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P.01.9 INCIDENCE AND TIME TRENDS OF INFLAMMATORY BOWEL DISEASES IN LOMBARDY FROM 2003 TO 2009
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Abstracts of the 19th National Congress of Digestive Diseases / Digestive and Liver Disease 45S (2013) S55–S218
P.01.7 ANTIBODIES TO GP2: A NOVEL SEROLOGICAL MARKER FOR CROHN’S DISEASE AND ITS POTENTIAL ASSOCIATION WITH DISEASE ACTIVITY AND LOCATION P. Rossetti ∗ ,2 , P. Sassaroli 2 , S. Gemini 2 , A. Di Sario 2 , A. Benedetti 2 , G. Ciarrocchi 1 , M. Tocchini 1 , E. Bendia 2 1 Ospedali Riuniti-Università Politecnica delle Marche, Laboratorio Analisi, Ancona, Italy; 2 Università Politecnica delle Marche-Ospedali Riuniti-Clinica di Gastroenterologia, Ancona, Italy
Background and aim: Crohn’s disease (CD) is an inflammatory bowel disease (IBD) characterized by reactivity against microbial and self antigens. Zymogen granule glycoprotein 2 (GP2) was identified as the major autoantigen of CD-specific pancreatic autoantibodies (PAB). Aim: To evaluate the positivity of GP2 in patients with IBD such as CD and Ulcerative Colitis (UC), as well as the potential association with the activity and localization of the disease. Material and methods: We enrolled 83 consecutive patients affected by IBD and 35 blood donors (healthy controls).The diagnosis of CD or UC was based on accepted clinical and endoscopic criteria. GP2 serological detection was performed with a commercially available ELISA kit, according to the manufacturer’s instructions (cut-off 15 U/ml). Results: The reactivity found in patients with CD was significantly higher than in patients with UC or healthy controls. Preliminary data show that GP2 positivity in CD correlates with moderate-severe activity of disease, ileo-colic localization and structuring e/o penetrating disease. Under a methodological point of view, the anti-GP2 test resulted reproducible, had a good linearity, and showed minor interferences. Conclusions: Anti-GP2 reactivity was significantly higher in CD patients than in UC patients and controls; In contrast to other auto-antibodies found in CD, such as ASCA, Anti-GP2 positivity was found associated to moderate/severe activity disease, ileo-colic localization and structuring e/o penetrating disease.
P.01.8 SMALL BOWEL CAPSULE ENDOSCOPY FOR ASSESSING EARLY POSTOPERATIVE RECURRENCE OF CROHN’S DISEASE: A PROSPECTIVE LONGITUDINAL STUDY G. Condino ∗ , E. Calabrese, S. Onali, E. Lolli, M. Ascolani, F. Zorzi, G. Sica, C. Petruzziello, F. Pallone, L. Biancone Università Tor Vergata, Rome, Italy Background and aim: The role of Small Bowel Capsule Endoscopy (SBCE) for assessing early CD recurrence is undefined. In a prospective longitudinal study, we invastigated the usefulness of SBCE for assessing the early CD recurrence when using ileocolonoscopy (IC) as gold standard. Whether SBCE may visualize upper gastrointestinal (GI) lesions not detected by standard techniques and the interobserver agreement using SBCE were also assessed. Material and methods: From Feb. 2011 to Oct. 2012, all patients (pts) undergoing ileo-colonic resection for CD were enrolled. Clinical assessment (CDAI) was performed at 3, 6, 12 months (mos). IC was performed <6mos and 12mos after surgery and recurrence graded (Rutgeerts score: recurrence≥1). Small Intestine Contrast Ultrasonography (SICUS) was performed <6mos after surgery for recurrence assessment followed, within 4wks, by SBCE in pts with no stenosis. SBCE images compatible with recurrence were graded by 2 indipendent gastroenterologists (score 0–3: recurrence≥1; Buchman AJG 2004). Results: During the study period, 18 pts (12M, median age 47, range 22–65) were enrolled. SBCE was not performed in 9/18 pts, due to strictures (n=2), low compliance to perform SBCE (n=3) or IC (n=2), impact risk (n=2). Early after surgery, among the 9 pts performing all the 3 procedures, 1 pt showed clinical recurrence (CDAI>150) and 7 pts endoscopic recurrence (grade 1: n=2; grade 2: n=2; grade 3: n=3). Early after surgery, findings compatible with recurrence were detected by SICUS in 6/9 pts (6 true positives,TP, 3 true negatives,TN) and by SBCE in 8/9 pts (grade 3; n=8; grade 0: n=1, according to both observers; 7TP, 1TN, 1FP). In 4/9 pts, SBCE showed multiple aphtoid ulcers in the upper GI tract not detected by standard imaging before and after surgery. No SBCE retention and a 100% interobserver agreement were
observed. At 12mos, 7/9 pts already completed the follow up, showing clinical recurrence in 2 pts with endoscopic recurrence at both <6mos (grade 1 and 2) and 12mos (grade 2, both). At 12mos, 6/9 pts performed IC, showing recurrence in 3/4 pts with evaluable score (grade 2: n=3). Conclusions: Early after surgery for CD, SBCE may visualize superficial upper GI lesions not detected by standard techniques. However, the early development of strictures indicates the need of a careful selection of patients, even in the absence of overt symptoms.
P.01.9 INCIDENCE AND TIME TRENDS OF INFLAMMATORY BOWEL DISEASES IN LOMBARDY FROM 2003 TO 2009 C. Fornari ∗ ,1 , F. Madotto 1 , G. Fiorino 2 , S. Ardizzone 2 , A. Bortoli 2 , F. Caprioli 2 , R. Cestari 2 , S. Conti 1 , C.C. Cortelezzi 2 , L.G. Mantovani 2 , A. Massari 2 , G. Meucci 2 , P. Ravelli 2 , M. Vecchi 2 , S. Danese 2 , G. Cesana 1 1 Università
degli Studi di Milano Bicocca, Milano, Italy; 2 Gruppo di lavoro EPICO MICI LOMBARDIA, Lombardia, Italy Background and aim: The incidence of inflammatory bowel diseases (IBD) is extremely variable worldwide. Several studies have suggested an increase in IBD incidence over the last decade in Eastern Europe and in Asia, while a stable rate has been reported in Western countries. The epidemiology of IBD in Southern Europe is still uncertain and Italian estimates of IBD incidence and prevalence date back to early 90s. The aim of this study was to assess incidence and time trends of Crohn’s disease (CD) and ulcerative colitis (UC) from 2003 to 2009 in Lombardy, a region in Northern Italy. Material and methods: We used healthcare administrative databases of Lombardy region organized in a data warehouse called DENALI, which matched the data with probabilistic record linkage. New cases of IBD were defined by exemptions from co-payment healthcare costs issued for IBD diagnosis every year. In detail we identified all subjects covered by the regional healthcare system since at least one year and with an exemption for CD (code 009.555) or UC (code 009.556) starting from January 1st, 2003 until December 31st, 2009. The starting date of exemption was used as proxy of the disease onset. Annual age-standardized incidence rates were computed separately for CD and UC using the population living in Lombardy at 2001 census. Results: Overall 9,035 new cases of IBD were identified from 2003 to 2009. During the whole period the annual incidence rate per 100,000 person-years of IBD was 13.8 (95% CI 13.5–14.1). UC and CD incidences were 8.6 (8.4–8.8) and 5.2 (5.1–5.4) respectively. Incidence rates of both diseases were higher in men than in women: the male to female ratio was 1.5 (1.4–1.6) in UC and 1.2 (1.1–1.3) in CD. However the difference in CD incidence between genders was not detected in each calendar year. IBD incidence was highest in people 20–40 years of age. No time trends in IBD incidence were observed from 2003 to 2009, both in the whole study population and in gender-specific subgroups. Conclusions: Our study provides important information on current epidemiology of IBD in Italy. IBD incidence in Lombardy is lower than in Northern Europe, and the data confirm that UC incidence is higher than that of CD. Moreover, in our study population IBD are gender specific, being more common in men than in women.
P.01.10 PROPOSAL OF A MODIFIED PHENOTYPE-BASED RADIOLOGICAL CLASSIFICATION: THE MAGNETIC RESONANCE CROHN’S DISEASE SEVERITY INDEX (MR-CSI) R. Sacco ∗ ,1 , E. Neri 2 , L. Faggioni 2 , R. Scandiffio 2 , D. Lauretti 2 , A. Romano 1 , M. Bertini 1 , M. Bertoni 1 , G. Federici 1 , S. Metrangolo 1 , G. Parisi 1 , A. Scaramuzzino 1 , E. Tumino 1 , G. Bresci 1 , C. Bartolozzi 2 1 A.O.U.P., Cisanello
- Gastroenterologia, Pisa, Italy; 2 A.O.U.P., Cisanello Radiologia, Pisa, Italy Background and aim: Crohn’s disease (CD) is a chronic inflammatory bowel disease, with different clinical features and pathological course, characterized by a relapsing and remitting trend. We work out a radiological score in the assessment of Crohn’s disease activity and severity.
Abstracts of the 19th National Congress of Digestive Diseases / Digestive and Liver Disease 45S (2013) S55–S218
P.01.7 ANTIBODIES TO GP2: A NOVEL SEROLOGICAL MARKER FOR CROHN’S DISEASE AND ITS POTENTIAL ASSOCIATION WITH DISEASE ACTIVITY AND LOCATION P. Rossetti ∗ ,2 , P. Sassaroli 2 , S. Gemini 2 , A. Di Sario 2 , A. Benedetti 2 , G. Ciarrocchi 1 , M. Tocchini 1 , E. Bendia 2 1 Ospedali Riuniti-Università Politecnica delle Marche, Laboratorio Analisi, Ancona, Italy; 2 Università Politecnica delle Marche-Ospedali Riuniti-Clinica di Gastroenterologia, Ancona, Italy
Background and aim: Crohn’s disease (CD) is an inflammatory bowel disease (IBD) characterized by reactivity against microbial and self antigens. Zymogen granule glycoprotein 2 (GP2) was identified as the major autoantigen of CD-specific pancreatic autoantibodies (PAB). Aim: To evaluate the positivity of GP2 in patients with IBD such as CD and Ulcerative Colitis (UC), as well as the potential association with the activity and localization of the disease. Material and methods: We enrolled 83 consecutive patients affected by IBD and 35 blood donors (healthy controls).The diagnosis of CD or UC was based on accepted clinical and endoscopic criteria. GP2 serological detection was performed with a commercially available ELISA kit, according to the manufacturer’s instructions (cut-off 15 U/ml). Results: The reactivity found in patients with CD was significantly higher than in patients with UC or healthy controls. Preliminary data show that GP2 positivity in CD correlates with moderate-severe activity of disease, ileo-colic localization and structuring e/o penetrating disease. Under a methodological point of view, the anti-GP2 test resulted reproducible, had a good linearity, and showed minor interferences. Conclusions: Anti-GP2 reactivity was significantly higher in CD patients than in UC patients and controls; In contrast to other auto-antibodies found in CD, such as ASCA, Anti-GP2 positivity was found associated to moderate/severe activity disease, ileo-colic localization and structuring e/o penetrating disease.
P.01.8 SMALL BOWEL CAPSULE ENDOSCOPY FOR ASSESSING EARLY POSTOPERATIVE RECURRENCE OF CROHN’S DISEASE: A PROSPECTIVE LONGITUDINAL STUDY G. Condino ∗ , E. Calabrese, S. Onali, E. Lolli, M. Ascolani, F. Zorzi, G. Sica, C. Petruzziello, F. Pallone, L. Biancone Università Tor Vergata, Rome, Italy Background and aim: The role of Small Bowel Capsule Endoscopy (SBCE) for assessing early CD recurrence is undefined. In a prospective longitudinal study, we invastigated the usefulness of SBCE for assessing the early CD recurrence when using ileocolonoscopy (IC) as gold standard. Whether SBCE may visualize upper gastrointestinal (GI) lesions not detected by standard techniques and the interobserver agreement using SBCE were also assessed. Material and methods: From Feb. 2011 to Oct. 2012, all patients (pts) undergoing ileo-colonic resection for CD were enrolled. Clinical assessment (CDAI) was performed at 3, 6, 12 months (mos). IC was performed <6mos and 12mos after surgery and recurrence graded (Rutgeerts score: recurrence≥1). Small Intestine Contrast Ultrasonography (SICUS) was performed <6mos after surgery for recurrence assessment followed, within 4wks, by SBCE in pts with no stenosis. SBCE images compatible with recurrence were graded by 2 indipendent gastroenterologists (score 0–3: recurrence≥1; Buchman AJG 2004). Results: During the study period, 18 pts (12M, median age 47, range 22–65) were enrolled. SBCE was not performed in 9/18 pts, due to strictures (n=2), low compliance to perform SBCE (n=3) or IC (n=2), impact risk (n=2). Early after surgery, among the 9 pts performing all the 3 procedures, 1 pt showed clinical recurrence (CDAI>150) and 7 pts endoscopic recurrence (grade 1: n=2; grade 2: n=2; grade 3: n=3). Early after surgery, findings compatible with recurrence were detected by SICUS in 6/9 pts (6 true positives,TP, 3 true negatives,TN) and by SBCE in 8/9 pts (grade 3; n=8; grade 0: n=1, according to both observers; 7TP, 1TN, 1FP). In 4/9 pts, SBCE showed multiple aphtoid ulcers in the upper GI tract not detected by standard imaging before and after surgery. No SBCE retention and a 100% interobserver agreement were
observed. At 12mos, 7/9 pts already completed the follow up, showing clinical recurrence in 2 pts with endoscopic recurrence at both <6mos (grade 1 and 2) and 12mos (grade 2, both). At 12mos, 6/9 pts performed IC, showing recurrence in 3/4 pts with evaluable score (grade 2: n=3). Conclusions: Early after surgery for CD, SBCE may visualize superficial upper GI lesions not detected by standard techniques. However, the early development of strictures indicates the need of a careful selection of patients, even in the absence of overt symptoms.
P.01.9 INCIDENCE AND TIME TRENDS OF INFLAMMATORY BOWEL DISEASES IN LOMBARDY FROM 2003 TO 2009 C. Fornari ∗ ,1 , F. Madotto 1 , G. Fiorino 2 , S. Ardizzone 2 , A. Bortoli 2 , F. Caprioli 2 , R. Cestari 2 , S. Conti 1 , C.C. Cortelezzi 2 , L.G. Mantovani 2 , A. Massari 2 , G. Meucci 2 , P. Ravelli 2 , M. Vecchi 2 , S. Danese 2 , G. Cesana 1 1 Università
degli Studi di Milano Bicocca, Milano, Italy; 2 Gruppo di lavoro EPICO MICI LOMBARDIA, Lombardia, Italy Background and aim: The incidence of inflammatory bowel diseases (IBD) is extremely variable worldwide. Several studies have suggested an increase in IBD incidence over the last decade in Eastern Europe and in Asia, while a stable rate has been reported in Western countries. The epidemiology of IBD in Southern Europe is still uncertain and Italian estimates of IBD incidence and prevalence date back to early 90s. The aim of this study was to assess incidence and time trends of Crohn’s disease (CD) and ulcerative colitis (UC) from 2003 to 2009 in Lombardy, a region in Northern Italy. Material and methods: We used healthcare administrative databases of Lombardy region organized in a data warehouse called DENALI, which matched the data with probabilistic record linkage. New cases of IBD were defined by exemptions from co-payment healthcare costs issued for IBD diagnosis every year. In detail we identified all subjects covered by the regional healthcare system since at least one year and with an exemption for CD (code 009.555) or UC (code 009.556) starting from January 1st, 2003 until December 31st, 2009. The starting date of exemption was used as proxy of the disease onset. Annual age-standardized incidence rates were computed separately for CD and UC using the population living in Lombardy at 2001 census. Results: Overall 9,035 new cases of IBD were identified from 2003 to 2009. During the whole period the annual incidence rate per 100,000 person-years of IBD was 13.8 (95% CI 13.5–14.1). UC and CD incidences were 8.6 (8.4–8.8) and 5.2 (5.1–5.4) respectively. Incidence rates of both diseases were higher in men than in women: the male to female ratio was 1.5 (1.4–1.6) in UC and 1.2 (1.1–1.3) in CD. However the difference in CD incidence between genders was not detected in each calendar year. IBD incidence was highest in people 20–40 years of age. No time trends in IBD incidence were observed from 2003 to 2009, both in the whole study population and in gender-specific subgroups. Conclusions: Our study provides important information on current epidemiology of IBD in Italy. IBD incidence in Lombardy is lower than in Northern Europe, and the data confirm that UC incidence is higher than that of CD. Moreover, in our study population IBD are gender specific, being more common in men than in women.
P.01.10 PROPOSAL OF A MODIFIED PHENOTYPE-BASED RADIOLOGICAL CLASSIFICATION: THE MAGNETIC RESONANCE CROHN’S DISEASE SEVERITY INDEX (MR-CSI) R. Sacco ∗ ,1 , E. Neri 2 , L. Faggioni 2 , R. Scandiffio 2 , D. Lauretti 2 , A. Romano 1 , M. Bertini 1 , M. Bertoni 1 , G. Federici 1 , S. Metrangolo 1 , G. Parisi 1 , A. Scaramuzzino 1 , E. Tumino 1 , G. Bresci 1 , C. Bartolozzi 2 1 A.O.U.P., Cisanello
- Gastroenterologia, Pisa, Italy; 2 A.O.U.P., Cisanello Radiologia, Pisa, Italy Background and aim: Crohn’s disease (CD) is a chronic inflammatory bowel disease, with different clinical features and pathological course, characterized by a relapsing and remitting trend. We work out a radiological score in the assessment of Crohn’s disease activity and severity.