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Abstracts / Digestive and L

Results. Main clinical differences between the two groupsre reported in table. First plasma Cit levels significantly cor-elated with bowel length (r2 = 0.21, p = 0.004). Median timeetween first and second plasma Cit evaluation was 5 months.

Discussion. In children with SBS plasma Cit strongly cor-elates with residual bowel length. Only in patients weanedff TPN during the study period, and therefore with tran-ient intestinal failure, plasma Cit level was >17 �M/l. In thisatients second Cit value was significantly higher than firstit value, while no differences was found in patients withermanent intestinal failure. Changes in plasma Cit levelseem to predict the duration of TPN.

In conclusion plasma Cit detection represents a useful tooln the follow-up of children with SBS, because it early predictnteral tolerance and duration of dependence to TPN.

ariables Group A Group B P (Mann–Whitney U-test)

edian bowel length (cm) 37.5 (15–80) 10.5 (4–15) <0.01edian TPN duration (days) 424 (300–1184) 1477 (754–3013) <0.01edian final citrulline value(�M/l)

51 (25–54) 13.5 (6–17) <0.01

oi:10.1016/j.dld.2008.07.210

P26SSOCIATION OF ELEVATED ALANINE-MINOTRANSFERASE WITH METABOLICACTORS IN OBESE CHILDREN: GENDER-ELATED ANALYSIS

. Di Bonito, G. Boccia, E. Sanguigno, T. Di Fraia, C.orziato, F. Saitta, M.R. Iardino, B. Capaldo

Dept. of Inter. Med., Dept. of Pediatrics, Dept. of Cl. Pathol-gy, “S. Maria delle Grazie”, Pozzuoli Hospital, Dep. Clin.xp. Med., Federico II University Naples, Italy

Alanine aminotransferase (ALT) elevations are consideredsurrogate of non-alcoholic liver disease and predict later

evelopment of diabetes and metabolic syndrome in adults.he aim of the present study is to evaluate the prevalence ofigh ALT levels in obese children using updated and gender-elated cut-off ALT value (ALT > 30 IU/L for boys and 19 U/Lor girls). We also analyzed the association of ALT levels withhe metabolic factors in the two sexes.

Materials and methods. The study population included58 obese children, 168 boys and 190 girls, with an age rangef 6–16 years, consecutively observed among subjects attend-ng the Outpatient Unit of the Pediatric Department. Inclusionriteria were: obesity, defined by an individual Body Massndex (BMI) ≥95th percentile for age and sex, negativity ofarkers for viral hepatitis, and no alcohol consumption. In

ll subjects were analyzed: Tanner stage, BMI in both parentsf obese children, BMI, waist circumference, blood pressure,LT, AST, fasting plasma glucose, cholesterol, triglycerides,DL-cholesterol, FT3, FT4 and insulin. HOMA-IR was cal-

ulated as index of insulin-resistance. The statistical analysis

elative to insulin, HOMA-IR, triglycerides, ALT, AST andT4 was applied after log-transformation.

Ca

ease 40 (2008) A41–A118 A63

Results. The percentage of obese children with elevatedLT was 36% in boys and 55% in girls. Obese boys withLT > 30 IU/L showed higher mother’s BMI (P < 0.025),MI, waist circumference, HOMA-IR (P < 0.0001, for all),

ystolic and diastolic blood pressure (P < 0.025, for both)ompared to those with ALT ≤ 30 IU/L. ALT levels corre-ated positively with BMI mother’s (P < 0.001), BMI, waistircumference, HOMA-IR (P < 0.001, for all), triglyceridesP < 0.05) and blood pressure (P < 0.01). At linear regressionnalysis, waist circumference resulted the only independentactor associated with ALT level (beta = 0.370, t = 3,905,< 0.0001).Obese girls with ALT > 19 IU/L exhibited lower age

P < 0.025), Tanner stage (P < 0.05), and higher triglyc-rides (P < 0.0001) than girls with ALT ≤ 19 IU/L. ALTevels correlated positively with triglycerides (P < 0.0001)nd HOMA-IR (P < 0.025) and negatively with age, andanner stage (P < 0.025). At linear regression analysis, ALT

evels was independently associated only with triglyceridesbeta = 0.330, t = 4.588, P < 0.0001).

Conclusions. A high proportion of obese children presentlevated ALT levels. This abnormality is associated, in boysore than in girls, with several components of the metabolic

yndrome.Our observations underscore the need to adopt gender-

elated cut off of ALT levels also for children. Prospectivetudies will verify the predictive power of these limits.

oi:10.1016/j.dld.2008.07.211

P27MPACT OF THE THERAPY ON HEALTH-RELATEDUALITY OF LIFE IN PAEDIATRIC PATIENTSITH INFLAMMATORY BOWEL DISEASE

.S. Basso a, F. Bracci a, Di Ciommo b, B. Papadatou a, A.iamanti a, A. Daniele a, C. Noto a, D. Baldini c, M. Castro a

Gastroenterology Unit, Children Hospital “Bambinoesù”, Rome, ItalyEpidemiology Unit, Children Hospital “Bambino Gesù”,ome, ItalyASL RMD DSM District II, Rome, Italy

Introduction. Health-related quality of life (HRQOL)uestionnaires have been used to measure and to evaluatehe impact of a chronic illness and its treatment on patient.he morbidity associated and the therapies for inflammatoryowel disease (IBD) have the potential to profoundly affecthis patients, overall children and adolescents.

It has been recently demonstrated that dexamethasone,he most frequently steroid used in IBD, introduced as dex-methasone 21 P (DEX 21-P) into red blood cells (RBC)nd infused to the same patient, exerts therapeutical effect in

rohn Disease (CD) and ulcerative colitis (UC) in childrennd adolescents.

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The aim of this study was to assess the impact of two differ-nt therapeutic interventions on own perception of HRQOLn IBD patient.

Methods and materials. Children and adolescentsffected by IBD were divided in two groups: first group intandard therapy (5ASA and azathioprine); second group intandard therapy plus monthly infusions of autologous redlood cell loaded with dexametasone -21P, because of theirependence.

Quality of life was assessed by a self-administered ques-ionnaire, Short Form 36 Health Survey (SF-36), that allubjects completed. The SF-36 is divided in two majorroups physical and mental, which include 7 domains.ann–Whitney U-test was performed to compare theRQOL between the 2 groups of IBD patients.Results. A total of 76 IBD patients followed at our Gas-

roenterology Unit aged 8-18 years were included. Amonghem 35 were affected by CD and 41 by UC (42 boys, 34irls). 56 patients were treated with the standard therapy and0 with standard therapy plus the infusions of autologousBC loaded with DEX 21-P (11 CD and 9 CU). No sig-ificant differences were found between the two groups forhysical and mental indexes (median 77, IQR 63–81 versus5, IQR 70–94 p = 0.07, and 71, IQR 52–82 versus 74, IQR0–89 p = 0.5 respectively).

Regarding the different domains, perception of generalealth was significantly lower in the group of patients treatedith the infusions of autologous RBC loaded with DEX-21P

n comparison to the group treated with standard therapy.o other significant differences were found in other domains

Physical Functioning, Body Pain, Vitality, Social Function,motional and Mental Health).

Conclusion. Perception of general health seems to beower in the group of patients treated with the infusions ofutologous RBC loaded with DEX-21P. We can hypothesizehat these group of patients had more severe or active dis-ase, and the monthly hospitalization impacts on their generalealth. Future research should investigate to correlate theirisease activity with HRQOL.

oi:10.1016/j.dld.2008.07.212

P28NTI-GLIADIN, ANTI-ENDOMYSIUM AND ANTI-ISSUE TRANSGLUTAMINASE ANTIBODIES INHE SERUM OF CELIAC CHILDREN YOUNGERHAN TWO YEARS

. Tosco, M. Maglio, F. Paparo, B. Colicchio, A. Sannino,. Granata, V. Indolfi, V. Discepolo, L. Rapacciuolo, R.uricchio, R. Troncone

Department of Pediatrics and European Laboratory for the

nvestigation of Food-Induced Diseases, University FedericoI, Naples, Italy

Introduction. Anti-endomysium (EMA) and anti-ransglutaminase (anti-TG2) antibodies are very specific and

Mto

ease 40 (2008) A41–A118

ensitive tools for the diagnosis of celiac disease (CD). Datarom literature suggest a less sensitivity of such antibodies inatients younger than two years.

Aim of the study. To evaluate the sensitivity of differ-nt serological markers for CD in children younger than twoears.

Patients and methods. The study involved 359 children100 aged less than 2 years) who underwent a small intestinaliopsy in our Department from January 2000 to Decem-er 2007. In all of them the diagnosis of CD was based onhe finding of intestinal mucosa villous atrophy and clinicalmprovement on gluten-free diet. The serum of 265/359 chil-ren was analysed to evaluate the levels of antigliadin (AGA),MA and anti-TG2 antibodies.

Results. AGA IgA antibodies were positive in 232/265atients, while AGA IgG in 204/265; moreover EMA wereresent in 252/265 children; finally, anti-TG2 were higherhan the cut off in 250/265 patients. Evaluating these anti-odies according to the age, we observed that in the groupf patients younger than two years, 92/100 (92%) presentedigh levels of AGA IgA and 96/100 (96%) of AGA IgG. Inhe group of patients older than two years, 140/165 (85%)howed high levels of AGA IgA and 108/165 (65%) of AGAgG. The presence of EMA was found in 90/100 (90%) chil-ren in the first group, and in 162/165 (98%) children in theecond group. Finally, levels of anti-TG2 higher than the cut-ff were found in 91/100 (91%) patients younger than twoears and in 159/165 (96%) of the older children.

Conclusions. Our experience confirms that EMA and anti-G2 antibodies are a more accurate diagnostic tool in childrenlder than two years compared to those of younger age. Inhis last group of patients. AGA IgA have still an importantole for the identification of children with CD.

oi:10.1016/j.dld.2008.07.213

P29NTI-TISSUE TRANSGLUTAMINASE ANTIBODIESND INFECTIOUS DISEASES IN CHILDREN

. Pastore, S. Quaglia, F. Ferrara, S. Martelossi, A. Ventura,

. Not, R. Giorgi

IRCCS Burlo Garofolo, Pediatric Department of Trieste Uni-ersity, Trieste, Italy

Background. A considerable interest focus on the hypoth-sis that some pathogens which share antigenic determinantsith gliadin or tissue transglutaminase enzyme might lead to

he development of celiac disease in susceptible individualshanks to a mechanism of molecular mimicry.

Aim. In this study we verified the relationship between thecute infectious diseases and the presence of serum anti-tTGntibodies.

Methods. We prospectively enrolled 154 children (fromarch to August 2007), suffering from fever and gas-

rointestinal or respiratory complaints at emergency servicef our children’s hospital. 154 sera samples were tested