P274 Clinical utility of measuring serum TNF alpha level, anti TNF alpha levels and antibody titers in critical situations in inflammatory bowel disease and in psoriasis

Abstract

Background: Bowel ultrasonography (US) is a non-invasive tool in the evaluation of inflammatory bowel diseases, especially Crohn’s disease. There are only few data on its role in Ulcerative Colitis (UC), particularly in children. We aimed to evaluate the usefulness of bowel US to assess pediatric UC pts and compare US findings with clinical and endoscopic data. Methods: 30 pediatric pts (median age 15 years; range 2 21; 14 males) were prospectively enrolled. Eight pts had a clinical suspicion of UC, 22 had an already established diagnosis and showed a flare-up of disease. All pts underwent clinical evaluation, bowel US with Color-Doppler examination (Toshiba equipment, 3.5 MHz convex and 7.5 MHz linear transducers) and ileo-colonoscopy. US and endoscopy were carried out by different operators, blind to the results of the other technique. For each patient Pediatric Ulcerative Colitis Activity Index (PUCAI) and Mayo endoscopic subscore were calculated. The US parameters assessed were Bowel Wall Thickness (BWT> 3mm), BW stratification, vascularity and presence of austrae: each parameter was assigned a value of 0 or 1 depending on the presence or absence of alteration. Results: 27/30 pts were finally diagnosed as UC. Extension of disease according to Paris Classification was: E2 (left-side colitis) in 12/27 (45%), E4 (pancolitis) in 15/27 (55%) pts. This extension was independently confirmed in 25/27 pts by US, that yielded a 85% concordance with endoscopy. Disease activity was mild (PUCAI 10 34) in 7 pts (25%), moderate (PUCAI 35 64) in 12 (45%) and severe (PUCAI >65) in 8 (30%). The mean values of PUCAI, Mayo score and US score respectively were: 40.5±24.4, 2±1 and 2.8±1.4. The mean BWT in affected colonic segments was 5±2mm. The US score strongly correlated with PUCAI (r = 0.85, p < 0.0001) and Mayo index (r = 0.90, p < 0.0001). A positive correlation was also found between PUCAI and Mayo score (r = 0.87, p < 0.05). Multiple regression analysis showed that variables making a significant contribution to the final value of Mayo score were BWT (p < 0.007) and vascularity (p < 0.038). Conclusions: Our preliminary data show a strong relationship between US and clinical and endoscopic findings, thus suggesting that colonic US might represent a useful first line tool in the evaluation of pediatric UC pts. It allows to assess in a relatively rapid manner the extension and activity of disease and to estimate the severity of a flare-up, prior to further invasive tests.