COMPARISON IN A SMAE PATIENT OF SHORT, MIDDLE AND LONG IEKM CHANGES IN SERUM AND INTESTINAL DIIWIINE OXIDASE PH-METRY RECORDING‘, IN THE PRESENCE OR ABSENCE OF A CASTKO- ACTIVITY (DAO) AITSR PIIOXIMAL ENTEKECTOFPI IN IWI'S : ESOllACEAL REFLUX (CER) IN I'HILDREN 5 n.C.Bolli C. Le Coultre. Lditroenterology and Nutrition Unit 8 CORRELATION WITtl MUCOSAL MASS PAWTERS. Departmen; of Pediatrics, University of Crneva, Hopital Cantonal J.P. BUTS, S. TtlEYS. Lab. of Paed. CastrocnLcrology Universitaire, 1211 Geneva 4, Srritzerland. and Nutrition, University of Louvain, Brussels, Dcl-ium. Long-term esophageal pH-metry has become the reference test to quantify acid CER. To assess u:.ctl;cr serum and mucosnl DAO activity reClccts Nevertheless, short-, middle- and long-term pH-metry withor without postcibal quantitative changcs in the small bowel mucosal mass (SHMM), 3 50% period are used by clinicidns to diagnose the presence or absence of CEK. To proximal entcrectomy or a single transection was pcrCormed in 20 detrt-sine the reliability of each recot.ding period, 35 children (r = 4.1 yr; 1 mth-16.5 y1.s) werc studied prospectively during the paat year an the babis , growing rats. Ten days after surgcry, hypcrplasia of SEMM was of a clinical suspicion. All patients experienced a 2211-recording pH-metry, demonstrated in each segment of the remaining gut (A : duodenum; which was scanned subsequently by a PROXEDA softviare in 3h, 6h, 12h after B : proximal and C : distal ileum). Mucosal weight, protein and insertion of the probe, 1211 noctu~.nal (12hn) and 3h postcibal (3hpc). This technique allowed us to analyze in a same patient the ditferent recording DNA content pcr cm were +38 to +782 higher (p < 0.01) in the intervdls. resected group than in transectcd controls. In segments U and C of Results: 16 children (gr' A) had patholoqical pH-metry (b rcflux time : 15.5 rcsccled rats, total DAO activity was also incrcascd rcspcrtivcly -"('I%) and 19 (gr 01 were normal (1.9 i 0.3%) using 22 h recording, The by +141% (p 0.05) and by +87% (p 0.01) over the controls, mean age of both groups was not statistically different. The clearance time < < of CER (3.3 * 0.5 vr 1.7 t 0.3 sin) and the number of reflux episodes 15 "tin wl~creasin segment A, cllangcs in 1)AO were small (+38X, n.s.1 and (0.40 t 0.10 vs 0.05 t 0.01 episode/ltr) were bignificantly higher in gr A not signil'icant. Io thc ilcum (U and C), thcre werc significant (pi .01). The reliability of the different recording periods is tabulated below.; correl.itions bctween total DAO and citl~ermucosal weight (r = 0.75, p C 0.01) or mucosal DNA concentration (r = 0.78, p < 0.01) but not between DAO and slicrgse activity. Compared to transected rats, the Sensitivity (Pa) 69 * 69 * 81' 63# 38P mean value of serum DA0 was 5 fold higher in thc rescctcd group Specificity ('8) 74 * 68 * 68 * 100' 74* -.----.------.------.------.------.------(p < 0.005). In conclusion : after jejunectomy : (1) intestinal DAO activity ( U a * : p .025 vs 22h; : p ( .O1 vs 22h; : no" significant reflects accurately quantitative clianges of tlie SBlM in the ileum In sunmary, this prospective study formally showed that sllort- and middle-term but not in the duodrnu~n (2) serum lcvcls of DAO could be a useful pH-metry, diurnal and/ornocturnal, as postcibal recordings, disclosed too many marker for ileal mucosal ad;~ptation. falre [lositive or false negative reaulta. Consequently, the long-term pH-mrtry rei~lainsan obligation.

THE EFFECT OF CALCIUM AND CHLORIDE CHANNEL BLOCKERS ON THE MOVEMENT OF ANTIBODIES AND ALBUMIN IN THE RAT INTESTINE

S.Freier, M.ERan, J.Fdber, The Snaare Zedek Medical Centre, Jerusalem, Israel.

We have previously shown that chloecystokinin (CCK) accerlerates the movement J~epartmentof Child Health, Queen's University, Be1 fast and of imurloglobulins across the intestinal rnucosa. This study investigates save Pakistan Medical Research Counci 1, Peshawar. mechanisms of this phenomenon, Hooded-Lister rats (160-180 g) were sensitized Absorption of fluid and electrolytes in the sn~allintestine of with 250ng Ovalbumin with Frcund's complete adjuvant. On the 14th day a booster injection was given. On the Zlbt day the rats were anaeitlretised 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 tbat 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 conposition of the rate of 0.5 ml/min. The calcium channel blocker, Verapamil (50 g/mll was injected i.v. 0.025 ml (1 ng) every 30 secundb for 20 ~nins. Ten rmin-. after red blood cell membrane and also that of the small intestinal StarLing Verapamil, 20 ng of CCK-octapeptide (CCK-OP) 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 wllet!~erthese animal studies have clinical IgA and a 15% rise of IGC (P(0.01) dbove baseline, Verapamil prevented this change. A second group received 0.2 mg of the chloride chani8el 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 diarrhoea controls), among whom diarrhoeal illnesses minutes was 358 above the baseline after CCK and only 138 above if F. was added with and 14 before the CCK (P ( 0.001). It is concluded that 1) 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 i~nplicationsfor the rehabilitation of children with diarrhoeal illnesses and malnutrition in developing countries.

TREATMENT OF CHILDOOD CHRONIC INFLAMMATORY IS CELIAC DISEASE A PREMALICbIAbIT STATE? BOWEL DISEASE WITH 7s-IMMUNOGLOBULIN C.Oioari H.Marcus, I .Zahavi, C.i4oror 7 ~ediatriiCI Unit and Roaotf Institute of Medical Rr~carch 1A () .. Beillnson Medical Centre, Petal Tiqva, Isr~cl M Teufell , KH Niessenl , R Behrensz , A Wolf3, L Reinken', HD Oldigsa HG Posseltb HW Rotthauwe7 Placental ibofcrritin (PLF) is a tumor-associated antirjen present in the . , . serum of oatients with active Hodokin's and non-Hadokin's Ivsuhama. and its J Sartorisl, H Skopnika, levela de'rrrase during remission of the diseasc. Because of. the stiang Univ.-Kinderkliniken 'Mannheim, ZErlangen, 3Ulm, 'Hamm, 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. with other GI disorders served as controlb. PLF was identified by usinq a monoclonal antibody which binds exclus~velyto PLF in an ELlSA p;ocedu;e. 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 CO Activc CO Contrals patients with Crohn's disease (CD) and ulcerative colitis (UC; Lancet I: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+/-5E, and demonstrate a high level inflammatory bowel disease (IBDI is unknown. Therefore of PLF during active disease, which decreases during renliasion on a gluten free 18 patients with histologically confirmed IBD (CD=12, diet (CFO). Immune staining of intestinal biopsies demonstrated that PLF originated in the lamina propria lymphocytes. PLF is known to suppress T cell UC=6) were treated by 7s-Immunoglubulin (0,4 g/kg for 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 lymphana. This is the first 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). Further investiga- tions are necessary to determine the benefit of immunoglobulin therapy of childhood IBD.