Extraintestinal Manifestation Of Ulcerative Colitis Research Articles

Immune Thrombocytopenic Purpura as an extra-intestinal manifestation in a patient with Ulcerative Colitis

Immune thrombocytopenic purpura (ITP) is characterized by immune-mediated platelet destruction of platelets. The condition involves the presence of autoantibodies targeting platelet membrane antigens. ITP has been documented in the literature as a rare extra-intestinal manifestation of inflammatory bowel disease (IBD). This case report aims to describe the rare association of ITP as an extra-intestinal manifestation of ulcerative colitis (UC), accompanied by a literature review. We report the case of a 21-year-old male presenting with acute bloody diarrhea refractory to broad-spectrum antibiotic therapy. Given the patient’s significant history of intermittent persistent diarrhea, hematochezia, hematuria, and thrombocytopenia, an evaluation for relapsing IBD was undertaken. Colonoscopic biopsy findings were consistent, with UC showing mild activity, while bone marrow aspiration revealed features indicative of chronic ITP. The patient was managed with oral corticosteroids for the IBD flare and oral mesalamine, resulting in a significant improvement in platelet count. Upon follow-up, with remission of UC, it was accompanied by a complete normalization of the patient’s platelet count. ITP has been reported as a rare extra-intestinal manifestation of IBD (UC). This report emphasizes the importance of suspecting IBD in cases of unexplained thrombocytopenia, particularly in compatible clinical settings, to enable timely diagnosis and management of both conditions, ultimately improving patient outcomes.

P0194 Osteoporosis and osteopenia as extraintestinal manifestations in ulcerative colitis

Abstract Background Inflammatory bowel diseases (IBD) are often characterized by associated conditions with extraintestinal manifestations that can make diagnosis and treatment difficult. It is known that chronic inflammation, nutritional deficiencies and corticosteroid treatment in IBD are the main risk factors for developing metabolic bone diseases. This study aims to evaluate ulcerative colitis (UC) patients with osteoporosis and osteopenia as extraintestinal manifestation. Methods We analyzed 79 patients (mean age 42 years) with UC and we measured bone mineral density by dual energy X-ray absorptiometry (DXA). Patients who received treatment with corticosteroids were not included in the study. 25(OH)D levels were also measured in all patients enrolled in the study. The patients did not follow vitamin D supplementation treatment. Disease remission was defined with partial Mayo score ≤2. Among the patients included in the study, 52 were under biologic therapy. Results Among the patients included in the study 55 patients (69%) were in remission and 49 patients (62%) with low vitamin D levels <20 ng/ml. Osteoporosis (T score <-2.5) was found in 24% of patients at the lumbar-sacral spine and in 13.9% of patients at the femoral neck; osteopenia (T score between -1.0 and -2.5) was also found in 40.5% of patients at the lumbar-sacral spine and in 35.5% of patients at the femoral neck. All patients with osteoporosis had vitamin D deficiency (p=0.01) and osteopenia was present in 61% of patients with vitamin D deficiency (p=0.05). Regarding disease activity, 23.6% patients in remission and 29.1% patients with active ulcerative colitis were diagnosed with osteoporosis (p=0.69), meanwhile in the osteopenia group, 38.1% patients were in remission and 41.6% patients were with active disease (p=0.84). From the patients included in the study, 65.8% were following biological therapy of which only 3.8% were diagnosed with osteoporosis (p=0.007) and 11.5% were diagnosed with osteopenia (p=0.006). Conclusion Our data confirm that osteoporosis and osteopenia are common extraintestinal manifestations in ulcerative colitis. Patients with vitamin D deficiency were more likely to develop metabolic bone diseases without statistically significant differences between ulcerative colitis patients with active disease or those in remission. Patients who follow biological therapy have a lower risk of developing metabolic bone disease. Screening for osteoporosis and osteopenia is indicated in UC patients and vitamin D supplements are mandatory.

S3866 An Unexpected Extraintestinal Manifestation of Ulcerative Colitis: Seronegative Necrotizing Myositis

S3866 An Unexpected Extraintestinal Manifestation of Ulcerative Colitis: Seronegative Necrotizing Myositis

Myositis as a de-novo extraintestinal manifestation of ulcerative colitis in a pediatric patient developing post-colectomy: a case report

This report presents the case of a 13-year-old female with a history of ulcerative colitis who underwent ileostomy closure after total colectomy. Postoperatively, she developed right leg paresis and extensive swelling of the lower extremities. Imaging investigations revealed myositis with avascular necrosis in the distal femoral condyles. These findings were consistent with myositis as an extraintestinal complication of ulcerative colitis.

S120 Beyond the Bowels: Immune Thrombocytopenic Purpura Presents as a Rare Extraintestinal Manifestation of Ulcerative Colitis

S120 Beyond the Bowels: Immune Thrombocytopenic Purpura Presents as a Rare Extraintestinal Manifestation of Ulcerative Colitis

S3278 Myositis as an Extra-Intestinal Manifestation of Ulcerative Colitis: A Case Report and Literature Review

S3278 Myositis as an Extra-Intestinal Manifestation of Ulcerative Colitis: A Case Report and Literature Review

Recurrent Cerebral Infarction due to Cerebral Vasculitis in a Patient with Ulcerative Colitis

Vascular complications are extraintestinal manifestations of ulcerative colitis. Although there has been some controversy regarding the association between ulcerative colitis and stroke, hypercoagulability and systemic inflammation are thought to be possible factors contributing to stroke pathogenesis. Herein, we report a case of recurrent ischemic stroke with significant arterial stenosis. Cerebral vasculitis was suggested in high-resolution magnetic resonance vessel wall imaging (VWI) and marked improvement was confirmed by follow-up VWI after steroid treatment. This case suggests that VWI can be a useful tool to diagnose cerebral vasculitis and evaluate therapeutic effect.

Pyoderma Gangrenosum Triggered by COVID-19 Vaccination in a Patient with Ulcerative Colitis: A Case Report.

Pyoderma gangrenosum (PG) is a rare inflammatory skin disease that is difficult to diagnose. PG may be an extra-intestinal manifestation of ulcerative colitis (UC). In recent times, coronavirus disease (COVID-19) vaccines have caused various adverse cutaneous reactions. However, to the best our knowledge, combinations thereof have not been reported. We encountered a case of PG triggered by COVID-19 vaccination in a patient with UC. A 40-year-old woman developed severe pain and an abscess in the dorsum of the left foot after receiving the first dose of the messenger RNA (mRNA)-based Pfizer/BioNTech BNT162b2 COVID-19 vaccine. Severe painful ulcers with purulent necrosis and gaseous gangrene progressed rapidly along the extensor tendons and muscles to the toes and ankle. Although surgical debridement can worsen PG by triggering pathergy, we nonetheless performed wide debridement including partial extensor tenotomy with abscess drainage to prevent progression to pyogenic ankle arthritis and to rescue the toes. Antibiotics, corticosteroids, and anticoagulants were prescribed during surgical wound management via negative pressure therapy. After the lesion improved, the skin and soft tissue defect were covered using a superficial circumflex iliac artery perforator free flap and a split-thickness skin graft. The patient was satisfied with the foot salvage, and could walk unaided (without a brace or cane) from 8 weeks after the final surgery. PG may be rare even in UC patients, but mRNA-based COVID-19 vaccines may find an immunosuppressive niche. A high level of caution and suspicion of skin manifestations after vaccination is essential.

A Case of Tracheobronchitis in a Patient with Ulcerative Colitis

Common extra-intestinal manifestations of ulcerative colitis (UC) have been previously described such as uveitis, conjunctivitis, seronegative arthritis, and erythema nodosum. Less well known extra-intestinal manifestations are described in the pulmonary organs. We present a case of a chronic cough thought to be habitual in nature that was ultimately diagnosed as a tracheobronchitis related to ulcerative colitis.

Garcinia mangostana and α-Mangostin Revive Ulcerative Colitis-Modified Hepatic Cytochrome P450 Profiles in Mice.

<b>Background and Objective:</b> Ulcerative colitis (UC) is inflammation of the large intestine with ulceration but can also cause extraintestinal manifestations (EIM) by damaging surrounding organs such as the liver. <i>Garcinia mangostana</i> (GM) pericarp and α-mangostin (MGS) have been reported to have anti-inflammatory activity. This study evaluated the effects of GM pericarp extract and MGS on the expression of hepatic cytochrome P450 (CYP) enzymes as an EIM of UC. <b>Materials and Methods:</b> Male ICR mice were orally administered GM pericarp extract (40, 200 and 1000 mg/kg/day), MGS (30 mg/kg/day) or sulfasalazine (SUL) (100 mg/kg/day) daily for 7 days. On days 4-7, UC was induced by dextran sulfate sodium (DSS 40 kDa, 6 g/kg/day). Profiles of CYP mRNA expression were determined by RT/qPCR. Alkoxyresorufin <i>O</i>-dealkylation (including ethoxy-, methoxy-, pentoxy- and benzyloxy-resorufin), aniline hydroxylation and erythromycin <i>N</i>-demethylation CYP responsive activities were also examined. <b>Results:</b> The DSS-induced UC mice showed suppressed expression<i> </i>of <i>Cyp1a1</i>, <i>Cyp1a2</i>, <i>Cyp2b9/10</i>, <i>Cyp2e1</i>, <i>Cyp2c29</i>, <i>Cyp2d9</i>, <i>Cyp3a11</i> and <i>Cyp3a13</i> mRNAs. The GM pericarp extract and MGS restored expression of all investigated CYPs and their responsive enzyme activities in DSS-induced UC mice to levels comparable to the control and parallel to the effects of the anti-inflammatory control SUL. <b>Conclusion:</b> The GM is a promising therapy to restore UC-modified hepatic CYP profiles.

Concomitant Guillain–Barré Syndrome in a young Sri Lankan male with severe ulcerative colitis

BackgroundGuillain–Barré Syndrome is an immune mediated polyneuropathy. Ulcerative Colitis is an immune mediated chronic inflammatory condition mainly of the large intestine. Guillain–Barré Syndrome can present as a rare extraintestinal manifestation of Ulcerative Colitis when in remission or in a relapse. However, the concomitant presentation of Guillain–Barré Syndrome during a relapse of Ulcerative Colitis is very rare and only a few cases are reported to date.Case presentationA 24 year old young male diagnosed of Ulcerative Colitis presented with bloody diarrhea of frequency more than six times a day. He had been in clinical remission even after defaulting treatment for more than a year. He had also noted difficulty in walking prior to admission to the hospital. He was managed as for a severe relapse of Ulcerative Colitis and Guillain–Barré Syndrome. Appropriate management of both the illnesses helped him to recover.ConclusionImmune mediated diseases can have rare coexisting presentations. We report a case of Ulcerative Colitis with concomitant Guillain–Barré Syndrome. It is essential to be open minded and timely, appropriate treatment led to successful management of both the illnesses.

Deficiency in glutathione synthesis and reduction contributes to the pathogenesis of colitis-related liver injury.

Liver disease is the most common extra-intestinal manifestation of ulcerative colitis (UC), but the underlying pathogenesis is still not clarified. It is well accepted that the occurrence of UC-related liver disease has close correlation with immune activation, intestinal bacterial liver translocation, inflammatory cytokine storm, and the disturbance of bile acid circulation. The occurrence of UC-related liver disease makes the therapy difficult, therefor study on the pathogenesis of UC-related liver injury is of great significance for its prevention and treatment. Glutathione (GSH) shows multiple physiological activities, such as free radical scavenging, detoxification metabolism and immune defense. The synthesis and the oxidation-reduction all contribute to GSH antioxidant function. It is reported that the deficiency in hepatic GSH antioxidant function participates in multiple liver diseases, but whether it participates in the pathogenesis of UC-related liver injury is still not clear. This study aims to investigate the feature and underlying mechanism of GSH synthesis and oxidation-reduction function during the development of UC, which will provide useful information for the pathogenesis study on UC-related liver injury. UC model was induced by 2,4,6-trinitrobenzenesulfonic acid (TNBS)-ethanol solution (5 mg/0.8 mL per rat, 50% ethanol) via intra-colonic administration in rats, and the samples of serum, liver, and colon tissue of rats were collected at the 3rd, 5th, and 7th days post TNBS. The severity degree of colitis was evaluated by measuring the disease activity index, colonic myeloperoxidase activity, and histopathological score, and the degree of liver injury was evaluated by histopathological score and the serum content of alanine aminotransferase. Spearman correlation analysis was also conducted between the degree of colonic lesions and index of hepatic histopathological score as well as serum aspartate aminotransferase level to clarify the correlation between liver injury and colitis. To evaluate the hepatic antioxidant function of GSH in UC rats, hepatic GSH content, enzyme activity of GSH peroxidase (GSH-Px), and GSH reductase (GR) were determined in rats at the 3rd, 5th, and 7th days post TNBS, and the protein expressions of glutamine cysteine ligase (GCL), GSH synthase, GSH-Px, and GR in the liver of UC rats were also examined by Western blotting. Compared with the control, the disease activity index, colonic myeloperoxidase activity, and histopathological score were all significantly increased at the 3rd, 5th, and 7th days post TNBS (all P<0.01), the serum aspartate aminotransferase level and hepatic histopathologic score were also obviously elevated at the 7th day post TNBS (all P<0.05). There was a significant positive correlation between the degree of liver injury and the severity of colonic lesions (P=0.000 1). Moreover, compared with the control, hepatic GSH content and the activity of GSH-Px and GR were all significantly decreased at the 3rd and 5th days post TNBS (P<0.05 or P<0.01), and the protein expressions of GCL, GSH-Px, and GR were all obviously down-regulated at the 3rd, 5th, and 7th days post TNBS (P<0.05 or P<0.01). There is a significant positive correlation between the degree of liver injury and the severity of colonic lesions, and the occurrence of reduced hepatic GSH synthesis and decreased GSH reduction function is obviously earlier than that of the liver injury in UC rats. The reduced hepatic expression of enzymes that responsible for GSH synthesis and reduction may contribute to the deficiency of GSH synthesis and oxidation-reduction function, indicating that the deficiency in GSH antioxidant function may participate in the pathogenesis of UC related liver injury.

Sweet's Syndrome: A Case Report of a Rare Extraintestinal Manifestation of Ulcerative Colitis

Sweet’s syndrome is a neutrophilic dermatosis of unknown etiology and a rare extraintestinal manifestation of ulcerative colitis.Classically, it is more common in women with active inflammatory bowel disease (IBD). This syndrome typically presents in patients with acute-onset painful tender erythematous skin lesions and is usually accompanied by fever, arthralgia, and elevated inflammatory markers. Histological examination is characterized by diffuse dense dermal neutrophilic infiltrate with leukocytoclasia, without vasculitis.The treatment goals are to reduce morbidity and complications, and the most effective therapy is systemic corticosteroids. Early recognition of this syndrome is essential to improve our diagnostic and therapeutic abilities.We report a case of a 59-year-old female with ulcerative colitis, which presented with manifestations of Sweet’s syndrome.

Prevalence of extraintestinal manifestations in ulcerative colitis and associated risk factors.

The data on prevalence of extraintestinal manifestations (EIM) in ulcerative colitis (UC) are scanty and highly variable. Consecutive patients with UC were prospectively evaluated from November 2016 to August 2017. A detailed history was obtainedand physicalexamination wasdone. Presence of EIM was confirmed bya consultant rheumatologist, ophthalmologist and dermatologist. Tests performed were hemogram, liver function test, abdominal ultrasound, slit lamp examination, X-ray and magnetic resonance imaging when deemed necessary. A total of 227 patients with UC were enrolled in this study. The prevalence of EIM was 7.92%. Mucocutaneous (4.84%) manifestations were the commonest, followed by musculoskeletal (1.32%) and ocular (0.88%). Hepatobiliary (0.44%) and vascular (0.44) manifestations were present in equal frequency. History of appendicectomy was associated with EIM. The prevalence of EIM in UC was low in our study. History of appendicectomy was a risk factor for EIM.

The impact of colectomy on the course of extraintestinal manifestations in Swiss inflammatory bowel disease cohort study patients.

Background and AimsExtraintestinal manifestations are reported to occur in up to 45% of inflammatory bowel disease (IBD) patients during the course of disease. It is unknown whether colectomy reduces the rate of de novo extraintestinal manifestations (EIMs) or impacts on severity of EIMs following a parallel versus independent disease course from underlying IBD.MethodsUsing data from the Swiss Inflammatory Bowel Disease Cohort Study we aimed to analyse the course of EIMs in ulcerative colitis (UC) and Crohn’s disease (CD) patients undergoing colectomy during the cohort’s prospective follow‐up.ResultsOne hundred and twenty‐one IBD patients (33 CD, 81 UC and seven unclassified) underwent colectomy during prospective follow‐up in the Swiss Inflammatory Bowel Disease Cohort Study. Within the 114 patients with UC or CD any EIM was reported in 40 (nine CD and 31 UC) patients. Activity of EIMs ceased entirely after colectomy in 21 patients (52.5%). Complete cessation of EIM after colectomy was higher in patients with UC versus CD with 58.1% versus 33.3%. After colectomy, 29 out of the 114 patients (25.4%) experienced any EIM. Two thirds of these (19 patients) represented persisting EIMs, while in one third (10 patients) EIM represented a de‐novo event after colectomy. Overall, 13.5% of IBD patients developed a de‐novo EIM after colectomy.ConclusionsIn IBD patients undergoing colectomy, EIMs present prior to surgery will persist in about half of patients. Complete cessation of EIM after colectomy may be less common in CD than in UC. In patients who never experienced EIMs prior to colectomy de‐novo manifestations thereafter should be expected in up to one in seven patients.

P455 Tofacitinib Therapy is Effective for Arthralgias Associated with Active Inflammatory Bowel Disease

Abstract Background Tofacitinib is an oral Janus kinase (JAK) inhibitor used to treat ulcerative colitis (UC). It is generally well tolerated and safe with mild to no side effects. Tofacitinib is FDA-approved for use in multiple inflammatory conditions such as rheumatoid arthritis, psoriasis and polyarticular course juvenile idiopathic arthritis as well as for ulcerative colitis (UC). Patients with UC often have extra-intestinal manifestations (EIMs) with up to 20% of patients having arthropathy. There are limited data describing the effect of tofacitinib therapy on EIMs in UC. The aim of this study is to determine whether tofacitinib therapy improves arthralgia in this patient population. Methods This retrospective study includes consecutive patients with active UC who initiated tofacitinib at our center since 2014 and remained on the therapy for at least 8 weeks. We reviewed electronic medical records to collect demographic and clinical data. Patients diagnosed with any EIM by the treating physician were included. Improvement in EIM symptoms was determined through patient reports or physician assessment. In the UC patients, a decrease in Simple Clinical Colitis Activity Index (SCCAI) of ≥ 3 was considered response and remission as a score of ≤ 2. In the CD patients, a 3-point reduction in Harvey Bradshaw index (HBI) was considered clinical response and a score of &amp;lt;5 remission. Results 112 patients were included in this cohort, with 36 (31 UC; 5 CD) having confirmed EIMs (32.1% of total). Basic demographic and clinical data are detailed in Table 1. 35 patients had peripheral arthralgia, 2 patients had primary sclerosing cholangitis (PSC) and 1 had pyoderma gangrenosum. 5 (13.9%) patients discontinued treatment during the induction phase due to lack of response. By 24 weeks, 26 (74.2%) out of 35 patients reported improvement in arthralgias, and 14 (40%) patients reporting resolution of joint symptoms. In terms of gastrointestinal disease activity, at week 24, 17/35 (48.6%) patients achieved clinical response and 11/35(31.4%) patients achieved clinical remission. There was no treatment effect noted on the other EIMs. Conclusion In our real world experience, treatment refractory IBD patients with peripheral arthralgia on tofacitinib showed significant improvement in joint symptoms, and this often paralleled improvement in gastrointestinal symptoms. This supports that tofacitinib is a suitable treatment for patients with IBD and concomitant peripheral arthralgia.

P653 Rheumatic extraintestinal manifestations in ulcerative colitis : Prevalence and predictive factors

Abstract Background Ulcerative colitis (UC) are an inflammatory condition affecting the gastrointestinal tract. They are considered as chronic disease with complex genetic, immune and environmental components. UC are not exclusive to the gastrointestinal system as they have been identified to be associated with extraintestinal manifestations (EIM) that encompass every other organ in the human body including musculoskeletal system. The aim of this study was to evaluate the prevalence and predictive factors of rheumatic EIM among patients with UC. Methods We carried out a retrospective study from January 2000 to December 2018 including all patients with UC. A complete rheumatologic examination, osteodensitometry,lumbosacral and sacroiliac X-rays were performed.The variables retrospectively analyzed were: gender, age,habits, location and extension of the disease, biochemical markers, other EIM, and previous immunosuppressive therapy. We investigated associations between rheumatic manifestations and clinical and biological criteria. Results Seventy eight patients were included in our study with an average age of 47,56 years [24–85 years]. Sex ratio M/F 0,85. Rheumatic manifestations of any type were present in 42,3%(33 of 78). Peripheral arthritis were observed in 3,8%. Axial involvement including sacroiliitis (SI), with or without spondylitis was noticed in 8,97%. Bone mineral loss was present in 25,6% with 13 cases of osteopenia and 7 cases of osteoporosis. Three patients (3,8%) had an association of SI and osteoporosis. No cases of enthesopathy have been reported. Otherwise, univariate and multivariate logistic regression methods testing for each predictor and their possible association with rheumatic manifestations among UC had shown a decreased risk for rheumatic manifestations with an age over 40 years (p=0,018), an hepatobiliary disorders such as the presence of hepatic cytolysis (p=0,034) and cholestasis (p=0,017) , the coexistence of dermatologic EIM (p=0,048). Forms complicated with an acute severe ulcerative colitis are likely to be correlated with rheumatologic manifestations (p=0,039) but location and extension of the disease had not shown any significant association. And finally, patients who underwent systemic corticosteroid treatment were highly associated with a decreased risk for rheumatic manifestations (p=0,044). Conclusion Predictive factors involved in the occurrence of rheumatic manifestations are: an advanced age, presence of other EIM, severe forms and the use of steroid. Regular screening for EIM and early use of biological therapies may prevent the development of musculoskeletal involvement . Medical care for patients with UC should be multidisciplinary involving the coordination between rheumatologists and gastroenterologists .

S2262 A Rare Manifestation of Cryptogenic Organizing Pneumonia in a Patient With Ulcerative Colitis Being Treated With an Anti-TNF Biosimilar

INTRODUCTION: Ulcerative colitis (UC) is an inflammatory bowel disorder (IBD) resulting in continuous mucosal inflammation from the rectum with variable extension to the proximal colon. Symptoms can include abdominal pain, hematochezia, or tenesmus. Anti-tumor necrosis factor (anti-TNF) therapy has been recognized as a treatment modality for moderate to severe UC. Extraintestinal manifestations of IBD have been well documented, with pulmonary manifestations being an uncommon presentation. One such manifestation is cryptogenic organizing pneumonia (COP). The most common finding is diffuse ground glass opacities and bilateral infiltrates on CT. In addition, COP has been described as a noninfectious complication associated with anti-TNF therapy. Here we present a case of COP in a patient being treated with an anti-TNF biosimilar for moderate to severe UC. CASE DESCRIPTION/METHODS: A 38 year-old female with left-sided UC presented to the hospital complaining of 2 weeks of progressively worsening shortness of breath. She had been on Inflectra and mesalamine for 2 years without complications. A chest CT revealed bilateral infiltrates concerning for organizing pneumonia. Bronchoscopy with bronchoalveolar lavage (BAL) was negative for fungal, pneumocystis jirovecii, bacterial, or viral etiologies. The patient was eventually discharged, however, she still required supplemental oxygen. She was started on prednisone and Bactrim for pneumocystis pneumonia prophylaxis. She was referred to gastroenterology for a concern of a possible association between Inflectra and COP. Mesalamine and Inflectra were stopped and the patient developed fecal urgency and rectal bleeding. The patient was started on vedolizumab and prednisone with an eventual prednisone taper, in addition to levalbuterol for her ongoing dyspnea. After two months of vedolizumab therapy, the patient noted significant improvement in her gastrointestinal symptoms as well as her pulmonary symptoms. DISCUSSION: There have been case reports detailing COP in patients undergoing therapy with Infliximab, however, this is the first known case of COP with a biosimilar. The improvement in pulmonary symptoms with discontinuing Inflectra, which was controlling her UC, and starting vedolizumab to continue control of the UC with subsequent improvement in her COP suggests the biosimilar, Inflectra, as opposed to an extra intestinal manifestation of UC, was the cause of COP.

Combination of ulcerative colitis with cirrhosis of the liver in the outcome of primary sclerosing cholangitis

A clinical case of a combination of ulcerative colitis with cirrhosis in the outcome of primary sclerosing cholangitis in a twelve-year-old child is presented. The uniqueness of the clinical observation lies in the atypical onset of ulcerative colitis in the form of complaints of weakness and headache, as well as detected anemia of 3 severity. It is important that the child lacked diarrhea, blood in the stool, tenesmus, weight loss, and fever. Of the most characteristic signs of liver damage, only itching of the skin of the lower extremities was noted. As a result, the child was diagnosed with cirrhosis of the liver at the end of the extraintestinal manifestation of ulcerative colitis — primary sclerosing cholangitis.

P056 Autoimmunity against type I collagen in ulcerative colitis

BACKGROUND: Immunological disorders play an important role in the pathogenesis of ulcerative colitis (UC). Collagen is the main component of the intercellular matrix of connective tissue. It can be assumed that the immune disorders leading to the production of autoantibodies to collagen play a role in the pathogenesis of UC. Aim: to study the level of IgM and IgG to type I collagen (COL1) in UC. METHODS: We prospectively included 61 patients with UC and 30 healthy controls. Mean age in UC was 37 ± 1.5 years and in control group—30 ± 1.5. Severity of UC was assessed by Mayo score: remission—5, mild—25, moderate—26, severe—5. Extraintestinal manifestations of UC were in 24 patients (39%). Level of serum IgM and IgG to COL1 was assessed by enzyme immunoassay. RESULTS: In active UC levels of IgM to COL1 was increased (0.17 [0.10; 0.20] mkg/mL) compared with healthy (0.09 [0.07; 0.12] mkg/mL; P &lt; 0.01). The difference between remission (0.1 [0.09; 0.19] mkg/mL) and exacerbation, remission and control group was not detected (P &gt; 0.05). In patients with severe UC IgM to COL1 was 0.19 [0.18; 0.25] mkg/mL, which was higher than in moderate UC—0.12 [0.08; 0.17] mkg/mL (P &lt; 0.05) and mild—0.18 [0.11; 0.20] mkg/mL (P &gt; 0.05). There was a tendency to increase of IgM to COL1 in patients with extraintestinal manifestations (0.17 [0.10; 0.22] mkg/mL) than without them (0.12 [0.09; 0.18] mkg/mL). The level of IgG to COL1 in active UC (24.69 [16.36; 99.12] mkg/ml) was higher than in the control group 11.36 [6.93; 19.83] (P &lt; 0.05) and remission—13.15 [8.88; 26.21] (P &gt; 0.05). There was not revealed the difference of IgG levels depending on the severity of disease. There was a tendency to increase of IgG to COL1 in patients with extraintestinal manifestations (16.18 [9.46; 26.21] mkg/mL), than without them (12.78 [8.81; 28.31] mkg/mL). There was increasing of ESR (r = 0.36; P &lt; 0.05) and leukocytosis (r = 0.32; P &lt; 0.05) with increase of IgM level to COL1. CONCLUSION(S): In active UC the level of serum antibodies of class IgM and IgG to COL1 increased compared with healthy. The maximum increase was found in the group of patients with severe relapse and in the presence of extraintestinal manifestations.