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O07 PREDICTORS OF CLINICAL OUTCOME IN CHILDREN WITH ULCERATIVE COLITIS (UC)
2 study to describe a rapidly rising incidence of IBD in young children (<10 years old). O05 EPIDEMIOLOGY OF GROWTH IMPAIRMENT IN PAEDIATRIC IBD T.D. Walters1 *, M. Sherlock1 , T. Seah1 , M. Zachos1 , A.M. Griffiths1 . 1 GI, Hepatology and Nutrition, SickKids, U. of Toronto, Toronto, Canada Background: Data concerning prevalence of growth impairment in paediatric IBD in the current era are limited. We prospectively monitored growth among young patients at a single centre, thereby facilitating comparisons with prior decades. Methods: Between 01/2001 and 12/2006, 205 children aged <14 years were diagnosed with IBD (63% CD, 61% Male) at Sick Kids, Toronto. Growth parameters standardized for age and gender (height: HtZ; height velocity: HVZ) were analyzed using parametric and non-parametric methods for paired data. Results: At diagnosis, mean HtZ was normal in UC (+0.04 +/- 0.9) but reduced (-0.5 +/- 1.1) in CD, albeit less than in previous decades (CD HtZ -1.1 in 1980’s; -0.74 in 1990’s). Mid-parental heights were normally distributed. After diagnosis, linear growth faltered in year 1 in both CD and UC [median HVZ: -1.3 CD, -1.7 UC; HVZ < 2: 43% CD, 41% UC; mean delta HtZ: 0.14 CD, 0.10 UC]. During year 2, growth rate normalized in UC (median HVZ -0.3; IQR -1.5 to 1.0), but remained slow in CD (median HVZ -0.8; IQR -2.3 to 1.0). Overall, HVZ was persistently < 2 in both years in 13% of CD (a significantly lower percentage than in previous decades) and in 5% of UC patients. Conclusion: Linear growth impairment prior to diagnosis is rare in UC, and less common now in CD, likely reflecting its earlier recognition. Following diagnosis, temporary growth impairment accompanies corticosteroid treatment of IBD regardless of type. Improvements in growth by year 2, compared to past decades, likely represent the earlier use of steroid-sparing agents. O06 INFLIXIMAB-INDUCED PSORIASIS IN PAEDIATRIC CROHN DISEASE; EXPERIENCE AT A TERTIARY CENTRE AND A POTENTIAL ASSOCIATION WITH A VARIATION IN THE IL-23 RECEPTOR GENE M. Sherlock1 *, T. Walters1 , A. Muise1 , M. Zachos1 , A. Griffiths1 . 1 Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada Background: New-onset psoriasis has been reported in adult Crohn Disease (CD) patients treated with infliximab (IFX). We reviewed the prevalence of new onset psoriasis in paediatric IFX-treated CD patients and examined the role of polymorphisms in the interleukin-23 receptor (IL-23R) gene, known to contribute to both CD and psoriasis susceptibility. Methods: The medical records of all IFX-treated CD patients were reviewed. DNA from those developing psoriasis was compared with that of diseasematched controls to examine the association of IL-23R polymorphisms. Results: 118 children received IFX from 2000 to 2008. Thirteen children (11%), (9 males) developed psoriasis following IFX therapy. The median duration of IFX exposure was 1.0 year (IQR 0.6 2.1). 11 of 13 responded well to topical steroids and successfully continued IFX. DNA was available on 8 of the 13 patients with psoriasis, 137 disease-matched controls and 86 ulcerative colitis (UC) patients. 75% of cases were homozygous for the IL-23R rs10489629 single nucleotide polymorphism compared with 42% of CD controls and 28% of UC controls, with an allele frequency of 88%, 65% and 53% for cases, CD controls and UC controls respectively. The odds ratio for an IFX-exposed patient developing psoriasis was 3.8 for heterozygotes and 14 for homozygotes (p = 0.07). Conclusion: The frequency of new-onset psoriasis in this IFX-treated paediatric cohort mirrors that of adult series. We found a trend towards an association with a variation in the IL-23R gene; the true significance warrants further investigation in large, adequately powered studies. O07 PREDICTORS OF CLINICAL OUTCOME IN CHILDREN WITH ULCERATIVE COLITIS (UC) J. Markowitz1 *, D. Mack1 , N. Leleiko1 , A. Otley1 , J. Evans1 , M. Pfefferkorn1 , M. Oliva-Hemker1 , W. Crandall1 , J. Rosh1 , M. Kappelman1 , D. Keljo1 , S. Kugathasan1 , T. Lerer1 , J. Hyams1 . 1 Pediatric IBD Collaborative Research Group, Hartford, United States At diagnosis (dx) serologic response to microbial antigens is associated with severe Crohn disease. Similar studies have not been reported in children with UC. Objective: To determine whether serologic response or other clinical characteristics at dx predict the need for colectomy or rescue therapy to prevent colectomy in children with UC. Methods: Data are drawn from the Peds IBD Collaborative Research Group Registry, a prospective, multicenter N Amer observational database of
Abstracts of PIBD 2009, 9 12 September 2009, Paris, France children newly diagnosed with IBD. Those with UC, >6 months follow-up and serology testing (IBD 7 Panel, Prometheus) were evaluated. Results: 30 children (Grp1) underwent colectomy (n = 15) or successful rescue therapy with infliximab (n = 15). 92 (Grp2) did not. Grp1 vs Grp2 had similar age at dx (12±4 v 12±3 yrs), follow-up duration (3±2 v 3±2 yrs), pancolitis at dx (83 v 83%), and moderate-severe UC at both dx (73 v 66%) and 30 days after dx (27% v 11%). Serologic response rates were similar: pANCA (80 v 78%), anti-ompC (7 v 11%), ASCA IgA (3 v 4%), ASCA IgG (0 v 3%), anti-CBir1 (19 v 37%). Treatments by 30 days after dx differed in the use of 5-ASA (Grp1 41%, Grp2 73%, p = 0.003) and infliximab (Grp1 10%, Grp2 0%, p < 0.02), but not steroids (61 v 49%) or immunomodulators (22 v 12%). Conclusion: 25% of children with UC require colectomy or rescue therapy within a mean of 3 yrs after dx. However, outcome following initial therapy is not predicted by a child’s clinical features at dx or serologic responses to nuclear or microbial antigens. O08 METHOTREXATE IN THE TREATMENT OF INFLAMMATORY BOWEL DISEASE: AN 8 YEAR RETROSPECTIVE STUDY IN A CANADIAN PEDIATRIC IBD CENTER S. Willot1 *, A. Noble1 , C. Deslandres1 . 1 Pediatric Gastroenterology, Hepatology and Nutrition, Saint Justine Hospital, University of Montreal, Montreal, Canada Background: Methotrexate (MTX) is used as an alternative immunosuppressive treatment for patients with inflammatory bowel disease (IBD). The aim of the study was to evaluate effectiveness and tolerance of MTX for children with IBD. Methods: A retrospective study was conducted in our pediatric IBD center on 93 children having received MTX for the treatment of their IBD between 2000 and 2008. Remission was defined as discontinuation of steroids and Harvey Bradshaw Index <4 for Crohn’s disease (CD) patients or PUCAI < 10 for ulcerative (UC) or indeterminate colitis (IC) patients. Results: Seventy-five patients had CD, 5 UC and 13 IC. There were 46 girls and 47 boys, with a mean age at diagnosis of 11 (0.6 17.4) years. Duration of disease prior to MTX therapy was 2.5 (0.1 11.1) years. Ninety patients were previously treated with purine analogues: 76 had failure and 14 had intolerance to this treatment. Twenty-six patients previously received anti TNF. Clinical remission was observed in respectively 27%, 34%, 23% and 15% of patients 3, 6, 12 and 24 months after initiation of MTX. The one year remission rate for CD patients was significantly higher in patients with colonic disease. Forty-nine patients (52%) experienced side effects but only 14 (15%) had to discontinue treatment because of intolerance, mostly because of nausea. Conclusion: The long term remission rate with MTX in our pediatric IBD population was low. However MTX was generally well tolerated and induced and maintained remission in some patients who previously had failed a purine analogue and/or anti TNF. O09 EXPOSURE TO DIAGNOSTIC IMAGING RADIATION IN CHILDREN UNDER 8 YEARS OLD WITH INFLAMMATORY BOWEL DISEASE K. Halamay1 *, G. Wahbeh2 , M. Golchha1 , T. Chapman3 , D. Suskind1 . 1 Gastroenterology, Seattle Children’s Hospital; 2 Gastroenterology, Seattle Children’s Hospital University of Washington; 3 Radiology, Seattle Children’s Hospital, Seattle, United States Background: The diagnosis and management of inflammatory bowel disease (IBD) often involves ionizing radiation modalities such as computed tomography (CT) and contrast fluoroscopy. It has been shown that ionizing radiation exposure poses cancer risk. Younger children with IBD are believed to be particularly vulnerable. Objective: Quantify the number of ionizing imaging studies performed in an IBD population consisting of children age 8 years or younger. Methods: Retrospective data review for 58 children diagnosed with IBD between 1998 2006. Mean age 5.5 years (11 months 8 years). The follow up period was 1 9 years, median 5. 31 patients had Crohn’s Disease, 21 Ulcerative Colitis and 6 IBD-Unclassified. 45 (77%) pts had at least 1 barium contrast study (range 1 5), 23 (40%) at least 1 CT (range 1 11), 14 (24%) had 3 CT/barium studies, range 2 16, median 5 studies per child. Mean estimate radiation dosage was 6.3 msv per patient. For patients with 3 studies, mean radiation dose estimate was 18 msv (range 7 48). Risks for increased radiation dose were Crohn’s disease and surgery. Conclusion: A subset of younger patients with IBD are at risk of significant imaging radiation exposure. Alternative radiation-free imaging modalities should be considered in young IBD patients, particularly when multiple studies are anticipated.
Abstracts of PIBD 2009, 9 12 September 2009, Paris, France children newly diagnosed with IBD. Those with UC, >6 months follow-up and serology testing (IBD 7 Panel, Prometheus) were evaluated. Results: 30 children (Grp1) underwent colectomy (n = 15) or successful rescue therapy with infliximab (n = 15). 92 (Grp2) did not. Grp1 vs Grp2 had similar age at dx (12±4 v 12±3 yrs), follow-up duration (3±2 v 3±2 yrs), pancolitis at dx (83 v 83%), and moderate-severe UC at both dx (73 v 66%) and 30 days after dx (27% v 11%). Serologic response rates were similar: pANCA (80 v 78%), anti-ompC (7 v 11%), ASCA IgA (3 v 4%), ASCA IgG (0 v 3%), anti-CBir1 (19 v 37%). Treatments by 30 days after dx differed in the use of 5-ASA (Grp1 41%, Grp2 73%, p = 0.003) and infliximab (Grp1 10%, Grp2 0%, p < 0.02), but not steroids (61 v 49%) or immunomodulators (22 v 12%). Conclusion: 25% of children with UC require colectomy or rescue therapy within a mean of 3 yrs after dx. However, outcome following initial therapy is not predicted by a child’s clinical features at dx or serologic responses to nuclear or microbial antigens. O08 METHOTREXATE IN THE TREATMENT OF INFLAMMATORY BOWEL DISEASE: AN 8 YEAR RETROSPECTIVE STUDY IN A CANADIAN PEDIATRIC IBD CENTER S. Willot1 *, A. Noble1 , C. Deslandres1 . 1 Pediatric Gastroenterology, Hepatology and Nutrition, Saint Justine Hospital, University of Montreal, Montreal, Canada Background: Methotrexate (MTX) is used as an alternative immunosuppressive treatment for patients with inflammatory bowel disease (IBD). The aim of the study was to evaluate effectiveness and tolerance of MTX for children with IBD. Methods: A retrospective study was conducted in our pediatric IBD center on 93 children having received MTX for the treatment of their IBD between 2000 and 2008. Remission was defined as discontinuation of steroids and Harvey Bradshaw Index <4 for Crohn’s disease (CD) patients or PUCAI < 10 for ulcerative (UC) or indeterminate colitis (IC) patients. Results: Seventy-five patients had CD, 5 UC and 13 IC. There were 46 girls and 47 boys, with a mean age at diagnosis of 11 (0.6 17.4) years. Duration of disease prior to MTX therapy was 2.5 (0.1 11.1) years. Ninety patients were previously treated with purine analogues: 76 had failure and 14 had intolerance to this treatment. Twenty-six patients previously received anti TNF. Clinical remission was observed in respectively 27%, 34%, 23% and 15% of patients 3, 6, 12 and 24 months after initiation of MTX. The one year remission rate for CD patients was significantly higher in patients with colonic disease. Forty-nine patients (52%) experienced side effects but only 14 (15%) had to discontinue treatment because of intolerance, mostly because of nausea. Conclusion: The long term remission rate with MTX in our pediatric IBD population was low. However MTX was generally well tolerated and induced and maintained remission in some patients who previously had failed a purine analogue and/or anti TNF. O09 EXPOSURE TO DIAGNOSTIC IMAGING RADIATION IN CHILDREN UNDER 8 YEARS OLD WITH INFLAMMATORY BOWEL DISEASE K. Halamay1 *, G. Wahbeh2 , M. Golchha1 , T. Chapman3 , D. Suskind1 . 1 Gastroenterology, Seattle Children’s Hospital; 2 Gastroenterology, Seattle Children’s Hospital University of Washington; 3 Radiology, Seattle Children’s Hospital, Seattle, United States Background: The diagnosis and management of inflammatory bowel disease (IBD) often involves ionizing radiation modalities such as computed tomography (CT) and contrast fluoroscopy. It has been shown that ionizing radiation exposure poses cancer risk. Younger children with IBD are believed to be particularly vulnerable. Objective: Quantify the number of ionizing imaging studies performed in an IBD population consisting of children age 8 years or younger. Methods: Retrospective data review for 58 children diagnosed with IBD between 1998 2006. Mean age 5.5 years (11 months 8 years). The follow up period was 1 9 years, median 5. 31 patients had Crohn’s Disease, 21 Ulcerative Colitis and 6 IBD-Unclassified. 45 (77%) pts had at least 1 barium contrast study (range 1 5), 23 (40%) at least 1 CT (range 1 11), 14 (24%) had 3 CT/barium studies, range 2 16, median 5 studies per child. Mean estimate radiation dosage was 6.3 msv per patient. For patients with 3 studies, mean radiation dose estimate was 18 msv (range 7 48). Risks for increased radiation dose were Crohn’s disease and surgery. Conclusion: A subset of younger patients with IBD are at risk of significant imaging radiation exposure. Alternative radiation-free imaging modalities should be considered in young IBD patients, particularly when multiple studies are anticipated.