34 P Severe lower gastrointestinal bleeding in Crohn's disease successful treatment with infliximab

inflammatory bowel diseases

35 P

33 P COMPARISON REMISSION

OF LACTOBACU.LUS OF ,NFLAMMATORY

MA Zocco, E C NisIa, Gasbmini, A Gashtini “mvers~td

Cattohca

M

GG ANTI MESALAZINE BOWEL DISEASES

Candelli,

f A Cazzato,

V Ojetti,

IN MAINTANNG

C Di Campli,

L

Smttdli,

G

del Sacra Cuore-Roma

Backgmund recent studier have shown that d&rem probiotics could be useful m maintaining remission in ukemtive colitis (UC) and in preventing the postoperative recurrence ofCrobn ‘s disease (CD). Lactobacillus GG is a safe probiotic bacterium known to tmmiently colonize the human itttestme Aim ofthir study w*s to evaluate the efficacy of Lactobacillus GG, Lactobacillus GG and mesaltine and mesaltie alone to prevent IBD relapse Metbads: We em&d 36 patients with inactive ulcerative colitis (20 male/l6 female, mean age 32 * 5 yrs) and 32 patim with quiescent Crobn ‘I disease (18 maWl4 female, mean age 30 * 4 yn). 22 patients (proups A 12 UC and lo CD,) were randomized to receive Lanabacillus GG 18x109/d ofviable bacteria KiiRorex. ErreKapra Eumterwici SpA Milah Italy), 22 patients (groups B 10 UC, 12 CD) t; me&&e 2,4Jd and 25 patients &ups C 14 UC, I I CD) to mesalazine 2.4 g,d and Lactobacdius GG 18xlO9,d of viable bacteria. CAI (Colitis Activity Index) or CDAI (Crobn ‘s Disease Activity Index), endoscopic score and histological score were determined at 0.6 and 12 months and in case of relapse Patients were followed up for a maximum of 12 mombs. The primary end point of efficacy was relapse as d&ted by clinical symptoms and endoscopic features, the second end point was the occul~ellcc of side e&cts Results No ditTerences in the relapse rate were obsewed “long the three treatment groups far patients with ulcerative colitis (25%. 22% and 21% respectively for the first, second and thkh group). As concm Cmhn ‘J dise.w B slightly sipifs& difference was observed among groups, only considering an intention-mtreat analysis (40%. 25% and 27% respectively, group A YS group B and C p
ROLE OF MAGNETIC RESONANCE (MR) WT” CROWS DISEASE (CD) F. MACCIONI*. A. VISCIDO. A ARATAPJ, CAPRILLI

IN THE

MANAGmWf

V D’OVlDIO,

OF PATIENTS

A STASOLW

‘DIPARIMENTO DI RADIOLOGIA “NIVERSITA’ LA SAPIENZA ‘DIPARTTMENTO DI SCIENZE CLINKHE I CATIEDRA DI GASTROENTEROLOGIA UNTVERSITA’ LA SAPIENZA ROMA

R

ROMA,

Background. Evaluation of pts with CD is based an clinical, laboratory, endoscopic and radiologic examinations Recently abdominal MR is more frequently used for the evaluation ofCD Aim To investigate the role of MR in CD for morpholagical evaluation and assessment of disease activity Materials and Methods. 90 pts underwent MR, clinical, laboratory, endoswpic and Rx evaluations. MR was performed at 1.5 Teda with mgative oral contrast agent, T2w fat-suppressed and non suppressed sequences, Tlw sequencaa before and after Gadolimmn(Gd) injection (double contrast technique) For momhokxical evaluation the aut was divided in 1 tracts jejunum, ikum -dent, tmttwer, de&n&n8 and sigmoi~ colon, rectum Site and &t&ion of lesions, presence of mrromings and fist&a were assessed and compared wth endoscopy and conventional radiology, considered as gold-standard (GSm) At lesion level, 4 parameters were assessed and graded bowel wall thickness, Tl bowel wail Gd-enhancement, T2 bowel wall signal, T2 signal of 6bro-fatty proliferation. These parameters were correlated with acute phase reactants, considered BS gold-standard for disease activity (GSa). Statistical analysis Spearman correlation and Fisher ‘s test. Results MX detected 165,630 (26%) uacu &&ted by CD, whereas GSm 157/630 (25%) The mean disease extent was 32.2( hl9.9) cm by h+& 35.X +X2.1) cm by GSm MR detected 92% (ZOUZZO) of strictures end 75% (36148) offistulas respect to GSm. A8 the MR pammeters car&ted with Gsa- bowel wall thickness+ 0.59). Tl bowel wall Gdetthawmmtt(r:0.84). T2 bowel wall signal(r 0 84). T2 signal of fibro-fatty pmliiation(r 0 76) Furthermore, in IO pts MR showed complications (1 hydronephrosis, 3 abscesses, 2 pblegmonq I pancreatic duct stones, 1 entemvescical t&da, 2 ovarian involvements) contimted by US/CT; out of these, 7 were wnt?mted at surgery Adhesions were suspected by MR in 80 mstances. Conclusions MR could be a global diaaoostic tool in CD. being able to assess site, extent (through and beyond the v&6, i&,mn&y activity of the lesions and abdominal complications It is suggested that MR might be used as unique imaging technique in CD.

34 P SEVERE LOWER GASTRO,NTESTMAL SUCCESSFUL TREAI’MENT WlTH L Gili,

C Papi, M

Dpt Gastroentemlogm

Tarquti,

BLEEDlNG INFLIYGMAB

G Anton&.

& Medicina

lntema

L Osp

IN CROWS

DISEASE

Capurso S Filippa

Neti,

Roma

Case report A 50.yr-old man was admitted to another General Hospital because of massive lower GI bleedii with hypotmsion (BP=80/60 mm&) and severe atmmm @lb==6 9 g/dl) Because of persistent bleeding the patients underwent emergent surgery At laparotomy a” bttkmmatory mm involving the distal ileum and the cecum was detected: resection with ileo-colordc end to side anastomosis was performed Pathological examinntion WBS consistent wth Crok’s disease (CD) The patient was dihged without any specitic therapy. Nine months latex the patient was referred to mu Gl unit because of severe rectal bleeding (HIF8 SB/dl) Colonascopy showed severe recurrent CD with 3 large ulcers m the mmtomods, nm tezminal ikum and tmttsver~e colon. Bleeding subsided spontaneously. steroids and azatbioprine were started. Four months later tk patient complained recurrem bleeding (Hb=9g/dl) The endoscopic pmture was unchanged. The patient was Vealed with anti TNF a antibodies (Infliximab) 5 mg/kg at 0.2 and 6 weeks maintaining azathioprine 2 @kg/day At 4 weeks atIer the third Intliximab infusion a complete healing of the colonic ulcer and a near complete haling of the deal and Bnastomotic ulcers could be observed NO recurrent bleeding occurred during the following year Discussion Acute lower GI bleeding is a rare complication of CD occurring in 0 9-6% of cases. The fcqumcy of bleeding is higbsr in patients wth c&tic involvement and in 95% of cases the hemorrbane mimnates from colomc ulcers Akhowb UD to 50% of b&din= episodes subside sp~nta&usly, rccamence IS lugb, up to 25-3&o Surgical resect& should be recommended for patients with massive and bfe threating bleeding Several Conservative therapies have been attempted including endoscopic (laser coagulation, adrenalin imectian. bioalar coamdationl and mtelventional aneiomaohv Ivasoomssm infusion. e~boliz&o~) Anti ‘& a &bodies have been sh~~ttdp&ce &osal he&m patients wth active CD Achieving mucosal healing IS the most imponam goal to prevent recurrent bleeding considering that most bleeding episodes originate from severe mucosal lesions such as ulcers To our knowlege this is the first case of CD in which lnfliximab has been empoyed for this purpose

LONG-TERM BY FISTULAS

COURSE TREATED

OF PATIENTS WITH WITH INFLlXlMAB

G

L

A Orlando,

MarIoram,

Divisione Palem0

Oliva,

di Medicina

e Pneumologia

A Cash, Clinica

CROWS

M

Media

DISEASE

COMPLICATED

Cottone R Azienda

Ospedaliera

V

Cervello

Background Several studies have demonstrated the efficacy ofintliximab, an am-tumor necrosis fanor monoclonal antibody, in the treatment of patients (pts) with active Crohn ‘s disease (CD), with tistulas Few data are available on the long term course of fist&s after treatment Aim The aim ofthis ooen-label studv WBS to analvze the lmw-term course of a cohort of pts with CD complicated dy fistules t&d with intliimab Methods 27 pts with CD complicated by fismlas were selected for the treatment with intlidmab : lo with conwmit& active &tam CD and 17 with fist&s only @‘ianal or abdominal). 25 pts received at least three infusions of intliximab (5 “g/kg) at weeks (wks) 0, 2 and 6. while the other 2 ots did not comolete the scheduled infUsions Every patient was evaluated at wks 8,24 & and one year f;om first infusion with the Crohn ‘I Disease Activity Index (CDAl) and the P&anal Disease Activity Index (PDAI) to evaluate the ani& of the disease~attd of the pmimml manifestations, respectively Response was defined as the reduction of 50 percent or more fwm baseline in the number of draining fistulas or m the auantitv of drainane from the fistulas. remission as the closure of fist&w. R&s A; 8 wks from first infusion 5 l 8% of pts (1407 pts) had clinical response and 44.4% (IX27 ms) of them had remission. At ‘24 wks 42 3% of pts (1 l/26 pts) maintained clinical ;espon& hd 42 3% (1 l/26 pts) of them remission. 18 &ents had a follow-up of at least one year after first mtiaion among these pts, 6 were operated withm one year with following indications3 resistant disease, 1 abdominal abscess, 2 sub-occlusions Among those not operated on, 5O?/. (6112 pts) were m rermsaon, 25% (3112 pts) had a response and 25% (3/12 pts) were actively draining Candusions These data do not allow a firm conclusion on long term effectiveness of irdliximab in pts with CD complicated by fistulas

A85