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Annual Meeting 2020 Abstracts INCORPORATING JOINT STUDY DAY Platinum Sponsor WITH CYSTIC FIBROSIS TRUST FRIDAY 31ST JANUARY 2020 E&OE ANNUAL MEETING 2020 WEDNESDAY 29TH – FRIDAY 31ST JANUARY. THE DOME, CHURCH STREET, BRIGHTON ABSTRACTS Brighton Dome Thanks to all of our sponsors On behalf of BSPGHAN and the local organisers in Brighton, we are sincerely most grateful to all our partners for their contributions to the Annual Meeting. Our commercial sponsors and charitable organisations play an integral part in our meeting to complement the independently developed scientific programme. This interaction provides the opportunity to share and acquire knowledge in partnership for the mutual benefit of patient care. We are pleased to welcome established and new sponsors to our 2020 meeting providing some continuity but also variety with opportunity for new dialogue. Informed dialogue and open exchange of information are of key importance; it is with this spirit, that we encourage all delegates to take time to visit the exhibitors and to thank them for their continued support of our annual BSPGHAN events. ANNUAL MEETING BSPGHAN PLATINUM SPONSOR SILVER SPONSOR BRONZE SPONSORS POSTER IBD AWARD Dr Falk 29TH - 31ST JAN 2020 CHARITIES Children’s Liver Disease Foundation CICRA GUTS UK SPONSORED SYMPOSIA BSPGHAN Abstract Book Index: Plenary Abstracts: Session I Wednesday P3 Session II Thursday P11 Session III Friday P23 Posters selected for: BSPGHAN Best Poster Award P32 Dr Falk IBD Award P105 BSPGHAN Annual Meeting 29th – 31st January 2020, Brighton Abstracts RCPCH has approved this activity for CPD in accordance with the current RCPCH CPD Guidelines 1 Wednesday 29th January 2020 Plenary Session I Oral Abstract Presentations BSPGHAN Annual Meeting 29th – 31st January 2020, Brighton Abstracts RCPCH has approved this activity for CPD in accordance with the current RCPCH CPD Guidelines 2 12.10 – 12.20 Nabilone for Gastrointestinal Dystonia. A single centre case series Miss Michelle Brooks1, Dr Joseph Symonds2, Miss Sarah Bremner3, Dr Victoria Merrick1, Dr Diana Flynn1, Miss Christina McGuckin1, Mr Simon Fraser4, Miss Karen Fraser5, Mr Gregor Walker6, Mr James Andrews6, Mr Timothy Bradnock6, Dr Andreas Brunklaus2, Dr Katharine Forrest2, Dr Valerie Orr7 and Andrew Barclay1. 1Paediatric Gastroenterology, Royal Hospital for Children, Glasgow UK; 2Paediatric Neurology, Royal Hospital for Children, Glasgow UK;3Paediatric Dietetics, Royal Hospital for Children, Glasgow, UK; 4Paediatric Pharmacy, Royal Hospital for Children, Glasgow, UK; 5Admin Services, Royal Hospital for Children, Glasgow, UK;6Paediatric Surgery, Royal Hospital for Children, Glasgow, UK;7Paediatric Neurodisability, Royal Hospital for Children, Glasgow, UK In severe neurodisabling conditions the clinical constellation of pain behaviour, retching, bloating, abdominal distension and constipation/pseudo-obstruction can be referred to as gastrointestinal dystonia (GID)(1).The evidence base for effective therapies are very limited (1) and symptoms can remain disabling. Nabilone a synthetic analogue of the active component tetrahydrocannabinol (THC) found in cannabis has a licence in paediatrics for the treatment of severe chemotherapy induced nausea, however, as medical cannabis has also been implicated in the treatment of pain, spasticity, gastrointestinal upset and apetite stimulation, it has been hypothesised as a potential agent to treat GID. To date we are unaware of any published work reporting the use of Nabilone in GID. We aimed to describe our experience of using nabilone for patients with GID. Approval was sought on a named patient basis from the clinical directorate and head pharmacist on the basis that; patients fulfilled our criteria for GID (1), patients had been trialled on medical therapies, jejunal feeding and blended diet, concomittant medication reviewed in MDT including tone management and to review potential exacerbants to GID, all members of MDT were in agreement that trial of treatment was warranted. Patients were admitted for 48hrs of documentation of symptoms using modified paediatric pain score. TPR and overnight saturations were peformed pre and post treatment for 48hrs. With the potential for pre-existing neuro- respiratory depression, Nabilone was commenced below previously described paediatric dosing and then incremented in 250ug doses to a dosage of <18kgs: 500ug bd and 18-27kg: 500ug tds. Efficacy was assessed by parents and clinicians perception, PedsQL ver 3.0 (GI questions) and sleep diary, all performed prior to treatment and one month after stable dose. Global Peds QL scores analysed by paired student's t-test (p<0.05). 3 patients were treated - all male, 2.4-9yrs, 10.5-18kg, 2 cerebral palsy and 1 undiagnosed condition. Parents and clinicians perceptions were that treatment had improved symptoms. All patients had an increase in their Peds QL scores post treatment. Most significant increase in median scores were in the domains 'stomach discomfort when feeding' (5 to 85 (p<0.006)) and 'nausea and vomiting' (6.25 to 56.25 (P=0.02)). The patient with sleep disturbance was awoken a median of 3 times pre to once per night on treatment. Nabilone shows promise in treating GID , a poorly understood debilitating complication of severe neurodisability, in particular, symptoms of nausea and retching. Of note, two patients were being considered for parenteral nutrition for nutritional failure. Further evaluation of this treatment is warranted in clinical trials or on a further named patient basis. The authors advocate a wide MDT setting, with input from Gastroenterology, Surgery and Neurodisability. We currently reserve this for refractory patients for whom most known measures have been ineffective. The authors also note that the current objective tools have limitations in capturing efficacy of interventions for GID due to diffuse and complex symptoms. Future study would be aided by the existence of a specific assessment tool for symptomatology. 1. McConnell N, Beattie LM, Richards CE, Protheroe S, Barclay AR,JPGN;66 (supp 2):1002;2018 BSPGHAN Annual Meeting 29th – 31st January 2020, Brighton Abstracts RCPCH has approved this activity for CPD in accordance with the current RCPCH CPD Guidelines 3 12.20 – 12.30 Children and young people with inflammatory bowel disease attend less school than their healthy peers Claire Barnes1, James Ashton1, Florina Borca2, Mick Cullen1, Dawn Walker3 and Robert Beattie1. 1University Hospital Southampton 2 3 NIHR Southampton Biomedical Research Centre; University of Southampton Aim: Chronic diseases, such as inflammatory bowel disease (IBD), can impact negatively on education and social development. The aim of this study is to examine the extent to which IBD affects school/college attendance for children and young people (CYP) and determine contributing factors. Methods: We performed a cross-sectional survey to determine the school/college attendance rates, the reasons for absence related to IBD and facilitators/barriers to school/college attendance. In a subset followed-up locally, we performed a detailed review of hospital attendance data, to assess the healthcare burden. Results: Two-hundred-and-thirty-one questionnaires were given to CYP with IBD aged 5-17 years. The response rate was 74% (final sample 169). The median school/college attendance rate was 92.5%; significantly lower than all children in England (95.2%). 39.6% of children with IBD were persistently absent, defined nationally as missing 10% or more of school. Only five children (3%) had a 100% attendance record. Increasing age and use of monoclonal therapy were predictors of poor school attendance. Concerns about feeling unwell at school/college, access to toilets, keeping up with work, and teachers’ understanding of IBD are the main issues for CYP with IBD. (This is highlighted in the word cloud - figure 1, illustrating the questionnaire free text comments). There was a significant negative correlation between number of days in hospital and school attendance. Conclusion: IBD has a significant impact on school/college attendance, with hospital attendance, disease burden, and school difficulties being major factors. Employing strategies to minimise healthcare burden and developing a partnership between health and education, to support children with IBD will serve to facilitate school/college attendance. Figure 1 – Word cloud of questionnaire free text comments A graphical representation of word frequency from the questionnaire free text comments. The size of the word indicates its frequency; the more often a word appears in the text the bigger and bolder it appears in the word cloud. BSPGHAN Annual Meeting 29th – 31st January 2020, Brighton Abstracts RCPCH has approved this activity for CPD in accordance with the current RCPCH CPD Guidelines 4 12.30 – 12.40 D1 biopsies increases the diagnostic yield in coeliac disease in children Chloe Ashton1, Jeng Cheng1 and Veena Zamvar1. 1 Leeds Teaching Hospitals Introduction/Background: Coeliac disease is an autoimmune systemic condition, which is triggered by gluten in genetically predisposed patients. These patients are genetically predisposed to HLA markers DQ2 or DQ8. Coeliac disease can present in children with gastrointestinal symptoms, failure to thrive and dermatitis herpetiformis; and can be asymptomatic especially in high-risk individuals such as children with Down’s syndrome, Type 1 diabetes and Turner’s syndrome. Children who are symptomatic, are recommended to undergo total immunoglobulin A (IgA), tissue transglutaminase (TTG) and
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