M.D. Martín Arranz

Smoking does influence disease behaviour and impacts the need for therapy in Crohn′s disease in the biologic era

Recently, the notion that smoking may adversely affect Crohn′s disease (CD) outcomes has been challenged by the suggestion that the widespread use of immunosuppressants and anti‐TNF drugs might offset the adverse effects of tobacco.

Role of TNFRSF1B polymorphisms in the response of Crohn's disease patients to infliximab.

Infliximab (IFX) is a valid treatment for Crohns disease (CD), but a relevant percentage of patients do not benefit from this therapy. In the Japanese population, the response to IFX was associated with markers in the TNF receptor superfamily 1A (TNFRSF1A) and 1B (TNFRSF1B) genes. We aimed to replicate the association previously described in the Japanese population and to ascertain the role of TNF receptors as modulators of the response to IFX. We studied 297 white Spanish CD patients with a known response to IFX: 238 responders and 59 primary nonresponders. Four single nucleotide polymorphisms (SNPs) were analyzed: rs767455 in TNFRSF1A and rs1061622, rs1061624, and rs3397 in TNFRSF1B. Comparisons between groups were performed with chi-square tests or the Fishers exact test. Different features (sex, age, disease duration, smoking among others) were evaluated as possible confounding factors. No significant association was found between the studied TNFRSF1A polymorphisms and response to IFX. In the TNFRSF1B gene, the haplotype rs1061624_A-rs3397_T was significantly increased in nonresponders: p = 0.015, OR = 1.78, 95% CI 1.09-2.90; and an increased frequency of rs1061622_G carriers was observed in patients with remission: p = 0.033 vs nonresponders and p = 0.023 vs patients with a partial response. Our results support a role of TNFRSF1B gene variants in the response to IFX in CD patients.

Acute spontaneous tumor lysis syndrome in a patient with Crohn's disease taking immunosuppressants.

Acute tumour lysis syndrome (TLS) is a catastrophic complication of the treatment of certain neoplastic disorders. It most commonly occurs in association with hematologic malignancies and appears a few hours to a few days after initiation of specific chemotherapy, as the result from the release of intracellular components into the bloodstream due to abrupt malignant cell death. Acute spontaneous TLS is rare, and it has been described in leukemia and lymphoma and in some patients with solid tumors prior to institution of therapy. The syndrome is characterized by hyperuricemia, hyperphosphatemia, hypocalcemia, hyperkalemia, and acute oliguric or anuric renal failure due to uric acid precipitation within the tubules (acute uric acid nephropathy) and to calcium phosphate deposition in the renal parenchyma and vessels.We report a case of acute spontaneous TLS in a patient with Crohn s disease treated with immunosuppressive drugs, who developed a plasmocytoma, in which serum uric acid concentration attained exceptionally high levels (44 mg/dL). The patient underwent acute oliguric renal failure, which required treatment with hyperhydration, urine alkalinization, urate oxidase and hemodialysis, with a fatal evolution.In conclusion, the present case report has several peculiarities: that of being one of the rare examples of spontaneous TLS, that of showing an exceptionally severe hyperuricemia, probably the highest ever reported in the literature, and that of the possible increased risk of tumours in patients with Crohn s disease taking inmunosuppressives and/or TNF antagonists.

Púrpura trombocitopénica idiopática como manifestación extraintestinal de la enfermedad de Crohn

Resumen La purpura trombocitopenica idiopatica es una manifestacion extraintestinal poco frecuente de la enfermedad inflamatoria intestinal, y sobre todo es rara en la enfermedad de Crohn, donde presenta ciertas peculiaridades respecto a su clinica habitual, de tal manera que ocurre con mas frecuencia cuando la enfermedad de Crohn es de predominio colonico, suele aparecer un tiempo despues del diagnostico de esta y, ademas, complica el curso clinico de ambas enfermedades. En este trabajo se presenta un caso de enfermedad de Crohn asociada a purpura trombocitopenica idiopatica, en una mujer de 14 anos en la que la purpura trombocitopenica idiopatica se inicio de forma simultanea a la enfermedad de Crohn, con mala evolucion clinica y resistencia a los tratamientos habituales de ambas enfermedades.

Amiloidosis globular focal localizada en colon: Un diagnóstico inusual

Globular amyloidosis is a very infrequent amyloidosis subtype, characterized by the deposition of rounded bodies of protein, occasionally perivascular instead of the usual linear deposits. The most frequently affected organ is the liver, although other organs can also been involved. To date, only eight cases (1-3) of globular amyloidosis of the gastrointestinal tract have been described. Clinical meaning of this morphologic variation of amyloidosis is unknown.

P367 Compliance to the scheduled treatment with infliximab. Experience in a tertiary care hospital

Background: Scheduled infliximab infusions are effective inducing and maintaining remission in IBD. Compliance with the schedule is important to avoid infusional reactions and loss of response. The aim of this report is to assess the compliance to this treatment in our Unit. Methods: All infliximab infusions received in the IBD Day Care Centre of our hospital since its opening in March 2007 were recorded. Treatment schedule consists in an induction phase 0, 2, 6 weeks and maintenance every 8 weeks. Treatment intensification was prescribed following medical criteria. Infusion delay was defined when the interval between two maintenance doses exceeded 63 days (9 weeks) or when infusion was delayed more than 5 days from calculated date in the induction phase. Intervals when treatment was stopped due to pregnancy, “drug holidays” by medical criteria, etc were excluded. We define “non-adherent patient” when at least three doses and 25% of the total are delayed. Results: 128 patients received 1508 infliximab infusions in our hospital from March 2007 to October 2011. Mean number of infusions was 11.78 (SD 8.9). 60 patients (46.9%) were male and 68 (53.1%) female. The indication was Crohn’s disease in 98 patients (76.5%) and ulcerative colitis in 30 (23.4%). Age at start of the therapy was 39 years (SD 14.6 range 15 77). 74 patients (57.81%) had some dose delayed, being 1.73 the mean number of infusion delayed (SD 2.4). Mean delay was 11.97 days (SD 16.4 median 7 days). Only 19 (14.84%) patients had at least one interval between doses greater than 12 weeks. 13 patients were defined as non-adherent (10,15%) 8 male (53.3%) and 5 female. The type of disease was Crohn in 9 cases (69.2%) and ulcerative colitis in 4 (30.8%). Differences between adherent (AP) and non-adherent patients (NAP) were analyzed: there is no difference in gender or type of disease. Statistically significant differences were found in mean age at start of the therapy (39.44 SD 14.6 AP vs 25.67 SD 5.6 NAP, p < 0.001), number of doses received 11.78 SD 8.9 AP vs 19.15 SD 7.9, NAP p < 0.001), and time on therapy (202.25 SD 9.6 AP vs 99.3 SD 94.9 NAP, p < 0.001). There is no difference in treatment intensification need between both groups; 24 of 115 patients (20.8%) in adherent vs 3 of 13 (23%) in non-adherent (p =NS). Conclusions: Our patients have a good scheduled doses compliance on infliximab therapy in our Unit, even after years of treatment. Risk factors for poor compliance are young patients and need of prolonged therapy. P368 Routine practice of iron infusion therapy in IBD T. Iqbal1 *, G. Rogler2, C. Hoffman3, J. Stein4. 1University Hospital Birmingham, Gastroenterology, Birmingham, United Kingdom, 2University Hospital Zurich, Klinik fur Gastroenterologie und Hepatologie Department fur Innere Medizin, Zurich, Switzerland, 3Vifor Pharma Ltd., Glattbrugg, Switzerland, 4Interdisciplinary Crohn Colitis Centre Rhein Main, Frankfurt, Germany