Day 1 :
Keynote Forum
Dinesh S. Pashankar
Yale University School of Medicine, USA
Keynote: Obesity and Inflammatory Bowel disease in children
Time : 9:30 am - 10:15 am
Biography:
Dinesh Pashankar has completed his medical school training and pediatric residency in India. He has worked in Glasgow and London in the UK and has passed MRCP examination.. He completed pediatric gastroenterology fellowship training from Vanocuver, Canada. He worked at University of Iowa for 5 years and has been working at Yale University for 11 years. H is the director of Pediatric IBD program at Yale. He is also a fellowship program director. He has given talks in national and international conferences and has more than 50 publications in reputed journals. He serves on an editorial board of Journal of Pediatric Gastroenterology and Nutrition.
Abstract:
There is an epidemic of obesity affecting adults and children in the USA and developed countries in the world. Obesity in children is associated with multiple medical conditions including diabetes, hypertension, fatty liver and metabolic syndrome. Over last few years, we have reported a significant association between obesity and gastrointestinal disorders in children. Our first study showed that obese children are more likely to have gastroesophageal reflux symptoms compared to children with normal weight in primary pediatric clinics. In another study we reported higher prevalence of obesity in children with constipation compared to healthy controls. In a prospective study we reported higher prevalence of functional abdominal pain and irritable bowel syndrome in obese children compared to normal weight children. In a recent review, we assessed relationship of obesity and gastrointestinal disorders in children. We have observed rising prevalence of obesity in children with inflammatory bowel disease in children and are investigating the relationship.
Keynote Forum
Aliza B Solomon
Weill Cornell Medicine, USA
Keynote: EoE: What have we learned in the last 20 years
Time : 10:15 am - 11:00 am
Biography:
Aliza B Solomon is an Assistant Professor of Pediatrics and Fellowship Director of the Pediatric Gastroenterology and Nutrition Program. She has completed her Medical training at New York College of Osteopathic Medicine in 2002. After completing a three-year Residency in Pediatrics at Infants and Children's Hospital of Brooklyn, Maimonides Medical Center in 2005, she was selected for a Fellowship in Pediatric Gastroenterology at New York-Presbyterian Hospital/Weill Cornell Medical Center, which she completed in 2008. Her clinical expertise includes all aspects of pediatric gastroenterology with a focus on Eosinophilic Esophagitis/Allergic GI Disorders and Inflammatory Bowel Disease. She currently divides her time between patient care, clinical research and mentoring residents and fellows.
Abstract:
Eosinophilic Esophagitis (EoE) is a chronic immune mediated disease affecting both adults and children. It was described in 1995 and since that time there have been numerous updates to the literature regarding the pathogenesis of the disease, diagnostic features and treatment associated with EoE. The relationship between food allergies & eosinophilic esophagitis (EoE) is well established. Aeroallergens may also contribute to the development of EoE, however there are limited data to support or refute this hypothesis.rnrnAim: The objectives of this pilot study were to determine whether there is a seasonal variation in the onset of symptoms and/or diagnosis of EoE and whether these correlate with a specific pollen concentration within New York City (NYC).rnrnMethods: We performed a retrospective chart review to identify all pediatric patients at New York Presbyterian Weill Cornell Medical Center diagnosed with EoE between 2002 and 2012. Sixty-six patients were identified and 28 were excluded. Cases were classified by both date of initial symptoms as well as date of histologic diagnosis. Pollen counts from a certified NYC counting station and the percent of EoE cases were collated monthly and seasonally and compared. rnrnResults: There was a seasonal variation in onset of symptoms as well as diagnosis of EoE with the highest number of patients reporting onset of symptoms of EoE in July-September and those being diagnosed with EoE in October-December. There was a seasonal correlation between peak levels of grass pollen and peak onset of EoE symptoms which were both highest in July-September. The diagnosis of EoE peaked one season later.rnrnConclusions: This study suggests that there is a correlation between specific aeroallergens and both the onset of symptoms as well as time of diagnosis of patients with EoE.rn
- Clinical Pediatric Gastric Problems
Pediatric and Neonatal Gastroenterology
Pediatric Gastrointestinal Surgery
Session Introduction
Seungil Ro
University of Nevada School of Medicine, USA
Title: Loss of miR-10b triggers depletion of interstitial cells of Cajal in diabetic mice
Time : 11:20 am - 11:50 am
Biography:
Seungil Ro has obtained his PhD in Cell and Molecular Biology from the University of Nevada, Reno, USA in 2002, where he has been Associate Professor since 2015 in the Department of Physiology and Cell Biology in School of Medicine. His research interest includes the roles of microRNAs that regulate gastrointestinal smooth muscle motility and epigenetic remodeling. He has 35 papers published to his credit.
Abstract:
Both acute and chronic hyperglycemias in diabetes are linked to gastrointestinal (GI) complications that can change normal function of motility in the gastrointestinal (GI) tract. The most common pathological abnormality in diabetic patients in the GI tract is characterized by depletion of interstitial cells of Cajal (ICCs). ICCs are pacemakers in the GI tract that regulate GI motility through spontaneous electrical slow waves. ICCs exclusively express the receptor tyrosine kinase KIT, which is required for the normal development and maintenance of ICCs. However, underlying molecular mechanisms in depletion of ICCs in diabetic patients are largely elusive. Here we report a microRNA mediated ICC depletion in the diabetic animal model. We identified miR-10b-5p as a diabetic cell marker that was dramatically diminished in the diabetic ICCs. MiR-10b-5p targets an epigenetic repressor, nuclear receptor co-repressor 2 (NCOR2), which negatively regulates expression of KIT. Expression of KIT and NCOR2 proteins was negatively related in diabetic intestine where KIT+ ICCs were found in lower concentration. ICC restricted miR-10b knockout in mice resulted in depletion of ICCs in the intestine. Our findings on KIT regulation by miR-10b-5p targeted NCOR2 offer a new insight into how ICCs is phenotypically changed and become non functional in diabetic conditions. Moreover, this study suggests miR-10b-5p may be potentially an attractive therapeutic target to restore KIT expression in diabetic ICCs of patients with GI dysmotility.
Taiji Akamatsu
Suzaka Prefectural Hospital, Japan
Title: Screening to Identify and Eradicate Helicobacter pylori Infection in Teenagers in Japan
Time : 11:50 am - 12:20 pm
Biography:
Taiji Akamatsu is the Director of Endoscopy Center and Vice-Director, Nagano Prefectural Suzaka Hospital, Nagano Prefectural Hospital Organization, Suzaka, Nagano, Japan. He is a Clinical Professor of Shinshu University School of Medicine, Matsumoto, Nagano, Japan. He is a Councilor of Japan Gastroenterological Endoscopy Society, Councilor of Japanese Society of Gastroenterology and Councilor of Japanese Society of Helicobacter Research. He is also a Member of American Gastroenterological Association.
Abstract:
To elucidate the prevalence and effect of H. pylori infection in Japanese teenagers, we underwent an examination and treatment of it in one high school health screening between 2007 and 2013. The study subjects were students ages 16 to 17. Students who tested positive on this screening using urine based rapid test kits (RUPIRAN®) examination visited Shinshu University Hospital and underwent esophagogastroduodenoscopy (EGD) and were taken biopsy samples to determine their H. pylori status using culture and histology. Cure of H. pylori infections was determined by urea breath test. For 7 years, 3,251 of 3,263 students (99.6%) received a screening examination for H. pylori infection. One hundred and thirty-six of 3,251 students (4.2%) were positive for H. pylori. Seventy four of these 136 H. pylori positive students visited our hospital and 72 underwent EGD and 60 (83.3%) were confirmed to be H. pylori infected. The most common endoscopic findings for H. pylori infection were nodular gastritis (83.3%) and closed type atrophic gastritis (60.0%). Duodenal scar was recognized in 4 of them (6.7%) and intestinal metaplasia was histologically present in two. 56 of 60 students with H. pylori infection and their parents agreed to receive eradication therapy using regimens according to the susceptibility of H. pylori. Finally, all were successfully cured of H. pylori infection. If this procedure were to be introduced into nationwide health screening at Japanese high schools, we calculated that the cost of the prevention of a gastric cancer would be 481,144 yen (4,184 dollars) for each person. The low rate of prevalence of H. pylori infection in present Japanese teenagers would make it possible and cost effective to perform examinations and carry out treatment for this infection in nationwide health screenings of high school students.
Yan Suqi
Wuhan Children's Hospital, China
Title: Preventative effect of massage on gastric volvulus in infants with gastroesophageal reflux-induced pneumonia
Time : 12:20 pm - 12:50 pm
Biography:
Yan Suqi is a Supervisor, Head of Integrated Traditional Chinese and Western Medicine Department of Wuhan Children's Hospital, earning a title of young and middle-aged famous Doctor of Traditional Chinese Medicine (TCM) in Hubei Province of China. For yeapediatric liver and lung diseasers, she has been studying the prevention and treatment of via TCM. As a host of National Natural Science Foundation project, she has published more than 30 papers in Chinese reputed journals and has been serving as a Standing Director of Pediatric Education Research Association of China Traditional Chinese Medicine Association of Higher Education.
Abstract:
Pneumonia with severe coughing and recurrent respiratory infections that is refractory to antibiotic treatment in those aged <6 months warrants targeted therapy. We found that infant pneumonia was closely related to gastric volvulus (GV) with gastroesophageal reflux (GER) and that the complications of GER may be responsible for the ineffectiveness of antibiotic treatment in infant pneumonia. To study the preventative effects of massage on GV in infants with GER induced pneumonia, we recruited 180 infants (1-6 months) admitted to the Department of Integrated Traditional Chinese and Western Medicine of Wuhan Children's Hospital for GV with GER induced infant pneumonia. Those 180 inpatients were divided randomly into four groups: Basic treatment 1/2 (n=60/30) and massage treatment 1/2 (n=60/30). Clinical examinations selected between groups 1 and 2 were different. Radiography of the upper gastrointestinal tract using iodine containing contrast was assessed in group 1 before and after treatment, whereas 24 hours pH monitoring of the distal esophagus was assessed in group 2 before and after treatment. Symptom scores and chest radiography were assessed in all groups upon hospital admission and after procedures. Clinical effects were estimated after procedures in all groups. The prevalence of severe pneumonia among the four groups was compared. Our research illustrated that massage can prevent GV with GER induced infant pneumonia by timely correction of stomach rotation and subsequent attenuation of GER. Massage as an intervention in Traditional Chinese Medicine may be an important method for infants with GER induced pneumonia.
Dinesh Pashankar
Yale University School of Medicine, USA
Title: Improving outcome of inflammatory bowel disease in children
Time : 13:50 pm - 14:20 pm
Biography:
Dinesh Pashankar has completed his medical school training and pediatric residency in India. He has worked in Glasgow and London in the UK and has passed MRCP examination. He completed pediatric gastroenterology fellowship training from Vanocuver, Canada. He worked at University of Iowa for 5 years and has been working at Yale University for 11 years. He is the Director of Pediatric IBD program at Yale. He is also a fellowship program director. He has given talks in national and international conferences and has more than 50 publications in reputed journals. He serves on an Editorial Board of Journal of Pediatric Gastroenterology and Nutrition.
Abstract:
Inflammatory bowel disease is a chronic condition affecting gastrointestinal tract and is characterized by relapses and remission. Aim of therapy is to keep children in remission for long time without any adverse effects of medications. We at Yale New Haven Hospital are a part of a large quality improvement network of 87 international centers. We use various quality improvement methods such as pre-visit planning and population management to improve outcome in our patients. We follow evidence-based diagnostic and therapeutic guidelines and regularly measure various parameters on remission, nutrition and growth. We have improved our remission rates with this systematic approach. Our remission rates of 87% in our patient population are better than target rates of the network (80%).
Eyad Mahmoud Altamimi
Mutah University, Jordan
Title: Functional gastrointestinal disorders (FGIDs) in children: A developing country insight
Time : 14:20 pm - 14:50 pm
Biography:
Eyad Mahmoud Altamimi is an Associate Professor of Pediatrics at the Faculty of Medicine at Mutah University, Jordan. He has completed his Pediatric Gastroenterology training at McMaster University, Hamilton, Canada. His most recent research focused on functional pediatric gastrointestinal disorders.
Abstract:
Functional gastrointestinal disorders (FGIDs) include a variable combination of age dependent, chronic or recurrent gastrointestinal symptoms not otherwise explained by structural or biochemical abnormalities. Although FGIDs have been extensively studied, the exact etiology is not fully understood. Parents are confused with the vague explanation of why is this happening. Patients are frustrated even with the fact that no serious cause for the real pain they feel. A number of theories have been put forth, including autonomic nervous system instability, visceral hyperalgesia, intestinal dysmotility and stressful life events, none of which alone can explain the condition. FGID has become a major health issue in Jordanian children. One of four children between the ages of 11 and 15 years exhibits at least one abdominal pain-predominant FGID. The most common form of abdominal pain-predominant FGID in our children was IBS. Females are affected more often than males. Intestinal and extra-intestinal symptoms are seen regularly with abdominal pain-predominant FGIDs. Diagnosis of FGIDs in children is not standardized and may vary between countries. It is essential to correctly diagnose these disorders in order to optimize the use of economic resources and avoid unnecessary investigations. Treatment options for these disorders are limited and even not standardized. In developing countries, dealing with this rolling down snowball is exhausting and will have enormous pressure on both health systems and care givers.
Taiji Akamatsu
Suzaka Prefectural Hospital, Japan
Title: Workshop on Helicobacter pylori infection in young people
Time : 14:50 pm - 15:50 pm
Biography:
Taiji Akamatsu was graduated from Shinshu University of Medicine in 1980 and completed Postdoctoral studies from Shinshu University Hospital. He is the Vice- Director of Nagano Prefectural Suzaka Hospital, a Councilor of Japan Gastroenterological Endoscopy Society, Japanese Society of Gastroenterology, Japanese Society of Helicobacter Research and a Member of American Gastroenterological Association.
Abstract:
Helicobacter pylori infection is well known to be related to several gastric diseases such as gastritis, gastroduodenal ulcer, gastric cancer, and gastric mucosa-associated lymphoid tissue (MALT). On the other hand, H. pylori infection is suspected to be connected with extra-gastric diseases such as iron deficiency anemia, idiopathic thrombocytopenia, chronic urticaria, and cap polyposis of the colon, etc. Gastric cancer is one of the common malignant neoplasms in the East Asia, and about 50,000 persons are died of this disease each year in Japan. Recently, it has been showed that H. pylori infection is a significant risk factor of gastric cancer epidemiologically, experimentally, and clinically. Nozaki, et al reported that early-stage eradication of H. pylori was more effective in reducing the late of occurrence of gastric cancer compared with late-stage eradication in animal experimentation. Furthermore, H. pylori-related diseases, for example complicated gastroduodenal ulcer that would sometimes cause a death due to perforation or bleeding especially in developing countries, could be prevented by cure of H. pylori. From these reasons, eradication of H. pylori is thought to be beneficial for the prevention of H. pylori-related disease and it is more effective to perform the treatment of H. pylori infection in young people. In this workshop, we like to discuss about H. pylori-related several diseases which have been tormenting people and a measure in children.
Hiroyuki Uehara
Suzaka Prefectural Hospital, Japan
Title: Workshop on Helicobacter pylori infection in young people
Time : 14:50 pm - 15:50 pm
Biography:
Hiroyuki Uehara is a medical doctor at the department of gastroenterology at Suzaka Hospital.
Abstract:
Helicobacter pylori infection is well known to be related to several gastric diseases such as gastritis, gastroduodenal ulcer, gastric cancer, and gastric mucosa-associated lymphoid tissue (MALT). On the other hand, H. pylori infection is suspected to be connected with extra-gastric diseases such as iron deficiency anemia, idiopathic thrombocytopenia, chronic urticaria, and cap polyposis of the colon, etc. Gastric cancer is one of the common malignant neoplasms in the East Asia, and about 50,000 persons are died of this disease each year in Japan. Recently, it has been showed that H. pylori infection is a significant risk factor of gastric cancer epidemiologically, experimentally, and clinically. Nozaki, et al reported that early-stage eradication of H. pylori was more effective in reducing the late of occurrence of gastric cancer compared with late-stage eradication in animal experimentation. Furthermore, H. pylori-related diseases, for example complicated gastroduodenal ulcer that would sometimes cause a death due to perforation or bleeding especially in developing countries, could be prevented by cure of H. pylori. From these reasons, eradication of H. pylori is thought to be beneficial for the prevention of H. pylori-related disease and it is more effective to perform the treatment of H. pylori infection in young people. In this workshop, we like to discuss about H. pylori-related several diseases which have been tormenting people and a measure in children.
Wassihun Nega
Bahirdar University, Ethiopia
Title: Craniopagus parasiticus: Parasitic head protuberant from temporal area of cranium: A case report
Time : 16:10 pm - 16:40 pm
Biography:
Wassihun Nega is a G.C graduated from Jimma University for the Doctor of medicine and has two years working experience as a lecturer at Bahirdar University. At present, he is a third year resident in Gyne /Obstetrics in BDR University.
Abstract:
Background: Craniopagus parasiticus is a rare medical case and it is unique unalike other case reported from different literature. The head of parasitic twins is protruding from the temporal area of cranium. Parasitic head had two deformed lower limbs; one is too rudimentary attached to the mass; Long bones of bilateral lower limbs and some pelvic bone. After dissection of the mass, the intestine was seen but no chest organs and other abdominal organs: There is also rudimentary labium but no vaginal opening. Case presentation: A 38-years-old multigravida (Gravida V para IV) woman from Amhara ethnicity referred from rural health centre to Referral Hospital due to prolonged second stage of labor at 42+1 weeks. Upon arrival she had contraction, term sized gravid uterus, and foetal heart beat was 112. On digital pelvic examination the cervix was fully diluted, station of the head was high and the pulsating umbilical cord coming in front of the presenting part with ruptured membrane but yet in the vaginal canal. The team decides to emergency cesarean section and then a live female infant weighing 4200 g was delivered. The placenta was single and normal. The APGAR scores were 7 and 9 at 1 and 5 min, respectively. The infant appeared to be grossly normal except the parasitic co-twin attached at the cranium. After a week of extensive counselling and investigations, successful separation operation was done. During post-operative time the neonate comfortably suckling on breasts and no neurological deficit. Two weeks after separation the neonate was discharged in a good healthy with arrangement for Post-natal follow up. Conclusion: The causes of craniopagus Parasiticus still unknown due to a rarity of cases. Doctors, genetic scientists and researchers continue to investigate this case as the reasons that could clue to birth defect and to provide answer for better prognosis of cases and improved the life chances of the twins.