- Email: [email protected]
T1263 Serrated Polyps in Patients With Inflammatory Bowel Disease
and UC regardless of the level of disease activity. These findings strongly indicate that small intestinal permeability is involved in the disease onset of both UC and CD.
T1265 Inter-Observer and Inter-Modality Agreement for Detection of Small Bowel Crohn's Disease With MRI- And CT-Enterography Michael D. Jensen, Tina J. Ormstrup, Chris A. Vagn-Hansen, Lone L. Østergaard, Søren R. Rafaelsen
AGA Abstracts
T1263 Serrated Polyps in Patients With Inflammatory Bowel Disease Driffa Moussata, Matthieu Allez, Stéphane Nancey, David Laharie, Jean-Marc Gornet, Jean-Marie Reimund, Philippe Marteau, Yoram Bouhnik, Arnaud Bourreille, Guillaume Cadiot, Bernard Flourie, Marc Lemann
Background and study aims: Magnetic resonance imaging (MRI) and computed tomography scanning (CT) enables a detailed visualisation of the entire small bowel and extra-intestinal surroundings. Previous studies have confirmed a high diagnostic accuracy for Crohn's disease (CD) and its complications. The aim of this study was to determine the inter-observer and inter-modality agreement for detection of small bowel CD with MRI- and CT-enterography. Patients and methods: Fifty patients with suspected or known CD were included in the study. Four radiologists with experience in abdominal radiology, MRI- and CT-technique participated. All patients underwent MRI- and CT-enterography on the same day and in alternating order. Observers were blind to patient histories, the results of ileo-colonoscopies and other small bowel examinations. Readers assessed the image quality, the presence of small bowel CD, and seven pathological findings consistent with CD. Results: The image quality was better with CT- than MRI-enterography (p < 0.001). For the diagnosis of small bowel CD, the inter-observer agreement was substantial in CT (kappa = 0.64) and moderate in MRI (kappa = 0.48) with full agreements obtained in 70% and 54% of patients, respectively. The inter-modality agreement for the diagnosis of small bowel CD was fair to substantial (kappa = 0.40-0.64) for different observers. Bowel wall thickening and hyper-enhancement was detected with moderate to substantial agreement between modalities (kappa = 0.420.70). Two abscesses were detected and confirmed at subsequent surgery. One abscess was not detected with MRI and only recorded by two observers in CT. A total of ten fistulas were detected. Three fistulas were confirmed at subsequent surgery and four fistulas were false positive findings. Conclusions: CT provides better image quality and superior interobserver agreement compared to MRI. However, in a substantial number of patients the diagnosis of small bowel CD is observer and modality dependent. In patients with suspected CD, disease activity should be confirmed by other examinations before introducing medical treatment.
Sessile serrated adenomas (SSA) and hyperplastic polyps (HP) belong to the same histologic group of serrated polyps. In patients with inflammatory bowel disease (IBD), pseudo-polyps, adenoma-like mass and dysplasia associated lesion on mass are common colonoscopic abnormalities, but little is known about the serrated polyps. Aim : To evaluate the incidence, number and location of the serrated polyps - SSA and HP - in patients with IBD compared to control patients. Methods : From January 2008 to September 2009, 222 IBD patients (120 patients with Crohn's disease (CD), 102 ulcerative colitis (UC)) included in a clolonoscopic surveillance program were analyzed. In the same period, 114 age-matched patients underwent colorectal cancer screening and were used as controls. The mean (± SEM) age was 45 ± 3 yrs and 48 ± 4.5 yrs in IBD and control patients, respectively. We evaluated the incidence of SSA and HP, number, size and location in the colon of IBD and control patients. Results : 15% of IBD (33/222, 22 UC and 11 CD) and 37.7% (43/114) of controls (p<0.01) presented HP at a mean age of 50 ± 4.1 and 48 ± 8 yrs respectively. 5% (11/222) of IBD and 7.8% (9/114) of controls presented SSA (p = 0.06) at a mean age of 54 ± 4 and 48 ± 2.7 yrs, respectively. The 11 IBD patients presented SSA (7 UC and 4 CD) with a mean delay from the beginning of the disease of 23 ± 3.3 and 18.5 ± 5 yrs in UC and CD respectively (p = 0.36). These 11 IBD patients was older than IBD patients without any serrated polyps (n = 178) (54 ± 3 vs 43 ± 4 yrs old) (p = 0.01) with a mean delay from the beginning of the disease of 21.5 ± 3 vs 22.6 ± 7 years, respectively. The characteristics of the polyps are summarized in table 1. Conclusion : Hyperplastic polyps are significantly less frequent and sessile serrated adenomas tend to be less frequent in IBD patients compared to age-matched controls. In addition, IBD patients with SSA are older and their number of polyps is smaller than those evidenced in controls. Table 1: Characteristics of the polyps (* p < 0.05)
T1266 Inter-Observer Agreement for Detection of Small Bowel Crohn's Disease With Capsule Endoscopy Michael D. Jensen, Torben Nathan, Jens Kjeldsen Background and study aims: Compared to other modalities, capsule endoscopy (CE) has a high diagnostic yield for diagnosing small bowel Crohn's disease (CD). The aim of this study was to determine the inter-observer agreement for detection of small bowel CD with predefined diagnostic criteria. Patients and methods: Thirty patients with suspected or known CD were included in the study. Observers were blind to patient histories, the results of ileocolonoscopies and small bowel examinations. More than three aphthous lesions or the presence of stenosis caused by inflammation or fibrosis was diagnostic for CD. Three observers with experience in CE participated in the study. Results: The inter-observer agreement was substantial for the diagnosis (kappa = 0.68) and moderate for the localisation of CD (kappa = 0.44). Aphthous lesions were detected with only fair inter-observer agreement (kappa = 0.38). Observer 1, 2 and 3 detected small bowel CD in 14, 9 and 14 patients, respectively. Observers subsequently reached consensus about the presence of CD in 11 patients, and the diagnosis was considered unequivocal in 28 of 30 CE's. The time intervals to passage of the pylorus and ileo-cecal valve were detected with excellent intra-class correlation. However, one observer misplaced the ileo-cecal valve in two patients, and colon lesions were interpreted as CD in the distal ileum. Conclusions: In patients with suspected and known of CD, CE is performed with substantial inter-observer agreement. Minor lesions are commonly overlooked or misinterpreted, but in the majority of patients, the diagnosis is unequivocal.
T1264 Anti-Glycan Antibodies are Significantly Increased in Crohn's Disease Patients and Their First Degree Relatives Iris Dotan, Hadar Meringer, Aaron Lerner, Timna Naftali, Ayala Yaron, Shimon Reif, Zamir Halpern Background: Disease specific antibodies have been described in patients with inflammatory bowel disease (IBD) and their first degree relatives. The recently described anti-glycan antibodies (AGA): anti-laminaribioside, chitobioside and mannobioside (ALCA ACCA and AMCA respectively) and anti-Saccharomyces cerevisiae antibodies (gASCA) specifically favor a Crohn's disease (CD) diagnosis and prediction of disease behavior, however, little is known about their prevalence in healthy first degree relatives (FDR) and its significance. Aim: To investigate whether AGA will identify a specific IBD patients subgroup as well as their FDR. Methods: IBD patients and their healthy FDR and control patients undergoing investigation due to gastrointestinal symptoms, and their FDR (FDRc) were included. Demographic and disease data were recorded and correlated with inflammatory markers and AGA (Glycominds Ltd, Israel). Results: Thirty five IBD patients (age 28.8±15 years, 19 CD, 19 females) and 37 FDR were compared to 39/68 control patients/FDR. CRP (10.30±17.9 mg%) and ESR (32.8±26 mm/hour) levels were significantly higher in patients compared to FDR or control groups (p=0.06 and 0.01, respectively). AGA were detected in 15 (43%, 12 CD) IBD patients (7 ALCA, 13 ASCA, 1 ACCA, 1 AMCA) and 12 (32%) FDR (9 CD-FDR, p =0.36), however, double AGA positive patients (7) only occurred in CD. Nine FDRc but no controls were AGA positive. ALCA levels were significantly increased in both CD patients and FDR (38.6±24.8 and 34.6±25.7 units, respectively), vs. control/FDRc, p= 0.001. gASCA was significantly higher in CD patients (44.4±44.2 units) vs. FDR (p<0.001) and controls/FDRc (p<0.001). Interestingly, positive compared to negative AGA IBD patients were significantly younger: 23.2±8.3 vs. 33±17.6 years (p=0.04) and had shorter disease duration: 3.6±4 vs. 8±8.3 years (p=0.06). Immunomodulators/biologics had no effect on serologic response. Importantly, 40% AGA positive in contrast to 25% AGA negative IBD patients had AGA positive FDR. Conclusions: AGA are significantly increased in CD patients and FDR compared to controls. gASCA best differentiated between CD and FDR. Positive AGA are associated with younger age and shorter disease duration. Thus, AGA panels contribute to CD diagnosis and prognostic stratification. The correlation between CD patients-FDR seropositivity may support either genetic anticipation or similar environmental exposures.
AGA Abstracts
T1267 The Gut in Health and Disease: Scenting the Difference by 'Electronic Nose' Ramesh P. Arasaradnam, Nabil Quraishi, Sudhesh Kumar, Chuka U. Nwokolo, Karna D. Bardhan, James Covington Background: Resident colonic bacteria (anaerobes and firmicutes) ferment undigested fibre. The balance between their large species number is influenced by the host genetic make up. An individuals ‘fermentation profile' (FP) is therefore likely to comprise a stable ‘personal signature' and a variable portion, which is influenced by the gut environment - diet and to a lesser extent drugs, thus offering an insight into colonic microbial health. A method of monitoring FP is by analysing the gaseous release that emanates off a patient's urine or faecal sample. This can then be characterised using various techniques, but two options are: Artificial olfaction (the so called electronic nose or e-nose), which offers a method to rapidly identify disease groups based on the a complete ‘bio-odorant signature'; Gas Chromatography/ Mass Spectrometry, which seeks to identify all the chemical components within a sample. Aim: Pilot study using an ‘e-nose' to determine if disease groups can be distinguished and indentified from faeces and urine samples. Methods: Subjects and patients: 2 healthy (normal) volunteers; Ulcerative Colitis (n=1; active disease induced into remission), Crohns Disease (n=1). Biological samples of faeces and urine were collected and urine samples were analysed. Samples were prepared in universal containers (10ml) and heated to 38 ± 0.1oC. The headspace (the air above the sample) was then analysed using a Cyrano A320 (Smith Detection) e-nose, employing 32 carbon black composite chemoresistive chemical sensors. These instruments employ a series of sensors with overlapping sensitivity, thus creating a ‘fingerprint' of the total chemical composition of a sample (as with the human nose). Each headspace was sampled for 30 seconds, and purged for a further 30 seconds in laboratory air. The differential response between the sample and the background air was used for analysis. Results: The PCA plot (not shown - high resolution) demonstrates the e-nose's capability to distinguish between disease groups based on their gaseous profile from urine samples with >90% selectivity. Specifically there was polarity between UC and CD subjects
S-524
T1265 Inter-Observer and Inter-Modality Agreement for Detection of Small Bowel Crohn's Disease With MRI- And CT-Enterography Michael D. Jensen, Tina J. Ormstrup, Chris A. Vagn-Hansen, Lone L. Østergaard, Søren R. Rafaelsen
AGA Abstracts
T1263 Serrated Polyps in Patients With Inflammatory Bowel Disease Driffa Moussata, Matthieu Allez, Stéphane Nancey, David Laharie, Jean-Marc Gornet, Jean-Marie Reimund, Philippe Marteau, Yoram Bouhnik, Arnaud Bourreille, Guillaume Cadiot, Bernard Flourie, Marc Lemann
Background and study aims: Magnetic resonance imaging (MRI) and computed tomography scanning (CT) enables a detailed visualisation of the entire small bowel and extra-intestinal surroundings. Previous studies have confirmed a high diagnostic accuracy for Crohn's disease (CD) and its complications. The aim of this study was to determine the inter-observer and inter-modality agreement for detection of small bowel CD with MRI- and CT-enterography. Patients and methods: Fifty patients with suspected or known CD were included in the study. Four radiologists with experience in abdominal radiology, MRI- and CT-technique participated. All patients underwent MRI- and CT-enterography on the same day and in alternating order. Observers were blind to patient histories, the results of ileo-colonoscopies and other small bowel examinations. Readers assessed the image quality, the presence of small bowel CD, and seven pathological findings consistent with CD. Results: The image quality was better with CT- than MRI-enterography (p < 0.001). For the diagnosis of small bowel CD, the inter-observer agreement was substantial in CT (kappa = 0.64) and moderate in MRI (kappa = 0.48) with full agreements obtained in 70% and 54% of patients, respectively. The inter-modality agreement for the diagnosis of small bowel CD was fair to substantial (kappa = 0.40-0.64) for different observers. Bowel wall thickening and hyper-enhancement was detected with moderate to substantial agreement between modalities (kappa = 0.420.70). Two abscesses were detected and confirmed at subsequent surgery. One abscess was not detected with MRI and only recorded by two observers in CT. A total of ten fistulas were detected. Three fistulas were confirmed at subsequent surgery and four fistulas were false positive findings. Conclusions: CT provides better image quality and superior interobserver agreement compared to MRI. However, in a substantial number of patients the diagnosis of small bowel CD is observer and modality dependent. In patients with suspected CD, disease activity should be confirmed by other examinations before introducing medical treatment.
Sessile serrated adenomas (SSA) and hyperplastic polyps (HP) belong to the same histologic group of serrated polyps. In patients with inflammatory bowel disease (IBD), pseudo-polyps, adenoma-like mass and dysplasia associated lesion on mass are common colonoscopic abnormalities, but little is known about the serrated polyps. Aim : To evaluate the incidence, number and location of the serrated polyps - SSA and HP - in patients with IBD compared to control patients. Methods : From January 2008 to September 2009, 222 IBD patients (120 patients with Crohn's disease (CD), 102 ulcerative colitis (UC)) included in a clolonoscopic surveillance program were analyzed. In the same period, 114 age-matched patients underwent colorectal cancer screening and were used as controls. The mean (± SEM) age was 45 ± 3 yrs and 48 ± 4.5 yrs in IBD and control patients, respectively. We evaluated the incidence of SSA and HP, number, size and location in the colon of IBD and control patients. Results : 15% of IBD (33/222, 22 UC and 11 CD) and 37.7% (43/114) of controls (p<0.01) presented HP at a mean age of 50 ± 4.1 and 48 ± 8 yrs respectively. 5% (11/222) of IBD and 7.8% (9/114) of controls presented SSA (p = 0.06) at a mean age of 54 ± 4 and 48 ± 2.7 yrs, respectively. The 11 IBD patients presented SSA (7 UC and 4 CD) with a mean delay from the beginning of the disease of 23 ± 3.3 and 18.5 ± 5 yrs in UC and CD respectively (p = 0.36). These 11 IBD patients was older than IBD patients without any serrated polyps (n = 178) (54 ± 3 vs 43 ± 4 yrs old) (p = 0.01) with a mean delay from the beginning of the disease of 21.5 ± 3 vs 22.6 ± 7 years, respectively. The characteristics of the polyps are summarized in table 1. Conclusion : Hyperplastic polyps are significantly less frequent and sessile serrated adenomas tend to be less frequent in IBD patients compared to age-matched controls. In addition, IBD patients with SSA are older and their number of polyps is smaller than those evidenced in controls. Table 1: Characteristics of the polyps (* p < 0.05)
T1266 Inter-Observer Agreement for Detection of Small Bowel Crohn's Disease With Capsule Endoscopy Michael D. Jensen, Torben Nathan, Jens Kjeldsen Background and study aims: Compared to other modalities, capsule endoscopy (CE) has a high diagnostic yield for diagnosing small bowel Crohn's disease (CD). The aim of this study was to determine the inter-observer agreement for detection of small bowel CD with predefined diagnostic criteria. Patients and methods: Thirty patients with suspected or known CD were included in the study. Observers were blind to patient histories, the results of ileocolonoscopies and small bowel examinations. More than three aphthous lesions or the presence of stenosis caused by inflammation or fibrosis was diagnostic for CD. Three observers with experience in CE participated in the study. Results: The inter-observer agreement was substantial for the diagnosis (kappa = 0.68) and moderate for the localisation of CD (kappa = 0.44). Aphthous lesions were detected with only fair inter-observer agreement (kappa = 0.38). Observer 1, 2 and 3 detected small bowel CD in 14, 9 and 14 patients, respectively. Observers subsequently reached consensus about the presence of CD in 11 patients, and the diagnosis was considered unequivocal in 28 of 30 CE's. The time intervals to passage of the pylorus and ileo-cecal valve were detected with excellent intra-class correlation. However, one observer misplaced the ileo-cecal valve in two patients, and colon lesions were interpreted as CD in the distal ileum. Conclusions: In patients with suspected and known of CD, CE is performed with substantial inter-observer agreement. Minor lesions are commonly overlooked or misinterpreted, but in the majority of patients, the diagnosis is unequivocal.
T1264 Anti-Glycan Antibodies are Significantly Increased in Crohn's Disease Patients and Their First Degree Relatives Iris Dotan, Hadar Meringer, Aaron Lerner, Timna Naftali, Ayala Yaron, Shimon Reif, Zamir Halpern Background: Disease specific antibodies have been described in patients with inflammatory bowel disease (IBD) and their first degree relatives. The recently described anti-glycan antibodies (AGA): anti-laminaribioside, chitobioside and mannobioside (ALCA ACCA and AMCA respectively) and anti-Saccharomyces cerevisiae antibodies (gASCA) specifically favor a Crohn's disease (CD) diagnosis and prediction of disease behavior, however, little is known about their prevalence in healthy first degree relatives (FDR) and its significance. Aim: To investigate whether AGA will identify a specific IBD patients subgroup as well as their FDR. Methods: IBD patients and their healthy FDR and control patients undergoing investigation due to gastrointestinal symptoms, and their FDR (FDRc) were included. Demographic and disease data were recorded and correlated with inflammatory markers and AGA (Glycominds Ltd, Israel). Results: Thirty five IBD patients (age 28.8±15 years, 19 CD, 19 females) and 37 FDR were compared to 39/68 control patients/FDR. CRP (10.30±17.9 mg%) and ESR (32.8±26 mm/hour) levels were significantly higher in patients compared to FDR or control groups (p=0.06 and 0.01, respectively). AGA were detected in 15 (43%, 12 CD) IBD patients (7 ALCA, 13 ASCA, 1 ACCA, 1 AMCA) and 12 (32%) FDR (9 CD-FDR, p =0.36), however, double AGA positive patients (7) only occurred in CD. Nine FDRc but no controls were AGA positive. ALCA levels were significantly increased in both CD patients and FDR (38.6±24.8 and 34.6±25.7 units, respectively), vs. control/FDRc, p= 0.001. gASCA was significantly higher in CD patients (44.4±44.2 units) vs. FDR (p<0.001) and controls/FDRc (p<0.001). Interestingly, positive compared to negative AGA IBD patients were significantly younger: 23.2±8.3 vs. 33±17.6 years (p=0.04) and had shorter disease duration: 3.6±4 vs. 8±8.3 years (p=0.06). Immunomodulators/biologics had no effect on serologic response. Importantly, 40% AGA positive in contrast to 25% AGA negative IBD patients had AGA positive FDR. Conclusions: AGA are significantly increased in CD patients and FDR compared to controls. gASCA best differentiated between CD and FDR. Positive AGA are associated with younger age and shorter disease duration. Thus, AGA panels contribute to CD diagnosis and prognostic stratification. The correlation between CD patients-FDR seropositivity may support either genetic anticipation or similar environmental exposures.
AGA Abstracts
T1267 The Gut in Health and Disease: Scenting the Difference by 'Electronic Nose' Ramesh P. Arasaradnam, Nabil Quraishi, Sudhesh Kumar, Chuka U. Nwokolo, Karna D. Bardhan, James Covington Background: Resident colonic bacteria (anaerobes and firmicutes) ferment undigested fibre. The balance between their large species number is influenced by the host genetic make up. An individuals ‘fermentation profile' (FP) is therefore likely to comprise a stable ‘personal signature' and a variable portion, which is influenced by the gut environment - diet and to a lesser extent drugs, thus offering an insight into colonic microbial health. A method of monitoring FP is by analysing the gaseous release that emanates off a patient's urine or faecal sample. This can then be characterised using various techniques, but two options are: Artificial olfaction (the so called electronic nose or e-nose), which offers a method to rapidly identify disease groups based on the a complete ‘bio-odorant signature'; Gas Chromatography/ Mass Spectrometry, which seeks to identify all the chemical components within a sample. Aim: Pilot study using an ‘e-nose' to determine if disease groups can be distinguished and indentified from faeces and urine samples. Methods: Subjects and patients: 2 healthy (normal) volunteers; Ulcerative Colitis (n=1; active disease induced into remission), Crohns Disease (n=1). Biological samples of faeces and urine were collected and urine samples were analysed. Samples were prepared in universal containers (10ml) and heated to 38 ± 0.1oC. The headspace (the air above the sample) was then analysed using a Cyrano A320 (Smith Detection) e-nose, employing 32 carbon black composite chemoresistive chemical sensors. These instruments employ a series of sensors with overlapping sensitivity, thus creating a ‘fingerprint' of the total chemical composition of a sample (as with the human nose). Each headspace was sampled for 30 seconds, and purged for a further 30 seconds in laboratory air. The differential response between the sample and the background air was used for analysis. Results: The PCA plot (not shown - high resolution) demonstrates the e-nose's capability to distinguish between disease groups based on their gaseous profile from urine samples with >90% selectivity. Specifically there was polarity between UC and CD subjects
S-524