P-045: The usefulness of fecal calprotectin in monitoring inflammatory activity among children with Crohn’s disease and ulcerative colitis

S410 Conclusion: South East Asian children appear to be able to achieve clinical remission with relatively lower Aza dose and 6-TGN levels. Further efforts are required to define a more accurate therapeutic range for Asian IBD patients. P-045 The usefulness of fecal calprotectin in monitoring inflammatory activity among children with Crohn’s disease and ulcerative colitis O. Belei *, O. Marginean. University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania Background: An accurate monitoring of mucosal inflammation is important for an effective management of children with inflammatory bowel disease (IBD). Objectives: The aim of the study was to evaluate the efficacy of fecal calprotectin (Cal) as indicator of inflammatory activity in children with Crohn’s disease (CD) and ulcerative colitis (UC) by correlating it with biological, clinical and endoscopic indices. Methods: A total of 22 children presenting IBD were evaluated (16CD/6UC). Fecal Cal, blood tests, Pediatric CD Activity Index(PCDAI), Pediatric UC Activity Index (PUCAI), CD Endoscopic Index of Severity (CDEIS) and Mayo Disease Activity Index (MDAI) were used for evaluation at diagnosis and after one year of treatment. Results: In CD children, Cal proved a high correlation (r = 0.775) with mucosal inflammation, showed by CDEIS and a medium correlation with CRP (r = 0.623). It didn’t correlate with PCDAI (r = 0.325). In UC children, Cal correlated moderate (r = 0.581) with CRP and it was strongly correlated with PUCAI (r = 0.752) and MDAI (r = 0.796). Cal levels decreased significantly after one year of treatment in all patients (p = 0.038). Conclusions: In CD children fecal Cal was more accurate in detection mucosal inflammation when compared to clinical score and CRP. The poor correlation between Cal and PCDAI may be due to the fact that PCDAI is mostly a clinical score, not sensitive enough to detect subclinical activity of the disease. Fecal Cal correlated well with endoscopic indices both in CD and UC children, being valuable not only for IBD screening, but also for monitoring disease activity and reducing the need for colonoscopy in children. P-045A Prediction of relapse using consecutive measurements of fecal calprotectin in pediatric Crohn’s disease patients A.J. Foster1 *, K. Jacobson2 . 1 British Columbia Children’s Hospital, Vancouver, Canada, 2 University of British Columbia, Vancouver, Canada Introduction: In Crohn’s disease, inflammatory markers (ESR and CRP), disease activity scoring tools (PCDAI), and physician global assessments (PGA) are used to estimate underlying inflammation. Fecal calprotectin may be a more reliable test to detect inflammation, and may provide earlier knowledge of subclinical inflammation than current tests. Aim: To evaluate the use of consecutive fecal calprotectin measurements in predicting relapse in pediatric Crohn’s disease patients. Methods: Pediatric patients with Crohn’s disease in clinical remission, receiving infliximab maintenance therapy, were prospectively enrolled. At infusion visits every 4 8 weeks fecal calprotectin, ESR, CRP, PCDAI and PGA were recorded. Each patient had four consecutive fecal calprotectin measurements followed by a continued observation period of 6 months to monitor for relapse. Results: Preliminary data has been obtained from 37 patients, with a total of 90 fecal calprotectin levels. An elevated fecal calprotectin level of >150 mg/L was found in 41% of samples with normal ESR, 42% with normal CRP, and 50% with normal PCDAI. Three patients have had clinical relapse, and all three had an elevation in fecal calprotectin (mean time: 36 days prior to

Thursday, 11 September 2014 relapse). Two of the three patients had otherwise normal ESR, CRP and PCDAI scores prior to the relapse. Conclusion: Preliminary results suggest fecal calprotectin levels are elevated prior to disease relapse, and may be a more reliable tool than ESR or CRP. P-046 Damage and inflammatory activity in pediatric Crohn’s disease (CD) based on radiologist and gastroenterologist physician global assessment G. Focht1 *, T. Traub2 , P. Church3 , T.D. Walters3 , M.L. Greer3 , M. Amitai4 , R. Cytter1 , D.A. Castro3 , A. Otley5 , M. O’Brien5 , D.R. Mack6 , J. Davila7 , A.M. Griffiths3 , D. Turner1 . 1 Shaare Zedek Medical Center, Jerusalem, Israel, 2 Mercer University School of Medicine, Savannah, United States of America, 3 The Hospital for Sick Children, Toronto, Canada, 4 The Chaim Sheba Medical Center, Ramat gan, Israel, 5 IWK Health Centre, Halifax, Canada, 6 The CHEO Research Institute, Ontario, Canada, 7 Children’s Hospital of Eastern Ontario, Ontario, Canada Introduction: Currently there are no data to support using radiologic global assessment (RGA) as an overall reflection of pediatric CD by MRE. Using data from the ongoing ImageKids prospective international study, we aim to validate RGA of damage and inflammatory activity in Pediatric CD. Methods: 90 children with CD, prospectively enrolled in the ImageKids study, recruited at 15 pediatric IBD centers worldwide [mean age 13.9±2.4 years, 52 males (58%), disease duration 54 days (IQR 1 117), 28 (31%) at disease onset, 22 (24%) were in remission, 17 (19%) had mild disease and 39 (43%) had mod severe disease]. All children had ileocolonoscopy (measured using the SES-CD index), gastroscopy and blood tests at time of MRE. The radiologist and the gastroenterologist completed standardized forms independently; RGA was scored both on 100 mm VAS and Likert scale. Results: Median RGA for inflammation was 38 mm (IQR 15 52) and for damage 1 mm (0 26). RGA of inflammation correlated significantly with the SES-CD (r = 0.37, P < 0.003), with PCDAI (r = 0.54, P < 0.001), with CRP (r = 0.47, P < 0.001) and with the gastroenterologists global assessment (r = 0.59, P < 0.001). 12/90 (13%) children had evidence of narrowing of the ICV by ileocolonoscopy (or inability to intubate the ICV), of whom 9 (75%) were judged as having damage by the RGA (P = 0.035). Conclusion: RGA on MRE correlate with constructs of disease activity in pediatric CD. RGA can be now used in the ImageKids study to assist in developing MRE-based pediatric inflammatory and damage scores (i.e. PICMI and P-MEDIC scores). Funding: The ImageKids study is supported by a grant from Abbvie. P-047 The safety and effectiveness of carbon dioxide insufflation during colonoscopy in sedated pediatric patients with inflammatory bowel disease N. Abe *. Shinshu University, Matsumoto, Japan Introduction: Several studies in adults have shown that insufflation of carbon dioxide (CO2 ) instead of air can minimize postcolonoscopy abdominal pain. However, no studies have shown the safety and effectiveness of CO2 insufflation in sedated pediatric patients with inflammatory bowel disease(IBD). The objective of our study was to investigate whether CO2 insufflation can reduce abdominal pain after colonoscopy and leads to CO2 retension. Methods: A total of consecutive 54 patients with Crohn’s disease or ulcerative colitis were undergo total colonoscopy with insufflation of air (n = 18) or CO2 (n = 36). The intervension time, abdominal circumference before and after colonoscopy,