Abstracts / Digestive and Liver Disease 38 (2006) A87–A120 A97 for CMV in serum was negative. He was treated with proton pump inhibitor once a day and his condition gradually improved with complete histological recovery after 3 months. Conclusions. The case is described owing to the rarity of this disease in the international literature. The course of this pathology in childhood is typically benign and brief. May be important to establish the diagnosis of CMV infection in cases of suspect paediatric Menetrier’s disease. doi:10.1016/j.dld.2006.07.041 PP 13 GASTROPANEL: A USEFUL SCREENING TEST IN PAEDIATRIC POPULATIONS Graziella Guariso, Daniela Basso, Silvia Conte, Michela Fasolo, Adriano Tasinato, Filippo Navaglia, Paola Fogar, Carlo-Federico Zambon, Eliana Greco, Stefania Schiavon, Mario Plebani Universit` a degli Studi di Padova, Pediatria, Padua, Italy Objective. Ascertain the role of gastropanel (GP) in screening children for gastric inflammation. Methods. One hundred and ninety-five children (101 F, 94 M; mean age 7 years) underwent EGDS for chronic abdominal pain. During endoscopy, 105 had no evident lesions, 43 antral erythema, 15 diffuse gastritis, 4 duodeni- tis, 11 oesophagitis, 10 micronodular gastritis, and 7 had mosaic duodenal mucosa. Helicobacter pylori was histologically diagnosed in 17.6% of cases. In fasting sera pepsinogen A (PGA), pepsinogen C (PGC), gastrin-17 (G17), anti-H. pylori Ab were assayed and analysed by the GastroSoft for Excel (Biohit ® , Helsinki, Finland). Results. 108/195 children had a histologically normal mucosa; 68 had gastric inflammation and 19 had extra-gastric lesions. PGC and anti-H. pylori were significantly correlated with H. pylori infection (t = 4.22, p < 0.001 and t = 5.28, p < 0.001). The GastroSoft provided five categories: normal, antral gastritis, antral atrophy, antral + body atrophy, body atrophy. GP sen- sitivity in identifying children with gastric inflammation was 29.4%, the specificity towards extra-gastric diseases was 68.4% while that towards controls was 95.4% (PPV 83.9%; PNV 70.7%). None of the single param- eters discriminated gastric inflammation (under ROC curves areas: 0.60 for PGA, 0.63 for PGC, 0.57 for G-17, 0.72 for anti-H. pylori). Six of seven children with mosaic duodenal mucosa were biochemically classified as having corpus atrophy: two had autoimmune gastritis and four coeliac disease. Conclusion. GP might be a useful non invasive test for screening gastric inflammation in children. This test seems able to indicate also in children the presence of corpus atrophy which has probably to be histologically searched especially in subjects with coeliac disease. doi:10.1016/j.dld.2006.07.042 PP 14 CASE REPORT: A CERVICAL OESOPHAGEAL TIGHT STENOSIS IN A PATIENT WITH AUTOIMMUNE POLIENDOCRINOPATHY TYPE 2 F. Fornaroli, B. Bizzarri, G. Biasucci, L. D’Amato, V. Corroppolo, A. Ghiselli, G. Carolla, G.L. de’ Angelis U.O.S. Gastroenterologia Pediatrica, Neonatologia e puericoltura, Parma, Italy We report the case of a young girl 7 years old, of Albanian origins, born in Italy, followed elsewhere for an autoimmune poliendocrinopathy (Addi- son disease, Hashimoto thyroiditis, hypoparathiroidism, vitiligo, ungueal distrofia, macrocitosis), sent to our Institute. She followed a substitutive therapy with Hydrocortisone, sodic Levotiroxina, Calcitriolo, Carbonate cal- cium, acetate fludrocortisone, and she was in good metabolic balance. The genetic study excluded the mutation of AIRE gene. No failure to thrive was recorded; stool were normal. The Colleagues asked us to evaluate the possi- bility of a gastrointestinal autoimmune involvement, in particular a coeliac disease or an atrophic gastritis. At the higher endoscopy exam (premed- ication by midazolam 0.6 mg/kg i.r.), the endoscope (Olympus GIF-160) stopped because of a cervical oesophageal tight stenosis; the procedure was repeated with the neonatal endoscope (Olympus GIF XP 160) with the same result. At a following meeting with the parents, they referred occasional dysphagia to solid and liquid foods. An upper endoscopy in surgery room in anaesthesia was planned. The exam showed a tight stenosis, non surmount- able by the instrument, not even under direct vision of the laryngoscope. A perendoscopic dilatation by Savary probe was performed, being impossi- ble a pneumatic dilatation. The dilatation allowed the following endoscopy to the distal duodenum, that showed no lesion at any level (the perendo- scopic biopsies were negative). The post operative period passed regularly with e.v. treatment by antibiotics (amoxicilline + clavulanate, gentamicine), steroids, fasting for 24 h long, and following re-feeding. At the laboratory, an elevation of platelets rate (1,469,000/mmc). The haematologist suggested a treatment by acetilsalicilate (5 mg/(kg die)); it has not been made because of the haemorrhagic risk secondary to the dilatation procedure and to the seat of the lesion; it would have been extremely difficult to stop a bleeding, either surgically or endoscopically. Three weeks later, a second perendo- scopic dilatation was repeated, by Savary probe (7 and 9 mm), the pneumatic balloon maintained in place at 12 mm for 1 min. To complete the diagnostic procedure, A thoracic CT with contrast liquid excluded morpho-structural alteration of the mediastinic and peri-oesophageal organs. The case report shows two series of interrogative: (1) The aetiopathogenesis of the stenosis and her correlation to autoimmu- nity, important for long term prognosis. (2) We cannot explain the scant symptomatology, the good general and nutritional condition in relation to the seriousness of the oesophageal stenosis, that, before the dilatation, did not permit the introduction of an 8 French nasogastric sonde. doi:10.1016/j.dld.2006.07.043 PP 15 ACUTE LIVER FAILURE AND LIVER TRANSPLANT FOR AUTOIMMUNE HEPATITIS ASSOCIATED WITH COELIAC DISEASE G. Torre, M. Candusso, P. Stroppa, M.L. Melzi, M. Bravi, M. Bosisio, M.G. Alessio, A. Sonzogni, M. Colledan Ospedali Riuniti di Bergamo, Pediatria, Bergamo, Italy Coeliac disease (CD) is associated with increased risk of developing autoimmune disorders; tyroiditis and type-1 diabetes are diagnosed in a large number of CD patients and their relatives, while autoimmune hepatitis (AIH) is less frequently associated with CD. We report an 8-year-old girl who showed progressive cholestatic liver failure, with severe coagulopathy and portosystemic encephalopathy. At diagnostic work-up, positivity for anti-transglutaminase and antyendomysial antibodies was found, together with positivity for antinucleus (ANA), anti smooth-muscle (SMA) and anti- LC1 antibodies (conventional methods). Despite gluten-free diet (GFD), steroid and cyclosporine therapy, the clinical conditions did not improve. For progressive neurological impairment (EEG findings) and orthotopic liver transplant (Oltx), the aptients required 4 weeks to improve after admission to our unit. The procedure was not complicated, the child received the usual immunosuppressive therapy, still on GFD; acute rejection was diagnosed in the 2nd week after Oltx, for increased transaminases and for the typical histological findings. The usual therapy (3 day steroid bolus) did not lead to recovery and 1 week later, liver biopsy was repeated for the recurrence of high transaminase level (>500 UI/ml); at the same time, autoantibodies were checked. Biopsy picture was highly suggestive for autoimmune hepatitis, which was confirmed by the positivity of liver–kidney microsomal (LKM) antibodies, for the first time. The child re-started the steroid therapy at 2 mg/(kg day) associated with azathyoprine (2.5 mg/(kg day)), in adjunction to tacrolimus, and