important for VLBW infants. We report results of the ‘Connection Study’, a phase 3 trial of IBP‐9414 (NCT03978000) conducted under US IND and EU CTXs in 95 NICUs.
Methods: 2117 infants born at gestational age 23‐32 weeks (median, 27w) were randomized 1:1 to once daily enteral treatment with IBP‐9414 or placebo from <48 hours after birth until a postmenstrual age of 346/7 weeks. A primary study outcome was time to sustained feeding tolerance (SFT) defined as a 10‐day consecutive time during which nutrition was exclusively enteral (feedings >120 ml/kg/day) and average weight gain was >10 g/kg/day. Analysis of time to SFT was stratified for birth weight and adjusted for competing risk.
Results: SFT was reached by 75% of IBP‐9414 treated infants and 71% of those receiving placebo. The median time to SFT was numerically shorter (21 days vs. 23 day[1] [2] s) in the IBP‐9414 group (p = 0.07). Subgroup analysis demonstrated a shorter time to SFT for infants born at 500‐749 g (p = 0.04) and those in the United States (p = 0.03). Feeding patterns varied widely among study sites (Fig. 1). A sensitivity analysis using a 5‐day consecutive time endpoint demonstrated an increase in the proportion of infants reaching SFT and reduced time to SFT (p = 0.02). There were no safety concerns as to the incidence of adverse events and no case of L. reuteri bacteremia.
Fig. 1. Median volumes of total, daily enteral feeds over time at each of the 95 NICUs treating up to 91 infants each.
Conclusions: Treatment with IBP‐9414 resulted in a numerical reduction of time to SFT with an extent that previously has been shown as clinically relevant. The large variability in feeding patterns across NICUs may have obscured treatment effects. Together with the lack of safety concerns, IBP‐9414 has a positive benefit: risk profile in promoting enteral feeding.
Contact e‐mail address: neuj@peds.ufl.edu
N‐OP020. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐OP020.1. VALIDATION OF SUBJECTIVE GLOBAL NUTRITIONAL ASSESSMENT (SGNA) IN PATIENTS WITH LIVER DISEASES IN CHILDREN: A HOSPITAL‐BASED STUDY
Piyush Upadhyay, Ankita Mishra
Division Of Pediatric Hepatology And Gastroenterology, Department Of Pediatrics, Dr RML Institute of Medical Sciences, North India, India
Objectives and Study: To do the criterion validation of Subjective Global Nutritional Assessment (SGNA) by comparison with a reference standard i.e. complete objective nutritional assessment (WHO guidelines) and to compare their prognostic value in paediatric patients with liver diseases admitted in the hospital.
Methods: This prospective observational study was conducted at a tertiary care hospital in Lucknow from April 2023 to March 2024. Newly admitted patients in the Department of Pediatric Hepatology and Gastroenterology who met the inclusion criteria and provided consent were enrolled prospectively. Nutritional status was assessed first using anthropometric measurements according to WHO standards, followed by SGNA. Correlations between SGNA and anthropometric parameters were evaluated using Kendall's tau correlation coefficient for ordinal data and Spearman's coefficient for continuous data. Agreement between SGNA and anthropometric measurements was assessed using the Kappa coefficient and ANOVA statistics. Survival analysis was performed with Kaplan‐Meier analysis.
Results: There is a significant association between the WHO classification of malnutrition and the SGNA score (Chi‐square = 43.704, p < 0.001), indicating that the two measures are strongly related. Most children classified as having "Moderate" or "Severe" malnutrition according to the WHO classification also had moderate or severe SGNA scores. Kappa value of 0.247 suggests a fair level of agreement between the WHO classification and the SGNA score. A significant association was found between the SGNA score and clinical outcomes (Chi‐square = 15.566, p < 0.001). A higher proportion of children with severe SGNA scores experienced poor outcomes (30.4%) compared to those with moderate (52.2%) and normal (17.4%) scores.
Conclusions: Compared to anthropometric measures, SGNA proves to be a more effective tool for nutritional assessment. It is not only reliable and comprehensive but also a better predictor of adverse outcomes in children with liver diseases.
Contact e‐mail address: Ankitamishra838@gmail.com
N‐OP021. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐OP021.1. MODULATION OF THE IMMUNE RESPONSE AND METABOLISM IN GERM‐FREE MICE BY BIFIDOBACTERIUM ANIMALIS SUBSP. LACTIS BB12 IN EARLY LIFE
Yuxing Zheng 1, Feitong Liu2, Lingling Zhao1, Yuanyuan Duan3
1China Research And Innovation Center, H&H Group, Guangzhou, China, 2H&H Group, H&H Research, China Research and Innovation Center, Guangzhou, China, 3The First Affiliated Hospital, Biomedical Translational Research Institute And Guangdong Province Key Laboratory Of Molecular Immunology And Antibody Engineering, Jinan University, Guangzhou, China
Objectives and Study: The establishment of the gut microbiota in early life plays a crucial role in immune development, germ‐free animal which possess inherent immune deficiencies, due to the lack of microbial stimulation. This study aims to using germ‐free mice to clarify the direct modulation effect of Bifidobacterium animalis subsp. lactis BB12 on host immune and gut metabolism in early life.
Methods: Germ‐free mice were gavaged with BB12 at 1×108 CFU/day starting from the second week of birth and continued until weaning at the fourth week. The proportion of T cells and B cells in spleen and intestinal intraepithelial lymphocytes were analyzed by flow cytometry. The activation and maturation of T cells and B cells in thymus and spleen were analyzed to evaluate the immune status of the mice. In addition, tryptophan metabolites were measured in colon feces to assess the effects of BB12 intervention on the production of intestinal metabolites.
Results: Early life administration of BB12 significantly increased the proportion of Treg cells in the spleen and the number of thymus B cells of germ‐free mice. The number of effector CD4+ T cells and central memory CD4+ T cells were significantly increased in the spleen after the intervention of BB12, which indicates that BB12 stimulated the activation of CD4+ T cells in the spleen. Central memory CD8+ T cells also notably increased, while naïve CD8+ T cells were significantly decreased in the spleen. It is worth noting that microbes derived metabolites such as indole‐3‐lactic acid (ILA) and indole‐3‐aldehyde (IAId) were greatly promoted in BB12 group, and the content of 5‐HTP and picolinic acid in feces also increased.
Conclusions: Early life BB12 administration can significantly affect the immune maturation of germ‐free mice and induced tryptophan metabolism to promote the production of ILA, IAId, 5‐HTP, picolinic acid, which may benefit immune mature in whole life.
Contact e‐mail address: cindy.zheng@hh.global
N‐OP022. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐OP022.1. IMPACT OF FOOD PORTION SIZE INTERVENTIONS ON ENERGY INTAKE AND RISK OF OBESITY IN PRESCHOOL CHILDREN; A SYSTEMATIC REVIEW
Sara Alfaraidi, Julie Lanigan, Natasha Schoeler, Atul Singhal
Faculty Of Population, Policy And Practice, University College London Great Ormond Street Institute of Child health, London, United Kingdom
Objectives and Study: The rise in childhood obesity over the past three decades has paralleled an increase in the portion sizes of food served to children. Presenting children with larger portions of energy‐dense foods tends to increase their overall energy intake ‐ a phenomenon known as the ‘portion size effect’. The UK Scientific Advisory Committee on Nutrition (SACN) recently reported that large portion sizes in children aged 1–5 years can contribute to excessive energy intake and weight gain. This review systematically evaluates the impact of interventions to optimise portion size on energy intake in preschool children.
Methods: A PICO framework was used to identify relevant studies from Embase (Ovid), Medline (Ovid), and the Cochrane Library. Eligible studies were published between 2000 and 2024, conducted in high‐ or middle‐income countries, and focused on preschool and early childhood including children aged 1–6 years. The interventions involved manipulation of portion size, expressed as grams, or as energy intake, per portion offered to children. Only studies with experimental and quasi‐experimental designs were included. The risk of bias was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. The protocol was registered in PROSPERO (CRD42024611774).
Results: Sixteen studies met the inclusion criteria, of which nine studies were conducted in laboratory settings, 5 in daycare centres, and 2 in kindergartens. Thirteen studies reported that larger portion sizes significantly increased food and/or energy intake; the increase in energy intake per meal ranged from 15 to 191 kcal. Three studies found no significant effects of portion size on energy intake.
Conclusions: Larger portion sizes increased energy intake in preschool children, highlighting portion size as a critical modifiable factor influencing dietary behaviours. Future studies that investigate portion size interventions in real‐life settings are needed to determine long‐term impacts for the prevention of obesity in young children.
Contact e‐mail address: sara.alfaraidi.22@ucl.ac.uk
N‐OP023. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐OP023.1. CORRELATIONS BETWEEN GUT MICROBIOTA AND NUTRIENT PROFILE IN CHILDREN WITH OBESITY UNDERGOING POLYSACCHARIDE MACROMOLECULE SUPPLEMENTATION AND MEDITERRANEAN DIET TREATMENT: RESULTS FROM THE POLYMETS STUDY
Giulia Fiore 1,2, Diego De Zan1, Asli Altayeva3, Simona Panelli3, Francesco Comandatore3, Valeria Calcaterra1,4, Martina Tosi1,5, Alessandra Bosetti1, Gian Vincenzo Zuccotti1,6, Elvira Verduci5,7
1Department Of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy, 2Department Of Health Sciences, University of Milan, Milano, Italy, 3Department Of Biomedical And Clinical Sciences, Pediatric Clinical Research Center "romeo And Enrica Invernizzi", University of Milan, Milan, Italy, 4Internal Medicine, Paediatric and Adolescent Unit, Pavia University, Pavia, Italy, 5Department Of Health Sciences, University of Milan, Milan, Italy, 6Department Of Biomedical And Clinical Science, University of Milan, Milan, Italy, 7Department Of Pediatrics, Unit Of Metabolic Disease, V. Buzzi Children's Hospital, Milan, Italy
Objectives and Study: Pediatric obesity is a global public health issue. We aim to determine the effects of polysaccharide macromolecules supplementation combined with dietary intervention on gut microbiota composition and its association with nutrient profile intakes in children and adolescents with obesity
Methods: In this intervention trial, children (8‐14 years) with obesity (defined as body mass index > +2 standard deviation score[SDS] according to World Health Organization) and cardio‐metabolic alterations (hypertriglyceridemia, hypertension, hypo‐HDL cholesterol, altered glucose metabolism) were enrolled. Participants received from baseline(T0) to 4 months(T1) combined polysaccharidic macromolecules supplementation(5 g/die of soluble and insoluble fibres) and Mediterranean diet intervention, from 4 to 8 months(T2) they underwent dietary intervention alone. At T0, T1 and T2 gut microbiota analysis, body composition assessment, blood tests and Mediterranean diet adherence(according to KIDMED) were assessed.
Results: Overall, 31 children were enrolled (age 10.4 ± 1.6 y). BMI SDS significantly decreased at each timepoint(p < 0.001), whilst fat mass% significantly decreased only at T1(p = 0.035), vs T0. KIDMED score increased significantly at T1 (p < 0.001) and remained stable at T2. At taxonomic level, the Principal Component Analysis show a trend of dispersion reduction of phyla abundance over time(Fig.1). The Firmicutes/Bacteroidetes ratio decreased from 0.62 at T0 to 0.41 at T1, followed by an increase to 0.55 at T2 after the discontinuation of the supplementation, although without significance. After supplementation, families Monoglobaceae, Erysipelatoclostridiaceae and genus Clostridia_UCG_014 were significantly reduced compared to baseline(Fig.2).The matrix correlation of dietary intakes and gut microbiota at baseline, showed a direct correlation between specific genus (eg. Ruminococcus spp.,Dialister spp.) and healthy food components (fibres,vegetable proteins,vitamins); whilst others genus are an hallmark of unhealthy nutrient profile(Fig.3).
Conclusions: Supplementation itself contributes to fat mass reduction as well as reduction of obesity‐associated bacterial families, and the observed changes did not persist after discontinuation of fibre supplement. Different clusters of nutrient intakes are associated with specific bacterial genera in children with obesity
Contact e‐mail address: giulia.fiore@unimi.it
N‐OP024. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐OP024.1. ASSOCIATION OF THREE DIFFERENT DIETARY PATTERNS WITH THE METABOLOMIC PROFILES OF CHILDREN: THE BIOMARKID PROJECT
Irina Gheorghita 1, Lara Vehovec2, Mariona Gispert‐Llauradó1, Natalia Ferre1, Berthold Koletzko3, Veit Grote3, Gabi Kastenmüller2, Klaus Kratochwill4, Elvira Verduci5, Dariusz Gruszfeld6, Joaquín Escribano1, Veronica Luque1
1Pediatric, Nutrition And Development Research Unit, Universitat Rovira i Virgili. IISPV, Reus, Spain, 2Helmholtz Zentrum München, München, Germany, 3Pediatrics, Dr. von Hauner Children's Hospital, LMU Universität Munich and German Center for Child and Adolescent Health, Munich, Germany, 4Medical University of Vienna, Vienna, Austria, 5Unit Of Metabolic Disease, Ospedale dei Bambini Vittore Buzzi, Milano, Italy, 6Neonatal And Nicu Department, Children's Memorial Health Institute, Warsaw, Poland
Objectives and Study: Three different dietary patterns (DP) were identified in the Childhood Obesity Project, named “CORE” foods (vegetables, fruits, fish, meat, olive oil), “Poor‐quality fats and sugars” (F&S) (soft cheese, butter, added sugars, juices) and “Protein sources” (PROT) (vegetables, flavoured milk, fish, white meat, processed meat, snacks). The aim was to identify individual metabolites and groups of metabolites associated with these dietary patterns.
Methods: Liquid chromatography‐mass spectrometry (LC/MS‐MS) was used to quantify 236 metabolites in blood samples of 424 children at ages 5 and 8 years. Linear mixed models were used to analyse the relationship between dietary patterns and individual metabolite levels, adjusting for sex, energy intake, body mass index, season and age, while including subject and country as random effects. Metabolites were grouped based on hierarchical clustering. Metabolite set enrichment analysis was performed to analyse the associations between DPs and groups of metabolites.
Results: We found 22, 18, and 11 metabolites associated with the CORE, PROT and F&S, respectively (p < 0.05) (Figure 1 A). CORE and F&S showed opposite directions in the enrichment analysis for several metabolite groups, while PROT did not follow a consistent pattern with either (Figure 1B). A group of phosphatidylcholines (PCs) with high abundance of saturated fatty acids (FA) was positively associated with the CORE foods DP. A group of polyunsaturated DHA‐containing FA (22:6) in the PC side chains and a group of long chain FA were positively associated with PROT. Both PROT and F&S were inversely associated with a group of short PCs. A group of urea cycle and pyruvate‐linked amino acids showed significant inverse associations with the CORE foods and a positive association with the F&S.
Conclusions: Both single metabolites and groups of metabolites could be used as predictors of adherence to dietary patterns in children.
Contact e‐mail address: pediatria@iispv.cat
N‐OP025. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐OP025.1. FROM CHILDHOOD ADVERSITY TO ADULT OBESITY, THE ROLE OF EARLY LIFE STRESS IN SHAPING FUTURE WEIGHT OUTCOMES
Niga Hama Rashid
DR.JAR pediatric teaching hospital, Sulaimanya, Iraq
Objectives and Study: From childhood adversity to adult obesity, the role of early life stress in shaping future weight outcomes Adverse childhood experiences(ACES)encompass a range of stressful or traumatic events, including abuse, neglect and household dysfunction, that occur during childhood, the aim of this study is to find how common is ACEs among adolescence and adults in Sulaimanyah Governorate, and to examine the prevalence of obesity among individuals with a history of ACEs
Methods: In this retrospective study (948)adolescents and adults, aged 18 years and older in Sulaimani Governorate were randomly selected and associations between 10 forms of adverse experiences during their childhood, and rate of obesity during their adolescent and adult life were examined. participants filled a regional copy of ACEs questionnaire which is originally produced by CDC and WHO. SPSS software package (version 22) was used for statistical analysis. Compare means analysis was used to find the correlation between the variables, the results were considered significant when P values were < 0.05. height and weight of the cases were taken, and BMI was calculated for them, According to WHO classification of BMI, cases of BMI ≥ 30 were considered obese in our research.
Results: The results indicated that 59.4% of the participants reported at least one of the 10 categories of ACEs, and around 26% experienced > 4. The most common adverse childhood experiences reported were physical abuse, emotional abuse, psychological neglect, physical neglect and domestic violence. the results shows that there was a relatively strong graded relationship between number of adverse childhood experiences and obesity (p value 0.003)
Conclusions: This study provides evidence that child abuse, neglect and household dysfunction is common, and there is a clear association between them and obesity prevention and treatment of child abuse is recommended to decrease occurrence of some behaviors that may lead to health problems in future.
Contact e‐mail address: nigashafiq1988@gmail.com
N‐OP026. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐OP026.1. ASSOCIATION BETWEEN FOOD PORTION SIZE DURING COMPLEMENTARY FEEDING AND OBESITY RISK AT 2, 8 AND 11 YEARS
Irene Hernández Pérez 1, Veronica Luque1, Joaquín Escribano1, Mariona Gispert‐Llauradó1, Mireia Alcázar1, Berthold Koletzko2, Veit Grote2, Elvira Verduci3, Dariusz Gruszfeld4, Annick Xhonneux5
1Pediatric, Nutrition And Development Research Unit, Universitat Rovira i Virgili. IISPV, Reus, Spain, 2Pediatrics, Dr. von Hauner Children's Hospital, LMU Universität Munich and German Center for Child and Adolescent Health, Munich, Germany, 3Unit Of Metabolic Disease, Ospedale dei Bambini Vittore Buzzi, Milano, Italy, 4Neonatal And Nicu Department, Children's Memorial Health Institute, Warsaw, Poland, 5Groupe Santé CHC, Liege, Belgium
Objectives and Study: Early life dietary choices predict later obesity risk, but the effect of other factors such as portion size consumption during complementary feeding is unknown. Our aim was to describe the consumed portion sizes during complementary feeding and its association with overweight and obesity risk at 2, 8 or 11 years.
Methods: Observational prospective study in 5 European countries embedded into the European Childhood Obesity trial (during which effects of milk protein supply in infancy on later obesity risk was tested). Three‐day food diaries were collected at ages 6, 12, 18 and 24 months, and internal‐for‐age portion size z‐scores were calculated for 33 food groups. Of all groups together a final mean z‐score per child was calculated. Children were classified as either normal weight or overweight/obesity. Student's t‐tests and Mixed effects logistic regression model adjusted for breastfeeding and the original intervention, including country as random effects, were performed.
Results: Figure 1 shows the effect of food portion size during complementary feeding on long‐term weight status (11 years). Food portions at 18 months were significantly higher in children with obesity at 2, 8 and 11 years (p = 0.034, p = 0.003 and p = 0.037 respectively). The adjusted mixed models revealed for all time points a trend for a positive association of average portion sizes during complementary feeding on later obesity risk; portion size at 18 months was significantly associated with overweight/obesity at 2 years (OR = 2.5 [1.0‐6.1], p = 0.043) and showed borderline association with overweight and obesity at 8 years (OR = 1.7 [0.99‐2.9], p = 0.052).
Figure 1. Portion size during complementary feeding and Body Mass Index category at 11 years.
Conclusions: Portion size at 18 months was associated to overweight/obesity risk at 2 years and showed a trend to increased risk at 8 years. The possible effect of portion sizes during complementary feeding and long‐term obesity risk deserves further attention.
Contact e‐mail address: irene.hernandez@urv.cat
N‐OP027. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐OP027.1. PROTEIN‐RICH FOODS DURING COMPLEMENTARY FEEDING INFLUENCE THE OCCURRENCE OF RAPID WEIGHT GAIN IN INFANTS: A RANDOMIZED CONTROLLED FEEDING TRIAL [THE MINT STUDY]
Kinzie Matzeller 1,2, Mikayla Hernandez2, Gabrielle Glime2, Claudia Schaefer2, Audrey Hendricks2, Daniel Frank2, Edward Melanson2, Nancy Krebs2, Minghua Tang1,2
1Dept Of Food Science And Human Nutrition, Colorado State University, Fort Collins, CO, United States of America, 2Pediatric Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
Objectives and Study: Examine the impact of different protein‐rich foods on the occurrence of rapid weight gain (RWG) in infants during complementary feeding.
Methods: This analysis included a subgroup of 185 healthy, 5‐month‐old full‐term infants from a larger ongoing randomized controlled trial in Denver, CO, USA. Participants were recruited and block‐randomized to one of four arms: meat, dairy, plant, or ad lib, with blocks defined by mode of feeding, infant sex, and delivery mode. Dietary intake data and anthropometrics were collected by researchers at 5 and 12 months; z‐scores were calculated using WHO growth standards. Using the most common metric, RWG was defined as an increase in weight‐for‐length z‐score (WLZ) > 0.67. Primary caregivers completed weighed diet records to quantify intake of formula, solid foods, and breastmilk via test weighing. Records were analyzed using the Nutrition Data System for Research (University of Minnesota). Differences in RWG between diet groups were analyzed using chi‐squared and post‐hoc tests. For each time point, one‐way ANOVA compared dietary intake data and mean anthropometric z‐scores. Bonferroni correction was completed to account for multiple testing (dietary intake p < 0.01, anthropometrics p < 0.008).
Results: At both timepoints, no significant differences among groups for weight, length, or head circumference z‐scores, including WLZ, were detected. However, RWG rates differed significantly between groups (p = 0.006); dairy (16%) and meat groups (20%) had significantly lower rates of RWG than plant (28%) and ad lib (46%). Total energy intake, calories/kg, and macronutrients (g/day) did not differ significantly between diet groups at either time point.
Conclusions: In this analysis, we did not detect statistically significant differences in energy intake or average growth z‐scores by intervention group. However, occurrence of RWG was significantly different, which may be driven by differences in linear growth versus weight gain between groups. These results suggest that protein‐rich foods during complementary feeding, independent of energy intake, may have a critical on impact growth patterns, including RWG.
Contact e‐mail address: kinzie.matzeller@colostate.edu
N‐OP028. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐OP028.1. ASSOCIATIONS OF INSULIN‐LIKE GROWTH FACTOR‐1 (IGF‐1), BINDING PROTEINS IGFBP‐2 AND IGFBP‐3 WITH THE LIPID PROFILE IN TODDLERS AT AGE 12 AND 24 MONTHS
Johanna Neiß 1,2, Fabian Geyer1,2, Alexander Triebswetter1,2, Dudung Angkasa1,2, Joaquín Escribano3, Mariona Gispert‐Llauradó3, Natalia Ferre3, Berthold Koletzko1,2, Veit Grote1,2
1Pediatrics, Dr. von Hauner Children's Hospital, LMU Universität Munich, Munich, Germany, 2German Center for Child and Adolescent Health, Munich, Germany, 3Pediatric, Nutrition And Development Research Unit, Universitat Rovira i Virgili. IISPV, Reus, Spain
Objectives and Study: The Insulin‐like growth factor axis is postulated to influence adipocyte activity and lipolysis in early life. Our aim was to investigate whether Insulin‐like growth factor 1 (IGF‐1) and Insulin‐like growth factor binding proteins (IGFBP‐2 and IGFBP‐3), are associated with the lipid profile of healthy toddlers.
Methods: This is a secondary analysis of data from the randomized double‐blind Toddler Milk Intervention (ToMI) trial conducted in Germany and Spain during the second year of life. At 12 months 1624 healthy, term born toddlers were randomized to receive either a regular or a reduced protein content young child milk formula. Blood was drawn at 12 and 24 months from 828 and 736 toddlers, respectively, with 444 children at both timepoints. Blood concentrations of IGF‐1, IGFBP‐2, IGFBP‐3, low‐ and high‐density lipoprotein cholesterol (LDL‐C, HDL‐C), total cholesterol (TC) and triglycerides (TG) were measured. Mixed linear models were applied to examine the associations between the IGF‐1 axis and the lipid profile, combining the data from the 12‐ and 24‐months visits, adjusted for sex, fasting time, country, and body mass index.
Results:
Fifty‐four percent of the blood samples were from Spain; BMI was on average 17.1 ± 1.4 kg/m2 at 12 months. About 50% of all samples were fasted > 6 hours. Toddlers had significantly higher IGF‐1 (mean (M) 74.9 ng/ml), LDL‐C (M:80.5 mg/dl), HDL‐C (M:42.3 mg/dl), and TC (M:141.7 mg/dl) values at 24 months compared with 12 months, while IGFBP‐2 (M:575.5 ng/ml) and IGFBP‐3 (M:2630.3 ng/ml), and TG (M:101.2 mg/dl) parameters were significantly lower at 24 months. IGF‐1 and IGFBP‐3 were significantly positively associated, whereas IGFBP‐2 was significantly negatively associated with LDL‐C, HDL‐C and TC.
Conclusions: The insulin‐like growth factor axis has been shown to be associated with serum lipoprotein levels which suggests it may play a role in the development of dyslipidemia in toddlers. However, associations were weak.
Contact e‐mail address:
N‐OP029. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐OP029.1. A MOTHER‐NEWBORN‐OFFSPRING STUDY IN AN AREA OF MILD‐TO‐MODERATE IODINE DEFICIENCY TO PREDICT CHILDHOOD OBESITY RISK USING MACHINE LEARNING
Yaniv Ovadia 1, Natalya Bilenko2,3, Naama Fisch‐Shvalb4,5, Orit Mazza6, Shani Rosen7, Eyal Anteby1,3, Simon Shenhav1,3
1Obstetrics And Gynecology Division, Barzilai University Medical Center Ashkelon, Ashkelon, Israel, 2Medical Office Of Southern District, Ministry of Health, Ashkelon, Israel, 3Ben‐Gurion University of Negev, Beersheba, Israel, 4The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, 5Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 6Loewenstein Rehabilitation Medical Center, Ra'anana, Israel, 7School Of Nutritional Science, Institute of Biochemistry, Food Science and Nutrition; Robert H. Smith Faculty of Agriculture, Food and Environment; The Hebrew University of Jerusalem, Rehovot, Israel
Objectives and Study: Childhood obesity (CO) and iodine deficiency (ID) are prevalent in Europe and Israel. There is evidence that CO is associated with adverse health outcomes in adulthood. Recent study suggested that maternal mild‐to‐moderate ID may increase the risk of large‐for‐gestational (LGA) newborns. Although LGA has been shown to influence CO, it remains difficult to predict CO during pregnancy. Therefore, we sought to predict risk for CO development from anthropometrics, thyroid function tests, iodine status, and iodine intake related parameters of pregnant mothers with mild‐to‐moderate ID.
Methods: A diagnostic accuracy study was conducted using 87 parameters from a mother‐newborn‐child prospective cohort (N = 191). Maternal iodine status and thyroid functions were measured during the second half of pregnancy, including serum thyroglobulin (Tg). A semi‐quantitative iodine food frequency questionnaire was used to assess maternal iodine intake. For anthropometrics, pregnant women were measured in late pregnancy, newborns were measured at birth, and offspring were measured at two years old (a gender‐adjusted weight percentile over 85% was considered overweight). Using Synthetic Minority Oversampling Technique (SMOTE), five synthetic mother‐newborn‐offspring datasets were created to compare the performance of six machine learning algorithms (Extreme Gradient Boosting, Artificial Neural Networks, Random Forests, Decision Trees, Penalized Logistic Regression and Support Vector Machines) in predicting overweight offspring.
Results: The highest performance in predicting offspring overweight was achieved by a decision tree after SMOTE implantation with a 7‐fold increase in sample size (1400 instances with a balanced predicted outcome). Accuracy, Kappa, and F‐score were 0.74, 0.25 and 0.41, respectively. Parameters included anthropometrics (height), thyroid‐related (Tg), demographics (education classification, religion and age) and nutritionals (yellow cheese consumption and estimated iodine intake).
Conclusions: Offspring overweight (an indicator of CO) can be predicted using ML in pregnant mothers with mild‐to‐moderate ID. If validated, these findings may lead to treatments that reduce CO incidence.
Contact e‐mail address: yaniv.ovadia@mail.huji.ac.il
N‐OP030. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐OP030.1. POLY‐ AND PERFLUOROALKYL SUBSTANCES (PFAS) IN THE FIRST 1000 DAYS REDUCE LINEAR GROWTH, LEAN BODY MASS AND BONE MINERAL DENSITY AT AGE 3 YEARS
Inge Van Beijsterveldt 1, Demi Dorrepaal1, Bertrand Van Zelst2, Sjoerd Van Den Berg2, Anita Hokken‐Koelega1
1Pediatrics, Erasmus Medical Center ‐ Sophia Children's hospital, Rotterdam, Netherlands, 2Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
Objectives and Study: PFAS are non‐degradable ‘Endocrine Disrupting Chemicals’ and are thought to have adverse effects on several (neuro)developmental outcomes in children. Especially when exposure occurs during susceptible periods, such as early life. During the ‘first 1000 days’ exclusively breastfed (EBF) infants persistently have 3‐times higher plasma PFAS levels compared to those exclusively formula‐fed (EFF). We assessed the associations between early life plasma PFAS levels, growth and body composition at age 3 years and examined whether PFAS exposure through human milk may diminish the known health benefits of breastfeeding.
Methods: In 237 healthy term‐born infants (99 EBF, 57 EFF and 81 mix), included in Sophia Pluto birth cohort, we determined anthropometrics, blood pressure and body composition including bone mineral density (BMD) by Dual‐energy‐X‐ray‐Absorptiometry (DXA) at age 3 years. PFAS levels during the ‘first 1000 days’ were determined by liquid‐chromatography‐electrospray‐ionization‐tandem‐mass‐spectrometry (LC‐ESI‐MS/MS) in blood collected at 3 months and 2 years. We studied the associations between PFAS levels and outcomes using multiple regression models.
Results: Higher PFAS levels at age 3 months and 2 years were associated with less linear growth from birth‐3 years (B: ‐0.068, p = 0.004 and B:‐0.105, p < 0.001) and with lower height SDS (B: ‐0.063, p = 0.010 and B:‐0.099,p < 0.001) at age 3 years. Additionally, PFAS levels at age 2 years were negatively associated with lean body mass (LBM) SDS and BMD SDS at age 3 years (B: ‐0.064, p = 0.003 and B:‐0.075, p = 0.018, respectively). In contrast, exclusive breastfeeding for at least 3 months was positively associated with the same outcomes (B: 0.204, p = 0.010 and B: 0.274, p = 0.019, respectively).
Conclusions: Higher plasma PFAS levels in ‘the first 1000 days’ were negatively associated with linear growth, LBM and BMD SDS at age 3 years, while EBF for at least 3 months was positively associated with these outcomes. This suggests that PFAS could jeopardize breastfeeding's health benefits, which warrants further research.
Contact e‐mail address: i.vanbeijsterveldt@erasmusmc.nl
N‐OP031. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐OP031.1. IMPACT OF GLP‐1 RAS ON MENTAL HEALTH IN PEDIATRIC PATIENTS WITH OBESITY AND MASLD: A POPULATION‐BASED STUDY
Arleen Delgado1, Saman Aryal1, Luis Nieto2, Thomas Wallach 3
1Woodhull Medical and Mental Health Center ‐ ‐ Brooklyn, NY, Brooklyn, United States of America, 2Adult Gastroenterology, Emory University School of Medicine, Atlanta, United States of America, 3Pediatric Gastroenterology, SUNY Downstate Health Sciences University, Brooklyn, United States of America
Objectives and Study: This study aims to determine the neuropsychiatric benefits of GLP‐1 receptor agonists (GLP‐1 RAs) in pediatric patients with obesity and metabolic dysfunction‐associated steatotic liver disease (MASLD).
Methods: We conducted a retrospective cohort study using data from the TriNetX platform, including 206,418 patients aged 12–21 with obesity and a MASLD diagnosis between January 2014 and 2024. The study examined the impact of GLP‐1 RAs (Semaglutide, Liraglutide, Dulaglutide, Tirzepatide, and Exenatide) on the odds of developing new mental health disorders. Logistic regression was used to calculate odds ratios (ORs) in raw and propensity score‐matched cohorts, with statistical significance set at p < 0.05.
Results: The GLP‐1 RAs group had lower ORs for depression (OR: 0.70, 95% CI: 0.52–0.94, p < 0.01), nicotine (OR: 0.61, 95% CI: 0.39–0.95, p = 0.029) and vaping use (OR: 0.58, 95% CI: 0.37–0.91, p < 0.01). For suicidal ideations, the GLP‐1 RAs group had lower odds (OR: 0.54, 95% CI: 0.29–1.00), nearing statistical significance (p = 0.047). Similarly, reduced odds were observed for drug (OR: 0.66, 95% CI: 0.35–1.24) and alcohol use (OR: 0.52, 95% CI: 0.24–1.12), though no statistical significance (p = 0.198 and p = 0.091, respectively). No differences were observed in anxiety (OR: 0.78, 95% CI: 0.57–1.06, p = 0.12), attention‐deficit/hyperactivity disorder (ADHD) (OR: 0.98, 95% CI: 0.40–2.36, p = 0.964), conduct (OR: 0.99, 95% CI: 0.41–2.38, p = 0.984) and in the eating disorder (OR: 1.10, 95% CI: 0.51–2.35, p = 0.799). Comprehensive outcomes after propensity score matching are detailed in Table 1.
Conclusions: GLP‐1 RAs may offer mental health benefits in patients with obesity and MASLD, mainly by reducing the odds of depression, nicotine dependence, and vaping; this could be attributed to overlapping pathways involved in addiction and impulsivity, that can be attributed to antioxidative and anti‐inflammatory properties. Additional research is necessary.
Contact e‐mail address: arleendelgadomd@gmail.com
N‐OP032. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐OP032.1. LIVER HEALTH OF CHILDREN WITH INTESTINAL FAILURE IN THE COMPOSITE LIPID EMULSION ERA
Ugo Cucinotta 1, Maud Prevot2, Angela Alibrandi3, Elise Payen4, Cécile Talbotec4, Florence Lacaille1, Cécile Lambe4
1Hepatology Unit, Pediatric Hospital Necker Enfants malades, Paris, France, 2Hopital Necker enfants malades, Paris, France, 3Economics, University of Messina, Messina, Italy, 4Gastroenterology And Nutrition Unit, Pediatric Hospital Necker Enfants malades, Paris, France
Objectives and Study: The introduction of mixed oil lipid emulsions (SMOFlipid®) has decreased the prevalence of intestinal failure‐associated liver disease (IFALD) but long‐term outcomes in children are scarce. Our aim was to describe the liver profile of children receiving this lipid emulsion, and to identify factors associated with the development of liver disease.
Methods: All children followed at the Necker Hospital, Paris, for intestinal failure (IF) up to September 2022, who had received ≥ 2 years of parenteral nutrition (PN) including SMOFlipid®, were included. Patients were classified in 3 groups based on their biochemical profile at last visit (for patients still on PN), or at the time of PN weaning, or before death or intestinal transplantation: normal liver tests (group 1); isolated increase in transaminases (group 2); increased conjugated bilirubin regardless of GGT and/or transaminases (group 3). Independent predictors of liver disease were analyzed by multivariate logistic regression.
Results: We included 234 children, mean age of 12 years, and mean PN duration of 8.6 years. At last visit, 82 (35%) children were weaned from PN, 18 (8%) had received an intestinal transplantation, and 12 (5%) had died. Most patients (63%) had normal liver tests, 58 (25%) isolated increase of transaminases, and 29 (12%) had increased conjugated bilirubin (group 3). Compared to group 1 and 2, children with increased bilirubin had higher PN‐dependency (p < 0.001), higher lipids intake (p = 0.007), lower oral feeding (p < 0.001), more histological fibrosis (p = 0.004) and higher ferritin levels (p < 0.001). Children in the group 3 also underwent more frequently intestinal transplantation (p < 0.001) and death (p < 0.001). Logistic regression analysis did not show any predictive factor of increased bilirubin.
Conclusions: Children with IF receiving long‐term PN and SMOFlipid® still present liver complications, particularly those with greater PN dependency and reduced oral feeding. Increased bilirubin is associated with higher rates of transplantation and death, although no independent predictors of cholestasis were found.
Contact e‐mail address: ugo.cucinotta@aphp.fr
N‐OP033. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐OP033.1. D‐LACTATE IN PEDIATRIC PATIENTS ON ENTERAL AND LONG‐TERM PARENTERAL NUTRITION
Rita Halasova, Jan Melek, Rana Ibrahim, Stanislava Rosinska, Alena Ticha, Radomir Hyspler, Radek Stichhauer
Department Of Pediatrics, University hospital Hradec Kralove, Hradec Kralove, Czech Republic
Objectives and Study: D‐lactate is the minor enantiomer of the two stereoisomers of lactate in humans. Intestinal microbiota stands as one of the most significant sources in production of D‐lactate in certain conditions such as short bowel syndrome (SBS). It was recently discovered that humans also possess the enzyme D‐lactate dehydrogenase, which metabolizes D‐lactate. The primary goal of the study was to compare serum and urinary D‐lactate levels among 4 groups of patients: long‐term parenteral nutrition, after intestinal adaptation from SBS, enteral nutrition, and healthy children on a normal diet. For selected patients with elevated D‐lactate levels, a genetic sub analysis was conducted to identify any pathogenic variants in the LDHD enzyme.
Methods: A retrospective and prospective observational study including 129 pediatric patients was conducted. The cohort includes patients on home parenteral nutrition (PN, N = 22), with bowel adaptation after SBS (POST, N = 27), patients on enteral nutrition administered through a PEG tube (PEG, N = 13), patients on standard diet with other underlying gastrointestinal disease (nonPEG, N = 14), and healthy controls (C, N = 53). D‐lactate was measured by an established enzymatic assay combined with spectrophotometry.
Results: Serum D‐lactate level was significantly higher in the POST group, with a median of 40 µmol/l (IQR: 29‐70) compared to healthy controls (C group) at 29 µmol/l (IQR: 25‐35) (p = 0,0007). Similarly, the urine D‐lactate level was elevated in the POST group 595 µmol/l (IQR: 547‐955) versus the C group 410 µmol/l (IQR: 199‐724) (p = 0,0158). Comparisons among the other groups did not yield statistical significance. No pathogenic variants of the LDHD enzyme were found among patients with elevated D‐lactate.
Conclusions: Pediatric patients with bowel adaptation after SBS have higher serum and urine D‐lactate levels compared to healthy controls. According to our data, we established the physiological values of D‐lactate for healthy children as 29 µmol/l (IQR: 25‐35) in serum and 409 µmol/l in urine (IQR: 199‐724).
Contact e‐mail address: ritahalasova@gmail.com
N‐OP034. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐OP034.1. PROPHYLACTIC ANTICOAGULATION IN CHILDREN RECEIVING HOME PARENTERAL NUTRITION: AN INTERNATIONAL PROSPECTIVE MULTICENTER STUDY
Aysenur Demirok1, Sjoerd Nagelkerke1, Samantha Gouw2, Barbara De Koning3, Heleen Van Ommen4, Rozemarijn Duister5, Marc Benninga1, Cécile Lambe6, Merit Tabbers 1
1Department Of Pediatrics, Division Of Gastroenterology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands, 2Department Of Pediatrics, Division Of Hematology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands, 3Department Of Pediatrics, Division Of Gastroenterology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, Netherlands, 4Department Of Pediatric Hematology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, Netherlands, 5Pediatric Gastroenterology, Erasmus MC, Rotterdam, Netherlands, 6Service De Gastro‐entérologie Et Nutrition Pédiatrique, AP‐HP. Centre‐ Université Paris Cité, Hôpital Necker‐Enfants Malades, Paris, France, Paris, France
Objectives and Study: Catheter‐related thrombosis (CRT) is a serious complication associated with home parenteral nutrition (HPN) in children with chronic intestinal failure (CIF). Guidelines on pediatric HPN state that there is insufficient evidence to advocate prophylactic anticoagulation (PA) use. Aim is to evaluate the efficacy and safety of PA in preventing CRT in children on HPN.
Methods: We performed a retrospective, international, multicenter study across three expertise centers. Children aged 0‐18 years on HPN were included and divided into two groups: primary/secondary prophylaxis‐ and non‐prophylaxis group. Participants were followed for 24 months and screened for CRT using ultrasonography annually. Primary outcomes included total incidence of CRT per 1000 catheter days, and association between PA and CRT. Secondary outcomes included incidence of catheter‐related bloodstream infections (CRBSI), correlation between CRT and CRBSI, and bleeding events per 1000 catheter days.
Results: A total of 115 children, mean age of 6,9 years (SD 4,6), were included. Fifty‐seven patients were receiving PA (50%). The overall incidence of CRT was 0.17 per 1000 catheter days in 13 patients (11%), with no significant difference between the prophylaxis (n = 7) and non‐prophylaxis group (n = 6) (odds ratio 0.89, 95% CI: 0.28–2.84, p = 0.847). Incidence rate of CRBSIs was 0.34/1000 catheter days (n = 25). Patients with CRT during follow up were significantly more likely to have a CRBSI (54%) compared to those without (14%) (p = 0.010). Two minor bleeding events were reported in the prophylaxis group, resulting in an incidence of 0,03/1000 catheter days.
Conclusions: Our study shows that PA does not significantly reduce the incidence of CRT in children on HPN. Our results underline the importance of catheter care and infection prevention, and emphasize the need for larger multicenter trials to establish evidence‐based recommendations for the use of prophylactic anticoagulation in children on HPN.
Contact e‐mail address:
N‐OP035. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐OP035.1. EFFECTIVENESS OF A MOTIVATIONAL INTERVENTION TO IMPROVE GUT MICROBIOTA DIVERSITY IN CHILDREN WITH OBESITY: A RANDOMIZED CLUSTERED OPEN‐LABEL INTERVENTION TRIAL
Mireia Alcázar 1, Joaquín Escribano1,2, Natalia Ferre1, Mariona Gispert‐Llauradó1, Judit Muñoz‐Hernando1, Carme Rubio‐Torrents1, Gemma Castillejo1,3, Albert Feliu1,2, Veronica Luque1
1Pediatric, Nutrition And Development Research Unit, Universitat Rovira i Virgili. IISPV, Reus, Spain, 2Pediatrics, University Hospital Sant Joan Reus, Reus, Spain, 3Paediatric Gastroenterology, Hospital Universitario Sant Joan, Reus, Spain
Objectives and Study: Gut microbiota diversity is associated with better metabolic health. This study aimed to evaluate whether the OBEMAT2.0 intervention (motivational interview) was more effective than regular treatment for childhood obesity in increasing microbiota diversity.
Methods: Obemat2.0 was a randomised clustered trial conducted in primary care centres from Tarragona, Spain (June 2016‐June 2019). Paediatrician‐nurse pairs were randomized to either continue their regular practice (control) or receive 12 hours of training in motivational interviewing. Children with obesity, aged 8–14 years, were invited by their regular practitioners to participate. Both patients’ groups attended up to 11 treatment visits in primary care over one year and completed baseline and final assessments at the hospitals, where faecal samples were collected. Gut microbiota was sequenced using 16S rRNA, and improvements in microbiota diversity (Simpson and Shannon indices) over the treatment period were compared between groups.
Results: Out of 303 allocated children, 72 (n = 39 intervention group) provided faecal samples at both baseline and final visits and completed at least one treatment visit. The intervention group showed a significant improvement in both the Shannon and Simpson indices (Figures 1 A & 1B) compared to the control group. The motivational intervention had a significantly higher impact on gut microbiota diversity compared to regular practice in both Shannon (median of the difference = 0.08[‐0.15;0.28] and ‐0.07[‐0.33;0.06], respectively; p = 0.039) and Simpson indices (median of the difference= 0.01[‐0.01;0.03] and 0.00[‐0.02‐0.01], respectively; p = 0.034) (Figures 1 C & 1D).
Conclusions: Our results suggest that the motivational intervention of Obemat2.0 was effective at improving gut microbiota diversity, likely due to a higher adherence to dietary and physical activity recommendations.
Contact e‐mail address: mireia.alcazar@urv.cat
N‐OP036. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐OP036.1. RELATIONSHIP OF EARLY INTESTINAL COLONIZATION AND PERINATAL FACTORS ON BEHAVIOURAL PROFILES IN A LONGITUDINAL COHORT OF CHILDREN
Maria Carmen Collado 1, Miriam García‐Fernández2, Marta Selma‐Royo1,3, Anna Samarra1, Raquel Pérez‐Suárez2, Caterina Calderon4, Cecilia Martínez‐Costa2
1Institute of Agrochemistry and Food Technology‐National Research Council, Paterna, Spain, 2Department Of Pediatrics, University of Valencia, Valencia, Spain, 3BCNatal, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)‐ Fundació Clínica per la Recerca Biomèdica, Barcelona, Spain, 4Department Of Clinical Psychology And Psychobiology, University of Barcelona, Barcelona, Spain
Objectives and Study: Early intestinal colonization coincides with a crucial period of neuronal plasticity. Our objective was to correlate this process with subsequent behavioural profiles in a longitudinal cohort.
Methods: Children (n = 107) from a longitudinal birth cohort (MAMI‐plus) were followed up to six years of age. Behavioural assessment at 6 years was conducted using two specific neuropsychologist‐reviewed questionnaires: BASC‐3, which provides a multidimensional assessment of emotional‐cognitive‐executive aspects to analyse adaptive and non‐adaptive behaviour; and BRIEF‐2, which evaluate executive function. The gut microbial profile was analysed in early faecal samples (at 7 days, 1, 6 and 12 months) by 16S rRNA amplicon sequencing. Clinical and dietary records were available, as well as anthropometric and sociodemographic characteristics.
Results: The population was mostly healthy, with normal nutritional status. BASC‐3 and BRIEF‐2 revealed: externalizing (20%) and internalizing (16%) problems, social (16%) and adaptative (7%) skills limitations, and executive skills difficulties (17%). Males predominated in social (p = 0.009) and adaptative (p = 0.044) difficulties profiles. Having pets at 6 years was negatively associated with social and executive limitations (p = 0.014 and p = 0.043, respectively) and children with executive difficulties spent less time in after‐school sport activities (p = 0.013). Internalizing problems and social limitations had lower incidence among children born vaginally (p = 0.024). Breastfeeding duration was shorter in children with adaptative (p = 0.027) and internalizing (p = 0.011) problems. Children with externalizing problems had higher relative abundances of Clostridium spp. and Klebsiella spp. at 6 months of age (p = 0.04 and p = 0.05, respectively), while those with internalizing problems were highly colonized with Enterococcus spp. at 7 days of age (p = 0.04) and Clostridium spp. at 1 year of age (p = 0.01). Enterococcus genus showed higher relative abundance in children with adaptative difficulties (1 year of age; p = 0.01).
Conclusions: Our findings underline the relevance to investigate the complex connections between early intestinal colonization, perinatal factors, and neurodevelopment during infancy.
Contact e‐mail address: mcolam@iata.csic.es
N‐OP037. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐OP037.1. FECAL MICROBIOTA PROFILING AS AN EARLY NONINVASIVE PREDICTIVE BIOMARKER FOR GRAM‐NEGATIVE LATE‐ONSET SEPSIS IN PRETERM INFANTS: A LONGITUDINAL CASE‐CONTROL MICROBIOME STUDY
Rimke De Kroon 1,2, Aranka Van Wesemael1,2, Nina Frerichs1,2, Veerle Cossey3, Chris Van Den Akker1,2,4, Willem De Boode5, Christian Hulzebos6, Daniel Vijlbrief7, Esther D'Haens8, Marlou Raets9, Johannes Van Goudoever10, Wouter De Jonge11, Andries Budding12, Hendrik Niemarkt13,14, Tim De Meij1,2,15
1Amsterdam Reproduction And Development Research Institute, Amsterdam UMC, Amsterdam, Netherlands, 2Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands, 3Neonatal Intensive Care Unit, UZ Leuven, Leuven, Belgium, 4Neonatal Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands, 5Neonatal Intensive Care Unit, Amalia Children's Hospital, Radboud UMC, Nijmegen, Netherlands, 6Neonatal Intensive Care Unit, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, Netherlands, 7Neonatal Intensive Care Unit, Wilhemina Children's Hospital, UMC Utrecht, Utrecht, Netherlands, 8Neonatal Intensive Care Unit, Amalia Children's Center, Isala, Zwolle, Netherlands, 9Neonatal Intensive Care Unit, MosaKids Children's Hospital, Maastricht University Medical Centre, Maastricht, Netherlands, 10Department Of Pediatrics, Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands, 11Tytgat Institute For Liver And Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands, 12inbiome BV, Amsterdam, Netherlands, 13Neonatal Intensive Care Unit, Máxima Medical Centre, Veldhoven, Netherlands, 14Department of electrical engineering, Technical University Eindhoven, Eindhoven, Netherlands, 15Department Of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands
Objectives and Study: Late‐onset sepsis (LOS) by Gram‐negative pathogens is an important cause of morbidity and mortality in preterm infants. Increasing evidence suggests that Gram‐negative pathogens may originate from the gut. We aimed to assess the potential of fecal microbiota profiling as a predictive biomarker for Gram‐negative LOS.
Methods: Preterm infants born between 24‐30 weeks of gestation in one of nine neonatal intensive care units in the Netherlands and Belgium with blood culture‐proven LOS were included. Daily fecal samples collected within five days preceding clinical onset of LOS were analyzed by IS‐PRO. This untargeted microbiota detection technique is capable of generating absolute and relative abundances (RA) on species level within six hours following sampling. Cases were 1:3 matched to controls based on gestational and postnatal age.
Results: 532 fecal samples of 58 LOS cases and 174 controls were retrospectively analyzed. Compared to controls, the RA of the causative pathogen was significantly higher in LOS cases with Escherichia coli (n = 11 cases, p < 0.001), Serratia marcescens (n = 6 cases, p = 0.009), and Klebsiella spp. (n = 5 cases, p = 0.005), in the five days prior to LOS. Using an optimal cut‐off value based on E. coli RA, E. coli cases could successfully be discriminated from controls (AUC 0.90, sensitivity 100%, specificity 81%, p < 0.001). The optimal cut‐off value for Klebsiella spp. RA discriminated Klebsiella spp. cases from controls (0.77, 77%, 78%, p = 0.001), while the optimal cut‐off value for Serratia spp. RA discriminated S. marcescens cases (0.94, 92%, 97%, p < 0.001).
Conclusions: Our findings reveal significant preclinical intestinal microbial alterations up to five days prior to Gram‐negative LOS, characterized by an increased abundance of the causative pathogen. These results strongly support the potential of fecal microbiota profiling as a noninvasive predictive biomarker for Gram‐negative LOS. This approach potentially offers clinicians a critical window for targeted microbiota‐based interventions, which could improve health outcomes and reduce unnecessary antibiotic treatments.
Contact e‐mail address: r.r.dekroon@amsterdamumc.nl
N‐OP038. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐OP038.1. EFFECTS OF DIETARY INTERVENTIONS ON GUT MICROBIOTA AND RELATED CARDIOMETABOLIC CHANGES IN CHILDREN AND ADOLESCENTS WITH OVERWEIGHT OR OBESITY: A METANALYSES OF INTERVENTION TRIALS
Giulia Fiore 1,2, Mireia Alcázar3, Irene Hernández Pérez4, Judit Muñoz‐Hernando4, Emma Perucho4, Natalia Ferre4, Joaquín Escribano4, Gian Vincenzo Zuccotti1,5, Elvira Verduci2,6, Veronica Luque4
1Department Of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy, 2Department Of Health Sciences, University of Milan, Milano, Italy, 3Pediatric, Nutrition And Development Research Unit, Universitat Rovira i Virgili, Reus, Spain, 4Pediatric, Nutrition And Development Research Unit, Universitat Rovira i Virgili. IISPV, Reus, Spain, 5Department Of Biomedical And Clinical Science, University of Milan, Milan, Italy, 6Department Of Pediatrics, Unit Of Metabolic Disease, V. Buzzi Children's Hospital, Milan, Italy
Objectives and Study: Gut microbiota imbalance may contribute to the development of obesity and cardiometabolic alterations. Whether dietary interventions could modulate gut microbiota and metabolic improvements in children and adolescents has not thoroughly been reviewed and synthesized. The objective of the present systematic review and metanalysis is to study the impact of dietary interventions on the gut microbiota of children and adolescents with overweight or obesity, and whether these microbiota changes are associated with cardiometabolic health improvements
Methods: A systematic search of clinical trials in PubMed, Cochrane and EMBASE databases was conducted up to December 2023 following PRISMA guidelines for systematic reviews and meta‐analyses (PROSPERO registration n°CRD42024505494). Risk of bias assessment was performed with RoB2 and ROBINS, for randomized‐controlled trials and intervention studies, respectively
Results: Overall, 47 articles were assessed for eligibility, 5 included in the review, and 3 that allowed a quantitative analysis of the effect of alpha‐diversity were meta‐analysed. Four studies implemented calorie‐restricted diets, and one a low free‐sugar diet. The main outcomes were changes in alpha‐diversity, Firmicutes/Bacteroidetes ratio, specific taxa‐level modifications and the association of these variables with cardiometabolic changes. There was considerable heterogeneity in specific taxa‐level changes reported by the different trials. An increase in bacteria such as Faecalibacterium and Roseburia genus, was observed after dietary interventions in 3 studies. The meta‐analysis revealed that intervention with balanced diet and calorie‐restriction were associated with significant increases in CHAO (43.11 [3.59;82.64]; p = 0.003) and Observed Species (37.28 [7.09;67.48]; p = 0.015)(Fig.1) Fig.1 Forest plot on pooled effect of dietary interventions on gut microbiota diversity indexes (CHAO, Observed species and Shannon index)
Conclusions: There is moderate evidence that balanced dietary intervention with calorie restriction adequate for pediatric age could increase gut microbiota diversity and the abundance of butyrate‐producing bacteria. Further clinical trials should report on potential metabolic improvements associated with dietary‐driven gut microbiota changes to design personalized interventions
Contact e‐mail address: giulia.fiore@unimi.it
N‐OP039. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐OP039.1. EFFECTS OF CHICORY‐DERIVED INULIN‐TYPE FRUCTANS ON GUT MICROBIOTA AND BOWEL FUNCTION IN YOUNG CHILDREN WITH FUNCTIONAL CONSTIPATION: FINDINGS FROM THE CONSTICHILD II STUDY
Weihui Yan1, Ying Wang1, Lu Jiang1, Jessica Van Harsselaar 2, Stephan Theis2, Wei Cai1
1Division Of Pediatric Gastroenterology And Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, Shanghai, China, 2Beneo Institute, c/o BENEO GmbH, Obrigheim/Pfalz, Germany
Objectives and Study: Functional constipation is a common issue in young children, often associated with low dietary fiber intake and/or changes in life circumstances. Chicory‐derived inulin‐type fructans (ITF) are prebiotic fibers known for their Bifidogenic effects and potential to improve bowel function. This study aimed to assess the effects of ITF on gut microbiota composition and stool consistency in toddlers aged 1‐3 years with functional constipation.
Methods: The CONSTICHILD II study was a randomized, double‐blind, and placebo‐controlled trial conducted in a Chinese cohort. A total of 100 children were randomly assigned to receive either 2x2 g/day ITF or placebo for four weeks. Of these, 88 children (46 placebo and 42 ITF) completed the study and were included in the Intention‐to‐Treat (ITT) analysis, while 78 children (41 placebo and 37 ITF) were analyzed in the per protocol population (PP). The primary outcomes included stool consistency, assessed using the Bristol Stool Form Scale (BSFS), and gut microbiota composition, analyzed through metagenomics.
Results: ITF supplementation improved stool consistency, resulting in softer stools compared with baseline (3.5 vs. 3.1 in ITT, P < 0.05; 3.5 vs. 3.0 in PP, P < 0.05). Microbiota analysis revealed a notable Bifidogenic effect, with increases in Bifidobacterial spp. levels. STAMP analysis showed that selected probiotics, such as Bifidobacterium longum and Parabacteroides distasonis, were increased in the ITF group while microbial diversity remained unchanged. The placebo group exhibited no significant change in gut microbiota profile or bowel function. Importantly, the ITF intervention was well tolerated by the participants, and no significant adverse events were reported.
Conclusions: Chicory‐derived ITF improves stool consistency and increases the proportion of selected probiotics in toddlers with functional constipation. These findings highlight the potential of ITF as a prebiotic dietary fiber for promoting gut health in young children with functional digestive disorders.
Contact e‐mail address:
N‐OP040. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐OP040.1. MACHINE LEARNING WAS USED TO ELUCIDATE THE EFFECTS OF KEY COMBINATIONS OF BREAST MILK PREBIOTIC‐LIKE SUBSTANCES ON BREAST MILK AND INFANTS’ GUT MICROBIOTA
Menglu Xi1, Sufang Duan2,3, Ignatius Szeto2,3, Yalu Yan3, Wenhui Ye3, Biao Liu3, Ai Zhao 1
1Vanke School Of Public Health, Tsinghua University, Beijing, China, 2National Center of Technology Innovation for Dairy, Hohhot, China, 3Inner Mongolia Yili Industrial Group, Co. Ltd., Hohhot, China
Objectives and Study: Human oligosaccharides (HMOs) and fatty acids (FA) in breast milk play an important role in infant growth and intestinal microbiota. Machine learning is one of the most critical and influential subfields of artificial intelligence (AI). This study aims to identify the key combination of HMOs and FA variables that have the greatest contribution to maternal breast milk and infants’ guts microbiota through machine learning algorithms.
Methods: We enrolled 50 paired mothers and their infants in their 42 days postpartum. Whole genome shotgun sequencing was applied to determine the microbial composition of breast milk and infant feces. Canonical Correspondence Analysis (CCA) and Spearman were used to analyze the correlation between single variables of HMO and FA on microbiota. Symbiotic network relationships were used to identify the key regulatory microbiota. Box‐Cox data transformation and multiple additive regression tree (MART) models were further utilized to explore key HMOs and FA combinations that have a greater contribution to breast milk and infant microbiota.
Results:
Through the screening of significant variables, 6′SL, DSLNT, C22:6, and C20:5 are the key factors affecting breast milk and infant intestinal microbiota. Lactobacillus salivarius (mean=10463.75, edge=11, P < 0.05) and Lactobacillus gasseri (mean=25636.32, edge=7, P < 0.05) are the dominant symbiotic bacteria. C22:6, C22:5, and DSLNT are the key combination factors that influence Lactobacillus salivarius in breast milk. LNnT and C22:6 are the key combination factors affecting Lactobacillus gasseri in infants’ guts.
Conclusions: In this study, machine learning was used for the first time to identify the best combination of breast milk HMO and FA, providing a theoretical reference for the healthy growth of mothers and infants by AI. It also revealed that FA and HMO in breast milk may have joint targeted regulatory effects on specific bacteria.
Contact e‐mail address: aizhao18@tsinghua.edu.cn
N‐EP001. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP001.1. HUMAN MILK OLIGOSACCHARIDES (HMOS) LEVELS IN BREAST MILK ASSOCIATES WITH BONE QUALITY AND LENGTH DURING EARLY LIFE: DATA FROM OBSERVATIONAL CHINESE COHORT BAMBOO
Jing Wang1, Qiangrong Zhai2, Chang Jiang1, Lingyan Feng1, Yu Zhang1, Yuanyuan Guo1, Gongshu Liu1, Xi Li2, Guohong Zhang3, Keqing Wang3, Fangyi Ren4, Lingyao Guan4, Jiayu Chen4, Ya Gao3, Mo Chen5, Noura Darwish6, Atiye Nazari6, Sara Colombo Mottaz6, Yumei Zhang7, Dantong Wang5, Shaillay Dogra5, Longfei Wang5, Fang Huang5, Sean Austin5, Marie Noelle Horcajada5, Nicolas Bonnet 5
1Tianjin Women's and Children's Health Center, Tianjin, China, Tianjin, China, 2BGI‐Shenzhen, Shenzhen, 518083, China, Shenzhen, China, 3Shenzhen Engineering Laboratory for Birth Defects Screening, Shenzhen, 518083, China, Shenzhen, China, 4China National Gene Bank, BGI‐Shenzhen, Shenzhen, 518120, China, Shenzen, China, 5Nestlé research/Société des produits Nestlé, lausanne, Switzerland, 6Clinical Research Unit, Nestlé Research, Lausanne, Switzerland, la, Switzerland, 7Peking University, China, pekin, China
Objectives and Study: Bone growth during infancy is a key period for bone strength later in life. Human milk oligosaccharides (HMO), key components of breast milk, can rescue bone growth in malnourished infants. However, among the 26 HMOs that we are able to characterized in milk samples it is not known which specific HMOs are involved in bone growth and quality.
Methods: The Bone And MicroBiOme Onset (BAMBOO) study is an observational study, aiming to determine for bone development trajectories. 690 children were recruited at birth and followed up to 12 months. HMOs levels were measured by HPLC, in a subgroup of mother‐infant pairs with breastmilk collection at 1 and 3 months, respectively n = 137 and 87. Tibia and radius quality were assessed by ultrasound and length by ruler at 3, 6, 9 and 12months, association with HMOs were made by spearman's and 3‐knot linear model.
Results: The most abundant HMOs (>250 mg/L) are 2′FL, 3′FL, LNDFHI, LNT, LNFP‐II, LNFP‐I, LNFP‐III with the highest (>950 mg/L) being 2′FL and 3′FL. 2′FL and LNFP‐I were positively associated with bone length at 6 M, with LNFP‐I continuing at 9 M. 2′FL, 3′FL, 3′SL, 6′SL, DSLNT, LNH, LNFPV, LNnT, LSTb, LNFPII, LNT were positively associated with bone length at 6 M, 9 M and 12 M but only above a certain cutoff (respectively >2100 mg/L, >530 mg/L, >460 mg/L, >103 mg/L, >200 mg/L, >65 mg/L, >37 mg/L, >115 mg/L, >49 mg/L, >279 mg/L, >585 mg/L). 3′FL, LNFP‐V, LNFP‐II, LNFP‐III were positively associated with bone quality at 6 M and 2′FL, LNFP‐I with bone quality at 9 M. We identified 8 clusters of HMOs positively associated with bone length and 2 clusters to bone quality. Only LNFP‐1 was positively associated with both bone length and quality.
Conclusions: On top of neutral HMOs associated with bone quality, sialylated ones associate with bone length. These findings underscore the importance of HMOs for healthy bone growth during the first year of life.
Contact e‐mail address:
N‐EP002. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP002.1. SEX‐DEPENDENT EFFECTS OF AN INFANT FORMULA ENRICHED WITH OSTEOPONTIN & SYNBIOTICS ON INFANT'S IMMUNE DEVELOPMENT UP TO 12 MONTHS OF AGE: THE EARLYTOLERA STUDY
José Antonio García‐Santos1, Elena Requena1, María García‐Ricobaraza2, Ana Nieto‐Ruiz3, Antonio Jerez4, Florian Herrmann4, Roser De Castellar5, Maria Teresa Pérez‐Hernández5, Mercedes García‐Bermúdez1, Cristina Campoy 4
1EURISTIKOS Excellence Centre for Pediatric Research, Granada, Spain, 2IBS‐Granada‐Instituto de Investigación Biosanitaria, Granada, Spain, 3Department Of Methodology And Behavior Treatment, University of Granada, Granada, Spain, 4Department Of Pediatrics. School Of Medicine, University of Granada, Granada, Spain, 5Scientific Department, Laboratorios ORDESA, S.L., Barcelona, Spain
Objectives and Study: After birth, immune system development is orchestrated by several endogenous and exogenous factors, such as sex and modulatory effects of bioactive compounds present in human milk. As part of the EarlyTOLERA Study (ClinicalTrials.gov ID: NCT04306263), current analysis aimed to evaluate the potential sex‐dependent effects of a new bioactive compounds‐enriched infant formula on immune development in healthy infants up to 12 months of life.
Methods: 231 healthy babies aged 0‐2 months were randomized to receive, during their first year of life, a standard infant formula (SF = 79) or an experimental formula (EF = 75) enriched with Osteopontin, Galactooligosacharides (GOS), Human Milk Oligosaccharides (HMOs) (2′FL) and probiotics (B. Infantis & L. Rahmnosus). Additionally, 77 breastfed infants (BF) were enrolled as reference group. Saliva samples were collected under sterile conditions at 3, 6 and 12 months of life. sIgA levels were measured by Secretory IgA ELISA (Calbiotech, CA, USA), and cytokines levels [IL‐6, Il‐10 and TNF‐alpha] were obtained using LUMINEX xMAP technology (HSTCMAG‐28SK, Merck‐Millipore).
Results: BF infants showed higher sIgA levels at 12 months compared to formula‐fed infants (p < 0.001). EF infants presented higher anti‐inflammatory response (lower Il‐6/IL‐10 and TNF‐alpha/IL‐10 ratios) compared to BF and SF infants, from 6 to 12 months (p < 0.001). Although no differences were found between boys/girls in immune development up to 12 months, further analysis considering sex and type of early nutrition showed that EF girls at 12 months, but not boys, did not differed in sIgA levels compared to BF girls (p > 0.05). Moreover, anti‐inflammatory response was more pronounced in EF girls at 6 and 12 months of life, compared to SF ones (p < 0.05).
Conclusions: Bioactive nutrients‐enriched infant formula seems to modulate infant immune development up to 12 months of life in a sex‐specific way, mimicking immunomodulatory properties of breast milk. Funding: Laboratorios Ordesa S.L. and TOLERA (CIEN Project)‐Spanish Ministry of Science, Innovation & Universities (IDI‐20170870).
Contact e‐mail address: ccampoy@ugr.es
N‐EP003. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP003.1. ASSOCIATION OF EARLY LIFE NUTRITION ON GUT MICROBIOTA, AND ON PARENT‐REPORTED ILLNESS INCIDENCE IN CHINESE CAESAREAN BORN INFANTS: AN OBSERVATIONAL STUDY IN A REAL‐WORLD SETTING
Kexin Zhang1, Kit Ying Tsoi2, Chee Yong Goh3, Christophe Lay3, Jiachi Chiou 1,4
1Food Science And Nutrition, The Hong Kong Polytechnic University, Hung Hom, Hong Kong PRC, 2Danone Nutricia Early Life Nutrition (Hong Kong) Limited, Hong Kong, Hong Kong PRC, 3Danone Global Research & Innovation Centre, Precision Nutrition D‐Lab, Singapore, Singapore, 4Research Institute For Future Food, The Hong Kong Polytechnic University, Hung Hom, Hong Kong PRC
Objectives and Study: Caesarean section (CS) rates are progressively rising in many parts of the world, potentially increasing the risk of compromised health1. The objective of this study was to investigate the association between an infant formula supplemented with and without a synbiotics mixture (short‐chain galacto‐oligosaccharides [scGOS], long‐chain fructo‐oligosaccharides [lcFOS] in 9:1 ratio, Bifidobacterium breve M16‐V [BBM16V]) on gut microbiota and parent‐reported illness incidence of CS born infants in a real‐world setting.
Methods: A total of 192 infants were enrolled from clinics across Hong Kong and classified as: vaginally‐born mixed‐fed; Human Milk and formula without probiotics (VD reference), CS born mixed‐fed with formula without probiotics (CS‐control) or CS born mixed‐fed with formula with synbiotics (CS‐test). Fecal microbiota was analyzed by qPCR at Day 0‐2, Week 1, 2, 4 and 12, and 12 months of age. At 12 months, 112 infants completed the health survey, defining illness as presence of physical symptoms requiring medical consultation and treatment.
Results: Infants from CS‐control group showed delayed colonization of human infant‐type Bifidobacterium species compared to VD. This was restored in the CS‐test within the first week of life up to the level observed in the VD group. Moreover, in the CS‐test group 10.7% (3/28) reported 3 or more illness episodes, compared to 30.6% (11/36) in the CS‐control group and 14.6% (7/48) in the VD group. Of the CS‐test group 3.5% (1/28) used antibiotics, compared to 19.5 % (7/36) in the CS‐control group and 14.3% (8/48) in the VD group.
Conclusions: In this real‐world setting study, delayed colonization by Bifidobacterium was observed in CS born infants which could be rapidly restored with a specific synbiotic mixture, as previously reported in a randomized controlled trial2,3. The data indicate that this nutritional strategy could potentially support immune development in CS born infants in the first year of life, requiring further research for validation.
Contact e‐mail address: jiachi.amber.chiou@polyu.edu.hk
N‐EP004. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP004.1. LONGITUDINAL SURVEY OF FUNCTIONAL GASTROINTESTINAL DISORDERS FROM BIRTH TO 24 WEEKS AND THEIR ASSOCIATIONS WITH FEEDING PRACTICES AND GROWTH OUTCOMES
Sirinuch Chomtho 1, Orapa Suteerojntrakool1, Eakkarin Mekangkul2, Nathawan Khunsri1, Sophie Gallier3
1Center Of Excellence In Pediatric Nutrition, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 2Department Of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand, 3Dairy Goat Co‐Operative (N.Z.) Ltd. (DGC), Hamilton, New Zealand
Objectives and Study: Functional gastrointestinal disorders (FGIDs) are major concerns for families, affecting quality of life for the mother‐child dyads. This study aimed to examine the prevalence of FGIDs and their associations with feeding practices and growth outcomes.
Methods: A prospective longitudinal survey was conducted among healthy full‐term Thai infants from birth. Demographic data, feeding practices, and gastrointestinal symptoms were assessed through telephone interview at 2, 4, 6, 9, 12, 16, and 24 weeks of age. FGIDs were diagnosed based on ROME IV criteria. Weight, length, and head circumference were obtained from infant vaccination records at 9, 16, and 24 weeks.
Results: A total of 483 infants (51%female) with mean age of 2.1(95%CI 2.1‐2.2) weeks were recruited. Forty percent were predominantly breastfed (PBF) until 24 weeks; however, only 10.6% solely received direct breastfeeding. The percentage of formula to total milk intake significantly increased overtime from 16.1(13.8‐18.4) at 2 weeks to 46.3(42‐50.5) percent at 24 weeks. The highest prevalence of infant regurgitation (8.6%) occurred at 6 weeks and decreased to 2% at 24 weeks. Regurgitation frequency peaked at the age of 6 weeks [10(8.7‐11.2) times/week] and significantly decreased with age; mean change over time ‐0.22 (‐0.26to‐0.19) times/week for every 1 week increase in age. Regurgitation frequency was not different between PBF, mixed feeding, and formula feeding group and showed no significant association with any of the growth parameters. The reported prevalence of bloating and dyschezia was highest at 4 weeks of age (10.3%and 9.2%, respectively) and the latter significantly declined overtime. The prevalence of infantile colic was very low at 1.4% and none was diagnosed as having functional constipation.
Conclusions: Infant regurgitation peaked at 6 weeks of age and diminished overtime, independent of feeding practices and growth. Health care providers should be well‐informed and able to provide reassurance for the families. (TCTR20220215012)
Contact e‐mail address: schomtho@gmail.com
N‐EP005. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP005.1. REDUCED DIETARY PROTEIN INTAKE IN THE SECOND YEAR OF LIFE INCREASES PLASMA FGF21 LEVELS
Fabian Geyer 1,2, Hans Demmelmair1,2, Jibran Wali3, Joaquín Escribano4, Natalia Ferre4, Judit Muñoz‐Hernando4, Veronica Luque4, Berthold Koletzko1,2, Veit Grote1,2
1Pediatrics, Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. Von Hauner Children's Hospital, LMU University Hospital, Munich, Germany, Munich, Germany, 2German Center for Child and Adolescent Health, Munich, Germany, 3Nestlé Institute Of Health Sciences, Nestlé Research, Lausanne, Switzerland, 4Pediatric, Nutrition And Development Research Unit, Universitat Rovira i Virgili. IISPV, Reus, Spain
Objectives and Study: Fibroblast growth factor 21 (FGF21) is a hepatokine associated with diet, metabolism and energy expenditure in pre‐clinical studies and human adults. It was suggested to have long‐term health effects. We studied the effect of dietary macronutrient balance on FGF21 levels in toddlers in a randomized trial, exploring the effect of young child milk formula with different protein concentrations.
Methods: In the Toddler Milk Intervention (ToMI) trial (NCT02907502), healthy, term‐born children were randomized at the age of 12 months to receive isocaloric young child milk formulas with either lower protein (LP) or higher protein (HP) content (1.5 g vs 6.1 g protein/100 kcal; fat content adjusted) up to age 24 months. Diet was assessed by 24h‐recalls and FGF21 was measured in plasma before the intervention at 12 months and at 24 months. Linear regression models were fit to examine the effect of the intervention as well as of total protein intake and the carbohydrate‐to‐protein‐ratio on log‐transformed FGF21 levels, adjusted for sex, country (Germany/Spain), fasting status and, as applicable, total energy intake.
Results: Median FGF21 (IQR) levels were 65 pg/ml (35‐117; n = 434) in LP and 64 pg/ml (32‐112; n = 431) in HP at 12 months (p = 0.709), but at 24 months higher (p < 0.001) in LP (70 pg/ml, 40‐119; n = 387) than in HP (42 pg/ml, 30‐65; n = 365). At both time points, total dietary protein intake was inversely associated with FGF21. The carbohydrate‐to‐protein‐ratio (3.4, 2.7‐4.3 at 24 months, n = 736) was positively associated with FGF21 at both 12 months (β = 0.19, 95% CI 0.14‐0.25; p < 0.001) and 24 months (β = 0.21, 95% CI 0.17‐0.25; p < 0.001).
Conclusions: Lower protein intake and a higher carbohydrate‐to‐protein‐ratio during the second year of life were associated with higher FGF21 plasma levels. Preclinical studies suggest that higher FGF21 levels may have lasting health benefits. Therefore, further investigation of possible long‐term health impact is warranted in children.
Contact e‐mail address: fabian.geyer@med.uni-muenchen.de
N‐EP006. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP006.1. EVALUATION OF LIPIDS IN HUMAN MILK AT DIFFERENT GESTATIONAL AGES: A PROSPECTIVE MONOCENTRIC OBSERVATIONAL COHORT STUDY
Marta Giovengo 1, Giuseppina Leone2, Federica Izzo2, Maurizio Giordano3, Matteo Delli Carri4, Giacomo Pepe4, Pietro Campiglia4, Claudia Mandato1, Giuseppe De Bernardo2
1Department Of Medicine And Surgery, Scuola Medica Salernitana, Section Of Pediatrics, University of Salerno, Salerno, Italy, 2Department of Woman and Child, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy, Napoli, Italy, 3Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy, napoli, Italy, 4Department of Pharmacy, University of Salerno, Via G. Paolo II, Fisciano, 84084 Salerno, Italy, Salerno, Italy
Objectives and Study: The composition of breast milk (BM) is influenced by various factors, including maternal diet, health status, gestational age (GA) at which milk is produced. The aim of the study was to analyze the lipidic profile in BM at different GA through a metabolomics‐based approach and its correlation with maternal diet during pregnancy.
Methods: Mothers were recruited based on GA at delivery: <32 weeks (Group A), 32–36 + 6 weeks (Group B), and > 37 weeks (Group C). At 7 days postpartum (T0) and 1 month postpartum (T1), a sample of 10 ml hindmilk was collected, at least 2 hours after the previous feeding. Lipid composition was analyzed using UPLC‐MS/MS. A dietary questionnaire was administered to evaluate maternal diet.
Results: A total of 98 mothers were enrolled. Linoleic acid (LA) was the most abundant lipid across groups at both T0 and T1. At T0, Group B exhibited lower concentrations of palmitic acid (PA) compared to Group C. Additionally, at T1, stearic acid (SA) concentrations were higher in Group A. Fish consumption was negatively correlated with alpha‐linolenic acid (ALA), LA, and arachidonic acid (ARA) at T0. At T0, red meat consumption positively correlated with capric acid, while fruit consumption positively correlated with stearic acid and cis‐9‐oleic acid (CO). At T1, red meat consumption positively correlated with ALA, LA, SA, and PA, whereas dairy product consumption was positively correlated with SA, and fruit consumption positively correlated with eicosapentaenoic acid (EPA), capric acid (CA), LA, and CO.
Conclusions:
No statistically differences were observed, except for Group A and C that showed significantly higher concentrations of stearic acid at T1 and palmitic acid at T0, respectively. Maternal diet during pregnancy correlates with the lipid composition of breast milk. Further investigations are needed for their implications on the developmental outcomes of preterm and term infants and for strategies for a GA‐based nutrition.
Contact e‐mail address: m.giovengo@studenti.unisa.it
N‐EP007. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP007.1. FEEDING DIFFICULTIES ARE MAJOR RISK FACTORS FOR READMISSION OF LATE PRETERM NEONATES
Deepa Hariharan, Lavanya Balasubramanian, Abilash M S
Neonatology, Sooriya Hospital, Chennai, India
Objectives and Study: Late preterm infants have delayed oral feeding independence due to lower oromotor tone and incoordination, immature gut function and discharge before feeding readiness. We analyzed feeding difficulties as risk factors for readmission of late preterm infants.
Methods: In this cohort study, late preterm infants, born between 34 0/7 nd 36 6/7 weeks gestation, readmitted within 28 days of life to NICU during a 2‐year study period were enrolled (n = 111). The demographics, treatment during primary admission, reasons for readmission, exclusive breastfeeding rates, and trends in postnatal weight gain were analyzed.
Results: Of 111 subjects, 40 were <35 weeks completed gestation, and 71 between 36 aand 36 6/7 weeks gestation. Mean birth weight was 2108 g + 366 g. Main reasons for readmission were poor feeding (35), jaundice (34), lethargy (34), infections (14). 70/111 infants were exclusively breastfed. Weight loss >15% was seen in 36 infants (range 13% to 27%). Multivariate analysis during showed shorter initial hospital stay as a major factor associated with readmission. 75 infants were treated at mother's side/exclusive rooming‐in (group A), and 26 admitted in NICU/nursery (Group B) (p < 0.01). This correlated with duration of hospital stay: 3.2 days in group A, 6.7 days in group B (p < 0.01). Exclusive DBF at initial discharge was 51/75 in Group A, 18/26 in Group B. Maternal satisfcation about feeding readiness at initial discharge (Breastfeeding Self‐efficacy Scale) was surprisingly lower in Group A, compared to Group B (p < 0.01); there were reports of more feeding reinforcement by medical personnel in group B, despite illnesses in infants. Gestation, respiratory status were not significant.
Conclusions: While rooming‐in is beneficial for "apparently well" late preterm infants, adequate feed establishment is a prerequisite for discharge. Early discharge of such infants with less time and effort for establishing feeds leads to higher readmission rates, nutritional morbidity.
Contact e‐mail address: nicu_deepa@yahoo.com
N‐EP008. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP008.1. THE EFFECT OF DONOR HUMAN MILK IMPLEMENTATION IN FEEDING PRACTICES ON NEONATAL OUTCOMES
Laurence Mangel1, Bar Frumer2, Dror Mandel1, Jacky Herzlich 1
1Department Of Neonatology, Tel Aviv Medical Center, Tel Aviv, Israel, 2Tel Aviv University, Tel Aviv, Israel
Objectives and Study: Mother's Own Milk (MOM) is recommended for premature infants for its protective benefits. When unavailable, pasteurized Donor Human Milk (DHM) serves as a substitute. DHM was introduced in our NICU in August 2020, and this study aimed to evaluate its impact on infant health outcomes.
Methods: We analyzed data from preterm infants born at <32 weeks gestational age (GA) or with birth weights (BW)<1500 g from 2018 to 2023. Neonatal outcomes were compared between pre‐ (epoch‐1) and post‐DHM implementation (epoch‐2) periods. Primary outcomes included necrotizing enterocolitis (NEC, according to Bell's criteria: stage 2 and above), feeding intolerance (FI, defined as ≥20% residuals), hypoglycemia, weight gain percentage (WG%) at 14 and 28 days and bone metabolism during the first 28 days of life.
Results: Among 343 infants (139 in epoch‐1, 204 in epoch‐2), epoch‐1 infants had lower GA, BW, and were sicker (Table 1). While WG% was similar across epochs, NEC and FI rates were higher in epoch‐1. Although not significant, hypoglycemia rate rose by 50% in epoch‐2. Infants with FI had lower GA (p = 0.006), lower BW (p = 0.003), delayed initiation of enteral feeding (p = 0.004), delayed full enteral feeding (p < 0.001), prolonged parenteral nutrition (p < 0.001) and prolonged hospital stay (p < 0.001). Forward stepwise regression analysis showed that the risk of NEC increased with longer durations of parenteral nutrition (95% CI [1.055, 1.113]) and FI episodes (95% CI [1.095, 5.861]), but not with epochs. Osteopenia and refeeding syndrome rates were similar across epochs.
Conclusions: In our setting, while the rates of NEC and FI appeared higher in epoch‐1, they were not directly associated with epochs. Infant growth and bone metabolism were unaffected by feeding practice changes. Ongoing analysis examines the impact of different milk types.
Contact e‐mail address:
N‐EP009. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP009.1. OSTEOPONTIN PEPTIDES PREPARED BY INFANT DYNAMIC DIGESTION AND ITS CALCIUM‐PROMOTING AND OSTEOGENIC ACTIVITIES
Wenjun Cao1,2, Xuanxiang Zhao1, Kaite Chen1, Pantian Huang3, Feitong Liu3, Ruibiao Hu 3, Jianyin Miao1
1College Of Food Science, South China Agricultural University, Guangzhou, China, 2College Of Food Science, South China Agricultural University, Guanzhou, China, 3H&H Group, H&H Research, China Research and Innovation Center, Guangzhou, China
Objectives and Study: Osteopontin (OPN), a vital component in breast milk, plays a critical role in the growth and development of infants and young children. This study aimed to explore the infant dynamic digestion of OPN in vitro and the potential effects of osteopontin peptides (OPN‐P) on bone development and health.
Methods: The OPN‐P was obtained by dynamic simulating infant digestion of OPN in vitro and analyzed by amino acid analyzer and identified by LC‐MS/MS. The calcium chelating activity of OPN‐P was evaluated and the ability to promote calcium transport was further studied in the Caco‐2 intestinal epithelial cell model. Then, the proliferation, differentiation and mineralization potential of OPN‐P were studied in the MC3T3‐E1 osteoblast model. Finally, the relationship between peptides' characteristics and functional activities of the OPN‐P was further analyzed.
Results: After digested and analyzed, the result showed that OPN‐P contained 8.18% aspartate, 11.24% serine and 21.23% glutamate and 77.13% of the peptides in OPN‐P were phosphorylated peptides, which indicated calcium irons binding potential of OPN‐P. Then, OPN‐P showed good calcium chelation activity (79.06 µg/mg) in vitro and the calcium transport capacity of OPN‐P was increased by 36.6% than that of the control group(CaCl2) in the Caco‐2 intestinal epithelial cell model. Moreover, compared with the control group, the proliferation, alkaline phosphatase and mineralization activities of OPN‐P significantly increased by 27.85%, 200.63% and 41.85% (p < 0.05), respectively, in the MC3T3‐E1 osteoblast model. The good calcium‐promoting and osteogenic activity of OPN‐P may be related to the amino acid combination and phosphorylation of OPN‐P.
Conclusions: The OPN‐P prepared by infant dynamic digestion exhibits a strong calcium chelation ability and effectively promotes calcium transport. Meanwhile, OPN‐P has a significant osteogenic activity and may contribute to bone growth. The results provide a scientific basis for the research and development of infant formula and calcium supplements.
Contact e‐mail address: miaojy8181@scau.edu.cn
N‐EP010. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP010.1. GROWTH PATTERNS OF INFANTS BREASTFED FOR MORE THAN ONE YEAR: A COMPARISON OF EXCLUSIVE BREASTFEEDING VERSUS FORMULA SUPPLEMENTATION
Rona Krinsky Dror 1, Hadar Moran‐Lev2, Ronit Lubetzky3, Dror Mandel4
1TEL AVIV SOURASKY MEDICAL CENTER ICHILOV, TEL AVIV, Israel, 2Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel aviv, Israel, 3Departments Of Neonatology And Pediatrics, Sourasky Medical Center, Tel Aviv and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, 4Tel Aviv Sourasky Medical Cener, Tel Aviv, Israel
Objectives and Study: The American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for six months, followed by continued breastfeeding alongside complementary foods, with breastfeeding continuation for two years or more as mutually desired by the mother and infant. However, the effects of prolonged breastfeeding beyond one year on infant growth rates remain controversial. This study aimed to describe the growth patterns of infants breastfed for more than one year without formula supplementation compared to those with formula supplementation and to evaluate the necessity of adding formula to the diet of infants who are breastfed for extended periods.
Methods: Data from 252 children were analyzed, including 174 exclusively breastfed infants and 78 infants who were breastfed with added formula. Growth data were collected up to 5 years of age. Demographic information, medical history, breastfeeding history, and overall health data of both mothers and infants were collected and compared.
Results: Among boys, the weight of exclusively breastfed infants was significantly lower than that of infants who received formula supplementation between 13 to 18 months. A similar trend was observed among girls. After 18 months, no significant differences in growth were observed between the two groups, and this trend persisted up to 5 years (Figure 1).
Conclusions: The results underscore the need for careful consideration before recommending formula supplementation in cases of slow growth during prolonged breastfeeding.
Contact e‐mail address: hadarlev6@gmail.com
N‐EP011. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP011.1. ESTABLISHMENT OF GUT MICROBIOTA IN THE FIRST FOUR MONTHS OF LIFE IN HEALTHY BRAZILIAN INFANTS EXCLUSIVELY BREASTFED, ACCORDING TO DELIVERY MODE
Tamara Lazarini 1, Karina Tonon2, Humberto Araujo Filho1, Mauro Morais1
1Nutrition Postgraduate Program, UNIVERSIDADE FEDERAL DE SAO PAULO, São Paulo, Brazil, 2Department Of Environmental & Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, United States of America
Objectives and Study: This study aimed to evaluate the gut microbiota profile of healthy infants, born via vaginal or cesarean delivery, during the first and fourth months of life, highlighting the influence of delivery mode and breastmilk's bioactive components on microbiota composition.
Methods: This study enrolled 28 healthy, full‐term infants (15 born via vaginal and 13 via c‐section). Fecal samples in the 1st and 4th months of life were analyzed. The V3 and V4 regions of the 16S rRNA gene were amplified and sequenced on the Illumina MiSeq. ANOVA, Kruskal‐Wallis, richness indices (Chao1, Shannon), UniFrac distances, and the Adonis tests were used to perform statistical analyses on the relative abundance of phyla, as well as the alpha and beta‐diversity of the gut microbiota.
Results: The relative abundance of phyla Actinobacteria, Bacteroidota, Firmicutes and Proteobacteria, was similar between in both groups. No statistically significant difference was observed in the Shannon alpha diversity between the groups at baseline (1,63 and 1,39; p = 0,198) and after 90 days (1,65 and 1,57; p = 0,636). However, the Chao1 showed higher diversity in the c‐section group at baseline compared to the vaginal delivery group (20,3 e 15,6; p = 0.025). This difference did not persist in the fourth month (21,7 and 20,3; p = 0,505). Beta diversity comparisons using weighted and unweighted UniFrac matrices revealed no statistically significant differences between the groups at baseline (p = 0,298 and p = 0,150) or at four months of life (p = 0,338 and p = 0,581).
Conclusions: Cesarean‐born infants on exclusive breastfeeding did not exhibit differences in gut microbiota diversity compared to those born vaginally, except for greater richness observed in the first month, which disappeared by the fourth month of life. The comparison of phyla revealed no differences in relative abundance during the study period. The similarity in alpha diversity at the end of the follow‐up may have been facilitated by the bioactive components of breast milk.
Contact e‐mail address: tamara.lazarini78@gmail.com
N‐EP012. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP012.1. COMPARATIVE ANALYSIS OF LIPIDS IN AN INFANT FORMULA CONTAINING A BLEND OF DAIRY AND PLANT‐BASED LIPIDS VERSUS A FORMULA EXCLUSIVELY USING PLANT‐BASED LIPIDS
Charlotte Magnant, Mathilde Guerville, Amandine Ligneul, Véronique Carbon, Isabelle Cuinet, Emmeline Salameh, Romane Troadec
Research, Lactalis research and development, RETIERS, France
Objectives and Study: Breast milk is the nutritional gold standard, rich in lipids like fatty acids, phospholipids, gangliosides, and cholesterol, crucial for infant growth, immune function, and cognitive development. However, replicating this complexity in infant formulas (IFs) is challenging. Dairy lipids are diverse, and combining them with plant‐based lipids could improve IF lipid profiles. This study compares the lipid composition of an IF containing a blend of dairy and plant‐based lipids (DL‐IF) to two IFs made exclusively from plant oils (P‐IF1 and P‐IF2).
Methods: Three IFs were analyzed: DL‐IF, P‐IF1, and P‐IF2. Lipid components, including fatty acids, phospholipids, and gangliosides, were studied. Cholesterol was quantified using gas chromatography after thin‐layer chromatography separation. Fatty acid profiles were assessed via gas chromatography of methyl esters, while phospholipids and gangliosides were analyzed using HPLC and HPLC‐MS, respectively. Sn‐2 palmitic acid content was measured through enzymatic hydrolysis.
Results: Lipid content was 26.3 g/100 g (DL‐IF), 24.8 g/100 g (P‐IF1), and 27.5 g/100 g (P‐IF2). DL‐IF had higher palmitic acid levels (19 g/100 g total fat) compared to P‐IF1 (7 g/100 g) and P‐IF2 (6 g/100 g). The sn‐2 palmitic acid proportion in DL‐IF was 33%, significantly higher than P‐IF1 (6%) and P‐IF2 (5%).
Conclusions: Combining dairy and plant‐based lipids in IFs provides a richer fatty acid profile, closer to breast milk, which has 17–25% palmitic acid, with 70% in the sn‐2 position. The results suggest that incorporating dairy lipids in IFs may better mimic breast milk, supporting optimal infant health and development
Contact e‐mail address:
N‐EP013. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP013.1. PREBIOTIC FIBERS AS A STRATEGY TO IMPROVE IRON STATUS: ENHANCING IN VITRO IRON ABSORPTION THROUGH PREBIOTIC FERMENTATION
Fernanda Olguin‐Diaz, Gabriel Thomassen, Ioannis Kostopoulos, Guus Roeselers, Marion Jourdan, Jan Knol, Ingrid Renes
Danone Global Research & Innovation Center, Utrecht, Netherlands
Objectives and Study: Iron deficiency anemia (IDA) in children impairs growth and quality of life. Prebiotics may improve iron absorption by directly increasing iron bioavailability (IB) or through short‐chain fatty acid (SCFA) production during colonic fermentation. This study explored the potential of supplementing infant milk formula (IMF) with prebiotics: Inulin, lcFOS, and Inulin:lcFOS (1:1 and 2:1), to improve IB and uncover the underlying mechanisms. Short‐chain (sc)GOS: long‐chain (lc)FOS, with proven clinical efficacy1, was included as a reference.
Methods: In vitro gastrointestinal digestions were performed using control IMF and IMF with 0.8 g/dL prebiotics containing 1.0 mg/dL FeSO4. Additionally, in vitro colonic fermentations were conducted using fecal donations from 6‐12 month‐old infants to determine the SCFA profiles for each prebiotic. Digests containing prebiotics or dialyzed control digests (with added SCFAs) were incubated on Caco‐2 cells to measure IB under small intestinal or colonic conditions, respectively. Intracellular ferritin levels were measured as a marker for IB.
Results: Inulin:lcFOS mixes significantly increased small intestinal IB. These mixes also significantly boosted SCFA production and acidification rates compared to individual fibers. All prebiotics significantly increased colonic IB, with Inulin:lcFOS mixes outperforming Inulin and lcFOS alone. SCFAs lowered colonic pH from 6.5 to ~5.5 without affecting FeSO₄ solubility, indicating potential systemic or chelating effects. These mechanisms were observed for both Inulin:lcFOS and the reference. Combined effect of small intestinal and colonic IB in both Inulin:lcFOS mixes resulted in an ~18% increase compared to individual fibers, and a ~ 48% increase compared to control IMF.
Conclusions: This study highlights the potential of supplementing IMF with Inulin:lcFOS mixes to enhance IB in children. SCFAs generated during colonic fermentation were identified as key contributors to improved colonic IB through mechanisms independent of pH changes. These findings emphasize the value of leveraging prebiotic‐driven approaches as part of innovative nutritional strategies to mitigate IDA in children. References:1.doi:10.1016/j.ajcnut.2023.11.018.
Contact e‐mail address: fernanda.olguin-diaz@danone.com
N‐EP014. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP014.1. THE PREDICTORS OF THE PERCEIVED INSUFFICIENT MILK SUPPLY
Elena Roslavtseva 1, Yakov Yakovlev2, Olga Lukoyanova1, Tatiana Borovik1
1Healthy And Sick Child Nutrition Laboratory, National Medical Research Center for Children's Health, Moscow, Russian Federation, 2Pediatric And Neonatology, NSIFTPh – Branch Campus of the FSBEI FPE RMACPE MOH, Novokuznetsk, Russian Federation
Objectives and Study: Perceived Insufficient Milk Supply (PIMS) is a mother's belief that she is not producing enough milk for her baby in the absence of objective evidence of deficiency. PIMS is associated with early discontinuation of breastfeeding. The aim of our study was to Identify PIMS predictors.
Methods: The single‐center, one‐time survey study was conducted. The multivariate logistic regression (MLR) was carried out with PIMS as an outcome with the definition of adjusted odds ratio (AOR [CI 95%]).
Results: The study included 6,263 mother with breastfed children. The median lactation duration was 10 (4; 18) months. 38.5% of surveyed mothers believed that they have PIMS. 51 factors were selected for the analysis, including sources of information about breastfeeding, factors in the maternity hospital and after discharge, weight gain, etc. MLR revealed 7 predictors (p < 0.05) that affect the risk of PIMS. The predictors that reduced the risk of PIMS were training of pregnant women by breastfeeding consultants (AOR 0.65 [0.47; 0.90], p = 0.009), weight gain of more than 1.5 Z‐score in the first month (AOR 0.75 [0.67; 0.84], p < 0.001) and more than 1.2 Z‐score in the second month (AOR 0.89 [0.79; 0.99], p = 0.40). The predictors that increased the risk of PIMS were infant formula supplementation in the maternity hospital (AOR 2.05 [1.63; 2.58], p < 0.001) and after discharge (AOR 3.31 [2.29; 4.79], p < 0.001), supplementation with water in the first 6 months (AOR 1.67 [1.21; 2.30], p = 0.002) and regular expression of milk (AOR 2.26 [1.64; 3.12], p < 0.001).
Conclusions: The greatest risk of developing PIMS is associated with the infant formula supplementation. The protective predictors are the preparing of pregnant women for lactation by breastfeeding consultants and the good baby weight gain in the first months of life.
Contact e‐mail address: roslikea@gmail.com
N‐EP015. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP015.1. INFANT FORMULA WITH 5 SPECIFIC HUMAN MILK OLIGOSACCHARIDES SUPPORTED MICROBIOME DEVELOPMENT IN INFANTS BORN VIA C‐SECTION
David Hill1, Anice Sabag‐Daigle 1, Grace Niemiro2, Rachael Buck1, Elizabeth Reverri2, Penni Hicks2
1Gut, Immunity, & Brain Health, Abbott Nutrition, Columbus, United States of America, 2Nutrition Science & Innovation, Abbott Nutrition, Columbus, United States of America
Objectives and Study: Infants born by Cesarean‐section are at increased risk of infections and have microbiome development that is distinct from vaginally delivered infants. Breastfeeding reduces the risk of complications for infants born via C‐section, potentially due to specific protective factors such as human milk oligosaccharides (HMOs).
Methods: 607 healthy, term infants were randomized to a control formula without HMOs (CF) or study formula (SF) with 2.5 g/L of 5 HMOs (2ʹ‐FL, 3‐FL, LNT, 3ʹ‐SL, and 6ʹ‐SL), with a breastfed group as reference (HM). 251 infants provided a stool sample at 6 months of age; 69 (27.4%) were born via C‐section (CF = 22, SF = 20, HM = 27). Stool was analyzed by metagenomic sequencing for microbiome composition, including community level differences, taxa‐specific differences, and differences in functional genes. Test results were considered significant at P < 0.05. All statistical analyses were performed in R v. 4.4.0.
Results: Infants fed SF and born via C‐section had greater abundance of bacterial taxa in the genus Bifidobacterium compared to CF (83.9% vs. 75.3%, P < 0.001; Figure 1) and not different from HM (82.6%, P = 0.11 vs. CF). Infants fed SF and born by C‐section had a greater abundance of bacterial genes belonging to the glycoside hydrolase family 33 relative to CF (P = 0.02) and not different from HM (P = 0.98).
Conclusions: These results demonstrated that adding 5 HMOs to infant formula supported increased Bifidobacterium, a beneficial microbe linked to immune maturation, in infants born via C‐section. Further, glycoside hydrolase family 33 enzymes are critical to HMO metabolism and are important markers of microbiome function. In summary, infants fed SF and born by C‐section had a microbiome like that of breastfed infants.
Contact e‐mail address: david.hill1@abbott.com
N‐EP016. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP016.1. THE CIRCADIAN VARIATION OF ANTIBACTERIAL PROPERTIES OF BREAST MILK OF INFANTS IN NICU: A PROSPECTIVE STUDY
Mina Misirligil1, Belma Saygılı Karagöl 2, Tuğrul Hoşbul3, Gökçe Karaman3
1Department Of Pediatrics, University of Health Sciences, Dr. Sami Ulus Child Health and Diseases Training and Research Hospital, Ankara, Turkey, 2Department Of Pediatrics, Division Of Neonatology, University of Health Sciences, Gülhane Medicine Faculty, Ankara, Turkey, 3Department Of Microbiology, University of Health Sciences, Gülhane Medicine Faculty, Çankaya, Turkey
Objectives and Study: Breast milk is a ideal biologic nutritional fluid for infants, and alters with circadian rhythms. Breast milk possesses either bacteriostatic or bactericidal properties. Current research has not yet explored the potential influence of circadian changes in breast milk on its antibacterial activity. This study aims to reveal the association between the antibacterial activity of breast milk with circadian rhythm.
Methods: The study was designed as double blind and conducted with breast milk of neonates who hospitalized our neonatal intensive care unit in May 2024. Infants were randomly selected and grouped as hospitalized for infection or non‐infection reasons. Breast milk samples were classified based on the time of collection: milk obtained between 04:00 and 22:00 was designated as daytime breast milk, while milk gathered between 22:00 and 04:00 was referred to as nighttime breast milk. A total of sixty breast milk samples were stored at ‐80°C, and the antibacterial activity of these samples was assessed after six months.
Results: Significant difference was observed between day and night breast milk regarding their antibacterial activity against Escherichia coli (E. coli) both infection group and non‐infection group (respectively, p = 0.03; p = 0.01). Overall, there was a considerable difference antibacterial activity of day and night breast milk (p = 0.00). Daytime breast milk has notably higher antibacterial activity against E. coli than nighttime breast milk in all group.
Conclusions: Our study proved that the antimicrobial activity of breast milk alters with circadian rhythm and daytime breast milk more protective on E. coli.
Contact e‐mail address: drmisirligil@gmail.com
N‐EP017. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP017.1. HUMAN MILK OLIGOSACCHARIDES CONCENTRATIONS AND TRAJECTORY IN THE FIRST YEAR OF CHINESE HUMAN MILK: THE PHOENIX STUDY
Shuangling Sun 1, Jingyu Yan2, Shiqi Liu3, Xianfeng Zhao3, Bernd Stahl4,5, Marko Mank4, Zhixu Wang6
1Danone Open Science Research Center, Shanghai, China, 2Dalian Institute Of Chemical Physics, Key Laboratory Of Separation Science For Analytical Chemistry, Chinese Academy of Sciences, Dalian, China, 3Life Science, Danone Open Science Research Center, Shanghai, China, 4Danone Nutricia Research, Utrecht, Netherlands, 5Chemical Biology And Drug Discovery, Utrecht Institute For Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands, 6Department Of Maternal, Child And Adolescent Health, School Of Public Health, Nanjing Medical University, Nanjing, China
Objectives and Study: The Phoenix study investigated the longitudinal changes on twenty‐four measurable human milk oligosaccharides (HMOs) across six cities in China over 769 mothers throughout 12‐month postpartum. HMOs may convey multiple benefits relevant for infants’ health, gut, immune and brain development. These potential benefits were also explored in this study, with analysis ongoing.
Methods: Human milk was collected by mothers under the guidance of trained staff at 1, 4, 6, 12 months. Absolute concentrations of twenty‐four HMOs were quantified by liquid chromatography‐ tandem mass spectrometry (LC‐MS/MS) using a validated high‐throughput multiple reaction monitoring (MRM) method. Total measurable HMO was defined as sum of detected 24 HMOs concentrations.
Results: The mean total measurable HMO‐concentration decreased from 7.0 ± 1.6 g/L at 1‐month to 5.0 ± 1.3 g/L at 4‐month, and gradually decreased to 4.8 ± 1.2 g/L around 12‐month postpartum. The concentrations of 5 individual HMOs representing neutral fucosylated, sialylated and neutral non‐fucosylated structures are shown in Table 1. The dynamic changes of total measurable HMO vary over 12‐month at the individual level among 194 mothers (Figure 1).
Table 1. Concentrations(g/L) of 5 representative oligosaccharides in the first year
| Oligosaccharides (Mean ± SD) | Lactation Period | ||||
|---|---|---|---|---|---|
| 1st month | 4th month | 6th month | 12th month | ||
| 2′‐FL | 1.668 ± 1.110 | 1.138 ± 0.879 | 1.025 ± 0.777 | 0.867 ± 0.719 | |
| 3‐FL | 0.562 ± 0.496 | 1.189 ± 0.792 | 1.324 ± 0.821 | 1.421 ± 0.858 | |
| 3′‐SL | 0.105 ± 0.026 | 0.111 ± 0.057 | 0.121 ± 0.048 | 0.159 ± 0.069 | |
| 6′‐SL | 0.368 ± 0.149 | 0.090 ± 0.048 | 0.062 ± 0.045 | 0.028 ± 0.033 | |
| LNT | 0.772 ± 0.503 | 0.322 ± 0.203 | 0.286 ± 0.181 | 0.329 ± 0.255 | |
Conclusions: The Phoenix study revealed HMOs profiles in Chinese human milk. Total measurable HMO decreased over lactation period in the first year. The dynamic changes of HMO‐concentrations vary between mothers and structure level. Formula feeding inspired by the HMO structures highlighted in this study would more closely resemble the composition of human milk. Nevertheless, it can be expected that supplementation of additional non‐digestible oligosaccharides to those selected HMOs is required to cover the full potential of all HMOs detected in human milk.
Contact e‐mail address: lynn.sun@danone.com
N‐EP018. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP018.1. IMPACT OF LIPID DROPLET STRUCTURE ON LIPID DIGESTION AND ABSORPTION IN INFANT NUTRITION: A COMPARATIVE STUDY OF HUMAN MILK AND INFANT FORMULAS
Gabriel Thomassen 1, Armelle Penhout2, A. Durand2, S. Chanon2, Jan Knol1, Ingrid Renes1, Marie‐Caroline Michalski2, Evan Abrahamse1
1Danone Global Research & Innovation Center, Utrecht, Netherlands, 2Université Claude Bernard Lyon 1, CarMeN, Pierre‐Bénite, France
Objectives and Study: Lipids provide most of the infant's energy need, and lipid droplet structure differs in early life nutrition. Human milk (HM) has large lipid droplets (~4 µm) with a milk fat globule membrane (MFGM), while standard infant formula (sIF) and sIF with added MFGM (sIFM) have smaller droplets (0.3‐1.0 µm) coated with milk proteins. A new concept infant formula (cIF, Nuturis) has large (3‐5 µm) milk phospholipid coated droplets and demonstrated infant growth patterns that were closer to HM¹. Infant growth may be influenced by lipid digestion and absorption. We examined the effects of droplet size and the presence of MFGM on these processes.
Methods: Infant formula (IF) and HM were digested under simulated infant conditions. Samples were taken over time for free fatty acid (FFA) analysis. Gastrointestinal digests were diluted to equimolar FFA concentrations and were incubated apically on intestinal epithelial cells (Caco‐2/TC7) in Transwell® plates. Intracellular lipid droplets (LD) were imaged, and their size was determined. FA absorption and basolateral triglyceride secretion were measured after 6 and 16 hours.
Results: Intestinal lipolysis rates were higher for sIF and sIFM than for cIF and HM. In Caco‐2/TC7 cells, proportional fatty acid uptake was not different between the milks. LD tended to be larger, and triglyceride secretion was increased for sIFM compared to sIF. Both LD size and triglyceride secretion were similar between cIF and HM.
Conclusions: In vitro infant intestinal lipolysis rates were influenced by lipid droplet size, with sIF and sIFM showing higher rates than cIF and HM. Addition of MFGM to sIF increased triglyceride secretion, while cIF showed similar triglyceride secretion levels compared to HM. Given that cIF (Nuturis) and breastfeeding have been shown to produce similar growth patterns in infants, our findings support the hypothesis that lipid digestion and intestinal absorption can influence growth outcomes in infants. Reference 1, 10.1016/j.ajcnut.2023.10.017
Contact e‐mail address: gabriel.thomassen@danone.com
N‐EP019. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP019.1. PEPTIDOME PROFILING OF HUMAN MILK REVEALS NATURAL PRESENCE OF BOVINE PEPTIDES
Pieter Dekker1, Janna Van Diepen 2, Gabriele Gross2, Ruth Simmons3, Kasper Hettinga1
1Food Quality And Design Group, Wageningen University and Research, Wageningen, Netherlands, 2Mead Johnson Nutrition Institute, Hoofddorp, Netherlands, 3Mead Johnson Nutrition Institute, Slough, United Kingdom
Objectives and Study: Human milk provides a constant supply of peptides to newborns, that may provide benefits and support healthy development. These peptides are either endogenous (maternal orgin) or exogenous (originating from maternal diet or environment). Recent improvements in advanced mass spectrometry allows for evaluation of large‐scale peptidomics datasets to study naturally occurring peptides, even at low abundances. The current research was conducted to identify exogenous peptides naturally present in human milk from a large mother‐child cohort.
Methods: Peptides in 287 milk samples from mother‐child dyads in the CHILD cohort study (6‐35 weeks post‐partum) were analyzed using non‐targeted nanoLC‐Orbitrap‐MS/MS. Reprocessing of untargeted shotgun human milk peptidomics data with a smaller database and extended peptide length range (6 to 52 amino acids) increased identified peptides from 7,200 to 10,738. After filtering for valid values, 3,200 peptides from 100 precursor proteins were retained for further analysis. In processing of the data, a fasta database containing a selection of 29 non‐human (bovine) protein sequences was added. This selection was made based on an initial processing of the data with a larger non‐human database (Dekker, 2024).
Results: In total there were 86 unique bovine peptides identified in the human milk samples. These peptides predominantly matched protein sequences of β‐lactoglobulin (39 peptides), β‐casein (13 peptides), and αS1‐casein (7 peptides). Large inter‐individual differences were observed; for instance, 51 out of the 86 non‐human peptides were identified in ≤5 human milk samples. On average, 5 non‐human peptides were identified per sample.
Conclusions: This research reinforces that human milk contains bovine peptides, likely due to potential transfer mechanisms from the maternal diet or other sources. It highlights the complexity of the human milk peptidome and underscores the need for further research on factors influencing peptide presence and variability, as well as their role for infant health.
Contact e‐mail address: janna.vandiepen@reckitt.com
N‐EP020. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EP020.1. EFFECT OF MATERNAL CONSUMPTION OF MILK FREE OF A1‐TYPE BETA‐CASEIN VS CONVENTIONAL MILK ON BREASTFED INFANT COMFORT AND GASTROINTESTINAL OUTCOMES: A DOUBLE‐BLIND RANDOMIZED CONTROLLED TRIAL
Zhixu Wang 1, Yi Sun2, Fan Yang3
1School Of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, China, 2Obstetrics And Gynecology Department, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 3Department Of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China
Objectives and Study: Fragments of cows' milk proteins from milk consumed by nursing mothers can be detected in their breastmilk. Conventional (CON) milk contains both A1‐ and A2‐type beta‐casein, and digestion of A1‐type beta‐casein is reported to have many gastrointestinal effects, including increased inflammation. These effects may be avoided by consuming milk free of A1‐type beta‐casein (A1PF milk). This study's objective was to compare the effects of A1PF milk vs. CON milk on mothers and the subsequent transfer to their breastfed infants aged 2 − 3 months.
Methods: This double‐blind, randomized controlled trial (NCT05829720), conducted in China, compared the effect of A1PF milk vs CON milk (200 mL, twice per day, for 14 days) on nursing mothers and any subsequent effects on their breastfed infants.
Results: Breastfed infants in the A1PF group (n = 25) had lower salivary marker levels (including tumor necrosis factor‐alpha [mean difference: −40.40 ng/L], interleukin‐4 [difference: −44.35 ng/L], immunoglobulin [Ig]A [difference: −1.72 µg/mL], IgG [81.41 µg/mL vs. 99.17 µg/mL] and IgG1 [difference: −7.60 µg/mL]), higher salivary glutathione levels (difference: 8.93 ng/L), higher levels of gut health markers (including total short‐chain fatty acid concentrations [559.51 µg/mL vs. 391.75 µg/mL]), improved gastrointestinal symptoms, and less itching and scratching, compared with infants in the CON group (n = 25) (all P < 0.05). Mothers who consumed A1PF milk had similar changes in inflammatory markers, increased salivary glutathione, and increased gut health markers, and their breastmilk had more iron and zinc (all P < 0.05). There were no notable differences in infant growth, sleep, or crying, or the frequency of adverse events.
Conclusions: Mothers who consumed A1PF milk had reduced markers of gastrointestinal and systemic inflammation and improved gastrointestinal outcomes compared with mothers who consumed CON milk. Importantly, these beneficial effects were passed on to their breastfed infants.
Contact e‐mail address: zhixu.wang@126.com
N‐EP021. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EP021.1. NUTRITIONAL MANAGEMENTOF FUNTIONAL GASTROINTESTINAL DISORDERS IN INFANTS:QUALITY OF LIFE EVALUATION
Mabel Carosella 1, Marisa Breton2, Maria Blumetti3, Sergio Aquino4, Eduardo Vainstein5, Silvia Fernandez6, Maria Bergese7, Veronica Noguera8, Maria Maciero1, Paula Micone1, Argentina Azurmendi9
1GRUPO PEDIATRICO BELGRANO R, BUENOS AIRES, Argentina, 2CONSULTORIO DOCTORA MARISA BRETON, BUENOS AIRES, Argentina, 3CONSULTORIO DOCTORA BLUMETTI, BUENOS AIRES, Argentina, 4Policonsultorio Pediátrico Jujuy, CORRIENTES, Argentina, 5CONSULTORIOS VAINSTEIN, BUENOS AIRES, Argentina, 6Consultorio Dra Silvia Fernandez, BUENOS AIRES, Argentina, 7Consultorios Neuquén., BUENOS AIRES, Argentina, 8Policonsultorios El Alba., CORRIENTES, Argentina, 9Centro Médico Odontológico del Abasto, TUCUMAN, Argentina
Objectives and Study: Colic and constipation are common functional gastrointestinal disorders (FGIDs) in infants, which may lead to a reduced quality of life (QoL) of infants and their families as these conditions may cause persistent infant discomfort and family distress. This study aimed to evaluate the change in QoL of infants and their families during intervention with a formula containing partially hydrolyzed whey proteins, prebiotic short‐chain galacto‐ oligosaccharides and long‐chain fructo‐oligosaccharides (scGOS/lcFOS 9:1) and high b‐palmitic acid content.
Methods: A prospective multicenter 1‐month study in a real world setting with a before‐after design was conducted. Full‐term infants aged 0‐3 months with FGIDs (colic and constipation), according to physician's criteria, were included after formula prescription and parental consent. The primary outcome was to assess the infant's QoL (PedsQLTM 1.0 Infant Parent Report) and its weekly progression, along with the family impact (PedsQLTM 2.0 Family Impact). Secondary outcomes included gastrointestinal symptoms (IGSQ‐13 at baseline and after 1 month), anthropometric measurements and formula acceptability.
Results: A total of 102 infants were recruited, with 25 excluded due to incomplete data or dropout. On day 30, infant QoL and family impact scores showed significant improvement, with a positive and significant change already evident by day 7 (Figure 1). A progressive and significant reduction in gastrointestinal symptoms was observed after 1 month vs. baseline (p < 0.001). Difficulty in defecation (≥4 times/week) decreased from 24% to 1%, milk regurgitation (≥4 times/week) decreased from 27% to 5%, gas‐related discomfort occurring "always" or "almost always" decreased from 73% to 7% and daily crying time (≥1 hour) decreased from 47% to 7%. The formula demonstrated high acceptability.
Conclusions: From the first week of nutritional intervention with the formula, infant and family QoL improved significantly, with sustained benefits during the observational period. Gastrointestinal symptoms significantly decreased, and the formula was well tolerated.
Contact e‐mail address: mabucarosella@gmail.com
N‐EP022. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EP022.1. POTENTIAL ROLE OF ADVANCED GLYCATION END‐PRODUCTS IN PEDIATRIC EOSINOPHILIC ESOPHAGITIS
Serena Coppola 1, Arianna Minieri1, Alessandra Agizza1, Maria Belliotti1, Laura Carucci1, Alessandra Ripa1, Greta Aquilone1, Letizia Ciliberti1, Roberto Berni Canani2
1Department Of Translational Medical Science, University of Naples Federico II, Naples, Italy, 2Department of Translational Medical Science and Immuno Nutrition Lab of the CEINGE Advanced Biotechnologies Research Center and Task Force on Microbiome Studies and European Laboratory for the Investigation of Food‐Induced Diseases at the University of Na, Namples, Italy
Objectives and Study: Eosinophilic esophagitis (EoE) is one of the most prevalent non‐communicable chronic inflammatory pediatric GI disorders. Emerging evidence suggest a potential role for ultraprocessed foods (UPFs) in facilitating the occurrence of chronic non‐communicable disorders. Advanced glycation end‐products (AGEs), main detrimental compounds in UPFs, could be involved in the EoE pathogenesis. In this study we investigated the potential association between dietary AGEs intake and pediatric EoE.
Methods: We comparatively evaluated the intake of the three major dietary AGEs [Nε‐(carboxymethyl)lysine (CML), Nε‐(1‐carboxyethyl)lysine (CEL) and Nδ‐(5‐hydro‐5‐methyl‐4‐imidazolon‐2‐yl)‐ornithine (MG‐H1)] in EoE pediatric patients vs sex‐ and age‐matched healthy controls with a 1:2 ratio. Furthermore, daily proportion (%) of UPFs in the total weight of food and beverages consumed (g/day) and energy (kcal) deriving from UPFs were also analyzed.
Results: A total of 30 children were enrolled: 10 EoE patients (80% male, mean age 12.7 years ± 4.5 SD) and 20 healthy controls (80% male, mean age 11.2 yrs ± 5.1 SD). A higher consumption of the three AGEs was observed in EoE patients vs controls [CML: 3.0 mg (95%CI 2.6‐4.1) vs. 2.5 mg (95%CI 1.9‐3.2), p = 0.04; CEL: 1.9 (95%CI 1.1‐3.8) vs. 1.5 mg (95%CI 0.9‐2.6), p = 0.13; MG.H1: 20.6 mg (95%CI 13.8‐21.5) vs. 13.1 mg (95%CI 9.7‐17.3), p = 0.05]. Furthermore, we observed a trend toward higher daily dietary intake of UPFs patients than healthy controls.
Conclusions: Results from this study support a potential role for dietary AGEs exposure in facilitating the occurrence of pediatric EoE. Additional analyses with a larger sample size are ongoing to confirm our findings.
Contact e‐mail address: serena.coppola3@unina.it
N‐EP023. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EP023.1. PERFORMANCE OF QUICK, POINT OF CARE KITS TO DETECT GLUTEN IMMUNOGENIC PEPTIDE IN FAECES AND URINE
Konstantinos Gkikas 1, Laura Gianolio2, Caroline Kerbiriou1, Miles Kavanaugh1, Maria Lima1, Vaios Svolos1, Richard Hansen3, Richard Russell4, Konstantinos Gerasimidis1
1School Of Medicine, University of Glasgow, Glasgow, United Kingdom, 2Pediatrics, Vittore Buzzi Hospital, Milan, Italy, 3Department Of Child Health, University of Dundee, Dundee, United Kingdom, 4Department Of Paediatric Gastroenterology And Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
Objectives and Study: Detection of gluten immunogenic peptides (GIP) serves as an objective compliance biomarker to gluten‐free diet (GFD). However, current methods (ELISA) require stool collection, specialised laboratories and involve considerable turnaround time and analytical cost. We evaluated novel point‐of‐care (POC) kits for GIP detection in faeces and urine.
Methods: After completing a naturally GFD, [exclusive enteral nutrition (EEN)], ten children with Crohn's disease followed an additional 3‐week GFD. 95 serial faecal and urine samples were collected (i.e. before EEN completion, at six timepoints during GFD, and 10 days after return to unrestricted diet). Single stool and urine samples were collected from 17 healthy adults, following seven days of EEN. GIP in stool was measured using the reference method (Stool ELISA), a POC method (Stool POC) and in urine using lateral flow tests (Urine LFT). Agreement between methods to detect GIP was assessed using kappa statistics. Receiver operating characteristic (ROC) curve analysis was performed to determine detection thresholds for GIP in Stool POC and Urine LFT kits.
Results: Substantial inter‐class agreement was noted between the ELISA and POC stool kits (sample concordance:88%, kappa=0.74 [0.1]). The optimal concentration for detection of GIP using the stool POC was >0.11 μg/g (sensitivity:100%, specificity:91%) (Figure1). This cut‐off was only slightly higher than the detection limit of Stool ELISA; 0.078 μg/g. In contrast, lower agreement was shown between urine LFT and Stool ELISA (sample concordance:73%, kappa=0.39 [0.1]). ROC curve analysis produced a sensitivity of 69% and specificity of 75%. Non‐adherence to GFD was detected in samples of 8/10 patients using Stool ELISA, compared to 2/10 using conventional dietary assessment methods. Results were similar between paediatric patients and healthy adults.
Conclusions: A POC kit is a suitable alternative to ELISA for stool GIP detection, demonstrating high sensitivity and specificity except for marginally low GIP concentration. However, detection of GIP in urine is less accurate.
Contact e‐mail address: konstantinos.gkikas@glasgow.ac.uk
N‐EP024. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EP024.1. ASSESSMENT OF ENERGY EXPENDITURE MEASURED WITH INDIRECT CALORIMETRY IN CHILDREN WITH SEPSIS DURING RECOVERY PERIOD
Vigunya Taranajetda 1, Natthida Asawasudsakorn2, Lalida Kongkiattikul2, Kritsaporn Sujjavorakul3, Sirinuch Chomtho4
1Division Of Nutrition, Department Of Pediatrics, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand, 2Division Of Pulmonary Disease And Pulmonary Critical Care, Department Of Pediatrics, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand, 3Critical Care Excellence Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand, 4Center Of Excellence In Pediatric Nutrition, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Objectives and Study: Resting energy expenditures (REE) in septic children could vary through stages of illness. Studies regarding longitudinal changes in REE measured using the gold‐standard indirect calorimetry (IC) in pediatric septic patients remain scarce. Primary objective is to assess the change in REE in septic children. Secondary objectives are to compare measured REE (mREE) vs. predicted REE (pREE) calculated by Schofield equation, as well as to compare them with prescribed vs. actual energy intake.
Methods: Patients aged 1‐15 years old, diagnosed with sepsis were enrolled from the pediatric intensive care unit from June 2023‐May 2024. MREE was measured with IC at 2,48,72 hours, and 7 days after resuscitation. The pREE was calculated from the Schofield equation. The prescribed and actual energy intake was recorded on the same measurement date.
Results: Eighteen patients with a median (IQR) age of 9(5.5‐12.5) years old participated. Two‐thirds were male(66.7%). The median (IQR) BMI z‐score was ‐0.57(‐0.99‐1.45). The most common source of infection was the respiratory system(44.4%). The mean (SD) of mREE at 2,48,72 hours, and 7 days were 40.9( ± 14.5), 38.3( ± 18.3), 41.5( ± 15.8), and 47.3( ± 16.4) kcal/kg/day, accordingly. However, repeated measure ANOVA showed no significant difference in the trend (p = 0.19). The mean (SD) of predicted REE was 42.5( ± 13.07) kcal/kg/day. There was variability of the difference between mREE vs pREE over the 7‐days. Prescribed energy and actual energy intake at 2 hr were significantly lower than mREE [mean difference (95%CI) are 28(19.7‐36.4) and 29.1(20.9‐37.3) kcal/kg/day, respectively]. The energy intake increased and approached the mREE at 48 hours.
Conclusions: Despite minimal changes in the measured REE during sepsis and its recovery period, an upward trend was observed on the 7th day. Further research into REE changes beyond the first week is warranted. The common practice of prescribing low energy intake during the initial 48 hours may contribute to the risk of malnutrition.
Contact e‐mail address: vigunya.t@gmail.com
N‐EP025. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EP025.1. MONITORING MUAC REFLECTS THE ADEQUACY OF NUTRITIONAL SUPPORT IN CRITICALLY ILL CHILDREN WITH A LONGER INTENSIVE CARE UNIT STAY: A SINGLE‐CENTER PROSPECTIVE COHORT STUDY
Zhang Yue, Yi Feng
Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
Objectives and Study: Critically ill children often suffer from inadequate nutrition leading to body composition changes. We studied the nutritional status and body composition changes in children with prolonged Pediatric Intensive Care Unit (PICU) stay using mid‐upper arm circumference (MUAC) and triceps skinfold thickness (TSF) measurements.
Methods: A single‐center prospective cohort study tracked nutritional support for children hospitalized in the PICU for more than six days. MUAC and TSF measurements were taken at admission and every other day up to the 15th day of the PICU stay. As the target energy for this study, basic energy expenditure was calculated using the Schofield formula without applying stress correction. A recommended protein intake was 1.5 g/(kg·d). Factors affecting changes in anthropometry were analyzed using pairwise correlation and regression analysis.
Results: A total of sixty children with a median PICU stay of 9 days were included. MUAC decreased by 2.53% in one week and by 7.42% in two weeks. During the first week in PICU, the average energy and protein intakes were only 53.0% and 41.3% of the recommended intakes, respectively. The decline in MUAC was associated with mean cumulative energy deficits (1 week: r = 0.310, P = 0.016; 2 weeks: r = 0.504, P = 0.023) and mean cumulative protein deficits (1 week: r = 0.304, P = 0.018).
Conclusions: Not all children with a longer PICU stay achieved energy and protein recommendations. MUAC decreasing was associated with energy and protein deficits. Monitoring MUAC is a suitable method for evaluating the adequacy of nutritional support in children with a longer PICU stay.
Contact e‐mail address:
N‐EP026. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EP026.1. GENETIC AND ENVIRONMENTAL CONTROL OF FAMILIAL LOW BMI: INSIGHTS FROM A REVIEW OF POPULATION‐BASED STUDIES
Fawzia Alyafei1, Khadija Khudabakhsh 2, Sohair Elsiddig3, Saleha Abbasi2, Ahmed Elawwa1, Nada Alaaraj1, Noor Hamed1, Shayma Mohammed1, Ashraf Soliman1
1Pediatrics, Hamad Medical Corporation, Doha, Qatar, 2Sidra Medicine, Doha, Qatar, 3Paediatrics, Hamad Medical Corporation, Doha, Qatar
Objectives and Study: Familial low BMI, marked by a tendency for leanness within families, is a multifaceted trait shaped by genetic and environmental factors. Although underweight is less studied than obesity, its investigation is critical due to associated health risks, including compromised immunity and poor reproductive outcomes. Heritability estimates as high as 90% underscore a strong genetic component, while environmental factors such as socioeconomic status, diet, and physical activity significantly influence BMI.
Methods: This review synthesizes findings from 17 studies examining genetic and environmental factors in BMI, with a focus on familial low BMI. Data from twin studies, genome‐wide association studies (GWAS), and gene‐environment interaction analyses were reviewed, encompassing cohorts ranging from small samples to studies with up to 50,000 participants.
Results: Genetic Influence: Twin and family studies estimate BMI heritability at 50‐90%. Genes such as TRHR, HTR2C, Gremlin1, and loci on 16p11.2 are consistently linked to leanness. Familial clustering of low BMI is confirmed through excess relatedness analysis. Environmental Interactions: Gene‐environment interactions are pivotal, with dietary factors, physical activity, and socioeconomic conditions modulating genetic predispositions. Early‐life nutrition and lifestyle factors particularly influence BMI during childhood. Health Risks: Maternal underweight is tied to adverse pregnancy outcomes, while childhood underweight increases long‐term health risks, emphasizing the need to distinguish genetic from modifiable influences.
Conclusions: Discussion and Conclusion:
Familial low BMI arises from a dynamic interplay between genetic and environmental factors. Genes like Gremlin1 regulate lean mass, and polymorphisms in neurotransmitter‐related genes (HTR2C, 5HTT) affect BMI. Environmental exposures significantly modulate genetic predispositions. Identifying these interactions can inform targeted interventions to mitigate underweight‐related health risks, warranting further research into underlying mechanisms.
Contact e‐mail address:
N‐EP027. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EP027.1. IMPLICATIONS OF FORTIFYING VEGETABLE OILS WITH VITAMINS A AND D FOR NUTRITIONAL HEALTH: A SYSTEMATIC REVIEW
Éva Szabó1, Ildikó Csölle2, Regina Felső2, Daniela Kuellenberg De Gaudry2, Tamás Ferenci3, Szimonetta Lohner 2
1Department Of Biochemistry And Medical Chemistry, University of Pécs, Medical School, Pécs, Hungary, 2Cochrane Hungary, University of Pécs, Pécs, Hungary, 3Óbuda University, Budapest, Hungary
Objectives and Study: This systematic review evaluates the effectiveness and safety of vitamin A and/or D‐fortified edible vegetable oils and fats in improving vitamin intake and addressing deficiencies in the general population.
Methods: In November 2022, we searched MEDLINE, Cochrane CENTRAL, Scopus, Global Index Medicus, ClinicalTrials.gov, and WHO ICTRP for randomized controlled trials (RCT) and non‐randomized studies of interventions (NRSI) that compared vitamin‐fortified oils with non‐fortified counterparts. We combined data using a random effects model. We used Mantel–Haenszel weighting for dichotomous outcomes and inverse variance for continuous outcomes. We assessed methodological quality using Cochrane's risk of bias tool 2.0 for RCTs and the ROBINS‐I tool for NRSIs. We followed the GRADE approach to rate the certainty of evidence.
Results: Available evidence showed no significant effect of fortification with vitamin A on serum retinol levels (RCTs: MD 0.35 µmol/L, 95% CI ‐0.43 to 1.12; two trials; 514 participants; low‐certainty evidence; NRSIs: MD 0.31 µmol/L, 95% CI ‐0.18 to 0.80; two trials; 205 participants; very low‐certainty evidence) and on subclinical vitamin A deficiency. Low‐certainty evidence showed no effect of vitamin D fortification on serum 25‐hydroxy vitamin D concentration (MD 6.59 nmol/L, 95% CI ‐6.89 to 20.07; one trial; 62 participants).
Conclusions: The limitations of this systematic review include investigating several prespecified outcomes in few trials or the absence of data. This systematic review indicates that the fortification of vegetable oils and fats with vitamins A and D may have limited effectiveness in improving serum levels within the general population, primarily related to the doses used in the trials. Specifically, vitamin A fortification showed little to no impact on serum retinol levels, suggesting that the dosages tested may be insufficient to adequately address subclinical deficiencies. Similarly, the vitamin D fortification did not significantly affect serum 25‐hydroxy vitamin D concentrations.
Contact e‐mail address: lohner.szimonetta@pte.hu
N‐EP028. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EP028.1. EFFECT OF ORAL NUTRITIONAL SUPPLEMENTS ADMINISTRATION ON THE MANAGEMENT OF CHILDREN WITH PICKY EATING AND UNDERWEIGHT: A SYSTEMATIC REVIEW AND META‐ANALYSIS
Agata Stróżyk, Julia Iwańska, Łukasz Pskit, Andrea Horvath, Sonia Statuch, Hania Szajewska
Department Of Paediatrics, Medical University of Warsaw, Warsaw, Poland
Objectives and Study: Feeding difficulties, including picky eating and avoidant/restrictive food intake disorder (ARFID), are common in children. Oral nutritional supplements (ONS) are specialized high‐calorie, nutrient‐rich products used to help improve growth outcomes in children with feeding difficulties. This systematic review aims to evaluate the efficacy and safety of ONS in managing children with ARFID and/or picky eating alongside dietetic consultation (DC).
Methods: We systematically searched CENTRAL, MEDLINE, and EMBASE from 2000 to March 2024 for randomized controlled trials (RCTs) that compared the use of ONS (regardless of type and dosage) to any comparator in children of any age with ARFID or picky eating. The primary outcome was growth (reported using any measures) during the intervention.
Results: We summarized 5 RCTs involving 874 randomised children with picky eating and underweight. All RCTs assessed the use of ONS with DC compared to DC only. In three RCTs, there was an increase in weight, weight‐for‐height and weight‐for‐age in the ONS + DC group compared to the control group. Inconsistencies were noted with regard to height and BMI. Adverse events were reported in all RCTs, with no difference found between groups at 90 days (meta‐analysis of three RCTs; relative risk [RR] = 0.92, 95% confidence interval [CI], 0.71 to 1.20, I2 = 17%, n = 573) and at 180 days (1 RCT; RR = 1.16, 95% Cl 0.85 to 1.59, n = 35) in the ONS + DC group compared to the control group. Fewer children with upper respiratory tract infections were found in the ONS + DC group compared to the DC only group in a meta‐analysis of two RCTs (RR = 0.62, 95% Cl, 0.42 to 0.91, n = 359, I2 = 0%; NNH = 10.4).
Conclusions: This systematic review provides moderate evidence supporting the combined use of ONS and DC in managing picky eating and underweight in children.
Contact e‐mail address: agata.strozyk@wum.edu.pl
N‐EP029. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EP029.1. IMPACT OF ORAL NUTRITIONAL SUPPLEMENT ON GROWTH AND APPETITE HORMONES IN MALNUTRITON AT RISK AND MALNOURISHED CHILDREN: MARVEL STUDY, A RANDOMIZED CONTROLLED TRIAL
Orapa Suteerojntrakool 1, Patcharapa Thaweekul2, Suchaorn Saengnipanthkul3, Kamolmart Wannaphahoon2, Eakkarin Mekangkul4, Nathawan Khunsri1, Sirinuch Chomtho1
1Center Of Excellence In Pediatric Nutrition, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 2Department Of Pediatrics, Faculty Of Medicine, Thammasat University, Pathum Thani, Thailand, 3Department Of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 4Department Of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
Objectives and Study: Undernutrition in early childhood has a long‐lasting effect on growth and development. Few studies investigated the effect of both macro/micronutrient supplementation on changes in hormone regulation. We aimed to study the effects of oral nutritional supplements (ONS) on changes in growth and appetite hormones in these children.
Methods: Children aged 1‐6 years with weight‐for‐height (WFH) z‐score between ‐1SD and ‐3SD (WHO growth standards) were randomly assigned to either receive nutritional counseling (control group) or receive the same counseling plus ONS (1 kcal/mL, 420 mL/day) for 3 months. Weight, height, and body composition (via bioelectrical impedance analysis) were assessed at baseline, 1 and 3 months. Ghrelin, leptin, peptide YY(PYY), and insulin were measured by Luminex; IGF‐1 and IGF BP3 were measured by ELISA pre‐and post‐intervention.
Results: A total of 159 children (58% boys; 78 control and 81 ONS) with median (IQR) ages of 3.5(2.1‐4.9) and 3.3(2‐4.8) years were recruited. After three months, the ONS group showed greater increases in weight, height, weight‐for‐age z‐score(WFA), and fat‐free mass(FFM) than the control group [mean difference(95% CI):weight 0.16(0.04–0.28)kg, height 0.42(0.05–0.79)cm, WFA 0.1(0.01–0.18), FFM 0.36(0.1–0.63)kg]. There was no significant between‐group difference in any of the hormones. However, PYY and insulin significantly increased in the ONS group [mean difference(95%CI): PYY 19.4(6.1‐ 32.8) pg/mL, insulin 112(47.7‐174.1) pg/mL] whereas only PYY increased in the control group [mean difference (95%CI) 18.6(5.8 to 31.4) pg/mL]. The changes in WFA positively correlated with the changes in IGF‐1, IGFBP‐3 and leptin (IGF‐1: r 0.207, p 0.018; IGFBP‐3: r 0.197, p 0.024; leptin: r 0.270, p 0.004).
Conclusions: ONS improved growth and FFM in undernourished children. No significant difference in growth and appetite hormones were observed between the groups. Future research should explore the long‐term effect of ONS on these hormonal regulations and subsequent eating behavior. TCTR 20220908004.
Contact e‐mail address: orapa.s@chula.ac.th
N‐EP030. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EP030.1. HIGH PREVALENCE OF EATING DISORDERS IN PRETERM CHILDREN
Stefano Pellicani1, Valentina Rizzo1, Mariapaola Mazzarelli2, Chiara Seletti2, Francesca Pennetta3, Antonio Di Lorenzo4, Nicola Laforgia1, Maria Elisabetta Baldassarre 1
1Section of Neonatology and NICU, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy., Bari, Italy, 2Dipartimento Biscienze, Scienze della Nutrizione per la Salute Umana, Università degli Studi di Bari «Aldo Moro», Bari, Italia., bari, Italy, 3DiMePRe‐J‐Department of Precision and Rigenerative Medicine‐Jonic Area, University of Bari "Aldo Moro", 70100 Bari, Italy., bari, Italy, 4DiMePRe‐J‐Department of Precision and R University of Bari "Aldo Moro", 70100 Bari, Italy., Bari, Italy
Objectives and Study: Eating disorders (EDs), characterized by significant deviations from age‐ and context‐appropriate eating habits, frequently emerge during adolescence. In Western countries, prevalence rates range from 5.5–17.9% in females and 0.6–2.4% in males. Feeding difficulties are commonly observed among preterm neonates, often resulting in extended neonatal intensive care unit (NICU) stays and persisting as feeding challenges throughout early childhood. This study aimed to investigate the correlation between preterm birth and the development of EDs.
Methods: A total of 116 former preterm patients aged 0‐7 years were enrolled, divided into two cohorts: 84 children aged 0–3 years and 32 children aged 4–7 years. Clinical data (e.g., gestational age, birth weight, nasogastric tube (NGT) feeding duration, etc.) were extracted from medical records. Enrollment involved an initial telephone contact, followed by consent form completion. Parents completed an “Eating Disorders Questionnaire in Childhood” (EDQ‐C).
Results: Mean birth weight was 1835.04 g (± 649.56 g) and 1887.34 g (± 703.83 g) in 0–3 years and 4–7 years cohort, respectively. While mean gestational age was 32.04 weeks (± 2.79 weeks) and 32.12 weeks (± 3.47 weeks) in 0–3 years and 4–7 years cohort, respectively. Moreover, NGT feeding was employed in 53.57% of neonates for an average of 22.01 days (± 24.87 days), and in 53.12% of children for an average of 14.28 days in 0–3 years and 4–7 years cohort, respectively. Finally, by three years of age, 72.62% of children in the younger cohort had developed one or more EDs, whilst 71.88% of the older cohort (23 out of 32) developed one or more EDs.
Conclusions: These findings show a high ED prevalence in both age groups suggesting that conditions associated with preterm birth may play a role in the development of EDs, particularly in early childhood.
Contact e‐mail address: stefano.pellicani@gmail.com
N‐EP031. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EP031.1. HUMAN MILK‐ VS. COW MILK‐DERIVED FORTIFICATION AND NECROTIZING ENTEROCOLITIS IN VERY LOW BIRTHWEIGHT INFANTS: STATE OF EVIDENCE AND SYSTEMATIC REVIEW WITH META‐ANALYSIS
Jenelle Ferry 1, Sarah Reyes2, Tristen Paul2
1Pediatrix Medical Group of Tampa, Tampa, United States of America, 2Rev Bioscience, Boise, United States of America
Objectives and Study: Human milk is associated with reduced risk of NEC in VLBW infants. Evidence regarding effectiveness of human milk‐derived fortifiers in preventing NEC remains mixed. We aimed to systematically evaluate the effects of an exclusive human milk diet (EHMD) utilizing human milk‐derived fortifiers versus a cow milk‐derived (CMD) diet utilizing cow milk‐derived fortifiers on medical and surgical necrotizing enterocolitis in VLBW infants
Methods: Review and meta‐analysis was conducted following PRISMA guidelines and registered on OSF; trials assessed for risk of bias. Included any RCT or observational cohort study that investigated EHMD vs CMD and NEC in premature infants <1250 grams. Control group received cow milk‐derived fortifiers or formula, and CMD was further divided into those with and without use of formula (CMD+f, CMD‐f); CMD‐f received a base diet of human milk with cow milk‐derived fortifiers. Primary outcomes were medical and surgical NEC.
Results:
Six RCTs and 16 observational cohort studies were included, totalling 7,081 infants. 3,258 received the EHMD of human milk with added vat‐pasteurized human‐derived fortifier. 3,823 received CMD. Birthweights were 796 to 1361 grams with GA 25.5 to 29.8 weeks. Head‐to‐head comparison of human milk‐ versus cow milk‐derived fortifiers was evaluated in the EHMD vs CMD‐f groups. 13 studies reported any medical NEC; 11 reported Bells Stage >2 (3 RCTs, 8 observational). EHMD was associated with 38% reduction in any medical NEC and 31% reduction in Bells Stage >2. 6 studies reported surgical NEC (2 RCTs, 4 observational). EHMD was associated with 50% reduction in surgical NEC. A similar effect was seen for RCTs and observational studies for all comparisons.
Conclusions: Use of human‐derived fortifiers significantly reduced medical and surgical NEC compared to cow milk‐derived fortifiers. Effect was similar across study types despite different p‐values, likely reflecting different sample sizes. Evaluating all studies is necessary to determine outcomes for this rare disease.
Contact e‐mail address: jenelle.ferry@pediatrix.com
N‐EP032. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EP032.1. BODY COMPOSITION AT 2 YEARS OF AGE IN MODERATE AND LATE PRETERM INFANTS
Anne Lafeber 1, Mark Bosch1, Nicole Van Veenendaal2, Cornelieke Aarnoudse ‐ Moens3, Johannes Van Goudoever3, Femke De Groof1
1Pediatrics And Neonatology, North West Clinics, Alkmaar, Netherlands, 2Emma Children's Hospital Department Of Pediatrics, Amsterdam UMC, Amsterdam, Netherlands, 3Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, Netherlands
Objectives and Study: Higher fat mass is associated with metabolic and cardiac diseases, and with the increasing prevalence of childhood obesity and diabetes, studies on body composition are more important than ever. However, data on body composition in moderate and late preterm infants (MLPTI, gestational age 32 0/7 – 36 6/7 weeks) is scarce and mostly only determined in the first few months of life. This study aimed to determine the body composition of MLPTI at two years corrected age for prematurity (CA) and to compare this with literature on body composition at 2 years CA.
Methods: In this single‐center prospective cohort study, we included MLPTI born between January 2016 and July 2018. At 2 years CA, body composition was determined using deuterium‐labeled water. We compared our data to literature of term‐born infants, very preterm term infants (gestational age <32 0/7 weeks) and MLPTI.
Results: A total of 80 MLPTI were included. At 2 years CA, MLPTI had a fat mass percentage of 25.18% and a lean body mass percentage of 74.66%. There were no significant differences in body composition between moderate preterm infants (gestational age 32 0/7 weeks – 33 6/7 weeks) and late preterm infants (gestational age 34 6/7 weeks and 36 6/7 weeks).
Conclusions: MLPTI have a higher fat mass percentage compared to literature on term‐born infants. Depending on the measuring method, fat mass percentage in MLPTI varies between 6% higher to +2 SD. There are no other studies on body composition in MLPTI at 2 years CA and data for very preterm infants at 2 years CA is scarce. This study highlights the importance of more research on body composition in MLPTI and its associated factors, as well as the need for consensus on the most favorable method for estimating body composition.
Contact e‐mail address: ah.lafeber@nwz.nl
N‐EP033. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EP033.1. NON‐NECROTISING ENTEROCOLITIS BLOODY STOOLS IN THE NEONATAL INTENSIVE CARE UNIT: A JOINT NEONATOLOGIST‐GASTROENTEROLOGIST ALGORITHM FOR DIAGNOSIS AND MANAGEMENT OF AN EMERGING CLINICAL PICTURE
Francesco Morotti 1, Lucia Fiore1,2, Ilaria Scavone1,2, Anna Brunelli1,2, Vera Cutuli1,2, Maurizio Fuoti3, Ilaria Rochira3, Roberto Marzollo1, Alessandra Codega1, Salvatore Aversa1, Francesco Risso1
1Neonatology And Neonatal Intensive Care Unit, Spedali Civili Hospital, Brescia, Italy, 2Pediatrics Clinic, ASST Spedali Civili di Brescia, Brescia, Italy, 3University Department Of Pediatrics, Children's Hospital, Spedali Civili, Pediatric Gastroenterology and Endoscopy Unit, Brescia, Italy
Objectives and Study: Rectal bleeding is an ominous sign in newborns, as it may represent an early sign of necrotising enterocolitis (NEC), a high‐morbidity and mortality neonatal disease. Nevertheless, rectal bleeding might present in less compelling diseases, such as those related to food protein allergy. A thorough differential diagnosis workup is pivotal. In recent years, we observed a substantial increase in rectal bleeding despite the stability of NEC cases. We analysed our cohort to find predictors of non‐NEC episodes and created a literature‐based algorithm for diagnosis and management.
Methods: In 2023, we enrolled newborn inpatients with rectal bleeding. We compared prenatal and postnatal elements, feeding regimes, bleeding episodes, and management features between NEC and non‐NEC episodes. A mixed team of neonatologists and gastroenterologists created a management algorithm based on available literature.
Results: In 2023, we observed 42 (8,7% of all inpatients) cases. NEC was diagnosed in 8 (19%). Other identifiable causes were present in 3 (norovirus, maternal blood ingestion, anal fissure). In the remaining 31 (74%) patients, all bleeding resolved after trial intervention with amino acid‐based formula. Relapse after previous feeding resumption was observed in 15 (35%) cases diagnosed as food protein allergy‐related proctocolitis. The remaining 16 (38%) were classified as indeterminate colitis. Despite a slightly lower birth gestational age (week 30 [26‐35] vs 32 [28‐35]) and earlier onset of first manifestation (day of life 15 [10‐36] vs 22 [9‐44]) in NEC patients, no differences in risk factors or previous feeding regimen were observed between the groups. Substantial variability was found in the initial management of non‐NEC patients.
Conclusions: Non‐NEC rectal bleeding is a growing clinical problem at our centre. Research is needed to identify elements for early differential diagnosis. The development of an algorithm is intended as a step toward a standardised approach, which could optimise patient management and make data collection more consistent.
Contact e‐mail address: fmorotti90@gmai.com
N‐EP034. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EP034.1. ABSORPTION OF BOVINE MILK‐DERIVED EXTRACELLULAR VESICLES IN ISOLATED GUT SECTIONS IN A NEONATAL PIGLET MODEL
Thomas Thymann 1, Stanislava Pankratova1, Christian Juul2, Jan Rasmussen2, Kristine Holgersen1, Simone Offersen1, Kristine Blans3, Kasper Lauridsen3, Jørgen Kjems2
1Dept. Of Veterinary And Animal Science, University Of Copenhagen, Frederiksberg C, Denmark, 2Aarhus University, Aarhus, Denmark, 3Arla Foods Ingredients, Viby J, Denmark
Objectives and Study: Relative to infant formula, breast milk associates with better gut development and protection against enteric disease. This may partly relate to bioactive components in breast milk such as extracellular vesicles (EVs) and their cargo of microRNA (miRNA). Industrial processing of bovine milk‐derived ingredients used in infant formula may result in a limited content of EVs and miRNA in the final product. Moreover, little is known about capacity for intestinal absorption of bovine milk‐derived EV's in a neonatal intestine. Our specific objective was therefore to qualitatively assess intestinal absorption of fluorescently labeled EVs in a neonatal piglet surgical model.
Methods: Neonatal piglets (n = 3) were anesthetized and catheterized in the umbilical artery for monitoring of blood pressure and blood gases. Likewise, an umbilical venous catheter was used for continues infusion of anesthetics and analgesics. Oxygenation was secured with a mechanical ventilator. The small intestine was exposed through a midline laparotomy, and we established up to 10 isolated sections of each 4 cm, distributed from the proximal to the distal end of the small intestine. Each section was injected with fluorescently labeled EVs or placebo. Tissues were collected from 30 min to 180 min after injection, and assessed qualitatively using immunohistochemistry and fluorescence microscopy.
Results: Procedures for catheterization, intubation, ventilation and surgical establishment of ligated isolated intestinal sections were established. The isolated gut sections appeared well perfused, and no histopathological changes were observed. indicatory of EV absorption, we did observe fluorescent material in both lamina epithelialis and lamina propria, particularly after 180 min. Further studies are planned to determine the influence of isolated milk EV fractions on the gut mucosal cell transcriptome.
Conclusions: The neonatal piglet model with isolated gut sections is feasible and can be instrumental for assessment of qualitative absorption in situ of labeled compounds like extracellular vesicles.
Contact e‐mail address: thomas.thymann@sund.ku.dk
N‐EP035. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EP035.1. ROLE OF MATERNAL PRE‐GESTATIONAL WEIGHT AND GESTATIONAL CRP EVOLUTION PATTERN ON THE OFFSPRING BRAIN MORPHOLOGY AT 6.5 YEARS OLD: THE PREOBE FOLLOW‐UP STUDY
Lucía Pérez‐Rodero1, Ana Nieto‐Ruiz2, Hatim Azaryah3, José Antonio García‐Santos1, Mireia Escudero‐Marín1, Rocío Bonillo‐León1, Andrés Catena4, Cristina Campoy 5
1EURISTIKOS Excellence Centre for Pediatric Research, Granada, Spain, 2Department Of Methodology And Behavior Treatment, University of Granada, Granada, Spain, 3IBS‐Granada‐Instituto de Investigación Biosanitaria, Granada, Spain, 4Experimental Psychology, University of Granada, Granada, Spain, 5Department Of Pediatrics. School Of Medicine, University of Granada, Granada, Spain
Objectives and Study: CRP increases at the beginning of pregnancy related to placentation and in overweight/obese mothers, and decreases progressively till delivery. We aimed to analyze the effects of the evolution of gestational CRP on children‐brain morphology.
Methods: 84 mother‐children pairs participating in the PREOBE study (ClinicalTrials.gov ID:NCT0163446), normal weight (NW) (n = 45) and overweight/obese (OW/OB) (n = 39) were considered in the present study. CRP evolution was evaluated at gestational weeks 24‐34, 34‐40 and 24‐40. Brain imaging data was obtained by MRI at 6.5 years old by FreeSurfer Software and analyses with vertex wise and QDECR (Quantitative Data Extraction and Conditional regression).
Results: In the OW/OB group CRP decreases from weeks 24‐34 and resulted negatively associated with the left precuneus thickness [‐0.024, 76.54%], and positively to the right‐pericalcarine volume [0.051, 97.07%]. In NW group, CRP decline between 24‐40 weeks of pregnancy and was positively correlated with the left insula thickness [0.027, 100%] and the right‐frontal volume [0.046, lateralorbitofrontal‐100%] in the offspring at 6.5 yrs. In addition, in OB/OW group, CRP decrement from 24‐40 weeks, exhibited negative associations with the precuneus and frontal left‐thicknesses [‐0.021, precuneus (79.17%); ‐0.018, rostralmiddlefrontal (100%)]; and with the right‐frontal and left‐parietal volumes [‐0.060, superiorfrontal (100%); ‐0.031, inferiorparietal (92.22%)]. Finally, in the NW group, CRP decrement from 34‐40 weeks of pregnancy was positively associated with the right‐frontal and left‐precuneus volumes [0.136, caudalmiddlefrontal (97.49%); 0.100, precuneus (100%); and areas [0.031, caudalmiddlefrontal (90.88%); 0.027, precuneus (98.35%)].
Conclusions: Pre‐pregnancy BMI determines CRP levels and its decline till delivery is associated with offspring brain morphology. Some volumes and areas (i.e. precuneus & frontal lobe) are associated with maternal inflammatory profile differently by groups, which could affect the development of higher cognitive functions, such as decision making or other important executive functions. Funding: Andalusian Government, Economy, Science & Innovation Ministry (PREOBE Excellence Project‐P06‐CTS‐02341) and DynaHEALTH H2020 EU Project, GA nº:63359511
Contact e‐mail address: ccampoy@ugr.es
N‐EP036. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EP036.1. LONG‐TERM EFFECTS OF FISH OIL AND/OR 5‐METHYLTETRAHYDROFOLATE SUPPLEMENTATION DURING PREGNANCY ON THE BEHAVIOR OF THE OFFSPRING DURING CHILDHOOD: THE NUTHEAL STUDY
Natalia Toloza1, María Victoria Escolano‐Margarit1, Hatim Azaryah2, Antonio Jerez3, Miguel Pérez‐García4, Hans Demmelmair5, Tamas Decsi6, Berthold Koletzko7, Cristina Campoy 3
1Pediatrics, University Hospital San Cecilio ‐ Granada, Granada, Spain, 2IBS‐Granada‐Instituto de Investigación Biosanitaria, Granada, Spain, 3Department Of Pediatrics. School Of Medicine, University of Granada, Granada, Spain, 4Personality And Neuropsychology Treatment, University of Granada, Granada, Spain, 5Pediatrics, Ludwig‐Maximiliams University of Munchen, Munchen, Germany, 6Department Of Paediatrics, University Of Pécs, Medical School, Pécs, Hungary, 7Division Of Metabolic And Nutritional Medicine, Department Of Paediatrics, Dr. Von Hauner Children's Hospital, LMU University Hospital, Munich, Germany, Munich, Germany
Objectives and Study: Prenatal long‐chain polyunsaturated fatty acids (LC‐PUFAs) and folate supplementation has demonstrated potential benefits for neurodevelopment and for preventing autism or ADHD. However, all these results remain still inconsistent.
Methods: The current analysis included children participating in the NUHEAL Follow‐up, whose mothers were supplemented with fish oil (FO) {docosahexaenoic acid (DHA) (500 mg/day) + eicosapentaenoic acid (EPA) (150 mg/day)} and/or 5‐methyltetrahydrofolate (5‐MTHF) (400 mg/day) during pregnancy and were evaluated at 5 (n = 156) and 7.5 years old (n = 117). LC‐PUFAs in plasma and erythrocyte membrane phospholipids and total homocysteine (tHcy) were determined by GC/MS methods. Plasma folic acid was determined by microbiological assay. Behavioral disorders were evaluated by Children Behavior Checklist (CBCL). Chi‐square, one‐way ANOVA tests with Bonferroni post‐hoc corrections, and mixed model analysis was conducted.
Results: Prenatal supplementation with FO seems to have no long‐term effects on children CBCL scores. However, an age‐dependent increase of Internalising (IP), Externalising (EP) and Total Problems (TP) scores were observed; in fact, children at 7.5 years showed an increase of 10.2, 5.30 and 2.1 points in the mean of these scores respectively, compared to 5 years old. Moreover, higher levels of DHA in phosphatidyl choline (PC) in erythrocytes from cord blood and in maternal plasma phospholipids at delivery were associated with a decrease of 4.52 and 3.23 points in the mean of IP and TP scores, respectively. In addition, each unit of increase in AA/DHA ratio in erythrocyte PC in cord blood predicts a decrease of 2.32 points in the mean of the EP score.
Conclusions: These findings suggest that higher maternal DHA and AA:DHA ratio status at delivery may be associated with better behavioral development in the long‐term, which would be of interest to guide future research and personalized interventions. Funding through EU Projects: NUHEAL (FP5 BIOMED QRLT‐1999‐00888), EARNEST (FP6 FOOD‐CT‐2005‐007036) and NUTRIMENTHE (FP7, KBBE‐2007‐1‐ 212652).
Contact e‐mail address: ccampoy@ugr.es
N‐EP037. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EP037.1. SEX‐SPECIFIC EFFECTS OF CRP MATERNAL PROFILE ON BRAIN DEVELOPMENT IN HEALTHY INFANTS AT 6.5 YEARS OLD: THE PREOBE FOLLOW‐UP STUDY
Lucía Pérez‐Rodero1, Ana Nieto‐Ruiz2, Hatim Azaryah3, José Antonio García‐Santos1, Antonio Jerez4, Francisco Contreras5, Mireia Escudero‐Marín1, Rocío Bonillo‐León1, Andrés Catena6, Cristina Campoy 4
1EURISTIKOS Excellence Centre for Pediatric Research, Granada, Spain, 2Department Of Methodology And Behavior Treatment, University of Granada, Granada, Spain, 3IBS‐Granada‐Instituto de Investigación Biosanitaria, Granada, Spain, 4Department Of Pediatrics. School Of Medicine, University of Granada, Granada, Spain, 5Pediatrics, IBS‐Granada‐Instituto de Investigación Biosanitaria, Granada, Spain, 6Experimental Psychology, University of Granada, Granada, Spain
Objectives and Study: Maternal CRP levels during pregnancy has been associated to brain development in the offspring. Indeed, previous research suggests that gestational CRP acts differently in a sex‐dependent way. Current analysis is aimed to evaluate whether female and male children may exhibit different brain development based on their mothers inflammatory profile during pregnancy.
Methods: 84 mother‐children pairs participating in the PREOBE study (ClinicalTrials.gov ID: NCT0163446) were selected and classified by sex in boys (n = 42) and girls (n = 42). CRP levels decline during pregnancy was calculated between weeks 24‐34, 34‐40 and 24‐40. Children neuroimaging data was obtained by MRI at 6.5 years old processed via FreeSurfer software and vertex wise analysis and QDECR (Quantitative Data Extraction and Conditional regression) were performed.
Results: CRP decrease between weeks 24‐34 was negatively correlated with the volume of nearly the entire left postcentral gyrus [‐0.040, (94.94%)], and with the right orbitofrontal area [‐0.013, lateralorbitofrontal (75.15%)] in boys; in addition, CRP decrease from weeks 24‐40 was negatively associated with the entire area of the right superior frontal gyrus [‐0.017, superior frontal (100%)] only in boys. CRP decline between weeks 24‐40 was negatively linked to the right fusiform area in girls [‐0.028, fusiform (97.92%)]; and positively linked to the same area in boys [0.020, fusiform (71.04%)]; boys also showed a negative association with the left fusiform thickness [‐0.056, fusiform (100%)].
Conclusions: Boys showed more brain‐maternal CRP decline associations than girls, within different time frames and hemispheres. CRP decline affects commonly between sexes on the right fusiform gyrus, which could affect visual processing. CRP decline affects differently by sexes on parietal, frontal and temporal areas, which could affect higher cognitive functions, such as memory, language or executive functions. Funding: Andalusian Government, Economy, Science & Innovation Ministry (PREOBE Excellence Project‐P06‐CTS‐02341) and DynaHEALTH H2020 EU Project, GA nº:633595.
Contact e‐mail address: ccampoy@ugr.es
N‐EP038. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EP038.1. FEEDING PRACTICES, LENGTH OF STAY AND DIETETIC REVIEW FREQUENCY POST GASTROSTOMY DEVICE INSERTION
Máire Concannon 1, Clodagh Barrett2, Julie Lanigan3
1Nutrition & Dietetics, Children's Health Ireland Crumlin, Dublin, Ireland, 2School Of Agriculture And Food Science, University College Dublin, Dublin, Ireland, 3Childhood Nutrition Research, University College London, London, United Kingdom
Objectives and Study: Current guidelines recommend feed initiation 3 hours post‐percutaneous endoscopic gastrostomy (PEG)1. There are no published guidelines to inform feed initiation following open (OG) or laparoscopic gastrostomy (LG). Studies report safe feed initiation at 3 hours, regardless of surgical approach2. An audit of clinical practice in gastrostomy placement and feeding was conducted in a tertiary paediatric centre. Outcomes assessed were time to initiate and establish full feeds, length of stay (LOS) and frequency of dietetic review. Prior nasogastric‐feeding and surgical approach were evaluated to explore associations between feed initiation and progression.
Methods: Retrospective review of paediatric gastrostomy placement between January 2022 to May 2023. The audit was approved by the local ethics committee.
Results: Sixty‐two children (51.6% male) were included. Median time to initiate feeds was 7.1 hours. Time to establish feeds was 32.4 hours. Median LOS was 95.3 hours. Ninety percent (n = 56) received a dietetic review before starting feeds. Prior nasogastric‐feeding (n = 48) was associated with a shorter time to initiate (mean difference 18.7 hours, (p < .001) and establish feeding (mean difference 41.4 hours, p = .003). LG (n = 14) was associated with earlier feed initiation compared with open gastrostomy (n = 4; mean difference 38.1 hours, p < .002) and PEG (n = 44; mean difference: 4.9 hours, p < .007). Time to feed establishment was longer in OG compared with LG (mean difference: 83.4 hours, p < .008) and PEG (mean difference: 10.1 hours, p < .007).
Conclusions: Earlier initiation and LG were associated with improved feeding outcomes. Further research is required to confirm the findings. Local practice could be revised based on findings of previous research and this audit. 1. Homan, M. et al. (2021) ‘Percutaneous Endoscopic Gastrostomy in Children: An Update to the ESPGHAN Position Paper’, Journal of Pediatric Gastroenterology and Nutrition, 73(3), 415–426 2. Jensen, A.R. et al. (2018) ‘Why wait: Early Enteral feeding after Pediatric Gastrostomy Tube Placement’, Journal of Pediatric Surgery, 53(4), 656–660.
Contact e‐mail address: maire.concannon22@cuh.ie
N‐EP039. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EP039.1. TRANS FATTY ACID EXPOSURE OF CHILDREN AND YOUNG ADULTS WITH TYPE 1 DIABETES MELLITUS
Éva Szabó 1,2, Krisztina Mihályi2,3, Szimonetta Lohner2,4, Tamás Marosvölgyi2,5, Tamas Decsi2
1Department Of Biochemistry And Medical Chemistry, University of Pécs, Medical School, Pécs, Hungary, 2Department Of Paediatrics, University Of Pécs, Medical School, Pécs, Hungary, 3Department Of Emergency Medicine, Medical School, University of Pécs, Pécs, Hungary, 4Department Of Public Health Medicine, University Of Pécs, Medical School, Pécs, Hungary, 5Institute Of Bioanalysis, University Of Pécs, Medical School, Pécs, Hungary
Objectives and Study: In patients with type 1 diabetes mellitus, the results of studies on trans fatty acid (TFA) intake are controversial. The aim of the present study was to investigate the levels of TFAs in diabetic patients and healthy controls, and to investigate a possible association between TFAs and levels of polyunsaturated fatty acids.
Methods: We re‐analysed our data from three case‐control studies investigating the polyunsaturated fatty acid composition of plasma and erythrocyte membrane lipids in diabetic children (n = 40; mean[SD] age: 12.03[3.90] years), diabetic young adults (n = 34; age: 21.8[3.1] years), and diabetic children during and after diabetic ketoacidosis (DKA, n = 9; age: 16.05[3.3] years). In these studies, TFA data were quantified by gas chromatography, but have not yet been published.
Results: Both diabetic young adults and diabetic children had lower total TFA levels in plasma sterol esters compared to healthy controls (0.54[0.34] vs 0.64[0.37] and 0.51[0.13] vs. 0.65[0.29] respectively, w/w%, median[IQR], p < 0.05). In contrast, there was no significant difference in total TFA levels during and after DKA, except for the free fatty acid fraction (3.05[0.71] vs. 4.36[1.60], p < 0.05). In addition, children with DKA had almost twice total TFA values in all plasma lipid fractions as diabetic young adult and children (phospholipids: 1.25[0.94] vs 0.43[0.17] and 0.39[0.23]). Several negative correlations were found between TFA and n‐3 and n‐6 long‐chain polyunsaturated fatty acid levels in all groups, especially in the erythrocyte membrane lipid fraction. However, in the plasma fractions the correlation was less clear: both positive and negative correlations were found in each of the groups studied.
Conclusions: The low TFA values in young people and children with diabetes may reflect a healthier diet due to the disease, while the higher TFA values seen in DKA may reflect the difficulty of adhering to a diabetic diet.
Contact e‐mail address: szabo.eva.dr@pte.hu
N‐EP040. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EP040.1. EFFECT OF FORTIFIED MILK ENRICHED WITH LUTEIN AND VITAMIN A ON VISUAL HEALTH IN CHILDREN 4 TO 7 YEARS OLD: A RANDOMIZED DOUBLE‐BLIND CLINICAL TRIAL
Yelan Yeertai 1, Shuai Mao1, Hua Jiang2, Yibing Ning3, Jing Yin4, Nan Sheng3, Yumei Zhang4
1Department Of Nutrition And Food Hygiene, School Of Public Healt, Peking University, Beijing, China, 2School of Nursing, Peking University, Beijing, China, 3The Joint Laboratory of Human Milk Research & Life Science by The Health Science Center of Peking University and the Junlebao Dairy Group, Beijing, China, 4Department Of Nutrition And Food Hygiene, School of Public Health, Peking University, Beijing, China
Objectives and Study: Preschool children have fully transparent lenses, allowing higher blue light transmittance. Chromophores are most abundant between birth and age 6. Macular pigment density, measuring blue light attenuation, reaches adult levels by age 4. The retina, rich in unsaturated fatty acids and highly metabolically active, is prone to oxidative damage from light‐induced reactions. Lutein, an antioxidant, absorbs blue light. β‐Lactoglobulin (β‐LG) in milk acts as a resistant carrier for retinol. With insufficient dairy intake in this age group, milk is used as a carrier to assess the effect of fortified milk on visual health in 4‐7‐year‐olds.
Methods: A randomized, double‐blind, controlled trial was conducted with 113 children meeting inclusion and exclusion criteria, divided into two groups: the fortified milk group (intervention group) and the milk group (control group). The intervention lasted for 6 months, with children consuming one box (200 ml) of milk daily during school breaks. Surveys, physical exams, and eye exams were conducted at baseline, 3 months (mid‐intervention), and 6 months (end of intervention). Blood samples for nutritional biomarkers were collected at baseline and at the end of the intervention. Results were analyzed using the Wilcoxon test and t‐test.
Results:
Both groups showed significant increases in serum vitamin A and lutein levels at 3 and 6 months (p < 0.05). At 6 months, vitamin A levels were significantly higher in the intervention group (443.5 ± 108.2) compared to the control group (396.1 ± 84.6, p < 0.05), while no significant difference was observed for lutein levels (p > 0.05). At 6 months, significant improvements were observed in Flicker Fusion Frequency (22.27 ± 5.57) and visual acuity (left: 5.01 ± 0.13*, right: 5.02 ± 0.12*) compared to baseline (p < 0.05), but no significant between‐group differences were found.
Conclusions: These results suggest milk may benefit visual health by increasing vitamin A and lutein levels, regardless of fortification.
Contact e‐mail address:
N‐EP041. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EP041.1. IMPACT OF IRON DEFICIENCY ANEMIA ON GROWTH AND ENDOCRINE FUNCTIONS: REVERSIBILITY WITH TREATMENT
Ashraf Soliman1, Saleha Abbasi 2, Fawzia Alyafei1, Ahmed Elawwa1, Nada Alaaraj1, Noor Hamed1, Shayma Mohammed1, Khadija Khudabakhsh2, Sohair Elsiddig3
1Pediatrics, Hamad Medical Corporation, Doha, Qatar, 2Sidra Medicine, Doha, Qatar, 3Paediatrics, Hamad Medical Corporation, Doha, Qatar
Objectives and Study: Iron deficiency anemia (IDA) is the most common micronutrient deficiency worldwide, affecting over 40% of children under five, especially in low‐ and middle‐income countries. Beyond its well‐documented hematological effects, IDA disrupts endocrine functions, including growth, thyroid, pituitary, and adrenal systems, leading to growth retardation, hormonal imbalances, and altered metabolic processes. This review synthesizes evidence from clinical and experimental studies to evaluate IDA's impact on growth and endocrine functions and the reversibility of these impairments following iron therapy.
Methods: A systematic review of 12 studies, including 567 patients with IDA and several animal models, assessed the effects of IDA on growth velocity, IGF‐I secretion, thyroid hormones, adrenal reserve (ACTH and cortisol), and post‐treatment recovery.
Results: Key findings include: Growth: IDA reduces growth velocity and IGF‐I secretion, impairing height‐for‐age z‐scores and BMI. Iron therapy restored growth markers in all studies. Thyroid Function: Mild hypothyroidism was documented in 220 patients, with iron supplementation normalizing thyroid hormone levels. Pituitary Function: Suppressed GH and IGF‐I secretion were noted in 345 patients, with significant post‐treatment recovery and metabolic improvement. Adrenal Function: Severe IDA cases (145 patients) showed reduced ACTH and cortisol levels, which improved with iron therapy. The findings highlight the systemic impact of IDA on growth and endocrine axes. Timely diagnosis and iron therapy effectively reverse these impairments, underscoring the importance of early intervention. Future research should focus on long‐term outcomes and optimizing treatment strategies for IDA‐related endocrine dysfunctions.
Conclusions: The findings highlight the systemic impact of IDA on growth and endocrine axes. Timely diagnosis and iron therapy effectively reverse these impairments, underscoring the importance of early intervention. Future research should focus on long‐term outcomes and optimizing treatment strategies for IDA‐related endocrine dysfunctions.
Contact e‐mail address:
N‐EP042. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EP042.1. LOW BIRTH WEIGHT IS ASSOCIATED WITH HYPERTENSION IN CHILDREN AND ADOLESCENTS
Marco Brandimonte‐Hernández 1, Sophia Blaauwendraad2, Arwen Kamphuis2, Eduard Flores‐Ventura3, Marieke Abrahamse ‐Berkeveld4, Maria Carmen Collado3, Janna Van Diepen5, Patricia Iozzo6, Karen Knipping7, Carolien Van Loo‐Bouwman8, Romy Gaillard2, Angel Gil1, Francisco Ruiz‐Ojeda1
1Department Of Biochemistry And Molecular Biology Ii, University of Granada, Granada, Spain, 2The Generation R Study Group Erasmus MC, University Medical Center, Rotterdam, the Netherlands, Rotterdam, Netherlands, 3Institute of Agrochemistry and Food Technology‐National Research Council (IATA‐CSIC), Spain, Valencia, Spain, 4Danone Nutricia Research, 3584 CT Utrecht, The Netherlands, Utrecht, Netherlands, 5Reckitt Benckiser/Mead Johnson Nutrition, 6545 CJ Nijmegen, The Netherlands, Nijmegen, Netherlands, 6Institute of Clinical Physiology, National Research Council (CNR), Via G. Moruzzi 1, 56124, Pisa, Italy, Pisa, Italy, 7Ausnutria B.V., 8025 BM Zwolle, The Netherlands, Zwolle, Netherlands, 8Yili Innovation Center Europe, 6708 WH Nijmegen, The Netherlands, Nijmegen, Netherlands
Objectives and Study: Early life exposures may predispose to the development of metabolic and cardiovascular diseases later on. There is growing evidence that certain perinatal factors, including low birth weight (LBW), may be associated with a higher risk of hypertension during childhood and adolescence. We conducted a meta‐analysis to clarify the association between LBW and hypertension in children and adolescents.
Methods: We selected and extracted data from longitudinal studies that evaluated and defined moderate (percentile< 25th) to LBW (percentile<10th) and related it to high blood pressure (percentile> 90th) and hypertension (percentile>95th) later in children and adolescents. Random effects models were used to estimate the pooled odds ratio (OR) and 95% confidence interval (CI) for hypertension. Heterogeneity was assessed with the Q‐test and the I2 statistic, representing the total variation across studies. P value below 0.05 was considered statistically significant.
Results: 10 articles were included in the meta‐analysis. Compared to children born with normal weight, LBW exhibited 1.98‐fold higher systolic blood pressure or risk of developing hypertension (95% CI: 1.46‐2.70, p < 0.01). Furthermore, in 4 articles that evaluated the association of LBW with hypertension, LBW was significantly associated with hypertension (OR: 1.77, 95% CI: 1.12‐2.80, p < 0.01).
Conclusions: LBW is associated with both high blood pressure and hypertension in children and adolescents. These findings may be of significant clinical relevance, as they are useful for predicting the risk for cardiometabolic outcomes later on, especially hypertension. Despite the relevant results, more studies are needed, pointing to the presence of a potentially vulnerable subgroup of children and adolescents, for which screening tests and early preventive strategies could be beneficial.
Contact e‐mail address: mbrandimonte@ugr.es
N‐EP043. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EP043.1. PERINATAL RISK FACTORS FOR CHILDHOOD OBESITY IN A COHORT OF PREDOMINANTLY LATINX PRETERM INFANTS
Eisha Jain 1, Janet Wojcicki2
1Department Of Pediatrics, University of California, San Francisco Medical Center, San Francisco, United States of America, 2Department Of Epidemiology And Biostatistics, University of California, San Francisco, San Francisco, United States of America
Objectives and Study: Childhood obesity is linked to the early onset of chronic diseases, disproportionately affecting those born preterm. While rapid infant weight gain (RIWG) has been identified as an independent risk factor for childhood obesity, it is encouraged in preterm infants for neurodevelopmental protection. The aim of this study is to identify variables that may modulate risk for obesity while controlling for RIWG.
Methods: This retrospective study involves 50 preterm infants (32‐37 weeks gestation) born at the University of California, San Francisco (UCSF) Health System from 2016 to 2023. Maternal, delivery, and newborn data was collected with EPIC chart review and patient interview. Logistic regression analyses conducted using R assessed associations between various perinatal factors and childhood obesity (weight‐for‐age >95th percentile at age 2) controlling for RIWG (weight‐for‐age z‐score change >0.67 from birth to 6 months). UCSF IRB approved this study with mothers’ written consent for participation.
Results: Mean gestational age and birthweight were 35.3 weeks (SD 1.41) and 2.57 kg (SD 0.51 kg), respectively. 34% of newborns were female, 80% had a parent self‐reported as Latinx, 12% were obese at 2 years age, and 62% had RIWG. Pre‐pregnancy BMI, gestational diabetes mellitus, and juice intake of at least 3 cups per week during pregnancy increased odds of childhood obesity independent of RIWG (OR 18.1 p = 0.01, OR 10.6 p = 0.03, OR 6.55 p = 0.05, respectively). Breastfeeding at time of hospital discharge and at 4‐6 weeks age decreased odds of childhood obesity independent of RIWG (OR 0.09 p = 0.02, OR 0.07 p = 0.03, respectively). Other perinatal factors were not significantly associated with childhood obesity.
Conclusions: Our study identifies several modifiable perinatal factors for childhood obesity in preterm infants despite often necessary rapid weight gain in infancy. Reducing juice intake during pregnancy and breastfeeding early in infancy may help attenuate the higher risk for childhood obesity and associated health complications in this population.
Contact e‐mail address:
N‐EP044. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EP044.1. EFFECTS OF HUMAN MILK FAT SUBSTITUTES ON LIPID METABOLISM AND ADIPOSITY IN FIRST‐WEANED RATS
Yangzheng He1, Jing Li1, Ting Li2, Sufang Duan2, Biao Liu2, Ignatius Szeto 3, Zeyuan Deng1
1State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, China, 2Inner Mongolia Yili Industrial Group Co. Ltd., Yili Maternal and Infant Nutrition Institute (YMINI), Beijing, China, 3National Center of Technology Innovation for Dairy, Hohhot, China
Objectives and Study: Formula‐fed infants often exhibit higher weight gain and body fat than breastfed infants. The impact of differences in lipid composition between infant formula and breast milk on infant weight and adiposity remains unclear.
Methods: First‐weaned Sprague‐Dawley (SD) rats with normal growth and development were fed diets containing either human milk fat substitutes (HMFS), a mixed vegetable oil blend (Control group), or blend vegetable oil supplemented with OPO (1,3‐dioleic acid‐2‐palmitoyl triglyceride; OPO group). Comprehensive analyses were conducted to investigate body fat composition, obesity‐related biochemical markers, fecal short‐chain fatty acids (SCFAs), alterations in gut microbiota, hepatic lipid metabolites, and their interrelationships.
Results:
HMFS had no observable effect on the body weight of the rats; however, it significantly reduced their body fat content. Glycerophospholipid was the primary differentiating lipid present in the liver of HMFS‐fed rats. The abundance of bacteroides significantly increased in the intestines of HMFS‐fed rats, accompanied by a substantial rise in their SCFAs levels. The “Bacteroidetes–SCFAs–Glycerophospholipid pathway” was identified as a potential mechanism through which HMFS administration influences body fat accumulation in first‐weaned rats. Also, HMFS administration significantly promoted lipid metabolism in the rat liver at both the gene and protein levels.
Conclusions: This research underscores the role of HMFS in enhancing lipid metabolism, as demonstrated by modifications in liver lipid composition and the upregulation of genes and proteins involved in lipid metabolic pathways. HMFS was shown to positively modulate gut microbiota, notably increasing the abundance of bacteroides and stimulating the production of short‐chain fatty acids (SCFAs). The proposed “Bacteroidetes–SCFAs–Glycerophospholipid pathway” offers a mechanistic explanation for the observed reduction in body fat levels. Collectively, these findings provide important insights into the nutritional benefits of HMFS, supporting its potential application in infant formula to promote healthy growth and development.
Contact e‐mail address:
N‐EP045. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EP045.1. THE COMPLEX RELATIONSHIPS OF MICROBIOTA‐GUT‐BRAIN AXIS IN CHILDHOOD OBESITY
Chonnikant Visuthranukul 1, Sira Sriswasdi2, Jaraspong Uaariyapanichkul3, Yutthana Joyjinda3, Sirinuch Chomtho4
1Center Of Excellence In Pediatric Nutrition, Faculty of Medicine, Chulalongkorn university, Bangkok, Thailand, 2Faculty of Medicine, Chulalongkorn university, Bangkok, Thailand, 3King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand, 4Center Of Excellence In Pediatric Nutrition, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Objectives and Study: Gut microbiota influences energy regulation and appetite control through microbial‐derived compounds that can impact the central nervous system by modifying physiological mechanisms in childhood obesity. This study aimed to assess the complex relationships of gut‐brain axis (GBA)‐related amino acids and bioactive amines with gut microbiota and clinical parameters in children with obesity.
Methods: This cross‐sectional study enrolled children with obesity aged 7‐15 years. Plasma amino acids and microbial‐derived compounds were analyzed using LC‐MS/MS. Stool samples were analyzed by 16S rRNA sequencing using the Illumina Miseq platform. Relationships of plasma amino acids and bioactive molecules with gut microbiota, lifestyle activity, and metabolic profiles were assessed by Spearman's correlation coefficient.
Results: A total of 164 children (59% male, mean age: 10.4 ± 2.2 years) with a BMI z‐score of 3.2 ± 1 were included. Specific amino acids and microbial‐derived compounds demonstrated diverse associations with gut microbiota, lifestyle, and inflammation. Among amino acids, glutamate correlated with Streptococcus, glutamine with Bifidobacterium, and histidine with Bifidobacterium and Streptococcus, but negatively with Parabacteroides and Prevotella. Tryptophan was linked to Bifidobacterium but inversely to Prevotella, while tyrosine associated with Lactobacillus. For microbial‐derived compounds, dopamine positively correlated with Bifidobacterium but negatively with Prevotella. Putrescine related to Bacteroides and Fusobacterium, and spermine to Bifidobacterium and Blautia. Additionally, glutamate and dopamine were associated with butyrate, histidine with GLP‐1, and tryptophan and tyrosine negatively with screen time. Glutamine, histidine, tryptophan, dopamine, and histamine were inversely correlated with inflammation markers (IL‐1β, IL‐6, TNF‐α), suggesting their potential anti‐inflammatory roles.
Conclusions: Specific GBA‐related amino acids and microbial‐derived compounds were significantly associated with gut microbiota, lifestyle activity, and biochemical parameters. Although further research is needed to establish causality in the microbiota‐gut‐brain axis in childhood obesity, evidence suggests a complex interplay between beneficial microbes and the secretion and function of GBA‐related amino acids and microbial‐derived bioactive molecules.
Contact e‐mail address: chonnikant.v@chula.ac.th
N‐EP046. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐EP046.1. AUDIT OF MICRONUTRIENT INTAKE IN CHILDREN RECEIVING SUPPLEMENTED PARENTERAL NUTRITION MULTI‐CHAMBER BAGS COMPARED TO ESPGHAN RECOMMENDATIONS
Melody Chan, Rosie Glyde, Akshay Batra
Southampton Children's Hospital, Southampton, United Kingdom
Objectives and Study: Supplemented regimens of multi‐chamber bags (MCBs) are useful in managing paediatric patients who require parenteral nutrition (PN). Patients who are on PN short term and low risk are often managed with supplemented MCBs at University Hospital Southampton (UHS). Standardised PN formulations are recommended to reduce cost, compounding errors and microbial contamination. We audited micronutrient intakes in paediatric patients receiving supplemented MCB PN against recommended intakes in ESPGHAN 2018 PN guidelines.
Methods: Children managed by the paediatric intestinal failure team who received supplemented MCBs between September 2023 and September 2024 were reviewed. Four MCBs, supplemented with adult micronutrient preparations, are available at UHS for patients weighing more than 10 kg. The adult micronutrient preparation used at UHS has a higher vitamin A content than paediatric preparations and does not contain vitamin K. Recommended daily intake of vitamin A is significantly higher for adults than for children. Prescriptions were reviewed at the point when maximal macronutrient requirement was achieved. Intake of vitamin A, D, E, zinc, selenium, copper, and manganese were compared to recommendations. This project received local audit approval.
Results: Fifty‐six patients were reviewed (age range 1 to 16 years). Intakes are summarised in the accompanying table.
Vitamin A intake was consistently in excess of the target range. No trends can be identified with regards to the patients’ weight or age and micronutrient intake, due to micronutrients are added into the total MCB volume, meaning macronutrient and micronutrient ratio is proportionate to the patient's needs.
Conclusions: The audit suggests that use of adult micronutrient preparations are not suitable for children of all ages as no micronutrient intake was met consistently. Micronutrient status of paediatric patients receiving supplemented MCBs should be monitored regularly. Review of current MCB supplementation should be undertaken and the feasibility of stocking multiple supplemented MCB with different micronutrients preparations should be explored.
Contact e‐mail address: melody.chan@uhs.nhs.uk
N‐EP047. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐EP047.1. THE INCIDENCE OF CATHETER‐RELATED BLOODSTREAM INFECTIONS IN PAEDIATRIC PATIENTS RECEIVING PARENTERAL NUTRITION IN INPATIENT AND OUTPATIENT SETTINGS AT A REGIONAL PAEDIATRIC HOME PARENTERAL NUTRITION CENTRE
Autumn Lumb
Pharmacy Department, King's College Hospital NHS Trust, London, United Kingdom
Objectives and Study: Children with intestinal failure receiving parenteral nutrition (PN) via a central venous catheter are at significant risk of catheter‐related bloodstream infections (CRBSI). The objective of this study was to assess and compare the incidence of CRBSI in patients receiving PN in both inpatient and outpatient/home settings across a 10‐month period.
Methods: Data was collected using Epic (electronic prescribing records) and the Intestinal Failure Registry for patients receiving PN from 1st January to 31st October 2024 at a major teaching hospital, which is also a regional paediatric home PN center based in London. For the purpose of this study, CRBSI was confirmed by calculating the differential time between paired blood cultures drawn from the central catheter and a peripheral vein.
Results: 107 paediatric patients received PN through a central line, 34 of which had their PN stopped due to a potential line infection (temperature spike or change in clinical or laboratory parameters indicative of an infection) and 9 of these developed CRBSI (6 inpatient, 3 outpatient). For patients receiving home PN (n = 35) the incidence of CRBSI was 0.30 per 1000‐line days compared to that of patients receiving PN as an inpatient (n = 72) which had an incidence of 2.14 per 1000‐line days with an overall incidence of 0.70 per 1000‐line days across both inpatients and outpatients. For 11 of the 34 suspected line infections (32.4%), paired samples were not taken.
Conclusions: There was a lower rate of CRBSI in patients receiving PN at home vs inpatients (0.30 v 2.14 per 1000‐line days), this could be due to multiple factors; including fewer individuals handling the line at home, sterility of the environment and exposure to infections. The percentage of paired samples taken for any suspected line infection needs to be improved within the trust to ensure correct diagnosis and management of CRBSI.
Contact e‐mail address: autumn.lumb@nhs.net
N‐EP048. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EP048.1. CROSS‐TALK BETWEEN MATERNAL AND INFANTS’ GUT MICROBIOME MEDIATED BY FUNCTIONAL PROTEIN ALTERATIONS IN BREAST MILK
Celi Yang1,2, Yalu Yan3, Sufang Duan 3,4, Ignatius Szeto3,4, Wenhui Ye3, Biao Liu3, Ai Zhao1,2
1Vanke School Of Public Health, Tsinghua University, Beijing, China, 2Institute for Healthy China, Beijing, China, 3Inner Mongolia Yili Industrial Group, Co. Ltd., Hohhot, China, 4National Center of Technology Innovation for Dairy, Hohhot, China
Objectives and Study: Postpartum sleep disorder and mental disorders are common unpleasant conditions faced by women, which bring many adverse effects on both mothers and infants. However, the association and the mechanism are not determined. This study aimed to explore the cross‐talk between maternal sleep/psychological status and infants’ gut microbiome.
Methods: Based on a birth cohort, this pilot study included 41 mother‐infant pairs. Breast milk and infants’ faecal samples were collected at 42 days and 3 months postpartum and analyzed using liquid chromatography‐mass spectrometry and metagenomics, respectively.
Results: At 42 days postpartum, disordered sleep was negatively correlated with α‐lactalbumin (cor = –0.578, p＜0.001), osteopontin (cor = –0.522, p＜0.01) and κ‐casein (cor = –0.451, p＜0.01). Depression was negatively correlated with αs1‐casein (cor = –0.422, p＜0.01), β‐casein (cor = –0.317, p＜0.05) and casein (cor = –0.318, p＜0.05). Meanwhile, the relative abundance of Clostridium butyricum of infants’ gut microbiota in the sleep disorder group was significantly reduced compared to the control. This bacterium also showed a positive correlation with α‐lactalbumin and κ‐casein in breast milk. Further KEGG pathway analysis indicated that serotonergic and dopaminergic pathways were affected in the sleep disorder group, which may impact the neurodevelopment during early life. At the same time, the changes of functional proteins in breast milk caused by maternal depression significantly affected the composition of the infants’ gut microbiota. However, at 3 months postpartum, most associations between sleep disorder/depression and breast milk protein had disappeared, but the impact on the infant gut microbiota still persisted. The level of Haemophilus parainfluenzae in infants' guts were significantly increased, while Bifidobacterium breve were decreased in the maternal sleep disorder group. In the maternal depression group, the relative abundance of Parabacteroides goldsteinii were significantly reduced.
Conclusions: Sleep disorder/depression could lead to significant protein changes in breast milk profiles, which further affected the infants’ gut microbiome, posing adverse effects on the infants' health.
Contact e‐mail address: celiyang@tsinghu.edu.cn
N‐EP049. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EP049.1. INFANT FORMULA WITH 5 HUMAN MILK OLIGOSACCHARIDES PROMOTED A GUT MICROBIOME LIKE BREASTFED INFANTS AT 6 MONTHS OF AGE
Grace Niemiro 1, Anice Sabag‐Daigle2, David Hill2, Elizabeth Reverri3, Penni Hicks1
1Nutrition Division, Nutrition Science & Innovation, Abbott Laboratories, Columbus, United States of America, 2Nutrition Division, International Nutrition Science & Global Platforms Innovation And Research, Abbott Laboratories, columbus, United States of America, 3Nutrition Science & Innovation, Abbott Nutrition, Dublin, United States of America
Objectives and Study: Human milk oligosaccharides (HMOs) are naturally occurring prebiotic carbohydrates found in human milk. Exclusively breastfed infants have been shown to have higher abundances of beneficial gut microbiota populations such as Bifidobacterium. The effect of a formula with 5 of the most abundant HMOs on the infant gut microbiome at 6 months of age has not been evaluated in the US.
Methods: 607 healthy, term infants were randomized to a control formula without HMOs (CF) or study formula (SF) with 5 HMOs (2ʹ‐fucosyllactose, 3‐fucosyllactose, lacto‐N‐tetraose, 3ʹ‐sialyllactose, and 6ʹ‐sialyllactose) for the first 6 months of life ad libitum, with a human milk group as reference (HM). 251 participants provided a stool sample at 6 months of age (CF: n = 85, HM: n = 85, SF: n = 81), which was analyzed by shotgun metagenomic sequencing. Abundance analyses were compared only among samples where a given taxon was detected. To control false discovery rate (FDR), P‐values were adjusted separately for each category and test type. Test results were considered significant at FDR < 0.1 and P < 0.05. All statistical analyses were performed in R version 4.4.0.
Results: The beta‐diversity in the SF group was closer to HM than CF (HM vs SF: P > 0.05; HM vs CF: P = 0.01; CF vs SF: P = 0.029). Aggregated abundance of infant specific Bifidobacterium populations and Lactobacillales in SF was higher than CF and not different from HM, while the CF group was lower compared to HM (Fig. 1). The abundance of genes encoding glycoside hydrolase family GH33 was higher in SF compared to CF, not different between SF and HM, and lower in CF relative to HM (Fig. 1).
Conclusions: Taken together, infants fed a formula with 5 HMOs had a microbiome composition that resembled breastfed infants at 6 months of age and higher abundances of keystone HMO‐utilizing species and sialylated HMO‐metabolizing genes compared to infants fed formula without HMOs.
Contact e‐mail address: grace.niemiro@abbott.com
N‐EP050. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EP050.1. THE DISAPPEARING BIFIDOBACTERIUM MICROBIOTA IN INFANTS OVER 25 YEARS
Teo Oksanen 1, Martina Baizán‐Urgell2, Maria Carmen Collado2, Samuli Rautava3, Erika Isolauri1,4
1Department Of Pediatrics And Adolescent Medicine, Faculty of Medicine, University of Turku, Turku, Finland, 2Institute of Agrochemistry and Food Technology‐National Research Council, Paterna, Spain, 3Department Of Neonatology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland, 4Department Of Pediatrics And Adolescent Medicine, Turku University Hospital, Turku, Finland
Objectives and Study: Bifidobacteria typify the gut microbiota composition of healthy, breast‐fed infants. Low bifidobacterial abundance in infancy has been linked with a heightened risk of non‐communicable diseases in later childhood. Our objective was to assess factors associated with the gut microbiota composition in infants throughout the allergy and obesity epidemics of the past decades.
Methods: We studied 72 full‐term, breastfed infants participating in prospective clinical studies, grouped by the year of birth into three time periods (1997‐2001, 2005‐2009, 2015‐2022). Faecal samples were collected for microbiota profiling by 16S rRNA gene sequencing at the age of 1‐3 months. Perinatal factors including mode of birth, antibiotic exposure during pregnancy and at birth were taken into account in the analysis.
Results: The richness and diversity of the infant gut microbiota decreased significantly over the three time periods, mainly as a result of reduced abundance of the phylum Actinobacteria, and its genus Bifidobacterium in children born in 2015‐2022 as compared to those born during the time periods 1997‐2001 and 2005‐2009 (FIGURE 1). The time period of birth was the strongest determinant of the gut microbiota composition, followed by mothers’ pre‐pregnancy body mass index, intrapartum antibiotic contact and mode of birth. The relative abundance of members of the genus Bifidobacterium was negatively associated with elapsed time (1997‐2022 p = 0.0005) and in trapartum antibiotic exposure (p = 0.0026).
Conclusions: The abundance of the genus Bifidobacterium has gradually decreased over the past 25 years. The depletion of gut microbiota richness and diversity, and the selective disappearance of the genus Bifidobacterium has occurred parallel to the increase in the prevalence of non‐communicable diseases.
Contact e‐mail address:
N‐EP051. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EP051.1. BLUEBERRY AS A FIRST FOOD DURING COMPLEMENTARY FEEDING PROMOTES A MORE FAVORABLE GUT MICROBIOTA PROFILE IN U.S. BREASTFED INFANTS
Minghua Tang 1, Gabrielle Glime2, Daniel Frank2, Carina Venter3, Wayne Campbell4, Nancy Krebs2
1Dept Of Food Science And Human Nutrition, Colorado State University, Fort Collins, CO, United States of America, 2Pediatric Nutrition, University of Colorado Anschutz Medical Campus, Aurora, United States of America, 3Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, United States of America, 4Nutrition Science, Purdue University, West Lafayette, United States of America
Objectives and Study: Studies in adults and animal models showed that blueberries promote gut commensal growth, possibly modulated by the rich flavonoid and anthocyanin contents. However, how blueberries affect infant gut microbiota is not known. Here we hypothesize that introducing blueberry as a first food during complementary feeding would positively affect infant gut microbiota development.
Methods: This was a double‐blind, randomized controlled feeding trial. Healthy, full‐term, exclusively breastfed infants were recruited from the metro Denver area (Colorado, United States) and randomized to receive either a freeze‐dried blueberry powder or a placebo (calorie, color and taste matched) at 10 g/d (~40 kcal/d) as a first solid food. Infant diet was otherwise not restricted but blueberry/blackberry was avoided. The intervention started ~5‐6 months when complementary feeding began and ended at 12 months of age. Anthropometrics, diet records and fecal samples were collected at baseline, 7, 9, 11 and 12 months. Multivariate analysis was used to determine the effects of time and group on gut microbial diversity and composition.
Results: N = 76 infants were enrolled and n = 60 completed the study. There was no difference in sex or race/ethnicity between groups. Length and weight did not differ between groups at any time point. In an intent‐to‐treat analysis, after controlling for sequencing batch, mode of delivery, and mode of feeding (infant formula was introduced to some participants during the intervention but did not differ between groups), gut microbiota alpha diversity increased over time (P < 10‐6) without significant group‐by‐time interactions. Three genera had nominally significant group‐by‐time (P < 0.05) interactions and were less abundant by counts in the blueberry group at 12 months compared to the placebo group: Escherichia−Shigella, Streptococcus and Clostridioides.
Conclusions: Consuming blueberry as a first food during complementary feeding did not affect alpha diversity increase as infants age but may have favored a gut microbial composition with less abundance of certain potential pathogens.
Contact e‐mail address: minghua.tang@colostate.edu
N‐EP052. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EP052.1. FORMULA SUPPLEMENTATION TO BREASTFED INFANTS ALTERS CIRCULATING LIPIDS AND THE GUT MICROBIOTA
Inge Van Beijsterveldt 1, Pernille Myers2, Stuart Snowden3, Carsten Eriksen2, Henrik Bjorn Nielsen4, Ken Ong5, Anita Hokken‐Koelega1, Albert Koulman6, Susanne Brix7
1Pediatrics, Erasmus Medical Center ‐ Sophia Children's hospital, Rotterdam, Netherlands, 2Biotechnology And Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark, 3Core Metabolomics And Lipidomics Laboratory, University of Cambridge, Cambridge, United Kingdom, 4Clinical‐Microbiomics, Copenhagen, Denmark, 5Paediatrics, University of Cambridge, Cambridge, United Kingdom, 6Core Metabolomics And Lipidomics Laboratory, University of Cambridge, Cambridge, Netherlands, 7Biotechnology And Biomedicine, Technical University of Denmark, Kongens Lyngby, Netherlands
Objectives and Study: Breastfeeding has multiple health benefits, including protection against obesity. Exclusive breastfeeding, compared to exclusive formula feeding, in the first months of life is associated with different lipid metabolism and gut microbiota composition. It is not well known if these differences hold in mixed‐fed infants, and if they are related to the amount of formula. We examined relationships between feeding practice, circulating lipids and gut microbiota composition.
Methods: Blood and fecal samples of 519 healthy term‐born children aged 3 months, from two independent cohort studies were examined. Using random forest models, lipid and microbial biomarkers, predictive for exclusive formula‐ and breastfeeding practices, were identified in the Sophia Pluto cohort study (the Netherlands) and validated in the Cambridge Baby Growth Study (United Kingdom). In mixed‐fed infants, differences in biomarkers, compared to exclusive feeding, were studied using Mann‐Whitney U‐test. Correlations with volume of formula and days since introduction were analyzed using Kendall‐rank correlation coefficient.
Results: Forty‐six lipid biomarkers and 39 microbial species were identified to be highly predictive (above 99% for lipids, and 94% for species) for exclusive formula‐ or breastfeeding. Data from mixed fed infants showed that the volume of formula supplemented to breastfed infants was correlated with circulating lipids, while gut microbiota diversity was influenced by the time since introduction of formula. Moreover, formula rich in intact whey protein resulted in increased S. thermophilus abundance in the infant gut.
Conclusions: Together, our findings demonstrate that the amount and duration of formula supplementation to breastfed infants differentially influence circulating lipids and the gut microbiota composition, potentially impacting child health through various mechanisms.
Contact e‐mail address: i.vanbeijsterveldt@erasmusmc.nl
N‐EP053. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EP053.1. GUT MICROBIOTA MEDIATE PUFA METABOLISM AND ENHANCE COGNITIVE DEVELOPMENT VIA A NOVEL BRAIN ENDOCANNABINOID SYSTEM
Hao Zheng 1, Zhaopeng Zhong1, Sufang Duan2, Biao Liu2, Ignatius Szeto2
1College of Food Science & Nutritional Engineering, Beijing, China, 2Inner Mongolia Yili Industrial Group Co. Ltd., Yili Maternal and Infant Nutrition Institute (YMINI), Beijing, China
Objectives and Study: Dietary PUFAs serve as precursors to a diverse array of signaling molecules, fundamentally contributing to numerous physiological processes. The gut microbiota plays a crucial role in modulating lipid metabolism, yet the complex interactions are not fully elucidated. In this study, we examined how humanized nutritional PUFAs and structured lipids, incorporated into infant formula, influence cognitive development, emphasizing the crucial role of the gut microbiota in their biotransformation and metabolism.
Methods: Using the gnotobiotic honeybee model, we fed bees with specific ratios of LA:ALA, DHA:ARA, and OPL:OPO:LPL to evaluate the impact of lipids on learning and memory behaviors, while employing metabolomic profiling to trace lipid metabolism. We employed brain single‐cell transcriptomics to reveal their specific mechanisms on neuronal networks and cognitive behaviors.
Results: Our research demonstrates that specific lipid ratios exert a profound influence on honeybee cognitive function. In particular, a dietary formulation consisting of an LA:ALA ratio of 1:1, a DHA:ARA ratio of 1:1, supplemented with lecithin, and an OPL:OPO ratio of 2.5:1, proved to be the most effective in enhancing learning, memory, and social interaction behaviors. Notably, the gut microbiota expressing Δ‐6 desaturase was instrumental in facilitating the elongation of LA and ALA and the biosynthesis of anandamide, a pivotal lipid neurotransmitter within the endocannabinoid system. Our snRNA analysis indicates that anandamide subsequently activated TRPA receptors in brain astrocytes, leading to modulation of the glutamate‐GABA balance, which is essential for maintaining optimal synaptic transmission and neuroplasticity.
Conclusions: Our study provides insights into the relationships among infant formula lipids, gut microbiota, and neurodevelopment, establishing a foundation for future research on how dietary lipids influence neurodevelopment through microbiota‐mediated mechanisms. These findings suggest that gut bacteria in infants can produce bioactive molecules that modulate cognitive development, offering a pathway for strategies to enhance early brain health and resilience.
Contact e‐mail address:
N‐RF001. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐RF001.1. NEW CONCEPT INFANT FORMULA WITH LARGE LIPID DROPLETS, SCGOS/LCFOS, BIFIDOBACTERIUM BREVE M‐16V, AND HMOS, STIMULATES GUT EPITHELIAL DEFENSE AND GUT BARRIER FUNCTION IN CACO‐2 CELLS
Fadoua Daouad, Noortje Ijssennagger, Evan Abrahamse, Gabriel Thomassen, Jan Knol, Ingrid Renes
Danone Global Research & Innovation Center, Utrecht, Netherlands
Objectives and Study: A well‐functioning gut epithelium is essential for newborns as it serves as the first line of defense. Intestinal alkaline phosphatase (iALP) is a key marker of gut barrier maturation, function and protection. We studied the benefits of a concept infant formula (IF) comprised of large phospholipid coated lipid droplets (LPCLD), supplemented with short chain galacto‐oligosaccharides and long chain fructo‐oligosaccharides (scGOS/lcFOS), probiotic Bifidobacterium breve M‐16V (B. breve M‐16V) and a blend of five human milk oligosaccharides‐HMOs (2′‐FL, 3′‐FL, LNT, 3′‐SL, 6′‐SL) on gut maturation and gut defense in vitro.
Methods: Five IFs containing scGOS/lcFOS were digested using an in vitro digestion model; IF‐A, containing LPCLD (Nuturis); IF‐B, containing LPCLD and B. breve M‐16V; IF‐C, containing LPCLD and HMOs; IF‐D containing LPCLD, B. breve M‐16V and HMOs; and IF‐E, containing small lipid droplets (SLD), B. breve M‐16V and HMOs. Lipolysis kinetics were assessed by measuring levels of released free fatty acids. Intestinal digests were diluted and incubated on Caco‐2 cells for 4 days. Secreted iALP was measured daily. Following incubation, intracellular iALP was measured.
Results: Our data demonstrate that all IFs with LPCLD were digested slower than the one containing SLD as previously shown with human milk. The combination of B. breve M‐16V and HMOs – with the presence of large lipid droplets (IF‐D) – induced higher levels of intracellular and secreted iALP after 4 days, compared to IF‐A, IF‐B and IF‐C. Moreover, the combination of B. breve M‐16V, HMOs and large lipid droplets (IF‐D) resulted in an earlier increase in iALP levels, compared to IF‐E.
Conclusions: The new concept infant formula with large lipid droplets combining scGOS/lcFOS, B. breve M‐16V and HMOs, synergistically stimulates gut epithelial defense and barrier function, in a Caco‐2 model. This IF may, therefore, improve maturation and maintenance of the gut epithelium defense capacity and thereby promote the infant's overall health.
Contact e‐mail address: fadoua.daouad@danone.com
N‐RF002. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐RF002.1. DIFFERENTIAL HMO UTILIZATION OF BREASTFED INFANTS IS LINKED TO THEIR GUT MICROBIOME COMPOSITION AND FUNCTIONALITY
Florac De Bruyn 1, Léa Siegwald2, Ornella Cominetti3, Eugenia Migliavacca4, Claire Boulangé2, Maria Pillar Giner3, Omar Delannoy‐Bruno2, Adrien Dardinier4, Thierry Benet3, Seorim Park1, Jean‐Philippe Godin3, Sprenger Norbert2, Hanne L.P. Tytgat2
1Nestlé Research and Development, Konolfingen, Switzerland, 2Nestlé Research, Nestlé Institute of Health Sciences, Lausanne, Switzerland, 3Nestlé Research, Nestlé Institute of Food Safety and Analytical Sciences, Lausanne, Switzerland, 4Nestlé Research, Clinical Research Unit, Lausanne, Switzerland
Objectives and Study: Human milk oligosaccharides (HMOs) are complex, structurally diverse carbohydrates, and the third most prevalent component in breast milk. Being indigestible by infants, HMOs act as prebiotics and influence early life gut microbiome, immune system, and overall development.
Methods: To understand how HMOs are metabolized by the gut microbiota, we quantified 20 individual HMOs in breastmilk and infant fecal matter of 39 mother‐infant dyads using a newly developed HPLC‐FLD method.
Results: We found that while some HMOs can be fully utilized by all infants, others cannot. The extent of HMO utilization varies among infants, which we could categorize into full or partial consumers and link with their gut microbiome composition. Specifically, distinct Bifidobacterium species and subspecies were differentially abundant between full and partial consumers. This difference in HMO consumption was also reflected in the CAZyome (Carbohydrate Active EnZymes) and metabolome of full and partial consumers.
Conclusions: Our findings offer a novel understanding of how HMO utilization is associated with the gut microbiome and its functionality.
Contact e‐mail address:
N‐RF003. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐RF003.1. ENERGY RESTRICTION, WEIGHT LOSS AND GLYCAEMIA IN LATE PREGNANCY AND BREASTFEEDING OUTCOMES IN WOMEN WITH GESTATIONAL DIABETES; RESULTS FROM THE DIGEST TRIAL
Sarah Dib 1, Laura Kusinski1, Danielle Jones2, Nooria Atta2, Suzanne Smith2, Emanuella De Lucia Rolfe3, Helen Murphy4, Roy Taylor5, Claire Meek1
1Leicester Diabetes Centre And Leicester Nihr Biomedical Research Centre, University of Leicester, Leicester, United Kingdom, 2Institute Of Metabolic Science – Medical Research Laboratories, Unviersity of Cambridge, Cambridge, United Kingdom, 3Mrc Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom, 4University of East Anglia, Norwich, United Kingdom, 5Newcastle University, Newcastle, United Kingdom
Objectives and Study: Reducing gestational weight gain and improving glycaemia in women with gestational diabetes (GDM) can improve maternal, pregnancy and infant outcomes. However, it remains unclear how this can impact breastfeeding outcomes. We aimed to assess if energy restriction, weight loss or maternal glycemia in late pregnancy were associated with breastfeeding outcomes.
Methods: The dietary intervention in gestational diabetes (DiGest) was a randomised controlled trial involving 425 participants with gestational diabetes and with BMI ≥ 25 kg/m2. Participants were randomly assigned to receive a standard‐energy (2000 kcal/day) or reduced‐energy (1200 kcal/day) dietbox from 29 weeks until delivery. Breastfeeding outcomes (intention to breastfeed, any breastfeeding, exclusive breastfeeding) were documented at study visits during pregnancy and at 3 months postpartum. Regression models were used to assess the association of diet assignment, gestational weight gain, weight loss, and glycaemic control during pregnancy with breastfeeding outcomes.
Results: Energy restriction or weight loss in late pregnancy were not associated with significant changes to breastfeeding outcomes. Achieving ≥90% time‐in‐range (3.5‐6.7 mmol/L; 90‐120 mg/dL) with a low glycemic variability were associated with breastfeeding at 3 months postnatally, but not with intention to breastfeed. No association was found between gestational weight gain and breastfeeding outcomes.
Conclusions: Improved late pregnancy glycaemia and decreased glucose variability, but not weight loss or energy restriction, were associated with breastfeeding after gestational diabetes.
Contact e‐mail address: sd637@leicester.ac.uk
N‐RF004. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐RF004.1. MOTHER OWN MILK AND/OR DONOR HUMAN MILK FEEDING IN EXTREMELY LOW BIRTH WEIGHT NEONATES
Jacky Herzlich 1, Laurence Mangel1, Bar Frumer2, Dror Mandel1
1Department Of Neonatology, Tel Aviv Medical Center, Tel Aviv, Israel, 2Tel Aviv University, Tel Aviv, Israel
Objectives and Study: Extremely low birth weight (ELBW) infants face high risks of neonatal morbidity, such as necrotizing enterocolitis (NEC), bloodstream infection (BSI), and poor growth. When mother's own milk (MOM) is unavailable, donor human milk (DHM) ‐ a pasteurized alternative with a distinct nutritional profile ‐ offers a valuable substitute. This study aims to assess the impact of DHM on ELBW neonatal outcomes.
Methods: We analyzed data from ELBW infants born between 2018‐2023. Outcomes were compared across pre‐DHM (epoch‐1) and post‐DHM (epoch‐2) periods. Primary outcomes included NEC (according to Bell's criteria: stage 2 and above), feeding intolerance (FI, defined as ≥20% residuals), hypoglycemia, BSI (positive blood culture), and weight gain percentage (WG%) at 14‐ and 28‐days chronological age.
Results: Neonates in epoch‐1 (n = 54) and epoch‐2 (n = 53) had comparable birth weight (BW), gestational age (GA), hospital length of stay, and WG% at 14‐ and 28‐days, but small for gestational age neonates were twice as common in epoch‐1 (Table 1). NEC, FI, and BSI rates remained consistent across epochs. Although enteral feeding began earlier in epoch‐2 (1.6 vs 2.4 days), neonates in both epochs regained their BW at similar age. However, full enteral feeding was achieved later in epoch‐1 (31.2 vs 16.3 days), with prolonged parenteral nutrition (30 vs 25.2 days). Hypoglycemia was linked to earlier enteral feeding, starting at 1.8 ± 0.9 days for hypoglycemic neonates and at 2.2 ± 0.9 days for non‐hypoglycemic neonates (p = 0.033). Linear regression analysis showed that FI (95% CI [1.622, 14.212]) and extended parenteral feeding (95% CI [0.150, 0.569]) delayed full enteral feeding, while epoch‐2 neonates transitioned to full enteral feeding sooner (95% CI [‐17.759, ‐5.291]). The model was adjusted for BW, GA, and gender.
Conclusions: The introduction of DHM into preterm infant feeding practice did not reduce rates of NEC, FI, or BSI, nor did it enhance infant weight gain.
Contact e‐mail address:
N‐RF005. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐RF005.1. FACTORS ASSOCIATED WITH DELAYED INITIATION OF BREASTFEEDING IN RURAL AND URBAN HEALTH DISTRICTS IN THE CENTRE REGION OF CAMEROON
Isabelle Mekone Nkwele 1, Ahmed Lara1, Epéé Ngoue Jeannette1, Kamo Hélène2, Mah Mungeh Evelyn1
1Pediatrics, Faculty of medecine and biomedical sciences of the university of Yaoundé I, Yaoundé, Cameroon, 2Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Garoua., garoua, Cameroon
Objectives and Study: Despite the fact early initiation of breastfeeding (EIBF) is a key practice to improve neonatal outcomes and reduce infant mortality, delayed initiation remains a significant problem. The objective was to identify the factors contributing to delayed initiation of breastfeeding (DIBF) in both rural and urban health districts within the Centre region of Cameroon.
Methods: This was a cross‐sectional analytical study involving 404 mothers from selected urban and rural health districts from November 2023 to September 2024. Data were collected through structured surveys, which assessed socio‐demographic characteristics, perinatal information and maternal knowledge on breastfeeding practices. The prevalence of DIBF was determined, Multivariate logistic regression was used to determine different associations, p < 0.05.
Results: Prevalence of DIBF was 52.5% in the rural district and 52.4% in the urban district.Factors associated with DIBF in the urban district were delivery by caesarean section (aOR 3.71; 95%CI (1.53‐9.02); p = 0.004), being employed as a civil servant (aOR 3.35; 95%CI (1.02‐10.97); p = 0.045) and having a newborn with a low birth weight (LBW) (aOR 2.97; 95%CI (1.04‐8.45); p = 0.041), while advanced maternal age (aOR 0.41; 95%CI (0.19‐0.89); p = 0.025) was identified as a protective factor. In the rural district, DIBF was associated with delivery by caesarean section (aOR 10.38; 95%CI (1.20‐89.959); p = 0.033), fewer than four antenatal care visits (aOR 2.18; 95%CI (1.01‐4.73); p = 0.047) and absence of counselling on breastfeeding (aOR 2.39; 95%CI (1.07‐5.32); p = 0.032). Skin‐to‐skin contact (aOR 0.45; 95%CI (0.25‐0.83); p = 0.007) was a protective factor.
Conclusions: The prevalence of DIBF in both rural and urban settings remains average, with distinct factors influencing each context. Addressing these factors through targeted interventions, such as improved antenatal education and enhanced healthcare infrastructure, could help reduce delays and promote better breastfeeding practices.
Contact e‐mail address: isamekone@yahoo.fr
N‐RF006. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐RF006.1. PROTEOMIC ANALYSIS TO IDENTIFY PROTEINS DERIVED FROM MATERNAL DIET IN HUMAN MILK: A PASSAGE FROM MATERNAL FOOD TO INFANT NUTRITION?
Belén Pastor‐Villaescusa 1, Carlos A. Fuentes‐Almagro2, Francisco Amil‐Ruiz3, Katherine Flores‐Rojas1, Mercedes Gil‐Campos1, Lucía Izquierdo‐Palomares4, José Luis Gómez‐Chaparro Moreno1
1Metabolism In Childhood, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain, 2Proteomics Unit, Central Service For Research Support (scai), University of Cordoba, Cordoba, Spain, 3Bioinformatics Unit, Central Research Support Service (scai), University of Cordoba, Cordoba, Spain, 4Pediatrics Radiology Section, Radiodiagnostic Service, Reina Sofia University Hospital, Cordoba, Spain
Objectives and Study: Dietary proteins ingested by the mother are broken down into peptides and probably some of them are transferred into human milk (HM) through the bloodstream and lymphatic systems. The presence of these peptides in HM is still under investigation. This study aimed to identify non‐human proteins in HM to better understand the maternal‐child link that might contribute to food allergy prevention strategies in children.
Methods: This is a descriptive cross‐sectional study using 1 ml HM samples from 10 healthy mothers with uncomplicated, singleton pregnancies and full‐term vaginal deliveries of newborns with appropriate birth weight. This research employed a high‐performance liquid chromatography system coupled with a timsTOF Pro2 to analyze the HM samples in Data‐Independent Acquisition (DIA) mode with Parallel Acceleration Spectral Acquisition (PASEF). Spectral data were processed using Spectronaut software, along with 25 reference proteomes including animals and plant species. For species lacking a reference proteome, it was inferred from available transcriptomic data. Statistical analysis was performed with an in‐house R script (v3.5.3). The study was conducted following the standards of the Declaration of Helsinki and approved by the Ethics Committee of the participating hospital.
Results:
Of the 7,869 identified protein IDs, 2,683 were of exclusive human origin. However, a substantial number of species‐specific proteins were identified (Figure 1). Among them, the highest number of non‐human proteins were derived from pig and rabbit meats. Interestingly, animal‐derived proteins were considerably more prevalent than plant‐derived proteins, with wheat being the most abundant plant‐derived protein.
Conclusions: Proteins from non‐human species were identified within the HM proteome. The biological pathways involved in the transfer of dietary proteins into HM require further investigation, and dietary intake records should be collected to corroborate protein sources. The presence of non‐human proteins in HM may play a role in either sensitizing or promoting tolerance in breastfeeding neonates.
Contact e‐mail address: belen.pastor@imibic.org
N‐RF007. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐RF007.1. IMPACT OF EARLY‐LIFE ORGANIC FEEDING ON INFANT GROWTH AND GUT MICROBIOTA: A RANDOMIZED CONTROLLED TRIAL
Yulin Zhang1, Lijuan Mi2, Celi Yang1, Menglu Xi1, Shanshan Guo2, Shuqi Liu1, Ai Zhao 1, Jinzhu Pang2
1Vanke School Of Public Health, Tsinghua University, Beijing, China, 2Mengniu lnstitute of Nutrition Science, Global R&D Innovation Center, Beijing, China
Objectives and Study: Organic foods are known for their rich nutrient content. However, the effects of organic infant foods in early life remain unexplored. This study evaluates how early‐life organic formula and complementary feeding influence infant growth and gut microbiota, offering evidence‐based insights into dietary strategies for early‐life health.
Methods: Infants aged 0–2 months were recruited from three maternal‐child healthcare centers in China, with one center serving as the breastfed reference group, while participants from the other two centers were randomly assigned to the organic‐fed and conventionally fed groups. Data and feces samples were collected at baseline and 2, 4, 6, and 8 months (Figure a). Measurements included anthropometric indices, neurodevelopmental assessments using the Ages and Stages Questionnaires, and gut microbiota profiling through 16S rRNA sequencing. Statistical analyses employed linear mixed‐effects models to explore group differences. Bioinformatics tools were used to analyze gut microbial diversity and taxonomic composition. Functional pathway analysis via KEGG was conducted to identify metabolic implications of gut microbiota variations.
Results: In all, 66 participants were included in this study. The organic‐fed group exhibited superior length growth at 4 and 6 months compared to the breastfed group (Figure b). There were no significant differences in weight and head circumference across groups. Neurodevelopmental assessments highlighted significantly higher scores in communication in the organic‐fed group by 8 months. Gut microbiota analysis revealed enriched levels of beneficial bacteria, including Bifidobacterium longum (Figure c), Bifidobacterium bifidum (Figure d), and Bifidobacterium adolescentis (Figure e), in the organic‐fed group. KEGG pathway analysis identified enhanced activity in metabolic pathways, including nitrogen, D‐alanine, and glutathione metabolism (Figure f), which might contribute to the early length growth and certain Bifidobacterium colonization in guts.
Conclusions: Early‐life organic formula and complementary feeding are associated with better growth and gut Bifidobacterium colonization, highlighting their role in fostering healthy early‐life development and advancing infant nutrition strategies.
Contact e‐mail address: aizhao18@tsinghua.edu.cn
N‐RF008. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐RF008.1. DIETARY AMINO ACIDS AND THE ODDS OF METABOLIC DYSFUNCTION‐ASSOCIATED FATTY LIVER DISEASE (MAFLD) AMONG OVERWEIGHT AND OBESE CHILDREN AND ADOLESCENTS: A PRINCIPAL COMPONENT ANALYSIS APPROACH
Ali Nikparast1, Mohammadhassan Sohouli2, Pamis Mirzaei1, Zeinab Tadayoni1, Deniz Behrad1, Maryam Razavi3, Pejman Rohani4, Golaleh Asghari 1
1Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 2Pediatric Gastroenterology and Hepatology Research Center Pediatrics Centre of Excellence Children's Medical Center Tehran University of Medical Sciences, Tehran, Iran, 3Growth and development research center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran, 4Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
Objectives and Study: Given the limited understanding of how dietary amino acid intake affects metabolic dysfunction‐associated fatty liver disease (MAFLD), we examined the potential relationship between dietary amino acid patterns and the odds of MAFLD in children and adolescents with overweight and obesity.
Methods: This cross‐sectional study was conducted among participants aged 6 to 18 years with WHO body mass index (BMI)‐for‐age z‐score ≥1. MAFLD was diagnosed based on the criteria outlined in the international expert consensus statement. Principal component factor analyses were conducted based on eighteen amino acids. Logistic regression models, adjusted for potential confounders, were used to estimate the odds of MAFLD across quartile of amino acid pattern scores.
Results: A total of 505 (52.9% boys) with mean ± SD age and BMI‐for‐age‐Z‐score of 10.0 ± 2.3 years and 2.70 ± 1.01, respectively, were enrolled. Among the total sample, 52.9% were boys, 76.6% were classified as being in pubertal status, and 38.8% were diagnosed with MALFD. Three major amino acid patterns were characterized: (1) higher loads by branched chain, lysine, tyrosine, threonine, methionine, histidine, alanine, and aspartic acid; (2) higher loads of proline, serine, glutamic acid, and phenylalanine; (3) higher loads of tryptophan, arginine, glycine, and cysteine. After adjusting for all potential confounders, participants in the highest quartile of the first amino acid pattern tended to be associated with increased odds of MAFLD (OR: 2.14; 95% CI: 0.97‐4.77). There was no significant association for the second amino acid pattern (OR: 1.51; 95% CI: 0.81‐2.80) and third amino acid pattern (OR: 0.62; 95% CI: 0.33‐1.53).
Conclusions: These novel data suggest that the amino acid composition of an individual's diet may modify their odds of MAFLD.
Contact e‐mail address: g_asghari@hotmail.com
N‐RF009. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐RF009.1. TECHNICAL REVIEW BY THE ESPGHAN SPECIAL INTEREST GROUP ON GUT MICROBIOTA AND MODIFICATIONS ON THE HEALTH OUTCOMES OF INFANT FORMULA SUPPLEMENTED WITH POSTBIOTICS
Hania Szajewska1, Ener Dinleyici 2, Alfredo Guarino3, Alexis Mosca4, Raanan Shamir5, Yvan Vandenplas6, Members Berni Canani R; Campoy C; Domellöf M; Dinleyici Ec; Gutiérrez‐Castrellon P; Guarino A; Haiden N; Hojsak I; Indrio F; Mihatsch W; Mosca A; Orel R; Salvatore S; Savino F; Shamir R; Szajewska H; Vandenplas Y; Van Den Akker C.H.P; Van Goudoever J.B.; Weizman6
1Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland, 2Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey, 3Pediatric Infectious Disease Unit, Department of Maternal and Child health, University Hospital "Federico II", Naples, Naples, Italy, 4Department of Pediatric Gastroenterology and Nutrition, Robert‐Debré Hospital, Paris, France, 5Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 6KidZ Health Castle UZ Brussel, Brussels, Belgium
Objectives and Study: This technical review, one of five developed by the ESPGHAN Special Interest Group (SIG) on Gut Microbiota and Modifications (GMM), supports the creation of a Position Paper on the use of infant formulas supplemented with biotics, including postbiotics. Postbiotics are defined as inanimate [i.e., dead, non‐viable] microorganisms and/or their components that confer health benefits to the host. This review focuses on the clinical outcomes of infant formulas supplemented with postbiotics.
Methods: The SIG GMM conducted a systematic review to evaluate the clinical outcomes of postbiotic‐supplemented infant formulas in healthy infants (0‐12 months) published before 2024. Based on the findings of a systematic review, all members of the SIG (n = 20) voted anonymously on statements related to clinical outcomes with a score between 0 and 9. A score higher than 6 indicated agreements. A statement was rejected if <75% of the members agreed. Twelve randomized controlled trials (RCTs) met the inclusion criteria.
Results: The postbiotics studied so far showed no difference compared to the control formula in outcomes such as anthropometric data, gastrointestinal symptoms including stool characteristics, crying/sleep patterns, infantile colic, cow's milk allergy prevention, and adverse effects. There was no difference in tolerability and no safety concerns were raised with the postbiotics studied so far. The RCTs evaluating postbiotics added to infant formula are heterogeneous due to differences in study design, variations in postbiotics and durations of interventions.
Conclusions: The studies were powered to demonstrate and did show that there was good tolerance and adequate, safe growth comparable to non‐supplemented formula in presumed healthy infants. This technical review provides the foundation for recommendations on the use of postbiotic‐supplemented infant formulas in healthy infants.
Contact e‐mail address: yvan.vandenplas@uzbrussel.be
N‐RF010. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐RF010.1. BIOTICS IN INFANT OR FOLLOW‐ON FORMULAE: A POSITION PAPER BY SPECIAL INTEREST GROUP ON GUT MICROBIOTA & MODIFICATIONS
Ener Dinleyici 1, Flavia Indrio2, Hania Szajewska3, Iva Hojsak4, Silvia Salvatore5, Walter Mihatsch6, Roberto Berni Canani7, Cristina Campoy1, Magnus Domellöf8, Ruggiero Francavilla9, Alfredo Guarino10, Pedro Gutierrez‐Castrellón11, Nadja Haiden12, Alexis Mosca13, Rok Orel14, Francesco Savino15, Raanan Shamir16, Johannes Van Goudoever17, Chris Van Den Akker18, Zvi Weizman19, Yvan Vandenplas20
1Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey, 2. Department of Experimental Medicine, University of Salento, Lecce, Italy, 3Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland, 4Children's Hospital Zagreb, Zagreb, Croatia, 5Department of Medicine and Technological Innovation, Pediatrics, Hospital "F. Del Ponte", University of Insubria, Varese, Italy, 6Department of Pediatrics, Ulm University, Ulm, Germany, 7Department of Translational Medical Science and Immuno Nutrition Lab of the CEINGE Advanced Biotechnologies Research Center and Task Force on Microbiome Studies and European Laboratory for the Investigation of Food‐Induced Diseases at the University of Na, Namples, Italy, 89. Department of Clinical Sciences, Paediatrics, Umeå University, Umea, Sweden, 910. Department of Interdisciplinary Medicine ‐ University Aldo Moro, Bari, Italy, 10Pediatric Infectious Disease Unit, Department of Maternal and Child health, University Hospital "Federico II", Naples, Naples, Italy, 11Universidad Juarez del Estado de Durango & International Scientific Council for Probiotics S.C, Mexico City, Mexico, 12Department of Neonatology, Kepler University Hospital, Linz, Austria, 13Department of Pediatric Gastroenterology and Nutrition, Robert‐Debré Hospital, Paris, France, 14University Children's Hospital, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia, 15Ospedale Infantile Regina Margherita di Torino, Città della salute e della Scienza di Torino, Torino, Italy, 16Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 17Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, Netherlands, 18Department of Pediatrics ‐ Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, University, Amsterdam, Netherlands, 19Faculty of Health Sciences, Ben‐Gurion University, Beer‐Sheva, Israel, 20KidZ Health Castle UZ Brussel, Brussels, Belgium
Objectives and Study: Breastfed infants generally have better health outcomes than those who are formula‐fed, partly due to differences in their gut microbiota. For many years, biotics have been added to infant formula in an effort to reduce differences in gut microbiota composition to enhance the health outcomes of formula‐fed infants.
Methods: To review and update the evidence on biotic‐supplemented infant formula, the Special Interest Group on Gut Microbiota and Modifications (SIG‐GMM) evaluated the clinical outcomes of infant formula supplemented with probiotics, prebiotics, synbiotics, postbiotics, and human milk oligosaccharides‐analogues (HMO‐analogues). Our focus was on safety, tolerability, growth and clinical health outcomes. Recommendations were formulated only when at least two well‐designed randomized controlled trials (RCTs) evaluating similar biotics were available. If only one RCT was available, no recommendation was made, regardless of whether a benefit was demonstrated. A modified Delphi process was used to establish consensus on the statements. Limitations of the current evidence and research gaps are discussed. This document is supported by separately published technical reviews, providing a detailed synthesis of the evidence from which these recommendations were formulated.
Results: We conclude that the currently evaluated infant formulas supplemented with biotics for healthy infants do not raise safety concerns regarding growth, tolerance and adverse effects. While some beneficial clinical effects are possible, there is currently no robust evidence to strongly recommend or discourage their routine use. This conclusion may reflect the limited data on specific biotics and outcomes rather than an actual lack of effect. To strengthen conclusions and formulate evidence‐based recommendations, at least two independent high quality and adequately powered studies with a similar design and methodology should be performed.
Conclusions: Differences in inclusion criteria and outcomes, no recommendations can be made "in favor" or "against" the biotic interventions evaluated so far, except for prebiotics shown to soften stools by reducing stool consistency.
Contact e‐mail address: yvan.vandenplas@uzbrussel.be
N‐RF011. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐RF011.1. A RETROSPECTIVE NUTRITIONAL ASSESSMENT IN A COHORT OF PREGNANT WOMEN IDENTIFIED BY NEONATAL SCREENING FOR COBALAMIN DEFICIENCY IN OFFSPRING
Martina Tosi1,2, Alice Colombo1, Giulia Fiore 1, Alessandra Cecchini1, Marianna Zobele1, Veronica Tagi1,3, Chiara Montanari1,3, Alessandra Bosetti1, Gian Vincenzo Zuccotti1,3, Elvira Verduci2,4
1Department Of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy, 2Department Of Health Sciences, University of Milan, Milan, Italy, 3Department Of Biomedical And Clinical Science, University of Milan, Milan, Italy, 4Unit Of Metabolic Disease, Ospedale dei Bambini Vittore Buzzi, Milano, Italy
Objectives and Study: During pregnancy, nutritional needs increase to support maternal and fetal health. To avoid deficiencies impacting both fetal development and pregnancy outcomes, nutritional assessment is essential. The objective is to retrospectively evaluate nutritional status and dietary intakes in a cohort of mothers identified by neonatal screening for cobalamin deficiency in offspring.
Methods: From 2022, 107mother‐infant dyads with cobalamin deficiency were identified and referred to Buzzi Children's Hospital. Before hydroxycobalamin administration, mothers’ dietetic history during pregnancy was retrospectively collected and evaluated by registered dietitians. Metabolic and nutritional biochemistry was performed during the first month after delivery.
Results:
The average age was 32.5 years (range:15‐46). Ethnicity, BMI categories and type of infant feeding are shown in Figure1A. Mean plasma values revealed: B12 240 pg/ml (SD ± 116) and homocysteine 14.2μmol/L (SD ± 6.7); 33.6% had hemoglobin (Hb) levels below 12.5 g/dl. During pregnancy, 69% were supplemented with folic acid, 15% took a supplement containing vitamin B12, but only 14% supplemented both. Among women supplementing B12 in pregnancy, mean plasma B12 was higher than unsupplemented (255.5±113vs231.2±104 pg/ml). Additionally, 9% had positive anti parietal cells antibodies, 11% suffered from hyperemesis gravidarum. Regarding dietary habits: 71% were omnivores (O), 16% lacto‐vegetarian (LV), 12% lacto‐ovo‐vegetarian (LOV), and 1% vegan. Figure1B shows dietary intake during pregnancy compared to EFSA Dietary Reference Values (DRVs) and the distribution of women achieving DRVs according to dietary pattern. For vitamin B12, considering also supplementation, 21% women (95%O and 5%LOV) achieved the DRVs. No significant differences between dietary patterns (O, LV and LOV) with regard to plasma B12, folate, ferritin and Hb were observed.
Conclusions: It is crucial to address maternal dietary needs since the preconception period, as dietary patterns are not always representative of micronutrient intake, as omnivores having unbalanced diet are equally at risk of not achieving DRVs. This approach is necessary to appropriately supplement, ensuring better future health of offspring.
Contact e‐mail address:
N‐RF012. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐RF012.1. TECHNICAL REVIEW BY THE ESPGHAN SPECIAL INTEREST GROUP ON GUT MICROBIOTA AND MODIFICATIONS ON THE HEALTH OUTCOMES OF INFANT FORMULA SUPPLEMENTED WITH HUMAN MILK OLIGOSACCHARIDES‐ANALOGUES
Iva Hojsak 1, Ener Dinleyici2, Chris Van Den Akker3, Magnus Domellöf4, Nadja Haiden5, Hania Szajewska6, Yvan Vandenplas7, Members Berni Canani R; Campoy C; Domellöf M; Dinleyici Ec; Gutiérrez‐Castrellon P; Guarino A; Haiden N; Hojsak I; Indrio F; Mihatsch W; Mosca A; Orel R; Salvatore S; Savino F; Shamir R; Szajewska H; Vandenplas Y; Van Den Akker C.H.P; Van Goudoever J.B.; Weizman7
1Children's Hospital Zagreb, Zagreb, Croatia, 2Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey, 3Department of Pediatrics ‐ Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, University, Amsterdam, Netherlands, 48. Department of Clinical Sciences, Paediatrics, Umeå University, Umea, Sweden, 5Department of Neonatology, Kepler University Hospital, Linz, Austria, 6Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland, 7KidZ Health Castle UZ Brussel, Brussels, Belgium
Objectives and Study: This technical review, one of five developed by the ESPGHAN Special Interest Group (SIG) on Gut Microbiota and Modifications (GMM), supports the creation of a Position Paper on the use of biotic‐supplemented formulas, including those containing human milk oligosaccharide analogues (HMO‐analogues). These are biotechnologically produced and identical to HMOs found in human milk, though they do not originate from it.
Methods: This review focuses on the clinical outcomes related to the supplementation of infant formulas with HMO‐analogues. The SIG GMM conducted a systematic review to evaluate the clinical outcomes of HMO‐analogues‐supplemented infant formulas in healthy infants (0‐12 months) published before 2024. Following the review, all 20 members of the SIG anonymously voted on each statement, scoring them between 0 and 9. A score of > 6 indicated agreement. A statement was rejected if <75% of the members agreed.
Results: Six RCTs and two mechanistic sub‐studies met the inclusion criteria and investigated different combinations of HMO‐analogues added to formula. The HMO‐analogues studied so far show no difference compared to the control formula in outcomes such as: anthropometric data, regurgitation‐related symptoms, crying, fussiness, or colic. A specific combination of 5 HMO‐analogues (2′fucosyllactose (FL), 3′‐FL, lacto‐N‐tetraose (LNT), 3′‐sialyllactose (SL) and 6′‐SL) suggest a softer stool consistency and more frequent defecation in presumable healthy infants, but these studies also used the highest amount of HMO‐analogues; however, the clinical relevance of this finding remains uncertain. Regarding infection prevention, no clear conclusion can be drawn.
Conclusions: There was no difference in tolerability and no safety concerns were raised with the HMO‐analogues studied so far. This technical report serves as the background for formulating recommendations on the use of HMO‐analogies‐supplemented infant formula in healthy infants studied so far.
Contact e‐mail address: yvan.vandenplas@uzbrussel.be
N‐RF013. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐RF013.1. ENTERAL NUTRITION IN PAEDIATRIC ONCOLOGY PATIENTS IN THE ICU: PRESCRIPTION PRACTICES AND ASSOCIATIONS TO SHORT TERM CLINICAL OUTCOMES
Nara Elizabeth Lara Pompa 1, María Eugenia Nieto Carbó2, Gabriela Escamilla Asiain3
1Clinical Nutrition, Hospital Infantil Teletón De Oncología, Santiago de Queretaro, Mexico, 2Universidad del Valle de Atemajac, Santiago de Queretaro, Mexico, 3Hospital Infantil Teletón De Oncología, Santiago de Queretaro, Mexico
Objectives and Study: Paediatric oncology patients have a high risk of malnutrition, further complicated in critical illness. Enteral nutrition (EN) is a key component of nutritional management, but its prescription remains non‐standardized in this population. This retrospective study described EN prescription and associations to short‐term clinical outcomes in children (0‐18 years) admitted to the intensive care unit (ICU) at a tertiary paediatric oncology hospital from 2014 to 2020.
Methods: Data was obtained from electronic medical records on 1) patient characteristics 2) EN prescription 3) nutritional status 4) clinical outcomes: length of stay (LOS) and mechanical ventilation. Data was summarised as percentages, means, standard deviations (SD), median and interquartile ranges (IQR). Associations were analysed with independent‐samples t‐tests and risk ratios (RR).
Results: We identified 542 cases (mean 7.2 yr; 56.3% male). Most (38.9%) post‐surgical, 20.3% admitted for sepsis. EN was prescribed in 43.5%: 48.4% nasogastric, 38.7% oral and12.9% gastrostomy. Median start was 3 days (IQR 2‐5 days), with 25.2% (IQR 13.5‐53.3%) calculated caloric requirements, reaching maximum 45.4% (IQR 23.9‐79.3%) by day 3. Blenderized feeds were used in 58.2%, 32.5% from the start. Commercial formula was prescribed in 66.1% (71% polymeric, 16% hydrolysed, 11% lactose‐free and 2% elemental). Transient interruption ocurred in 33%. On admission, 6.2% were severely undernourished, 8.5% moderately, 6.4% overweight and 0.6% obese. Patients receiving EN had a significant shorter LOS (5.6 vs 13.7, p < 0.001) and mechanical ventilation (6.9 vs 1.8 days, p < 0.001). Patients without EN had increased risk of prolongued LOS (RR 2.1, 95%CI 1.7,2.5) and ventilation (RR 1.8, 95%CI 1.4,2.2).
Conclusions: EN in paediatric oncology patients in the ICU was common and feasible, with a preference for nasogastric tube and blenderized feeds. EN was associated with shorter LOS and days of mechanical ventilation. Future studies should explore associations to short and long‐term clinical outcomes and clarify different aspects of EN prescription in this population.
Contact e‐mail address: nara.lara@hospitalteleton.org.mx
N‐RF014. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐RF014.1. SYNTHETIC HUMAN MILK GM3 GANGLIOSIDE SUPPORTS GUT BARRIER INTEGRITY
Fichot Marie‐Claire
Carbocode SA, Konstanz, Germany
Objectives and Study: Cow's milk gangliosides (mainly GD3) have been shown to improve intestinal permeability. The objective of this study was to compare cow's milk GD3 with human identical GM3 ganglioside, predominant in mature breastmilk.
Methods: Caco 2 cells were incubated for 2 days with either synthetic human milk GM3 (CarboCode SA) or cow's milk GD3 (Avanti ®) at a concentration of 10 mg/l (similar to GM3 concentration in mature breastmilk) before exposure to pro‐inflammatory stimuli (LPS or DSS) for 24/48 hours. Epithelial barrier function was measured by transepithelial electric resistance (TEER) at 8, 24 and 48 hours and culture supernatants from the apical chamber were collected at 24 hours to measure sPLA2 by ELISA, as a marker of inflammation.
Results: Both DSS and LPS treatments led to a decrease in TEER, as compared to the control. Both GD3 and GM3 showed an improvement in TEER at 24 hours, indicating a mitigation of barrier damage. These results are consistent with the published data on cow's milk GD3 (Miklavcic et al., 2021), and support a similar protective benefit of human milk GM3. LPS did not significantly alter sPLA2 secretion, and the addition of gangliosides did not impact secretion as well. DSS caused a marked increase in sPLA2 levels, indicative of a strong inflammatory effect. Both GD3 and GM3 lowered sPLA2 levels compared to DSS alone, indicating a potential anti‐inflammatory effect through the modulation of inflammatory enzyme secretion.
Conclusions: Synthetic human milk GM3 ganglioside displays similar protective benefits as cow's milk GD3 on the gut barrier function. It can help preserving tight junction integrity of epithelial cells under inflammatory conditions and may mitigate inflammation through the modulation of inflammatory enzyme secretion.
Contact e‐mail address: marieclaire.fichot@carbocode.com
N‐RF015. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐RF015.1. TECHNICAL REVIEW BY THE ESPGHAN SPECIAL INTEREST GROUP ON GUT MICROBIOTA AND MODIFICATIONS ON THE HEALTH OUTCOMES OF INFANT FORMULA SUPPLEMENTED WITH PREBIOTICS
Walter Mihatsch 1, Ener Dinleyici2, Roberto Berni Canani3, Iva Hojsak4, Alexis Mosca5, Rok Orel6, Silvia Salvatore7, Francesco Savino8, Hania Szajewska9, Chris Van Den Akker10, Zvi Weizman11, Yvan Vandenplas12, Members: Berni Canani R; Campoy C; Domellöf M; Dinleyici Ec; Gutiérrez‐Castrellon P; Guarino A; Haiden N; Hojsak I; Indrio F; Mihatsch W; Mosca A; Orel R; Salvatore S; Savino F; Shamir R; Szajewska H; Vandenplas Y; Van Den Akker C.H.P; Van Goudoever J.B.; Weizman12
1Department of Pediatrics, Ulm University, Ulm, Germany, 2Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey, 3Department of Translational Medical Science and ImmunoNutritionLab of the CEINGE Advanced Biotechnologies Research Center and Task Force on Microbiome Studies and European Laboratory for the Investigation of Food‐Induced Diseases at the University of Napl, Naples, Italy, 4Children's Hospital Zagreb, Zagreb, Croatia, 5Department of Pediatric Gastroenterology and Nutrition, Robert‐Debré Hospital, Paris, France, 6University Children's Hospital, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia, 7Department of Medicine and Technological Innovation, Pediatrics, Hospital "F. Del Ponte", University of Insubria, Varese, Italy, 8Ospedale Infantile Regina Margherita di Torino, Città della salute e della Scienza di Torino, Torino, Italy, 9Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland, 10Department of Pediatrics ‐ Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, University, Amsterdam, Netherlands, 11Faculty of Health Sciences, Ben‐Gurion University, Beer‐Sheva, Israel, 12KidZ Health Castle UZ Brussel, Brussels, Belgium
Objectives and Study: This technical review, one of five developed by the ESPGHAN Special Interest Group (SIG) on Gut Microbiota and Modifications (GMM), supports the development of a Position Paper on the use of infant formulas supplemented with biotics, including prebiotics. Prebiotics are defined as substrates that are selectively utilized by host microorganisms, conferring a health benefit. This review focuses on the clinical outcomes of infant formulas supplemented with prebiotics.
Methods: The SIG GMM conducted a systematic review to evaluate the clinical outcomes of prebiotic‐supplemented infant formulas in healthy infants (0‐12 months) published before 2024. Following the review, all 20 SIG members anonymously voted on each statement, scoring them from 0 to 9. A score greater than 6 indicated agreement. A statement was rejected if less than 75% of the members agreed.
Results: Forty‐five randomized controlled trials were included, focusing on prebiotics such as short‐chain galacto‐oligosaccharides, long‐chain fructo‐oligosaccharides, acidic oligosaccharides, and polydextrose/galacto‐oligosaccharides. Attrition rates were high, reaching up to 56% over five years, limiting the strength of the evidence. The variability in outcome measures prevented meta‐analysis. Overall, no significant clinical health benefits were observed in terms of growth, infections, or antibiotic use.
Conclusions: Forty‐five randomized controlled trials were included, focusing on prebiotics such as short‐chain galacto‐oligosaccharides, long‐chain fructo‐oligosaccharides, acidic oligosaccharides, and polydextrose/galacto‐oligosaccharides. Attrition rates were high, reaching up to 56% over five years, limiting the strength of the evidence. The variability in outcome measures prevented meta‐analysis. Overall, no significant clinical health benefits were observed in terms of growth, infections, or antibiotic use.
Contact e‐mail address: yvan.vandenplas@uzbrussel.be
N‐RF016. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐RF016.1. RESTING ENERGY EXPENDITURE AND NUTRITION STATUS IN ADOLESCENTS WITH CROHN'S DISEASE ON CDED VS. NORMAL DIET: A PILOT STUDY
Ivana Blažević1, Ana Ilić1, Ivana Rumbak1, Tena Niseteo 2
1Nutrition, Faculty of Food Technology and Biotechnology, Zagreb, Croatia, 2Children Hospital Zagreb, Zagreb, Croatia
Objectives and Study: Nutritional status in teenagers with Crohn's disease (CD) is often impacted by diet restrictions or self‐initiated dietary changes. This pilot study assessed the nutritional status of teens on the Crohn's Disease Exclusion Diet (CDED) compared to unrestricted standard diet.
Methods: The study included 20 patients (18 boys), with a median age of 15.0 (14.0–17.0) years. Nutritional status was assessed using body weight (BW), body height (BH), body mass index (BMI), dietary record, diet type (unrestricted standard diet or CDED), vitamin‐mineral status (iron, ferritin, B12, zinc, vitamin D, A, E), and resting energy expenditure (REE) measured by indirect calorimetry (IC).
Results: All patients were in remission, with 80% receiving biologic therapy. Median BW was 58.5 (53.6‐68.5) kg, BH 175.0 (170.0‐179.0) cm, and BMI 19.2 (18.3‐21.8) kg/m², with a median BMI z‐score of ‐0.41 SD (‐0.92 ‐0.33 SD). No undernourished patients were found, though 15% were overweight. IC REE showed higher values than estimated (median 112.0%, 104.0‐118.5%), indicating an elevated metabolic rate. There were no differences in energy, macronutrient intake, anthropometry, or vitamin‐mineral status between patients on CDED and those on a unrestricted standard diet. However, CDED patients had statistically significant higher serum vitamin E levels (p = 0.018). The median energy intake via oral nutritional supplements (ONS) for CDED patients was 34.4% (0.0‐76.5%) of total energy intake (TEI), while patients on unrestricted standard diet had 0.0% (0.0‐16.2%) of TEI.
Conclusions: Teenagers with CD in remission showed adequate nutrition status both anthropometrically and biochemically. Energy and macronutrient intake met dietary needs, with no significant differences between CDED and normal diet groups. Although the sample size was small, the results showed that regardless of the diet on nutritional status of both patient groups was similar.
Contact e‐mail address:
N‐RF017. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐RF017.1. DIFFERENT NUTRITIONAL SUPPLEMENTS COMPOSITION, ALWAYS DIFFERENT ADHERENCE AND BENEFITS? PERCEPTIONS JR STUDY EXPERIENCE
César Sánchez Sánchez 1, María Del Mar Tolín Hernani1, Carmen Miranda‐Cid1, Guillermo Alvarez Calatayud1, The Perceptions Jr Study Group2
1Pediatric Department. Pediatric Gastroenterology Unit, H.G.U. Gregorio Marañón. H. Materno Infantil, Madrid, Spain, 2The PerceptiONS Jr Study Group, Madrid, Spain
Objectives and Study: To explore doctors and family's perception of three different children nutritional supplements (NS): hyper‐caloric oral with fiber (HOFF), oral peptide (OPF), and hyper‐caloric infant (HIF). To evaluate tolerance and adherence factors related of these formulas.
Methods: Cross‐sectional, observational study, based on electronic surveys on the perceptions of physicians and their patients and families with NS. Socio‐demographic variables, nutritional status, characteristics of NS, administration, benefits, satisfaction, adherence, and acceptance were included.
Results: 163 doctors, 815 children included. 64% of children received HOFF, 16% OPF and 20% HIF, 84% administered exclusively orally. The range of total calories of NS was 30‐75%, with a higher intake observed in children < 6 months. Benefits of HOFF included was improve in nutritional status, mood, and overall condition with higher calorie intake (p < 0.05). OPF was associated with enhanced quality of life and symptom relief in older children (p < 0.05), not confirmed with HIF. None of benefits were correlated with baseline nutritional status. Taste (82%), texture (77%), and smell (74%) were crucial for acceptance. Similar results were found with HIF and HOFF, a greater importance of taste and texture in the degree of satisfaction for OPF. Adherence levels were similar across NS types. Continued follow‐up was the most important factor in adherence, most in younger patients with HIF (90%). Adequate information about NS was essential, smell was the main factor for nonadherence, similar in all formulas. 97% of doctors would prescribe the same NS again.
Conclusions: Physicians and families perceived excellent benefits from all our NS. HOFF showed improvement of nutritional status and mood with a higher calorie intake. Quality of life was better in older children with OPF. Taste was the critical factor for satisfaction, and continued follow‐up was vital for adherence. Medical prescribers would recommend the same formula again.
Contact e‐mail address:
N‐RF018. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐RF018.1. ADVANCING PEDIATRIC MALNUTRITION CARE: INITIAL FINDINGS FROM THE MULTICENTRE P‐INPAC IMPLEMENTATION STUDY
Tejas Desai 1,2, Zujaja Tul‐Noor2, Romy Shenderey3, Sarah Tiessen4, Jeremy Schneeweiss2,3, Erika Gibson5, Megan Healey6, Adelina Morra6, Fariha Chowdhury3,4, Jillian Owens4, Robert Bandsma2,7, Bonnie Fleming‐Carroll8, Daina Kalnins5, Koen Huysentruyt9, Kim Brunet‐Wood10, Valerie Marchand11, Nikhil Pai3,4,12, Jessie Hulst2,7
1Department Of Pediatrics, Division Of Gastroenterology, Hepatology & Nutrition, Children's Hospital London Health Sciences Centre, London, Canada, 2Department Of Pediatrics, Division Of Gastroenterology, Hepatology & Nutrition, The Hospital for Sick Children, Toronto, Canada, 3Department Of Pediatrics, Division Of Gastroenterology, Hepatology & Nutrition, McMaster University, Hamilton, Canada, 4McMaster Children's Hospital, Hamilton, Canada, 5Department Of Clinical Dietetics, The Hospital for Sick Children, Toronto, Canada, 6Department Of Pediatrics, The Hospital for Sick Children, Toronto, Canada, 7Department Of Pediatrics And Nutritional Sciences, University of Toronto, Toronto, Canada, 8Learning Institute, The Hospital for Sick Children, Toronto, Canada, 9Department Of Pediatric Gastroenterology, Hepatology And Nutrition, UZ Brussel, Brussels, Belgium, 10Canadian Nutrition Society, Ottawa, Canada, 11Division Of Gastroenterology, Hepatology & Nutrition, Ste‐Justine UHC, Quebec, Canada, 12Division Of Gastroenterology, Hepatology & Nutrition, Children's Hospital of Philadelphia, Philadelphia, United States of America
Objectives and Study: Disease‐associated malnutrition in hospitalized children is associated with adverse outcomes, yet standardized malnutrition screening, assessment and management are underutilized. The Canadian Malnutrition Task Force developed the Pediatric Integrated Nutrition Pathway for Acute Care (P‐INPAC) to address this gap. Objective: Evaluate feasibility of adopting the first two steps of P‐INPAC including standardized nutritional risk screening and nutritional assessment.
Methods: This prospective study on pediatric/surgical units of two tertiary care pediatric hospitals in Canada included patients ≥30 days old and admitted ≥24 hours(h). Phase 1 (8 weeks) assessed current nutrition practices. Phase 2 (8 weeks) involved staff training on workflow changes, standardized protocols using newly developed educational resources, and tools in electronic medical records. In Phase 3 (16 weeks), audits were conducted twice monthly to assess completion of nutritional risk screening (STRONGkids) ≤ 24 h, and measurements of weight (W) and length/height (H) by nursing staff ≤48 h after admission (step 1). Completion of Subjective Global Nutritional Assessment (SGNA) by dietitians for at‐risk patients (high STRONGkids score and/or any z‐score < ‐2SD for W/H/BMI, step 2) was also assessed.
Results: Total 324 patients (54.9% male, median age 7 years, median hospital stay 4 days) were audited. Across each hospital, screening rates peaked at 64% and 60% for STRONGkids, 67% and 54% for weight and, 48% and 31% for height respectively (FIGURE). Overall, STRONGkids was performed in 34.3% of patients, identifying 9% as high‐risk; whereas, 55.2% had W and/or H measured ≤48 h, with 16.2% showing z‐scores < ‐2SD. Both assessments were completed in 21% of patients, and 68.5% had either done. SGNA was completed ≤72 h in 52.6% of patients needing step#2, with 55% confirmed malnourished.
Conclusions: Initial results of P‐INPAC implementation indicate reasonable adoption of STRONGkids, weight measurements, and SGNA in routine care, while measuring length/height proved more challenging. Continuous quality improvement efforts are essential for further adoption and sustainability.
Contact e‐mail address: jessie.hulst@sickkids.ca
N‐RF019. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐RF019.1. THE TUBE WEANING PROGRAM AT THE HELSINKI UNIVERSITY'S CHILDREN'S HOSPITAL, 2016‐2023: SAFETY AND EFFICIENCY
Josefine Limnell 1,2, Anna Kaarina Kukkonen3, Päivi Peldan3, Laura Merras‐Salmio3
1University of Helsinki, Helsinki, Finland, 2The wellbeing services county of Ostrobothnia, Vaasa central hospital, Vaasa, Finland, 3Childrens Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Objectives and Study: To evaluate the pediatric tube weaning program at the Helsinki University's Children's Hospital.
Methods: A retrospective cohort study of patients who started the multidisciplinary tube‐weaning program between 2016‐ 2023. Inclusion criteria were tube‐feeding at start of program and completion of at least 2/3 weeks. We classified the patients’ level of oral feeding (LOF) with scores from 0 to 6. As the main outcome, we determined complete tube weaning. We collected patient data and conducted quantitative descriptive statistical analyses.
Results: We included 49/55 patients (n = 2 had no tube feeds, n = 4 did not complete the program). After 1 month of program 86% (N = 42) had improved oral feeding and 65% (N = 32) had discontinued tube‐feeding completely. Feeding tube was removed in 55% (N = 27). Hypoglycemia (35%, N = 17) and dehydration (31%, N = 15) were the main adverse effects. Median LOF at the beginning of the program was higher in the weaned group vs. not weaned with scores of 6 vs 3 (p = 0.02); and lower in the hypoglycemic group vs. non‐hypoglycemic, 2 vs 3.5 (p = 0.001).
| Characteristics of pediatric patients undergoing weaning from tube feeding | |||
|---|---|---|---|
| N | Median/n | IQR/n% | |
| Gestational Age, wk | N = 46 | 39 | (33‐39) |
| Birthweight, g | N = 47 | 3210 | (1890‐3780) |
| Born premature, <gw37 | 17 | 37% | |
| Age at program, years | N = 49 | 2,9 | (2,2‐4,4) |
| Years with feeding tube before program | N = 49 | 2,45 | (1,93‐3,46) |
| Weight change during program | N = 49 | ‐6,30% | (‐8,3‐(‐3,6)) |
| Any adverse effect during program | 24 | 49% | |
| Follow‐up time, years | 2,4 | (1,1‐4,8) | |
| Successfully weaned 12 months after program | N = 47 | 33 | 70% |
Conclusions: The tube‐weaning program at Helsinki University's Children's Hospital is effective in improving oral feeding. Adverse effects were common but transitory. Better oral feeding skills at start may be beneficial and might have less associated hypoglycemia. More research is needed to identify risk factors of severe adverse effects in this heterogenic patient group.
Contact e‐mail address: josefine.limnell@ovph.fi
N‐RF020. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐RF020.1. FEEDING DIFFICULTIES AMONG CHILDREN WITH AUTISTIC SPECTRUM DISORDER (ASD)
Hadar Moran‐Lev, Tut Galai
Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel aviv, Israel
Objectives and Study: Data on feeding difficulties in children with autism spectrum disorder (ASD) is limited. We aimed to investigate factors associated with Pediatric Feeding Disorder (PFD) among children with ASD.
Methods: A retrospective analysis was conducted on medical records of infants and toddlers diagnosed with PFD, based on the WHO‐defined criteria. Children with ASD and PFD were compared to children with PFD but without an ASD diagnosis.
Results: The study included 141 children with PFD (median age [interquartile range]: 6 [4, 15] months at diagnosis). Among them, 47 were diagnosed with ASD. In 15 children (33%), the diagnosis of PFD preceded the diagnosis of ASD. Significantly more children in the ASD group were male (52.6% vs. 34.4%, p = 0.03) and were born to parents with lower academic backgrounds (p < 0.05, table 1). Additionally, children with ASD were older at PFD diagnosis (10 vs. 5 months,respectively, p = 0.05). When comparing PFD domains, children with ASD exhibited significantly more nutritional dysfunction and less psychosocial dysfunction than those without ASD figure 1, p = 0.007).
| Variable | PFD with ASD N = 47 | PFD without ASD N = 94 | P value |
|---|---|---|---|
| Sex. Male | 39 (83) | 56 (59) | 0.004 |
| Age, at PFD diagnosis months | 10 (5, 20.25) | 5 (3.62, 10.25) | 0.05 |
| 1st Parental academic background | 14 (29) | 57 (61) | 0.002 |
| 2nd Parental academic background | 12 (25) | 63 (67) | <0.001 |
| Number of siblings | 1 (0,2) | 1 (0,1.5) | 0.19 |
| Delivery by C/S | 19 (38) | 22 (23) | 0.03 |
| Gestational age | 38 (35.2,39) | 38 (37,39) | 0.35 |
| Birth weight, grams | 3000 (2155, 3446.5) | 3042.5 (2705, 3405) | 0.43 |
| Breastfeeding | 21 (44) | 30 (32) | 0.06 |
| Age at complementary food introduction, months | 6 (5,8) | 6 (5,7) | 0.96 |
| Gastrostomy tube feeding | 4 (8) | 3 (3) | 0.168 |
Conclusions: Children with ASD and PFD present distinct challenges, including later diagnosis more nutritional difficulties and less psychosocial difficulties. Early screening and tailored interventions are essential to address their specific needs.
Contact e‐mail address: hadarlev6@gmail.com
N‐RF021. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐RF021.1. CARDBOARD BOX PACKAGING OF THERAPEUTIC FEEDS FOR PLAY AND STIMULATION IN THE MANAGEMENT OF ACUTE MALNUTRITION: PROJECT PLAY
Nicolette Nabukeera Barungi
Paediatrics And Child Health, Makerere University College of health Sciences, Kampala, Uganda
Objectives and Study: We present an innovation in which play materials were made from the ready‐to‐use therapeutic feeds (RUTF) cardboard boxes. We determined the acceptability, playability and appropriateness of delivery of the innovation.
Methods: The intervention included 40 minutes of daily supervised play using RUTF‐box‐based play materials for children with acute malnutrition at 3 Referral Hospitals. Data was collected using tablets among 400 children. Assessments were standardized by using the same five play materials at the 3 sites. Acceptability was measured using a composite score. Qualitative data on experiences of caregivers and health workers was captured using 9 FGDs involving caregivers and 9 KIIs with health workers at the three sites. Qualitative data analysis was done using Atlas‐ti 7.0.83 using content thematic approach analysis while quantitative used Stata V.18 for analysis.
Results: We found that 367 (91.7%) of the children, 389 (97.2%) of caregivers demonstrated interest in play and 389 (97.2%) of caregivers rated their experiences as “good” and “very good”. The age of the child and caregiver were significantly associated with acceptability of the play materials. For each year increase in the child's age, the odds of accepting the intervention increased by 4% (OR = 1.04, 95%CI: 1.00‐1.08). Conversely, for each year increase in caregiver's age, the odds of accepting the intervention decreased by 4% (OR:0.96, 95%CI: 0.92‐1:00). Additionally, households where caregivers are worried about their next meal showed 1.82 times higher odds of accepting the intervention. Play materials were reported to be safe by 395 (98.7%). Benefits reported included quicker recovery of their children, shorter hospital stay, smiles from their children, better relationships with the health workers among others.
Conclusions: The RUTF play materials were acceptable by all especially the older children, younger mothers and households with food insecurity. This innovation should be rolled out to all nutrition units in Uganda and similar settings.
Contact e‐mail address:
N‐RF022. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐RF022.1. EFFECT OF ORAL NUTRITIONAL SUPPLEMENT ON DIETARY INTAKE AND MICRONUTRIENT STATUS IN MALNUTRITION AT‐RISK CHILDREN (MARVEL STUDY): A MULTICENTER, RANDOMIZED CONTROLLED TRIAL, THAILAND
Suchaorn Saengnipanthkul 1, Orapa Suteerojntrakool2,3, Patcharapa Thaweekul4, Kamolmart Wannaphahoon4, Nathawan Khunsri3, Eakkarin Eakkarin Mekangkul5, Prapassara Sirikarn6, Sirinuch Chomtho2
1Department Of Paediatrics, Faculty Of Medicine, Khon Kaen University, Khon Kaen, Thailand, 2Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 3Center Of Excellence In Pediatric Nutrition, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 4Department Of Pediatrics, Faculty Of Medicine, Thammasat University, Pathum Thani, Thailand, 5Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand, 6Epidemiology And Biostatistics, Faculty Of Public Health, Khon Kaen University, Khon Kaen, Thailand
Objectives and Study: Malnutrition and micronutrient deficiencies impact children's health, especially in developing countries. This study evaluates the effect of oral nutritional supplements (ONS) with dietary counseling on dietary intake, micronutrient status, and health outcomes in malnutrition‐at‐risk children.
Methods: This multicenter, randomized controlled trial included 159 malnutrition‐at‐risk and malnourished children aged 1–6 years in Thailand, defined by a weight‐for‐height Z‐score between ‐1 SD and ‐3 SD. Participants were randomized to receive either 420 mL/day of ONS with dietary counseling (intervention) or dietary counseling alone (control) for 90 days. Baseline and post‐intervention assessments included dietary intake (24‐hour recall) and biochemical markers (hemoglobin, iron studies, vitamin D, and zinc).
Results: Of 159 children enrolled (81 intervention, 78 control), 148 completed the study. At 90 days, the intervention group demonstrated significant improvements in calcium, iron (total and animal sources), vitamin B12, vitamin C, and zinc intake compared to controls, adjusted for baseline. Vitamin D levels increased significantly in the intervention group (2.6 ng/ml in intervention vs. ‐3.0 ng/ml in control, p = 0.002), with a lower prevalence of vitamin D deficiency (25OHD < 20 ng/ml) (4.2% vs. 13.6%, p = 0.049) compared to controls. Moreover, the risk difference for vitamin D insufficiency (25OHD 20‐30 ng/ml) was ‐21.9 (95% CI: ‐38.0, ‐0.06, p = 0.008), indicating a significant reduction in the intervention group, compared to control group. Iron deficiency (TF saturation <15%) showed a trend toward reduction in intervention group (RD = ‐11.5, 95% CI: ‐24.0, 0.01, p = 0.071). Median changes in other biomarkers were not significant.
Conclusions: ONS supplementation, alongside dietary counseling, improved key micronutrient consumption and vitamin D status in malnutrition‐at‐risk/malnourished children. While general dietary improvements contributed to better intake of other nutrients, vitamin D levels were notably enhanced through fortification, highlighting the potential of ONS to address nutritional gaps and improve health outcomes in vulnerable pediatric populations.
Contact e‐mail address: schomtho@gmail.com
N‐RF023. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐RF023.1. DIFFICULTIES OF EATING AND MASTICATING SOLID FOOD IN CHIDREN WITH SPINAL MUSCULAR ATROPHY – PRELIMINARY STUDY
Ewa Winnicka 1, Adrianna Łabuz1, Tomasz Grochowski1, Zbigniew Kułaga2, Piotr Socha3
1Department Of Otolaryngology, Audiology And Phoniatrics, The Children's Memorial Health Institute, Warsaw, Poland, 2Public Health Department, The Children's Health Institute, Warsaw, Poland, 3Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
Objectives and Study: Feeding dificulties are a relevant but often underestimated problem in children suffering from spinal muscular atrophy (SMA). They can lead to aspiration pneumonia or malnutrition due to muscles weakness and degeneration of nerves and muscles fibers. The improvement of muscles strength and endurance and increasing patients’ motor skills are observed since the treatment was introduced. The update of knowledge about swallowing and masticating solid food is needed. The aim of our study was to determine whether the effectiveness of swallowing and masticating is depended on the strenght of the tongue muscles.
Methods: We investigated 17 children with SMA (aged 7;5 ± 2;11), treated with various medications: nusinersen (n = 13), risdiplam (n = 4), branaplam (n = 2), and onasemnogene (n = 5). 6/17 patients received more then one therapeutic option. 13/17 children with SMA I, 2/17, SMA II, 2/17, SMA III. 2/17 were partialy fed by gastrostomy tube (SMA I), the others were fed only orally. We used the Iowa Oral Performance Instrument (IOPI) to assess maximal tongue muscle strength. Swallowing and masticating solids was evaluated based on videos recorded during the consumption of a Gran Pavesi Salati cracker (IDDSI 7a), in accordance with the TOMASS‐C test guidelines. Four categories was assessed: number of discrete bites, cycles of mastication, number of swallows; duration of eating.
Results: The average result of IOPI measurement was 18,5 kPa ±14,5 (detailed as follows: SMA I 15 kPa±11,6; SMA II 14,5 kPa±7,8; SMA III 45 kPa±10). Statistical analysis by using Spearman's rank correlations confirmed statistical significance between strength of tongue muscles and each of TOMASS‐C categories: number of discrete bites (p = 0.003; r = ‐0.68); cycles of mastication (p = 0.001; r = ‐0.73); number of swallows (p = 0.0001; r = ‐0.80), duration of eating (p < 0.0001; r = ‐0.83).
Conclusions: Difficulties with oral feeding still can affect patients with SMA, despite the treatment. Weakened tongue muscle strength can results in reduce effectiveness in eating solid foods.
Contact e‐mail address: ewa.winnicka33@gmail.com
N‐RF024. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐RF024.1. COMPARISON OF THE FENTON CURVE AND THE INTERGROWTH‐21ST CURVE IN MONITORING THE GROWTH OF PREMATURE INFANTS AT CIPTO MANGUNKUSUMO HOSPITAL, JAKARTA, INDONESIA
Nitish Adnani, Rinawati Rohsiswatmo, Damayanti Sjarif, Rismala Dewi, Fatima Alatas, Murti Andriastuti
Paediatrics, Faculty of Medicine, Universitas Indonesia ‐ Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Objectives and Study: Approximately 10.6% of all deliveries worldwide are premature. Adequate growth monitoring is essential in the care of preterm infants to prevent excessive or undernutrition, which can currently be performed using the Fenton 2013 curve or the INTERGROWTH‐21st curve. Due to differences in the methods and study population involved in the development of these two curves, there is a high possibility of obtaining different results. Therefore, a study is warranted to compare the two curves in the Indonesian premature infant population.
Methods: This prospective cohort study involves premature neonates with gestational age of 28–36 weeks born in Cipto Mangunkusumo Hospital during June–September 2022. The growth of all subjects were plotted on the Fenton and INTERGROWTH‐21st curves for 2 weeks, and differences in weight, height, and head circumference percentiles, proportion of SGA, AGA, and LGA, and proportion of infants with weight below the 10th percentile between the two curves at 2 weeks were also compared.
Results: Among 131 subjects meeting the inclusion criteria, the weight, height, and head circumference percentiles were significantly higher on the INTERGROWTH‐21st curve compared to the Fenton curve. As many as 17 of 36 (47.2%) subjects classified as SGA on the Fenton curve were AGA on the INTERGROWTH‐21st curve, and 30 of 89 (33.7%) subjects classified as AGA on the Fenton curve were LGA on the INTERGROWTH‐21st curve. The prevalence of infants without SGA at birth but classified as EUGR at 2 weeks was significantly higher on the Fenton curve (14.7%) than the INTERGROWTH‐21st curve (8.9%, p < 0.001).
Conclusions: The incidence of SGA was significantly higher with the Fenton curve, whereas LGA was significantly higher with the INTERGROWTH‐21st curve. At 2 weeks, the proportion of subjects with EUGR was significantly higher with the Fenton curve compared to the INTERGROWTH‐21st curve.
Contact e‐mail address: nitish.adnani@gmail.com
N‐RF025. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐RF025.1. REVIEW OF TRANS‐PYLORIC FEEDING IN EXTREMELY LOW BIRTH WEIGHT INFANTS WITH SEVERE BPD: A 10 YEAR EXPERIENCE IN A SINGLE CENTRE TERTIARY LEVEL NEONATAL UNIT
Rashmi Gandhi, Mohammed Attia Khalifa, Rebecca Lee
Neonatal Unit, 4th Floor Golden Jubilee Wing, Kings College Hospital NHS Foundation Trust, SE RS, United Kingdom
Objectives and Study: Lower oesophageal sphincter dysfunction is seen commonly in extremely low birth weight infants (ELBW) causing recurrent/silent aspiration contributing to adverse respiratory outcomes. This is often managed by reducing enteral intake and supplementing nutritional requirements by prolonged parenteral nutrition (PN). We describe our experience of trans‐pyloric feeding (TPF) in ELBW neonates at risk of severe bronchopulmonary dysplasia (BPD) over 10 years. Objective: To review the short‐term outcomes of TPF in babies with severe BPD Study: Retrospective cohort study
Methods: Retrospective data was reviewed for babies fed TP from Jan 2014‐Dec2023. Inclusion criteria: < 32 weeks gestation born or transferred very early to our tertiary neonatal unit. Babies with surgical condition and congenital conditions of GI tract were excluded. Data analysis was performed using SPSS. Mean and SD were calculated where the data was normally distributed.
Results: Of 745 eligible babies 314 babies had diagnosis of BPD at 36 weeks corrected GA (45.9%). 43 (13.6%) babies with severe BPD had TPF during this period. Severe BPD was defined as ongoing need of invasive or high oxygen requirement on non‐invasive ventilation. TPF was commenced by treating clinician when there were clinical concerns of recurrent aspiration requiring ongoing ventilatory support. nsertion and management of babies via TPF was performed as per unit guidelines. All babies were commenced on TPF after 31 weeks corrected GA. TPF continued for minimum of 5 weeks until there was improvement in their respiratory condition when they were switched back to gastric feeding. Only one baby had stage 2 NEC after commencement of TPF. The discharge weight Z score was acceptable. The infants tolerated feeds without any complications. 69.8% of babies were able to re‐establish gastric feeds and 60.5% babies were discharged home orally feeding.
Conclusions: TPF is safe in babies with severe BPD and may possibly help improving overall weight gain.
Contact e‐mail address: rashmigandhi@nhs.net
N‐RF026. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐RF026.1. LIONEO PROJECT – A RANDOMISED DOUBLE‐BLIND PHASE 2 CLINICAL TRIAL FOR NUTRITION OF VERY‐LOW‐BIRTH WEIGHT INFANTS: A NEW GOLD STANDARD?
José Simon Camelo Junior1, Maria Carolina Achcar Feih1, Adriana Carnevale Da Silva1, Tatiana Soares1, Amanda Ansani1, Vanessa Silva Bomfim1, Mariana Moraes De Oliveira1, Larissa Garcia Alves2, Tania Maria Beltramini Trevilato3, Isabela Spido Dias3, Marisa Márcia Mussi‐Pinhata1, Fabio Carmona1, Davi Casale Aragon1, Fabio Da Veiga Ued 4, Luciana Mara Monti Fonseca5, Vicky Nogueira‐Pileggi1
1Department Of Pediatrics, University of São Paulo, Ribeirão Preto, Brazil, 2Human Milk Bank – Clinics Hospital, University of São Paulo, Ribeirão Preto, Brazil, 3Laboratory Of Pediatrics (metals And Rare Diseases), University of São Paulo, Ribeirão Preto, Brazil, 4Department Of Health Sciences, University of São Paulo, Ribeirão Preto, Brazil, 5Department Of Maternal‐infant And Public Health Nursing, University of São Paulo, Ribeirão Preto, Brazil
Objectives and Study: The LioNeo is a new multinutrient supplement developed in Brazil, formulated using freeze‐dried human milk (HM) obtained from donor milk processed through a Human Milk Bank. The preclinical phase demonstrated that LioNeo exhibited physicochemical stability and microbial safety. Phase 1 involved testing on 40 very low birth weight infants (VLBWI), confirming that LioNeo was safe and well tolerated in hemodynamically stable VLBWI. Phase 2 aimed to evaluate the efficacy of LioNeo in promoting growth (specifically head circumference and length) and weight gain and to determine its non‐inferiority compared to the commercial product currently used for HM fortification.
Methods: This was a Phase 2, double‐blind, randomized controlled clinical trial involving 129 VLBWI. The intervention group (n = 67) received LioNeo (75 ml of HM plus 7 g of powdered HM). The control group (n = 62) received HM plus a commercial additive (HMCA) containing hydrolyzed cow's milk protein. Participants were followed up for 21 consecutive days. Adverse events and serum micronutrient levels were assessed. Universal Trial Number: U1111‐1220‐0550.
Results: Regression models revealed no significant differences in the variation of z‐scores for length, head circumference, and weight between the groups at the end of the 21‐day study period (Figure 1). Adverse events, including regurgitation, vomiting, abdominal distension, and gastrointestinal bleeding, were reported with similar frequencies across groups. The HMCA group experienced six cases of late‐onset neonatal sepsis and three cases of necrotizing enterocolitis, but no statistically significant differences were observed (Table 1). Two patients unfortunately passed away, though no correlation was established with the use of either fortifier. The deficiency of copper and zinc was suggestive for both fortifiers, indicating the necessity for supplementation.
Conclusions: The data presented in the Phase 2 study corroborates the Phase 1 findings showing that HM fortifier (LioNeo) is non‐inferior to the standard fortifier HMCA for VLBWI.
Contact e‐mail address: jscamelo@fmrp.usp.br
N‐RF027. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐RF027.1. COMPARISON OF NUTRIENT INTAKE BETWEEN STANDARDIZED AND NON‐STANDARDIZED COMPLEMENTARY FEEDING IN VERY LOW BIRTH WEIGHT INFANTS DURING THE FIRST YEAR OF LIFE
Melanie Gsoellpointner1, Margarita Thanhaeuser2, Margit Kornsteiner‐Krenn2, Fabian Eibensteiner2, Robin Ristl3, Bernd Jilma4, Sophia Brandstetter2, Angelika Berger2, Nadja Haiden 1
1Department of Neonatology, Kepler University Hospital, Linz, Austria, 2Department Of Pediatrics And Adolescent Medicine, Comprehensive Center For Pediatrics, Medical University of Vienna, Vienna, Austria, 3Center For Medical Data Science, Medical University of Vienna, Vienna, Austria, 4Department Of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
Objectives and Study: The complementary feeding (CF) period is a crucial phase for ensuring an adequate intake of both macronutrients and micronutrients to support optimal growth and development, particularly in very low birth weight (VLBW) infants. This analysis aims to compare nutrient intake data from two distinct CF studies in VLBW infants: a standardized, interventional study and a non‐standardized, parent‐led study.
Methods: Both studies included infants with a birth weight below 1500 g. The standardized study followed an age‐dependent, step‐up CF protocol up to 12 months CA using pre‐prepared commercial baby foods. In contrast, CF in the non‐standardized, observational study was parent‐driven with no food restrictions. Nutritional intake was recorded at 3, 6, 9, and 12 months CA using 3‐day dietary records. Statistical analysis was done using linear mixed‐effects models adjusting for sex, gestational age, nutrition at discharge, and stratification group, with a random intercept for sibling correlation of multiple births.
Results: In total, 177 infants in the standardized study and 218 in the non‐standardized study were included, with 63–72% and 52–79% of dietary protocols available for analysis, respectively. Energy intake (kcal/d) was significantly higher in the non‐standardized study at 3 months CA (standardized: 487 kcal/d, non‐standardized: 531 kcal/d; p = 0.004) but remained comparable between the studies thereafter. Protein intake (g/kg/d) was significantly higher in the non‐standardized study at 6 and 9 months CA, while fat intake (g/d) remained consistently higher throughout. Docosahexaenoic and arachidonic acid levels and most micronutrients, including iron, phosphorus, calcium, zinc, vitamin B12 were also higher in the non‐standardized group from 6 to 12 months CA.
Conclusions: The findings suggest that parent‐driven, non‐standardized CF may lead to higher intakes of most macronutrients and micronutrients compared to a standardized CF protocol. These results can help inform the choice of CF approach to better address the individual nutritional needs of VLBW infants.
Contact e‐mail address: melanie.gsoellpointner@kepleruniklinikum.at
N‐RF028. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐RF028.1. INTESTINAL TISSUE METABOLOME REVEALS DEPLETION OF BUTYRATE AND ELEVATION OF INDOXYL SULFATE IN PATIENTS WITH NECROTIZING ENTEROCOLITIS
Joann Romano‐Keeler 1, De‐Ann Pillers1, Muthusamy Thiruppathi1, Hua Geng1, Xiao‐Di Tan1, Jorn‐Hendrik Weitkamp2
1Department Pediatrics, University of Illinois at Chicago, Chicago, United States of America, 2Department Of Pediatrics, Vanderbilt University Medical Center, Nashville, United States of America
Objectives and Study: Necrotizing enterocolitis (NEC) remains a devastating gastrointestinal emergency affecting up to 15% of infants <1,500 grams. While prior metabolomic studies profile metabolite derangements associated with this disease, no studies focus on intestinal tissue, the primary site of injury. In this study, we performed metabolomics on intestinal tissue from patients with NEC and surgical controls to identify metabolic pathways affected by this illness that could contribute to its onset and presentation
Methods: Tissue samples were collected during surgery from twenty‐three patients (8 surgical controls, 13 NEC cases) and stored at ‐80 ºC. Samples underwent metabolomics by Metabolon using liquid chromatography‐tandem mass spectrometry. Raw data were extracted, peak‐identified, and QC processed. Compounds were identified by comparison to a library of purified standards. Following normalization for extracted mass and log transformation, Welch's two‐sample t‐test and matched pairs t‐test were used to identify biochemicals that achieved statistical significance.
Results: There were no statistically significant differences in sex, gestational age, days of life, early and late antibiotic use, or type of feeds between control and NEC patients. Principal coordinates and hierarchical clustering analysis revealed distinct clustering of NEC versus control patients. Indole‐containing compounds were elevated in NEC patients, including 3‐indoxyl sulfate, known to cause epithelial barrier dysfunction. NEC patients also had increased caffeine metabolites. A trend toward decreased 3‐hydroxybutyrate in NEC patients was observed but was not statistically significant.
Conclusions: This is one of the only studies evaluating metabolites in intestinal tissue of infants with and without NEC. Distinct metabolite profiles were detected, with patients clustering based on disease state. Notably, indole‐containing compounds, known to incite bowel injury, were elevated in NEC patients. Elevated caffeine metabolites suggest vasoconstriction may play a role in NEC pathogenesis. The observed trend toward decreased butyrate supports its potential gut‐protective role. These findings underscore the importance of tissue‐based studies in understanding NEC pathophysiology.
Contact e‐mail address: jromanok@uic.edu
N‐RF029. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐RF029.1. EVALUATION OF STORAGE CONDITIONS OF HUMAN MILK
Merve Yılmaz Yeşilalan1, Belma Saygılı Karagöl 2, Tuğrul Hoşbul3, Aylin Var3, Bülent Ünay1,4,5
1Department Of Pediatrics, University of Health Sciences, Gülhane Medicine Faculty, Ankara, Turkey, 2Department Of Pediatrics, Division Of Neonatology, University of Health Sciences, Gülhane Medicine Faculty, Ankara, Turkey, 3Department Of Microbiology, University of Health Sciences, Gülhane Medicine Faculty, Çankaya, Turkey, 4Department Of Pediatrics, Gülhane Training and Research Hospital, Ankara, Turkey, 5Department Of Pediatrics, University of Health Sciences, Gülhane Medicine Faculty, Ankara, Turkey
Objectives and Study: Objective: Breast milk is themost important source of newborn nutrition. The original composition and function of milk must be preserved during storage.The aim of our study is to investigate the bactericidal activity of breast milk stored inpolyethylene bags and pyrex bottles against E.Coli, S.aureus, S.agalactiae bacteria which are common infectious agents in theneonatal period.
Methods: The study was carried out between 15 December 2023 and 15 March 2024, on term babies who were brought to SBU Gülhane Training and Research Hospital Neonatal Polyclinic on the 7th or 10th day and whose mothers were aged between 18 and 40. It was carried out as a prospective experimental study with human milk. In the study in which 30 mothers were included and the milk taken from the mothers by manual milking was transferred to a polyethylene bag or pyrex bottle. The milks were diluted after being kept in the oven at 0, 24, and 48 hours and planted on MacConkey or sheep blood agar. Statistical analysis was performed by comparing the number of colonies formed after transplantation.
Results: In all bacteria and all time zones; when paired comparisons were made in breast milk stored in pyrex bottles and polyethylene bags, colony numbers did not create a statistically significant difference.However, the difference between the number of colonies formed by S.agalactiae between the 0th, 24th and 48th hours in milk stored in pyrex bottles is statistically significant (p = 0,003). In the milk stored in a polyethylene bag, difference between the number of colonies formed by S.aureus between the 0th, 24th and 48th hours is statistically significant (p = 0,036).
Conclusions: Our study could not detect a significant relationship between the number of bacterial colonies in breast milk stored in different storage containers. A relationship was found between the number of colonies formed by different bacteria in different storage containers and storage time.
Contact e‐mail address: belmakaragol@gmail.com
N‐RF030. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐RF030.1. LONGITUDINAL ALKALINE PHOSPHATASE LEVELS IN EXTREMELY PRETERM AND TERM HUMAN MILK
Susanne Way 1,2, Ulrika Sjöbom3,4, Ann Hellström3, David Ley1,2, Ingrid Hansen Pupp1,2, Anders Nilsson3
1Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden, 2Skåne University Hospital, Malmö and Lund, Sweden, 3Department of Clinical Neuroscience at the Institution of Neuroscience and Physiology at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden, 4Learning and Leadership for Health Care Professionals at the Institute of Health and Care Science at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
Objectives and Study: Human milk is rich in bioactive components that positively influence the gut microbiome of the neonate. One such component is alkaline phosphatase (AP), an enzyme with anti‐inflammatory properties that promotes bacterial diversity and may protect against necrotizing enterocolitis in preterm infants. AP is degraded during the pasteurization of human milk and is therefore absent in pasteurized donated human milk. It remains unclear whether longitudinal AP activity differs between the milk of mothers delivering preterm and term infants.
Methods: Human milk morning samples were collected on postpartum days 3, 7, 10, 14, 21, and 28 from mothers of infants born before 27 + 0 gestational weeks who were included in a prospective multicenter intervention study (Less is more) and from mothers of term infants. Total AP activity was quantified by photometrical catalytical assay in 718 milk samples (n = 666 extremely preterm, n = 52 term). Data were analyzed using descriptive statistics and linear mixed models.
Results: In the extremely preterm group (n = 141), the mean (SD) gestational age was 25.0 (1.1) weeks and the mean birthweight 713 (147) g. The corresponding values in the term group (n = 15) were 39.8 (1.7) weeks and 3468 (761) g. At baseline (day 3), there was no significant difference in AP activity between preterm and term infants. The highest AP activity was observed in day 3 milk, which then declined over the study period in both groups, Fig 1. However, preterm milk exhibited significantly higher AP activity compared to term milk between days 3 and day 28 (p = 0.01 for group and time interaction).
Conclusions: Preterm human milk has higher AP activity than term milk and shows a slower decrease postpartum. This may be protective during intestinal development in extremely preterm infants. Measures to increase the supply of mother's own milk in extremely preterm infants should be supported.
Contact e‐mail address: susanne.way@med.lu.se
N‐RF031. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐RF031.1. A TWO‐STAGE FORMULA WITH HUMAN MILK OLIGOSACCHARIDES AND PARTIALLY HYDROLYZED PROTEIN SUPPORTS GROWTH, GASTROINTESTINAL TOLERANCE AND SAFETY OF PRETERM INFANTS: A MULTI‐CENTER, OPEN‐LABEL, INTERVENTIONAL TRIAL
Boutaina Zemrani 1, Klaudia Demova2, Mickaël Hartweg3, Niels Rochow4, Christoph Fusch5, Zuzana Uhrikova6, Mirko Zibolen7
1Clinical Research And Development, Pediatric Nutrition, Société des Produits Nestlé, Vevey, Switzerland, 2Faculty Hospital Nové Zámky, Nové Zamky, Slovak Republic, 3Clinical Research Unit, Société des Produits Nestlé, Lausanne, Switzerland, 4Department Of Pediatrics, Paracelsus Medical School, General Hospital of Nuremberg, Nuremberg, Germany, 5Department Of Pediatrics, Paracelsus Medical School, General Hospital of Nuremberg, Nuremberg, Switzerland, 6Jessenius Faculty of Medicine, Martin/Comenius University, Bratislava, Slovak Republic, 7Jessenius Faculty of Medicine, Martin/Comenius University, Bratislava, Switzerland
Objectives and Study: Human milk is the gold standard in preterm nutrition. Human milk oligosaccharides (HMOs) are an important component of human milk that can provide benefits to preterm infants. Our objective was to assess the growth and safety of infants fed the first 2‐stage partially hydrolyzed protein‐based preterm formulas with HMOs (PTF‐HMO).
Methods: In a multi‐center open‐label trial, clinically stable preterm infants (birthweight ≤1500 g) received Stage1 PTF‐HMO (3.6 g protein/100 kcal) until a weight of 1800g, then Stage2 PTF‐HMO (2.8 g protein/100 kcal) until 60 days post‐discharge. Both formulas contained 1.5 g/L HMOs (2′FL, LNnT). The primary outcome was the weight‐adjusted weight gain from the first day of full enteral feeding (FEF) until the infant reached 1800g. Secondary outcomes included growth, gastrointestinal tolerance, fecal microbiota, adverse events (AE) and biomarkers of protein status and bone health from birth until 60 days post‐discharge.
Results: Twenty‐six infants [mean (range) gestational age 29 weeks (27‐34), mean (range) birthweight 1245 g (940‐1600)] were enrolled. The adjusted mean weight gain was non‐inferior to Fenton median growth velocity in the intention‐to‐treat and per‐protocol populations (20.3 g/kg/day, 95% CI [18.6, 22.1], p < 0.001; 21 g/kg/day, [19.5, 22.6], p < 0.001 respectively). Growth velocity, weight‐for‐age, length‐for‐age and head‐circumference‐for‐age z‐scores from birth until 60 days post‐discharge were within recommended goals. Median time from birth to reach FEF was 10 days. Gastrointestinal tolerance was good with no formulas‐related gastrointestinal AEs, necrotizing enterocolitis or formula discontinuation. Average stool frequency (2‐3 stools/day) and consistency (soft) were age appropriate. Absolute fecal bifidobacteria abundance increased progressively over time. Blood and urinary biomarkers of bone health and protein status were within normal range. Fifty‐three AEs were reported in 21 infants. None were related to PTF‐HMO or were fatal.
Conclusions: The first ‘in‐hospital’ and ‘post‐discharge’ preterm hydrolyzed formulas containing HMOs are safe and promote age‐appropriate growth and good gastrointestinal tolerance from birth until 60 days post‐discharge.
Contact e‐mail address: Boutaina.Zemrani@nestle.com
N‐RF032. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF032.1. MEAL AND SNACKING PATTERNS OF ADOLESCENTS AND YOUNG ADULTS ON A GLUTEN‐FREE DIET DUE TO CELIAC DISEASE, ON OTHER SPECIAL DIETS, OR NO FOOD RESTRICTIONS
Heli Pihlajamäki1,2,3, Linnea Aitokari 2,3,4, Laura Kivelä3, Sanna Arnala3,5, Pilvi Laurikka3, Hannu Tuuri6, Kalle Kurppa2,3,7, Kaija Nissinen6
1Seinäjoki Social and Health care Center, Seinäjoki, Seinäjoki, Finland, 2Tampere University, Tampere Center for Child, Adolescent and Maternal Health Research, Tampere, Finland, 3Tampere University, Celiac Disease Research Center, Faculty of Medicine and Life Sciences, Tampere, Finland, 4Valkeakoski Social and Healthcare Center, Wellbeing Services County of Pirkanmaa, Valkeakoski, Finland, 5The Finnish Coeliac Society, Tampere, Finland, Tampere, Finland, 6Seinäjoki University of Applied Sciences, Seinäjoki, Finland, Seinäjoki, Finland, 7The University Consortium of Seinäjoki, Seinäjoki, Finland
Objectives and Study: Individuals with celiac disease (CeD) may face challenges in maintaining healthy eating habits while following a strict gluten‐free diet (GFD), but data on this is scarce. We compared meal and snacking patterns between adolescents and young adults 1) with CeD and GFD, 2) with other special diet than GFD and 3) with no food restrictions.
Methods: A survey on demographic data and various diet‐related lifestyle factors was distributed to 422 16‐30‐year‐old individuals, including members of Finnish Celiac Society and students from Seinäjoki University of Applied Sciences and Seinäjoki Vocational School.
Results: In total, 80% of the 422 responders were women and 67% were students, with no significant differences between participants with CeD and GFD (n = 210), those on other special diets (n = 69), and those with no food restrictions (n = 143). Respondents with CeD had more frequent meal patterns (3.4 vs 3.0 meals/day, p = 0.008) and consumed lunch at work or school cafeteria less often than those without food restrictions (18% vs 38%, p = 0.002). They also consumed ice cream (0.9 vs 0.3 times/week, p < 0.001), low‐fiber bread (1.6 vs 0.8 times/week, p < 0.001) and plant oil‐based margarine/fat spreads (2.4 vs 1.2 times/week, p = 0.004) more frequently than those without restrictions, while consuming sugar‐sweetened beverages (0.6 vs 1.2 times/week, p < 0.001) and pizza (0.2 vs 0.4 times/week, p = 0.01) less often. Respondents on other special diet used non‐dairy milk substitutes more frequently than those on a GFD or with no dietary restrictions (2.7 vs 0.8 and 0.4 times/week, respectively, p ≤ 0.001).
Conclusions: Adolescents and young adults with CeD exhibited more frequent meal patterns and lower consumption of some nutritionally unfavorable foods and snacks compared to those without food restrictions. However, CeD patients also had a higher risk for reduced fiber intake. These issues should be considered during the follow‐up of CeD and the transfer of care from pediatric to adult healthcare.
Contact e‐mail address: heli_pih@hotmail.com
N‐RF033. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF033.1. OUTCOMES AND CHALLENGES IN PEDIATRIC INTESTINAL FAILURE IN LATIN AMERICA
Veronica Busoni 1, Marcela Dalieri2, Maria Ines Martinez3, Helena Goldani4, Carola Saure5, Natascha Silva Sandy6, Martin Balacco7, Monica Maria Contreras Ramirez8, María Fernanda Carvalho De Camargo9, Lidia Patricia Valdivieso10, Betsy Luz García Ventura11, Jose Vicente Spolidoro12, Carlos Cuadros13, Maria Noel Tanzi14, Clara Eugenia Plata Garcia15, Daniela Gattini16
1Pediatric Gastroenterology & Hepatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 2Hospital S.M. Ludovica, La Plata, Argentina, 3Fundacion Favaloro, CABA, Argentina, 4Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil, 5Nutrition And Diabetes, Hospital JP Garrahan, C.A.B.A, Argentina, 6Hospital Infantil Sabará, Sao Paulo, Brazil, 7Hospital de ninos Santisima Trinidad, Cordoba, Argentina, 8Gastroenterology, Hospital Pablo Tobon Uribe, Medellin, Colombia, 9Hospital Samaritano Higienópolis, Sao Paulo, Brazil, 10Hospital San Bartolome, Lima, Peru, 11Instituto Nacional de Salud del Niño San Borja, Lima, Peru, 12Hospital Moinhos de Vento, Porto Alegre, Brazil, 13Hospital Internacional de Colombia, Bogota, Colombia, 14Centro Hospitalario Pereira Rossell, Montevideo, Uruguay, 15Hospital Universitario San Ignacio, Bogota, Colombia, 16Hospital for Sick Children, Toronto, Canada
Objectives and Study: Multicenter studies suggest an improvement in survival of children with intestinal failure (IF) in recent decades. However, there is paucity of data from Latin America. This study aimed to assess outcomes of pediatric IF in Latin America.
Methods: A multicenter cross‐sectional analysis of children with IF was conducted. The study included children with primary diagnosis of IF followed by an intestinal rehabilitation (IR) center from Latin America, with active follow‐up from January 2021 to December 2023, and with at least 6 months of follow‐up. Categorical variables were presented as number (percentage) and continuous variables as median (IQR). Chi‐square tests were used to assess differences in outcomes between types of centers.
Results: The study included 666 patients with IF, median age 5.7 years (IQR 2.6‐9.6), 59.5% male. Fifteen centers were included, 53.3% had ≥10 years of experience and 67% had access to GLP‐2 analogs. Primary etiologies included short bowel syndrome, 558 (83.8%); dysmotility disorder, 92 (13.8%); and mucosal enteropathy, 16 (2.4%). The number of patients that achieved enteral autonomy were 314 (47.2%), remained PN dependant 298 (44.7%), required intestinal transplantation 7 (1.05%), or died 47 (7.05%). 88.2% of PN dependant patients had access to home PN. Centers with ≥10 years of experience had a significantly higher proportion of patients achieving enteral autonomy (54.4% versus 34,7%, P < 0.00001) and significantly lower deaths (4.5% versus 11.8%, P < 0.0007) compared with centers with <10 years of experience.
Conclusions: The rates of enteral autonomy in children with IF in Latin America are comparable to those reported in North America and Europe. However, the proportion of children that underwent intestinal transplantation is significantly lower, highlighting the challenges in access to transplantation in the region. Furthermore, these results emphasize the impact of experienced IR centers in patient outcomes. Prospective cohort studies are needed to assess the long‐term outcomes of children with IF.
Contact e‐mail address: veronica.busoni@hospitalitaliano.org.ar
N‐RF034. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF034.1. DIFFERENTIAL EFFECTS OF HIGH‐PROTEIN AND HIGH‐CALORIC DIETS ON GROWTH AND IGF‐1 LEVELS IN INFANTS AND CHILDREN: A COMPREHENSIVE REVIEW
Sohair Elsiddig 1, Ashraf Soliman2, Ahmed Elawwa2, Nada Alaaraj2, Noor Hamed2, Shayma Mohammed2, Fawzia Alyafei2
1Paediatrics, Hamad Medical Corporation, Doha, Qatar, 2Pediatrics, Hamad Medical Corporation, Doha, Qatar
Objectives and Study: Children's diet composition significantly affects their growth and hormonal function. High‐protein diets and calorie‐rich diets, especially those high in carbohydrates and fats, influence linear growth, weight gain, and insulin‐like growth factor‐1 (IGF‐1) levels differently. Objectives: To evaluate the effects of high‐protein versus high‐calorie diets on linear growth, weight gain, and IGF‐1 levels in infants and children and to provide guidance on optimizing nutrition for growth.
Methods: This systematic review examines 10 studies (1990‐2024) involving diverse populations from China, Bangladesh, Germany, UK, Honduras, and USA, spanning infants to adolescents. The review evaluates high‐protein(animal protein &formula), high‐caloric diets (rich in carbohydrates and fats), focusing on effects on linear growth, weight gain, and IGF‐1 levels.
Results: ‐Linear Growth:High‐protein diets, especially those with animal protein, enhanced linear growth, as noted by Kabir et al. (2002) and Hoppe et al. (2004). However, Xiong et al. (2023) cautioned that excessive protein could negatively impact growth and lead to stunting. ‐ Weight Gain:High‐caloric diets resulted in greater weight gain than high‐protein diets. Dewey et al. (1993) and Ong et al. (2000) found that high‐energy diets increased body weight without significantly improving height or IGF‐1 levels. ‐IGF‐1 Levels: High‐protein diets significantly increased IGF‐1 levels, according to Heinig et al. (1993) and Koletzko et al. (2009), while high‐caloric diets had minimal effects on IGF‐1.
Conclusions: Discussion Animal‐derived proteins provide important amino acids like leucine, which activates anabolic pathways including mTOR signaling and boosts liver IGF‐1 production. Protein intake increases growth hormone levels, boosts IGF‐1 synthesis, epiphyseal plate development, and builds lean body mass better than carbohydrate‐ or fat‐rich diets. High‐calorie diets encourage fat storage rather than linear growth because carbs and fats don't deliver protein's anabolic triggers, reducing IGF1 stimulation. Conclusion High‐protein impact and IGF‐1 levels better than high‐calorie diets. Findings emphasize the importance of protein quality in children's nutrition.
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N‐RF035. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF035.1. THE INDIVIDUAL AND COMBINED INFLUENCES OF DIETARY BEHAVIOR AND SCREEN TIME ON CHILDREN'S PHYSICAL FITNESS IN EVERYDAY LIFE
Jennifer Wieprecht1, Federico Morassutti Vitale1, Delphina Gomes 2, Maren Baethmann1, Anja Tengler1, Roxana Riley1, Guido Mandilaras1, Pengzhu Li1, Nikolaus Haas1, Meike Schrader1
1Division Of Pediatric Cardiology And Intensive Care, University Hospital Munich, Munich, Germany, 2Department Of Pediatrics, LMU University Hospital Munich, Dr. von Hauner Children's Hospital, Munich, Germany
Objectives and Study: Digital technologies are integral to children's lives, increase screen‐times may however raise health concerns. Changes in dietary habits over recent decades have further impacted children's physical fitness, contributing to rising rates of overweight and obesity. This study aims to examine the effect of screen time and diet on physical fitness in school children.
Methods: As part of the prospective epidemiological study “Hand aufs Herz“ of the Department of Pediatric Cardiology at the Munich University Hospital, a comprehensive cardiovascular system check‐up was conducted on approximately 1,000 German schoolchildren. Dietary behavior and screen time were assessed using a questionnaire, including the KIDMed 2.0 score for Mediterranean diet adherence. A validated stair‐climbing test from our department was used to assess children's fitness.
Results: A total of 819 schoolchildren aged 10‐20 years were included in the analysis. Nearly 4‐in‐5 children (685/818, n = 83.7%) exceeded the daily screen time recommendation of age‐adopted hours (mean[SD] screen time during weekdays = 3.8 [1.6] hours; mean[SD] screen time during weekends = 4.4 [1.6] hours). The weight of school children was positively correlated with screentime hours (R2 = 0.36, p < 0.001). Furthermore, 37.7% children with a high screen time had a low score for nutritional intake compared to 20% in the group of children with normal screen time duration. Children who had a high screen time appeared to have a poor lifestyle (37.6%) compared to 6.8% in children who had screen time within recommendations (p < 0.001). We did not yet find any significant difference between screen time groups in terms of the stair‐climbing test.
Conclusions: Excessive screen time in children is linked to higher weight and poor nutrition, increasing long‐term cardiovascular risks. Public health efforts should enforce guidelines, promote healthy diets, and implement family‐, school‐, and community‐based strategies to mitigate these risks.
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N‐RF036. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF036.1. CARDIOVASCULAR RISK PROFILE AND LIFESTYLE OF YOUNG ENERGY DRINK CONSUMERS
Meike Schrader, Federico Morassutti Vitale, Jennifer Wieprecht, Maren Baethmann, Anja Tengler, Roxana Riley, Guido Mandilaras, Pengzhu Li, Nikolaus Haas, Delphina Gomes
Division Of Pediatric Cardiology And Intensive Care, University Hospital Munich, Munich, Germany
Objectives and Study: Energy Drinks (ED) are popular among children and adolescents due to their taste and stimulating effect. With increasing popularity, however, there is also increasing evidence of possible harmful effects of consumption. We investigated whether school‐children consuming ED have a different cardiovascular risk profile than counterparts who do not or only rarely consume energy drinks.
Methods: The “Hand‐on‐Heart study” is an ongoing study that enables school children in Munich to have their cardiovascular system examined free of charge. Children were asked about possible risk behaviors. A total of 933 school children completed the survey (m = 501, f = 432, mean ± SD age: 13.3 ± 2.9 years). Data were collected with RedCap and analyzed with R.
Results: A total of 834 children (mean ± SD age: 13.5 ± 2.2 years) were evaluated. A higher proportion of ED consumers were males (56.4%). ED consumers were also older compared to children who did not use ED ever (14 years versus 12 years, p < 0.001). Children who consumed ED had a higher mean BMI (20.4 kg/m2 versus 18.5 kg/m2, p < 0.001), had poorer nutrition (39.2% versus 27.2%, p = 0.002), and an unhealthier lifestyle (25.8% versus 11.5%, p < 0.001). Children who consumed ED several times a week were more often not a part of a sports club (53.1%) as compared to children who never consumed ED (26.5%). Sleep duration of these children was more frequently below the recommendations. (55.1% versus 34.6%, p < 0.001). Children who consumed ED were engaged in other addiction items such as smoking (20.3% versus 0.7%, p < 0.001), vaping (35.8% versus 2.3%, p < 0.001), alcohol (57.8% versus 12.5%, p < 0.001), and shisha (15.9% versus 1.0%, p < 0.001).
Conclusions: Frequent consumption of ED is associated with an unhealthier lifestyle and an overall increased cardiovascular risk. More studies are needed to provide sufficient evidence. Consumption recommendations should be issued to minimize the negative effects of these popular beverages.
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N‐RF037. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF037.1. EARLY LIFE IRON DEFICIENCY AND COGNITIVE ABILITIES AT 6‐8 YEARS
Elisa Holmlund‐Suila 1,2, Emma Laine3, Vilja Seppälä4, Helena Hauta‐Alus5,6,7,8, Sture Andersson3, Outi Mäkitie5,6,9,10, Katri Räikkönen10, Kati Heinonen4,8
1Research Program For Clinical And Molecular Metabolism (camm), University of Helsinki, Helsinki, Finland, 2Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, 3University Of Helsinki, Helsinki, Finland, 4University of Tampere, Tampere, Finland, 5Folkhälsan Institute of Genetics, Helsinki, Finland, 6Research Program For Clinical And Molecular Metabolism (camm), University Of Helsinki, Helsinki, Finland, 7University of Oulu, Oulu, Finland, 8Helsinki University, Helsinki, Finland, 9Department Of Molecular Medicine And Surgery, Karolinska University Hospital, Stockholm, Sweden, 10University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Objectives and Study: Iron is an important micronutrient for normal brain development. Risk of iron deficiency (ID) is increased during periods of rapid growth. Although iron deficiency anemia has been linked with impaired neurodevelopment in children, the impact of ID is less clear. We aimed to examine how ID at 1 or 2 years associated with cognitive abilities in 6‐8 years old children.
Methods: Participants were derived from Vitamin D Intervention in Infants (VIDI) study, in which 987 two‐week‐old infants were randomized to receive daily vitamin D supplementation of 10 µg or 30 µg until 2 years. Serum ferritin was measured at 1 and 2 years as a marker of iron status; ID was defined as ferritin below 10 µg/L. Wechsler Intelligence Scale for Children‐IV was used to assess total IQ and verbal comprehension, perceptual reasoning, working memory and processing speed at 6‐8 years of age. Data on ferritin and neurocognitive abilities were available from 281 children.
Results: ID was present in 24 (9%) and 38 (14%) children at 1 and 2 years, respectively. Only 5 children had ID at both time points. ID and iron sufficient children did not differ in total IQ (mean (SD), 102 (11) vs 102 (12), and 100 (10) vs 102 (12), for those with ID at 1 or 2 years, respectively) or in any subindices (p‐values > 0.12). Serum ferritin was not associated with total IQ or any of the subindices (p‐values > 0.11). Results remained the same after adjustment for sex, parental education, high‐sensitivity C‐reactive protein and maternal age.
Conclusions: Although ID was relatively common in otherwise healthy children at 1 and 2 years, it didn't affect cognitive abilities in school‐aged children. Yet, future studies are needed to test the impact of chronic ID.
Contact e‐mail address: elisa.holmlund-suila@hus.fi
N‐RF038. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF038.1. LONG‐TERM EFFECTS OF FEEDING LOW‐PROTEIN INFANT FORMULA ENRICHED WITH ALPHA‐LACTALBUMIN OR REDUCED IN GLYCOMACROPEPTIDE WHEY DURING EARLY INFANCY
Eleni Kordi 1, Olle Hernell2, Bo Lönnerdal3, Pia Karlsland Åkeson1
1Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden, 2Department of Clinical Sciences, Pediatrics, Umeå University, 901, Umeå, Sweden, 3Department of Nutrition, University of California, Davis, California, United States of America
Objectives and Study: High protein intake during infancy could increase the risk of childhood overweight and obesity. In the ALFoNS study, we have previously shown that infants fed low‐protein (LP) formula during early infancy had similar weight gain as breastfed (BF) infants between 6 and 12 months, and comparable weight and BMI to BF infants at 18 months, whereas these parameters were higher in infants fed standard formula (SF) compared to BF infants. This follow‐up evaluates possible long‐term effects on growth at 36 and 60 months in the ALFoNS study.
Methods: In the ALFoNS study, a randomized controlled trial, 245 healthy term infants were randomized to LP formulas; alpha‐lactalbumin enriched whey (α‐lac‐EW) (1.75 g protein/100 kcal), or glycomacropeptide reduced whey (CGMP‐RW) (1.76 g protein/100 kcal), or SF (2.2 g protein/100 kcal) from 2‐6 months, where 83 BF infants constituted the reference. In this follow‐up, growth and dietary intake were assessed at 36 and 60 months and compared to data from 18 months.
Results: At 36 months, 70% of children remained in the study, decreasing to 38% at 60 months due to early study closure. Mean weight and BMI at 36 and 60 months, and absolute weight gain (g/d) between 18‐36 months, and 36‐60 months, were similar in all study groups. Relative weight gain (g/kg/day) at 18‐36 months was higher in BF compared to SF (p = 0.022) and to CGMP‐RW (p = 0.044) group, but with no differences between the other study groups. Dietary intake was similar in all study groups at 36 and 60 months.
Conclusions: No long‐term effects on growth were seen at 36 or 60 months of age of feeding modified LP formulas compared to SF or breastmilk during early infancy.
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N‐RF039. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF039.1. EFFECTS OF MATERNAL AND NEONATAL VITAMIN D STATUS ON BEHAVIORAL AND SOCIAL DEVELOPMENT AT 4 YEARS OF AGE: A PROSPECTIVE BIRTH COHORT STUDY
Luanluan Li 1, Xiaodan Yu2
1Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 2Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Objectives and Study: This study aimed to investigate the association of 25‐hydroxyvitamin D [25(OH)D] in three trimesters and at birth with children's behavioral and social development at 4 years of age.
Methods: From 2013 to 2016, pregnant women from the Shanghai Birth Cohort in China were recruited for the study. Altogether, 454 mother‐infant pairs were included. Serum 25(OH)D was measured with mass spectrometry in three trimesters and cord blood. Children's behavioral and social development was assessed at 4 years of age using the Strengths and Difficulties Questionnaire (SDQ) and the Social Responsiveness Scale (SRS), respectively.
Results: In girls, cord blood 25(OH)D < 12 ng/mL was positively associated with higher SDQ total score [β = 1.89, 95% confidence interval (CI) = 0.38–3.40] and SRS total score (β = 1.62, 95%CI = 0.10–3.14); maternal blood 25(OH)D < 20 ng/mL in late pregnancy was also positively associated with higher SRS total score (β = 1.72, 95%CI = 0.12–3.32). In boys, no significant associations were observed for either maternal or cord blood 25(OH)D levels with SDQ or SRS total scores.
Conclusions: Vitamin D deficiency in late pregnancy and at birth was associated with higher behavioral and social problems in girls, but not in boys, suggesting potential sex‐specific effects on child development.
Contact e‐mail address:
N‐RF040. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF040.1. INFANT FEEDING SUPPORT AND ITS ASSOCIATION WITH MATERNAL MENTAL HEALTH DURING COVID‐19: A MULTI‐COUNTRY CROSS‐SECTIONAL STUDY
Chuwen Liu 1, Mengyun Liu1, Sarah Dib2, Milagros Ferrando3, Mary Fewtrell2, Masaharu Kagawa4, Krongporn Ongprasert5, Emeline Rougeaux2, Nurul Shukri6, Adriana Vazquez2, Jonathan Wells2, Jinyue Yu2
1University College London, London, United Kingdom, 2Policy& Practice Department, University College London, London, United Kingdom, 3Instituto Universitario Vive Sano, Sao Paulo, Brazil, 4Kagawa Nutrition University, Saitama, Japan, 5Chiang Mai University, Chiang Mai, Thailand, 6Universiti Putra Malaysia, Serdang, Malaysia
Objectives and Study: To identify and compare predictors of maternal mental health (MMH), including infant feeding support, across seven countries (UK, China, Japan, Malaysia, Mexico, Argentina, Thailand) during the COVID‐19 lockdown.
Methods: Data on infant and maternal outcomes were collected using a questionnaire developed in the UK, translated into the languages of collaborating countries, and completed during 2021/2022 by 7,650 postpartum women aged ≥18 years who delivered an infant before or during lockdown. The impact of socioeconomic and maternal characteristics, infant feeding support (from family and friends, health professionals, online support groups, no support) and maternal support (overall sufficient support, housework division, access to maternal healthcare) on components of MMH (perceived mood – worrying, sadness, loneliness, relaxation, annoyance), measured using a Likert 4‐item scale and recoded to binary outcomes (no/little impact of pandemic=better MMH; moderate/strong impact=worse MMH), was analysed using multivariable logistic regression.
Results: > 90% of mothers in China, Mexico, and Thailand but only 58% in the UK reported sufficient infant feeding support. Predictors of worse MMH were maternal age 26‐35 y, older infant, postgraduate education, single mother, living alone or in overcrowded housing, and infrequent exercise. Better MMH was associated with maternal age 41+y, being married, living with family, higher income, primiparity, living in China, Japan, Malaysia or Thailand, and giving birth during lockdown. After adjustment for these factors, infant feeding support from the partner predicted better MMH for loneliness, OR = 1.24 (1.05, 1.47) and relaxation 1.21 (1.02, 1.42), whilst getting support from online groups predicted greater loneliness, OR = 0.79 (0.68, 0.93), and annoyance, 0.86 (0.74, 0.99).
Conclusions: This study identified maternal and contextual factors associated with MMH disparities, emphasising the importance of appropriate infant feeding support during future emergencies.
Contact e‐mail address:
N‐RF041. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF041.1. PREVALANCE OF COPPER AND ZINC DEFICIENCIES AMONG CHILDREN RECEIVING JEJUNAL NUTRITION
Neha Nar 1, Ryen Crabb2, Thant Zin2, Elieth Ramos3, Jessica Prentice2, Rachel Arthur2, Michael Brown3, Shyla Kishore2
1Paediatric Gastroenterology, Royal Aberdeen Children's Hospital, AB ZG, United Kingdom, 2Paediatric Gastroenterology, Royal Aberdeen Children's Hospital, ZG, United Kingdom, 3General Paediatrics, Raigmore hospital, UJ, United Kingdom
Objectives and Study: The objectives of this study are to review the prevalence of zinc and copper deficiencies among children who have been on jejunal nutrition.
Methods: A retrospective review of notes, electronic and paper records of children who received jejunal nutrition between 2018 and 2024.
Results:
Between 2018 and 2024, 86 children received jejunal nutrition, 40/86 also received supplemental oral nutrition. 38/86 continued on jejunal feeding, 26/86 transitioned to other enteral feeding methods, 17/86 died, and the feeding status of 5 remained unknown as they relocated. The overall average age at commencement of jejunal feeding was 5.2 years, with the youngest being 3 weeks old. The average duration of jejunal feeding was 3.3 years. Jejunal‐fed children had Glasgow nutrition screen done annually. From 2018 to 2021, average monitoring rate was 48.75%. This increased to 68% in 2022, 80% in 2023, and 61.5% by mid‐2024. Micronutrient monitoring improved significantly after an appointment of a nutritional nurse in 2021. 28% of children were zinc‐deficient, and 17% had copper deficiencies, while 62% had normal or high copper levels. 33% had low albumin, and 50% had elevated CRP at the time of zinc deficiency. Similarly, 60% of children with normal or high copper levels had elevated CRP. As per ESPEN guidelines of clinical nutrition, in an acute phase of inflammation, the copper concentration in plasma rises while zinc concentration decreases. In our study, micronutrient monitoring was also done during inpatient stay. It is likely that the zinc levels were falsely low and copper deficiencies were masked showing false normal or high copper levels.
Conclusions: Copper and zinc deficiencies were noted in children with jejunal nutrition. Micronutrient monitoring improved significantly after an appointment of nutritional nurse. Given the likelihood of false results during an intercurrent infection, micronutrient monitoring should be done when children are well.
Contact e‐mail address: shyla.kishore@nhs.scot
N‐RF042. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF042.1. SURVEY OF UK PAEDIATRIC DIETITIANS: INSIGHTS INTO PRESCRIBING PRACTICES AND ISSUES CAUSED BY PRESCRIBING DELAYS
Jodie Owen 1, Sharon Huish2
1Nutrition And Dietetics, Birmingham Community Healthcare, Birmingham, United Kingdom, 2Nutrition And Dietetics, Royal Devon University Healthcare Trust, Exeter, United Kingdom
Objectives and Study: UK based paediatric dietitians recommend specialist infant formulas, oral nutrition supplements (ONS) or enteral feeds (known as 'borderline substances'), which are usually prescribed by General Practice (GP). Prescribing delays may be common and may have consequences on patients, family/carers and dietetic time; this is not well evidenced. UK Dietitians can qualify as supplementary prescribers. Evidence has shown supplementary prescribing is challenging to implement, and its continued use has been called into question. The aim of this study is to explore paediatric dietitian perspectives on current prescribing practices including delays and the role of dietitian prescribing.
Methods: An anonymised online survey was distributed via the British Dietetic Associations’ Paediatric Specialist Groups (1130 members) in October 2024.
Results: 124 paediatric dietitians completed the survey. 98% (121/124) ask GPs to prescribe specialist infant formula, ONS or enteral feeds.
86% (104/121) cite GP delays in actioning requests as a main reason for delay, as well as supply issues (81%, 98/121). 34% (41/121) report issues with delivery companies. 79% of dietitians report spending 0.5 to over 3 hours per week managing delays. Only 8% (10/124) are supplementary prescribers of which 3 report limitations (of supplementary prescribing) prevent them prescribing. 64% (74/115) were interested in becoming non‐medical prescribers but 34% (39/115) felt that independent prescribing rights were needed. Recommendations to improve prescribing delays included independent prescribing rights and removing the requirement for a prescription for borderline substances.
Conclusions: Prescribing delays are common and impact on dietitian and parent/carer time, as well as causing stress/anxiety. Importantly, prescribing issues can cause treatment delay and clinical risk. There is an evident need for independent prescribing rights for dietitians. Another solution is removing the need for a prescription for borderline substance. Further research is needed to quantify the financial cost and clinical risk.
Contact e‐mail address: jodie.owen8@nhs.net
N‐RF043. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF043.1. SLEEP/WAKE ORGANIZATION DEVELOPMENT IN INFANTS RECEIVING COW'S MILK‐BASED FORMULA WITH ADDED BOVINE MILK FAT GLOBULE MEMBRANE THROUGH ONE YEAR
Sussanne Reyes1, Cecilia Algarin1, Teresa Murguia‐Peniche2,3, Jennifer Wampler2, Patricio Peirano 1
1Sleep And Neurofunctional Laboratory, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile, 2Medical Sciences, Reckitt‐Mead Johnson Nutrition Institute, Evansville, United States of America, 3School of Medicine, Indiana University, Indianapolis, United States of America
Objectives and Study: In this double‐blind trial, healthy full‐term infants were enrolled before 120 days post‐term age and randomized to receive a standard cow's milk‐based infant formula (SF) or a similar formula with an added source of bovine milk fat globule membrane (experimental formula, EF) through 12 months of age. In a subset of participants, the effect of infant feeding (EF vs SF) on sleep/wake patterns (SWP) was evaluated at 6 (baseline) and 24 months (m) of age.
Methods: Actigraphic recordings were performed over a 7‐day period at baseline and 24 m. SWP were identified during daytime and nighttime periods and averaged for the 7‐day period. The interaction of study time point (baseline and 24 m) by feeding (EF and SF) was assessed using linear mixed models.
Results: A total of 100 infants were assessed (SF = 53, EF = 47). Infant and family characteristics were similar by group. No significant group differences in SWP were detected at baseline. At 24 m (vs baseline) significant differences in SWP were detected for the EF group alone during (a) nighttime: longer mean duration of sleep episodes (4.9 ± 0.3 vs 3.5 ± 0.2 h, p = 0.03), reduced number of wake episodes (1.5 ± 0.2 vs 2.0 ± 0.1, p = 0.03), and (b) daytime: longer first nap episode (1.3 ± 0.1 h vs 1.0 ± 0.1 h, p = 0.03), and increased mean duration of nap episodes (1.2 ± 0.1 h vs 0.8 ± 0.0 h, p < 0.01). Reduced total nap time was the only significant difference detected for both groups (EF: 1.8 ± 0.2 vs 2.7 ± 0.2 h, p = 0.01; SF: 1.3 ± 0.1 vs 3.0 ± 0.1 h, p = 0.01).
Conclusions: Results indicate faster SWP consolidation in the EF group. The current study supports evidence showing that formula with an added source of bovine milk fat globule membrane provides beneficial effects in neurofunctional development.
Contact e‐mail address: sreyes@inta.uchile.cl
N‐RF044. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF044.1. KNOWLEDGE, ATTITUDES, AND PRACTICES OF IRON DEFICIENCY ANEMIA AND RISK OF ANEMIA AMONG CHILDREN AGED 6–24 MONTHS IN NORTHEAST THAILAND: INSIGHTS FROM PANT STUDY
Suchaorn Saengnipanthkul 1, Prapassara Sirikarn2, Sasupang Musikaboonleart3
1Department Of Paediatrics, Faculty Of Medicine, Khon Kaen University, Khon Kaen, Thailand, 2Epidemiology And Biostatistics, Faculty Of Public Health, Khon Kaen University, Khon Kaen, Thailand, 3Nutrition, Srinagarind Hospital, Faculty Of Medicine, Khon Kaen University, Khon Kaen, Thailand
Objectives and Study: Iron deficiency anemia (IDA) is closely associated with impaired growth and development, particularly in young children. Caregivers’ knowledge, attitudes, and practices (KAP) regarding iron‐rich diets are essential for prevention and management of IDA. However, data on KAP and its association with anemia risk in young children are limited, particularly in developing regions. This study assessed anemia risk using non‐invasive technology and explored caregivers' KAP regarding iron‐rich diets among children aged 6–24 months in Northeast Thailand.
Methods: A cross‐sectional study was conducted from September 2022 to March 2023, involving 753 children aged 6–24 months from rural and urban areas, selected using cluster random sampling. Anemia risk was screened with Masimo Rad‐67, and caregiver KAP and dietary data (via food frequency questionnaire covering the past week) were collected. Children born preterm or with congenital heart or lung diseases were excluded.
Results: Of the 753 participants, 426 (56.6%) were from urban areas, with a median age of 12.2 months. Urban participants had higher rates of low birth weight, maternal thalassemia, and prior IDA diagnoses. The prevalence of at‐risk anemia (SpHb <13.0 g/dL) was 42.6%, with urban rates higher than rural areas (46.7% vs. 37.3%, p < 0.01). Iron supplementation rate, according to government policy, was 49.3%. Breastfeeding was observed in 39.8%, and 56.2% consumed iron‐fortified formula, though only 32.9% met daily iron intake recommendations (mean 4.6 mg/day). Consuming 600‐900 ml/day of iron‐fortified formula was more common in participants without anemia risk. Moderate knowledge of IDA was reported by caregivers, with 65.7% receiving education on IDA and only 49.1% aware of iron‐rich foods. Factors associated with anemia risk included breastfeeding, parental concern about IDA, and maternal thalassemia, while receiving education was a protective factor.
Conclusions: Non‐invasive screening identified a high prevalence of anemia risk. Enhanced caregiver education and adherence to supplementation policies are essential to reducing anemia in young children.
Contact e‐mail address: suchsa@kku.ac.th
N‐RF045. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF045.1. EVALUATING MICRONUTRIENT SUFFICIENCY OF BLENDED DIETS IN CHILDREN: A RETROSPECTIVE ANALYSIS OF NUTRITIONAL BLOOD MONITORING (NTBM)
Laura Shanahan 1, Andrew Barclay2, Michelle Brooks2, Diana Flynn2, Jacqueline Hay2, Gillian Smith3, Nicola Johnstone2, James Andrews4, Konstantinos Gerasimidis1, Kerry Watkin5, Tracey Ross6
1Medicine, University of Glasgow, Glasgow, United Kingdom, 2Paediatric Gastroenterology, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom, 3Department Of Paediatrics, University Hospital Wishaw, Wishaw, United Kingdom, 4Paediatric Surgery, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom, 5Dietetic Department, NHS Forth Valley, Stirlingshire, United Kingdom, 6Paediatric Dietetic Department, NHS Dumfries and Galloway, Dumfries, United Kingdom
Objectives and Study: The administration of blended diet (BD), instead of commercial prepared enteral formulas was, until recently, considered potentially unsafe.1 Nutritional deficiency is a perceived risk, however there is limited NTBM data in the BD population. We aimed to retrospectively review NTBM for BD within our region to inform recommendations for practice.
Methods: Patients commenced on BD between January 2017 and May 2024 were identified from regional dietetic databases. Baseline demographics, and diagnoses including the presence of Gastrointestinal Dystonia (GID) were gathered. BD patients were defined as either full or partial BD (BD combined with commercial enteral formula). Local guidance recommends NTBM at baseline, 6 months, and annually thereafter for; U + E, LFT, Bone Profile, PTH, Vitamins A, B12, D, E, zinc, copper, selenium, magnesium, FBC, ferritin and folate.2 Blood test results were recorded. Comparison of proportions by fishers exact test.
Results: 96 patients met inclusion criteria. 24(25%) patients received concurrent vitamin supplementation. 31(32.3%) patients had GID. 70(72.9%) patients received partial BD. 26(27%) patients received full BD. Abnormalities in NTBM identified after ≥6 months receiving BD are outlined in figure 1. 19(35.8%) patients tested had low ferritin. Further analysis found that 50% of those prescribed full BD were low in ferritin in comparison to 30.8% prescribed partial BD (p < 0.2146). All patients with elevated vitamin E had normal vitamin E:cholesterol ratios. Abnormal results had action plans outlined.
Conclusions: The frequency and severity of NTBM abnormalities compared favourably with previous review of enteral or orally fed patients with neuro‐disability.3 We postulate that these favourable outcomes with NTBM reflect careful patient selection and intensive dietetic support. Under this pathway, we postulate that routine NTBM for Vitamin E, Copper and Selenium are not required in BD, and that NTBM is required only annually if initial NTBM is within normal limits. Iron insufficiency risk warrants additional examination in patients prescribed BD.
Contact e‐mail address: 2527010s@student.gla.ac.uk
N‐RF046. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF046.1. DIETARY IMPROVEMENT AND WEIGHT MANAGEMENT SUPPORT THROUGH A DIGITALIZED MATERNAL NUTRITION INTERVENTION TOOL: A PILOT RWE STUDY
Hanxiao Zhang1, Wenqi Cao2, Jingtian Wu 2, Yuan Dong2, Yi Jin2, Hong Jiang1
1School Of Public Health, Fudan University, Shanghai, China, 2Danone Open Science Reserch Center, Shanghai, China
Objectives and Study: Appropriate nutrition intake has significant roles in maintaining overall wellbeing and achieving better reproductive health. However, the access to precise nutrition evaluation and guidance is limited in the current maternal and child healthcare system. A maternal nutrition mini‐app (WO2024060126A1) was developed in 2020 to assess women's dietary intake and weight status, and to provide millions of dietary recommendations via Artificial Intelligence from preconception to postpartum within the context of Chinese dietary complexity. Our study conducted preliminary analysis to explore the effectiveness of app application in the Real‐World situation.
Methods: The longitudinal dietary data with ≥2 records and ≥8 days interval, and longitudinal weight data with ≥2 records and ≥1 month interval were analyzed. We used linear mixed model and generalized linear model to estimate the mean change of Nutrient Adequacy Ratio (NAR) and weight. Generalized estimating equation model was used to estimate the percentage of users meeting Recommended Nutrient Intake (RNI).
Results: Among 51 women with eligible longitudinal dietary data, the NAR of fish, meat and egg significantly increased from 89% to 104% (95%CI 0.72,3.06, p < 0.001) compared to baseline. The NAR of cereals and grain increased from 87% to 95% (95%CI 0.04,2.00, p = 0.06). The percentage meeting RNI of protein and iron increased by 11% (95%CI 0.03,0.37, p < 0.01) and 7% (95%CI 0.06,0.46, p < 0.01) respectively. Among 17 overweight/obese preconception women, the average weight decreased by 1.9 kg (95%CI ‐3.97,0.15, p = 0.07) after app use. Furthermore, lactating women using both dietary & weight functions (‐0.6 kg, N = 44) showed an average 1.2 kg more weight loss than those only using weight function (0.4 kg, N = 83), without statistical significance (95%CI ‐3.00,0.68, p = 0.22).
Conclusions: Our preliminary analysis demonstrated that the mini‐app was promising in improving dietary behaviors and supporting weight management for women from preconception to postpartum. Future research with larger sample size is warranted to confirm the findings.
Contact e‐mail address: h_jiang@fudan.edu.cn
N‐RF047. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐RF047.1. VITAMIN D STATUS FOR CHINESE CHILDREN AND ADOLESCENTS IN CNNHS 2022‐2023
Wenxuan Wu, Lichen Yang
National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
Objectives and Study: Vitamin D has a wide range of biological effects. The vitamin D status of children and adolescents was monitored and assessed by analyzing serum 25‐hydroxyvitamin‐D (25(OH)D) concentration in Chinese children and adolescents aged 6‐17 years in the National Nutrition and Health Survey.
Methods: Data were collected from the China National Nutrition and Health Survey (CNNHS) in 2022‐2023, which used a multistage stratified whole‐cluster random sampling method to sample children and adolescents in 98 urban and 102 rural areas in China. The concentration of 25(OH)D was detected by LC‐MS/MS. Vitamin D deficiency or insufficiency was determined by the cut‐off level of 12 ng/mL or 20 ng/mL, respectively.
Results: A total of 45,623 children and adolescents (23,045 boys and 22,578 girls) aged 6‐17 years were included in this study. The median serum 25(OH)D concentration was 17.3 ng/ml. The prevalence rates of vitamin D insufficiency and deficiency were 39.2% and 23.8%, respectively. Of particular concern is the highest prevalence of deficiency among adolescents aged 12‐17 years, which reached 33.5%; and the general vitamin D deficiency rate was even a little higher than the last round CNNHS 2016‐2017 (18.6%). On the other hand, the distribution comparison showed that the prevalence of vitamin D deficiency in girls was significantly higher than boys (29.9% vs 18.6%), while the rate was higher among urban residents than rural residents (25.1% vs 21.8%).
Conclusions: Vitamin D deficiency and insufficiency continue to grow among Chinese children and adolescents aged 6‐17 years, while in those aged 12‐17 years, who may undertake a greater academic burden and have less time for outdoor face a higher risk. Effective sun exposure should be encouraged, and appropriate dietary vitamin D and vitamin D supplements are also recommended for them to prevent the potential adverse health effect.
Contact e‐mail address: yanglc@ninh.chinacdc.cn
N‐RF048. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐RF048.1. THE IMPACT OF CARBOHYDRATE QUALITY AND QUANTITY ON INSULIN RESISTANCE IN CHILDREN AND ADOLESCENTS: A SYSTEMATIC REVIEW AND META‐ANALYSIS
Yasaman Khorshidi1, Farane Zolfaghari1, Nazanin Moslehi2, Mahdieh Golzarand2, Golaleh Asghari 1
1Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 2Nutrition and Endocrine Research Center, Research Institute for Endocrine Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Objectives and Study: To assess the impact of carbohydrate quality and quantity on insulin resistance in children and adolescents.
Methods: This systematic review and meta‐analysis was conducted following PRISMA guidelines and registered in PROSPERO (CRD42022359275). A comprehensive search of PubMed, Scopus, and Web of Science was conducted up to March 9, 2024, with no language restrictions. Randomized clinical trials evaluating the effects of dietary carbohydrate quantity or quality on insulin resistance in overweight/obese children and adolescents were included. Data extraction, risk of bias assessment (using the Cochrane RoB tool), and meta‐analyses were conducted. Subgroup analyses evaluated carbohydrate proportion, energy restriction, study duration, and NAFLD diagnosis. Statistical analyses were performed using STATA 14.
Results: Seventeen studies, involving a total of 832 participants, were included after screening 5255 records. One study on sugar reduction was excluded from the meta‐analysis due to limited data. For fasting insulin, low‐GI diets showed no significant overall effect (WMD = ‐1.13µIU/mL; 95%CI: ‐4.62 to 2.35; I² = 60.8%), though subgroup analysis revealed a significant reduction with energy restriction (WMD = ‐3.10µIU/mL; 95%CI: ‐5.22 to ‐0.87; I² = 0%). LCDs had no significant impact on fasting insulin (WMD = ‐0.22µIU/mL; 95%CI: ‐3.46 to 3.20; I² = 86.7%). For HOMA‐IR, low‐GI diets showed no significant overall effect (WMD = ‐0.48; 95%CI: ‐0.99 to 0.03; I² = 32.7%); however, after excluding one NAFLD study, a significant reduction (WMD = ‐0.49; 95%CI: ‐0.90 to ‐0.07) was found. Subgroup analyses revealed significant reductions in insulin resistance when interventions included diets with standard carbohydrate proportions or those incorporating energy restriction. LCDs showed no significant effect on HOMA‐IR (WMD = ‐0.29; 95%CI: ‐0.99 to 0.40; I² = 61%). No publication bias was detected, and sensitivity analysis confirmed robust findings.
Conclusions: Our review highlights the significance of carbohydrate quality, especially low glycemic index/load diets, in improving insulin sensitivity in obese children and adolescents. Low carbohydrate diets did not affect insulin resistance. The impact of sugar reduction remains unclear due to limited studies.
Contact e‐mail address: g_asghari@hotmail.com
N‐RF049. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐RF049.1. L‐CIT SUPPLEMENTATION AND HIIT ON LIPID PROFILE, ARTERIAL STIFFNESS AND FAT MASS IN OBESE YOUNG WITH METABOLIC‐DYSFUNCTION ASSOCIATED FATTY LIVER DISEASE: A RANDOMIZED CLINICAL TRIAL
Alan Rodríguez1, Ma Eugenia Garay‐Sevilla 1, Arturo Figueroa2, Armando Ojeda1, Katya Vargas‐Ortiz1, Mario Espinoza‐Vargas1, Lorena Ibarra1
1Medicina Y Nutrición, Universidad de Guanajuato, León, Mexico, 2Deparment Of Kinesiology And Sport Management, Texas Tech University, Lubock, United States of America
Objectives and Study: Metabolic dysfunction‐associated steatotic liver disease (MASLD) and obesity contribute to vascular dysfunction through oxidative stress, heightening cardiovascular risk. Oral supplementation with L‐citrulline (L‐Cit), a precursor of L‐arginine (L‐arg) and nitric oxide, and high‐intensity interval training (HIIT) may improve vascular function and cardiometabolic health. Objective: This study aimed to evaluate the combined effects of L‐Cit supplementation and HIIT on arterial stiffness, body composition, glucose metabolism, lipid profile, and blood pressure (BP) in adolescents with MASLD and obesity.
Methods: In this double‐blind, placebo‐controlled, randomized clinical trial, 44 adolescents (15–19 years) with MASLD and obesity were assigned to HIIT + L‐Cit (n = 14), HIIT+placebo (n = 14), or L‐Cit (n = 15) for 12 weeks. HIIT sessions (85% and 60% peak heart rate during intense and recovery periods) occurred thrice weekly. Training volume progressively increased, and participants performed 20 min of HITT per session in the last 8 weeks. Outcomes included pulse wave velocity (PWV), augmentation index (Aix75), VO₂ peak, body composition, BP, glucose and lipid profiles, and hepatic steatosis.
Results: Compared to L‐Cit, HIIT + L‐cit improved non‐high‐density lipoprotein‐cholesterol (p = 0.04), very low‐density lipoprotein‐cholesterol (p = 0.01), triglycerides (p = 0.02), and VO₂peak (p = 0.001). No significant between‐group changes were found in PWV, AIx75, hepatic steatosis, and body composition. HIIT+Pla improved VO₂peak (p = 0.002) and L‐Cit decreased the degree of steatosis (p = 0.038).
Conclusions: HIIT + L‐Cit supplementation enhanced lipid profile and cardiorespiratory fitness, while HIIT+placebo improved cardiorespiratory capacity and L‐cit alone decreased hepatic steatosis. Thus, L‐cit could be an effective strategy to manage MASLD and obesity in adolescents.
Contact e‐mail address: alan.rodriguez@ugto.mx
N‐RF050. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐RF050.1. ADHERENCE TO FIBRE INTAKE RECOMMENDATIONS IS NOT ASSOCIATED WITH CARDIOMETABOLIC HEALTH IN EUROPEAN CHILDREN: ARE FIBRE INTAKE RECOMMENDATIONS FOR CHILDREN ADEQUATE?
Susana Larrosa1, Veronica Luque 2, Joaquín Escribano1,2, Mariona Gispert‐Llauradó2, Natalia Ferre2, Veit Grote3, Berthold Koletzko3, Elvira Verduci4, Dariusz Gruszfeld5, Louise Etienne6
1Pediatrics, University Hospital Sant Joan Reus, Reus, Spain, 2Pediatric, Nutrition And Development Research Unit, Universitat Rovira i Virgili. IISPV, Reus, Spain, 3Pediatrics, Dr. von Hauner Children's Hospital, LMU Universität Munich and German Center for Child and Adolescent Health, Munich, Germany, 4Unit Of Metabolic Disease, Ospedale dei Bambini Vittore Buzzi, Milano, Italy, 5Neonatal And Nicu Department, Children's Memorial Health Institute, Warsaw, Poland, 6Groupe Santé CHC, Liege, Belgium
Objectives and Study: Dietary fibre intake recommendations for children are extrapolated from adults. Our aim was analysing whether adherence to dietary fibre recommendations for children were associated with cardiometabolic health.
Methods: Observational longitudinal study embedded in the Childhood Obesity Project Trial, conducted in 5 European countries. Up to 6 three‐day food diaries were collected between 2 and 8 years. Fibre intake was compared to the European Food Safety Authority recommendations. Children were classified as compliant if their intake was ≥ recommendations and categorized as sustained compliant if this happened ≥ 3 out of 6 visits. At 8 years, body mass index (BMI), systolic blood pressure, lipids and HOMA‐IR were assessed and considered altered if ≥ 90th centile (or ≤ 10th for HDL cholesterol).
Results: 361 children completed the visit, dietary record and blood sample at 8 years (49.9% girls). No significant differences in health outcome parameters were identified between children with or without sustained compliance to the fiber recommendations (Table 1). Multivariate regression models adjusted by country, sex, maternal education and child's BMI, confirmed the lack of association. The ROC curves for fibre intake at 8 y were not discriminant for any cardiometabolic alteration.
Table 1. Cardiometabolic health parameters at 8 years according to sustained adherence to fibre recommendations during childhood.
| Health outcomes | Sustained compliance Mean (+/‐SD) | No sustained compliance Mean (+/‐SD) | p‐value |
|---|---|---|---|
| BMI (z score) | 0.39 (1.25) | 0.46 (1.23) | 0.164 |
| Cholesterol LDL (mg/dL) | 95 (26) | 95 (23) | 0.627 |
| Triglycerides (mg/dL) | 59 (25) | 61 (27) | 0.435 |
| HOMA‐IR (IU/ml)* | 1.81 (0.64) | 1.82 (0.83) | 0.287 |
| Systolic blood pressure (percentile) | 57.1 (27.3) | 57.7 (30.5) | 0.810 |
P‐value for Student's t‐test between groups. *Logarithmic HOMA‐IR for Student's T‐test.
Conclusions: Adherence to the current recommendations of dietary fibre intake during childhood up to 8 years was not associated with cardiometabolic risk.
Contact e‐mail address: pediatria@iispv.cat
N‐RF051. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐RF051.1. HEPATIC FAT AND DIETARY INTAKE AS DETERMINANTS OF METABOLIC HEALTH IN OBESE ADOLESCENTS: A CROSS‐SECTIONAL MRI STUDY
Hadar Moran‐Lev 1, Yftach Gepner2, Shlomi Cohen1
1Pediatric Gastroenterology Institute, "Dana‐Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel aviv, Israel, 2Tel Aviv University, tel aviv, Israel
Objectives and Study: Obesity in youth is highly associated with metabolic risk. However, a subset of individuals maintains metabolic health despite the presence of obesity. This study aims to identify key factors associated with a metabolically healthy obese (MHO) in adolescents.
Methods: This cross‐sectional study included 31 adolescents with obesity [median age:14 y, median body mass index (BMI) Z‐score:2.58] categorized as MHO (n = 16) or metabolically unhealthy obese (MUO, n = 15), based on the presence of one or more metabolic syndrome criteria. A comprehensive evaluation included MRI assessments of abdominal adipose tissue distribution and hepatic fat content (HFC), physiological and metabolic assessment, serum biomarkers, prenatal and sociodemographic characteristics, and dietary habits.
Results: Compared to the MUO, MHO individuals exhibited significantly lower HFC (14.0 ± 9.8%, vs. 6.1 ± 9.8%, p = 0.01) and experienced a lower risk of complications during birth (46.7% vs. 12.5%, p = 0.03). No diffrence was found in total abdominal fat, viseral adipose tissue or skeletal muscle mass between group nor in metabolic and physical activity performence. Additionally, MHO participants had significantly lower intake of total calories (p = 0.04), animal protein (p = 0.005), red meat (p = 0.02), sodium (p = 0.027), palmitic acid (p = 0.04), stearic acid (p = 0.029), arachidonic acid (p = 0.005) and calories from ultra‐processed grains (p = 0.049) compared to their MUO counterparts‐ table 1.
Conclusions: Adolescents with MHO show lower hepatic fat, improved liver markers, and healthier dietary patterns than MUO peers. These findings underscore the potential influence of prenatal and lifestyle factors in distinguishing metabolic health profiles in adolescents with obesity.
Contact e‐mail address: hadarlev6@gmail.com
N‐RF052. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐RF052.1. VALIDATION OF EQUATIONS FOR PREDICTING FAT MASS AND LEAN MASS IN PEDIATRIC POPULATION WITH OBESITY
Judit Muñoz‐Hernando 1, Emma Perucho1, Mariona Gispert‐Llauradó1, Carme Rubio‐Torrents1, Mireia Alcázar1, Joaquín Escribano1,2, Natalia Ferre1, Veronica Luque1
1Pediatric, Nutrition And Development Research Unit, Universitat Rovira i Virgili. IISPV, Reus, Spain, 2Pediatrics, University Hospital Sant Joan Reus, Reus, Spain
Objectives and Study: The 4‐component model (4CM) is the gold standard for measuring fat mass (FM) and lean mass (LM), however, it is not feasible for clinical practice. Other 2‐component techniques, such as air displacement plethysmography (ADP) exist, but have limitations, including the assumption of constant density and hydration of LM. Recent studies have demonstrated that the hydration and density of LM change with age and body mass index. Our aim was to confirm the validity and accuracy of equations developed for predicting FM and LM, using ADP in a paediatric population with obesity.
Methods: Secondary cross‐sectional study of Obemat 2.0 trial. Data from 37 children with obesity aged 9 to 14 years were analysed, comparing FM, LM, %FM, and their indexes (FMI and LMI) using ADP. Comparisons were made assuming constant LM density (LMBodPod and FMBodPod), with those in which LM density was adjusted for BMI and age (LMADP and FMADP). Both were compared to the gold standard, the 4CM.
Results: Significant differences were observed between the results obtained with BodPod and ADP‐adjusted models (p < 0.001) and between BodPod and 4CM (p < 0.001), but not between ADP‐adjusted models and 4CM. Bland & Altman plots revealed that the agreement of FM and LM measurements obtained by ADP‐adjusted models were greater than those obtained by BodPod algorithms compared to the 4CM (0.51 kg (95% CI ‐1.45, 2.48) for LMADP vs. 1.51 kg (95% CI ‐0.72, 3.74) for LMBODPOD and ‐0.51 kg (95% CI ‐2.48, 1.46) for FMADP vs. ‐1.47 kg (95% CI ‐3.69, 0.75) for FMBODPOD (Figure 1).
Conclusions: Considering the varying density of the lean mass according to the degree of obesity reduces bias when measuring FM and LM through ADP, thus improving the assessment of body composition in children with obesity.
Contact e‐mail address: judit.munoz@iispv.cat
N‐RF053. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐RF053.1. BENEFITS AND HARMS OF TREATMENT OF LIPID DISORDERS IN CHILDREN AND ADOLESCENTS: AN OVERVIEW OF SYSTEMATIC REVIEWS
Thu Giang Le Thi1, Milena Geist2, Delphina Gomes1, Yuliia Novosad2, Anna Litwin1, Juliane Grünzner3, Berthold Koletzko1, Bernadeta Patro‐Golab 1
1Department Of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany, 2Stiftung Kindergesundheit, c/o Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany, 3Division Of Lipidology, Integrated Social Paediatric Center (ispz), Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany
Objectives and Study: This overview of systematic reviews (SRs) aimed to summarize evidence on benefits and harms of treatment for pediatric familial hypercholesterolemia (FH) or multifactorial dyslipidemia (MFD).
Methods: We systematically searched MEDLINE, EMBASE, Cochrane, and Epistemonikos for relevant SRs of randomized controlled trials (RCTs) published from 01.01.2015 to 15.05.2024. SRs on different therapeutic interventions assessing surrogate and long‐term health outcomes were eligible. We used AMSTAR‐2 tool to appraise SRs and GRADE to rate certainty of evidence (CoE).
Results: Of 804 records screened, eight SRs were included, with six focusing on statin therapy. Results from high‐quality SRs were prioritized for reporting and GRADE assessment. Among children with FH, in a meta‐analysis of six RCTs, statins significantly reduced cholesterol levels (total cholesterol/LDL‐cholesterol) compared to placebo over up to 2‐years follow‐up (mean difference, MD ‐32.15% (95% confidence interval, CI: ‐34.9; ‐29.4) for LDL‐cholesterol; CoE moderate). Similarly, children treated with ezetimibe (1 RCT) had lower cholesterol levels (MD ‐63 mg/dL (95% CI: ‐79.5; ‐46.5) for LDL‐cholesterol; CoE moderate). Bile acid sequestrants, fibrates, and PCSK‐9 inhibitors also showed significant lipid‐lowering effects, however CoE was low/very low. No significant differences in adverse events during short‐term follow‐up were observed between study groups for all drugs. Finally, plant sterols significantly reduced cholesterol levels, with MD for LDL‐cholesterol ranging from ‐22.4 to ‐30.1 mg/dL (2 RCTs; CoE very low), while no significant effects were observed for behavioral intervention (1 RCT). Among children with MFD, two RCTs on behavioral counseling supporting healthy diet demonstrated a modest lipid‐lowering effect that attenuated over time (CoE low). No significant effects were observed for polyunsaturated fatty acids supplementation in children with dyslipidemias (CoE very low).
Conclusions: Statins are effective as lipid‐lowering therapy in pediatric FH, but long‐term safety requires further investigation. Evidence evaluating non‐pharmacological interventions, particularly behavioral interventions in childhood dyslipidemias, is sparse, indicating the need for more research.
Contact e‐mail address: bernadeta.patrogolab@med.uni-muenchen.de
N‐RF054. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐RF054.1. COMPARISON BETWEEN METABOLIC CONTROL OF BASAL BOLUS INSULIN AND SPLIT‐MIX INSULIN IN CHILDREN WITH TYPE‐1 DIABETES AND ITS ASSOCIATED FACTORS
Pebriansyah Pebriansyah, Aman Pulungan, Yogi Prawira, Putri Masubrin, Zakiudin Munasir, Darmawan Setyanto
Department Of Child Health, FKUI RSCM, Jakarta, Indonesia
Objectives and Study: Adequate metabolic control is the successful indicator of therapy and main goal of type‐1 diabetes melitus (T1DM) management in children. It is affected by both type and insulin regimen administration. To date, the effect of basal bolus regimen and split‐mix regimen on metabolic control in children with T1DM and its associated factors remained unclear.
Methods: This retrospective cohort study involved 106 children and adolescents age 5‐18 years old with T1DM in Cipto Mangunkusumo Hospital which divided to basal bolus and split‐mix regimen. Associated risk factors including age, sex, diabetes duration, frequency of dietetic clinic visits, and adherence of therapy was identified using electronic health record, interview, and completing the Morisky Medication Adherence Scale‐8 (MMAS‐8) questionnaire. Multivariate linear regression was used to evaluate associated predictors for metabolic control.
Results: HbA1c value in basal bolus group was 8.3% (7.1%‐11%) whereas HbA1c value in split‐mix group was 10% (8.5%‐12.2%). Diabetes duration for more than one year was associated with 2.9% lower HbA1c value (95% CI ‐4.388 ‐ 1.596; p < 0.0001) and monthly dietetic clinic visits was associated with 1.8% lower HbA1c value (95% CI 0.520‐3.253; p = 0.008) in the basal‐bolus group. Monthly dietetic clinic visits were associated with 1.6% lower HbA1c value (IK 95% ‐2.999 ‐ 0.225; p = 0.024) in the split‐mix group.
Conclusions: Metabolic control in basal bolus group is better than split‐mix group. Nonetheless, the split‐mix insulin regimen may be an option when basal‐bolus insulin is not available and in patients with limited time to insulin injection at least four times a day. Diabetes duration for more than one year and monthly dietetic clinic visits improved metabolic control in children and adolescent with T1DM.
Contact e‐mail address: eepansyah@gmail.com
N‐RF055. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐RF055.1. SUMMARY OF CONSENSUS ON THE DIAGNOSIS, TREATMENT AND FOLLOW‐UP OF OVERWEIGHT AND OBESITY IN CHILDREN AND ADOLESCENTS: REPORT FROM LASPGHAN OBESITY WORKING GROUP
Yunuen Rivera‐Suazo 1, Julia Alberto‐Meléndez2, Jaime Alfaro‐Bolaños1, Felipe Álvarez‐Chávez3, Ana Ayala German4, María Galaviz‐Ballesteros5, Michelle Higuera‐Carillo6, Claudia Taquez‐Castro7, Alejandra Villa Gómez3, Britta Villaroel‐Ibarra8, Berta Alvarado‐Cárcamo9, Fátima Reynoso‐Zarzosa10, Yazmín Quiñones‐Pacheco11, Carlos Timossi‐Baldi12, Rodrigo Vázquez‐Frias13
1Centro Médico Nacional 20 de Noviembre ISSSTE, Mexico City, Mexico, 2Hospital Zafiro, Tegucigalpa, Honduras, 3Hospital General de Zona No. 1 IMSS, Tepic, Mexico, 4Unidad Medica de Alta Especialidad IMSS, Merida, Mexico, 5Hospital General de Occidente, Zapopan, Mexico, 6Universidad Nacional de Colombia, Bogota, Colombia, 7Centros Médicos Colsanitas, Medellin, Colombia, 8Caja Nacional de Salud, Cochabamba, Bolivia, 9Hospital Comarcal Sant Jaume de Calella, Barcelona, Spain, 10Hospital Ángeles Puebla, Puebla, Mexico, 11Hospital Dr. Agustín O'Horán, Merida, Mexico, 12Departamento de Investigación y Desarrollo, Mexico City, Mexico, 13Hospital Infantil de México Federico Gómez, Mexico City, Mexico
Objectives and Study: To provide guidelines on the diagnosis, treatment and follow‐up of overweight and obesity in children and adolescents in Latin America.
Methods: An anonymous voting was conducted using Delphi method (34 specialists from 21 countries), using 3‐point Likert scale; statements were accepted if > 80% agreement, Cronbach's alpha >0.88 was reached.
Results: After two rounds of voting, 22 statements were obtained (Table).
| Topics | Statements | Recommendations |
|---|---|---|
| Introduction | 3 | Ob is a multifactorial, chronic, progressive and recurrent neurometabolic disease. Prevalence is increasing. In addition to the host's own conditions, a positive energy balance is necessary to modify the accumulation of adipose tissue. |
| Diagnosis | No consensus | < 2 years of age WHO 2006 Overweight: W/L > 2 SD or ≥ 97.7th Obesity W/L > 3 SD or > 99.9th > 2 years of age CDC 2000 Overweight BMI > 85th Obesity BMI ≥ 95th |
| Comorbidities | 3 | We recommend evaluating for hypertension and MASLD. |
| Metabolic evaluation | 6 | At first visit, we recommend screening liver enzymes, metabolic syndrome, glucose, HbA1c (one or more risk factors for DM2 and prediabetes), lipid profile, and vitamin D status. |
| Treatment | 5 | ‐Multidisciplinary approach. ‐Nutritional treatment should be individualized. ‐Physical intervention should be individualized. ‐Pharmacological treatment is indicated in > 12 years of age with Ob, when no response to a multidisciplinary intervention. ‐Bariatric/metabolic surgery is reserved for adolescents with BMI > 40 kg/m2 or > 35 kg/m2 in presence of severe comorbidities. |
| Prevention | 5 | ‐Exclusive breastfeeding is a protective factor. ‐Prevention requires identification of risk factors. ‐Use of strategies to promote healthy lifestyle habits is recommended. ‐Close and regular follow‐up contributes to establishment of goals. ‐Including strategies in education and childcare can be beneficial for adherence to healthy habits and prevention. |
Conclusions: There is a lack of uniformity for clinical diagnosis, and different considerations regarding biochemical evaluation. We attempt to unify criteria for a multidisciplinary approach.
Contact e‐mail address: rivera.suazo@outlook.com
N‐RF056. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐RF056.1. EVALUATION OF THE TREATMENT EFFECTIVENESS OF PATIENTS PARTICIPATING IN THE MULTISPECIALIST OBESITY TREATMENT PROGRAM BASED ON ANTHROPOMETRIC PARAMETERS AND BODY COMPOSITION
Anna Świąder‐Leśniak 1, Sebastian Więckowski2, Elżbieta Moszczyńska3, Piotr Socha2
1Department Of Anthropology, The Children's Memorial Health Institute, Warsaw, Poland, 2Department Of Gastroenterology, Hepatology, Nutritional Disorders And Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland, 3Department Of Endocrinology And Diabetology, The Children's Memorial Health Institute, Warsaw, Poland
Objectives and Study: The treatment of obesity in the pediatric population is currently a significant challenge for the health care. In 2021 in the Children's Memorial Health Institute we established the Obesity Treatment Program (OTP). Patients are provided with multi‐specialist medical care (e.g. experts in gastroenterology, psychology, anthropology, dietetics, physiotherapy). The series of 6 visits is carried out for each patient in OTP.
Methods: 480 patients (254 boys/226 girls) completed a series of 6 visits in OTP. 286 (60%) patients in OTP that children with 2nd and 3rd degree of obesity and with metabolic complications. The individual diet was prepared by dietitians. Personalized physical activity was recommended by physiotherapists. Anthropometric measurements were performed using a standard measurement technique (body weight and height, waist and hip circumferences). Body composition analysis was performed using by bioelectrical impedance (BIA). All patients were provided with psychological support at every stage of treatment in OTP.
Results: The results of anthropometric parameters between first and 6th visit were compared. The body weight, BMI and waist circumference were significantly decreased: 2.5 ± 0.66 vs 2.32 ± 0.72 (p < 0.01); 2.45 ± 0.47 vs 2.26 ± 0.54 (p < 0.001) and 2.38 ± 0.48 vs. 2.19 ± 0.52 (p < 0.001) z‐score respectively. The percentage of body fat was decreased from 33.3 to 31.2 (p < 0.001) and from 37.7 to 36 in boys and girls respectively. Lean body mass was increased in group of boys: 61.3 vs. 62.1 kg (ns) and decreased in group of girls: 52.6 vs. 51.5 kg (p < 0.001). 243 patients (50.6%) reduced their body weight by 3% or more; 174 patients (36.3%) reduced their body weight by 5% or more.
Conclusions: OTP at the Children's Memorial Health Institute provides multidisciplinary medical care for obese patients, with ongoing monitoring of results and motivational support, which compared to standard care for children with obesity, increases the effectiveness of achieved results by over 50% in clinical goal ‐ weight loss.
Contact e‐mail address: a.swiader-lesniak@ipczd.pl
N‐RF057. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐RF057.1. USE OF PYRIDOSTIGMINE IN A CASE SERIES OF PRIMARY AND SECONDARY PEDIATRIC INTESTINAL PSEUDO OBSTRUCTION (PIPO) IN A TERTIARY REFERRAL CENTER FOR INTESTINAL FAILURE
Teresa Capriati 1, Fabrizio Chiusolo2, Renato Tambucci3, Fabio Fusaro4, Gaia Paolella4, Tamara Caldaro5, Chiara Trovato1, Roberto De Giorgio6, Antonella Diamanti1
1Nutritional Rehabilitation, Children's Hospital Bambino Gesù, IRCSS, Rome, Italy, 2Anesthesia And Critical Care Medicine, Bambino Gesù Children's Hospital, Rome, Italy, 3Gastroenterology And Nutrition, Bambino Gesù Children's Hospital, Rome, Italy, 4Surgery And Rehabilitation Of Intestinal Failure Unit, Children's Hospital Bambino Gesù, Rome, Italy, 5Digestive Endoscopy And Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy, 6Department Of Traslational Science, University of Ferrara, Ferrara, Italy
Objectives and Study: Primary and secondary forms of pediatric intestinal pseudo‐obstruction (PIPO) are severe intestinal dysmotility disorders with high risk of mortality and poor quality of life. Nutritional supports and, in selected cases, surgery improved the prognosis, although several unmet needs exist. Prokinetic drugs can support strategies of increasing enteral nutrition (EN)/oral feeding (OF) and decreasing parenteral nutrition (PN). Pyridostigmine has been effectively used in adults with PN‐dependent severe intestinal dysmotility, however experience in PIPO patients is still limited.
Methods: patients intolerant to EN/OF in the previous six months were treated with pyridostigmine. We studied nutritional outcomes (caloric intake by EN/OF and PN and growth) at beginning and after 6 and 12 months of pyridostigmine. We collected also clinical outcome ‐ admission episodes and central line associated bloodstream infection (CLABSI) episodes ‐ 12 months before and after pyridostigmine treatment.
Results: A total of 13 patients (6 males and 7 females; age range at inclusion: 0.5‐18.25 years) were included. Pyridostigmine (dose range: 0.44‐3.4 mg/Kg/day) resulted in a significant increase in tolerance to EN: median caloric intake provided by EN/OF was >25% of caloric requirements at 12 months (p = 0.0156). In 2 cases improved EN tolerance was accompanied by weaning from PN. In all patients there was an amelioration of growth (increase in median weight z score from ‐1.3 to ‐0.9) and a reduction in the number of hospitalizations and CLABSI in the year following pyridostigmine treatment. The drug was well tolerated by all patients.
Conclusions: This study, the first on PIPO series, showed that pyridostigmine improved the tolerance to EN/OF in patients with neurogenic/myogenic PIPO. Pyridostigmine use supports the management of artificial nutrition and reduces the dependence on PN. Our data provide a basis for future, ad hoc designed clinical trials of pyridostigmine in PIPO.
Contact e‐mail address: teresa.capriati@opbg.net
N‐RF058. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐RF058.1. ORAL AND DENTAL STATUS IN CHILDREN ON LONG‐TERM PARENTERAL NUTRITION
Anat Guz Mark 1,2, Dror Shouval1,2, Raanan Shamir1,2, Esti Davidovich3
1Institute Of Gastroenterology, Nutrition And Liver Diseases, Schneider Children's Medical Center, Petach Tikva, Israel, 2Faculty Of Medicine & Health Sciences, Tel‐Aviv University, Tel‐Aviv, Israel, 3Department Of Pediatric Dentistry, The Hebrew University Hadassah School of Dental Medicine, Jerusasem, Israel
Objectives and Study: Children with intestinal failure (IF) requiring long‐term parenteral nutrition (PN), may face various complications and feeding challenges. However, dental health complications remain underexplored. This study aimed to assess oral health and dental outcomes in pediatric patients with IF.
Methods: A cross‐sectional study was performed at a tertiary care pediatric center's Intestinal Failure and Rehabilitation Clinic, during the year 2024. Collected data included demographics, IF etiology, PN parameters (volume, calories, infusion duration), and feeding assessment. Oral hygiene habits and dental outcomes, including plaque index, gingival index, dental calculus, caries status, and enamel hypoplasia, were evaluated by a pediatric dentist.
Results: Nineteen patients (42.1% females, median age 6.9 [IQR 4.8‐12.4] years) were included. IF etiologies included short‐bowel syndrome (52.6%), congenital enteropathies (26.3%), and dysmotility (21.1%). Most patients (68.4%%) required daily PN (ranged 2‐7 days/week), with a median infusion duration of 10 (IQR 9‐14) hours/day. Restricted oral intake was observed in 9/19 (47.4%) patients: 7 consumed bite‐sized solids, 1 followed a liquid‐only diet, and 1 had severe food aversion. Four patients (21.1%) received gastrostomy feeding. Only 15.8% brushed their teeth twice daily. Dental calculus was observed in 57.9%, correlating with older age (p = 0.02) and higher PN volume (p = 0.03). Dental caries were present in 15.8%. Enamel hypoplasia in permanent molar teeth was observed in 7/10 (70%) patients that were older than 6 years, exhibiting severe disruption often involving all four molars. Restricted oral feeding was borderline associated with hypoplasia (p = 0.058). No predictors were found for plaque, gingival, or caries indices.
Conclusions: Children with IF often demonstrate impaired oral hygiene and gingival inflammation. Restricted oral feeding and higher PN volume are associated with enamel hypoplasia and dental calculus. These findings emphasize the importance of integrated nutritional and dental care in managing pediatric patients with IF.
Contact e‐mail address: anatguz@gmail.com
N‐RF059. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐RF059.1. CHOLESTASIS AND HEPATIC DYSFUNCTION ASSOCIATED WITH PARENTERAL NUTRITION IN A TERTIARY NEONATAL INTENSIVE CARE UNIT (NICU): A RETROSPECTIVE COHORT STUDY
Zeba Moin 1, Helen Evans1, Mariam Buksh2, David Knight2, Amin Roberts1
1Paediatric Gastroenterology And Hepatology, Starship Child Health, Auckland, New Zealand, 2Starship Newborn Services, Starship Child Health, Auckland, New Zealand
Objectives and Study: Cholestasis occurs frequently in premature infants due to co‐morbidities. Retrospective audit of NICU guidelines for investigating cholestasis identified a sub‐group who fulfilled definitions of intestinal failure (PN ≥ 60 days) and intestinal failure‐associated liver disease (IFALD, PN ≥ 60 days and hepatic dysfunction persisting without sepsis).
Methods: Babies born 2008‐2022, admitted to NICU, with conjugated bilirubin ≥ 20 µmol/L and fraction of total bilirubin ≥ 20% were identified from laboratory records. Infants exposed to prolonged PN ( ≥ 30 days) were categorised by the presence or absence of intrinsic GI disease and compared.
Results: Cholestasis occured in 208 infants; 99 (47.6%) received prolonged PN. There was no GI disease in 39 (39.4%) and 46 of 60 (76.7%) with GI disease had stomata; none received chyme reinfusion. Both groups were equally (p < 0.05) very preterm (median 27 vs 26 weeks) and low birth weight (median 838 vs 795 grams). There was no difference (p > 0.05) in co‐morbidities: CMV (20% vs 35.9%), hypothyroidism (5% vs 7.7%), endotracheal ventilation (median 26 days each), septicaemia and necrotising enterocolitis (median one episode each). There was no difference (p > 0.05) between infants with or without GI disease in median age at cholestasis onset (36 vs 44 days), peak bilirubin (139 vs 130 µmol/L), peak GGT (219 vs 224 IU/L), hepatic coagulopathy (35% vs 20.5%) or time to normalise liver function tests (141 vs 112 days). Infants with GI disease had greater PN exposure (median 72 vs. 40 days, p < 0.0001), development of IFALD (56.7% vs 15.4%, p < 0.0001) and PN‐dependence at death (21.7% vs 7.7%, p = 0.01). Overall, 40 (19.2%) infants developed IFALD but none died from liver disease.
Conclusions: Babies without GI disease exposed to prolonged PN for prematurity alone can still develop intestinal failure complications. This cohort's duration and severity of hepatic dysfunction can rival that of premature peers with intrinsic pathology for intestinal failure.
Contact e‐mail address:
N‐RF060. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐RF060.1. EVALUATING RISK FACTORS AND BONE HEALTH MONITORING IN PAEDIATRIC HOME PARENTERAL NUTRITION PATIENTS
Virginia Chatzidaki, Afreen Mushtaque, Raja Padidela, Timothy Morris, Rachel Wood, Loveday Jago, Chai Lee, Adnaan Kala, Andrew Fagbemi, Sian Copley, Maureen Lawson
Manchester children's hospital, Manchester, United Kingdom
Objectives and Study: To identify high‐risk groups for metabolic bone disease (MBD) and evaluate the monitoring of bone health in children on home parenteral nutrition.
Methods: Retrospective review of clinical records for all HPN patients. Data collected included DEXA scan results, peripheral quantitative CT (pQTC) measurements, and biochemical bone profile.
Results: 24/36 children had at least one reported DEXA scan (>5 years). The median age was 12 years (range 5–18 years), 45.8% male. The mean BMI z score was –0.39 ± 0.96, t = ‐1.99, p = 0.29, and height z score was –1.96 ± 1.2, t = ‐7.98, p < 0.001. 20.8% had congenital enteropathies, 75% short bowel syndrome, and 8.3% chronic intestinal pseudo‐obstruction syndrome. The median HPN duration was 10.53 years (2.94–17.65 years). 56.5% had at least one DEXA parameter with a Z‐score ≤ ‐2, indicating low bone mineral density (BMD). 13.6% had temporarily low mineralization, and 31.8% showed temporary changes in spinal morphology secondary to osteopenia. One patient had fractures. Follow‐up scans continued to show low BMD in 75%; however, bone mineralization and spinal changes improved with aggressive biochemical management. BMD and BMAD mean z scores were significantly lower in our cohort (z = ‐4, p = 0.028 and z = ‐0.52, p = 0.049, respectively), while 4% pQCT mean cortical/trabecular and cortical z scores did not differ from the general population (z = 0.14, p = 0.34 and z = 0.53, p = 0.06). Low BMD was not associated with diagnosis, duration, PN dependency, or parenteral mineral provision. Only 3/24 patients had elevated PTH levels for over two months, despite normal Vitamin D levels (mean 25‐OHD3 69.7 ± 23.3).
Conclusions: Children with IF are at risk for bone complications even with intense biochemical monitoring. Low BMD, once diagnosed, has been persistent. However, mineralization changes reversed with vitamin D and calcium supplementation. DEXA and pQCT scans should be done at regular intervals. While DEXA metrics are height‐dependent, pQCT is less affected by height and may be more accurately measure of BMD.
Contact e‐mail address: Allowed
N‐RF061. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐RF061.1. ANNUAL SURVEILLANCE CXR IN CHILDREN ON HOME PARENTERAL NUTRITION (HPN) – A NECESSITY IN ALL?
Micol Sonnino, Hannah Littlechild, Sophie Montgomery‐Stuart, Rulla Al‐Araji, Susan Hill, Jutta Koeglmeier
Paediatric Gastroenterology, Great Ormond Street Hospital, London, United Kingdom
Objectives and Study: The 2018 ESPGHAN guidelines on paediatric HPN recommend a routine chest X‐ray (CXR) every 12 months. Regular imaging can expose children to increased radiation and adds to the financial burden of health care systems. This study evaluates if annual surveillance CXRs impact on patient central venous catheter (CVC) management.
Methods: 5‐year retrospective data collection (2019–2023) from electronic records of all children (age 0‐18) receiving HPN in an intestinal failure (IF) centre. All patients with a central venous catheter (CVC) in place for > one year were included. Patient demographics (gender, age), underlying IF diagnosis, annual CXR reports, and corresponding CVC management were recorded.
Results: A total of 137 routine annual CXR were performed on 54 patients (62% female). IF phenotype was 49/137 (36%) short gut syndrome, 47/137 (34%) gut motility disorders, 30/137 (22%) mucosal disease, 7/137 (5%) haematological conditions, 1/137 (1%) post bone marrow transplantation (BMT), 1/137 (1%) immunological condition, 2/137 (1 %) neurodevelopmental disorder. 129/137 (94%) CXRs did not result in a CVC intervention. Only 3% of 137 x‐rays, affecting 4 patients, had a CVC change carried out based on the CXR result. 1/4 children underwent CXR due to clinical symptoms (pain at CVC site) and 1/4 children had suspected cuff migration, which coincided with their annual surveillance image. Only 1/54 patients (0.7% of x‐rays) underwent a CVC replacement as a direct outcome of the CXR findings (displaced CVC), 1/54 patients (1/137 x‐rays) underwent a CVC repair after catheter blockage identified on annual CXR.
Conclusions: Routine annual chest X‐rays may be unnecessary in asymptomatic patients on long‐term PN and could be limited to symptomatic patients and to those during periods of rapid growth, when there is a higher risk CVC tip migration. Adopting a more selective approach could lower radiation exposure and alleviate the economic burden on healthcare providers.
Contact e‐mail address: m.sonnino@nhs.net
N‐RF062. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐RF062.1. KNOWLEDGE AND USE OF PROBIOTICS IN LATIN AMERICAN DOCTORS: A MULTICENTRIC STUDY
Fernando Medina‐Monroy1, Michelle Higuera2, Jhon Camacho‐Cruz3, Carlos Timossi4, Christian Boggio Marzet 5, Maritza Graciela Ríos6, Julián Fernández7, Karolina López Barrera8, Jorge Chavez‐Saenz9, Alexandra Salvador De Ávila10, Robin Tarazona Martínez11, Maria Becerra Rueda12, Ana Abreu Y Abreu13, Dianora Navarro14
1Santander, UGANEP, BUCARAMANGA, Colombia, 2Universidad Nacional de Colombia, Bogota, Colombia, 3Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud (FUCS), Sociedad de Cirugía de Bogotá‐Hospital San José, Fundación Universitaria Sanitas, Clínica Reina Sofía Pediátrica y Mujer Colsanitas, Universidad Nacional de Colombia (UNAL), Bogota, Colombia, 4Miramar MedCom, Mexico, Miramar, Mexico, 5Pediatric Gastroenterology and Nutrition Section. “Dr. Ignacio Pirovano” Acute General Hospital. Buenos Aires. Argentina, Buenos Aires, Argentina, 6Nutrición Clínica Cenna‐Hospital Pacifica Salud, Punta Pacífica, Panamá, Punta Pacifica, Panama, 7Hospital materno infantil de Tigre, Buenos Aires, Argentina., Buenos Aires, Argentina, 8Jefe de la Unidad de Nutrición y Gastroenterología Hospital "Dr. Miguel Pérez Carreño", Caracas, Venezuela, Caracas, Venezuela, 9Pediatric gastroenterologist Centro Medico Puerta de Hierro, Zapopan, Jalisco, México., Zapopan, Mexico, 10Grupo Hospitalario Kennedy. Guayaquil‐Ecuador, Guayaquil, Ecuador, 11Internal Medicine Physician, Allergist and Clinical immunologist, Jose Ignacio Baldo “Algodonal” Hospital Complex, Caracas, Venezuela., Caracas, Venezuela, 12Departamento de Pediatría, Consulta Externa, Coomultrasan, Bucaramanga, Colombia, 13Hospital Angeles del Pedregal, Ciudad de Mexico, Mexico, 14Hospital General Dr Miguel Perez Carreño, Caracas, Venezuela
Objectives and Study: Probiotic use and recommendations by healthcare professionals in Latin America vary significantly due to differing levels of knowledge. This study aimed to evaluate the understanding and application of probiotics among physicians across diverse healthcare centers in the region. Employing an observational, descriptive, and cross‐sectional design, the research sought to uncover trends and gaps in this area.
Methods: From August to November 2024, an online survey was conducted among Latin American physicians using a non‐probabilistic convenience sampling strategy to maximize participation across multiple countries. The structured questionnaire included sections on demographics, knowledge of intestinal microbiota, probiotics, and prebiotics, clinical practices, and sources of continuing education. Key themes assessed were definitions, mechanisms of action, clinical benefits, and patterns of probiotic recommendations. Descriptive statistics were used to analyze the data.
Results: A total of 748 physicians participated, with the majority aged 31‐50 years (49.7%), followed by those over 50 years (45.3%) and under 30 years (5.0%). Table1"Probiotic," a well‐known concept, had 655 correct answers (87.6%), followed by "prebiotic" with 482 correct answers (64.5%). In contrast, the less familiar terms "postbiotic" and "synbiotic" showed lower knowledge levels, with 210 correct answers (28.1%) and 175 correct answers (23.4%), respectively. Probiotics were predominantly consumed separately from food (40.4%), followed closely by indifference to timing (40.1%) and with food (19.5%). Acute diarrhea (39%) and functional intestinal disorders (35%) were the most frequently cited indications for probiotic use. Familiarity with strains like Lacticaseibacillus rhamnosus GG and Saccharomyces boulardii CNCM I‐745 was common, especially for managing diarrhea. However, over 70% of respondents reported lacking formal training in probiotics, highlighting a significant educational gap.
Conclusions: This study reveals strong interest in probiotics among healthcare professionals in LatinAmerica but highlights significant gaps in formal education. The benefits of probiotics for conditions like diarrhea are recognized, yet there is a need for improved educational efforts
Contact e‐mail address: Famm1962@hotmail.com; michellehiguera@yahoo.com; Jhcamacho@fucsalud.edu.co; ctimossi@miramar.mx; Cboggio35@hotmail.com; graciela.nutricion@gmail.com; doctorfernandezjulian@yahoo.com.ar; drakarolinalopezb@gmail.com; jchavezmd@gmail.com; alexsalmed@hotmail.com; Roaltama5@hotmail.com
N‐RF063. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐RF063.1. MULTIVARIATE ANALYSIS OF DIFFERENCES IN GUT MICROBIOME COMPOSITION IN INFANCY IN RELATION TO THE PRESENCE OF PARENT‐REPORTED ALLERGY
Egija Zelča1, Dita Gudrā2, Daiga Karklina1, Larisa Zaharova1, Jana Peterlevica1, Davids Fridmanis2, Ingrida Rumba‐Rozenfelde1, Inese Polaka3, Ilva Daugule 1
1Faculty Of Medicine, University of Latvia, Riga, Latvia, 2Latvian Biomedical Research and Study Centre, Riga, Latvia, 3Institute Of Clinical And Preventive Medicine, University of Latvia, Riga, Latvia
Objectives and Study: The development of the gut microbiome plays an important role in shaping the immune system. However, the exact role of different taxa linked to an increased risk of allergies is unclear. Aim: to analyse changes of gut microbiome and association with parent‐reported allergy in infancy.
Methods: Parents of infants filled out a questionnaire and brought two faecal samples: at the age of 0‐6 and 12‐15 months. Metagenomic sequencing was performed and median relative abundance(MRA) of different taxa was compared among children with different health and nutrition history. Statistical analyses: descriptive statistics, logistic regression.
Results: The participant sample included 66 infants(F/M:27/39; the mean age in the baseline sample ‐ 3,1 months(2.6 – 3.5 05%CI); in the follow‐up sample 12,12 months(95% CI 11.420 to 12.823); 77.3% were delivered vaginally). Analysing the difference between abundance of taxa in the 1st and 2nd half year of life (controlling for the type of delivery and exclusive breast‐feeding (EBF)), the presence of allergy was associated with EBF for 6 months (OR = 65.28; p = 0.009). Children without parent‐reported allergy had significantly higher increase of Ruminococcaceae(OR = 2.42; p < 0.001), Dialisteraceae (OR = 1.24; p = 0.002), while smaller increase of Atopobiaceae(OR = 0.57; p = 0.004), Oscillospiraceae(OR = 0.64; p = 0.017), Erysipelatoclostridiaceae(OR = 0.5; p = ,01), and Burkholderiaceae(OR = 0.61; p = 0.010) was noted. Comparing the abundance of taxa at the second half year of life (adjusting for delivery and EBF), children without allergy had a lower abundance of Lachnospiraceae(OR = 0.24; p < 0.001), Bacteroidaceae (OR = 0.23; p < 0.001). Introduction of solid food, antibacterial treatment during delivery and the first months of life did not add significant changes in the model.
Conclusions: Such taxa as Ruminococcaceae and Dialisteraceae(associated with a decreased risk of allergy) could play a role in modulating the immune system, while Lachnospiraceae, Bacteroidaceae Atopobiaceae, Oscillospiraceae seem to increase the risk of presence of allergy. A possible association between allergic reaction and longer EBF could suggest that some mothers should avoid potentially allergic foods during breast‐feeding.
Contact e‐mail address:
N‐RF064. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐RF064.1. CHANGES OF GUT MICROBIOME IN INFANCY AFTER INTRODUCTION OF SOLID FOOD AND ASSOCIATION WITH PARENT‐REPORTED ALLERGY
Egija Zelča1, Dita Gudrā1, Davids Fridmanis1, Daiga Karklina2, Larisa Zaharova2, Jana Peterlevica1, Ingrida Rumba‐Rozenfelde1, Ilva Daugule 1
1Faculty Of Medicine, University of Latvia, Riga, Latvia, 2University of Latvia, Riga, Latvia
Objectives and Study: Infant gut microbiome is going through profound changes after the introduction of solid food. However, the core gut microbiome in infancy is unclear. Aim: to analyse changes of gut microbiome after the introduction of solid food and association with parent‐reported allergy in infancy.
Methods: Parents of infants filled out a questionnaire and brought two faecal samples: at the age of 0‐6 months and 12‐15months. Metagenomic sequencing was performed and median relative abundance (MRA) of different taxa was compared among children with different health and nutrition history. Statistical analyses: Mann‐Whitney test, Wilcoxon test.
Results: Participant sample included 66 infants (F/M: 27/39; the mean age in the baseline sample ‐ 3,1 months (2.6 – 3.5 05%CI); in the follow‐up sample – 12,12 months (95% CI 11.420 to 12.823); 77.3% were delivered vaginally). In the 2nd half year of life a major increase of the following taxa was noted: Butyricicoccaceae, Ruminococcaceae, UBA1390, Peptostreptococcaceae, Lachnospiraceae, Erysipelatoclostridiaceae, Oscillospiraceae; showing significant association also with the introduction of food items. Among the follow‐up samples only six taxa showed significant differences in relation to type of delivery: infants delivered by c‐section had higher abundance of Clostridiaceae, Enterobacteriaceae, but lower abundance of Bacteriodacae, Coriobacteriaceae, Planococcaceae, Tannerellaceae. In children with parent‐reported allergy, the most significant increase in the 2nd half year of life was noted for Butyricicoccaceae, Oscillospiraceae, UBA1390, Peptostreptococcaceae, Erysipelatoclostridiaceae, Lachnospiraceae. In follow‐up samples among infants with parent‐reported allergy, MRA was significantly higher for Anaerovoracaceae, CAG‐272, Dialisteraceae and Planococcaceae.
Conclusions: An increase of taxa responsible for fermentation and butyrate production was noted in the 2nd half year of life, while differences between vaginally‐born and C‐section delivery diminish with age. Although the composition of gut microbiome in children with parent‐reported allergy did not differ much, some transient colonizers and taxa linked to gut microbiome imbalance were identified.
Contact e‐mail address:
N‐RF065. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐RF065.1. SYSTEMATIC REVIEW AND META‐ANALYSIS OF RANDOMIZED CONTROLLED TRIALS ON PRE‐, PRO‐, POST‐ AND SYNBIOTIC SUPPLEMENTATION IN FOLLOW‐ON FORMULA
Hanne Delcourt, Liesbet Verbrugghe, Koen Huysentruyt, Yvan Vandenplas
KidZ Health Castle UZ Brussel, Brussels, Belgium
Objectives and Study: The remarkable plasticity of the gut microbiome during the first three years of life offers a critical window of opportunity to influence gut health. The aim of this study is to summarize high quality evidence from randomized controlled trials on the health benefits (respiratory tract infections, diarrheal episodes, febrile days, antibiotic use, microbiome modulation and secretory IgA) of prebiotics, probiotics, synbiotics and postbiotics added to follow‐on formula.
Methods: A comprehensive literature search for randomized controlled trials (RCTs) using Medline, Embase, Lilacs, and Cochrane was performed up to May 2024 (PROSPERO CRD42024500457). Only RCTs involving healthy children between six months and three years were considered. Quality assessment was done using the ROBINS II tool. Random effects models were used to obtain odd ratio (OR) and number needed to treat (NNT) via meta‐analysis.
Results: Out of 2414 search results, 22 studies were included (n = 6955 children) with an overall low risk of bias (13/22) as assessed by the Robins II tool. The OR for respiratory tract infections in prebiotics and synbiotics added to a follow‐on formula was 0.84 (95% CI: 0.66‐1.07; NNT = 28; 95% CI: 11‐75) and 0.75 (95% CI: 0.54‐1.05; NNT = 18; 95% CI: 9‐102), respectively. The OR for diarrheal episodes in prebiotics and synbiotics added to a follow‐on formula 1.40 (95% CI: 0.71‐2.79; NNT = 40, 95% CI: 10‐53) and 1.26 (95% CI: 0.96‐1.66; NNT = 17, 95%CI: 8‐94), respectively. The use of prebiotics and synbiotics appears to be more effective in the context of viral infections than in addressing diarrheal episodes but more evidence is needed. For the combination of other interventions with other outcomes insufficient studies were available to perform a meta‐analysis.
Conclusions: High quality evidence for the effect of biotics added to follow‐on formula on health outcomes is sparse. More research is needed to confirm the observed health effects.
Contact e‐mail address: hanne.delcourt@vub.be
N‐RF066. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐RF066.1. FORMULAS CONTAINING SIX HUMAN MILK OLIGOSACCHARIDES AND PROBIOTICS HELP THE AGE‐APPROPRIATE DEVELOPMENT OF A SPECIFIC BIFIDOBACTERIUM‐ENRICHED GUT MICROBIOME THROUGH AGE 15 MONTHS: A RANDOMIZED TRIAL
Jean‐Charles Picaud1, Janne Moll2, Jacob Agerbo Rasmussen2, Javier Miranda‐Mallea3, Olivier Claris4, Laura Palomino Fernández5, Ignacio Salamanca De La Cueva6, Luc Cornette7, Philippe Alliet8, André Léké9, Mireille Castanet10, Hugues Piloquet11, Virginie De Halleux12, Delphine Mitanchez13, Yvan Vandenplas14, Pierre Maton15, Frank Jochum16, Dirk Olbertz17, Sergio Negre Policarpo18, Shaillay Dogra19, Luca Lavalle20, Irma Silva Zolezzi21, Nicholas P. Hays 21, Norbert Sprenger22
1Service De Néonatologie, Hôpital Universitaire de La Croix‐Rousse, Lyon, France, 2Cmbio, Copenhagen, Denmark, 3Department Of Pediatrics, Hospital Vithas, Valencia, Spain, 4Department Of Neonatology, Hôpital Femme Mère Enfants, Bron, France, 5Metabolism Unit, University Hospital Reina Sofia, Imibic, University of Córdoba, Córdoba, Spain, 6Department Of Pediatrics, Instituto Hispalense de Pediatria, Sevilla, Spain, 7Department Of Neonatology, AZ Sint‐Jan Hospital, Brugge, Belgium, 8Department Of Pediatrics, Jessa Hospital, Hasselt, Belgium, 9Neonatal Medicine And Intensive Care, Centre Hospitalier Universitaire Amiens Picardie, Amiens, France, 10Cic Inserm U1404, Department Of Pediatrics, Rouen University Hospital Charles Nicole, Rouen, France, 11Child Chronic Disease Service, Centre Hospitalier Universitaire de Nantes, Nantes, France, 12Neonatology Division, CHU de Liège‐CHR de la Citadelle, Liège, Belgium, 13Service De Néonatologie, Centre Hospitalier Universitaire de Tours, Tours, France, 14KidZ Health Castle UZ Brussel, Brussels, Belgium, 15Service Néonatal, Clinique CHC‐Montlégia, Liège, Belgium, 16Department Of Pediatrics, Evangelisches Waldkrankenhaus Spandau, Berlin, Germany, 17Department Of Neonatology, Klinikum Südstadt Rostock, Rostock, Germany, 18Department Of Pediatrics, Hospital Quironsalud, Valencia, Spain, 19Nestlé research/Société des produits Nestlé, lausanne, Switzerland, 20Clinical Research Unit, Nestlé Research, Lausanne, Switzerland, 21Clinical And Nutritional Research Unit, Nestlé Product Technology Center – Nutrition, Vevey, Switzerland, 22Nestlé Institute Of Health Sciences, Nestlé Research, Lausanne, Switzerland
Objectives and Study: Formulas supplemented with human milk oligosaccharides (HMOs) and probiotics may promote immune‐related benefits in formula‐fed infants through supporting an age‐appropriate gut microbiome development. We assessed gut microbiome development in infants fed formulas supplemented with 6 manufactured HMOs and two probiotics from birth to age 15 months (m).
Methods: In a multicenter European trial (Clinicaltrials.gov: NCT04962594), formula‐fed infants aged ≤14 days were randomized to control formula (n = 117, partially hydrolyzed 100% whey‐based formula) or test formula (n = 119, same formula supplemented with HMOs [2′FL, DFL, 3FL, LNT, 3′SL, 6′SL] at 1.77 g/L until 6 m, 0.87 g/L from 6‐12 m, and 0.75 g/L from 12‐15 m, and B.infantis [LMG11588; 5x105 CFU/g], and B.lactis [CNCM I‐3446; 1x106 CFU/g]). Non‐randomized breastfed infants (n = 82) served as reference group. Fecal samples were analyzed for microbiome and key metabolites.
Results: The following global microbiome indices showed differences between infants fed test or control formulas: 1) intra‐ (at 3 m) and inter‐ (at 3 and 6 m) individual diversity; 2) interindividual bifidobacteria diversity (3, 6 and 15 m); and 3) microbiome maturation trajectory (with fewer infants off the trajectory in the test formula group). Butyrate and related microbial metabolic capacity were significantly lower in test versus control (3 and 6 m; p < 0.05) reaching similar levels thereafter following a more pronounced increase (6 to 12 m) as seen in breastfed infants. At the level of taxa, relative abundance of infant‐type bifidobacteria were higher through 6 m in infants fed test versus those fed control (Figure, Panel A); B.infantis and B.lactis were also higher through 15 m. At the strain level, infants fed the test formula had higher B.infantis LMG11588 (supplemented in the formula), as well as other autochthonous strains through 15 m (Figure, Panel B).
Conclusions: Infant formulas supplemented with a synbiotic blend support the development of an age‐appropriate gut microbiome with specific, beneficial bifidobacteria through age 15 m. This may contribute to overall health and immune development.
Contact e‐mail address: nicholaspaul.hays@rd.nestle.com
N‐RF067. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐RF067.1. FOOD PROTEIN‐INDUCED ENTEROCOLITIS SYNDROME IN CHILDREN IS ASSOCIATED WITH GUT AND SALIVARY DYSBIOSIS, WITH PARTIAL RESOLUTION AT THE END OF FOLLOW‐UP AFTER TOLERANCE
Anaïs Lemoine 1,2,3, Ioannis Nicolis4, Nathalie Kapel3,5, Camille Mayeur2, Marie‐Noëlle Rossignol6, Aurélia Bruneau2, Patrick Tounian3, Karine Adel‐Patient7, Muriel Thomas2
1Sorbonne University ‐ Trousseau Hospital APHP, Paris, France, 2INRAE, Micalis, UMR1319, Jouy‐en‐Josas, France, 3FHU‐PaCeMM, Paris, France, 4Ur 7537 Biostm, Université de Paris Cité, Paris, France, 5Functional Coprology Laboratory, APHP‐Pitié‐Salpétrière Hospital, Paris, France, 6@Bridge plateform, GABI, UMR1313, JOUY‐EN‐JOSAS, France, 7Université Paris‐Saclay, CEA, INRAE, DMTS, Gif‐sur‐Yvette, France
Objectives and Study: Gut microbiota and their metabolites could play a key role in digestive dysimmunity and breakdown of tolerance, leading to pathologies such as food protein‐induced enterocolitis syndrome (FPIES), a non‐IgE‐mediated food allergy. This study aims to compare both gut and salivary microbiota over time between allergic and tolerant patients and matched controls.
Methods: Fecal and salivary samples were collected from patients with FPIES at the time of diagnosis on elimination diet, and after tolerance acquisition, and from matched controls (1:1 ratio). 16S rRNA gene sequencing (V3‐V4 regions) and biostatistical analyses (ANCOM‐BC, DESeq2, LEfSe, paired ALDEx2 and MaAsLIN2) were used to compare microbiota composition between groups. Gut microbiota functions were evaluated through measurement of fecal short‐chain fatty acids (SCFAs).
Results: Thirty‐eight allergic patients were included (median age: 1.3 years old), and 22 became tolerant over time. Allergic patients exhibited lower gut and salivary alpha‐diversities, distinct fecal beta‐diversity, several different genera (12 in stools including less Ruminococcus, 2 in saliva including less P5D1‐392), and lower relative abundance of acetate compared to controls. With tolerance acquisition, fecal alpha‐diversities partially increased, whereas SCFAs normalized compared to controls. Ultimately, there were more differences in fecal and salivary microbiota between tolerant and allergic patients (i.e. more Blautia, Ruminococcus, Faecalibacterium, Prevotella‐9, and less Escherichia‐Shigella in tolerant patients) than between controls over time, suggesting a role of the food allergy rather than the effect of time. Image: Main differences in bacterial genera in patients during FPIES versus after acquisition of tolerance (Venn diagrams)
Conclusions: The fecal and salivary dysbiosis observed in allergic patients with FPIES partially resolved after tolerance acquisition. Understanding the underlying mechanisms of dysbiosis is crucial to prevent and or to help in management of FPIES. A prolonged follow‐up could determine if dysbiosis resolution could be complete, and if this early‐infancy dysbiosis has long‐term consequences on health.
Contact e‐mail address: anais.lemoine@aphp.fr
N‐RF068. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐RF068.1. MATERNAL ANTIBIOTIC PROPHYLAXIS DURING CESAREAN SECTION AFFECTS FAECAL TRYPTAMINE IN NEONATES: A SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL
Yannick Van Schajik 1, Emma Ronde2, Thomas Dierikx3, Trishla Sinha4, Mark Davids5, Marjon De Boer6, Wouter De Jonge1,7, Bruno Sovran1,8,9, Tim De Meij10
1Tytgat Institute For Liver And Intestinal Disease, Amsterdam UMC, Amsterdam, Netherlands, 2Obstetrics And Gynecology, Erasmus MC, Rotterdam, Netherlands, 3Medical Microbiology, Maastricht UMC, Maastricht, Netherlands, 4Genetics, UMC Groningen, Groningen, Netherlands, 5Microbiota Center Amsterdam, Amsterdam, Netherlands, 6Obstetrics And Gynecology, Amsterdam UMC, Amsterdam, Netherlands, 7Department of Surgery, University Clinic of Bonn, Bonn, Germany, 8Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam University Medical Centre, Amsterdam, Netherlands, 9Emma Center for Personalized Medicine, Amsterdam University Medical Centre, Amsterdam, Netherlands, 10Paediatric Gastroenterology, Emma Children's hospital, Amsterdam UMC, VU University, Amsterdam, Netherlands
Objectives and Study: Over 20% of global births are delivered via caesarean‐section(c‐section) and use prophylactic maternal antibiotics as preventive standard care to infectious complications. Effects of maternal prophylactic antibiotics on neonatal intestinal microbiota development has been shown to be limited, however the effects on neonatal gut metabolome remains largely unexplored. Here, we assess the effects of maternal prophylactic antibiotics on neonatal tryptophan metabolism, which affects intestinal barrier and immune functions.
Methods: Faeces were collected at 1&4 weeks‐of‐life in C‐section born neonates exposed or not to maternal prophylactic cephalosporin (nAB=32, nNoAB=16) as part of a two previous RCTs, performed in Amsterdam and Groningen UMCs, with vaginally born (non‐antibiotics exposed) neonates (n = 20) as controls (Figure1A). Microbiota composition was determined by shotgun metagenomic sequencing. Targeted metabolomics(HPLC/MS) was performed to determine composition/levels of tryptophan metabolites. Microbiota‐metabolite correlations were assessed by Spearman's correlation coefficients and linear models.
Results: Beta diversity showed trend of difference (P = 0.012) based on prophylactic antibiotic exposure (Figure1B). Tryptamine, a microbiota‐derived tryptophan catabolite was significantly increased (P = 0.027) in antibiotic‐exposed neonates compared to non‐exposed C‐section and vaginally born controls (Figure 1 C,D). It was associated with Enterococcus, resistant to cephalosporins, and Blautia, reported as tryptamine producer. Although not differing between the subgroups, picolinic‐acid negatively correlated to maternal antibiotic levels at 1 week of life (Figure 1E).
Conclusions: In this secondary analysis of 2 RCT cohorts, we performed a multi‐omics approach linking microbiota‐tryptophan metabolites in C‐section born neonates, with/without antibiotic prophylaxis. Although antibiotic exposure did not strongly affect microbiota, increased levels of tryptamine were observed in antibiotic‐exposed neonates. A negative correlation of antibiotic‐concentration/picolinic‐acid, associated to neurodevelopment, was observed in both RCT‐cohorts. Our results suggest that maternal antibiotic prophylaxis in C‐section born neonates may impact tryptophan metabolism. Tryptamine and picolinic‐acid may affect development via the brain‐gut axis, follow‐up studies are urgently needed to better understand long‐term health impacts to this early‐life alteration.
Contact e‐mail address: y.vanschajik@amsterdamumc.nl
N‐RF069. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐RF069.1. IMPLEMENTATION OF PROBIOTIC ADMINISTRATION IN EXTREMELY PRETERM INFANTS IN DUTCH NICUS: EFFECT ON CLINICAL OUTCOMES AND GUT MICROBIOTA COLONIZATION
Aranka Van Wesemael 1,2, Rimke De Kroon1,2, Nina Frerichs1,2, Lizy Van Eijk3, Martine Bos4, Andries Budding4, Chris Van Den Akker1,2,5, Christian Hulzebos6, Willem De Boode7, Marijn Vermeulen8, Anton Van Kaam5, Tim De Meij9, Hendrik Niemarkt10,11
1Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, Netherlands, 2Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands, 3Faculty Of Health, Medicine & Life Sciences, Maastricht University, Maastricht, Netherlands, 4inbiome BV, Amsterdam, Netherlands, 5Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands, 6Beatrix Children's Hospital, University Medical Center Groningen, Groningen, Netherlands, 7Department of Perinatology, Division of Neonatology, Radboud UMC Amalia Children's Hospital, Nijmegen, Netherlands, 8Erasmus MC‐Sophia Children's Hospital, Department of Pediatric & Neonatal Intensive Care, Rotterdam, Netherlands, 9Paediatric Gastroenterology, Emma Children's hospital, Amsterdam UMC, VU University, Amsterdam, Netherlands, 10Department of Neonatology, Maxima Medical Centre, Veldhoven, Netherlands, 11Department of Electrical Engineering, Technical University Eindhoven, Eindhoven, Netherlands
Objectives and Study: Probiotic administration in preterm infants is associated with a reduction in necrotizing enterocolitis (NEC) and possibly late‐onset sepsis (LOS). However, its efficacy in extremely preterm infants (EPIs; gestational age <28weeks) remains unclear due to limited data and potential safety risks. In Dutch Neonatal Intensive Care Units (NICUs), a three‐strain probiotic product is implemented as standard of care. This study aims to evaluate the effect of implementation of probiotics on clinical outcomes in EPIs and the presence of these probiotic species in their gut microbiota.
Methods: Pre‐ and postimplementation cohorts of EPIs from 5 Dutch NICUs (2018‐2023) participating in a fecal biomarker study were included. Clinical data and fecal samples from the first 28 days of life were collected. Incidence of NEC (modified Bell's stage ≥ IIA), LOS and mortality were compared with logistic regression, adjusting for birthweight. Time‐to‐full‐enteral‐feeds (tFEF) was analyzed through multiple regression, adjusting for feeding type and birthweight. Presence of probiotic species was assessed in week‐2 fecal samples, using species‐ and strain‐specific qPCR assays.
Results: In total, 463 EPIs were included (202 pre‐, 261 post‐implementation). The adjusted odds ratio for NEC was 0.4 (95%CI 0.2‐0.8; p < 0.05); 0.8 (95%CI 0.5‐1.2; p = 0.28) for LOS and 0.6 (95%CI 0.3‐1.1; p = 0.12) for mortality in the probiotic‐exposed group. The tFEF was 2.1 days shorter (p < 0.001) in probiotic‐supplemented infants. qPCR analysis on a subset of 136 probiotic‐supplemented infants showed that 90% of the infants had all three probiotic species present.
Conclusions: This multicenter pre‐postimplementation study provides real‐world evidence that our used multi‐strain probiotic product in EPIs is associated with a significant reduction in NEC and tFEF. This effect may be attributed to successful gastrointestinal colonization of probiotic species, as 90% of probiotic‐supplemented EPIs showed presence of all three probiotic species. Further research is needed to determine whether EPIs with insufficient colonization are at higher risk for NEC.
Contact e‐mail address: a.j.vanwesemael@amsterdamumc.nl
N‐EV001. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV001.1. ASSESSMENT OF MYCOTOXIN EXPOSURE THROUGH BREAST MILK IN INFANTS: A PILOT STUDY
Netanel Agajany 1, Elkana Kohn1, Malka Britzi2, Dror Mandel3, Matitahu Berkovich1
1Shamir Medical Center, Zerifin, Israel, 2Israeli National Residue Control LAboratory, Beit Dagan, Israel, 3Tel Aviv Sourasky Medical Cener, Tel Aviv, Israel
Objectives and Study: Mycotoxins are toxic compounds produced by molds, primarily entering the human body through contaminated food. Chronic exposure to mycotoxins is associated with various health risks. While Israel monitors mycotoxins in food products, there is no data on human exposure, particularly through breast milk. Studies from Europe and the Middle East have reported mycotoxins in breast milk, but such data is lacking for the Israeli population. We aimed to measure mycotoxin levels in breast milk of Israeli mothers and identify potential dietary and environmental sources of exposure.
Methods: Breastfeeding mothers provided breast milk samples and completed comprehensive demographic and dietary questionnaires. Samples were analyzed for 11 mycotoxins using liquid chromatography‐tandem mass spectrometry (LC‐MS/MS), including Zearalenone, Deoxynivalenol, Fumonisins B1 and B2, Aflatoxins (B1, B2, G1, G2, M1), Ochratoxin A, T‐2 toxin, and HT‐2 toxin.
Results: Eighty‐two mothers participated, with an average age of 31.9 ± 4.7 years and infants aged 5.1 ± 4.6 months. All but one birth was full‐term. Fumonisin B2 was detected in 26 samples but remained below the limit of quantification (LOQ). Fumonisin B1 and Aflatoxin B2 were detected above the limit of detection (LOD) but below LOQ in three samples each. No other mycotoxins were found.
Conclusions: Mycotoxin levels in breast milk were very low, suggesting minimal exposure among Israeli breastfeeding mothers. While these findings are reassuring, further research is needed to assess long‐term exposure risks and environmental sources in Israel.
Contact e‐mail address: nagajany@gmail.com
N‐EV002. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV002.1. DETERMINATION OF FAT CONTENT RELATION TO MICROBIAL COMPOSITION IN BULGARIAN HUMAN MILK
Asya Asenova, Stanimira Ivanova, Viliana Miteva, Trayana Nedeva, Petya Hristova, Iliyana Rasheva
General And Industrial Microbiology, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria
Objectives and Study: Human milk (HM) contains all necessary components for infant nutrition. Different physico‐chemical characteristics of HM predispose different microbiota content. Even though, many components of the HM are relatively constant, the HM macronutrient third in quantity, the fat, is a parameter that is directly affected by mother's nutrition. The purpose of the current study was to determine the relation between fat content and milk microbiome.
Methods: Each of the eleven lactating mothers from a Bulgarian cohort group enrolled in the current study provided two HM samples. Written informed consent regarding their participation was obtained according to the Nuremberg Code. Gravimetric analysis was performed for determination of the HM fat content. Total DNA was obtained from each sample and was sent for 16S rRNA sequencing by Illumina MiSeq platform in Novogene, Inc.
Results: The average percentage of fat content in all samples was 3.55%. Samples that displayed fat percentage below 3.0% were considered low‐fat HM (eight samples), samples that exhibited fat percentage above 4.0% were considered high‐fat HM (seven samples), samples that showcased fat content between 3.0% and 4.0% were defined as normal‐fat HM (seven samples). Streptococcus spp. was predominating in high‐fat samples, while Staphylococcus was the most represented genus in the low‐fat HM. Normal‐fat HM samples exhibited the most even distribution of genera without significant prevalence of any of them. Rothia spp. often associated with non‐infection mastitis, was well‐represented in the high‐fat HM samples.
Conclusions: Mother's eating habits directly affect the HM fat content, which is related to the HM microbiome. Additional research including increased amount of samples is needed for confirmation. Acknowledgments: Funding Sources ‐ Bulgarian National Science Fund National Science Fund, Project КP‐06‐ Н61/9/15.12.2022, Conference attendance grant BG‐RRP‐2.004‐0008‐C01 – SUMMIT.
Contact e‐mail address: asjaaa@uni-sofia.bg
N‐EV003. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV003.1. A CONSENSUS ON HEALTH IMPACT OF CAESAREAN SECTION RELATED DYSBIOSIS AND NUTRITIONAL STRATEGIES TO RESTORE GUT MICROBIOTA
Marion Aw 1, Jarungchit Ngamphaiboon2, Raman Subramaniam3, Keth Lysotha4, Nhi Nguyen5, Fook Choe Cheah6, Soumitra Dutta7, Chirag Amin8, Chanane Wanapirak9, Chonnikant Visuthranukul10, Voranush Chongsrisawat11
1Department Of Paediatrics, National University of Singapore, Singapore, Singapore, 2Department Of Paediatrics, Chulalongkorn University, Bangkok, Thailand, 3Fetal Medicine & Gynaecology Center, Selangor, Malaysia, 4Perinatal Society of Cambodia, Phnom Penh, Cambodia, 5Tam Anh General Hospital, Ho Chi Minh, Viet Nam, 6Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, 7Intensivist Bhagirathi Neotia Woman and Child Hospital, Kolkata, India, 8Amin's Hospital for Women, Gujarat, India, 9Chiang Mai University, Chiang Mai, Thailand, 10Center Of Excellence In Pediatric Nutrition, Faculty of Medicine, Chulalongkorn university, Bangkok, Thailand, 11Division Of Pediatric Gastroenterology And Hepatology, Department Of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Objectives and Study: The rising global prevalence of c‐section raises concerns as c‐section delivery (CSD) has been associated with a higher risk of diseases such as atopy, asthma and obesity; with the etiology of these linked to dysbiosis. This consensus aims to evaluate the health impact of CSD infants’ gut microbiota and identify strategies to mitigate this dysbiosis.
Methods: The consensus was performed using a modified Delphi method with 11 experts in paediatrics, obstetrics, and gynaecology (from India and South‐East Asia). The process included (i) identifying a corpus of statements for evaluation, (ii) a review of existing literature, (iii) three rounds of discussion around a set of questions and (iv) a virtual meeting to gather and refine expert opinions. Consensus was defined as high when agreement was ≥ 75%, moderate when 55‐74% and low when < 55%.
Results: Ten key consensus statements were identified; 5 on the health impact of CSD and 5 on recommendations for managing gut dysbiosis. Agreement was high for 9 and moderate for 1. The key statements include:‐ ‐The mode of delivery substantially impacts the composition of an infant's gut microbiota. (High) ‐The first 3–4 months of life represent the most optimal 'window of opportunity' for modifying the infant gut microbiota towards that of vaginally delivered infants. (Moderate) ‐Infants who are not exclusively breastfed, the use of nutritional supplementation alongside breastfeeding represent the safest approach to do so. (High) ‐Synbiotic (as demonstrated by studies of combination of scGOS/lcFOS(9:1) and B. breve M‐16V), may effectively restore the gut microbiota in infants born via c‐section. (High)
Conclusions: This consensus highlights the recognition that CSD results in dysbiosis in infants and that early‐life interventions, particularly breastfeeding and/or the use of synbiotic (combination of scGOS/lcFOS(9:1) and B. breve M‐16V) supplementation, during a critical period in first 3‐4 months, are important interventions to mitigate it.
Contact e‐mail address: paeawm@nus.edu.sg
N‐EV004. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV004.1. ASSOCIATION BETWEEN TIMING OF MATERNAL ENERGY CONSUMPTION AND ADIPOSITY IN BREASTFEEDING INFANTS: A PROSPECTIVE COHORT STUDY
Deniz Yaprak1, Mina Misirligil2, Nüket Ünsal3, Necati Balamtekin 4, Belma Saygılı Karagöl5, Ebru Dumlupınar6
1Pediatrics, Division Of Neonatology, University of Health Sciences, Gülhane Training And Research Hospital, Ankara, Turkey, 2Department Of Pediatrics, University of Health Sciences, Gülhane Medicine Faculty, Ankara, Turkey, 3Department Of Nutrition And Dietetics, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey, 4Department Of Pediatrics, Division Of Pediatric Gastroenterology, University of Health Sciences, Gülhane Medicine Faculty, Ankara, Turkey, 5Department Of Pediatrics, Division Of Neonatology, University of Health Sciences, Gülhane Medicine Faculty, Ankara, Turkey, 6Department Of Biostatistics, Ankara University, Ankara Medicine Faculty, ANKARA, Turkey
Objectives and Study: Background: Lactating women's food intake timing may play a critical role in maternal and infantile nutritional health. We aimed to examine associations of breastfeeding mothers’ diet quantity and circadian timing of food intake with subsequent weight status of exclusively breastfed infants over next 6‐months
Methods: Methods: This prospective observational study comprised pairs of healthy singleton breastfed newborn infants and their corresponding healthy lactating mothers. Reported food intake times and diet content used to define maternal eating patterns. WHO Child Growth Standards 2006 were used to determine the infant body mass index–for‐age z scores (BAZs) at birth, 2 and 6 mo of age. The associations of maternal eating pattern with the alterations in infant BAZ gain and nutritional status based on infant BAZs at 6 mo of age were investigated in multiple regression analyses.
Results: In comparison to maternal DT eating, maternal NT eating was linked to a greater increase in infantile BAZ from 2 to 6 months of age (adjusted ß = 0.49; 95% CI: 0.05, 0.92; p = 0.03) and a heightened likelihood of being overweight at 6 months of age (adjusted OR: 3.81; 95% CI: 1.41, 6.63; P = 0.01), after adjusting for factors including maternal age, education level, household income, parity, pregestational BMI, BAZ at 2 months, total daily energy consumption, and the percentages of energy derived from macronutrients.
Conclusions: Conclusion: Disruption of rhythmic physiology from irregular eating habits can lead to circadian misalignment, which may result in abnormal weight gain in infants and an increased likelihood of being overweight in the early postnatal period. Circadian alignment is fundamental for regulating women‐infant dyads’ health.
Contact e‐mail address: drdenizyaprak@gmail.com
N‐EV005. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV005.1. EXPLORING FEEDING PRACTICES AND NUTRITIONAL DEFICIENCIES IN PEDIATRIC HOSPITALIZED INFANTS
Tatiana Chisnoiu1,2, Adriana Balasa 2, Cristina Mihai1,2
1Constanta Clinical Emergency Hospital, Pediatric Department, Romania, Constanta, Romania, 2Ovidius University, Faculty of Medicine, Pediatric Department, Romania, Constanta, Romania
Objectives and Study: Nutrition is fundamental for infant development, serving as a cornerstone for healthy growth and long‐term wellbeing. Deviation from an optimal diet during early life can result in medical complications, underscoring the need for early detection and intervention to mitigate nutritional deficiencies
Methods: This retrospective study evaluated the nutritional status and associated factors in 66 hospitalized infants at the Pediatric Clinic of the Emergency County Clinical Hospital "St. Apostol Andrei," Constanța, over one month (January 2024). Data were analyzed based on age, sex, origin, gestational age, birth weight, nutritional practices, maternal factors, and rickets prophylaxis
Results: The study found that 56% of the infants were aged 1–6 months, with a slight male predominance (53%). Urban areas accounted for 62% of the cases, while 38% came from rural settings. Birth weight ranged predominantly between 3000–4000 grams, correlating with gestational age and genetics. Malnutrition was identified in 7 cases, with 5 classified as first‐degree and 2 as second‐degree malnutrition. Nutrition patterns revealed a balance between natural (39%) and artificial feeding (35%), with diversification typically beginning at 6 months. However, cases of early diversification at 4–5 months were noted. Maternal factors such as age (ranging from 13 to 41 years) and marital status (62% married) were also significant in understanding infant nutrition.
Conclusions: This study highlights the critical role of early and appropriate nutrition, particularly during diversification, in preventing deficiencies and promoting harmonious growth. Addressing nutritional imbalances in infancy and improving rickets prophylaxis are crucial for optimizing developmental outcomes. Further studies are needed to explore the long‐term impact of early nutrition interventions on growth and health in diverse populations.
Contact e‐mail address:
N‐EV006. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV006.1. DIGESTIVE TOLERANCE OF PARTIALLY HYDROLYSED HYPERCALORIC FORMULA IN POSTOPERATIVE CARDIAC SURGERY IN CHILDREN UNDER 18 MONTHS: A PROSPECTIVE OBSERVATIONAL STUDY
Celia Bueno Suárez, Victoria Ramos Casado, Ana Arias Felipe, Aranzazu Flavia Gonzalez Posada Flores, Raquel Nuñez Ramos, Elena Martos Anguita, Marta Germán Díaz
Hospital Universitario 12 de Octubre, Madrid, Spain
Objectives and Study: Malnutrition in critically ill paediatric patients is associated with increased morbidity and mortality, emphasizing the importance of early enteral nutrition via breastmilk or infant formulas. Postoperative digestive intolerance frequently disrupts enteral feeding, necessitating alternative or elemental formulas. This study aimed to evaluate whether a partially hydrolysed formula introduced to infants post‐cardiac surgery is well tolerated and meets more than 70% of energy requirements within 72 hours, reducing the need for elemental diets.
Methods: This prospective observational study collected clinical and analytical data from patients under 18 months admitted to the paediatric intensive care unit (PICU) following cardiac surgery. Statistical analysis was conducted in collaboration with Nestlé Health Science, and results were independently evaluated by the investigators, ensuring no conflict of interest.
Results: Among 25 patients, 60% (15/25) started with Infasource® upon PICU admission, while 40% (10/25) transitioned to it within the first week. Patients had a mean weight of 4.39 ± 1.35 kg and a mean age of 3.86 ± 3.11 months. Most patients (84%; 21/25) tolerated the study formula well, with only 16% (4/25) temporarily discontinuing due to vomiting, abdominal distension, or gastric remnants. Nearly all patients (96%; 24/25) achieved 70% of their nutritional requirements within 72 hours. Formula intake increased from 60.96 ± 42.78 ml/kg on day 1 to around 100 ml/kg in subsequent weeks. Weight improved steadily, reaching significant gains by day 22.
Conclusions: Infasource® was well tolerated, with no need for formula changes or prokinetics. Most patients met energy targets quickly and demonstrated steady weight gain. Further studies with larger populations are needed to confirm these findings, particularly in populations with high breastfeeding prevalence.
Contact e‐mail address: cbuenos@salud.madrid.org
N‐EV007. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV007.1. MATERNAL NUTRITIONAL STATUS MAY HAVE AN IMPACT ON HUMAN MILK OLIGOSACCHARIDES (HMO) COMPOSITION IN BREASTMILK OF INDIAN POPULATION
Khun Aik Chuah, Dieu Huynh
Nutrition Science, Abbott Nutrition R&D for Pacific Asia, Singapore, Singapore
Objectives and Study: This longitudinal study aims to understand the maternal nutritional status of Indian mothers and its association with HMO composition in breastmilk.
Methods: A total of 246 mother‐infant pairs were recruited for a 14‐week follow‐up study in India. The lactating mothers, aged between 20‐35 years, were categorized into three groups based on their Body Mass Index (BMI): undernourished (BMI < 18.5), normally nourished (BMI 18.5‐25.0), and overnourished (BMI > 25.0). A total of 307 breastmilk samples were collected at 2, 6, and 14 weeks postpartum and analyzed using LC‐MS/MS for 5 HMOs: 2′‐FL, 3‐FL, LNT, 3′‐SL, and 6′‐SL.
Results: Overall, 19%, 55%, and 26% of mothers were classified as undernourished, normally nourished, and overnourished, respectively. The analysis of 307 milk samples from 246 Indian mothers revealed that 2′‐FL was the most abundant HMO (226.8 mg/100 g, 51.9%), followed by LNT (83.7 mg/100 g, 19.1%) and 3‐FL (80.3 mg/100 g, 18.4%). The least abundant HMOs were 6′‐SL (33.2 mg/100 g, 7.6%) and 3′‐SL (13.1 mg/100 g, 3.0%). All HMOs showed a decreasing trend except for 3‐FL, which increased across lactation periods from 2 to 14 weeks. Overnourished mothers had relatively lower levels of 2′‐FL, 6′‐SL, 3′‐SL, and LNT compared to normally nourished mothers, but the highest level of 3‐FL among the three groups.
Conclusions: 2′‐FL, 3‐FL, and LNT were the three most abundant HMOs in Indian breastmilk. Maternal nutritional status may impact HMO composition in breastmilk.
Contact e‐mail address: khunaik.chuah@abbott.com
N‐EV008. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV008.1. THE ROLE OF MILK TYPE IN EARLY CHILDHOOD DEVELOPMENT: INSIGHTS FROM A LONGITUDINAL ANALYSIS AT AGES 2 AND 5
Maria Dzhogova, Rouzha Pancheva, Desislava Zhelyazkova, Velina Atanasova, Simoneta Popova, Martin Petrov, Ivan Ivanov, Ralitsa Yordanova
Medicine, Medical University Prof Dr Paraskev Stoyanov Varna, Varna, Bulgaria
Objectives and Study: Infant milk type—breast milk, hydrolyzed hypoallergenic formula, or standard infant formula—may influence key developmental outcomes. This study examines its role in predicting cognitive, motor, and behavioral development at ages 2 and 5.
Methods: A cohort of 92 term‐born children (39 girls, 53 boys) from Varna, Bulgaria, with normal birth weight and no perinatal complications, was followed from birth to 5 years (±3 months). Infant feeding practices and demographic data were collected. At age 2, the Developmentl profile‐3 test (DP‐3) assessed physical, adaptive, social‐emotional, cognitive, and communication skills. At age 5, the Neurodevelopmental Test for Five‐Year‐Olds NDT5 evaluated motor skills, speech, articulation, nonverbal intelligence, and behavior. Linear regression models, adjusted for demographic confounders, explored associations between milk type and developmental outcomes.
Results: At age 2, breastmilk significantly predicted higher physical development scores (R2 = 0.256,p = 0.034), explaining 25.6% of the variance after adjusting for residence, ethnicity, maternal education, smoking during pregnancy, and birth mode. However, predictions for adaptive behavior, social‐emotional skills, and communication were not significant (p > 0.05). At age 5, breastmilk again emerged as a predictor of developmental outcomes. Significant associations and predictive capacity were found for language behavior (R2 = 0.254,p = 0.004), articulation (R2 = 0.286,p < 0.01), and overall developmental scores (R2 = 0.204,p = 0.025). These models underscored milk type's predictive value for language and communication skills, even after controlling for confounders.
Conclusions: Milk type, especially breastmilk significantly predicts developmental outcomes, particularly language and communication skills at age 5, underscoring its importance for early childhood development. These findings highlight the need for early nutritional strategies to optimize developmental trajectories.
Contact e‐mail address: mariadzhogova@gmail.com
N‐EV009. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV009.1. OPTIMIZING INFANT FEEDING CARE: A RETROSPECTIVE AUDIT OF A RAPID ACCESS CLINIC FOR INFANTS WITH FEEDING DIFFICULTIES PRESENTING TO THE EMERGENCY DEPARTMENT
Aoife Fitzgerald 1,2, Irina Ciocoiu2
1Paediatric Department, Galway University Hospital, HYR, Ireland, 2Galway University Hospital, HYR, Ireland
Objectives and Study: Background: Feeding issues in infancy constitute approximately 30% of visits to the Emergency department (ED). Our clinic was established to address the feeding difficulties and reduce the need for hospital admission in infants aged 0‐6 months presenting to the ED. Objective: The primary aim was to provide rapid access to specialized infant feeding support from a consultant paediatrician and clinical dietitian with expertise in infant nutrition. We sought to assess the presentation and management of this patient cohort.
Methods: A retrospective audit was conducted, reviewing case notes from 40 patients seen in our clinic between February and December 2024.
Results: The average time between referral and appointment was 2 weeks. The first appointment was a face‐to‐face consultation, followed by either a virtual or in‐person follow‐up. Common complaints included irritability, poor feeding, vomiting, blood and/or mucous in stools. The most frequent diagnoses were cow's milk protein allergy (CMPA), gastroesophageal reflux, and faltering growth. Less common conditions included multiple allergies, Food Protein‐Induced Enterocolitis Syndrome (FPIES), and hypercalcaemia. Notably, four patients who were initially diagnosed with CMPA had this diagnosis subsequently excluded.
Conclusions: Rapid access to the clinic was successfully achieved, with timely appointments following referral. The most common diagnosis was CMPA for which parents received the appropriate diagnosis, advice and follow up. Remarkably 10% of our patients had a diagnosis of CMPA ruled out, thus reducing the significant impact of the nutritional and psycho‐social aspect of this condition. Maternal anxiety was prevalent in our cohort, largely due to inadequate community support systems and the provision of inaccurate advice. This specialised service has proven invaluable, reducing the admission rate and the waiting times for paediatric outpatient consultant clinics. It offers families timely and accurate advice, alleviating parental anxiety. Future plans include expanding referral pathways to ensure broader access to specialized infant feeding support.
Contact e‐mail address: irina.ciocoiu@hse.ie
N‐EV010. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV010.1. IMMUNOLOGY OF BREAST MILK: DYNAMICS OF SECRETORY IGA CONTENT IN BREAST MILK
Mariana Iskiv 1,2, Natalia Gromnatska3, Iryna Pasichnyuk3
1Department Of Medical Genetics, SI Institute of hereditary of NAMNS of Ukraine, Lviv, Ukraine, 2LCC Medicover Ukraine, Lviv, Ukraine, 3Danylo Halytskyy Lvv National Medical University, Lviv, Ukraine
Objectives and Study: In addition to the nutritional component, and beneficial effect on the physical and mental development of the child breast milk has an immunogenic function. The leading role in breast milk's anti‐infective action has secretory IgA (SIgA).Aim. To determine the level of SIgA in colostrum and breast milk of mothers with different volumes of lactation: normal lactation, early and late hypogalactia, and in mothers whose children had recurrent viral diseases and those, who were healthy during the lactation period.
Methods: The level of SIgA was determined in colostrum and breast milk of 372 mothers with normal lactation and 208 with hypogalactia, including 72 with early and 146 with late hypogalactia at different stages of lactation (1‐8 days, 1 and 3 months).
Results: In mothers with normal lactation, early and late hypogalactia, the maximum content of SIgA was determined in the first 4 days after delivery (p < 0.05). In early and late hypogalactia, the content of SIgA did not statistically differ from the level of SIgA in colostrum and milk of mothers with normal lactation both in the early neonatal period and at 1‐3 months of secretion. Children with mother's hypogalactia received a smaller volume of milk, and accordingly, a smaller amount of SIgA, which negatively affected the immune status and morbidity of children. The content of SIgA in colostrum and milk of mothers of children with recurrent viral diseases, regardless of the volume of lactation, was lower in all periods of lactation (p < 0.05).
Conclusions: The amount of milk received by children with hypogalactia, and the quantity of SIgA, was insufficient, and the deficiency was higher the sooner hypogalactia developed. The content of SIgA in colostrum and milk of mothers of children with recurrent viral diseases, regardless of the volume of lactation, was lower in all periods of lactation.
Contact e‐mail address: iskivmarjana20@gmail.com
N‐EV011. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV011.1. EFFECT OF A GOAT MILK‐BASED INFANT FORMULA WITH SYNBIOTICS AND BETA‐PALMITATE: PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL
Mateusz Jankiewicz, Hania Szajewska
Department Of Paediatrics, Medical University of Warsaw, Warsaw, Poland
Objectives and Study: Goat milk‐based formulas (GMFs) may improve digestion and gastric emptying, as suggested by in vitro studies. Probiotics like Bifidobacterium animalis BB‐12 enhance microbiota balance, while prebiotics stimulate beneficial bacteria growth, and beta‐palmitate supports fat absorption and stool consistency. This pragmatic study aims to evaluate the impact of a GMF with synbiotics and beta‐palmitate, compared to a commercially available cow milk‐based formula (CMF), on the severity and frequency of gastrointestinal, other associated symptoms, and the quality of life in infants who exhibit symptoms that may be related to cow milk.
Methods: It is a randomized double‐blind, controlled trial involving healthy, exclusively formula‐fed infants aged 14 to 90 days, previously on CMF for at least 7 days, with Cow Milk‐related Symptom Score (CoMiSS) between 6 and 10. Participants will be randomly allocated to GMF or CMF for 4 weeks. The primary outcome is the change in CoMiSS after 2 weeks. Secondary outcomes include percentages of infants with changes in CoMiSS, scores on the Pediatric Quality of Life Inventory, severity and frequency of gastrointestinal symptoms measured by the Infant Gastrointestinal Symptom Questionnaire, growth parameters, and adverse events. The study protocol was approved by the Ethics Committee of the Medical University of Warsaw.
Results: Infants consuming the GMF are expected to exhibit a lower severity and frequency of gastrointestinal and other symptoms, compared to those consuming the CMF and this improvement is expected to result in a higher health‐related quality of life in the infants consuming the GMF.
Conclusions: By comparing a study product to a commercially available formula, this pragmatic trial directly addresses real‐world decision‐making in infant formula selection. The findings will expand the understanding of the effects of a GMF enriched with synbiotics and beta‐palmitate on cow milk‐related symptoms in infants, potentially providing valuable insights for clinical practice.
Contact e‐mail address: mateusz.j.jankiewicz@gmail.com
N‐EV012. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV012.1. ANALYSIS OF MACRO‐NUTRIENTS IN THE COMPLEMENTARY FOODS OF KOREAN INFANTS WITH STANDARD GROWTH
Yeji Kim 1, Shinjie Choi1, Youn Ha Kang1, Sunwoo Park1, Lia Kim1, Jeong Eun Ahn1, Kyung Jae Lee1, Minsoo Shin2, Ki Soo Kang3, Yeoun Joo Lee4, Jung Ok Shim5, Jee Yoon Park6, Chan‐Wook Park7, Young Hwa Jung8, Chang Won Choi8, Jae Hyun Kim8, Seung Han Shin8, Yun Jeong Lee8, Young Ah Lee8, Choong‐Ho Shin2, Young Eun Kim8, Jae Sung Ko1, Jin Soo Moon1
1Department Of Pediatrics, Seoul National University Hospital, Seoul, Korea, Republic of, 2Department Of Pediatrics, Korea National University College of Medicine, Seoul, Korea, Republic of, 3Pediatrics, Jeju National University College of Medicine, Jeju‐si, Korea, Republic of, 4Pediatrics, Korea University Guro Hospital, Seoul, Korea, Republic of, 5Pediatrics, Korea University College of Medicine, Seoul, Korea, Republic of, 6Obstetrics And Gynecology, Seoul National University College of Medicine, Gyeonggi‐do, Korea, Republic of, 7Obstetrics And Gynecology, Seoul National University College of Medicine, Seoul, Korea, Republic of, 8Pediatrics, Seoul National University College of Medicine, Seoul, Korea, Republic of
Objectives and Study: From a prospective national South Korean children's growth cohort, the nutritional analysis of healthy South Korean infants whose growth parameters lay between the two standard deviation z scores for height‐for‐age, weight‐for‐age, and BMI‐for‐age were analyzed.
Methods: A longitudinal study of Korea's infant physical growth experimental survey (KIPGros) (n = 256) was taken and children aged < 24 months were evaluated. Each group's mean value of growth parameters divided up in months (6 mo – 12 mo, 12 mo – 24 mo) were evaluated. A single‐day nutritional intake questionnaire was taken and analyzed every month from birth to 12 months and every 3 months from 12 months to 24 months by a clinical dietitian. The values of energy, protein, fat, carbohydrate, and micronutrients were calculated using a Computer Aided Nutritional Analysis program.
Results: Infants (6–11.9 months).
Infants had a mean energy intake of 542.7 kcal/day, below the EAR of 600.0 kcal/day. Protein intake of 18.9 g/day exceeded the EAR by 12 g/day. Most consumed adequate calcium, potassium, iron, zinc, and vitamins C, D, E, and B6. Sodium, vitamin A, and folate were notably below the Korean Dietary Reference Intake recommendations. Toddlers (12–23.9 months)
Toddlers’ mean energy and protein intakes were 1013.9 kcal/day and 40.9 g/day, surpassing the EARs of 900 kcal/day and 15 g/day. Dietary fiber was insufficient at 9.8 g/day (AI: 15 g/day). Vitamin A, vitamin D, calcium, and iron were adequate, but vitamin B6 and folate fell short of the AI. The mean sodium level was 1164 mg/d, exceeding the AI of 810 mg/d. High phosphorus and low potassium intakes were observed, highlighting key areas for dietary improvement.
Conclusions: This was a prospective cohort study of the growth and nutritional analysis of Healthy Korean infants from 0 to 24 months. We hope our outcome will serve as a future growth reference and dietary guidance.
Contact e‐mail address: joing325@gmail.com
N‐EV013. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV013.1. MINIMAL PROCESSING OF INFANT MILK FORMULA PRESERVES SUPERIORITY OF INGREDIENTS, IMPROVES DIGESTIBILITY AND PROMOTES HEALTH FUNCTION
Alina Kondrashina, Clodagh Walsh, Reuben O'Hea, Jonathan Lane
Research And Innovation, H&H Group, Fermoy, Ireland
Objectives and Study: Breast milk is considered the gold standard for infant nutrition, and research focuses on mimicking its composition and functionality in infant milk formula (IMF) while ensuring safety. Traditionally, microbiological safety in IMF is maintained through thermal treatments during ingredient and final formula production, often involving temperatures as high as 95°C for up to 30 minutes. However, repeated exposure to high temperatures can alter milk protein structure, negatively impacting digestibility and functionality. Recent studies indicate that minimizing heat exposure during IMF processing can help maintain proteins in their native state, thereby enhancing their functionality.
Methods: We formulated two nutritionally equivalent IMFs that differed solely in the source of the most heat‐sensitive protein fraction, whey protein. The control IMF (S‐HT) utilized whey protein derived from cheese production and underwent pasteurization at 85°C. In contrast, the test IMFs incorporated native whey protein obtained through membrane filtration with minimal heat exposure and were pasteurized at either 85°C (N‐HT) or 77°C (N‐LT).
Results: Compositional analysis revealed that reducing heat exposure preserved functional proteins such as lactoferrin and IgG, while also minimizing protein aggregation, resulting in increased protein solubility. Each thermal step in IMF production contributed to the formation of Maillard reaction byproducts, with the majority generated during the drying process. The enhanced digestibility of N‐LT IMF was confirmed through simulated infant gastrointestinal digestion, evaluating nutrient bioaccessibility, peptide size distribution, protein hydrolysis, and free amino acid release. Bioavailability and intestinal health were assessed using an infant intestinal barrier model with human Caco‐2 epithelial cells. Compared to S‐HT, N‐LT IMF showed superior support for intestinal barrier integrity, demonstrated by the upregulation of tight junction proteins Claudin‐1 and ZO‐1.
Conclusions: These findings highlight the benefits of lower‐temperature processing in IMF, including reduced Maillard reaction byproducts, preserved functional proteins, enhanced protein solubility and digestibility, leading to improved nutritional and functional outcomes.
Contact e‐mail address: alina.kondrashina@hh.global
N‐EV014. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV014.1. ENTERAL NUTRITIONAL PRACTICE IN NICU FOR PRETERM INFANTS WITH BIRTHWEIGHT UNDER 1800G EXPERIENCE AND RESULTS
Vyara Konstantinova, Radka Maslarska, Vassilena Alexandrova, Lyuba Emiliyanova
Neonatology Department, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
Objectives and Study: Human milk (HM) is the best form of nutrition for term and preterm infants. For low‐birth‐weight infants, HM does not provide sufficient nutrition when taking usual feeding volumes. HM should be fortified to meet the high requirements of this group of babies. The aim of this study is to establish the effect of fortified HM to promote growth in preterm infants.
Methods: A retrospective single‐center clinical study among preterm infants with birth weight (BW)<1800g at a tertiary referral hospital for one‐year period. The included neonates were distributed into three groups: Group 1 ‐ ‘BW <999 g’ – 5 infants; Group 2 – ‘BW ‐ 1000‐1499 g’ – 13 infants; and Group 3 – ‘BW 1499‐1800g’ – 25 infants. Birth characteristics were analysed ‐ gestational age, mode of delivery, sex and morbidity. Initiation of feeding and weight gain patterns were analysed and compared between the groups. Fortification (with human fortifier) was initiated when enteral intakes reached 40 ml/kg/d.
Results: Enteral feeding was initiated within the first 3 days in 90% of the infants, and up to day 6 in the other 10%, in 95% of the babies with hydrolysed formula (HF) and in 5% with HM. Between days 4 and 25, with establishment of good enteral tolerance, HF was changed with HM, if provided, or with premature formula. Analysed data showed that standard fortification of HM provides similar weight gain pattern to the intrauterine growth ‐ 16gr/day for Gr 1, 18gr/day for Gr 2, 16gr/day for Gr 3, comparable to the weight gain pattern in infants fed premature formula. Standard fortification had no consistent adverse effects on NEC and sepsis.
Conclusions: Based on the obtained data, the postnatal growth rate in enrolled preemies with birth weight <1800g is similar to the intrauterine growth. Early fortification is efficient, safe and well tolerated by premature babies.
Contact e‐mail address: vyara_konstantinova@mail.bg
N‐EV015. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV015.1. THE BIFIDOGENIC EFFECT OF BREAST MILK ON THE GUT MICROBIOME OF HEALTHY BRAZILIAN INFANTS
Tamara Lazarini 1, Karina Tonon2, Humberto Araujo Filho1, Mauro Morais1
1Nutrition Postgraduate Program, UNIVERSIDADE FEDERAL DE SAO PAULO, São Paulo, Brazil, 2Department Of Environmental & Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, United States of America
Objectives and Study: Breast milk is rich in bioactive components which are crucial for establishing gut microbiota. The objective this study was to examine the bifidogenic effect of breast milk on the gut microbiota of healthy infants.
Methods: TThis study analyzed 58 healthy infants, divided into a breast milk (BM) group (n = 28) and an infant formula (IF) group (n = 30). Stool samples collected at 1 and 4 months were analyzed using 16S rRNA sequencing (V3–V4 regions, Illumina MiSeq) to assess changes in microbial diversity and relative abundance of phyla and genera over time.
Results: At admission, infants in the BM group had significantly lower alpha diversity in their gut microbiome compared to the IF group (Chao 1: 17.8 ± 5.6 vs. 23.6 ± 7.2; Shannon: 1.5 ± 0.5 vs. 1.8 ± 0.4; p < 0.01). This difference persisted in the fourth month (Chao 1: 20.9 ± 5.5 vs. 27.7 ± 7.9; Shannon: 1.6 ± 0.4 vs. 2.1 ± 0.5). Beta‐diversity showed no significant difference between groups based on the weighted UNIFRAC matrix (p = 0.185), but the unweighted UNIFRAC matrix revealed a significant difference (p = 0.002). At admission, the relative abundance of the four dominant phyla (Actinobacteriota, Bacteroidota, Firmicutes, and Proteobacteria) was similar between groups. However, the IF group showed significantly higher abundance of the genera Clostridium sensu stricto 1 (median: 8.0% vs. 0.2%) and Enterobacter (median: 1.4% vs. 0.0%; p < 0.05). Between admission and the fourth month, the BM group exhibited a greater increase in Actinobacteriota (medians: 16.1% vs. 2.1%; p < 0.001) and Bifidobacterium (medians: 16.1% vs. 2.8%; p < 0.001) compared to the IF group. By the fourth month, the IF group had higher relative abundance of Bacteroidota (p = 0.017), Ruminococcus gnavus (p = 0.009), and Lacticaseibacillus (p = 0.029).
Conclusions: Breastfed Brazilian infants had a greater bifidogenic effect, whereas alpha diversity was higher in the infant formula group throughout the first four months.
Contact e‐mail address: tamara.lazarini78@gmail.com
N‐EV016. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV016.1. GASTROINTESTINAL HEALTH BENEFITS OF A GOAT MILK‐BASED FORMULA IN HEALTHY CHINESE TODDLERS: AN EXPLORATORY SINGLE‐ARM DECENTRALIZED REAL‐WORLD EVIDENCE CLINICAL STUDY
Yifei Han1, Jinyuan Zhu2, Muqing Xie1, Zailing Li 3
1Danone Open Science Research Center, Shanghai, China, 2Shunde Women and Children's Hospital of Guangdong Medical University, Shunde, China, 3Peking University Third Hospital, Beijing, China
Objectives and Study: Goat milk‐based formula is considered a safe and suitable source of nutrition, offering potential health benefits. This exploratory single‐arm decentralized real‐world evidence study aimed to understand the impact of a goat‐milk based young child formula (YCF) containing Prebiotics, SN‐2 palmitate, and Probiotics on the gastrointestinal (GI) functioning and related health benefits in Chinese toddlers.
Methods: This study (NCT06287385) applied a digital platform, enhancing weekly assessment and monitoring on GI health and functioning during the 4‐week intervention period in healthy, term‐born Chinese toddlers aged 1‐2 years (n = 120), where artificial intelligence (AI) was integrated to collect and assess stool consistency and complementary food intake. An adapted Infant Gastrointestinal Symptoms Questionnaire was used to evaluate GI symptoms and GI‐related behaviors over the prior 7 days, each consisting of 6 items. The scores were converted to a scale of 1‐5 with a higher score indicating a higher frequency, intensity or duration of the symptoms. Wilcoxon signed rank was used to compare outcomes at each timepoint with baseline.
Results: Overall, both scores on clinician‐monitored parent‐reported GI symptoms and GI‐related behaviors decreased over time. The mean (SD) score of GI symptoms was 7.80 (2.01) at baseline, 7.60 (1.71, P > 0.05), 7.50 (1.72, P = 0.04), 7.20 (1.58, P < .001) and 7.00 (1.50, P < .001) after 7, 14, 21 and 28 days of study product intake, respectively. The mean (SD) score of GI‐related behaviors was 9.50 (2.70) at baseline, 9.10(2.51, P > 0.05), 8.60 (2.23, P < .001), 8.20 (2.20, P < .001), 8.10 (2.08, P < .001), respectively.
Conclusions: The significant reduction in clinician‐monitored parent‐reported GI symptoms and GI‐related behaviors after the goat milk‐based YCF consumption indicates potential benefits for overall gastrointestinal health and functioning in Chinese toddlers. Further insights will be obtained following a comprehensive analysis that incorporates AI collected and assessed stool consistency and complementary food intake.
Contact e‐mail address: topbj163@sina.com
N‐EV017. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV017.1. IMPROVED PEDIATRIC QUALITY OF LIFE AFTER TRANSITION TO GOAT‐MILK BASED FORMULA IN HEALTHY CHINESE TODDLERS: AN EXPLORATORY SINGLE‐ARM DECENTRALIZED REAL‐WORLD EVIDENCE CLINICAL STUDY
Yifei Han1, Jinyuan Zhu2, Muqing Xie1, Zailing Li 3
1Danone Open Science Research Center, Shanghai, China, 2Shunde Women and Children's Hospital of Guangdong Medical University, Shunde, China, 3Peking University Third Hospital, Beijing, China
Objectives and Study: Goat milk‐based formula is considered a safe and suitable source of nutrition. This exploratory single‐arm decentralized real‐world evidence study aimed to explore the impacts of a goat milk‐based young child formula (YCF) containing Prebiotics, SN‐2 palmitate, and Probiotics on the health‐related quality of life (HRQoL) of Chinese toddlers.
Methods: This study (NCT06287385) enrolled 120 healthy, term‐born toddlers aged 1‐2 years, who consumed the study formula over a period of 4 weeks. This decentralized study, conducted in a real‐world environment, utilized a digital platform to assess health status in practical scenarios. Additionally, the integration of artificial intelligence enabled recording of real‐time stool consistency and complementary food intake, providing opportunities to detect immediate anomalies alongside clinician monitoring. In this study, the HRQoL of subjects was evaluated through parent‐proxy reporting using the validated Pediatric Quality of Life Inventory (PedsQL) at baseline and after 4 weeks of using study product. The PedsQL was transformed to a scale of 0‐100, with higher scores indicating better HRQoL.
Results: The mean (SD) total score after 4 weeks was 87.62 (11.15), compared to a baseline score of 83.38 (10.95) (P < .0001). Results showed significantly higher scores after 4 weeks in four domains compared to baseline on physical functioning (88.84 vs. 84.91, P = 0.002), physical symptoms (90.88 vs. 87.08, P < .0001), emotional functioning (82.79 vs. 76.51, P < .0001), and cognitive functioning (86.02 vs. 82.01, P < 0.02). Social functioning score improved from 92.10 to 93.40, although showed no statistical significance (P > 0.05).
Conclusions: The significant increase in PedsQL scores observed in this study indicates improvements in HRQoL of Chinese toddlers, suggesting health benefits of the goat‐milk based YCF on overall health and well‐being across various domains including physical symptoms, physical functioning, emotional functioning, and cognitive functioning. The correlation between HRQoL and complementary feeding will be further investigated to provide an extensive understanding of actual conditions and behaviors in real‐world scenarios.
Contact e‐mail address: topbj163@sina.com
N‐EV018. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV018.1. ADEQUATE GROWTH UP TO SCHOOL‐AGE IN CHINESE CHILDREN FED A PARTIALLY HYDROLYZED FORMULA WITH SYNBIOTICS DURING INFANCY: FOLLOW‐UP OF A RANDOMIZED CONTROLLED TRIAL
Ying Wang1, Jieling Wu2, Zailing Li3, Min Liu 4, Yifei Han5, Kelly Mulder6, Wei Cai1
1Division Of Pediatric Gastroenterology And Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, Shanghai, China, 2Guangdong Women and Children Hospital, Department of Children Health Care, Guangzhou, China, Guangzhou, China, 3Peking University Third Hospital, Department of Pediatrics, Peking, China, Peking, China, 4Shanghai Public Health Clinical Center, Obstetrics Department, Shanghai, China, Shanghai, China, 5Danone Open Science Research Center, Shanghai, China, 6Danone Nutricia Research, Utrecht, Netherlands
Objectives and Study: This follow‐up (FU) study aimed to characterize the longitudinal growth trajectory of Chinese children up to 48 months of age who were fed a partially hydrolyzed protein formula with a specific synbiotic mixture of short‐chain galacto‐oligosaccharides and long‐chain fructo‐oligosaccharides (scGOS/lcFOS; 9:1) and Bifidobacterium breve M‐16V (Test) or an intact protein infant formula with scGOS/lcFOS (Control) during infancy (Randomised Controlled Trial Registration: NCT03520764). Previously, we demonstrated that these formulas were well tolerated and supported adequate growth in healthy, term‐born infants (Wang et al., 2021).
Methods: Healthy, term‐born, fully formula‐fed Chinese infants were randomly assigned to the Test (n = 112) or Control (n = 112) group for the first 4 months of age. Fully breastfed infants (n = 60) were included as a reference. In the FU study (NCT05476289), anthropometrics were assessed at 24, 30, 36 and 48 months for participants who had completed the 4‐month visit. Exploration of additional health outcomes is ongoing.
Results: In total, 129 of the 284 infants (45%) from the original study completed the FU study. No differences in demographics were observed between the original and FU study populations. During the follow‐up, no significant differences in mean values for weight, height, and body mass index (BMI) were observed between the Test (n = 51), Control (n = 51), and Breastfed groups (n = 27). Additionally, median z‐scores for weight‐for‐age, height‐for‐age, BMI‐for‐age, and weight‐for‐height were close to the median of the WHO growth standards for all groups across all timepoints.
Conclusions: The results indicate adequate long‐term growth up to 48 months of age in healthy Chinese children who were fed a partially hydrolyzed protein formula with a specific synbiotic mixture in early life.
Contact e‐mail address: wangying02@xinhuamed.com.cn
N‐EV019. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV019.1. COMPARATIVE ANALYSIS IN VITRO GASTRIC DIGESTION PATTERNS AT DIFFERENT PH OF KEY MILK PROTEINS IN GOAT‐MILK AND COW'S MILK‐BASED INFANT FORMULAS AND HUMAN MILK
María Del Nogal‐Ávila1, Marta Soria‐López2, Isabel Sánchez‐Vera1, Rosa Plaza‐Clavero1, Daniel Cabello‐Rivera1, Karen Knipping3, Alejandro López‐Escobar 4
1Departamento De Ciencias Médicas Básicas, Facultad De Medicina, Universidad CEU‐San Pablo, CEU Universities, Alcorcón, Madrid, Spain, 2Pediatrics Department, HM Hospitales, Madrid, Spain, 3Ausnutria B.V., 8025 BM Zwolle, The Netherlands, Zwolle, Netherlands, 4Pediatrics Department, Hospital Universitario General de Villalba. Facultad de Ciencias de la Salud, Universidad Internacional de la Rioja (UNIR), Madrid, Spain
Objectives and Study: Objectives and study: Gastroesophageal reflux disease (GERD) affects about 8% of infants. Treatment aims to alleviate symptoms and protect the esophagus by using medications that adjust gastric pH, which can influence milk protein digestion. Studies suggest that goat milk is easier to digest than cow's milk due to higher buffering capacity and less compact coagulates in stomach acid, which may benefit infants with GERD. The objective is to assess the influence of pH on the digestion of proteins in different types of milk; human milk (HM), cow's milk‐based formula (CMF) and goat's milk‐based formula (GMF).
Methods: Methods: HM, CMF and GMF were subjected to in vitro digestion using human gastric juice at different pH (2.5, 4 and 6) with undigested as control, and samples were collected after 30 minutes of digestion. The protein fractions were studied by SDS‐PAGE and band densities were measured.
Results: Results: Caseins exhibited a high degree of digestion at pH2.5 in all milk types, and was more pronounced in HM and GMF. At pH4, GMF had 51% higher casein degradation compared to HM. Lactoferrin digestion was more effective in HM and GMF at pH2.5, while no differences were observed at higher pH. Albumin digestion at pH2.5 showed a high degree of digestion for all milk types, with nearly complete degradation in HM and GMF. At higher pH, albumin degradation was more pronounced in GMF compared to CMF and HM. α‐Lactalbumin digestion showed considerable higher degradation in GMF compared to HM at pH2.5. At higher pH, GMF exhibited a substantial degradation of α‐lactalbumin, whereas no digestion was observed in CMF and HM.
Conclusions: Conclusions: These results indicate that GMF has better protein digestibility than CMF at all pH levels, suggesting it may be prescribed for conditions like gastroesophageal reflux, where stomach pH is more alkaline due to medication use.
Contact e‐mail address: alejandro@sietepicos.com
N‐EV020. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV020.1. THE ASSOCIATION BETWEEN THE ANTIBACTERIAL PROPERTIES OF BREAST MILK AND THE CIRCADIAN RHYTHMS VARIATIONS: A PROSPECTIVE STUDY
Mina Misirligil1, Belma Saygılı Karagöl 2, Deniz Yaprak3, Bülent Ünay1, Gökçe Çiçek Karaman4, Tuğrul Hoşbul4
1Department Of Pediatrics, University of Health Sciences, Gülhane Medicine Faculty, Ankara, Turkey, 2Department Of Pediatrics, Division Of Neonatology, University of Health Sciences, Gülhane Medicine Faculty, Ankara, Turkey, 3Pediatrics, Division Of Neonatology, University of Health Sciences, Gülhane Training And Research Hospital, Ankara, Turkey, 4Clinical Microbiology And Infectious Diseases, Gülhane Training And Research Hospital, Ankara, Turkey
Objectives and Study: Objective: Breast milk is a sophisticated biological fluid that provides an ideal nutritional composition for infants, and also exhibits variation in circadian rhythms. Breast milk possesses either bacteriostatic or bactericidal properties. Current research has not yet explored the potential influence of circadian changes in breast milk on its antibacterial activity. This study aims to reveal the association between the antibacterial activity of breast milk with circadian rhythm.
Methods: The study was conducted with the participation of volunteer mothers who presented to our neonatal outpatient clinic between March and May 2024. Breast milk samples is classified based on the time of collection: milk obtained between 04:00 and 22:00 is designated as daytime breast milk, while milk gathered between 22:00 and 04:00 is referred to as nighttime breast milk. A total of sixty breast milk samples were stored at +4°C, and the antibacterial effectiveness of these samples was assessed within 24 hours of milking.
Results: No significant difference was observed between day and night breast milk regarding their antibacterial activity against Escherichia coli (E. coli) (p = 0.819). Additionally, no correlation was found between the number of bacterial colonies in 60 breast milk samples and the storage time of the milk (r = 0.19, p = 0.1). A moderate positive correlation was found between the number of E. coli colonies in day breast milk and the storage time of breast milk (r = 0.431, p = 0.02).
Conclusions: Our study demonstrated that while immunological factors in breast milk exhibit a circadian variation, the antimicrobial activity of breast milk remains consistent and shows no significant difference.
Contact e‐mail address: drdenizyaprak@gmail.com
N‐EV021. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV021.1. EFFECTS OF HIGH SN‐2 PALMITATE INFANT FORMULA ON GROWTH, FECAL CALCIUM CONTENTS AND MICROBIOTA IN HEALTHY TERM INFANTS: A CLUSTER RANDOMIZED CLINICAL TRIAL
Qianqian Shen 1, Wei Wu1, Yibing Ning2, Jing Yin1, Nan Sheng2, Tao Liu3, Peiyu Wang4, Hua Jiang5, Yumei Zhang1
1Department Of Nutrition And Food Hygiene, School of Public Health, Peking University, Beijing, China, 2The Joint Laboratory of Human Milk Research & Life Science by The Health Science Center of Peking University and the Junlebao Dairy Group, Beijing, China, 3Shahe People's Hospital, Xingtai City, China, 4Department Of Social Medicine And Health Education, School of Public Health, Peking University, Beijing, China, 5School of Nursing, Peking University, Beijing, China
Objectives and Study: Palmitic acid (PA), the most abundant saturated fatty acid in human milk, predominantly esterifies the sn‐2 positions of glycerol. Little evidence shows the impact of increasing the proportion of sn‐2 PA in infant formula on health outcomes. This study evaluated high sn‐2 PA infant formula's effect on growth, fecal calcium contents and microbiota in healthy full‐term infants.
Methods: Infants aged≤14 days were enrolled: 66 breastfed (BF) group and 133 formula‐fed infants who were clustered and randomly assigned to receive formula containing high sn‐2 palmitate (sn‐2 group, n = 66) or low sn‐2 palmitate (control group, n = 67) for 24 weeks, where 46.3% and 10.3% of the PA was sn‐2‐palmitate, respectively. Anthropometric measurements were performed and stool samples were collected.
Results: No statistical difference in weight‐for‐age z‐score, height‐for‐age z‐score and weight‐for‐height z‐score among groups at all time points, but sn‐2 group had faster body weight growth than BF group (P Group*Time < 0.001). Calcium content in infant feces declined over time in BF and sn‐2 groups (P adjusted for Time = 0.028). No significant difference was observed between the two groups (P adjusted for Group*Time = 0.097). However, at week 24, sn‐2 group had lower calcium than controls. At week 24, sn‐2 group had lower gut microbiota Alpha‐diversity than controls. At week 16, sn‐2 group showed abundant species, higher Ace, Chao and Shannon indices, and lower Simpson index than BF group. At weeks 16 and 24, sn‐2 group had lower Beta‐diversity (Bray‐Curtis), higher Bifidobacteria and Lactobacillus abundances, and higher acetic acid content in feces than controls. At week 24, propionic acid content was also higher in sn‐2 group.
Conclusions: Increasing the sn‐2 palmitate content in infant formula can effectively promote weight gain and decrease fecal calcium content. Additionally, it can beneficially regulate the gut microbiota and metabolites, making them more similar to those observed in breastfed infants.
Contact e‐mail address: zhangyumei@bjmu.edu.cn
N‐EV022. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV022.1. EFFECT OF INFANT FORMULA MADE WITH MILK FREE OF A1‐TYPE BETA‐CASEIN VS CONVENTIONAL FORMULA ON INFANT GROWTH AND COMFORT: A RANDOMIZED CONTROLLED TRIAL
Xiaoyang Sheng 1, Jing Li2
1Department Of Developmental Behavioral And Child Health Care, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China, 2Neonatology Department, Shanghai First Maternity and Infant Hospital, Shanghai, China
Objectives and Study: Many infants will consume both breastmilk and infant formula. The base ingredient of infant formula, conventional (CON) milk, contains both A1‐ and A2‐type beta‐casein. Replacing this ingredient with milk free of A1‐type beta‐casein (A1PF milk) may avoid negative gastrointestinal effects. This study's objective was to compare the effects of an A1PF infant formula and a CON infant formula on mixed‐fed (i.e., regularly consuming breastmilk and ≥400 mL/day of formula) infants aged 3–4 months.
Methods: This open‐label randomized controlled trial (NCT06256094), conducted in China, compared anthropometric measurements and comfort (via the Infant Gastrointestinal Symptom Questionnaire [IGSQ] and frequency of crying) of healthy mixed‐fed infants consuming A1PF vs. CON infant formula (prepared and administered per the label for 56 days). Parent/caregiver satisfaction surveys and adverse events were also assessed.
Results: There were no significant differences in anthropometric measurements between infants in the A1PF (n = 140) and CON (n = 140) groups. Compared with the CON group, the A1PF group had significantly lower mean (standard deviation) daily total IGSQ scores (19.15 [3.74] vs. 21.21 [3.30]), stooling (2.55 [0.67] vs. 2.69 [0.63]), spitting up/vomiting (5.72 [1.45] vs. 6.36 [1.40]), crying (4.59 [1.29] vs. 5.10 [1.32]), and fussiness (2.99 [0.96] vs. 3.43 [0.98]) domain scores, and fewer daily crying periods at week 2 (3.14 [2.73] vs. 4.09 [2.70]) (all P < 0.05). These improvements were maintained at week 4. More parents/caregivers in the A1PF group reported improvements in gastrointestinal symptoms (64.29% vs. 43.20%), vomiting after feeding (43.65% vs. 25.60%), digestion (33.33% vs. 15.20%), and stool characteristics (31.75% vs. 18.40%) (all P < 0.05). Both formulas were well‐tolerated.
Conclusions: Mixed‐fed infants fed A1PF formula achieved similar growth to those fed CON infant formula but had significantly improved comfort (including gastrointestinal symptom relief and fewer crying periods).
Contact e‐mail address: xiaoyang_sheng@163.com
N‐EV023. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV023.1. THE ROLE OF BREASTFEEDING IN THE PSYCHO ‐ SOCIAL ADAPTATION OF CHILDREN IN SOCIETY
Nafisa Sultanova 1, Guloyim Avezova2
1Propaedeutics Of Children Diseases, Tashkent medical academy, Tashkent, Uzbekistan, 2Propedeutics Of Children Diseases, Tashkent Medical academy, Tashkent, Uzbekistan
Objectives and Study: To study the features of the formation of somatic pathology as well as psycho‐emotional development in 445 children over 14 years, depending on the types of feeding
Methods: Long‐term follow‐up of children included a clinical examination in combination with a survey of parents, analysis of clinical and laboratory examination data.
Results: In the study conducted at the City Perinatal Center No. 1 of the city of Tashkent, the level of psychophysical and cognitive development was studied in breastfed and artificially fed children. Follow‐up observation was carried out for 205 children in dynamics. It was found that 85.4% (175) of children were breastfed and 14.6% (30) of children were artificially fed. A lag in pre‐speech development was noted in 1% of breastfed children, compared with 16.6% of formula‐fed children.
Conclusions: It turned out that children who were exclusively breastfed for at least the first three months of life had the best results on tests of cognitive abilities. On tests of verbal intelligence, they scored an average of 7.5 points higher (on a 100‐point scale), on a test of non‐verbal intelligence, 2.9 points higher, and on tests of general intelligence, 5.9 points higher. This effect may be due to the influence of components of breast milk or physical and social factors that occur during contact between mother and infant during breastfeeding.
Contact e‐mail address: sulnafisa865@gmail.com
N‐EV024. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV024.1. COMPARISON OF PREMATURITY‐RELATED OUTCOMES AND COMPLICATIONS IN VERY LOW BIRTH WEIGHT (VLBW) NEONATES FED WITH MOTHER'S OWN MILK VERSUS DONOR MILK: A COMPARATIVE STUDY
Zahra Vahedi 1, Majid Karoobi2, Amir Azimi3, Hamed Zarei4, Maryam Saboute2, Nasrin Khalessi1
1Pediatrics, H.Aliasghar children hospital,Iran University of Medical Sciences, Tehran, Iran, 2Pediatrics, Iran University of Medical Sciences, Tehran, Iran, 3Medicine, Rajaie Cardiovascular Medical and Research Cente,Iran University of Medical Sciences, Tehran, Iran, 4Medicine, Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
Objectives and Study: When mother's own milk (MOM) is unavailable or insufficient, donor milk (DM) from a human milk bank serves as an alternative feeding option. Our study sought to investigate and compare the outcomes and complications of very low birth weight (VLBW) preterm infants who receive MOM versus DM.
Methods: In this retrospective cohort study conducted between 2018 and 2022, we compared 70 VLBW preterm infants exclusively fed with DM to 70 randomly selected counterparts fed with MOM. Both groups began enteral feeding within 72 hours of birth. Various clinical outcomes were investigated during a three‐month follow‐up. The clinical outcomes were compared via independent t‐tests, Mann‐Whitney U, and Fisher's exact test.
Results: The mean gestational age of the infants who were included was 29.6 ± 1.6 weeks, 84 (60%) were males, and the average birth weight was 1217 ± 151 grams. Both groups had similar baseline characteristics. The results of the study demonstrated no statistically significant differences between the groups in terms of hospital length of stay (37 ± 16.3 days in MOM vs 40.3 ± 16.9 days in DM group, P = 0.17), growth rate (13 ± 4 gram/day in MOM vs 13 ± 4 gram/day in DM group, P = 0.51), growth velocity (9.8 ± 3.0 g/kg/d in MOM vs 9.5 ± 3.2 g/kg/d in DM group), infants with in‐hospital vomiting (51 cases in MOM vs 59 cases in DM group, P = 0.15),vomiting frequency (1.3 ± 1.1 times in MOM vs 1.5 ± 1.0 times in DM group), incidence of retinopathy of prematurity (ROP) (4 cases in MOM vs 5 cases in DM group, P > 0.999) and incidence of bronchopulmonary dysplasia (BPD) (7 cases in MOM vs 6 cases in DM group, P > 0.999).
Conclusions: Our study findings indicate that the utilization of DM didn't have a substantial negative impact on infants' outcomes nor any complications in comparison with MOM.
Contact e‐mail address: vahedizahra1395@gmail.com
N‐EV025. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV025.1. PRECISION HUMAN MILK OLIGOSACCHARIDE BLENDS MODULATE IMMUNE RESPONSE IN GUT INFLAMMATION MODELS
Clodagh Walsh 1, Jonathan Lane1, Douwe Van Sinderen2, Rita Hickey3
1Health And Happiness Research, Health and Happiness Group, Co. Cork, Ireland, 2School Of Microbiology, APC Microbiome Ireland and University College Cork, Cork, Ireland, 3Teagasc Food Research Centre, Cork, Ireland
Objectives and Study: Infants rely on their developing immune system and the protective properties of breast milk to combat bacterial and viral pathogens, as well as immune‐related conditions like food allergies, until the introduction of solid foods. When breastfeeding is not an option, fortified infant formula, typically derived from cow's milk substitutes, is commonly used. This study aims to explore whether specific combinations of commercial human identical milk oligosaccharides (HiMO) ingredients can replicate the immunomodulatory effects of natural HMO pools.
Methods: A co‐culture model of Caco‐2 intestinal epithelial cells and THP‐1 macrophages was developed to mimic the hallmarks of intestinal inflammation and used to investigate the effects of different synthetic HiMO blends. Concentration and ratio dependency assays were performed to elucidate the functional synergy between HMO structures in mitigating inflammation.
Results: Our findings reveal that specific combinations of synthetic HMOs, particularly 2′‐fucosyllactose (2′‐FL) and 6′‐siallylactose (6′‐SL), effectively reduce pro‐inflammatory cytokine levels. These effects were dependent on both the HMO concentration and their ratios, reflecting those naturally present in breast milk. Interestingly, adding other HiMO structures did not enhance the anti‐inflammatory benefits.
Conclusions: This study highlights the potential of targeted HMO blends, such as 6′‐SL and 2′‐FL, to mimic breastmilk benefits by supporting intestinal function and preventing excessive inflammation. It emphasizes the distinct biological activities of structurally different HMOs and their role in modulating inflammatory responses in human epithelial cells. The effects depend on HMO structures, concentrations, and conditions, with ongoing research further clarifying their individual and combined impacts on inflammation and immune function.
Contact e‐mail address:
N‐EV026. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV026.1. CONCENTRATION OF HUMAN MILK LYSOZYME IS ASSOCIATED WITH INFANT ALLERGIC DISEASES
Shuxia Wang, Zhenyu Yang
Chinese Institute for Nutrition and Health,Chinese Center for Disease Control and Prevention, Beijing, China
Objectives and Study: To explore the relationship between the concentration of lysozyme in human milk and infant allergic diseases.
Methods: A large cross‐sectional study conducted in 11 provinces across China between 2011 and 2013. 6481 lactating women and their breastfeeding infants within 0‐330 days postpartum were investigated, and human milk samples were collected to analyze the nutrition composition. A sub‐sample of 813 lactating women and their infants were randomly selected. A structured questionnaire was used to collect socio‐economic status, demographic status, gestational and parturition information, breastfeeding information, and allergic diseases among their infants. The concentration of human milk lysozyme was measured by ultra‐high performance liquid chromatography (HPLC)/mass spectrometry (MS). Logistic regression analysis was used to examine the relationship between human milk lysozyme concentration and infant allergic diseases.
Results: The mean maternal age was 26.6 years. 51.5% of the infant were boys, and 5.3% were preterm. 10.8% of lactating women self‐reported an allergic history. The mean concentration of human milk lysozyme was 4.57 mg/dL, 4.11 mg/dL, and 9.82 mg/dL for colostrum (0‐7 days), transitional milk (8‐14 days), and mature milk (>14 days), respectively. The mean concentration of human milk lysozyme was 10.94 mg/dL and 5.99 mg/dL for infants with and without allergic diseases. After adjusting for maternal allergic history, preterm birth, and stage of lactation, concentration of human milk lysozyme was associated with infant allergic disease (OR = 1.037, P = 0.013).
Conclusions: Human milk lysozyme concentration is associated with infant allergic diseases.
Contact e‐mail address: wangsx@ninh.chinacdc.cn
N‐EV027. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV027.1. THE EFFECTS OF 2′‐FL, OPN AND B. INFANTIS ON THE DEVELOPMENT OF T/B CELLS AND IMMUNE TOLERANCE IN YOUNG MICE
Xin Wang 1, Xiaoming Zhang2, Jie He1, Yi Wang1, Feitong Liu3, Ming Li2, Bing Wang1
1Department Of Immunology,college Of Basic Medical Science, Dalian Medical University, Dalian, China, 2Department Of Pathogen Biology And Microecology,college Of Basic Medical Science, Dalian Medical University, Dalian, China, 3H&H Group, H&H Research, China Research and Innovation Center, Guangzhou, China
Objectives and Study: The aim of this study is to investigate the regulatory effect and mechanism of the combined application of 2′‐FL, OPN and B. infantis on T/B cells and immune tolerance formation of young mice. To provide a theoretical basis for the rational addition of milk powder to infant formula.
Methods: From the 2nd week after birth, the mice are administered 2′‐FL, OPN, B.infantis R0033 orally. After 2 weeks and 4 weeks of intervention, the length, body weight and organ development of the mice were measured. Flow cytometry was used to determine the number and proportion of T and B lymphocytes at different stages in the thymus, bone marrow, spleen and intestine of each group. Western blot and qPCR were used to detect the barrier function of the intestinal mucosa. ELISA have been used to measure cytokine levels.
Results: The results showed that the weight and length of mice in the triple intervention group were larger than those in the control group, and the length of the spleen and colon were slightly longer than those in the control group. It also reduces the number of Th17 and Th2 cells in the peripheral blood, spleen and colon, upregulates the concentration of Treg and Th1 cells, and increases the concentration of IL‐10. The Th17/Treg, Th1/Th2 and CD4+/CD8+ cell ratios were better maintained than in the other groups and also effectively increased the total number of B cells in peripheral blood and promoted B cell maturation in the bone marrow.
Conclusions: 2′‐FL, OPN combined with B.infantis R0033 can improve the immune tolerance of young mice and has a good regulatory effect on promoting the development and maturation of the immune system and immune response of young mice. These results have important implications for elucidating the mechanism of action of infant feeding therapy.
Contact e‐mail address: wbing79@126.com
N‐EV028. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV028.1. IMPACT OF LARGE, PHOSPHOLIPID‐COATED LIPID DROPLETS INFANT FORMULA ON IN VITRO LIPID/PROTEIN DIGESTION AND LIPID TRANSPORT
Wei Wei 1, Shuangling Sun2, Ingrid Renes3, Evan Abrahamse4, Nana Bartke3, Xianfeng Zhao5, Xingguo Wang1
1Jiangnan University, Wuxi, China, 2Danone Open Science Research Center, Shanghai, China, 3Danone Nutricia Research, Utrecht, Netherlands, 4Danone Global Research & Innovation Center, Utrecht, Netherlands, 5Life Science, Danone Open Science Research Center, Shanghai, China
Objectives and Study: Novel IF with large, phospholipid‐coated lipid droplets (Nuturis) shows similar structural changes during gastric phase and comparable shifts of lipolysis degree in the gastric/intestinal phase compared to human milk. This work studied the digestion and absorption profile of milk formula with different lipid droplets.
Methods: LIF (D4,3 ~ 5 μm,) was used prepared to SIF (D4,3 ~ 0.34 μm) using high‐pressure homogenization mimicking commercial infant formula. The digestive properties were evaluated using a dynamic digestion model simulating term‐infant gastrointestinal tract. The absorption were conducted by Caco‐2 Model. The lipolysis products and proteolysis products were quantified. Structural changes were comprehensively observed.
Results: LIF was similar to human milk, with larger spherical lipid droplets enveloped by a phospholipid membrane. In contrast, SIF are small lipid droplets, with phospholipids and proteins adsorbed at the oil‐water interface. At G120 min, the lipolysis degree of LIF was 5.61%, while SIF reached 8.07%. LIF has a higher digestion rate in the intestinal phase. In the micellar phase, the fatty acid content of LIF (0.24 mg/mL) significantly exceeded that of SIF (0.065 mg/mL, P < 0.05), mainly 12:0, 18:1 n‐9, 18:2 n‐6, and 18:3 n‐3. LIF also contained significantly higher levels of VA and VE compared to SIF (P < 0.05), with these differences persisting in the micellar phase. During digestion, SIF experienced greater loss of intact proteins than LIF. LIF demonstrated superior stability in gastric‐phase emulsions, and its lipid droplets within cells were relatively larger. Both LIF and SIF promoted intracellular TAG synthesis, with LIF exhibiting a more pronounced effect.
Conclusions: LIF exhibited slower lipid digestion in the gastric phase but generated micellar phases with higher fatty acid and vitamin content. Compared to conventional IF, LIF demonstrated enhanced bioaccessibility for 18:2 n‐6, 18:3 n‐3, VA, and VE, which illustrated better nutritional benefits.
Contact e‐mail address: weiw@jiangnan.edu.cn
N‐EV029. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV029.1. FACTORS ASSOCIATED WITH BREASTFEEDING INTENTION, PREVALENCE, AND SUPPORT DURING COVID‐19 PANDEMIC: A SYSTEMATIC REVIEW
Jinyue Yu, Matthew Mccann, Michael Clesham, Mary Fewtrell
Gos Institute Of Child Health, University College London, London, United Kingdom
Objectives and Study: To systematically evaluate the factors influencing breastfeeding (BF) intention, prevalence, and support during the COVID‐19 pandemic and lockdown period. Understanding these factors is important to plan and support breastfeeding in current and future emergencies.
Methods: A systematic literature review was conducted using Medline (Ovid), Embase, AMED, and Web of Science. Inclusion criteria were: 1) quantitative studies published in peer‐reviewed journals, 2) breastfeeding mothers of infants under 24 months without serious health conditions, and 3) outcomes including feeding methods and support during the pandemic. Studies involving exclusively COVID‐positive mothers were excluded. The study was registered at PROSPERO (IDCRD42022354670).
Results: We screened 5707 studies, of which 49 met the criteria for data extraction. A total of 46,187 breastfeeding mothers across 49 studies from multiple regions were included, primarily from high‐income countries (Europe, North and South America, Asia, and Australia). Of these, 24 studies compared breastfeeding rates before and during the pandemic. Findings revealed inconsistent impacts: BF rates decreased (n = 8), increased (n = 3), or showed no significant change (n = 13). Reduced face‐to‐face professional support was reported in eight studies, with family members (n = 3) and online information (n = 2) emerging as alternative support sources. Lower exclusive breastfeeding rates were linked to reduced support (n = 3) and younger maternal age (n = 2).
Conclusions: Although breastfeeding rates during the pandemic varied, many studies reported no significant change. Reduced face‐to‐face professional support was partially offset by alternative support from family and online resources. This underscores the importance of flexible online interventions for breastfeeding support during future emergencies.
Contact e‐mail address: jin.yu.16@ucl.ac.uk
N‐EV030. Topic: AS03. NUTRITION/AS03a. Breast Milk and Infant Feeding
N‐EV030.1. WHAT CAN WE SAY TODAY ABOUT POLLUTION AND BREASTMILK?
Gabriela Zaharie 1, Monica Hasmasanu1, Nicoleta Grosu1, Ioana Rotar1, Nicoleta Brisan2, Carmen Robu2, Adelina Tutu1, Melinda Matyas1
1Mother And Child, University of Medicine and Pharmacy Iuliu Hatieganu Cluj, Cluj Napoca, Romania, 2Faculty of Environmental Science and Engineering, Cluj Napoca, Romania
Objectives and Study: Unfortunately, breast milk is not pristine. It contains: polychlorinated biphenyls (PCBs), DDT and its metabolites, dioxins, dibenzofurans, polybrominated diphenyl ethers (PBDEs), and heavy metals. Finally, breast milk PCB levels differ according to occupation; students and professionals have higher levels than laborers and farmers. World Health Organization (WHO) makes this statement, "The advantages of breastfeeding far outweigh the potential risks from environmental pollutants. Taking into account breastfeeding's short‐ and long‐term health benefits for infants and mothers, WHO recommends breastfeeding in all but extreme circumstances. Aims: Authors have done a pilot study; were analyzed 32 breastmilk samples from mothers that lived in different location of Cluj district.
Methods: Analytical methods: The milk samples were collected in sterile vials; were fixed with 16 mg K2Cr2O7 and kept at 4°C until analysis.Mothers have 29.37 ± 1.25 years old: 24 were from urban area and 8 from rural area. Milk samples were analyzed on gas chromatography equipped with electron capture detector and flame ionization detector (GC‐ECD‐FID) for quantitative analysis of chlorinated organic pollutants such as THMs species. Also, after analysis on GC‐ECD‐FID all samples were checked on gas chromatography coupled quadrupole mass spectrometer detectors (GC‐MS) using selective ion monitoring methods and full scan methods for identification of other organic pollutants.
Results: The most important pollutants found were C2HCl3(Trichloroethene) (TR: 1.29); CHCl3(Chloroform) (TR: 2.78); CHCl2Br (TR: 4.11); CHClBr2 (Dichlorobromomethane) (TR: 5.21); C2Cl4(Tetrachloroethylene) (TR: 16.05); C14H8Cl5(DDE) (Dichlorodiphenyltrichloroethane)(DDT)(TR: 40.9) and C14H8Cl5() (TR: 43.48). In mother's breast milk who live in urban area chloroform concentration (45,5 mg∙L‐1 vs 21,25 mg∙L‐1) and dichlorobromomethane concentration (0.5 mg∙L‐1 vs 7.16 mg∙L‐1) were higher. In mother's breast milk who live in rural area, concentration were significantly higher for : trichloroethene (1.675 mg∙L‐1 vs 0.55 mg∙L‐1), DDT(3.00 mg∙L‐1vs 0.26 mg∙L‐1) and DDE (4.82 mg∙L‐1 vs 1.39 mg∙L‐1).
Conclusions: Breastmilk is contaminated with the polutants founded in their habitat area. We founded no correlations with age or parity.
Contact e‐mail address: gzaharie@umfcluj.ro
N‐EV031. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV031.1. UNMASKING THE HIDDEN LINK: MALNUTRITION AND ALLERGIES IN PEDIATRIC PATIENTS
Alessandra Agizza 1, Serena Coppola1, Arianna Minieri1, Oglio Franca1, Greta Aquilone1, Letizia Ciliberti1, Laura Carucci1, Roberto Berni Canani2
1Department Of Translational Medical Science, University of Naples Federico II, Naples, Italy, 2Department of Translational Medical Science and ImmunoNutritionLab of the CEINGE Advanced Biotechnologies Research Center and Task Force on Microbiome Studies and European Laboratory for the Investigation of Food‐Induced Diseases at the University of Napl, Naples, Italy
Objectives and Study: Malnutrition is a common feature in pediatric allergic diseases. It could contribute to immune system dysfunction and influence the disease course. Thus, preventing and treating malnutrition is of pivotal importance for an effective management of these conditions. We evaluated malnutrition and its contributing factors in a cohort of allergic pediatric patients visiting a tertiary center for Pediatric Allergy.
Methods: We evaluated pediatric patients (both sexes, age 2‐18 yrs) with respiratory (RA), food (FA) and drug (DA) allergy and with malnutrition by excess (defined by a BMI‐for‐age z‐score >+2 SD) or by defect (defined by a BMI‐for‐age z‐score <‐2 SD). Main anamnestic, demographic, lifestyle and dietary variables were assessed.
Results: A total of 204 allergic patients (62.7% male, mean age 9.2 yrs) were evaluated: 121 patients with RA, 57 with FA and 14 with DA. Twelve patients presented multiple allergies (9 with both RA and FA, and 3 with both RA and DA). Malnutrition by excess was more frequent if compared with malnutrition by defect in allergic patients (86.3% vs 13.7%, p < .05). It was more frequent in patients with RA (95.8%) and with DA (100%) if compared with patients with FA (59.6%)(p < .05). Key contributing factors included poor parental education, high screen time, sedentary behavior, excessive consumption of ultra‐processed foods, and reduced intake of healthy, minimally processed foods.
Conclusions: Findings from this study underscore the need for an integrated approach to address malnutrition by excess in allergic patients, particularly those with severe or drug‐resistant conditions. Lifestyle and dietary interventions could be crucial for preventing malnutrition and managing allergic diseases effectively.
Contact e‐mail address: agizza.alessandra@gmail.com
N‐EV032. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV032.1. THE MEDITERRANEAN DIET'S ROLE IN MODULATING LIPID METABOLISM, INSULIN SENSITIVITY, AND HORMONAL REGULATION: A COMPREHENSIVE REVIEW
Nada Alaaraj 1, Ashraf Soliman1, Sohair Elsiddig2, Noor Hamed1, Shayma Mohammed1, Ahmed Elawwa1, Fawzia Alyafei1
1Pediatrics, Hamad Medical Corporation, Doha, Qatar, 2Paediatrics, Hamad Medical Corporation, Doha, Qatar
Objectives and Study: The Mediterranean diet (MD) is rich in fruits, vegetables, whole grains, nuts, seeds, and olive oil, with moderate intake of fish and dairy and minimal consumption of red and processed meats. Recognized for its cardiometabolic benefits, emerging evidence highlights its impact on lipid metabolism, insulin sensitivity, adipokines, glucose metabolism, and gut hormones. ObjectivesThis review synthesizes evidence on the MD's role in improving lipid profiles, insulin sensitivity, hormonal balance, and metabolic health while exploring potential mechanisms of action.
Methods: A review of 20 studies (2000–2024) was conducted, including randomized controlled trials, cohort studies, systematic reviews, and meta‐analyses. The studies involved diverse populations with metabolic syndrome, obesity, and type 2 diabetes. Data on study design, participant characteristics, and key outcomes were extracted.
Results: Key Findings Lipid Metabolism MD adherence improved lipid profiles by increasing HDL cholesterol, reducing LDL cholesterol, and lowering triglycerides, contributing to cardiovascular risk reduction. Insulin Sensitivity and Glucose Metabolism The MD enhanced insulin sensitivity, reduced fasting glucose levels, and improved glycemic control, particularly in individuals with metabolic syndrome and type 2 diabetes. Adipokines and Inflammation MD adherence increased adiponectin levels, reduced inflammatory markers (e.g., C‐reactive protein), and improved metabolic flexibility. Gut Hormones The MD positively influenced gut hormones like GLP‐1, enhancing satiety and glucose regulation, while reducing ghrelin levels, aiding appetite control and weight management.
Conclusions: The Mediterranean diet is a powerful tool for improving lipid metabolism, insulin sensitivity, and hormonal balance. Its benefits stem from monounsaturated fats, fiber, antioxidants, and anti‐inflammatory components. While evidence is strong, further research is needed on long‐term hormonal effects and diverse populations. The MD should be integrated into clinical and public health strategies
Contact e‐mail address:
N‐EV033. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV033.1. QUALITY OF LIFE IN CHILDREN WITH CROHN'S DISEASE UNDER CROHN'S DISEASE EXCLUSION DIET: PRELIMINARY RESULTS OF A PROSPECTIVE STUDY
Lale Alıbaylı 1, Ayşegül Aslan Culum2, Elif Turkmen1, Zerrin Önal1, Aysel Majıdova1, Zeynep Günal Türk1, Beyza Eliuz Tipici3, Ozlem Durmaz1
1Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul University Faculty of Medicine, Istanbul, Turkey, 2Department Of Pediatrics, Faculty of Medicine, İstanbul University, İstanbul, Turkey, 3Department Of Family Health, Institute of Child Health, İstanbul University, İstanbul, Turkey
Objectives and Study: Treatment options for Crohn disease includes immunosuppressives, immunmodulators and dietary therapies. Dietary modifications, used as primary or supportive treatment may influence patients' quality of life. The Crohn's Disease Exclusion Diet (CDED) with partial enteral nutrition (PEN) is designed to reduce exposure to dietary components that may modify microbiome. We aimed to assess the changes in health‐related quality of life (HRQoL) in patients with CD under CDED.
Methods: Four pediatric crohn patients (age range 11‐17.5 year, 3 males) were started on CDED as an induction therapy over a 12‐weeks period. IMPACT‐III Questionnaire was used to assess quality of life at baseline and 6.weeks. This questionnaire consists of four items: well‐being, emotional functioning, social functioning,and body images. We recorded data for all patients and results were reviewed in an intention‐to‐treat analysis to demonstrate the early effects of CDED on life quality.
Results: One patient withdrew during the first phase of CDED shortly after answering the questionnaire yielding a dropout rate of 25 %. Other three participants were eager to gain weight and adapted well with the questionnaires. Patients who continued on diet were only allowed to deviate from the CDED by up to 5% in each phase. Comparison of IMPACT‐III item scores at baseline and at 6 weeks highlighted the positive effects of the treatment and increased motivation during the process. (Table 1)
Conclusions: Our preliminary data suggest that most of the children can adapt to CDED and CDED combined with PEN is not only beneficial for correcting the nutritional status rapidly but also an effective strategy for improving HRQoL in children with CD even in the early phases of treatment. IMPACT‐III is well adapted by children with CD.
Contact e‐mail address: dr.lalealibeyli@gmail.com
N‐EV034. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV034.1. PREDICTIVE EQUATIONS UNDERESTIMATE ENERGY REQUIRE‐MENTS IN CRITICALLY ILL CHILDREN: AN INDIRECT CALORIMETRY STUDY
Louise Pedersen1, Ghita Brekke 1, Sisse Larsen1, Christian Mølgaard1, Marina Bak1, Ina Pedersen1, Lise Aunsholt2, Anne‐Mette Jensen2, Jacob Gjedsted3, Jørgen Wiis4, Inge‐Lise Jarnvig4, Anders Perner4, Sigurður Sigurðsson5, Kaare Lundstrøm6
1Pediatric Nutrition Unit, University Hospital Rigshospitalet, Copenhagen, Denmark, 2Department Of Neonatology, University Hospital Rigshospitalet, Copenhagen, Denmark, 3Department Of Cardio Thoracic Anesthesia, University Hospital Rigshospitalet, Copenhagen, Denmark, 4Department Of Intensive Care, University Hospital Rigshospitalet, Copenhagen, Denmark, 5Department Of Neuro Anesthesiology, University Hospital Rigshospitalet, Copenhagen, Denmark, 6Department Of Pediatrics And Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
Objectives and Study: Energy requirements for critically ill pediatric patients are commonly estimated using predictive equations, based on data from healthy children. These estimations may lead to over‐ or undernutrition due to altered metabolic responses during critical illness, potentially increasing morbidity, and mortality risk. This study aimed to investigate the divergence between measured resting energy expenditure (REE) using indirect calorimetry (IC), “the gold standard”, and predicted values.
Methods: In this observational prospective study conducted at Rigshospitalet’ s intensive care units (ICU), energy requirements were measured daily using IC (Carescape monitor B650, GE Healthcare) in critically ill pediatric patients. Inclusion criteria were patients aged 0‐17 years admitted to the pediatric ICU for > 48 hours. Measured REE was compared with predicted REE calculated using The Oxford Equation for basal metabolic rate, increased by the generally accepted10% to resemble REE.
Results: We included 8 children and adolescents (4 males, median age of 12 years, range 2‐17), whit primary diagnoses of head trauma (n = 4), severe burns (n = 2) and acute infections (n = 2). The Oxford equations underestimated REE (p < 0.001) and REE per kg body weight (p < 0.001). Bland‐Altman analysis revealed a mean underestimation of 282 kcal/day (95% CI: 188, 375 kcal/day) or 6.9 kcal/kg/day (95% CI: 4.6, 9.1 kcal/kg/day) between predicted REE and measured REE. The 95% limits of agreement ranged from ‐331 to 895 kcal/day, or ‐7.8 to 21.5 kcal/kg/day, indicating substantial individual variability.
Conclusions: Our findings suggest that The Oxford equations for predicting REE may lead to inadequate estimations of energy requirements. This emphasizes the importance of using IC for accurate energy assessment. Further research is needed to develop more accurate predictive equations for this population and to standardize IC measurement procedures in critically ill.
Contact e‐mail address: louise.lindkvist.pedersen@regionh.dk
N‐EV035. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV035.1. NUTRITIONAL OUTCOME OF CFTR MODULATOR THERAPY IN PAEDIATRIC PATIENTS WITH CYSTIC FIBROSIS IN MEDELLÍN, COLOMBIA
Monica Maria Contreras Ramirez 1, Paula Roldan Cano2, Margarita Suarez3, Gustavo Giraldo Ospina4
1Gastroenterology, Hospital Pablo Tobon Uribe, Medellin, Colombia, 2Nutrition, Hospital Pablo Tobon Uribe, Medellin, Colombia, 3Hepatology, Hospital Pablo Tobon Uribe, Medellin, Colombia, 4Genetic, Hospital Pablo Tobon Uribe, Medellin, Colombia
Objectives and Study: Describe baseline characteristics and Body Weight Index in paediatric patients with Cystic Fibrosis (CF) after starting CFTR modulator therapy at a CF multidisciplinary program in Medellín, Colombia
Methods: Single center retrospective cohort study was conducted involving subjects with CF 6‐18 years of age, followed at the CF Pablo Tobon Uribe multidisciplinary program who were started on CFRT modulator therapy in the last 2 years (2023‐2024). Data was obtained from the clinical charts. The protocol was approved by the Hospital Research Comitte. A descriptive analysis of clinical characteristics and Body Mass Index (BMI) using percentages and interquantile ranges.
Results: Eleven children were initiated on CFTR Modulator Therapy. 7 were females. Median follow up of patients after starting CFTR treatment was 12 months (min 0,23‐ max 20) and median age of starting CFTR Modulator was 13 years (min 8‐max 17). 9 patients were homozygous for F508Del mutation. Important increases were seen in BMI Z‐scores: Median 0.84 (min 0.4‐max 2.7).
Conclusions: Nutritional optimization has been a focus of care in patients with CF, with BMI being utilized as the primary marker of adequate nutritional status. We identified overall improvement in BMI in this Colombian series of patients. CFTR modulator therapy has a beneficial effect on BM and larger studies are needed to further investigate if this effect translate into improvement on pulmonary status.
Contact e‐mail address: mcontreras@hptu.org.co
N‐EV036. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV036.1. A RARE CLINICAL PRESENTATION AND DIFFUCULT MANAGEMENT IN AN INFANT WITH SEVERE CONGENITAL THROMBOPHILIA AND INTESTINAL FAILURE
Ibrahim Darakchi 1, Hristo Naydenov1,2, Emilia Nedeva‐Dobreva1, Petyo Hadzhiyski1,2, Petar Nikolov1, Tihomir Todorov3, Albena Todorova3,4, Atanas Banchev2,5, Tsvetko Georgiev6, Bogdan Mladenov7, Mila Baycheva1,2
1Department Of Gastroenterology And Hepatology, University Children's Hospital, Sofia, Bulgaria, 2Paediatrics, Medical University of Sofia, Sofia, Bulgaria, 3Genetic Medico‐Diagnostic Laboratory Genica, Sofia, Bulgaria, 4Medical University of Sofia, Sofia, Bulgaria, 5Department Of Paediatric Haematology And Oncology, University Hospital “Tsaritsa Yoanna – ISUL“, Sofia, Bulgaria, 6Department Of Paediatric Surgery, Multiprofile Hospital for Active Treatment and Emergency Medicine "N. I. Pirogov", Sofia, Bulgaria, 7Department Of Paediatric Anaesthesiology And Intensive Care, Multiprofile Hospital for Active Treatment and Emergency Medicine "N. I. Pirogov", Sofia, Bulgaria
Objectives and Study: Short bowel syndrome (SBS) is a complex disease, the most common cause of intestinal failure (IF) in childhood as a result of extensive bowel resection or congenital disease, leading to nutritional, metabolic and infectious complications. Severe thrombophilia due to hereditary antithrombin III deficiency (ATd) is a rare genetic disorder leading to an increased risk of deep venous thrombosis (DVT) and heterogenous phenotype. Rarely, the affected patients present with mesenteric DVT complicated with SBS.
Methods: This is a clinical case of severe thrombophilia and SBS.
Results: A 2‐year‐old girl born at term from a normal pregnancy presented at the age of 14 days with bloody diarrhoea, fever and raised inflammatory markers. She was admitted in the hospital and treated for enterocolitis and suspected sepsis. After 24 hours she developed an intestinal obstruction with abdominal distention and bilious vomiting, and was referred to surgery. A transverse laparotomy was performed with evidence of peritonitis and severe necrotic enterocolitis. An extensive intestinal resection was needed after which only 25 cm of small bowel were left. The child had a problematic venous access with development of recurrent thrombosis and difficulties to provide parenteral nutrition (PN) via central line or peripherally. She was referred for genetics and a homozygous mutation in SERPINC1 gene confirmed the ATd. Complex management was required: she needed anticoagulants, antithrombin III substitution and antibiotics; the intestinal rehabilitation was very challenging due to lack of venous access for PN; the family could not provide a good care. At the age of one year and stable enteral nutrition the child was stared on teduglutide, a glucagon‐like peptide‐2 analogue, with good effect.
Conclusions: Patients with SBS, IF and severe thrombophilia have a complicated course of the disease. They need a good multidisciplinary care in an expert centre but the prognosis remains unclear.
Contact e‐mail address: mila.baycheva@gmail.com
N‐EV037. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV037.1. NATIONAL SURVEY ON THE USE OF PAEDIATRIC NUTRITION SCREENING TOOLS IN ITALIAN HOSPITALS
Elisabetta Di Profio 1, Domenica Elia2,3, Armando Scognamiglio1,4, Elena Banci3,5, Maria Paola Ierardi1,6, Teresa Capriati2, Ersilia Troiano1,7, Valentina Pierattini5, Micaela Gentilucci1,8
1Pediatrics Study Group of the Technical‐Scientific Association of Food,Nutrition and Dietetics(ASAND), Catania, Italy, 2Artificial Nutrition Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy, 3Dietetics Working Group of the Italian Society of Pediatric Gastroenterology and Nutrition (SIGENP), Rome, Italy, 4Clinical Nutrition Unit, A.O.R.N. Santobono‐Pausilipon Children's Hospital, Naples, Italy, 5Dietetics Unit, Meyer Children's Hospital IRCCS, Florence, Italy, 6Nutrition And Dietetic Service, Institute G. Gaslini Children's Hospital IRCCS, Genoa, Italy, 7Social Educational Directorate Of Rome Iii, Montesacro Municipality, Rome, Italy, 8Nutrition Unit, Local Health Authority of Pescara, Pescara, Italy
Objectives and Study: Malnutrition is common in children admitted to hospital and is associated with adverse effects on disease outcome.Therefore several paediatric nutrition screening tools (PNST) have been developed.The objective of this survey was to assess their use in clinical practice in the Italian paediatric hospitals and paediatric wards.
Methods: The study was designed and co‐ordinated by the Dietetics Working Group of the Italian Society of Pediatric Gastroenterology and Nutrition(SIGENP) and the Pediatrics Study Group of the Technical‐Scientific Association of Food,Nutrition and Dietetics(ASAND).An online questionnaire of 11 questions,was sent by e‐mail to registered members (pediatricians and dietitians).All answers were collected anonymously, recording only the referring hospital.The questions concerned the use of PNST or other nutritional assessments (e.g. anthropometry) and the role of pediatric dietitian in nutritional intervention.Data were collected between 12/2023 and 01/2024.
Results: The hospitals(N = 31) which answered the survey were located in 14 out of 20 italian regions and distributed mainly in the northern ones(North45%,Centre32%,South23%).The respondent paediatric hospitals were 10 out of 13 (77%).PNST is performed in 39% of the centres:26% within 48 h,while13% during hospitalisation (see Graphic1).The type of PNST adopted are shown in Table1.The nutritional intervention managed by a dietitian is required by: the ward pediatrician(52%),the nurse(29%),and the pediatrician nutrition specialist(13%).
Conclusions: The questionnaire had a good response rate, providing interesting data regarding PNST use in Italy. ESPGHAN recommends all pediatric hospitals/wards to implement procedures for identification of children with (risk of) disease‐associated malnutrition, including nutritional screening.Surprisingly, in our study the PNST are absent in more than half of the surveyed hospitals.Instead, when PNST are performed and tests positive, a dietician is usually involved and it is known that his intervention can significantly reduce complications.Italian pediatric hospitals and wards should incorporate the routine use of PNST into clinical evaluations to better identify at‐risk patients and improve overall care outcomes.
Contact e‐mail address:
N‐EV038. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV038.1. TECHNICAL REVIEW BY THE ESPGHAN SPECIAL INTEREST GROUP ON GUT MICROBIOTA AND MODIFICATIONS ON THE HEALTH OUTCOMES OF INFANT FORMULA SUPPLEMENTED WITH PROBIOTICS
Ener Dinleyici 1, Hania Szajewska2, Iva Hojsak3, Pedro Gutierrez‐Castrellón4, Alfredo Guarino5, Flavia Indrio6, Johannes Van Goudoever7, Magnus Domellöf8, Raanan Shamir9, Francesco Savino10, Yvan Vandenplas11, Members: Berni Canani R; Campoy C; Domellöf M; Dinleyici Ec; Gutiérrez‐Castrellon P; Guarino A; Haiden N; Hojsak I; Indrio F; Mihatsch W; Mosca A; Orel R; Salvatore S; Savino F; Shamir R; Szajewska H; Vandenplas Y; Van Den Akker C.H.P; Van Goudoever J.B.; Weizman11
1Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey, 2Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland, 3Children's Hospital Zagreb, Zagreb, Croatia, 4Universidad Juarez del Estado de Durango & International Scientific Council for Probiotics S.C, Mexico City, Mexico, 5Pediatric Infectious Disease Unit, Department of Maternal and Child health, University Hospital "Federico II", Naples, Naples, Italy, 6. Department of Experimental Medicine, University of Salento, Lecce, Italy, 7Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, Netherlands, 88. Department of Clinical Sciences, Paediatrics, Umeå University, Umea, Sweden, 9Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 10Ospedale Infantile Regina Margherita di Torino, Città della salute e della Scienza di Torino, Torino, Italy, 11KidZ Health Castle UZ Brussel, Brussels, Belgium
Objectives and Study: This technical review, one of five developed by the ESPGHAN Special Interest Group (SIG) on Gut Microbiota and Modifications (GMM), supports the creation of a Position Paper on the use of biotic‐supplemented formulas, including those containing probiotics. This review focuses on the clinical outcomes related to the supplementation of infant formulas with probiotics.
Methods: The SIG GMM conducted a systematic review to evaluate the clinical outcomes of probiotic‐supplemented infant formulas in healthy infants (0‐12 months) published before 2024. Following the review, all 20 members of the SIG anonymously voted on each statement, scoring them between 0 and 9. A score of > 6 indicated agreement. A statement was rejected if <75% of the members agreed.
Results: The systematic review included 28 publications that evaluated the effects of probiotic‐supplemented infant formula. The studies varied in terms of probiotic strains, study design, and intervention durations. The trials, primarily conducted in Western countries, demonstrated that probiotic‐supplemented formulas were well tolerated, with no significant differences in growth parameters compared to non‐supplemented formulas.
Conclusions: Some evidence suggested potential benefits in reducing gastrointestinal and respiratory infections, though these findings were inconsistent and not of high quality. This technical report serves as the background for formulating recommendations on the use of probiotic‐supplemented infant formula in healthy infants studied so far.
Contact e‐mail address: yvan.vandenplas@uzbrussel.be
N‐EV039. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV039.1. DIETARY PRACTICES IN INFLAMMATORY BOWEL DISEASE – AN INTERNATIONAL SURVEY
Catarina Fandinga 1, Lorraine Cooney2, Jennifer Clowe3, Kelly Issokson4, Ben Nichols1, Inez Martincevik5, Alicia Sandall6, Emma Halmos7, Catherine Wall8, Miranda Lomer9, Konstantinos Gerasimidis1
1University of Glasgow, Glasgow, United Kingdom, 2Blackrock Clinic, Dublin, Ireland, 3NHS Glasgow and Greater Clyde, Glasgow, United Kingdom, 4Cedars‐Sinai Medical Center, California, United States of America, 5The Hospital for Sick Children, Toronto, Canada, 6Nutrition & Dietetics, Guy's and St Thomas' Hospital, London, United Kingdom, 7Monash University, Melbourne, Australia, 8University of Otago, Christchurch, New Zealand, 9King's College London, London, United Kingdom
Objectives and Study: This study described the current practices of dietitians managing patients with CD in five countries; focusing predominantly on the use of diet therapies and Exclusive Enteral Nutrition (EEN).
Methods: Electronic questionnaire survey distributed to dietitians’ professional associations and networks.
Results: 198 responded; 124 responses were valid/mostly complete [n = 52 (42%) UK, n = 31 (25%) Canada, n = 16 (13%) Ireland, n = 15 (12%) Australia and n = 10 (8%) New Zealand (NZ)]. In UK, Ireland, Canada and NZ most responders worked with adult patients. 90% of Canadian responses were from paediatric dietitians.
There were no significant differences in EEN protocols used in all countries for maintenance of remission, before and after surgery. When used to induce remission, responders from UK, Canada and Australia advised mostly 6‐8 weeks of EEN, whilst those from Ireland and NZ advised 4‐6 weeks (p = 0.005). Use of EEN feeds/supplements varied across countries (p = 0.003), as was also the allowance of other foods/fluids alongside EEN (p = 0.024). Canada allowed food and fluids with EEN (73%), NZ and Australia only allowed EEN (89% and 73%) and UK and Ireland, allowed both equally (53% and 57% only EEN supplements). Practices on food‐reintroduction after EEN cessation varied too. UK and Canada advised food reintroduction within 1 (24% and 29%) or 2 weeks (34% and 29%) after EEN, respectively, Ireland over 1 week (71%), Australia over 3 days (33%) or 1 week (33%) and NZ over 3 days (44%). Advice given for a diet after EEN also differed (p = 0.002) with UK, Ireland and Canada advising a modified diet (82%, 86% and 86%) and NZ and Australia advising patients to follow their usual diets (56% and 67%).
Conclusions: Despite some similarities, practices in dietary management of CD vary significantly among countries, most likely reflecting the absence of quality evidence and inconsistency in recommendations made among healthcare professional associations.
Contact e‐mail address: catarina.farinhafandinga@glasgow.ac.uk
N‐EV040. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV040.1. LONGITUDINAL NUTRITIONAL STATUS AND BODY COMPOSITION CHANGES OF CHILDREN AND ADOLESCENTS AFTER ONSET OF TYPE 1 DIABETES
Giulia Fiore 1,2, Giulia Smylie2, Stefano Baresi2, Federica Porta2, Francesca Eletti2,3, Maddalena Macedoni2, Agnese Petitti2, Francesca Redaelli2, Alessandro Leone4, Gian Vincenzo Zuccotti2,3, Chiara Mameli2,3, Elvira Verduci1,5
1Department Of Health Sciences, University of Milan, Milano, Italy, 2Department Of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy, 3Department Of Biomedical And Clinical Science, University of Milan, Milan, Italy, 44. international Center For The Assessment Of Nutritional Status (icans), Department Of Food, Environmental And Nutritional Sciences (defens), University of Milan, Milan, Italy, 5Department Of Pediatrics, Unit Of Metabolic Disease, V. Buzzi Children's Hospital, Milan, Italy
Objectives and Study: The onset of type 1 diabetes (T1D) deeply impacts nutritional status of children and adolescents. Currently, little is known about body composition changes in paediatric age after T1D diagnosis and insulin therapy initiation. We aim to study longitudinal changes in body composition from the onset to 6‐months follow‐up.
Methods: Newly diagnosed T1D children and adolescents aged 3‐16 years were recruited and visited at onset (T0) and at 6 weeks (T1), 3 months (T2) and 6 months (T3) follow‐up. Full anthropometric assessment was performed including weight, height, body mass index (BMI), waist circumference (WC), waist‐to‐height‐ratio(WHtR), mid upper arm circumference (MUAC), tricipital skinfold thickness(TSF) and related z‐scores. Body composition, namely fat mass (FM) and fat free mass (FFM) and related indexes FFMI and FMI, was measured by means of air plethysmography(BODPOD).
Results: Overall, 41 patients were enrolled (9.54 ± 3.04 years; 17 F 42%). At T0 FMI was significantly related to insulin requirement at the onset (Spearman correlation coeff.r 0.428), and FM% was significantly related to both ketoacidosis and insulin requirement at the onset (coeff.r 0.368 and 0.457, respectively). BMI z‐score increased significantly between baseline and T1 (p < 0.0001). Significant increase in WC, WHtR, MUAC z‐score, and TSF z‐score was observed at follow‐up, peaking at 3 months, followed by a minor non‐significant decline at 6 months (Tab.1). Furthermore, a constant upward significant trend is observed in the FFM (kg) from baseline to T3, which is also confirmed by the increase in FFMI from T0 to T1.
Conclusions: A higher fat mass at the T1D onset is associated with higher insulin requirement and ketoacidosis occurrence. Newly diagnosed children with T1D after insulin therapy initiation experienced a constant recovery of FFM during the 6‐month follow‐up, as well as abdominal fat mass increases at 6 weeks from baseline. Overall, an improvement in nutritional status and body composition is achieved, supporting disease management
Contact e‐mail address: giulia.fiore@unimi.it
N‐EV041. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV041.1. NUTRITIONAL PRACTICES AND EXCLUSION DIETS IN PEDIATRIC AGE: A SURVEY BY THE ITALIAN SOCIETY OF PEDIATRIC GASTROENTEROLOGY HEPATOLOGY AND NUTRITION
Alessandra Mari1, Giulia Fiore 2, Jonabell Dolor2, Chiara Tricella2, Teresa Capriati3, Lorenzo Norsa4, Elvira Verduci5, Claudio Romano6
1Department Of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy, 2Department Of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy, 3Nutritional Rehabilitation, Children's Hospital Bambino Gesù, IRCSS, Rome, Italy, 4Paediatrics, Buzzi Children's Hospital, University of Milan, Italy, 5Department Of Paediatrics, Ospedale dei bambini Vittore Buzzi, University of Milan, Milano, Italy, 6Pediatric Gastroenterology and Cystic Fibrosis Unit, University Hospital “G. Martino”, Messina, Italy
Objectives and Study: Food trends and exclusion diets are on the rise among pediatric age groups. Currently little is known about the nutritional practices and trends pursued by children and adolescents in Italy. Objective of this study to assess their use in Italy from the point of view of pediatric specialists
Methods: An online questionnaire investigating experience and perceptions of pediatric specialists (PS) concerning nutritional practices and exclusion diets in pediatric age was circulated between members of the Italian society of pediatric gastroenterology hepatology and nutrition between September‐November2024. Questions focused on complementary feeding(CF), adoption of plant‐based diets(PBD), and exclusion diets(ED) (medical indication vs. gluten exclusion, lactose exclusion or other food trends)
Results: 50 PS from 16 Italian regions participated to the survey. Regarding CF, the adoption of baby‐led weaning is highly spread among Italian caregivers, as 86% of PS assisted families who adopted it. Even though 72% of PS claimed that less than 10% of their patients follow ED diets without medical indication, 18% reported rates of around 10‐30% (Fig.1). Also, 33/50(66%) PS think ED are a rising trend, mostly influenced by the use of intolerance tests not scientifically validated or social networks (according to 66% and 50%, respectively)(Fig.1). More than half (62,5%) of PS assist patients on PBD, with ethical/cultural reasons being the main drive for parents/adolescents to choose PBD. 23/50(46%) PS have detected micronutrient deficiencies in children on PBD, mostly iron and vitamin B12 (12/50 and 9/50). The main challenges in an effective dietetic management of children are lack of dedicated professionals and children's poor compliance, according to 31,6% and 28,9% of PS respectively.
Conclusions: Pediatricians should be aware of the increasing trend of adoption of ED among paediatric age groups, discouraging practices without medical indication and based on poor information. Their role is crucial in supporting families preventing and screening for micronutrient deficiencies.
Contact e‐mail address:
N‐EV042. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV042.1. COMPARISON OF MACRO AND MICRONUTRIENT INTAKES IN DIFFERENT NUTRITIONAL APPROACHES FOR THE TREATMENT OF CROHN'S DISEASE: A RETROSPECTIVE SINGLE‐CENTER COHORT STUDY
Alice Bianchi1, Eliana Perna1, Laura Gianolio 1, Francesca Penagini1, Dario Dilillo1, Alessandra Bosetti1, Elvira Verduci1, Gian Vincenzo Zuccotti1,2, Lorenzo Norsa1
1Paediatrics, Buzzi Children's Hospital, Milan, Italy, 2Department Of Biomedical And Clinical Sciences, University of Milan, Milan, Italy
Objectives and Study: Cumulative evidence supports the use of dietary approaches for the treatment of Crohn's disease (CD). This study aims to compare the macro and micronutrient intakes provided by exclusive enteral nutrition (EEN) and Crohn's disease exclusion diet (CDED), to identify nutritional deficiencies and suggest the need for nutritional supplementation.
Methods: A retrospective single‐center cohort study was performed among paediatric CD patients treated with EEN or CDED between 2020 and 2024. The patients were divided into four categories (7 patients on EEN, 11 on CDED1, 8 on CDED2, and 10 on CDED3), with the same patients potentially being included in multiple categories. Macronutrient (carbohydrates, proteins, lipids) and micronutrient (calcium, iron, magnesium, vitamin D) intakes were collected at baseline for each category and compared with the Dietary Reference Intakes (DRIs) for age.
Results: The energy intakes of all patients were adequate to their total energy expenditure (TEE). In terms of macronutrient intake, carbohydrates were below the recommended levels in the EEN group, whereas lipids exceeded these references. Conversely, macronutrient intakes were within recommended ranges for CDED1, CDED2, and CDED3. Regarding micronutrient intake, calcium was adequate in all patients in the EEN group, whereas deficiencies were observed in 5/11 (46%) CDED1 patients, 8/8 (100%) CDED2, and 4/10 (40%) CDED3. VitaminD intake was adequate in the EEN group, but insufficient in 9/11 (82%) CDED1 patients, and in all those on CDED2 and CDED3. Finally, iron and magnesium intakes were adequate in all groups.
Conclusions: This study shows that calcium and vitaminD intakes may be inadequate in patients on CDED, with significant declines between CDED1 and CDED2. These findings emphasize for the first time the importance of addressing calcium and vitaminD supplementation across the different phases of CDED, with particular attention to CDED2.
Contact e‐mail address:
N‐EV043. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV043.1. PREDIMED AMONG NURSING STUDENTS: A STUDY AT UNIVERSITY OF SALERNO
Pietro Aliberti1, Annalaura Giordano 1, Carmela Pia Senatore2, Antonietta Pacifico3, Angelo Cianciulli3, Rossella Colantuono1,4, Grazia Massa4, Claudia Mandato1
1Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Pediatrics Section, University of Salerno, Baronissi, Salerno, Italy, 2University of Salerno, Fisciano, Italy, 3Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Salerno, Italy, 4Pediatric Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
Objectives and Study: The Mediterranean diet is a nutritional model based on foods primarily found in the Mediterranean countries. The PREDIMED questionnaire was developed to assess adherence to this diet.
Methods: A monocentric study was conducted with 254 students from the nursing degree program at the University of Salerno. All participants completed a questionnaire to assess their knowledge of the Mediterranean diet and their adherence to it. The analyses were conducted using R.
Results: The descriptive analysis divided the students into three categories (good, average, and poor adherence) and revealed a predominance of students with average adherence (174, or 70.2% of the sample). On the other hand, only 41 students (16.5%) showed good adherence, indicating that a minority follows the Mediterranean diet guidelines optimally.
Among the most significant associations, the consumption of extra virgin olive oil as the main condiment emerged, along with the consumption of less than one serving of butter or margarine.
Conclusions: Good adherence to the Mediterranean diet is clearly associated with consistent healthy behaviors (high consumption of fruit, vegetables, fish, nuts, and use of olive oil). Conversely, poor adherence is linked to less healthy habits, such as low vegetable consumption and a preference for animal fats.
The data indicate that nursing students at our center do not demonstrate optimal adherence to the principles of the Mediterranean diet. It is important to note that most students are aware of the advantages of the Mediterranean diet and study its benefits in at least one university course. In fact, only 16.5% of the sample exhibit dietary habits aligned with the Mediterranean diet. In the future, we aim to expand the student sample in order to gain a better understanding of adherence to the Mediterranean diet.
Contact e‐mail address: p.aliberti20@studenti.unisa.it
N‐EV044. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV044.1. CLINICAL FOLLOW‐UP OF PAEDIATRIC PATIENTS RECEIVING ENTERAL NUTRITION THERAPY: THE HACETTEPE EXPERIENCE
Ayse Demir Ozaltun1, Hayriye Hizarcioglu Gulsen 2, Ersin Gumus2, Inci Nur Saltik Temizel2, Hulya Demir2, Hasan Ozen2
1Department Of Pediatrics, Hacettepe University, Ankara, Turkey, 2Department Of Pediatric Gastroenterology, Hacettepe University, Ankara, Turkey
Objectives and Study: To evaluate the nutritional features of paediatric patients receiving enteral nutrition (EN) via feeding tubes/stomas.
Methods: Patients who received EN via tube/stoma (regardless of oral feeding) for at least six months were included. Demographic characteristics, feeding modalities, and anthropometric measurements were noted.
Results: 296 patients (female:46.3%) were included. The median EN duration (oral or tube/stoma) was 2.8 years (3 months–14.8 years). The median duration of oral feeding without tube/stoma was 1.2 years. Neurological disorders were the most common diagnosis(51.4%). 86.5% of the patients had inadequate/unsafe oral intake. Stoma feeding was more frequent than the tube feeding (63.5% vs 36.5%). Postpyloric feeding was implemented in 4 patients (1.4%). Bolus feeding (88.9%) was the most common mode of delivery. The complication rate within 48 hours of tube insertion was 0.7%. Table 1 summarizes the changes in anthropometric measurements.Tube/stoma feeding had a positive effect on z scores of weight and body mass index (p < 0.001, both), especially during the first 6 months (Figure 1), but did not affect the height z‐scores. Intakes of energy (p = 0.011) and protein (p = 0.023) were higher in tube feeding than in stoma.
Table 1. Anthropometric Measurements
| Visit | Mean ± SD | P‐ value | |
|---|---|---|---|
| Weight z‐score | First | ‐2,7 ± 2,8 | <0,001 |
| 6th month | ‐1,8 ± 2,7 | ||
| 12th month | ‐1,4 ± 2,5 | ||
| Last | ‐1,6 ± 3,0 | ||
| Height z‐score | First | ‐2,6 ± 2,4 | 0,072 |
| 6th month | ‐2,1 ± 2,0 | ||
| 12th month | ‐2,0 ± 2,1 | ||
| Last | ‐2,2 ± 2,1 | ||
| Body mass index z‐score | First | ‐1,7 ± 2,5 | <0,001 |
| 6th month | ‐0,6 ± 2,5 | ||
| 12th month | ‐0,3 ± 2,5 | ||
| Last | ‐0,2 ± 2,4 |
Conclusions: EN therapy is a treatment with a low complication rate and a significant positive impact on growth during the acute phase, regardless of the application method. In cases where gastrostomy is not feasible, sufficient calorie and protein intake can still be achieved through feeding tubes.
Contact e‐mail address: hayriyegulsen@gmail.com
N‐EV045. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV045.1. A SINGLE‐CENTRE, OPEN‐LABEL STUDY ON THE TOLERABILITY AND NUTRITIONAL ADEQUACY OF A HYPERCALORIC, PLANT‐BASED, REAL FOOD INGREDIENT FORMULA FOR TUBE FED PEDIATRIC PATIENTS
Alyssa Ramuscak1, Inez Martincevic2, Hebah Assiri1, Estefania Carrion1, Jessie Hulst 1,3
1Gastroenterology, Hepatology & Nutrition, The Hospital for Sick Children, Toronto, Canada, 2Dietetics, The Hospital for Sick Children, Toronto, Canada, 3Pediatrics & Nutritional Sciences, University of Toronto, Toronto, Canada
Objectives and Study: Homemade or commercially available food‐based feeds are increasingly being used for nutrition support and are associated with improved feeding tolerance among children with medical complexity (CMC). However, feed volumes needed to meet energy needs may limit the use in CMC. This study evaluated the tolerability and nutritional adequacy of a commercial hypercaloric, plant‐based, real food ingredient formula (HPF) in tube‐fed CMC.
Methods: This prospective, single‐arm, open‐label study included stable CMC tube‐fed patients aged 1‐13 years from outpatient clinics at a tertiary care hospital (May 2023‐June 2024). At baseline, demographics, and weight and height were obtained, with weight reassessed at study completion. Participants exclusively used the HPF (1.5 kcal/mL) for 14 days after a 3‐day transition period. Daily amount of HPF was isocaloric compared to usual feeds. Total fluid needs were met by adding water. Caregivers monitored daily intake volume, feeding tolerance, and frequency and consistency of bowel movements during the transition and study period. Weight‐for‐age (WFA) and BMI‐for‐age z‐scores were compared using paired t‐tests between baseline and end‐of‐study. Nutritional adequacy was assessed as % of calories received over prescribed, and amount protein received (g/kg/day) as per dietary reference intake for age and weight.
Results: Twenty‐seven children (median age 5.5 years, 59 % male, 52% genetic/congenital conditions) were recruited with 26 completing the study. Mean WFA and BMI‐for‐age z‐scores significantly improved from ‐1.75 ± 1.93 to ‐1.67 ± 1.88 (p < 0.01), and from ‐0.63 ± 1.54 to ‐0.48 ± 1.48 (p < 0.01), respectively. No significant changes were observed with feeding tolerance (vomiting, gagging, tube‐venting, pain/discomfort) or bowel movements. Participants achieved 100% of prescribed energy for nearly all study days (13 ± 1.7 days) and exceeded daily protein requirements. Most caregivers (84.6%) were satisfied/very satisfied with the HPF.
Conclusions: Exclusive hypercaloric, plant‐based, real food ingredient formula was well tolerated and nutritionally adequate, facilitating weight maintenance or gain in stable, medically complex children over a 14‐day study period.
Contact e‐mail address: jessie.hulst@sickkids.ca
N‐EV046. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV046.1. DEVELOPMENT OF CENTILE CHARTS FOR THE COW_S MILK‐RELATED SYMPTOM SCORE (COMISS) IN PRESUMED HEALTHY INFANTS
Koen Huysentruyt 1, Katerina Bajerova2, Christophe Dupont3, Mikael Kuitunen4, Rosan Meyer5, Anna Nowak‐Wegrzyn6, Carmen Ribes‐Koninckx7, Silvia Salvatore8, Raanan Shamir9, Annamaria Staiano10, Hania Szajewska11, Carina Venter12, Yvan Vandenplas1
1KidZ Health Castle UZ Brussel, Brussels, Belgium, 2Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic, 3Clinique Marcel Sembat, Ramsay Group, Boulogne‐Billancour, France, 4Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, 5Department Dietetics, Winchester University, Winchester, United Kingdom, 6Hassenfeld Children's Hospital, New York, United States of America, 7La Fe University, Valencia, Spain, 8Department of Medicine and Technological Innovation, Pediatrics, Hospital "F. Del Ponte", University of Insubria, Varese, Italy, 9Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 10University of Naples "Federico II", Naples, Italy, 11Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland, 12Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, United States of America
Objectives and Study: The Cowʼs Milk‐related Symptom Score (CoMiSS) is an awareness tool for cow's milk allergy (CMA) in infants. “Normal” CoMiSS values change in function of age in some studies; therefore this study aims to develop CoMiSS centile charts for presumed healthy infants.
Methods: Original data of prospective studies investigating normal CoMiSS values in presumed healthy infants (≤12 months) were pooled. Preliminary 50th, 90th and 97th centiles were modeled using GAMLSS (generalized additive models for location, scale and shape) in R v4.1.3. Lower Aikake Information Criteria (AIC) was used for model selection.
Results:
CoMiSS was collected from 2,574 infants (52.0% boys; difference between countries: p = 0.476) from Belgium (n = 300), Brazil (n = 101), Bulgaria (n = 60), Czech Republic (n = 206), Egypt (n = 808), Indonesia (n = 286), Italy (n = 200), Mexico (n = 106), Poland (n = 366) and Spain (n = 141). The overall median (Q1;Q3) age was 5.2 (2.6;8.7) months, with a significant difference (p < 0.001) between countries. Solid feeds was started in 60.6% of the 1,981 infants without missing data. The overall mean (SD) and median (Q1;Q3) CoMiSS was respectively 4.0 (2.6) and 4 (2;6). CoMiSS was <6 in 71.9% (significant differences between countries, p < 0.001: range 60.4% to 88.5%). A CoMiSS ≥10 was present in 1.0% (significant differences between countries, p < 0.001: range 0% to 5.0%). Using a Zero Altered Negative binomial type I distribution, an acceptable fit was obtained for the higher centiles: 52%, 95% and 98% of the observed data fell below the 50th, 90th and 97th centile respectively. The 50th centile remains relatively constant at 4, whilst the 90th and 97th centiles vary slightly with age (see Figure 1). The 97th centile fluctuates between 9 and 10 the first 6 months and decreases thereafter.
Conclusions: A analyses show that in pooled data from prospective studies in healthy infants CoMiSS varies only slightly with age of life. The variation mainly occurs in the higher centiles.
Contact e‐mail address: yvan.vandenplas@uzbrussel.be
N‐EV047. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV047.1. THE EFFECT OF GAME‐BASED NUTRITION EDUCATION ON PRESCHOOL CHILDREN& NUTRITIONAL KNOWLEDGE
Bahareh Imani
Pediatrics, Mashhad university of medical sciences‐Mashhad‐Iran, mashhad, Iran
Objectives and Study: Preschool‐aged children often lack adequate nutritional knowledge, which can lead to poor dietary choices and health issues. Traditional nutrition education approaches, often relying on didactic methods, may not be engaging enough for young children. This pilot study aimed to assess the impact of a game‐based nutrition education program on preschool children's nutritional knowledge
Methods: A four‐week, 60‐minute every day "Delicious Dice" game‐based nutrition education program was implemented with a group of 300 preschoolers aged 3‐5. "Delicious Dice" featured a game board that integrated concepts of "My Plate" (a visual representation of healthy proportions of food groups), physical activity, and food group recognition. Through engaging dice rolls and gameplay, children learned to identify different food groups and their examples, as well as the importance of incorporating physical activity into their daily routines. Pre‐ and post‐intervention assessments were conducted using parent surveys and the Child Eating Behavior Questionnaire (CEBQ)
Results:
Significant improvements were observed in the children's nutritional knowledge following the intervention. Specifically, there was a statistically significant increase in the children's understanding of food groups, healthy snacks, and the importance of food choice. In addition, there was a significant rise in the kids' willingness to try new foods, due to using the CEBQ questionnaire Food Fussiness (FF P‐value:0.029) Food Responsiveness (FR P‐value:0.045), Enjoyment of Food (EF P‐value:0.009) dimensions following the intervention. These findings suggest that the "Delicious Dice" game‐based approach was effective in engaging preschoolers and enhancingtheir nutritional knowledge
Conclusions: This pilot study provides preliminary evidence that game‐based nutrition education holds promise for improving preschool children's nutritional knowledge and help children to choose healthy diet. Further research is needed to investigate the long‐term effects and stalability of this approach. The study highlights the potential of using play‐based learning to make healthy nutrition education more engaging,joyful and effective for young children.
Contact e‐mail address: drbaharehimani@gmail.com
N‐EV048. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV048.1. EFFECTS OF PARTIAL ENTERAL NUTRITION COUPLED WITH CROHN'S DISEASE EXCLUSION DIET AND EXCLUSIVE ENTERAL NUTRITION ON PHASE ANGLE IN PAEDIATRIC CROHN'S DISEASE PATIENTS
Patricija Kunstek 1,2, Darja Urlep2, Evgen Benedik1,2
1Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia, 2Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia
Objectives and Study: Partial enteral nutrition (PEN) coupled with the Crohn's disease (CD) exclusion diet (CDED) and exclusive enteral nutrition (EEN) both induce remission in paediatric CD patients (PCDP). Data on the role of PEN + CDED and EEN on phase angle (PA), which is known to be an indicator of cell health, are scarce. The aim of this study was therefore to investigate the effects of treatment with PEN + CDED and EEN on PA in PCDP.
Methods: A prospective cohort study of children with active CD treated with PEN + CDED or EEN was conducted in a tertiary centre between June 2017 and November 2024. At baseline (t0) and after 6 weeks of treatment (t1), PA was measured by bioelectrical impedance analysis (AKern BIA101, Italy).
Results: A total of 28 paediatric patients (14 male, mean age 13.7 ± 3.57 years) with active CD were assigned to either the PEN + CDED (N = 14) or the EEN (N = 14) treatment group. The median PA of our cohort was 5.55 at t0 and 5.65 at t1. No statistically significant difference in PA was found between the groups, neither at t0 nor at t1, nor in the change from t0 to t1 in either group. The median PA for PEN + CDED was 5.75 at t0 and 5.55 at t1 (p = 0.13). The median PA for EEN was 5.35 at t0 and 5.15 at t1 (p = 0.12). When comparing newly diagnosed patients (N = 19) and patients with disease flare‐up (N = 9), median PA was lower in newly diagnosed patients at both t0 (5.50 vs. 6.00) and t1 (5.00 vs. 6.10).
Conclusions: Overall, these data suggest that PEN + CDED and EEN have similar effects on PA in PCDP. In addition, PA was lower in newly diagnosed patients compared to patients with disease flare‐up. This could be explained by the higher degree of inflammation and prolonged malnutrition in newly diagnosed PCDP.
Contact e‐mail address: evgen.benedik@kclj.si
N‐EV049. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV049.1. INFLUENCE ON QUALITY OF LIFE (QOL)OF TWO DIFFERENT NUTRITIONAL METHODS IN CHILDREN UNDERGOING HEMATOPOIETIC CELL TRANSPLANTATION
Sara Marin Juan 1, Karin Enskär2, Natalja Jackmann2, Thomas Mårtensson2, Thomas Casswall1, Britt Gustafsson1
1Division For Paediatrics, Department Clinical Interventions And Technology Clintec, Karolinska Institutet, Stockholm, Sweden, 2Akademiska Sjukhuset, uppsala, Sweden
Objectives and Study: A good nutritional status has prognostic implications in children undergoing hematopoietic cell transplantation (HCT). However, aspects of psychological and QoL associated with different nutrition methods are so far unknown. We have compared qualitative and quantitive data in two groups of children undergoing HCT: one with percutaneous gastrostomy (PEG) and the other group with nasogastric tube (NT) feeding.
Methods: In present interim analysis, five children (median=6 six years old) were included. They were divided into two groups: A) Children receiving PEG, (n = 2) and B) patients with NT (n = 3). Data was collected between 2019‐2024 at time of HCT, one‐ and three‐months post HCT. Data was collected through interviews with patients and parents based on the health‐related instrument PROMIS 25, together with supplementary semi‐structured questions concerning nutrition, nutrition method and how satisfied the family was. We assembled too the following quantitative data: weight, age at HCT, diagnosis and development of acute graft versus host disease (aGvHD).
Results: At time point of HCT, one‐and three months after HCT the NT group exhibited lower scores in overall pain and sense of independence. The PEG group were more satisfied with the nutrition method compared to the NT group. There were no differences between the groups in the incidence of developing aGvHD and weight within 100 days post HCT.
Conclusions: In this ongoing study, our preliminary conclusions shows that parents and patients felt more comfortable using PEG as a nutrition method without any negative effects on their weight. Thus, the use of a gastrostomy seems to be a good option to maintain a stable nutritional status and increased quality of life during the HCT procedure.
Contact e‐mail address: Sara.marin.juan@ki.se
N‐EV050. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV050.1. NUTRITIONAL ANALYSIS OF A POPULATION OF PATIENTS WITH TYPE I SPINAL MUSCULAR ATROPHY WITH AND WITHOUT GASTROSTOMY
Ana Moráis López, José D Andrade Guerrero, Ana Bergua Martínez, Elena Borregón Rivilla, Irene Merinero Ausín, Mar García Romero, Gonzalo Ruiz Zurita, Paula Aragón Ramos
La Paz University Hospital, Madrid, Spain
Objectives and Study: Type 1 spinal muscular atrophy (SMA1) causes progressive muscle wasting, loss of functional capacity and nutritional derangement. Our aim was to describe the nutritional status of a sample of patients with SMA1, and to investigate wether having a gastrostomy (G‐tube) favourably impacts nutritional status.
Methods: Descriptive cross‐sectional study of a cohort of 21 patients with SMA1 followed up in a single centre. Data concerning age, sex, clinical symptoms, G‐tube placement, tracheostomy, anthropometry and body composition (bioimpedance analysis [BIA]) were collected. Anthropometric data were compared with WHO/Spanish reference (<10 years/>10 years). BIA data: phase angle, fat‐free mass (FFM) and body cell mass (BCM). Statistical analysis was performed using SPSS v29.0.
Results: ‐ Age range of the patients was 1‐16 years (median 6 years). All received treatment with nusinersen. All patients had required hospital admission at some point, with 10 requiring admission to the ICU. Of these 10, all required G‐tube and 5 required tracheostomy. ‐ Of the 21 patients, 8 were fed exclusively orally. Of those with G‐tube, 61% (8 patients) were fed exclusively by this route, while 39% (5 patients) received mixed feedings (oral + G‐tube). ‐ Anthropometry: Children with G‐tube showed better values for mid‐upper arm circumference (MUAC) and body mass index (BMI) than patients without G‐tube (mean MUAC z‐score ‐1.2 vs ‐2.1 and mean BMI z‐score ‐0.91 vs ‐1.56). Patients fed exclusivelly by G‐tube had better nutritional indices than the other 2 subgroups (without G‐tube and with mixed feedings). ‐ BIA: mean phase angle in patients fed orally vs G‐tube alone vs mixed feedings was 2.4 vs 2.5 vs 2.14. Mean BCM (as percentage of FFM) was 25.56% vs 26.71% vs 22.88%.
Conclusions: Patients fed through G‐tube (exclusive or predominantly) had better body composition and nutritional indices, despite this group had greater morbidity (need for ICU, tracheostomy).
Contact e‐mail address:
N‐EV051. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV051.1. NUTRITIONAL SUPPORT IN ACUTE POISONING WITH CORROSIVE SUBSTANCES IN PEDIATRIC PATIENTS: A 9‐YEAR EXPERIENCE OF A PEDIATRIC POISON CENTER
Adriana Negoita 1, Cristian Lucaci1, Andra Postelnicu1, Ioana Ularu1, Andreea Lescaie1,2, Maria Marcu1,2, Dora Andreea Boghitoiu1,2, Carmen Daniela Chivu1,2, Maria Dorina Craciun1,2, Coriolan Emil Ulmeanu1,2, Gabriela Viorela Nitescu1,2
1Pediatric Poison Center, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania, 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Objectives and Study: Ingestion of corrosive substances presents considerable risks to children. Acute management requires not only medical treatment but also a stringent nutritional strategy. However, standardized guidelines are absent. This study aims to analyze nutritional management during the acute phase of corrosive substance poisoning.
Methods: A retrospective‐descriptive study from January 2015 to October 2024 included all acute poisoning cases involving corrosive substances. Statistical analysis utilized XLSTAT Software. Parenteral nutrition referred to intravenous administration of amino acids, lipid emulsions, dextrose, and electrolytes.
Results: The study included 143 cases, with a median age of 2.33 years (IQR:1.8–4.2) and a male‐to‐female ratio of 1.80. The initial management included cessation of oral intake until endoscopy (n = 114, 79.72%) or symptom resolution (n = 29, 20.28%). Patients without endoscopy started oral feeding with liquids and progressing to semisolids and solids. Post‐endoscopy nutritional management was guided by the Zargar grade. Oral feeding without additional nutritional support resumed in 90 (78.95%) cases, while 16 (14.03%) cases, including 1 with grade 1 lesions, 10 with grade 2, and 5 with grade 3, required oral feeding with parenteral nutrition support. Nasogastric tube feeding along with parenteral nutrition support was used in 8 (7.02%) cases, including 5 with grade 2 and 3 with grade 3. The nasogastric tube and parenteral nutrition support was maintained for a median of 5 days (IQR: 3‐7). The median hospitalization time was 4 days (IQR: 3–6). Follow‐up showed that 13 (9.10%) patients developed esophageal strictures.
Conclusions: Nutritional support is vital in managing children with corrosive substance ingestion. Intravenous administration of amino‐acids and lipid‐emulsions is essential for patients unable to resume oral feeding, as it supports tissue repair.
Contact e‐mail address: adriana.negoita98@gmail.com
N‐EV052. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV052.1. NUTRITIONAL SUPPORT IN PEDIATRIC PATIENTS POISONED WITH CORROSIVE SUBSTANCES: A SYSTEMATIC LITERATURE REVIEW
Adriana Negoita 1, Andreea Lescaie1,2, Coriolan Emil Ulmeanu1,2, Gabriela Viorela Nitescu1,2
1Pediatric Poison Center, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania, 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Objectives and Study: Caustic substance ingestion represents a frequent concern in the pediatric population. Nutritional management is a crucial aspect in the acute phase of the ingestion. Nevertheless, in the past 10 years there has been a lack of articles approaching this subject.
Methods: Three medical databases were reviewed to identify studies published between January 2014 and October 2024. The screening process was performed using Nested‐Knowledge software (Fig.1). Statistical analysis was performed using Microsoft Excel.
Results: This review included four articles roughly describing the nutritional management for the pediatric population. They all emphasized the initial need to stop oral intake, especially in all grade II burns or above, and proceed to intravenous hydration and different feeding methods depending on the burn degree. In cases when oral hydration is needed, it should not exceed 15 ml/kg, since it might cause vomiting. The study of Follent was the only one which showed that oral feeding should resume with clear fluids, followed by semi‐solids and solids food depending on the presence of dysphaga. Patients unable to tolerate oral‐feeding, were fed by nasogastric tube. No study mentioned the usage of intravenous amino‐acids and lipids emulsions.
Conclusions: Nutritional approach represents an important step in the management of acute corrosive substance ingestion. By reporting the cases and publishing dietary recommendation concerning this type of poisoning, the medical community can contribute to the improvement of the patients’ better outcome.
Contact e‐mail address: adriana.negoita98@gmail.com
N‐EV053. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV053.1. DEVELOPMENT OF TEST MEALS TO EVALUATE NUTRIENT INTAKE BY NUTRIENT‐RESPONSIVE BLOOD AND SALIVARY SECRETED MIRNAS AND THEIR APPLICATION TO DIABETES PREVENTION MEALS FOR PAEDIATRIC POPULATIONS
Futaba Nishikawa 1, Reina Watanabe1, Motoko Mihara1, Kano Hayashi1, Rin Niitsu1, Chisaki Taniguchi1, Tomoka Takahashi1, Sayuki Takahashi1, Ami Suzuki1, Erina Shigematsu1, Saeko Sugawara2, Terumi Hasegawa1, Moe Takahashi1, Nanae Kondo1, Kimie Kawachi1, Kouji Hirota3, Seiichi Oyadomari4, Masato Ono5, Kazuki Tajima5, Makoto Ujihara5, Taiji Ito1
1Department Of Nutrition And Dietetics, Faculty Of Family And Consumer Sciences, Kamakura Women's University, Kanagawa Pref. Kamakura City, Japan, 2Department Of Health And Nutrition, Jumonji University, Saitama Pref. Niiza City, Japan, 3Tokyo Metropolitan University, Tokyo. Hachioji City, Japan, 4Tokushima University, Tokushima Pref. Tokushima City, Japan, 5National Hospital Organization Yokohama Medical Center, Kanagawa Pref. Yokohama City, Japan
Objectives and Study: Diet in paediatric age groups with growth is important to reduce the risk of diabetes in adulthood. We are focusing on extracellular secretory micro (mi) RNAs that collectively suppress gene expression, and have identified 49 insulin resistance‐specific circulating miRNAs. The aim of this study was to develop a test diet for the identification of "nutrient‐responsive human circulating miRNAs" which fluctuate in expression specifically for each nutrient, and to develop a special diet that increases the amount of each of three major nutrients and has the same sensory evaluation as a normal diet as a placebo.
Methods: As the standard for menu, according to the Dietary Reference Intakes for Japanese (2020), we used the recommended amount, target amount, or standard amount for men in their 40 to 50′s and physical activity level II. The estimated energy requirement for male subjects in their 40 to 50 s is 2650 kcal. The ratio of three major nutrients to energy requirements is 13 ~ 20% for protein, 20 ~ 30% for lipids, and 50 ~ 65% for carbohydrates.
Results: We first created a menu that met the criteria, and then expanded it to increase content for each of three major nutrients. In doing so, there was no difference in sensory evaluation between the pre‐fortified and post‐fortified menus, and consideration was given to absence of psychological effects such as appearance, quantity, and taste intensity between the reference and nutrient‐fortified meals. In addition, the recommended amount, target amount, and standard amount were evaluated on the radar chart (Fig.1).
Conclusions: We established three patterns of daily standard menus for three meals and fortified diets for protein, lipid, and carbohydrate. In the future, these test meals will be made into frozen foods, and will be consumed by subjects who have obtained informed consent, and comprehensive identification of nutrient‐responsive miRNAs will be conducted.
Contact e‐mail address: ito@kamakura-u.ac.jp
N‐EV054. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV054.1. BONE MINERAL DENSITY OF CHILDREN WITH COW MILK ALLERGY ON THE ELIMINATION DIET
Omneya Magdy Omar, Mohamed Massoud, Gehad Ibrahim
Alexandria University, Alexandria, Egypt
Objectives and Study: To compare the bone mineral density (BMD) between children with cow milk protein allergy (CMPA) on the elimination diet
Methods: This study was carried out on forty children with cow milk protein allergy attending the Alexandria University Children's Hospital nutrition clinic and compared to forty apparently healthy children of matched age and sex as a control group. Anthropometric measurements were recorded. Laboratory investigations including calcium profile and serum 25 (OH) vitamin D were done. All patients underwent a Dual‐energy X‐ray absorptiometry (DEXA) scan of the lumbar spine
Results: Ten patients (25%) were found to have normal BMD (Z score > ‐1 SD) while 23 patients (57.5%) were found to have osteopenia (Z score from ‐1 to 2.5 SD) and 7 patients (7.5%) had osteoporosis (Z score <‐2.5 SD). There was a significant positive correlation between BMD Z score with dietary calcium intake in children with CMPA. Dietary calcium intake was a statistically significant predictor of a low BMD Z score.
Conclusions: Children with CMPA had lower lumbar spine BMD Z scores than healthy controls, which likely resulted from lower calcium
Contact e‐mail address: drmonymagdy@yahoo.com
N‐EV055. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV055.1. A PATIENT'S PERSPECTIVE ON THE USE OF EXCLUSIVE ENTERAL NUTRITION (EEN) FOR THE TREATMENT OF PAEDIATRIC CROHN'S DISEASE
Anna Martin1,2, Mairead O'Meara 2
1University College Dublin, Dublin, Ireland, 2Nutrition & Dietetics Department, Childrens Health Ireland at Crumlin, Dublin, Ireland
Objectives and Study: Crohn's Disease (CD) is a chronic condition and can result in the inflammation of any part of the gut. Children diagnosed with CD are at increased risk of nutrient malabsorption and poor growth. The first‐line treatment to induce remission and improve growth is a 6‐week dietary treatment called Exclusive Enteral Nutrition (EEN). This diet requires patients to stop eating food and switch to taking prescribed nutritional drinks. The objective of this study is to acquire an in‐depth understanding of the paediatric patient experience with EEN; identifying challenges and empowerment strategies that help increase patient adherence to the EEN treatment course.
Methods: Ethical approval was obtained from the CHI Ethics Committee in October 2023. This is a mixed‐research method that focuses on collecting both qualitative and quantitative data. Participants of the study include patients of both sexes and all ethnicities, between 1‐17years old, who were diagnosed with CD and advised to complete their first course of EEN during January 2022 and October 2023. An anonymised survey with 25 questions total was used to gather the information.
Results: 116 patients were approached to take part in the study and 47% of participants completed it. Two main themes were identified: (i) barriers to EEN compliance (subthemes; “feelings of isolation, taste/texture/smell of drinks and missing food), (ii) empowerment strategies for EEN (subthemes; drink preparation techniques, eliminating temptation, wide flavour choice, external support and health improvements). Of the 79% of patients who completed a full course of EEN; 55% found it ‘difficult’ and 60% reported that "they would attempt it again if required".
Conclusions: This study shows that patients find EEN to be a challenging diet which can have physical, emotional, and social impacts on aspects of the child's life. Empowerment strategies are imperative to help patients complete EEN.
Contact e‐mail address: mairead.omeara@childrenshealthireland.ie
N‐EV056. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV056.1. MANAGEMENT AND TREATMENT OF PROTEIN‐LOSING ENTEROPATHY IN PATIENTS WITH CONGENITAL HEART DISEASE
Vanessa Cabello Ruiz, Judith Raya Muñoz, Susana Redecillas Ferreiro, Raquel Nuñez Ramos, Marta Freixas Bermejo, Marina Alvarez Beltran, Saray Mesonero Cavia, Oscar Segarra Canton
Hospital Universitari Vall d'Hebrón, Barcelona, Spain
Objectives and Study: Protein‐losing enteropathy (PLE) is a condition observed in congenital heart disease. Its alters the prognosis and progression of the patient. Heart transplantation is the only described curative treatment. Objective: review the management of our patients and their evolution.
Methods: Retrospective descriptive study. Included all cases of PLE diagnosed between 1997 and 2023 in patients under 18 years with congenital heart disease. Demographic data, type of heart disease, surgical intervention, clinical‐analytical characteristics at PLE diagnosis, diagnostic studies, medical treatments, nutritional management, and clinical response were collected.
Results: Twelve patients. 5/12 patients with hypoplastic left heart syndrome. Seven underwent Fontan surgery (3 fenestrated). Clinical presentation: edema (91%), plus ascites in 2 patients and pleural effusion in 1. Diarrhea in 33%. All diagnosed by plasma hypoalbuminemia and elevated fecal alpha‐1‐antitrypsin. Other studies: radiolabeled albumin scintigraphy in 7 patients (normal in 1) and endoscopy with biopsies in 8 (2 with normal histopathology). Initial treatment in all was low‐fat diet. 75% supplemented with MCT oil, and 91% received protein modules. Seven patients received semi‐elemental formulas with high MCT percentage. Three patients required home parenteral nutrition. Additional treatments included oral budesonide (2/12), heparin (1/12), octreotide (2/12), midodrine (2/12), and systemic vasodilators (2/12), with no significant response. Eleven patients received regular albumin supplementation. 100% received vitamin D, 4/12 vitamin E, 7/12 vitamin B12 (2 intramuscularly), 6/12 iron (half intravenously), and 7/12 oral magnesium. Four patients underwent heart transplantation, three died from post‐transplant complications. PLE evolved favorably in 8/12 patients, with resolution following heart transplantation in one case, diet in three, catheterization in two, fenestration in one, and spontaneous resolution in one. Only three achieved complete resolution and diet liberalization.
Conclusions: An adequate nutritional management seems to be essential to control the disease, prevent and/or correct nutritional deficiencies, and ensure the patient reaches the best possible clinical condition for future transplantation.
Contact e‐mail address: vanessa.cabello@vallhebron.cat
N‐EV057. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV057.1. GASTROINTESTINAL MANIFESTATIONS FOLLOWING CAR‐T 19 THERAPY IN PEDIATRIC PATIENTS WITH CD19 + ACUTE LYMPHOBLASTIC LEUKEMIA‐
Judith Raya Muñoz 1, Melissa Romero2, Saray Mesonero Cavia1, Marta Freixas Bermejo1, Vanessa Cabello Ruiz1, Maria Cristina Maria Cristina Díaz De Heredia Rubio2, Susana Redecillas Ferreiro1, Oscar Segarra Canton1
1Pediatric Gastroenterology And Clinical Nutrition Unit., Vall d'Hebron Hospital, Barcelona., Barcelona, Spain, 2Pediatric Oncology And Hematology Service., Vall d'Hebron Hospital, Barcelona., Barcelona, Spain
Objectives and Study: Chimeric Antigen Receptor T‐cell (CAR‐T) therapy represents a novel and personalized strategy for hematological malignancies. Although the most frequently described adverse effects focus on cytokine release syndrome (CRS) and immune effector cell‐associated neurotoxicity syndrome (ICANS), information regarding gastrointestinal (GI) complications in pediatric patients with CD19+ acute lymphoblastic leukemia (ALL) remains scarce. This study aims to describe GI adverse effects and assess the nutritional trajectory of pediatric CD19 + ALL patients treated with CAR‐T at our institution.
Methods: We conducted a retrospective, descriptive analysis of patients younger than 18 years diagnosed with CD19 + ALL who received CAR‐T therapy at a tertiary care hospital between January 2020 and January 2024. We evaluated their baseline nutritional status, six‐month evolution, and GI complications according to CTCAE v5.0 criteria.
Results: Thirteen patients were included (median age: 8 years). Three had pre‐existing GI conditions (C. difficile pancolitis, intestinal pneumatosis, and hypertransaminasemia). Seventy percent developed GI complications following CAR‐T, with a median onset two days post‐infusion. Diarrhea was the most frequent symptom (46%, CTCAE grade 2‐3), with negative cultures except one C. difficile case. Other symptoms included abdominal pain (30%), nausea/vomiting (38%), hypertransaminasemia (15%), and persistent abdominal distension (15%). One patient developed hypercholesterolemia and cholestasis. Two patients experienced severe lower GI bleeding (CTCAE grade 4), requiring hemodynamic support. Nutritionally, 70% tolerated enteral feeding; however, 40% required feeding devices due to poor intake or oral aversion, and 31% needed parenteral nutrition, which was discontinued before one month in all cases. Chronic malnutrition increased from 23% at baseline to 30% at six months.
Conclusions: Up to 70% of patients treated with CAR‐T therapy developed GI complications, predominantly mild, self‐limiting diarrhea. These findings, combined with increased malnutrition rates, underscore the importance of multidisciplinary management and comprehensive adverse event documentation.
Contact e‐mail address: judith.raya@vallhebron.cat
N‐EV058. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV058.1. TECHNICAL REVIEW BY THE ESPGHAN SPECIAL INTEREST GROUP ON GUT MICROBIOTA AND MODIFICATIONS ON THE HEALTH OUTCOMES OF INFANT FORMULA SUPPLEMENTED WITH SYNBIOTICS
Silvia Salvatore 1, Ener Dinleyici2, Hania Szajewska3, Roberto Berni Canani4, Pedro Gutierrez‐Castrellón5, Iva Hojsak6, Flavia Indrio7, Walter Mihatsch8, Rok Orel9, Johannes Van Goudoever10, Yvan Vandenplas11, Members Berni Canani R; Campoy C; Domellöf M; Dinleyici Ec; Gutiérrez‐Castrellon P; Guarino A; Haiden N; Hojsak I; Indrio F; Mihatsch W; Mosca A; Orel R; Salvatore S; Savino F; Shamir R; Szajewska H; Vandenplas Y; Van Den Akker C.H.P; Van Goudoever J.B.; Weizman11
1Department of Medicine and Technological Innovation, Pediatrics, Hospital "F. Del Ponte", University of Insubria, Varese, Italy, 2Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey, 3Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland, 4Department of Translational Medical Science and Immuno Nutrition Lab of the CEINGE Advanced Biotechnologies Research Center and Task Force on Microbiome Studies and European Laboratory for the Investigation of Food‐Induced Diseases at the University of Na, Namples, Italy, 5Universidad Juarez del Estado de Durango & International Scientific Council for Probiotics S.C, Mexico City, Mexico, 6Children's Hospital Zagreb, Zagreb, Croatia, 7. Department of Experimental Medicine, University of Salento, Lecce, Italy, 8Department of Pediatrics, Ulm University, Ulm, Germany, 9University Children's Hospital, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia, 10Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, Netherlands, 11KidZ Health Castle UZ Brussel, Brussels, Belgium
Objectives and Study: This technical review, one of five developed by the ESPGHAN Special Interest Group (SIG) on Gut Microbiota and Modifications (GMM), supports the creation of a Position Paper on the use of synbiotic‐supplemented infant formulas. The review also presents the statements made by the SIG GMM.
Methods: The SIG GMM conducted a systematic review to evaluate the clinical outcomes of synbiotic‐supplemented infant formulas in healthy infants (0‐12 months) published before 2024. Following the review, all members of the SIG anonymously voted on each statement, scoring them between 0 and 9. Agreement was indicated by a score >6, with statements requiring ≥75% agreement for acceptance.
Results: of synbiotic‐supplemented infant formula, including twelve randomized controlled trials (RCTs) involving healthy infants and focusing on clinical outcomes. The studies varied in terms of synbiotic composition, study design, intervention duration, and outcomes. Formulas supplemented with synbiotics studied so far were well tolerated and showed no significant difference compared to the control formulas in growth parameters, gastrointestinal symptoms, and stool characteristics, or safety.
Conclusions: This technical report serves as the background for formulating recommendations on the use of synbiotic‐supplemented infant formula in healthy infants studied so far.
Contact e‐mail address: yvan.vandenplas@uzbrussel.be
N‐EV059. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV059.1. BODY COMPOSITION AND METABOLIC IMPACT OF NEW THERAPIES IN SPINAL MUSCULAR ATROPHY PATIENTS
Carola Saure, Soledad Monges, Jimena Lema
Nutrition And Diabetes, Hospital JP Garrahan, C.A.B.A, Argentina
Objectives and Study: Spinal Muscular Atrophy (SMA) involves progressive muscle function loss due to spinal cord nerve cell degeneration. Malnutrition and body composition changes are common in SMA patients due to muscle weakness and swallowing difficulties. New treatments add challenges to metabolic and nutritional evaluation. This study aimed to correlate new pharmacological therapies with body composition and metabolic impact in SMA patients.
Methods: A prospective, cross‐sectional study was conducted on SMA patients evaluated over 6 months (June ‐ December 2023) at a high‐complexity pediatric reference hospital in Buenos Aires, Argentina. Indirect calorimetry calculated Basal Metabolic Rate (BMR), and multifrequency bioimpedance assessed body composition, along with anthropometric measures and laboratory studies. Only patients treated with nusinersen were included in correlation analysis between medicated and non‐medicated groups, as only 3 patients received Zolgensma, all under 1 year old at evaluation.
Results: Forty‐nine SMA patients were analyzed (median age: 9.9 years; range: 0.6–17 years; 53% male). Seventy percent received medication (94% nusinersen, 6% Zolgensma). Ventilatory support was required by 49%, with 17% having tracheostomies. Oral nutrition was reported in 75%, and 28% required enteral support (69% via NGT). Swallowing disorders affected 25%, while 87% preserved speech production.Anthropometric and body composition analyses revealed no significant Z‐score differences across SMA types, but lean mass differences were significant. No patients had altered glycemia or dyslipidemia. Energy expenditure differed significantly between SMA types when adjusted for lean mass.Comparing medicated vs. non‐medicated patients, no differences were found in body composition or lab parameters. Swallowing disorders were significantly less prevalent in medicated patients (17% vs. 50%).
Conclusions: Our findings highlight the complex challenges faced by SMA patients, including significant changes in body composition and metabolic function. Despite new therapies, nutritional issues persist, emphasizing the need for early detection and tailored interventions
Contact e‐mail address: gocarola@icloud.com
N‐EV060. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV060.1. SELENIUM DEFICIENCY IN EPIDERMOLYSIS BULLOSA PATIENTS AND ITS ASSOCIATION WITH DILATED CARDIOMYOPATHY AND NUTRITIONAL STATUS
Carola Saure, Cristian Flores, Maria Araujo, Florencia Lynch
Nutrition And Diabetes, Hospital JP Garrahan, C.A.B.A, Argentina
Objectives and Study: Epidermolysis Bullosa (EB) is a genetic disease causing skin and mucous membrane fragility, leading to nutrient deficiencies. Dilated Cardiomyopathy (DCM) associated with selenium deficiency has been reported in EB patients. This study describes selenium deficiency prevalence in EB patients (0‐18 years) and its association with DCM, nutritional status, anemia, and other micronutrient deficiencies.
Methods: A retrospective study was conducted on EB patients tested for selenium at a pediatric hospital (2020‐2022). EB types were classified (simple, recessive dystrophic, dominant dystrophic, junctional). Selenium deficiency was defined as <50 µg/L. Patients were grouped by selenium status. Analyzed parameters included DCM, anemia, feeding modality, BMI, albumin, CRP, selenium, vitamins A, D, E, and B12, folate, zinc, and copper. Statistical significance was set at p < 0.05.
Results: Among 49 EB patients (mean age 9.5 ± 4.6 years), mean selenium was 61 µg/L, with 16 patients (32.65%) deficient. No gender differences were noted. Recessive Dystrophic EB was most common (73.5%); 24.5% of these patients had selenium deficiency. Significant differences were observed in albumin (3.2 ± 0.94 g/dL vs 4.1 ± 0.45 g/dL), CRP (60.72 ± 56.8 mg/L vs 13 ± 25 mg/L), total vitamin B12 (663.4 ± 484 pg/mL vs 454.9 ± 229.3 pg/mL), zinc (71.2 ± 18.5 µg/dL vs 87.6 ± 18.3 µg/dL), and hemoglobin (9.74 ± 2.8 g/dL vs 11.91 ± 1.36 g/dL). Nutritional risk was present in 49% of patients; 10.2% had a height Z‐score < ‐2, with 80% of these having selenium deficiency (p = 0.017). Selenium deficiency was higher in orally fed patients (p < 0.01). DCM linked to selenium deficiency occurred in one patient (4.8%). Additional deficiencies included vitamin A (23.9%), vitamin D (79.2%), and anemia (57.1%).
Conclusions: One‐third of EB patients had selenium deficiency. Its direct role in DCM remains unclear. Early nutritional assessment is essential to address macro and micronutrient deficiencies.
Contact e‐mail address: gocarola@icloud.com
N‐EV061. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV061.1. KETO‐START: CO‐DESIGN OF A PROGRAMME TO SUPPORT INITIATION, ADHERENCE AND CONTINUATION OF KETOGENIC DIET THERAPY FOR CHILDREN AND YOUNG PEOPLE WITH EPILEPSY AND THEIR PARENTS/CARERS
Natasha Schoeler 1,2, Elizabeth Neal2, Valerie Aldridge3, Victoria Whiteley4, Ruth Fisher5, Anita Devlin6, Ruth Ord6, Zoe Simpson1, Humzah Hameed7, Lenycia De Cassya Lopes Neri8, Glenn Robert9, J Helen Cross1,2
1Great Ormond Street Hospital for Children, London, United Kingdom, 2UCL Great Ormond Street Institute of Child Health, London, United Kingdom, 3Matthew's Friends charity, Lingfield, United Kingdom, 4Royal Manchester Children's Hospital, Manchester, United Kingdom, 5Oxford University Hospitals, Oxford, United Kingdom, 6Great North Children's Hospital, Newcastle, United Kingdom, 7University College London, London, United Kingdom, 8Università di Pavia, Pavia, Italy, 9King's College London, London, United Kingdom
Objectives and Study: Ketogenic diet therapy (KDT) is an effective treatment option for children and young people with drug‐resistant epilepsy. However, they require stringent dietary restriction. In UK centres, only 55% of children referred for KDT actually start diet and, of those who do start, 25% discontinue before the recommended 3‐month trial. We aim to better understand the reasons behind this and design an intervention to help support initiation, adherence and continuation of KDT.
Methods: Using experience‐based co‐design methodology, we collected data on facilitators and barriers to starting and staying on KDT from: i) a scoping review; ii) an international survey of parents/carers; iii) interviews of young people who are/were on KDT, or who were referred but chose not to start diet, and their parents/carers; iv) interviews and observation of ketogenic healthcare professionals. Interview and observation data were analysed by thematic framework analysis, underpinned by the Perceptions and Practicalities Approach. A ‘catalyst’ film was produced, used to help ‘prompt’ participants as they work together to pinpoint areas to target for improvement and co‐design interventions to help future families.
Results: 63 participants were recruited, of which 10 young people, 24 parents/carers and 16 healthcare professionals were interviewed. 60 articles were included in the scoping review. 86 parents/carers responded to the survey. 14 themes were identified, including trust and communication with healthcare teams, individualisation, knowledge and empowerment, finance and practicalities, and peer/network support. Co‐design work is currently underway to define the scope of participant's ‘top 5’ interventions.
Conclusions: The facilitators and barriers to starting and staying on KDT are multi‐factorial and extend beyond the realm of the individual. Our findings are helping shape an intervention ‘package’ to support future families, ultimately important for effective use of healthcare system resources by aiming to reduce KDT dropout rates and support KDT adherence.
Contact e‐mail address: n.schoeler@ucl.ac.uk
N‐EV062. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV062.1. EFFECT OF A LOW‐FODMAP DIET ON FUNCTIONAL ABDOMINAL PAIN DISORDERS IN CHILDREN: FINDINGS FROM AN EARLY‐TERMINATED RANDOMIZED CONTROLLED TRIAL
Agata Stróżyk, Anna Kozłowska‐Janowska, Andrea Horvath, Hania Szajewska
Department Of Paediatrics, Medical University of Warsaw, Warsaw, Poland
Objectives and Study: Evidence on the effectiveness of a low‐fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet for managing functional abdominal pain disorders (FAPD) in children is limited. We aimed to assess the efficacy of a low‐FODMAP diet compared to a regular diet on FAPD. The study was prematurely terminated due to recruitment challenges, adherence issues, and a lack of efficacy.
Methods: This randomized controlled trial originally planned to include 74 children aged 8 to 18 years with irritable bowel syndrome (IBS) or functional abdominal pain‐not otherwise specified (FAP‐NOS), diagnosed by Rome IV criteria. Participants were randomly assigned to either a low‐FODMAP diet or regular diet for 4 weeks. The primary outcome was the percentage of responders, defined as those with at least a 30% improvement in abdominal pain intensity on a 100‐mm Visual Analogue Scale (VAS) during the last week compared to baseline (≥25 mm change). Analysis included all randomized participants with at least one post‐randomization assessment.
Results: Due to recruitment challenges, only 42 participants (24 IBS and 18 FAP‐NOS; mean age 13.3 years) were randomized, and 37 completed the study (low‐FODMAP: n/N = 19/21; regular diet: 17/21). No significant differences in VAS abdominal pain intensity were observed between groups across weeks 1–4. Mean compliance during the 4‐week intervention was 74.8% to the low‐FODMAP diet and 75.6% to the regular diet, with 12 children achieving compliance ≥80%. Successful blinding was achieved in most participants (25 out of 33), with 75% of unblinded participants receiving the low‐FODMAP diet.
Conclusions: Preliminary evidence suggests that the low‐FODMAP diet may not reduce abdominal pain intensity in children with FAPD. The small sample size and early termination limit the robustness of these findings. Nevertheless, reporting these results is critical to ensure transparency, highlight challenges in dietary intervention trials, and guide the design of future studies.
Contact e‐mail address: agata.strozyk@wum.edu.pl
N‐EV063. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV063.1. FIBER INTAKE PROFILE AMONG CHILDREN 6–36 MONTHS IN RELATION TO GASTROINTESTINAL SYMPTOMS AND NUTRITIONAL STATUS: A CROSS‐SECTIONAL STUDY IN JAKARTA‐INDONESIA
Diana Sunardi, Saptawati Bardosono
Department Of Nutrition, Faculty of Medicine Universitas Indonesia, DKI Jakarta, Indonesia
Objectives and Study: Although there is similar dietary fiber intake among constipated and non‐constipated infants and young children, however, this study aims to explore the dietary fiber intake profile among Indonesian infants and young children and its association to constipation symptoms risk and nutritional status.
Methods: A cross‐sectional study was done among apparently healthy children age 6–36 months living in urban poor area of Kampung Melayu sub‐district, Jakarta‐Indonesia during September–October 2021 using structured questionnaires on dietary intake and constipation risk symptoms (i.e. frequency of defecation per‐week and type of stool in a week), anthropometric measures for nutritional status and venous blood withdrawal for hemoglobin assessment. Descriptive statistic and chi‐square test were used to analyze the data.
Results: Among 185 subjects, it revealed that the median of dietary fiber intake was 5.6 (0.1–37.4) g/day or 4.8 (0.1–25.4) g/1000 Kcal, in which 87.0% had dietary fiber intake less than 60% of its recommended requirement value for Indonesian children in g/1000 kcal. In terms of gastro‐intestinal symptoms, 21.6% of the subjects had constipation risk, while for nutritional status, it was found that 25.9% classified as stunted, 20.0% as underweight, 11.4% as wasted, and 41.7% as anemic. There are no significant association between low dietary fiber intake with constipation risk and nutritional status. It revealed from child's daily meals that water melon, fortified infant's porridge and cow's milk formula contributed the most to the dietary fiber intake.
Conclusions: Child dietary fiber intake not related to functional constipation symptoms nor nutritional status. Thus, the encouragement efforts to increase dietary fiber intake through daily meals among children is suggested to support assumption to its relation to their health later in life.
Contact e‐mail address: diana_sunardi@yahoo.com
N‐EV064. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV064.1. PREBIOTIC SUPPLEMENTATION IN CHILDREN WITH INTESTINAL FAILURE: A RANDOMIZED PILOT STUDY ON GI SYMPTOMS AND QUALITY OF LIFE
Rut Anne Thomassen 1,2, Janne Kvammen1,2, Beint Bentsen2, Marianne Bratlie2, Siv Bøhn3, Hanne Farstad4, Christian Kahrs5, Linh Ngo2, Camilla Nybø6, Camilla Sæland2, Erling Tjora7, Rune Tronstad7, Ketil Størdal2,8, Anne Charlotte Brun2, Christine Henriksen1
1Department Of Nutrition, University of Oslo, Oslo, Norway, 2Department Of Paediatric And Adolescent Medicine, Oslo University Hospital, Oslo, Norway, 3Faculty Of Chemistry, Biothechnology And Food Sciences, Norwegian University of Life Sciences, Ås, Norway, 4Department Of Pediatrics, St Olavs University Hospital of Trondheim, Trondheim, Norway, 5Department Of Pediatrics, Østfold Hospital Trust, Grålum, Norway, 6Department Of Pediatrics, Stavanger University Hospital, Stavanger, Norway, 7Department Of Pediatric And Adolescent Medicine, Haukeland University Hospital, Bergen, Norway, 8Department Of Pediatric Research, University of Oslo, Oslo, Norway
Objectives and Study: Patients with intestinal failure (IF) have a significant disease burden including gastrointestinal (GI) symptoms and reduced health‐related quality of life (HRQOL). This may be linked to an altered gut microbiota, which is common in IF. Prebiotics can potentially modulate gut microbiota and influence GI complications and symptoms. This study aimed to investigate the effect of prebiotic supplementation on GI symptoms and HRQOL in children with IF.
Methods: We conducted a randomized controlled trial with patients aged 1‐18 years with IF. The study comprised two phases. In phase 1, all participants received prebiotic supplementation for four weeks. In phase 2, participants were randomized to either continue supplementation (intervention group) or discontinue supplementation (control group) for six months. The primary endpoints were GI symptoms and HRQOL, assessed using the PedsQL 3.0 GI Symptom Scale and the PedsQL 4.0 Generic Core Scale, respectively, with scores ranging from 0‐100 (higher scores indicating better outcomes). Secondary endpoints included stool frequency, stool consistency, and nutritional support.
Results: Forty‐seven children completed phase 1, and 43 (24 in the intervention group and 19 in the control group) completed phase 2. After phase 1 (four weeks of prebiotic supplementation), 60% had reduced GI symptoms. At the 6‐month follow‐up (phase 2), the intervention group had a significant improvement in GI symptoms compared to the control group (mean diff 6.9, p = 0.01) and a reduction in stool frequency (median ‐1.0 vs 0, p = 0.003). A significantly higher proportion of the intervention group experienced normalisation of stool consistency compared to the control group (42 % vs 6 %, p = 0.02). No significant changes were observed in HRQOL scores or dependence on parenteral nutrition.
Conclusions: Long‐term prebiotic supplementation improved GI symptoms, stool frequency and stool consistency in children with IF, suggesting it may be a treatment option in paediatric IF. However, no effect on HRQOL was observed.
Contact e‐mail address: uxruom@ous-hf.no
N‐EV065. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV065.1. UNDERSTANDING THE NEED FOR PRE‐COMISS, A PARENT‐SPECIFIC COW'S MILK‐RELATED SYMPTOM SCORE: A QUALITATIVE STUDY
Yvan Vandenplas 1, Catherina Couchepin2, Katerina Bajerova3, Christophe Dupont4, Mikael Kuitunen5, Rosan Meyer6, Anna Nowak‐Wegrzyn7, Carmen Ribes‐Koninckx8, Silvia Salvatore9, Raanan Shamir10, Annamaria Staiano11, Carina Venter12, Jones Sue13, Anette Jarvi13
1KidZ Health Castle UZ Brussel, Brussels, Belgium, 2IPSOS, Brussels, Belgium, 3Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic, 4Clinique Marcel Sembat, Ramsay Group, Boulogne‐Billancour, France, 5Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, 6Department Dietetics, Winchester University, Winchester, United Kingdom, 7Hassenfeld Children's Hospital, New York, United States of America, 8Paediatric Gastroenterology And Hepatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain, 9Department of Medicine and Technological Innovation, Pediatrics, Hospital "F. Del Ponte", University of Insubria, Varese, Italy, 10Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 11University of Naples "Federico II", Naples, Italy, 12Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, United States of America, 13Nestle Health Science, Lausanne, Switzerland
Objectives and Study: Cow's milk allergy (CMA) presents a significant clinical burden in young children. The Cow's Milk ‐related Symptom Score (CoMiSS) for healthcare professionals is a validated clinical tool designed to increase awareness of CMA related symptoms. The objective of this qualitative study was to better understand whether a parent‐specific CoMiSS tool (called Pre‐CoMISS) may be useful for both parents and healthcare professionals.
Methods: Parents of babies aged 2 to 12 months and primary care physicians from four countries (UK, Germany, Sweden and Spain) were interviewed by trained researchers, guided by dedicated discussion guides. Narrative analysis of the data was undertaken and themes were derived from the data.
Results: A total of 24 parent interviews (6 for Germany and Sweden, 4 for Spain and 8 for the UK) and 18 HCP interviews (4 for Germany, Sweden and Spain and 6 for the UK) were conducted. While the process of observing and tracking symptoms of CMA was aligned in all four countries, the level of awareness for CMA and mindset varied amongst parents. The Pre‐CoMiSS concept was very positively received by parents in all countries and seen as highly beneficial. The HCPs were overall very confident in their knowledge of CMA and the varied symptoms, however, awareness and use of CoMiSS tool was different in the four countries. The Pre‐CoMiSS concept was very positively received by HCPs in UK, Spain, and Sweden but German HCPs expressed some concerns over the tool causing additional workload for HCPs.
Conclusions: A parent‐specific tool for recording cow's milk related symptoms was well received by parents and most physicians in this study. With further optimisation, Pre‐CoMiSS™ may be an important tool for parents to record their infant's symptoms related to cow's milk and support primary care physicians in considering CMA as a possible diagnosis
Contact e‐mail address: yvan.vandenplas@uzbrussel.be
N‐EV066. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV066.1. A SURVEY ON ATTITUDES AND KNOWLEDGE ON GASTROSTOMIES AMONG CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY AT TWO BELGIAN HOSPITALS
Liesbet Verbrugghe 1, Raquel Van Den Eynde1, An‐Sofie Lemmens1,2, Koen Huysentruyt1
1Department Of Pediatric Gastroenterology, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium, 2Department Of Pediatrics, Ziekenhuis Oost‐Limburg (ZOL), Genk, Belgium
Objectives and Study: The decision to place a gastrostomy is often met with a lot of doubt and resistance in caregivers of children with cerebral palsy (CP). This study aims to understand the attitudes and knowledge on gastrostomy care in caregivers of children with CP with or without a gastrostomy in place.
Methods: Caregivers of children with CP filled out an electronic questionnaire assessing their attitudes on gastrostomy placement and care. Questions of the survey were developed based on focus group interviews amongst pediatric gastro‐enterologists, neurologists and gastrostomy nurses.
Results: The survey was completed by 35 caregivers (73% already had a gastrostomy in place). The questionnaire revealed that placement of gastrostomy leads to emotional distress, parents reported fear (97%) and sadness (61%) as emotions associated with the idea of a gastrostomy. As potential benefits of gastrostomy, participants reported reduction of feeding‐related stress, easier administration of food and medication and improved growth. The main concerns reported regarding complications during and after gastrostomy placement were infection (82%), pain (51%) and tube dislodgement (52%). None of the participants rated the information provided by caregivers before placement of the gastrostomy as insufficient, with 72% choosing either ‘good’, ‘very good’ or ‘excellent’. In children with already a gastrostomy in place, 20% of the caregivers indicated that they were insufficiently informed about possible complications. When asked how they could be better informed and guided, 73% wanted more practice together with a specialized nurse, 61% wanted detailed information brochures and 74% chose explanation with video's.
Conclusions: Strong negative as well as positive emotions are reported amongst caregivers around placement of a gastrostomy. A larger and more international survey help clinicians to further understand caregiver's emotions around gastrostomies, which will help in improving pre‐ and post‐intervention counselling.
Contact e‐mail address: Liesbet.Verbrugghe@UZBrussel.be
N‐EV067. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV067.1. COST‐EFFECTIVENESS ANALYSIS OF PUBLIC HEALTH PROGRAMS TO THE TREAMENT OF COW'S MILK PROTEIN ALLERGY IN BRAZIL
Sarah Rodrigues, Jady Vidal, Bruno Oliveira, Erica Camargo, Matheus Luiz, Ana Claudia Grubba
DANONE BRAZIL, SAO PAULO, Brazil
Objectives and Study: To estimate the costs avoided with the implementation of public health programs to the access of extensively hydrolyzed formulas (EHF) for the treatment of cow's milk protein allergy (CMA) in children up to two years of age.
Methods: An economic decision tree model was used to compare the annual costs related to the access to EHF treatment. Costs included the management of adverse events (AEs), hospitalization days, acquisition of EHF, and litigation events, obtained from the Department of Informatics of the Unified Health System (DATASUS) (for the year 2022). Costs were analyzed at the population level and individual level from the perspective of the Ministry of Health (MH) and State Health Secretariats (SHS) in Brazil.
Results: The total estimated savings at the population level was BRZ 369.9 million (6,5 BRZ = 1 EUR) due to avoided costs of AEs and litigation (BRZ 3,699.82/patient). At the individual level, the savings were BRZ 8.489,24/year. The reduction in hospitalizations (734,499 days) and the number of cutaneous, respiratory, gastrointestinal, and anaphylactic shock AEs contributed to these results. The highest estimated savings were in São Paulo (BRZ 77.9 million) and the lowest in Roraima (BRZ 4.1 million). Other states with the largest annual cost reductions were Minas Gerais (BRZ 35.7 million) and Rio de Janeiro (BRZ 30.6 million). It was estimated that 331 additional patients would have access to EHF with a 90% reduction in litigation events.
Conclusions: The creation of programs to provide EHF by SHS would reduce the incidence and costs of litigation for access to treatment in children with CMA up to two years of age, in addition to reducing the costs of managing AEs, generating savings for the Brazilian Public Health System at both population and individual levels.
Contact e‐mail address:
N‐EV068. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV068.1. NUTRITIONAL STATUS AND GASTROINTESTINAL SYMPTOMS IN PEDIATRIC LEUKODYSTROPHY PATIENTS: AN OBSERVATIONAL STUDY
Sara Vizzuso 1, Carolina Todisco1, Giulia Fiore1,2, Giulia Poretti1, Francesca Eletti1,3, Davide Tonduti4,5, Ylenia Vaia6, Alessandra Bosetti7, Barbara Borsani6, Gian Vincenzo Zuccotti7,8, Elvira Verduci2,9
1Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy, Italy, 2Department Of Health Sciences, University of Milan, Milano, Italy, 3Department Of Biomedical And Clinical Science, University of Milan, Milan, Italy, 4Unit of Pediatric Neurology, C.O.A.L.A (Center for Diagnosis and Treatment of Leukodystrophies), V. Buzzi Children's Hospital, Milan, Italy., Milan, Italy, 5Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università degli Studi di Milano, Milan, Italy., Milan, Italy, 6Vittore Buzzi Children's Hospital Pediatric Neurology Unit Milan Italy., Milan, Italy, 7Department Of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy, 8Biomedical And Clinical Sciences, University of Milan, Milan, Italy, 9Unit Of Metabolic Disease, Ospedale dei Bambini Vittore Buzzi, Milano, Italy
Objectives and Study: Leukodystrophies are genetic disorders affecting the white matter of the central nervous system, characterized by the accumulation of various substances in the myelin sheath, leading to its degeneration. The age of onset and clinical presentation vary considerably. This study aims to evaluate the nutritional status and gastrointestinal symptoms of patients with leukodystrophy during their first referral to a tertiary care facility.
Methods: This observational study enrolled patients with leukodystrophies (1‐17 y), at first referral to the Buzzi Children's Hospital (May’20‐December’24). Patients underwent clinical evaluations, including detailed nutritional assessments, dietary history, and laboratory tests. Nutritional status was assessed using the standard deviation scores (SDS) of weight‐for‐height/BMI‐for‐age (wasting), height‐for‐age (stunting), and mid‐upper‐arm‐circumference (MUAC), triceps (TSF), and subscapular (SSF) skinfolds thicknesses.
Results: A total of 39 children (27 M, mean age 6.1 ± 4.6) were enrolled and categorized into subgroups: metachromatic leukodystrophy (G1), adrenoleukodystrophy (G2), thyroid leukodystrophies and others (G3‐4). A significant higher risk of stunting was observed in G1 compared to G2 (‐2.49 ± 1.0 vs ‐0.28 ± 1.3; p = 0.029). Similarly, in G2 there was a significant lower risk of wasting compared to G1 and G3_4 (‐2.74 ± 1.1 and ‐2.16 ± 2.3, vs 0.17 ± 0.8, p < 0.02). Regarding nutritional support, oral nutrition was preserved and only 8% were tube‐fed with enteral nutrition. Additionally, 23% received oral nutritional supplements. Overall, 9 (23%) presented epilepsy. Regarding GI symptoms, 14 children (35.9%) presented with gastroesophageal reflux disease (GERD), 19 children (48.7%) experienced constipation, and 19 (48.7%) had dysphagia. Other symptoms included vomiting (12.8%), retching (12.8%), loose stools (10.5%), and recurrent abdominal pain (2.5%).
Conclusions: Apart from adrenoleukodystrophy, all pediatric patients with leukodystrophy showed moderate‐to‐severe malnutrition, presenting with stunting, wasting, or both. Our study underscores the heterogeneity in growth impairment among different leukodystrophies, reinforcing the need for disease‐specific monitoring and tailored therapeutic approaches. The most frequent gastrointestinal symptoms observed were constipation and dysphagia, followed by GERD.
Contact e‐mail address:
N‐EV069. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV069.1. COMPLICATIONS OF USING PERCUTANEOUS GASTROSTOMY IN CHILDREN – 7‐YEAR EXPERIENCE OF A REFERENCE CENTER
Ivan Yankov, Ivelina Neicheva, Georgi Bukov, Dimitar Chatalbashev, Nikola Boyanov, Penka Stefanova, Danail Mitkovski, Stoyan Lupanov, Ivan Kirev, Biser Ivanov
Pediatrics, UMHAT Sveti Georgi, Plovdiv, Bulgaria
Objectives and Study: Nutritional status has significant importance for the overall health and quality of life of children with various chronic diseases. Enteral feeding methods allow for the maintenance of optimal nutritional status and minimize the negative effects of malnutrition.
Enteral feeding is a process of meeting the body's substrate needs for nutrients and energy, using the gastrointestinal tract via a specially introduced tube for specially prepared therapeutic foods.
A gastrostomy is an artificial opening for the prolonged delivery of nutrients. It is indicated not only for long‐term enteral feeding but also in certain clinical situations where gastrostomy is the only suitable method of feeding.
Methods: Retrospective research of medical files of patients with PEG. We assessed the complications as acute and chronic, grading the complications according the Clavien‐Dindo classification and type of complication.
Results: We enrolled 72 patients with PEG ‐ 41 (57,7 %) girls and 31 (42,4 %) boys. They underwent PEG placement from 2017 to 2024. According the Clavien‐Dindo classification we had distribution of patients as follows ‐ Grade I ‐ 18 (25,4 %), Grade II – 3 (4 %), Grade III – 4 (5,6 %), Grade IV ‐ 0, Grade V – 0. We found leakage in 2 children, Pneumoperitoneum with spontaneous resolution in 1 child, large‐amount pneumoperitoneum in 1 child, Buried Bumper Syndrome – 2 children, Fracture of PEG in 1 child, Spontaneous dislodgement of the internal disc in 1 child, Migration of the tube into the subcutaneous tissue in 1 child, Cellulitis in 3 children, postprocedural fever in 13 children.
Conclusions: Enteral nutrition aims to deliver nutritients through a device for gastric or enteral access to a partially or fully functioning GIT. Most complaints are more related to inconvenience and discomfort rather than procedure‐related complications. Serious complications can arise related to the placement of the PEG or the feeding process itself.
Contact e‐mail address: epediatrics@abv.bg
N‐EV070. Topic: AS03. NUTRITION/AS03b. Clinical Nutrition
N‐EV070.1. SAFETY AND TOLERABILITY OF MONOACYLGLYCEROL‐RICH OIL AS A NOVEL PREDIGESTED FAT SOURCE OF ENTERAL FORMULAS IN HEALTHY ADOLESCENTS AND ADULTS : A SINGLE‐ARM OPEN‐LABEL STUDY
Boutaina Zemrani 1, Laura‐Florina Krattinger2, Francesca Giuffrida3, John Corthésy3, Rinat Ran‐Ressler4, Jalil Benyacoub5
1Clinical Research And Development, Pediatric Nutrition, Société des Produits Nestlé, Vevey, Switzerland, 2Clinical Research Unit, Biostatistics, Société des Produits Nestlé, Lausanne, Switzerland, 3Nestlé Research, Nestlé Institute Of Food Safety And Analytical Sciences, Société des Produits Nestlé, Lausanne, Switzerland, 4Nutrition, Science & Technology, Nestle Product Technology Center, Société des Produits Nestlé, New Jersey, United States of America, 5Medical Affairs, Pediatric Medical Nutrition, Société des Produits Nestlé, Lausanne, Switzerland
Objectives and Study: Enteral formulas containing predigested lipids to support the needs of patients with fat maldigestion are currently unavailable. Monoacylglycerol (MAG)‐rich oils could offer potential benefits for fat absorption without prior digestion. We assessed the safety and tolerability of a new formula containing predigested lipids in the form of MAG‐rich oil.
Methods: In a single‐center open‐label clinical trial, two cohorts of healthy volunteers consisting of 12 adolescents (aged 12‐17 years) and 12 adults (aged >18 years) were recruited. Participants consumed an oral nutritional supplement containing MAG‐rich oil as the main lipid source three times daily for 2 weeks. Safety, tolerability, gastrointestinal symptoms, anthropometric, and blood parameters were assessed.
Results: All 24 participants completed the study without discontinuing the formula with good compliance. Median Visual Analogue Scale scores for gastrointestinal symptoms were low (average score 0.2 out of 10) in both groups, and the Gastrointestinal Symptom Rating Scale scores indicated no or minimal discomfort (average score 1 to 2 out of 7). Stool frequency and consistency remained within normal limits throughout the study. Serum triglyceride and cholesterol levels showed no clinically significant changes at the end of the study compared to baseline. The fatty acid profile and fat‐soluble vitamins showed a favorable trend at the end of the study. Adverse events were minor, and none were serious.
Conclusions: The new formula containing MAG‐rich oil was safe and well tolerated in healthy adolescents and adults. This formula could potentially address a gap in the nutritional management of patients with exocrine pancreatic insufficiency and fat maldigestion. Further studies are required to assess the efficacy of this new formula in the target population.
Contact e‐mail address: Boutaina.Zemrani@nestle.com
N‐EV071. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV071.1. SINGLE‐CENTRE EXPERIENCE OF PATIENTS JOURNEY IN NEURODISABLED FEEDING CLINIC
Ban Alkaaby 1, Navvya Girdhar2, Elizabeth Renji3, Manjula Nair3, Siobhan Mcmahon4, Alice Sutton5, Jeng Haw Cheng3
1Gastroenterology, Alderhey Children Hospital/Liverpool/NW, Liverpool, United Kingdom, 2University of Central Lancashire, Preston, United Kingdom, 3Gastroenterology, Alderhey Children Trust/Liverpool/NW, Liverpool, United Kingdom, 4Senior Speach And Language Therapist, Alderhey Children Trust/Liverpool/NW, Liverpool, United Kingdom, 5Senior Dietician, Alderhey Children Trust/Liverpool/NW, Liverpool, United Kingdom
Objectives and Study: This study aims to improve understanding of patients referred to the neuro‐disability feeding clinic (NDFC) at a tertiary pediatric center, focusing on waiting times for the iniatial evaluations and the insertion of Percutaneous Endoscopic Gastrostomy (PEG) tubes.
Methods: The electronic medical records of thirty‐three patients who attended the NDFC from May 2023 to June 2024 were reviewed. Demographic data, feeding history, medical background, and wait time from referral to first clinic visit. Furthermore, the clinic's outcomes regarding the necessity for gastrostomy insertion and the waiting period from the decision for placement to the actual insertion of the PEG tube.
Results: A total of 33 patients were identified, with ages varying from 7 months to 15.7 years. Notably, 67% (n = 22) of the patients were under 5 years old, with 54% (n = 12) between the ages of 1 and 2. Nearly half of the patients (45% or n = 15) had a complex neurological diagnosis, and 30% (n = 10) were preterm births. Symptoms such as vomiting, and weight loss were reported in 54% (n = 18) of the patients while feeding difficulties were experienced by 45% (n = 15). Regarding the waiting time, 36% (n = 12) of the patients were seen in the NDFC within 3 months, by 6 months, 80% had been evaluated. Among the 33 patients, 75% (n = 25) required PEG insertion. The majority, 54% (n = 18), had their gastrostomy placed endoscopically, and 21% (n = 7) underwent laparoscopic procedures due to severe scoliosis or previous abdominal surgeries. Remarkably, of those who needed PEG placement via endoscopy (n = 18), 61% (n = 11) received the procedure within 3 months, and by 6 months 94% had successfully undergone the placement. This highlights the proactive measures taken to support patient needs effectively.
Conclusions: This study emphasizes the importance of a multidisciplinary approach in addressing feeding difficulties in children with neuro‐disabilities. Early referrals and scheduled PEG insertions can improve patient management and outcomes.
Contact e‐mail address: banalkaaby@gmail.com
N‐EV072. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV072.1. PREVALENCE OF AT‐RISK‐OF ANEMIA AMONG CHILDREN AGED 6‐59 MONTHS IN CAMBODIA, 2024: A HOSPITAL‐BASED CROSS‐SECTIONAL STUDY
Kim Ang 1, Angkeabos Nhip1, Soklim Pay1, Samnang Um2, Patricia Logtens‐De Graaff3, Gechhorng Lim3, Thida Kun3, Michelle Hoi3, Angie Low3
1National Pediatric Hospital, Phnom Penh, Cambodia, 2Center For Health Research And Policy Support, National Insitute of Public Health, Phnom Penh, Cambodia, 3Nutrition, Danone Specialized Nutrition Sdn Bhd, Phnom Pneh, Cambodia
Objectives and Study: Childhood anemia is a major global public health concern in Cambodia, where in 2019, 49% of children aged 6‐59 months were affected, contributing to 2.9% of deaths. Non‐invasive screening assessments enable early detection and prompt treatment of anemia. However, the evidence on the use of such screening assessments is limited. The aim of the study is to assess the prevalence and factors associated with being at risk of anemia among Cambodian children outpatients aged 6‐59 months using non‐invasive total hemoglobin (SpHb), Masimo Rad‐67®
Methods: This was a cross‐sectional study of 1,560 outpatient Cambodian children aged 6‐59 months who were randomly selected from seven provincial and national hospitals from July to August 2024. The risk of anemia was assessed by (SpHb), with a cutoff value set at < 12.5 g/dL for children aged 6‐23 months and <13 g/dL for children aged 24‐59 months. Chi‐square test and multiple logistic regression with stepwise forward selection were used to identify factors associated with being at risk of anemia.
Results: 51.9% of the children were male, and 32.3% were under 24 months. The mean SpHb level was 13.09 g/dL (SD ± 1.20 g/dL), with 39.2% of children at risk of anemia (95% CI: 36.8‐41.6). 21.2% of children were stunted, 11.2% were wasted, 12.0% were underweight, and 3.3% were overweight. Caregivers aged 25 and above who completed university education and children aged 12‐23 months remained significantly associated with lower odds of being atrisk of anemia. Conversely, female children, children born via vaginal delivery, children who had stopped feeding (only pure water), and underweight children were associated with higher odds of being at risk for anemia.
Conclusions: Expanding the use of non‐invasive screening tools like the Masimo Rad‐67 in routine health checks, particularly in rural and underserved areas, could improve early detection and management of anemia.
Contact e‐mail address: Thida.KUN@danone.com
N‐EV073. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV073.1. OUTCOMES WITH PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) FEEDING FROM A PAEDIATRIC NEUROMEDICAL FEEDING CLINIC (NMFC): TWO YEAR SINGLE‐CENTRE EXPERIENCE
Abishek Arul Sothy 1, Ban Alkaaby2, Shanath Ramachandran2, Emma Jones2, Helen Garrett2, Manjula Nair2, Jeng Haw Cheng2, Elizabeth Renji2
1Alder Hey Children's Hospital, Liverpool, United Kingdom, 2Gastroenterology, Alderhey Children Trust/Liverpool/NW, Liverpool, United Kingdom
Objectives and Study: Children with Neurodisability (ND) experience unsafe oral motor function, reflux esophagitis and feed intolerance; this results in malnutrition. PEG feeding is widely recommended to manage malnutrition. This study reports weight outcomes in patients following PEG insertion; the impact of feed type and method of delivery alongside pharmacological and surgical (jejunal feeds) interventions are also reported.
Methods: A retrospective review of patients attending the NMFC at our tertiary centre from January 2022 to December 2023. We reported outcomes in those who underwent PEG insertion by measuring weight centiles 3‐6 months after PEG insertion, feed type and method of feeding. We reported the impact of pharmacological strategies implemented to improve feed tolerance. These methods of nutritional assessment were compared against the 2019 ESPGHAN guidelines for nutritional management in children with neurodisablity.
Results: 60 patients attended the NMFC: With genetic ND in 50%, and birth injury ND in 45%. PEGs used in 85% (n = 51). PEGs had already been inserted in 21.7% (n = 13) whilst 63.3% (n = 38) underwent PEG insertion following review. For previously inserted PEGs, unsafe swallow was main indication, 53% (n = 7). For PEGs post review, NG tube dependence (47.4%, n = 18) was leading, followed by unsafe swallow (36.8%, n = 14). Most patients (56.9%, n = 29) were exclusively PEG‐fed with standard feeds (78.4%, n = 40). Weight centiles improved in 45.1% (n = 23), 45.1% (n = 23) had decreased or static weight centiles. 66.7% (n = 34) tolerated bolus feeds, whilst anti‐acid medication used in 31.4% (n = 16), followed by prokinetics in 21.6% (n = 11). 6 patients transitioned to jejunal feeds.
Conclusions: Our approach to PEG feeding aligned with the 2019 ESPGHAN recommendations. PEG feeds helped attain sufficient weight gain, amalgamated with pharmacological adjuvants and adjusting feeding method (pump/bolus). We recommend studying the weight outcomes in our PEG‐J patients to develop our findings further.
Contact e‐mail address: abishek1910@gmail.com
N‐EV074. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV074.1. INVESTIGATING THE DIFFERENT FEEDING DIFFICULTIES EXPERIENCED BY PRIMARY CAREGIVERS OF SCHOOL‐AGE CHILDREN WITH AUTISM SPECTRUM DISORDER AND ITS POSSIBLE IMPLICATIONS TO THE CHILDREN'S NUTRITIONAL STATUS
Melvin Bernardino, Krizzia Anne Calimoso, Karylle Cabezas, Jeanne Carla Bruce
Nutrition And Dietetics Area, Colegio de San Juan de Letran Manila, Manila, Philippines
Objectives and Study: Autism Spectrum Disorder affects one out of every 36 children worldwide. According to a Department of Education research published in 2022, the prevalence of autism in children is 81.8% per 10,000, which is a major public health concern. Children with ASD often show atypical eating behaviors, making them nutritionally vulnerable. The study investigated the feeding and mealtime problems and its correlation with the nutritional status and diet quality in school‐age children (6 to 12 years old) with ASD.
Methods: The primary caregivers were given the Brief Autistic Mealtime Behavior Inventory (BAMBI) which measures the perceived feeding difficulties, the Individual Dietary Diversity Score (IDDS) which assesses dietary intake, and a 3‐day non‐consecutive food recall questionnaire. The nutritional status of the children was determined by their height and weight, which were measured and assessed using World Health Organization (WHO) cut‐offs.
Results: Majority (94.90%) of the participants exhibited feeding and mealtime problems such as food selectivity, food jags, food patterns (positive/negative), food rejection, and portion control. Most of the participants (50.96%) are obese followed by overweight (15.29%). 96.82% reported more frequent intakes of cereals and products, 88.54% consumed flesh meats and products, and 86.62% consumed sweets. Notably less frequent intakes of green leafy vegetables (49.04%), other vegetables (36.31%), and legumes, nuts, and seeds (35.67%) were reported. The results of the bi‐variate correlation reported no significant correlation between BAMBI scores and BMI‐for‐age (p = 0.482), as well as between BAMBI scores and IDDS (p = 0.471).
Conclusions: More comprehensive research is needed on energy and nutrient intake, the effect of caregiver or parental management of feeding challenges, and other factors influencing the health of children with ASD. Nutrition education programs should be tailored for children with ASD to improve their nutritional status and diet quality.
Contact e‐mail address: krizziaanne.calimoso@letran.edu.ph
N‐EV075. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV075.1. DIAGNOSTIC ACCURACY OF CLINICAL SIGNS AND CLINICAL DEHYDRATION SCALE IN PREDICTING DEHYDRATION IN CHILDREN WITH ACUTE MALNUTRITION ‐A PROSPECTIVE COHORT STUDY
Nisha Bhardwaj, Praveen Kumar, Anju Seth, Srikanta Basu
Department Of Pediatrics, Lady Hardinge Medical College, New Delhi, Delhi, India
Objectives and Study: I Objective: To determine diagnostic accuracy of clinical signs in assessing dehydration in children with wasting and to compare accuracy of clinical dehydration scale (CDS) with DHAKA score and IMNCI.
Methods: In this prospective cohort study, 94 children aged 2‐59 months with acute diarrhea and wasting were evaluated for clinical signs of dehydration. The study was registered at ClinicalTrials.gov (CTRI/2023/01/049244) and approved by IEC. Subjects were weighed at admission and every 4 hours till they had stable weight and percentage dehydration was calculated. Sensitivity, specificity, positive predictive value & negative predictive value for each clinical sign were calculated
Results: We found that general appearance had best sensitivity (83.7%) followed by sunken eyes (81.4%), mucous membrane dryness (80%), reduced tears (79.07%) & thirst (76.74%) while radial pulse had maximum specificity (100%) followed by deep breathing (100%), and heart rate (94.1%) & skin pinch (56%). The study revealed that skin pinch (p = 0.033), sunken eyes (p = 0.029) and reduced tears (p = 0.008) have best accuracy when combined sensitivity and specificity is used. ROC analysis along with Youden index was used to estimate the cut off values of Clinical dehydration scale and DHAKA scale to predict dehydration. From the ROC analysis the value of >2 was identified as the cut off value for both the scales in predicting dehydration. When comparing the Area under the curve (AUC), Clinical dehydration scale had a better AUC (AUC = 0.636, p = 0.017) compared to DHAKA scale (AUC = 0.625, p = 0.029) and IMNCI (AUC = 0.589, p = 0.1005) though the difference between two scales was not statistically significant (z = 0.315, p = 0.753).
Conclusions: We noted that no single clinical sign exhibited perfect accuracy, emphasizing the importance of using a combination of clinical signs in classifying dehydration. Our results reinforce current recommendation of slowly & carefully rehydrating a dehydrated malnourished child with a close look at the vitals throughout the rehydration process.
Contact e‐mail address: pkpaed@gmail.com
N‐EV076. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV076.1. MAINTENANCE CHEMOTHERAPY FOLLOWING NEUROSURGERY, INTENSE CHEMOTHERAPY AND CRANIO‐SPINAL IRRADIATION CARRIES THE HIGHEST RISK OF NUTRITIONAL DETERIORATION IN PEDIATRIC MEDULLOBLASTOMA PATIENTS – A RETROSPECTIVE STUDY
Agnieszka Budka‐Chrzęszczyk 1, Małgorzata Styczewska2, Agnieszka Szlagatys‐Sidorkiewicz1, Michał Brzeziński1, Małgorzata Krawczyk2, Ewa Bień2
1Department Of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University Of Gdańsk, Medical University of Gdańsk, Gdańsk, Poland, 2Department Of Pediatrics, Hematology And Oncology, Medical University of Gdańsk, Gdańsk, Poland
Objectives and Study: Medulloblastoma (MB) is the most common malignant brain tumor in children, requiring intense, multimodal therapy. Patients treated for MB are at risk for undernutrition. The study aimed to assess the patients’ nutritional status (NS) before and multiply during treatment, and to determine which phase of MB therapy carried the highest risk of undernutrition.
Methods: The clinical data of patients with MB treated in one pediatric oncology center between X’2015 and XII’2022 were analyzed retrospectively. Inclusion criteria comprised: age >3 < 18 years at diagnosis, no previous oncological treatments, and >80% of the chemotherapy (CHT) courses administered in our center. The treatment protocol included neurosurgery, induction CHT (CHT‐I), cranio‐spinal irradiation (CSI), and maintenance CHT (CHT‐M). The patient's NS was assessed based on body weight, height, and BMI, compared to Polish population norms.
Results: Nine of 14 patients with MB treated in our center during analyzed period met the inclusion criteria. Six (66,7%) patients were assigned to standard and 3 (33,3%) to high‐risk treatment group. During therapy, all patients experienced decrease in BMI standard deviation (SD) (median: ‐1.07) and eight of nine experienced decreases in height SD (median: ‐0.55). Patients treated with photon CSI experienced nutritional deterioration compared to patients treated with proton CSI (median difference in BMI SD during CSI: ‐0.81 vs +0.16). The most prominent NS deterioration was noted during CHT‐M (median decrease of BMI SD: ‐1.18). Zero and 5 patients met the criteria for undernutrition at diagnosis and at the end of the observation, respectively.
Conclusions: All phases of MB treatment predispose to undernutrition; however, the peak deterioration occurs during CH‐M. Identifying critical time points for the development of malnutrition during MB treatment may enable proactive nutritional intervention. This, in consequence, may result in improvement of the oncological outcomes, tolerance of treatment and the patients’ quality of life.
Contact e‐mail address:
N‐EV077. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV077.1. PREVAILING FACTORS OF COMPLICATED SAM AND ITS OUTCOME‐ ONE YEAR PROSPECTIVE STUDY IN A TERTIARY CARE HOSPITAL IN SOUTHERN ASSAM
Pinaki Chakraborty, Veeranna Chikkamath
Pediatrics, Silchar Medical College, Silchar, India
Objectives and Study: Severe Acute Malnutrition (SAM) remains a significant contributor to child morbidity and mortality in developing countries. This one‐year Prospective observational study conducted at a tertiary care hospital in Southern Assam aimed to identify the prevailing factors associated with complicated SAM and evaluate the outcomes of the affected children.
Methods: This study was conducted for 1 year from November 2023‐2024, enrolling children aged 6 months to 5 years diagnosed with SAM (WHO criteria) and presenting with complications such as infections, gastroenteritis, electrolyte imbalances, and organ dysfunction. Detailed clinical, demographic, and socio‐economic data were collected and analyzed to determine the contributing factors. Nutritional rehabilitation and medical interventions were provided, and outcomes were assessed in terms of recovery rates and mortality.
Results: Key findings revealed that low socio‐economic status, early child bearing primi(mean 19 yr) Low birth weight (mean 2.17 kg) and delayed healthcare‐seeking behaviour were significant contributors to complicated SAM. 80% cases were below 2 yrs of age with no Gender bias. Persistent diarrhea, Recurrent respiratory tract infections and Comorbidities like diagnosed Cerebral Palsy, Congenital Heart Disease, children living with HIV/AIDS and nutritional anemia added to the burden. Failure of Early initiation and Exclusive breastfeeding till 6months were absent in most. Complementary feeding was faulty in more than 80% of the children. Less than 10% were fully immunized as per age. Pneumonia and diarrhea were the most common complications. The mortality rate among the hospitalized cases of complicated SAM (79) was remarkably 15 %.
Conclusions: This study underscores the urgent need for integrated healthcare strategies of universal immunization, prevention of early marriage and educating the girl child and emphasizing need of exclusive breastfeeding and nutritional counselling. Focusing on the early growth faltering and prevention of SAM through community based healthcare strategy is the key. Timely treatment and referral of complicated SAM will help to reduce morbidity and mortality.
Contact e‐mail address: pinaki02@gmail.com
N‐EV078. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV078.1. IRON FORTIFIED GROWING UP MILK SUPPLEMENTATION EFFECTIVELY FULFILLED THE REQUIREMENTS OF DAILY IRON INTAKE IN CHILDREN AGED 1‐3 YEARS OLD
Dian Novita Chandra 1,2, Juwalita Surapsari1, Mia Puspita Ratih1, Aprilia Herawati1, Monica Prawari1, Tonny Sundjaja3, Charisma Dilantika4, Ray Basrowi5
1Indonesian Nutrition Association, DKI Jakarta, Indonesia, 2Department Of Nutrition, Faculty of Medicine Universitas Indonesia – dr. Cipto Mangunkusumo General Hospital, DKI Jakarta, Indonesia, 3Department Of Epidemiology, Faculty of Public Health, Universitas Indonesia, DKI Jakarta, Indonesia, 4Danone Specialized Nutrition, DKI Jakarta, Indonesia, 5Department Of Of Community Medicine, Faculty of Medicine Universitas Indonesia, DKI Jakarta, Indonesia
Objectives and Study: This clustered randomized controlled trial aimed to improve growth and reduce anemia in children aged 1–3 years by increasing their iron intake.
Methods: This study was conducted at Jatinegara District Health Centre, Jakarta, Indonesia, from October 2022 to June 2023. We randomized 177 children with iron intake less than 80% of the Indonesian Recommended Dietary Allowance at baseline. The intervention and control groups (82 and 95 children) received basic nutrition education through flyers about infant and young child feeding practices. Additionally, the intervention group received daily iron‐fortified growing‐up‐milk (GUM) for four months. Children's height, weight, dietary intake, and SpHb levels were measured at beginning and end of study. Various statistical tests were used to compare the results between both groups, including multivariate models due to cluster randomization, considering a p‐value < 0.05 as significant.
Results: No differences in socio‐demographics, except that parents in the intervention group were significantly older. Baseline food intake, anthropometric and anemia indicators were equal between groups. After four months, 82.9% of children in the intervention group met their daily iron intake requirements, compared to 12.6% in the control group. The intervention group had a higher mean iron intake (4.02 mg/day) and 57.45% increase in iron intake adequacy compared with control group (p < 0.001), even after adjusting for parental age. However, there were no significant differences in height and weight changes between groups. Hemoglobin levels were significantly higher in intervention group at the end of study (p = 0.015), but anemia risk was not significantly reduced. The only notable difference in food intake was an increase in dairy consumption in intervention group due to GUM supplementation.
Conclusions: Iron‐fortified GUM supplementation effectively improved iron intake adequacy in children aged 1–3 years. This approach can contribute to reducing iron deficiency and improving child health outcomes in Indonesia
Contact e‐mail address: dian.chandra@ui.ac.id
N‐EV079. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV079.1. DESCRIPTION OF PATIENTS WITH EATING DISORDERS IN EARLY CHILDHOOD AT AN INTERDISCIPLINARY UNIT
Marianna Di Campli Zaghlul 1, Carmen Martín Fernández2, Agustín De La Mano Hernández2, Elvira Cañedo Villaroya2, Marta Velasco Rodríguez‐Belvis2, Laura Palomino2, Jorge Martín Pérez2, Gloria Domínguez‐Ortega3, Nuria Puente Ubierna1, Amalio Fernández Leal1, Ana Martin Adrados1, Sara Arozamena Aguayo2, Rosa Ana Muñoz Codoceo2
1Hospital Infantil Niño Jesús, Madrid, Spain, 2Pediatric Nutrition, Hospital Infantil Niño Jesús, Madrid, Spain, 3Hospital Universitario Niño Jesús, Madrid, Spain
Objectives and Study: Eating disorders (ED) in early childhood are a common reason for pediatric consultation. This study aims to describe the characteristics of children seeking care for EDs at a specialized unit composed of pediatricians, speech therapists, clinical psychologists, and occupational therapists in a tertiary hospital.
Methods: A single‐center, descriptive, observational, and retrospective study was conducted on patients with ED who consulted at our center between 2019 and 2023 (all included). Statistical analysis was performed using SPSS.
Results: The study included 601 patients, with a mean age of 2.4 ± 1.4 years. Referrals were made by primary care (40.8%), other hospital services (30.1%), and other hospitals (29.1%). The average time from referral to assessment was 1.4 months ± 1 month. 39% of patients had no underlying pathology, while 61% had comorbidities, such as neurological disorders (16.8%), autism spectrum disorder (12.3%), gastrointestinal disorders (8%), and others. ED types included restrictive (41.6%), mixed anorexic‐restrictive (25.8%), anorexic (15.3%), and phobic‐avoidant (7%). Anthropometric data showed a mean BMI standard deviation of 0.49 ± 1.24, weight ‐0.77 ± 1.19, and height ‐0.9 ± 1.35. External feeding devices (EFD) were used by 158 patients: 70 with nasogastric tubes, 45 with gastrostomies, and 2 with nasojejunal tubes. Of these, 47 required device changes, with a mean interval of 7.6 ± 5.1 months. No major complications were reported. Cyproheptadine was prescribed to 150 patients, showing a 76% positive response. Laboratory abnormalities were found in 204 patients, with iron deficiency (105) and vitamin D deficiency (100) being the most common. 90% of patients and families reported an improvement in quality of life after follow‐up.
Conclusions: The majority of ED patients had comorbidities, especially neurological disorders. The most common ED type was restrictive. Interdisciplinary management significantly improved patients quality of life.
Contact e‐mail address: mariannadicampliz@gmail.com
N‐EV080. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV080.1. COMPARISON OF SLOW VS. FAST ENTERAL NUTRITION IN ADOLESCENT PATIENTS WITH ANOREXIA NERVOSA: A RETROSPECTIVE ANALYSIS OF CLINICAL OUTCOMES
Gabriele Avino1, Eleonora Maurel2, Francesca Bravin3, Chiara Zanchi2, Grazia Di Leo 2
1Uo Pediatria Universitaria, Azienda Ospedaliero Universitaria Pisana, University Of Pisa, pisa, Italy, 2Institute for Maternal and Child Health‐IRCSS Burlo Garofolo, Trieste, Italy, 3Uo Pediatria Universitaria, Azienda Ospedaliero Universitaria Pisana, scuola di specializzazione in pediatria, pisa, Italy
Objectives and Study: Anorexia nervosa (AN) is a severe eating disorder with high morbidity and hospitalization risk, especially when complicated by extreme malnutrition. Clinicians face challenges in selecting the most effective nutritional approach for hospitalized AN patients, balancing the risk of refeeding syndrome and underfeeding syndrome. Currently, there is no consensus on the optimal rate of enteral nutrition (EN), with clinical practices varying between slow (S‐EN) and fast (F‐EN) protocols, depending on the time required to achieve the target caloric intake. The aim of this study was to compare these two approaches in terms of hospitalization and EN feeding duration, weight restoration efficiency, and patient outcomes.
Methods: The retrospective study included 14 adolescent AN patients requiring EN during hospitalization. Patients were categorized into S‐EN and F‐EN groups based on their refeeding protocol. Primary outcomes included hospital stay and EN duration. Secondary outcomes included weekly BMI increase, subsequent hospitalizations within six months, and electrolyte imbalances sign of refeeding syndrome. Statistical analysis included t‐tests for independent samples, with a significance threshold of p < 0.05.
Results:
| F‐EN (mean ± SD) | S‐EN (mean ± SD) | p value | |
|---|---|---|---|
| Age (years) | 11.4 | 14.6 | |
| BMI at hospitalisation (kg/m2) | ‐2.10 ± 0.48 | ‐3.19 ± 1.39 | 0.12 |
| Hospitalisation duration (days) | 61.4 ± 12.3 | 89.2 ± 14.8 | 0.01 |
| EN duration (days) | 54.3 ± 17 | 95.7 ± 26.1 | <0.05 |
| Weekly BMI increase (kg/m2) | 0.21 ± 0.05 | 0.12 ± 0.04 | 0.003 |
| New hospitalisation (%) | 14.3 | 42.9 | 0.04 |
No patients developed clinically significant refeeding syndrome; minor electrolyte imbalances occurred in 2 F‐EN and 3 S‐EN patients, all promptly corrected without complications (p = 0.58, not significant).
Conclusions: F‐EN protocol appears more effective in reducing hospital stay and improving weight restoration without increasing metabolic risks. The lower rate of subsequent hospitalizations suggests potential long‐term benefits. However, prospective trials are needed to confirm these findings and optimize enteral nutrition protocols for AN patients.
Contact e‐mail address:
N‐EV081. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV081.1. MAIN CLINICAL MANIFESTATIONS AND ANALYSIS DISORDERS OF ICHTHYOSIS DISEASE DURING CHILDHOOD
Amalio Fernández Leal 1, Ana Martin Adrados2, Marianna Di Campli Zaghlul1, Carmen Martín Fernández3, Sara Arozamena Aguayo3, David Cabañas Moreno1, Elvira Cañedo Villaroya3, Agustín De La Mano Hernández3, Marta Velasco Rodríguez‐Belvis3, Laura Palomino3, Jorge Martín Pérez3, Gloria Domínguez‐Ortega4, Rosa Ana Muñoz Codoceo3, Ángela Hernández Martín1
1Hospital Infantil Niño Jesús, Madrid, Spain, 2Hospital Fundación Alcorcón, Madrid, Spain, 3Pediatric Nutrition, Hospital Infantil Niño Jesús, Madrid, Spain, 4Hospital Universitario Niño Jesús, Madrid, Spain
Objectives and Study: Ichthyosis is a group of genetic keratinization disorders characterized by excessive hyperkeratosis, which is produced by hyperproliferative epidermis and cellular retention. Apart from the correct early diagnosis and treatment, it is important to analyze micronutrients disorders and control nutritional status to avoid deficiencies. The study aims to describe the main clinical manifestations, analysis disorders and treatment on ichthyosis patients
Methods: Single‐center, observational, descriptive and retrospective study of 98 patients, which were diagnosticated of ichthyosis disease and included in a multidisciplinary unit. Information on clinical data, laboratory results, treatment and micronutrients supplementation was collected for analysis of the prevalence. Data were analyzed with SPSS software(v.29.0.2.0).
Results: A total of 98 patients were treated in a Multidisciplinary Ichthyosis Unit. The average age of diagnosis was 0,81 (0‐1,96) years. 58,2% were male and 42,8% female. The main clinical manifestations, apart from cutaneous ones, were ophthalmic pathology (62,2%) as blepharitis, keratitis or ectropion; otic disease (40,8%) as conductive deafness; alopecia (23,5%), onychodystrophy (11,2%) and teeth dystrophy (4,1%). Statistically significant diferencies were observed between males and females in all except for onychodystrophy and teeth dystrophy. 40,8% of patients were born as baby collodion, more frequently in females (p:<0,01). During the assessment, 90 patients got blood analysis. The micronutrients disorders were deficiency of vitamin‐D (57,8%) associated to secondary hyperparathyroidism (6,7%), deficiency of selenium (22,2%), low iron deposits (14,4%), deficiency of zinc (11,1%) and deficiency of vitamin‐A (4,4%). Every deficiency was supplemented in diagnosis. 66,3% of patients only received topic treatment and 33,7% of them were also given oral treatment (acitretin or subcutaneous biologics).
Conclusions: Our study suggests that comorbidities in ichthyosis are common, so it is important to be part of multidisciplinary units to provide a correct assessment. The main micronutrients disorder is deficiency of vitamin‐D. Therefore, the early diagnosis and supplementation of deficiencies could be satisfactory in these patients.
Contact e‐mail address: amalioafernandez@gmail.com
N‐EV082. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV082.1. VITAMIN D DEFICIENCY ASSOCIATED TO ICHTHYOSIS DISEASE DURING CHILDHOOD
Amalio Fernández Leal 1, Ana Martin Adrados2, Carmen Martín Fernández3, Marianna Di Campli Zaghlul1, Sara Arozamena Aguayo3, Elvira Cañedo Villaroya3, Agustín De La Mano Hernández3, David Cabañas Moreno1, Marta Velasco Rodríguez‐Belvis3, Laura Palomino3, Jorge Martín Pérez3, Gloria Domínguez‐Ortega4, Rosa Ana Muñoz Codoceo3, Ángela Hernández Martín1
1Hospital Infantil Niño Jesús, Madrid, Spain, 2Hospital Fundación Alcorcón, Alcorcon, Spain, 3Pediatric Nutrition, Hospital Infantil Niño Jesús, Madrid, Spain, 4Hospital Universitario Niño Jesús, Madrid, Spain
Objectives and Study: Severe vitamin‐D deficiency and rickets are highly prevalent among children with ichthyosis disease. In these patients the epidermis thickness is even 10 fold greater than normal ones. That is why the photoactivation of 7‐dehydrocholesterol is impaired, causing the vitamin‐D deficiency. Literature describes even more deficiencies associated with some specific ichthyosis types. The study aims to describe the principal ichthyosis types and correlate the vitamin‐D deficiency with each one.
Methods: Single‐center, observational, descriptive and retrospective study of 98 patients, which were diagnosticated of ichthyosis disease and included in a multidisciplinary unit. Information on clinical data, laboratory results and micronutrients supplementation was collected for analysis. Data were analyzed with SPSS software (v.29.0.2.0).
Results: A total of 98 patients were treated in a Multidisciplinary Unit. The average age of diagnosis was 0,81(0‐1,96) years. 58,2% were male and 42,8% female. Most common types were: autosomal recessive congenital ichthyosis (ARCI) in 44,9%, X‐linked ichthyosis (XLI) in 18,4%, epidermolytic ichthyosis (EI) in 14,3%, Netherton syndrome (NS) in 6,1% and Confetti ichthyosis (CI) in 4,1%. Genetic analysis was studied in all patients with statistically significant differencies (p < 0,001). XLI is typical in males and ARCI in females. The prevalence of deficiency of vitamin‐D was 57,8%(p:0.09) associated with secondary hyperparathyroidism in 6,7%. CI required vitamin‐D supplementation in 100% of patients, EI in 71,4%, ARCI in 58,1%, NS in 50% and XLI in 35,3%, although not statistically significant. However, other deficiencies such as selenium or zinc deficiency were associated commonly with ARCI (p:0,03).
Conclusions: Our study suggests that vitamin‐D deficiency is higher in ichthyosis patients (57,8%). There are some types which have more risk of getting low levels such as EI or ARCI. Blood analysis is necessary for early diagnosis. The role of vitamin‐D in improving clinical manifestations requires more prospective studies.
Contact e‐mail address: amalioafernandez@gmail.com
N‐EV083. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV083.1. EFFECT OF EARTHQUAKE ON CHILDREN: MALNUTRITION
Sukru Gungor1, Ahmet Baştürk2, Emre Gok 1, Fatma Varol1, Melike Arslan3, Mahmut Tuluce4, Dogan Barut5, Senay Kenc6, Uğur Deveci7, Demet Teker Duztas4, Didem Gülcü Taşkın8, Mehmet Agin9, Halil Kocamaz10, Emine Kocamaz11, Yaşar Doğan7, Omer Beser12, Fügen Çullu Çokuğraş13
1Pediatric Gastroenterology, Hepatology And Nutrition, Inonu University, Malatya, Turkey, 2Pediatric Gastroenterology, Hepatoloji And Nutrition, Gaziantep University, Gaziantep, Turkey, 3Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Kahramanmaras State Hospital, Kahramanmaras State Hospital, Turkey, 4Pediatric Gastroenterology, Hepatology And Nutrition, Şanlıurfa Training and Research Hospital, Sanliurfa, Turkey, 5Pediatric Gastroenterology, Hepatology And Nutrition, Adıyaman Training and Research Hospital, Adıyaman, Turkey, 6Pediatric Gastroenterology, Hepatology And Nutrition, Malatya Training and Research Hospital, Malatya, Turkey, 7Pediatric Gastroenterology, Hepatology And Nutrition, Fırat University, Elazığ, Turkey, 8Pediatric Gastroenterology‐hepatology And Nutrition, Adana City Hospital, Adana, Turkey, 9Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey, 10Pediatric Gastroenterology, Hepatology And Nutrition, Diyarbakır Dicle University Hospital, Diyarbakır, Turkey, 11Pediatric Gastroenterology, Hepatology And Nutrition, Hatay Training and Research Hospital, Hatay, Turkey, 12Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 13Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Demiroglu Bilim University, Faculty of Medicine, Istanbul, Turkey
Objectives and Study: This study aimed to determine the frequency and risk factors of malnutrition in children after the major earthquake in Turkey. It aims to raise awareness and contribute to taking necessary precautions by revealing the effects of the earthquake on child nutrition and growth.
Methods: In this study, anthropometric measurements and demographic data of children aged 1 month to 18 years attending pediatric gastroenterology clinics in 9 provinces and 11 earthquake‐affected centers were reviewed. Malnutrition status was assessed and risk factors were analyzed.
Results: These results are the interim results of our study. They include data from a total of 1001 patients. Malnutrition was detected in 507(50.7%) patients. The mean age was lower in patients with malnutrition (p < 0.001). Malnutrition was more prevalent in those who moved after the earthquake (p:0.002). The rate of malnutrition was higher among those living in tents or containers outside their homes (p < 0.001). The education level of the mother and father was lower in patients with malnutrition (p:0.001, p:0.015, respectively). Of these patients, 252(25.2%) had mild malnutrition, 200(20%) had moderate malnutrition, and 55(5.5%) had severe malnutrition. Acute malnutrition was present in 17.8%, acute‐chronic malnutrition in 10.7%, and chronic malnutrition in 22.2% patients. The prevalence of chronic malnutrition was higher in children aged 5‐18 years (12%). The incidence of malnutrition was higher after the earthquake (23.5% and 50.7%, respectively, p < 0.001). We found that the earthquake increased the risk of malnutrition about 3‐fold and living in a tent or container about 4‐fold.
Conclusions: Our research has shown the serious impact of natural disasters such as earthquakes on children's nutrition and growth. We believe that early diagnosis and treatment of malnutrition is important and that public awareness should be increased. New monitoring programs should be developed to facilitate regular monitoring of children's nutrition and growth after natural disasters.
Contact e‐mail address: sukru.gungor@yahoo.com
N‐EV084. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV084.1. IRON DEFICIENCY ANAEMIA SCREENING AND MANAGEMENT IN YOUNG CHILDREN: INDIA AND SOUTHEAST ASIA CONSENSUS
Muhammad Yazid Jalaludin 1, Hamid Jan Jan Mohamed2, Sri Wahyu Taher3, Ang Kim4, Lam Pechkethia5, Suchaorn Saengnipanthkul6, Ketkesone Phrasisombath7, Alongkone Phengsavanh8, Reeta Bora9, Sunil Kumar Agarwalla10
1Faculty Of Medicine, University of Malaya, Kuala Lumpur, Malaysia, 2Nutrition Programme, School Of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia, 3Klinik Kesihatan Simpang Kuala, Kedah, Malaysia, 4National Pediatric Hospital, Phnom Penh, Cambodia, 5Department Of Hematology, National Paediatric Hospital, Phnom Penh, Cambodia, 6Department Of Paediatrics, Faculty Of Medicine, Khon Kaen University, Khon Kaen, Thailand, 7Department Of Hygiene And Health Promo, Ministry of Health, Lao PDR, Laos, 8Department Of Obstetrics And Gynaecology, Faculty Of Medicine, University of Health Sciences, Vientiane, Laos, 9Department Of Paediatrics, Assam Medical College, Dibrugarh, India, 10Department Of Paediatrics, SCB Medical College and Sishubhawan Sardar Vallabhbhai Patel Post Graduate Institute of Paediatrics, Cuttack, India
Objectives and Study: Iron deficiency anaemia (IDA) remains prevalent among children, with early diagnosis crucial due to its long‐term health implications. This consensus, developed by experts from India and Southeast Asia, aims to improve awareness, provide screening and management recommendations, and offer prevention insights.
Methods: The consensus was developed using the Delphi method. Ten primary experts formulated statements from a systematic review, which were refined through discussions and voted on by another 18 secondary experts, with consensus defined a priori as ≥70% agreement.
Results: Twelve statements achieved consensus, with 99% agreement from the primary group and 93% from the secondary. ‐Anaemia should be detected early to reduce related health consequences in children. ‐All children are recommended to undergo their first screening for anaemia between 9 to 12 months of age. ‐Annual screening for children aged 1 to 5 years. ‐Screening for anaemia should be done using a non‐invasive haemoglobin measurement device. ‐Children detected anaemic using non‐invasive screening should have further evaluation. ‐Further tests for thalassaemia should be performed in children found to have anaemia. ‐Iron deficiency anaemia is prevalent in India and Southeast Asia; hence, iron deficiency should be ruled out in children with anaemia. ‐Nutritional intervention, particularly milk and food fortification, should be introduced to all children to reduce the risk of IDA. ‐Active caregiver education on IDA, its risks, and ways to reduce the likelihood of developing IDA is recommended. ‐Improving women's iron status from pre‐pregnancy through lactation to reduce IDA risk in children. ‐Deworming in helminth‐endemic areas to curb iron loss among children. ‐Children with IDA should receive iron treatment and other measures to prevent or treat IDA.
Conclusions: By integrating these evidence‐based recommendations, the consensus statements provide direction in decision‐making for the screening, management, and prevention of IDA. Early detection and nutritional interventions are crucial to mitigate its health consequences in children.
Contact e‐mail address: yazidjal@um.edu.my
N‐EV085. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV085.1. IMPORTANCE OF INITIAL NUTRITIONAL STATUS IN REFEEDING SYNDROME IN CHILDREN WITH ANOREXIA NERVOSA
Hyun Jin Kim
Chungnam national university hospital, Daejeon, Korea, Republic of
Objectives and Study: Refeeding syndrome (RS) is defined as fluid and electrolyte shifts as a result of aggressive nutritional rehabilitation and these electrolyte imbalance can result in several cardiac complications.
Methods: We aimed to evaluate the incidences of RS and hypercholesterolemia in children with anorexia nervosa (AN) and related factors for that. We retrospectively evaluated the medical records of 51 patients aged 10‐18 years diagnosed with AN between January 2015 and May 2020.
Results: RS and hypercholesterolemia were seen in 21 (41.2%) and 39 (76.5%) of patients, respectively. Patients with RS had an older mean age (16.3 vs. 13.7 years, p = 0.021), lower body mass index (BMI) on admission (11.4 vs. 13.2 kg/m2, p = 0.003), and a higher degree of weight loss (16.5 vs. 12.7 kg, p = 0.005) than those without RS. Age (odds ratio [OR], 3.49; 95% confidence interval [CI], 0.913–8.790; p = 0.021), initial BMI (OR, 0.58; 95% CI, 0.324–1.753; p = 0.011), and BMI z‐score (OR, 0.56; 95% CI, 0.256–1.987; p = 0.045) were predictors of RS. For identifying occurrence of RS, the area under the curve for BMI was 0.679 and the optimal BMI cut‐off value was 11.8 kg/m2.
Conclusions: RS and hypercholesterolemia were frequently observed in patients with AN, and low BMI and older age were significantly associated with RS. Therefore, serum phosphate levels should be monitored more frequently in patients with severe malnutrition.
Contact e‐mail address:
N‐EV086. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV086.1. THE ASSOCIATION OF BABY‐LED WEANING AND PICKY EATING IN CHILDREN AGED 2‐5 YEARS
Francesca Denise Monica Layug‐Dionglay, Mary Jean Guno, Jacqueline Navarro, Kaye Napalinga
Institute Of Pediatrics, The Medical City, Pasig City, Philippines
Objectives and Study: Baby‐Led Weaning (BLW) is a method of complementary feeding linked to healthier eating habits and lower picky eating tendencies, but empirical evidence is limited. This study investigates the relationship between BLW and picky eating in children aged 2 to 5 years, comparing it to traditional spoon‐ feeding methods
Methods: A cross‐sectional study was conducted in Metro Manila, Philippines, from June to August 2024, using convenience and snowball sampling. Parents reported how complementary feeding was introduced to their child, categorizing it as: (1) Strict BLW (BLW > 90%), (2) Predominantly BLW (BLW 51‐90%), (3) Predominantly Traditional Weaning (BLW 10‐50%), or (4) Strict Traditional Weaning (BLW < 10%), following the classification method of Kominou, Halford, and Harrold (2019). Picky eating behaviors were assessed using the Children's Eating Behavior Questionnaire (CEBQ), focusing on the Food Fussiness subscale, with a score above 3 indicating picky eating behavior. Odds ratios were used to analyze the association between feeding method and picky eating. Additional CEBQ subscales were also examined for their relationship to picky eating.
Results: A significant association was found between complementary feeding method and picky eating. Children who were strictly Baby‐Led Weaned had a 94.5% lower likelihood of being picky eaters compared to those strictly traditionally spoon‐fed (p < 0.01). Predominantly BLW children had a 52.7% lower risk of picky eating, while those predominantly traditionally weaned had a 52.5% lower risk, compared to exclusively traditionally spoon‐fed children. Statistical analysis confirmed the significant association of strict Baby‐Led Weaning on reducing the odds of picky eating.
Conclusions: This study provides evidence that Baby‐Led Weaning is associated with a significantly lower likelihood of picky eating in children aged 2 to 5 years, compared to traditional spoon‐feeding methods.
Contact e‐mail address: chescalayugmd@gmail.com
N‐EV087. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV087.1. ZINC DEFICENCY ACRODERMATITIS: A DIAGNOSTIC CLUE
Federica Bona1, Marianna Di Frenna1, Paola Erba1, Letizia Franzetti1, Giacomo Galli1, Lorenzo Norsa 1, Gian Vincenzo Zuccotti1,2, Elvira Verduci1,3,4
1Department Of Paediatrics, Ospedale dei bambini Vittore Buzzi, University of Milan, Milano, Italy, 2Department Of Biomedical And Clinical Sciences, University of Milan, Milan, Italy, 3Metabolic Diseases Unit, Ospedale dei bambini Vittore Buzzi, University of Milan, Milan, Italy, 4Department Of Health Sciences, University Of Milan, Ospedale dei bambini Vittore Buzzi, University of Milan, Milan, Italy
Objectives and Study: Acrodermatitis Enteropathica is a dermatosis caused by zinc deficiency. It is characterized by dermatitis, alopecia and diarrhea. If left untreated, it can lead to many complications. The diagnosis is based on clinical findings and a rapid response to oral zinc therapy.
Methods: case report
Results: A female infant was admitted at 8 months of age with fever, poor feeding and diarrhea. On examination, a cumbusiform erythematous‐desquamative appearance in the posterior neck folds, face, erythematous‐brownish dermatitis in the diaper area, vesiculobullous lesions on the first and fifth toes of the left foot, hyperemic pharynx and oral candidiasis were observed. Blood tests showed inflammatory markers and complete blood count within normal limits, elevated lipase levels, low alkaline phosphatase levels, liver function tests at the upper normal limit. The child had a history of dermatitis for the past 4 months among the face, neck and diaper area. A topical treatment with fusidic acid and betamethasone, combined with systemic corticosteroid therapy, was prescribed with moderate clinical improvement. However, a dermatological consultation led to the suspicion of acrodermatitis enteropathica. Oral therapy with zinc sulfate (12 mg/kg/day) was initiated with a great improvement in the patient's skin condition. Additional diagnostic tests showed reduced total proteins, albumin, alkaline phosphatase levels and hypokalemia, which resolved with KCL supplementation. Celiac screening was negative. Low zinc levels were found (280 mcg/L, normal range 800‐1600), confirming the diagnostic suspicion of enteropathic dermatitis due to zinc deficiency secondary to insufficient breast milk (the infant had not yet started the complementary feeding). The patient was discharged with instructions to continue oral zinc supplementation until complete weaning.
Clinical presentation at the admission and after 4 days of oral supplementation
Conclusions: In this case report, the patient's clinical presentation, along with the response to zinc supplementation, supported the diagnosis of acquired acrodermatitis enteropathica due to insufficient breast milk.
Contact e‐mail address:
N‐EV088. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV088.1. THE OUTCOMES OF COMMUNITY‐BASED TREATMENT PROGRAMS FOR TREATMENT OF UNCOMPLICATED ACUTE MALNOURISHED CHILDREN AGED 6–59 MONTHS IN YOGYAKARTA, INDONESIA
Arie Nugrahaeni, Irma Hidayati, Neti Nurani
Child Health Department, Dr Sardjito Hospital, Yogyakarta, Indonesia
Objectives and Study: Malnutrition among children remains a significant concern in Indonesia. To improve the effectiveness and sustainability of patient management, we implemented a transition from hospital‐based to community‐centred approach, particularly in children with uncomplicated acute malnutrition. Rumah Pemulihan Gizi in Yogyakarta serves as a centre for addressing malnutrition in children by engaging parents and caregivers in the treatment process, resulting in a more comprehensive and holistic approach in combating malnutrition in children. This study aims to analyze the outcome of community‐based management for malnutrition. We used descriptive analytic cross‐sectional study to evaluate the outcomes of this approach in addressing malnutrition in children.
Methods: We used purposive sampling for subject recruitment. Children aged 6 to 59 months suspected with uncomplicated malnutrition at Rumah Pemulihan Gizi in 2023. Demographic information, as well as weight and length/height measurement, were collected upon initial registration and during weekly follow‐ups. Inclusion criteria was malnourished children without complication. The success was defined as improvement of nutritional status.
Results: Out of 92 screened children, 66 were diagnosed with malnutrition, of those 26 subjects (35.1%) were severe acute malnutrition, 40 subjects (54.1%) were moderate acute malnutrition. Based on gender, male dominated at 41 subjects (55.4%). Most children had a normal birth weight (between 2500‐4000 grams), accounting for 50 subjects (67.6%). Of those treated 34 subjects (45.9%) achieved success, 14 subjects (18.9%) were referred to hospitals due to stunting or other health issues, 19 subjects (25.7%) treatment failure, and 7 subjects (9.5%) dropped out. There was no significant difference between birthweight and treatment success (p = 0.913; 95% CI).
Conclusions: In conclusion, Rumah Pemulihan Gizi as a community‐centred approach, plays an important role in managing childhood malnutrition in Yogyakarta.
Contact e‐mail address: as.nugrahaeni@gmail.com
N‐EV089. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV089.1. THE CHALLENGES OF NUTRITIONAL RECOVERY IN ULLRICH CONGENITAL MUSCULAR DYSTROPHY
Alexandra‐Ioana Sprinceana, Ioana Oprescu, Stefania Bobes, Oana Oprea, Cristina Becheanu
Pediatrics, Emergency Clinical Hospital for Children Grigore Alexandrescu, Bucharest, Romania
Objectives and Study: Ullrich congenital muscular dystrophy (UCMD) is a severe disorder caused by mutations in the Collagen VI genes, primarily affecting skeletal muscles and connective tissues. It involves the respiratory tract, leading to recurrent infections, and the gastrointestinal system, causing feeding difficulties and growth faltering. The aim is to explore the challenges of nutritional recovery in a pediatric patient with UCMD.
Methods: A 5‐month‐old female infant, with a medical history of global developmental delay and severe malnutrition due to feeding difficulties and malabsorption, requiring enteral nutrition via nasogastric tube with an energy‐dense formula since birth, was admitted for poor weight gain and recurrent respiratory tract infections. Physical examination revealed severe malnutrition, facial dysmorphism, batrachian posture, kyphotic contracture of the spine, gingival hyperplasia, poor sucking reflex, dysphagia, generalized hypotonia and tetramelic motor deficit with a proximal‐to‐distal gradient of muscle weakness, distal joint hyperlaxity. Paraclinical findings, including normal serum creatine kinase, electromyography, nerve conduction velocity and brain Magnetic Resonance Imaging, excluded neuropathies, spinal muscular atrophy and brain‐related conditions. Genetic testing confirmed homozygosity for a mutation in the COL12A1 gene responsible for UCMD. Nutritional management included enteral nutrition via nasogastric tube with a semi‐elemental, hypoallergenic formula, followed by an open gastrostomy with Nissen fundoplication and a blended diet of solid foods via the gastrostomy tube. Laser excision of the hyperplastic gingival tissue allowed the intake of small amounts of formula and blended food orally, improving the swallowing reflex.
Results: The patient's nutritional recovery was gradual, with positive outcomes regarding weight and length growth, a decreased frequency of respiratory tract infections, and improved neuromuscular and psychological development.
Conclusions: Nutritional recovery in UCMD is often underestimated, as greater importance is placed on the neuromuscular symptoms. Multidisciplinary management is crucial, focusing on optimal nutrition in order to achieve better global development.
Contact e‐mail address: alexandrasprinceanaioana@gmail.com
N‐EV090. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV090.1. FEEDING CHALLENGES AMONG CHILDREN WITH NEURODEVELOPMENTAL DISORDERS IN BULGARIA: PRELIMINARY RESULTS
Reni Petkova 1, Rozalina Braykova2, Rositsa Chamova2, Albena Toneva2, Silviya Nikolova3, Dimitar Marinov2, Stanislava Hadzhieva2, Nikoleta Yoncheva4, Stefka Tsvetanova4, Rouzha Pancheva2
1Department Of Hygiene And Epidemiology, Medical University "Dr. Paraskev Stoyanov" ‐ Varna, Varna, Bulgaria, 2Department Of Hygiene And Epidemiology, Medical University Prof Dr Paraskev Stoyanov Varna, Varna, Bulgaria, 3Department Of Social Medicine And Healthcare Organization, Medical University Prof Dr Paraskev Stoyanov Varna, Varna, Bulgaria, 4Karin Dom Foundation, Varna, Bulgaria, Varna, Bulgaria
Objectives and Study: Neurodevelopmental disorders, including autism spectrum disorder (ASD) and cerebral palsy (CP), are often associated with persistent feeding behaviors such as food selectivity and neophobia, which can adversely affect health and quality of life into adulthood. The primary objective of this study is to assess feeding challenges among children with neurodevelopmental disorders in Northeastern Bulgaria.
Methods: This cross‐sectional study included 146 children, of whom 73.3% were diagnosed with ASD (n = 102, 81.4% male) and 26.7% with CP (n = 44, 54.5% male). Data on demographic characteristics, food type, texture, and taste preferences, as well as their self‐feeding skills, were collected and analyzed. Statistical analysis was performed using Jamovi v2.6.17, with Fisher's exact test used to determine associations between qualitative variables. A p‐value < 0.05 was considered statistically significant.
Results: Self‐feeding inabilities were reported in 39.6% of the participants (ASD = 24%, CP = 79.5%, p < 0.001). Food aversion was observed in 54% of children, with a higher prevalence in ASD (62.0% vs. 23.1%, p < 0.001), particularly among those with moderate disabilities (41.5%, p = 0.042). Lack of appetite was reported in 4.3% of children with CP and 19% of those with ASD. Children with CP (75.7%) exhibited stronger preferences for specific textures (p = 0.033) than those with ASD (55.4%). Over two‐thirds of children with CP preferred mushy food, while 64.8% of children with ASD favored crunchy textures (p < 0.001). Severe disabilities were associated with a preference for mushy food (63.2%, p < 0.006). Taste preferences were more prominent among children with ASD (69.3% vs. 46.2%, p = 0.038), with 45.3% favoring salty food, while children with CP preferred sweet foods (50%, p < 0.048).
Conclusions: Understanding feeding challenges and preferences in children with neurodevelopmental disorders can guide families and healthcare professionals in addressing gastrointestinal difficulties and improving quality of life.
Contact e‐mail address: reni.petkova02@gmail.com
N‐EV091. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV091.1. MALNUTRITION AMONG ALGERIAN CHILDREN: DIETARY PATTERNS AND HEALTH IMPLICATIONS
Isma Behar1,2, Hakim Rahmoune 1,3, Nada Boutrid1,2
1Medicine, University of Setif 1, Setif, Algeria, 2EHS El Eulma, Setif, Algeria, 3University Hospital of Setif, Setif, Algeria
Objectives and Study: A nutritious diet coupled with regular physical activity is vital for children's overall well‐being, growth, and development. The childhood years are crucial for establishing healthy eating behaviors that influence lifelong dietary habits, often shaped within family settings and reinforced by schools. Contemporary trends such as meal skipping, high consumption of sugary drinks, reliance on convenience foods, and eating meals in front of screens are emerging as significant contributors to malnutrition—manifesting as overweight, obesity, or underweight. Objective: This study aims to assess the prevalence of malnutrition (overweight, obesity, and underweight) among Algerian children while evaluating their anthropometric measurements and dietary behaviors.
Methods: A sample of 129 children aged 5 to 11 years from schools in El Eulma, Algeria, was examined. Data collection included anthropometric measurements, dietary habits, and socioeconomic status assessments using the International Obesity Task Force (IOTF) criteria for evaluating weight categories.
Results: The overall prevalence of overweight was recorded at 32.2%, with obesity at 13.2%, while underweight affected 7.7% of participants (4.6% exhibiting severe underweight). Overweight and obesity were notably more prevalent in families with lower socioeconomic status (72% for overweight; 55.8% for obesity) compared to medium (54%; 51.9%) or high socioeconomic levels (14%; 11.9%). Additionally, a higher percentage of obese children skipped breakfast compared to their normal‐weight peers (57.4% vs. 32.6%), while many reported consuming lunch twice daily (73.6% vs. 10.9%). Screen time during meals was reported by 15.6% of normal‐weight children, rising to 27% for those overweight and 57.4% for obese children.
Conclusions: Our findings highlight children behaviors in Algeria linked to an increased risk of malnutrition—specifically overweight or obesity as well as underweight—associated with poor dietary practices prevalent among lower socioeconomic groups.
Contact e‐mail address:
N‐EV092. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV092.1. URBAN VS. RURAL: UNRAVELING THE ANTHROPOMETRIC DISPARITIES IN ALGERIAN CHILDREN
Isma Behar1,2, Hakim Rahmoune 1,3, Nada Boutrid1,2
1Medicine, University of Setif 1, Setif, Algeria, 2EHS El Eulma, Setif, Algeria, 3University Hospital of Setif, Setif, Algeria
Objectives and Study: Disparities between urban and rural environments can significantly influence the nutritional status. Urban children often have greater access to processed foods and experience more sedentary lifestyles, which can lead to higher rates of overweight and obesity. In contrast, rural children may benefit from different dietary habits and increased physical activity levels, highlighting the need for targeted interventions that address these environmental differences. This study aims to examine variations in Body Mass Index (BMI) among school‐aged children in urban versus rural settings within the El Eulma district, Algeria.
Methods: A cross‐sectional survey was conducted across several public schools in El Eulma (North‐East of Algeria) involving a total sample size of 129 children aged between 6 to 11 years. A standardized questionnaire collected information regarding living conditions, hygiene practices, dietary habits alongside anthropometric measurements encompassing weight, height, and BMI calculations.
Results: Urban children constituted 85.3% of the surveyed population compared to only 14.7% from rural backgrounds. Stratification revealed that urban students exhibited higher BMI across all studied ages regardless of sex: p‐value = 0.001244 (Significant at p < .05.), this difference was particularly pronounced among girls and statistically significant (p‐value = 0.009817)
Conclusions: In our cohort, overall BMI was found to be higher among urban school children, which correlates probably with a Westernized life style. Close anthropometric surveillance, especially among urban Algerian children, is mandatory The findings from this local study provide also valuable insights for targeted health promotion initiatives aimed at improving nutritional status in Algerian children.
Contact e‐mail address:
N‐EV093. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV093.1. FOOD FREQUENCY CONSUMPTION AND ADHERENCE TO DIETARY RECOMMENDATIONS IN NEUROLOGICALLY IMPAIRED CHILDREN
Elena Scarpato, Maria Rosaria Serra, Linda Varcamonti, Antonio Poziello, Massimo Martinelli, Erasmo Miele, Annamaria Staiano
University Federico II of Naples, Naples, Italy
Objectives and Study: Malnutrition is common in orally fed children with neurological impairment (NI). Data on food frequency consumption in NI children are scarce. The aim of the present study is to evaluate food frequency consumption and its association with dysphagia in NI children.
Methods: In this prospective study orally fed NI children and adolescents were enrolled. For each subject the following data were collected: demographic characteristics and anthropometric parameters, GMFCS level, dysphagia severity according to EDACS level and PEDIEAT‐10, food frequency consumption.
Results: Twenty‐three children were included (M 60%; mean age 11.6 ± 4.4 years) with 4% GMFCS 2, 21% GMFCS 4, and 73% GMFCS 5. As for dysphagia, 4% had EDACS 1, 34% EDACS 2, 34% EDACS 3, 13% EDACS 4, and 13% EDACS 5; mean PEDIEAT‐10 score in our population was 9.4 ± 8.1. Regarding food frequency consumption: only 65% of patients consumes cereals several times a day, while 60% consumes meat several times a week, also reporting a high frequency of consumption of processed meats (52% several times a week). Fish intake appears insufficient, with 17% never consumeing it, and only 43,4% eating it several times/week. As for milk/yogurt, only 47.8% consumes them several times a day. Of note, 21.7% declares to never consume fresh fruit, while only 30.4% eats vegetables several times a day, and 13% declares to not consume vegetables at all.
Conclusions: A varied and balanced diet, with reduced consumption of red meat, frequent intake of cereals, fruits and vegetables, and habitual consumption of milk and dairy products, is recommended in all children. In our population of NI children adherence to dietary recommendations is inadequate in most cases, with excessive intake of meat/processed meat and insufficient consumption of fruit, vegetables, and milk/dairy products. No impact of dysphagia severity on adherence to dietary recommendations is found.
Contact e‐mail address: elenascarpato@hotmail.it
N‐EV094. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV094.1. REVISITED NINHYDRIN METHOD AND SIMPLE ALGORITHM ALLOW FOR THE MEASUREMENT OF THE POSTPRANDIAL APPEARANCE OF PEPTIDES AND FREE AMINO ACIDS IN THE BLOOD
Anna Socha‐Banasiak 1, Stefan Pierzynowski2,3, Piotr Wychowański4, Wieslaw Szczesny5, Robert Gallotto6, Kamil Zaworski7, Dominika Szkopek8, Jaroslaw Wolinski8, Janine Donaldson8, Kateryna Pierzynowska2
1Gastroenterology, Allergology And Pediatrics, Polish Mother's Memorial Hospital, Lodz, Poland, 2Department Of Biology, Lund University, Lund, Sweden, 33. department Of Medical Biology, Institute of Rural Health, Lublin, Poland, 46. department Of Interventional Dentistry, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland, 5Institute Of Information Technology, Warsaw University of Life Sciences, Warsaw, Poland, 6Anagram Therapeutics, Framingham, United States of America, 710. department Of Animal Physiology, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Jabłonna, Poland, 811. large Animal Models Laboratory, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Jablonna, Poland
Objectives and Study: The protein digestion and subsequent peptide appearance in the blood have not been studied in depth. In the clinical practice, there is lack of useful and simply method to confirm the effectiveness of pancreatic enzyme replacement therapy (PERT) in children with exocrine pancreatic insufficiency (EPI). The aim of this study was developed on animal model a simple mathematical model/algorithm to evaluate the effectives of revisited ninhydrin method to measure postprandial appearance of amine groups derived either from free amino acid or peptides in blood.
Methods: The experiment was performed on healthy and EPI pigs (n = 18). The ninhydrin method modified by Pierzynowska et al (2024) followed by the mathematical algorithm calculations was used for the measurement of the free amino acids vs. peptide blood appearance in pig exposed to PERT.
Results: It was showed that postprandial appearance of amine groups coming from di‐ and tripeptides exceeded number of such one coming from free amino acids several folds as counted with algorithm (Fig.1). PERT increased postprandial appearance of peptide‐derived amine groups but not free amino acids. The amine group reflecting free amino acid pool in blood in healthy and EPI status is stable (5 ‐15%) and doesn't reflect protein digestion (Fig. 1).
Conclusions: We hypothesize that measuring of postprandial plasma di‐ and tripeptides vs. free amino acids could be a useful clinical tool to determine their metabolic importance in health and disease and the efficacy of protein digestion. Presented results and algorithm applied clearly showed that peptides longer than tri amino acids rather do not appear postprandially in blood in significant amounts recognized by ninhydrin method.
Contact e‐mail address:
N‐EV095. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV095.1. SILENT GROWTH THREATS: ASSESSING AND MONITORING MALNUTRITION IN OUTPATIENT PEDIATRIC POPULATIONS
Omer Beser1, Fügen Çullu Çokuğraş2, Ipek Ulkersoy 1, Erkan Akkus1, Oguzhan Tin1, Nursena Kologlu Ates1, Haluk Cokugras3, Alihan Sürsal4, Emre Özkan5, Abdullah Akçil6, Abdullah Akkuş7, Ahmet Baştürk8, Ahmet Osman Kılıç9, Alaaddin Yorulmaz10, Ali Kanık11, Arzu Gülseren12, Aslı Aslan13, Asuman Demirhan14, Asuman Nur Karhan15, Aydın Çelikyurt16, Aylin Yücel17, Ayşe Burcum Sertel18, Ayşe Güngör19, Ayşegül Bükülmez19, Aysen Uncuoglu20, Banu Bal Çermik21, Belkıs Ipekçi22, Betül Aksoy23, Betül Kösa24, Büşra Sultan Kibar25, Cansu Baş26, Cihat Erol27, Damla Geçkalan28, Demir Gökçer Özek29, Deniz Güven30, Didem Gülcü Taşkın31, Duran Arslan32, Duygu Gümüş Oğuz33, Duygu Doğan34, Duygu Sömen Bayoğlu35, Ebru Tayfun Şentürk36, Ece Koyuncu37, Ece Söylem Avlaç38, Ecem Ipek Altınok39, Ekin Nurhan24, Elif Sinem Eryiğit40, Elif Turkmen41, Emel Örün42, Emre Çelik43, Enes Kaan Kılıç44, Eren Yıldız45, Esma Gökçen Saraç Çelik46, Fatih Suna47, Fatma Beşiroğlu Çetin48, Ferit Durankuş49, Fırat Erdoğan49, Fırat Kaya50, Filiz Tubaş51, Funda Çetin52, Gamze Özgürhan53, Gamze Seval Özzorlar54, Gönül Çaltepe55, Gözde Atasever Yıldırım56, Gülfer Akça57, Günsel Kutluk58, Halil Haldun Emiroğlu59, Halil Kocamaz60, Hanife Ayşegül Arsoy61, Hasan Keleş62, Hatice Kup63, Hatip Kılıç64, Hicran Altın65, Hilmi Onur Kabukçu66, Hülya Karaahmetoğlu67, Hüseyin Elçi68, Hüsnü Fahri Ovalı69, Ilhan Abidin70, Ilksen Demir71, Ismail Yıldız72, Kaan Demirören73, Kadriye Nil Kaptan Bezci74, Mahmut Can Şerbetçi75, Maşallah Baran76, Mehmet Deniz Erhan77, Mehmet Ertaş78, Meliha Sevim79, Meltem Gümüş80, Meltem Kaplan Gezerer81, Ayşe Usta82, Mine Özdil Çirkinoğlu83, Miray Karakoyun84, Muharrem Bostancı85, Murat Çakir86, Murat Soner Çirkinoğlu87, Nagihan Erdoğ Şahin88, Nelgin Gerenli89, Nergis Karayel36, Neslihan Gürcan90, Neslihan Korkmaz Uzunömer91, Nevin Ceylan Ilbars92, Nevzat Aykut Bayrak93, Nihal Uyar Aksu94, Nijat Aliyev1, Nurbanu Bilgin95, Önder Kılıçaslan96, Özge Günal97, Özgür Kızılca98, Özlem Tezol99, Özlem Kalaycik Sengül100, Pinar Yamac Dilaver101, Rabia Gönül Sezer Yamanel102, Seda Mamak Aldemir65, Selim Dereci103, Selin Kuzucu104, Semih Sandal105, Senanur Şanlı Çelik106, Serenay Alaca107, Serhat Demir108, Şamil Hızlı103, Şeyma Taş1, Şule Gökçe109, Taner Adıgüzel110, Taner Özgür36, Tuğba Gürsoy Koca111, Uğur Deveci112, Ulaş Emre Akbulut113, Ümit Gültekin114, Ünal Akça115, Vefik Arıca110, Yaşar Doğan112, Yeşeren Demirhan116, Yusuf Beker117, Yusuf Usta118, Zehra Kardaş119, Zeynep Muştucu120, Hacer Efnan Melek Aksoy121, Pervin Uçkan44
1Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 2Department Of Pediatric Gastroenterology, Hepatology And Nutrition, Demiroglu Bilim University, Istanbul, Turkey, 3Department Of Pediatric Allergy And Immunology, Istanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 4Statistician, Ankara, Turkey, 5Other, Private Physician, Ankara, Turkey, 6Child Health And Diseases, Düzce Atatürk State Hospital, Düzce, Turkey, 7Child Health And Diseases, Necmettin Erbakan University, Konya, Turkey, 8Department Of Child Health And Diseases, Gaziantep University, Gaziantep, Turkey, 9Department Of Child Health And Diseases, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey, 10Pediatrics Health And Diseases, Selçuk University Faculty of Medicine Hospital, Konya, Turkey, 11Pediatrics Health And Diseases, Izmir State Hospital, Izmir, Turkey, 12Pediatric Gastroenterology, Kayseri State Hospital, Kayseri, Turkey, 13Child Health And Diseases, Izmir University of Economics Medical Point Hospital, Izmir, Turkey, 14Pediatric Health And Diseases, Mersin State Hospital, Mersin, Turkey, 15Pediatric Gastroenterology, Hepatology And Nutrition, Ankara Etlik City Hospital, Ankara, Turkey, 16Department Of Child Health And Diseases, Erciyes University Faculty of Medicine, Kayseri, Turkey, 17Department Of Pediatric Gastroenterology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey, 18Pediatric Gastroenterology, Kocaeli State Hospital, Kocaeli, Turkey, 19Pediatrics Health And Diseases, Afyonkarahisar Health Sciences University Faculty of Medicine Hospital, Afyonkarahisar, Turkey, 20Pediatric Gastroenterology, Kocaeli Medical School, Kocaeli, Turkey, 21Pediatric Gastroenterology, Suleymaniye Gynecology and Pediatrics Training and Research Hospital, Istanbul, Turkey, 22Pediatric Gastroenterology, Health Ministory Van State hospital, Van, Turkey, 23Pediatric Gastroenterology Hepatology And Nutrition Clinic, Izmir State Hospital, Izmir, Turkey, 24Department Of Pediatricts, Istanbul Universty‐Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 25Pediatrics, Sakarya Training and Research Hospital, Sakarya, Turkey, 26Pediatrics, Bor State Hospital, Nigde, Turkey, 27Pediatrics, Health Ministory Van State hospita, Van, Turkey, 28Pediatrics, Izmir Çiğili State Hospital, Izmir, Turkey, 29Pediatrics, Antalya Training and Research Hospital, Antalya, Turkey, 30Pediatrics, Ankara Etlik City Hospital, Ankara, Turkey, 31Pediatric Gastroenterology‐hepatology And Nutrition, Adana City Hospital, Adana, Turkey, 32Pediatric Gastroenterology, Erciyes University Children's Hospital, KAYSERI, Turkey, 33Child Health And Diseases, Afyonkarahisar Zübeyde Hanım Gynecology and Pediatrics Hospital, Afyonkarahisar, Turkey, 34Pediatric Gastroenterology, Tekirdağ Dr. İsmail Fehmi Cumalıoğlu City Hospital, Tekirdag, Turkey, 35Pediatric Gastroenterology, Umraniye Training and Research Hospital, Istanbul, Turkey, 36Pediatric Gastroenterology, Uludag University, Bursa, Turkey, 37Child Health And Diseases, Pamukkale University Hospital, Denizli, Turkey, 38Child Health And Diseases, Tekirdağ Kapaklı State Hospital, Tekirdag, Turkey, 39Child Health And Diseases, Ordu University Training and Research Hospital, Ordu, Turkey, 40Child Health And Diseases, Gaziantep City Hospital, Gaziantep, Turkey, 41Pediatric Gastroenterology, Hepatology And Nutrition, Istanbul Faculty of Medicine, İSTANBUL, Turkey, 42Child Health And Diseases, Ankara Etlik City Hospital, Ankara, Turkey, 43Child Health And Diseases, Bursa State Hospital, Bursa, Turkey, 44Child Health And Diseases, Ankara Bilkent City Hospital, Ankara, Turkey, 45Child Health And Diseases Clinic/polyclinic, Kastamonu Training and Research Hospital, Kastamonu, Turkey, 46Child Health And Diseases, Ümraniye Training and Research Hospital, Istanbul, Turkey, 47Child Health And Diseases, Samsun Training and Research Hospital, Samsun, Turkey, 48Child Health And Diseases, Medical Park Ordu Hospital, Ordu, Turkey, 49Child Health And Diseases, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey, 50Pediatric Gastroenterology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey, 51Child Health And Diseases, Erciyes University Faculty of Medicine Hospitals, Kayseri, Turkey, 52Pediatric Gastroenterology, Hepatology And Nutrition, Izmir University of Economics Medical Point Hospital, Izmir, Turkey, 53Children's Health And Diseases, Suleymaniye Gynecology and Pediatrics Training and Research Hospital, Istanbul, Turkey, 54Child Health And Diseases, Cengiz Gökçek Children's Hospital, Gaziantep, Turkey, 55Pediatric Gastroenterology, Ondokuz Mayıs University Health Application and Research Center, Samsun, Turkey, 56Child Health And Diseases, Adana State Hospital, Adana, Turkey, 57Children's Health And Diseases, Samsun University Faculty of Medicine, Department of Internal Medicine, Child Health and Diseases, Samsun, Turkey, 58Pediatric Gastroenterology, Health Sciences University Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey, 59Department Of Child Health And Diseases, Selcuk University/Faculty of Medicine/Department of Internal Medical Sciences, Konya, Turkey, 60Department Of Child Health And Diseases, Diyarbakır Dicle University Hospital, Diyarbakır, Turkey, 61Pediatric Gastroenterology Hepatology And Nutrition, Bursa State Hospital, Bursa, Turkey, 62Child Health And Diseases, Mücahitler State Hospital, Gaziantep, Turkey, 63Pediatric Gastroenterogist, Mersin State Hospital, Mersin, Turkey, 64General Pediatrics, Mardin Kiziltepe State Hospital, Mardin, Turkey, 65General Pediatrics, Antalya Training and Research Hospital, Antalya, Turkey, 66General Pediatrics, Kastamonu University Faculty of Medicine, Kastamonu, Turkey, 67General Pediatrics, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey, 68General Pediatrics, Mardin Kızıltepe State Hospital, Mardin, Turkey, 69General Pediatrics, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey, 70Pediatric Gastroenterology, Selcuk University, Konya, Turkey, 71Paediatric Gastroenterology, İzmir City Hospital, izmir, Turkey, 72General Pediatrics, Istanbul University Faculty of Medicine, İstanbul, Turkey, 73Pediatric Gastroenterology, Bursa High Specialization Training and Research Hospital, Bursa, Turkey, 74Pediatric Gastroenterology, Bursa City Hospital, Bursa, Turkey, 75General Pediatrics, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey, 76Pediatric Gastroenterology, İzmir City Hospital, İzmir, Turkey, 77General Pediatrics, Adana City Hospital, Adana, Turkey, 78General Pediatrics, Birecik State Hospital, Şanlıurfa, Turkey, 79General Pediatrics, Ankara Training and Research Hospital, Ankara, Turkey, 80Pediatric Gastroenterology, Selçuk University Medical Faculty Hospital, Konya, Turkey, 81General Pediatrics, Balıkesir City Hospital, Balıkesir, Turkey, 82Pediatric Gastroenterology, şişli hamidiye etfal training and research hospital, istanbul, Turkey, 83General Pediatrics, Balıkesir State Hospital, Balıkesir, Turkey, 84Pediatric Gastroenterology, Ege University Medical Faculty Hospital, İzmir, Turkey, 85General Pediatrics, Bursa High Specialization Training and Research Hospital, Bursa, Turkey, 86Pediatric Gastroenterology, Medical Park Karadeniz Hospital, Trabzon, Turkey, 87General Pediatrics, Sındırgı State Hospital, Balıkesir, Turkey, 88General Pediatrics, Kayseri City Hospital, Kayseri, Turkey, 89Pediatric Gastroenterology, Istanbul Umraniye Education and Research Hospital, İstanbul, Turkey, 90Pediatric Gastroenterology, Ankara Training and Research Hospital, Ankara, Turkey, 91General Pediatrics, Diyarbakır Children's Hospital, Diyarbakır, Turkey, 92General Pediatrics, Nevşehir State Hospital, Nevşehir, Turkey, 93Pediatric Gastroenterology, Hepatology And Nutrition, University of Health Sciences, Zeynep Kamil Women & Children's Training & Research Hospital, Istanbul, Turkey, 94Pediatric Gastroenterology, Kocaeli University, Kocaeli, Turkey, 95General Pediatrics, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey, 96Pediatric Infectious Diseases, Diyarbakır Children's Hospital, Diyarbakır, Turkey, 97Pediatric Infectious Diseases, Bulanık State Hospital, Muş, Turkey, 98Pediatric Cardiology, Tekirdag Namık Kemal University, Tekirdag, Turkey, 99General Pediatrics, Mersin University Hospital, Mersin, Turkey, 100Pediatric Gastroenterology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey, 101Pediatric Gastroenterology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey, 102General Pediatrics, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, İstanbul, Turkey, 103Pediatric Gastroenterology, Ankara Bilkent City Hospital, Ankara, Turkey, 104General Pediatrics, Sorgun State Hospital, Yozgat, Turkey, 105Pediatric Gastroenterology, ANKARA TRAINING AND RESEARCH HOSPITAL, Ankara, Turkey, 106General Pediatrics, Kocaeli City Hospital, Kocaeli, Turkey, 107Pediatric Gastroenterology, Hepatology And Nutrition, Izmir City Hospital, Izmir, Turkey, 108General Pediatrics, Erzurum City Hospital, Erzurum, Turkey, 109General Pediatrics, Ege University Medical Faculty Hospital, İzmir, Turkey, 110General Pediatrics, Yalova University Faculty of Medicine, Yalova, Turkey, 111General Pediatrics, Pamukkale University Hospital, Denizli, Turkey, 112Pediatric Gastroenterology, Fırat University, Elazığ, Turkey, 113Pediatric Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey, 114General Pediatrics, Siirt Training and Research Hospital, Siirt, Turkey, 115General Pediatrics, Samsun Education and Research Hospital, Samsun, Turkey, 116General Pediatrics, Medical Park Karadeniz Hospital, Trabzon, Turkey, 117General Pediatrics, Şırnak State Hospital, Şırnak, Turkey, 118Pediatric Gastroenterology, Mersin University Hospital, Mersin, Turkey, 119Child Health And Diseases, Kayseri State Hospital, Kayseri, Turkey, 120General Pediatrics, Uludag University, Bursa, Turkey, 121Child Health And Diseases, Sakarya University Faculty of Medicine, Sakarya, Turkey
Objectives and Study: Malnutrition can lead to irreversible consequences such as stunted growth, increased susceptibility to infections, immune system dysregulation, and an increased risk of autoimmunity. We aimed to detect the prevalence of malnutrition among children without any known chronic diseases attending to the pediatric outpatient clinics and to present the preliminary findings on the associated symptoms, contributing factors, and the nutritional status during follow‐up.
Methods: This is a multicenter, prospective study included 4943 randomly selected patients. Newborns, patients in emergency/intensive care units, and those who had received steroids, appetite‐stimulating drugs, or enteral nutrition therapy within the last 3 months were excluded. Demographic data, anthropometric measurements (Z‐scores for weight‐for‐length/height(WFL/H), body mass index(BMI)‐for‐age, and length/height‐for‐age(L/HFA) calculated using the Anthro software developed by the WHO), chief complaint for the patient's visit were collected. Nutritional interventions including nutritional counselling and/or enteral nutritional support was performed. Patients were re‐evaluated at the third/sixth months of follow‐up.
Results: At the time of the first visit, the rates of acute, chronic and mixed malnutrition were 26.9%, 19.6%, and 8.8%, respectively. The rate of chronic malnutrition was higher in children <5 years. Additionally, factors such as preterm birth, incomplete vaccination, crowded household conditions, and low educational levels of parents were found to increase the rates of all types of malnutrition (p‐value:<0.001). The mean Z‐score of BMI of patients at admission was ‐0.58( ± 1.57); following nutritional interventions, it increased to ‐0.42( ± 1.45)(p‐value:<0.001). Among acute mild malnutrition group, BMI Z‐scores decreased below ‐2 in 6,8% of patients, while those of 25% increased above ‐1. At third/six‐month‐follow‐up, those with a decrease in WFL/H Z‐score >3% were patients <5 years.
Conclusions: The assessment of nutritional status should be standardized and integrated as a routine component of the clinical examination. Early recognition and intervention of malnutrition in outpatient settings can help identify at‐risk individuals and contribute to the reduction of morbidity/mortality.
Contact e‐mail address: ipekulkersoy@gmail.com
N‐EV096. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV096.1. STUNTING PREVALENCE AND ASSOCIATED UNDERLYING DISEASES IN UNDER‐FIVE ADMITTED TO NATIONAL REFERRAL HOSPITAL IN JAKARTA, INDONESIA
Klara Yuliarti 1, Angelina Clarissa2, Gita Karina2
1Child Health, Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia, 2Medical School, University of Indonesia, Jakarta Pusat, Indonesia
Objectives and Study: Stunting, defined as chronic malnutrition causing height‐for‐age z‐score (HAZ) below ‐2 standard deviations of WHO growth standard, remains a major child health issue in Indonesia with prevalence 21.5% as of 2023. Stunting is caused by multiple factors including inadequate complementary feeding practices, economic factors, lack of education, poor sanitation, and clinical/subclinical infections. Cipto Mangunkusumo Hospital (CMH) as a national referral hospital handles children with complex and/or chronic diseases which potentially cause stunting.
Methods: A retrospective cohort study was conducted at CMH, recruiting total sampling of inpatients aged 1–60 months admitted in 2023. Data on age, weight/height, nutritional status, underlying diseases, nutrition treatment, and nutritional status at discharge were collected from the electronic medical record.
Results: Out of 2,684 patients, 1,011 (37.7%) were stunted, of which 61.7% aged 0–2 years old. The three most common underlying diseases in stunting patients included congenital heart disease (22.4%), malignancy (12.0%), and chronic liver disease (13.6%). This was fathomable since CMH serve as the referral hospital for the diseases. Bivariate analysis showed that those diseases demonstrated significant association (p < 0.05) with stunting. Only 11/1,011 (1,1%) recovered from stunting at discharge while 51 out of 1,673 non‐stunting patients (3.0%) developed stunting during hospitalization. Many cases came at late stage affecting the outcome of stunting and the underlying diseases. Weight‐for‐height z‐score (WHZ) analysis revealed that 39.8% stunting children was wasted or severely wasted. Formula for special medical purpose (FSMP) according to National Guideline for Stunting was given to the treat stunting.
Conclusions: The prevalence of stunting among hospitalized children aged 1–60 months at Cipto Mangunkusumo Hospital in 2023 was 37.7%, surpassing national stunting prevalence. High stunting rate was significantly associated with congenital heart disease, malignancy, and chronic liver diseases. The recovery rate of stunting was very low (1.1%), indicating that addressing stunting due to complex underlying disease is challenging.
Contact e‐mail address: klarayuliarti@yahoo.com
N‐EV097. Topic: AS03. NUTRITION/AS03c. Malnutrition and Feeding Disorders
N‐EV097.1. PATIENTS WITH PEG‐J REQUIRE FREQUENT UNSCHEDULED ENDOSCOPIC CHANGES OF THE JEJUNAL TUBE
Kristýna Zárubová, Tereza Lerchova, Jiri Bronsky
Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
Objectives and Study: PEG‐J (percutaneous endoscopic gastrostomy with a jejunal feeding tube) represents an alternative for some patients indicated for surgical procedures such as fundoplication with gastrostomy, also can be used for patients with intolerance to prepyloric feeding or those with duodenal obstruction. The aim of this study was to evaluate the need for unscheduled endoscopic procedures to address technical complications with the jejunal tube or PEG.
Methods: We reviewed electronic hospital records to identify patients based on the reported insurance code (15960) from January 2017 to March 2024. Patients had to have undergone at least one endoscopy for the insertion of a newly placed PEG‐J or a jejunal tube through an existing PEG. We collected data on diagnoses, reasons for PEG‐J insertion, types of endoscopic procedures, time to the first endoscopy, and other follow‐up data. In our center scheduled changes of jejunal tube are planned once a year.
Results: We identified 68 patients in our hospital records; 14 were excluded due to incomplete data. Of the remaining 54 patients, 27 had a newly inserted PEG‐J, 25 had a jejunal tube placed through an existing PEG, and 2 patients had a Button‐J after surgical gastrostomy. Only 10 patients underwent a scheduled change of the jejunal tube after one year, whereas 21 experienced complications with the tube (e.g. dislocation) or PEG sooner (p = 0.02). Conversely, 8 patients no longer required jejunal feeding and were able to tolerate gastric feeding during this period. The median time from insertion to the endoscopy was 23 weeks (IQR = 3.72–65.71 weeks).
Conclusions: PEG‐J is a viable option for providing jejunal feeding in high‐risk patients. However, our data suggest a high need for general anesthesia due to the frequent occurrence of unscheduled endoscopic procedures. Further studies are needed to identify predictors and risk factors for these complications.
Contact e‐mail address: zarubova.kristyna@gmail.com
N‐EV098. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV098.1. EFFECT OF LACTOBACILLUS REUTERI SUPPLEMENTATION ON WEIGHT GAIN AMONG VERY LOW BIRTHWEIGHT PRETERM NEONATES: A RANDOMIZED CONTROLLED TRIAL
Joanna Mae Abalos 1, Rachelle Perez1,2,3
1Department Of Pediatrics, Region 1 Medical Center, Dagupan City, Philippines, 2Dagupan Doctors Villaflor Memorial Hospital, Dagupan City, Philippines, 3Blessed Family Doctors General Hospital, San Carlos City, Philippines
Objectives and Study: Preterm neonates are susceptible to feeding intolerance and infection due to their immature gastrointestinal tracts, low immune function and delayed colonization of intestinal flora, which can affect their growth and quality of life. This study evaluated the effect of Lactobacillus reuteri on weight gain, feeding tolerance, and hospital stay in preterm neonates.
Methods: Forty‐two very low birth weight (VLBW) preterm neonates (1000–1499 g), who were exclusively breastfed, hemodynamically stable, able to tolerate at least 50% full enteral feeding, and had completed antibiotic treatment, were enrolled. The study group received breastmilk with multivitamins, ferrous sulfate, and Lactobacillus reuteri drops, while the control group received only breastmilk with multivitamins and ferrous sulfate. This randomized controlled trial was conducted in a neonatal intensive care unit (NICU) of a tertiary hospital in Pangasinan, Philippines from December 2023 to April 2024.
Results: The study group had significantly higher average daily weight gain (12.28 g/day) compared to the control group (7.80 g/day, p < 0.05). No significant differences were observed in length gain, head growth, or hospital stay duration between the groups. Data were insufficient to assess the effect of Lactobacillus reuteri on feeding tolerance. Only one case of abdominal distention was reported in the study group.
Conclusions: Lactobacillus reuteri supplementation shows potential benefits for weight gain in VLBW preterm neonates. Further research with larger sample sizes, multicenter trials, and extended study periods is needed to validate efficacy and explore optimal dosing, duration, and mechanisms for improved outcomes in this population.
Contact e‐mail address: jmt.abalos@gmail.com
N‐EV099. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV099.1. THE EFFECT OF KINESIO TAPING TECHNIQUE ON ORAL FEEDING AND SWALLOWING FUNCTIONS: ACOUSTIC ANALYSIS OF SWALLOWING SOUNDS IN LATE PRETERM INFANTS
Nilay Comuk Balcı1, Deniz Anuk Ince 2, Ayse Nur Ecevit2, Balkar Erdogan3, Ilknur Ezgi Dogan4, Ozden Turan2, Aylin Tarcan3
1Department Of Physiotherapy And Rehabilitation, Ondokuz Mayıs University Faculty of Health Sciences, Samsun, Turkey, 2Department Of Pediatrics, Baskent University Faculty of Medicine, Ankara, Turkey, 3Odtü Technocity, Technology Transfer Office, KuartisMED Medical Ltd, Ankara, Turkey, 4Department Of Physiotherapy And Rehabilitation, Baskent University Faculty of Health Science, Ankara, Turkey
Objectives and Study: Feeding difficulties in late preterm infants are the leading causes of prolonged hospital stays and readmissions. Early interventions for the maturation process of the sucking and swallowing muscles in preterm infants may facilitate their safe discharge. This study aimed to investigate the effect of kinesio‐taping (KT) technique on the sucking‐swallowing function in late preterm infants and evaluate sucking‐swallowing function through acoustic analysis of swallowing sounds.
Methods: The study included 74 late preterm infants (mean GA: 35.3 ± 0.81 weeks), in two groups including KT and a control group. The KT technique was applied by a physiotherapist to support the jaw and hyoid muscles, and the tape was removed after 48 hours. Swallowing sounds were recorded using a digital stethoscope before and after the KT application. The amount of milk intake, oxygen saturation, and heart rate were also recorded. Maximum rhythmic swallowing count was determined through the analysis of swallowing sounds. Time to full oral feeding and length of hospital stay were also documented.
Results: A significant difference was found between the KT and control groups in terms of maximum rhythmic swallowing count (p < 0.05). However, no significant differences were observed regarding the amount of milk intake, oxygen saturation during feeding, time to transition to full oral feeding, or hospital stay duration (p > 0.05).
Conclusions: The KT technique had a positive effect on the oral feeding skills of infants in the neonatal intensive care unit, particularly on the maximum rhythmic swallowing frequency, which is an indicator of swallowing maturation. The study observed better swallowing function in these infants. Early support of sucking‐swallowing muscles may facilitate safe discharge and reduce feeding‐related morbidities in preterm infants. Future studies with larger sample sizes, including small preterm infants can be used with kinesio‐taping among recommended oral motor interventions for preterm infants.
Contact e‐mail address: denizanuk@yahoo.com
N‐EV100. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV100.1. SHORT‐TERM GROWTH OUTCOMES OF TRANS‐PYLORIC FEEDING IN EXTREMELY LOW BIRTH WEIGHT INFANTS WITH SEVERE BPD: 10‐YEAR EXPERIENCE IN SINGLE CENTRE TERTIARY LEVEL NEONATAL UNIT
Mohammed Attia Khalifa, Rebecca Lee, Kate Arnold, Carolina Zorro, Rashmi Gandhi
Neonatal Unit, 4th Floor Golden Jubilee Wing, Kings College Hospital NHS Foundation Trust, SE RS, United Kingdom
Objectives and Study: Introduction: Establishing full gastric feeds in extremely low birth weight (ELBW) infants with significant respiratory morbidity can be challenging due to concerns of silent aspiration contributing to adverse respiratory outcomes. This is often managed by reducing enteral intake and supplementing nutritional requirements with prolonged parenteral nutrition (PN). Objective: To review the short‐term growth outcomes of TPF in babies with severe BPD over 10 years Study: Retrospective cohort study
Methods: Retrospective data was reviewed for babies fed TP from Jan 2014‐Dec 2023. Inclusion criteria: < 32 weeks' gestation born or transferred very early to our tertiary neonatal unit who subsequently developed BPD. Babies with surgical conditions and congenital conditions of GI tract were excluded. Severe BPD was defined as ongoing need of invasive or high oxygen requirement on non‐invasive ventilation. TPF was commenced by treating clinician when there were clinical concerns of recurrent aspiration. The insertion and management of babies via TPF was performed as per unit guidelines. Data analysis was performed using SPSS. Mean and SD were calculated where the data was normally distributed.
Results: Of 745 eligible babies 314 babies had diagnosis of BPD at 36 weeks corrected GA (45.9%). 43 (13.6%) babies with severe BPD had TPF during this period. There was decrease in weight Z score from birth to the point of staring TPF. After starting TPF we were able to maintain the growth of the babies until discharge. There was no statistical difference between weight z score from the point of starting TPF to discharge (p value 0.99). Majority of babies were able to re‐grade back to gastric feeds and oral feeds before discharge. There were no serious adverse events associated with TPF in our cohort
Conclusions: TPF is safe in babies with severe BPD and supports stable weight gain without prolonged requirement of parenteral nutrition.
Contact e‐mail address: rashmigandhi@nhs.net
N‐EV101. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV101.1. SERUM FERRITIN AND RETICULOCYTE HEMOGLOBIN EQUIVALENT AS BIOMARKERS FOR IRON DEFICIENCY IN NEONATES BORN TO IRON‐DEPLETED MOTHERS
Reeta Bora, Shruti Kashyap
Dept Of Pediatrics, Assam Medical College, Dibrugarh, Dibrugarh, India
Objectives and Study: Iron deficiency (ID) in infancy, even without anemia, is associated with long‐term neurocognitive impairment. Screening for ID by measuring hemoglobin (Hgb) delays detection. Serum ferritin levels may be affected by inflammation. Reticulocyte hemoglobin equivalent(RET‐He) reflects real‐time bone‐marrow iron status. The objective of the present study was to evaluate whether Ret‐He can detect ID earlier than serum ferritin and whether cord blood RET‐He can predict neurodevelopmental outcome(NDO) at 6 months of age in infants born in a population with a high prevalence of ID.
Methods: This hospital‐based Case‐Control Study was performed in the newborn unit in northeast India over one year. Anemic (Hgb<110 g/L and non‐anemic (Hgb >110 g/L) term expectant mothers attending labour room and their neonates were enrolled. RET‐He, complete hemogram& iron profile were determined in cord blood, 48‐72hrs, 6 weeks & 6 months age in exclusively breastfed infants. Ages‐and‐Stages Questionnaire‐3 was used for neurodevelopmental assessment at 6 months.
Results: Among 111neonates compared to infants of non‐anemic mothers(n = 64) mean cord RET‐He(11.2 + 0.5 pg) was significantly lower in infants of anemic mothers(n = 47)(9.3 + 1.4 pg), and also at rest of 3 timepoints, (p < 0.001). Cord RET‐He < 10.6 pg was the strongest determinant of anemia at 6 m (sensitivity,86%; specificity,69%). Cord blood & 48‐72 hr RET‐He were the best predictors of impairment in communication & gross motor skills, respectively, at 6 m age.
Conclusions: Cord and 48 hrs RET‐He values in the non‐anemic group were lower than Western normative data, probably due to the high prevalence of ID in the study population. Serum‐ferritin is a poor predictor of anemia and NDO. RET‐He is an early marker of ID & NDO in infants. In neonates born to iron‐depleted populations, using RET‐He as a biomarker for early detection of ID to decide on iron supplementation can be an area for research.
Contact e‐mail address: bora64reeta@gmail.com
N‐EV102. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV102.1. FEEDING DISORDERS IN CHIDREN WITH A HISTORY OF PREMATURITY
Elvira Cañedo Villaroya 1, Agustín De La Mano Hernández1, Carmen Martín Fernández1, Marianna Di Campli Zaghlul2, Amalio Fernández Leal2, Esther Juste Sánchez2, Elena Pérez Llorente2, Sonia Alvarez Hernández2, Ana Martin Adrados2, Sara Arozamena Aguayo1, Laura Palomino1, Marta Velasco Rodríguez‐Belvis3, Gloria Domínguez‐Ortega3, Silvia Gallego Vázquez1, Lara Sánchez Trujillo1, Maria Esteban Vera1, Rosa Ana Muñoz Codoceo1
1Pediatric Nutrition, Hospital Infantil Niño Jesús, Madrid, Spain, 2Hospital Infantil Niño Jesús, Madrid, Spain, 3Department of Pediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
Objectives and Study: It is estimated that up to 45% of premature newborn (PTNB) experience feeding disorders (FD) even without any associated comorbidity. Adequate knowledge of the factors involved in the genesis of FD in this group is key to their prevention and successful treatment. The aim of this study is to describe the characteristics of PTNB < 35 weeks gestational age without associated pathology who were referred to the specialised Feeding Disorders Unit of a tertiary hospital and to compare them with the rest of the patients referred.
Methods: Single‐center, observational, descriptive, and retrospective study of 601 patients treated in the Unit between 2019 and 2023. We specifically described the characteristics of the 44 healthy PTNB referred. Statistical analysis was performed using SPSS.
Results: 601 patients were treated. 54% of them had some associated pathology, 39% had no other disease and 7.3% (44) were PTNB. 47% (21) of the latter had a feeding tube(FT): NG tube in 16 of them was exchanged for a G tube in a median time of 5 months. 6 of them did not eat anything by mouth (median age 18 months) and all of them started oral feeding in the first year of follow‐up in the Unit and after the change to G tube. All patients who did not eat anything by mouth had a phobic‐avoidant disorder as opposed to the rest who had anorexic or restrictive disrders. The percentage of PTNB with FT at the first visit was significantly higher than in the rest of patients but their withdrawal was no less likely.
Conclusions: Patients with prematurity are at high risk of developing FD. Tube dependency is present in a high percentage of them. Absolute refusal of oral feeding requires a specific multidisciplinary approach and switching from NG tube to G tube may facilitate the process.
Contact e‐mail address: elviracaedo@yahoo.es
N‐EV103. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV103.1. AN EXCLUSIVE HUMAN MILK DIET MAY IMPROVE ESSENTIAL FATTY‐ACIDS IN EXTREMELY‐PREMATURE INFANTS
Jenelle Ferry 1, Brandon Tucker2, Brittany Bundy2
1Pediatrix Medical Group of Tampa, Tampa, United States of America, 2St. Joseph Women's Hospital, Tampa, United States of America
Objectives and Study: Long chain polyunsaturated fatty‐acid (FA) intake in preterm infants is crucial for neurodevelopmental outcomes, decreased morbidities, and linear growth. Preterm infants are born deficient in docosahexaenoic acid (DHA) and arachidonic acid (AA), levels decrease significantly, and deficits are largest in lower birthweights. The relation of FA levels to each other also affects outcomes. Studies regarding supplementation have included a bovine fortified diet. We aim to evaluate how an exclusive human milk diet (EHMD), utilizing human‐derived fortifiers with fat modular supplement, can support FA intake.
Methods: 27 infants received and EHMD; average birthweight 773 grams, gestational age 26 weeks and 3 days, and 2.9% small for gestational age. They received enteral feeds by 12‐24 hours, fortification at 40 mL/kg/day, human derived cream supplement at 80 mL/kg//day, and reached full feeds by average day 14. Serum levels of 5 essential FAs were measured at 4 timeframes. Actual intake volumes of milk and fortifiers were measured daily; levels of average daily enteral FA were reported.
Results: Serum DHA and AA levels minimally declined, then increased above birth by 30 days. Eicosopentoic acid had an initial increase, declined, then began to recover by 30 days. The ratio of AA:DHA declined over time (always greater than 2.7:1); LA:DHA declined over time. At 30 days all FAs were at or above birth levels.
Conclusions: An EHMD has been associated with decreased morbidities, and FA intakes have been tied to outcomes for extremely premature infants. Levels of DHA and AA experienced less of a decline than previously reported. AA:DHA remained above levels shown to improve outcomes. LA:DHA decreased over time, shown to be important in reduction of lung disease and sepsis. Early fortification with an exclusive human milk diet may provide improved FA intake to prevent significant deficits in highest risk patients.
Contact e‐mail address: jenelle.ferry@pediatrix.com
N‐EV104. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV104.1. OROPHARYNGEAL COLOSTRUM THERAPY WITH MOTHER'S OWN MILK IN PRETERM INFANTS IS ASSOCIATED WITH HIGHER BREASTFEEDING RATES IN INFANCY
Deepa Hariharan, Lavanya Balasubramanian, Abilash M S
Neonatology, Sooriya Hospital, Chennai, India
Objectives and Study: Oropharyngeal colostrum therapy (OCT) with mother's own milk in very low birth weight premature infants is reported to be safe and feasible and reduces risk of nosocomial sepsis. While immune activation is postulated as the main mechanism, higher breastfeeding rates in the neonatal period may be contributory. In addition, OCT may improve breastfeeding rates in infancy.
Methods: In a longitudinal study, 135 preterm infants with BW < 1.5 kg were enrolled during the 18‐month study period, in an exclusive referral NICU. 80 infants received OCT (study/OCT group) and 55 did not receive OCT (control group). OCT with 0.1 ml on each cheek Q6H was given from day 1 for 7 days. The control group did not receive OCT due to logistic difficulties in a referral unit.The 2 groups were compared for demographics, clinical variables, late‐onset sepsis, time to full enteral feeds, time to full oral feeds, breastfeeding rates at on discharge and at 4 months of age.
Results: The 2 groups were similar in maternal characteristics that could affect breastmilk production, mean birth weight, gestation, ventilator days and inotrope use. Late‐onset sepsis was lower in OCT group (3/80) compared to study group (7/50). Standardized feeding protocols were used in the 2 groups. Time to full feeds was shorter and exclusive breastfeeding rates higher in OCT group (table)
| OCT | control | |
|---|---|---|
| Time to full enteral feeds (days) | 12 + 4 | 16 + 3.5# |
| Exclusive breastfeeds on discharge | 56/80 | 25/50* |
| Exclusive breastfeeds at 4 months of age | 46/80 | 13/50* |
| Weight less than 10th centile at 4 months of age | 15/80 | 17/50* |
*p < 0.01 #p < 0.05 Maternal Breastfeeding Evaluation Scale showed higher mean satisfaction score in OCT group, compared to control group (p < 0.05).
Conclusions: OCT in VLBW infants is associated with less clinical morbidity, greater psychological boost to mothers, positive mother‐infant interaction in NICU, better nutrition, and higher breastfeeding rates extending into infancy.
Contact e‐mail address: nicu_deepa@yahoo.com
N‐EV105. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV105.1. NEW INSIGHT OF THE THERAPEUTIC ROLE OF ALPHA‐TOCOPHEROL FOR HYPERBILIRUBINEMIA IN PRETERM NEONATES: META‐ANALYTICAL EVALUATION OF EFFICACY AND SAFETY
Agniya Hikmat 1, Fahrul Nurkolis2, Muhammad Rizki Mustakim1, Hardinsyah Hardinsyah3, Nurpudji Astuti Taslim4
1Department Of Health Child, Sayang Regional Hospital, Cianjur, West Java, Indonesia, Cianjur, Indonesia, 2Master Of Basic Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia, 3Division Of Applied Nutrition, Department Of Community Nutrition, Faculty Of Human Ecology, IPB University, Bogor, Indonesia, 4Division Of Clinical Nutrition, Department Of Nutrition, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Objectives and Study: Hyperbilirubinemia, commonly presenting as neonatal jaundice, affects 60‐80% of newborns, contributing significantly to neonatal hospital admissions worldwide. Alpha‐tocopherol (Vitamin E), a potent antioxidant, may stabilize erythrocyte membranes and mitigate bilirubin accumulation through oxidative stress reduction. Despite promising biological mechanisms, the clinical impact of alpha‐tocopherol on hyperbilirubinemia in preterm neonates remains underexplored. This study provides a novel meta‐analytical evaluation of its therapeutic potential.
Methods: A systematic search was conducted across PubMed, ProQuest, Cochrane, Wiley, and Epistemonikos, yielding 2,357 studies. After removing duplicates and applying strict inclusion and exclusion criteria, five relevant studies were included. Bias risk was assessed using ROBINS‐I and RoB 2.0 tools, while statistical analysis was performed using RevMan 5.4.
Results: Two studies reported alpha‐tocopherol levels involving 24 participants in the intervention group and 20 in the control group, showing a significant difference favoring the control group (MD 0.93 [95% CI 0.35; 1.50], P = 0.002). Analysis of bilirubin levels, involving 192 participants in the intervention group and 189 in the control group, indicated a non‐significant overall effect favoring the intervention group (MD ‐0.90 [95% CI ‐2.25; 0.44], P = 0.19).
Conclusions: The findings suggest that alpha‐tocopherol or Vitamin E may have a limited but promising role in managing hyperbilirubinemia in preterm neonates. Additional high‐quality clinical trials are crucial to clarify its efficacy and optimize therapeutic protocols
Contact e‐mail address: agniyalifahmi@gmail.com
N‐EV106. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV106.1. PREDICTIVE FACTORS ASSOCIATED WITH MORTALITY IN INFANTS UNDER 6 WEEKS OF AGE WITH TEMPORARY ILEOSTOMY
Andreea Iordache 1,2, Roxana Smadeanu1,3, Andra Diaconu2, Laura Bălănescu1,2, Ana Maria Brădeanu1, Cristina Becheanu1,2
1Grigore Alexandrescu Emergency Children's Hospital, Bucharest, Romania, 2UMF Carol Davila Bucharest, Bucharest, Romania, 3Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Objectives and Study: Temporary ileostomy in infants under 6 weeks of age is a surgical procedure performed in cases of abdominal surgical emergencies such as necrotizing enterocolitis or intestinal malformations, conditions with high mortality. In this study, we aim to identify some of the risk factors associated with the death of infants with ileostomy.
Methods: We performed a retrospective observational study in the Grigore Alexandrescu Emergency Children's Hospital from Bucharest over a period of 10 years on a group of 52 children hospitalized in the neonatal period with acute abdomen that required ileostomy. We collected socio‐demographic data, the causes that led to ileostomy, type of delivery, gestational age, birth weight, type of nutrition, cause and age at death.
Results: The current group includes 52 patients, of whom 21 were diagnosed with necrotizing enterocolitis, 10 with intestinal malformations, 7 with meconium ileus (cystic fibrosis), 6 with congenital megacolon and 8 with other conditions (gastroschisis, volvulus, intestinal perforation). In our group the mortality was 27% (14 deaths). We identified as potential risk factors for death female sex (RR = 1.3), cesarean delivery (RR = 1.12), prematurity (RR = 2), low birth weight (RR = 2.1) and implicitly low weight at the time of ileostomy, intestinal resections (RR = 1.8), the impossibility of resuming enteral nutrition (RR = 9).
Conclusions: Although the patient group is small and heterogeneous, we identified certain risk factors associated with mortality in infants with temporary ileostomy. We hope that in the future we will be able to propose new strategies to increase the standard of care of these infants.
Contact e‐mail address: andreea-maria.vlad@drd.umfcd.ro
N‐EV107. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV107.1. TO ASSESS CURRENT SCREENING PRACTICES AND MANAGEMENT OF PRETERM NEONATES LESS THAN 32 WEEKS AT RISK OF METABOLIC BONE DISEASE OF PREMATURITY (MBDP)
Stephane Maingard1, Ireti Farombi‐Oghuvbu2, Niamh Kelly 2
1Paediatrics, Our Lady of Lourdes Hospital, Drogheda, Ireland, 2Our Lady of Lourdes Hospital, Drogheda, Ireland
Objectives and Study: Background:
MBDP is characterised by under mineralisation of the skeleton of preterm infants arising from prenatal and postnatal factors.1Infants who are born preterm are deprived of fetal mineral accumulation, 80% which occurs in the third trimester.2 A combination of raised ALP ( > 700IU) with elevated PTH and low serum phosphate is highly sensitive and specific for diagnosis of MBDP.3 Objectives To assess current screening practices for MBPD for preterm neonates < 32 weeks.To assess current management of preterm neonates at risk of MBDP. To determine prominent risk factors for MBDP in our preterm neonatal population
Methods: We conducted an audit and did a retrospective chart review from January‐ to December 2023. We included all preterm neonates less than 32 weeks gestation. We reviewed the vitamin D content of all the different feed types.
Results: 24 neonates met the inclusion criteria. Weekly bone profile monitoring was done in 66% of neonates. 25% had raised ALP > 700IU. 16% of these had follow up PTH and Vitamin D levels checked, whereas 50% had only Vitamin D levels checked. Risk factors identified with raised ALP > 700IU were diuretics (33%), antacid (50%), NEC (16%), CLD (100%). 95% of neonates were commenced on Vitamin D 200IU. Our analysis showed TPN provided only 150IU/kg/d of Vitamin D and fortified breastmilk with 200IU vit D only provided 400IU/kg/d of Vitamin D.
Conclusions: There was no standardisation on management of neonates with raised ALP > 700IU. Vitamin D of 200IU is not adequate as a starting dose. Multiple risk factors were identified in our cohort of patients. We will develop a new guideline on prevention, investigation and management of MBDP in our NICU and will re‐audit in six months.
Contact e‐mail address: montgomery.stephane@gmail.com
N‐EV108. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV108.1. BREASTFEEDING PREMATURE BABIES: PEER‐SUPPORT EXPERIENCE IN A EUROPEAN MULTICENTER STUDY
Sophie Laborie 1, Céline Fischer‐Fumeaux2, Angélique Denis3, Amélie Zelmar4, Sophie Hommey4, Julie Haesebaert4, Fabien Subtil3, Marine Butin1
1Neonatology, Hopital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France, 2Service De Néonatologie, Département Femme‐mère‐enfant, Centre hospitalier universitaire vaudois et Université de Lausanne, Lausanne, Switzerland, 3Service De Biostatistique, Hospices civils de Lyon, Lyon, France, 4Pôle Santé Publique, Hospices civils de Lyon, Lyon, France
Objectives and Study: Breastfeeding support by experienced mothers promotes breastfeeding of full‐term newborns, but few data are available concerning premature infants. One‐to‐one breastfeeding support was set up as part of a clinical trial with mothers of preterm infants <35SA. The aim was to assess the feasibility of structured peer support in neonatology and peer satisfaction.
Methods: A stepped wedge cluster randomized trial in 8 European centers compared periods without and with peer support. Outcomes were the proportion of mothers accepting peer support, its modalities, and the peer's satisfaction. 2 nurses per center were trained in peer support network facilitation (5 days). These facilitators recruited, trained (20 h) and monitored peers who had breastfed premature infants, with a view to supporting breastfeeding mothers of premature infants via weekly contacts from birth until 1 month after their return home.
Results: 19 trained facilitators recruited and trained 131 peers. 102 (78%) completed the full training and 90 (69%) accompanied at least one mother. Of the 747 mothers in the intervention periods, 557 (75%) accepted the intervention, contact was proposed for 386/557 (69%) and support was initiated for 316/386 (82%), with a median support duration of 7.5 weeks (Q1‐Q3: 3.7, 12.3). Contacts took place: face‐to‐face (15%), by phone call (23%), video (2%), SMS/WhatsApp/voice messages (58%). This support complied with the protocol in 173/316 (55%) of cases. Peer satisfaction (n = 30/90) was excellent for 17%, high for 60%, moderate for 17% and low for 6%.
Conclusions: The feasibility of structured breastfeeding peer support for premature infants has been verified, but requires a major commitment on the part of facilitators and peers. The number of protocol‐compliant supports is limited. Feedback from peers was positive, despite the limitations of face‐to‐face contact linked to covid. The effectiveness of this strategy on breastfeeding proportions is currently being evaluated.
Contact e‐mail address: sophie.laborie@chu-lyon.fr
N‐EV109. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV109.1. MODALITIES OF ADMINISTRATION OF CALCITRIOL AND ALFACALCIDOL IN NEONATAL INTENSIVE CARE UNITS: RESULTS OF A FRENCH NATIONAL SURVEY
Sophie Laborie 1, Justine Bacchetta2, Marine Butin1
1Neonatology, Hopital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France, 2Service De Néphrologie, Rhumatologie Et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
Objectives and Study: Calcitriol and alfacalcitdol are used to treat neonatal hypocalcemia and osteopenia in premature infants. However, there are no recommendations and very few data on the effect of these treatments in the neonatal population. The aim of this survey was to assess French experience of using calcitriol and alfacalcidol in neonatology.
Methods: An online survey was sent to all NICUs in France. One response per center was included in the analysis.
Results: Of the 54 NICUs contacted, 41 (76%) responded. Only 1/41 (2%) used calcitriol. 30/41 (73%) used alfacalcidol, of which 5 (12%) more than once a month. The indications for alfacalcidol are severe hypocalcemia in 29/30 units (97%) and/or osteopenia of prematurity in 7/30 units (23%). The period of use is mainly before 15 days of life (22/30 units, 73%). The duration of use is <10 days in 27/30 units (90%). The birth term of use is <28 gestational weeks (GW) in 9/30 (30%) units, 28‐32 GW in 15/30 (50%) units and/or 32‐36 GW in 25/30 units (83%). Dosages varied from 1 to 20 drops/kg/d. Most units (25/27, 93%) adjusted doses according to blood calcium levels, 6/27 (22%) according to alkaline phosphatase levels, 2/27 (7%) according to 1,25(OH)2D levels, 5/27 (18%) according to 25(OH)D levels.
Conclusions: The main indication for alfacalcidol is neonatal hypocalcemia, but some units use it to treat osteopenia of prematurity. There are wide variations in alfacalcidol administration protocols. Animal data suggest that calcitriol may be of interest in the lung development, with a very narrow therapeutic margin. In this context, it would be of high interest to conduct studies to assess the value of these molecules in neonatal supplementation, and to determine the dose to be used and the impact on phosphocalcic metabolism, as well as on bronchopulmonary dysplasia.
Contact e‐mail address: sophie.laborie@chu-lyon.fr
N‐EV110. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV110.1. MODALITIES OF NATIVE VITAMIN D ADMINISTRATION IN NEONATOLOGY: RESULTS OF A FRENCH NATIONAL SURVEY
Sophie Laborie 1, Justine Bacchetta2, Marine Butin1
1Neonatology, Hopital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France, 2Service De Néphrologie, Rhumatologie Et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
Objectives and Study: In view of recent data suggesting that 25OHVitamin D (25OHD) deficiency and excessive concentrations are associated with clinical consequences in premature infants, French recommendations were updated in 2022, recommending an initial enteral dosage of 600‐1000 IU/d, adjusted monthly to target a 25OHD between 50 and 120 nmol/L. The aim of this survey was to assess current practices regarding vitamin D administration in neonatology.
Methods: This online survey was sent to all NICUs in France (one response expected/centre) to analyze the implementation of recommendations, vitamin D administration methods and their relationship with possible excessive concentrations or deficiencies.
Results: Out of 54 NICUs, 41 (76%) responded; vitamin D is administered parenterally (32‐400IU/d or 33‐200IU/kg/d) or enterally (500‐1400IU/d). Regular dosage of 25OHD and adaptation of dosage were carried out in 25 NICUs (61%) and 19 NICUs (46%) respectively. In 18/25 (72%) NICUs, cases of excessive concentrations and/or deficiency were observed irrespective of the vitamin D dosage administered. When more than 800 IU/d of vitamin D was administered diluted in water or milk, the number of NICUs observing deficits appeared to be higher (notably deficits observed in 3 out of 4 NICUs administering diluted vitamin D, versus 1 out of 9 administering undiluted vitamin D, p = 0.05).
Conclusions: Vitamin D excessive concentrations and deficiencies are observed irrespective of the dosage administered, encouraging regular monitoring of 25OHD levels. Our survey also shows that vitamin D administration protocols are highly heterogeneous and during parenteral nutrition vitamin D intakes are frequently under the ESPGHAN recommandation. Diluting vitamin D before administration seems to increase the variability of 25OHD levels.
Contact e‐mail address: sophie.laborie@chu-lyon.fr
N‐EV111. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV111.1. SERUM CORD BLOOD IGF‐1, LEPTIN, ADIPONECTIN AND VITAMIN D LEVEL IN EXTRA UTERINE GROWTH RESTRICTION (EUGR) INFANT : A PILOT STUDY
Maria Mexitalia 1, Ferdy Cayami1, Epriyan Saputra2, Rina Pratiwi1
1Pediatrics, Faculty of Medicine Universitas Diponegoro/Dr. Kariadi Hospital, Semarang, Indonesia, 2Pediatrics, Pesawaran Hospital, Lampung, Indonesia
Objectives and Study: Extra uterine growth restriction (EUGR) prevalence in increased as the increased survival of the premature and VLBW infants. Recognizing the risk factors and metabolic biomarkers is necessary to prevent the EUGR as it may worsened the outcome of the premature and VLBW infants. The objectives of the study is to examine the risk factors of EUGR including the growth and metabolic biomarkers.
Methods: Prospective cohort study was performed in premature and LBW babies in tertiary hospital. The EUGR was determined longitudinally from loss of <1 SD of weight at 28 days compared to birth weight. Objective of the study was to analyse the risk factors and metabolic biomarker of EUGR infants.
Results: A total of 50 infants were including in this study. After 28 days of follow up, around 32% (n 16 infants) were EUGR. The significant risk factors of the EUGR are infection, total parenteral infusion. Interestingly, vitamin D is significantly lower in EUGR infants (17.51 ng/ml vs 23.01 ng/ml, p = 0.035). Although IGF‐1 and adiponectin were lower in EUGR babies and leptin was higher in EUGR infants, but the result was not significant. Table 1. Serum cord blood of IGF‐1, Leptin, Adiponectin and Vitamin D level
| EUGR | Non EUGR | P value# | |
|---|---|---|---|
| IGF1 (ng/ml) | 50.95 + 29.28 | 68.57 + 42.46 | 0.167 |
| Leptin (ng/ml) | 10.56 + 2.19 | 8.32 + 11.01 | 0.423 |
| Adiponectin (ng/ml) | 20.95 + 10.37 | 22.32 + 12.18 | 0.670 |
| Vitamin D (ng/ml) | 17.51 + 14.77 | 23.01 + 11.89 | 0.035* |
#Mann Withney, * significant with p value < 0.05
Conclusions: The risk factors of EUGR are infection and total parenteral infusion, meanwhile vitamin D is significantly lower in EUGR infants compared with non‐EUGR infants.
Contact e‐mail address: dr.mexitalia@gmail.com
N‐EV112. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV112.1. A STUDY ON SERUM ADIPONECTIN AND LEPTIN CONCENTRATIONS IN PRETERM VS. TERM NEWBORNS AND THEIR LINK TO ANTHROPOMETRIC DATA
Snezana Palcevska 1, Natasha Nikchevska2, Natasha Aluloska2, Simonida Spasevska1, Jana Jovanovska1
1Neonatology, Clinical Hospital Acibadem‐Sistina, Skopje, North Macedonia, 2Pediatrics, Acibadem Sistina University hospital, Skopje, Skopje, North Macedonia
Objectives and Study: This study aimed to examine the correlation between anthropometric parameters and adiponectin and leptin levels in healthy preterm and term newborns.This study aimed to examine the correlation between anthropometric parameters and adiponectin and leptin levels in healthy preterm and term newborns.
Methods: A cohort of 110 neonates, including both sexes, was categorized into preterm (PT) (n = 36) and term (AT) (n = 74) groups. The term group was further classified as AT‐AGA (n = 36), AT‐SGA (n = 18), and AT‐LGA (n = 20), while the preterm group was subdivided into PT‐AGA (n = 24), PT‐SGA (n = 12), and PT‐LGA (n = 12).
Results: Sex did not influence the mean serum levels of leptin and adiponectin. However, there were significant differences between the preterm and term groups (p < 0.01) for both leptin (2.20 ± 1.02 ng/mL vs. 1.24 ± 0.35 ng/mL) and adiponectin (30.77 ± 22.64 ng/mL vs. 9.44 ± 4.82 ng/mL). In the term subgroup, adiponectin levels were significantly higher in AT‐AGA and AT‐LGA compared to AT‐SGA (32.8 ± 25.41 ng/mL and 43.40 ± 16.98 ng/mL vs. 12.67 ± 2.45 ng/mL, respectively; p < 0.01). Similarly, leptin levels were significantly higher in AT‐LGA compared to AT‐AGA and AT‐SGA (3.12 ± 1.27 ng/mL vs. 1.93 ± 0.70 ng/mL and 1.71 ± 0.53 ng/mL, respectively; p < 0.01). No significant differences were found in leptin and adiponectin levels between PT subgroups (1.30 ± 0.38 ng/mL) or between the PT group and the AT‐SGA subgroup (1.71 ± 0.53 ng/mL). Both leptin and adiponectin levels showed positive correlations with all anthropometric parameters: BW, BL, BW/BL, BMI, and PI (p < 0.05).
Conclusions: In conclusion, these results suggest that the level of body growth maturity is positively correlated with the adipocytokines involved in fetal growth regulation.
Contact e‐mail address: snezana.palcevska@acibademsistina.mk
N‐EV113. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV113.1. CHANGES IN SERUM ZINC LEVEL AND FECAL MICROBIOTA COMPOSITION IN PRETERM INFANTS
Ji Sook Park 1,2, Jin Su Jun1,2, Seung Hee Park1,2, Dong Joon Kim1,2, Ji‐Hyun Seo1,2
1Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea, Republic of, 2Institute of Medical Science, Jinju, Korea, Republic of
Objectives and Study: Prematurely born infants have a risk of zinc deficiency, which increases the risk of diverse morbidities, including necrotizing enterocolitis (NEC) and chronic lung disease. Recently, gut dysbiosis in preterm infants has been implicated in the pathogenesis of prematurity‐associated morbidities. We aimed to investigate an association between serum zinc level and fecal microbial composition in preterm infants.
Methods: Serum zinc level was measured on mean 3.7 and 32.2 days after birth in preterm infants. Stool samples were collected on a mean of 32.0 days after birth, and fecal microbial compositions were analyzed based on 16S‐based microbiome taxonomic profiling (MTP). Analyzed fecal microbial compositions were compared according to changes in serum zinc level.
Results: In total, 91 preterm infants born at 29.4 weeks of gestation and weighed 1309.4 g were included. Among them, a positive change in serum zinc level was shown in 32 and a negative change in 59 infants. There were no differences in perinatal factors, neonatal morbidities, or rate of breastfeeding between positive and negative groups. For fecal microbiota composition, Proteobacteria was more abundant in the negative (45.9%) than in the positive group (30.2%, P = 0.444). However, there was no significance. Alpha‐diversity or beta‐diversity (P = 0.409) between both groups was not statistically significantly different. Bifidobacterium longum species were more prevalent in positive than in negative change in the zinc group (P = 0.045).
Conclusions: Positive changes in serum zinc level might be associated with the growth of Bifidobacterium longum in the gut of preterm infants.
Contact e‐mail address: csassi@gnu.ac.kr
N‐EV114. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV114.1. COMPLEMENTARY FEEDING AND PREMATURITY: ANALYSIS AND EVALUATION OF A NUTRITIONAL SURVEY
Eleonora Rostirolla 1, Elena Zorzetto2, Marta Meneghelli1, Veronica Boscolo Momolina1, Roberta Nurti1, Caterina Righetto1, Maria Elena Cavicchiolo3, Giovanna Verlato1
1Pediatric Nutrition Service Nicu, University Hospital of Padova., Padova, Italy, 2University of Padova, Padova, Italy, 3Neonatal Intensive Care Unit, University Hospital of Padova, Padova, Italy
Objectives and Study: Nutrition during the first 1,000 days of life plays a critical role in promoting well‐being and improving long‐term health outcomes, particularly for infants born prematurely. This study aims to compare the initiation and management of complementary feeding in terms of timing, quality, and quantity of food provided to preterm infants during the pre‐ and post‐SARS‐CoV‐2 pandemic periods.
Methods: We enrolled preterm infants (≤34 weeks of gestational age) born in the Neonatal Intensive Care Unit of the University Hospital of Padova. Clinical data and information on complementary feeding practices were collected through questionnaires at 1 year of corrected age. Macro‐ and micronutrient intakes were estimated using a 24‐hour dietary recall.
Results: A total of 180 infants were included in the study: 107 from the pre‐pandemic period and 73 from the post‐pandemic period. No significant differences in demographic characteristics were observed between the two groups. At the start of complementary feeding, 17% of infants in the pre‐pandemic group were breastfed, compared to 11% in the post‐pandemic group. Infants in the pre‐pandemic group demonstrated a
significantly higher consumption (p <; 0.05) of salt, sugar, honey, sweet foods, and beverages.
The 24‐hour dietary recall revealed that children in both groups consumed approximately 300 kcal/day more than recommended, with protein intake accounting for 15% of daily caloric intake.
Conclusions: This study underscores the need for tailored nutritional guidance for preterm infants, aligned with current complementary feeding guidelines. It also highlights the importance of promoting breastfeeding and healthy eating habits from early childhood to support optimal growth and
development.
Contact e‐mail address:
N‐EV115. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV115.1. ORAL DEXTROSE GEL AS A THERAPEUTIC OPTION IN NEONATAL HYPOGLYCAEMIA – EFFICACY AND IMPACT IN EXCLUSIVE BREASTFEEDING
Ana Silva, Ana Silva, Ana Martins, Raquel Henriques
Neonatology Service, ULS Coimbra, Coimbra, Portugal
Objectives and Study: Neonatal hypoglycemia is a common clinical condition in newborns, more frequent in the first days of life, and potentially severe. If left untreated, it can lead to complications, such as seizures, potential neurological damage, and neurodevelopment disorders. First‐line treatment includes breastfeeding and, when this is unavailable, the introduction of an infant formula (IF). The early introduction of an IF is associated with lower rates of exclusive breastfeeding and even the discontinuation of this feeding method. Also, there is evidence that exposure to artificial protein in the first days of life is linked to the development of cow's milk protein allergy. Our objective is to use 40% dextrose gel as an alternative therapeutic option to correct mild to moderate asymptomatic hypoglycemia in the neonatal period and to assess its potential positive impact on exclusive breastfeeding rates at hospital discharge and the maintenance of breastfeeding in the first months of life.
Methods: We will conduct a multicenter, prospective, randomized study. Episodes of mild to moderate asymptomatic neonatal hypoglycemia in newborns admitted Portuguese hospitals will be included. The newborns will be treated according to the study protocol (Image 1). The groups will initially be analyzed descriptively, including demographic data, clinical and laboratory variables, as well as data on length of hospital admission, need of neonatal intensive care, and feeding method (exclusive breastfeeding, IF, or mixed feeding). Later, a comparative analysis will be performed.
Results: still ongoing preliminary results will be firstly presented at ESPGHAN 2025
Conclusions: With this study, we aim to validate the effectiveness of 40% dextrose gel as a first‐line treatment for mild to moderate neonatal hypoglycemia in the Portuguese population. Additionally, we aim to evaluate its impact on the rate of exclusive breastfeeding at hospital discharge.
Contact e‐mail address: anairodriguesilva@gmail.com
N‐EV116. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV116.1. AN ASYMPTOMATIC EXTREMELY PRETERM CASE OF CMV TRANSMISSION THROUGH BREAST MILK: AN INCIDENTAL DIAGNOSIS
Hande Buse Bol Baydar1, Sezin Ünal 2, Ozlem Azap3, Ozden Turan2, Deniz Anuk Ince2, Ayse Nur Ecevit2
1General Pediatrics, Baskent University Faculty of Medicine, Ankara, Turkey, 2Pediatrics/division Of Neonatology, Baskent University Faculty of Medicine, Ankara, Turkey, 3Infectious Diseases, Baskent University Faculty of Medicine, Ankara, Turkey
Objectives and Study: Postnatal CMV transmission in preterm infants primarily occurs through breast milk in units where blood products are controlled for CMV. Viremia develops independently of maternal serology, as preterm birth occurs in the early third trimester, before maternal IgG transfer. We present a case of an asymptomatic preterm newborn diagnosed with CMV infection, with breast milk identified as the transmission route.
Methods: Case report
Results: An extremely premature infant (23 + 5 weeks, 710 g) with bronchopulmonary dysplasia (BPD) was tested for CMV prior to steroid treatment on day‐68. Serum CMV IgM‐IgG were positive, and CMV PCR was 1,500 IU/mL. A systemic work‐up was conducted. Oral valganciclovir was started and continued for 9 days until the pre‐treatment CSF CMV PCR was reported as negative. He had been on full enteral feeding with his mother's milk since day‐34. The mother's tests showed: Serum CMV IgM: negative, CMV IgG: >250 AU/mL, avidity: 97%, and CMV PCR: negative. CMV was detected in both fresh (2,200,000 IU/mL) and frozen (2,500 IU/mL) expressed breast milk. Due to sustained maternal breast milk CMV load, the infant was switched to premature formula and discharged on day 124, breathing room air.
Conclusions: During lactation, CMV reactivates in the milk ducts of 95% of seropositive mothers. In our case, a negative maternal serum CMV PCR alongside a positive milk CMV PCR confirmed this mechanism. Postnatal CMV has been linked to multisystemic effects and an increased risk of BPD. Pulmonary involvement was not assessed in this case, as the infant showed no new symptoms. CMV‐related morbidities may be misattributed to prematurity, and premature infants may also remain asymptomatic. This case underscores the importance of considering CMV infection during the evaluation and treatment of BPD, particularly when steroid treatment is planned. Proper counseling and precautions regarding CMV transmission through breast milk are essential for preterm infants.
Contact e‐mail address: sezinunal@gmail.com
N‐EV117. Topic: AS03. NUTRITION/AS03d. Neonatal and Preterm Nutrition
N‐EV117.1. ASSESSMENT OF GROWTH TRAJECTORIES AND ITS RELATIONSHIP WITH THE NEURODEVELOPMENT STATUS OF PRETERM INFANTS WITH GROWTH FALTERING
Ariadna Witte 1, Miguel Sáenz De Pipaón2, Susana Ares Segura2, Celia Díaz González2
1Neonatology, Biomedical Research Foundation of the La Paz University Hospital, Madrid, Spain, 2Neonatology, La Paz University Hospital, Madrid, Spain
Objectives and Study: Objectives: ‐ Assess growth trajectories according to desnutrition during the hospital stay until the 2 years of corrected age on preterm infants. ‐ Evaluate the effect of growth faltering in neurodevelopment at 2 years corrected age.
Methods: The inclusion criteria included infants with a gestational age (GA) < 32 weeks and/or a birthweight <1500 grams, that completed the follow – up at the neonatology outpatient clinic. We divided the sample into two groups according to growth evolution during the hospital stay infants who suffered from growth faltering (GF, n = 102) and infants who did not suffer from growth faltering (Non Growth Faltering, NGF, n = 66).
Results: In the Parent Report of Children's Abilities‐Revised (PARCA) questionnaire, NGF infants had a higher score in language development scale at 2 years (88.5 [78.5; 96.5] vs. 84.5 [69.5; 91.5], p = 0.037). In the Bayley‐III questionnaire, we found a significant difference in motor development scale, with a higher score in the NGF group (94 [88; 100] vs. 85 [79; 91], p = 0.033]. Infants with a higher difference in z‐score from birth to discharge obtained worst results in both PARCA scales at 2 years (language scale rho = ‐0.26, p = 0.0064; non‐verbal cognition scale rho = ‐0.19, p = 0.039).
Conclusions: Avoiding GF during the hospital stay should be a priority in preterm infants. In this cohort study, we identified GF of very preterm infants, less than 32 weeks of gestation, associated with a higher risk of adverse neurodevelopmental outcome at 2 years corrected age (CA).
Contact e‐mail address:
N‐EV118. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV118.1. MICRONUTRIENT STATUS OF CHILDREN WITH BMI > + 1 SD RECEIVING PROLONGED ENTERAL NUTRITION
Alper Akpınar 1, Ceyda Tuna Kirsaclioglu2, Zarife Kuloglu2, Aydan Kansu2
1Pediatrik Gastroenteroloji, Etlik Şehir Hastanesi, Ankara, Turkey, 2Pediatric Gastroenterolology, Hepatology And Nutrition, Ankara University School of Medicine, Ankara, Turkey
Objectives and Study: Introduction:
In tube‐fed children with body mass index (BMI) > 1 SD, micronutrient intake may be negatively affected due to reduced energy requirement. We aimed to investigate the total energy intake (EI) and micronutrient deficiencies in solely tube feeding.patients with BMI > 1 SD.
Methods: Methods:
The nutritional status, feeding type, enteral nutrition products (ENPs), EI, and micronutrient status of the patients with BMI > 1 SD who were solely feeding with ready‐to‐use ENPs for at least 6 months were analyzed retrospectively. Patients who had a malabsorption disorder were excluded. The restricted EI was defined if EI of the patient was less than resting energy expenditure (REE) according to Schofield equation.
Results: Results:
Eighteen patients (38,9% female) with a mean age of 5,3 ± 2,9 years (range: 2–12 years) were included to the study. Diagnoses included cerebral palsy (n = 8), metabolic diseases (n = 4), and chronic respiratory failure (n = 6). The mean BMI z‐score was 2 ± 0,64. Fourteen patients (77,8%) were fed via percutaneous gastrostomy and the remainder (22.2%) via nasogastric tube. All patients were fed by ready‐to‐use ENPs exclusively: 50% polymeric, 33,3% fiber‐enriched polymeric, and 16,7% partially hydrolyzed formulas. Isocaloric ENPs were used by 66,7% of patients, while 33,3% received hypercaloric ENPs. Ten patients had continuous, 8 patients had bolus feeding. The average EI was 85 ± 21.3% of REE, with 66,7% (n = 12) had restricted EI. Among 12 patients, who have restricted REE, low albumin (33.3%), calcium (25%), magnesium (16.7%), folic acid (8.3%) and ferritin (8.3%) were found. No deficiencies in phosphorus, vitamin B12, or vitamin E were observed. At least one micronutrient deficiency was present in 75% of patients with energy restriction.
Conclusions: Conclusion:
These data support the need for routine monitoring and supplementation of micronutrients of the patients who were receiving prolonged restricted EI.
Contact e‐mail address: alprakpnr@gmail.com
N‐EV119. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV119.1. GALACTOSEMIA DUE TO GALT DEFICIENCY: A VERY RARE CLINICAL VARIANT
Ana Moráis López, Ana Bergua Martínez, José D Andrade Guerrero, Irene Merinero Ausín, Elena Borregón Rivilla, Francisco J Climent Alacalá
La Paz University Hospital, Madrid, Spain
Objectives and Study: Classical galactosemia (CG) is an inherited metabolic disorder in which the body is unable to properly break down galactose. The main symptoms appear in the first weeks of life as jaundice, vomiting, diarrhea, liver failure and developmental delay.
Methods: A 21‐day‐old newborn with no relevant personal or family history was admitted to hospital with a 3‐day history of fever, rhinorrhea and cough. He was exclusively breastfed, with good tolerance. Blood test only showed an increase in PCR and PCT. Urine and CSF tests were normal. Antibiotic therapy was started and, during the first hours he had focal seizures in the left hemibody and right hemiparesis. A CT scan was performed which showed left thalamic ischemic infarction with left frontal hemorrhage and right intraparenchymal frontal hematoma. An urgent decompressive craniectomy was performed. He subsequently had a prolonged stay in the ICU, presenting 6 new thromboses in different locations since admission. Treatment with antithrombin‐III (AT‐III) and anticoagulation was started after finding decreased AT‐III (28%, N 80‐120%). The etiological study revealed an alteration of the glycosylation of AT‐III. A study of transferrin isoforms found a carbohydrate‐deficient transferrin value of 74.5% (N < 1.3%). Genetic study of primary and secondary glycosylation disorders found 2 variants in the GALT gene. Metabolic and enzimatic study of galactosemia was performed, which found elevated urinary galactitol and galactonate and very decreased GALT activity in erythrocytes, confirming the diagnosis of CG.
Results: During the entire follow‐up, liver function was rigorously normal. Free‐galactose diet therapy was started, leading to normalization of the transferrin isoform pattern and AT‐III activity, which finally allowed the withdrawal of anticoagulation.
Conclusions: The clinical presentation of this patient, without any liver involvement, was very different from that reported in the literature for CG, which led to a delay in diagnosis. Free‐galactose diet therapy normalized the analytical findings, resolving the thrombotic symptoms.
Contact e‐mail address:
N‐EV120. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV120.1. NEONATAL SHORT BOWEL SYNDROME (SBS): TWO YEAR FOLLOWUP AND OUTCOMES FROM A SINGLE CENTRE EXPERIENCE
Sybil Barr, Saleem Mammoo, Noora Al Shahwani, Jauro Kuna Gaji, Samir Gupta, Guy Brisseau
Neonatology, Sidra Medicine, Doha, Qatar
Objectives and Study: Neonatal Short Bowel Syndrome (SBS) is a challenging clinical condition in newborns, with paucity of long‐term outcome studies. Practice in managing these babies varies, with only a few centres globally managing these babies successfully. We share our findings from our Quaternary Neonatal Unit and Paediatric surgical Unit.
Methods: We prospectively collected data from 2019, when a multi‐disciplinary Neonatal SBS programme was established. SBS was diagnosed based on gut length <25% for expected gestational age and parenteral nutrition (PN) duration. We collected data during NICU stay, after transition to Paediatric ward and follow up in outpatients at 2 years
Results: Total number of newborns diagnosed with SBS were 32 ‐ 28/32 (87.5%), 95% CI (71,96) survived ‐ 28/32 (87.5%), 95% CI (71,96) were preterm ‐18/32 (56%), 95% CI (37,73) was due to NEC ‐ median stay in hospital was 233 days (interquartile range 180‐338) ‐ 20 babies are now 2 years of age a)16/20 (80%), 95% CI (56,94) went home on PN b) 8/20 (40%), 95% CI (19,64) were off PN at 1 years c) 15/20(75%), 95%CI (51,91) were off PN at 2 years d) 5/20 (25%), 95% CI (9,49) remain on PN at 2 years Nutritional outcomes 13/20 (65%), 95% CI (41,85) of weight Z scores age 2 years were less than birth weight Z scores. 12/15 (80%) 95% CI (52,95) of head circumference Z scores age 2 years were less than birth head circumference Z scores Neurodevelopmental outcome at 2 years 11/20 (55%), 95% (32,77) CI were assessed as normal 4/20, (20%), 95% (6,44) had mild to moderate concerns 5/20, (25%), 95% (9,49) had significant concerns
Conclusions: Survival following neonatal SBS at our centre is comparable to other quaternanry centres. Most babies don't need PN by 2 years of age. Growth, nutritional status and neurodevelopmental outcome are the main health concerns post‐discharge.
Contact e‐mail address: sbarr@sidra.org
N‐EV121. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV121.1. DUAL PERSPECTIVES ON FOOD PRODUCTS: A CROSS‐CLASSIFICATION ANALYSIS OF NUTRITIONAL QUALITY AND DEGREE OF PROCESSING OF SELECTED FOOD PRODUCTS IN SOUTHEAST ASIAN MARKET
Melvin Bernardino 1,2,3, Natalia Rosso1, Claudio Tiribelli1
1Masld, Fondazione Italiana Fegato, Basovizza, Basovizza Trieste, Italy, 2Department Of Life Sciences, University of Trieste, Trieste, Italy, 3Philippine Council For Health Research And Development, Department of Science and Technology, Taguig, Metro Manila, Philippines
Objectives and Study: The rising prevalence of metabolic dysfunction‐associated steatotic liver disease (MASLD) in Southeast Asia, with the highest regional rate at 29%, poses a major public health challenge. MASLD is linked to poor dietary habits and increased consumption of ultra‐processed, nutrient‐poor foods. Simplified nutrition labels like Nutri‐Score and NOVA aim to guide healthier food choices, but their effectiveness in Southeast Asia remains uncertain, leaving the population vulnerable to diet‐related diseases. This study aims to compare the nutritional quality and degree of processing of foods and to analyze their ability to discriminate the fat, saturated fat, sugar, and salt content of selected foods available in the Southeast Asia market
Methods: Data on nutrient composition (fat, saturated fat, sugar, and salt), nutritional quality (Nutri‐Score), and processing level (NOVA) were obtained from the Open Food Facts database. A cross‐classification matrix analyzed the distribution of products across Nutri‐Score and NOVA categories, with descriptive statistics summarizing frequencies. Spearman correlation was used to assess relationships between Nutri‐Score, NOVA scores, and nutrient content.
Results: The study analyzed 4,668 food products, classifying 2,068 with NOVA, 71% of which were ultra‐processed (NOVA 4). Nutri‐Score rated 4,568 products, with most scoring D (26%) or E (26%). Cross‐classifying 2,431 products revealed NOVA 4 foods span Nutri‐Scores A (9%), B (16%), C (17%), D (30%), and E (29%). Spearman's correlation showed Nutri‐Score aligns strongly with nutrient content—saturated fat (R = 0.364), sugar (R = 0.355), and fiber (R = ‐0.175), all P < 0.001. NOVA had weaker correlations, strongest for sugar (R = 0.149) and salt (R = 0.138), emphasizing food processing over nutrient profiles.
Conclusions: The findings suggest Nutri‐Score and NOVA are complementary: Nutri‐Score guides healthier choices by nutrient content, while NOVA emphasizes processing levels. This study supports developing comprehensive front‐of‐pack labels in Southeast Asia, combining nutrients and processing to improve dietary choices and public health.
Contact e‐mail address: melvin.bernardino@fegato.it
N‐EV122. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV122.1. A POTENTIAL NUTRITIONAL BIOMARKER OF ANASTOMOTIC ULCERATIONS IN CHILDREN WITH SHORT BOWEL SYNDROME
Viviana Fara Brindicci 1, Antonella Diamanti2, Teresa Capriati2
1Pediatric Section, University of Bari, Bari, Italy, 2Nutritional Rehabilitation, Children's Hospital Bambino Gesù, IRCSS, Rome, Italy
Objectives and Study: Anastomotic ulceration (AU) represents a potentially life‐threatening complication of intestinal resection whose diagnosis is often delayed. The principal aim of this study was to assess if vitamin b12 may represent a potential nutritional biomarker for AU.
Methods: The electronic clinical records of patients with short bowel syndrome (SBS) and AU at “Bambino Gesù” Children Hospital (Rome, IT) were retrospectively reviewed
Results: Eight out 184 SBS patients had a history of AU (4.3%). Underlying disease for AU were necrotizing enterocolitis (NEC, n = 3, 37.5%), intestinal atresia (n = 2, 25%), gastroschisis (n = 1, 12.5%), gut volvulus (n = 1, 12.5%) and congenital SBS (n = 1, 12.5%). The mean delay between onset and diagnosis was 4.9 months. AU, diagnosed through endoscopic evaluation, clinically presented in all patients with iron deficiency anemia (mean hemoglobin value 7 g/dl, mean ferritin value 10 ng/dl). In all three patients with NEC the anemia was normocytic (average mean corpuscular volume, MCV, 79 fL) and accompanied by vitamin B12 deficiency (mean 135 ng/ml). In the other 5 cases the anemia was microcytic (average MCV 63.8 fL) and vitamin B12 levels normal (mean 689.8 ng/ml). NEC cases also exhibited mildly elevated fecal calprotectin (FC) levels (mean 140 mcg/g). FC resulted increased only in 2 out 5 of the other patients (mean value: 1336 mcg/g). Inflammatory markers, ASCA and ANCA antibodies were negative in all patients. AU were localized only at the ileal or ileo‐colonic anastomoses, and recurred in all patients, necessitating repeated endoscopic interventions (mean number of endoscopic procedures 5.5).
Conclusions: Vitamin B12 and FC may be altered in some SBS cases (NEC patients in our series). While FC lacks specificity, vitamin B12 may better correlate with ulcer localization, typically ileal or ileocolic. Prospective studies measuring vitamin B12 before supplementation are needed to clarify its role as a nutritional marker of AU.
Contact e‐mail address: v.brindicci1@studenti.uniba.it
N‐EV123. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV123.1. IMPACT OF FORTIFIED WHOLE GRAIN INFANT CEREAL ON THE NUTRIENT DENSITY OF THE DIET IN BRAZIL, UAE, AND USA: A DIETARY MODELLING STUDY
Lynda O'Neill1, Maria Vasiloglou1, Fanny Salesse2, Carole Bru 3, Regan Bailey4, Carlos Nogueira5, Ayesha Al Dhaheiri6, Leila Cheikh Ismail7, Nahla Hwalla8, Tsz Ning Mak9
1Nestlé Institute of Health Science, Lausanne, Switzerland, 2University College Dublin, Dublin, Ireland, 3Société des Produits Nestlé, Orbe, Switzerland, 4Institute For Advancing Health Through Agriculture, Texas A&M University, College Station, United States of America, 5Department Of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil, 6Department Of Nutrition & Health, United Arab Emirates University, Al Ain, United Arab Emirates, 7Department Of Clinical Nutrition & Dietetics, University of Sharjah, Sharjah, United Arab Emirates, 8Department Of Nutrition And Applied Sciences, American University of Beirut, Beirut, Lebanon, 9Nestlé Institute of Health Science, Singapore, Singapore
Objectives and Study: Complementary feeding influences future health outcomes. The aim of this study was to evaluate the impact of fortified whole grain infant cereal (WGIC), a complementary food, among 6‐ to 12‐month‐old infants on the nutrient density of the diet in three diverse settings: Brazil, the UAE, and the US.
Methods: Data from the Feeding Infants and Toddler Study (FITS), a collection of dietary intake studies based on 24‐hr‐dietary recalls, from said countries was utilized. Nutrient intakes were calculated for infant cereal (IC) consumers and non‐consumers between the ages of 6 and 12 months. Diet modelling was applied to IC consumers to substitute their regular fortified IC with WGIC with improved fortification. The study estimated the average nutrient density, mean adequacy ratio (MAR), and percentage inadequacy of the diet in both IC consumers and non‐consumers. These analyses were done before and after modelling.
Results: The analyses indicated that infants who had consumed IC had significantly higher intakes of calcium, zinc, magnesium, iron, and vitamin D in the three countries. Reduced micronutrient inadequacies were observed among IC consumers, particularly in Brazil and the US. Diet modeling with WGIC revealed a significantly higher density of choline, magnesium, zinc, iron, fiber, and protein and reduced inadequacies. The MAR was significantly improved in the three countries
Conclusions: This study illustrates the potential role of fortified WGIC in increasing the nutrient density of the complementary diet. It demonstrates the value of the intrinsic micronutrients present in WGIC and their impact on the overall nutritional quality of complementary feeding for infants in diverse settings.
Contact e‐mail address: lynda.oneill1@rd.nestle.com
N‐EV124. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV124.1. EFFECT OF MALNUTRITION ON SOFT NEUROLOGICAL SIGNS
Ayşe Can 1, Şükrü Güngör2, Ayşe Tosun3
1Pediatric Gastroenterology, Hepatology And Nutrition, Gazi University School of Medicine, ankara, Turkey, 2Pediatric Gastroenterology, Hepatology And Nutrition, İnönü University School of Medicine, Malatya, Turkey, 3Pediatric Neurology, Adnan Menderes University School of Medicine, Aydın, Turkey
Objectives and Study: Soft neurological signs(SNS) are abnormal motor or sensory signs that can only be detected on examination without clinical symptoms. Malnutrition is a systemic disease that can affect all systems. We aimed to evaluate the frequency of SNS in pediatric patients with primary malnutrition.
Methods: This study was a single‐center prospective analytic study. We enrolled children aged 8‐17 years who were diagnosed with primary malnutrition and aged‐matched healthy children. Neurological Evaluation Scale (NES) was administered into both two groups. Age‐ and sex‐adjusted weight Z score, height Z score, and BMI Z score were calculated by the malnutrition criteria developed by WHO. Patients with a Z score below ‐2 for any of body weight, height, or BMI were considered to have malnutrition. Neurological‐demographic status and socioeconomic level of patients were noted.
Results: It enrolled 57 subjects aged 8‐17 years who were diagnosed with malnutrition.as the patient group and 59 age‐matched healthy subjects as the control group. Soft neurological signs rate was higher in malnourished patients (p < 0.001). The best total ‘NES’ score cut‐off point that distinguished the healthy control group from the malnutrition group was ≥7.5. Socioeconomic level, parental education level, birth weight, breastfeeding rate were lower in malnourished patients, while the rate of living in crowded families was higher (p < 0.05). Weight Z score cut‐off point ≤‐1.255 SDS (p < 0.001) increased the risk of having SNS by 116.66 times; height Z score cut‐off point ≤‐1.010 SDS (p < 0.001) increased the risk of having SNS by 64.8 times and BMI Z score cut‐off point ≤‐1 SDS (p < 0.001) increased the risk of having SNS by 62.66 times.
Conclusions: Our study shows that the frequency of SNS is higher in pediatric patients with primary malnutrition than in the healthy control group and that neurological effects increase as the degree of malnutrition increases even it starts in Z score under <‐1.
Contact e‐mail address: aysegunescan@hotmail.com
N‐EV125. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV125.1. CLINICAL AND LONG TERM NUTRITIONAL OUTCOMES OF INFANTS BORN WITH EXOMPHALOS: 20 YEAR EXPERIENCE FROM A UK REGIONAL INSTITUTION
Sian Copley 1, Alok Godse2, Gareth Waring3, Gareth Hosie2, Elda Dermyshi4, Naveen Athiraman4
1Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, United Kingdom, 2Department Of Paediatric Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom, 3Department Of Fetal Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom, 4Department Of Neonatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
Objectives and Study: Exomphalos (defined as major or minor) is a central abdominal wall defect allowing herniation of abdominal viscera, covered by a membrane, into the umbilical cord, occurring in 1/13000 live births. 72% have comorbidities. Literature on long‐term outcomes is limited. This single‐centre retrospective cohort study examined long‐term respiratory and nutritional outcomes of infants born between 2000–2020 with exomphalos.
Methods: Infants with abdominal wall defects were identified from the clinical database; gastroschisis were excluded. Data collected included demographics, exomphalos type, comorbidities, surgical management, respiratory and nutritional outcomes and mortality. Relative risk (RR) with 95% confidence intervals and p values were calculated (alpha of <0.05 considered significantly different)
Results: Gender and gestational age at delivery were similar. Higher incidence (40% versus 3%) of postnatal diagnosis was observed in minor. Comorbidities occurred in 48% with minor versus 75% major. Length of stay and invasive ventilation were longer in major (43 days versus 6 days; 13 days versus 4 days respectively). 1(3%) infant with major required home oxygen; 5 (14%) infants with major required tracheostomies. 1(4%) infant with minor required parenteral nutrition (PN) compared to 10 (28%) with major. Median days to full feeds was 4 days (minor) versus 8 days (major). All surviving minor were orally fed at age 3 compared to 67% major. None required home PN.
Conclusions: Prolonged hospital stay, significant comorbidities and complications were seen predominantly in exomphalos major. By age 3 all children with minor were orally fed, whereas 33% of those with major required enteral feeding support at age 3 years. No children required home parenteral nutrition. Understanding long‐term outcomes in exomphalos is useful for developing departmental practices and parental counselling. Further multi‐centre network research is needed.
Contact e‐mail address: sian.copley@mft.nhs.uk
N‐EV126. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV126.1. ADVANCED GLYCATION END‐PRODUCTS IN FORMULAS FOR THE DIETARY MANAGEMENT OF COW'S MILK PROTEIN ALLERGY
Serena Coppola 1, Vincenzo Fogliano2, Xie Yajing2, Alessandra Agizza1, Laura Carucci1, Roberto Berni Canani3
1Department Of Translational Medical Science, University of Naples Federico II, Naples, Italy, 2Food Quality And Design Group, Wageningen University, The Netherlands, Netherlands, Netherlands, 3Department of Translational Medical Science and Immuno Nutrition Lab of the CEINGE Advanced Biotechnologies Research Center and Task Force on Microbiome Studies and European Laboratory for the Investigation of Food‐Induced Diseases at the University of Na, Namples, Italy
Objectives and Study: Special formulas are commonly used for the dietary management of infants affected by cow's milk protein allergy (CMPA), if breastfeeding is not available. Evidence reported that dietary advanced glycation end‐products (dAGEs) could be involved in the pathogenesis of food allergy through detrimental effects on gut barrier, immune system and gut microbiome. The presence of dAGEs has been detected in standard infant formulas, but no data are available in special formulas for CMPA dietary management. To address this concern, we investigated the presence of dAGEs commercially available special formulas used in CMPA patients.
Methods: The concentration of lysin‐ and arginine‐derived dAGEs, that are particularly abundant in thermally processed foods, were determined by UPLC‐MS/MS in three different batches of the following commercially available special formulas: amino acid‐based formula (AAF), extensively hydrolyzed whey formula (EHWF), extensively hydrolyzed casein formula (EHCF), soy formula (SF), and hydrolyzed rice formula (HRF). All formulas were prepared according to standard procedures. In particular, the concentration of lysine‐derived dAGEs [Nε‐Carboxymethyllysine (CML) and Nε‐Carboxyethyllysine (CEL)] and arginine‐derived dAGEs [Methylglyoxal‐hydroimidazolone 1 (MG‐H1) and glyoxal‐hydroimidazolone 1 (G‐H)] were analyzed.
Results: Lysine‐derived dAGEs and arginine‐derived AGEs were detectable in all study formulas. But the levels of CML and CEL were significantly higher (+300%) in SF, and CML concentration was significantly higher (+200%) in HRF if compared with other study formulas. Arginine‐derived dAGEs levels (MG‐H1 and G‐H), were significantly higher (+250%) in SF and HRF if compared with other formulas.
Conclusions: Data from this study, reporting different dAGEs levels in special formulas used for the dietary management of CMPA, could influence formula choice in non‐breastfed CMPA infants.
Contact e‐mail address: serena.coppola3@unina.it
N‐EV127. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV127.1. IMPACT OF MATERNAL NUTRITION ON COMPOSITION OF FOLLICULAR FLUID
Abbassia Demmouche 1, Khalloua Zine Charaf1, Darnamous Racha Nassima2, Slimane Belbraouet3
1Biology, biotoxicology laboratory. department of biology. university DJILLALI LIABES, ITMA SBA, Algeria, 2Department Of Medicine, FACULTY OF HEALTH SCIENCES, SBA, Algeria, 3NUTRITION, canada, Canada
Objectives and Study: Aim: nutritional factors could have an influence on the quality of follicular fluid and consequently on the maturation and the oocyte quality The objective is to study the impact of diet and obesity on the fertility of a population of Algerian women. Also, to establish thecorrelation between dietary intake of trace elements, vitamin B12 and the quality of follicular fluid.
Methods: This is a prospective study and analytical, focused on 88 subfertile women. The study targeted women who were going to have IVF. Trace elements (zinc, iron, copper, magnesium) and vitamin B12 were measured in the follicular fluid
Results: The dietary survey revealed excessive intakes of simple carbohydrates, total lipids in particular saturated fatty acid but low in dietary fiber, the intake of mono and polyunsaturated fatty acids including omega‐3s were insufficient. Deficiencies in iron, zinc, vitamin: B6, B9, E, D were noted. Trace elements carried out in the follicular fluid have shown highly significant correlations with the diet of infertile women.
Conclusions: Diet and weight are two key elements to consider in the follow‐up of infertile couples. A better treatment strategy is more than necessary in our country.
Contact e‐mail address:
N‐EV128. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV128.1. INTRODUCTION TO ADDED SUGAR IN EARLY LIFE: A REVIEW OF RECENT LITERATURE
Yasmin Bakhtiar1, Shamira Aviella1, Leilani Muhardi1, Yoga Devaera 2
1Medical Affairs And Scientific Engagement, Nestle Indonesia, DKI Jakarta, Indonesia, 2Faculty Of Medicine, Department Of Child Health, University of Indonesia, Jakarta, Indonesia
Objectives and Study: The World Health Organization recommends limiting free sugar intake to a maximum of 10% of total energy. It is important to understand the total sugar intake and its source in early life as its intake affects health in later life.
Methods: Retrieved literature from the last 10 years from PubMed using key words1 with the following inclusion criteria: children 0‐47 months, food, sweet snack, sugar‐sweetened beverages, sucrose in milk & cereal, publication with primary data in English; and exclusion criteria (i.e., older than 47 monhts, non‐english literature, disease group subject, controlled intake, no sugar measurement).
Results:
Sixty retrieved papers (85% from 16 developed countries and 15% from 7 developing countries) reported that children under the age of three are already consuming added and free sugar. Limited findings on children under 12 months reported that sugar‐sweetened beverages (SSB) and confectionary were already given. Several studies reported that these children consumed up to 29 g sucrose from confectionary daily. More papers were retrieved for children aged 12 months and older which reported consumption of sugar per day ranged from 35 g to 99 g, with 7 g to 22.3 g coming from added sugars. Among those older than 2‐year‐old, the consumption was reported approximately 56.4 g to 96.4 g total sugar daily. One study in The Netherland reported a median consumption of 362 g sugar per day from SSB.
Conclusions: Intake of added sugar (including SSB & confectionary) tremendously increased during weaning period. This behavior needs to be discouraged. Further education to healthcare professionals and mothers on healthy diet in early life must be strengthened.
Contact e‐mail address: Shamiraviella@gmail.com
N‐EV129. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV129.1. GLOBAL PEDIATRIC NUTRITION STUDIES: A COMPARATIVE ANALYSIS WITH THE MIDDLE EAST
Ali Doğan 1, Alihan Sürsal2, Fatih Özdener3
1Medical Department, Nestle Nutrition, İstanbul, Turkey, 2Farmakon Research & Consultancy, İstanbul, Turkey, 3Department Of Pharmacology, Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
Objectives and Study: Nutritional clinical studies play a critical role in shaping health policies, improving the quality of life, implementing early nutritional interventions conducted under evidence‐based conditions. However, pediatric studies are insufficient and geographically unbalanced with, most concentrated in North America and Europe. Despite high pediatric population in the Middle East, it remains underrepresented. Over the past 20 years, Turkey has started to utilize its potential for qualified researchers, positioning itself as a leader in conducting nutrition and other studies in the Middle East, demonstrating the region's potential. However, with its untreated patient population, fertility rates above the European and American averages, and advanced technological facilities suitable for further studies, even Turkey is still behind its full potential.
Methods: All data were obtained through the advanced search option on the ClinicalTrials.gov website by applying the necessary filters.
Results: Globally, the number of clinical studies doubled in the past decade. While nutrition studies have shown a parallel trend, the number of pediatric studies and interventional‐to‐observational study ratio remain lower. Turkey has demonstrated the Middle East's potential by conducting 11,338 clinical studies between 2003‐2023, which is comparable to the total clinical studies conducted in the Middle East. In Turkey, pediatric nutrition studies have increased by 16.3 times, a growth rate higher than that observed in adult studies. While only 17% of industry‐sponsored studies globally focus on pediatric nutrition, this figure is 27.3% in Turkey. Figure‐1. Nutritional clinical studies conducted worldwide: 2003‐2013 vs. 2013‐2023
Conclusions: Certain regulations can improve the regional imbalances. Large, young patient population attracting the attention of developed countries can be leveraged to conduct innovative patient care interventions and make significant contributions to medical research and development.
Contact e‐mail address: AliEvrim.Dogan@tr.nestle.com
N‐EV130. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV130.1. EVALUATION OF DIETARY BELIEFS AND HABITS IN PEDIATRIC IBD PATIENTS: PRELIMINARY RESULTS FROM A SINGLE‐CENTRE SURVEY
Dóra Dohos, Dorina Bajzát, Emese Kasznár, Ágnes Tímár, Judit Szentannay, András Szabó, Eszter Gombos, Anna Karoliny, Katalin Eszter Müller
Gastroenterology And Nephrology Department, Heim Pal National Pediatric Institute, Budapest, Hungary
Objectives and Study: In the patomechanism of inflammatory bowel disease (IBD) environmental factors, such as dietary factors are suspected to have great importance. Patients and their parents often follow a diet based on symptoms and disease related experiences, which may lead to insufficient development and malnutrition. Our aim was to assess the IBD patients’ dietary habits, beliefs and their knowledge about nutrition and IBD.
Methods: This cross‐sectional study began in December 2023, pediatric IBD patients from Heim Pál National Pediatric Institute completed a 31‐item questionnaire on dietary habits. The associations between results and demographic factors were analysed using the Chi‐square test.
Results: During the first six months, 68 IBD patients were included (mean age [sd]: 16 [11]; boys: 39 [57 %], 30 (44%) Crohn's disease (CD)). Most of the patients (81%) were in remission based on the activity indexes (PCDAI, PUCAI ≤ 10). Almost half of the patients, 44%, did not believe their eating habits contributed to the development of IBD. After the diagnosis, 71% of the responders changed their eating habits. Diet changes were similar across disease types (X2: 0.67, p = 0.41) and sex (X2: 0.85, p = 0.17). Regardless of the disease type, 47% of patients agreed that their symptoms relieved with new eating habits (X2: 2.26, p = 0.13). Most (76%) of patients preferred dietary advice from family members, friends, and Internet community. One third of patients thought diet was more important than medication, while 56% of patients believed them equivalent. At least one food was avoided by 68% of the responders.
Conclusions: Nearly two‐thirds of responders changed their diet after diagnosis, reporting positive symptom change. Most of the patients believe diet plays an important role in the disease management, dietary advice from unknown and uncontrolled sources are preferable, that could contribute to nutritional deficiencies.
Contact e‐mail address: dohos.dora@gmail.com
N‐EV131. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV131.1. MATERNAL PROTEIN INTAKE DURING PREGNANCY AND ITS LONG‐TERM IMPACT ON CHILD GROWTH: A LIFESPAN PERSPECTIVE"
Sohair Elsiddig 1, Ashraf Soliman2, Nada Alaaraj2, Noor Hamed1, Shayma Mohammed2, Ahmed Elawwa2, Fawzia Alyafei2
1Paediatrics, Hamad Medical Corporation, Doha, Qatar, 2Pediatrics, Hamad Medical Corporation, Doha, Qatar
Objectives and Study: Maternal nutrition, particularly protein intake during pregnancy, is vital for fetal and childhood growth. Adequate protein supports healthy birth outcomes, while imbalances can negatively impact growth patterns. This review assesses studies on the relationship between maternal protein intake and child growth from birth through puberty, published between 1990 and 2024. Objective: To evaluate how maternal protein intake during pregnancy affects child growth at various stages.
Methods: A systematic review of 10 studies, including observational studies and randomized controlled trials, analyzed the link between maternal protein intake and child growth outcomes globally across low‐, middle‐, and high‐income countries.
Results: At Birth:
Higher maternal protein intake was associated with improved birth weight and length, as shown in USA, Ireland, and Japan studies. In low‐income settings, protein‐energy supplementation improved birth weight. During Infancy:
Adequate maternal protein intake positively influenced weight gain and height velocity in infants. During Childhood:
Maternal protein intake was linked to sustained growth benefits into early childhood, promoting height‐for‐age improvements without adverse metabolic effects. At Puberty:
Though evidence is limited, early growth improvements from maternal protein intake may positively affect growth trajectories into adolescence.
Conclusions: Discussion Maternal protein intake affects fetal growth through mechanisms such as improved placental function& enhanced IGF‐1 levels. In infancy and childhood, the effects persist, likely due to the role of early protein programming in skeletal and muscular development. Balanced intake during pregnancy is crucial, as both deficiencies and excesses in protein intake may have adverse effects, such as fetal growth restriction or increased adiposity. Conclusion Maternal protein intake during pregnancy has a profound influence on child growth from birth through childhood, with sustained benefits into later life. Strategies to optimize maternal protein intake, particularly in low‐resource settings, essential for improving global child health outcomes. Further research needed to explore its long‐term effects on adolescent growth and health.
Contact e‐mail address:
N‐EV132. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV132.1. A LESSER‐KNOWN CULPRIT: COW'S MILK PROTEIN ALLERGY BEHIND BEHAVIORAL CHANGES
Vanessza Emmert 1,2, Dominika Lendvai‐Emmert3,4, Gergely Tóth5
1Doctoral School Of Health Sciences, University of Pécs, Faculty of Health Sciences, Pécs, Hungary, 2Department Of Pediatrics, Erzsébet Teaching Hospital, Sopron, Sopron, Hungary, 3Neurotrauma Research Group, University of Pécs, Pécs, Hungary, 4Department Of Neurosurgery, University of Pécs, Pécs, Hungary, 5Department Of Pediatrics, University of Pécs, Pécs, Hungary
Objectives and Study: Our research on children with cow's milk protein allergy (CMPA) revealed frequent reports of behavioral issues such as hyperactivity, learning difficulties, impulsivity, and poor sleep quality. To quantify these psychological symptoms and monitor changes after a dairy‐free exclusion diet, we incorporated the DSM‐V ADHD scoring scale into our questionnaire. The biological connection between behavioral issues and milk protein remains unclear.
Methods: The study examined 36 children aged 1–18 years with CMPA at Erzsébet Teaching Hospital, Sopron, Hungary. Parents completed questionnaires at baseline and two follow‐ups, covering sociodemographic, health, and sleep data. Patients were grouped by dietary compliance.
Out of the initial 36 participants, 7 (19.44%) were excluded due to non‐compliance. Of the remaining 29 children (44.8% boys, mean age 7.10 ± 4.20 years), additional exclusions occurred for incomplete data (n = 2, 5.56%), insufficient biological samples (n = 1, 2.78%), unconfirmed CMPA (n = 2, 5.56%), or withdrawal (n = 2, 5.56%). Behavioral analyses excluded children under age 3 (n = 5, 17.24%) due to inapplicability of the DSM‐5 ADHD questionnaire.
Saliva samples were processed and stored following standard protocols, and alpha‐amylase levels were measured using the ELISA method (RE80111 alpha‐Amylase Saliva Assay, IBL International).
Results: Among children adhering strictly to the diet (n = 18), evening alpha‐amylase levels showed a marginally significant decrease after 3 months (117.18 ± 69.25 U/ml vs. 86.44 ± 42.41 U/ml, t(17) = 1.982, p = 0.064). Among those with notable behavioral improvement (n = 7), a strong, significant reduction in alpha‐amylase levels was observed (142.79 ± 52.98 U/ml vs. 95.14 ± 46.50 U/ml, t(6) = 3.734, p = 0.010, r = 0.82).
Conclusions: Our findings suggest that a dairy‐free diet reduces stress levels, as indicated by decreased evening alpha‐amylase. Behavioral improvements in children correlated strongly with this reduction (p = 0.010).
Contact e‐mail address: vanessza91@gmail.com
N‐EV133. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV133.1. LOOKING BEYOND "TUMMY TROUBLES" ‐ BEHAVIORAL CHANGES IN COW'S MILK PROTEIN ALLERGY
Dominika Lendvai‐Emmert1,2, Vanessza Emmert 3,4, Gergely Tóth4,5
1Department Of Neurosurgery, University of Pécs, Pécs, Hungary, 2Neurotrauma Research Group, University of Pécs, Pécs, Hungary, 3Department Of Pediatrics, Erzsébet Teaching Hospital, Sopron, Sopron, Hungary, 4Doctoral School Of Health Sciences, University of Pécs, Faculty of Health Sciences, Pécs, Hungary, 5Department Of Pediatrics, University of Pécs, Pécs, Hungary
Objectives and Study: This research examined the prevalence of altered behavior reported by parents of children attending pediatric gastroenterology clinics, alongside organic symptoms. These behavioral issues include hyperactivity, learning difficulties, impulsivity, and sleep disturbances. We hypothesized that these changes may be linked to shifted levels of stress‐related biomarkers and the potential role of cow's milk protein.
Methods: Conducted at the Erzsébet Teaching Hospital in Sopron and Balassa János County Hospital in Szekszárd, this study involved children aged 1‐18 years with symptoms indicative of cow's milk protein allergy (CMPA). Based on questionnaires completed by parents, participants were divided into strict dieters and low‐adherence dieters. Saliva and urine samples were collected to analyze potential biomarkers associated with behavioral differences, using ELISA tests to measure cortisol and alpha‐amylase in saliva, and 5‐hydroxyindoleacetic acid (5‐HIAA) in urine.
Results: In the cohort of Szekszárd (n = 45), cortisol levels showed no significant changes before diet initiation and after three months of the elimination diet (morning p = 0.721; evening p = 0.893). However, among strict dieters in Sopron (n = 18), we observed a marginally significant decrease in alpha‐amylase levels (t(17) = 1.982, p = 0.064). In a subgroup of dieters (n = 7) with notable behavioral improvements, significant changes in evening alpha‐amylase levels were identified (t(6) = 3.734, p = 0.010, r = 0.822). Urine analysis of 17 children indicated a trend toward change post‐diet, with 5‐HIAA levels decreasing (p = 0.287). Improvements in impulsivity scores correlated strongly with urine 5‐HIAA levels (n = 5, p = 0.003).
Conclusions: Our findings suggest no significant differences in cortisol levels among children with hyperactive/attention‐deficit symptoms before and after diet. The lack of correlation between cortisol levels and behavioral symptoms indicated the possible role of the sympathetic‐adreno‐medullar (SAM) axis, as evidenced by notable changes in alpha‐amylase levels accompanying behavioral improvements.
Contact e‐mail address: lendvai.dominika@pte.hu
N‐EV134. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV134.1. SEX‐SPECIFIC EFFECTS OF ENERGY DRINK CONSUMPTION AMONG SCHOOL CHILDREN
Delphina Gomes, Federico Morassutti Vitale, Jennifer Wieprecht, Maren Baethmann, Anja Tengler, Roxana Riley, Guido Mandilaras, Pengzhu Li, Nikolaus Haas, Meike Schrader
Division Of Pediatric Cardiology And Intensive Care, University Hospital Munich, Munich, Germany
Objectives and Study: Energy drinks (ED) are widely consumed worldwide and are often marketed as enhancers of energy and performance despite evidence of health risks. Existing research is either small‐scale or lack comprehensive analysis of sex‐specific effects of ED in school‐aged children. We assessed and compared effects of ED consumption in boys and girls aged 10 to 20 years.
Methods: The unique “Hand‐on‐Heart” study is an ongoing prospective study of to date 922 school children in Munich, Germany. Comprehensive data is collected on anthropometry, nutrition, physical activity, and clinical parameters to assess early risk factors of cardiovascular diseases. Data stored in RedCap were analyzed in R to evaluate sex‐specific implications in ED consumption.
Results: A total of 834 children (mean ± SD age: 13.5 ± 2.2 years) were included in analysis. Regarding the rate of ED consumption, ED‐usage at least once differed by sex (boys: 66.8%, girls: 59.4%, p = 0.033). A higher proportion of boys consumed ED more than the girls between 10 to 12 years and 15 to 17 years. From 13 to 14 years, ED consumption was more in girls compared to boys. ED consumption was related with higher body mass index (BMI) in both sexes, however the change was more pronounced in boys (Δ: 2.2 kg/m2) than girls (Δ: 1.6 kg/m2). Among girls (n = 387), those who consumed ED had a higher body fat percentage compared to those without ED consumption (21% versus 16%, p = 0.022). Among boys (n = 447), ED consumption was related to higher systolic blood pressure (122 mmHg versus 117 mmHg, p < 0.001) and poor nutrition (41.3% versus 25.7%, p = 0.005) compared to counterparts without ED consumption.
Conclusions: Energy drink consumption among school children has sex‐specific differences and potential impact on health outcomes, highlighting the need for targeted interventions. Future studies should conduct large scale assessment of long‐term implications of ED consumption in children.
Contact e‐mail address:
N‐EV135. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV135.1. MATERNAL DIET QUALITY AND ITS ASSOCIATION WITH FOETAL GROWTH: FINDINGS FROM THE NUPED COHORT STUDY
Cornelia Conradie1, Louise T. Göttsche 1, Jeannine Baumgartner1,2, Lizelle Zandberg1, Elizabeth A. Symington3, Linda Malan1, Mieke Faber1,4, Cornelius M. Smuts1
1Centre of Excellence for Nutrition (CEN), North‐West University, Potchefstroom, South Africa, 2Department Of Nutritional Sciences, King's College, London, United Kingdom, 3Department Of Life And Consumer Sciences, University of South Africa, Johannesburg, South Africa, 4Non‐communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
Objectives and Study: Several factors contribute to optimal infant development, of which maternal nutrition during pregnancy is regarded as an important external stimulus for foetal growth. While birth weight reflects foetal growth during pregnancy, it does not consider potential growth fluctuations during the foetal stage. Also, associations between maternal dietary quality and longitudinal ultrasound‐derived foetal growth remain limited. This study aimed to investigate associations between maternal dietary quality and foetal growth in 250 pregnant women (aged 18 to 39 years, single pregnancy) enrolled in the Nutrition during Pregnancy and Early Development (NuPED) cohort study in Johannesburg, South Africa.
Methods: Maternal dietary intake at <18 weeks’ gestation was obtained using a quantified food frequency questionnaire, after which a priori dietary patterns were defined using the Diet Quality Index‐International (DQI‐I). The DQI‐I tool considers four categories of dietary quality: variety, adequacy, moderation, and overall balance. Foetal growth was described using foetal ultrasonography at mid and late pregnancy in terms of biparietal diameter, head circumference, femur length, abdominal circumference, estimated foetal weight, and interval foetal growth (difference between biometric measures at two time points divided by the difference in gestational age). Regression analysis (including confounders) was used to determine associations.
Results: No associations were found between the DQI‐I (total score and categories) and foetal growth. However, when considering the associations between the DQI‐I and the growth rates of head circumference and femur length, respectively, maternal pre‐pregnancy body mass index (BMI) (r = 0.269, p = 0.027; r = 0.265, p = 0.039) and gestational weight gain (GWG) (r = 0.315, p = 0.009; r = 0.244, p = 0.051) were significant positive predictors of the growth rate.
Conclusions: The findings suggest that dietary quality may indirectly influence foetal growth, as diet quality was previously found to be associated with pre‐pregnancy BMI and excessive GWG.
Contact e‐mail address: cornelia.conradie@nwu.ac.za
N‐EV136. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV136.1. RISK OF ANEMIA AMONG MIDDLE EASTERN CHILDREN (IRON STRONG STUDY): NON‐INVASIVE ASSESSMENT OF TOTAL HEMOGLOBIN AND IRON STATUS
Adlette Inati 1, Abdel Al Sabbagh2, Ahmed Abdelmawla3, Ahmed Fadl4, Hassan Alsabea5, Manar Al Shawabkeh6, May Hakmeh6, Mohamed Shaheen7, Naguib Abdelrehim8, Peter Noun9
1Department Of Pediatrics, University of Balamand Faculty of Medicine, Balamand, Lebanon, 2Pediatric Specialist, Marouf Clinic, Kuwait City, Kuwait, 3Medical Affairs & Market Access Director, Danone Specialized Nutrition – MENA, Dubai, United Arab Emirates, 4Pediatric Consultant, Dr Samir Abbas Hospital, Jeddah, Saudi Arabia, 5Medical Park Consultant, Abu Dhabi, United Arab Emirates, 6Private Clinic, Amman, Jordan, 7Dallah Hospital, Riyadh, Saudi Arabia, 8University Hospital, Sharjah, United Arab Emirates, 9St George University Beirut, Beirut, Lebanon
Objectives and Study: Screening and early treatment of anemia are important for optimal growth and development of children. Non‐invasive hemoglobin (Hb) screening facilitates quick and painless assessment of total Hb (SpHb®), oxygen concentration (SpO2), pulse rate (PR), and perfusion index (PI). We assessed prevalence of anemia risk (SpHb <12 g/dL) among Middle Eastern children aged 12–72 months by non‐invasive Hb assessment using Masimo Rad‐67® Pulse CO‐Oximeter® and compared socio‐demographic characteristics, nutritional status, and diet between those with and without anemia risk.
Methods: Healthy children aged 12–72 months seen in outpatient clinics at medical centers in Jordan, Kuwait, Lebanon, Saudi Arabia, and United Arab Emirates were included. Demographic, individual and family characteristics, medical history, diet, nutritional status, SpHb, SpO2, PR, and PI were documented. Crude and adjusted odds ratio, 95% confidence intervals, and p‐values were recorded.
Results: Based on SpHb concentration, 255 (25.2%; 95% CI, 22.7–28.0) of 1,010 participants had anemia risk and 753 (74.5%) had no risk. Prevalence of anemia risk across countries ranged from 20.5–42.3%. Statistically significant differences (risk vs. no risk) were observed in relation to geographical setting (p = 0.0051), education (p = 0.0213), socio‐economic (p = 0.0176) and income (p = 0.0460) levels, and PI (p < 0.001). With multiple logistic regression, the odds of having anemia risk were 2‐times greater if the mother had gestational anemia and 49% lower if the child received iron supplementation longer than the past 6 months. No statistically significant differences were observed with other parameters.
Conclusions: This highlights the need for comprehensive and early screening for anemia in children across the region. Prevalence of risk factors such as maternal gestational anemia and inadequate iron intake underscore the need to enhance education on nutrition. Non‐invasive Hb testing is efficient for screening in the outpatient setting.
Contact e‐mail address: adlette.inati@fty.balamand.edu.lb
N‐EV137. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV137.1. MILK FAT GLOBULE MEMBRANE‐ENRICHED WHEY ENHANCES NEONATAL INTESTINAL EPITHELIAL MATURATION
Annemijn De Kleer1, Jacqueline Vermeulen1, Vanesa Muncan1,2, Bruno Sovran1,2,3, Tim Lambers 4, Wouter De Jonge1,5
1Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centre, Amsterdam, Netherlands, 2Emma Center for Personalized Medicine, Amsterdam University Medical Centre, Amsterdam, Netherlands, 3Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam University Medical Centre, Amsterdam, Netherlands, 4FrieslandCampina, Amersfoort, Netherlands, 5Department of Surgery, University Clinic of Bonn, Bonn, Germany
Objectives and Study: The intestine is structurally mature at birth, yet maturation of gut functions such as digestion, mucosal barrier and signaling functions continues for 1‐2 years after birth. Although it has been demonstrated that these transitions can occur in the absence of stimulatory factors, the rate of gut development and maturation may be modulated. Human milk and formulae impact maturation of these gut functions differently which is, amongst others, evident from pre‐clinical studies and clinical endpoints such as a reduced risk for infections, intestinal related diseases, and allergies for breastfed infants. We hypothesized that this is partly explained by the fact that breastmilk contains a unique fat component, the milk fat globule membrane (MFGM), mostly absent in formulae. In this study the effects of bovine milk MFGM on intestinal maturation was studied using human neonatal small intestinal organoids.
Methods: Primary human neonatal organoids were derived from ileal tissue collected during neonatal surgeries (age 5w–4 m). Three‐dimensional organoids were exposed for 7 days to either MFGM‐enriched whey or whey protein isolate (WPI; a whey protein control not containing MFGM). Differences in growth and morphology were assessed by microscopy. Epithelial maturation was studied by targeted analyses of maturation and differentiation markers, and untargeted analyses (mRNA sequencing). Functionally, the activity of several brush border enzymes was assessed.
Results: MFGM‐enriched whey stimulation enhanced maturation and reduced differentiation as reflected by an increased expression and function of brush border enzymes, secretory Paneth cell and Goblet cell markers, which was accompanied by a reduced expression of stemness markers. mRNA sequencing revealed a clear differentiation of MFGM‐stimulated organoids from control and WPI‐stimulated. Subsequent Bio‐IT analyses revealed that pathways involved in membrane processes and digestive functionality were highly regulated.
Conclusions: MFGM‐enriched whey stimulates epithelial maturation by enhancing expression of brush border enzymes and cell differentiation through regulation of distinct pathways.
Contact e‐mail address:
N‐EV138. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV138.1. VITAMIN A INTAKE STATUS AND ITS ASSOCIATION WITH GASTROINTESTINAL DISORDERS AMONG INFANTS AGED 6‐12 MONTHS IN URBAN CHINA
Wenxin Liang 1, Hua Jiang2, Mengying Wang1, Xin Liu1, Jianhui Yan3, Yang Lu4, Yumei Zhang1
1Department Of Nutrition And Food Hygiene, School of Public Health, Peking University, Beijing, China, 2School of Nursing, Peking University, Beijing, China, 3Affiliated Hospital of Xiangnan University, Chenzhou, China, 4Department Of Health Care, Changsha County Maternal and Child Health Care & Family Planning Service Center, Changsha, China
Objectives and Study: This cross‐sectional study aimed to investigate the level of vitamin A (VA) intake among infants aged 6‐12 months and its association with gastrointestinal disorders (GD) in urban China.
Methods: The data were collected from 974 infants across ten cities in China from 2019 to 2020. A total of 311 infants aged 6‐12 months were included in this analysis. Food consumption data were obtained through a one‐time 24‐hour dietary recall. Total VA intake (μg REA/day) was calculated based on the Chinese Food Composition Table and information from VA supplement packaging. Infants were divided into two groups based on the 2023 Chinese RNI for VA (350 μg REA/day): sufficient and insufficient intake. Sociodemographic information and gastrointestinal disorders (diarrhea, colic, and constipation) from the past three months were collected through face‐to‐face questionnaires by trained investigators. Chi‐square tests and multivariate logistic regression were used to analyze factors associated with VA intake and its association with GD adjusting for age, region, and gender.
Results: Nearly 69.45% of the infants meet the RNI for vitamin A. The mean VA intake was 527.47 ± 236.6 μg REA/day, with sufficant intake group averaging 659.15 ± 150.25 μg REA/day (more than UL for VA, 600 μg REA/day), compared to 228.05 ± 50.26 μg REA/day in the insufficient intake group. There were 51.13% of infants who had used VA supplements. Food costs and residential region were significantly associated with sufficient VA intake, with the highest proportion of infants meeting the RNI observed in Ningbo and the lowest in Suzhou. The prevalence of GD was 27.0% for diarrhea, 17.4% for constipation, and 5.5% for colic. Logistic regression analysis found no significant association between VA intake and GD after adjusting for region, age, and gender (all p > 0.05).
Conclusions: A high level of VA intake was observed among infants aged 6‐12 months in China. This study found no significant association between VA intake and GD.
Contact e‐mail address: wenxinliang@bjmu.edu.cn
N‐EV139. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV139.1. ADHERENCE TO FIBRE INTAKE RECOMMENDATIONS IN EUROPEAN CHILDREN
Susana Larrosa1, Veronica Luque 2, Joaquín Escribano2, Mariona Gispert‐Llauradó2, Natalia Ferre2, Berthold Koletzko3, Veit Grote3, Elvira Verduci4, Dariusz Gruszfeld5, Annick Xhonneux6
1Pediatrics, University Hospital Sant Joan Reus, Reus, Spain, 2Pediatric, Nutrition And Development Research Unit, Universitat Rovira i Virgili. IISPV, Reus, Spain, 3Pediatrics, Dr. von Hauner Children's Hospital, LMU Universität Munich and German Center for Child and Adolescent Health, Munich, Germany, 4Unit Of Metabolic Disease, Ospedale dei Bambini Vittore Buzzi, Milano, Italy, 5Neonatal And Nicu Department, Children's Memorial Health Institute, Warsaw, Poland, 6Groupe Santé CHC, Liege, Belgium
Objectives and Study: Our aim was describing the adherence to dietary fibre recommendations in European children aged 2 to 8 y.
Methods: Observational longitudinal study in 5 European countries embedded in the European Childhood Obesity Project Trial. Three‐day food diaries were collected at 1, 2, 3, 4, 5, 6 and 8 years, and fibre intake compared to the different available international recommendations. Children were classified as compliant if their intake was ≥ recommendations. We assigned a percentage score for their intake relative to recommendations.
Results: Figure 1. Percentage of fibre intake achieved relative to the recommended amounts.
Compliance prevalence ranged 1 to 65% depending of age and recommendation (Table 1). The degree of compliance with recommendations (Figure 1) shows that most of the children had intakes close to the AAP, <50% of NAS and ≈50‐100% of the EFSA thresholds. Logistic regressions adjusted by country, gender and maternal education revealed that being compliant at 2 y increased the odds of compliance at 8 y (OR = 2.374; p = 0.006). Table 1. Children compliant with different fibre intakes recommendations.
| Age (years) | AAP 1993 (0,5 g/kg body weight) % | AAP 1995 (Age in years + 5) % | NAS 2005 (14 g/1000 kcal) % | 2017 (8.4 g/1000 kcal) % |
|---|---|---|---|---|
| 1, n = 886 | 3.7 | 24.5 | ||
| 2, n = 754 | 47.5 | 2.0 | 20.2 | |
| 3, n = 534 | 65.1 | 50.2 | 1.5 | 23.6 |
| 4, n = 504 | 62.4 | 50.6 | 1.8 | 24.8 |
| 5, n = 447 | 56.7 | 45.7 | 1.3 | 23.9 |
| 6, n = 469 | 50.8 | 45.2 | 2.1 | 26.0 |
| 8, n = 400 | 35.9 | 36 | 1.0 | 31.3 |
AAP: American Academy of Pediatrics; NAS: National Academy of Sciences: EFSA: European Food Safety Authority
Conclusions: Most children did not achieve recommended dietary fibre intakes. This could be due to poor diet quality and/or extrapolation of recommendations from those for adults, rather than considering feasible intakes with proven benefits in childhood.
Contact e‐mail address: pediatria@iispv.cat
N‐EV140. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV140.1. DIFFERENCES IN THE LIPID CONTENT AND FATTY ACID COMPOSITION OF MEAT PRODUCTS AND THEIR PLANT‐BASED ALTERNATIVES
Tamás Marosvölgyi 1, Viktor Koczka2,3, Timea Dergez1, Éva Szabó3
1Institute Of Bioanalysis, University Of Pécs, Medical School, Pécs, Hungary, 2Doctoral School Of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary, 3Department Of Biochemistry And Medical Chemistry, University of Pécs, Medical School, Pécs, Hungary
Objectives and Study: Plant‐based diets are becoming increasingly popular with the growing interest in healthy lifestyles and more sustainable eating habits. A whole‐food, plant‐based diet has positive health effects. At the same time, the food industry has developed a variety of alternative products that differ significantly from a whole‐food plant‐based diet in their composition and degree of processing. The aim of this study was to compare the fatty acid composition and fatty acid‐based nutritional quality indices of ground beef‐based foods from different manufacturers and their fully plant‐based alternatives.
Methods: We investigated six plant‐based and four beef hamburger patties and one plant‐based and one beef minced meat product, each with three different expiry dates. After homogenisation, lipids were extracted and quantified by gravimetry. Fatty acid composition was determined by gas chromatography. Essential fatty acid index, n‐3/n‐6 polyunsaturated fatty acid ratio, unsaturation index, atherogenicity index, thrombogenicity index, hypocholesterolemic/hypercholesterolemic ratio were also calculated from the fatty acid values.
Results: The fat content of the plant‐based (10.25% [8.60%; 14.87%] median [Q1; Q3]) and animal‐based products (19.67% [16.16%; 26.68%]) was significantly different (p < 0.01). Compared to the plant‐based alternative, the animal‐based hamburger patties had a higher content of saturated fatty acids. Significantly different fatty acid composition profiles are observed between and within the product groups investigated for both animal and plant‐based product groups. There were significant differences between plant‐based and animal‐based products for each calculated lipid nutritional index for each food group.
Conclusions: Lipid content and fatty acid composition of plant‐based meat alternatives are significantly different from the animal‐based food, leading to differences in nutritional values. To provide a more accurate and comprehensive picture, further analytical and clinical studies are needed to explore the long‐term health effects of the foods included in this study.
Contact e‐mail address: szabo.eva.dr@pte.hu
N‐EV141. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV141.1. IMPACT OF MULTIVITAMIN SUPPLEMENTATION ON MALNUTRITION AND GROWTH OUTCOMES IN CHILDREN: A LITERATURE REVIEW
Ashraf Soliman1, Suzan Nassar 1, Sohair Elsiddig2, Ahmed Elawwa1, Noor Hamed1, Nada Alaaraj1, Shayma Mohammed1, Ahmed Khalil3, Fawzia Alyafei1
1Pediatrics, Hamad Medical Corporation, Doha, Qatar, 2Paediatrics, Hamad Medical Corporation, Doha, Qatar, 3Pediatric Clinical Pharmacy‐pharmacy Department, Hamad Medical Corporation, Doha, Qatar
Objectives and Study: Malnutrition remains a critical health issue, disproportionately affecting children in low‐resource settings. Micronutrient deficiencies, a key component of malnutrition, impair physical growth, cognitive development, and immune function. Multivitamin supplementation has been explored as an intervention to address these deficits and improve child growth and development. Review aims to summarize the evidence on the effects of multivitamin supplementation on growth outcomes, nutritional status, and related health metrics in malnourished children.
Methods: A comprehensive review of studies published between 2000‐2024 was conducted, focusing on randomized controlled trials, cohort studies, and observational research involving children with malnutrition. Data sources included PubMed, Consensus, and other indexed databases. Key outcomes included height, weight, weight‐for‐age z‐scores (WAZ), and height‐for‐age z‐scores (HAZ).
Results: Nutritional Recovery: Multivitamin supplementation consistently improved weight and serum micronutrient levels. For instance, multivitamins combined with folic acid were associated with significant weight gain and higher serum folate in malnourished children (Ratanachu‐ek,2003). Growth Metrics: Studies reported mixed effects on height and weight gain. Multivitamins improved height‐for‐age z‐scores in stunted populations when combined with zinc (Taneja et al., 2022). However, in Tanzanian children, supplementation showed no significant reduction in stunting or wasting despite modest improvements in WAZ (Locks et al., 2016). Disease‐Specific Contexts: Among children with tuberculosis, multivitamins enhanced hemoglobin levels but failed to significantly increase weight (Mehta et al., 2010). Similarly, in HIV‐exposed children, no growth improvements were observed overall, although some subgroups experienced height gains (Kupka et al., 2013). Fortified Foods and Appetite: Fortified multivitamin‐mineral supplements improved appetite but did not significantly affect growth in stunted children (Dossa et al., 2002).
Conclusions: Vitamin A, D, B‐complex, and zinc‐containing multivitamins can effectively promote growth in children. Tailored supplementation for specific deficiencies can help reduce stunting and improve nutrition globally. Further researches needed to optimize dosages & interventions for sustainability.
Contact e‐mail address:
N‐EV142. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV142.1. SURVEY ON TOLERANCE DEVELOPMENT IN PEDIATRIC COW'S MILK PROTEIN ALLERGY: INSIGHTS FROM PRIMARY AND HOSPITAL CARE SETTINGS
Rafael Martín‐Masot1, Juan Díaz‐Martín2, Alicia Santamaria Orleans3, Víctor Manuel Navas‐López 1
1Pediatric Gastroenterology And Nutrition, Hospital Regional Universitario de Málaga, Málaga, Spain, 2Pediatric Gastroenterology And Nutrition, Hospital Universitario Central de Asturias, Oviedo, Spain, 3Scientific Communication, Laboratorios Ordesa, Barcelona, Spain
Objectives and Study: Cow's milk protein allergy (CMPA) is one of the most common food allergies in pediatrics. Understanding tolerance acquisition patterns and diagnostic approaches is critical for optimizing patient care, particularly in Spain, where regional differences may impact management. This study aimed to analyze the practices applied to determine CMP oral tolerance acquisition by Spanish paediatricians.
Methods: A structured questionnaire was distributed to healthcare providers in primary and hospital pediatric settings across various Spanish provinces. The survey addressed demographic profiles, diagnostic approaches, tolerance acquisition, and dietary modifications.
Results: The survey included 269 respondents, of whom 73% were women. The mean age was 48.14 years (SD = 11.34). Most respondents (48.3%) worked in primary care, followed by 17.1% in public hospitals and 13.8% in private clinics. Of these, 64.3% indicated routinely referring CMPA cases to specialists. Main diagnostic tests were Ig‐E determination (15.6%), and allergen elimination for non‐IgE mediated allergies (27,5%). For IgE‐mediated cases, 85.9% preferred hospital‐based oral food challenges, whereas 72.1% opted for home‐based protocols for non‐IgE‐mediated cases. When initiating a protein‐free diet, more than 80% preferred extensively hydrolyzed formulas for both non‐IgE‐mediated and IgE‐mediated cases. Tolerance acquisition was evaluated annually by 67.7% of participants, with a mean success result of 80%. Variability was observed in exclusion durations, with 64.7% excluding cow's milk protein for 6–12 months. Minimum age for CMP reintroduction was considered dependent on phenotype and severity, with 12 months of age mentioned as the more frequent option (17.1%).
Conclusions: The findings underscore significant variability in CMPA management between primary and hospital care in Spain. While home‐based tolerance tests are considered safe for mild cases, clear discrepancies in exclusion durations and diagnostic methods emphasize the need for standardized guidelines. Future research should focus on refining reintroduction protocols to enhance tolerance acquisition outcomes.
Contact e‐mail address: victor.navas@gmail.com
N‐EV143. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV143.1. ASSESSMENT OF THE INNOVATION OF INFANT FORMULAS BY SPANISH PAEDIATRICIANS AND PHARMACY PROFESSIONALS, DIFFERENCES AND SIMILARITIES
Luis Ortiz‐González1, Paula Fernández‐Ribal2, Alicia Santamaria Orleans3, Cristobal Coronel‐Rodríguez4, Maite Pérez‐Hernández 5
1Department Of Biomedical Sciences, Medicine and Health Sciences Faculty, University of Extremadura, Badajoz, Spain, 2Central Pharmacy, Gelida, Barcelona, Spain, 3Scientific Communication, Laboratorios Ordesa, Barcelona, Spain, 4Paediatrics Service, Amante Laffón Health Care Centre, Sevilla, Spain, 5Medical Department, Laboratorios Ordesa S.L., Barce, Spain
Objectives and Study: This study aimed to evaluate the degree of knowledge and assessment of innovation in infant formulas by paediatricians, main prescribers, and pharmacy professionals, main distribution channel in Spain.
Methods: A descriptive, cross‐sectional observational study was conducted through surveys distributed to practicing professionals via social media and email databases.
Results: An observational, descriptive, cross‐sectional study was conducted using surveys distributed to active professionals through social media and emailing. 876 questionnaires were collected, 505 from paediatricians and 371 from pharmacy professionals (pharmacists and pharmacy technicians). In a 10 points scale, personal knowledge of infant formula was rated at 7.9 ± 1.3 by paediatricians and 6.7 ± 1.9 by pharmacy professionals (p > 0,00001), evolution of infant formula over the last five years at 9 ± 1.1 by paediatricians and 8.3 ± 1.7 by pharmacy professionals (p > 0,00001), interest in new developments at 8.8 ± 1.3 by paediatricians and 8.4 ± 1.8 by pharmacy professionals (p > 0,01428) and relevance of educating parents about formulas composition at 7.8 ± 1.7 by paediatricians and 8.3 ± 1.9 by pharmacy professionals (p > 0,00001). Most valued nutritional advancements were probiotics, milk fat globule membrane (MFGM), and HMOs (human milk oligosaccharides) for pharmacy professionals and MFGM, HMO, and A2 protein for paediatricians. Best ranked benefits were immune system development, tolerance/digestibility, and cognitive development for pharmacy professionals and immune system development, cognitive development and tolerance/digestibility for paediatricians. Regarding knowledge of ingredients physiological effects, paediatricians scored 9.4 ± 1.7 and pharmacy professionals 8.0 ± 2.4. Most common sources of scientific information on infant formula evolution were pharmaceutical industry (88.1%) and professional congresses (41.4%) for paediatricians and pharmaceutical industry (86.5%) and professional peers (39.4%) for pharmacy professionals.
Conclusions: Innovation in infant formulas was a topic of interest for surveyed health professionals. Most highly valued new ingredients and benefits are closely related, standing out immune system development. Besides pharmaceutical industry, as main sources of information about infant formula innovation, paediatricians rely on congresses, and pharmacists trust their professional colleagues.,
Contact e‐mail address: maite.perez@ordesalab.com
N‐EV144. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV144.1. IMPACT OF TEDUGLUTIDE ON BODY COMPOSITION IN SHORT BOWEL SYNDROME PATIENTS
Carola Saure, Natalia Veliz, Clara Chiufo, Maria Janer Titarell
Nutrition And Diabetes, Hospital JP Garrahan, C.A.B.A, Argentina
Objectives and Study: Chronic intestinal failure (CIF) is defined as the reduction of functioning intestinal mass below the necessary minimum for food digestion, absorption, hydroelectrolyte balance, nutritional status, and growth. The most common cause of CIF is short bowel syndrome (SBS). Advances in specialized teams, parenteral nutrition (PN) formulations, surgical techniques, and perioperative care have significantly improved treatment. Recently, teduglutide, a synthetic analogue of glucagon‐like peptide 2 (GLP‐2), has been developed to promote intestinal adaptation in SBS patients. Objectives and Study:this study aimed to evaluate the impact of teduglutide on body composition in SBS patients.
Methods: Body composition was prospectively assessed in five patients who began treatment with a GLP‐2 analogue between January 2023 and June 2024. Impedanciometry was performed with the InBody S10 Multifrequency Impedance Meter before treatment and after 3, 6, 9, and 12 months. At the time of this study, four patients had reached 12 months of treatment. Three patients were weaned off PN within an average of 4 weeks of treatment.
Results: Five patients with SBS were recruited, all treated with teduglutide. The average age was 8 years (range 2‐16 years); four patients were female. In three patients, SBS was of neonatal onset due to congenital malformations (duodenal atresia, gastroschisis with intestinal and colonic atresia, colonic atresia with volvulus), and one case was secondary to necrotizing enterocolitis(NEC) and one due to intestinal intussusception. The median weight was 20.7 kg (10.8‐38.9), median height was 109.1 cm(81.5‐145 cm), and median BMI was 16.43(15.4‐18.5) before treatment.The median treatment duration was 7 months (range 2‐12 months).Improvements were observed in height and BMI, with a decrease in fat mass percentage and an increase in lean mass after teduglutide treatment.
Conclusions: Treatment with GLP‐2 analogues in SBS patients significantly impacts body composition and anthropometry, independent of reduced dependence on parenteral feeding. Further information is anticipated at the presentation of this work.
Contact e‐mail address: gocarola@icloud.com
N‐EV145. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV145.1. ASSESSMENT HEMOGLOBIN DETERMINATION IN VENOUS AND SINGLE‐DROP BLOOD SAMPLES OF CHILDREN AGED 3‐18 YEARS IN DIFFERENT REGIONS OF CHINA
Jiang Shan, Pang Xuehong, Yang Zhenyu, Zhao Wenhua
National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention;, Beijing, China
Objectives and Study: This study aimed to estimate measurement errors in hemoglobin quantification using the HemoCue Hb 201+ with venous and single‐drop capillary samples, and compare the results.
Methods: A total of 70,840 children aged 3‐18 years were included. From 30 children aged 3‐5 years and 360 children aged 6‐18 years, 2 ml venous blood was collected at each site, with one drop used for hemoglobin measurement. The remaining children's hemoglobin was determined using single‐drop capillary blood. All blood samples were analyzed for hemoglobin via a portable hemoglobinometer (HemoCue Hb 201 + , Sweden).
Results: The average venous and capillary hemoglobin concentrations were 127.6 ± 10.4 and 125.1 ± 11.2 for 3‐5 years, and 140.1 ± 15.9 and 133.3 ± 14.1 for 6‐18 years. Venous hemoglobin concentrations in Guangdong, Henan, Hunan, Yunnan, and Chongqing were significantly higher than capillary samples for 3‐5 years, but lower in Guangxi. For 6‐18 years, venous samples had significantly higher hemoglobin than capillary samples in all regions except Shaanxi. Anemia prevalence was 6.5% and 10.2% for venous and capillary samples, respectively, for 3‐5 years (table 3). Prevalence was lower for venous samples in Guangdong and Chongqing, but higher in Guangxi. For 6‐18 years, prevalence was 5.8% and 10.1% for venous and capillary samples. Except for Jilin and Shaanxi, prevalence was lower for venous samples.
Conclusions: Compared to 3‐5 years, hemoglobin concentration variability was higher in venous samples and single‐drop blood for 6‐18 years, in deferent regions.
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N‐EV146. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV146.1. MILK PROTEIN GLYCATION LOWERS POST‐PRANDIAL PLASMA LYSINE AVAILABILITY IN VIVO IN HUMANS IN A DOSE DEPENDENT MANNER
Glenn Van Lieshout 1,2, Jorn Trommelen2, Jean Nyakayiru1, Janneau Van Kranenburg2, Joan Senden2, Annemie Gijsen2, Lex Verdijk2, Wilbert Pellikaan3, Marjolijn Bragt1, Luc Van Loon2
1FrieslandCampina, Amersfoort, Netherlands, 2Department Of Human Biology, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre + , Maastricht, Netherlands, 3Animal Nutrition Group, Wageningen University, Wageningen, Netherlands
Objectives and Study: Industrial processing and storage of milk products (e.g. infant formula) can strongly increase the level of protein glycation, which has been suggested to compromise amino acid bioavailability. The present study assessed the impact of protein glycation level on post‐prandial plasma lysine availability in vivo in humans.
Methods: Data were collapsed from two double‐blind randomized cross‐over studies in which a total of 30 healthy young males ingested 40 g milk protein with a low (3%), medium (20%), or high (50%) glycation level. Blood samples were frequently collected during a 6‐h post‐prandial period to assess post‐prandial plasma lysine concentrations. Incremental area under the curve for plasma lysine concentrations over the entire 6‐h post‐prandial period was calculated to assess plasma lysine availability. Post‐prandial plasma lysine availability was compared between treatments using one‐way ANOVA with Bonferroni correction. Linear mixed models were applied with whey protein content as covariate to assess the effect of protein glycation level on post‐prandial plasma lysine availability.
Results: Post‐prandial plasma lysine availability was lower following the ingestion of milk protein with a high versus low glycation level, with medium level glycation resulting in intermediate values (treatment effect: P < 0.001). Linear mixed models demonstrated that protein glycation level attenuates the post‐prandial rise in plasma lysine availability (lysineiAUC (mmol·L‐1·360 min‐1) = 21.9 – 0.6 · protein glycation level (% blocked lysine) + 0.2 · whey protein content (% of total protein); R2 = 0.71; P < 0.001). When applied to infant formula with a whey protein content of 60%, each percentage increase in protein glycation level would theoretically result in a ~ 1.8% lesser rise in post‐prandial plasma lysine availability.
Conclusions: Milk protein glycation compromises post‐prandial plasma lysine availability in vivo in humans in a dose‐dependent manner. Industrial processing and storage of (milk) protein products can lower the actual nutritional value of a protein source and should be considered when assessing protein quality.
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N‐EV147. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV147.1. PREVALENCE OF BEEF MEAT ALLERGY IN CHILDREN WITH IGE‐MEDIATED COW'S MILK ALLERGY IN GREECE
Stilianos Xinias, Theodora Delaporta, Georgios Xinias, Eugenia Voudouri, Charalambos Agakidis, Ioannis Roilidis, Antigoni Mauroudi, Ioannis Xinias
HIPPOCRATES GENERAL HOSPITAL, THESSALONIKI, Greece
Objectives and Study: Cow's milk protein allergy (CMPA) is one of the most common food allergies in children, affecting 2‐5% of the population. Cross‐reactivity with beef meat allergy (BMA) has been reported in 13‐20% of children with CMPA worldwide. However, data on this association in the Greek population remain scarce.To investigate the prevalence of BMA in children with diagnosed IgE‐mediated CMPA, with or without other food allergies.
Methods: Over five years, 98 children aged 2.5 months to 3 years were diagnosed with IgE‐mediated CMPA in our clinic. Diagnosis was based on clinical symptoms of allergy and positive laboratory criteria, including specific IgE tests (F2, F76, F77, F78) and/or skin prick tests.Fifty‐one out of these children (27 boys, 24 girls) manifested typical or atypical symptoms of allergy. Serum levels of total IgE and specific IgE against beef meat protein (F27) were determined using the UniCap system. Symptoms and allergic manifestations were recorded also, and all patients were followed in our outpatient clinics.
Results: Beef meat allergy was diagnosed in 3 of children (5.9%) with IgE‐mediated CMPA. Based on clinical and laboratory criteria (positive F27‐specific IgE and typical or atypical allergic symptoms). Total IgE levels in these cases were >1000, 161, and 274 IU/mL. Among these three, one child had multiple food allergy, while the other two had CMPA and beef meat protein allergy. Total IgE levels were higher in the patients with multiple food allergies.
Conclusions: The prevalence of BMA in Greek children with IgE‐mediated CMPA (5.9%) appears lower than that reported in other countries (13‐20%).This difference may be attributed to dietary habits, such as the traditional thorough cooking of beef in Greece, which might reduce the antigenicity of beef proteins like bovine serum albumin and gamma‐globulin. Further studies are needed to confirm these findings and explore the impact of cultural dietary practices on food allergy prevalence.
Contact e‐mail address: dvradelaporta@gmail.com
N‐EV148. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV148.1. THE IMPACT OF MATERNAL NUTRITION ON ANOGENITAL DISTANCE AND PENILE WIDTH IN NEONATES
Sivan Yochpaz 1, Yam Nof2, Ida Michnik2, Dana L Gal2, Sivan Ben Avraham3, Laurence Mangel1, Dror Mandel1, Danit R Shahar3, Ronit Lubetzky1
1Departments Of Neonatology And Pediatrics, Dana‐Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel, 2The Nutrition & Dietetics Unit, Dana‐Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel, 3The International Center For Health Innovation & Nutrition, School of Public Health, Faculty of Health Sciences, Ben‐Gurion University of the Negev, Beer‐Sheva, Israel
Objectives and Study: Anogenital distance (AGD), the distance from the anus to the genitals, is a sexually dimorphic measurement commonly used in neonatal studies. Animal research has shown AGD to be sensitive to androgen levels in utero, with shorter distances in male offspring indicating lower androgen exposure, and longer distances in females suggesting higher androgen exposure. This study aims to explore potential correlations between maternal dietary patterns and neonatal genital measurements, with a particular focus on AGD.
Methods: In this ongoing prospective study, mothers and their term infants have been recruited since 2023. Mothers completed an online Food Frequency Questionnaire to establish their nutrition profiles. AGD was measured according to the TIDES protocol.
Results: The analysis included 49 male and 56 female infants. AGD correlated with infant birth weight (BW); ano‐penile and ano‐clitoral distances were significantly shorter in small‐for‐gestational‐age (SGA) infants compared to large‐for‐gestational‐age (LGA) infants (p < 0.05). Positive correlations were found between AGD in female neonates and maternal intake of dietary fiber, folate, and iron, although these associations weakened after adjusting for infant BW and maternal energy intake.
Conclusions: Preliminary data suggest that maternal nutrition may influence AGD in female neonates. The link between BW and AGD underscores the importance of maternal nutrition in fetal development, and further analysis is ongoing.
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N‐EV149. Topic: AS03. NUTRITION/AS03e. Nutrition Other
N‐EV149.1. SYNBIOTICS REVERSE MATERNAL DIETARY FIBER DEPRIVATION INDUCED LONG‐LASTING CD4 + T CELL IMBALANCE IN MICE OFFSPRING
Zhongxin Li1, Yuxing Zheng 2, Feitong Liu3, Bin Zhang1, Lingling Zhao2
1South China University of Technology, Guangzhou, China, 2China Research And Innovation Center, H&H Group, Guangzhou, China, 3H&H Group, H&H Research, China Research and Innovation Center, Guangzhou, China
Objectives and Study: Maternal dietary fiber deficiency impedes gut microbiota development and consequently triggers long‐lasting immune dysfunction in offspring. This study investigated the long‐lasting effects of synbiotics (i.e., 2′‐FL and the key microbes) supplement in terms of ameliorating intestinal CD4+ T cell imbalance in offspring induced by maternal dietary fiber deprivation (mFD) during lactation.
Methods: Maternal mice were fed a fiber‐free diet during lactation, and their offspring were given 2′‐FL, and then all offspring were fed a control diet from weaning until adulthood. The synergistic and long‐lasting effects of synbiotics were elucidated by measuring CD4+ T cells.
Results: mFD resulted in colonic Th2 and Th17 cell expansion and gut microbial dysbiosis in the offspring at weaning, with these effects persisting into adulthood. The 2′‐FL intervention during lactation reversed Th2 and Th17 cell expansion. Differential microbial analysis revealed that 2′‐FL primarily increased the abundance of five genera at weaning, which are nearly depleted in adulthood. Notably, Bifidobacterium exhibited the most significant expansion, mainly comprising Bifidobacterium longum and Bifidobacterium bifidum. Only the combination of Bifidobacterium longum subsp. infantis R0033 (R33) or Bifidobacterium bifidum R0071 (R71) with 2′‐FL reduced Th2 and Th17 cell levels and altered microbial composition. Interestingly, transplantation of fecal microbiota derived from adult offspring of the synbiotic group (2′‐FL + R33 or 2′‐FL + R71) at weaning failed to reverse mFD‐induced CD4+ T cell imbalance, whereas co‐housing with mFD offspring from weaning to adulthood did not affect the reduced Th2 and Th17 cell levels in the synbiotic group. Moreover, alterations in tryptophan metabolism may underlie these effects, as mFD reduced tryptophan metabolite levels, including 5‐hydroxyindole‐3‐acetic acid (5‐HIAA) and indole‐3‐acetic acid (IAA), while 2′‐FL + R33 restored IAA and 2′‐FL + R71 restored 5‐HIAA levels.
Conclusions: This study demonstrated that early‐life synbiotics supplement could counteract the long‐lasting expansion of Th2 and Th17 cells in offspring triggered by mFD.
Contact e‐mail address: zhongxinli3@163.com
N‐EV150. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV150.1. PATHOGENIC DEEP INTRONIC PCSK1 VARIANT CAUSES PROPROTEIN CONVERTASE 1/3 DEFICIENCY IN A FAMILY
Leah Huber1, Asli Subaşıoğlu2, Alexander Jordan3, Dorota Garczarczyk‐Asim1, Taras Valovka1, Thomas Müller1, Andreas Janecke1,4, Rüdiger Adam 3
1Department Of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria, 2Medical Genetics, Izmir Katip Celebi University, Izm, Turkey, 3Ped. Gastroenterology, University Children's Hospital, Mannheim, Germany, 4Institute Of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
Objectives and Study: An infant with severe congenital malabsorptive diarrhea underwent exome sequencing (ES) with particular consideration of PC1/3 deficiency, but no mutations were found. As the clinical phenotype underwent a drastic change to from dependency of parenteral nutrition early in life to complete enteral nutrition, hyperphagia and onset of obesity in the second year of life in the proband, as well as in his equally affected cousin, suspicion of a deficiency of proprotein convertase 1/3 (PC1/3), encoded by PCSK1 increased.
Methods: Genomic DNA from peripheral blood was sequenced using the SureSelect Human All Exon V6 kit on a HiSeq platform. Variants were called with the Genome Analysis Toolkit (GATK) and filtered against the gnomAD database for rare variants. Pathogenic variants were prioritized from an intestinal failure gene panel. Fibroblast cultures from skin biopsies were used to analyze PCSK1 transcripts after puromycin treatment. The PCSK1 coding sequence was PCR‐amplified, sequenced, and novel variants analyzed for splicing effects with SpliceAI. Minigene constructs with wild‐type or variant PCSK1 sequences were transfected into HEK293T cells, and cDNA products were analyzed by gel electrophoresis and sequencing.
Results: Transcript analysis revealed minor amounts of an aberrant PCSK1 transcript containing intron 9 sequence and encoding a premature stop codon (p.Pro400Valfs*35). A deep intronic PCSK1 variant, NG_021161.1(NM_000439.5):c.1196+2681 T > A, was found to segregate in the proband's family with disease. A minigene approach demonstrated that the identified deep‐intronic variant underlies pseudo‐exon inclusion of intron 9 sequence in the transcript.
Conclusions: PC1/3 deficiency in children is a rare genetic disorder characterized primarily by severe early‐onset malabsorptive diarrhea. This disease is often associated with a range of additional symptoms such as deficiencies in hormones (insulin, glucagon) and prohormones (pro‐opiomelanocortin ‐ POMC), growth and developmental delays, obesity later in childhood and Hyperproinsulinemia. The characteristic phenotype of PC1/3 deficiency might require extended genetic testing to make a timely diagnosis.
Contact e‐mail address: ruediger.adam@umm.de
N‐EV151. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV151.1. ASSOCIATION BETWEEN BODY MASS INDEX (BMI) AND HEPATIC STEATOSIS SEVERITY IN CHILDREN WITH OBESITY AND METABOLIC DYSFUNCTION‐ASSOCIATED STEATOTIC LIVER DISEASE (MASLD)
Jaime Alfaro‐Bolaños, Yunuen Rivera‐Suazo, Juan Suárez‐Cuenca, Frida Lopez‐Alvarado
Paediatric Gastroenterology, National Medical Centre 20 de Noviembre ISSSTE, Mexico City, Mexico
Objectives and Study: The association between hepatic steatosis and adiposity in children has been described using surrogate markers. Limited information exists on risk factors for steatotic severity in obese children with MASLD, highlighting the need for prevention. This study explores the impact of BMI on hepatic steatosis severity in this population.
Methods: We retrospectively reviewed data (June‐November 2024). Clinical‐demographic data were collected from electronic records. The study population was divided according to BMI into overweight and obesity. MASLD diagnosis was performed according to liver steatosis on imaging and at least one specific cardiometabolic risk factor: 1) Overweight/Obesity (BMI ≥ 85th percentile for age/sex [BMI Z score ≥ +1] or waist circumference > 95th percentile) 2) Prediabetes/Type 2 diabetes (T2DM): fasting serum glucose ≥ 100 mg/dL or serum glucose ≥ 200 mg/dL or 2‐h oral glucose tolerance test ≥ 140 mg/dL or HbA1c ≥ 5.7% or diagnosed/treated T2DM; 3) Hypertension: blood pressure (BP) ≥ 130/85 mmHg for ≥ 13 years; for < 13 years, BP ≥ 95th percentile or ≥ 130/80 mmHg (whichever is lower) or antihypertensive treatment; 4) Triglycerides ≥ 100 mg/dL < 10 years or ≥ 150 mg/dL for ≥ 10 years or lipid‐lowering treatment; 5) Low cholesterol HDL ( ≤ 40 mg/dL) or lipid‐lowering treatment (1). MASLD were subdivided according to steatosis (ultrasound): “low” and “moderate‐advanced.”.
Results:
Sixty children were included [mean 12 ± 2.9 years old, 5‐18 years old, 45 (75%) males]. BMI was 28.8 ± 9.9 kg/m². According to steatosis: “low” 31 patients (51.6%) and “moderate‐advanced” 29 patients (48.4%). Risk provided by BMI for moderate‐advanced steatosis was OR 2.8 (95% CI 1.1 to 7.1) (P = 0.009).
Conclusions: Adiposity markers such as BMI own potential as risk factors for hepatic steatosis progression in children with obesity and MASLD.
Contact e‐mail address: je.gastropedia@gmail.com
N‐EV152. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV152.1. UNDERSTANDING GENETIC CONTRIBUTIONS TO BMI: A KEY TO PERSONALIZED WEIGHT MANAGEMENT
Fawzia Alyafei 1, Sohair Elsiddig2, Noor Hamed1, Shayma Mohammed1, Ahmed Elawwa1, Nada Alaaraj1, Ashraf Soliman1
1Pediatrics, Hamad Medical Corporation, Doha, Qatar, 2Paediatrics, Hamad Medical Corporation, Doha, Qatar
Objectives and Study: Diagnosing the genetic factors influencing Body Mass Index (BMI) is essential for managing obesity and underweight effectively. This review analyzes data from genome‐wide association studies, cohorts, and meta‐analyses (2000–2024) involving diverse populations to identify key genetic contributors and their implications.
Methods: Data from genetic contributors to BMI studies, including genome‐wide association, cohorts & meta‐analyses conducted in 2000‐2024,Studies involved diverse populations (500‐330,000 individuals). Key genes for BMI regulation and their impacts analyzed for insights into genetic diagnosis and intervention strategies.
Results: Key Findings: Major Genetic Contributors: FTO: Strongly linked to obesity risk across populations. MC4R: Plays a role in appetite regulation, reducing obesity risk. BDNF: Val66Met polymorphism associated with lower BMI, especially in women. PCSK1: Variants linked to early‐onset obesity and BMI variation. Emerging Insights: CNR1: Associated with BMI regulation via the endocannabinoid pathway. KLF7: Protects against obesity, reducing BMI and waist circumference. Chromosome 16p11.2: Copy number variations linked to obesity and underweight. Gene‐Environment Interactions: Genes like TRHR and Gremlin1 influence lean mass but interact with lifestyle factors like diet and exercise.
Table 1
| Gene | |
|---|---|
| FTO | Strongly linked to obesity and BMI regulation, across age groups and populations. |
| MC4R | Decreased obesity risk via appetite regulation; common in population studies. |
| BDNF | Val66Met polymorphism linked to lower BMI, particularly in women. |
| PCSK1 | Variants rs6232 and rs6235 associated with early‐onset obesity and BMI variation. |
| CNR1 | Modulates obesity risk and BMI via endocannabinoid pathway. |
| KLF7 | A‐allele of rs7568369 protects against obesity and reduces BMI and waist circumference. |
| Chromosome 16p11.2 | Copy number variations inversely linked to obesity and underweight. |
Conclusions: BMI is regulated by genes involved in appetite (e.g., FTO, MC4R), metabolism (PCSK1, BDNF), and neuronal pathways (CNR1, KLF7). Genetic diagnostics enable personalized interventions by identifying individuals at risk for obesity or underweight, guiding precision prevention and treatment strategies. Understanding BMI's genetic framework is crucial for mitigating weight‐related health risks.
Contact e‐mail address:
N‐EV153. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV153.1. THE IMPACT OF INTERMITTENT ENERGY RESTRICTION (IER) AND LOW ENERGY DIET (VLED) ON WEIGHT AND METABOLISM IN ADOLESCENTS WITH OVERWEIGHT AND OBESITY: AN UPDATED REVIEW
Ashraf Soliman1, Noor Hamed1, Nada Alaaraj1, Shayma Mohammed1, Sohair Elsiddig2, Fawzia Alyafei 1
1Pediatrics, Hamad Medical Corporation, Doha, Qatar, 2Paediatrics, Hamad Medical Corporation, Doha, Qatar
Objectives and Study: Intensive dietary interventions differ from conventional dietary advice as behavioral treatments to reduce energy intake using very low‐energy diets (VLEDs) or intermittent energy restriction (IER). It might be used when conventional treatment is unsuccessful for rapid weight loss needed due to comorbidities or when pharmacotherapy or surgery is unavailable.
Methods: The study aims to review the updates on the impact of IER and VLED on Weight and Metabolism in Adolescents with Overweight and Obesity. We reviewed and synthesized findings from 18 research papers published over the past 12 years between 2011 and 2024, which studied the effectiveness of different dietary strategies in obese adolescents and young adults.
Results: A summary of the outcomes from the reviewed studies is presented in the table below.
Conclusions: Evidence suggests that IER, TLE, and VLED present viable and flexible options and can be effective tools for addressing overweight and obesity in adolescents and young adults, with positive effects on weight, body composition, and metabolic health.
Contact e‐mail address:
N‐EV154. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV154.1. METABOLIC DISORDERS OF VARIOUS TYPES OF FEEDING IN ADOLESCENCE
Guloyim Avezova 1, Nafisa Sultanova2
1Propedeutics Of Children Diseases, Tashkent Medical academy, Tashkent, Uzbekistan, 2Propaedeutics Of Children Diseases, Tashkent medical academy, Tashkent, Uzbekistan
Objectives and Study: To study the features of metabolic disorders in adolescents depending on the types of feeding.
Methods: To achieve this goal
clinical and laboratory research methods were studied: general blood analysis, biochemical blood analysis: blood lipid spectrum: low‐density cholesterol, high‐density lipoprotein, triglycerides, as well as diagnosticobservations of children for 14 years.
Results: There was a significant increase in cholesterol with age, so if in the main group at the age of 4‐6 years, its indicators were 5.4 ± 0.1 mol/l, then at the age of 7‐14 years, they significantly increased (5.7 ± 0.10 mol/l; P < 0.05). A similar pattern is observed in the comparison group. Analyzing the frequency of detection of laboratory parameters indicating a violation of fat and carbohydrate metabolism, depending on the methods of care, wefound that in children in the main group there is a less pronounced dynamics in the frequency of occurrence of violations of metabolic parameters in laboratory parameters. An increase in glucose was observed in 16.7% of cases in the main group and 21.4% in the comparison group.
Conclusions: Thus, the metabolic characteristics of children in different periods of life reflect the general patterns of protective and adaptive processes and are manifested in different directions and varying degrees of changes, depending on the type of feeding and the principles of care. Metabolic changes in different age periods were characterized by heterogeneity, so in children aged 4‐6 years, laboratory indicators were characterized by a stable state of fat and carbohydrate metabolism, as well as the absence of segments of maximum metabolic stress, which cannot be said about children in adolescence.
Contact e‐mail address: guloyimavezova77@gmail.com
N‐EV155. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV155.1. ENERGY CHARACTERIZATION AND NUTRIENT COMPOSITION OF THE TRAFFIC LIGHT DIET : OUR EXPERIENCE
Grazia Massa1, Ottavia Giannetti1, Giulia Pastore1, Carmen Campanile1, Rosanna Masturzo1, Melissa Iandolo1, Anna Giulia De Anseris2, Annalisa Morelli1, Rossella Colantuono2, Angelo Colucci 1, Claudia Mandato1,2
1Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, Baronissi (Salerno), Italy, 2Pediatric Unit, University Hospital San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
Objectives and Study: The traffic light diet categorizes foods based on energy density and food quality. "Green" foods, low in energy density,can be eaten freely;"yellow" foods should be consumed moderately,and "red" foods should be consumed occasionally due to their higher energy density.However,doubts persist about the validity of the traffic light diet due to substantial disagreement about which foods should be classified in each of the three color categories. Furthermore,there is limited evidence in the literature regarding the characterization of this nutritional approach in terms of energy and nutrient composition. The objective of this study is to calculate,through the administration of an Food Frequency Questionnaire (FFQ) three months after initiating the traffic light diet,a range of energy intake in kcal/day and macronutrients (grams and percentage/day) in a sample of 50 pediatric patients with obesity (BMI and WC > 95°ct).
Methods: We introduced to fifty patients aged 11‐14 years,attending the obesity clinic at San Giovanni di Dio e Ruggid'Aragona Hospital in Salerno,the traffic light dietary model reviewed by our research team.After three months,patients were reevaluated and an FFQ was administered retrospectively assess the type of diet followed.
Results: Of the enrolled population: 30/50 followed the diet completely (kcal/die 1780 ± 232; protein g/die 89 ± 18 20%of total energy,lipid g/die 65 ± 14 33% of total energy, carbohydrates g/die 207 ± 18 47% of total energy), 10/50 occasionally (kcal/die 1843 ± 98; protein g/die 95 ± 6 21%of total energy,lipid g/die 64 ± 15 31% of total energy,carbohydrates g/die 210 ± 19 46% of total energy) and 10/50 did not(kcal/die 2159 ± 98;protein g/die 115 ± 7 21%of total energy,lipid g/die 86 ± 7 36% of total energy,carbohydrates g/die 224 ± 34 42% of total energy).
Conclusions: The results in terms of macronutrients and calories/day consumed by children who had good adherence to nutritional advice are agree with Mediterranean diet and are hypocaloric standards according to European Food Safety Authority‐EFSA (age 11‐14 2500 kcal/die,CHO 45‐60%, fat 20‐35%,protein 0,95 g/kg/die).
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N‐EV156. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV156.1. ULTRAPROCESSED FOODS AS MAIN DRIVER OF METABOLICALLY UNHEALTHY PEDIATRIC OBESITY
Serena Coppola 1, Arianna Minieri1, Alessandra Agizza1, Maria Belliotti1, Greta Aquilone1, Letizia Ciliberti1, Laura Carucci1, Roberto Berni Canani2
1Department Of Translational Medical Science, University of Naples Federico II, Naples, Italy, 2Department of Translational Medical Science and Immuno Nutrition Lab of the CEINGE Advanced Biotechnologies Research Center and Task Force on Microbiome Studies and European Laboratory for the Investigation of Food‐Induced Diseases at the University of Na, Namples, Italy
Objectives and Study: Emerging evidence suggest potential association between ultraprocessed foods (UPFs) exposure and adverse health outcomes, including obesity and metabolic complications. We assessed the cross‐sectional associations between UPFs intake and the obese phenotype in pediatric patients.
Methods: We comparatively evaluated intake of UPFs, and of their detrimental compounds advanced glycation end‐products (AGEs), in obese pediatric patients, obese pediatric patients complicated by metabolic syndrome (MetS), and sex‐ and age‐ matched normal‐weight healthy controls. AGEs skin accumulation was also evaluated.
Results: A total of 175 subjects were enrolled: 53 obese patients (52.8% male, mean age 10.7 years ± 3.5 SD), 22 obese with MetS (54.5% male, mean age 12.4 years ± 2.6 SD), and 100 controls (63% male, mean age 10.3 years ± 3.5 SD). UPFs intake resulted positively correlated with Body Mass Index (r = 0.35; p = 0.01). UPFs intake correlated with the MetS occurrence. UPFs and AGEs exposure resulted higher in MetS patients if compared to obese and controls. MetS patients also reported a higher skin AGEs accumulation.
Conclusions: Our findings support a pivotal role of UPFs in facilitating not only the occurrence of obesity but also in driving the metabolically unhealthy phenotype. These results support the need for dietary strategies limiting UPFs exposure for the prevention and treatment of obesity and its metabolic complications.
Contact e‐mail address: serena.coppola3@unina.it
N‐EV157. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV157.1. COMPARATIVE ANALYSIS OF BMI, OBESITY, HEIGHT SDS, BONE AGE, AND PUBERTAL TIMING IN PEDIATRIC POPULATIONS: A SYSTEMATIC REVIEW
Sohair Elsiddig 1, Noor Hamed2, Fawzia Alyafei2, Ahmed Elawwa2, Nada Alaaraj2, Shayma Mohammed2, Ashraf Soliman2
1Paediatrics, Hamad Medical Corporation, Doha, Qatar, 2Pediatrics, Hamad Medical Corporation, Doha, Qatar
Objectives and Study: To examine the relationship between BMI, obesity, and growth in children, and to identify trends in pubertal timing and growth spurts.
Methods: A systematic review of 23 studies from 2001‐2024 conducted. Patient characteristics, growth dynamics (height SDS and growth rate), bone age,pubertal timing were analyzed, Findings were categorized into three domains: BMI and height SDS BMI and bone age BMI and pubertal timing.
Results: BMI and Height SDS:
Obesity was consistently associated with accelerated height growth in childhood but lower height gain during puberty, as noted in studies involving 15,000+ patients. Notable exceptions were late catch‐up growth in specific cases and variability in height SDS across sexes. BMI and Bone Age:
Advanced bone age in obese children was frequently reported in 8 studies, particularly highlighting the role of leptin as a mediator. This finding was supported by studies comprising over 10,000 patients, indicating obesity's significant impact on epiphyseal maturation. BMI and Pubertal Timing:
A majority of studies (n = 15) found that obesity was linked to early pubertal onset in both boys and girls, with girls showing a stronger correlation. Notably, earlier puberty onset often coincided with reduced final adult height and faster biological maturation. The observed trends attributed to increasing childhood obesity rates, altering metabolic, hormonal pathways. Elevated leptin levels, may accelerate bone maturation, neuroendocrine triggers for puberty. The disparity between prepubertal height gain and reduced pubertal height gain suggests that obesity affects not only timing but also growth potential. These changes are likely driven by lifestyle factors, genetic predispositions, and improved monitoring techniques in recent studies. The increasing sample sizes and methodological rigor of later studies (e.g., 2023–2024) underscore the rising importance of addressing obesity in pediatric growth research.
Conclusions: Review highlights obesity multifaceted effects pediatric growth and development. Targeted interventions to manage childhood obesity may mitigate its impact on growth and maturation.
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N‐EV158. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV158.1. EXPLORING IMPACT OF GUT HORMONES, ADIPOKINES AND NEUROPEPTIDES IN APPETITE REGULATION AND WEIGHT MANAGEMENT IN CHILDREN; COMPREHENSIVES REVIEW
Niga Hama Rashid
DR.JAR pediatric teaching hospital, Sulaimanya, Iraq
Objectives and Study: The regulation of appetite and weight management is a complex interplay of gut hormones, Adipokines and neuropeptides, which has garnered significant attention in recent years. This literature review synthesizes findings from various studies to elucidate the mechanisms by which these biological factors influence feeding behavior and weight regulation in children, highlighting their potential therapeutic application.
Methods: A systematic literature review was conducted using databases such as PubMed, Google Scholer, and web of science. Searching for all trails published in English from 2014 up to June 2024, using key words. Articles were considered relevant and included in the analysis if (a) They were published in peer‐reviewed journals between 2014 and June 2024, (B) they investigate hormonal mechanism signaling weight regulation and appetite control, (c) studies involving human subjects, specifically children and adolescent.
Results: The literature review revealed that Gut hormones such as Ghrelin, peptide YY (PYY), glucagon like peptide‐1 (GLP‐1) and cholecystokinin (CCK) play significant role in appetite regulation and energy homeostasis. Ghrelin orexigenic hormone stimulate appetite, while PYY, GLP‐1, and CCK act as anorexigenic hormones promoting satiety and reducing food intake. Adipokines, including Leptin and adiponectin, were found to influence energy balance and body weight by modulating appetite and metabolic processes. Neuropeptides like neuropeptide Y(NPY) and proopiomelanocortin (POMC) were identified as critical regulators within the central nervous system, affecting hunger and energy expenditure. The interplay between these hormones and peptides is complex with evidence suggesting that dysregulation can lead to obesity and related metabolic disorders.
Conclusions: the literature presents a comprehensive understanding of the hormonal and peptogenic influences on appetite regulation and weight management in children. It highlights the intricate interplay between various hormones and the need for targeted interventions that consider these complex mechanisms. Future research should continue to explore these relationships, particularly in the context of rising childhood obesity rates.
Contact e‐mail address: nigashafiq1988@gmail.com
N‐EV159. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV159.1. IMPACT OF ZINC SUPPLEMENTATION ON GROWTH IN CHILDREN AND ADOLESCENTS: A REVIEW OF EVIDENCE ACROSS THREE DECADES
Ashraf Soliman1, Manasik Hassan 2, Fawzia Alyafei1, Sohair Elsiddig3, Noor Hamed1, Nada Alaaraj1, Shayma Mohammed1, Ahmed Khalil4, Ahmed Elawwa1
1Pediatrics, Hamad Medical Corporation, Doha, Qatar, 2HAMAD MEDICAL CORPORATION, DOHA, Qatar, 3Paediatrics, Hamad Medical Corporation, Doha, Qatar, 4Pediatric Clinical Pharmacy‐pharmacy Department, Hamad Medical Corporation, Doha, Qatar
Objectives and Study: Zinc, is essential for growth and development. Zinc deficient worldwide, especially in malabsorption disorders &malnutrition regions; Sub‐Saharan Africa, South‐Asia, and Latin‐America. Supplementation needed to address zinc deficiency's effects on growth, immunological function, and cognition.
Objective: This review evaluates zinc supplementation impact on linear growth (height) and weight gain in children &adolescents over past 30years. examining its potential as growth‐promoting factor.
Methods: Narrative review examined zinc supplementation on children's growth/weight over the past 30years.
Results: The review encompassed findings from eight studies, involving >37,500 subjects across various geographic regions and socioeconomic contexts. Zinc dosages varied between 5 and 30 mg/day, intervention periods lasting from 6weeks‐6months. Linear Growth: Studies demonstrated significant increase in height, particularly in zinc deficiency or malnutrition cases. Meta‐analyses reported height gains from 0.23 cm to 0.9 cm, with effects more pronounced in prepubertal children. Weight Gain: modest weight increases reported, with gains between 0.14kg‐0.51 kg in supplementation groups compared to controls. Contextual Variability: Outcomes were more robust in populations with baseline deficiencies, such as malnourished children or those from low‐income countries, highlighting the role of zinc in addressing growth stunting.
Conclusions: Discussuion:Zinc supplementation is effective, low‐cost intervention for promoting growth, particularly in at‐risk populations. Variations in study findings may arise from differences in baseline zinc status, age, intervention duration, and dietary context. Early studies, e.g. Friis et al.(1997), showed limited benefits, whereas recent research, Monfared et al.(2023), reported significant improvements due to better study‐designs and larger sample sizes. Although zinc supplementation effect are statistically significant, they are often modest, underscoring importance of combining zinc with other nutritional interventions. Conclusions Zinc has a positive impact on children's height and weight especially those with deficiencies or malnutrition. While it is not universal solution for growth stunting, it is crucial for vulnerable populations. Future research should prioritize long‐term outcomes and effective integration with other public health strategies.
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N‐EV160. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV160.1. EFFECT OF INFANT VITAMIN D SUPPLEMENTATION ON EPIGENOME‐WIDE DNA METHYLATION
Helena Hauta‐Alus 1,2,3, Minna Pekkinen1, Maria Enlund‐Cerullo1,2, Saara Valkama2,4, Sture Andersson4, Elisa Holmlund‐Suila2,4, Outi Mäkitie1,2,4,5
1Folkhälsan Institute of Genetics, Helsinki, Finland, 2Research Program For Clinical And Molecular Metabolism (camm), University Of Helsinki, Helsinki, Finland, 3University of Oulu, Oulu, Finland, 4Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, 5Department Of Molecular Medicine And Surgery, Karolinska University Hospital, Stockholm, Sweden
Objectives and Study: Early life exposures can alter individual's epigenome and lead to long‐term health consequences. Severe and chronic vitamin D deficiency causes nutritional rickets in childhood; however, high vitamin D dosages can also have disadvantageous health implications. Data on vitamin D and epigenetic alterations are limited. We aimed to examine whether higher vitamin D supplementation dose compared with a standard dose affects epigenome‐wide DNA methylation (DNAm) in 1‐year‐old infants.
Methods: In the Vitamin D Intervention in Infants (VIDI) study, 987 infants were randomized to receive daily vitamin D supplementation of 10 µg (group‐10) or 30 µg (group‐30) from age 2 weeks until age 2 years. To analyze DNAm with Illumina EPIC 850 K array, we randomly selected 286 participants at age 1 year with available DNA samples isolated from whole blood within intervention groups and sexes. Epigenome‐wide association analyses were conducted via R package Meffil adjusted for sex, parental smoking status, maternal age and education, infant length‐adjusted weight and age, cell count estimates and batch effect.
Results: We observed no significant epigenome‐wide DNAm differences between group‐10 (n = 143) and group‐30 (n = 143) (p < 9.4 × 10−8). Top three sites, comparing group‐10 with group‐30, were annotated to genes PRDM16 (cg05790380: coefficient 0.007, p = 3.0 × 10‐7), HIPK2 (cg20001906: 0.02, p = 1.9 × 10‐6) and PPM1H (cg03919488: 0.01, p = 2.4 × 10‐6) related with e.g. brown adipocyte differentiation, serine/threonine kinase functions and phosphorylation processes, respectively.
Conclusions: Our results indicate no effect of higher vitamin supplementation of 30 µg compared with standard dose of 10 µg on epigenome‐wide DNAm in infants aged 1 year. Further plan is to examine the effect in specific vitamin D related sites as well as to explore individual dose‐response effect on DNAm.
Contact e‐mail address: helena.hauta-alus@helsinki.fi
N‐EV161. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV161.1. GROWTH, NUTRITION AND PHYSICAL ACTIVITY IN EARLY SCHOOL YEARS
Maia Kherkheulidze, Nani Kavlashvili, Eka Kandelaki
State Medical University, Tbilisi, Georgia
Objectives and Study: Our study aims to assess children's physical development, activity level, and nutrition in the early school years.
Methods: A randomized cross‐sectional study was conducted that included 250 early school children aged 6–8 years. We assess weight, height, and BMI by percentile diagrams. Physical activity level and nutrition were assessed based on the selected questions from the SPAN (School Physical Activity and Nutrition Project) questionnaire. From the studied group, 43.2% (n = 108) were male and 56.8% (n = 142) were female.
Results: Assessment of growth parameters revealed that 21.2% (n = 53) of the studied population has overweight and obesity; from this, overweight (BMI 85‐97 percentile) was observed in 16.0% (n = 40), obesity (> 97 percentile) was seen in 5.2% (n = 13), and underweight was seen in 3.6% (n = 9) of children. There was not a statistically significant difference in overweight by sexes: 22.5% in females versus 19.4% in males. Assessment of nutritional intake shows that 19.6% (n = 49) children fruit intake and 45.2% (n = 113) vegetable intake do not meet recommended daily intake. 47.6% (n = 119) eat junk food 3 and more times per week; soft drinks are taken every day by 66.8% (n = 167) of children. 63.6 percent of children eat sweets every day. Physical activity daily recommendations are not met in 40.4% of studied children. The physical activity rate is significantly higher in boys than in girls (48.1% versus 34.5%). The screen time (TV, computer, phone) is higher than daily recommended and in 72.4% (n = 181) of children.
Conclusions: The study reveals a high incidence of overweight and obesity that is associated with inadequate nutrition and sedentary behaviour. It is important to conduct large survey in school‐age children and adolescents to develop the strategy for improvement policies physical activity and wellness
Contact e‐mail address:
N‐EV162. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV162.1. THE IRON KEY TO ADOLESCENCE: IMPACT OF CHRONIC IRON DEFICIENCY ANEMIA ON PUBERTAL HORMONES, TIMING, AND GROWTH
Ashraf Soliman1, Fawzia Alyafei1, Khadija Khudabakhsh 2, Nada Alaaraj1, Noor Hamed3, Shayma Mohammed1, Ahmed Elawwa1, Saleha Abbasi2, Sohair Elsiddig3
1Pediatrics, Hamad Medical Corporation, Doha, Qatar, 2Sidra Medicine, Doha, Qatar, 3Paediatrics, Hamad Medical Corporation, Doha, Qatar
Objectives and Study: Iron deficiency anemia (IDA) is a widespread nutritional deficiency, especially among adolescents, due to the increased iron demands during growth and puberty. Adolescence is a crucial developmental phase, where IDA can negatively affect hormonal changes, pubertal timing, and the growth spurt. Objective:
This review aims to explore the impact of chronic IDA on pubertal hormones, timing of puberty, and the growth spurt, based on studies from 2000 to 2024.
Methods: A literature review was conducted, synthesizing data from over 20 studies on the relationship between chronic IDA, pubertal hormones, and growth. The studies were categorized by patient characteristics, interventions, and outcomes.
Results: Hormonal Impact: Chronic IDA suppresses gonadotropin‐releasing hormone (GnRH) secretion, resulting in lower levels of luteinizing hormone (LH) and follicle‐stimulating hormone (FSH), which in turn reduce estradiol in females and testosterone in males, delaying pubertal development. Timing of Puberty: Adolescents with chronic IDA experienced delayed puberty, particularly females, whose menstrual blood loss exacerbates iron deficiency. Pubertal Growth Spurt: IDA led to reduced growth velocity and hindered the attainment of peak height during the pubertal growth spurt, due to decreased oxygen transport and energy metabolism. Intervention Outcomes: Iron supplementation effectively restored hormonal balance, improved growth velocity, and normalized the timing of puberty. Early detection and treatment are crucial for optimal outcomes.
Conclusions: Chronic IDA significantly disrupts pubertal hormones, delaying puberty and impeding growth. Early diagnosis and intervention are essential for ensuring normal growth and development. Further research is needed to examine the long‐term effects of IDA on reproductive and overall health.
Contact e‐mail address:
N‐EV163. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV163.1. CLINICAL OUTCOMES OF BARIATRIC METABOLIC SURGERY FOR CHILDHOOD OBESITY IN KOREA: A SINGLE CENTER EXPERIENCE
Tae Hyeong Kim 1, Ja Hyang Cho1, Sangjun Lee2, Ji Eun Jun3, In‐Kyung Jeong3, Sung Il Choi2
1Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea, Republic of, 2Department Of General Surgery, Kyung Hee University at Gangdong, Seoul, Korea, Republic of, 3Department Of Endocrinology And Metabolism, Kyung Hee University at Gangdong, Seoul, Korea, Republic of
Objectives and Study: The prevalence of morbid obesity in children and adolescents has increased through the COVID‐19 era. Despite lifestyle modification and medical treatment, bariatric metabolic surgery (BMS) may be considered in cases of persistent severe obesity (BMI > 120% of the 95th percentile), or with serious comorbidities such as diabetes, hypertension, dyslipidemia, and sleep apnea. This study aims to evaluate the clinical outcomes of BMS in Korean pediatric obesity to determine the extent to which effective postoperative interventions are needed.
Methods: Six cases of children who underwent BMS at Kyung Hee University Hospital at Gangdong between January 2020 and January 2024 were reviewed. The primary outcome measures included postoperative weight loss, obesity‐related comorbidities and nutritional indicators.
Results: All six children were girls, the mean age at presentation was 15.5 years (12 – 19 years). Four children underwent Laparoscopic sleeve gastrectomy and two children underwent Roux‐en‐Y gastric bypass. The bariatric surgery showed the considerable reduction of BMI at 6 months and 12 months compared to baseline (23% and 27%, respectively). Total body fat and visceral fat were significantly decreased at 6 months and 12 months compared to baseline (31% and 36%, 44% and 62%, respectively). All children had moderate to severe fatty liver on abdominal imaging, however, all fatty liver conditions improved within one year of surgery. Three children with high‐risk obstructive sleep apnea (OSA) improved after surgery. Although hypertension and dyslipidemia were observed preoperatively in all children, these conditions improved after surgery, and they were off medication within 1 year.
Conclusions: Pediatric metabolic surgery has been associated with not only significant weight loss, but also improvements in insulin sensitivity, lipid profile, blood pressure, fatty liver, and inflammatory markers. Further research is needed to evaluate the long‐term outcomes, including the effects on growth, nutritional status, and the need for additional interventions in adulthood.
Contact e‐mail address:
N‐EV164. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV164.1. THE PREVALENCE AND COVARIATES OF SEVERE OBESITY IN CHILDREN AND ADOLESCENTS
Zbigniew Kułaga1, Aneta Kotowska 1, Piotr Socha2
1Public Health, The Children's Memorial Health Institute, Warsaw, Poland, 22 deparment Of Gastroenterology, Hepatology And Nutrition Disorders, The Children's Memorial Health Institute, Warsaw, Poland
Objectives and Study: Severe childhood obesity (OB) is serious medical condition and major public health problem. The aim of the study was to investigate change in severe OB prevalence from 2007‐2010 to 2017‐2020 among Polish youth and to analyse family covariates and eating patterns.
Methods: Data from 4165 school‐aged children and adolescents, participating in the study within National Health Program in the years 2017‐2020 were analysed. The child's height and weight were measured and mother and father height and weight were collected using questionnaire. Frequency of 47 food items consumption was investigated with Food Frequency Questionnaire. In youth severe OB was categorized as having a BMI ≥ 120% of the 95th percentile (class II OB), and BMI ≥ 140% of the 95th percentile (class III OB). In adults, BMI ≥ 35 kg/m2 was categorized as severe OB. OB (class II, III) frequencies in youth were compared to the estimates from population representative study conducted in the years 2007‐2010. Odds ratios of severe paediatric OB relative to mother and father weight status were estimated with multinomial logistic regression. Frequencies of food consumption across non‐overweight, overweight (OW) and OB class I, and severe OB were compared with χ2 test.
Results: Severe OB rates in youth increased between 2007‐2010 and 2017‐2020 from 2.42% to 4.68% (p < 0.0001). Odds of severe OB in youth, as compared to OW and OB class I, were 4.593 (95% CI: 2.124 to 9.931) and 2.901 (95% CI: 1.454 to 5.784) for mother and father severe OB, respectively. Youth with severe OB more frequently declared no consumption of several energy‐dense foods and everyday consumption of energy drinks – Table.
Conclusions: Severe OB prevalence among Polish youth increased significantly over decade. Child's and parent's severe OB are interlinked. Energy‐dense foods are less frequently consumed by youth with severe OB.
Contact e‐mail address: a.kotowska@ipczd.pl
N‐EV165. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV165.1. ASSOCIATIONS BETWEEN THE MEDITERRANEAN DIET QUALITY INDEX FOR CHILDREN AND ADOLESCENTS (KIDMED) AND METABOLIC DYSFUNCTION‐ASSOCIATED STEATOTIC LIVER DISEASE (MASLD), IN A UK CLINIC
Helen Mortimer1, Sara Mancell 1,2, Hannah Spoor1, Caitlin Murphy1, Eirini Kryrana1,2
1Paediatric Liver, Gi And Nutrition Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom, 2King's College London, London, United Kingdom
Objectives and Study: A Mediterranean diet may be beneficial in children and young people (CYP)1. KIDMED, a validated questionnaire2, was introduced to facilitate dietary goal setting, and assessment of diet quality in CYP with MASLD.
Methods: KIDMED was offered to CYP attending our multidisciplinary MASLD clinic (February‐November 2024). Clinical, biochemical and anthropometric data were collected in addition to liver ultrasound and fibroscan. A KIDMED score of ≤3 indicates a very low quality diet (group [Gr]1), 4‐7 needs improvement (Gr2), ≥8 an optimal Mediterranean diet (Gr3). One‐way ANOVA assessed correlation between groups.
Results: Of 42CYP reviewed, the dietitian completed KIDMED for 34(17 F). Median (IQR) age was 14.7years (12.8, 16.6) and BMI z‐score was 3.1(2.7, 3.3). There were 15(44%) in Gr1, 16(47%) in Gr2 and 3(9%) in Gr3. Mean (SD) age was 13.7(2.3)(Gr1), 15.0(2.7)(Gr2) and 15.3(1.7)(Gr3) years. Alanine aminotransferase (ALT) was mean (SD) 53.6(43.3)IU/L with fibroscan controlled attenuation parameter (CAP) of 292.5(52.4)dB/m and liver stiffness measurement (LSM) of 7.6(2.9)kPa. CAP, LSM, ALT and HbA1c increased between Group 1 and 2, then reduced and were at their lowest in Gr3. ALT was higher in Gr2 than Gr3 (68.1 versus 26.7, p = 0.037) and approached significance for AST (40.8 versus 24.3, p = 0.054). Whilst not statistically significant mean weight z‐score was lower for those with higher KIDMED scores (Gr1 = 3.2, Gr2 = 3.0, Gr3 = 1.8) as was BMI z‐score (Gr1 = 3.0, Gr2 = 3.0, Gr3 = 2.4) and HbA1c (Gr=35.2, Gr2 = 37.1, Gr3 = 34.7).
Conclusions: Only 9% of CYP had an optimal Mediterranean diet. The high HbA1c in Gr2 may relate to a poorer CAP and the expectation that MASLD would be more advanced in older children. The lower KIDMED scores in younger CYP (Gr1) may coincide with the increased independence of starting UK secondary school, including around food choices. We plan to continue using KIDMED to build on these initial findings and as a tool for monitoring changes in dietary quality.
Contact e‐mail address: helenmortimer@nhs.net
N‐EV166. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV166.1. OBESITY'S IMPACT ON LIPID PROFILE AND LIVER HEALTH IN YOUTH: THE PROTECTIVE ROLE OF HDL AGAINST INFLAMMATION
Annalisa Morelli 1, Francesco Vergati1, Carmela Pia Senatore2, Caterina Voto1, Valentina Langella1, Annalaura Giordano1, Rosanna Masturzo1, Grazia Massa1, Anna Giulia De Anseris3, Rossella Colantuono3, Angelo Colucci1, Claudia Mandato1
1Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, Baronissi (SA), Italy, 2University of Salerno, Fisciano, Italy, 3Pediatric Unit, University Hospital San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy, Salerno, Italy
Objectives and Study: The rising prevalence of obesity in children and adolescents is a significant public health concern, elevating the risk of cardiovascular diseases (CVD) early in life. Obesity often alters hepatic lipid metabolism, resulting in atherogenic dyslipidemia characterized by low high‐density lipoprotein (HDL) cholesterol and elevated triglycerides. Beyond facilitating reverse cholesterol transport, HDL possesses anti‐inflammatory and antioxidant properties that protect the vascular endothelium from inflammation and oxidative stress. This study investigates the relationship between altered lipid profiles and indicators of metabolic‐associated fatty liver disease (MAFLD) in obese youth.
Methods: We retrospectively analysed data from 49 patients (21 females), aged 10 to 18, referred for obesity to the outpatient Hepatology, Obesity, and Nutrition Service at Salerno Hospital between 2017 and 2024. We evaluated growth metrics [Body Mass Index(BMI) and Mid‐Upper Arm Circumference (MUAC) z‐scores], laboratory measurements (total cholesterol, HDL, low‐density lipoprotein (LDL), triglycerides, alanine aminotransferase (ALT)], and the Homeostatic Model Assessment for Insulin Resistance (HOMA‐IR).
Results: Spearman correlation analysis revealed significant negative correlations between HDL and triglycerides (p = 0.012), confirming the atherogenic lipid profile in obesity, as well as with MUAC (p = 0.006) and HOMA‐IR (p = 0.010). ALT levels, serving as a marker for MAFLD, was inversely correlated with HDL (p = 0.047). Cluster analysis of patients with HDL < 10° centile identified two subsets revealing a statistically significant increase of both total cholesterol and triglyceride levels.
Conclusions: The findings indicate a strong association between obesity and dyslipidemia in children, characterized by a shift toward atherogenic profiles, increased insulin resistance, and hepatic involvement manifesting as steatosis. Addressing these metabolic disturbances during childhood is crucial for preventing CVD risk in adulthood.
Moreover, low HDL levels could serve as potential markers of MAFLD severity, underscoring the importance of monitoring and managing HDL levels to prevent hepatic and cardiovascular complications, warranting further studies to investigate the correlation between reduced HDL and altered metabolic parameters.
Contact e‐mail address: annalisa.morelli13@gmail.com
N‐EV167. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV167.1. CHANGES IN METABOLIC MARKERS –INSULINE‐LIKE GROWTH FACTOR‐1 AND INSULIN IN PRETERM INFANTS WITH INTRAUTERINE GROWTH RESTRICTION
Galya Mumdzhieva‐Vodenicharova 1,2, Lilia Vakrilova1,2, Stanislava Hitrova‐Nikolova1,2, Petya Radulova1,2, Violeta Dimitrova1,2, Teodora Alexandrova1,2, Boriana Slancheva1,2, Adelina Tzakova1,3
1Faculty Of Medicine, Medical University of Sofia, Sofia, Bulgaria, 2Neonatology Clinic, University Hospital Obstetrics and Gynecology “Maichin dom”, Sofia, Bulgaria, 3University Hospital “Alexandrovska”, Sofia, Bulgaria
Objectives and Study: To evaluate the effects of intrauterine growth restriction (IUGR) on preterm newborns by measuring dynamics of the serum levels of insulin and insulin‐like growth factor‐1 (IGF‐1). The relationship between these parameters and fetal growth are also examined.
Methods: This prospective study was conducted from November 2022 to May 2023 at the University Hospital of Obstetrics and Gynecology “Maichin dom”, Sofia. The study included 26 preterm liveborn singletons and twins without congenital anomalies. 16 of them were with IUGR (birth weight<10 percentile) and 10 with birth weight, appropriate for the gestational age (AGA). Measurements IGF‐1 and insulin levels were performed twice: from cord blood serum at birth and from venous blood serum before discharge. Used method was immunoassay for the in vitro quantitative determination of human insulin and IGF‐1 in human serum and plasma. Percentile for weight and lenght were also calculated at birth and at discharge.
Results: IGF‐1 levels and insulin levels in infants with IUGR at birth were found to be lower than in AGA infants (25,61 vs. 42,12 ng/mL for IGF‐1 and 8,35 vs. 28,24 mU/l for insulin). Controversially IGF‐1 levels before discharge are higher in infants with IUGR compared to AGA infants (58.08 vs. 56, 1 ng/mL). Insulin levels remain lower in infants with IUGR at discharge, compared to AGA infants(10,66 vs. 13,24 mU/l). We found no change in the growth canals in terms of weight and lenght of children with IUGR by the time of discharge from the hospital.
Conclusions: The study demonstrates the relationship between poor fetal growth and low levels of insulin‐like growth factor‐1 and insulin at birth. The research was sponsored by Medical University – Sofia, Bulgaria, GRANT Project Contract №191/03.08.2023
Contact e‐mail address:
N‐EV168. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV168.1. UNVEILING NEW NUTRIGENOMICS INSIGHT OF PLANT FOOD POLYPHENOLS IN CHILDHOOD OBESITY SUSCEPTIBILITY GENES: EPIGENETIC META‐ANALYSIS AS PRECISION NUTRITION APPROACH
Muhammad Rizki Mustakim 1, Agniya Hikmat1, Fahrul Nurkolis2
1Department Of Health Child, Sayang Regional Hospital, Cianjur, West Java, Indonesia, Cianjur, Indonesia, 2Science And Technology Faculty, Universitas Islam Negeri Sunan Kalijaga, yogyakarta, Indonesia
Objectives and Study: Objectives: This study aimed to evaluate the effect of plant food polyphenols supplementation on obese children.
Methods: The outcomes of interest of the study were the BMI, weight, total cholesterol, triglycerides (TG) level, high‐density lipoprotein (HDL) level, low‐density lipoprotein (LDL) level, and energy level. Quality appraisal was done using RoB 2.0 for the randomized studies and ROBINS‐I for the non‐randomized studies, while meta‐analysis used RevMan 5.4.
Results: A literature search across seven databases (PubMed, ScienceDirect, Epistemonikos, Scopus, Cochrane, EBSCO, and ProQuest) resulted in the selection of four articles for analysis with quality assessment categorized two studies as low‐risk and two as moderate‐risk of bias studies. Quantitative analysis indicated that polyphenol supplementation was successful in reducing BMI by 0.07 [95% CI ‐0.57; 0.43, P = 0.78], weight by 0.11 [95% CI ‐0.48; 0.27, P = 0.58], total cholesterol by 0.36 [95% CI ‐0.66; ‐0.07, P = 0.01], TG level by 1.75 [95% CI ‐3.57; 0.07, P = 0.06], and LDL level by 3.25 [95% CI ‐6.76; 0.26, P = 0.07]. However, polyphenol supplementation did not demonstrate effectiveness in increasing HDL levels and energy levels.
Conclusions: Conclusion: Polyphenol supplementation is shown to be beneficial in managing the condition of obese children by affecting several laboratory measurements. Further research needs to be done to assess specific intercorrelations between obesity susceptible genes in children with polyphenol supplementation.
Contact e‐mail address: muhammadrizkidm@yahoo.com
N‐EV169. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV169.1. METABOLIC AND HORMONAL SERUM MARKERS IN EARLY CHILDHOOD: FOLLOW‐UP OF A RANDOMIZED CONTROLLED TRIAL DURING INFANCY EVALUATING A MODIFIED, LOW‐PROTEIN INFANT FORMULA
Jacqueline Muts 1, Stefanie Kouwenhoven2, Nadja Antl3, Marieke Abrahamse‐Berkeveld4, Britt Van Keulen1, Hans Demmelmair5,6, Lesca Holdt7, Wolfgang Wilfert7, Chris Van Den Akker8, Berthold Koletzko9, Johannes Van Goudoever10
1Pediatrics, Amsterdam UMC, Amsterdam, Netherlands, 2Pediatric & Neonatal Intensive Care, Erasmus MC‐Sophia, Rotterdam, Netherlands, 3Pediatrics, LMU University Hospital, Munich, Germany, 4Danone Research & Innovation, Utrecht, Netherlands, 5Department Of Paediatrics, Division of Metabolic and Nutritional Medicine, Munich, Germany, 6Division Of Metabolic And Nutritional Medicine, Department Of Paediatrics, Dr. Von Hauner Children's Hospital,and German Center For Child And Adolescent Health, Site Munich, Germany., LMU University Hospital, Munich, Germany:, Munich, Germany, 7Laboratory Medicine, LMU University Hospital, Munich, Germany, 8Department of Pediatrics ‐ Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, University, Amsterdam, Netherlands, 9Pediatrics, Dr. von Hauner Children's Hospital, LMU Universität Munich and German Center for Child and Adolescent Health, Munich, Germany, 10Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, Netherlands
Objectives and Study: High protein intake during infancy has been linked to accelerated weight gain and an increased risk of obesity. This study aimed to examine the effects of reduced protein intake in early life on blood metabolic and hormonal markers during follow‐up in early childhood.
Methods: Formula‐fed infants (<1 month) were randomized to receive either a lower‐protein formula with modified amino acid composition (mLP; n = 90; 1.7 g protein/100 kcal) or a control formula (CTRL; n = 88; 2.1 g protein/100 kcal) until 6 months of age. Breastfed infants served as a reference (n = 67). Blood samples were collected during follow‐up at 1, 2, and 6 years of age. Key metabolic markers, including IGF‐1, IGF‐binding proteins, and leptin, were measured using ELISA, while glucose and insulin levels were assessed with enzymatic UV‐assay and ECLIA, respectively. Data were analyzed using linear mixed models, adjusting for sex and the randomization hospital. Insulin, HOMA‐IR, leptin, IGF‐1, and IGF‐BP1 were log‐transformed prior to analysis.
Results: Eighty‐seven infants (36%) had a successful blood withdrawal at age 1 year, 77 infants at 2 years of age, and 63 infants at 6 years of age. At 6 years, leptin (ng/mL) was slightly higher in the mLP‐fed infants compared to the CTRL‐fed infants (median [IQR]: mLP 2.30 [1.71–2.99] vs. CTRL 1.22 [0.83–2.82], p = 0.049). No other differences were found in any blood parameters between the formula groups at 1, 2, or 6 years of age. Compared to the breastfed reference group, IGF‐1 concentrations (ng/mL) in mLP‐fed infants at the age of 1 year were significantly higher (median [IQR]: mLP 114.5 [75.2–242.3] vs. BF 89.4 [58.5–146.5], p = 0.035).
Conclusions: Providing a modified, low‐protein infant formula during the first months of life was not associated with a major impact on hormonal and metabolic markers during early childhood. However, our findings should be interpreted with caution due to the small sample size.
Contact e‐mail address: j.muts@amsterdamumc.nl
N‐EV170. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV170.1. RED FLAGS FOR NUTRITIONAL DEFICIENCIES – A ROMANIAN STUDY ON OVERWEIGHT AND OBESE CHILDREN
Oana‐Andreea Istrate‐Grigore1, Daniela Păcurar 1,2, Raluca Vlad1,2
1Paediatrics, Grigore Alexandrescu Emergency Hospital for Children, Bucharest, Romania, 2Paediatrics, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Objectives and Study: Childhood obesity is a global public health issue, associated with multiple nutritional deficiencies, despite excessive caloric intake. This study aims to investigate the prevalence of nutritional deficiencies in overweight/obese children and to assess correlations between vitamin D/serum iron levels and body mass index (BMI).
Methods: We conducted a 15‐month retrospective observational study (September 2023–November 2024) on overweight/obese children admitted to “Grigore Alexandrescu” Hospital for unrelated conditions. Based on age‐ and gender‐specific BMI‐percentiles, children were classified as overweight (≥85thand <95thBMI‐percentile), obese (≥ 95thBMI‐percentile) or severely obese (>120% of 95thBMI‐percentile). Serum 25‐hydroxyvitamin D levels (ng/ml) were categorized as deficient (<10), insufficient (10‐29.9) or sufficient (30–100). Hemoglobin and serum iron levels were classified as normal, iron‐deficiency or iron‐deficiency anemia. Correlations between BMI, vitamin D levels and hematological status were analyzed.
Results: The cohort included 69 patients (mean age:11 years; 58% female; 66.6% urban). The average BMI was 27.19 kg/m², with 37.7% overweight, 42% obese and 20.3% severely obese children. Insufficient 25‐hydroxyvitamin D levels were found in 66.6% of patients, with deficiency in 2.9%. Insufficiency rates were 61.5% in overweight, 69% in obese, and 71.5% in severely obese children. A moderate inverse correlation was found between vitamin D levels and BMI (r = ‐0.31, p = 0.015). Iron‐deficiency was identified in 36.2% of children with a prevalence of 50% in overweight, 24.2% in obese and 28.6% in severe obesity. Iron‐deficiency anemia was present in 27.5% of patients: 38.5% in overweight, 17.3% in obese and 28.6% in the severely obese category. No correlation was found between serum iron levels and BMI (r = ‐0.02).
Conclusions: This study shows that vitamin D deficiency is highly prevalent in overweight/obese children and emphasizes the need for targeted screening, alongside dietary adjustments and vitamin D supplementation. The high prevalence of iron deficiency suggests that the adipose tissue contributes to chronic inflammation, disrupting iron homeostasis.
Contact e‐mail address: oana-andreea.grigore@rez.umfcd.ro
N‐EV171. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV171.1. BENEFITS AND HARMS OF UNIVERSAL SCREENING FOR LIPID DISORDERS IN CHILDREN AND ADOLESCENTS: AN OVERVIEW OF SYSTEMATIC REVIEWS
Bernadeta Patro‐Golab 1, Thu Giang Le Thi1, Milena Geist2, Anna Litwin1, Delphina Gomes1, Yuliia Novosad2, Juliane Grünzner3, Berthold Koletzko1
1Department Of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, München, Germany, 2Stiftung Kindergesundheit, c/o Dr. von Hauner Children's Hospital, LMU University Hospital, München, Germany, 3Division Of Lipidology, Integrated Social Paediatric Center (ispz), Dr. von Hauner Children's Hospital, LMU University Hospital, München, Germany
Objectives and Study: Early diagnosis and treatment of dyslipidaemias may reduce the risk of later cardiovascular disease. We summarize evidence from systematic reviews (SRs) on benefits and harms of universal or selective screening for dyslipidaemia, particularly, familial hypercholesterolemia, in children and adolescents.
Methods: The review protocol was registered at PROSPERO (CRD42024536209). We systematically searched MEDLINE, EMBASE (Ovid) and Cochrane Database of Systematic Reviews, for relevant SRs, published in English from January 2015 to April 2024. We used AMSTAR 2 tool to critically appraise included reviews.
Results: Of 4069 records screened, 5 SRs were eligible for inclusion. Included SRs targeted asymptomatic and/or undiagnosed children from general population (n = 4) or individuals at any age (n = 1) and focused on universal screening (n = 1), universal and selective screening (n = 3) or various systematic screening strategies (n = 1) for dyslipidaemia. All reviews aimed to assess the long‐term cardiovascular health outcomes including myocardial infarction, ischemic stroke or mortality, and/or intermediate outcomes such as serum lipid concentrations. Adverse effects were among outcomes of interest in four reviews. Evidentiary scope of eligible reviews varied. Randomized controlled trials and controlled clinical trials with (n = 2) or without (n = 2) cohort studies were eligible to assess screening benefits. Only in one SR, both clinical trials and observational studies of various designs were eligible. Four high‐quality SRs could not identify any primary studies on universal or selective lipid screening meeting the predefined inclusion criteria. One SR, rated as very low‐quality, identified a single pre‐post study in a school‐setting showing no significant difference in total cholesterol levels at 1 year follow‐up among children offered screening.
Conclusions: Evidence on the effectiveness of universal lipid screening in children concerning surrogate and population‐relevant outcomes and adverse effects is lacking. While awaiting new direct and indirect evidence on universal lipid screening, alternative screening strategies such as cascade screening should be considered.
Contact e‐mail address: bernadeta.patrogolab@med.uni-muenchen.de
N‐EV172. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV172.1. ASSESSMENT OF VITAMIN D STATUS IN CHILDREN WITH OBESITY
Simona Cosoveanu1, Cristina Singer1, Jaqueline Abdul‐Razzak2, Ileana Petrescu 1
12nd Pediatric Clinic, Emergency County Hospital Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania, 2Resident Doctor, Emergency County Hospital Craiova, Craiova, Romania
Objectives and Study: Assessment of vitamin D status in overweight and obese children. Lifestyle is a risk factor for obesity, which is associated with vitamin D deficiency. Inadequate artificial nutrition, early/inadequate diversification are predisposing factors for the appearance of obesity.
Methods: Inclusion criteria: 179 children aged 3‐18 years, with obesity: BMI ≥percentile 95/sex/age, overweight: 85 ≤ BMI < 95 percentile/sex/age, normal weight: 5 ≤ BMI < 85 percentile/sex/age.
Results: In 24% of cases, obesity was associated with a low serum 25‐OH‐vitamin D level; there is an inverse correlation between vitamin D concentration and BMI. We recorded a deficiency of 25‐OH‐vitamin D ( < 20 ng/ml) in 9% of obese children, in 14% of overweight children and in 5% of children with normal weight and an insufficient level of 25‐OH‐vitamin D (20‐30 ng/ml) in 27% of obese children, 24% of overweight children and 5% of normal weight children, without significant differences between groups of age/sex. Vitamin D deficiency/insufficiency prevailed in the cold season, being associated with lack of exposure to ultraviolet rays. The dietary survey of obese children revealed an increased consumption of fast food, sweet/carbonated drinks, lack of breakfast; decreased dietary vitamin D was associated with low serum 25‐OH‐vitamin D in 38% of cases. 25‐OH‐vitamin D deficiency in obese children aged 10‐16 years was associated with increased blood glucose and LDL‐cholesterol in 19% of cases.
Conclusions: The critical periods for the onset of obesity were 3‐6 years (the adipose rebound period) and adolescence. Obese children were deficient in vitamin D compared to normal‐weight children, probably due to increased storage of vitamin D in excess adipose tissue.
Contact e‐mail address:
N‐EV173. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV173.1. EFFECT OF BIFIDOBACTERIUM ANIMALIS SUBSP. LACTIS CECT 8145 + RESISTANT MALTODEXTRIN ON THE LIPID PROFILE OF OBESE CHILDREN AND ADOLESCENTS
Arturo Perea Martínez1, Lilia Mayrel Santiago Lagunes 1, Paul Rios2, Ariadna Guadalupe Lara Campos2, Ana Lidia Gonzalez Valadez2, Miriam Mercedes Padrón Martínez2
1Unidad De Nutriología Y Nutrición Hospitalaria (unnho), Instituto Nacional de Pediatría, Mexico City, Mexico, 2Nutrition And Hospital Nutrition Unit (unnho), National Institute of Pediatrics, Ciudad de México, Mexico
Objectives and Study: Dyslipidemia is a cardiovascular risk factor that occurs in up to 40% of obese children and adolescents. The basis of current treatment is a healthy diet, the use of lipid‐lowering drugs, and the recent inclusion of prebiotics and probiotics. Our objective was to evaluate the effect of the combination of Bifidobacterium animalis subsp. Lactis CECT 8145 + resistant maltodextrin on serum lipid levels in obese children and adolescents.
Methods: A randomized, double‐blind, longitudinal, prospective, two‐parallel‐group, placebo‐controlled clinical trial included 91 obese children and adolescents aged 8 to 18. The control group received Bifidobacterium animalis subsp. lactis CECT 8145 (1X1010) + resistant maltodextrin (5 g) and the other group received a placebo for 12 weeks. At all appointments, recommendations to improve lifestyle and assess adherence were made; medical and nutritional care was provided. Adverse events in both groups were considered mild. Statistical analysis was performed using SPSS Version 22.
Results: Blood lipid levels showed a statistically significant reduction in LDL cholesterol in the control group. Triglycerides decreased more in the control group than placebo group, these results were not statistically significant. Total cholesterol and HDL‐C did not show significant changes. In both groups, there were reductions in body weight, waist circumference, body mass index, and waist‐to‐height ratio, these results did not reach statistical significance in favor of either group. No serious adverse events related to product use were observed.
Conclusions: Bifidobacterium animalis subsp. Lactis CECT 8145 + maltodextrin significantly reduces LDL cholesterol levels in obese children and adolescents. This mixture significantly reduces triglyceride levels compared to lifestyle changes alone. It has no effect on total cholesterol and HDL cholesterol. Due to the adverse events observed, the product can be considered safe.
Contact e‐mail address: lilia.sanlag@gmail.com
N‐EV174. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV174.1. UNDERSTANDING PREFERENCES FOR CHILDHOOD OBESITY PREVENTION: INSIGHTS FROM BRAZILIAN IMMIGRANT PARENTS IN THE UNITED STATES
Ana Cristina Terra De Souza Lindsay 1, Qun Le2, Thais Vilasboas1, Mary Greaney3
1Urban Public Health, University of Massachusetts Boston, Boston, United States of America, 2University of Massachusetts Lowell, Lowell, United States of America, 3University of Rhode Island, Kingstown, United States of America
Objectives and Study: Brazilians represent a rapidly growing immigrant population in the United States (U.S.), yet there is a significant gap in childhood obesity prevention interventions tailored to Brazilian preschool‐age children. This formative research aims to assess Brazilian immigrant parents’ preferences for informational content, delivery modalities, and the use of communication technology in developing a family‐based intervention to promote healthful energy balance‐related behaviors (EBRBs) and prevent childhood obesity.
Methods: Guided by the family ecological model (FEM), this developmental cross‐sectional study assessed the preferences (content, intervention modality, and language) of 52 Brazilian immigrant parents (27 mothers and 25 fathers) regarding a family‐based intervention aimed at promoting healthful energy balance‐related behaviors (EBRBs).
Results: Overall, 85% or more of the parents expressed interest or strong interest in five of the seven EBRBs assessed: increasing fruits and vegetables, reducing unhealthy foods and sugar‐sweetened beverages, increasing physical activity, and decreasing screen time. Preferred intervention modalities included group sessions led by community health workers (CHWs; 86.5%), email (84.6%), and messaging (78.8%), with most parents (71.2%) preferring content in Portuguese.
Conclusions: This study is the first to assess the preferences of Brazilian immigrant parents regarding childhood obesity prevention interventions. Interventions that integrate multiple components, such as group sessions conducted by community health workers (CHWs) and text messaging via SMS and WhatsApp, should be prioritized. Future steps in intervention development should focus on exploring various communication channels and their integration into a culturally and linguistically tailored family‐based intervention to promote healthful EBRBs among preschool‐age children in Brazilian families living in the U.S.
Contact e‐mail address: Ana.Lindsay@umb.edu
N‐EV175. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV175.1. INSIGHTS INTO INDIRECT CALORIMETRY FOR CHILDHOOD OBESITY: EVALUATING RESTING ENERGY EXPENDITURE IN PEDIATRIC PATIENTS
Lorena Mihaela Manole1,2, Otilia Iftinchi1,3, Laura Otilia Boca3,4, Madalina Donos2,3, Elena Lia Spoiala1,2, Gabriela Ghiga3,5, Ioana Vasiliu1,6, Iulia Margasoiu7, Laura Mihaela Trandafir 3,5
1“Saint Mary” Emergency Hospital for Children, Iasi, Romania, 2Department Of Mother And Child, Faculty Of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Iasi, Romania, 3Department Of Mother And Child, Faculty Of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, iasi, Romania, 4Paediatrics, University of Medicine and Pharmacy “Grigore T Popa”, iasi, Romania, 5“Saint Mary” Emergency Hospital for Children, iasi, Romania, 6Department Of Morphofunctional Sciences I, Faculty Of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Iasi, Romania, 7Iosud, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Iasi, Romania
Objectives and Study: Addressing childhood obesity, a complex and rapidly growing global health challenge, is critical in preventing severe comorbidities such as cardiometabolic diseases. Indirect calorimetry, the gold standard for measuring resting metabolic rate (RMR), can guide personalized nutritional strategies to address obesity in children and adolescents, improving their health and reducing the risk of cardiometabolic conditions.
Methods: This study involved 140 children and adolescents (69 girls and 71 boys), aged 4 to 18 years (Mean age 12 years), who were diagnosed with obesity at Saint Mary Emergency Children Hospital Iași, România. RMR was measured through indirect calorimetry, using the Fitmate Pro Metabolic Technology, Cosmed calorimeter. Anthropometric measurements were taken, and biological samples were collected from all patients. The data obtained were processed and analyzed using SPSS software.
Results: The mean RMR of the study group was 1714.26 ± 457.83 kcal/day, with a median value of 1649 kcal/day. Girls had a mean RMR of 1578.41 kcal/day, while boys averaged 1848.04 kcal/day. Significant positive correlations (p < 0.001) were found between RMR and weight (r = 0.78), BMI (r = 0.56), abdominal circumference (r = 0.61), fat mass (r = 0.53), and systolic blood pressure (r = 0.46). A significant correlation was also observed between RMR and the HOMA‐IR score (p = 0.009; r = 0.49). Blood pressure values were elevated in 25.4% of participants, indicating hypertensive systolic levels and increased cardiometabolic risk. The median HOMA‐IR score was 4.92 ± 2.11, correlating positively with higher RMR and abdominal circumference. Personalized weight loss plans were implemented for each participant, involving dietary modifications and physical activity. A follow‐up evaluation after three months will assess clinical and metabolic improvements.
Conclusions: Indirect calorimetry is a critical tool in clinical practice for optimizing nutritional therapy, enabling the development of personalized diets that accurately address individual energy needs and sustain an appropriate caloric deficit for effective and lasting weight management.
Contact e‐mail address: lorena.manole@umfiasi.ro
N‐EV176. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV176.1. POLY‐ AND PERFLUOROALKYL SUBSTANCES (PFAS) AFFECT METABOLOMICS IN THE FIRST 2 YEARS OF LIFE
Pernille Neve Myers1, Inge Van Beijsterveldt 2, Demi Dorrepaal2, Bertrand Van Zelst3, Sjoerd Van Den Berg3, Albert Koulman4, Susanne Brix5, Anita Hokken‐Koelega2
1Cmbio, Copenhagen, Denmark, 2Pediatrics, Erasmus Medical Center ‐ Sophia Children's hospital, Rotterdam, Netherlands, 3Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands, 4Cambridge University, Cambridge, United Kingdom, 5Department Of Biotechnology And Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
Objectives and Study: PFAS are non‐degradable ‘metabolism disrupting agents’, which are thought to have a wide range of adverse developmental effects in children. Since PFAS are likely to lead to nuclear lipid hyperaccumulation and shift carbohydrate metabolism to fatty acid oxidation, it could alter plasma lipids in infants, which could, subsequently have long‐term effects on body composition and metabolic profile. It is known that exclusive breastfed (EBF) and exclusive formula fed (EFF) infants have different metabolic profiles from a young age onwards, which could contribute to the protection against obesity from breastfeeding. However, we found that infants that are EBF for the first 3 months of life have 2‐3 times higher plasma PFAS levels at least until the age of 2 years. We studied the associations between longitudinal plasma PFAS levels and metabolite profile in children aged 3‐24 months.
Methods: We determined plasma PFAS metabolomics in blood collected at 3 months and 2 years in 282 healthy term‐born infants from the Sophia Pluto birth cohort. We studied the associations between PFAS levels and metabolic profile using multiple regression models adjusting sex and for length of breastfeeding (exclusive and total).
Results: More than 20% of the lipids measured in plasma samples at 2 years correlated significantly after adjusting for multiple testing to at least one of the quantified PFAS. Most of these correlations could also be found in the 3‐month sample. At 3 months, the lipid and PFAS levels were strongly influenced by feeding type. PFAS levels also correlated negatively to the total fat free mass and the fat free mass index at 3 months and 24 months.
Conclusions: PFAS levels, which are positively associated to lower fat free mass, are strongly associated to the metabolic profile in children at 3 months and 24 months, showing that PFAS exposure affect lipid metabolism in early childhood.
Contact e‐mail address: i.vanbeijsterveldt@erasmusmc.nl
N‐EV177. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV177.1. UNEXPLAINED IRON‐REFRACTORY ANEMIA AND GROWTH RETARDATION IN A CHILD WITH FINAL DIAGNOSIS OF JUVENILE POLYPOSIS SYNDROME: A CASE REPORT
Theodora Delaporta1, Georgios Xinias2, Tatiani Papa3, Eugenia Voudouri3, Stilianos Xinias2, Ioannis Roilidis4, Ioannis Xinias 4
1HIPPOCRATES GENERAL HOSPITAL, THESSALONIKI, Greece, 2First Pediatric Department, HIPPOCRATES GENERAL HOSPITAL, THESSALONIKI, Greece, 3Third Pediatric Department, HIPPOCRATES GENERAL HOSPITAL, Thessaloniki, Greece, 4Third Pediatric Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Objectives and Study: Juvenile polyposis syndrome (JPS) is a rare genetic condition characterized by multiple hamartomatous polyps in the gastrointestinal tract and a predisposition to malignancy. Sporadic juvenile polyps are benign and limited, while syndromic cases require early identification due to associated malignancy risks.
Methods: A 9‐year‐old boy presented with a two‐year history of unexplained iron‐refractory anemia and growth delay. Investigations all this time, including hematological, biochemical, and serological tests, revealed anemia and low IgG levels. No cause of the symptoms was found and the child was referred for gastroenterological assessment. Gastroenterological evaluation showed occult blood and mild elevated fecal calprotectin (154 mg). A following throughout colonoscopy identified multiple stalked polyps throughout the colon. Histopathology revealed inflammatory polyps without dysplasia. Based on the number of polyps (>5) and a maternal history of polyposis, JPS was suspected. Genetic testing and polypectomy were recommended but not pursued by the family yet.
Results:
| Investigation | Result |
|---|---|
| Clinical presentation | Iron‐refractory anemia, growth delay |
| Hematology/Serology | Anemia, low IgG levels |
| Stool analysis | Positive occult blood, calprotectin 154 mg |
| Colonoscopy findings | Multiplr stalked polyps in the colon |
| Histopathology | Inflammatory polyps, no dysplasia |
| Family History | Maternal polyposis |
| Genetic Testing | Awaited |
Conclusions: JPS should be considered in children presenting with unexplained iron‐refractory anemia and growth delay, even without obvious gastrointestinal symptoms. Early diagnosis via endoscopy, histopathology, and genetic testing is essential to manage risks, including colorectal cancer. Awareness of this rare syndrome is important for all pediatric physicians.
Contact e‐mail address: dvradelaporta@gmail.com
N‐EV178. Topic: AS03. NUTRITION/AS03f. Obesity, Growth and Metabolism
N‐EV178.1. THE ASSOCIATION BETWEEN DIETARY INTAKE AND SARCOPENIC OBESITY IN KOREAN CHILDREN: A CROSS‐SECTIONAL STUDY
Ji‐Sook Park, Jung‐Eun Yim
Changwon National University, Changwon, Korea, Republic of
Objectives and Study: Sarcopenic obesity, defined as the concurrent presence of excessive fat mass and reduced muscle mass, has traditionally been associated with older populations. However, recent evidence suggests its emergence in pediatric cohorts. This study aims to elucidate the relationship between dietary intake patterns and sarcopenic obesity in Korean children.
Methods: A total of 59 children (29 boys and 30 girls) classified as overweight (≥85th percentile) or obese (≥95th percentile) according to age‐ and sex‐specific body mass index (BMI) percentiles based on the Korean National Growth Charts. Participants were aged between 7 and 12 years. Sarcopenic obesity was determined using muscle‐fat ratio (MFR) cutoff derived from body composition measurements. Dietary intake was assessed via three‐day dietary records (including two weekdays and one weekend day) completed by the participants.
Results: Children with sarcopenic obesity exhibited significantly higher mean values for weight, BMI, waist circumference, and hip circumference compared to their non‐sarcopenic obese children. Moreover, serum levels of alanine transferase(ALT), aspartate transferase(AST), and gamma‐glutamyl transpeptidase(GGT) were significantly elevated in the sarcopenic obesity group. Correlation analysis revealed that MFR was positively associated with the proportion of dietary carbohydrate intake, whereas the proportion of dietary fat intake demonstrated a negative association with MFR across all participants. No significant correlation was identified between dietary protein intake and MFR.
Conclusions: This study demonstrates that children with sarcopenic obesity are at a heightened risk of developing fatty liver disease. Additionally, a lower proportion of dietary carbohydrates and a higher proportion of dietary fats were found to be associated with sarcopenic obesity in Korean children. These findings highlight the pivotal role of macronutrient composition in modulating body fat and muscle mass in pediatric populations. Accordingly, preventive and therapeutic strategies addressing childhood obesity should prioritize the optimization of dietary macronutrient balance.
Contact e‐mail address: jeyim@changwon.ac.kr
N‐EV180. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐EV180.1. COMPARATIVE ANALYSIS OF GASTROINTESTINAL OUTCOMES IN PEDIATRIC TPN PATIENTS BY AGE GROUPS
Saman Aryal 1, Arleen Delgado1, Luis Nieto2, Ricardo Mora3
1NYC Health + Hospitals/Woodhull Medical and Mental Health Center ‐ ‐ Brooklyn, NY, Brooklyn, United States of America, 2Emory University School Of Medicine, Atlanta, United States of America, 3NYU Langone, New York, United States of America
Objectives and Study: Total parenteral nutrition (TPN) is a critical intervention for children unable to meet nutritional needs through enteral feeding. This study aimed to assess age‐related differences in gastrointestinal outcomes in children receiving TPN.
Methods: A retrospective cohort analysis was conducted using TriNetX data from 2010 to 2024. Patients aged 1–10 years were divided into two cohorts: 1–5 years and 6–10 years. The propensity score matched the balanced 41,922 patients per cohort. Outcomes included abnormal liver function tests (LFTs), metabolic syndrome, inflammatory bowel disease (IBD), jaundice, intestinal dysbiosis, vomiting, gastroesophageal reflux disease (GERD), and irritable bowel syndrome (IBS).
Results: The younger cohort showed significantly lower odds of abnormal LFTs (OR 0.498, 95% CI, 0.417–0.595, p < 0.001), metabolic syndrome (OR 0.238, 95% CI, 0.119–0.474, p < 0.001), and IBD (OR 0.390, 95% CI, 0.274–0.555, p < 0.001). Jaundice (OR 0.615, 95% CI, 0.498–0.761, p < 0.001), intestinal dysbiosis (OR 0.858, 95% CI, 0.767–0.960, p = 0.007), vomiting (OR 0.602, 95% CI, 0.576–0.630, p < 0.001), GERD (OR 0.714, 95% CI, 0.671–0.759, p < 0.001), and IBS (OR 0.354, 95% CI, 0.220–0.569, p < 0.001) were also less frequent in the 1–5 years group.
Conclusions: Younger children may be at lower risk because they have greater gastrointestinal adaptability and immune resilience, which reduce oxidative stress and inflammation. Conversely, older children face cumulative damage from prolonged TPN, increasing their risk of gastrointestinal complications. These findings emphasize the importance of age‐specific monitoring and tailored interventions to mitigate risks, especially for older patients. Future research should explore long‐term outcomes and underlying protective mechanisms.
Contact e‐mail address: samanaryal1992@gmail.com
N‐EV181. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐EV181.1. HOME PARENTERAL NUTRITION MONITORING IN A UK TERTIARY PAEDIATRIC HOSPITAL
Jonathan Baker, Patricia Clemente, Melody Chan, Akshay Batra
Southampton Children's Hospital, Southampton, United Kingdom
Objectives and Study: Parenteral nutrition (PN) is a vital source of nutrition for many patients with intestinal failure which occasionally must be continued at home. There are risks associated with long‐term PN use which must be monitored for and ESPGHAN has published a set of monitoring standards for paediatric home PN (HPN) patients. The aim of this study was to establish adherence to these standards in Southampton Children's Hospital over a 5 year period.
Methods: Retrospective data collection for all patients receiving HPN for more than 3 months, taken from patient electronic records, examining period between June 2019 to 2024. Monitoring periods were broken down into ESPGHAN recommended 3 month, annual and 3 year periods to achieve various monitoring requirements: 3 monthly (weight, height, clinical examination, dietetic assessment, basic blood tests, micronutrient blood tests, urine electrolytes); annual (abdominal ultrasound, dual‐energy X‐ray absorptiometry (DXA) bone density scan); 3 yearly (DXA body composition scan – usually >5 year old patients).
Results: 26 patients were identified as having HPN in the period examined. 1 patient had under 3 months of HPN and thus had no data obtained. 3 monthly parameters: weights were taken in 94.6% of periods, heights in 85.6%, clinical examination in 78.6%, dietetic assessment in 82.1%, basic blood tests in 87.2%, micronutrient blood tests in 73.5% and urine electrolytes in 16.9%. annual parameters: abdominal ultrasounds in 64.4%, DXA scans for bone density in 9.6%. In applicable patients, 3 yearly DXA body composition scans performed in 27.2%.
Conclusions: Key monitoring requirements were generally well met aside from urine electrolytes, impacted by reduced in person contact in COVID lockdowns and local hospital monitoring of blood tests. DXA scans infrequently used which could be improved. Recently restarted annual, structured reviews of HPN patients aims to improve compliance, alongside new local guideline based on ESPGHAN recommendations.
Contact e‐mail address: jonathan.baker@uhs.nhs.uk
N‐EV182. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐EV182.1. PERIPHERALLY INSERTED CENTRAL VENOUS CATHETERS (PICC) CAN BE SUCCESSFULLY USED TO ADMINISTER PARENTERAL NUTRITION (PN) AT HOME
Hanna Bjorn, Sophie Montgomery‐Stuart, Hannah Littlechild, Rulla Al‐Araji, Jutta Koeglmeier, Susan Hill
Department Of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
Objectives and Study: to investigate the success of using peripherally inserted central catheters (PICC) for administering parenteral nutriton (PN) at home (HPN) with care by formally trained parents. Although our preference is to to use a tunneled central venous catheter (CVC) for administering HPN in certain cases we have discharged children home with a PICC rather than routinely replacing with a tunneled CVC.
Methods: We reviewed the electronic clinical notes of all children managed by our HPN service from 2017‐2024 to see how many had been discharged home with a PICC and length of time ‘in situ’.
Results: From 2017‐2024, 86/87 patients on HPN had a tunneled CVC for the majority of the time and 24 had 46 PICCs. One patient (an adolescent with Crohn's disease) only had a PICC and 62 only had a tunnelled CVC. Twenty patients had one PICC only, 1 had two, 2 had three, 2 had four and 1 had six PICCs. The aetiology of intestinal failure in children who had PICCs was 6 short bowel syndrome, 9 enteropathy and 10 intestinal motility disorder. There were 17 CRBSI in 9392 catheter days = 1.8 CRBSI/1000 catheter days. 27 PICC catheters were routinely removed including 7 when the child weaned from PN. Other reasons for removal were: 5 occluded, 4 CRBSI and one was accidentally pulled out. PICCs were in situ from 8 (unexpectedly weaned from PN) to 717 days (median 140 days).
Conclusions: Although a tunneled CVC is the preferred type of central venous access for administering HPN, PICC can be successfully used for even up to almost 2 years. The practice of routinely replacing PICC with tunneled CVC should be reconsidered in order to limit anaesthetics, preserve venous access and judicious use of resources.
Contact e‐mail address: susan.hill@gosh.nhs.uk
N‐EV183. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐EV183.1. NATIONAL SURVEY ON POSITIONING AND MANAGEMENT VASCULAR ACCESS IN PATIENTS WITH INTESTINAL FAILURE: WHAT ARE THE DIFFERENCES
Teresa Capriati 1, Maria Immacolata Spagnuolo2, Antonella Lezo3, Paolo Gandullia4, Lorenzo Norsa5, Naire Sansotta6, Giovanna Verlato7, Giovanni Boroni8, Alessio Pini Prato9, Giulia Mottadelli10, Valentina Buccella11, Antonella Diamanti1, Laura Lacitignola12
1Nutritional Rehabilitation, Children's Hospital Bambino Gesù, IRCSS, Rome, Italy, 2Department Of Translational Medical Science, university Federico II, Naples, Italy, Naples, Italy, 3Dietetic And Clinical Nutrition Unit, Children's Hospital Regina Margherita, Città della Salute e della scienza, Turin, Italy, 4Pediatric Gastroenterology And Digestive Endoscopy Unit, G.Gaslini Institute for Maternal and Child Health, IRCCS, Genova, Italy, 5Paediatrics, Buzzi Children's Hospital, University of Milan, Italy, 6Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy, 7Pediatric Nutrition Service Nicu, University Hospital of Padova., Padova, Italy, 8Pediatric Surgery, University of Brescia, Brescia, Italy, 9Unit If Pediatric Surgery, St Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy, 10Unit Of Pediatric Surgery, St Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy, 11Unità Operativa Pediatrica, Ospedale S. Chiara, Trento, Trento, Italy, 12Department Of Neuroscience, Psychology, Pharmacology And Child's Healt, University of Florence, Meyer Hospital, Florence, Italy
Objectives and Study: Central Vascular Catheter (CVC) is crucial in management of intestinal failure (IF): it affects home parenteral nutrition (HPN) program effectiveness, patient's quality of life and healthcare costs. The objectives of survey are to investigate national habits on placement/management CVC in IF and to identify critical issues in these categories of patients.
Methods: Electronic survey (12 items) was sent to the main centers for pediatric IF in Italy
Results: Ten Italian centers responded to the survey (6 referral centers > 10 patients with IF). Placement of CVCs is only in 1 center by interventional radiologists (10%), in 7 centers (70%) by anesthetists and in the 3 smaller centers (< 10 patients) by surgeons (30%). In 5 centers out of 11 (50%) have silicone catheters available. For 80% centers, the absence of repair option for external segment is a problem (increases replacement procedures and depletes vascular patrimony). Polyurethane CVCs also appear to have critical issues in daily management in 60% (6/11) as they are more rigid (4/6), are difficult to clean and they dislocate more easily (2/11). Tunnelled CVC is present in 95% of cases. Cuffed CVC is not a constant: in 6/11 centers in < 50%. All centers have a secur a cath rate > 50% (> 80% in 60%). Grip locks and stat locks < 50% in 60% of centers. The 60% of the centers use ports in patients aged at least > 10 years usually for psychological reasons (rejection of the external CVC).
Conclusions: At present, guidelines on the placement and management of CVC are provided by anesthetists also for patients with intestinal failure. It is likely these patients requires specific indications and specialists in consideration of the long‐term program and the need to preserve the vascular heritage.
Contact e‐mail address: teresa.capriati@opbg.net
N‐EV184. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐EV184.1. PARENTAL CHOICE IN HOME PARENTAL NUTRITION TECHNIQUE AND ITS IMPACT ON THE INCIDENCE OF CATHETER RELATED BLOODSTREAM INFECTIONS
Patricia Clemente 1, Christopher Bakewell1, Akshay Batra1, Melody Chan1, Elena Kurteva2
1Southampton Children's Hospital, Southampton, United Kingdom, 2Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Objectives and Study: Catheter‐related bloodstream infections (CRBSIs) are a significant complication in children on home parenteral Nutrition (HPN), with sterile technique playing a critical role in infection prevention. This study evaluates the impact of standard aseptic non‐touch technique (ANTT) versus surgical ANTT on CRBSI rates in a cohort of children on HPN.
Methods: A retrospective review was conducted on paediatric patients currently receiving HPN at Southampton Children's Hospital. Number of admissions because of CRBSI were recorded between 1/11/2019 to 31/10/2024. Patients were grouped based on the aseptic technique employed: standard ANTT and surgical ANTT. Caregiver choice played an important role in selecting the technique, with some opting for surgical ANTT, despite the standard practice being using standard ANTT. Infection rates were calculated per 1,000 parenteral nutrition (PN) days, with CRBSI confirmed by positive blood cultures and clinical criteria.
Results: There were 26 patients actively on HPN. The duration of PN ranged from 8 to 1827 PN days. 19 patients were utilizing standard ANTT and experienced a CRBSI rate of 3.7 infections per 1,000 PN days, compared to a significantly reduced rate of 1 infection per 1,000 PN days in the 7 using surgical ANTT. All patients used taurolidine line locks. Those on standard ANTT had a median age of 14 months at the start of data collection versus 66 months for the surgical group. The overall CRBSI rate was 1.7/1000 PN days.
Conclusions: Standard ANTT was more commonly used in our unit, with only a small proportion using surgical. There was a lower risk of CRBSI in children using surgical ANTT. The smaller group size and older age of these patients may impact the degree of difference seen, but overall these data suggest that involving parents in the choice of technique used could impact CRBSI risk.
Contact e‐mail address: PATRICIA.CLEMENTE@UHS.NHS.UK
N‐EV185. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐EV185.1. PROSPECTIVE, OBSERVATIONAL SERVICE EVALUATION OF THE IMPLEMENTATION, SAFETY AND CLINICAL EFFECTIVENESS OF STANDARD PARENTERAL NUTRITION ON PAEDIATRIC INTENSIVE CARE UNIT
Jennifer Hatch1, Shannon Hartell 2
1Paediatric Intensive Care/Pharmacy, Evelina London Children's Hospital, London, United Kingdom, 2Paediatric Intensive Care/Dietetics, Evelina London Children's Hospital, London, United Kingdom
Objectives and Study: Parenteral nutrition (PN) is recommended for paediatric intensive care unit (PICU) patients who cannot meet their nutritional requirements enterally. Standard PN should be considered as first line therapy however for those whose requirements cannot be met by standard PN, individualised PN is recommended. Additionally, the use of standard PN can reduce prescribing errors and provides a cost‐benefit. The aim was to determine the safety and efficacy of standard PN on PICU, Evelina London Children's Hospital, where historically only individualised PN was used.
Methods: A prospective, observational service evaluation was conducted over 16 weeks, between August and December 2024. All patients prescribed parenteral nutrition were included and identified using an electronic patient record system. Data was collected and analysed using an access‐restricted Google Sheets document. A survey was conducted amongst staff involved in standard PN to capture qualitative data.
Results: There were 35 PN treatment episodes on PICU, with 60% eligible for standard PN. Of those receiving individualised PN, 50% were already established at the point of PICU admission. Standard PN was unsuitable for those with pre‐existing electrolyte disturbances, metabolic conditions, lipid intolerance or inadequate nutritional provision from standard PN. Standard PN was discontinued for most patients due to switching to individualised PN for various reasons, and one quarter stopping after successfully achieving sufficient enteral feeds. (figure.1)
Electrolyte replacements were required on 50% of standard PN therapy days with potassium, 77%, and magnesium, 46%, being the most common ‐ in line with expected PICU practice. This highlights the tolerability of a low‐electrolyte standard PN formulation.
Conclusions: This service evaluation supports existing literature that standard PN is safe and effective; and although electrolyte replacements were required, this was within usual practice. 100% of users surveyed felt that the introduction of standard PN benefitted patients. Future aims include investigating PN‐related electrolyte replacements, the use of lipid‐free standard PN and the annual cost‐savings.
Contact e‐mail address:
N‐EV186. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐EV186.1. MICROVILLUS INCLUSION DISEASE, INTESTINAL FAILURE AND RENAL FANCONI SYNDROME ASSOCIATED WITH A NOVEL STX3 VARIANT
Noha Heikal 1, Krishna Soondrum1, Susan Hill2
1Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, United Kingdom, 2Paediatric Gastroenterology, Great Ormond Street Hospital, London, United Kingdom
Objectives and Study: To report clinical and laboratory findings in three patients diagnosed with a homozygous nonsense mutation in STX3 (c.696dup p.(Glu233Argfs*17)), associated with microvillus inclusion disease (MVID).
Methods: Case notes of patients with the STX3 (c.696dup p.(Glu233Argfs*17)) were reviewed.
Results: Patient 1: 6‐year old girl presented in infancy with vomiting, severe metabolic acidosis, glycosuria, proteinuria and intestinal failure(IF). Small intestinal mucosal biopsy electron microscopy (EM) revealed microvillus inclusion bodies, and genetics identified homozygous STX3(c.696dup p.(Glu233Argfs*17)) mutation. She tolerated increased oral diet, and stopped parenteral nutrition (PN) aged 5.5 years. Patient 2: 7‐year‐old girl presented at birth with abdominal distension and dilated bowel loops. Biochemistry showed hypokalemia, hypophosphatemia, hyperchloremia, and non‐anion gap acidosis with low‐molecular‐weight proteinuria, glycosuria, aminoaciduria, and renal phosphate wasting, consistent with renal Fanconi syndrome. Initially suspected to have paediatric intestinal pseudobstruction, PIPO, small intestinal mucosal biopsy EM confirmed MVID when aged 5 years. Genetic testing revealed STX3(c.696dup p.(Glu233Argfs*17)) mutation. She is dependent on PN. Patient 3: 19‐month‐old brother of patient 2, presented with meconium aspiration, severe metabolic acidosis and IF. Genetic testing confirmed homozygous STX3(c.696dup p.(Glu233Argfs*17)) mutation. He remains PN dependent with suspected renal Fanconi syndrome. See Table 1 for clinical findings.
Conclusions: MVID, renal Fanconi, short stature, rickets, sensorineural hearing loss can be associated with this novel STX3(c.696dup p.(Glu233Argfs*17)) variant. IF can improve with age and one patient was weaned from PN. Diarrhoea was less severe than in classic MVID.
Contact e‐mail address: Noha.heikal1@nhs.net
N‐EV187. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐EV187.1. CLINICAL OUTCOMES OF PAEDIATRIC INTESTINAL FAILURE IN SINGAPORE: EXPERIENCE FROM A MULTIDISCIPLINARY INTESTINAL REHABILITATION PROGRAM (IRP) AT A TERTIARY CHILDREN'S HOSPITAL
Lay Queen Ng 1, Divya Pandey1, Lynette Goh1, Veena Logarajah1, Christopher Ho1, Charanya Rajan1, Sarah Wong1, Kong Boo Phua1, Pui Ling Wai2, Xiangrui Mai3, Bixia Ang4, Kar Yin Phuah4, Fang Kuan Chiou1
1Paediatric Gastroenterology, Hepatology And Nutrition, KK Women's and Children's Hospital, Singapore, Singapore, 2Nursing Clinical Services, KK Women's and Children's Hospital, Singapore, Singapore, 3Department Of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore, 4Nutrition And Dietietics, KK Women's and Children's Hospital, Singapore, Singapore
Objectives and Study: Paediatric intestinal failure (IF) is a rare condition associated with multiple significant life limiting complications necessitating a coordinated multi‐disciplinary approach in it's management. This study aims to review the clinical and nutritional outcomes of chronic IF patients at our center in Singapore.
Methods: Retrospective review of the clinical and nutritional outcomes of pediatric IF patients managed by IRP at KK Women's and Children's Hospital from 2013‐2024. Chronic IF patients requiring parenteral nutrition (PN) > 90 continuous days were included in this study. Intestinal failure associated liver disease (IFALD) was defined as having biochemical liver derangements of bilirubin, alanine transaminase (ALT) or gamma glutamyltransferase (GGT) > 1.5x upper limit of normal (ULN) for > 6 weeks.
Results: Thirty‐two patients were included with median follow up duration of 10 years. The two most common etiologies of IF were short bowel syndrome (SBS) with extensive surgical resection (n = 23, 71.9%) and chronic intestinal pseudo‐obstruction with dysmotility (n = 7, 21.9%) (Figure 1). Median plasma citrulline level (n = 17) was 9.0umol/L (IQR 10.5umol/L). With the initiation of a home PN program in 2014, 12 patients (37.5%) were successfully transitioned to Home PN. Central‐line associated blood stream infections (CLABSI) and vascular thrombosis rates were 1.85/1000 and 0.6/1000 catheter days respectively. IFALD was documented in 19 patients (59.4%). At the end of the study period, enteral autonomy was established in 18 patients (56%). Four patients (12.5%) underwent successful living donor isolated small bowel transplantation. Four patients died (12.5%), three from end stage complications of IF and the other from terminal illness (malignancy).
Conclusions: A well‐structured and protocolized multidisciplinary IRP including a new intestinal transplantation service has led to improved overall outcomes for paediatric IF patients in Singapore.
Contact e‐mail address: NG.LAY.QUEEN@KKH.COM.SG
N‐EV188. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐EV188.1. CENTRAL LINE ASSOCIATED SEPSIS (CLABSI) IN PAEDIATRIC HOME PARENTERAL NUTRITION PATIENTSxs:
Ummu‐Kulthum Othman 1, Virginia Chatzidaki2, Andrew Fagbemi2, Maureen Lawson2, Sian Copley2, Loveday Jago2, Adnaan Kala2
1Paediatrics, royal manchester children's hospital, manchester, United Kingdom, 2Manchester children's hospital, Manchester, United Kingdom
Objectives and Study: Central venous catheters (CVC) are vital for provision of long‐term parenteral nutrition (PN) but are associated with risk of central Line‐Associated Bloodstream Infections (CLABSI) a critical challenge for patients requiring home PN (HPN).
Methods: 37 patients were identified from the HPN database. We analysed epidemiology and management of CLABSI, time to antibiotic administration, fever episodes, and causative microbiological organisms in HPN patients over a 2 year period.
Results: 26/37 (70%) presented with fever at least once during the study period. Age at presentation ranged from 1 – 16. 31/37 used Taurolock as line lock, 3/31 Tarolidine and 3/37 heparin. Diagnoses included surgical short bowel syndrome, enteropathy, chronic intestinal pseudo‐obstruction, trichohepatoenteric syndrome, cystic fibrosis, DGAT Mutation, MYO5B gene mutation and small bowel sclerosis. There were 102 episodes of fever, median 2 per patient, with an outlier of 14 episodes of fever. More frequent line access appeared to be associated with more episodes of fever. 22/102 episodes (21.5%) were due to CLABSI. 15.7% had viral URTI (Rhinovirus (n = 7), Influenza (n = 5)) UTI, viral enteritis, 62.75% had no causative organism isolated. 14/37 patients had at least 1 confirmed CLABSI (Mode 0, mean 0.57, median 1). 10/14 had 1 episode, 2 episodes: 2/14; 3: 1/14; 4: 1/14). Most commonly isolated CLABSI‐associated organisms were: Enterococcus faecium (n = 4), Staphylococcus epidermidis (n = 3), Staphylococcus aureus (n = 3), and Candida (n = 3). 11/22 received antibiotics within 0‐1 hour of decision, while 8/22 received antibiotics within 1‐2 hours, and 3) received antibiotics >3 hours after the decision to start antibiotics was made.
Conclusions: The majority of fevers in the HPN population were not associated with CLABSI. The majority of CLABSI cases were single episodes, but a small proportion of patients experienced recurrent CLABSI. All cases of suspected CLABSI should receive IV antibiotics within 1 hour of decision to treat; barriers to this are under review.
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N‐EV189. Topic: AS03. NUTRITION/AS03g. Parenteral Nutrition
N‐EV189.1. CYSTATIN C: A NEW MARKER OF KIDNEY FUNCTION FOR PAEDIATRIC PATIENTS ON LONG TERM PARENTERAL NUTRITION (LTPN)
Alessia Salatto, Marilena Cipullo, Maria Immacolata Spagnuolo
Department Of Translational Medical Sciences (dismet), Section Of Pediatrics, University Federico II, Naples, Italy
Objectives and Study: Parenteral Nutrition (PN) in patients with intestinal failure (IF) can cause various complications. Cystatin C (Cys‐C), an early marker of renal damage, appears to be more reliable than creatinine as it is not influenced by muscle mass, physical activity, or diet in children. The primary aim of this study was to evaluate Cys‐C levels in paediatric IF patients on long‐term PN (LTPN). These values were then compared with a subgroup of weaned patients who had been on PN for at least six months.
Methods: We enrolled IF patients aged 2 to 14 years followed at the Pediatric Artificial Nutrition Center of the Federico II University Hospital in Naples. The study included patients currently on PN and those who had been weaned after receiving PN for at least six months. We measured creatinine, urea, and Cys‐C levels in all patients. In PN patients, the volume and duration of PN infusion were correlated with Cys‐C levels.
Results: A total of 52 patients were enrolled (32 on PN and 20 weaned). Among PN patients, 16 (50%) had Cys‐C > 1 with a mean value of 1.06 ± 0.29, compared to 4 weaned patients (19%) with a mean value of 0.79 ± 0.22 (p < 0.05). PN patients with Cys‐C > 1 had a mean daily fluid intake (QI) of 67.7 ± 13.28 ml, while those with Cys‐C < 1 had 44.3 ± 18.03 ml (p < 0.05). All patients had normal levels of creatinine, urea, and GFR.
Conclusions: Our study is the first to evaluate Cys‐C levels in pediatric IF patients on PN compared to weaned patients. Elevated Cys‐C levels in PN patients with increased QI suggest a potential impact on renal function due to fluid overload. Elevated Cys‐C in weaned patients may indicate previous PN‐related renal damage.
Contact e‐mail address: alessiasalatto1@gmail.com
N‐EV190. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV190.1. GUT MICROBIOTA COMPOSITION AND DEVELOPMENT OF ATOPIC DERMATITIS IN THE FIRST THREE YEARS OF LIFE
Alexandru Cosmin Pantazi1,2, Adriana Balasa 1,2, Cristina Mihai1,2, Tatiana Chisnoiu1,2, Larisia Mihai1,2, Corina Elena Frecus1,2, Adina Ungureanu1, Viviana Cuzic1, Simona Claudia Cambrea1
1Faculty of Medicine, Ovidius University of Constanta, Romania, Constanta, Romania, 2Pediatrics, Clinical Emergency Hospital of Constanta, Romania, Constanta, Romania
Objectives and Study: The intestinal microbiota has a significant role in preserving the integrity of the intestinal barrier, influencing the immune system, which increases the risk for manifestation of atopic disease.The aim of the study was to analyse and compare the composition of gut microbiota in AD and non‐AD groups.
Methods: The study included 52 patients aged 0 to 3 years with diagnosis of atopic dermatitis (AD) and 32 patients without atopic dermatitis (0‐3 years) (non‐AD) from Pediatrics Department of Clinical Hospital in Constanta, Romania, during a period of 2 years, between February 2022‐ February 2024. The exclusion criteria were the consumption of antibiotics, probiotics or the presence of gastrointestinal illnesses within four weeks before enrollment.
Results: Higher abundance of proteolytic bacteria from Enterobacteriaceae family specifically Escherichia coli was observed (P < 0.05) with concentrations reaching 2 x 10^9 CFU/g, while Klebsiella species presented elevated levels up to 4 x 10^8 CFU/g. A significant concentration of Enterococcus species was observed (7 x 10^8 CFU/g), although the levels of Bacteroides and Bifidobacterium species presented a significant lower abundance (P < 0.05), reaching less than 1 x 10^4 CFU/g. Candida albicans and Geotrichum species had values within the usual range (<1 x 10^3 CFU/g). The intestinal flora index indicated moderate dysbiosis (median 6), accompanied by elevated fecal pH (median 6.5).
Conclusions: The characteristics of the intestinal microbiota in infants and toddlers with atopic disease are a key factor in the field of personalized therapy, considering multi‐strain probiotics in conjunction with prebiotics and postbiotics.
Contact e‐mail address: dr_pantazi@yahoo.com
N‐EV191. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV191.1. SHAPING THE INFANT INTESTINAL RESISTOME EARLY IN LIFE: THE ROLE OF MODE OF BIRTH, BREASTFEEDING, AND BIFIDOBACTERIUM ABUNDANCE
Anna Samarra1, Narciso M. Quijada2, Alejandro Jimenez‐Alcañiz2, Cecilia Martínez‐Costa3, Maria Carmen Collado 1
1Institute of Agrochemistry and Food Technology‐National Research Council (IATA‐CSIC), Spain, Valencia, Spain, 2Department Of Microbiology And Genetics, Institute for Agribiotechnology Research (CIALE), University of Salamanca, Salamanca, Spain, 3Department Of Pediatrics, University of Valencia, Valencia, Spain
Objectives and Study: The first year of life is a critical period for the acquisition and establishment of the infant intestinal resistome, as the development of the microbiome is directly influenced by perinatal factors to which the neonate is exposed. This study aims to analyse the evolution of the infant resistome during the first year of life and provide more knowledge on how breastfeeding could modulate the acquisition of antimicrobial resistances.
Methods: Longitudinal metagenomic study of the intestinal microbiome of 50 infants from the MAMI cohort (aged 7 days, 1, 6, and 12 months). Detailed clinical data of mother‐child pairs including delivery type, antibiotic use during it, and breastfeeding practices were available. The microbial profile obtained after massive sequencing (Illumina) was analysed using the MetaPhlAn tool, while the resistome was obtained using Resfinder.
Results: During the first year of life, the composition of infants' microbiomes was classified into two groups based on the abundance of the genus Bifidobacterium: high abundance (High‐Bifidobacterium, HB) or low abundance (Low‐Bifidobacterium, LB). Infants in the LB group exhibited higher levels of antibiotic resistance gene (ARG) abundance, mainly associated with species such as Escherichia coli and Klebsiella pneumoniae. Exclusive breastfed infants carried less antibiotic resistances than those receiving other types of feeding, even if they were born by C‐section.
Conclusions: The genus Bifidobacterium was associated with a specific early microbiota profile that directly influences the neonates' resistome. Exclusive breastfeeding during the first month of life is essential for shaping infant's resistome as it reduces resistance abundance and erases the effect of C‐section procedures.
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N‐EV192. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV192.1. THE GUT MICROBIAL PROFILE IN INFANTS WITH REGURGITATION – METAGENOMIC SEQUENCING
Egija Zelča1, Dita Gudrā2, Daiga Karklina1, Larisa Zaharova1, Jana Peterlevica1, Davids Fridmanis2, Megija Lunge2, Ingrida Rumba‐Rozenfelde1, Ilva Daugule 1
1Faculty Of Medicine, University of Latvia, Riga, Latvia, 2Latvian Biomedical Research and Study Centre, Riga, Latvia
Objectives and Study: Regurgitation is common during infancy. Although uncomplicated regurgitation is not a disease, it could lead to parental distress and health‐care overload. Therefore more preventative strategies should be studied to promote a deeper understanding of regurgitation, especially since probiotics are increasingly being proposed as possible therapeutics for modifying regurgitation symptoms. Aim – to uncover the gut microbial profile in infants with regurgitation.
Methods: Healthy infants coming to prophylactic visits were included in the study. Parents of infants answered the questionnaire and brought two faecal samples: at the age of 0‐6 months and 12‐15 months. Infants with parents‐reported regurgitation were included in the study. Further, metagenomic sequencing was performed to detect taxonomic entities. The median relative abundance of taxa was compared among children with and without regurgitation. Statistics: Wilcoxon and Mann‐Whitney tests. P‐value < 0.05 was considered significant.
Results: The participant sample included 66 infants (F/M:27/39; the mean age in the baseline sample ‐ 3,1 months(2.6 – 3.5 05%CI); in the follow‐up sample – 12,12 months(95% CI 11.420 to 12.823); 77.3% were delivered vaginally). The regurgitation was reported in 38%(25/66) of infants. In the first half year of life, the following entities were higher in infants with regurgitation: Actinomycetaceae, Eggerthellaceae, Muribaculaceae, Mycobacteriaceae, QALW01, compared to infants without regurgitation. A significant increase of Pasteurellaceae, Peptostreptococcaceae and Saccharimonadaceain was noted in children aged 12‐15 months with parents‐reported regurgitation. On the other hand, in children without regurgitation, such entities like Anaerotignaceae, Dialisteraceae and Propionibacteriaceae were higher in the follow‐up samples.
Conclusions: Although the majority of bacteria found in children with regurgitation up to six months of age belong to the generally beneficial phylum Actinobacteria, these are not typical representatives of this phylum in the infants' gut flora, which indirectly shows a possible dysbiosis in children with regurgitation already in the first half year of life.
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N‐EV193. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV193.1. NON COMUNICABLE INFLAMMATORY DISEASES AND GUT MICROBIOTA COMPOSITION IN CHILDREN FOLLOWED UP AFTER WEANING WITH ADULT FOOD TYPICAL OF THE MEDITERRANEAN DIET
Raffaella De Franchis 1, Lorenzo D'antonio2, Giorgia Ippolito3, Luigi Bozza1, Pasquale Canale1, Maria Chiacchio1, Paolo Cortese1, Antonio D'Avino1, Maria De Giovanni1, Mirella Dello Iacovo1, Antonietta D'Onofrio1, Aniello Federico1, Nicoletta Gasparini1, Felicia Iaccarino1, Raffaella Spadaro1, Mariangela Tedesco1, Giuseppe Vitiello1, Angelo Antignani4, Francesca De Filippis5, Renata Auricchio6, Salvatore Auricchio6, Dario Bruzzese7
1Italian Federation of Maedical Paediatrics (FIMP), Naples, Italy, 2Department Of Translational Medical Sciences, Federico II University, Naples, Italy, 3Department Of Woman, Child And Of General And Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy, 4Department Of Prevention, Local Health Authority Napoli3 Sud, Torre del Greco‐ Naples, Italy, 5Department Of Agricultural Science, Federico II University, Portici‐Naples, Italy, 6Department Of Medical Translational Science And European Laboratory For The Investigation Of Food Induced Diseases, Federico II University, Naples, Italy, 7Department Of Public Health, Federico II University, Naples, Italy
Objectives and Study: We present the long term follow up of a randomized controlled trial evaluating the effects of weaning children with Mediterranean Diet (MD) (1).
Methods: We assessed the effects on adherence to MD by Kidmed questionnaire, BMI, incidence of chronic inflammatory diseases and differences in gut microbiota in a subset of 191 children (96 cases and 95 controls) of the original cohort.
Results: No difference in the KidMed score emerged (5.7 + ‐2.3 vs. 6.1 ± 2.3, in control and MD group, respectively; p = 0.274) although children in the experimental group showed higher regular consumption of fresh and cooked vegetables (71.9% vs 51.6%; p = 0005). No differences were observed in: BMI, (17.7 ± 3.5 kg/m2 vs 18.1 ± 3.4 kg/m2; p = 0.384) although an inverse correlation with KidMed score was observed. Incidence of chronic inflammatory diseases was similar in the two groups. However, out of the 21 cases of Atopic Dermatitis, only 7 were present in the MD group (7.5% vs 13.7%; p = 0.175). The same pattern was noted in allergic rhinitis (5.4% vs 9.8%; p = 0.29). Pooling both diseases, the prevalence was 12.9% vs 21.6% (p = 0.132). An higher prevalence of autism spectrum disorders (3.9% vs 0%; p = 0.123) and ADHD (3.9% vs 2.2%; p = 0.68) was observed in the control group. When pooling the two diseases, the prevalence was 7.8% vs 2.2% (p = 0.104). The biodiversity index in Gut Microbiota composition was preserved over time. Taxa of the MD group, showed an increase of the Short Chain Fatty Acid producers with a different representation of benefical species.
Conclusions: MD weaning may have a potential beneficial effect on gut‐microbiota development and on prevention of inflammatory chronic diseases. Larger studies and a longer follow up are necessary to evaluate these results. None of the authors declare any conflict of interest in this study. 1) de Franchis et al, Nutrients 2022; 14:2486
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N‐EV194. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV194.1. INFANT FORMULA WITH A SYNBIOTIC BLEND OF HUMAN MILK OLIGOSACCHARIDES, BOVINE MILK OLIGOSACCHARIDES, AND B. INFANTIS SUPPORTS HEALTHY GUT DEVELOPMENT
Mitzi Trinidad‐Aseron1, Nicola Procházková2, Pernille Neve Myers2, Janne Moll2, Vinna Marie R. Tenorio‐Quiñones3, Danai Andreadi4, Ger Ryan5, Mario Noti6, Norbert Sprenger6, Nicholas P. Hays 7, Maria Rosario Z. Capeding8
1University of Perpetual Help Dalta Medical Center, Las Pinas, Philippines, 2Cmbio, Copenhagen, Denmark, 3University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines, 4Clinical Research Unit, Nestlé Research, Lausanne, Switzerland, 5Product Development Group, Nestlé Development Center, Wyeth Nutritionals Ireland Ltd., Askeaton, Ireland, 6Nestlé Institute Of Health Sciences, Nestlé Research, Lausanne, Switzerland, 7Clinical And Nutritional Research Unit, Nestlé Product Technology Center – Nutrition, Vevey, Switzerland, 8Asian Hospital and Medical Center, Muntinlupa City, Philippines
Objectives and Study: Modulating early‐life gut microbiota development with age‐adapted synbiotics may support gut health in formula‐fed infants. We assessed microbiome and gut health indicators in healthy infants fed a new synbiotic‐supplemented formula through age 6 months (m).
Methods: Exclusively formula‐fed infants aged ≥14 to ≤35 days (n = 240) were randomized to receive control (CF; cow's milk‐based alpha‐lactalbumin‐enriched formula) or experimental formula (EF; same formula with 2.64 g/L added human identical milk oligosaccharides (HMOs; 2′‐FL,3‐FL,DFL,3′‐SL,6′‐SL,LNnT,LNT), 4.56 g/L bovine milk oligosaccharides (MOS), and 1x106 CFU/g B.infantis LMG11588. Growth, gastrointestinal tolerance, and blood biomarker results are reported separately. Early‐life gut and immune health indicators (fecal pH, secretory immunoglobulin A [sIgA], calprotectin, alpha‐1 antitrypsin [AAT]) and microbiome signatures were analyzed at baseline, 2, 4, and 6 m.
Results: Intra‐ and inter‐individual microbiome diversity indices were different (p < 0.0001) in EF vs. CF‐fed infants from 2‐6 m, indicating different microbiome compositions. EF‐fed infants had significantly higher relative and absolute abundance of bifidobacteria driven by infant‐type Bifidobacterium species (mainly B.infantis, B.breve, B.longum, B.bifidum) from 2‐6 m (Figure, Panel A). B.infantis dominated in EF‐fed infants and showed the strongest increase (p < 0.0001). From 2 m, B.infantis prevalence (probiotic LMG11588 and endogenous strains) was virtually 100% in EF‐fed infants, while most CF‐fed infants had no detectable B.infantis through 6 m. Infants born via C‐section and without older siblings showed the strongest bifidobacteria increase in EF vs. CF from 2‐6 m. Mucolytic R.gnavus and the opportunistic pathogen C.difficile were higher in CF vs. EF from 2‐6 m. These microbiome differences promoted lower fecal pH in EF from 2‐6 m (p < 0.0001). Gut health and immune markers were different between groups with lower AAT (2,4,6 m; p < 0.05), lower calprotectin (4 m, p = 0.026), and higher sIgA (4 m, p = 0.034) in EF (Figure, Panel B).
Conclusions: Infant formula supplemented with a synbiotic blend of HMOs, MOS, and B.infantis drives an infant‐type gut microbiome progression that positively impacts gut and immune function.
Contact e‐mail address: nicholaspaul.hays@rd.nestle.com
N‐EV195. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV195.1. GUT MICROBIOME ALTERATIONS AND THEIR CLINICAL CORRELATIONS IN PEDIATRIC TYPE 1 DIABETES: A CASE‐CONTROL STUDY
Mara Ionescu 1,2, Anca Boboc3, Gratiela Gradisteanu Pircalabioru4, Felicia Galos1,5
1Department Of Pediatrics, Marie Curie Emergency Children's Hospital, Bucharest, Romania, 2Department Of Functional Sciences, Division Of Physiology Ii—neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, 3Marie Curie Emergency Children's Hospital, Bucharest, Romania, 44. Research Institute of the University of Bucharest, Bucharest, Romania, 5Department Of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Objectives and Study: Type 1 Diabetes Mellitus (T1DM) is an autoimmune disorder characterized by the destruction of pancreatic beta cells, leading to insulin deficiency. While the exact mechanisms remain unclear, recent studies suggest that gut microbiome imbalances may contribute to the development and progression of T1DM. This study aimed to investigate specific gut microbiome alterations in children with T1DM and explore correlations between these changes and key clinical parameters.
Methods: Using a case‐control design, we compared the gut microbiome composition of pediatric T1DM patients and healthy controls. Ion Torrent amplicon sequencing was used to analyze microbial profiles, and Spearman correlation analysis was performed to identify associations with clinical parameters, including blood glucose levels, glycosylated hemoglobin (HbA1c), C‐peptide, vitamin D levels, thyroid hormones, and autoantibodies (islet cell autoantibodies [ICA], glutamic acid decarboxylase antibodies [GADA], and protein tyrosine phosphatase 2 antibodies [IA‐2A]).
Results: Children with T1DM demonstrated significant gut microbiome dysbiosis, characterized by a higher abundance of Escherichia coli and a reduced presence of beneficial bacteria, such as Faecalibacterium prausnitzii, Prevotella copri, Roseburia intestinalis, Parabacteroides merdae, and Parasutterella excrementihominis. Blood glucose levels were positively correlated with Bacteroides eggerthii, while increased HbA1c levels were associated with elevated Sutterellaceae. Vitamin D levels were negatively associated with Clostridiaceae and positively correlated with Bifidobacteriaceae. Notably, Roseburia intestinalis showed a negative correlation with ICA and IA‐2A autoantibodies, suggesting a potential protective role.
Conclusions: Our findings highlight significant gut microbiome imbalances in children with T1DM, marked by the depletion of beneficial bacteria and an overrepresentation of pathogenic species. These microbial shifts were closely linked to important clinical parameters, emphasizing their relevance to disease progression. This study underscores the potential role of gut microbiome dysbiosis in the pathogenesis of T1DM and identifies the microbiome as a promising target for therapeutic interventions to improve clinical outcomes in pediatric T1DM patients.
Contact e‐mail address: mara-ioana.ionescu@umfcd.ro
N‐EV196. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV196.1. HUMAN MILK METABOLITES ASSOCIATE WITH INFANT GUT MICROBIOME AND METABOLOME DEVELOPMENT
Heidi Isokääntä 1,2, Laura Perasto1, Alex Dickens3, Linnea Karlsson4, Anna‐Katariina Aatsinki1, Ulrik Sundekilde5
1Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland, 2Research Center for Infections and Immunity, Institute of Biomedicine, University of Turku, Turku, Finland, 3Turku Bioscience Centre, University of Turku, Turku, Finland, 4Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland, 5Department of food science, Aarhus University, Aarhus, Denmark
Objectives and Study: Human milk plays a vital role in establishing a healthy infant gut microbiome, which in turn is vital for maintaining host physiology which are partially mediated via the metabolites produced in the gut. However, our understanding of how milk metabolites are connected to the gut microbiome and metabolome maturation in early life remains limited. This study aims to investigate associations between the human milk metabolome and the gut microbiome in early childhood in FinnBrain Birth Cohort Study.
Methods: The fecal samples were collected at 2.5 (n = 282), 6 (n = 232) and 14 (n = 289) months of age. The milk samples were collected at 2 (n = 406), 6 (n = 176) and 14 (n = 80) months of age. Demographic factors were sourced from questionnaire data and health records. Next generation 16 s (V4) rRNA sequencing was performed with Illumina, and gut metabolome was analyzed with GC‐TOF‐MS and LC‐MS. Milk metabolites were analyzed with 1H‐NMR. Log‐transformation, linear mixed model, multi factor analysis (MOFA), Wilcoxon, Spearman correlation and FDR‐adjusted p‐values were utilized with the data.
Results: Milk metabolites and bile acids had the largest variance explained in the data sets. Secretor status of human milk oligosaccharides did not associate with bacterial diversity in infant's gut microbiome. Milk metabolites were associated with infant secondary bile acids, short chain fatty acids and polar metabolites. Bifidobacterium and other butyrate producers were associated with milk metabolites in a time‐dependent manner.
Conclusions: Milk composition clustered by mother's secretor status, however the overall milk metabolite composition did not drive the differences in gut microbiome beta diversity. Certain microbes were linked to specific milk metabolites, which were in turn associated with fecal metabolites. This suggests the existence of a microbial metabolic pathway in the gut that is influenced by milk‐derived metabolites.
Contact e‐mail address: hejokun@utu.fi
N‐EV197. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV197.1. EFFICACY OF PROBIOTICS AND SYNBIOTICS IN TYPE 2 DIABETES AND CORONARY ARTERY DISEASE: A SYSTEMATIC REVIEW AND META‐ANALYSIS
Juan Alessandro Jeremis Maruli Nura Lele1, Derren David Christian Homenta Rampengan2, Jeanette Irene Christiene Manoppo 3, Fahrul Nurkolis4,5
1Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia, 2Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia, 3Department Of Pediatrics, Sam Ratulangi University/Prof.dr.R.D.Kandou Hospital Manado, Manado, Indonesia, 4Master Of Basic Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia, 5Medical Research Center of Indonesia, Surabaya, Indonesia
Objectives and Study: Coronary Artey disease (CAD) associated with type 2 diabetes mellitus (T2DM) has been a major cause of mortality and morbidity. Probiotics and synbiotics supplementation has been claimed to improve cardiometabolic outcomes. However, the link between these supplementations in CHD patients with diabetes comorbidity has not been established. By evaluating the benefits on metabolic status, this review aims to assess the efficacy of probiotics and synbiotics as therapeutic interventions on individuals with T2DM and concurrent CHD.
Methods: The Preferred Reporting Items for Systematic Review and Meta‐analysis, commonly known as PRISMA, were adhered to in this research. Searches were conducted in the following medical databases up to September 22, 2023: PubMed, Epistemonikos, and Cochrane. Revised Tool for Risk of Bias in Randomized Trials (RoB 2.0) was used to evaluate the potential for bias, and Review Manager 5.4 was employed for the meta‐analysis.
Results: Five studies culminating in 204 patients with T2DM and CHD were included and screened with low risk of bias. Overall meta‐analysis showed that probiotics and synbiotics consumption in T2DM and CHD population led to significant improvements in lipid profile, in terms of higher HDL [MD 2.18 (95% CI 0.25‐4.10); p = 0.03] and lower total HDL‐C level [MD ‐0.26 (95% CI (‐0.49)‐0.03); p = 0.03]. Improvements in glucose metabolism and circulating biomarker parameters were also noted in our analysis. Compared with placebo, probiotics and synbiotics therapy showed small yet significant diastolic blood pressure control [MD ‐1.57 (95% CI (‐2.28)‐(‐0.86); p = 0.0001], but trivial increase in systolic blood pressure surprisingly elicited.
Conclusions: Probiotics and synbiotics exhibit favorable effects on lipid profiles and glucose metabolism in T2DM with concurrent CHD.
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N‐EV198. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV198.1. SYNERGISTIC SYNBIOTICS: INNOVATING IN EARLY LIFE NUTRITION WITH HMOS AND PROBIOTICS
Renaud Mestdagh 1, Leigh Ouellette2, Ghislain Schyns1, Mariana Coelho1, Despina Ioannides1, Sylvie Binda3, Valentine Barasse3
1DSM‐Firmenich, Kaiseraugst, Switzerland, 2DSM‐Firmenich, Lexington, United States of America, 3Lallemand Health Solutions, Blagnac, France
Objectives and Study: A healthy gut microbiome is key for the development and maturation of the immune system and gastrointestinal tract in infants. Human milk oligosaccharides (HMOs) are becoming widespread in infant formula, bringing it closer to the composition of human breast milk. Emerging evidence also highlights their synbiotic role when combined with preferred probiotic strains. In this context, we have investigated the potential of several synergistic synbiotics to beneficially impact infant health.
Methods: First, we studied how various bifidobacteria strains are capable of metabolizing fucosylated, neutral and sialylated HMOs. Then, we tested promising combinations of single or blends of HMOs with selected bifidobacteria in an ex‐vivo fermentation model using infant fecal samples. We looked for synergies by monitoring short‐chain fatty acid production and beneficial gut‐derived metabolites using both targeted and untargeted metabolomics.
Results: First, we observed that Bifidobacterium infantis Rosell®‐33 had a strong preference for fucosylated HMOs (2′‐fucosyllactose, 2′‐Fucosyllactose/Di‐fucosyllactose, 3′‐Fucosyllactose) while Bifidobacterium bifidum Rosell®‐71 was capable of metabolizing all types of HMOs with similar performance. In addition, the specific combination of 2′‐fucosyllactose with B. infantis Rosell®‐33 boosted the production of lactic, acetic acid and putrescine in our ex‐vivo model, setting the foundation for gut and immune health in infants. 2′‐fucosyllactose, 3′‐siallylactose, or a combination with Lacto‐N‐neotetraose and B. bifidum Rosell®‐71 demonstrated potential for the establishment of the gut‐brain axis. Finally, 5 different HMOs with various bifidobacteria strains were investigated for the first time and suggest incremental immune and gut health benefits to the infants in alignment with recent scientific advances (De Bruyn et al, 2024).
Conclusions: This work is paving the way for the development of new synergistic synbiotic solutions that will help bring infant formula even closer to providing infants with the same benefits as Human Breast Milk. We are now planning to study synergistic solutions in a clinical trial in healthy infants.
Contact e‐mail address: renaud.mestdagh@dsm-firmenich.com
N‐EV199. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV199.1. MODULATING INFANT GUT MICROBIOTA: A PILOT STUDY THE EFFECT OF LIMOSILACTOBACILLUS REUTERI DSM 17938 ON EARLY LIFE MICROBIAL DIVERSITY
Tanawan Noicharoen 1, Areewan Soontornsook2, Duc Long Tran3, Chonnikant Visuthranukul4, Palittiya Sintusek3, Sunchai Payungporn5
1Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, bangkok, Thailand, 2Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 3Pediatrics, Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology., BANGKOK, Thailand, 4Center Of Excellence In Pediatric Nutrition, Faculty of Medicine, Chulalongkorn university, Bangkok, Thailand, 5Biochemistry, Chulalongkorn University, BANGKOK, Thailand
Objectives and Study: Alteration of gut microbiota might influence various health conditions, including functional gastrointestinal disorders. This pilot study evaluates the impact of Limosilactobacillus reuteriDSM 17938 supplementation on the gut microbiota of healthy Thai infants.
Methods: Healthy, term infants born at King Chulalongkorn Memorial Hospital, Thailand, between March and June 2024 were randomly assigned to receive either L. reuteri DSM 17938 or a placebo for two months. Fecal samples were collected at baseline, 1, 2, and 4 months of age, and analysed using full‐length 16S sequencing via Oxford Nanopore Technology.
Results: A total of 24 fecal samples per visits (10 from the probiotics group, 14 from the placebo group) were analysed. Baseline characteristics showed no significant differences between groups. Alpha diversity varied significantly by delivery method (caesarean section (CS) vs. normal labour (NL)) at baseline. At 1 month, infants in the probiotics‐NL group had higher alpha diversity compared to the placebo‐CS group (p < 0.05). At 2 months, probiotics‐NL infants demonstrated significantly greater diversity than placebo‐NL infants (p < 0.05). By 4 months, differences were no longer significant, likely due to external factors like type of feeding and environmental influences.
Conclusions: L. reuteri DSM 17938 supplementation positively influenced gut microbial diversity at 1 and 2 months of age, particularly in vaginally delivered infants. These findings suggest the potential effect of probiotics in modulating the infant gut microbiome early in life. Larger studies and longer follow‐up are warranted to explore additional factors affecting gut diversity and to support probiotic use in paediatric gastrointestinal health.
Contact e‐mail address: ployje1993@gmail.com
N‐EV200. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV200.1. CHARACTERIZATION OF THE INTESTINAL MICROBIOMA IN NEWBORNS WITH CONGENITAL DEFECTS OF THE GASTROINTESTINAL TRACT SUBMITTED TO SURGICAL CORRECTIONS
Nadia Sandra Orozco Vargas, Rubens Feferbaum, Maria Esther Jurfest Ceccon, Uenis Tannuri, Werther De Carvalho
Paediatric, Instituto da Criança HCFMUSP, São Paulo, Brazil
Objectives and Study: To evaluate the evolution of the composition of the intestinal microbiota of newborns in the postoperative period of abdominal surgery, admitted to a neonatal ICU, during the period of hospitalization and to relate any clinical complications; to evaluate the composition of the fecal microbiota of children in prolonged fasting and in the presence of neonatal sepsis.
Methods: 30 newborns with malformations of the abdominal wall were included, who were divided into groups according to the malformation presented: gastroschisis (n = 18), omphalocele (n = 8) or atresia/hernia (n = 4). Stool samples were collected sequentially, every seven days, until discharge, immediately placed in a refrigerator and transferred on ice for storage in a ‐80°C freezer. DNA extraction was performed using the QiaAmp DNA Stool kit (Qiagen), and stored at ‐20°C, sequencing and bioinformatics analysis was performed. By comparison, the phyla and genre to which they belong were identified.
Results: The most abundant phylum at birth was Firmicutes, the second Proteobacteria. The main genres at birth in the omphalocele and atresia/hernia group was Staphylococcus. In gastroschisis Streptococcus. The Proteobacteria and Bacteroidetes phylum most abundant in the group with more than 3 cycles of antibiotics. Firmicutes and Actinobavteria werw more abundant in the group that received less than 3 cycles. T The prevalent genre in the group that received more than 3 cycles of antibiotics was Klebsiella, Serratia, Stenotrophomonas, and Veillonella and in the group that received less than 3 cycles Escherichia‐Shigella, Streptococcus and Enterococcus. The genre with statistical difference Pevotella, Regarding the time of NPP use, the phylum with weak positive correlation Actinobacteria and Bacteroidetes. Genres Lactobacillus and Lachnospiraceae.
Conclusions: The results may be important to understand how the colonization of the intestinal microbiota occurs in children with abdominal wall malformations and clinical consequences and the interventions to improve the intestinal adaptation and quality of life of these patients
Contact e‐mail address: nsdia.orozco@hc.fm.usp.br
N‐EV201. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV201.1. EFFECT OF CITRUS LOW‐METHOXY PECTIN ON REGURGITATION EVENTS AND GUT MICROBIOME OF INFANTS: PRECLINICAL INVESTIGATIONS
Frederique Respondek 1, Sara Autzen2, Pieter Van Den Abbeele3, Adrian Parkinson4, Felix Macdougal4, Andrew Woodcock4
1CP Kelco France, Levallois‐Perret, France, France, 2CP Kelco Aps, Lille, Denmark, 3Cryptobiotix, Ghent, Belgium, 4Technostics Limited, Cottingham, United Kingdom
Objectives and Study: To assess the efficacy of infant formulae thickened with citrus low‐methoxy pectin (LM pectin) or locust bean gum (LBG) in reducing regurgitations compared to a non‐thickened formula and to evaluate their effects on the infant gut microbiome.
Methods: An infant formula versus formula thickened with 4 g/L of LM pectin or LBG was adjusted to different pH values (6.25 to 4.25) by adding HCl. An artificial infant stomach model was used (85 ml, 37°C) to simulate an internal pressure, inducing regurgitation events. Five events were performed at 5‐minute intervals and repeated 6 times for each formulation. A separate study, using the ex‐vivo SIFR® technology, evaluated the effects of 5 g/L of LBG or 1.25; 2.5 and 5 g/L of LM pectin on the infant gut microbiome composition and fermentative activities for 48 hours. Faecal samples from 6 healthy, formula‐fed infants (2.2 ± 0.7 months) were used.
Results: The addition of LM pectin to the infant formula reduced the refluxate height at pH values 6.25, 5.75 and 5.25 (p < 0.001) similarly to LBG, which was not significant for pH values 4.75 and 4.25. LM pectin was extensively fermented by the infant gut microbiome, as illustrated by higher production of SCFA, especially acetate. LBG rather stimulated the production of butyrate. Both LBG and LM pectin fibres significantly stimulated Bacteroidadeae and Enterococcaceae and reduced Peptostreptococcaeae families. Acetate content positively correlated with the abundance of Bifidobacterium longum (LM pectin) and Bacteroides uniformis (LBG) and negatively correlated to Clostridioides difficile (p < 0.05).
Conclusions: These preclinical studies highlight that LM pectin appears as a relevant alternative to LBG, used at similar doses. The higher acetate production linked to LM pectin fermentation is particularly interesting in infants to maintain acidic conditions in the gut. They confirm some clinical studies with infants where pectin was used between 2 and 4 g/L of infant formula in association with LBG and starches.
Contact e‐mail address:
N‐EV202. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV202.1. INFANT HEALTH OUTCOMES WERE ASSOCIATED WITH GUT MICROBIOME FINDINGS: A RANDOMIZED, CONTROLLED TRIAL
Anice Sabag‐Daigle 1, David Hill1, Grace Niemiro2, Elizabeth Reverri2, Rachael Buck1, Penni Hicks2
1Nutrition Division, International Nutrition Science & Global Platforms Innovation And Research, Abbott Laboratories, columbus, United States of America, 2Nutrition Division, Nutrition Science & Innovation, Abbott Laboratories, Columbus, United States of America
Objectives and Study: Human milk oligosaccharides (HMOs) in breast milk shape the infant gut microbiome. Previous research showed that infants fed a formula containing five specific HMOs had fewer days with infections. We investigated whether this was linked to changes in microbiome composition and function.
Methods: In this randomized, controlled trial, healthy, term infants were assigned to receive either a control formula without HMOs (CF) or a study formula (SF) with 2.5 g/L of five HMOs (2′‐FL, 3‐FL, LNT, 3′‐SL, 6′‐SL). A human milk group (HM) served as the reference. Stool samples from 251 participants at 6 months were analyzed for intervention effects within subgroups based on stratification of metadata variables. Significance was set at P < 0.05. Statistical analyses were performed in R version 4.4.0.
Results: In those infants with reported parent‐perceived illness, infants fed SF had significantly higher abundance of infant‐type Bifidobacterium species and greater abundance of known HMO metabolism genes compared to CF (Figure 1). In infants with reported healthcare visits beyond routine well visits, those fed SF had a higher abundance of infant‐type Bifidobacterium species and known HMO metabolism genes compared to CF (Figure 1). In infants with incidence of reported infections, those fed SF had a higher abundance of the species Bifidobacterium bifidum compared to CF (Figure 1). In infants who received antibiotics, those fed SF had significantly lower abundance of the genus Streptococcus, which includes opportunistic childhood associated pathogens, and a Streptococcus‐associated virulence factor gene, pneumococcal surface antigen A (psaA) compared to CF (Figure 1).
Conclusions: Formula containing five specific HMOs strengthened early‐life microbiome resilience by increasing Bifidobacterium abundance in infants who were ill and suppressing opportunistic pathogens in infants who received antibiotics. These findings provide mechanistic insight into previous reports of fewer infections in infants fed formula with HMOs.
Contact e‐mail address: anice.sabagdaigle@abbott.com
N‐EV203. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV203.1. IMPACT OF DELIVERY MODE AND MATERNAL WEIGHT ON GUT MICROBIOTA DIVERSITY IN HEALTHY THAI INFANTS
Palittiya Sintusek 1, Areewan Sunthornsook1, Duc Long Tran1, Tanawan Noicharoen1, Sunchai Payungporn2
1Pediatrics, Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology., BANGKOK, Thailand, 2Biochemistry, Chulalongkorn University, BANGKOK, Thailand
Objectives and Study: Gut microbiota plays a crucial role in infant health. This study aims to evaluate the gut microbiota diversity and composition in healthy Thai infants, assessing prenatal and perinatal factors influencing these aspects.
Methods: Stool specimens from 107 infants were collected within three days after birth and analyzed using full‐length 16S sequencing with Oxford Nanopore Technologies.
Results:
Among the infants, 49.5% were female. Vaginally delivered infants (n = 36) had lower family income, younger maternal age, lower paternal education, and higher family smoking prevalence compared to those delivered by cesarean section (n = 71) but no significant differences in maternal nutritional status, feeding mode, or allergic family histories between 2 groups were observed. In aspect of gut microbiota analysis, there were significant differences in microbiota diversity and composition between delivery modes, with vaginally delivered infants showing higher alpha (Chao1 Index, p = 0.001; Shannon Index, p = 0.004) and beta diversity (p = 0.001). Vaginally delivered infants had more Streptococcus gallolyticus, Escherichia coli, Clostridium rectum, and Bacteroides species, while cesarean‐delivered infants had more Lactococcus lactis, Enterococcus faecium and Staphylococcus haemolyticus. Additionally, maternal weight influenced gut microbiota in vaginally delivered infants. No differences were found in microbiota diversity and composition concerning family history of allergic diseases.
Conclusions: Vaginally delivered infants exhibited greater microbiota diversity and distinct microbial profiles compared to those delivered by the cesarean section. Maternal weight was found to influence the gut microbiota in vaginally delivered infants. These findings emphasize the role of delivery mode and maternal factors in shaping the early gut microbiota, which may have implications for infant health.
Contact e‐mail address: palittiya.s@chula.ac.th
N‐EV204. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV204.1. IDENTIFICATION OF SYNERGISTIC EFFECTS OF FRUCTAN AND HMO COMBINATIONS ON TODDLER GUT MICROBIOTA USING AN IN VITRO MODEL OF INTESTINAL FERMENTATION (POLYFERMS®)
Maria Pudenz1, Stephan Theis1, Lea Bircher2, Jessica Van Harsselaar 1, Christophe Lacroix2
1Beneo Institute, c/o BENEO GmbH, Obrigheim/Pfalz, Germany, 2Institute Of Food, Nutrition And Health, ETH Zurich, Zurich, Switzerland
Objectives and Study: The study aimed to examine the metabolic and compositional effects of chicory derived inulin‐type fructans and the human milk oligosaccharide 2′‐fucosyllactose (2′‐FL), as well as their combinations on toddler gut microbiota. Specifically, it sought to determine whether the novel combinations have additive or synergistic effects on gut microbes with a focus on the bifidogenic response.
Methods: Microbial community composition and metabolic changes were studied on two toddler stool samples using the continuous PolyFermS® in vitro fermentation model. Treatments included 2′‐FL alone, fructans alone, and fructan/2′‐FL combinations. High‐performance liquid chromatography was used to quantify the concentrations of short‐chain fatty acids. 16S‐rRNA sequencing and the bifidobacterial ITS sequencing were performed to assess changes in the microbial community.
Results: Most of the metabolic and compositional changes were detected with fructans, while 2′‐FL alone showed less prominent effects. Furthermore, distinct shifts were noted when fructans were combined with 2′‐FL, suggesting additive or synergistic effects. The ability to stimulate the beneficial metabolite butyrate, correlated with a specific boost of Faecalibacterium and other members of the Lachnospiraceae family. The bifidobacterial community showed specific alterations, with the novel prebiotic combination enhancing the bifidogenic effect. These changes were dependent on the initial microbiota, with Bifidobacterium breve, B. pseudocatenulatum, and B. catenulatum increasing in one donor and B. longum and B. pseudocatenulatum increasing in the other.
Conclusions: The study provided insights into the effects of fructans, 2′‐FL, and the additive or even synergistic effects of the combination thereof on toddler gut microbiota, especially in stimulating beneficial bifidobacteria and metabolites such as butyrate. Testing on different toddler microbiota using a reproducible high‐throughput protocol could further enhance the understanding of these interactions.
Contact e‐mail address: maria.pudenz@beneo.com
N‐EV205. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV205.1. THE IMPACT OF NOVEL GOAT MILK FORMULA ON THE GUT MICROBIOTA OF C‐SECTION‐BORN INFANTS
Ingmar Van Hengel 1, Pieter Van Den Abbeele1, Atefeh Fooladi Moghaddam2, Monika Schaubeck2
1Cryptobiotix, Ghent, Belgium, 2HiPP GmbH & Co. Vertrieb KG, Pfaffenhofen, Germany
Objectives and Study: Human milk is the best nutrition for infants as it ensures optimal growth and development. Therefore, infant formulas (IFs) intend to mimic the effects of human milk, when breast‐feeding is not possible. Recently, there is increasing interest in alternatives for cow milk based formula (CMF), such as goat milk based formulas (GMF), particularly for sensitive infants showing signs of gastrointestinal discomfort, e.g. by increased intestinal gas production. The aim of this preclinical study was to compare the impact of cow and goat milk matrix on the gut microbiota of Caesarean‐section (CS)‐born infants.
Methods: The impact of CMF and GMF, the latter also supplemented with prebiotic galactooligosaccharides (GMF + GOS), on the infant gut microbiota was investigated using the ex vivo SIFR® technology. Faecal samples were collected from CS‐born infants (n = 6, aged 3.1 months ± 3w). Test products underwent upper GIT digestion and absorption adapted to the infant gut, followed by colonic fermentation over 24 h in SIFR® bioreactors. Gas production, SCFA (acetate, propionate, butyrate), pH and lactate were analysed.
Results: GMF + GOS most strongly increased health‐related acetate, propionate, and butyrate, while inducing the least gas production. Interpersonal differences among CS‐born infants were large, with initial faecal Bifidobacteriaceae levels between 0%‐90%. CMF stimulated SCFA production, significantly decreased pH and increased production of gases, compared to no‐substrate control. Interestingly, gas production was lowest for GMF + GOS amongst all milk matrices, particularly compared to GMF without GOS supplementation that most strongly increased gas production by the microbiota of CS‐born infants.
Conclusions: The present results highlight the potential health benefits and tolerability of GMF + GOS based on the increase in SCFA production combined with lower gas production, compared to CMF and GMF alone. The results of this study form a basis for potential future clinical investigations.
Contact e‐mail address: pieter.vandenabbeele@cryptobiotix.com
N‐EV206. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV206.1. CAESEREAN SECTION WITH OR WITHOUT ANTIBIOTICS: IMPACT ON INFANT GUT MICROBIOTA
Aino Virolainen 1,2, Marianne Lalli3, Tommi Vatanen3,4,5,6, Samuli Rautava7, Erika Isolauri8,9
1Department Of Clinical Sciences, University of Turku, Turku, Finland, 2Department Of Paediatrics And Adolescent Medicine, Turku University Hospital, Turku, Finland, 3Helsinki Institute Of Life Science, Institute of Biotechnology, Helsinki, Finland, 4Department Of Microbiology, University of Helsinki, Helsinki, Finland, 5Broad Institute of MIT and Harvard, Cambridge, United States of America, 6Liggins Institute, University of Auckland, Auckland, New Zealand, 7Department Of Neonatology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland, 8Department Of Pediatrics And Adolescent Medicine, Turku University Hospital, Turku, Finland, 9Department Of Pediatrics And Adolescent Medicine, Faculty of Medicine, University of Turku, Turku, Finland
Objectives and Study: Infant gut microbiome development is critical for immune maturation and later disease risk, yet the combined effects of maternal antibiotic use and caesarean section on this process remain unclear. This study aimed to evaluate how maternal antibiotic exposure and probiotic use influence gut microbiome composition and antibiotic resistance gene (ARG) load in caesarean section born infants.
Methods: We analyzed gut metagenomes from 71 mother‐child pairs from two elective caesarean section intervention studies (2002–2009, 2015–2019), using linear mixed models to assess associations with maternal antibiotic exposure (46 cases, 25 controls) and probiotic use. Additionally, we had a reference group of 8 vaginally born children, who had no exposure to antibiotics or probiotics. Bacterial species were identified and quantified via MetaPhlAn4 from fecal metagenomic data, and ARG profiling done via CARD RGI software.
Results: Caesarean‐born infants had significantly lower Bifidobacterium longum abundance 2‐5 days after birth compared to vaginally born infants, showing dose‐response to antibiotics (β = ‐10.13, CI: ‐14.21, ‐ 6.05, P = 6.64 × 10⁻⁴ for antibiotic exposed; β = ‐7.27, CI: ‐7.94, ‐6.36, P = 4.57 × 10⁻² for no antibiotics). The antibiotic resistome was significantly lower (p = 0.02, Wilcoxon test) in infants with detectable Lacticaseibacillus rhamnosus GG (LGG) at 1 month, with an inverse correlation observed between LGG abundance and Escherichia coli (β = ‐0.16, p = 0.02).
Conclusions: Antibiotic exposure at delivery may induce a shift in the compositional development of the gut microbiota over the period of immunological and metabolic maturation of the child. Microbiota modulation during this critical time‐window may be granted a position in the fight against non‐communicable disease by ensuring a balanced composition of the gut microbiota.
Contact e‐mail address: aimvir@utu.fi
N‐EV207. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV207.1. TEMPERATURE, PH DEPENDENCY AND ACTIVITY OF MICROBIAL TRANSGLUTAMINASE AND ITS GLIADIN CROSS‐LINKED NEO‐COMPLEXES
Torsten Matthias, Patricia Wusterhausen
Research & Development, AESKU.Diagnostics GmbH & Co. KG, Wendelsheim, Germany
Objectives and Study: Microbial transglutaminase (mTG) is a bacterial survival factor and is widely used as a food additive in the processed food industry. As an enzyme, its activity is sensitive to temperature and pH. Aim of the study, was to investigate the temperature and pH ranges at which mTG operates effectively, specifically in its ability to cross‐link gliadin peptides.
Methods: After optimizing conditions for mTG‐mediated gliadin peptide cross‐linking, temperature and pH dose‐response curves were evaluated. Gliadin peptides, mTG, and the cross‐linked products were analyzed using SDS‐PAGE and ELISA.
Results: mTG exhibited optimal activity at 37–60°C, efficiently cross‐linking gliadin peptides and producing high antibody titers in ELISA assays using CD patient sera. Beyond 60°C, mTG activity decreased sharply, resulting in a statistically significant reduction of about 65% in immunoreactive epitopes (p < 0.001). Heating mTG to 80°C to denature it and subsequently cooling it to room temperature did not restore its activity. However, complexes formed at 37°C remained stable even when incubated at elevated temperatures, showing consistent immunoreactive ELISA values (1.19–1.17 OD). Regarding pH, mTG retained its activity at pH 4.0 and above.
Conclusions: During the preparation of processed foods, mTG cross‐links gliadin peptides before heating or boiling. The resulting covalent isopeptide bonds are highly resistant to luminal proteases. Upon ingestion, gastric acidity is neutralized, with pH levels potentially rising to 4.5. Many children, adults on acid‐suppressive medication, and infants or elderly individuals with higher gastric pH levels, as well as those with alkaline reflux, may be affected. Temperature and pH conditions during food preparation do not compromise mTG‐induced cross‐linking of gliadin peptides, allowing these cross‐linked complexes to survive and reach the gut lumen. These stable cross‐linked complexes exhibit heightened immunoreactivity in CD patients, potentially triggering or exacerbating immune responses associated with CD pathology.
Contact e‐mail address: wusterhausen@aesku.com
N‐EV208. Topic: AS03. NUTRITION/AS03h. The Gut Microbiome
N‐EV208.1. DONOR HUMAN MILK BACTERIAL MICROBIOTA COMPOSITION IS SHAPED BY BREASTFEEDING MODE
Xufei Wang, Fangfei Xiao, Xiaolu Li, Lin Ye, Yizhong Wang, Pei Xiao
Shanghai Children's Hopsital, China, Shanghai, China
Objectives and Study: To profile the bacterial composition of donor human milk (DHM) samples from Shanghai, China, and to explore the factors influencing its composition.
Methods: A cross‐sectional study was conducted from February 2018 to July 2022, involving 252 participants from the Shanghai Donor Human Milk Bank, Shanghai Children's Hospital. 16S rRNA sequencing was performed, and the microbiota composition was analyzed using K‐means clustering, multivariate linear regression, and sparse estimation of correlations among microbiomes.
Results: The majority of detected taxa belonged to the phyla Firmicutes, Proteobacteria, Bacteroidota, and Actinobacteriota. Four clusters enriched with Staphylococcus, Staphylococcus and Achromobacter, Achromobacter and Streptococcus, and Streptococcus and Acinetobacter were identified. Multivariable linear regression showed that at least some indirect breastfeeding was independently associated with lower bacterial diversity. At least some indirect breastfeeding, preterm birth and cesarean section were associated with a higher relative abundance of Staphylococcus. Higher milk protein content was linked to increased levels of Lactobacillus and Enterococcus, while lactation stage at sample collection inversely related to these genera. More linear and nonlinear relationships among the predominant genera of direct breastfeeding group were found compared to at least some indirect breastfeeding group.
Conclusions: Breastfeeding mode was identified as a pivotal determinant of human milk microbial composition. Investigation of the milk microbiota composition may provide clues for optimizing DHM collection, processing, and utilization practices.
Contact e‐mail address:
I‐OP001. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐OP001.1. UNTARGETED METABOLOMIC STUDY IN TYROSINEMIA TYPE I INDICATES THAT AFFECTED METABOLIC PATHWAYS ANTICIPATE THE APPEARANCE OF HEPATOCELLULAR CARCINOMA
Anna Sidorina1, Karen Fuenzalida2, Giulio Catesini1, Carolina Arias2, Maria Jesus Leal Witt2, Veronica Cornejo2, Carlo Dionisi Vici 1, Cristiano Rizzo1
1Division Of Metabolic Diseases And Hepatology, Bambino Gesù Childrens Hospital IRCCS, Rome, Italy, 2Instituto De Nutrición Y Tecnología De Alimentos Inta, Universidad de Chile, Santiago, Santiago, Chile
Objectives and Study: Tyrosinemia type I (HT1) causes severe liver and kidney dysfunction, due to deficient fumarylacetoacetate hydrolase activity. Treatment with nitisinone suppresses the formation of abnormal metabolites, which have a high oncogenic action on the liver. Newborn screening, which allows early diagnosis/treatment, significantly reduces the risk of hepatocellular carcinoma (HCC), a frequent complication in late‐treated patients (doi: 10.1186/s13023‐014‐0107‐7; 10.1016/S2213‐8587(21)00092‐9). In this study, we investigated untargeted serum metabolomic profile in HT1 patients.
Methods: Serum samples from 16 HT1 patients on nitisinone therapy, all diagnosed on clinical bases [median age at diagnosis/treatment initiation 9.8 months (2.6‐63.4), median age at blood sampling 9.7 years (1.5–22), median AFP 6.0 ng/mL (2‐2370)] were analyzed by LC‐HRMS untargeted metabolomics and compared with 16 age‐/sex‐matched controls. Two patients had suspicion of HCC. The most significantly changed compounds (p < 0.05; log2FC >|1 | ) were selected for identification and association with metabolic pathways.
Results: LC‐HRMS analysis revealed in all patients a consistent profile with 1070 significantly changed compounds, 546 increased and 524 decreased, of which 159 were identified. Increased metabolites included aromatic compounds, medium‐ and long‐chain acyl‐carnitines, bile acids (mainly taurine‐conjugated), indole‐based compounds, modified nucleosides and nucleobases. Decreased metabolites were related to lipid classes, i.e. lysophosphatidylcholines, lysophosphatidic acids, long‐chain fatty acids, and acylglycerols.
Conclusions: The untargeted metabolomic study in HT1 showed, besides the expected perturbations of tyrosine‐/tryptophan‐related pathways, a complex profile with net dysregulation of lipid, bile acid, and nucleosides/nucleobases associated‐molecules. The same complex profile, combining apparently unrelated metabolic pathways, has been recently described in HCC patients (doi: 10.1186/s12967‐023‐04801‐4), due to the aberrant Wnt/β‐catenin signalling cascade (doi: 10.1016/j.bbalip.2024.159514; 10.1111/cpr.12772). Our results highlight that cellular mechanisms linked to HCC are already active in late‐diagnosed/treated HT1 patients, anticipating the appearance of HCC, indicating the need to explore novel therapeutic interventions and to extend the use of neonatal screening for HT1 to prevent HCC.
Contact e‐mail address: carlo.dionisivici@opbg.net
I‐OP002. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐OP002.1. FONTANELLE STUDY RESULTS: PREDICTING GUT HEALTH EFFECTS OF EARLY LIFE NUTRITION INGREDIENTS FOR INFANTS AND PIGLETS BY INTEGRATING MICROBIOME, GUT TISSUE, AND IMMUNE NETWORK DATA
Joanne Donkers 1, Maria Wiese2, Martien Caspers2, Xavier Sa Castro Pinho3, Michelle Van Der Wurff2, Nicole Plomp2, Bo Heming1, Klaudyna Borewicz4, Erik Eckhardt5, Regiane Santos6, Margreet Heerikhuisen2, Marjolein Meijerink3
1Metabolic Health Research, TNO, Leiden, Netherlands, 2Microbiology And Systems Biology, TNO, Leiden, Netherlands, 3Risk Analysis For Prevention, Innovation & Development, TNO, Utrecht, Netherlands, 4Mead Johnson B.V. Nijmegen part of Mead Johnson Nutrition and Health Innovation Institute, Nijmegen, Netherlands, 5DSM‐Firmenich Houdan SAS, Houdan, France, 6Schothorst Feed Research, Lelystad, Netherlands
Objectives and Study: Early life nutrition ingredients can ameliorate gut and overall health of infants and piglets. The interdisciplinary research model established in public private partnership FONTANELLE integrates data from in vitro microbiome, ex vivo gut tissue, and in silico network modeling to predict gut health benefits of early life nutrition.
Methods: Four benchmark ingredients, 2′‐fucosullactose (2′‐FL, 4 mg/mL), Lactobacillus Rhamnosus GG, galacto‐oligosaccharides, and zinc oxide were added to the early life in vitro i‐screen® microbiome screening platform (48 hours) and early life ex vivo gut tissue InTESTine™ platform (6 hours). Subsequently, i‐screen® fermented ingredients were added to InTESTine™. In silico network modeling was performed on RNA sequencing data from the InTESTine™ exposed gut tissue. The experiments were conducted with and without 10% predigested infant/piglet milk (IFM/PMR).
Results: For 2′‐FL 108 (without IFM) or 52 (with IFM) differentially expressed pathways (DEPs, ‐logP>2 or p < 0.01) were discovered in jejunum, with 2.6% overlap between treatments. In the colon, 2′‐FL exposure only resulted in DEPs when added after i‐screen® fermentation (260 DEPs for breastfed‐ and 157 for formula fed infant microbiome). In line with published clinical data, 2′‐FL beneficially influenced gut immune function by enhancing cytokine signaling pathways (e.g. IL‐17 and IL‐23). Additionally, wound healing signaling and platelet aggregation pathways were upregulated, and gut barrier function was improved by enhanced gene expression related to extracellular matrix organization in jejunum (p < 0.01). The latter finding matches our InTESTine™ results on reduced gut leakage (by 31% and 47% in jejunal small and large molecule transport, respectively). Additionally, we found a downregulation of cholesterol biosynthesis pathways in jejunum and colon by 2′‐FL, likely through stimulation of acetic acid production.
Conclusions: Our novel platform integrates data from in vitro, ex vivo, and in silico platforms and thereby delivers a comprehensive prediction of gut health benefits of early life nutrition ingredients for infants and piglets.
Contact e‐mail address: marjolein.meijerink@tno.nl
I‐OP003. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐OP003.1. UPREGULATION OF MATRIX METALLOPROTEINASE‐7 AND OSTEOPONTIN SECRETION IN NOVEL HUMAN PRECISION‐CUT LIVER SLICES MODEL OF BILIARY ATRESIA‐ASSOCIATED LIVER FIBROSIS
Jeske Fridrichs 1,2, Mark Nomden2,3, Sarah Mitchel1, Jeffrey Sewdihal1, Alan Gorter1, Dorenda Oosterhuis1, Marius Van Den Heuvel4, Henkjan Verkade3, Vincent De Meijer5, Jan Hulscher2, Peter Olinga1
1Pharmaceutical Technology And Biopharmacy, University of Groningen, Groningen, Netherlands, 2Division Of Pediatric Surgery, Department Of Surgery, University Medical Center Groningen, Groningen, Netherlands, 3Division Of Pediatric Gastroenterology And Hepatology, Department Of Pediatrics, University Medical Center Groningen, Groningen, Netherlands, 4Department Of Pathology, University Medical Center Groningen, Groningen, Netherlands, 5Division Of Hepato‐pancreatico‐biliary Surgery And Liver Transplantation, Department Of Surgery, University Medical Center Groningen, Groningen, Netherlands
Objectives and Study: Biliary atresia (BA) is a rare cholangiopathy affecting the neonatal bile ducts, leading to significant liver injury. BA is treated with Kasai portoenterostomy (KPE), though liver fibrosis often progresses. The mechanisms underlying the fibrosis is incompletely understood, as is the role of matrix metalloproteinase‐7 (MMP‐7) and osteopontin (OPN). Precision‐Cut Liver Slices (PCLS) provide an ex vivo model to study organs in vitro. This study aims to establish a novel model using PCLS to investigate BA‐associated liver fibrosis.
Methods: Precision‐Cut Biliary Atresia Liver Slices (PCBALS) were prepared from liver explants obtained during transplantation of BA patients who had undergone prior KPE. Viability was evaluated using ATP/protein content and histology (H&E staining). MMP‐7 and OPN secretion into the culture medium was quantified via ELISA to examine its association with BA pathology. Liver explants from healthy and disease control livers were used to prepare Precision‐Cut Healthy Liver Slices (PCHLS), Primary Biliary Cholangitis Liver Slices (PCPBCLS), and Primary Sclerosing Cholangitis Liver Slices (PCPSCLS).
Results: PCBALS were generated from four BA patients, with a mean time of 123 (standard error (SE): ±46.8) days between KPE and transplantation. The mean ATP/protein content of PCBALS remained constant at 4.9 ± 1.9 pmol/µg after 48 h. The percentage of viable hepatocytes on H&E staining showed variability (mean 29 ± 9%). The mean ATP/protein content of PCBALS was comparable to PCPSCLS (6.0 ± 0.9pmol/µg), PCPBCLS (6.1 ± 0.6 pmol/µg) and PCHLS (7.4 ± 1.1 pmol/µg; Figure A). The mean MMP‐7 and OPN secretion after 48 h was profoundly higher in PCBALS (35.1 ± 5.0 ng/mL; 73.7 ± 28.9 ng/mL) compared to PCPSCLS (6.0 ± 2.5 ng/mL; 5.9 ± 2.4 ng/mL), PCPBCLS (5.5 ± 1.0 ng/mL; 19.5 ± 7.0 ng/mL) and PCHLS (0.5 ± 0.4 ng/mL; 2.3 ± 0.4 ng/mL; Figure B, C).
Conclusions: PCBALS secreted markedly higher levels of MMP‐7 and OPN compared to controls, aligning with features of BA‐associated liver fibrosis. We conclude that PCBALS provide an ex vivo platform for investigating BA‐associated liver fibrosis.
Contact e‐mail address: p.olinga@rug.nl
I‐OP004. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐OP004.1. EXTRA‐UTERINE GROWTH AMONGST SMALL FOR GESTATIONAL AGE PRETERM INFANTS
Babu Madarkar, Sateesh Devara
Pediatrics, KIMS CUDDLES SECUNCDERABAD, HYDERABAD, India
Objectives and Study: Small for gestational age (SGA) preterm infants follow distinct growth patterns compared to appropriate for gestational age (AGA), but the definition of extra‐uterine growth retardation (EUGR) remains a subject of debate. This study investigated whether a weight decline of >1.20 z‐scores from birth to discharge could serve as a better indicator of EUGR in SGA infants compared to the conventional criterion of weight <10th percentile at discharge.
Methods: Data were obtained from prospective cohort of 323 preterm infants in the study, with 130 (40.2%) classified as SGA. EUGR was evaluated using two definitions: (1) the proposed criterion of weight decline >1.20 z‐scores (2) usual criterion of weight <10th percentile at discharge. The time to achieve full feeding and risk factors associated with EUGR were compared across groups. Multivariate modified Cox regression was performed to identify independent risk factors.
Results: Using the proposed definition, the prevalence of EUGR was comparable between SGA and AGA infants (23.2% vs. 22.3%, *p = 0.279*). In contrast, the usual definition showed a significantly higher EUGR prevalence in SGA infants (94.5% vs. 23.5%, *p < 0.001*). SGA infants with EUGR, defined by weight decline, required significantly longer to achieve full feeding compared to their non‐EUGR counterparts (38.8 ± 3.9 vs. 18.9 ± 3.5 days, *p < 0.001*). However, no significant difference in feeding time was observed under the usual definition (13.1 ± 0.6 vs. 15.1 ± 2.7 days, *p = 0.408*). Independent risk factors for EUGR based on proposed definition included bronchopulmonary dysplasia (aRR 3.38, 95% CI 1.46–3.08), extended parenteral nutrition duration (aRR 2.11, 95% CI 1.23–3.11), neonatal sepsis (aRR 3.08, 95% CI 1.11–2.18), and extreme prematurity (aRR 2.08, 95% CI 1.16–3.08).
Conclusions: The use of a weight decline >1.20 z‐scores from birth to discharge offers a more accurate and clinically relevant measure of EUGR in SGA preterm infants compared to the conventional single‐time weight‐based definition.
Contact e‐mail address: babumadarkar@yahoo.co.in
I‐OP005. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐OP005.1. PATIENT DERIVED INTESTINAL ORGANOIDS: AN IN VITRO MODEL TO STUDY GASTROINTESTINAL DISORDERS
Elena Spinelli 1, Giorgia Fontana2, Fabiana Ziberna2, Giuseppe Molinario1, Sandra Casasola1, Grazia Di Leo2, Adamo Pio D'adamo2, Michelangelo Aloisio3, Luigina De Leo2
1University of Trieste, Trieste, Italy, 2Pediatrics, Institute For Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy, 3IRCCS De Bellis, Castellana Grotte, Italy
Objectives and Study: Human intestinal epithelial organoids (IEOs) are widely used in gastrointestinal research because they better recapitulate the native intestinal epithelium. However, IEOs need to be cultured and expanded over time for experimental use and the effects of prolonged in vitro culturing are not well known. The aim of our study is to characterize human IEOs generated from duodenal biopsies over prolonged culture time periods, monitoring both DNA methylation (DNAm) and gene expression together with functional evaluation.
Methods: We generated IEOs from 33 pediatric patients, suffering from different gastrointestinal disorders. IEOs were maintained in culture and passaged every 5‐7 days. DNA/RNA were obtained from IEOs every 5 passages, from passage 1 to passage 30. DNA was screened with Illumina HumanMethylationEPIC BeadChips for DNAm analysis. Gene expression was investigated in RNA by using RNA sequencing (RNAseq) analysis. Both DNAm and RNAseq data were analysed by using Principal Component Analysis (PCA).
Results: PCA performed on DNAm and RNAseq data showed differences in the methylation and transcriptional profiles over passages. An evident association between DNAm and RNAseq changes with passage was observed. PCA showed separataion affected mainly by passage and not by clinical condition. In particular, IEOs show a clear separation between passage 1 and higher passages (Figure 1).
Figure 1. PCA of DNAm data (a) and of RNAseq data (b) of IEOs over prolonged culture time periods.
Conclusions: These data show that the epigenetic and transcriptional profiles of IEOs seem to be affected by culture duration. Functional evaluation of IEOs over prolonged in vitro culturing will be performed, by measuring pro‐inflammatory cytokines released in culture medium after inflammatory stimuli. However, this preliminary analysis highlights the importance of considering the culture duration in the experimental design that could affect the final results.
Contact e‐mail address: elena.spinelli@burlo.trieste.it
I‐OP006. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐OP006.1. MACHINE LEARNING INSIGHTS INTO THE GUT‐BRAIN AXIS: IMPLICATIONS FOR MENTAL HEALTH IN PEDIATRIC CELIAC DISEASE
Rida Taher 1, Mahmoud Masri2
1Essonnes, Hospital center Sud Francilien, Corbeil Essonnes, France, 2Saint Quentin En Yvelines, Expleo group, Montigny le Bretonneux, France
Objectives and Study: Objectives and Study: The gut‐brain axis (GBA) plays a crucial role in pediatric health, with evidence linking gut microbiome dysbiosis to mental health disorders in celiac disease (CD). This study explores the potential of machine learning (ML) to identify microbiome patterns associated with anxiety and depression in children with CD, aiming to enhance early diagnosis and personalized therapies.
Methods: Methods: A review of literature and meta‐analyses was conducted, focusing on microbiome data in pediatric CD patients. Random Forest (RF) was chosen for its ability to handle high‐dimensional data and identify microbial biomarkers, while deep learning algorithms modeled non‐linear interactions and integrated multi‐omics data. Datasets such as the American Gut Project, Human Microbiome Project, and pediatric studies (e.g., Tedjo et al., 2016) were analyzed for relevance to CD and mental health.
Results: Results: ML algorithms achieved high accuracy (>95%) in predicting CD from microbiome profiles. Altered gut microbiota composition included reduced diversity in short‐chain fatty acid‐producing genera and increased neuroinflammatory markers. These findings align with evidence linking dysbiosis to disruptions in neurotransmitter pathways, such as serotonin and kynurenine, contributing to anxiety and depression. Personalized interventions, including probiotics and tailored diets, showed promise in restoring microbiome balance and alleviating psychological symptoms.
Conclusions: Conclusions: ML offers transformative potential for understanding the microbiome‐mental health relationship in pediatric CD. By integrating datasets and identifying actionable biomarkers, ML can enhance diagnosis and inform targeted interventions. Future research should validate findings through longitudinal studies and diverse populations. Collaboration among pediatricians, data scientists, and psychologists is essential to advance pediatric care, aligning with ESPGHAN's mission.
Contact e‐mail address: rida.taher@hotmail.com
I‐OP007. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐OP007.1. PREVALENCE AND RISK FACTORS FOR ANEMIA AND IRON DEFICIENCY IN 18 MONTHS OLD TODDLERS WITHIN THE NORTHPOP PROSPECTIVE BIRTH COHORT
Iratxe Urkia‐Susin, Magnus Domellöf, Richard Lundberg‐Ulfsdotter
Department Of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
Objectives and Study: How common are iron deficiency and anemia in non‐low birth weight 18 months‐old toddlers? Which are their main risk factors? This is a substudy of a prospective birth‐cohort in northern Sweden (NorthPop).
Methods: A total of 2511 non‐low birth weight (> 2500 g) toddlers were assessed for iron status at 18 months using the combination of haemoglobin (Hb) and mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC). The following definitions were used: anemia (Hb < 73 g/L and MCV ≥ 110 fL), microcytosis (Hb ≥ 73 g/L and MCV < 110 fL) and iron deficiency (Hb < 73 g/L or MCV < 110 fL or MCHC < 323 g/L or iron supplements between 3‐18 months of age). Risk factors considered included weight at birth and 18 months, gestational age at birth, gender, breast feeding duration, and intake of iron fortified gruel at 9 and 18 months. Linear regression analysis were conducted to assess the relationship between risk factors and iron deficiency and anemia.
Results: The prevalence of anemia and iron deficiency was 4.7% and 10.2%, respectively. A negative association (standardized beta = ‐0.153, p < 0.001) was found between anemia and weight at 18 months. Iron deficiency was associated with fortified gruel intake (standardized beta = ‐0.009, p = 0.011), female gender (standardized beta = 0.078, p = 0.046) and gestational week when born (standardized beta = ‐0.125, p = 0.001). Boys were heavier (p < 0.005) than girls at birth and 18 months of age. They also had higher MCHC values compared to girls, but lower MCV values (both p < 0.005).
Conclusions: Low weight at 18 months was found to be a risk factor for anemia in non‐low birth weight infants; whereas low iron fortified gruel intake, female gender and low gestational age at birth were risk factors for iron deficiency.
Contact e‐mail address:
I‐EP001. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐EP001.1. EFFECT OF PROBIOTICS SUPPLEMENTATION ON INCIDENCE OF ANTIBIOTIC‐ASSOCIATED DIAPER DERMATITIS
Mojca Železnik1, Petra Bratina2, Andreja Valcl3, Katja Lozar Manfreda4, Evgen Benedik 5,6, Tanja Obermajer7, Bojana Bogovič Matijašić7, Aleksander Mahnič8,9, Darja Paro‐Panjan1,10, Jana Lozar Krivec1,10
1Department Of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia, 2Department Of Neonatology, Hospital for Women Diseases and Obstetrics Postojna, Postojna, Slovenia, 3Department Of Pediatrics, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia, 4University of Ljubljana, Faculty of Social Sciences, Ljubljana, Slovenia, 5Department Of Food Science And Technology, University of Ljubljana, Biotechnical Faculty, Ljubljana, Slovenia, 6Department Of Gastroenterology, Hepatology And Nutrition, Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia, 7Department Of Animal Science, Institute Of Dairy Science And Probiotics, University of Ljubljana, Biotechnical Faculty, Domžale, Slovenia, 8Department For Microbiological Research, National Laboratory for Health, Environment and Food, Maribor, Slovenia, 9University of Maribor, Faculty of medicine, Maribor, Slovenia, 10University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
Objectives and Study: Diaper dermatitis is a common dermatological condition in infancy, particularly prevalent after antibiotic treatment due to its effects on the gut microbiota and increased incidence of diarrhoea. We aimed to evaluate the efficacy of Limosilactobacillus reuteri DSM 17938 supplementation in reducing the incidence of diaper dermatitis in antibiotic‐treated neonates.
Methods: The randomised, double‐blind, placebo‐controlled trial included 89 term neonates treated with antibiotics for neonatal infection in the first 3 weeks of life (ClinicalTrials.gov: NCT02865564). Neonates received either probiotic supplementation or placebo during and after antibiotic treatment, for a total of 6 weeks. Data were collected on the incidence of diaper dermatitis, the composition of the gut microbiota, and relevant clinical data. Bacterial community structure was determined by 16S rRNA amplicon sequencing.
Results: Of all infants, 24 (27%) had diaper dermatitis and 6 (7 %) fungal diaper dermatitis. The results demonstrated no significant difference in the incidence of diaper dermatitis or fungal diaper dermatitis between the probiotic and placebo groups (30% vs 25% and 7% in both groups). Additionally, probiotic supplementation did not influence the gut microbiota composition or diversity. Furthermore, gut microbiota composition did not differ in absolute abundances for all bacteria (Lactobacillus, Bifidobacterium and Enterobacteriaceae groups), bacterial community structure, richness nor Shannon diversity between infant who developed diaper dermatitis and infants without diaper dermatitis. Multivariate regression analyses revealed no protective effect of probiotic supplementation, though breastfeeding was identified as a significant protective factor against fungal diaper dermatitis.
Conclusions: Limosilactobacillus reuteri DSM 17938 supplementation during and post‐antibiotic treatment does not significantly reduce the incidence of diaper dermatitis in neonates. However, breastfeeding remains a key protective factor for fungal diaper dermatitis. Further studies are warranted to elucidate the intricate relationship between probiotics, gut microbiota, and neonatal skin health.
Contact e‐mail address: jana.lozarkrivec@kclj.si
I‐EP002. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐EP002.1. INFANT MICROBIOME COLONISATION‐ A SYSTEMATIC REVIEW AND SECONDARY BIOINFORMATIC RE‐ANALYSIS OF 16S SEQUENCING DATA
Brendan Chadwick 1, Fan Zhang2, Vasiliki Sinopoulou3, Peter Rimmer4, Aarav Kanar3, Zain Patel3, Nicholas Conway1, Georgina Hold2, Morris Gordon3, Richard Hansen1
1School Of Medicine, University of Dundee, Dundee, United Kingdom, 2School Of Clinical Medicine, University of New South Wales, Sydney, Australia, 3School Of Medicine And Dentistry, University of Central Lancashire, Preston, United Kingdom, 4University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
Objectives and Study: The gut microbiota is increasingly appreciated as having an important impact on health. Its development in infancy remains an important topic but understanding of this is hampered by many small studies with heterogeneous methodology. We employed a systematic review methodology to identify studies that have reported on gut microbiome in infancy. We performed a unified bioinformatic reanalysis of sequence outputs to characterise changes in gut microbiome in infants aged 8 weeks to 1 year of life.
Methods: MEDLINE and Embase searches to February 2024 identified studies of interest. Where available, 16S rRNA sequence datasets were downloaded and missing datasets requested. Integrated datasets were run through a unified QIIME2 pipeline supplemented by phyloseq.
Results: 3664 studies were screened, of which 11 manuscripts, comprising 1508 stool samples from 902 infants, were suitable for bioinformatic re‐analysis. Age at time of sampling was grouped by 2 month bands for the purposes of analysis (2‐4 m, 4‐6 m, 6‐8 m, 8‐10 m and 10‐12 m with 458, 394, 109, 340, 207 samples respectively). Shannon diversity was shown to increase over the first year of life, with an acceleration after 8 months of age (Figure 1 A). Principal components analysis of Bray‐Curtis beta diversity (PCoA) Figure 1B) demonstrated contraction of the range of microbial community structures and migration away from the starting point with time, particularly after 8 months. Compositional data demonstrated the arrival and expansion of Faecalibacterium and Blautia spp. after 6 months, in keeping with a change in available dietary substrate.
Conclusions: This singular re‐analysis of sequence data from over 900 infants reiterates the growth in microbial diversity throughout infancy and demonstrates a rapid acceleration post 8‐months months, coinciding with the pivot towards a solid food diet. Further study is required to understand the specific drivers of this change and to explore the therapeutic potential of directly influencing this phase of colonisation.
Contact e‐mail address: BChadwick001@dundee.ac.uk
I‐EP003. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐EP003.1. EVALUATION OF TWO DIFFERENT DOSES OF THE L.FERMENTUM LC40 AND B.BREVE BFM26 COMBINATION ON EARLY COLONIZATION AND MICROBIOTA OF PREMATURE INFANTS: A RANDOMIZED CLINICAL TRIAL
José Antonio Hurtado Suazo1, Almudena Alonso Ojembarrena2, Laura Serrano López1, Tomás Sánchez Tamayo3, Luz Martínez Pardo4, Ruth Blanco Rojo5, Manuela Peña Caballero1, Estefania Martín Alvarez1, Javier Díez Delgado Rubio6, David Mora Navarro7, Juan Antonio Ruiz Moreno8, José María Lloreda9, Eva Torres Begara10, Carmen Macías Macías11, Mercedes Granero Asencio11, Teresa De Benito12, Oscar Bañuelos5, María Eugenia Sáez5, Mónica Olivares 5
1Paediatrics. Neonatology Division, Hosp. Univ. Virgen de las Nieves, Granada, Spain, 2Hosp. Univ. Puerta del Mar, Cádiz, Spain, 3Hosp. Univ. Regional de Málaga, Granada, Spain, 4Paediatrics. Neonatology Division, Hosp. Univ. Jaen, Granada, Spain, 5Kerry Group, Granada, Spain, 6Paediatrics. Neonatology Division, Hosp. Univ. Torrecárdena, Almería, Spain, 7Paediatrics. Neonatology Division, Hosp. Univ. Juan Ramón Jiménez, Huelva, Spain, 8Paediatrics. Neonatology Division, Hosp. Univ. Costa del sol, Marbella, Spain, 9Paediatrics. Neonatology Division, Hosp. Univ. Santa Lucía de Cartagena, Cartagena, Spain, 10Paediatrics. Neonatology Division, Hosp. Univ. Virgen de Valme, Sevilla, Spain, 11Paediatrics. Neonatology Division, Hosp. Univ. Virgen del Rocío, Sevilla, Spain, 12Paediatrics. Neonatology Division, Hosp. Univ. Jerez, Jerez, Spain
Objectives and Study: To evaluate the dose effect of the administration of Limosilactobacillus fermentum CECT5716 LC40 and Bifidobacterium breve CECT7263 BfM26 on colonization and microbiota abundance in premature infants after 2‐weeks of intervention, and its relationship with the risk of sepsis.
Methods: A multicenter, randomized, double‐blind study was performed in very low birth weight preterm neonates (≤32 + 6 gestational weeks and <1500 g) that initiated enteral nutrition in the first 72 h of life (>5 ml/kg/day). A total of 583 neonates were randomized to receive either a High Dose (HD) (1x109 CFU/day per strain) or a Low Dose (LD) (1x106 CFU/day per strain) of the LC40 + BfM26 combination until 36 + 6 weeks postmenstrual age or hospital discharge. Rate of colonization and impact on different bacterial populations have been analyzed in infant's feces after 2‐weeks of intervention. Regression lineal analyses between these data and the incidence of sepsis during the intervention were performed
Results: Colonization by LC40 strain after 2‐weeks was significantly higher in HD than in LD (75.7% vs 43.1%; p < 0.001). Regarding to BfM26 strain, a trend of higher level of colonization was observed in the HD group (77.0% in LD vs 85.5% in HD; p = 0.051). After 2‐weeks of intervention a significant increase was observed in most of the studied bacterial groups versus baseline (p < 0.05). Lactobacillus count at 2‐weeks was significantly higher in HD than in LD (6.49 ± 1.34 vs 5.32 ± 1.69 logCFU/g; p < 0.001). The presence of BfM26 was related to a lower probability of sepsis (RR:0.580; CI:0.361‐0.930). Similarly, higher abundance of Bifidobacterium was also related with lower risk of sepsis (RR:0.811; CI:0.733‐0.897).
Conclusions: A higher dose of the probiotic administration resulted in higher level of the probiotic strains colonization in preterm infants after 2‐weeks of intervention. BfM26 colonization and Bifidobacterium abundance may be related with reduction of risk of sepsis in these infants.
Contact e‐mail address: jahsuazo@yahoo.es
I‐EP004. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐EP004.1. RETROSPECTIVE STUDY OF A COHORT OF PEDIATRIC PATIENTS WITH CHRONIC LIVER DISEASE UNDERGOING ESOPHAGOGASTRODUODENOSCOPY FOR SUSPECTED ESOPHAGEAL VARICES: A SINGLE‐CENTER EXPERIENCE
Antonio Pizzol, Matteo Borsani, Laura Giugliano, Michele Pinon, Anna Opramolla, Caterina Rigazio, Pier Luigi Calvo
Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Turin, Italy
Objectives and Study: Esophageal varices (EV) are one of the main comorbidities in patients with portal hypertension (PH). Currently, there are no validated pediatric criteria to determine the optimal timing for EGDS in hepatopatic patients. Objectives: Characterization of a paediatric population with chronic liver disease for the identification of risk factors associated with EV presence with application of adult derived risk scores and liver elastography.
Methods: This retrospective study included all consecutive pediatric patients who underwent EGDS for suspected EV at a tertiary level pediatric hospital between Jan 2018 and June 2024.
Results: A cohort of 80 patients was stratified according to the site of portal hypertension in the following: Pre‐Hepatic (PrH): 16/80 patients diagnosed with portal cavernoma; average age of EV diagnosis 20 months; Hepatic (H): 45/80 patients with cirrhosis from various causes; average age of EV detection 112 months. Post‐Hepatic (PoH): 19/80 patients, all single‐ventricle surgery;123 months at EV diagnosis. In the PrH group, EV were found in 11/16 patients (70%, of which were high‐grade), in the H group 21/45 (of which 6/21 were high‐grade), while in the PoH group 0/19 (0%, low‐grade). Statistically significant variables associated with EV included liver stiffness (p < 0.05) and the platelet to spleen z‐score ratio (PLT/SAZ, p < 0.007) in the H group. The Clinical Prediction Rule (CPR) was significantly correlated with EV presence in both the H (p < 0.012) and PrH (p < 0.009) groups. Patients with polycystic kidney disease (in the H group) showed an increased risk of EV development (75%, all high‐grade)
Conclusions: Portal cavernoma and liver fibrosis associated with polycystic kidney disease have the highest risk of developing EV. Platelet count and splenomegaly were the non invasive parameters most associated with the presence of EV. Patients with surgically corrected single‐ventricle hearts have a low risk of developing varices irrespective of liver elastography. Liver stiffness is predictive of EV in hepatic primitive disease.
Contact e‐mail address: pizzol.antonio@gmail.com
I‐EP005. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐EP005.1. ENDOSCOPIC EXAMINATION OF THE INTESTINAL INFLAMMATION IN MANDUCA SEXTA LARVAE
Hannah Vogt 1, Ronaldo González García2, Adrian Regensburger1, Benno Weigman3, Oana‐Maria Thoma3, Maximilian Waldner3, Anton Windfelder4,5, Ferdinand Knieling1
1Department Of Pediatrics And Adolescent Medicine, University Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, Germany, Erlangen, Germany, 2Pediatric Gastroenterology, Universitätsklinikum Erlangen, Erlangen, Germany, 3Department Of Medicine 1, University Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, Germany, Erlangen, Germany, 4Department Of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Giessen, Germany, 5Laboratory Of Experimental Radiology, Justus Liebig University Giessen, Giessen, Germany
Objectives and Study: The Manduca sexta larva represents a suitable alternative animal model for the in vivo study of the intestine, given its comparable size to that of the mouse. Furthermore, the investigation of intestinal diseases in M. sexta larvae may facilitate the identification of a biomarker for inflammatory bowel disease (IBD) due to the conserved disease genes, with up to 92% homology between mammals and insects. DUOX has been identified as a key factor in intestinal inflammation in larvae, as is the case in IBD and very‐early‐onset (VEO) IBD.
Methods: First, a larval dextran sulfate sodium (DSS) model was established to induce intestinal inflammation and imaged by endoscopy. To assess the integrity of the intestinal epithelial membrane, black ink was injected into the dorsal vessel during the endoscopy.
Results: The gut of M. sexta larvae was clearly visualized and divided into the following regions: the hindgut, including the rectum, colon, and ileum, as well as the pylorus and the hexagonal structure of the midgut (Fig. 1 A). Larvae fed with 5% DSS appeared to have undergone some degree of ulceration (Fig. 1 C). Injection of the black ink into the dorsal vessel in healthy animals resulted in an even distribution of the ink around the gut without any leakage into the gut (Fig. 1E).
Conclusions: A detailed examination of the intestinal tract of the M. Sexta larvae was successfully performed using endoscopy. Ulcerations were observed in animals that had been fed 5% DSS, while the intact intestinal epithelial structure was demonstrated in healthy animals by ink injection. This illustrates the value of endoscopy in studying intestinal inflammation in M. sexta. Most importantly, the study of M. sexta larvae offers the potential to refine animal studies by replacing the mouse model.
Contact e‐mail address: Hannah.Vogt@uk-erlangen.de
I‐EP006. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EP006.1. PSYCHOSOCIAL MODEL OF CHILDREN AND ADOLESCENTS WITH GASTROINTESTINAL DISEASES
Afroditi Kourti 1, Evdokia Pasalari1, Georgia Triantafyllou1, Vasiliki Efstathiou2, Aikaterini Chira1, Chrysoula Kosmeri1, Ino Kanavaki1, Smaragdi Fessatou1
1Department Of Paediatric Gastroenterology, Hepatology And Nutrition, 3rd Department Of Paediatrics, Attikon University General Hospital, Chaidari Attikis, Greece, 2Department Of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
Objectives and Study: Inflammatory bowel disease(IBD), including Crohn's disease(CrD) and Ulcerative Colitis(UC),as well as Celiac Disease(CD),are chronic immune‐mediated diseases that significantly impact the gastrointestinal tract.Research indicates a heightened risk for mental health conditions among individuals with these diseases.The objective of our study was to examine the psychosocial factors influencing the quality of life in children and adolescents diagnosed with IBD and CD.
Methods: Participants included children and adolescents aged 8‐17 with a confirmed diagnosis of IBD or CD.Each participant completed a series of validated questionnaires that assessed anxiety and depression(Revised Children's Anxiety and Depression Scale,RCADS),automatic thoughts(Children's Automatic Thoughts Scale,CATS),quality of life (Pediatric Quality of Life Inventory,PedsQL),and Alexithymia(Toronto Alexithymia Scale,ACQ).
Results: A total of 64children participated in the study,consisting of 33boys (51.6%) and 31girls (48.4%).The diagnostic distribution was as follows: 22children(34.3%) with CrD, 6(9.3%) with UC, and 36(56.2%) with CD. In this sample,10participants (15.6%) reported elevated levels of anxiety and depression symptoms.Upon analysis, self‐reported anxiety symptoms—such as separation anxiety,obsessive‐compulsive disorder,generalized anxiety,depression,social anxiety,and panic disorder—were positively correlated at a statistically significant level (p > 0.05) with negative automatic thoughts.Moreover, Alexithymia subscales,specifically the Difficulty Identifying Feelings,Difficulty Expressing Feelings, and Externally Oriented Thinking, also showed positive correlations with anxiety symptoms and negative automatic thoughts.A negative correlation was observed between overall quality of life scores and anxiety symptoms, automatic thoughts, and Alexithymia scores(Table 1).The Kruskal‐Wallis test evidenced that children with CrD exhibited higher anxiety and automatic thought scores compared to those with CD, while children with CD had higher scores than those with UC.
Conclusions: Psychosocial factors related to anxiety and negative automatic thoughts were prevalent and interconnected in children with gastrointestinal disorders.Considering that anxiety levels affect the central nervous system and the gut‐brain axis producing further arousal and symptom exacerbation,psychological therapies,could be implemented in children with gastrointestinal diseases and anxiety/negative thoughts comorbidity to reduce symptoms and ameliorate their quality of life.
Contact e‐mail address: afroditi_kourti@yahoo.gr
I‐RF001. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐RF001.1. PILOT STUDY: RIVAROXABAN TO PREVENT CATHETER‐RELATED THROMBOSIS IN PEDIATRIC INTESTINAL FAILURE PATIENTS
Rozemarijn Duister 1, Xavier Werner2, Aysenur Demirok2, Barbara De Koning1, Merit Tabbers2, Heleen Van Ommen3, Samantha Gouw4
1Department Of Pediatrics, Division Of Gastroenterology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, Netherlands, 2Department Of Pediatrics, Division Of Gastroenterology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands, 3Department Of Pediatric Hematology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, Netherlands, 4Department Of Pediatrics, Division Of Hematology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands
Objectives and Study: In the Netherlands, pediatric patients with chronic intestinal failure (IF) on home parenteral nutrition (PN) use prophylactic anticoagulants to prevent catheter‐related thrombosis. Currently, low molecular weight heparins are frequently prescribed, but the subcutaneous injections are burdensome. Rivaroxaban is a direct oral anticoagulant approved in children for treatment and prevention of venous thromboembolism, however, its absorption in pediatric patients with short bowel syndrome (SBS), congenital enteropathies and motility disorders remains unclear. This prospective multicenter observational study evaluates rivaroxaban absorption in pediatric IF patients.
Methods: We included pediatric patients with IF aged 0‐18 in two tertiary care centers in the Netherlands. Rivaroxaban doses and therapeutic target ranges (TTR) were based on the pediatric phase III venous thrombosis treatment study. Rivaroxaban concentrations were determined before, and 2 to 4 hours after administration using an anti‐factor Xa assay and liquid chromatography‐mass spectometry.
Results:
Table 1
| N | Concentration (ng/dL), median (range) | IN TTR N (%) | |
|---|---|---|---|
| DAY 0 Cmax | 4 | 97.5 (30.0‐251.0) | 3 (75%) |
| DAY 7‐14 Ctrough Cmax | 3 5 | 30.0 (30.0‐47.0) 124.0 (87.0‐413.0) | 3 (100%) 4 (80%) |
| DAY 90 Ctrough Cmax | 1 2 | <15.0 180.0 (86.0‐274.0) | 0 1 (50%) |
| DAY 180 Ctrough | 1 | 30.0 | 1 (100%) |
Eight patients, 7 boys, median age 11.0 (range 2.3‐16.0) were included. Five patients had SBS (median bowel length 60 cm (range 24‐180)). On the first day of administration, 3 out of 4 patients exhibited rivaroxaban peak concentrations within TTR. By day 7 and day 90, rivaroxaban concentrations were within TTR 2 to 4 hours post‐administration in 80% and 50% of patients respectively (Table 1). Doses were adjusted when values fell below TTR.
Conclusions: Our pilot study showed that pediatric IF patients can effectively absorb rivaroxaban. Monitoring of concentrations is indicated as not all patients reached TTR. More data are required to confirm these preliminary findings.
Contact e‐mail address: r.duister@erasmusmc.nl
I‐RF002. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐RF002.1. AMNIOTIC FLUID RUBIDIUM AND FETAL WEIGHT DYNAMICS: A MATERNAL‐FETAL‐NEWBORN STUDY
Yaniv Ovadia 1, Ishai Dror1, Gad Liberty2, Maayan Sultani2, Eyal Anteby3,4, Han Zhang1, Brian Berkowitz1, Efraim Zohav4
1Earth And Planetary Sciences, Weizmann Institute of Science, Rehobot, Israel, 2Barzilai University Medical Center Ashkelon, Ashkelon, Israel, 3Obstetrics And Gynecology Division, Barzilai University Medical Center Ashkelon, Ashkelon, Israel, 4Ben‐Gurion University of Negev, Beersheba, Israel
Objectives and Study: Environmental factors may affect developing fetuses' health. We previously reported a link between mid‐pregnancy amniotic fluid rubidium concentrations and birthweight. About 40% of fetal growth restriction cases are idiopathic while maximal growth occurs during pregnancy's second half. Hence, mid‐pregnancy amniotic fluid rubidium concentrations and fetal weight trajectories from mid‐pregnancy to birth were examined.
Methods: Pregnant women without fetal growth restriction records were studied prospectively. Rubidium concentrations were quantified in mid‐pregnancy amniotic fluid. Statistical analysis was performed on maternal, fetal, and newborn characteristics. Based on the comparison of the weight percentiles at recruitment and birth, fetal weight percentiles were categorized as increased or decreased, respectively. For each fetus, a daily percentile ratio index was calculated by dividing the total estimated fetal weight percentile change by the period (from recruitment to birth).
Results: Amniotic fluid rubidium concentrations correlated significantly with fetal weight trajectory. In predicting a decreased fetal weight trajectory, reduced amniotic fluid rubidium concentration ranked the highest contributor (33.1%). Using an algorithmic partitioning protocol, the study cohort was divided into two subgroups based on a amniotic fluid rubidium threshold value of 122 μg/L. Fetuses with rubidium levels below this threshold were significantly more likely to experience a decreased fetal weight trajectory. The frequency of decreased fetal weight percentiles was approximately three‐fold higher in the <122 μg/L subgroup (OR = 3.2 [95% CI (1.1, 8.8)]; P = 0.03). The daily percentile ratio index was negative vs. positive for the amniotic fluid rubidium < vs. ≥ 122 μg/L subgroups, respectively (P = 0.02). There was a significant correlation between mid‐pregnancy amniotic fluid rubidium concentrations and estimated fetal weight percentile change, adjusting for possible confounders (β = 0.3, P = 0.01).
Conclusions: Mid‐pregnancy amniotic fluid rubidium concentrations may correlate with later prenatal weight dynamics. During this time period, such lower rubidium concentrations might be associated with decreased fetal weight trajectories. Furher understanding of rubidium's role in fetal development is needed.
Contact e‐mail address: yaniv.ovadia@mail.huji.ac.il
I‐EV001. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐EV001.1. FECAL PANCREATIC ELASTASE RAPID TEST ACCELERATES THE ASSESSMENT OF PANCREATIC ENDOCRINE INSUFFICIENCY ‐ QUANTUM BLUE FPELA ASSAY
Leslie Anchling 1, Ueberschlag Marie‐Eve1, Anna Melone2, Alina Thürig1, Joana Afonso1, Thomas Schuster1, Christian‐Benedikt Gerhold1
1BÜHLMANN, Schönenbuch, Switzerland, 2BÜHLMANN, Schönenbuch, France
Objectives and Study: Fecal pancreatic elastase (fPELA) is an established biomarker for the assessment of pancreatic function in patients suffering from pancreatic exocrine insufficiency (PEI). The present work evaluates key analytical performance of a new fPELA lateral flow assay to determine elastase levels in human stool samples. Quantum Blue® fPELA is an easy to use rapid test, running on the Quantum Blue® Reader a compact lateral flow test reader.
Methods: The method comparison with the established immunoturbidimetric BÜHLMANN fPELA® turbo assay was assessed according to the CLSI guideline EP09c‐Ed3 with 120 samples in the range of 30 – 368 µg/g. The agreement was established with 351 patient samples. The reference interval study was conducted according to the CLSI guideline C28‐Ed3 with 128 stool samples of self‐declared healthy volunteers.
Results: Method comparison of the Quantum Blue® fPELA with BÜHLMANN fPELA® turbo, revealed good analytical agreement with a slope of 1.03 (Passing‐Bablok), a relative bias at cutoff (200 µg/g) of ‐3.7% and a mean relative bias of 7.2% (Bland‐Altman). When using 200 µg/g as a clinical decision threshold the positive predicted agreement and negative predicted agreement were 91% and 94%, respectively. Out of the 128 stool samples measured for the reference interval study, 15 were < 200 µg/g (14 for fPELA® turbo).
Conclusions: The Quantum Blue® fPELA test has been developed to run on the Quantum Blue® Reader without the need for extensive laboratory equipment. The test revealed acceptable correlation and a comparable reference limit to the reference assay BÜHLMANN fPELA® turbo, making it an attractive alternative to turbidimetric assay with a quick turn‐around time of only 15 minutes, enabling patients’ management without the need of large and expensive clinical chemistry analyzers.
Contact e‐mail address: lea@buhlmannlabs.ch
I‐EV002. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐EV002.1. APPLICATION OF ELECTRONIC‐NOSE (ENOSE) FOR NON‐INVASIVE DIAGNOSIS OF GASTROINTESTINAL DISORDERS IN CHILDREN: A CASE‐CONTROL STUDY
Michele Fingerle, Laura Tenero, Michele Piazza, Elena Caneva, Sonia Morano, Mariachiara Bagnato, Marco Deganello Saccomani, Giorgio Piacentini, Claudia Banzato
Pediatric Unit, Department Of Surgical Sciences, Dentistry, Gynecology And Pediatrics, University of Verona, Verona, Italy
Objectives and Study: Volatile organic compounds (VOCs) present in organic samples such as feces, urine, exhaled breath and blood have been studied in the medical field for about 10 years for their potential to enable early and non‐invasive diagnosis of various pathologies. Although not yet validated, there is growing evidence pointing to certain VOCs in feces and exhaled breath as biomarkers for gastrointestinal diseases in children. The objective of this study is to use e‐Nose analysis on feces and exhaled breath to detect differences in the olfactory patterns of patients with gastrointestinal disorders compared to healthy individuals and assess the capability of distinguishing among different gastrointestinal conditions.
Methods: This case‐control study included 51 children aged 0 to 18 years, who were visiting the Pediatric Gastroenterology Unit of a Tertiary Center in Northern Italy for assessments. Fecal samples from all participants and exhaled breath samples from those older than 5 years were analyzed using e‐Nose (Cyranose 320). The graphs derived from resistance changes in the 32 sensors were processed by the instrument's software using pattern recognition algorithms and principal component analysis (PCA).
Results: From the VOCs analysis of feces, 8 sensors are capable to discriminate the presence of gastrointestinal disorder (Eosinophilic Esophagitis [EoE], Celiac Disease [CD], Inflammatory Bowel Disease [IBD], Gastroesophageal Reflux Disease [GERD]) compared to controls. Additionally, one sensor (F28) shows high sensitivity in distinguishing the diseases from each other (p = 0.0007). From the VOCs analysis of exhaled breath, 4 sensors can differentiate EoE and IBD from controls, and one sensor (E28) demonstrates high sensitivity in distinguishing various gastrointestinal disorders in the studied population (p = 0.0032).
Conclusions: In pediatric patients, e‐Nose instruments can detect pathological alteration in the gastrointestinal system compared to healthy controls and distinguish between different gastrointestinal pathologies.
Contact e‐mail address: fingerle.michele@gmail.com
I‐EV003. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐EV003.1. IMPACT AND OUTCOMES OF GENERAL PAEDIATRIC ADVANCED NURSE PRACTITIONER (INTEGRATED CARE) CARE ON COMMON GASTROINTESTINAL CONDITIONS IN CHILDREN
Siobhain Kiernan
General Paediatrics, Portiuncula University Hospital, H T, Ireland
Objectives and Study: The objectives of this study is to demonstrate the impact and outcomes of care from advanced nurse practice (ANP) posts in a general paediatric setting in Ireland.
Methods: Data was colleced over a 1 year period on: Referral source Cohort Specific Outcomes Management Duration Patient/Parent satisfaction survey.
Results: Results General Paediatric waiting list reduced significantly from >6 months to <4 months for non‐urgent referral. 2024 data demonstrates that the RANP activity is 10% of the total general paediatric outpatient activity. Clinical outcome results include: 80% of patients with RAP were discharged after six month follow up 44% of patients with RAP had investigations Patients with constipation were discharged on average after three ANP contacts and within four months or referral Most common age for constipation referrals was 6months to 3years 84% of patients responded to first line macrogol treatment Improved RANP coeliac management in line with ESPGHAN guidelines: 92% of 1st degree relatives were screened for coeliac disease in the RANP clinic versus 10% in the general paediatric clinics 100% of patients received 6 month review and bloods following new diagnosis of coeliac disease in the RANP clinic versus 12.5% in the general paediatric clinic 100% of patients receive yearly review and bloods in the RANP clinic versus 25% in general paediatric clinic. Patient/Parent satisfaction results include: 81% of patients/parents reported RANP care extremely valuable 90% patients/parents reported they would be satisfied to receive care in the future from RANP 60% patients/parents reported they felt confident and 40% reported they felt extremely confident managing their child's RAP following review by RANP.
Conclusions: Effective management of common gastrointestinal conditions is reliant on timely access to a service that has a practitioner with advanced knowledge of the conditions being treated as well as education, patient empowerment and follow up.
Contact e‐mail address: siobhain.kiernan@hse.ie
I‐EV004. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐EV004.1. ESTABLISHMENT AND CLINICAL APPLICATION OF A RAPID VISUALIZATION METHOD FOR GENOTYPING G AND P GENES OF ROTAVIRUS
Yan Lu, Zhifeng Liu
Department Of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
Objectives and Study: To establish a simple, economical, and rapid genotyping method for group A rotavirus (RVA) G and P genes and explore its clinical application value.
Methods: A genotyping method for RVA G and P genes based on polymerase chain reaction combined invasive reaction coupled with oligonucleotide probe‐modified gold nanoparticles (PCR‐Invader‐AuNP) was established. The feasibility and specificity of this method for RVA molecular typing were examined by constructing standard plasmids. The accuracy of this method was validated in actual samples, compared with the traditional nested PCR method, and confirmed by gold standard Sanger sequencing.
Results: Representative standard plasmids of RVA G1, G2, G3, G4, G8, G9, G12, and P[4], P[6], P[8], P[9] types were successfully constructed in this study. The PCR‐Invader‐AuNP method for genotyping of RVA G and P genes was successfully established, and the designed universal primers and specific probes were feasible. This method demonstrated good specificity in detecting RVA, with no cross‐reactivity between genotypes. When applied to actual samples, this method outperformed traditional nested PCR and yielded results consistent with Sanger sequencing.
Conclusions: We successfully established a PCR‐Invader‐AuNP‐based genotyping method for RVA G and P genes, which demonstrated good specificity and could identify common genotypes of RVA G and P genes. Compared to traditional electrophoresis‐based and sequencing‐based genotyping methods, this method is simpler to operate, requires shorter time, yields easily interpretable results, and is more suitable for clinical application.
Contact e‐mail address:
I‐EV005. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐EV005.1. THE APPLICATION OF ARTIFICIAL INTELLIGENCE CAN EFFECTIVELY ASSIST INFANT STOOL TRACKING IN REAL‐LIFE IN CHINA
Fangfei Xiao 1, Muqing Xie2, Wenqi Cao3, Songyuan Wang2, Xiaoming Ma3, Yuan Dong3, Pei Xiao1
1Shanghai Children's Hopsital, China, Shanghai, China, 2Danone Open Science Research Center, Shanghai, China, 3Danone Open Science Reserch Center, Shanghai, China
Objectives and Study: An AI‐based smartphone application for assessing stool consistency in diapers (Stool Tracker, ST) was developed, providing a modern, digital approach to potentially address and mitigate unnecessary parental concerns. Its validated algorithm offers precise assessments in a cohort study (NCT05235412) of breastfed infants, achieving 95.8% accuracy compared with 66.9% in parent‐reported outcomes. This abstract aimed to describe the effectiveness of ST in real‐world pediatric practices and illustrate stool consistency differences through big health data from formula‐fed children in parental practices.
Methods: ST leveraged a large database of 2.5 million children's (0‐60 months) stool images to differentiate stool consistency, based on the Brussels Infant and Toddler Stool Scale (BITSS). It was used in real‐world pediatric and parental practices in non‐toilet‐trained children in China since 2019.
Results: In pediatric practices, ST was used in a decentralized real‐world study (NCT06287385), which recruited 121 toddlers aged 1 to 2 years within 4 months, achieving 98.3% completion rate and full compliance to ST. When applied in parenting practices, the ST was able to detect, in a group of 325 children consuming formula containing scGOS/lcFOS and SN‐2 palmitate, a positive change in stool consistency between two valid records and showed improvement in 5 days (median interval). Applying the same data selection criteria as performed above, 252 children consuming formula supplemented with scGOS/lcFOS and B. breve M‐16V, 92% were seen to end their last record on what is considered favorable stool consistency. Additionally, in parenting practices, long‐lasting stool consistency duration, from first to last record of soft stool, was 87 days (median interval), demonstrating long‐term effect.
Conclusions: This validated AI‐based ST offered efficient stool consistency assessments for pediatricians and parents to monitor children's gut health. The collected big health data suggests scGOS/lcFOS with or without B. breve M‐16V or SN‐2 palmitate may have stool softening effect in real‐world settings.
Contact e‐mail address:
I‐EV006. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐EV006.1. EVALUATING THE ACCURACY OF AN ARTIFICIAL INTELLIGENCE DERIVED ALGORITHM FOR ESTIMATING HEIGHT AND WEIGHT IN CHILDREN: PRELIMINARY FINDINGS OF A CROSS‐SECTIONAL STUDY
Daniel Chan1,2,3, Jill Wong4, Sankha Mukherjee4, Xin Liu5, Muhammad Nabeel Eusoff4, Fabian Yap 1,2,3
1Endocrinology Service, Division Of Medicine, KK Women's and Children's Hospital, Singapore, Singapore, 2Duke‐NUS School of Medicine, Singapore, Singapore, 3Lee Kong Chian School Of Medicine, Nanyang Technological University, Singapore, Singapore, 4Danone Research and Innovation, Singapore, Singapore, 5Danone Research and Innovation, Utrecht, Netherlands
Objectives and Study: Regular and accurate monitoring of children's growth, including height and weight, is crucial, but rarely performed with precision at home. Our earlier work demonstrated the feasibility of an artificial intelligence (AI) algorithm to predict recumbent length and weight of young children from digital images, with potential for parent/caregiver engagement in performing home‐based anthropometric measurements for their children (NCT05079776). Building on insights gained, this study will develop and assess refined AI algorithms to predict child height and weight from images and depth sensors commonly found in smartphones, exploring the feasibility of using home‐accessible tools for growth monitoring.
Methods: This single‐center exploratory study recruited children aged 2 to under 6 years (NCT06578338). Investigators measured each child's height and weight using standard World Health Organization methods and captured 25 images of the child standing upright from multiple angles, while parents captured five similar images of their child at home. We tested two AI models: Model A compares a reference object size to the size of the child to determine height and weight; Model B uses body segment lengths and depth map as input to an advanced deep learning model. Mean absolute and percentage error (MAE, MAPE) for height and weight predictions were compared between models.
Results: The study commenced on 23‐Sep‐2024. By 29‐Oct‐2024, 118 image sets from 118 children were analyzed. Height MAE/MAPE was 0.74 cm (0.76%) for Model A, 3.20 cm (3.28%) for Model B; weight MAE/MAPE was 1.07 kg (7.31%) for Model A, 1.45 kg (9.92%) for Model B (Figure 1). Final results will be presented at ESPGHAN.
Conclusions: Regular monitoring of anthropometric measurements is vital in young children. Though Model A demonstrated higher accuracy with a reference object, Model B demonstrated greater usability without a reference object, potentially facilitating accurate height‐weight prediction of children in a home setting.
Contact e‐mail address: fabian.yap.k.p@singhealth.com.sg
I‐EV007. Topic: AS04. INTERDISCIPLINARY/AS04a. Basic and/or Translational Science
I‐EV007.1. INFLAMMATORY MARKERS ROLE IN PREDICTING NECROTIZING ENTEROCOLITIS
Melinda Matyas, Monica Hasmasanu, Gabriela Zaharie
Neonatology, University of Medicine and Pharmacy Cluj Napoca, Cluj Napoca, Romania
Objectives and Study: Background More than half of preterm births are triggered by inflammatory processes at the foeto‐maternal interface. These inflammatory processes can persist after birth due to the unique vulnerabilities of preterm infants, often resulting in sustained inflammation. This chronic inflammation plays a significant role in complications such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and periventricular leukomalacia (PVL).
The aim of this study was to analyze the role of maternal and neonatal inflammation on the incidence of NEC in preterm neonates.
Methods: We conducted a prospective longitudinal study in the Neonatology Department of the 1st Obstetrics Clinic, Cluj‐Napoca. A total of 82 preterm newborns (gestational age <34 weeks + 6 days), admitted between May 2022 and December 2022, were enrolled in the study. Interleukin‐3 (IL‐3) and matrix metalloproteinase‐9 (MMP‐9) levels were measured using the ELISA technique from blood samples collected at birth. Additionally, C‐reactive protein (CRP) and procalcitonin (PCT) were measured in the first days of life. We analyzed the correlation between these inflammatory markers and NEC’ s development in the study group. Furthermore, we examined the role of maternal inflammation and chorioamnionitis in relation to NEC incidence.
Results: Out of the 82 neonates enrolled, 20 (24.29%) developed NEC. Neonates who developed NEC had higher IL‐3 levels at birth. A significant positive correlation was found between maternal CRP levels and neonatal IL‐3 levels (r = 0.541, p < 0.001). In the NEC group, maternal CRP levels were also elevated compared to those in neonates who did not develop NEC.
Conclusions: Neonatal inflammation is associated with an increased incidence of NEC. Prenatal inflammatory conditions appear to trigger a persistent inflammatory process in preterm neonates, raising the risk of NEC.
Contact e‐mail address:
I‐EV008. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV008.1. ASSESSING THE PERCEPTION OF COW'S MILK ALLERGY ASSOCIATED SYMPTOMS AMONG CZECH PAEDIATRIC PRACTITIONERS
Katerina Bajerova 1, Nabil El‐Lababidi2, Simona Belohlavkova3
1Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic, 2Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic, 3AlergoCentrum dr.Belohlavkove, sro., Prague, Czech Republic
Objectives and Study: The incidence of cow's milk allergy (CMA) diagnosed by general paediatricians (GPs) in the Czech Republic is an unreported topic. Variations in GPs' sensitivity to symptoms of CMA could potentially lead to over‐/underdiagnosis of CMA among the infant population. We aimed to evaluate the approximate incidence of CMA and to elucidate the perception of some of the clinical symptoms possibly associated with CMA. The Ethical Committee of University Hospital Brno approved the study.
Methods: We collected data using an anonymous online questionnaire. The questions focused on the duration of the individual medical practice, the number of newborns assessed annually, and the number of infants diagnosed with CMA per year by the same clinician. We also collected data on symptoms practitioners do not perceive as possibly associated with CMA. Statistical analysis was performed using Microsoft Excel 2016 tools.
Results: We obtained responses from 98 GPs, of whom 96 (98%) diagnose CMA independently. The TABLE summarises the approximate CMA incidence in groups of GPs with different durations of clinical practice. Sixty (61%) GPs do not consider the runny nose a sign of CMA, 16 (16%) the lower respiratory tract symptoms, 13 (13%) the hoarseness, 6 (6%) cough, and 4 (4%) the watery stools.
TABLE
| Years of practice | Number of reponders | Minimal incidence of CMA in % | Maximal inciednece of CMA in % |
|---|---|---|---|
| ˂ 5 | 9 | 1 | 13 |
| 5 to 10 | 11 | 3 | 10 |
| 10 to 20 | 13 | 2 | 14 |
| 20 to 30 | 21 | 1 | 8 |
| 30 to 40 | 28 | 1 | 13 |
| ˃ 40 | 14 | 1 | 20 |
Conclusions: Czech GPs differ in their sensivity to symptoms possibly associated with CMA in infants. While literature suggests incidence of CMA between 0.5 and 3 %, based on our collected data it would seem that GPs overestimate the incidence considerably, with a mean educated guess of up to 20%.
Contact e‐mail address:
I‐EV009. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV009.1. KNOWLEDGE EMPOWERS! EMPOWERMENT OF PARENT AND CHILD WITH FUNCTIONAL ABDOMINAL PAIN
Martin Classen 1, Verena Ness2, Humberg Clarissa2, Leandra Eidt2, Lisa‐Marie Rau2, Thomas Berger3, Jens Berrang4, Stephan Buderus5, Nils Syring1, Christine Vietor6, Lorin Stahlschmidt2, Julia Wager2
1Pediatric Clinic Klinikum Bremen Mitte, Gesundheit Nord gGmbH, Bremen, Germany, 2German Paediatric Pain Centre; University Witten/Herdecke, Datteln, Germany, 3Paedriatic Gastroeenterology, Children and Adolescent's Hospital Datteln, Datteln, Germany, 4Pediatric Hospital, Klinikum Dortmund, Dortmund, Germany, 5Pediatric Hospital, GFO clinics Bonn, St. Marien Hospital, Bonn, Germany, 6Techniker Krankenkasse, Hamburg, Germany
Objectives and Study: Functional abdominal pain (FAP) is a frequent issue in paediatrics. For improvement, knowledge on FAP is crucial. However, in clinical practice, there is little time for education. Therefore, we developed and evaluated an evidence‐based website (meine‐bauchstelle.com). The objective of our study was to investigate the efficacy of visiting the website as an add‐on to the doctor's visit within a longitudinal randomized‐controlled study.
Methods: Pediatric patients diagnosed with FAP and their parents were recruited at outpatient gastroenterologists (N = 187). All families completed questionnaires after the doctor's visit (T0) as well as one (T1) and three months after (T2). Via randomization, half of the families got website access before the doctor's visit (intervention group, IG); the control group (CG) after T2. Data on abdominal pain knowledge, symptomology and impairment, pain handling, and the physician‐patient‐interaction was obtained (patient response rate: nT0 = 166, nT1 = 86, nT2 = 80; parent response rate: nT0 = 169, nT1 = 86, nT2 = 83). We calculated group comparisons at T0 (t‐test/Wilcoxon‐test) and longitudinally (multilevel analyses). We distinguished intention‐to‐treat‐analyses (group comparison by randomization) and per‐protocol‐analyses (group comparison by having visited the website or not).
Results: There was an overall decrease in passive pain handling (p = .049), missed school days (p = .013), pain‐related impairment (p < .001) as well as symptomology (p < .001) in the intention‐to‐treat‐analyses (main effect of time). Additionally, participants were able to increase their knowledge (patients: p < .001; parents: p = .012).
Per‐protocol‐analyses indicated that patient website visitors had more knowledge at T0 (p = .037). At T0 (p = .022) as well as longitudinally (p < .001) patients having visited the website were less disabled by pain. Their parents described a better interaction with the physician (p = .005).
Conclusions: The website meine‐bauchstelle.com can help improve education on FAP. By visiting the website, participants were able to increase their knowledge and further reduce their impairment. Furthermore, parents who visited the website felt in better hands during their physician appointments.
Contact e‐mail address: v.ness@deutsches-kinderschmerzzentrum.de
I‐EV010. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV010.1. MUTATIONS IN TRIM‐32 AND NEDD4L: UNVEILING A NOVEL SCLEROSING CHOLANGITIS VARIANT WITH ELEVATED IGE AND EOSINOPHILIA
Valentina Langella1, Francesco Vergati1, Caterina Voto1, Rossella Colantuono 1, Carmen Campanile1, Melissa Iandolo1, Rosanna Masturzo1, Massimo Triggiani2, Vincenzo Casolaro3, Claudia Mandato1
1Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, Baronissi (SA), Italy, 2Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy., Baronissi (SA), Italy, 3Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, Salerno, Italy, Baronissi (SA), Italy
Objectives and Study: Sclerosing cholangitis is a rare liver disease involving bile duct inflammation and fibrosis. Genetic, immune,
and environmental factors contribute to its etiology. This case explores mutations in TRIM‐32 and NEDD4L
genes linked to sclerosing cholangitis with elevated IgE and eosinophilia.
Methods: We describe a male child born with neonatal jaundice not requiring phototherapy. He showed poor weight gain and persistent elevation of transaminases, γ‐GT, and bile acids, normalized by ursodeoxycholic acid. Intrahepatic bile duct stones were successfully treated with ERCP. Liver biopsy revealed secondary sclerosing cholangitis.
Whole exome sequencing identified pathogenic heterozygous mutations in TRIM‐32 and NEDD4L. The patient exhibited eosinophilia, high IgE levels, and a family history of elevated IgE and atopic dermatitis in a sibling.
Results: NEDD4L encodes an E3 ubiquitin ligase regulating sodium transport and mast cell activity. Its deficiency leads to excessive inflammatory mediator release and prolonged IgE‐mediated reactions. TRIM‐32 regulates Th2 responses, contributing to allergic dermatitis and increased IgE levels in murine models.
The co‐occurrence of these mutations likely explains the sclerosing cholangitis and immune dysregulation observed. The sibling's similar history suggests a hereditary component.
Conclusions: This case highlights the interplay between genetic mutations and immune dysregulation in sclerosing cholangitis. Mutations in TRIM‐32 and NEDD4L may influence liver pathology and Th2‐mediated responses. Further research could uncover new therapeutic targets in managing immune‐related liver diseases.
Contact e‐mail address: pediavajro@gmail.com
I‐EV011. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV011.1. FROM VULNERABILITY TO VITALITY: COMBATING ESCALATING DATA BREACH COSTS IN PEDIATRIC GI, HEPATOLOGY, AND NUTRITION THROUGH TARGETED CYBERSECURITY EDUCATION
Iliada Evripidou 1, Antriani Evripidou2, Evangelia Zacharioudaki3, Victoria Didichenko2, Stelios Zacharioudakis4, George Tsovilis5, Avgousta Kyriakidou ‐ Zacharoudiou6, Maria Paschalidou7, Lefteris Zacharioudakis1,6,8
1Computer Science, Neapolis University Pafos, Pafos, Cyprus, 2Obstetric Gynecological Center, pafos, Cyprus, 3Medical School, European University Cyprus, Nicosia, Cyprus, 4Department Of Informatics And Telecommunications, National and Kapodistrian University of Athens, Athens, Greece, 5Department Of Electrical Engineering And Computer Engineering And Informatics, Cyprus University of Technology, Limassol, Cyprus, 6Computer Science, Neapolis University Pafos, pafos, Cyprus, 7School Of Medicine, National and Kapodistrian University of Athens, Athens, Greece, 8Computer Engineering, National Technical University of Ukraine, Igor Sikorsky Kyiv Polytechnic Institute, Kyiv, Ukraine, Kyiv, Ukraine
Objectives and Study: The average cost per healthcare data breach rose from $3.50 million in 2014 to $10.93 million in 2024, indicating a Compound Annual Growth Rate (CAGR) of approximately 12.1%. Given the sensitive and often lifelong nature of pediatric patient data—especially within the realms of gastroenterology, hepatology, and nutrition—understanding and mitigating escalating breach costs is essential. This study projects these costs into 2030, 2035, and 2040, underscoring the need for robust cybersecurity education and training in pediatric healthcare settings.
Methods: Global data from IBM's annual Cost of a Data Breach reports (2014–2024) were analyzed to determine the CAGR and generate future cost projections. We assumed steady trends without major regulatory or technological shifts. To ensure relevance to the pediatric gastrointestinal community, we highlight how these vulnerabilities affect children's long‐term health records and trust in care systems.
Results: If current patterns persist, the average cost per healthcare data breach may reach about $21.6 million by 2030, $38.4 million by 2035, and $67.7 million by 2040. Pediatric sectors are disproportionately impacted because breaches compromise sensitive patient histories essential for managing chronic conditions, monitoring growth, and ensuring dietary and therapeutic interventions are informed by accurate, secure data.
Conclusions: As these costs rise, strategic action is crucial. Implementing mandatory cybersecurity training for healthcare teams, integrating AI‐driven threat detection, and strengthening data backup systems can help safeguard pediatric patient information. These proactive measures not only protect young patients’ privacy and foster trust with families but also preserve critical resources, ensuring that future investments can remain focused on improving outcomes in pediatric gastroenterology, hepatology, and nutrition.
Contact e‐mail address: i.evripidou@nup.ac.cy
I‐EV012. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV012.1. TRAUMA RELATED INCIDENTS TO CHILDREN WITH GASTROINTESTINAL DISEASES
Georgia Triantafyllou1, Afroditi Kourti 1, Evdokia Pasalari1, Vasiliki Efstathiou2, Chrysoula Kosmeri1, Aikaterini Chira1, Ino Kanavaki1, Smaragdi Fessatou1
1Department Of Paediatric Gastroenterology, Hepatology And Nutrition, 3rd Department Of Paediatrics, Attikon University General Hospital, Chaidari Attikis, Greece, 2Department Of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
Objectives and Study: This study investigates the prevalence of trauma‐related events in children and adolescents diagnosed with Inflammatory Bowel Disease(IBD) and Celiac Disease(CD).Given the chronic nature of these gastrointestinal diseases(GIDs) and their multifactorial etiology,it is crucial to understand how health and psychosocial factors,particularly trauma‐related events and the psychological reactions to these events,may influence the patients' health and quality of life.
Methods: The study involved 64 children and adolescents with diagnosed IBD and CD who completed a questionnaire assessing their experiences with trauma‐related events and their psychological responses to those events.The trauma‐related events examined included:Violent assault,Inappropriate touch,Death of a loved one,Death of a pet,Loss of job/unemployment,Birth of a sibling,Bullying at school,Serious accident in the family,Sexual molestation,Family disputes,Violence in the family,Parents’ divorce,Serious illness in the family,Physical disaster.Participants also reported on their psychological reactions, including:Intrusions or nightmares,Avoidance of stimuli,Taking precautions in their environment,Feeling detached from self or others,Feeling guilty or blaming others after the trauma‐related event.
Results: Descriptive statistics indicated the occurrence of various trauma‐related events among children with GIDs.The Mann‐Whitney test was employed to identify significant relationships between specific trauma events and their psychological reactions.Key findings included:Significant Trauma Events:Bullying at School:Z = ‐3.026, P = 0.025,Loss of Job/Unemployment:Z = ‐2.247,P = 0.02,Parents’ Divorce:Z = ‐2.257,P = 0.024, Psychological Reactions to Trauma:Increased numbers of intrusions,avoidance behaviors, precautions taken, and feelings of detachment correlated with the frequency and severity of trauma events(Table 1).
Conclusions: The study underscores that trauma‐related events and the psychological responses associated with these events can adversely affect health outcomes and the quality of life in children with GIDs.These factors should be better understood to support this vulnerable population, given that trauma related events have imprints and alterations on the emotional brain of children resulting in a series of body manifestations.Further studies are warranted to fully elucidate these relationships implementing a brief trauma related screen and improve care protocols to address these specific needs in a pediatric population.
Contact e‐mail address: afroditi_kourti@yahoo.gr
I‐EV013. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV013.1. COMPLEX POLYPOSIS SYNDROME WITH DELETIONS ENCOMPASSING PTEN AND BMPR1 GENES
Elena Kurteva 1, Emily Charkin2, Dorotyhy Hawes2, Nayana Lahiri3, Katherine Lachlan4, Warren Hyer5, Nada Ibrahim2, Tracy Coelho1
1Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, 2University Hospital Sussex NHS Foundation Trust, Chichester, United Kingdom, 3Clinical Genetics, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, 4Clinical Genetics, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, 5Paediatric Gastroenterology, Chelsey and Westminster Hospital NHS Foundation Trust, London, United Kingdom
Objectives and Study: Juvenile polyposis syndrome (JPS) is a rare genetic condition with hamartomous polyps predominantly in the colon, with implicated genes including BMPR1 and SMAD4 among others. On the other hand, PTEN mutations can lead to a systemic polyposis syndrome like PTEN‐hamartoma tumour syndrome (PHTS), affecting the gut and other systems. We report a patient with complex polyposis throughout the gastro‐intestinal tract and multi‐system involvement due to deletions encompassing both the BMPR1 and PTEN genes.
Methods: A 10‐year‐old female patient who initially had genetic testing for macrocephaly was found to have 10q23.1‐q23.32 deletion including PTEN and BMPR1 genes. She presented subsequently with intermittent bleeding per rectum. This report includes a retrospective case review, summarizing the key findings, management, future treatment options and surveillance recommendations.
Results: Initial endoscopy revealed a large non‐occluding duodenal polyp > 5 cm involving the ampulla, with multiple other polyps in the stomach and duodenum. Numerous sessile and pedunculated polyps were identified throughout the colon, three of which were removed. Histopathology showed ganglio‐neuromatous and hamartomatous features raising the possibility of Cowden's/PHTS. MRCP showed the large duodenal polyp as a fat‐filled lesion occupying the lumen of the duodenum and engulfing the ampulla, which remains under yearly surveillance. Colonoscopy monitoring has been advised once every 3 years. Given the cancer risk, surveillance of other systems including breast and thyroid screening at the appropriate age has also been recommended by the genetics team.
Conclusions: Our case highlights the challenges of managing complex polyposis, especially with large duodenal polyps involving the ampulla. It underscores the importance of vigilant surveillance, proactive treatment, and a multidisciplinary approach in managing young patients with polyposis syndromes and multi‐system involvement, particularly given the genetic complexity and increased risk of malignancy. Regular monitoring, early intervention, and collaboration between specialists are key to optimizing patient care and outcomes.
Contact e‐mail address: elena.kurteva@uhs.nhs.uk
I‐EV014. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV014.1. ANTIPSYCHOTIC‐INDUCED WEIGHT GAIN (AIWG) IN CHILDREN AND ADOLESCENTS
Nighat Nadeem
South West London and St George's Mental Health NHS Trust, London, United Kingdom
Objectives and Study: Antipsychotics (AP) are increasingly prescribed in children and adolescents and can cause antipsychotic induced weight gain (AIWG). This combined with paediatric obesity compounds the risk of cardiometabolic abnormalities which increase the risk of physical health complications.
Methods: Baseline and monthly weight data was extracted from medical records of patients initiated on AP on the general adolescent unit (GAU) over 2 years (1.3.2022‐1.3.2024). Data was analysed quantitatively using SPSS.
Results: Of 144 admissions, 57 patients were included. In the short term (1‐month) and long term (upto 4months), there was highly significant AIWG from baseline to final weight; 3.12 kg and 8.62 kg, respectively, p < 0.001. AIWG was significantly different across BMI percentile groups, reflecting greater AIWG gain in BMI < 15 and 15‐85 percentiles (BMI<15th percentile: 3.69 kg in 1‐month and 6.70 kg in long term (p < 0.01); BMI 15‐85th percentile: 4.36 kg in 1‐month and 8.02 kg in long term (p < 0.001)). AIWG was significant for male and females with increased z‐BMI at discharge (p < 0.008); AIWG of 3.52 kg v 2.71 kg after 1‐month, and 7.20 kg v 6.11 kg at long term follow up. In the long term, Risperidone (8.99 kg) and Olanzapine (6.96 kg) were linked to particularly high AIWG; at 1‐month AIWG was approx. 4.30 kg and 3.65 kg respectively. Higher doses of all AP were moderately associated with AIWG if taken over a longer period of time.
Conclusions: Significant AIWG occurred in the whole sample and was more marked in males, with Risperidone or Olanzapine, and in those with BMI < 15 and 15‐85 percentile classifications. Correlational analyses suggested that neither baseline weight, BMI or age were associated with weight changes but higher doses of all AP (except Aripriprazole) were associated with AIWG if taken over a longer period of time. This information is useful to improve training and develop interventions to minimise and manage AIWG in children and adolescents.
Contact e‐mail address:
I‐EV015. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV015.1. PHYSICAL HEALTH ASSESSMENT OF ADOLESCENT PSYCHIATRIC INPATIENTS
Nighat Nadeem
South West London and St George's Mental Health NHS Trust, London, United Kingdom
Objectives and Study: The interface between children's mental and physical health is well known and young people with mental health problems have more comorbid physical illness and adverse side effects of psychotropic medications. The aim of this study was to explore the standard of physical health assessments on a general adolescent unit (GAU).
Methods: A retrospective study of patient medical records was conducted to evaluate physical health assessments of all young people admitted to a GAU in South West London. Data was collected between 01.1.23‐31.5.2023 (cycle 1; 5 months) and 01.06.23‐30.11.23 (cycle 2; 6 months). Based on Trust policy, 100% completion within 7 days of admission is recommended for physical examination, blood tests, ECG, urinalysis and BMI. Data was analysed quantitively and this study was registered with the Trust audit department.
Results: There were 28 and 29 new admissions to the GAU in cycle 1 and 2. In both cycles, all domains did not achieve 100% completion within 7 days of admission. In both cycles, physical examination had the highest completion rate and urinalysis had the lowest completion rate. Within 7 days of admission, 84.6% of physical examinations were completed in cycle 1 and 96.6% completed in cycle 2. Recording of BMI remained similar (cycle 1, 79.5%; cycle 2, 79.3%). The completion of blood tests within 48 hours of admission had reduced from 64.1% in cycle 1 to 62% in cycle 2. Completion of ECGs increased from 61.5% in cycle 1 to 79.3% in cycle 2. Urinalysis completion rate increased from 25.6% in cycle 1 to 44.8% in cycle 2.
Conclusions: Completion of physical health assessments were suboptimal resulting in the development of recommendations leading to some improvement. There is a clear need to further improve practice and this data can inform policy and guidelines to improve physical health assessments on a GAU.
Contact e‐mail address:
I‐EV016. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV016.1. EVALUATION OF THE IMPLEMENTATION OF A HOTLINE IN PAEDIATRIC HEPATOLOGY, GASTROENTEROLOGY AND NUTRITION
Thibault Lassalle1, Emma Wischlen2, Nicolas Caron2, Eduardo Couchonnal2, Rémi Duclaux‐Loras2, Sophie Heissat2, Helene Jeanpetit2, Irene Loras‐Duclaux2, Stephanie Marotte2, Pierre Poinsot2, Barbara Rohmer2, Mathias Ruiz2, Anais Sierra Torre2, Noemie Laverdure2, Noel Peretti 3
1Service Hépatologie ‐ Gastroentérologie ‐ Nutrition Pédiatrique, CHU Lyon HCL ‐ GH Est‐Hôpital Femme Mère Enfant, Bron, France, 2Service Hépatologie ‐ Gastroentérologie ‐ Nutrition Pédiatrique, CHU de Lyon HCL ‐ GH Est‐Hôpital Femme Mère Enfant, Bron, France, 3Service Hépatologie ‐ Gastroentérologie ‐ Nutrition Pédiatrique, CHU Lyon HCL ‐ GH Est‐Hôpital Femme Mère Enfant, lyon, France
Objectives and Study: Medical subspecialization, and improved survival rates for patients with complex chronic diseases have led to an increased demand for specialized consultations from both healthcare professionals and patients. To address this growing need, a telephone consultation line (Hotline) was created in 2022 for urgent medical advice for families and professionals dealing with pediatric Hepato‐Gastroenterology and Nutrition problems. This study aimed to describe the activity on this Hotline and its evolution during the second year of use to optimize its functionality.
Methods: This descriptive, monocentric, retrospective study included all calls received from January 1 to December 31, 2023. Calls were categorized by reason (medical or non‐medical), patient status (new or chronic), type of caller (family, physician, or other), call origin (internal or external), and management type (hospitalization, follow‐up, or other). Descriptive statistical analysis was performed, with results expressed as total numbers (percentages) and average ages (minimum‐maximum).
Results: A total of 1,762 calls were included, with 68.7% being medical and 30% non‐clinical (certificates, prescriptions), including 6.9% unjustified calls. The average age of children was 7 years, with two‐thirds under 10. New patients accounted for 35.6% of requests, with 65.6% not requiring specialized care. Among those needing specialized care, 14.4% were hospitalized, and 21.5% initiated follow‐up. External calls predominated (57.5%), with 24.7% from patient families. Gastroenterological issues constituted 46% of the consultations, with Hepatology and Nutrition representing 36.2% and 17.6%, respectively. The second year showed a 15.85% decrease in calls and a reduction in unjustified calls of 7%.
Conclusions: The implementation of hotline effectively addresses a significant number of specialized advice requests from both caregivers and families, facilitating quicker management. Although the second year showed improvements in unjustified calls, user education and better organization of calls are essential for optimizing functionality. Long‐term analysis would provide insights into the effectiveness of these management measures.
Contact e‐mail address: thibault.lassalle@chu-lyon.fr
I‐EV017. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV017.1. EVALUATING MULTILINGUAL LARGE LANGUAGE MODELS FOR THE GI CLINIC
Bryce Schroeder, Thomas Wallach
Pediatric Gastroenterology, SUNY Downstate Health Sciences University, Brooklyn, United States of America
Objectives and Study: Large Language Models (LLMs) have revolutionized natural language interaction with computers, and are coming to be used in clinical practice. We expect the automation of many medical office tasks in the near future, and, in time, models may even be expected to answer medical questions within a defined scope. In order to verify their safety and accuracy, especially as a practice in a diverse city where many languages are spoken, and to compare various models objectively, a robust suite of publicly available testing instruments are needed. We intend to create specialty‐specific multilingual instruments, including one for GI which will be able to evaluate performance at tasks such as explaining colonoscopy preparation to patients.
Methods: We are using student and professional volunteers to create exemplary system‐patient interactions, and leverage procedural substitutions and large language models to create more variations on the interactions. The interactions feature tool‐use (i.e. function calling) behavior so that the model can learn to look up data (e.g. appointment schedules or patient education materials) to ground its responses and prevent confabulation. We will split our dataset into training and testing items, the latter being the basis for an instrument we will develop for comparing models. We are also developing our own fine‐tuned models based on existing function‐calling models availble to researchers.
Results: This project is in its early stages, but so far, but preliminary testing with off‐the‐shelf models has been encouraging with regard to their ability to handle medical office tasks and use tools to retrieve patient data in multiple languages used in our area. By the time of the conference, we hope to present data comparing the performance of various off‐the‐shelf tool‐using models.
Conclusions: AI and LLMs are rapidly becoming clinically important, but to avoid compromising patient safety we must have robust multilingual testing instruments to evaluate models and enable objective comparisons.
Contact e‐mail address: bryce.schroeder@downstate.edu
I‐EV018. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV018.1. THE CURRENT LANDSCAPE OF PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION TRAINING IN THE ASIA‐PACIFIC REGION: AN INTERNATIONAL SURVEY OF TRAINING CENTERS
Mu‐Ming Chien1, Kathleen Mcgrath2, Po‐Yee Leung3, Satoshi Nakano4, Vikrant Sood 5, Ruey Terng Ng6, Tae Hyeong Kim7, Chatmanee Lertudomphonwanit8, Andy Darma9
1Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan, 2Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia, 3Prince of Wales Hospital, The Chinese University of Hong Kong, Hongkong, Hong Kong PRC, 4Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan, 5Department Of Pediatric Hepatology And Liver Transplantation, Institute of Liver and Biliary Sciences, Delhi, India, 6Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia, 7Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea, Republic of, 8Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 9Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Objectives and Study: Published data on the status of pediatric gastroenterology, hepatology, and nutrition (PGHN) training centers in the Asia‐Pacific Region are lacking. Improving the understanding of this has the potential to enhance the future quality of care provided to an increasing number of children with PGHN conditions in this region.
Methods: An international multicenter cross‐sectional questionnaire based survey was conducted among Asia‐Pacific nations between August 2023 and July 2024 by the Asian Pacific Association of Gastroenterology Emerging Leaders Committee Pediatric Focus Group.
Results: A total of 43 responses were collected from 11 countries (figure 1). The majority of centers (58.14%) operated with < three full‐time specialists, while more than 80% of the centers maintained a ratio of no more than two trainees per specialist. The reported outpatient volume of the centers varied widely, but the inpatient volume was mostly 501‐1500 patients per year. Only about one‐third of the institutions (30.23%) had separate facilities for specialized PGHN wards for inpatient admissions. Motility procedures were available in 26 centers (60.47%), but a considerable number of these centers had a very low (≤10) volume of motility studies. Endoscopies and liver biopsies were available in almost all centers, while 50% of the centers reported fewer than 100 colonoscopies per year. While endoscopies are mostly performed by pediatric gastroenterologists, liver biopsies and intestinal ultrasounds are frequently performed by specialized radiologists. Twenty‐one centers (48.84%) perform liver transplantation, with nearly half (47.62%) conducting > 20 transplantations per year. Only two of the participating centers offer intestinal transplantation.
Conclusions: We provide the first overview of the current PGHN training centers in the Asia‐Pacific region, including specialist numbers, patient volumes, and available procedures during training. Notable gaps were identified in the infrastructure and training opportunities for colonoscopy, intestinal ultrasonography, and motility studies. Increased collaboration between training centers and adult gastroenterology departments may ameliorate this.
Contact e‐mail address:
I‐EV019. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV019.1. CLINICAL COMPETENCY LEVEL AND SATISFACTION RATE AMONG PEDIATRIC GASTROENTEROLOGY FELLOWS IN SAUDI ARABIA
Ghassan Sukkar
College Of Medicine ‐jeddah, KING SAUD BIN ABDULAZIZ UNIVERSITY HEALTH SCIENCE, jeddah, Saudi Arabia
Objectives and Study: • To Assess the competency and satisfaction level among our fellows across the Kingdome and provide practical insight into how to accomplish full evaluation to pediatric gastroenterology fellowship curriculum. •To evaluate the clinical competency level of fellows in different academic years. •To estimate the satisfaction rate among fellows regarding their program.
Methods: This is quantitative study type to determine the competency of activities comparing to traditional methods. It was done by questionnaire with five domains. All Fellowes in Peds GI of all levels irrespective to age and gender who are registered in Saudi counsel in all accredited centers. Internal reliability. Validated, and reliability test was done. Overall internal reliability (Cronbach's alpha=0.81).
Results: Response rate was 100%, all fellows completing the questionnaire.32 participants were included in final analysis.53% were female and 47% were male. Mean age were 33 years (SD = 2.7 Y).There were three levels in our program. Fellows level one n = 15 (47%).Fellows level two n = 9 (28%)Fellows level three n = 8 (25 %). Satisfaction rate was 90%, mean satisfaction level 4.5 (sd = 0.51). Activity satisfaction rate was 79 %. These fellows were distributed as following :Riyadh = 24 (75%),Jeddah = 5 (16%), Dammam 3 (9%).69% of our study populations were Saudi. Number of consultants were compliant to SCFHS recommendation. 72 % of the hospitals had more than three consultants and 28% had three consultant.
Conclusions: The questionnaire assessed in this study proved to be a valid and reliable tool to measure the knowledge on our ped GI fellowship program. High rate of satisfaction and agreement between fellow regarding their centers. Further studies need to compare our fellows with international fellows at north American centers which will give a great insight and more improve in our program.
Contact e‐mail address: DR_GHASSAN@HOTMAIL.COM
I‐EV020. Topic: AS04. INTERDISCIPLINARY/AS04b. Education/Training
I‐EV020.1. POCKET‐SIZED HAND‐HELD ULTRASOUND FOR EVALUATING PEDIATRIC FUNCTIONAL CONSTIPATION BY BOTH NOVICE AND EXPERT CLINICIANS
Pola Waissman 1, Ron Berant2, Lisa Amir3, Shimon Reif4, Shmuel Springer1
1Neuromuscular And Human Performance Laboratory, Department Of Physiotherapy, Ariel University, Ariel, Israel, 2Sackler Faculty Of Medicine, Tel Aviv University, Tel Aviv, Israel, 3Department Of Pediatric Emergency Medicine, Schneider Children's Medical Center of Israel, Petah tikva, Israel, 4Department Of Pediatrics, Hadassah ‐Hebrew University Medical Center, Jerusalem, Jerusalem, Israel
Objectives and Study: Pediatric functional constipation (PFC) is commonly diagnosed using the Rome IV criteria, but its reliance on self‐reported symptoms presents challenges. Alternative methods, such as digital rectal examination (DRE) and X‐ray imaging, have limitations, highlighting the need for non‐invasive, objective tools. Point‐of‐care ultrasound (POCUS) enables real‐time assessment of rectal parameters such as transverse rectal diameter (TRD) and rectal anterior wall thickness (RAWT), which may reflect fecal retention and chronic rectal changes. While conventional ultrasound (US) has been validated for PFC assessment, the role of pocket‐sized ultrasound (PsUS) remains unclear. This study aimed to: Assess the validity of PsUS compared to conventional US. Evaluate agreement between expert and novice clinicians. Establish reference values for TRD and RAWT. Examine the temporal stability of these measurements over two weeks.
Methods: In this cross‐sectional study, 52 children aged 4‐14 (PFC, n = 28; non‐constipated, n = 24) were assessed using conventional US and PsUS at a Children's Medical Center. TRD and RAWT measurements were obtained by an experienced and a novice clinician. Agreement and validity were assessed using intraclass correlation coefficients (ICC), diagnostic accuracy through receiver operating characteristic (ROC) curve analysis, and temporal stability in a subset of participants after two weeks.
Results: PsUS showed excellent validity for TRD (ICC > 0.9) and good‐to‐excellent validity for RAWT (ICC = 0.87). Inter‐rater agreement was excellent for both parameters. TRD and RAWT demonstrated high temporal stability (ICC = 0.79–0.85 for TRD, >0.9 for RAWT). ROC analysis identified optimal diagnostic cut‐offs: TRD > 30.25 mm (AUC = 0.88) and RAWT < 2.05 mm (AUC = 0.91), with high sensitivity and specificity.
Conclusions: PsUS is a valid, reliable, and non‐invasive tool for PFC assessment, demonstrating strong agreement with conventional US and usability by clinicians with varying experience. Its portability and ease of use support broader accessibility for objective PFC assessment.
Contact e‐mail address: polaw.pt@gmail.com