bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP‐2 THE DIAGNOSTIC VALUE OF RADIOLOGICAL COLONIC TRANSIT STUDY COMPARED WITH HIGH‐RESOLUTION COLONIC MANOMETRY.
Authors: Sintusek Palittiya , Mutalib Mohamed , Thapar Nikhil , Lindley Keith 
Published: September 2015

Background:Chronic constipation is one of the most common chronic disease in children. Most of cases are functional, however some has problem of organic myopathic or neuropathic colon. Colonic transit study with oro‐anal transit markers is the basic diagnostic tool for colonic dysmotility in clinical practice, colonic manometry is the recommended investigation in the next step. Nevertheless, the colonic manometry is considered more invasive, expensive and also unavailable in many countries. The aim of this study is to assess the diagnostic value of conventional method as colonic transit study compared with the novel high‐resolution colonic manometry in diagnose colonic abnormalities.Methods:Fifty constipated children in Great Ormond Street hospital were retrospectively reviewed in demographic data and investigation result. The diagnosis of constipation was based on history and physical examination which followed Rome III criteria. All of enrolled patients received colonic manometry investigation before colonic transit study in order to reduce the bias. For colonic transit protocol, patients had to ingest a 10‐markers capsule on 3 consecutive days and an abdominal x‐ray was obtained on day 4. The cut‐off values for abnormal segmental and total colonic transit time(CTT) were based on Arhan et al publication.Results:Fifty constipated children with the mean age of 9.77 years (1.15–17.32) were included. Of all, 39(78%) patients had colonic abnormality detected by colonic manometry while 38(76%) patients had abnormal CTT.The sensitivity, specificity, and positive predictive value(PPV) of colonic transit study for abnormal total CTT were 46.2%, 72.7% and 85.7%, respectively. In aspect of abnormal segmental CTT, the sensitivity, specificity and PPV of right colon are 66.7%, 63.6% and 20%; left colon are 16.7%, 72.7% and 7.69%; and rectosigmoid colon are 29.4%, 68.8% and 66.7%, respectively.Conclusions:Colonic transit study seemed to have satisfied posttest probability to diagnose total colonic abnormality. However, for segmental CTT, this test might be invalid and the consideration to use as predictor of segmental abnormality was not recommended.
OP‐5 INTEROBSERVER VALIDITY OF THE REFLUX FINDING SCORE FOR INFANTS (RFS‐I) IN FLEXIBLE VERSUS RIGID LARYNGOSCOPY.
Authors: Singendonk MMJ , Pullens B , van Heteren JAA , de Gier HHW , Hoeve HJ , König‐Jung AM , van der Schroeff MP , Hoekstra CEL , Veder LL , van der Pol RJ , Benninga MA , van Wijk MP 
Published: September 2015

Background:The Reflux Finding Score for Infants (RFS‐I) was developed to objectively assess signs of laryngopharyngeal reflux (LPR). Based on review of flexible laryngoscopic videos, only moderate inter‐ and highly variable intraobserver reliability was found. We hypothesized that examination of the infant larynx with rigid laryngoscopy would provide better agreement. AIM: to assess the validity of the RFS‐I in the detection of LPR‐related findings using flexible versus rigid laryngoscopy.Methods:Thirty consecutive infants underwent flexible and rigid laryngoscopy. Based on the recorded videos, RFS‐I was scored by 4 otorhinolaryngologists, 2 otorhinolaryngology fellows, and 2 inexperienced observers. Videos were presented in a randomized order, blinded for clinical profile and findings during initial examination. Observers were provided an instruction sheet prior to evaluation. For categorical data, agreement was calculated using Cohen's kappa (2 observers) and Fleiss’ kappa (>2 observers). For ordinal data the intraclass correlation coefficient (ICC) was used.Results:Of 30 included patients (17 M; median age 7.5 (0–19.8) months), main reasons for referral were: stridor (n = 15,50%), ALTE/apneas (n = 7,23.3%), follow‐up of laryngeal abnormalities (n = 6,20%), aspiration (n = 5,16.7%), and other indications (n = 7,23.3%). Overall interobserver agreement of the RFS‐I was moderate for both flexible (ICC = 0.60, [95%CI 0.44–0.76]) and rigid (ICC = 0.42, [95%CI 0.26–0.62] laryngoscopy. There were no significant differences in agreement on overall RFS‐I scores and individual RFS‐I items for flexible versus rigid laryngoscopy. We did observe higher overall agreement amongst the 2 inexperienced observers for rigid (ICC = 0.40, [95%CI 0.03–0.67]), compared to flexible (ICC = 0.11, [95%CI 0.17–0.41]) laryngoscopy, albeit not significant. Comparing RFS‐I results for flexible versus rigid laryngoscopy per observer, agreement ranged from no to substantial agreement (k = ‐0.16–0.63, mean k = 0.22) and the observed agreement (not adjusted for chance) was 0.08–0.35%.Conclusions:Interobserver agreement of the RFS‐I was only moderate and did not differ between flexible and rigid laryngoscopy. This indicates that the RFS‐I should not be used with flexible, nor rigid laryngoscopy to detect signs of LPR.
OP‐6 INTRAGASTRIC PRESSURE MEASUREMENT DURING NUTRIENT INTAKE
Authors: Carbone F. , J.Tack  , Hofmann I. 
Published: September 2015

Background:Functional dyspepsia (FD) in pediatrics is defined as the presence of upper abdominal symptoms for at least 2 months in the absence of organic or metabolic disease likely to explain the symptoms. The main proposed pathophysiological mechanisms are visceral hypersensitivity,impaired gastric accommodation (GA) and delayed gastric emptying. At present, the gastric barostat is the gold standard to measure GA. However, this procedure is perceived as very invasive and it might alter the normal gastric physiology. Recently, we proposed the intragastric pressure (IGP) measurement during nutrient intake as a potential alternative for assessing GA in adults. This technique uses a thin manometry catheter that measures the IGP over the entire length of the stomach. By means of this study we aim to introduce the HRM as new minimally invasive technique to measure GA and nutrient tolerance in children.Methods:After the manometry probe and a second infusion catheter were positioned through the nose into the stomach, the IGP was measured 30 minutes before and during intragastric infusion of nutrient drink (300 Kcal, 60 ml per minute). The patients were asked to score hunger and satiation and 6 epigastric symptoms (fullness, nausea, belching of air, cramps in the abdomen, bloating and pain) at 5‐minute intervals. The experiment ended when the volunteers scored maximal satiation at 1‐minute intervals by using a graphic rating scale that combines verbal descriptors on a scale graded from 0–5 (1, threshold; 5, maximum satiety).Results:For this study 13 FD pediatric patients (92% female, 14.8 ± 0.8 years old, BMI: 19.5 ± 0.8) and 12 young adult volunteers (100% female, 22.2 ± 0.4 years old, BMI: 21.2 ± 0.3) were recruited. The Rome III questionnaire showed that FD patients suffered mainly from postprandial fullness (75%), epigastric pain (58%), bloating (50%), nausea (50%) and early satiation (42%). In both groups, intragastric infusion of nutrient drink induced a rapid drop in proximal stomach IGP. The average AUC change from baseline was ‐44.7 ± 11.0 mmHg in patients and ‐48.4 ± 25.2 mmHg in healthy subjects. Patients tended to score maximal satiation at lower volumes compared healthy subjects (433.8 ± 64.2 ml and 600.0 ± 67.6 mL respectively, p = 0.1). All FD patients and healthy subjects tolerated the catheters and could finalize the study.Conclusions:The IGP measurement during intragastric nutrient drink infusion is a promising minimally invasive alternative to the gastric barostat method to assess GA and nutrient tolerance. Future studies need to increase the patient numbers and compare the measurements in different subsets of pediatric FD (e.g. weight loss vs. no weight loss, present or absent early satiation, etc.).
OP‐8 SOCIAL CONCERNS IN CHILDREN BEING INVESTIGATED FOR CHRONIC INTESTINAL PSEUDO‐OBSTRUCTION
Authors: Brind J , Bowring E , Larmour K , Cronin H , Barkley L , Rybak A , Saliakellis E , Lindley KJ , Borrelli O , Thapar N 
Published: September 2015

Background And Aims:Fabricated induced illness (FII) is recognised amongst children presenting with suspected Chronic Intestinal Pseudo‐Obstruction (CIPO) (Hyman 2012). We aimed to investigate the presence, nature and potential causes of social concerns in children being referred to our national centre with possible CIPO.Methods:All patients accepted into the CIPO diagnostic pathway over 3 years (April 2012‐April 2015) were reviewed. Acceptance criteria included all of the following (1) referral from a paediatric gastroenterologist or surgeon suspecting a diagnosis of CIPO, (2) mechanical obstruction of the intestine excluded and 3) reliance on specialised enteral or parenteral feeding. The presence and nature of social concerns were recorded pre‐ & post‐assessment along with associated characteristics pertaining to the referral, family situation as well as child protection. Comparison was made to referrals to the IBD service within the department.Results:Of 78 accepted children (mean 5.2 years, 42F) 57 were diagnosed with CIPO, 53 (4.2yrs 31F) by abnormal antroduodenal manometry (ADM) and 4, unsuitable for ADM, by clinical picture. Of the remaining 21 patients (5.8yrs 12F) with normal ADM, 8 were found to have FII; 4 driven by a parent and 4 by the patient (teenage girls). The remaining 13 patients had non‐CIPO diagnoses. Of those with normal ADM 17/21 had social concerns; 10 with formal child protection or FII and 7 with concerns over treatment compliance and ambiguity of symptoms. Of those with CIPO 18/57 had social concerns including 2 formally listed as child protection for neglect/parenting concerns and 1 with possible FII. The remaining CIPO cases had a variety of concerns mainly around ambiguity and reliability of reporting. Comparison with a newly diagnosed IBD cohort (161 patients) during the same period revealed only 7 with social concerns. Recurrent themes in those with social concerns, particularly CIPO, included consumerism, internet and media involvement (Facebook, fundraising and celebrity events), resistance to positive news and pain predominant clinical picture.Conclusions:Social concerns (including safeguarding and child protection) in children thought to have CIPO are prevalent (45%) and approximately 10‐fold higher than seen in IBD (4.3%). Although commoner in non‐CIPO patients, social concerns are also prevalent in those proven to have CIPO (32%). These concerns should be explored and addressed along with an emerging ‘profile’ of associated risk factors such as use of multi‐media, medical consumerism and a pain predominant clinical picture.
OP‐22 PERCEPTIONS AND KNOWLEDGE ABOUT CONSTIPATION IN ARGENTINE PEDIATRICIANS. RESULTS OF A PRELIMINARY SURVEY.
Authors: Christian Boggio Marzet , Valeria Prieto Cunello , Lized Ticona Huaquisto , Teresa Basaldúa María 
Published: September 2015

Introduction:Constipation is a frequent cause of medical consultation in pediatric practice. However a lack of knowledge about good practice in the management and treatment of these patients is evidenced.Aim:To evaluate the knowledge, attitudes and current practices of pediatricians with regard to constipation.Methods:A closed‐ended structured questionnaire was implemented in a cohort of pediatricians belonging to a continuous medical education program. Sample size: 123.Results:123 doctors were included. Females 70.8%. Age: 60.2% above 40 years. Professional practice: 56.6% more than 15 years with 43% working in both public and private practice. 95.6% ask about bowel habits in their patients, but only 40% know well Rome III criteria. 53.9% make the initial evaluation with abdominal palpation and inspection of the anal region but 76% never make a digital rectal examination on the first visit. The Bristol stool scale was known by 41.3% of doctors and they consider useful 98.1%. Only 19.4% ask additional studies, being the abdominal x‐ray the most frequent (95%). Diet with fiber was the first line treatment for constipation (97%). Only 32% use laxatives to treat a constipated child, being lactulose the most used (64.4%). For disimpaction the use of Murphy enema (36.5%) and phosphate enemas (34.4%) were the most frequent. 63% of doctors consider that a diet with adequacy of soluble and insoluble fiber was the best (63%). Psychological assessment was “sometimes” considered in constipated children (64%).Conclusions:Although argentine pediatricians ask about bowel habits in pediatric practice only a few know well Bristol stool scale and Rome III criteria. Dietary fiber is the first line treatment. Only one in every three pediatricians indicates laxatives in constipation showing the need to enhance medical education about this problem.
OP‐24 ESOPHAGEAL BASELINE IMPEDANCE IN NEUROLOGICALLY IMPAIRED CHILDREN
Authors: Tambucci Renato , Thapar Nikhil , Saliakellis Efstratios , Pescarin Matilde , Quitadamo Paolo , Lindley Keith J. , Borrelli Osvaldo 
Published: September 2015

Introduction:Dysphagia, feeding difficulties and gastro‐oesophageal reflux (GORD) are common complaints in neurologically impaired children. Motor pattern generators localised in the brain stem and CNS reflexes play a key role on controlling oesophageal peristalsis and lower oesophageal sphincter activity. Thus, it is not surprising that brain abnormalities may result in significant oesophageal motor dysfunction. In this prospective study we evaluated the differences in multichannel intraluminal impedance‐pH monitoring (MII‐pH monitoring) pattern between children with cerebral palsy (CP) and 2 groups of neurologically normal children with normal and abnormal MII‐pH monitoring. We mainly focused our attention on oesophageal baseline impedance (BI), which has been proposed as useful parameter in predicting GORD severity.Methods:Twenty children with CP and 40 neurologically normal children with suspected GORD underwent MII‐pH impedance. Classical MII‐pH impedance parameters as well as BI values in both proximal and distal oesophagus were analysed. MII‐pH monitoring was considered abnormal if acid exposure time (AET) was >5% and/or SAP was >95%.Results:Nine CP children had a diagnosis of GORD. Of neurologically normal children, 20 had an abnormal (GR‐A) and 20 a normal MII‐pH monitoring (GR‐B). A significant difference in the proportion of children with abnormal AET was found between CP and GR‐A (9/20 vs 17/20; p < 0.05). GR‐A showed a significantly greater percentage of AET (15.97 [6.4–34.9]) than both CP (8.21 [0–31.9], p < 0.05) and GR‐B (1.4, [0–4.5], p < 0.0001), whereas between the latter groups CP showed a greater AET (p < 0.05). Proximal BI values were significantly lower in CP (1759 [691–3133]Ω) than GR‐A (2396 [1080–3850]Ω, p < 0.05) and GR‐B (3385 [2249–4817]Ω, p < 0.0001). No difference in distal BI was found between in CP (1106 [279–3098]Ω) and GR‐A (1152 [246–2526]Ω), while was lower in CP than in GR‐B (2965 [1986–3984]Ω, p < 0.001). Considering all patients as a whole group, an inverse correlation was found between distal BI and AET (r‐0.66; p < 0.001), whereas within groups an inverse correlation was only confirmed in GR‐A pts (r‐0.67; p < 0.001).Conclusions:Although an abnormal pH‐impedance monitoring was detected in almost half of children with CP, no correlation was found between the AET and BI values, suggesting that the latter cannot be used as predictor of reflux severity in this group of patients. The presence of low impedance values in both proximal and distal oesophagus in children with CP supports the view that in neurologically impaired children BI mainly reflects oesophageal motor abnormalities, which have been previously reported.
PP‐4 ANORECTAL MALFORMATIONS
Authors: Bigliardi Roman N. , Ditaranto A. , Reynoso R. , Vidal J.H. , Messere G. , Toca M. , Silvestri G. , Ortiz G. , Noriega S. , Varela A. 
Published: September 2015

Background:Anorectal malformations (ARM) are infrequent anatomic defects with a prevalence of 1 each 5000 alive newborns. Most of the patients repaired of this illness have some degree of constipation or fecal incontinence. There are few reports about manometric studies and biofeedback treatment in patients with anorectal malformations.Objectives:To evaluate of our population's anorectal functionality late after surgery by anorectal manometry; To study the response to diet, toilet training, and/or biofeedback.Methods:Anorectal manometry was done in 39 patients with ARM and 35 of them received combinated treatment of diet, toilet training and biofeedback. Age: 6 to 17 years old. Mean age: 8.05 years. Descriptive study. From april 2004 to april 2015. 14 patients had high malformations(36%), 18 had low malformations(46%) and 7 had cloaca(18%). Inclusion criteria: children over 6 years of age with anorectal malformation operated using Peña's technique (postsagittal anorectoplasty). Exclusion criteria: patients with neurological disorders that do not non‐compliant with study and treatment indications.Results:Average resting pressure was 28 mmHg(High level 25,5 and Low level 29,8 mmHg), range between 7 and 51 mmHg. Squeezing pressure between 29 and 120 mmHg(mean:69mmHg). Combined treatment of diet, toilet training, and biofeedback was succesfull to get total continence in 22 patients (4 cloacas, 10 high malformations and 8 low malformations), partial continence in 6(all low) and without response in 3(1 low, 1 high and 1 cloaca); 2 patients archived continence only with toilet training and 2 were lost in follow up(T.Fisher: 0,1). In high ARM 8 had positive(+) rectoanal inhibitory reflex(RAIR) and 6 negative(¬). In cloacas it was (+) in 3, (¬) in 3 and doubtful in 1. In low ARM 15(+), 2 (¬) and 1 doubtful. Reflex was obtained with 20 to 60cc of air(mean 31,36). The RRAI duration was 10 to 17 seconds(mean: 13 seconds). From 22 total continent, RAIR was (+) in 13, (¬) in 7 and hazardous in 2. All 6 partially continent had (+) RAIR; and from 3 incontinent, 2 had (+) RAIR and 1 (¬). From succesfully treated, 10 showed low resting pressures at the anal channel and 12 had normal pressures. Squeezing pressure was normal in 35 and negative in 4.Conclusions:1) RAIR was (+) in most of low malformations, while in high and cloacas only nearly half of them were (+). 2) RAIR and resting pressures at the anal channel were not useful to predict treatment success. 3) Malformation Height was not significant to determine patients outcome. 4) Combined dietary, toilet training and biofeedback therapy was effective for achievement of fecal continence in most of our population.
PP‐7 CHILDHOOD RECURRENT ABDOMINAL PAIN IS ASSOCIATED WITH DUODENAL EOSINOPHILIA REGARDLESS OF H. PYLORI INFECTION
Authors: Wauters L. , Harris P. , Serrano C. , Villagrán A. , Duarte I. , Rakhra G. , Jones M. , Talley N. , Crabtree J. , Walker M. 
Published: September 2015

Objectives:This study aimed to investigate histologic features of children with RAP undergoing upper gastrointestinal endoscopy, after exclusion of common organic disease.Methods:Children referred for endoscopy were prospectively enrolled at a single tertiary center between 2008 and 2010, after obtaining informed consent. Cases were defined as children with clinical diagnosis of RAP, as opposed to controls with suspicion of organic disease. Gastric and duodenal biopsies were analysed by pathologists blinded to indication. Demographic and clinical variables, H. pylori infection, biochemical, endoscopic and pathologic results were compared between cases and controls.Results:A total of 101 children were included after exclusion of villous enteropathy (n = 6) and parasitic, rotaviral or salmonella enteritis (n = 14), resulting in 72 cases and 29 controls. There were no significant differences in demographics, clinical symptoms, H. pylori infection and endoscopic findings between cases and controls. Duodenal eosinophil counts per 5 HPF were significantly increased in cases vs. controls (median (IQR) 86 (62–114) vs. 49 (31–88); p < 0.001) and did not differ regarding age, gender and H. pylori. Intraepithelial lymphocytes per 100 enterocytes were similar in cases vs. controls (19 (15–25) vs. 18 (14–23); p = 0.89) with ≥ 25 in 25% of cases. Duodenal eosinophilia was equally observed in H. pylori negative cases (n = 50) vs. controls (n = 19) (87 (61–119) vs. 53 (36–95); p = 0.01), as well as positive cases (n = 21) vs. controls (n = 10) (85 (55–105) vs. 42 (18–65); p = 0.03). Logistic regression yielded an adjusted odds ratio of 1.23 (95% CI 1.08–1.40) for duodenal eosinophilia in RAP.Conclusions:Children with a clinical diagnosis of RAP have marked duodenal eosinophilia, independent of H. pylori infection, suggesting the role of unknown infectious or allergic triggers in the pathogenesis of functional gastrointestinal disorders in childhood. Further research is needed on the diagnostic and therapeutic benefits of targeting duodenal eosinophilia.
PP‐11 PROLONGED INTRA‐ESOPHAGEAL PH PROFILE AND ESOPHAGEAL MOTILITY IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS (EOE)
Authors: Rossi P. , Isoldi S. , Mallardo S. , Biscione G. , Oliva S. , Rossetti D. , Lucarelli S. , Cucchiara. S. 
Published: September 2015

Background:Patients (pts) with eosinophilic esophagitis (EoE), a chronic immune‐mediated disorder, may exhibit symptoms of disturbed food transit (i.e. dysphagia, impaction) or mimicking gastro‐oesophageal reflux (GOR). We aimed at characterizing in EoE pts the intra‐esophageal pH pattern with 24‐h multichannel intraluminal impedance (MII‐pH) as well as the esophageal motility with high‐resolution manometry (EHRM)Methods:during a 30 month period we studied 57 patients (pts), median age 11 years (range: 7–16): 25 with EoE, diagnosed according to widely agreed criteria (JPGN 2014;58:107–18; ESPGHAN guidelines) and 32 with GOR disease (GORD). All underwent esophagogastro‐duodenoscopy, MII‐pH and EHRM. The pH‐MII and data analysis were done according to ESPGHAN EURO‐PIG protocol (JPGN 2012;55:230–4); variables analysed: reflux index, symptom index, number and type of liquid reflux, number of long lasting reflux episodes, correlation symptom‐reflux. The test was diagnostic of GORD if at least ≥ 2 of the previous variables were positive. The EHRM was performed with water perfused catheters and swallow contractile patterns categorized using criteria recently reported by a paediatric group (Am J Gastroenterol 2010;105:460–7). Several motility variables were analysed: esophago‐gastric junction (EGJ) morphology, end‐expiratory and end‐inspiratory EGJ pressure, distal contractile integral (DCI), pressurization front velocity (cm/s), peristaltic propagation pattern.Results:An abnormal MII‐pH profile was markedly more common in GORD pts (27; 84.37%) than in EoE pts (4; 16%; p < 0.001). On the contrary, EHRM irregularities were detected more commonly in EoE that the GORD pts: in particular, when motility tracing were analysed no significant difference for EGJ pressure and deglutitive EGJ relaxation was detected between the 2 groups; however, abnormalities such as peristaltic dysfunction (i.e. failed peristalsis, aperistalsis, and esophageal spasm features) and lower distal contractile integral adjusted for esophageal body length (DCIa) were more common in EoE (17; 68%) than in GORD pts (15; 46.8%) (p < 0.05)Conclusions:1) The great majority of EoE pts have a normal MII‐pH profile that doesn’t support the use of proton pump inhibitory therapy. 2) EoE pts exhibit higher prevalence of oesophageal motility abnormalities than GORD: this feature is likely sustained by the inflammatory infiltrate that characterizes the esophageal wall in EoE and accounts for the esophageal dysmotility complaints often detected in EoE pts.