María Dolores Martín Arranz

210 Management and Course of Inflammatory Bowel Disease Patients With Associated Cancer

DOP071 Inflammatory bowel diseases: a new cardiovascular risk factor? L. Caillo1 *, G. Danan1, V. Georgescu2, L. Papineau1, F. Gonzalez1, J.-F. Bourgaux3, F. Guillon4, G.-P. Pageaux1, R. Altwegg1 *. 1University Hospital of St Eloi, Departement of Hepatology and Gastroenterology, Montpellier, France, 2University Hospital, Department of Medical Information, Montpellier, France, 3University Hospital, Department of Hepatology and Gastroenterology, Nimes, France, 4University Hospital of St Eloi, Department of Digestive Surgery, Montpellier, France

Gastrostomía endoscópica percutánea: nuestra experiencia

Fundamento y objetivo En pacientes con disfagia, la gastrostomia endoscopica percutanea (GEP) es superior a la sonda nasogastrica en cuanto a una mayor recuperacion de peso y masa corporal. Por su utilidad, seguridad, bajo coste y facil mantenimiento es, en estos momentos, de eleccion en pacientes con problemas de deglucion. Pacientes y metodo Se incluyo a 77 pacientes en este estudio, a quienes se administro profilaxis antibiotica previamente al procedimiento. Las indicaciones para la colocacion de la GEP fueron: enfermedad neurologica (46%), neoplasias de cabeza y cuello (26%) y un tercer grupo de miscelanea (29%). Resultados En el seguimiento posterior a la colocacion de la GEP se detecto la aparicion de complicaciones mayores en el 1,3% de los pacientes, y en el 18,18% de ellos aparecieron complicaciones menores; la infeccion del estoma represento el 15%. Conclusiones La gastrostomia endoscopica percutanea es el metodo de eleccion para facilitar una nutricion enteral prolongada.

La hemorragia digestiva alta en el paciente anciano mayor de 80 años

OBJECTIVES To evaluate the patient characteristics, outcome, and prognosis of upper gastrointestinal haemorrhage in the elderly. MATERIAL AND METHODS A prospective study was conducted on 103 patients aged 80 years and over, admitted to a Gastrointestinal Bleeding Unit after an episode of upper gastrointestinal bleeding. We analysed the personal history, the characteristics of the bleeding event, and whether an urgent diagnostic or therapeutic endoscopy was performed, in order to identify clinical data and endoscopic findings that may have an influence on the outcome of the haemorrhage. RESULTS The major cause of the haemorrhage was peptic ulcer in 65.1%, and 60.2% of patients were on chronic treatment with non-steroidal anti-inflammatory drugs. An urgent diagnostic endoscopy was performed in all of them, identifying the source of bleeding in 94.2%, and treatment was carried out on 28.2%. The likelihood of rebleeding was 8%, and 4.9% of patients underwent emergency surgery, with an overall mortality rate of 5.8%. CONCLUSIONS The performance of urgent endoscopy and the application of endoscopic haemostasis are safe and effective in stopping upper gastrointestinal bleeding in the elderly. This has significantly reduced the need for emergency surgery, improving the survival of the bleeding elderly patient and preventing recurrent bleeding.

Sa1902 Short- and Long-Term Outcomes of Infliximab Dose Intensification in Patients With Ulcerative Colitis

Shortand Long-Term Outcomes of Infliximab Dose Intensification in Patients With Ulcerative Colitis Carlos Taxonera, Manuel Barreiro-de Acosta, Marta Calvo, Cristina Saro, Guillermo Bastida, Maria Dolores Martin Arranz, Javier P. Gisbert, Valle Garcia-Sanchez, Ignacio Marin-Jimenez, Fernando Bermejo, Maria Chaparro, Angel Ponferrada Diaz, Ignacio Fernandez-Blanco, Pilar Martinez-Montiel, R. Pajares, Celia de Gracia, David Olivares, Fermin Estremera Arevalo, Juan L. Mendoza

Endoscopic submucosal injection of adipose-derived mesenchymal stem cells ameliorates TNBS-induced colitis in rats and prevents stenosis

BackgroundMesenchymal stem cells have potential applications in inflammatory bowel disease due to their immunomodulatory properties. Our aim was to evaluate the feasibility, safety and efficacy of endoscopic administration of adipose-derived mesenchymal stem cells (ASCs) in a colitis model in rats.MethodsColitis was induced in rats by rectal trinitrobenzenesulfonic acid (TNBS). After 24 h ASCs (107 cells) or saline vehicle were endoscopically injected into the distal colon. Rats were followed for 11 days. Daily weight, endoscopic score at days 1 and 11, macroscopic appearance at necropsy, colon length and mRNA expression of Foxp3 and IL-10 in mesenteric lymph nodes (MLN) were analyzed.ResultsEndoscopic injection was successful in all the animals. No significant adverse events or mortality due to the procedure occurred. Weight evolution was significantly better in the ASC group, recovering initial weight by day 11 (− 0.8% ± 10.1%, mean ± SD), whereas the vehicle group remained in weight loss (− 6.7% ± 9.2%, p = 0.024). The endoscopic score improved in the ASC group by 47.1% ± 5.3% vs. 21.8% ± 6.6% in the vehicle group (p < 0.01). Stenosis was less frequent in the ASC group (4.8% vs. 41.2%, p < 0.01). Colon length significantly recovered in the ASC group versus the vehicle group (222.6 ± 17.3 mm vs. 193.6 ± 17.9 mm, p < 0.001). The endoscopic score significantly correlated with weight change, macroscopic necropsy score and colon length. Foxp3 and IL-10 mRNA levels in MLN recovered with ASC treatment.ConclusionsASC submucosal endoscopic injection is feasible, safe and ameliorates TNBS-induced colitis in rats, especially stenosis.

Sa1251 Infliximab Trough Levels and Antibodies: Relationship With Infusion Reaction, Immunomodulators and Biological Parameters

Background: Adalimumab (ADA), a monoclonal antibody against TNFα is effective therapy for inflammatory bowel diseases (IBD: ulcerative colitis (UC) and Crohns disease (CD)). Loss of response to ADA may be the consequence of increased ADA clearance (CL), resulting in short half-life (t1/2) and decreased troughs. Studies evaluating ADA pharmacokinetics (PK) in IBD are scarce. Aim: To generate a preliminary PK model for ADA and to investigate factors affecting ADA PK variability in IBD. Methods: IBD patients were prospectively recruited; ADA serum concentrations as well as antibodies toward ADA (ATA) were measured by ELISA (Immundiagnostik AG) during therapeutic drug monitoring (TDM). Demographic, clinical and laboratory data were recorded. ADA data were evaluated using population modeling (NonmemVersion 7.2 Icon Development). Standard PKmodel building approaches and performance evaluations were used. The absorption rate constant (Ka) was fixed to 0.02 hr-1 (consistent with the product label). Apparent CL/bioavailability (F), volume of distribution and between-patient variability for CL/F were estimated. Results: ADA concentrations (n=87) from 63 patients (CD:56, UC:7) were evaluated. Baseline (mean ± SD) demographics were: weight 60.5±23.9 kg, age 36.4±12.1 years, males: 33, BMI 21.0±7.8 kg/cm2, CRP 19.7±28.4 mg/L, albumin 4.0±0.54 g/dL. Positive ATA at first sampling were present in 9 patients, and further developed in 2. Moderate/severe disease activity was detected in 17/2 subjects, respectively. ADA as second line treatment was given to 37/63 (58.7%) patients. Dosage at sampling was 40/2 mg/weeks for 54 (85.7%), and 80/2 for 7 (11.1%) subjects. PK data were best described using a one compartment model with linear elimination. Parameter precision was good ( 0.05. Typical (ATA negative, weight 70 kg, ALB 4 g/dL) CL/F was 0.0124 L/hr. ATA formation was associated with a nearly 5 fold increase in ADA CL/F. Conclusions: ADA CL/F is significantly influenced by patient factors. ATA, concomitant use of antibiotics and corticosteroids, higher ADA doses and ADA as second line of therapy increase CL/F. The highly variable t1/2 suggests that interval shortening rather than increased doses may ensure higher exposure and increased troughs. The high between-patient variability suggests that additional factors affect troughs and that individualized, PK-guided rather than fixed dosing, may improve IBD patient outcomes.

Profilaxis secundaria mediante ligadura con bandas elásticas en varices esofagogástricas

Resumen El objetivo del presente estudio fue determinar la utilidad de la ligadura con bandas elasticas en la prevencion de la recidiva hemorragica por varices esofagogastricas. Se incluyo a 65 pacientes que sobrevivieron a un episodio hemorragico por varices. Veintinueve (45%) eran Child A, 25 (38%) B y 11 (17%) C; el virus C y el alcohol fueron la etiologia de la cirrosis en el 45 y el 31% de los casos, respectivamente. La primera sesion de ligadura se realizo entre el tercer y el quinto dia despues del episodio hemorragico, y las sesiones posteriores a intervalos de 3-4 semanas. Las sesiones de ligadura se realizaron con profilaxis antibiotica. Se aplico una media de 2,7 bandas por sesion (rango, 1-5), y la media de sesiones por paciente hasta erradicar las varices fue de 2,5 (rango, 1-6). La tasa de recidiva hemorragica fue del 24,6% (16 episodios). En conclusion, la ligadura endoscopica con bandas elasticas es una tecnica util para la erradicacion de varices esofagicas y en la prevencion de recidiva hemorragica.

Uso de gadolinio como contraste en CPRE en pacientes con reacciones adversas a contrastes yodados

INTRODUCTION Radiologic contrasts are required during endoscopic retrograde cholangiopancreatography (ERCP). The most frequently used are iodine-based contrast media. Controversy still surrounds the optimal strategy in patients with previous adverse reactions to iodine contrasts that need to undergo an ERCP. OBJECTIVE To evaluate the safety and efficacy of a gadolinium-derived contrast medium in patients with previous reactions to iodine-derived agents during ERCP. MATERIAL AND METHODS Thirteen ERCP were performed in 11 patients with well-established adverse reactions to iodine compounds. ERCP was carried out with gadobutrol, a non-ionic gadolinium compound and without prophylaxis. RESULTS In all patients, ERCP were satisfactorily completed. Thirteen cholangiograms and one pancreatogram were obtained. All procedures were technically successful, allowing diagnosis and endotherapy. The quality of the images was good, similar to those obtained with standard contrast media, and did not represent a limitation. No contrast-related adverse events were observed, and there were no post-ERCP complications. CONCLUSIONS Gadolinium-derived agents are a safe and effective alternative in iodine-allergic patients.