S. Gologan

Diagnostic Delay in Romanian Patients with Inflammatory Bowel Disease: Risk Factors and Impact on the Disease Course and Need for Surgery

BACKGROUND The epidemiology of inflammatory bowel disease [IBD] in Eastern Europe is poorly understood, particularly with regard to diagnostic delay. Here we investigated the factors leading to delayed diagnosis and the effect of the delay on several disease progression and outcome measures. METHODS A total of 1196 IBD cases [682 ulcerative colitis [UC], 478 Crohns disease [CD], 36 indeterminate colitis] from the Romanian national registry IBDPROSPECT were reviewed. Standard clinical and demographic factors were evaluated as predictors of a long diagnostic delay in both CD and UC. Diagnostic delay was subsequently evaluated as a potential risk factor for bowel stenoses, bowel fistulas, perianal fistulas, perianal surgery, and intestinal surgery in CD patients. RESULTS The median diagnostic delay was significantly longer in CD [5 months] than in UC [1 month] patients [p < 0.001]. Compared with 5 months for UC patients, 75% of CD patients were diagnosed within 18 months of symptom onset. In CD patients, extra-ileal location was a protective factor (odds ratio [OR], 0.5; p = 0.03), whereas being an active smoker [OR, 2.09; p = 0.01] and symptom onset during summer [OR, 3.35; p < 0.001] were independent risk factors for a long diagnostic delay [> 18 months]. In UC patients, an age > 40 years was a protective factor [OR, 0.68; p = 0.04] for a long delay. Regarding outcomes, a long diagnostic delay in CD patients positively correlated with bowel stenoses [OR, 3.38; p < 0.01] and any IBD-related surgery [OR, 1.95; p = 0.03] and had a positive trend for intestinal fistulas [OR, 2.64; p = 0.08] and perianal fistulas [OR, 2.9; p = 0.07]. Disease duration since diagnosis positively correlated with bowel stenoses [OR, 1.04; p = 0.04], any IBD-related surgery [OR, 1.04; p = 0.02], and intestinal surgery [OR, 1.07; p < 0.01]. CONCLUSIONS A long diagnostic delay in IBD correlates with an increased frequency of bowel stenoses and need for IBD-related surgery.

Inflammatory gene expression profiles in Crohn's disease and ulcerative colitis: A comparative analysis using a reverse transcriptase multiplex ligation-dependent probe amplification protocol

BACKGROUND AND AIMS Cytokines and their receptors play a critical role in the pathogenesis of the inflammatory bowel disease (IBD). The aim of this study was to investigate the expression profiles of inflammatory genes in inflamed and non-inflamed colonic tissue samples in patients with Crohns disease (CD) and ulcerative colitis (UC), and to identify molecular signatures for different IBD phenotypes. METHODS Seventy-one patients diagnosed with IBD (38 CD, 33 UC) and 15 non-IBD controls have been included in the study. For each patient, biopsy samples were obtained during colonoscopy from inflamed (L) and healthy (N) mucosa. We investigated by commercially available reverse-transcriptase multiplex ligation-dependent probe amplification (RT-MLPA) kit the mRNA expression of a set of 40 genes involved in inflammation: cytokines, chemokines, receptors, signal transduction molecules and transcription factors. RESULTS In L biopsies from patients with CD, higher expression levels were found for IL-4 (p=0.009) and IL-12p35 (p=0.0005), whereas in L biopsy samples from patients with UC higher expression levels were found for IL-8 (p=0.03), chemokines SCYA3 (p=0.05), SCYA4 (p=0.01) and glutathione S-transferase P1 (p=0.01). In N biopsies of patients with CD higher expression levels were found for IL-1R (p=0.01) and IL-12p35 (p=0.007), whereas in N biopsies of patients with UC higher expression levels were found for IL-15 (p=0.009) and SCYA8 (p=0.001). The logistic regression analysis has indicated that low expression levels of IL-2 and IL-10, together with higher ASCA IgG titers were independently associated with penetrating/stricturing CD. CONCLUSIONS RT-MLPA is a sensitive and effective method for the evaluation of the profiles of inflammatory genes in IBD, with potential future applications for diagnosis, phenotypic stratification and targeted therapy.

P630 Epidemiological and phenotypic characteristics of IBD patients in Romania – results of a nationwide hospital-based registry

C. Gheorghe1, A. Dimitriu1 *, R. Iacob1, M. Cojocaru1, C. Lupei1, R. Vadan1, D. Dobru2, A. Trifan3, M. Tantau4, A. Goldis5, G. Constantinescu6, S. Gologan7, B. Mateescu8, D. Gheonea9, L. Gheorghe1, M. Diculescu1, on behalf of the IBDPROSPECT Study Group. 1Fundeni Clinical Institute, Digestive Diseases and Liver Transplantation Center, Bucharest, Romania, 2Municipal Hospital Targu Mures, Gastroenterology, Targu Mures, Romania, 3Gastroenterology and Hepatology Institute Iasi, Gastroenterology, Iasi, Romania, 43rd Medical Clinic Cluj-Napoca, Gastroenterology, Cluj-Napoca, Romania, 5District Hospital Timisoara, Gastroenterology, Timisoara, Romania, 6Floreasca Emergency Hospital, Gastroenterology, Bucharest, Romania, 7Elias Universitary Hospital, Gastroenterology, Bucharest, Romania, 8Colentina Clinical Hospital, Gastroenterology, Bucharest, Romania, 9University of Medicine and Pharmacy Craiova, Romania, Immunology, Craiova, Romania

P227 - Inflammatory genes expression profiles in patients with IBD investigated using multiplex ligation-dependent probe amplification (MLPA)

P226 High incidence of Crohn’s disease in Western Hungary between 2002 2006 L. Lakatos1, G. David1, T. Pandur1, Z. Erdelyi1, G. Mester2, M. Balogh2, I. Szipocs3, C. Molnar4, E. Komaromi5, O. Gemela6, P.L. Lakatos6 *. 1Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary, 2Department of Medicine, Grof Eszterhazy Hospital, Papa, Hungary, 3Department of Medicine, Municipal Hospital, Tapolca, Hungary, 4Department of Infectious Diseases, Magyar Imre Hospital, Ajka, Hungary, 5Department of Gastroenterology Municipal Hospital, Varpalota, Hungary, 6Semmelweis University, Budapest, Hungary

P049 - The value of capsule endoscopy for the phenotypic classification and the management of patients with Crohn's disease

P048 Factors affecting post-operative recurrence in Crohn’s disease A. Ouakaa-Kchaou*, N. Ben Mahmoud, H. Elloumi, D. Gargouri, R. Hefaiedh, A. Kochlef, A. Kilani, M. Romani, J. Kharrat, A. Ghorbel. Habib Thameur Hospital, Tunis, Tunisia Background: Crohn’s disease is a chronic inflammatory gastrointestinal disorder with an unpredictable clinical course characterized by the high incidence of recurrence. In spite of the important role of conservative treatment, up to 90 % of all patients with Crohn’s disease require surgery during their lifetime. However, the factors that predict post-operative recurrence remain controversial. Aim: This study was designed to identify the risk factors for recurrence in patients with Crohn’s disease and the influence of the primary operation. Methods: From 1994 through 2006, 40 patients affected by Crohn’s disease required operative treatment. All these patients underwent a primary procedure. There were 29 men and 11 women (mean age: 33 years). Recurrence was defined by the presence of clinical symptoms. Univariate and multivariate analysis were performed to find the predictors of recurrence. Results: The most common indication for the surgical treatment was stenosis (45%). As the most frequent procedures, the ileocoecal resection (37.5%) and the partial resection of the small bowel (32.5%) were performed. The mean length of the follow-up was 48 months. The overall recurrence rate was 40%. Logistic regression analysis revealed that age at onset of disease (p = 0.01), age at surgery (p = 0.02), smoking (p = 0.005), preoperative treatment (p = 0.04), urgent surgery (p = 0.03) and prophylactic medical treatment (p = 0.00) were associated with the risk of recurrence. Neither gender, form of aggressiveness of the disease, duration of Crohn’s disease before surgery and anatomical site of involvement, nor microscopically affected resection margins and typical granulomas were found to predict the recurrence of the disease. Conclusion: In the treatment of Crohn’s disease, it is important to identify a group with high risk of recurrence in order to undertake an appropriate medical prophylaxis. This is very important because of the higher risk for complications caused by reoperations. That is why interdisciplinary cooperation including postoperative care and optimal conservative treatment are absolutely essential.