M. Brinar

A pilot study of transrectal endoscopic ultrasound elastography in inflammatory bowel disease

BackgroundUsing standard diagnostic algorithms it is not always possible to establish the correct phenotype of inflammatory bowel disease which is essential for therapeutical decisions. Endoscopic ultrasound elastography is a new endoscopic procedure which can differentiate the stiffness of normal and pathological tissue by ultrasound. Therefore, we aimed to investigate the role of transrectal ultrasound elastography in distiction between Crohns disease and ulcerative colitis.MethodsA total 30 Crohns disease, 25 ulcerative colitis, and 28 non-inflammatory bowel disease controls were included. Transrectal ultrasound elastography was performed in all patients and controls. In all ulcerative coltis patients and 80% of Crohns disease patients endoscopy was performed to assess disease activity in the rectum.ResultsSignificant difference in rectal wall thickness and strain ratio was detected between patients with Crohns disease and controls (p = 0.0001). CD patients with active disease had higher strain ratio than patients in remission (p = 0.02). In ulcerative colitis group a significant difference in rectal wall thickness was found between controls and patients with active disease (p = 0.03). A significant difference in rectal wall thickness (p = 0.02) and strain ratio (p = 0.0001) was detected between Crohns disease and ulcerative colitis patient group. Crohns disease patients with active disease had a significantly higher strain ratio compared to ulcerative colitis patients with active disease (p = 0.0001).ConclusionTransrectal ultrasound elastography seems to be a promising new diagnostic tool in the field of inflammatory bowel disease. Further study on a larger cohort of patients is needed to definitely assess the role of transrectal ultrasound elastography in inflammatory bowel disease.

MDR1 polymorphisms are associated with inflammatory bowel disease in a cohort of Croatian IBD patients

BackgroundInflammatory bowel diseases (IBD) are chronic diseases of unknown etiology and pathogenesis in which genetic factors contribute to development of disease. MDR1/ABCB1 is an interesting candidate gene for IBD. The role of two single nucleotide polymorphisms, C3435T and G2677T remains unclear due to contradictory results of current studies. Thus, the aims of this research were to investigate the association of MDR1 polymorphisms, C3435T and G2677T, and IBD.MethodsA total of 310 IBD patients, 199 Crohns disease (CD) patients and 109 ulcerative colitis (UC) patients, and 120 healthy controls were included in the study. All subjects were genotyped for G2677T/A and C3435T polymorphism using RT-PCR. In IBD patients, review of medical records was performed and patients were phenotyped according to the Montreal classification.ResultsSignificantly higher frequency of 2677T allele (p = 0.05; OR 1.46, 95% CI (1.0-2.14)) and of the 3435TT genotype was observed among UC patients compared to controls (p = 0.02; OR 2.12; 95% CI (1.11-4.03). Heterozygous carriers for C3435T were significantly less likely to have CD (p = 0.02; OR 0.58, 95% CI (0.36-0.91)). Haplotype analysis revealed that carriers of 3435T/2677T haplotype had a significantly higher risk of having UC (p = 0.02; OR 1.55; 95% CI (1.06-2.28)).ConclusionMDR1 polymorphisms are associated with both CD and UC with a stronger association with UC.

Increased arterial stiffness – similar findings in patients with inflammatory bowel disease without prior hypertension or diabetes and in patients with well-controlled hypertension

Abstract Purpose: Chronic inflammatory diseases are related with earlier onset of atherosclerosis. We hypothesized that inflammatory bowel disease patients with chronic, systemic inflammation have an increased arterial stiffness associated with the disease duration. Also, we wanted to compare arterial stiffness markers between inflammatory bowel disease and well-controlled hypertension patients. Materials and methods: A total of 89 inflammatory bowel disease patients (60 patients with Crohn’s disease and 29 patients with ulcerative colitis, age range 20–64 years) without history of arterial hypertension or diabetes were enrolled and age matched with a control group of patients (73 patients, age range 25–69 years, 41 (56.1%) males) with known history of well-controlled arterial hypertension. We have used a noninvasive device that simultaneously measures brachial blood pressure and estimates PWV and AIx in inflammatory bowel disease and hypertension groups of patients. Results: Patients with pathological PWV values were significantly older, had significantly longer duration of inflammatory bowel disease, higher values of serum cholesterol and HDL-cholesterol, and higher AIx (17.4% vs. 9.8%) (all p < .05). Higher PWV was associated with age and duration of inflammatory bowel disease in the linear regression model. PWV values were higher in hypertensive patients in the first two age quartiles while interestingly, in the last two quartiles, PWV was lower than in inflammatory bowel disease group of patients. Conclusions: Chronic subclinical inflammation is responsible for dyslipidemia and accelerated atherosclerosis which consequently alterates arterial elasticity. Inflammatory bowel disease and its duration should also be considered a risk factor for subclinical organ damage, as well as hypertension.

P747 Extracolonic and colonic cancer risk in patients with ulcerative colitis and primary sclerosing cholangitis

P746 Clinical characteristic of Crohn’s disease patients in Polish population M. Lodyga*1, P. Eder2, M. Gawron-Kiszka3, M. Hartleb3, J. Kierkus4, M. Klopocka5, M. Kukulska6, K. Linke7, E. MaleckaPanas8, E. Poniewierka6, I. Smola6, T. Rawa9, J. Regula9, G. Rydzewska1,10 1Central Clinical Hospital of the Ministry of the Interior, Department of Internal Medicine and Gastroenterology with IBD Subdivision, Warsaw, Poland; 2Poznan University of Medical Sciences, Department of Gastroenterology, Human Nutrition and Internal Diseases, Poznan, Poland; 3Medical University of Silesia, Department of Gastroenterology and Hepatology, Katowice, Poland; 4Children’s Memorial Health Institute, Department of Gastroenterology, Hepatology, and Feeding Disorders, Warsaw, Poland; 5Nicolaus Copernicus University, Gastroenterology Nursing Unit, Centre for Therapeutic Endoscopy, University Hospital No 2, Collegium Medicum in Bydgoszcz, Torun, Poland; 6Wroclaw Medical University, Department of Gastroenterology and Hepatology, Wroclaw, Poland; 7Poznan University of Medical Sciences, 2Department of Gastroenterology, Human Nutrition and Internal Diseases, Pozan, Poland; 8Medical University of Lodz, Department of Gastrointestinal Tract Diseases, Lodz, Poland; 9Medical Centre for Postgraduate Education, Department of Gastroenterology and Hepatology, Warsaw, Poland; 10Jan Kochanowski University, Department of the Prevention of Alimentary Tract Diseases, Faculty of Medicine and Health Science, Kielce, Poland

P655 Diffuse jejunoileitis – a unique subtype of Crohn's disease?

with a nation-wide survey in 19 community hospitals and 12 academic referral centers. Methods: The survey was conducted between June and December 2011, using a standardized questionnaire administered during the hospital visits over a one month period. The patients’ attitudes and perceptions, adherence to therapy, QoL (assessed by IBDQ), and access to health service was evaluated. Eligible patients (pts) consisted of men and women at least of 15 years of age with UC confirmed by standard clinical, endoscopic and histopathological criteria. Pts with previous colectomy or proctitis were excluded. Results: A total of 858 pts completed the survey. The majority self-reported to be in remission (51%), with a mean of 4.1 flares during the past 5 years with no differences for age and gender. A mean of 1.1 and 0.5 hospitalizations related or not to UC during the past 5 years were reported, respectively. Overall, the IBDQ scores were similar in pts with disease duration over 10 years than in pts diagnosed less than 3 years (4.97 and 5.01, respectively). The IBDQ scores were also lower in pts with active and chronically active disease than in pts with remission (4.18, 4.22 and 5.55, respectively). Only 35% of pts on combined (oral and topical) therapy reported to adhere to treatment, whereas 47% of pts reported to forget at least one pill during last 2 weeks. Twenty-eight per cent of pts reported a poor adherence to therapy, irrespective of gender, education, and employment status. Conclusions: Patients generally revealed a great impact of UC on day-by-day life, including disease burden and control, quality of life, coping skills, and treatment adherence. On behalf of: Ardizzone S. Milano, Atzei A. Cagliari, Bernasconi G. Busto Arsizio, Biancone L. Roma, Castiglione F. Napoli, Coccia G. Genova, D’Inca’ R. Padova, Costa F. Pisa, Danese S. Milano, Daperno M. Torino, De Petris G. Trento, Di Mario F. Treviso, Di Todaro E. Taranto, Di Sabatino A. Pavia, Fries W. Messina, Gallo V. Salerno, Gionchetti P. Bologna, Hadad Y. Lecce, Kohn A. Roma, Manca A. Cuneo, Milla M. Firenze, Merli M. Roma, Neri M. Chieti, Orlando A. Palermo, Pomarico G. Andria, Salvagnini M. Vicenza, Sarpi L. Perugia, Terpin M. Legnano, Tomarelli L. Ancona, Vecchi M. Milano, Zilli M. Udine.

P303 Anticardiolipin antibodies as potential serologic markers of thrombosis risk in IBD patients; a pilot study in referral IBD center

Results: 98 patients were recruited. One patient was lost to follow up and the care of 4 patients was transferred to another centre before 12 months of follow up data was available. Of the 93 remaining patients 11 (12%) relapsed within 12 months. The median FC was lower for non-relapsers, 79mg/g (IQR 39 226) than for relapsers, 322mg/g (IQR 136 557) (p = 0.002). The area under the ROC curve to predict relapse using FC was 74.8%. (Figure 1). Utilising a cut-off FC value of 240mg/g to predict relapse of quiescent Crohn’s disease over the course of one year was associated with a sensitivity of 72.7% and specificity of 74.3%, negative predictive value was high at 95.3% and a positive predictive value of 27.6%. On Kaplan Meier plots, there is a significant difference in time to relapse for those with the first FC value below or above 240 mg/g (p = 0.01) (Figure 2).