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North American Society for Pediatric Gastroenterology, Hepatology, And Journal of Pediatric Gastroenterology and Nutrition 45:E1–E90 # 2007 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Abstracts North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Annual Meeting October 25–27, 2007 Salt Lake City, Utah POSTER SESSION I colon. Furthermore, the patient’s colitis is indeterminate. THURSDAY, OCTOBER 25, 2007 Although no known patient with DC-associated IBD has ever been treated with infliximab, the patient has shown signifi- 5:00 PM – 7:00 PM cant improvement on this regimen. This case has significant implications for the role of the fecal stream in the pathogenesis of Intestine/Colon/IBD IBD and illustrates the systemic dimensions of a local disease. 1 2 INFLAMMATORY BOWEL DISEASE ASSOCIATED WITH A NEOVAGINA IN A PEDIATRIC PATIENT IS CBir1 A PREDICTOR OF PEDIATRIC Jonathan M. Gisser, Rebekah Slocum, Robert L. Parry, INFLAMMATORY BOWEL DISEASE? Jeffrey A. Morganstern1, Taaha Shakir2, Anupama Chawla1. Raymond W. Redline, Gisela G. Chelimsky, Reinaldo 1 Pediatrics, University Hospital Rainbow Pediatrics, Division of Gastroenterology, Stony Brook Garcia-Naveiro. 2 Babies and Children’s Hospital, Cleveland, OH. University Medical Center, Pediatrics, Stony Brook, NY. Case: A 30-month-old caucasian girl presented with a one week Aim: Review charts of all pediatric patients at Stony Brook history of abdominal pain, fever, hematochezia and vaginal University Medical Center who underwent CBir1 (anti-flagellin) discharge. She had a congenital cloacal malformation that was testing to assess its diagnostic value for inflammatory bowel repaired in infancy with construction of a neovagina made from disease (IBD). a segment of her descending colon and a rectal pull-through. Methods: Forty patients were tested for the CBir1 marker since On admission, she was passing bloody stools from her it became available. Ages ranged from 6–19 and genders neorectum, and a bloody discharge from her partially prolapsed were 48% male, 52% female. The most common indications neovagina. She had hypoalbuminemia, leukocytosis and a were abdominal pain, irregular bowel habits, and hematochezia. markedly elevated inflammatory bowel disease (IBD) serolo- Sensitivity, specificity, and positive/negative predictive values gical marker (pANCA 192 EU/ml). Endoscopic examination were calculated. Diagnosis was based on interpretation of the revealed gastritis, duodenitis and colitis consistent with IBD. complete workup by a pediatric gastroenterologist. Her neovaginal inflammation, however, was more severe than Results: Twenty patients (50%) had positive CBir1 antibodies, her colonic disease. After a prolonged course, complicated above the cutoff of 21 EU/mL. Of this subgroup, 9 were diag- by Clostridium difficile neovaginitis and a poor response to nosed with IBD (PPV 45%). Seven of these 9 were also positive immunomodulator therapy with azathioprine, she improved for one of the more traditional markers (ASCA/OmpC/pANCA). on a regimen of subcutaneous methotrexate, intravenous inflix- Ten patients were positive for only CBir1, with no other IBD imab, and topical metronidazole to her neovagina. markers. In this group, only two patients were diagnosed with Discussion: This is an unusual case of probable diversion colitis IBD (PPV 20%). Eleven (48%) of the 23 patients without IBD (DC) associated with IBD. DC involves a segment of bowel were CBir1 positive. that has been diverted from the alimentary tract, such as a Conclusion: CBir1 is a poor predictor for IBD, compared to neovagina, and is treated by restoring bowel continuity. It is a ASCA. Combining the two markers improved overall sensi- relatively common occurrence among patients with sigmoid tivity and negative predictive value but specificity and positive neovaginas. However, there are only five reported cases of adult predictive value remained low. The above data are limited by patients with DC developing ulcerative colitis in the in-stream sample size and the duration offollow-up; therefore, evaluation of bowel. Ours is the youngest case of DC-associated IBD, and the a larger cohort of patients is warranted. While CBir1 may have only one involving the stomach and small bowel, in addition to the other uses, its utility as a diagnostic test for IBD in the pediatric patient appears to be limited due to a large number of false positive results. Until further studies are completed, we recom- ÃPosters of Distinction. mend exercising caution in interpreting positive CBir1 results. E1 E2 Background: Serum antibodies are associated with Crohn’s CBir1 ASCA ASCA + CBir1 disease (CD), correlate with disease location, and predict dis- Sensitivity 53% 41% 76% ease phenotype. The aim of this study was to determine Specificity 52% 96% 52% relationships between serum antibodies and growth parameters PPV 45%à 88% 54% in newly diagnosed pediatric CD. NPV 60% 69% 75% Methods: A retrospective review was conducted on children ÃPPV of CBir1 in patients with no other positive markers is 20%. diagnosed with CD from 2003–6. All children who underwent IBD First Step (Prometheus Laboratories, Inc.; San Diego, CA) were included. Height (Ht), weight (Wt), and BMI prior to diagnosis and therapy were converted to Z-scores for age 3 and gender. Children with IBD Predicted, CD Predicted, GASTROINTESTINAL NOROVIRUS INFECTION and children with the presence of specific antibodies were ASSOCIATED WITH EXACERBATION OF compared to children with IBD Not Predicted using unpaired INFLAMMATORY BOWEL DISEASE t-tests. John N. Udall, Raheel R. Khan, Amana N. Nasir, Kathleen J. Results: 72 patients met inclusion criteria. Newly diagnosed Martin, April D. Lawson. Pediatrics, WVU Health Sciences CD patients with IBD Predicted and/or CD Predicted results had Center, Charleston Division, Charleston, WV. significantly decreased Ht and Wt Z-scores compared to newly diagnosed CD patients with IBD Not Predicted result. Patients Introduction: Norovirus is a common cause of acute gastro- with a positive ASCA IgA or IgG had significantly decreased enteritis in children and adults. The pathogenesis of Norovirus Wt and BMI Z-scores compared to those with IBD Not infection is poorly understood because the virus does not grow Predicted. Patients with a positive Anti-OmpC IgA had a well in cultured cells, and there is no commonly accepted small significantly decreased Ht Z-score compared to those with animal model to study the virus (Science 2003; 299:1575–8). IBD Not Predicted. Patients with a positive pANCA did not Infectious agents may be associated with exacerbations of inflam- differ from patients with IBD Not Predicted. matory bowel disease (IBD); however, there have been no reports Discussion: This study correlates growth parameters at diagnosis suggesting Norovirus may be associated with the disease. with serum antibodies in children with inflammatory bowel Methods: We performed a retrospective chart review of 8 IBD disease, and provides evidence that certain subsets of chil- patients with exacerbations since November 2006. We ident- dren diagnosed with CD are at greater risk of growth ified those with Norovirus documented by the presence of impairment. Norovirus antigen in stool samples and/or rectal swabs. Type of IBD, gender, age, presence or absence of diarrhea/hemato- Mean Anthropometric Z-scores in Patients With Newly chezia and the need for hospitalization was assessed. The charts Diagnosed Crohn’s Disease of six non-IBD patients seen in clinic who had Norovirus positive diarrhea were used as controls. IBD first step n Mean height Mean weight Mean BMI Results: Of the IBD patients; 6 had UC, 1 had CD and 1 panel result z-score z-score z-score indeterminate colitis. All eight IBD patients presented with bloody diarrhea. Two patients also had other pathogens in the All Patients 72 À0.33 À0.54 À0.41 stool including adenovirus and/or Clostridium difficile at the IBD Not Predicted 14 0.29 0.08 À0.08 à à IBD Predicted 58 À0.50 À0.69 À0.49 time they tested positive for Norovirus. All control group à à CD Predicted 51 À0.61 À0.99 À0.82 patients experienced diarrhea, however no hematochezia was à à ASCA IgA + 37 À0.40 À0.77 À0.69 noted. No control group patients required hospitalization. à à ASCA IgG + 24 À0.32 À0.97 À0.90 Conclusion: We conclude that Norovirus may be associated à OmpC IgA+ 21 À0.80 À0.88 À0.28 with exacerbations of IBD. When Norovirus accompanies IBD pANCA + 18 0.19 À0.26 À0.27 it appears more likely to be associated with hematochezia and à require hospitalization than when the infection occurs in the P < 0.05 compared to IBD Not Predicted. absence of IBD. Whether the virus initiates or contributes to the severity of an exacerbation or is a ‘‘bystander’’ during an exacerbation is not known. 5 AN EDUCATION PROGRAM FOR ADOLESCENTS Mean age Hospital WITH INFLAMMATORY BOWEL DISEASE Groups Sex (range) Diarrhea Hematochezia admission Lynelle M. Boamah1, Janet Bohren2, Raymond Baker1, Susan Moyer1. 1Cincinnati Children’s Hospital, Cincinnati, OH; IBD 5M/3F 14 y (10–17 y) 8 of 8 8 of 8 4 of 8 2University of Cincinnati. Non-IBD 5M/1F 13 y (10–18 y) 6 of 6 0 of 6 0 of 6 Background: 25% of patients with inflammatory bowel disease 4 (IBD) are diagnosed in childhood, particularly adolescence. Adolescents lack IBD-specific knowledge. There are no edu- SERUM ANTIBODIES AND GROWTH PARAMETERS cational programs for adolescent patients with IBD. AT DIAGNOSIS IN PEDIATRIC CROHN’S DISEASE Hypothesis: A well-designed education program for adoles- Anna Trauernicht, Steven Steiner. Indiana University School of cents with IBD using an interactive CD-ROM will significantly Medicine, Indianapolis. improve IBD-specific knowledge. J Pediatr Gastroenterol Nutr, Vol. 45, No. 4, October 2007 E3 Methods: IRB approval and informed consent/assent was Background: The diagnosis of Inflammatory Bowel Disease obtained. Assessment of baseline IBD knowledge was performed (IBD) is based typically on endoscopy and mucosal biopsy.
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