charcoal reduced the number of flatus passed in patients to 12.5 � 2.1(range 11–14), bloating score to 5.3 � 1.0 (range 4–6) and cumulativehydrogen to 1664 � 22 ppm (range 1266–1879). Activated charcoalreduced the no. of flatus in controls to 9.6 � 2.0 (range 6–14), bloatingscore to 4.2 � 1.1 (range 3–5) and cumulative H2 to 1021 � 14 ppm (range606–1241).Conclusions: Male patients with complaints of excessive gas produce moreH2 more passage of flatus and have higher bloating score in response tolactulose compared to healthy controls. Activated charcoal reduced allthese parameters in both patients and healthy controls.

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NOSOCOMIAL BACTEREMIA FROM LACTOBACILLUSSUPPLEMENTATION IN SHORT GUT SYNDROME: A CASEREPORTAnjali N. Kunz, M.D., James M. Noel, M.D.*, Mary P. Fairchok, M.D.Madigan Army Medical Center, Fort Lewis, WA.

Purpose: We report the first cases of bacteremia secondary to Lactobacil-lus supplementation in two infants with ultra short gut syndrome (USGS).The infants were started on Lactobacillus gg enteral supplementation toprevent intestinal bacterial overgrowth. We speculate that intestinal inflam-mation, denudation, and increased permeability led to transmigration of thelactobacillus gg from the intestinal lumen to the systemic circulation,resulting in bacteremia.Methods: Patient 1 was started on Lactobacillus gg supplement on day oflife17. On day of life186, he developed fever. Evaluation for sepsis re-vealed a positive blood culture for Lactobacillus GG. The patient wasstarted on antibiotics for approximately 10 days. Lactobacillus GG wasdiscontinued and subsequent blood cultures were negative. Patient 2 wasstarted on lactobacillus GG on day of life 95. On day of life 118, this patientdeveloped signs of sepsis. Sepsis evaluation revealed lactobacillus in hisblood cultures. Lactobacillus supplementation was discontinued in thispatient and he was treated with a course of antibiotics, with resolution ofinfection.Results: Due to the suspicion for translocation of the supplement into thebloodstream, the lactobacillus isolated from Patient 1 and a sample of thelactobacillus gg supplement that he was taking, were sent to the Universityof Washington Department of Clinical Microbiology for typing by pulsedfield gel electrophoresis of chromosomal DNA using Sfi 1 and Not 1digests. The results showed the 2 isolates to be indistinguishable, confirm-ing that the supplement had been the source of the bacteremia in thispatient.Conclusions: Lactobacillus is a gram-positive rod that is indigenous to thehuman intestine. This organism attaches to the human intestinal epitheliumand acts synergistically with the host’s immune system to protect againstbacterial overgrowth with pathogenic organisms. Lactobacillus gg is mar-keted as a safe probiotic supplement that has been used in a variety ofclinical conditions including USGS. Although it is used in clinical condi-tions characterized by increased gut permeability, there are no prior reportsof Lactobacillus gg causing bacteremia in infants. We suggest that use ofthis supplement in infants with USGS is not without risk. Therefore, werecommend that if infants with USGS are given this supplement anddevelop signs of sepsis, empiric antimicrobial coverage for this organismshould be provided and the supplement should be held until results of bloodcultures are known.

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THE PRESENCE OF CONSTIPATION AND METHANE ONLACTULOSE BREATH TEST IN IBS SUBJECTS ISASSOCIATED WITH LOWER SEROTONIN LEVELSCOMPARED TO HYDROGEN ALONEMark Pimentel, M.D., FACG*, Yuthana Kong, M.P.H., Sandy Park, B.A.Cedars-Sinai Medical Center, Los Angeles, CA and University ofCalifornia, Los Angeles, Los Angeles, CA.

Purpose: We have recently demonstrated a high prevalence of abnormallactulose breath test (LBT) in subjects with IBS and that methane on LBTis uniformly associated with constipation predominant IBS (Pimentel, et al,in press, Am J Gastro). Since serotonin has a role in transit and IBS, the roleof serotonin was evaluated in IBS subjects with hydrogen and methane onLBT.Methods: Consecutive IBS subjects meeting Rome I criteria were enrolledand asked to complete a symptom questionnaire. All subjects underwent alactulose breath test after a 12 hour fast. On a subsequent day of fasting,subjects were asked to ingest a 75g glucose solution. At 60 minutes, a bloodsample was drawn. Subjects were then given open label neomycin 500 mgbid for 10 days and asked to return for repeat breath and serotonin testingin sequence. The prevalence of methane and hydrogen was determinedfrom the LBT. The prevalence of constipation and diarrhea predominantIBS was determined. Blood samples were used to determine the serotoninlevels via HPLC. The effect of treatment on methane and serotonin wasexamined.Results: 20 subjects were eligible to participate in the study. Of these, 5had methane and 15 had only hydrogen on LBT. Three subjects were notincluded in the analysis due to inadequate blood sampling for serotoninlevels. There was a significant inverse correlation between the degree ofconstipation subjects reported (0-5) and serotonin levels (r��0.67,p�0.01). No correlation was seen between the degree of diarrhea andserotonin levels (r�0.003, p�1.0). C-IBS subjects had lower serotoninlevels (49�6 ng/mL) than D-IBS subjects (90�52 ng/mL) (p�0.08).Serotonin levels after glucose were lower in methane subjects (33�24ng/mL) than in hydrogen IBS subjects (89�44 ng/mL) (p�0.05). Therewas also an inverse correlation between the degree of methane productionon LBT and serotonin levels (r��0.49, p�0.06). In two methane subjectswith antibiotic elimination of methane on LBT, serotonin was seen toincrease.Conclusions: Serotonin levels seem to correlate better with clinical con-stipation rather than diarrhea. Methane on LBT in IBS subjects appears tobe associated with lower serotonin levels.

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MEFV GENE MUTATIONS IN IRANIAN PATIENTS WITHFAMILIAL MEDITERRANEAN FEVER (FMF)Mohammad Reza Zali, M.D., FACG*,Seyed Javad Mirhassani Moghaddam, M.D., Farnaz Taghizadeh, M.Sc.,Nastaran Noroozi, M.D., Akram Narimani, B.S., Sarvin Peyman, B.S.,Faramarz Derakhshan, M.D. Research Center for Gastroenterologyand Liver Disease, Shaheed Beheshti University of Medical Sciences,Tehran, Islamic Republic of Iran.

Purpose: Familial Mediterranean fever (FMF) is an autosomal recessivedisease, which is characterized by recurrent short episodes of inflammationin serous membranes. It is most prevalent in Western Mediterraneanpopulation. MEFV is the only gene currently known to be associated withthis disease. Molecular genetic tests detecting the MEFV gene located onchromosomal locus 16p13.3 usually confirm the diagnosis. Previous stud-ies revealed that 6% of Iranian Jewish residents in Israel were carriers ofMEFV mutation. The present study was undertaken to analyze the threeknown mutations of this gene in Iranian patients.Methods: After signing informed consent, 28 patients meeting full inclu-sion criteria and 30 healthy controls enrolled in the study. To detectM694V, M680I and V726I mutations, genomic DNA, extracted fromperipheral blood lymphocytes, was examined using amplification refractorymutation system (ARMS-PCR) with common, normal and mutant specificprimers.Results: Fever and intermittent episodic abdominal pain were the mostcommon manifestations among the cases. Of the 28 cases with full inclu-sion criteria, 8(28.6%) were positive for M694V mutation (2 homozygote,5 simple heterozygote, and one compound heterozygote), 4 (14.3%) forM680I mutation (one homozygote, 2 simple heterozygote, and one com-

S72 Abstracts AJG – Vol. 98, No. 9, Suppl., 2003