Digestive and Liver Disease - Volume 48 - Supplement 2

e186

Abstracts of the 22

National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231

Material and methods:

Sixty obese patients and normal lean

controls were enrolled for SIBO detection. Diagnosis of SIBO was

performed by a glucose breath test. A 24-hour recall questionnaire

was administered to investigate macronutrient daily intake between

the two obese patient subgroups (with/without SIBO).

Results:

The presence of SIBO in obese and controls was

respectively 23.3% and 6.6% (p=0.02, OR=4.26, 95% Confidence

interval=1.31-13.84). Obese patients with SIBO ingested more

carbohydrates (252.75±30.53 versus 201±70.76 g/day, p=0.01), more

refined sugars (104.15±28.69 versus 73.32±44.93 g/day, p=0.02) and

less total and insoluble fibers (9.6±1.97 versus 14.65±8.80 g/day -

p=0.04 and 4.7±1.11 versus 8.82±5.80 g/day - p=0.01, respectively).

There were no significant differences in lipid and protein intake

between the two groups.

Conclusions:

SIBO is widespread in obese subjects. Carbohydrates

might promote the development of SIBO in obesity and fibers

provide a protective function. Our results suggest a close relationship

between diet and SIBO in obesity, thus supporting a possible role for

intestinal microbiota.

P.12.5

EXOCRINE PANCREATIC INSUFFICIENCY IN ADULT CELIAC

DISEASE IS ASSOCIATED WITH SYMPTOM SEVERITY AND READILY

RESPONDS TO GLUTEN EXCLUSION

Efthymakis K.*, Serio M., Barone E., Milano A., Laterza F.,

Bonitatibus A., Neri M.

Department of Medicine and Ageing Sciences, “G.D’Annunzio”

University and Foundation, Chieti, Italy

Background and aim:

Exocrine pancreatic insufficiency (EPI)

has been described in children with celiac disease (CD), variably

correlating with symptom severity at presentation. Different

mechanisms have been proposed, although etiology could be

multifactorial. In adults, EPI has been associated to symptom

persistence, although data are scarce.

Aims of this study were to explore the prevalence of EPI in a cohort

of adult celiacs and the clinical/laboratory response to gluten-free

diet (GFD).

Material and methods:

We recruited consecutive adults, showing

antitTG positivity and villous atrophy. As controls we recruited

consecutively: a) asymptomatic celiacs under adequate GFD for ≥24

months; b) RomeIII D-IBS patients; c) healthy subjects.

Results:

Among celiacs (n=43, mean age (ma)=42.9ys) prevalence of

EPI was highest at diagnosis (overall 47%, severe 12%). At 6 months,

EPI remained higher (4.7%) compared to patients on GFD=24

months (n=54, ma=48.9ys) and healthy controls (n=64, ma=51.5ys),

respectively 1.9%,1.6%. Mean FE-1 was lowest at diagnosis

(188.6±81.9µgr/gr), showing a significant improvement already after

3 months (248.9±78.5, p<0.001), alongside symptoms when present.

At 6 months, mean FE-1 levels (362.8±76.4) were comparable

to healthy controls and celiacs in GFD=24 months (respectively

376.5±68.0, 422.4±82.7; p>0.5). Overall, FE-1 was significantly

lower in subjects with diarrhea (p<0.001), showing a strong inverse

correlation to symptom severity (rs=-0.51, p<0.001). At CD diagnosis

mean FE-1 or EPI status did not significantly differ based on

symptoms. Statistical significance for FE-1 levels and EPI association

with diarrhea was attained at 3 months (respectively, p=0.02;

p=0.04). At diagnosis, FE-1 and EPI severity strongly correlated to

symptom severity (rs=-0.59, p<0.001; rs =0.81,p<0.001). One healthy

control showed severe EPI without symptoms. Among IBS patients

(n=28, ma=38.3ys) EPI prevalence was 14%; mean FE-1 (310.5±144.1)

was comparable to titers of celiacs at 6 months (p>0.5). FE-1 levels

did not correlate to sex or age.

Conclusions:

In newly diagnosed adult celiacs, EPI (FE-1 <200)

was frequent; FE-1 and EPI showed correlation to severity but not

to presence of diarrhea, probably owing to the multifactoriality

of the initial presentation. In most patients EPI recovered after

3-6 months, alongside symptoms, without need for additional

treatment. Subjects with persisting diarrhea at 3-6 months showed

significantly lower FE-1 levels and higher EPI prevalence, suggesting

a more direct causality. EPI in celiacs under long-term GFD has a

comparable prevalence to healthy controls. It is frequent in RomeIII

D-IBS patients, probably due to inadequate screening. Symptom

presentation of CD should guide pancreatic function testing and

early treatment, in an effort to reduce symptom severity and fat

malabsorption where needed.

P.12.6

GENETIC VARIANTS ASSOCIATED WITH ANAEMIA IN ADULT

COELIAC PATIENTS: THE ROLE OF TMPRSS6 AND HFE

Imperatore N.*

, Rispo A.

, De Falco L.

, Capone P.

, Bruno M.

Gerbino N.

, Caporaso N.

, Iolascon A.

, Tortora R.

Gastroenterology, Department of Clinical Medicine and Surgery,

“Federico II” University of Naples, Naples, Italy,

Department of

Molecular Medicine and Medical Biotechnologies, University “Federico

II” of Naples, CEINGE, Advanced Biotechnologies, Naples, Italy,

Department of Medicine, Section of Internal Medicine, University of

Verona,, Verona, Italy

Background and aim:

Coeliac disease (CD) is a chronic, immune-

mediated disease occurring in genetically predisposed individuals

who assume gluten. Iron deficiency anaemia (IDA) is very common

in CD and has been reported in up to 46% of cases of subclinical CD.

Even though the link between malabsorption and anaemia is well

known, the role of genetic factors remain unexplored. We speculated

that common SNPs of iron metabolism genes would be associated

with anaemia of CD patients.

Material and methods:

From October 2011 to July 2015 we

prospectively assessed the frequency of TMPRSS6 variant rs855791

and HFE variants rs1800562 and rs1799945 in both anemic and

non-anemic CD patients at time of CD diagnosis. We also estimated

the association of these variants with some hematological and iron

parameters (Hb, MCV, serum iron and serum ferritin). Statistical

analysis was performed by using T-student and X-square test when

indicated; all differences were considered significant when p< 0.05.

Results:

Finally, 491 patients were enrolled: 266 with IDA (mean age

31.2; females 88%), 225 with non-IDA (mean age 32.4; females 65%).

TMPRSS6 variant rs855791 and HFE variant rs1799945 were found

higher in non-IDA than IDA CD patients (52.2% vs 47% and 27% vs

24.5%, respectively), although not statistically significance (p=0.1).

Conversely, HFE variant rs1800562 was found to be significantly

higher in IDA than non-IDA CD patients (3.4% vs. 0.8%, p=0.03).

Furthermore, CD subjects with TMPRSS6 variant rs855791 showed

higher Hb and serum ferritin and lower MCV and serum iron level

compared to CD subject with TMPRSS6 WT variant. IDA subjects

with HFE variant rs1800562 showed increased serum iron and

ferritin values in comparison with CD subject carrying the wild type

variant.

Conclusions:

In CD patients, HFE variant rs1800562 appeared to be

more frequent in IDA than in non-IDA and it associated with higher

iron status, so conferring a protective role regarding IDA in CD.

P.12.7

OUTCOME OF PATIENTS WITH POSITIVE BREATH TEST FOR SIBO

SIX MONTHS AFTER COMBINED TREATMENT WITH RIFAXIMIN

AND PROBIOTICS

Leonello R., Noris R., Casini V., Pace F.*

Gastroenterology Department Bolognini Hospital, Seriate (BG), Italy