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sP = NS). Urinary i-FABP was increased in NEC cases although there were no differences inS100A8/9, 5-HT or 5-HIAA (see Table). An i-FABP cutoff value of 5.5 pg/nmol Cr resultsin a sensitivity of 33% with 100% specificity whereas a cutoff value of 3.0 pg/nmol Cr yieldsa 67% sensitivity and 79% specificity. Conclusions: Despite an elevated mean urinary i-FABP in NEC cases, there is significant overlap of values with control subjects which yieldsa poor sensitivity and specificity profile in this pilot study. This overlap may be due to theexact timing of sample collection relative to the intestinal inflammation and onset of NEC.A larger longitudinal study is required to identify the appropriate timing of sample collection.(Supported by the Ada Jacox Award from Wayne State University and the Division ofNeonatology at Michigan State University).Table: Urinary Biomarker Levels

*P < 0.01 vs Controls; #P = NS vs Controls

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Mediterranean Diet (MD) Efficacy in Patients With Slow Transit Constipation(STC)Andrea Lisotti, Giuseppe Mazzella, Roda Enrico

Aim: MD rich in vegetable can be useful in patients with STC for the high availability infibers and of precursors of nitric oxide (main relaxing agent of the gastric fundus); moreoverMD substantially alters the composition of fecal microbiota. Methods: Sixty six prospectivelyenrolled STC patients ( mend age 58; 32 m 34 f) were randomized to adopt either MD ora prudent diet (carbohydrates 55%; protein 15- 20%; fat 30%).The study design wascomposed by a two weeks run-in period, an eight weeks treatment period and a two weekswash out period. During each period bowel movements and stool consistency using a Bristolscale were recorded. Colon transit time was determined by the Hinton test using radiopaquemarkers. Patients with transit time longer than 72 hrs. were included in the study. Generalgastrointestinal symptoms were evaluated weekly with a questionnaire and the measurementof the colic transit time was repeated after the intervention. Results: MD resulted in asignificant acceleration of the total colonic transit time from 94.4 to 77.2 hrs. (p<0.05).mainly promoted in the sigma and rectum. As for gastrointestinal symptoms abdominalpain/ discomfort and global self-assessment ( Likert scale) was significantly reduced onlyafter MD diet ( p: 0.05). Conclusion: MD after 8 weeks is effective in reducing symptomsin patients with the STC.

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Increased Anti-Flagellin- and Anti-Lipopolysaccharide Immunogloblulins inPediatric Intestinal Failure: Associations With Fever and Central Line-Associated Blood-Stream InfectionsDavid Galloway, Misty Troutt, Mitchell B. Cohen, Samuel A. Kocoshis, Andrew T.Gewirtz, Thomas R. Ziegler, Conrad R. Cole

Objective: Central line associated blood stream infections (CLA-BSI) pose a significantchallenge in the lives of patients with intestinal failure (IF). We evaluated plasma antibody(immunoglobulin) levels against Gram negative bacteria-derived flagellin (FLiC) and lipopoly-saccharide (LPS) as potential biomarkers for CLA-BSI in patients with IF. We hypothesizedthat plasma immunoglobulins against Flagellin and (LPS) would be able to differentiateCLA-BSI from non-bacterial febrile episodes and that levels would increase with infectionand decline following appropriate antibiotic treatment. Patients and Methods: Patients withIF, including due to short bowel syndrome (SBS), between the ages of 3 months and 4years of age, were recruited from the institutional database at Cincinnati Children's HospitalMedical Center. Anti-FLiC and anti-LPS plasma antibody levels were measured in 13 childrenwith IF at baseline, during febrile events and also following treatment with antibiotics. Thesesame levels were also measured in 10 children without IF as control cases. Results: PlasmaFLiC IgA levels increased during febrile episodes in all IF subjects [baseline mean of 1.10versus febrile episode mean of 1.32 optical density (OD) units, respectively; p= 0.046].Neither plasma FLiC nor LPS IgA or IgG immunoglobulin levels distinguished CLA-BSIfrom non-bacterial febrile episodes compared to baseline levels. Compared to controls,subjects with IF had significantly higher plasma levels of anti-FLiC IgA [mean (+/- SD) IFof 1.01 (+/- 0.56) versus controls 0.52 (+/- 0.29) OD units respectively; p = 0.02] andhigher plasma levels of anti-LPS IgA compared to controls [mean (+/- SD)IF 1.43 (+/- 1.01)versus 0.45 (+/- 0.09), respectively; p =0.004]. Conclusions: Plasma anti-FLiC IgA antibodylevels rise during febrile episodes, but do not differentiate between nonbacterial febrileillnesses and CLA-BSI in pediatric IF. Anti-FLiC and anti-LPS antibodies are present athigher levels in the plasma of patients with IF compared to control children withoutIF, potentially due to gut-derived Gram negative bacterial translocation in IF. Althoughupregulation of these antibodies in IF suggest the systemic presence of Gram negativebacterial products, their specific role as biomarkers for infection requires further evaluation.

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Evaluation of Fatty Acid Absorption in the Small Intestine Using a 13C BreathTest -Comparison Between the Presence and Absence of Bile Acids in theSmall Intestine-Michiaki Takii, Daisuke Masuda, Akira Imoto, Takeshi Ogura, Kazuhide Higuchi

Background/Aims: Dietary fatty acids form mixed micelles with bile acids that are absorbedby small intestinal epithelial cells. A novel absorption test in the small intestine was inventedusing 13C-labeled fatty acids. Fatty acid absorption in the small intestine was compared

S-798AGA Abstracts

between the presence and absence of bile acids in the small intestine. Subjects: Six healthysubjects and five pancreatic head cancer patients with obstructive jaundice were included.Methods: Palmitic acid is a representative long-chain fatty acid. The subjects received theoral administration of 13C palmitic acid (10 mg/kg body weight). Exhaled breath wascollected every 60 minutes for 480 minutes to measure Δ13CO2 concentrations using a massspectrometer. The total bilirubin values of pancreatic head cancer patients with obstructivejaundice were reduced to 3 mg/dl or below using endoscopic nasal bile drainage (ENBD).Subsequently, a 13C palmitic acid breath test was conducted 1) immediately before and 2)seven days after stent placement for bile duct stricture. The time-course of the Δ13CO2

concentrations was represented by a curve with its peak value as C max (‰) and time asTmax (min). Results: For the healthy subjects, an arcuate line was obtained with Tmax of240 (min), Cmax of 5.83 (‰), and AUC of 1,951 ± 479 (‰/min). For the patients withbiliary tract obstruction 1), a flat curve was obtained with Tmax of 480 (min), Cmax of0.88 (‰), and AUC of 129 ± 55 (‰/min), suggesting extremely low absorption. For thepatients after biliary stent placement 2), the absorption recovered to a normal level, withTmax of 360 (min), Cmax of 7.04 (‰), and AUC of 2,308 ± 1,147 (‰/min). Conclusions:The novel 13C-labeled fatty acid breath test demonstrated extremely low fatty acid absorptionin a state of bile deficiency in the small intestine due to bile duct obstruction. The fattyacid absorption in the small intestine recovered to a normal level after biliary stent placement.Thus, bile acids play a critical role in fatty acid absorption.

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Total Decompression After Colonoscopy Decreases Abdominal Pain: ARandomized Controlled TrialSe Woo Park

Background Abdominal pain occurring after colonoscopy may cause significant discomfortin some patients and residual bowel gas is a key contributor to abdominal pain. Aim Todetermine whether total decompression decreased abdominal pain and improve patienttolerance compared with the conventional procedure Methods Asymptomatic 163 patientswho underwent total colonoscopy were randomized to total colonic decompression or tothe control group. The procedure was performed uniformly in both groups. After completionof the routine colonoscopy, the colonoscope was advanced again to the cecum and the airaspirated during withdrawal in the decompression group. We withdrew the colonoscopeimmediately in the control group. Abdominal pain was assessed in the recovery room andin 24-48 hours using a 10-point scale. Results The two groups were similar with regard toclinical and demographic factors and to procedure factors. Among 156 patients, the incidenceof abdominal pain after colonoscopy was 65/156 (41.7%); 44 (56.4%) of 78 patients in thecontrol group and 21 (26.9%) of 78 patients in the decompression group (P <0.01). Butthere was no significant reduction in the decompression group compared with the controlgroup regarding the abdominal pain when questioned in 24-48 hours after the procedure.The reduction rate of abdominal pain was 81.3% through multivariate analysis (HR 0.187[0.081-0.429], P <0.001). Furthermore, young age (<50) and female sex were identified asindependent factors for abdominal pain. Conclusion Total colonic decompression aftercolonoscopy had beneficial effect on reducing of abdominal pain without additional complica-tion.

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An Overview of the Impact of Fecal Calprotectin Testing in the Managementof Patients Within the Gastroenterology Outpatient Clinic in a GeneralHospitalJohn Eccles, Alan Neely, Mark Lynch, Charles B. Ferguson, Graham Morrison

Fecal calprotectin (FC) testing serves several functions within the gastroenterology clinic -firstly, a negative test supports a diagnosis of irritable bowel syndrome (IBS) in patientswith lower gastrointestinal symptoms and helps identify patients requiring investigations toexclude inflammatory bowel disease (IBD). Secondly, FC acts as a surrogate marker fordisease activity in IBD and may aid clinical decision-making in treatment. We present ourdata on the impact that FC testing has made within our clinic. Method: FC testing wasutilized in 119 clinic patients (83 adults and 36 children) between Septembers 2012-2013. Quantitative laboratory testing was done using either one of two enzyme-linkedimmunosorbent assay (ELISA) platforms, one of range 30-1800 mcg/g and another of range10-600 mcg/g. Results were interpreted using an applied normal cut-off value of 60 mcg/g. Results: In 58 patients (aged 15-80 years) referred with lower gastrointestinal symptoms,35 patients had a negative FC result (<60mcg/g), supporting a diagnosis of IBS withoutneed for endoscopy (except in 4 cases). 8 patients with low elevated levels were alsodiagnosed with IBS and managed without further investigations. Only 15 test-positive patientsunderwent endoscopy, small bowel imaging or both; 7 were diagnosed with IBD, 1 withmicroscopic colitis, and 1 with giardiasis; the remaining 6 were diagnosed with IBS. FCtesting helped in assessment of disease activity and decision-making in 25 patients withknown IBD; 7 patients improved with steroids, 5 were commenced on thiopurines or hadtheir dose increased, and 6 were escalated to biological therapy or switched to an alternativeagent, whilst 4 were felt to be in remission on biological therapy. 3 patients needed surgery.36 samples were sent from the pediatric clinic (age range 3-14 years); of 30 patients withabdominal pain, bloating, or altered bowel habit, 21 had a normal FC result and exclusionof IBD. In 9 patients with mildly elevated results (ranging from 62-125mcg/g), IBD was feltto be unlikely and further investigations deferred. 2 patients presenting with abdominalpain and rectal bleeding had FC levels >1200mcg/g and so underwent endoscopy and smallbowel imaging - 1 had severe pancolitis, the other had evidence of proctitis, and both werecommenced on steroids and aminosalicylates. In 4 pediatric patients with known IBD, 1had a normal level and was felt to be in remission; 3 had modestly elevated levels, with 1patient being treated with steroids, another being commenced on azathioprine, and a thirdfailing to settle with infliximab and requiring surgery. Conclusion: Fecal calprotectin (FC)testing is an effective tool in corroborating a clinical diagnosis of IBS (and exclusion of IBD),but can also serve as a marker for disease activity in known IBD and aid clinical decision-making in patient management.