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Early onset inflammatory bowel diseases: Prevalence and clinical features
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Abstracts / Digestive and Liver Disease 49(4S) (2017) e243–e286
Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.042 P039 Early onset inflammatory bowel diseases: Prevalence and clinical features M.A. Catena ∗ , V. Dipasquale, S. Gramaglia, C. Romano Dip di Patologia umana dell’adulto e dell’età evolutiva G.Barresi Policlinico G.Martino Univ degli studi di Messina, Italy Inflammatory bowel disease (IBD) are diagnosed in 25% of cases in pediatric age, with onset before 10 years of age in 5% of cases (Early IBD, E-IBD). They have peculiar characteristics regarding the onset symptoms, clinical course and response to therapies. Genetic mutations (XIAP gene and IL-10 receptors A and B) and association with primitive immunodeficiency were identified. Aim of the study was to verify prevalence of early forms, disease characteristics and onset symptoms in a cohort of 150 patients with IBD between 2006 and 2016. Results: Prevalence of early onset forms was 11% (17 patients), median age at diagnosis was 3.43 years (range 0.8–5.9 years) with 10 males (58.8%) and 7 females (41.1%). Ulcerative colitis (UC) has been diagnosed in 70.5% (12 patients); 8 patients had pancolonic ulcerative colitis, 3 patients left colitis and 1 patient ulcerative proctitis. Crohn’s disease (CD) has been diagnosed in 17.6% (3 patients); 2 patients had ileocolonic involvement, 1 patient colic involvement. The onset symptoms were diarrhea (76.4%), bloody stools (88.2%), abdominal pain (11.7%), weight loss (11.7%), fever (11.7%), mouth cavity (5.8%). Patients were subjected to a study of the immune system (serum immunoglobulins and lymphocyte subpopulations) to exclude primitive immunodeficiency and to a study of IL10 receptors, FOXP3 and XIAP gene and chronic granulomatous disease mutations. Conclusions: Early onset IBD have a significant prevalence in pediatric age with aggressive clinical course and poor therapeutic response. The introduction of immunomodulatory drugs is earliest while surgical risk is higher than late-onset disease. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.043 P040 The role of inflammation in the endothelial dysfunction in a cohort of pediatric IBD patients M. Andreozzi 1,∗ , F. Giugliano 1 , C. Strisciuglio 2 , T. Strisciuglio 3 , E. Pirozzi 3 , P. Perrone Filardi 3 , E. Miele 1 , A. Staiano 1 1
Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Italy 2 Department of Woman, Child and General and Specialized Surgery, Second University of Naples Luigi Vanvitelli, Italy 3 Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Italy Background and aims: Chronic inflammation plays a central role in the etiology of endothelial damage. Endothelial dysfunction is the inability of the artery to dilate in response to an endothelial
stimulus. We assessed the endothelial dysfunction (ED) by measuring the reactive hyperemia index (RHI) and the flow-mediated dilation (FMD) in a cohort of pediatric patients affected by inflammatory bowel disease (IBD) and comparing these parameters to a group of healthy controls (HC). Methods: Forty-one patients were consecutive enrolled. ED was evaluated by both the plethysmographic RHI method and the measurement of the FMD of brachial artery after occlusion of the blood flow. Differences between patients and controls were assessed by the Mann–Whitney test. In each IBD patient, the main inflammation markers were detected and correlated to RHI and FMD by a linear regression test. Results: We enrolled 23 (56%) IBD patients and 18 (44%) HC. When comparing FMD value at diagnosis it was significantly lower in IBD patients than in HC (p = 0.05). This result was confirmed at follow-up, when this difference became even more significant (p = 0.003). A significant indirect correlation was found between FMD and fecal calprotectin (r2 : 0.17; p = 0.04). No differences were found when comparing RHI. Conclusions: Our results show how inflammation could lead to endothelial dysfunction assessed by ultrasound flow-mediated dilation (FMD). These data were not confirmed by RHI, however this could be due to the lack of a standardized pediatric cut-off. More studies are necessary to confirm our data. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.044 P041 Varicella infection after the first dose of infliximab in a partially-vaccinated 13-year-old boy with Crohn’s disease: A case report E. Farinelli ∗ , A. Brusaferro, L. Zenzeri, G.F. Cappello, R. Cozzali, S. Esposito Pediatric Clinic, Dep. of Surg. and Biom. Sciences, Università degli Studi di Perugia, Perugia, Italy Children with inflammatory bowel disease (IBD) and other autoimmune conditions treated with chronic immunosuppressive therapy and particularly with anti-tumor necrosis factor (TNF)a agents (i.e., infliximab or adalimumab) are exposed to the risk of severe infectious diseases. Therefore, immunization prior to the start of the anti-TNFa treatment is strongly recommended to minimize the risk of vaccine-preventable infections. We present the case of a 13-year-old boy with recent diagnosis of Crohn’s disease, vaccinated for varicella with one single dose at the age of 6 years, who developed acute varicella infection five days after receiving the first dose of infliximab (5 mg/kg/day). The infection was promptly diagnosed and immediately treated with i.v. acyclovir. The child finally developed an infection of moderate severity, confined to the skin, with low grade fever, that resolved completely in one week, confirmed by positive serum VZV-IgM. The Varicella-Zoster Virus (VZV)-IgG serum levels collected before the beginning of infliximab resulted at 20.7 mIU/mL and were not indicative of protection. VZVIgG serum levels were also checked soon after the discharge and resulted at >4000 mIU/mL. Conclusions: One single dose of varicella vaccine does not guarantee protection against VZV infection; we strongly recommend to check adequate level of VZV-IgG and perhaps repeat a dose of vaccine prior to the beginning of an immunosuppressive therapy. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.045
Abstracts / Digestive and Liver Disease 49(4S) (2017) e243–e286
Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.042 P039 Early onset inflammatory bowel diseases: Prevalence and clinical features M.A. Catena ∗ , V. Dipasquale, S. Gramaglia, C. Romano Dip di Patologia umana dell’adulto e dell’età evolutiva G.Barresi Policlinico G.Martino Univ degli studi di Messina, Italy Inflammatory bowel disease (IBD) are diagnosed in 25% of cases in pediatric age, with onset before 10 years of age in 5% of cases (Early IBD, E-IBD). They have peculiar characteristics regarding the onset symptoms, clinical course and response to therapies. Genetic mutations (XIAP gene and IL-10 receptors A and B) and association with primitive immunodeficiency were identified. Aim of the study was to verify prevalence of early forms, disease characteristics and onset symptoms in a cohort of 150 patients with IBD between 2006 and 2016. Results: Prevalence of early onset forms was 11% (17 patients), median age at diagnosis was 3.43 years (range 0.8–5.9 years) with 10 males (58.8%) and 7 females (41.1%). Ulcerative colitis (UC) has been diagnosed in 70.5% (12 patients); 8 patients had pancolonic ulcerative colitis, 3 patients left colitis and 1 patient ulcerative proctitis. Crohn’s disease (CD) has been diagnosed in 17.6% (3 patients); 2 patients had ileocolonic involvement, 1 patient colic involvement. The onset symptoms were diarrhea (76.4%), bloody stools (88.2%), abdominal pain (11.7%), weight loss (11.7%), fever (11.7%), mouth cavity (5.8%). Patients were subjected to a study of the immune system (serum immunoglobulins and lymphocyte subpopulations) to exclude primitive immunodeficiency and to a study of IL10 receptors, FOXP3 and XIAP gene and chronic granulomatous disease mutations. Conclusions: Early onset IBD have a significant prevalence in pediatric age with aggressive clinical course and poor therapeutic response. The introduction of immunomodulatory drugs is earliest while surgical risk is higher than late-onset disease. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.043 P040 The role of inflammation in the endothelial dysfunction in a cohort of pediatric IBD patients M. Andreozzi 1,∗ , F. Giugliano 1 , C. Strisciuglio 2 , T. Strisciuglio 3 , E. Pirozzi 3 , P. Perrone Filardi 3 , E. Miele 1 , A. Staiano 1 1
Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Italy 2 Department of Woman, Child and General and Specialized Surgery, Second University of Naples Luigi Vanvitelli, Italy 3 Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Italy Background and aims: Chronic inflammation plays a central role in the etiology of endothelial damage. Endothelial dysfunction is the inability of the artery to dilate in response to an endothelial
stimulus. We assessed the endothelial dysfunction (ED) by measuring the reactive hyperemia index (RHI) and the flow-mediated dilation (FMD) in a cohort of pediatric patients affected by inflammatory bowel disease (IBD) and comparing these parameters to a group of healthy controls (HC). Methods: Forty-one patients were consecutive enrolled. ED was evaluated by both the plethysmographic RHI method and the measurement of the FMD of brachial artery after occlusion of the blood flow. Differences between patients and controls were assessed by the Mann–Whitney test. In each IBD patient, the main inflammation markers were detected and correlated to RHI and FMD by a linear regression test. Results: We enrolled 23 (56%) IBD patients and 18 (44%) HC. When comparing FMD value at diagnosis it was significantly lower in IBD patients than in HC (p = 0.05). This result was confirmed at follow-up, when this difference became even more significant (p = 0.003). A significant indirect correlation was found between FMD and fecal calprotectin (r2 : 0.17; p = 0.04). No differences were found when comparing RHI. Conclusions: Our results show how inflammation could lead to endothelial dysfunction assessed by ultrasound flow-mediated dilation (FMD). These data were not confirmed by RHI, however this could be due to the lack of a standardized pediatric cut-off. More studies are necessary to confirm our data. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.044 P041 Varicella infection after the first dose of infliximab in a partially-vaccinated 13-year-old boy with Crohn’s disease: A case report E. Farinelli ∗ , A. Brusaferro, L. Zenzeri, G.F. Cappello, R. Cozzali, S. Esposito Pediatric Clinic, Dep. of Surg. and Biom. Sciences, Università degli Studi di Perugia, Perugia, Italy Children with inflammatory bowel disease (IBD) and other autoimmune conditions treated with chronic immunosuppressive therapy and particularly with anti-tumor necrosis factor (TNF)a agents (i.e., infliximab or adalimumab) are exposed to the risk of severe infectious diseases. Therefore, immunization prior to the start of the anti-TNFa treatment is strongly recommended to minimize the risk of vaccine-preventable infections. We present the case of a 13-year-old boy with recent diagnosis of Crohn’s disease, vaccinated for varicella with one single dose at the age of 6 years, who developed acute varicella infection five days after receiving the first dose of infliximab (5 mg/kg/day). The infection was promptly diagnosed and immediately treated with i.v. acyclovir. The child finally developed an infection of moderate severity, confined to the skin, with low grade fever, that resolved completely in one week, confirmed by positive serum VZV-IgM. The Varicella-Zoster Virus (VZV)-IgG serum levels collected before the beginning of infliximab resulted at 20.7 mIU/mL and were not indicative of protection. VZVIgG serum levels were also checked soon after the discharge and resulted at >4000 mIU/mL. Conclusions: One single dose of varicella vaccine does not guarantee protection against VZV infection; we strongly recommend to check adequate level of VZV-IgG and perhaps repeat a dose of vaccine prior to the beginning of an immunosuppressive therapy. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.045