V Chhaya

Small intestinal contrast ultrasonography for the detection of small bowel complications in Crohn's disease: correlation with intraoperative findings and magnetic resonance enterography.

In evaluating small bowel Crohns disease (CD), small intestine contrast‐enhanced ultrasonography (SICUS) is emerging as an alternative to magnetic resonance enterography (MRE). This retrospective study compared the diagnostic accuracy of SICUS and MRE with surgical findings, and their level of agreement.

Assessment of cytology and mucin 2 in colorectal mucus collected from patients with inflammatory bowel disease: Results of a pilot trial

Non‐invasive diagnosis of colorectal disease remains problematic, fecal biomarkers presenting the only current option. Colorectal mucus is the diagnostically informative element of stool samples, but its separation from stool is difficult. We aimed to: (i) test a novel method of non‐invasive colorectal mucus sampling in a pilot clinical trial; (ii) evaluate sampling method acceptance by study participants; (iii) characterize the collected material cytologically; and (iv) assess feasibility of quantitative protein analysis in the samples.

Colorectal mucus non-invasively collected from patients with inflammatory bowel disease and its suitability for diagnostic cytology

Colorectal mucus is a key component of the protective gut barrier which is altered in inflammatory bowel disease (IBD). We aimed to cytologically characterize colorectal mucus non‐invasively collected from IBD patients using our new sampling technique. Colorectal mucus was self‐collected by 58 IBD patients comprising 31 ulcerative colitis (UC) and 27 Crohns disease (CD) cases. The samples were examined cytologically, and immunocytochemically. Large numbers of well‐preserved granulocytes were typically detected (neutrophils undergoing degradation were observed as well). Plasma cells and erythrophagocytosis were present in 18.2% and 29.1% of cases, respectively, predominantly in patients with UC and distal CD. Immunocytochemical visualization of calprotectin in neutrophils, eosinophil‐derived neurotoxin in eosinophils and tumour necrosis factor‐α in macrophages was also achieved. Correct cytological diagnosis was made in 61.8% of analysed IBD cases. Our new method of colorectal mucus sampling provides highly informative material for cytology. Findings of the presence of plasmocytes and erythrophagocytosis in colorectal mucus are unique and may reflect previously unknown mechanisms of IBD pathogenesis. Immunocytochemical detection of inflammation biomarkers demonstrates the suitability of this material for biomarker quantification. These promising results suggest a potential role for colorectal mucus cytology in the non‐invasive diagnosis of IBD.

Inflammatory bowel disease detection and monitoring by measuring biomarkers in non‐invasively collected colorectal mucus

Non‐invasive detection and monitoring of inflammatory bowel disease (IBD) is an important clinical challenge. Stool calprotectin is the most popular among available options, but the necessity of stool collection limits its acceptability. This study aimed to evaluate biomarker measurement in non‐invasively collected colorectal mucus as a new tool for IBD detection and activity monitoring.

Effects of eosinophilic oesophagitis on quality of life in an adult UK population: a case control study

Eosinophilic oesophagitis (EoE) is a chronic immune-mediated esophageal disease, characterized by symptoms related to esophageal dysfunction and histologically by eosinophil predominant inflammation. Current evidence for an adverse impact on quality of life (QoL) is conflicting and there are no data from a UK population regarding QoL. We conducted a prospective cross-sectional observational study using the Short Form-36 Health Survey, Hospital Dysphagia/Odynophagia Questionnaire, and the EoE Adult Quality of Life Questionnaire to assess QoL and severity of dysphagia in EoE patients, compared to age and gender matched healthy control subjects. Data were also collected on comorbidity and medication use. Eighty-eight subjects were recruited (44 patients). Patients had higher rates of antihistamine and topical (swallowed) corticosteroid use. Physical QoL did not differ between patients and controls, although patients did report a statistically significant lower mental QoL, with small absolute magnitude of difference. Patients reported higher dysphagia scores and these were negatively correlated with both physical and mental QoL. Higher rates of dysphagia and medication use in patients may among other things account for lower mental QoL. However, a higher rate of dysphagia in patients is not associated with a reduced physical QoL. Our findings are of clinical value, particularly when a new diagnosis of EoE is made, as clinicians can reassure patients that their general physical health should not be greatly affected by the diagnosis. Moreover, it may also be useful for patients to be aware that EoE may have an impact on their mental health, but this effect is likely to be small. We therefore advocate education and reassurance in this respect for all patients at diagnosis.

PWE-106 Small Intestine Ultrasonography With Oral Contrast (sicus) For The Detection Of Small Bowel Complications In Crohn’s Disease: Correlation With Intra-operative Findings

Introduction SICUS accurately assesses small bowel lesions in patients with Crohn’s disease (CD) without exposure to diagnostic medical radiation.1 Its role in identifying intra-abdominal complications associated with CD remains to be confirmed. The aim of this retrospective study was to compare the diagnostic sensitivity of SICUS with subsequent surgical findings. Methods Patients with CD evaluated by SICUS who subsequently required bowel resection within 6 months were identified. Radiological findings and operation notes were collated. The accuracy and agreement of SICUS to detect the site and length of strictures, fistulae, abscesses and mucosal thickening, was compared with surgical findings and assessed by kappa (κ) coefficient statistical analysis. Stricture lengths were compared using student’s t-test. CRP and platelet count were recorded within 2 weeks of SICUS and surgery as surrogate markers of disease activity. Results A total of 25 patients (12 male) with a mean age of 29.9 years were included in the study. Mean time from SICUS to respective bowel surgery was 91.5 days (Range 5–176). Ultrasonographic and surgical inter-rater agreement was good for the presence of strictures (κ=0.73, sensitivity and specificity both 88%), their number (κ=0.65, 95% CI: 0.31–0.96) and stricture site (κ =0.72, 95% CI: 0.44–1.00). Stricture length was 7.4 ± 1.5 cm identified at surgery vs. 5.8 ± 1.8 cm by SICUS (NS). Agreement was excellent for the presence of fistulae (κ = 0.82, sensitivity 86%, specificity 94%), location of fistula (κ=0.92, 95% CI: 0.76–1.00), presence of abscess (κ = 0.87, sensitivity 100%, specificity 95%) and its location (κ = 0.87, 95% CI: 0.63–1.00). Agreement was moderate for mucosal wall thickening (κ = 0.51, sensitivity 95%, specificity 50%). Markers of inflammation (CRP and platelet count) showed no significant difference at the time of SICUS and surgery. Conclusion SICUS accurately identifies small bowel complications in CD and offers an alternative in the pre-operative stage of CD complications. Its wider use should be adopted. Reference Chatu S, Pilcher J, Saxena SK, et al. Diagnostic accuracy of small intestine ultrasonography using an oral contrast agent in Crohn’s disease: comparative study from the UK. Clin Radiol 2012 Jun;67(6):553–9 Disclosure of Interest None Declared.

PTU-052 The Impact of Thiopurines on Risk of Intestinal Surgery in Elderly-Onset IBD: Abstract PTU-052 Table 1

Introduction Thiopurines (TP) have an established role in the maintenance of steroid-free remission in IBD. Their role in reducing the need for surgery in younger populations has been recently highlighed.1 TPs are associated with an increased risk of lymphoma in the elderly but their role in reducing the risk of surgery in patients with elderly-onset IBD (EO-IBD) is not established. We therefore aimed to evaluate the impact of TPs on the risk of surgery in EO-IBD, using a nationally representative research database. Methods This was a retrospective descriptive study using data from the Clinical Practice Research Datalink (CPRD). Incident cases of IBD were isolated using previously validated Read codes. Patients were included if they had codes for ulcerative colitis (UC) or Crohn’s disease (CD), and their date of diagnosis was on/after their 60 th birthday. Information extracted included sex, age at diagnosis, smoking status, and prescription data for IBD medications. Finally, we obtained data on our main outcomes: colectomy in UC and first intestinal surgery in CD. A multivariate Cox proportional hazard model was generated to deduce the risk of surgery according to TP use. The model was adjusted for potential confounders including sex, smoking, 5 ASA use and early steroid use (corticosteroid within 3 months of diagnosis). In a subgroup of TP users, a second proportional hazard model was used to define the impact of duration of TP treatment on the risk of surgery. Results 2758 and 1349 were identified with EO-UC and EO-CD respectively, with a mean follow up of 4.9 years. Mean age at diagnosis was 71.8 years. Table 1 demonstrates the summary demographic and prescription data for both groups.Abstract PTU-052 Table 1 Elderly-onset UC Elderly-onset CD Male 50% 40% Smoking at diagnosis 9% 22% 5 ASA use 80% 63% Steroid use 56% 52% Thiopurine use 13% 16% Surgery 4% 13% TP use was associated with an increased risk of colectomy in EO-UC (HR 3.5, CI 2.28–5.35, p < 0.0001), but not an increased risk of first intestinal surgery in EO-CD. In subgroup analysis restricted to TP users only, TP use for greater than 12 months in EO-UC was associated with a 64% reduction in risk of colectomy (HR 0.36, CI 0.18–0.7, p = 0.003). Similar findings were not seen in EO-CD. Conclusion TP use for longer than 12 months is associated with a reduced risk of colectomy in EO-UC but in contrast does not appear appear to impact on the risk of first intestinal surgery in EO-CD. This is an important observation since the risk of TP-associated lymphoma is substantially increased in this age group. Further work is needed to evaluate the role of TPs in EO-IBD. Reference 1 Chhaya V, et al. Impact of early thiopurines in 2770 children and young people diagnosed with IBD: a national population-based study. Aliment Pharmacol Ther. 2015 Oct;42(8). Disclosure of Interest C. Alexakis: None Declared, S. Saxena Grant/research support from: SS is funded by a National Institute for Health Research Career Development Fellowship (NIHR CDF-2011-04-048). The views expressed are not necessarily those of the NHS, NIHR, or Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript, V. Chhaya: None Declared, E. Cecil Grant/research support from: EC is funded by a National Institute for Health Research Career Development Fellowship (NIHR CDF-2011-04-048). The views expressed are not necessarily those of the NHS, NIHR, or Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript, R. Pollok: None Declared

PWE-070 Perspectives And Attitudes To Colonoscopy In Patients With Inflammatory Bowel Disease

Introduction Visualisation of mucosa at ileocolonoscopy (IC) remains the gold standard in the assessment of mucosal healing (MH) in patients with inflammatory bowel disease (IBD). MH is evolving as a key endpoint in assessing response to therapy. This will invariably mean an increased endoscopic burden on these patients. We aimed to investigate IBD patients’ perspectives on this, as well as their tolerance of IC. Methods Consecutive patients attending IBD clinic between September and December 2013 were questioned on their experience of IC. Data on sex, age, disease type (Crohn’s (CD) or ulcerative colitis (UC)), duration of illness, and no. of IC was obtained. They were asked to grade various components of the IC experience (concerns about complications, bowel preparation, disruption to life, procedure discomfort, travel to hospital) on a standardised tolerance scale from 1–5. They were also asked to qualitatively rate their overall experience of IC (not unpleasant/neither unpleasant nor pleasant/bearable/unpleasant/very unpleasant). Finally, they were asked how often they would be prepared to undertake IC in the future. Results 98 patients responded (46% male). Mean age was 43.2 years. 33 had UC, 50 had CD, and 11 were unsure of diagnosis. Mean no. IC was 3.7. 62% had a disease duration >5 years, with only 4% diagnosed in the previous year. Mean tolerance scores for the group were: concerns about complications 2.6, bowel preparation 3.0, disruption to life 2.4, discomfort during procedure 3.0, travel to/from hospital 1.7. Comparisons between patient subgroups CD versus UC, age ≥55 years versus age <55 years, ≥4 IC versus <4 IC, and diagnosis ≥5 years versus diagnosis <5 years, revealed no significant differences in scores. However, comparison between sexes showed females were more worried about the procedure than males (3.0 vs. 2.1, p = 0.02), were less tolerant of bowel preparation (3.5 vs. 2.3, p < 0.001), experienced more disruption to their lives (2.9 vs. 1.9, p < 0.001) and were more troubled by travel concerns (2.0 vs. 1.4, p = 0.02). The majority of the patients felt IC was bearable (53%) with only 13% describing it as very unpleasant. 55% would have the procedure as frequently as required if their physician felt it appropriate. 7% would only have IC every 5 years. Conclusion Bowel preparation and procedural discomfort are the most bothersome aspects of IC amongst IBD patients. There are clear differences in tolerance between female and male patients, and these results should prompt endoscopy units to find ways of improving patient acceptability. This could be provided in the form of a pre-test telephone consultation. A minority of patients were reluctant to increase their frequency of IC, which may be relevant in the monitoring of MH in their future management. Disclosure of Interest None Declared.

PTU-073 Comparison Of Sicus Versus Mr-enterography In Patients With Crohn’s Disease

Introduction Small intestinal contrast-enhanced ultrasonography (SICUS) is an emerging radiological technique for the imaging of patients with Crohn’s disease that avoids exposure to diagnostic medical radiation. We have previously demonstrated that SICUS is diagnostically comparable to small bowel barium follow through and computerised tomography in the diagnosis of Crohn’s.1 MR enterography (MRE) is becoming the gold standard radiological technique for the diagnosis of complications in patients with Crohn’s, but is expensive and access is limited. We aimed to compare the diagnostic sensitivity of SICUS with MRE in routine clinical practice. Methods Patients with established Crohn’s disease, who had undergone both SICUS and MRE within 6 months of each other were identified retrospectively from the radiology database at a UK tertiary centre. Imaging and reports were reviewed for both modalities. Kappa coefficient data was calculated for luminal parameters including the presence of strictures, stricture number and location, the presence of abscess/fistulae, mucosal thickening, active mucosal inflammation and fibrotic changes. Reported stricture lengths were compared using paired student’s t-test. Inflammatory markers including platelet levels, where available, were recorded within 2 weeks of each of the imaging modalities as a surrogate marker for active inflammation. Results 20 Crohn’s patients were identified (10 male), with a mean age of 30.1 years at time of first investigation. Mean time between modalities was 72.3 days (range 2–147). There was no significant difference between mean platelet counts between the 2 radiological tests. Agreement between the 2 modalities was excellent for the presence of stricturing disease (k=0.92, 95% CI 0.71–1.00), stricture number (k=0.91, 95% CI 0.73–1.00) and stricture location (k=0.91, 95% CI 0.71–1.00). Agreement was good for the presence of fistulae (k=0.74, 95% CI 0.40–1.00) and mucosal thickening (k=0.74, 95% CI 0.40–1.00). Agreement was moderate for the presence of abscess (k=0.46 95% CI 0.14–1.00), acute mucosal inflammatory changes (k=0.55, 95% CI 0.19–0.90) and fibrotic changes (k=0.50, 95% CI 0.04–0.95). There was no significant difference in the mean estimated stricture length between MRE and SICUS. Conclusion SICUS compares favourably with MRE in the diagnosis of complications in patients with Crohn’s disease. This imaging technique is particularly useful in patients with stricturing (Montreal B2) disease. SICUS is a useful alternative diagnostic technique to MRE, particularly when access to MR may be limited or is poorly tolerated by the patient. Reference Chatu S et al. Diagnostic accuracy of small intestine ultrasonography using an oral contrast agent in Crohn’s disease: comparative study from the UK. Clin Radiol. 2012 Jun;67(6):553-9 Disclosure of Interest None Declared.

PWE-022 Patient Acceptability Of A Novel, Non-invasive Method Of Colonic Sampling For Biomarker Analysis

Introduction Biomarker analysis is commonly used for the diagnosis of those presenting with colorectal symptoms and monitoring of inflammatory bowel disease (IBD), but the acceptability of stool sampling is poor. It is proposed that material rich in the colonic mucocellular layer is deposited on the anal surface post-defaecation and can be sampled for biomarker analysis. Our aim was to develop a novel, non-invasive method of material collection post-defaecation and assess patient acceptability. Methods Patients with IBD (active cases and those in remission), irritable bowel syndrome (IBS) and a group of healthy volunteers were recruited. Participants were instructed to collect material from the surface of the anus immediately post-defaecation using a specially designed swab covered with flocked nylon (designed by DiagNodus Ltd). The collection process and preparation of samples was performed by patients at home using a specially designed kit. Samples were mailed back, ready for cytological and immunochemical analysis. Patients were provided with kits and asked to collect and return samples at predefined time-points. Patients completed a simple questionnaire to evaluate: (a) procedure convenience/acceptability, (b) ease of sample collection, (c) adequacy of time required for sampling and (d) overall impression each using a 5-point rating scale (1=poor to 5=good). Results 112 patients were recruited comprising of 60 patients with active IBD, 14 patients with IBD in remission, 31 patients with IBS and 7 healthy volunteers. Collected samples were returned by 97 (86.6%) study participants (88.3% of patients with active IBD, 78.6% of patients with IBD in remission, 87.1% of patients with IBS and 100% of healthy volunteers). Completed questionnaires were returned by 92 trial participants (94.8% of those providing samples). The mean and standard deviation (SD) of participant responses is provided in the table below. Abstract PWE-022 Table 1 Mean SD Convenience/Acceptability 4.57 0.497 Sampling ease 4.54 0.595 Adequacy of time required for sampling 4.53 0.575 Overall impression 4.57 0.553 Sampling was not associated with discomfort or harm. The material obtained proved suitable for both cytological assessment and protein biomarker estimation. Conclusion Material from the colonic mucocellular layer deposited in the anal area following defaecation is readily collectable using our specially designed kit and can provide material for both cytological assessment and biomarker quantification. This simple, reliable process is well tolerated and convenient as patients can provide samples from the comfort of their own home. This new technique warrants further study in different patient groups. Disclosure of Interest V. Chhaya: None Declared, A. Poullis: None Declared, T. Bandaletova Shareholder of: DiagNodus Ltd, Conflict with: Founder of DiagNodus Ltd, A. Loktionov Shareholder of: DiagNodus Ltd, Conflict with: Founder of DiagNodus Ltd.