PP77 CELIAC DISEASE'S SOCIAL DAMAGE

Abstract

gastrointestinal tract is a common finding in pediatric colonoscopies. Its clinical significance and its pathophysiological mechanism are yet unclear, although it was described as being associated with cow’s milk and other food allergies. Aim of this study was to evaluate the clinical course of LNH in a group of children undergone different treatment strategies and to assess the possible association between LNH and food allergy (FA). Methods: We performed a retrospective chart review of 66 consecutive patients (pts) with a diagnosis of LNH (39 male, 27 female, median age 7.5 years). Nineteen pts were treated with a cow’s milk, egg and soy elimination diet (Group A), 16 with mesalamine (Group B), 14 with elimination diet plus mesalamine (Group C), and 17 had no therapy (Group D). Apart from ileocolonoscopy with biopsy, all pts underwent routine biochemistry, skin prick tests and atopy patch test for food allergens. In each patient an accurate family and personal history for atopy was recorded. All pts were followed for at least 4 months. Response to treatment was defined as having no symptoms at the end of the observational period. Results: Indications to colonoscopy were: hematochezia (with or without diarrhea) in 73% of pts, recurrent abdominal pain with chronic diarrhea in 25%, chronic diarrhea in 2%. Forty-five of 66 pts (68%) presented a LNH of the terminal ileum, whereas 21 (32%) had a LNH of terminal ileum and colon. No patient had an isolated LNH of the colon. Allergy tests were positive in 35% of pts, of these 61% had positive skin prick tests, and 35% positive patch tests. Four percent of pts had positive both tests. Eighty, 86, 83 and 79% in group A, B, C, and D, respectively, had a clinical response. No significant differences in the response rates among the 4 groups based on family or personal clinical history of allergy, type and duration of clinical symptoms, localization of LNH (ileum vs ileum plus colon), positive allergy tests, were recorded. Conclusions: In our study, all treatments were equally effective in improving symptoms related to LNH, not supporting the hypothesis of a correlation between LNH and FA. Our data suggest that LNH may be a benign, self-limited condition, possibly normal or age-related. Nevertheless large, prospective, controlled studies are needed to better define its clinical significance and its association with food allergy.