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Comparison of colonoscopy and magnetic resonance imaging in active Crohn disease
AGAA1369
April 2000
54 wks, serious adverse events were reported in 21% pbo vs 17% infliximab and serious infections in 8% pbo vs 6% infliximab. Three of 86 pbo pts (3.5%) died compared with 5 of 342 infliximab pts (1.5%). Infusion reactions occurred infrequently (-2% pbo, - 5% infliximab), were generally mild and transient, and did not increase over time. No serious infusion reactions were reported. One case of lymphoma and I possible case of drug-induced lupus (mild and reversible) occurred among infliximabtreated pts. Assessment of jo int damage by x-ray at 54 wks showed 7-8% progression in pbo compared to 0% in infliximab pts (p
6227 PATIENT PERCEPTION AND PREFERENCE FOR DIAGNOSTIC TESTS OF INTESTINAL INFLAMMATION. Alan Schwarz, Dan Pavel, Univ of Illinois at Chicago, Chicago, IL. Background;The radiolabled white cell scan has been shown to be an accurate method of detecting intestinal inflammation. Its usefulness is further assessed by determining what diagnostic tests individuals might prefer in the diagnosis of inflammatory bowel disease. Method;Two survey groups are included in this study: one with IBD which has experienced all of the diagnostic tests in question, and one which has experienced none of them (naive group). A questionnare was administered describing the preparation and performance of colonoscopy (C), barium enema (B) and technitium labled white cell scan (WCS), then asking the above subjects which test they would prefer. In addition to preference, subjects were asked to rank the tests according to perceived pain, embarrassemnt, inconvenience and danger. Results;Both Groups had significantly greater preference for WCS than either C or B (p< O.OI by Wilcoxon signed rank tests). Ranks were similar for discomfort, embarrassment, inconvenience and danger except that the naive group expected C to be significantly more painful and embarrassing than B. WCS was perceived as more inconvenient than C but less inconvenient than B in the IBD group. Conclusion; The usefullness of the WCS in the diagnosis of IBD is further established by its perceived advantages over other methods by both IBD patients and healthy individuals. Mean Rank Order (Lower is Preferred)
WCS Colonoscopy Barium Enema
IBO Group
Naive Group
2.46 4.20 4.28
2.51 5.59 3.82
6228 MODIFICATION OF INTRACELLULAR CYTOKINES BY ANTICD4 ANTffiODIES IN CROHN'S DISEASE. Yvonne Schwitalle, Ruediger Laub, Ulrike Melle, Frank Emmrich, Stefan Liebe, Joerg Emrnrich, Inst of Clin Immunology, Univ Leipzig, Leipzig, Germany; Dept of Internal Medicine, Univ Rostock, Rostock, Germany. It was suggested that Crohn's disease (CD) is characterized by a predominance of a TH I-like functional phenotype of T cells. Anti-CD4 antibodies were successfully used for tbe therapy of CD. Here, we present modification of cytokine production by peripheral and lamina propria T cells caused by anti-CD4 antibodies at the single cell level. Methods: The study included patients with CD (n= 10) as well as healthy controls (n= 12). Peripheral blood lymphocytes (PBMC) were isolated by density gradient centrifugation. Lamina propria lymphocytes (LPL) were obtained using collagenase digestion of colon biopsies. T lymphocytes were stimulated with PHA/Ionomycin in the presence of protein transport inhibitors to allow intracellular cytokine accumulation. After 20h cells were fixed, permeabilized and stained for IFNy, IL-2 and TNFo: as typical THIcytokines, and IL-4, IL- IO and IL-6, representing the specific TH2 response. Semiquantitative comparison of cytokine expression was performed based on fluorescence intensities (MFI) assessed by flow cytometry. Results:LPL from CD patients displayed significantly increased
expression of IL-2, IFNy and TNFo: compared to healthy controls. In PBMC, only TNFo: levels were increased in comparison to controls. Anti-CD4 antibodies were able to significantly reduce the expression of IFNy and TNFa in LPL accompanied by an elevation of IL-4. In addition, IL-2 was diminished in PBMC after incubation with anti-CD4 antibodies. Conclusion: The inflammatory response of lymphocytes in CD is mediated by THI related cytokines. This reaction can be switched to a TH2 type reaction using anti-CD4 antibodies.
6229 COMPARISON OF COLONOSCOPY AND MAGNETIC RESONANCE IMAGING IN ACTIVE CROHN DISEASE. Javier Sempere, Enrique Medina, Vicente Martinez, Adolfo Benages, Alicia Tome, Antonio Tuset, Luis Ferrer, Maria Rios, Maria Martinez, HOSP Gen Univ, Valencia, VA, Spain; H CLINICO Univ, Valencia, Spain. Chronic inflammatory bowel diseases (IBD) are characterized by intermittent relapses and remision periods.Furthermore, Crohn disease (CD) can be complicated by abscesses and fistulae.In clinical decision making an accurate asessment of disease activity, extension and complications with minimal disconfort and hazard is essential. Evaluation of disease extension and activity frequently remains problematic due to lack of consistency in findings by different modaiities.MRI non invasively evaluates localization, extension, and grade of inflammation, including assesment of the full wall thickness and potencial extraenteric disease processes such as abscesses and fistulae. Tha aim of this preliminar study is to evaluate the use of low field MRI for the assesment of disease extension and activity in Crohn disease comparing the findings of MRI with colonoscopy. MATERIALS AND METHODS Nine patiens with CD ( 4 men, 5 women ; median age 34.5) with high activity score (CDAI > ISO) were examined using colonoscopy and MRI. MRI studies were conducted in transverse and coronal planes before and after an intravenously administred bolus of gadolinium.Activity was considered if an increase of signal intensity after administration of gadolinium on TI -weighted images were produced. Colonoscopy was carried out in the usual manner and assessment was made by experienced endoscopists. To compare the results of both technics, colon and ileum were divided is segments as following: I.-Rectumsigma. 2.- Left colon. 3.- Transversum.4.- ascendent colon. 5.- cecum and terminal ileum. Endoscopic findings for each segment were graded as active or normal. RESULTS: A total of 30 segments was finaly compared regarding to presence of absence of activity In 24 segments (80%),there was correlation between endoscopic and MRI findings. In 6 semgents (20%) there was lack of correlation. CONCLUSION: MRI seems a promising non-invasive, non radiating method in the evaluation of Crohn disease.
6230 SURGERY IS ASSOCIATED WITH FLUCTUATIONS IN ASCA LEVELS SUGGESTING ANTIGENIC STIMULATION. Boualem Sendid, Severine Vermeire, Michel Cassagnou, Sofie Joossens, Francois Collet, p. Quandalle, Daniel Poulain, Marc Peeters, Paul Rutgeerts, Jean-Frederic Colombel, CHRU lille, Lille, France; Univ hospitals Gasthuisberg, Leuven, Belgium. Introduction: ASCA have been described as associated with CD but their long term evolution is unknown. The aim of this study was to follow up ASCA levels in patients undergoing surgery for CD. Methods : Serum samples were collected prospectively in 30 patients operated on for CD. Samples were available the day before (day-I)(n = 30) and the day after (day l)( n=30) surgery and at day 7 (n =30), monthl (MI)(n=20), M2-M3 (n= 16) and M6 (n= ll).Measurement of ASCA was performed using ELISA. Results : Before surgery 21 patients (70%) were ASCA positive and 9 (30%) were ASCA negative. ASCA status remains stable in 19/30 patients after surgery. Among ASCA positive patients, 15n l remained ASCA positive throughout the study: 5/21 became ASCA negative at day I but 4/5 became again ASCA positive at day 7. Five out of 9 ASCA negative patients became ASCA positive between day 7 and M6. Analysis of ASCA levels revealed significant kinetic variations with a decrease in 83% of patients the day after surgery which was generally followed by a secondary raise leading to values higher than those observed before surgery. ASCA levels significantly decreased between day - 1 and day I (p =0.OOI2) , were not different between day - 1 and day 7 and significantly increased between day I and MI (p
April 2000
54 wks, serious adverse events were reported in 21% pbo vs 17% infliximab and serious infections in 8% pbo vs 6% infliximab. Three of 86 pbo pts (3.5%) died compared with 5 of 342 infliximab pts (1.5%). Infusion reactions occurred infrequently (-2% pbo, - 5% infliximab), were generally mild and transient, and did not increase over time. No serious infusion reactions were reported. One case of lymphoma and I possible case of drug-induced lupus (mild and reversible) occurred among infliximabtreated pts. Assessment of jo int damage by x-ray at 54 wks showed 7-8% progression in pbo compared to 0% in infliximab pts (p
6227 PATIENT PERCEPTION AND PREFERENCE FOR DIAGNOSTIC TESTS OF INTESTINAL INFLAMMATION. Alan Schwarz, Dan Pavel, Univ of Illinois at Chicago, Chicago, IL. Background;The radiolabled white cell scan has been shown to be an accurate method of detecting intestinal inflammation. Its usefulness is further assessed by determining what diagnostic tests individuals might prefer in the diagnosis of inflammatory bowel disease. Method;Two survey groups are included in this study: one with IBD which has experienced all of the diagnostic tests in question, and one which has experienced none of them (naive group). A questionnare was administered describing the preparation and performance of colonoscopy (C), barium enema (B) and technitium labled white cell scan (WCS), then asking the above subjects which test they would prefer. In addition to preference, subjects were asked to rank the tests according to perceived pain, embarrassemnt, inconvenience and danger. Results;Both Groups had significantly greater preference for WCS than either C or B (p< O.OI by Wilcoxon signed rank tests). Ranks were similar for discomfort, embarrassment, inconvenience and danger except that the naive group expected C to be significantly more painful and embarrassing than B. WCS was perceived as more inconvenient than C but less inconvenient than B in the IBD group. Conclusion; The usefullness of the WCS in the diagnosis of IBD is further established by its perceived advantages over other methods by both IBD patients and healthy individuals. Mean Rank Order (Lower is Preferred)
WCS Colonoscopy Barium Enema
IBO Group
Naive Group
2.46 4.20 4.28
2.51 5.59 3.82
6228 MODIFICATION OF INTRACELLULAR CYTOKINES BY ANTICD4 ANTffiODIES IN CROHN'S DISEASE. Yvonne Schwitalle, Ruediger Laub, Ulrike Melle, Frank Emmrich, Stefan Liebe, Joerg Emrnrich, Inst of Clin Immunology, Univ Leipzig, Leipzig, Germany; Dept of Internal Medicine, Univ Rostock, Rostock, Germany. It was suggested that Crohn's disease (CD) is characterized by a predominance of a TH I-like functional phenotype of T cells. Anti-CD4 antibodies were successfully used for tbe therapy of CD. Here, we present modification of cytokine production by peripheral and lamina propria T cells caused by anti-CD4 antibodies at the single cell level. Methods: The study included patients with CD (n= 10) as well as healthy controls (n= 12). Peripheral blood lymphocytes (PBMC) were isolated by density gradient centrifugation. Lamina propria lymphocytes (LPL) were obtained using collagenase digestion of colon biopsies. T lymphocytes were stimulated with PHA/Ionomycin in the presence of protein transport inhibitors to allow intracellular cytokine accumulation. After 20h cells were fixed, permeabilized and stained for IFNy, IL-2 and TNFo: as typical THIcytokines, and IL-4, IL- IO and IL-6, representing the specific TH2 response. Semiquantitative comparison of cytokine expression was performed based on fluorescence intensities (MFI) assessed by flow cytometry. Results:LPL from CD patients displayed significantly increased
expression of IL-2, IFNy and TNFo: compared to healthy controls. In PBMC, only TNFo: levels were increased in comparison to controls. Anti-CD4 antibodies were able to significantly reduce the expression of IFNy and TNFa in LPL accompanied by an elevation of IL-4. In addition, IL-2 was diminished in PBMC after incubation with anti-CD4 antibodies. Conclusion: The inflammatory response of lymphocytes in CD is mediated by THI related cytokines. This reaction can be switched to a TH2 type reaction using anti-CD4 antibodies.
6229 COMPARISON OF COLONOSCOPY AND MAGNETIC RESONANCE IMAGING IN ACTIVE CROHN DISEASE. Javier Sempere, Enrique Medina, Vicente Martinez, Adolfo Benages, Alicia Tome, Antonio Tuset, Luis Ferrer, Maria Rios, Maria Martinez, HOSP Gen Univ, Valencia, VA, Spain; H CLINICO Univ, Valencia, Spain. Chronic inflammatory bowel diseases (IBD) are characterized by intermittent relapses and remision periods.Furthermore, Crohn disease (CD) can be complicated by abscesses and fistulae.In clinical decision making an accurate asessment of disease activity, extension and complications with minimal disconfort and hazard is essential. Evaluation of disease extension and activity frequently remains problematic due to lack of consistency in findings by different modaiities.MRI non invasively evaluates localization, extension, and grade of inflammation, including assesment of the full wall thickness and potencial extraenteric disease processes such as abscesses and fistulae. Tha aim of this preliminar study is to evaluate the use of low field MRI for the assesment of disease extension and activity in Crohn disease comparing the findings of MRI with colonoscopy. MATERIALS AND METHODS Nine patiens with CD ( 4 men, 5 women ; median age 34.5) with high activity score (CDAI > ISO) were examined using colonoscopy and MRI. MRI studies were conducted in transverse and coronal planes before and after an intravenously administred bolus of gadolinium.Activity was considered if an increase of signal intensity after administration of gadolinium on TI -weighted images were produced. Colonoscopy was carried out in the usual manner and assessment was made by experienced endoscopists. To compare the results of both technics, colon and ileum were divided is segments as following: I.-Rectumsigma. 2.- Left colon. 3.- Transversum.4.- ascendent colon. 5.- cecum and terminal ileum. Endoscopic findings for each segment were graded as active or normal. RESULTS: A total of 30 segments was finaly compared regarding to presence of absence of activity In 24 segments (80%),there was correlation between endoscopic and MRI findings. In 6 semgents (20%) there was lack of correlation. CONCLUSION: MRI seems a promising non-invasive, non radiating method in the evaluation of Crohn disease.
6230 SURGERY IS ASSOCIATED WITH FLUCTUATIONS IN ASCA LEVELS SUGGESTING ANTIGENIC STIMULATION. Boualem Sendid, Severine Vermeire, Michel Cassagnou, Sofie Joossens, Francois Collet, p. Quandalle, Daniel Poulain, Marc Peeters, Paul Rutgeerts, Jean-Frederic Colombel, CHRU lille, Lille, France; Univ hospitals Gasthuisberg, Leuven, Belgium. Introduction: ASCA have been described as associated with CD but their long term evolution is unknown. The aim of this study was to follow up ASCA levels in patients undergoing surgery for CD. Methods : Serum samples were collected prospectively in 30 patients operated on for CD. Samples were available the day before (day-I)(n = 30) and the day after (day l)( n=30) surgery and at day 7 (n =30), monthl (MI)(n=20), M2-M3 (n= 16) and M6 (n= ll).Measurement of ASCA was performed using ELISA. Results : Before surgery 21 patients (70%) were ASCA positive and 9 (30%) were ASCA negative. ASCA status remains stable in 19/30 patients after surgery. Among ASCA positive patients, 15n l remained ASCA positive throughout the study: 5/21 became ASCA negative at day I but 4/5 became again ASCA positive at day 7. Five out of 9 ASCA negative patients became ASCA positive between day 7 and M6. Analysis of ASCA levels revealed significant kinetic variations with a decrease in 83% of patients the day after surgery which was generally followed by a secondary raise leading to values higher than those observed before surgery. ASCA levels significantly decreased between day - 1 and day I (p =0.OOI2) , were not different between day - 1 and day 7 and significantly increased between day I and MI (p