or separated. They reported significantly higher scores on neuroticism, experienced morepsychological distress (mainly anxiety, somatisation and depression) and reported morephysical problems (not constipation). Differences in parenting behavior were small. Differ-ences found between both study groups could mainly be attributed to differences betweenmothers. Conclusion: Differences are found between parents of constipated children andparents of controls with regard to personality, physical and psychological health. Thesedifferences can be mainly attributed to mothers. Because parental participation is importantin treating FC in children, a more family based treatment strategy should be considered.

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Does Impedance Baseline Values Reflect Esophageal Damage in Children ?Maria G. Donato Bertoldi, Judith Cohen Sabban, Marina Orsi, Silvia B. Christiansen,Maria Teresa Davila

In previous studies in animals and adults it has been suggested that baseline impedance (BI) measurements could be a valuable indicator of esophageal mucosa integrity, being lowerin patients with esophagitis. Aim: To compare the impedance baseline values in childrenwith and without esophagitis. Material &Methods: Review of MII tracings performed betweenMay 2008 and October 2012, in children suspected of having gastroesophageal reflux. Allpatients underwent upper endoscopy with multiple esophageal biopsies followed by a 24hr MII-pH study. Esophageal histology was reported by two independent pathologists in ablinded manner. MII tracings were analyzed manually by two physicians using Sandhillsoftware. Mean IB was measured retrospectively by 6 channel impedance testing at everyhour for 24 h impedance-pH recording, excluding swallows and reflux. T-test and MannWhitney tests were used for statistical analysis. Biopsies were classified according to histologi-cal score: Grade 0= Normal mucosa; 1=Minor abnormalities (scanty intraepithelial poly-morphs, or submucosal vascular dilatation, or basal epithelial cell thickening); 2=Conspicu-ous intraepithelial polymorphs, 3= Ulcer slough present. T-test and Mann Whitney testswere used for statistical analysis. Patients with eosinophilic esophagitis were excluded.Results: Tracings of 70 children, 39 male, were evaluated; mean age: 8.37 yrs (r3-17yrs).Due to technical defects 15 tracings were excluded .Fifty five could be properly analyzed:29 with esophagitis (E) and 26 with normal mucosa (N). In 23/29 mild esophagitis (Ea)was observed and 6/29 had moderate to severe esophagitis (Eb). Significant differences wereobserved when Ea was compared with Eb and between Eb with N, but not between Eawith N Conclusions: The evaluation of the IB may be a good method to predict esophagealdamage. Although it is time consuming it may be of particular interest to spare endoscopyin high risk infants and in critically ill cases.

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Functional Gastrointestinal Disorders Dominate Pediatric GastroenterologyOutpatient PracticeAudra Rouster, David Silver, Landon Tomb, Harris S. Rosenblum, Paul Hyman

Purpose of Study: Symptom-based diagnostic criteria have improved recognition and stand-ardization of pediatric functional gastrointestinal disorders (FGIDs). We used Rome diagnos-tic criteria to determine the ratio of FGIDs to organic disease in outpatients. Methods: Weenrolled all new patients ≤18y referred to pediatric GI clinic over a 4 month period.Subjects or guardians completed a demographic survey and a Rome Diagnostic Questionnaire(validated QPGS-RIII for children ≥4 years or a new infant-toddler questionnaire) beforevisiting with a clinician. We recorded the chief complaint and clinician's diagnosis followingthe visit. Summary of Results: We acquired data from 306 subjects (144 male), 181 subjects≥4y, 125 subjects ,4y, 178 white, 91 African American and 13 Latino. There was no

S-609 AGA Abstracts

significant difference in frequency of FGIDs among racial groups or gender. Of those ≥4y,138 (76%) met criteria for a FGID on the questionnaire. Of those ,4y, 67 (54%) metcriteria for a FGID. Forty-six (25%) older children and 12 (10%) infants and toddlers metcriteria for 2 or more FGIDs. Common FGIDs included: IBS (27%), functional constipation(20%), abdominal migraine (10%), cyclic vomiting syndrome (7%), aerophagia (6%), func-tional dyspepsia (6%), infant regurgitation (6%) and functional abdominal pain syndrome(3%). Of those who reported missing ≥15 school days/year, 31 of 35 met criteria for aFGID. Of 25 patients reporting high level of stress, 22 met criteria for a FGID. Of 21 infantsreferred for chief complaints of "reflux" "vomiting" or "spitting up", 15 infants met criteriafor infant regurgitation, 4 met cyclic vomiting, 2 met infant dyschezia and 2 met functionalconstipation on the questionnaire. Clinicians did not diagnose gastroesophageal reflux diseasein any of the infants. In 83 of 206 children meeting symptom-based criteria there wasconcordance between clinician and questionnaire diagnosis. Conclusions: Over half of thenew patients in pediatric GI clinic met symptom-based diagnostic criteria for one or moreFGIDs. Satisfying symptom-based diagnostic criteria might facilitate diagnosis on the firstvisit. However, practicing clinicians agreed with questionnaire-based functional diagnosesin only 40% of the instances. Explanations for this discrepancy might include inaccuraciesin the diagnostic questionnaires or incomplete physician education or acceptance aboutfunctional disorders.

Mo1219

Prevalence of Abdominal Pain (AP) Related Functional GastrointestinalDisorders (FGIDs) in Pediatric Recipients of Hematopoietic Stem CellTransplant (HSCT)Miguel Saps, Larisa Broglie, Karina Danner-Koptik, Kimberley Dilley, Morris Kletzel,Sonali Chaudhury

Consultation for AP on pediatric HSCT recipients is common. GI graft versus host disease(GVHD) and infectious complications are common in HSCT. GI inflammation (infectiousand non-infectious) has been associated with postinflammatory (PI) AP-FGIDs. PI-AP-FGIDsusually improve with time (months/ years). The presence of AP-FGIDs in HSCT recipientshas never been described. Aim: Assess prevalence of AP and AP-FGIDs in pediatric HSCTrecipients. Hypothesis: 1-AP-FGIDs are frequent after HSCT. 2- AP-FGIDs frequency willdecrease with time from HSCT. Methods: Parents of children who had HSCT (allogeneicand autologous) . 2 years earlier, followed in clinic and had no recent GI infection/active GVHD completed the Questionnaire of Pediatric Gastrointestinal Symptoms (APcharacteristics and FGIDs diagnosis). Results: 44 HSCT children, 59.1% males, mean age10.2 years (range 5-17). Caucasian 59.9%, African-American 15.9%, Hispanic 11.3%, Asian4.5%, 8.4% unknown. Average time interval from HSCT: 72.11 months (range 31-142).AP reported: 7/44 (15.9%), 5/7 males. Mean age HSCT recipient with AP: 9.7 years (3-15)vs. 10.4 years (4-17) in no AP. AP-FGIDs diagnosed in 3 (IBS, functional AP, dyspepsia).3/7 AP group had GVHD or GI infections after HSCT. The AP group also had more frequentabdominal infections (40% vs. 15% p=0.009). Those with AP had a higher incidence ofsecond transplant (28.5% vs. 4.9% p=0.007), which were performed for relapse. The timeinterval from HSCT in the abdominal pain group is shorter (4 years), compared to the non-abdominal pain group (6 years), p=0.029. Conclusions: AP-FGIDs are common after HSCTin children. AP was more frequent in patients with shorter interval from HSCT. Studysuggests that post-HSCT AP-FGIDs course is similar to other inflammatory GI conditions.Large studies should confirm our findings. The investigation of post-HSCT AP-FGIDs mayhelp understand pathogenic factors of FGIDs including role of inflammation, stress, copingand families.

Mo1220

Pediatric Obesity and GERD: Correlation Between Impedance Baselines andEsophagitisRachel J. van der Pol, Amber P. Rongen, Yvan Vandenplas, Marc A. Benninga, SilviaSalvatore, Michiel P. van Wijk

Introduction: In adults, the obesity epidemic affects the rising incidence of gastroesophagealreflux (GER) disease and reflux esophagitis (RE). It has been shown that impedance baselines(IB) are significantly lowered in patients with RE. Inconsistent data are reported in childrenregarding the association between BMI, RE and IB. Aim: To assess if impedance baselinesand presence of RE correlate with body mass index (BMI) in children (0-18 years) withGER symptoms. Methods: Patients suspected of GERD who underwent endoscopy between2007 and 2012, and had pH impedance performed, with a maximum time interval of threemonths between the two tests, were studied retrospectively. Endoscopies were graded forreflux esophagitis (RE) according to the Los Angeles classification. BMI-for-age z-scores(BMI-z), using WHO guidelines for infants and children (0-18 yrs), and BMI percentiles(BMI-p) using growth charts for Centers for Disease Control and Prevention (CDC) (2-18yrs) were calculated. Overweight was defined as a BMI from the 85th-95th percentile andobesity as a BMI>95th percentile. Statistical analysis, using SPSS Statistics 19, was performed.Results: 123 children and 54 infants (0-24 months) were included with a mean age of 77.0months (SD:4.3). Forty-seven (26.6%) patients had RE. The mean BMI-z was -0.1 (SD:1.3),for BMI-p this was 43.5±31.2. Nine children fulfilled criteria for overweight (7.3%) and 5for obesity (4.1%). BMI-z did not differ significantly in patients with esophagitis (p=0.68),nor did it correlate with the mean of the most distal MII baseline (p=0.86). The sameaccounted for the BMI-p, esophagitis and MII baselines (p=0.91 and p=0.76 respectively),neither was a significant correlation found between overweight and obese children andpresence of RE. MII baselines were not significantly lowered in patients with esophagitis(p=0.54) . Conclusion: In children with GER symptoms, impedance baselines do not correlatewith BMI. In contrast to adults, RE is not more common in children suspected of GERdisease and overweight or obesity. There is a need for well-designed case-control studieswith valid statistical power, to further investigate these findings.

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