Inflammatory Bowel Disease Group Research Articles

Evaluation of microRNAs-29a, 92a and 145 in colorectal carcinoma as candidate diagnostic markers: An Egyptian pilot study

Colorectal cancer (CRC) is one of the most common malignant neoplasms in Egypt, and interestingly in young age. Adenomatous polyps and inflammatory bowel diseases (IBD) are considered the commonest pre-malignant lesions for CRC. A possible diagnostic role for different microRNAs on CRC has been suggested by numerous studies. To assess the serum expression of 3 microRNA markers (miR-29a, miR-92a and miR-145) in pre-malignant and malignant colorectal lesions. The 60 patients studied were divided into 4 groups: CRC group (25 patients), IBD group (11 patients), adenomatous polyps group (14 patients) and control group (10 patients). The serum expression of the 3 markers (miR-29a, miR-92a and miR-145) has been assessed by RT-PCR. All CRCs were sporadic cases. Significant downregulation of miR-145 in CRC group was reported at all levels, i.e. when compared to normal, among the 3 studied groups, and when compared between CRC and non-CRC groups. Significant upregulation of miR-29a in CRC was reported when compared to normal, but no significant difference existed either among the 3 studied groups or between CRC and the other 2 groups. All 3 miRNAs studied were positively inter-correlated. miR-145 may be considered a promising non-invasive reliable diagnostic marker in CRC. Extended studies are needed to ascertain the diagnostic role of miRNAs in CRC.

Pro- and anti-inflammatory cytokine gene single-nucleotide polymorphisms in inflammatory bowel disease.

Anti-inflammatory cytokines have an important role in disease, tumour and transplant processes. Alterations in the regulation of several cytokines have been implicated in a variety of inflammatory disorders, including IBD (inflammatory bowel disease) [Crohn's disease (CD) and ulcerative colitis (UC)]. Cytokine polymorphisms are also known to affect the level of gene expression. Thus, the aim of this study was to determine the relationship between cytokine polymorphisms and the IBD pathologies in a Spanish population. Polymorphisms analysis was performed using PCR-SSOP using a microbeads luminex assay. The following polymorphisms were determined: TNFα [-238G/A (rs361525) and -308G/A (rs1800629)], IFNγ [+874A/T (rs62559044)], TGFβ [+869C/T (rs1982073) and +915G/C (rs1800471)], IL10 [-1082A/A (rs1800896), -592A/C (rs1800872), -819C/T (rs1800871)], IL6 [-174C/G (rs1800795)], IL12p40 [3'UTR -1188A/C (rs3212227)], IL1α [-889C/T (rs1800587)], IL1β [-511C/T (rs1143634) and +3962C/T (rs1143633)], IL1R [Pst-1 1970C/T] and IL1RA [Mspa-1 11100C/T]. No statistical differences in TNFα, IFNγ, TGFβ, IL10, IL6, IL1α, IL1β, IL1R and IL1Ra genotypes and allele distributions between the IBD groups and healthy controls were found. However, we observed significant differences in the 3'UTR -1188A/C polymorphism of IL12p40. So -1188A allele was increased in patients with UC and the -1188C allele (high IL12p40 production) was increased in patients with CD with respect to controls. These data are in concordance with the fact that CD has been shown to be associated with a Th1 T-cell-mediated inflammation model and high IL12/IFNγ production at histological affected sites. These data suggest that cytokine polymorphisms in TNFα, IFNγ, TGFβ, IL10, IL6 and IL1α, IL1β, IL1R and IL1Ra cytokine gene do not seem to be relevant in IBD susceptibility and IL12p40 3'UTR -1188A/C polymorphism seems to be associated with a differential IBD development.

Genetic polymorphism of ABCB1 gene (C3435T) in patients with inflammatory bowel diseases. Is there any gender dependency?

BackgroundIn recent years, an increasing incidence of inflammatory bowel disease (IBD) has been reported, mainly as Crohn's disease (CD) and ulcerative colitis (UC). The individual susceptibility, the disease's course and response to the applied therapy is likely due to genetic factors such as ABCB1 gene mutations, exemplified by C3435T polymorphism.The aim of the study was to evaluate the distribution of C3435T polymorphism regarding the gender in IBD patients and control subjects from Lower Silesia region and its possible association with IBD susceptibility. MethodsThe research was conducted in groups of 61 IBD patients and 101 healthy subjects from the Lower Silesia region. Polymorphism of C3435T was determined using PCR-RFLP method. ResultsFrequency distributions of C3435T genotype and of 3435T or 3435C gene alleles of IBD, CD or UC patients were compared to control group; each treated as a whole or split further by gender. The statistically significant correlation was discovered between gender and C3435T genotype both for IBD and CD patients, with 3435CT heterozygote prevailing in IBD and CD males.Odds ratio calculations revealed statistically significant difference for the 3435CT genotype between control and: IBD group considered as a whole; IBD males; CD males; and for 3435TT variant between control and IBD males. Conclusions. The 3435CT genotype could be a risk factor for IBD and CD in men. The 3435TT genotype in males seems to be associated with the lower chance of IBD presence.

Clinical significance of serum anti-microbial antibodies test in inflammatory bowel disease

Objective To investigate the clinical significance of serum anti-Saccharomyces cerevisias antibody （ASCA）,anti-outer membrane porin C （anti-OmpC）,antibody to Pseudomonas fluorescens-associated sequence I2 （anti-I2 ）and antibody to bacterial flagellin （anti-CBirl ）in the diagnosis and treatment of inflammatory bowel disease （IBD）.Methods From 2011 to 2013,87 patients with IBD were enrolled and divided into Crohn′s disease （CD）group （66 cases）and ulcerative colitis （UC）group （21 cases）.A total of 62 age and gender matched healthy individuals were enrolled as the control group. Fasting blood samples （2 mL）of the subjects were collected.The expression of ASCA,anti-OmpC,anti-I2 and anti-Cbirl antibodies was detected with enzyme-linked immunosorbent assay （ELISA）kits.The diagnosis value of each antibody in IBD and the differential diagnostic value of in UC and CD were compared by receiver operating characteristic （ROC）curve.Results The area under the curve （AUC）of ASCA between IBD and the healthy control group,between CD group and UC group was 0.580 and 0.512, respectively;the accuracy in diagnosis was low.The AUC of anti-CBirl between IBD and the healthy control group was 0.617.There was no differential diagnosis significance of the other antibodies.The positive rate of ASCA in IBD group was 62.1 % （54/87）,which was significantly higher than that in the control group （38.7%,24/62）.The positive rates of anti-OmpC and anti-I2 in IBD group was significantly lower than those in the control group and the differences were statistically significant （both P 〈0.05）.No difference was observed in positive rates of serum antibodies among the others groups （all P 〉0.05）.The specificity,sensitivity,positive predictive value （PPV）and negative predictive value （NPV）of ASCA in differential diagnosis of CD and UC was 52.4%,66.7%,81 .48% and 33.33%,respectively.The specificity and sensitivity of anti-OmpC,anti-I2 and anti-CBirl in differential diagnosis of CD and UC was 81 .0% to 100.0% and 9.1 % to 37.9%,respectively.The specificity,sensitivity,PPV and NPV of double-positive ASCA and anti-I2 in the diagnosis of CD was 57.1 %,86.4%,82.6% and 50.0%, respectively.The positive rate of ASCA and anti-I2 in CD group was significantly higher than that in UC group （84.8%（56/66）vs 57.1 % （12/21 ）;χ2 =5 .633,P =0.018 ）.Conclusions Positive ASCA has some significance in the diagnosis of patients with IBD in our country.The detection of anti-I2 can help to diagnose ASCA negative CD.Because of low sensitivity and positive rate,anti-OmpC and anti-CBirl have limited value in the diagnosis of IBD and the differential diagnosis of UC and CD in our country. Key words: Inflammatory bowel diseases; Diagnosis, differential; Antibodies, fungal; Antibodies, bacterial; Anti-Saccharomyces cerevisiae antibodies~ Bacterial outer membrane pore protein C; Pseudomonas fluorescens associated sequence I2

Fecal Calprotectin Levels for the Ethiological Diagnosis in Brazilian Patients With Gastrointestinal Symptoms

Introduction: Determination of fecal calprotectin (FC) can provide an important guidance for the physician, also in primary care, in the differential diagnosis of gastrointestinal disorders mainly between inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS). The aims of the present study were to prospectively investigate, in Brazilian adults with gastrointestinal complaints, the value of FC as a biomarker for the differential diagnosis between functional and organic disorders and to correlate the concentrations with the activity of IBD. Methods: The study included consecutive patients who had gastrointestinal complaints in which the measurement levels of FC were recommended. FC were measured using a Bühlmann (Basel, Switzerland) ELISA kit. Results: A total of 270 patients were included in the study, with median age of 39 years (range, 18-78 years). After clinical and laboratorial evaluation and considering the final diagnosis, patients were allocated into the following groups: a) IBS group: 154 patients (102 female and 52 male subjects), b) IBD group: 112 patients; 73 with Crohn’s disease (CD); 38 female and 35 male patients; 52.1% (38/73) presented active disease, and 47.9% (35/73) had disease in remission and 39 patients with ulcerative colitis (UC);19 female and 20 male patients; 48.7% (19/39) classified with active disease and 49.3% (20/39) with disease in remission. A significant difference (p<0.001) was observed between the median value of FC in IBS group that was 50.5 μg/g (IQR=16-294 μg/g); 405 μg/g (IQR=29-1980 μg/g) in CD patients and 457 μg/g (IQR=25-1430 μg/g) in UC patients. No difference was observed between the values found in the patients with CD and UC. Levels of FC were significantly lower in patients with IBD in remission when compared with active disease (p<0.001). Conclusion: The present study showed that the determination of FC assists to differentiate between active and inactive IBD and between IBD and IBS. Additionally, it may be used as a guide to classify the activity of the disease, monitor the treatment, predict relapses, and suggest if the clinical symptoms are from the basic disease or from functional comorbidity.Figure 1: Fecal calprotectin in the studied groups.

Inflammatory bowel disease is associated with an increased risk of hospitalization for heart failure: a Danish Nationwide Cohort study.

Inflammatory bowel disease (IBD) has been linked to adverse cardiovascular events, but a relation to heart failure (HF) is uncertain. We investigated the IBD-associated risk of HF in a nationwide setting. A total of 5 436 647 Danish citizens, with no history of IBD or HF, were included on January 1, 1997, and followed up until first hospitalization for HF, death, or December 31, 2011. Of these subjects, 23 681 developed IBD for which disease activity was determined continuously throughout the study. The risk of hospitalization for HF was estimated with a Poisson regression model adjusting for comorbidity and cardiovascular pharmacotherapy as time-dependent covariates. During a mean follow-up of 11.8 years in the reference population and 6.4 years in the IBD group, hospitalization for HF occurred in 553 subjects with IBD and 171 405 in the reference population. Patients with IBD had a 37% increased risk of hospitalization for HF (incidence rate ratio, 1.37; 95% confidence interval, 1.26-1.49) compared with the reference population. IBD activity-specific analyses showed markedly increased risk of HF hospitalization during flares (incidence rate ratio, 2.54; 95% confidence interval, 2.13-3.04) and persistent activity (incidence rate ratio, 2.73; 95% confidence interval, 2.25-3.33) but not in IBD remission (incidence rate ratio, 1.04; 95% confidence interval, 0.94-1.16). In a nationwide cohort, IBD was associated with an increased risk of hospitalization for HF, and this risk was strongly correlated to periods of active disease. The mechanisms underlying this finding warrant further studies.

Impaired coronary microvascular and left ventricular diastolic function in patients with inflammatory bowel disease

Background and aimIncreased incidence of coronary vascular events in patients with inflammatory bowel disease (IBD) is known. However, the association between coronary microvascular function and IBD has not been fully defined. We aimed to investigate whether coronary flow reserve (CFR) and left ventricular diastolic function were impaired in IBD patients. MethodsSeventy-two patients with IBD (36 patients with ulcerative colitis [UC] and 36 Crohn's disease [CD]) were registered. Each subject was evaluated after a minimum 15-day attack-free period. For the control group, 36 age- and sex-matched healthy volunteers were included into the study. IBD clinical disease activity in UC was assessed by the Truelove–Witts Index (TWAS) and in CD by the Crohn's Disease Activity Index (CDAI). In each subject, CFR was measured through transthoracic Doppler echocardiography. ResultsCompared to the controls, the CD group and UC group had significantly higher high-sensitivity C-reactive protein (hs-CRP) and erythrocyte sedimentation rate. Baseline diastolic peak flow velocity (DPFV) of the left anterior descending artery (LAD) was significantly higher in the IBD group (24.1±3.9 vs. 22. 4±2.9, p<0.05), and hyperemic DPFV (56.1±12.5 vs. 70.6±15.3, p<0.05) and CFR (2.34±0.44 vs. 3.14±0.54, p<0.05) were significantly lower in the IBD group than in the control group. In stepwise linear regression analysis, hs-CRP and lateral Em/Am ratio were independently correlated with CFR. ConclusionCFR, reflecting coronary microvascular function, is impaired in patients with IBD. CFR and left ventricular diastolic function parameters are well correlated with hs-CRP.

Extraintestinal Manifestations in Children With Gastrointestinal Food Allergy

The presence of extraintestinal manifestations (EIM) in children with gastrointestinal (GI) food allergy (GIFA) is greatly debated. In the present study we assessed the prevalence of EIM in children with GIFA and investigated whether their presence is helpful in the allergy-focused history-taking process. The medical records of all children with a proven diagnosis of GIFA were reviewed along with those of children diagnosed as having inflammatory bowel disease (IBD) as controls. Data regarding age at onset, age at diagnosis, atopic family history, atopic comorbidities, GI symptoms, and EIM were recorded. Data from 436 children with GIFA and 74 children with IBD were included in the analysis. EIM were documented in 368 children with GIFA, including fatigue (53.0%), allergic shiners (49.1%), mouth ulcers (39.0%), joint pain/hypermobility (35.8%), poor sleep (34.4%), night sweats (34.4%), headache (22.7%), and bed-wetting (17.7%). The proportion of patients with EIM was higher in the GIFA group compared with that in the IBD group (368/436 [84.4%] vs 40/74 [54.1%]; P < 0.001). Segregating the GIFA group into children with and without atopic comorbidities, both atopic (276/30; 89.9%) and nonatopic (93/130; 71.5%) children showed higher proportion of EIM than children with IBD ([40/74; 54.1%], P < 0.01 and <0.05, respectively). GIFA are commonly associated with a wide range of EIM, which appear to represent important and specific clinical features of this group of conditions. Their recognition in taking an allergy-focused history may play an important role for both diagnosis and management.

Meta-analysis: fecal calprotectin for assessment of inflammatory bowel disease activity.

Fecal calprotectin (FC) is a promising biomarker for diagnosis of inflammatory bowel disease (IBD). However, the utility of FC for assessment of IBD activity has yet to be clearly demonstrated. The aim of our study was to evaluate the diagnostic accuracy of FC for differentiating between patients with active IBD and those in remission. We systematically searched the databases Medline, Web of Science, Cochrane Library, and EMBASE for eligible studies from December 2013 or earlier that evaluated activity in ulcerative colitis (UC) and Crohn's disease (CD). A hierarchical summary receiver operating characteristic model was performed to calculate the area under the curve to evaluate the overall diagnostic accuracy. The sensitivities and specificities of each commonly applied cutoff value were pooled using a random effects model. We included 13 studies (744 patients with UC and 727 with CD) in the final analysis. The area under the curve values were 0.89 (95% confidence interval, 0.86-0.92), 0.93 (0.89-0.97), and 0.88 (0.83-0.93) in the IBD, UC, and CD groups, respectively. For the IBD group at a cutoff value of 50 μg/g, the pooled sensitivity was 0.92 (0.90-0.94) and specificity 0.60 (0.52-0.67). For a cutoff value at 100 μg/g, the pooled sensitivity was 0.84 (0.80-0.88) and specificity was 0.66 (0.59-0.73). For a cutoff value at 250 μg/g, the pooled sensitivity was 0.80 (0.76-0.84) and specificity was 0.82 (0.77-0.86). The FC test is a reliable marker for assessing IBD disease activity and may have greater ability to evaluate disease activity in UC than CD.

Health-related self-perceptions over time and provider-based Complementary and Alternative Medicine (CAM) use in people with inflammatory bowel disease or arthritis

To prospectively investigate how health-related self-perceptions are associated with use of provider-based CAM in two chronic inflammatory diseases, arthritis and inflammatory bowel disease (IBD). A prospective online survey was administered to convenience samples of individuals with arthritis or inflammatory bowel disease, and a follow-up survey completed 6 months later. Participants were recruited via online ads, through national organizations, and support groups. Surveys included measures of demographics, use of provider-delivered CAM, disease-related factors, self-perceptions of having a healthy lifestyle and being able to handle stress, and trait resilience. 325 people (170 with arthritis and 155 with IBD) completed the initial and follow-up surveys. Rates of CAM use were 43.2% and 45.9% for the arthritis and IBD groups, respectively. T-tests revealed significant differences on healthy lifestyle self-perceptions and trait resilience for both illness groups. Differences in self-perceptions about handling stress were only significant in the IBD group. Multivariate logistic regression controlling for demographics and health-related variables revealed that seeing oneself as having a healthy lifestyle predicted CAM use in both illness groups. Being resilient predicted CAM use only in the IBD group, and self-perceptions about handling stress predicted CAM use only in the arthritis group. This study provides insights into how health-related self-perceptions are prospectively linked to provider-based CAM use in patients with chronic inflammatory disease. This information is important for both health-care practitioners and researchers as it has implications for maximizing the health-promoting aspects of CAM use and understanding CAM adherence.

PWE-037 Panenteric Capsule Endoscopy: An Alternative Non-invasive Tool To Screen For Idiopathic Inflammatory Bowel Disease (ibd)

IntroductionCompared to conventional endoscopy, capsule endoscopy (CE) is potentially safer, non-invasive, performed in out-patients and may be an alternative first line investigation in patients with suspected inflammatory bowel disease (IBD)....

PWE-102 Infective Diarrhoea Complicating Ibd Vs Non-ibd Patients

IntroductionClinical features associated with infective diarrhoea and flare up of Inflammatory Bowel Disease (IBD) are very similar and presents a challenge to gastroenterologists to distinguish the two especially at the...

The prevalence of Helicobacter pylori gastritis in newly diagnosed children with inflammatory bowel disease.

Recent studies have shown that patients with inflammatory bowel disease (IBD) are less likely to be infected with Helicobacter pylori compared with non-IBD patients. We aimed to study the prevalence of H. pylori-positive and H. pylori-negative gastritis in newly diagnosed children with IBD in comparison to those with non-IBD in Greece. All children who underwent first esophagogastroduodenal endoscopy between 2002 and 2011 were retrospectively included. Four groups were studied: patients with Crohn's disease (CD), ulcerative colitis (UC), IBD unclassified (IBDU), and non-IBD individuals (non-IBD). Helicobacter pylori infection was defined by positive culture or by positive histology and CLO test. Those children with negative or not available culture and only one positive test (histology or CLO) were further evaluated by urea breath test, and the positives were also included in the infected group. We studied 159 patients with IBD (66 CD, 34 UC, and 59 IBDU) and 1209 patients in non-IBD individuals. Helicobacter pylori gastritis was less frequent in the IBD group (3.8% vs 13.2% in the control group, p < .001), whereas IBD patients were significantly older than non-IBD children (p < .001). Children with H. pylori-negative gastritis were 3.3 times more likely to belong in the IBD group compared with H. pylori-positive patients (p = .006). Occurrence of H. pylori gastritis is less frequent in children with IBD compared with controls. Our study confirms an inverse association between H. pylori and IBD. Future studies are needed to distinguish between a true protective role of H. pylori and a confounding effect due to previous antibiotic use in children with IBD.

Su1295 Expression of Surrogate Markers for Early Atherosclerosis (ATS) in Young Patients With Inflammatory Bowel Disease (IBD) Compared With Healthy Controls (HC)

BACKGROUND AND AIM: recent studies have documented an increased rate of cardiovascular events in IBD patients. Studies on surrogate markers for early ATS have led to conflicting results. Our aim was to investigate the prevalence of increased intima-media thickness (IMT) of the carotid arteries and of arterial stiffness in a homogeneous cohort of young patients with IBD. METHODS: we recruited 68 consecutive IBD patients (35 males), and 38 sex and age matched HC. Median age was 31.6 ± 8.1 years. Data on clinical and demographic features, cardiovascular risk factors, personal and familial history of cardiovascular events, concomitant therapies were registered on a dedicated database. Forty-five out of IBD patients had Crohn disease (CD) and 23 had Ulcerative Colitis (UC). Twenty-two CD patients had a disease duration greater than 5 years and 9 showed a clinically active disease. In the UC group 8 patients had a disease duration greater than 5 years and 3 clinically active disease. Sixteen out of 68 IBD patients were smokers, 9 ex-smokers; 29 had a family history of cardiovascular events, 3 were hypertensive and 2 patients had diabetes mellitus, 21 had a BMI greater than 25. Left and right carotid IMT was evaluated using high resolution Bmode ultrasonography. Arterial stiffness was assessed by measurement of carotid-femoral Pulse Wave Velocity (PWV) and Augmentation Index (AI). RESULTS: there was a statistically significant difference between IBD patients and HC for total cholesterol values (P <0.013) and LDL-cholesterol (P <0.019). There was no difference in lipid profile between CD and UC. There was a trend toward significance in the distribution of BMI values between patients and HC (P 0.082). Right carotid IMT was higher in IBD group than in controls (P <0.047), but there was no statistically significant difference between subjects with CD and UC. Moreover, PWV average and AORTIC AIX (AIx) were significantly higher in patients than in controls (P <0.006 and P <0.004 respectively). CONCLUSION: in our study we have found increased expression of surrogate markers for early onset ATS in young Mediterranean patients with IBD. This seems not to be related to traditional risk factors for ATS. Clinical follow-up of IBD patients should include assessment at diagnosis and monitoring of IMT of the carotid arteries and of arterial elastic properties, in order to reduce the risk of cardiovascular events.

PD28-11 URINARY STONE RISK AFTER COLON SURGERY: THE INFLAMMATORY BOWEL DISEASE BIAS

INTRODUCTION AND OBJECTIVES: Previous studies investigating urinary stone risk after colon surgery have demonstrated significant reductions in urinary pH, volume, citrate, and magnesium that correspond to an increased incidence of kidney stones. These studies, however, have consistently included patients with inflammatory bowel disease (IBD) which may bias their findings due to known urinary abnormalities present prior to surgery and differences in length of bowel removed compared to other types of colon surgery. This study aims to evaluate urinary stone risk after colon surgery in patients with and without IBD. METHODS: Retrospectively, baseline 24-hour urine samples of 21 kidney stone patients with a history of colon resections were evaluated from a data set of over 800 patients. Urinary chemistries of those who required colon surgery for IBD (9 patients) and non-IBD reasons (12 patients) were compared to each other and a control of 52 first-time stone formers without bowel disease. RESULTS: The IBD colectomy group had a significantly lower urinary pH (5.55 vs 6.08, P1⁄40.003), magnesium (41.8mg/d vs 103.7mg/d, P1⁄40.0002), citrate (109.8mg/d vs 230.4mg/d, P1⁄40.0001), sodium (95.2mmol/d vs 177.9mmol/d, P1⁄40.013), and calcium (109.8mg/d vs 230mg/d, P1⁄40.01) than the control. The non-IBD colectomy group had lower pH (5.69 vs 6.09, P1⁄40.015) and higher supersaturation of uric acid (1.62 vs 0.87, P1⁄40.015) compared to the control. The IBD colectomy group revealed a lower magnesium (P1⁄40.04), citrate (P1⁄40.007), and sodium (P1⁄40.045) than the non-IBD colectomy group. 66% of the colectomies in the IBD group were total while 100% of the colectomies in the non-IBD group were partial. CONCLUSIONS: The urinary stone risk of colectomy patients with IBD is significantly different from colectomy patients without IBD and is more reflective of abnormalities present in IBD patients prior to surgery such as low citrate, magnesium, and urinary pH. It is likely the IBD patients biased the findings of previous studies investigating the urinary stone risk after colon surgery. Patients who underwent colon surgery for non-IBD reasons, however, have few urinary abnormalities and a urinary risk more similar to first-time stone formers. The difference in urinary risk of colectomy patients with and without IBD may be explained by the intrinsic stone risk present in IBD and the differences in length of bowel removed.

Detection of liver injury in IBD using transient elastography

BackgroundUp to 5% of inflammatory bowel disease (IBD) patients are thought to have clinically significant liver disease due to multifactorial causes, however, this figure may be an underestimate due to reliance on abnormal liver tests (LTs) and/or liver biopsies. AimsOur aim was to evaluate the prevalence of clinically significant liver disease in IBD patients as defined by an increased liver stiffness measurement (LS) ≥8kPa using transient elastography (TE). Methods110 IBD patients, and 55 non-IBD control subjects, had their LS recorded using FibroScan® (EchoSense, Paris, France) by a single blinded operator trained in TE. Results71 Crohn's disease and 39 ulcerative colitis subjects were included. All demographic variables were similar between the IBD and control groups apart from a significantly higher proportion of IBD patients who smoked (17.3% vs 3.6%, P=0.013). Seven IBD patients (6.4%) had an LS over 8kPa and 3 had persistently elevated LS 6months later. One patient had compensated cirrhosis. No significant differences in overall LS were observed between the IBD and control groups. Increased BMI and age, however, were independently associated with a higher LS in the IBD but not in the control group (P<0.001 and 0.010 respectively). ConclusionUsing TE, the prevalence of clinically significant liver disease in IBD patients is low. The association of increased BMI and age with increased LS in IBD suggests fatty liver disease being the prevailing aetiology in these patients.

P433 Is e-Health, web-based monitoring and treatment, useful for children and adolescents with inflammatory bowel disease? – a paediatric clinical trial

Background: Cholangiocarcinoma (CC) complicates in 10 20% of the patients with dominant stricture (DS) in patients with primary sclerosing cholangitis (PSC) related with inflammatory bowel diseases (IBD). Methods: We investigated 2200 patients with IBD for PSC with DS. Results: PSC was diagnosed in 41 pts (1.6%). Of the 41 pts with PSC, DS was diagnosed in 14 (34%); 64% were male, and followed for a mean of 4.86 yrs (0 13 yrs). Main finding was pruritis alone in 64% pts with DS as in 15% without DS (p = 0.003). The diagnose date of both IBD and PSC was younger in pts with DS than without DS (36.9 yrs vs. 38.1 and 40.2 yrs vs. 41.1 yrs; p > 0.05, respectively). Only current ALP and GGT levels were differ between the groups (p: 0.003 and p: 0.001, respectively). In this study, ERCP performed in 22 pts with PSC and was the main diagnostic tool for the questioning the occurence of DS (p = 0.011), besides CT, MRI and liver bx. ERCP usually performed more than once. EST and baloon dilation performed in all pts with stenting in 9 pts. Brush cytology performed only in 3 pts with strong suspicious for CC and benign pathology reported. IBD disease duration was longer in pts without DS than with DS (10.4 yrs vs. 8.1 yrs, p > 0.05). During the follow-up, 2 patients dead due to the causes other than CC; one due to endstage liver disease, and one had back wash ileitis complicated with colon malignancy and later died. Liver transplantation performed twice in one patient and still alive and in a good condition. At the same time, we evaluated our last 5-years pathology records for CC in a different study, and found 19 cases. None was related with our IBD or PSC-IBD group. Of the 19, colonoscopy performed in 5, and showed no IBD on biopsy. Conclusions: In our series, dominant strictures with PSC related with IBD showed a relatively benign nature differently from the current literature.

Malignancy and mortality in pediatric patients with inflammatory bowel disease: a multinational study from the porto pediatric IBD group.

The combination of the severity of pediatric-onset inflammatory bowel disease (IBD) phenotypes and the need for intense medical treatment may increase the risk of malignancy and mortality, but evidence regarding the extent of the problem is scarce. Therefore, the Porto Pediatric IBD working group of ESPGHAN conducted a multinational-based survey of cancer and mortality in pediatric IBD. A survey among pediatric gastroenterologists of 20 European countries and Israel on cancer and/or mortality in the pediatric patient population with IBD was undertaken. One representative from each country repeatedly contacted all pediatric gastroenterologists from each country for reporting retrospectively cancer and/or mortality of pediatric patients with IBD after IBD onset, during 2006-2011. We identified 18 cases of cancers and/or 31 deaths in 44 children (26 males) who were diagnosed with IBD (ulcerative colitis, n = 21) at a median age of 10.0 years (inter quartile range, 3.0-14.0). Causes of mortality were infectious (n = 14), cancer (n = 5), uncontrolled disease activity of IBD (n = 4), procedure-related (n = 3), other non-IBD related diseases (n = 3), and unknown (n = 2). The most common malignancies were hematopoietic tumors (n = 11), of which 3 were hepatosplenic T-cell lymphoma and 3 Ebstein-Barr virus-associated lymphomas. Cancer and mortality in pediatric IBD are rare, but cumulative rates are not insignificant. Mortality is primarily related to infections, particularly in patients with 2 or more immunosuppressive agents, followed by cancer and uncontrolled disease. At least 6 lymphomas were likely treatment-associated by virtue of their phenotype.

A2.6 Enthesis inflammation in inflammatory bowel diseases without spondyloarthritis

IntroductionDuring the past century has found an interesting interconnection between some intestinal diseases and arthritis. This link is most evident in inflammatory bowel disease (IBD), Crohn disease (CD) and ulcerative...

Differences in the adverse effects of azathioprine between inflammatory bowel disease and autoimmune hepatitis in Korean patients.

Azathioprine (AZA) has been widely used in the therapy of inflammatory bowel disease (IBD) and autoimmune hepatitis (AIH). However, studies evaluating the adverse effects of AZA in these two diseases are lacking. The aim of this study was to compare the adverse effects of AZA in Korean IBD and AIH patients. Patients with IBD or AIH who were treated with AZA at Keimyung University Dongsan Medical Center (Daegu, Korea) between January 2002 and March 2011 were enrolled. Their medical records were reviewed retrospectively in terms of clinical characteristics and adverse effects of AZA. A total of 139 IBD patients and 55 AIH patients were finally enrolled. Thirty IBD patients (21.6%) and eight AIH patients (14.5%) experienced adverse effects of AZA. In particular, the prevalence of leukopenia was significantly higher in the IBD group than in the AIH group (p=0.026). T474C mutation was observed in three of 10 patients who were assessed for thiopurine methyltransferase (TPMT) genotype. IBD patients are at increased risk for the adverse effects of AZA compared with AIH patients, of which leukopenia was the most commonly observed. Therefore, IBD patients receiving AZA therapy should be carefully monitored.