Abstracts / Digestive and Liver Disease 50(4S) (2018) e359–e418
increased in the last few decades. Classic CD with mild to severe
gastrointestinal symptoms (diarrhoea, weight loss, abdominal
pain) is less common than non-classic CD characterized by iron
deficiency anaemia, dermatitis herpetiformis, chronic fatigue,
migraines, epilepsy, short stature, failure to thrive, dental enamel
defects and autoimmune disorders. The latest ESPGHAN guidelines
allow diagnosing CD in symptomatic children only with specific
pattern of immunoserological tests. The aim of our retrospective
study was to evaluate the application of ESPGHAN 2012 guidelines
in real life setting. Our study population is composed of 277 patients
aged 1 to 12 years, collected between 2012 and 2017. We found a
greater incidence in females (F 66%). The mean age at the diagnosis
was 6 years. In 170 out of 277 (61%) CD diagnosis was performed
according to only serological data; 62% of these patients presented
CD classical symptoms while the others had not abdominal classical
signs. Our data show that our centre diagnosed CD strictly following
ESPGHAN guidelines in patients with classic symptoms while the
duodenal biopsy remains the gold standard for diagnosing non-
classical CD forms.
Conflict of interest: None declared.
P115
Eight case reports of food protein-induced
enterocolitis syndrome (FPIES) in province of
Trento
C. Polloni1, T. Benuzzi1, F. Sorrentino1, E. Dal Bon1,
M. Pace1, F. Caldonazzi1
1
U.O. Pediatria, Osp. Santa Maria del Carmine,
Rovereto (TN), Italia
Food protein-induced enterocolitis syndrome (FPIES) is a
reproducible non-immunoglobulin E-mediated adverse reaction
to food protein (most commonly cow’s milk) occurring 1–4 h after
exposure. Symptoms (acute or chronic) include profuse, repetitive
vomiting, lethargy, pallor, and sometime diarrhea. The pathogenesis
is not well understood. Diagnosis is guided by history and it can
be confirmed by the resolution of symptoms after an elimination
diet or by performing an oral food challenge (OFC). FPIES tends to
resolve at age of 3–5 years. A retrospective descriptive single-center
study was performed on children with acute FPIES who referred to
the Center for Pediatric Food Related Diseases of St. Mary Hospital,
Rovereto (TN), from January 2015 to June 2018. Eight patients
(5 females, 3 males) with acute FPIES were evaluated. None had
history of atopy, positive allergy tests and more than 1 trigger food.
Cow milk was the most common triggering food (50%), followed by
fish (25%), wheat (12.5%) and rice (12.5%). The average time from
ingestion to symptom onset was 2h. All of them had vomiting,
lethargy, and pallor and were treated with intravenous rehydration
(3 with steroids). All of them had a food avoidance plan and clinical
follow up. Episodes of vomiting, pallor, lethargy, hypotonia few
hours after food ingestion, in otherwise healthy children, should
suggest diagnosis. Differential diagnosis are allergic disorders, acute
gastroenteritis, neurological disorders (cycling vomiting syndrome),
inborn errors of metabolism, intoxications. Anamnestic signs and
symptoms, lack of laboratory findings, resolution of symptoms after
an elimination diet and OFC should get diagnosis right
Conflict of interest: None declared.
e399
P116
Eosinophilic colitis: a case report (not
everything is Celiac disease , not everything is
IBD)
C. Pacenza1, F. Chiera1, C. Rosso1, F. Paravati1
1
UOC Pediatria, Ospedale San Giovanni di Dio,
Crotone
A 13-year-old boy was admitted at hospital with a year history
of persistent nausea exacerbated by wheat, bloody diarrhea and
anemia. He had weight loss (6 kg in a year), no abdominal pain, fever
or rash. He did not suffer from other diseases, included food or drug
allergies. Physical examination showed skin pallor and tachycardia.
Lab test showed increased ESR and CRP (respectively 51 mm/h and
8×N) low hemoglobin (9.2 g/dl), with normal white blood counts and
eosinophils. Coagulation, liver and renal tests, IgE, skin prick test,
Celiac screening, ASCA and ANCA were negative or in normal range.
Calprotectin was high (>200 g/mg) while repeated parasitological
examination, stool culture and abdominal ultrasonography were
normal. Colonoscopy showed areas of erythematous, granular
mucosa with muco-fibrinous indwelling, pseudopolyps in the sigma
whilst ileum was healthy. Based on these data, we suspected an
ulcerative colitis, so he started mesalazine therapy with no clinical
response. Histology revealed an eosinophilic infiltrate in the mucosa
(>50 eosinophils/HPF) suggesting the diagnosis of eosinophilic
colitis. We observed a marked clinical improvement after starting a
6-food elimination diet (milk, egg, wheat, fish, shellfish, tree nuts)
and oral budesonide 6 mg/day for 8 weeks. Then we reintroduced
all foods except wheat, because its flavor caused strong nausea.
Eosinophilic colitis is a rare form of gastrointestinal disorder and may
occur as primary or secondary to drug/food allergy, gastrointestinal
infection, inflammatory bowel disease, Celiac disease and vasculitis.
Conflict of interest: None declared.
P117
Fecal calprotectin in Celiac children at diagnosis
and on gluten-free diet: a pilot study
L. Galdiolo1, C. Malaventura1, L. Matarazzo2,
G. Maggiore1
1
Section of Pediatrics, Department of Medical
Sciences, University of Ferrara, Ferrara, Italy
2
Department of Medicine, Surgery, and Health
Sciences, University of Trieste, Trieste, Italy
Introduction: Calprotectin is a neutrophil antimicrobial
protein released during inflammation. Fecal calprotectin (FC) is
an inflammatory mucosal biomarker used to distinguish between
organic and functional gastrointestinal disease. The aim of this
study was to estimate the prevalence of abnormal FC values in Celiac
disease (CD).
Methods: A stool sample was collected from 16 children (mean
age: 5.8 years) at the time of diagnosis of CD and after 6 months
of gluten free diet. Values for FC were considered abnormal when:
>910 g/g of stool between 0–12 months of age; >286 g/g of stool
between 1–4 years and >54 g/g of stool at age greater than 4 years
(Roca, J Pediatr Gastroenterol Nutr 2017;65(4):394–8).
Results: At diagnosis 3 patients were asymptomatic and 7 had
gastrointestinal symptoms; 9 were diagnosed without small bowel
biopsy according to ESPGHAN guidelines. Seven out of 16 patients
had an abnormal value of FC (median of 75 g/g of stool, range
5–688); of these 4 had gastrointestinal symptoms. Two out of 7
children with small bowel lesions showed an abnormal value FC,
both had a IIIc lesion according to Marsh. Patients with abnormal
e400 Abstracts / Digestive and Liver Disease 50(4S) (2018) e359–e418
value FC had an anti-TTGA titre higher than patients with a normal
FC level. After 6 months gluten free, all patient reduced FC levels
(median FC value 28 g/g of stool, range 3.8–242) and the antibody
titre. Only one patient had still abnormal FC value together with
higher anti-transglutaminase titre when compared to the other
patients.
Conclusions: Increased fecal calprotectin concentration could
be used as a non-invasive biomarker in the diagnosis of Celiac
disease, especially in patients with gastrointestinal symptoms. Fecal
calprotectin concentration returns to normal after a strict gluten-
free diet. Fecal calprotectin might be used as a marker of diet
adherence and improvement in gastrointestinal lesions in children
with Celiac disease.
Conflict of interest: None declared.
P118
How much Celiac disease in 2017? The
experience of a pediatric gastroenterologic unit
in Milan
A. Petitti1, G.M.L. Cammi1, C. Mantegazza1, E. Pozzi1,
C. Cocuccio1, S. Paccagnini1, G.V. Zuccotti1
1
Clinica Pediatrica, Ospedale dei Bambini Vittore
Buzzi, Università degli Studi di Milano, Milano, Italia
All children who attended a first consultation in pediatric
gastroenterology for suspected Celiac disease (CD) in 2017 were
retrospectively enrolled (153/1008, 15.2% of consultation). 33/153
(21.6%) had negative anti-transglutaminase A (TGA); 15/153 (9.8%)
had borderline TGA; 82/153 (53.6%) were diagnosed with CD. 4/153
had TGA positive and were lost. Esophagogastroduodenoscopy with
biopsy (OGD) was omitted in 19/153 (12.4%) patients, according to
2012 ESPGHAN guidelines. OGD was performed in 88/153 patients
(57.5%): 63 were diagnosed with CD; 19 were defined “potential CD
(P-CD)”; 2 patients with suggestive symptoms, genetic predisposition
and negative/borderline TGA, had a pathological biopsy (Marsh-
Oberhuber 3B). 30/63 CD patients (47%) were defined as affected by
silent CD with a high TGA (>10×ULN). Mean anti-transglutaminase
A titer (MTGA) was 20.5×ULN (range 1–148×ULN) in all CD children.
MTGA in CD patients who underwent OGD, was significantly lower
than the MTGA in children who omitted OGD (n=63: 16.9×ULN vs
n=19: 36.3×ULN; p<0.05). P-CD patients had a significantly lower
MTGA than the 82 CD patients (mean 4.3×ULN; range 1–18.2;
p<0.05).TGA showed a positive predicted value (PPV) for CD of 68%;
a high TGA showed a PPV of 96%. In silent CD, the PPV difference
between high and low TGA was statistically significant (94% vs 66%;
p<0.05). Many patients attending our unit are not properly screened
for CD before consultation explaining the low frequency of CD.
The high number of P-CD is surprising; this is explained by poor
selection or too early execution of TGA.
Conflict of interest: None declared.
P119
Neurotensin: any clue in pediatric Celiac
disease?
D. Iorfida1, M. Montuori1, F. Valitutti1, C.M. Trovato1,
C. Tiberti2, S. Cucchiara1
1 80% of children from the diagnosis. Considering, in addition to
UOC di Gastroenterologia ed Epatologia Pediatrica,
Dip. di Pediatria, Sapienza Università di Roma
2 two years after the diagnosis, the percentage of correctly identified
Dip. di Medicina Sperimentale, Sapienza Università
di Roma
Background and aims: Neurotensin (NT) is a gut hormone
secreted by specific endocrine cells scattered throughout the
epithelial layer of the small intestine which has been identified
as an important mediator in several gastrointestinal functions and
disease conditions. Its potential involvement in Celiac disease (CD)
has been investigated, but there are conflicting findings. The aim
of this study was to evaluate serum NT levels in children with CD
at diagnosis comparing to a control group and to investigate if NT
correlated in CD patients with symptoms, antibody response and
intestinal mucosal damage.
Patients and methods: Children who underwent gastrointestinal
endoscopy for CD or other clinical reasons were enrolled. Patients
with CD diagnosed according to the latest ESPGHAN guidelines
without biopsy were also recruited. Fasting serum samples were
analyzed for NT levels using ELISA. Mann Whitney, Wilcoxon rank
sum and Spearman’s rank tests were used for statistical analysis.
Results: 30 children (12 M, 18 F, aged 1–16 years) were enrolled
in this study. Of 25 patients who underwent endoscopy, 9 were
CD patients, 13 were controls, 3 were excluded due to unspecific
inflammation at duodenal biopsy. CD was diagnosed in 5 patients
without biopsy. NT median was higher in CD patients compared
to controls (13.25 pg/ml vs 7.8 pg/ml; p=0.02) (Mann-Whitney and
Wilcoxon tests). No statistically significant correlation of NT with
clinical, serological or histological data of CD was observed in this
cohort.
Conclusion: To our knowledge, this is the first Italian study that
evaluates NT in pediatric CD. Results show that NT is higher in the
serum of CD children at diagnosis compared to controls; however,
larger scale studies are required to validate these findings. Whether
serum NT levels can be an adjunctive marker for pediatric CD
remains currently elusive.
Conflict of interest: None declared.
P120
Personalized approach for the management of
potential Celiac children
R. Auricchio1, R. Mandile1, M.R. Del Vecchio1,
S. Scapaticci1, M.A. Maglio1, D. Cielo1, M. Galatola1,
E. Miele1, V. Discepolo1, R. Troncone1, L. Greco1
1
Dipartimento di scienze mediche traslazionali,
Sezione di Pediatria, Federico II, Napoli
Background and aims: Management of potential Celiac disease
(PCD) is still a controversial issue. The aim of our study was to
identify risk factors possibly associated to the development of
villous atrophy (VA).
Methods: We prospectively enrolled 340 pediatric PCD children.
280 of them were asymptomatic and followed up on a gluten
containing diet (GCD) up to 12.5 years. We checked for antibodies
and clinical conditions every 6 months and duodenal biopsy every
2 years. Clinical, HLA and non-HLA genes and histological data were
combined in a multivariate analysis to predict evolution to VA from
the time of diagnosis.
Results: Over a median follow up time of 60 months (range 18–
150 months), 42/280 (15%) children developed a VA while 89/280
(31.7%) stopped producing anti-transglutaminase antibodies. 
lymphocytes in the first biopsy were the best discriminators,
followed by age at diagnosis and the individual genetic profile.
Overall, the discriminant analysis model allows to correctly classify
these factors, the persistence of anti-tranglutaminase antibodies
individuals reaches 87%.
Conclusion: Only 15% of PCD patients will develop a VA over a
12-year long follow-up. Considering the age at the diagnosis together
with other risk factors ( infiltration, genetic profile), we provided