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Background: Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome (MetS) and is characterized by increased hepatocyte triglyceride content in the form of lipid droplets. Recent evidence suggests that lysosomal acid lipase (LAL) may play a role in lipid droplet degradation through the autophagic pathway which contributes to the development of insulin resistance. The aim of this study was to investigate the association between LAL activity in the blood and the severity of hepatic steatosis and features of MetS. Methods: Consecutive children with evidence of hepatic steatosis on ultrasound (US) were included. The severity of steatosis was graded as follows: 1 (mild), 2 (moderate), 3 (severe). Demographic, anthropometric, and routine laboratory data were collected on all subjects. Insulin resistance was evaluated by homeostatic model assessment (HOMA-IR). LAL activity was measured in dried blood spot using Lalistat 2 per standard protocol. Spearman rank correlation coefficient (rho) was used to assess the relationship between LAL activity and clinical features. Results: 161 children were included, 56% male, mean age of 12.3 ± 8.6 years, 90% were overweight or obese. Liver US showed mild steatosis in 36%, moderate in 47% and severe in 17%. The mean LAL activity was 1.29 ± 0.66. There was a weak but significant negative correlation between LAL activity and BMI z score (rho = -0.36), fasting insulin (-0.20), HOMA-IR (-0.22) and uric acid (-0.26); p value 90% and severe steatosis (grade 3) on liver US (p < 0.05 for all). Conclusion: Peripheral blood LAL activity correlates with features of the MetS and the severity of hepatic steatosis in children.

Background: The life expectancy of the population is rising. The number of octogenarian (80 years or older) undergoing endoscopy evaluation is rising. The utility of double balloon enteroscopy (DBE) procedure in Octogenarians have not been previously reported. Aim: To determine the safety and diagnostic yield of DBE procedure in the octogenarians. Methods: We reviewed our large prospectively collected DBE database from 2006 to 2011. The octogenarian patients aged 80 years or older were included in our study analysis. Patients' demographics along with DBE procedure indication, findings, and complications were recorded. The safety and diagnostic yield of DBE procedure was calculated by the frequency statistics. Results: A total of 1218 DBE procedure were performed from 2006 to 2011 at our tertiary referral center. Out of these DBE procedures, 108 DBE (60 antegrade and 48 retrograde approaches) performed in 86 different patient encounters among 68 octogenarian (54.4% Male) were included in our study analysis. The average age of these patients was 84 (80-95) years and BMI was 26.2 (18.6-45.13) kg/m2. The most common indication for DBE was overt bleeding 29.6% (See table below). The most common finding during these DBE was bleeding AVM (arterio-venous malformation) among 38% (n=33) encounters. The overall diagnostic (pertinent positive findings) or therapeutic yield of DBE was found to be 91.86% (79/86 encounters). The diagnostic and therapeutic yield was found to be 91% (71/ 78 encounters) for evaluation of gastrointestinal bleeding and 100% (5/5 encounters) for evaluation of suspected mass or bowel stricture among octogenarian. There was no immediate (

Background and Aims: The epidemiology of gastrointestinal disorder is poorly described among Japanese children. Our aim is to clarify the trend of GI diseases' prevalence at Pediatric GI practice in Japan over the last decade. Methods: Children and adolescents with GI symptoms from 2001 to 2011 were identified by endoscopic databases at Shinshu University Hospital and Showa Inan General Hospital. Procedures were performed by pediatric GIs and routine biopsies were taken from every landmark. The prevalence of newly diagnosed GI disorders, especially Helicobacter pylori related disorders, eosinophilic gastrointestinal diseases (EGIDs) and inflammatory bowel disorder (IBD), are evaluated. Results: In total, 772 procedures (534 esophagogastroduodenoscopy[EGD] and 237 colonoscopy[CS]) were performed for 552 Japanese children and adolescents (54% female, average 11.47±4.57 year). Of 552 patients, 93 (18%) had H. pylori infection, and 27 (29%) of H. pylori positive subjects had peptic ulcer (22 duodenal ulcer and 5 gastric ulcer). Twenty-two patients (4%) were diagnosed as EGIDs (11 eosinophilic gastroenteritis, 11 eosinophilic colitis and no patient of eosinophilic esophagitis despite routine biopsies from esophagus). Twelve patients were diagnosed as IBD (10 Ulcerative colitis and 2 Crohn's disease). The trend of each disorder was shown in Figure 1. Conclusion: EGIDs have increased dramatically in a few years. On the other hand, H. pyori infection decreased almost one-fifth over 10 years in Japanese children.

the potential involvement of histamine receptors was also examined in current studies. Both cimetidine (1 raM) and diphenhydramine (0.1raM), H2 and H1 histamine receptor antagonists respectively, had no effect on inhibition of 36C1 uptake by TDC. In conclusion, our studies, provide direct evidence for inhibition of human intestinal luminal CI'/OH (HCO~) exchange activity by bile acids. The results of our studies demonstrate that bile acid effects on the apical CI/OH exchange in Caco2 cells are not mediated via histamine receptors and involve a cAMP-independent but Ca + +, PKC and PI3 kinase-dependent pathways.

Our aim was to evaluate the usefulness of the 13C-urea breath test (UBT) for the diagnosis of Helicobacter pylori infection, for assessment of the efficacy of eradication therapy, and for post-treatment follow-up in children. Methods. Seventy-two patients who underwent endoscopy for symptoms related to the upper gastrointestinal tract were examined by rapid urease test, histology, and culture. The patients were also studied with serology and UBT. Results. Forty-seven of the 72 patients were diagnosed with H. pylori infection, based on the results of biopsy-based tests and serology. As an initial diagnostic test to detect H. pylori infection, the sensitivity of the UBT was 95%, which was comparable with that of histology (94%), rapid urease test (96%), and serology (91%) and was greater than that of culture (79%). The specificity of the UBT was 100%, which was comparable with that of the other four tests. The efficacy of eradication therapy was assessed by biopsy-based tests and the UBT in 24 H. pylori-positive patients. For this purpose, the sensitivities of UBT and histology were 100%, while the sensitivities of culture and the rapid urease test were 88%. The specificity was 100% for all of these tests. Eleven patients were assessed by biopsy-based tests and UBT after more than 6 months of post-treatment follow-up. There were no discordances between the results of the UBT and those of the biopsy-based tests in any of the patients. Conclusions. The UBT may be useful for detecting H. pylori infection in children with upper gastrointestinal tract symptoms, for assessment of the efficacy of eradication therapy, and for the follow-up evaluation of patients after the therapy.