Gastroenterology

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Introduction: There are few published series of IBD in children aged less than five years, and there are no data on incidence, ethnicity, or whether these children represent a distinct clinical sub-group. Methods: From June 1998 to June 1999 the British Paediatric Surveillance Unit and the British Society of Gastroenterology Research Unit (BSGRU) prospectively surveyed paediatricians and adult gastroenterologists respectively, to identify newly diagnosed cases of IBD. Results: 28 newly diagnosed cases of IBD were identified aged < 5.0 years, representing 4% of all cases aged 0 to 16.0. The youngest child was aged 6 months and 5 others were < 2.0 years at diagnosis. 2/28 cases were identified by the BSGRU survey, indicating that the initial management of such young children was provided by adult services. There were 9 cases of Crohn’s Disease (CD), 2 of Orofacial Granulomatosis (OFG), 10 of Ulcerative Colitis (UC) and 7 of Indeterminate Colitis (IC). Only a minority (39%) of children aged < 5.0 were diagnosed as CD/OFG compared to a majority of older children aged 5.0-16.0 (61%), p = 0.03. The proportion of children from an ethnic background and the number with a family history of IBD in the CD/OFG group was the same as in older children but there was a trend for more IC/UC children aged < 5.0 to come from an Asian Background (18% v 11%, p = 0.08). Pain, lethargy and weight loss were reported less often, and rectal bleeding more often in younger children with CD/OFG. Investigation and disease distribution of CD/OFG was the same as in older children, except for a trend to less involvement of the ileum (36% v 61%, p = 0.10) Presenting symptoms, investigation, disease extent and management in the UC/IC group aged < 5.0 were not significantly different to that of older children. Conclusion: 4% of children with IBD present age<5.0 yrs. In this age group Colitis (Ulcerative or Indeterminate ) is more common than Crohn’s disease and is positively associated with an Asian ethnic background . At presentation the group does not have any other definitive clinical features .

P40 – Body Mass Index (BMI) in Assessnent of Adolescents with Anorexia Nervosa

Aim Anorexia nervosa (AN) is a major cause of malnutrition in the developed world. Assessment of nutrition in this disorder uses Ideal Body Weight, which is unsuitable for adolescents as no appropriate tables exist, or weight for height, which is unsatisfactory because of the wide distribution of weight for age during puberty. The WHO supports BMI for age as an indicator of nutritional status in adolescence. We evaluated the relationship between BMI and complications related to malnutrition in adolescents with AN. Method Eighty patients with AN and thirty healthy controls were studied. Assessment included a structured medical examination and Dual Energy Xray Absorptiometry to determine percent body fat. A clinical score was developed from clinical features graded during the medical assessment: including pulse rate, blood pressure, temperature and duration of amenorrhoea. Results As expected BMI was lower in AN compared to controls (p < 0.0001) and clinical score was higher for AN compared to controls (p < 0.0001). BMI correlated with clinical score (p < 0.001, r = 0.5) and with percent body fat (p < 0.001, r = 0.5). In a multivariate model including BMI and weight for height, BMI was the independent predictor of both clinical score and percent body fat. Conclusions BMI is associated with risk of medical complications that may be attributed to malnutrition and summarised as a clinical score. This supports the role of BMI in the nutritional assessment of adolescents with AN. New standards for defining underweight in adolescent AN using BMI will be suggested.

This study was performed to compare the effects of recombinant human growth hormone (rhGH), Glutamine (Gln) and simultaneous treatment with rhGH and Gln in rats subjected to 75% intestinal resection and maintained with parenteral nutrition (PN) for 6 days. Morphological changes including mucosal thickness, villus height, crypt depths and villus surface area of the residue jejunum were measured under a light microscope; Expression of PCNA as an index of cell proliferation and apoptotic cells were observed using immunohistochemical staining; Ileal IGF-1 mRNA was determined by Northern blot analysis. The morphological parameters of the jejunal mucosa in rats treated with PN alone were only about 52~62% of those in reference group (P<0.01), this atrophy of the jejunal mucosa was accompanied by a 2.5-fold decrease in absolute counts of PCNA and a 10-fold increase in apoptotic index (P<0.01), IGF-1 mRNA transcript in residue ileum was decreased significantly (P<0.01). However, with rhGH or Gln, the mucosal architecture was improved significantly and was further improved when rhGH and Gln were given together (P<0.01), the morphological values in rats with Gln+rhGH was 79% higher than those with PN alone, and was associated with a 2-fold increase in PCNA counts and a 4-fold decrease in apoptotic index (P<0.01), IGF-1 mRNA expression was 78% higher than those with PN alone (P<0.01). We conclude that rhGH and Gln have synergistic effects on adaptation of the intestinal remnant in parenterally fed, short-bowel rats. The underlying mechanisms are associated with increased proliferation and decreased apoptosis in the intestinal epithelial cells. Local intestinal production of IGF-1 plays an important role in adaptation of the small intestine. Our findings support the concept that specific gut-trophic nutrients and growth factors may be combined to enhance the intestinal adaptation.

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Last modified: December 10, 2001