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P238 Diagnostic value of serum adenosine deaminase levels in patients with inflammatory bowel diseases
Clinical: Diagnosis & outcome
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variants of colonoscopy, and 9 variants of CTE were significant different between ITB and ileocolic CD. But no parameters of biopsy was found significant different between two groups. 3. Multivariate analysis showed that 8 variants were independent factors for the differential diagnosis between ITB and ileocolic CD, including PLT, TSPOT positive, transverse ulcer, patulous ileocecal valve, involvement of sigmoid colon, involvement of small intestine, comb sign, and perianal lesion (Table 1). 4. Predicted model was constructed by multivariate analysis as follows, Logit P = 2.703 + 0.012·PLT 4.264·(TSPOT positive) 4.253·(transverse ulcer) 3.569·(patulous ileocecal valve) + 1.507·(involvement of sigmoid colon) + 1.869·(involvement of small intestine) + 1.885·(comb sign) + 1.797·(perianal lesion). The best diagnostic cut-off point (P = 0.4979) are obtained by ROC analysis (Figure 1). The sensitivity and specificity of the model to identify ITB patients were 88.57% and 100% respectively, and the AUC was 0.9798. Table 1. Variants with significant difference between ITB and ileocolic CD by using multivariate analysis
PLT TSPOT positive Transverse ulcer Patulous ileocecal valve Involvement of sigmoid colon Involvement of small intestine Comb sign Perianal lesion Constant
Regression coefficient
Standard error
P value
OR (95% CI)
0.012 4.264 4.253 3.569 1.507 1.869 1.885 1.797 2.703
0.007 1.207 1.502 3.127 1.249 1.247 1.080 1.715 2.311
0.084 0.000 0.005 0.254 0.228 0.134 0.081 0.295 0.242
1.012 0.014 0.014 0.028 4.512 6.480 6.584 6.029 0.067
(0.998 (0.001 (0.001 (0.000 (0.390 (0.563 (0.793 (0.209
1.026) 0.150) 0.270) 12.939) 52.185) 74.636) 54.688) 173.720)
P238 Diagnostic value of serum adenosine deaminase levels in patients with inflammatory bowel diseases C. Gonen1 *, Y. Gokden1 , A. Salturk1 , K. Kochan1 , S. Ozkara2 . 1 Haydarpasa Numune Training and Research Hospital, Department of Gastroenterology, Istanbul, Turkey, 2 Haydarpasa Numune Training and Research Hospital, Department of Pathology, Istanbul, Turkey Background: Adenosine deaminase (ADA) is a purine catabolic enzyme, and has been considered as a marker of T-cell activation. Serum ADA activity has been shown to increase in inflammatory conditions. The aim of this study was to investigate the diagnostic value of serum ADA levels in patients with inflammatory bowel diseases (IBD). Methods: A total of 92 patients with IBD (43 Crohn’s disease [CD] and 49 ulcerative colitis [UC]), and 31 healthy controls (HC) were included in this study. Haematological and biochemical parameters were determined for both patients and controls. Serum ADA levels were studied by spectrophotometric analysis. UC patients were classified as inactive, if endoscopic Mayo scores less than 3 and Rachmilewitz Clinical Activity Index less than 5. CD patients with Crohn’s Disease Activity Index <150 and endoscopic SES-CD <3 were classified as inactive. Results: Serum ADA levels were elevated significantly in IBD patients (median 24.77 U/L, range 9.6 74.9 U/L) compared to the HC group (median 20.8 U/L, 13.8 38.9 U/L) (p:0.0013). Although there were no difference between UC (median 23.8, 9.6 43) and CD patients (median 26.5, 13.8 74.9), serum ADA levels were significantly higher in both groups compared to controls (p: 0.02). Serum ADA levels were increased significantly in active UC patients (median 25.65, 9.6 43) when compared to inactive UC patients (median 20.9, 11 28.7), and controls (p < 0.005). When a cut off level of 21.64 U/L was used with a confidence interval of 77%, to distinguish active UC from inactive patients, a sensitivity of 89% and a specifity of 60% have been reached. There were no significant correlation between serum ADA levels and disease extent or localization. Conclusions: Serum ADA levels were found to be elevated in IBD patients when compared to healthy controls suggesting a partial role of activated T-cell activity in the disease pathogenesis. Serum ADA activity can be used as an alternative marker to identify IBD patients, and to discriminate active and inactive UC patients. Further studies are needed to investigate the role of ADA activity measurement for disease diagnosis, and activity assesment. P239 Diagnostic delay in pediatric Crohn’s disease patients is longer than in pediatric ulcerative colitis patients
Figure 1. ROC analysis for the diagnostic value of the prediction model. For IBD diagnosis, sensitivity was 0.8857, specificity 1, AUC 0.9798.
Conclusions: 1. PLT, TSPOT positive, transverse ulcer, patulous ileocecal valve, involvement of sigmoid colon, involvement of small intestine, comb sign, and perianal lesion are important features for distinguishing between ITB and ileocolic CD. 2. Predicted model was constructed with high sensitivity and specificity for the differential diagnosis between ITB and ileocolic CD.
A. Schoepfer1 *, E. Safroneeva2 , N. Fournier3,4 , G. Rogler5 , A. Nydegger6 , S. Vavricka5 , C. Braegger7 . 1 Centre Hospitalier Universitaire Vaudois, Gastroenterology, Lausanne, Switzerland, 2 University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland, 3 Institute of Social and Preventive Medicine, Healthcare Evaluation Unit, Lausanne, Switzerland, 4 University of Lausanne, IUMSP, Lausanne, Switzerland, 5 University of Zurich, Gastroenterology and Hepatology, Zurich, Switzerland, 6 University of Lausanne, Pediatric Gastroenterology, Lausanne, Switzerland, 7 University of Zurich, Pediatric Gastroenterology, Zurich, Switzerland Background: We have recently shown that the median diagnostic delay (time from first IBD symptoms until IBD diagnosis is established) was 9 months in adult Crohn’s disease patients and 4 months in adult ulcerative colitis (UC) patients in Switzerland. Of note, 25% of CD patients had a diagnostic delay >24 months. We also showed that the length of diagnostic delay in CD patients represents a risk factor for complicated disease
S161
variants of colonoscopy, and 9 variants of CTE were significant different between ITB and ileocolic CD. But no parameters of biopsy was found significant different between two groups. 3. Multivariate analysis showed that 8 variants were independent factors for the differential diagnosis between ITB and ileocolic CD, including PLT, TSPOT positive, transverse ulcer, patulous ileocecal valve, involvement of sigmoid colon, involvement of small intestine, comb sign, and perianal lesion (Table 1). 4. Predicted model was constructed by multivariate analysis as follows, Logit P = 2.703 + 0.012·PLT 4.264·(TSPOT positive) 4.253·(transverse ulcer) 3.569·(patulous ileocecal valve) + 1.507·(involvement of sigmoid colon) + 1.869·(involvement of small intestine) + 1.885·(comb sign) + 1.797·(perianal lesion). The best diagnostic cut-off point (P = 0.4979) are obtained by ROC analysis (Figure 1). The sensitivity and specificity of the model to identify ITB patients were 88.57% and 100% respectively, and the AUC was 0.9798. Table 1. Variants with significant difference between ITB and ileocolic CD by using multivariate analysis
PLT TSPOT positive Transverse ulcer Patulous ileocecal valve Involvement of sigmoid colon Involvement of small intestine Comb sign Perianal lesion Constant
Regression coefficient
Standard error
P value
OR (95% CI)
0.012 4.264 4.253 3.569 1.507 1.869 1.885 1.797 2.703
0.007 1.207 1.502 3.127 1.249 1.247 1.080 1.715 2.311
0.084 0.000 0.005 0.254 0.228 0.134 0.081 0.295 0.242
1.012 0.014 0.014 0.028 4.512 6.480 6.584 6.029 0.067
(0.998 (0.001 (0.001 (0.000 (0.390 (0.563 (0.793 (0.209
1.026) 0.150) 0.270) 12.939) 52.185) 74.636) 54.688) 173.720)
P238 Diagnostic value of serum adenosine deaminase levels in patients with inflammatory bowel diseases C. Gonen1 *, Y. Gokden1 , A. Salturk1 , K. Kochan1 , S. Ozkara2 . 1 Haydarpasa Numune Training and Research Hospital, Department of Gastroenterology, Istanbul, Turkey, 2 Haydarpasa Numune Training and Research Hospital, Department of Pathology, Istanbul, Turkey Background: Adenosine deaminase (ADA) is a purine catabolic enzyme, and has been considered as a marker of T-cell activation. Serum ADA activity has been shown to increase in inflammatory conditions. The aim of this study was to investigate the diagnostic value of serum ADA levels in patients with inflammatory bowel diseases (IBD). Methods: A total of 92 patients with IBD (43 Crohn’s disease [CD] and 49 ulcerative colitis [UC]), and 31 healthy controls (HC) were included in this study. Haematological and biochemical parameters were determined for both patients and controls. Serum ADA levels were studied by spectrophotometric analysis. UC patients were classified as inactive, if endoscopic Mayo scores less than 3 and Rachmilewitz Clinical Activity Index less than 5. CD patients with Crohn’s Disease Activity Index <150 and endoscopic SES-CD <3 were classified as inactive. Results: Serum ADA levels were elevated significantly in IBD patients (median 24.77 U/L, range 9.6 74.9 U/L) compared to the HC group (median 20.8 U/L, 13.8 38.9 U/L) (p:0.0013). Although there were no difference between UC (median 23.8, 9.6 43) and CD patients (median 26.5, 13.8 74.9), serum ADA levels were significantly higher in both groups compared to controls (p: 0.02). Serum ADA levels were increased significantly in active UC patients (median 25.65, 9.6 43) when compared to inactive UC patients (median 20.9, 11 28.7), and controls (p < 0.005). When a cut off level of 21.64 U/L was used with a confidence interval of 77%, to distinguish active UC from inactive patients, a sensitivity of 89% and a specifity of 60% have been reached. There were no significant correlation between serum ADA levels and disease extent or localization. Conclusions: Serum ADA levels were found to be elevated in IBD patients when compared to healthy controls suggesting a partial role of activated T-cell activity in the disease pathogenesis. Serum ADA activity can be used as an alternative marker to identify IBD patients, and to discriminate active and inactive UC patients. Further studies are needed to investigate the role of ADA activity measurement for disease diagnosis, and activity assesment. P239 Diagnostic delay in pediatric Crohn’s disease patients is longer than in pediatric ulcerative colitis patients
Figure 1. ROC analysis for the diagnostic value of the prediction model. For IBD diagnosis, sensitivity was 0.8857, specificity 1, AUC 0.9798.
Conclusions: 1. PLT, TSPOT positive, transverse ulcer, patulous ileocecal valve, involvement of sigmoid colon, involvement of small intestine, comb sign, and perianal lesion are important features for distinguishing between ITB and ileocolic CD. 2. Predicted model was constructed with high sensitivity and specificity for the differential diagnosis between ITB and ileocolic CD.
A. Schoepfer1 *, E. Safroneeva2 , N. Fournier3,4 , G. Rogler5 , A. Nydegger6 , S. Vavricka5 , C. Braegger7 . 1 Centre Hospitalier Universitaire Vaudois, Gastroenterology, Lausanne, Switzerland, 2 University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland, 3 Institute of Social and Preventive Medicine, Healthcare Evaluation Unit, Lausanne, Switzerland, 4 University of Lausanne, IUMSP, Lausanne, Switzerland, 5 University of Zurich, Gastroenterology and Hepatology, Zurich, Switzerland, 6 University of Lausanne, Pediatric Gastroenterology, Lausanne, Switzerland, 7 University of Zurich, Pediatric Gastroenterology, Zurich, Switzerland Background: We have recently shown that the median diagnostic delay (time from first IBD symptoms until IBD diagnosis is established) was 9 months in adult Crohn’s disease patients and 4 months in adult ulcerative colitis (UC) patients in Switzerland. Of note, 25% of CD patients had a diagnostic delay >24 months. We also showed that the length of diagnostic delay in CD patients represents a risk factor for complicated disease