F. De Lazzari

IgE binding to soluble and insoluble wheat flour proteins in atopic and non-atopic patients suffering from gastrointestinal symptoms after wheat ingestion

Background The involvement of IgE‐mediated hypersensitivity reactions in the genesis of gastrointestinal symptoms after ingestion of foods containing wheat has been rarely reported.

Neurological complications of celiac disease and autoimmune mechanisms: preliminary data of a prospective study in adult patients.

Abstract: Antibodies to gangliosides and Purkinje cells have been reported in patients with celiac disease (CD) with neuropathy and ataxia, respectively. Whether these antibodies are pathogenic is not clear. The response of neurological symptoms and antibody titers to a gluten‐free diet is still controversial. The objective of our study was to assess whether neurological manifestations in CD patients correlate with antibody titers and a gluten‐free diet.Thirty‐five CD patients (9 males, 26 females, mean age 37.1 ± 12.6 yrs) were followed prospectively. At initial evaluation, 23 were on a gluten‐free diet, 12 were not. At recruitment and during follow‐up, patients underwent neurological and electrophysiological evaluation. IgG, IgM, and IgA anti‐ganglioside antibodies were assayed by ELISA; anti‐neuronal antibodies were assessed by immunohistochemistry and Western blot. Four patients, all males, had electrophysiological evidence of neuropathy; three had been on a gluten‐free diet for several months, and one was newly diagnosed. One had reduced tendon reflexes; another complained of distal paresthesias. With regard to anti‐ganglioside antibodies, three patients had a moderate increase in antibodies without symptoms or signs of neuropathy. No patients had ataxia or cerebellar dysfunction, although in four patients reactivity to neuronal antigens was found. In 17 patients, an electrophysiological follow‐up (mean duration of follow‐up, 9 months) showed no changes. In conclusion, the preliminary results of this prospective study indicate that neuropathy, usually subclinical, may accompany CD. Antibody titers do not seem to correlate with neurological symptoms/signs or diet. Ongoing follow‐up will help confirm these data and clarify the role, if any, of antibodies in neurological involvement in CD.

Glycaemic fall after a glucose load. A population-based study

BACKGROUND AND AIMS A blood glucose (BG) fall after an oral glucose load has never been described previously at a population level. This study was aimed at looking for a plasma glucose trend after an oral glucose load for possible blood glucose fall if any, and for its impact on coronary mortality at a population level. METHODS AND RESULTS In subjects from an unselected general population, BG and insulin were detected before and 1 and 2h after a 75-g oral glucose load for insulin sensitivity and β-cell function determination. Blood pressure, blood examinations and left ventricular mass were measured, and mortality was monitored for 18.8±7.7 years. According to discriminant analysis, the population was stratified into cluster 0 (1-h BG < fasting BG; n=497) and cluster 1 (1-h BG ≥ fasting BG; n=1733). To avoid any interference of age and sex, statistical analysis was limited to two age-gender-matched cohorts of 490 subjects from each cluster (n=940). Subjects in cluster 0 showed significantly higher insulin sensitivity and β-cell function, lower visceral adiposity and lower blood pressure values. Adjusted coronary mortality was 8 times lower in cluster 0 than 1 (p<0.001). The relative risk of belonging to cluster 1 was 5.40 (95% CI 2.22-13.1). CONCLUSION It seems that two clusters exist in the general population with respect to their response to an oral glucose load, independent of age and gender. Subjects who respond with a BG decrease could represent a privileged sub-population, where insulin sensitivity and β-cell function are better, some risk factors are less prevalent, and coronary mortality is lower.

PWE-008 Colorectal cancer screening programs and the rate of surgical oncology procedures in the veneto region (italy)

Introduction Colorectal cancer (CRC) is a leading cause of cancer mortality in the Veneto Region (North-east Italy). Population screening of adults between 50 and 75 for CRC was begun in 2002, and it became standard practice in all 21 local health units (LHU) of the region in 2008, 14 LHU provided in the program also follow-up colonoscopy and 7 LHU no. This study was carried out to evaluate the impact on surgery rates of CRC screening and follow-up programs. Method This is a retrospective cohort study on administrative data based on anonymous computerised database of Veneto Region hospital discharges between 2000 and 2015. All Veneto residents (in screening age) discharge records with principal diagnosis of CRC treated with surgery were included in the study. The number of patients studied rose approximately 18% reaching 1,547,097 for the last year (2015). The Standardised Hospitalisation Ratio (SHR) per five-year age group was calculated and expressed per 10 000 population. Results During the study period, 30 399 surgical procedures for colorectal cancer were performed (colon 63%, rectum 36%, secondary malignant neoplasm 1%) with a SHR of 139.1, higher in males (OR: 1.66; CI 95%: 1.62–1.7; p<0.05). An analysis of the annual SHR distribution uncovered two distinct phases: during the first phase there was a rising tendency that reached a maximum value in 2007 (166,9; X2 trend: 46.731; p<0.05) and during the second there was a falling tendency that reached its minimum value in 2015 (102.3; X2 trend: 429.791; p<0.05), with a total reduction of 28%. The cancer stratification by site shows that the rate of surgical procedures of the proximal colon during the last year was the same as the 2000 value (41.5), instead there was a significant decrease (−37,3%; X2 trend: 559.282; p<0.05) in the rate of procedures on the distal colon and rectum which fell from 94.4 to 59.2 (Figure1). The stratification of LHU in which the screening program included a follow-up colonoscopy and others didn’t show significant difference in the reduction in surgical procedures (Figure2). Abstract PWE008 Figure 1 Abstract PWE-008 Figure 2 Conclusion Study findings confirmed that CRC screening was effective in reducing the number of oncological surgical oncology procedures particularly with regard to the distal colon and rectum. Data analysis showed that the screening seemed to accelerate reaching the peak rate in surgical procedures that took place in 2007. After that time point the number of operations began to fall as far as the distal colon was concerned (it fell by 37.3%). Finally data suggest that the real benefit in reduction of oncological surgery procedures is due to the first screening colonoscopy. Disclosure of Interest None Declared

PWE-032 Fatty Liver Index (FLI), Which is An Accurate Predictor of Nonalcoholic Fatty Liver Disease (NAFLD), Is A Better Predictor of Cardiovascular Disease Risk in Type 2 Diabetic Patients than The UK Prospective Diabetes Study (UKPDS Risk Engine V 2.0)

Introduction NAFLD, which is increasingly and rapidly becoming the cause of liver disease in Western countries, is characterised by higher serum triglyceride and LDL levels, lower HDL levels, insulin resistance, and glucose intolerance, all crucial risk factors for the development of atherogenesis. The UK Prospective Diabetes Study (UKPDS risk engine v 2.0) and the Fatty liver index (FLI) are both validated prognostic scores for cardiovascular disease (CVD) risk and NAFLD in diabetic patients. Methods We retrospectively analysed 1902 patients attending our Diabetes Ambulatory in 2012–2013. The UKPDS risk engine and the FLI were calculated for each of these patient. Ninety-nine (19.2%) of these patients resulted at high CVD risk according to their UKPDS evaluation and underwent a complete CVD assessment (ergometric/ecostress test (EET), coronarography (CORO)). A two tailed t-test, Person’s Chi square test, and analysis of variance (ANOVA) were carried out. Results Sixty-six (59 M, mean age 68.1 y, mean disease duration 16.1 y, HbA1c > 7 prevalent) pts presented UKPDS positive/FLI > 60, 8/66 CORO+ (5 percutaneous transluminal coronary angiopathy-PTA, 3 cardiac bypass sugery-CABG, 1 peripheral transluminal angioplasty-PTA AAII) and 5 (4 M, mean age 68.6 y, mean duration disease 18.4 y, HbA1c > 7 prevalent) pts presented UKPDS positive/FLI < 20,1/5 CORO+ (1 PTCA; 1 CABG; 0 PTA, AII). In the light of this analysis, were able to pinpoint a FLI cutoff that is better able to identify, with respect to UKPDS, patients who will result positive at CORO (FLI > 52 detected 9/14 pts positive at CORO with p < 0.05). Ninety-nine pts UKPDS positive(EET negative 69.6% > 69/99) (100% > 14/14 CORO+) vs 81 pts FLI > 52 (EET negative 92.5% > 75/81) (64.2% > 9/14 CORO+). As expected, we found a significant association between CORO+ and FLI+ patients and microalbuminuria (p < 0.048), cholesterol (p < 0.020); triglycerides (p < 0.001), and LDL (p < 0.005). The only drug associated to CV risk was cardioaspirn (p < 0.003). Conclusion Study results demonstrate that FLI can be used as a marker to predict CVD risk in patients with FLI > 52. The number of patients who undergo CVD screening with a low percentage of positivity can thus be reduced. An early and aggressive treatment and monitoring program can instead be begun for type 2 diabetic patients with FLI > 52 and a reasonable suspicion of NAFLD because this population has higher risk of developing CVD events with respect to patients with FLI < 20. Disclosure of Interest None Declared

PTU-016 The Endoscopic Submucosal Dissection Learning Curve: The Experience of a Large Volume Italian Colorectal (CRC) Screening Centre

Introduction Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique. In Eastern countries the learning curve is begun with gastric GI lesions carried out under expert supervision and then goes on to address esophageal and colon lesions. As Early Gastric Cancer (EGC) is a rare disease in Western countries, expert guidance is not commonly available. Methods All the ESD performed in our Endoscopy Unit in Padua from February 2012 to December 2015 including 12,552 colonoscopies were recruited retrospectively in this study. We considered the learning curve of a single endoscopist who performed 10 ESD on in vivo animal models under expert supervision before starting on human subjects. All the dissections were performed using a Hybridknife needle and ERBEJET2 (ERBE®). ESD was performed if the neoplastic lesion was considered susceptible to ESD regardless to the size. T tests for unpaired data and Pearson’s chi-test were used for statistical analysis. Results 49 ESD were performed, 28 M(57%), mean age 63 yr. The breadown was: 29 rectum (59%), 12 sigmoid tract (24%), 2 trasverse colon (4%), 4 ascending colon (8%), 2 stomach (4%). The neoplastic lesions were: 36 laterally spreading tumours (73%), 5 polypoid lesions 0 Is (10%), 4 recurrent ton scars (8%), 4 polypoid lesions 0 Isp(10%). Mean polyp area was 17.6 cm2 (range 1–70). Mean intervention time was 98 min (range 20–240). En-bloc dissection was successful in 34/49 (69%) and R0 was reached in 24/33 (72%). The histological features of the polyps were: 10 LGD (20%), 27 HGD (55%), 9 pT1 (18%), 3 pT2 (6%). The procedural complications that took place (14/49 = 28%) included: perforation during the procedure in 10/49 (20%), delayed bleeding in 3/49 (6%), rectal stenosis in 3/49 (6%). No deaths or surgical interventions followed the periprocedural complications. From the 12th procedure onwards the surgical performance became acceptable 22/27 (81%) vs 3/12 (25%) (p < 0.001). From the 30th procedure onwards the surgical performance became good 17/19 (90%, p < 0.05) and the mean execution time was significantly lower 55 vs 122 min (p < 0.0001) with no significant difference in the mean area of the lesions 15.6 vs 18.2 cm2 (p=ns). Only 3 complications occurred after the 30th procedure (p=ns). Conclusion Our findings demonstrate than an endoscopist can reach a satisfactory level of competence in ESD procedures by beginning training with in vivo animal models (at least 10 procedures) and then should go on to colo-rectal neoplasms (without size limits and no less than 12 procedures). Trainees have probably still not reached a learning curve plateau even after 40 procedures. Disclosure of Interest None Declared

OC.05.5 CANCER INVADING THE SUBMUCOSAL LAYER: IS IT TIME TO CHANGE SURGICAL INDICATIONS FOR SCREENING COLONOSCOPIES?

CANCER INVADING THE SUBMUCOSAL LAYER: IS IT TIME TO CHANGE SURGICAL INDICATIONS FOR SCREENING COLONOSCOPIES? E. Rosa-Rizzotto ∗ ,1, M. Lo Mele2, D. Caroli 3 , E. Guido1, F. Ancona1, L. Peraro1, R. Cappellesso2 , S. Cocchio4 , V. Baldo4, M. Rugge2, F. De Lazzari 1 1Dpt of Medicine, Gastroenterology Unit, St Anthony Hospital, Padova, Italy; 2Department of Diagnostic, Medical Sciences and Special Therapies, Surgical Pathology and Cytopathology Unit, University of Padua, Padua, Padova, Italy; 3Dpt of Medicine, Chioggia Hospital, Venice, Italy; 4Dpt of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padua, Padova, Italy

OC8 SCREENING FOR HBV IN IMMIGRANTS: PILOT PHASE OF EPIDEMIOLOGICAL STUDY IN HEALTY POPULATION

Results: We evaluated 118 subjects (55 M, 63 F), 71 (60.1%) 25–45 years old, 28 (23.7%) >45 years old, 16 (13.5%) 15–24 years old and 3 (82.5%) 20,000 in 4 (33.3%). Conclusions: The data of this pilot phase suggest a high prevalence of HBV infection in the immigrant population. The prevalence appears similar to that of country of birth. HBV-DNA quantification indicate that 50% of carriers have to be evaluated for treatment. On the basis of these data we confirm the utility of a screening programme for HBV in the immigrants.