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PA.145 INCREASED THROMBIN GENERATION IN INFLAMMATORY BOWEL DISEASES
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Abstracts / Digestive and Liver Disease 40S (2008), S1–S195
increase vs basal) and release (0.05 and 0.31 ng/ml), which were not affected by BUD. LPS/IFN-γ stimulated iNOS expression and NO production (2.9 and 4.1 and 1.5 and 2.5 fold increase vs basal respectively), which were reduced by BUD, both in control and UC patients (-64 and -46% respectively); an inhibition was also obtained by anti-RAGE and anti-S100B antibodies (-61 and -68, -47 and -63% in controls and UC, respectively). Conclusions: We showed that EGC activation stimulates NO production in UC via S100B up-regulation and via activation of RAGE in a steroid insensitive pathway. Our data highlight a pivotal role of S100B in the mechanism of NO production underlying the involvement of EGC in gut inflammation. # L. Inflammatory bowel diseases 1. Basic science
PA.145 INCREASED THROMBIN GENERATION IN INFLAMMATORY BOWEL DISEASES V. Saladino ∗ ,1 , F. Villa 1 , S. Saibeni 2 , B. Savino 2 , M. Vecchi 3 , C. Sei 1 , R. de Franchis 1 , P.M. Mannucci 1 , V. Chantarangkul 1 , A. Tripodi 1 1 IRCCS
Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano; 2 Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milano; 3 IRCCS Policlinico San Donato and University of Milan, San Donato Milanese
Background and aim: Inflammatory Bowel Diseases (IBD) are characterized by an increased thrombotic risk. Endogenous Thrombin Potential (ETP), a parameter of the thrombin generation curve, represents a new tool in the evaluation of thrombotic and bleeding disorders. Aim: to study ETP in IBD patients and to correlate the results with clinical and biochemical features. Material and methods: 74 IBD patients (37 ulcerative colitis and 37 Crohn’s disease) and 57 healthy controls enrolled. ETP values, measured with or without thrombomodulin, are expressed as nM thrombin times minutes. Results: In the presence of thrombomodulin, IBD patients with increased C-reactive protein (CRP) had significantly higher mean (± SD) ETP values (1,721.3±458.0 nM·min) than either patients with normal CRP (1,356.6±394.5 nM·min) and controls (1,277.1 ± 402.7 nM·min) (p<0.001). A significant correlation was observed between ETP and CRP (r=0.28, 95% C.I., 0.06-0.48, p=0.015) and erythrocyte sedimentation rate (ESR) (r=0.26, 95% C.I. 0.04-0.47, p=0.022). ETP values higher than the 95th percentile of control values were significantly more frequent in IBD patients than in controls (RR 1.71, 95% C.I. 1.33-2.20; p<0.002). Conclusions: ETP is increased in IBD patients, markedly in those with increased acute-phase reactants. ETP may help to identify IBD patients at increased thrombotic risk, regardless the underlying causes. # L. Inflammatory bowel diseases 1. Basic science
PA.146 UNDERSTANDING OF DISEASE IN PATIENTS WITH A RECENT DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE M. Martinato ∗ , M. Ferrante, B. Burattin, V. Di Leo, L. Oliva, P. Bertomoro, M. Piovanello, T. Slongo, G.C. Sturniolo, R. D’Incà Azienda Ospedaliera - Università di Padova, Padova Background and aim: Inflammatory bowel diseases (IBD) have a negative impact on patients’ daily activities and health-related quality of life (HRQOL). Information about the disease may improve their HRQOL, reducing anxiety and depression, facilitating adherence to treatment, containing health-related costs and improving outcomes.
This study aims to identify the features of IBD patients exposed to the risk of knowing little about their disease and to establish which patients would benefit from educational programs. Material and methods: All IBD patients followed up at a tertiary referral centre, diagnosed less than 18 months previously and with no prior major surgery (ileostomy, ileo-anal pouch) or other concurrent chronic diseases, were tested with the Crohn’s and Colitis Knowledge (CCKNOW) Score, a valid index with a high internal consistency and a good level of reliability for assessing IBD patients’ understanding of their disease. Quality of life was investigated with the Short Inflammatory Bowel Disease Quality of Life (S-IBDQ) questionnaire. Disease activity was assessed using the MTWSI (Modified Truelove and Witts Severity Index) for ulcerative colitis (UC) and the Harvey Bradshaw Index for Crohn’s disease (CD). Results: Forty-nine patients gave their written informed consent and completed both questionnaires, and had their disease activity index assessed. More than half the patients had an appropriate understanding of IBD diagnostic tests, symptoms and general issues. Questions on medical treatment, disease aetiology, bowel anatomy and extra-intestinal manifestations were answered correctly by 25-30% of patients, while 15% knew about the side effects of medical therapy and 4% had some knowledge of the areas relating to fertility, pregnancy and surgery. The patients’ level of understanding of IBD correlated with their schooling (Spearman’s rho=0.40;p=0.01) and age (Spearman’s rho=0.30; p=0.05). Conclusions: Educational measures should target elderly patients, and those without higher education, focus particularly on the type of medical therapy and its side effects, and on the complications of surgery. Information provided during specialist consultations or hospital stays appears to have little effect on the patients’ understanding of IBD, so ad hoc patient education schemes should be implemented soon after a new case of IBD has been diagnosed. # L. Inflammatory bowel diseases 1. Basic science
PA.147 PROLONGED SCHEDULED THERAPY WITH INFLIXIMAB IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: EVALUATION OF CLINICAL REMISSION AND MUCOSAL HEALING L. Grossi ∗ , M. Spezzaferro, L.F. Sacco, M.E. Serio, M. Amitrano, B. Cerasa, L. Marzio G d’Annunzio University School of Gastroenterology c/o Digestive Physiopathology, Ospedale Spirito Santo, Pescara Background and aim: The use of infliximab for one year is known to guarantee remission in a good percentage of patients with Crohn’s Disease(CD) and Ulcerative Colitis(UC) refractory or intolerant to traditional medical therapies. There is still a paucity of data regarding similar therapies prolonged after the conventional 12 months regimen in IBD patients. Aim of our study was to analyse the clinical, serological and endoscopic patterns in IBD patients receiving scheduled infliximab infusions for more than 1 year. Material and methods: Data are related to IBD patients of our Unit receiving scheduled infliximab for periods longer than 12 months, evaluating the clinical remission, mucosal healing, CRP levels and steroid sparing. Each of these patients received 8-weekly scheduled 5 mg/kg infliximab treatment, with endoscopic examination performed every 12 months. Laboratory exams were also performed every 3 months. In case of reduced effect the time interval between the infusions was reduced to 6 weeks, with the dose subsequently increased to 10 mg/kg every 8 weeks if further needed. The treatment was then stopped in case of lack of response. Results: A total of 39 patients, 23 CD and 16 UC were treated for a mean period of 34 months (range CD: 20-80 months, UC:16-26 months), obtaining the following results: Pts. in Clinical Remission: CD 21/23 (91%), UC 12/16 (75%); Pts with Mucosal healing (%):
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195
increase vs basal) and release (0.05 and 0.31 ng/ml), which were not affected by BUD. LPS/IFN-γ stimulated iNOS expression and NO production (2.9 and 4.1 and 1.5 and 2.5 fold increase vs basal respectively), which were reduced by BUD, both in control and UC patients (-64 and -46% respectively); an inhibition was also obtained by anti-RAGE and anti-S100B antibodies (-61 and -68, -47 and -63% in controls and UC, respectively). Conclusions: We showed that EGC activation stimulates NO production in UC via S100B up-regulation and via activation of RAGE in a steroid insensitive pathway. Our data highlight a pivotal role of S100B in the mechanism of NO production underlying the involvement of EGC in gut inflammation. # L. Inflammatory bowel diseases 1. Basic science
PA.145 INCREASED THROMBIN GENERATION IN INFLAMMATORY BOWEL DISEASES V. Saladino ∗ ,1 , F. Villa 1 , S. Saibeni 2 , B. Savino 2 , M. Vecchi 3 , C. Sei 1 , R. de Franchis 1 , P.M. Mannucci 1 , V. Chantarangkul 1 , A. Tripodi 1 1 IRCCS
Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano; 2 Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milano; 3 IRCCS Policlinico San Donato and University of Milan, San Donato Milanese
Background and aim: Inflammatory Bowel Diseases (IBD) are characterized by an increased thrombotic risk. Endogenous Thrombin Potential (ETP), a parameter of the thrombin generation curve, represents a new tool in the evaluation of thrombotic and bleeding disorders. Aim: to study ETP in IBD patients and to correlate the results with clinical and biochemical features. Material and methods: 74 IBD patients (37 ulcerative colitis and 37 Crohn’s disease) and 57 healthy controls enrolled. ETP values, measured with or without thrombomodulin, are expressed as nM thrombin times minutes. Results: In the presence of thrombomodulin, IBD patients with increased C-reactive protein (CRP) had significantly higher mean (± SD) ETP values (1,721.3±458.0 nM·min) than either patients with normal CRP (1,356.6±394.5 nM·min) and controls (1,277.1 ± 402.7 nM·min) (p<0.001). A significant correlation was observed between ETP and CRP (r=0.28, 95% C.I., 0.06-0.48, p=0.015) and erythrocyte sedimentation rate (ESR) (r=0.26, 95% C.I. 0.04-0.47, p=0.022). ETP values higher than the 95th percentile of control values were significantly more frequent in IBD patients than in controls (RR 1.71, 95% C.I. 1.33-2.20; p<0.002). Conclusions: ETP is increased in IBD patients, markedly in those with increased acute-phase reactants. ETP may help to identify IBD patients at increased thrombotic risk, regardless the underlying causes. # L. Inflammatory bowel diseases 1. Basic science
PA.146 UNDERSTANDING OF DISEASE IN PATIENTS WITH A RECENT DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE M. Martinato ∗ , M. Ferrante, B. Burattin, V. Di Leo, L. Oliva, P. Bertomoro, M. Piovanello, T. Slongo, G.C. Sturniolo, R. D’Incà Azienda Ospedaliera - Università di Padova, Padova Background and aim: Inflammatory bowel diseases (IBD) have a negative impact on patients’ daily activities and health-related quality of life (HRQOL). Information about the disease may improve their HRQOL, reducing anxiety and depression, facilitating adherence to treatment, containing health-related costs and improving outcomes.
This study aims to identify the features of IBD patients exposed to the risk of knowing little about their disease and to establish which patients would benefit from educational programs. Material and methods: All IBD patients followed up at a tertiary referral centre, diagnosed less than 18 months previously and with no prior major surgery (ileostomy, ileo-anal pouch) or other concurrent chronic diseases, were tested with the Crohn’s and Colitis Knowledge (CCKNOW) Score, a valid index with a high internal consistency and a good level of reliability for assessing IBD patients’ understanding of their disease. Quality of life was investigated with the Short Inflammatory Bowel Disease Quality of Life (S-IBDQ) questionnaire. Disease activity was assessed using the MTWSI (Modified Truelove and Witts Severity Index) for ulcerative colitis (UC) and the Harvey Bradshaw Index for Crohn’s disease (CD). Results: Forty-nine patients gave their written informed consent and completed both questionnaires, and had their disease activity index assessed. More than half the patients had an appropriate understanding of IBD diagnostic tests, symptoms and general issues. Questions on medical treatment, disease aetiology, bowel anatomy and extra-intestinal manifestations were answered correctly by 25-30% of patients, while 15% knew about the side effects of medical therapy and 4% had some knowledge of the areas relating to fertility, pregnancy and surgery. The patients’ level of understanding of IBD correlated with their schooling (Spearman’s rho=0.40;p=0.01) and age (Spearman’s rho=0.30; p=0.05). Conclusions: Educational measures should target elderly patients, and those without higher education, focus particularly on the type of medical therapy and its side effects, and on the complications of surgery. Information provided during specialist consultations or hospital stays appears to have little effect on the patients’ understanding of IBD, so ad hoc patient education schemes should be implemented soon after a new case of IBD has been diagnosed. # L. Inflammatory bowel diseases 1. Basic science
PA.147 PROLONGED SCHEDULED THERAPY WITH INFLIXIMAB IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: EVALUATION OF CLINICAL REMISSION AND MUCOSAL HEALING L. Grossi ∗ , M. Spezzaferro, L.F. Sacco, M.E. Serio, M. Amitrano, B. Cerasa, L. Marzio G d’Annunzio University School of Gastroenterology c/o Digestive Physiopathology, Ospedale Spirito Santo, Pescara Background and aim: The use of infliximab for one year is known to guarantee remission in a good percentage of patients with Crohn’s Disease(CD) and Ulcerative Colitis(UC) refractory or intolerant to traditional medical therapies. There is still a paucity of data regarding similar therapies prolonged after the conventional 12 months regimen in IBD patients. Aim of our study was to analyse the clinical, serological and endoscopic patterns in IBD patients receiving scheduled infliximab infusions for more than 1 year. Material and methods: Data are related to IBD patients of our Unit receiving scheduled infliximab for periods longer than 12 months, evaluating the clinical remission, mucosal healing, CRP levels and steroid sparing. Each of these patients received 8-weekly scheduled 5 mg/kg infliximab treatment, with endoscopic examination performed every 12 months. Laboratory exams were also performed every 3 months. In case of reduced effect the time interval between the infusions was reduced to 6 weeks, with the dose subsequently increased to 10 mg/kg every 8 weeks if further needed. The treatment was then stopped in case of lack of response. Results: A total of 39 patients, 23 CD and 16 UC were treated for a mean period of 34 months (range CD: 20-80 months, UC:16-26 months), obtaining the following results: Pts. in Clinical Remission: CD 21/23 (91%), UC 12/16 (75%); Pts with Mucosal healing (%):