Spleen wondering and torsion following Nissen Fundoplication: A Case report.

Background: Chronic liver disease (CLD) in children is associated with reduction of bone mineral density.Glucagon like peptide-1 (GLP-1) is essential for bone metabolism and bone turnover.GLP-1 role in bone disease associated with CLD remains to be studied.Aim of the work: to study the relationship between GLP-1 and osteoporosis among children with CLD.Subjects and Methods: This cross-sectional study included 60 children with CLD as a study group and 60 healthy participants as a control group.GLP-1 was measured using ELISA technique and compared between groups.All children with CLD underwent liver biopsy and bone density dual-energy X-ray absorptiometry (DEXA) scan.The study was conducted at Benha University Hospital, Egypt.Results: The mean SD age of the included children with CLD and control group was 9.3 5.1 years and 10.43 5.54 years (p=0.130).Females and males comprised 33 (55%) and 27(45%) of the CLD group and 41 (68.3%) and 19 (31.7%) of the control group (p=0.133).The mean SD duration of liver diseases was 7.14 4.51 years.Osteoporosis was encountered among 53 (88.3%) children with CLD.Their mean SD age was 9.51 5.27 and their mean SD disease duration was 7.22 4.65 compared to 7.71 3.13 SD and 6.60 3.52 SD of those who did not have osteoporosis (p=0.498) and (p=0.910)respectively.The mean SD bone mineral density (BMD) and Z-score for lumber spine in children with CLD was 0.46 0.14 g/cm 2 and mean SD Z-score was -2.7 0.38.BMD correlated negatively with liver disease duration: r: -0.135, p=0.303, histological activity index: r: -0.101, p=0.441, fibrosis: r: -0.046, p= 0.726, PELD: r= -0.46; p= 0.003; MELD: r= -0.71; p< 0.001; CHILD Pugh: r= -0.26; p= 0.04).The mean SD serum GLP-1 among children with CLD was 3.06 1.07 pg/ml and 6.5 2.01 pg/ml in the control group (p= 0.001).Serum GLP-1 correlated negatively with progressive fibrosis (p=0.008).Serum GLP-1 correlated with BMD (p=0.013), and at a cut-off value of 4 pg/mL, GLP-1 had 86.7% sensitivity and 83.3% specificity in diagnosis of osteoporosis in children with CLD.Serum 25(OH) vit D less than 28 nmol/L had a 100% sensitivity and specificity for detection of osteoporosis.Conclusion: DEXA confirmed osteoporosis of lumbar vertebrae among children with CLD.Serum GLP-1 level was reduced among children with CLD.Serum GLP-1 correlated inversely with degree of liver fibrosis and histological activity index and positively with the progression of osteoporosis in children with CLD.Low serum 25(OH) vit D is a sensitive and specific diagnostic marker of osteoporosis in CLD.