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Treatment of Childood Chronic Inflammatory 7 COMPARISON IN A SMAE PATIENT OF SHORT, MIDDLE AND LONG lERM CHANGES IN SERUM AND INTESTINAL DIIWIINE OXIDASE PH-METRY RECORDING‘, IN THE PRESENCE OR ABSENCE OF A CASTKO- ACTIVITY (DAO) AUSR PIIOXIMAL ENTERECT0I.n' IN Icn'l'S : ESOllACEAL REFLUX (CER) IN I'HILDREN 5 n.C.Bolli C. Le Coultre. Laitroenterology and Nutrition Unit 8 CORRELATION WITB MUCOSAL MASS PAWMETERS. Departmen; of Pediatrics, University of Crneva, Hopital Cantonal J.P. BUTS, S. TtlEYS. Lab. of Paed. Gastrocntcrology Universitaire, 1211 Geneva 4, Switzerland. and Nutrition, University of Louvain, Brussels, 0el:ium. Long-term esophageal pH-metry has become the reference test to quantify acid CER. To assess u:.ctl;cr serum and mucosal DAO activity reflects Nevertheless, short-, middle- and long-term pH-metry withor without postcibal quantitative changes in the small bowel mucosal mass (SHMM), a 50% period are used by clinlcidns to diagnose the presence or absence of CER. To proximal entcrectomy or a single Lranscction was pcriormed in 20 detrt-"line the reliability of each recor.ding period, 35 children ("8 = 4.1 yr; 1 mth-16.5 y1.s) werc studied prospectively during the paat year an the babis , growing rats. Ten days after surgery, hypcrplasia of SEMM was of a clinical suspicion. All patients experienced a 221,-recording pH-metry, demonstrated in each segment of the remaining gut (A : duodenum; which was scanned subsequently by a PROXEDA softriare in 3h, 6h, 1Zh after B : proximal and C : distal ileum). Mucosal weight, protein and insertion of the probe, 1211 noctu~.nal (12hn) and 3h postcibal 13hpc). This technique allowed us to analyze in a sanbe patient the ditferent recording DNA content pcr cm were +38 to c78Z higher (p < 0.01) in the intervdls. resected group than in transectcd controls. In segments I3 and C oE Results: 16 children Igr' A1 had patholoqical pHwetry (b rcflux time : 15.5 resrcLed rats, total DAO activity was also incrcascd rcspcrtivcly Tn(4'6) and 19 lgr 0) were normal (1.9 i 0.3%) using 22 h recording, The by +141% (p 0.05) and by +87% 0.01) over the controls, mean age of both groups was not statistically different. The clearance time < (p < of CER 13.3 * 0.5 vr 1.7 t 0.3 #sin) and the number of reflux episodes 15 "tin wl~creas in sr?gment A, cllangcs in DAO werc small (+38%, n.s.1 and (0.40 * 0.10 vs 0.08 t 0.01 episode/hrl were hignificantly higher in gr A not signil'icant. Io thc ilcum (U and C), there were significant (p( .Dl). The reliability of the different recording periods is tabulated below.; -------------------------------------------------------.----..-----.-------------correl.ltions between total DAO and cither mucosal weight (r = 0.75, p < 0.01) or mucosal DNA concentration (r = 0.78, p < 0.01) but not between DAO and sucrase activity. Coinpared to transected rats, the Sensitivity 1%) 69 * 69 * 81' 63# 38P mean value of serum DA0 was 5 fold higher in the rcscctcd group Specificity ('8) 74 * 68 * 68 * 100' 74* -.----.------------------------------------------.-----------------.-------------(P < 0.005). In conclusion : after jejunectomy : (1) intestinal DAO activity * : p ( .025 vs 22h; U : p ( .O1 us 22h; a : "on significant reflects accurately quantitativc cl~anges of the SBlM in the ilcum In sunmary, this prospective study formally showed that short- and middle-term but not in the duodrnu~n (2) serum levels of DAO rould be a useful pH-metry, rliurnal and/ornocturnal, as postcibal recordings, disclosed too many marker for ileal mucosal ad;;ptation. falre positive or false negative reaulta. Consequently, the long-term pH-mrtry reinains an obligation. THE EFFECT OF CALCIUM AND CHLORIDE CHANNEL BLOCKERS ON THE DOES DIETARY FAT ACFFCT TllF SE\'CI:ITY Or Cll1l.D~lOCD MOVEMENT OF ANTIBODIES AND ALBUMIN IN THE RAT INTESTINE 0 DIV??HOEA? S.Freier, M.ERan, J.Fdber, The Snaare Zedek Medical Centre, 7 Jerusalem, Israel. P. ~c~lean',FA saqherl, T. ~khtar', JA nodgel, We have previously shown that chloecystokinin (CCK) accerlerates the movement J~e~artmentof Child Health, Queen's University, Be1 fast and of imurloglobulins acro3s the intestinal rnucosa. This study investigates save Pakistan Medical Research Counci 1, Peshawar. mechanisms of this phenomenon, Hooded-Lister rats 1160-180 g) were sensitized Absorption of fluid and electrolytes in the snall intestine of with 250ng Ovalbumin with Frcund's complete adjuvant. On the lltth day a booster injection was given. On the 2lbt day the rats were anaeit1,etised and 0.5nCi young rats can be considerably improved by giving them a diet rich radiodinatcd human serum albumin was given i.v. A segment of inteatine 10 cm in polyunsaturated fatty acids. Our laboratory studies show that long was isolated 10 cm, distal to the pylorus and perfused with 0.9% NaCl at a dietary fatty acid profile is reflected in the corzposition of the rate of 0.5 ml/min. The calcium channel blocker, Verapamil (50 g/ml) was injected i.v. 0.025 ml ll ng) every 30 sccundb for 20 ~nins.Ten rmin-. after red blood cell membrane and also that of the small intestinal 5tarLing Verapamil, 20 ng of CCK-octapeptide (CCK-OPI was given i.v. A control epithelium. group received CCK-OP only. While in the control group there was a 20'6 rise of To find out wl~et!lerthese animal studies have clinical IgA and a 15'8 rise of ICC (P(0.01) dbove baseline, Verapamil prevented this change. A second group received 0.2 mg of the chloride channel blocker, relevance we have examined the fatty acid profile of red blood Furosernide (F) i.v. and 0.5 mg in the perfusate. F. also prevented the CCK- cells in 44 children from Northern Ireland with diarrhoea and 32 induced rise of antibodies. The difference between the treated and the control controls, and compared them with those of Pakistani children (28 groups remained significant for about 12.5 minutes. The loss of albumin at 2.5 minutes was 358 above the baseline after CCK and only 13% above if F. was added with diarrhoea and 14 controls), among whom diarrhoeal illnesses before the CCK (P ( 0.001). It is concluded that 11 CCK provokes an increased are more severe. Significant (D 0.05) differences in RBC fatty shift of albuntin, IgA and IgC into the lumen of the intestine. (2) CCK causer acid composition were observed between the Irish and Pakistani a rise of cystolic calcium. (3) CCK-induced translocation of albumin, IgC and IgA is prevented by F. children, with a higher proportion of saturated fatty acids and a lower proportion of polyunsaturated essential fatty acids in the Pakistanis. These findings are consistent with the view that a relatively high intake of polyunsaturated fatty acids improves fluid and electrolyte absorption and protects against secretory diarrhoea in humans as well as in rats. They may have imnortant implications for the rehabilitation of children with diarrhoeal illnesses and malnutrition in developing countries. TREATMENT OF CHILDOOD CHRONIC INFLAMMATORY IS CELIAC DISEASE A PREMALICbIAbIT STATE? 7 BOWEL DISEASE WITH 7s-IMMUNOGLOBULIN C.Dinari, H.Marcus, 1.Zahavi. C.Moror 10A Pediatric CI Unit and Roaotf Institute of Medical Rr~carch .. Deilinson Medical Centre, Petal Tiqva, Isr.lcl M Teufell , KH Niessenl , R Behrensz , A Wolf3, Placental ibofcrritin (PLF) is a tumor-associated antigen present in the L Reinken', HD Oldigsn , HG Posseltb , HW Rotthauwe7. serum of patients with active Hodgkin's and non-Hadgkin's lysphama, and its J Sartoris' , H Skopnika , levels derrrase during remission of the diseabc. Because of the strang Univ.-Kinderkliniken LMannheim, ZErlangen, 3Ulm, 'Ham, association between celiac disease (CD) and lymphoma, we screened 19 children with active CD and 25 with inactive CD for the presence of PLF. 32 children DKiel, 'Frankfurt, 'Bonn, aAachen, F.R.G. wit17 other GI disorders served as controls. PLF was identified by using a monoclonal antibody which binds exclus~velyto PLF in an ELlSA procedure. Preliminary reports suggest that intravenous immuno- The mean age of the children was 8+/-1 .1 years. globulins may be helpful in the treatment of adult Inactive CD Activc CD Controls patients with Crohn's disease (CD) and ulcerative colitis (UC; Lancet 1:170, 1987). However, the effi- 43.8+/- 10.2 117+/- 22.8 14+/- 2.8 cacy of this treatment in children with chronic p = 0.03 p = 0.0004 REsults are expressed in U/ml. as the mean+/-SE, and demonrtraLe a high level inflammatory bowel disease (IBD) is unknown. Therefore of PLF during active disease, which decreases during remiasion on a gluten free 18 patients with histologically confirmed IBD (CD=12, diet (CFO). Immune staining of intestinal biopsies demonstrated that PLF UC=6) were treated by 7s-Immunoglubulin (0.4 g/kg for originated in the lamina propria lymphocytes. PLF is known to suppress T cell function and imunosuppressin during active CD may be one of the necessary 7 consecutive days) in 8 pediatric hospitals in the steps in the development of malignancy. CFD, by reversing this state, might P.R.G. 10 children suffered from relapses and 8 from prevent the development of lymphona. This is the flrst report of a marker newly diagnosed IBD. 5 patients showed a marked im- fur the possible premalignant state in children with active CD. provement already short time after therapy was started. 4 children have still been in remission for several months. In contrast 13 children did not benefit from the immunoglobulins. 4 of them even deteriorated and needed additional treatment with 5-ASA and steroids. Side effects of the therapy with immunoglobulins were anaphylaxis (lx) and fever (lx).
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