Joan Tosca

HLA-DQ: Celiac disease vs inflammatory bowel disease

AIM To determine the genetic predisposition to celiac disease (CeD) in inflammatory bowel disease (IBD) patients by quantifying the frequency of CeD-related human leucocyte antigen (HLA) (HLA-CeD: HLA-DQ2 and -DQ8) in IBD patients globally, by type of IBD and gender, and by calculating the protective/risk contribution of these haplotypes in the development of the IBD disease. METHODS We conducted a prospective study with IBD patients from our Unit. Clinical information was gathered and blood was tested for HLA-CeD. The control group was made up of unrelated Valencian organ donors. RESULTS 1034 subjects were analyzed: 457 IBD [207 ulcerative coliti (UC) and 250 Crohn’s disease (CD)] patients and 577 healthy controls. 39% of the controls and 34% of the patients had HLA-CeD (P = 0.0852). HLA-DQ2 was less frequent in UC patients (P = 0.0287), and HLA-DQ8 in CD (P = 0.0217). In women with UC, the frequency of DQ2.5cis (DQB1*02:01-DQA1*05:01) was reduced ≥ 50% [P = 0.0344; preventive fraction (PF) = 13%]. PFs (7%-14%) were obtained with all HLA-CeD haplotypes. HLA DQB1*02:02-DQA1*02:01 (HLA-DQ2.2) was more frequent in CD patients with respect to controls (P = 0.001) and UC patients (etiological fraction = 15%). CONCLUSION HLA-CeD is not more frequent in IBD patients, with an even lower frequency of HLA-DQ2 and -DQ8 in UC and CD respectively. HLA-DQ2.5 confers protection from the development of UC, especially in women, and HLA-DQ8 does so for the appearance of CD. HLA-DQ2.2 is present in 34% of the CD patients and may constitute a genetic risk factor for CD development.

Su1189 There Is a Different Tissue Transglutaminase (tTG) Distribution in Celiac Disease (CD) and Inflammatory Bowel Disease (IBD) Duodenal Mucosa

central review of endoscopic images on patient selection and trial outcomes. Methods: We utilized data from a placebo-controlled randomized trial of Asacol®, an 800mg formulation of mesalamine, conducted in patients with mildly-to-moderately active UC (NCT01059344). Eligible patients had a UC-DAI total score of 4 10 and an endoscopy sub-score 2. Patients were randomized 1:1 to Asacol® 4.8 g/day or placebo for 10 weeks. Outcomes were assessed at weeks 6 and 10. Post-hoc exploratory analyses compared week 6 clinical and endoscopic outcomes in site investigator (SI)and central reader (CR)-defined endoscopically eligible populations, as well as outcomes in CReligible patients using SI versus CR scoring. Results: A total of 281 patients comprised the SI population. Of these, 194 (69%) were considered eligible by the CR and were included in CR-based analyses. The effect size (percent difference Asacol® minus placebo) was consistently greater for all outcomes in the CR-versus SI-defined population (see Table 1). Placebo rates were uniformly greater in the SI population due to inclusion of patients with low endoscopic disease activity as judged by the CR. No difference in effect size was observed between CRand SI-based outcomes at week 6 in the CR-defined population.

EDAD Y COMORBILIDAD COMO FACTORES PRONÓSTICOS EN PANCREATITIS AGUDA BILIAR

Antecedentes La identificacion precoz de los factores pronosticos de gravedad en la pancreatitis aguda (PA), es un determinante fundamental para detectar aquellos pacientes con mas riesgo de presentar una mala evolucion. Objetivos Determinar la influencia de factores intrinsecos del paciente (edad y comorbilidad) en la evolucion de la PAbiliar, valorando como parametros respuesta la gravedad, la mortalidad y el ingreso en UCI. Metodos Se incluyeron todos los pacientes ingresados en el Servicio de Gastroenterologia o UCI con un primer episodio de PA biliar entre Enero de 2000 y Diciembre de 2007. La gravedad de la PAse definio utilizando los criterios de Atlanta. No se considero factor determinante de gravedad de la PAla presencia de fallo organico transitorio ( Resultados En el periodo de estudio, ingresaron 482 pacientes con un primer episodio de PA biliar (mediana de edad 71 anos), 118 (24,5%) presentaron una PA biliar grave. La mortalidad total fue de 2,7% (13 pacientes). La edad avanzada (OR 1,04, CI 95% 1,02–1,07, p=0,000) y la comorbilidad (OR 1.39, CI 95% 1,21–1,63, p=0,000) influyeron en el desarrollo de fallo organico; 89 pacientes presentaron fallo de uno o mas organos, 79% de estos tenian algun grado de comorbilidad y 70% eran mayores de 71 anos. No pudimos establecer relacion significativa entre la edad y/o la comorbilidad con la aparicion de complicaciones locales. La gravedad de la PAbiliar fue influenciada por la edad (OR 1,02, CI 95% 1,01–1,04, p=0,001) y el indice de Charlson (OR 1,2, CI 95% 1,09–1,41, p=0,001). La mortalidad no se relaciono de modo significativo con la edad ni con la comorbilidad, aunque 61,5% de los pacientes fallecidos eran mayors de 71 anos y el 54% presentaron algun grado de comorbilidad asociada. No hubo asociacion entre el ingreso en UCI y la edad o la comorbilidad de los pacientes. Conclusiones La edad avanzada y la presencia de comorbilidad determinan una mayor gravedad de la PA biliar, pero no influye en la mortalidad de los pacientes.