AGA Abstracts Endoscopic Findings in Children with Gastroesophageal Reflux (n=255) Mo1184 Acid and Nonacid Gastroesophageal Reflux and Pepsin Isoforms (A and C) in Tracheal Secretion of Critically Ill Children Cristiane Hallal, Gilberto C. Borges, Veridiana S. Chaves, Isabel C. Werlang, Fernanda U. Fontella, Ursula Matte, Marcelo Z. Goldani, Paulo R. Carvalho, Jeferson P. Piva, Sergio G. Barros, Helena A. Goldani Background and Aims: Gastroesophageal reflux (GER) and pulmonary aspiration (PA) are frequent in intensive care unit (ICU) patients. The presence of pepsin in airways seems to be the link between them. However, pepsin isoforms A (gastric specific) and C (pneumocyte potentially derived) needs to be distinguished. This study aimed to evaluate GER patterns and to determine the presence of pepsin A and C in tracheal secretion of critically ill mechanically ventilated children. Patients and Methods: Thirty-four critically ill children undergoing mechanical ventilation were enrolled. All were sedated, on full enteral nutrition and underwent multichannel intraluminal impedance-pH monitoring (MII-pH) by using equipment Sleuth-Sandhill Scientific, USA. Data were manually analyzed by using software BioVIEW Analysis version 5.6 (Sandhill Scientific). MII-pH parameters analyzed were: num- ber of total episodes of GER (NGER); height of refluxate (proximal or distal); reflux content (acid, when ph<4 or nonacid, when pH>4); and acid reflux index [(ARI) percentage of time when pH<4, considered altered when ARI was >10% in children under 1 year age and >5% in older than 1 year). Tracheal secretion samples were collected from each patient to determine the presence of pepsin. Pepsin A and C were evaluated by Western-Blot. The following variables were also considered for analysis: use of antiacid medicines (yes or no) and placement of enteral feeding tube (gastric or post-pyloric). Wilcoxon test was used to compare acid vs nonacid GER. Mann-Whitney test was used to compare the number of reflux episodes of patients on and off antiacid medicines or patients with gastric or post- pyloric feeding. Results: Median (range) age was 4(1-174) months and 23 were males. Nineteen (55.9%) were on antiacid secretory medicines (9 ranitidine, 10 omeprazol). MII- pH detected 2172 GER episodes, 77.0% were nonacid and 71.7% were proximal. Median (25 th -75 th percentile) of NGER episodes/patient was 59.5 (20.3-85.3). Nonacid GER episodes/ patient were significantly more frequently than acid GER episodes/patient [median (25 th - 75 th percentile) 43.5 (20.3 - 68.3) vs 1.0 (0 - 13.8), respectively], p<0.001. Only 3 patients had acid reflux index altered (44.9%, 12.7%, and 13.6%), all off antiacid drugs. The results remained significant after controlling the use of antiacids and placement of enteral tube feeding to all parameters. Pepsin A was found in 100% of samples, pepsin C in 76.5%. Conclusion: The majority of GER episodes of ICU children were proximal and nonacid. All patients had aspiration of gastric contents detected by pepsin A in tracheal fluid. A specific pepsin assay should be performed to establish gastropulmonary aspiration since pepsin C was found in more than 70% of samples. Mo1185 Clinical Outcome of Patients With Neuronal Intestinal Dysplasia Type B: Results of Different Therapeutic Options Marcos C. Angelini, Laura L. Rosa, Erika P. Ortolan, Vanessa M. Granado Cassettari, Bonifácio K. Takegawa, Simone A. Terra, Maria Aparecida M. Rodrigues, Pedro L. Lourenção Introduction: Neuronal Intestinal Dysplasia type B (NIDB) is a rare disease characterized by complex changes of the enteric nervous system. In most of cases, its diagnosis is performed by histopathological analysis of rectal biopsies from patients with severe chronic constipation. The treatment of NIDB is still controversial and may be pharmacological or surgical. However, the results of these treatments are discordant and follow-up studies are rare and composed by a limited number of patients. Objective: To investigate the long-term clinical follow up of patients with NID, submitted to different types of treatment. Patients and Methods: This study was conducted in two parts. First, we retrospectively reviewed data from 17 children with NIDB diagnosed by histopathological analysis of rectal biopsies from 1998 to 2010, focusing on the clinical course of the disease (clinical condition before treatment and type of treatment performed). In a second step, prospectively, these patients were invited to an interview to investigate the current clinical status, focusing on defecation habits and fecal incontinence. The outcome was analyzed by a classification based on clinical and functional aspects at the time of the interview. It was considered as a "successful outcome" if the patient presented, for a period of at least 4 weeks, more than 3 bowel movements S-632 AGA Abstracts per week, without painful or hard defecations and nor episodes of fecal incontinence. Results: In most cases, symptoms had begun in the neonatal period (70.6%). Intestinal chronic constipation, defined by the Rome III criteria, was present in all of the cases at the diagnosis. Five patients developed acute intestinal obstruction and required emergency colostomy and later colorectal pull-through surgery (3 cases performed by Duhamel technique and 2 cases performed by Soave technique). Another 10 patients were submitted to surgical treatment (performed by Transanal Endorectal Pull-through technique), after failure of medical treatment and/or family choice. Two patients were maintained with exclusive clinical treatment (dietary changes and laxatives drugs). The median follow-up time was 6 years, with minimum of 4 years and maximum of 20 years. The overall results of treatment, with emphasis on the functional aspects of bowel habits, are presented on Table 1. There was statistically difference (p<0.05) only for 3 of the 8 functional characteristics analyzed before and after treatment. The outcome results are shown on Table 2. Only 3 patients achieved "successful outcome" status without the need for continuous use of laxatives. Conclusion: Although surgical treatment can be considered the most effective modality, often used as the option for the failure of clinical treatment, it is related to significant morbidity, especially because of fecal incontinence and its direct consequences on the quality of life. Table 1: Functional aspects of bowel habit before and after treatment * McNemar Test # Presence of at least one episode of fecal incontinence per week. This analysis was performed including only 10 of the 17 patients because 7 patients had less than 4 years of age at the beginning of treatment. Table 2: Treatment outcome based on clinical and functional aspects of the bowel habit at the time of the interview # successful outcome: patient who presented, for a period of at least 4 weeks, more than 3 bowel movements per week, without painful or hard defecations and nor episodes of fecal incontinence. Mo1186 Are Duodenal Biopsies Necessary for the Diagnosis of Celiac Disease in Diabetes Mellitus Type 1 Patients With Positive Serology Rami Gebrail, Alberto Rubio-Tapia, Joseph A. Murray, Imad Absah Background and study aim: Patients with diabetes mellitus type1 (DM1) are at higher risk of developing other autoimmune disorders like thyroid disease or celiac disease (CD). It is recommended that all patients with new onset DM1 get screened for CD. Recommended screening test is anti-tissue transglutaminase antibodies immunoglobulin A (TTG IgA). Small bowel biopsy (SBB) showing the classic histologic changes is still required as the gold standard confirmatory test, but many patients are treated with gluten free diet (GFD) without confirmatory SBB. Aims of this study are to assess 1) number of new onset DM1patients with positive celiac serology who had confirmatory SBB, 2) if confirmatory SBB can be omitted in new onset DM1 patients with highly positive celiac serology. Patients and methods: We performed a retrospective review of the electronic medical record of the Mayo Clinic between1980-2014. All patients age (1-60 years) with DM1 and positive celiac serology were included. Demographics, clinical and histopathological parameters were recorded. This study was approved by the Mayo Clinic IRB. Results: We identified 73 patients (37 Adults and 36 children) with new onset DM1 and positive celiac serology. Average age at diagnosis was 21.16 ± SD 3.53 years (range 2-53) at the time of diagnosis. Thirty patients (41%) were asymptomatic at the time of screening (23 Females, 7 males). Forty three (59%) patients had gastrointestinal (GI) symptoms (Table1) at the time of screening (31 females, 12 males). Demographic is summarized in table 2. Sixty one (84%) patients underwent a confirmatory biopsy, 25 asymptomatic and 36 symptomatic. In symptomatic patients 6 with weakly positive serology (less than 2X UNL) had normal SBB, whereas 30 (83%) patients had histologic changes suggestive of CD, 4 had intraepithelial lymphocytosis (IEL), 26 (87%) had villous atrophy (11 partial and 15 complete). In asymptomatic patients 2 had IEL with