Shay Matalon

Serum alpha-1 antitrypsin: a noninvasive marker of pouchitis.

Background:Patients with ulcerative colitis undergoing total proctocolectomy with ileal pouch-anal anastomosis may develop pouchitis. Alpha-1-antitrypsin (AAT) is an acute phase reactant produced mainly by hepatocytes, but also locally in the gut. Data on noninvasive biomarkers of pouchitis are scarce. Methods:To identify biomarkers that correlate with pouch inflammation, ulcerative colitis pouch patients were prospectively recruited and underwent clinical, endoscopic, and histologic evaluations. The Pouchitis Disease Activity Index (PDAI) was calculated, and pouchitis was defined by a score ≥7. Serum and fecal AAT, C-reactive protein (CRP), fecal calprotectin, ferritin and albumin levels were measured. Results:Seventy-one ulcerative colitis pouch patients (mean age 43.8 ± 8.3 yr, 50.7% males) were included. The main indication for ileal pouch-anal anastomosis was intractable colitis (83.1%). Median serum AAT level (183.0 mg/dL, 155.1–232.0) was significantly higher in patients with a PDAI ≥7 compared with those with a PDAI <7 (167.6 mg/dL, 151.0–181.0) (P = 0.03). Serum AAT, CRP, and fecal calprotectin levels significantly correlated with PDAI scores: r = 0.583, P < 0.001; r = 0.584, P < 0.001; and r = 0.606, P = 0.001, respectively. Serum AAT and CRP levels correlated significantly (r = 0.650, P < 0.001), as did serum AAT and fecal calprotectin levels (r = 0.663, P < 0.001). Fecal AAT levels did not correlate with any tested biomarker. Receiver operating characteristic analysis demonstrated sensitivity, specificity, and positive predictive value of 55.6%, 100%, and 100%, respectively, for diagnosing pouchitis at a serum AAT cutoff level of 189 mg/dL. Conclusions:Serum AAT is a specific noninvasive biomarker of pouchitis. AAT levels correlate with disease activity and CRP and calprotectin levels.

Adolescent transition clinic in inflammatory bowel disease: quantitative assessment of self-efficacy skills

Objectives There is no model for the process of transition of adolescents with inflammatory bowel diseases (IBD) to the adult care protocol. We recently established a transition clinic where 17-year-old to 18-year-old IBD patients are seen by a multidisciplinary team including pediatric and adult gastroenterologists with expertise in IBD treatments, an IBD nurse, and a psychologist. We quantitatively describe this model and its benefits, and correlate demographic and transition parameters to self-efficacy in IBD adolescent patients before and after transition. Patients and methods All adolescent IBD patients enrolled in our transition clinic between January 2013 and December 2015 were included. They completed a self-efficacy questionnaire (‘IBD-yourself’) before and after the transition. The scores were correlated to demographic, disease, and transition parameters. Results Thirty of the 36 enrolled patients (mean age: 19±1.8 years, range: 17–27) had Crohn’s disease. Twenty-seven patients completed the transition protocol, which included an average of 3–4 meetings (range: 2–8) over 6.9±3.5 months. Self-efficacy scores in all domains of the questionnaire were significantly higher after completion of the transition. The weighted average score of the questionnaire’s domains was 1.85±0.3 before and 1.41±0.21 after transition (P<0.0001). Age, sex, disease duration, duration of transition, and the number of meetings in the clinic correlated with the questionnaire’s scores in the domains of coping with IBD, knowledge of the transition process, and medication use. Conclusion A well-planned adolescent IBD transition clinic contributes significantly toward improved self-efficacy in IBD. We recommend its implementation in IBD centers to enable a personalized transition program tailored to the needs of adolescents with IBD in specific domains.

Su1165 Serum Alpha-1-Antitrypsin: A Non-Invasive Marker of Pouchitis

106 DBEs were performed in 61 patients. (47 oral , 59 anal) with total enteroscopy achieved in 30%; 69% had history of previous surgical resection. Among those with established DBE, findings led to escalation of medical therapy in 30%, maintenance of therapy in 25%, and referral to surgery (25% resection, 8% bowel preservating). 4 patients underwent repeat DBE for disease monitoring after therapeutic escalation. Among 61 patients with known CD, 17 underwent dilation of 67 strictures during 32 endoscopic sessions. Of these patients, 65% were surgery-free during the study period. In those with CD diagnosis made at time of index DBE, 23 DBEs were performed in 18 patients (11 oral, 12 anal). Of these, 1 had total enteroscopy and 2/2 had successful capsule retrieval. All patients had previously undergone ileocolonoscopy and small bowel imaging without an established diagnosis (Table). Overall, there was one perforation in a patient with CD and a prior surgical resection; no patients developed DBE-associated pancreatitis or died during immediate followup period. Conclusions: Diagnostic and therapeutic DBE is safe and effective in patients with suspected or established CD, even in high risk patients with previous small bowel resection. DBE identified small bowel stricturing disease missed on prior ileocolonoscopy and small bowel imaging studies, and offers therapeutic potential for stricturing disease that might otherwise require surgery. Operating Characteristics of Small Bowel Imaging and Ileocolonoscopy for the Diagnosis of Isolated Small Bowel Crohns Disease Using DBE as Reference