Jeroen Maljaars

Effect of fat saturation on satiety, hormone release, and food intake

BACKGROUNDnIleal delivery of fat reduces hunger and food intake through activation of the ileal brake. Physicochemical properties of fat have been shown to affect satiety and food intake.nnnOBJECTIVEnThe objective of this study was to assess the effect of ileal fat emulsions with differing degrees of fatty acid saturation on satiety, food intake, and gut peptides (cholecystokinin and peptide YY). We hypothesized that long-chain triacylglycerols with diunsaturated fatty acids would increase satiety and reduce energy intake compared with long-chain triacylglycerols with monounsaturated or saturated fatty acids.nnnDESIGNnWe performed a double-blind, randomized, crossover study in which 15 healthy subjects [mean age: 24 y; mean body mass index (in kg/m(2)): 22] were intubated with a naso-ileal catheter and participated in 4 experiments performed in random order on 4 consecutive days. After consumption of a liquid meal, subjects received a fat or control infusion in the ileum. Fat emulsions consisted of 6 g of 18:0 (shea oil; mainly 18:0), 18:1 (canola oil; mainly 18:1), or 18:2 (safflower oil; mainly 18:2) oils. Food intake was measured during an ad libitum lunch. Satiety questionnaires (visual analog scale) and blood samples were collected at regular intervals.nnnRESULTSnCompared with the control, only 18:2 and 18:1 significantly increased fullness and reduced hunger. No effect on food intake was observed. 18:1 and 18:2 increased cholecystokinin secretion significantly compared with the control. Fatty acid saturation did not affect peptide YY secretion.nnnCONCLUSIONSnWhen infused into the ileum, triacylglycerols with unsaturated fatty acids increase satiety, whereas triacylglycerols with saturated fatty acids does not. This trial was registered with the Dutch Trial Register as: ISRCTN51742545.

Telemedicine for management of inflammatory bowel disease (myIBDcoach): a pragmatic, multicentre, randomised controlled trial

BACKGROUNDnTight and personalised control of inflammatory bowel disease in a traditional setting is challenging because of the disease complexity, high pressure on outpatient clinics, and rising incidence. We compared the effects of self-management with a telemedicine system, which was developed for all subtypes of inflammatory bowel disease, on health-care utilisation and patient-reported quality of care versus standard care.nnnMETHODSnWe did this pragmatic, randomised trial in two academic and two non-academic hospitals in the Netherlands. Outpatients aged 18-75 years with inflammatory bowel disease and without an ileoanal or ileorectal pouch anastomosis, who had internet access and Dutch proficiency, were randomly assigned (1:1) to care via a telemedicine system (myIBDcoach) that monitors and registers disease activity or standard care and followed up for 12 months. Randomisation was done with a computer-generated sequence and used the minimisation method. Participants, health-care providers, and staff who assessed outcome measures were not masked to treatment allocation. Primary outcomes were the number of outpatient visits and patient-reported quality of care (assessed by visual analogue scale score 0-10). Safety endpoints were the numbers of flares, corticosteroid courses, hospital admissions, emergency visits, and surgeries. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02173002.nnnFINDINGSnBetween Sept 9, 2014, and May 18, 2015, 909 patients were randomly assigned to telemedicine (n=465) or standard care (n=444). At 12 months, the mean number of outpatient visits to the gastroenterologist or nurse was significantly lower in the telemedicine group (1·55 [SD 1·50]) than in the standard care group (2·34 [1·64]; difference -0·79 [95% CI -0·98 to -0·59]; p<0·0001), as was the mean number of hospital admissions (0·05 [0·28] vs 0·10 [0·43]; difference -0·05 [-0·10 to 0·00]; p=0·046). At 12 months, both groups reported high mean patient-reported quality of care scores (8·16 [1·37] in the telemedicine group vs 8·27 [1·28] in the standard care group; difference 0·10 [-0·13 to 0·32]; p=0·411). The mean numbers of flares, corticosteroid courses, emergency visits, and surgeries did not differ between groups.nnnINTERPRETATIONnTelemedicine was safe and reduced outpatient visits and hospital admissions compared with standard care. This self-management tool might be useful for reorganising care of inflammatory bowel disease towards personalised and value-based health care.nnnFUNDINGnMaastricht University Medical Centre and Ferring.

OP017 Telemedicine enables a safe shift from examination room based care to personalised care for inflammatory bowel disease: a pragmatic randomised multicenter trial with myIBDcoach

de Jong M.*1,2, van der Meulen-de Jong A.3, Romberg-Camps M.4, Becx M.5, Cilissen M.1, Maljaars J.3, van Bodegraven A.4, Mahmmod N.5, Markus T.6, Hameeteman W.1, Dijkstra G.7, Masclee A.1,2, Boonen A.8,9, Jonkers D.1,2, van Tubergen A.8,9, Pierik M.1,2 1Maastricht University Medical Center (MUMC), Department of Internal Medicine, division of Gastroenterology and Hepatology, Maastricht, Netherlands 2Maastricht University Medical Center (MUMC), NUTRIM – School for Nutrition and Translational Research in Metabolism, Maastricht, Netherlands 3Leiden University Medical Centre, Department of Gastroenterology and Hepatology, Leiden, Netherlands 4Zuyderland Medical Centre, Department of Gastroenterology and Hepatology, Sittard-Geleen, Netherlands 5St. Antonius Hospital, Department of Gastroenterology and Hepatology, Nieuwegein, Netherlands 6CCUVN, Woerden, Netherlands 7University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, Netherlands 8Maastricht University Medical Center (MUMC), Department of Internal Medicine, division of Rheumatology, Maastricht, Netherlands 9Maastricht University Medical Center (MUMC), CAPHRI School for Public Health and Primary Care, Maastricht, Netherlands

Liver test abnormalities predict complicated disease behaviour in patients with newly diagnosed Crohn's disease

BackgroundsIn coeliac disease, the prevalence of liver test abnormalities (LTAs) is higher in patients with more severe mucosal inflammation. In Crohn’s disease, prognosis is related to the severity of mucosal inflammation.AimThe aim of this study was to investigate whether the presence of LTA predicts the occurrence of complicated disease behaviour in newly diagnosed Crohn’s disease.MethodsA retrospective cohort study was performed in patients newly diagnosed with Crohn’s disease between 2002 and 2011. The complicated disease was defined as the occurrence of stricturing and/or perforating disease. LTAs were defined as a value of any of alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), or alanine aminotransferase (ALT) over the upper limit of normal.ResultsThree hundred eighty-three patients were included, of whom 34.1% had LTA. LTAs were mostly mild (less than two times the upper limit of normal). During the 5-year follow-up, 33.1% of patients in the group with LTA developed complicated disease behaviour compared to 14.6% in patients without LTA (pxa0<xa00.001). The presence of LTA was identified as a risk factor for complicated disease behaviour (HR 2.6, 95% confidence interval (CI) 1.5–4.2, pxa0<xa00.0001).ConclusionsIn newly diagnosed Crohn’s disease, the presence of LTA was an independent risk factor for the development of complicated disease behaviour.

Genomic and expression analyses identify a disease modifying variant for fibrostenotic Crohn's disease

Background and AimsnCrohns disease [CD] is a chronic inflammatory disease with unpredictable behaviour. More than half of CD patients eventually develop complications such as stenosis, for which they then require endoscopic dilatation or surgery, as no anti-fibrotic drugs are currently available. We aim to identify disease-modifying genes associated with fibrostenotic CD.nnnMethodsnWe performed a within-case analysis comparing extreme phenotypes using the Immunochip and replication of the top single nucleotide polymorphisms [SNPs] with Agena Bioscience in two independent case-control cohorts totalling 322 cases with fibrostenotis [recurrent after surgery] and 619 cases with purely inflammatory CD.nnnResultsnCombined meta-analysis resulted in a genome-wide significant signal for SNP rs11861007 [p = 6.0910-11], located on chromosome 16, in lncRNA RP11-679B19.1, an lncRNA of unknown function, and close to exon 9 of the WWOX gene, which codes for WW domain-containing oxidoreductase. We analysed mRNA expression of TGF-β and downstream genes in ileocecal resection material from ten patients with and without the WWOX risk allele. Patients carrying the risk allele [A] showed enhanced colonic expression of TGF-β compared to patients homozygous for the wild-type [G] allele [p = 0.0079].nnnConclusionnWe have identified a variant in WWOX and in lncRNA RP11-679B19.1 as a disease-modifying genetic variant associated with recurrent fibrostenotic CD and replicated this association in an independent cohort. WWOX can potentially play a crucial role in fibrostenosis in CD, being positioned at the crossroads of inflammation and fibrosis.

P667 Safety of anti-TNF treatment in liver transplant recipients – a meta-analysis

s of the 12th Congress of ECCO – European Crohn’s and Colitis Organisation S421 Conclusions: The short-term efficacy of adalimumab treatment for CD patients was demonstrated by the second week. Approximately 50% of the patients achieved remission with a normal CRP level at 4 weeks. Previous IFX use, higher CRP levels and a higher BMI appear to be associated with poor short-term outcomes of adalimumab treatment. P667 Safety of anti-TNF treatment in liver transplant recipients – a meta-analysis M. Westerouen van Meeteren1, A. Inderson1, B. Hayee2, A. van der Meulen1, R. Altwegg3, B. van Hoek1, G.-P. Pageaux3, T. Stijnen4, D. Stein5, J. Maljaars*1 1LUMC, Department of Gastroenterology-Hepatology, Leiden, Netherlands; 2King’s College Hospital, Department of Gastroenterology, London, United Kingdom; 3University Hospital of St. Eloi, Department of Hepatology and Gastroenterology, Montpellier, France; 4LUMC, Department of Medical statistics, Leiden, Netherlands; 5Medical College of Wisconsin, Division of Gastroenterology and Hepatology, Milwaukee, United States Background: Primary Sclerosing Cholangitis (PSC) patients with refractory inflammatory bowel disease (IBD) after liver transplantation (LT) pose a dilemma for treating physicians, as little is known about the risk of serious infection when combining anti-TNF therapy with immunosuppression for prevention of rejection. Our aim was to investigate the infection risk in this patient group by systematic review and meta-analysis of the available data. Methods: A literature search was conducted for full papers and conference proceedings through September 2015 regarding liver transplant recipients and anti-TNF therapy. All studies were appraised using the adapted Newcastle-Ottawa Scale (NOS), which contains 9 criteria for cohort studies and is adapted to 6 criteria for case series and case reports. Two reviewers (MWvM and PWJM) independently extracted study and control-patient data (age, duration of follow up, number of all infections, number of serious infections, time since transplant). As additional control population, PSC-IBD patients from the LUMC LT cohort were used. Poisson regression was used to compare serious infections (according to ICH-definition) Abstract P668 – Table 1. Patient demographics and clinical characteristics per patient year follow up between the anti-TNF and control group, correcting for mean time since transplant. Results: Initially, 465 articles and abstracts were identified, of which 8 were included. These 8 studies contained 53 post-LT patients on anti-TNF therapy and 23 post-LT control patients not on anti-TNF therapy. None of the studies scored less than 75% of the NOS quality criteria. From the LUMC LT cohort, 41 PSC-patients with PSC-IBD but without anti-TNF therapy were included as control population. Serious infection rates differed from 0 to 0.38 serious infections per patient year in the anti-TNF therapy group, and 0.04 to 0.24 in the control group. The overall infection rate for TNF-exposed patients was 0.12, compared to 0.15 in the control patients, resulting in a rate ratio of 0.80 (95% CI: 0.17–3.97, p=0.80). Age at time of transplant was not associated with the rate ratio for serious infections, whereas the time since transplantation was. Although correcting for time since transplant causes the infection rates in the anti-TNF-group to be higher than in the control group (0.13 vs 0.12 serious infections per patient year) the rate ratio remained non-significant (1.1, p=0.82). Conclusions: No significant increase in the serious infection rate was observed in LT-recipients with PSC-IBD during exposure to anti-TNF therapy. However, the wide confidence intervals of these results show that more data is needed to provide a definitive conclusion on the safety of anti-TNF therapy in these patients.P668 – Table 1. Patient demographics and clinical characteristics per patient year follow up between the anti-TNF and control group, correcting for mean time since transplant. Results: Initially, 465 articles and abstracts were identified, of which 8 were included. These 8 studies contained 53 post-LT patients on anti-TNF therapy and 23 post-LT control patients not on anti-TNF therapy. None of the studies scored less than 75% of the NOS quality criteria. From the LUMC LT cohort, 41 PSC-patients with PSC-IBD but without anti-TNF therapy were included as control population. Serious infection rates differed from 0 to 0.38 serious infections per patient year in the anti-TNF therapy group, and 0.04 to 0.24 in the control group. The overall infection rate for TNF-exposed patients was 0.12, compared to 0.15 in the control patients, resulting in a rate ratio of 0.80 (95% CI: 0.17–3.97, p=0.80). Age at time of transplant was not associated with the rate ratio for serious infections, whereas the time since transplantation was. Although correcting for time since transplant causes the infection rates in the anti-TNF-group to be higher than in the control group (0.13 vs 0.12 serious infections per patient year) the rate ratio remained non-significant (1.1, p=0.82). Conclusions: No significant increase in the serious infection rate was observed in LT-recipients with PSC-IBD during exposure to anti-TNF therapy. However, the wide confidence intervals of these results show that more data is needed to provide a definitive conclusion on the safety of anti-TNF therapy in these patients. P668 Post-marketing experience of vedolizumab in inflammatory bowel disease: analysis of pneumonia and other respiratory tract infections F. Bhayat1, A. Blake*2, S. Travis3 1Takeda Development Centre Europe Ltd, Global Pharmacovigilance, London, United Kingdom; 2Takeda Development Center Europe Ltd, Global Pharmacovigilance, London, United Kingdom; 3University of Oxford, Translational Gastroenterology Unit, Nuffield Department of Medicine, Oxford, United Kingdom Background: The annual incidence of pneumonia has been reported as 13.8/1000 in patients with IBD versus 7.6/1000 in healthy subjects (IRR 1.82; 95%CI: 1.75–1.88) [1]. Vedolizumab (VDZ) is a huD ow naded rom http/academ ic.p.com /ecco-jcc/article-/11/suppl_1/S421/2961610 by gest on 11 April 2019

P235 Does liver transplantation affect the risk for colorectal neoplasia in PSC-IBD patients?

Background: In IBD, primary sclerosing cholangitis (PSC) confers an increased risk of colorectal neoplasia (CRN). The aim of this study was to evaluate the effect of liver transplantation (LT) on development of CRN in patients with PSC and IBD. Methods: From our LT cohort (n = 275, period 1992 2011), 21 patients were identified with PSC and IBD and a follow-up post LT >6 months (PSC+LT). We further identified 39 patients with PSC and IBD without LT (PSC). In these patients with PSC and IBD, we performed a Cox regression analysis with LT as a timedependent covariate. We additionally compared development of CRN after LT between patients with PSC and IBD and the non-PSC LT population. To this end, we compared PSC+LT to a group of LT patients without PSC or IBD that was matched for sex, age and duration of post LT follow up (LT). Results: In patients with PSC, LT increased the risk of CRN in PSC patients with IBD in the univariate analysis; this effect was no longer present in the multivariate analysis. Cumulative incidence of CRN was 29% in the PSC+LT group vs. 10% in the PSC group (ns). CRN-free survival did not differ between PSC+LT and LT groups. Cumulative incidence of CRN for the groups was similar (resp. 29% vs. 32%, ns). Conclusions: Liver transplantation did not increase the rate of CRN in patients with both PSC and IBD. Furthermore, the rate of development of CRN did not differ between PSC+LT patients and the general LT population.