P-079: Comparison of quality of life among children treated with nutritional and anti-TNF therapies for active Crohn’s disease in North America

Abstract

s of the 3rd International Symposium on Pediatric Inflammatory Bowel Disease S423 P-079 Comparison of quality of life among children treated with nutritional and anti-TNF therapies for active Crohn’s disease in North America A.R. Otley1 *, D.Y. Lee2, R.N. Baldassano2, A.M. Griffiths3, C.W. Compher4, L.G. Allenberg2, F.D. Bushman4, G.D. Wu4, J.D. Lewis4. 1IWK Health Centre/Dalhousie University, Halifax, Canada, 2Children’s Hospital of Philadelphia, Philadelphia, United States of America, 3Sick Kids Hospital, Toronto, Canada, 4University of Pennsylvania, Philadelphia, United States of America Introduction: Enteral nutrition (EN) and anti-TNF therapy (TNF) represent alternative approaches to treat Crohn’s disease (CD) with varying potential to impact quality of life (QOL). Aim: To contrast QOL for patients receiving partial EN (PEN), exclusive EN (EEN), and TNF therapies with ad lib diet for CD. Methods: Children with active CD, initiating treatment with PEN, EEN and TNF were prospectively followed over 8 weeks. All EN delivered by NG tube. PCDAI, and IMPACT for diseasespecific QOL were evaluated. Results: Patients on TNF had longer disease duration (n = 52; 1.3±1.7 years) than the PEN (n = 16; 0.3±0.7) or EEN (n = 22; 0.1±0.2) (p 12.5; 90%) or remission rates at 8 weeks (PCDAI <7.5; 82%) (ns). There were no significant differences between the pre(n = 45) and post-2001 (n = 79) cohorts, excluding nonresponders, on baseline characteristics including height z-score, age, weight, and BMI (ns). There were no differences in disease location by response to EN (ns), but there were differences in disease location by cohort: 61% of pre-2001 had L1 disease vs. 40% post-2001 (p < 0.001), 0% of pre-2001 had L3+L4all vs. 43% post-2001 (p < 0.001). Conclusion: Differences in disease location preto post-2001 were due to selection bias of participants in assignment to EN, but did not influence success of EN. P-081 The major pathway by which polymeric formula reduces intestinal inflammation in Crohn’s disease patients a microarray-based analysis L. Nahidi1, J. Wei2, A.S. Day3 *, D.A. Lemberg4, S.T. Leach1. 1UNSW, Sydney, Australia, 2University of Sydney, Sydney, Australia, 3University of Otago, Christchurch, New Zealand, 4Sydney Children’s Hospital, Sydney, Australia Introduction: Exclusive Enteral Nutritional (EEN) therapy is well-established therapy to induce remission in active Crohn’s disease (CD). Evidence indicates that EEN alters both the intestinal microbiota and directly suppresses the inflammatory response in the intestinal mucosa. However, the pathway(s) through which EEN suppresses inflammation are unknown. Aim: The aim of this study was to investigate the major pathway by which PF alters the inflammatory processes in epithelial cells in vitro. Methods: HT-29 cells were grown to confluence and co-cultured with tumor necrosis factor (TNF)-a (100 ng/ml) for 5 hours in the presence or absence of polymeric formula (PF), as used for EEN. Following incubation, RNA was extracted and subjected to polymerase chain reaction (PCR) and microarray analysis. Enzyme-linked immunosorbent assay (ELISA) was employed to evaluated cytokine protein levels. Results: Microarray analysis showed that PF modulated expression of genes linked to nuclear factor (NF)-uB. These findings were confirmed by real-time PCR of selected genes. Up-regulation of IL-6 and IL-8 genes in TNF-a stimulated cells was significantly reduced with PF treatment (P< 0.01 for both comparisons). Conclusion: These results indicate that EEN alters the epithelial inflammatory responses through modulation of the NF-uB pathway with this activity independent of modulation of intestinal bacteria. Oral presentations 11:30 12:40 O5. Surgery case discussions O-24 10 year experience of surgery for 69 children with Crohn’s disease: indications, complications and outcome M.P. Stanton*, S. Blackburn, A. Wiskin, C. Barnes, K. Dick, N.A. Afzal, M.D. Griffiths, R.M. Beattie. University Hospital Southampton, Southampton, United Kingdom Introduction: Outcome data for surgery in paediatric Crohn’s disease (CD) are limited. Aim: We aimed to report 10 years’ experience of Crohn’s surgery at a regional paediatric gastroenterology centre. Methods: Children were identified from a prospectively maintained database (January 2002 to December 2012). Data were obtained regarding indications, early/late complications, disease relapse and height/weight responses. Data are median (range). Height/BMI SDS before/after surgery were compared Mann Whitney U test (significance p < 0.05). Results: 69 children, aged 13.8 years (6.3 17.0) at diagnosis, were included. Follow up was 1.8 years (27 days to 6 years). Surgery followed diagnosis by 9 months (0 days to 7 years).58 (84%) underwent abdominal surgery, 40 had right hemicolectomy. 10 children (14%) underwent surgery for perianal disease. The commonest indications for intra-abdominal surgery were stricturing disease 35 (60%) and unresponsive luminal disease 13 (22%). by gest on M ay 3, 2016 http://eccoxfordjournals.org/ D ow nladed from