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Impact of race and ethnicity on inflammatory bowel disease (IBD) in minority populations
S252
Abstracts
AJG – Vol. 97, No. 9, Suppl., 2002
767 MAGNIFICATION AND CHROMOENDOSCOPY IN THE DETECTION OF COLORECTAL NEOPLASIA IN PATIENTS WITH ULCERATIVE COLITIS Jeremy J. Schwartz, M.D., Julius J. Deren, M.D., F.A.C.P., Chinyu Su, M.D., James D. Lewis, M.D. and Gary R. Lichtenstein, M.D., FACG*. Department of Medicine, Division of Gastroenterology, University of Pennsylvania School of Medicine, Philadelphia, PA. Purpose: Endoscopic differentiation of neoplastic from non–neoplastic polyps and mucosa has limited success using standard endoscopic techniques in patients with ulcerative colitis (UC). This study sought to determine whether chromoendoscopy (CE) and magnification endoscopy (ME) can differentiate polyps and detect neoplasia in flat colorectal (CR) mucosa in UC patients undergoing surveillance for CR neoplasia. Methods: Patients with UC ⬎ 8 years duration undergoing surveillance colonoscopy for CR neoplasia were invited to participate in this prospective, blinded study. Demographics, duration and extent of UC, and other historical data were recorded. Colonoscopy was performed using the Olympus CFQ160ZL magnification (150X) colonoscope fitted with an Olympus D–201–16403 endoscopic cap for optimal imaging. Using an Olympus PW–5V–1 radial array spray catheter, 0.4% indigo carmine was applied, as a topographical chromo– enhancing agent, to flat mucosa in the right, transverse, left colon and rectum and to any polyps seen. These areas were then evaluated with ME. These areas were assessed, before and after CE and ME, for neoplastic potential (low, intermediate, high). For polyps, specific surface patterns were described. Biopsies were obtained from each of these areas and sent for histology as a gold–standard for assessing neoplastic potential. All patients underwent standard neoplasia surveillance with 4 quadrant biopsies every 10 cm. Results: 11 patients were enrolled. CE coupled with ME did not identify any neoplasia in flat mucosa. 10 polyps were seen: 6 pseudopolyps, 3 hyperplastic polyps, and 1 DALM lesion. On CE and ME, pseudopolyps had shiny, smooth, featureless appearances, hyperplastic polyps had very ordered, finely honeycombed features arrayed in 2 dimensions, and the DALM lesion had larger, highly disordered features growing in bizarre shapes arrayed in 3 dimensions. CE and ME correctly differentiated 10/10 polyps. Without CE and ME, these polyps could not be distinguished with absolute certainty. Conclusions: CE and ME are valuable in differentiating hyperplastic from pseudopolyps from DALM lesions in patients with UC. We did not identify neoplasia in flat CR mucosa using these techniques; however, this was a small trial evaluating limited surface areas. A larger trial applying CE and ME to greater mucosal surface is warranted. 768 IMPACT OF RACE AND ETHNICITY ON INFLAMMATORY BOWEL DISEASE (IBD) IN MINORITY POPULATIONS Joseph H. Sellin*, Ivelisee Lopez and Dhiman Basu. Division of Gastroenterology, University of Texas Medical School at Houston, Houston, TX. Purpose: To determine the impact of race and ethnicity on the type of IBD and its clinical characteristics. Methods: Using generally accepted clinical criteria, the diagnosis of Ulcerative Colitis(UC) or Crohn’s Disease(CD) was established. Clinical and laboratory parameters of consecutive Black and Hispanic patients with IBD from a single practice were compared to Caucasian patients in the same practice. Results: 32 Black, 22 Hispanic and 37 Caucasian patients were enrolled in the study. Blacks were overwhelmingly more likely to have CD (75%) while 90% of Hispanics were diagnosed with UC.
UC CD
Caucasians
Blacks
Hispanics
13 24
8 24
20 2
(Chi–square 24.232, p value less than 0.001)
Indeterminate colitis was the final diagnosis in 3 patients all of whom were Black. A family history of IBD was less common in Blacks and Hispanics than Caucasians. (p value ⫽0.012 by Chi–square test). Blacks with CD had a higher incidence of intestinal stricture, symptomatic intestinal obstruction, hair loss and eye manifestations but less incidence of joint problems compared to the Caucasians.There was no difference in the incidence of either fistulous disease or any other extraintestinal manifestations among the IBD patients in these minority population compared to the Caucasians. Despite a higher proportion of UC, Hispanics were less likely to smoke (p value⫽0.032 by Chi–square test ) or consume alcohol (p value⫽0.037 by Chi–square test ). We did not detect a notable difference in either serum ANCA or ASCA titres as a function of race or ethnicity although the numbers were relatively small. Rectal bleeding was more common in Hispanics probably reflecting the higher proportion with UC. An extremely exuberant pseudopolyposis was noted in several Hispanics with UC. Conclusions: Race and ethnicity have a significant impact on the type of IBD in minority population. Blacks are much more likely to have CD while Hispanics predominantly have UC. Clinical parameters of UC and CD may differ as a function of race and ethnicity.These differences may provide an important insight into the different etiologies of UC and CD.
769 ENHANCED BIOAVAILABILITY OF IMURAN THERAPY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A PHARMACOKINETIC EQUIVALENCY ANALYSIS Carmen Cuffari, M.D., Themos Dassopoulus, M.D., Lisa Turnbough, R.N., Richard Thompson, M.D. and Theodore Bayless, M.D.*. Pediatrics, The Johns Hopkins University, Baltimore, MD; Medicine, The Johns Hopkins University, Baltimore, MD; Medicine, The Johns Hopkins University, Baltimore, MD; Public Health, The Johns Hopkins University, Baltimore, MD and Medicine, The Johns Hopkins University, Baltimore, MD. Purpose: The immunosuppressive properties of 6 –mercaptopurine (6 – MP) and its parent compound azathioprine are mediated by its active 6 –thioguanine nucleotide (6 –TG) metabolites. Therapeutic responsiveness to antimetabolite therapy may in part be dependent on differences in bioavailability between generic and non– generic forms of azathioprine therapy (Aliment Pharmacol Ther 2000:14;1009). Aim: To perform a pharmacokinetic (PKA) bioequivalence analysis of several antimetabolite formulations in patients with IBD. Methods: Thirty–three consecutive patients with steroid dependent IBD (Crohn’s disease (CD), 25; ulcerative colitis (UC), 8) underwent induction antimetabolite therapy. Thiopurine methyl transferase (TPMT) enzyme activity, the key enzyme involved in AZA catabolism, was measured, as per Weinshilboum et al. (Clin Chem Acta 1978;85:323) and expressed as U/mL blood. A PKA was based on the measure of serial erythrocyte 6 –TG levels as measured by HPLC under UV detection (6 –TG, 340nm) over the 4 months observation period. Each patient was contacted by telephone so that the exact drug formulation could be determined for comparison. Results: Despite high TPMT activity levels, the Imuran treated patients achieved higher 6 –TG metabolite levels compared to those patients on non– generic forms of azathioprine. A conversion factor of 2.08 was used to establish a dose equivalency comparison between azathioprine and 6 –MP treated patients (Table). Conclusions: Imuran has improved bioavailability compared to 6 –mercaptopurine based on the measure of erythrocyte 6 –TG metabolite levels. The enhanced 6 –TG levels observed in patients on Imuran compared to generic azathioprine may influence clinical response in patients with IBD. Future controlled studies are needed to compare the clinical efficacy of these drug formulations.
Abstracts
AJG – Vol. 97, No. 9, Suppl., 2002
767 MAGNIFICATION AND CHROMOENDOSCOPY IN THE DETECTION OF COLORECTAL NEOPLASIA IN PATIENTS WITH ULCERATIVE COLITIS Jeremy J. Schwartz, M.D., Julius J. Deren, M.D., F.A.C.P., Chinyu Su, M.D., James D. Lewis, M.D. and Gary R. Lichtenstein, M.D., FACG*. Department of Medicine, Division of Gastroenterology, University of Pennsylvania School of Medicine, Philadelphia, PA. Purpose: Endoscopic differentiation of neoplastic from non–neoplastic polyps and mucosa has limited success using standard endoscopic techniques in patients with ulcerative colitis (UC). This study sought to determine whether chromoendoscopy (CE) and magnification endoscopy (ME) can differentiate polyps and detect neoplasia in flat colorectal (CR) mucosa in UC patients undergoing surveillance for CR neoplasia. Methods: Patients with UC ⬎ 8 years duration undergoing surveillance colonoscopy for CR neoplasia were invited to participate in this prospective, blinded study. Demographics, duration and extent of UC, and other historical data were recorded. Colonoscopy was performed using the Olympus CFQ160ZL magnification (150X) colonoscope fitted with an Olympus D–201–16403 endoscopic cap for optimal imaging. Using an Olympus PW–5V–1 radial array spray catheter, 0.4% indigo carmine was applied, as a topographical chromo– enhancing agent, to flat mucosa in the right, transverse, left colon and rectum and to any polyps seen. These areas were then evaluated with ME. These areas were assessed, before and after CE and ME, for neoplastic potential (low, intermediate, high). For polyps, specific surface patterns were described. Biopsies were obtained from each of these areas and sent for histology as a gold–standard for assessing neoplastic potential. All patients underwent standard neoplasia surveillance with 4 quadrant biopsies every 10 cm. Results: 11 patients were enrolled. CE coupled with ME did not identify any neoplasia in flat mucosa. 10 polyps were seen: 6 pseudopolyps, 3 hyperplastic polyps, and 1 DALM lesion. On CE and ME, pseudopolyps had shiny, smooth, featureless appearances, hyperplastic polyps had very ordered, finely honeycombed features arrayed in 2 dimensions, and the DALM lesion had larger, highly disordered features growing in bizarre shapes arrayed in 3 dimensions. CE and ME correctly differentiated 10/10 polyps. Without CE and ME, these polyps could not be distinguished with absolute certainty. Conclusions: CE and ME are valuable in differentiating hyperplastic from pseudopolyps from DALM lesions in patients with UC. We did not identify neoplasia in flat CR mucosa using these techniques; however, this was a small trial evaluating limited surface areas. A larger trial applying CE and ME to greater mucosal surface is warranted. 768 IMPACT OF RACE AND ETHNICITY ON INFLAMMATORY BOWEL DISEASE (IBD) IN MINORITY POPULATIONS Joseph H. Sellin*, Ivelisee Lopez and Dhiman Basu. Division of Gastroenterology, University of Texas Medical School at Houston, Houston, TX. Purpose: To determine the impact of race and ethnicity on the type of IBD and its clinical characteristics. Methods: Using generally accepted clinical criteria, the diagnosis of Ulcerative Colitis(UC) or Crohn’s Disease(CD) was established. Clinical and laboratory parameters of consecutive Black and Hispanic patients with IBD from a single practice were compared to Caucasian patients in the same practice. Results: 32 Black, 22 Hispanic and 37 Caucasian patients were enrolled in the study. Blacks were overwhelmingly more likely to have CD (75%) while 90% of Hispanics were diagnosed with UC.
UC CD
Caucasians
Blacks
Hispanics
13 24
8 24
20 2
(Chi–square 24.232, p value less than 0.001)
Indeterminate colitis was the final diagnosis in 3 patients all of whom were Black. A family history of IBD was less common in Blacks and Hispanics than Caucasians. (p value ⫽0.012 by Chi–square test). Blacks with CD had a higher incidence of intestinal stricture, symptomatic intestinal obstruction, hair loss and eye manifestations but less incidence of joint problems compared to the Caucasians.There was no difference in the incidence of either fistulous disease or any other extraintestinal manifestations among the IBD patients in these minority population compared to the Caucasians. Despite a higher proportion of UC, Hispanics were less likely to smoke (p value⫽0.032 by Chi–square test ) or consume alcohol (p value⫽0.037 by Chi–square test ). We did not detect a notable difference in either serum ANCA or ASCA titres as a function of race or ethnicity although the numbers were relatively small. Rectal bleeding was more common in Hispanics probably reflecting the higher proportion with UC. An extremely exuberant pseudopolyposis was noted in several Hispanics with UC. Conclusions: Race and ethnicity have a significant impact on the type of IBD in minority population. Blacks are much more likely to have CD while Hispanics predominantly have UC. Clinical parameters of UC and CD may differ as a function of race and ethnicity.These differences may provide an important insight into the different etiologies of UC and CD.
769 ENHANCED BIOAVAILABILITY OF IMURAN THERAPY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A PHARMACOKINETIC EQUIVALENCY ANALYSIS Carmen Cuffari, M.D., Themos Dassopoulus, M.D., Lisa Turnbough, R.N., Richard Thompson, M.D. and Theodore Bayless, M.D.*. Pediatrics, The Johns Hopkins University, Baltimore, MD; Medicine, The Johns Hopkins University, Baltimore, MD; Medicine, The Johns Hopkins University, Baltimore, MD; Public Health, The Johns Hopkins University, Baltimore, MD and Medicine, The Johns Hopkins University, Baltimore, MD. Purpose: The immunosuppressive properties of 6 –mercaptopurine (6 – MP) and its parent compound azathioprine are mediated by its active 6 –thioguanine nucleotide (6 –TG) metabolites. Therapeutic responsiveness to antimetabolite therapy may in part be dependent on differences in bioavailability between generic and non– generic forms of azathioprine therapy (Aliment Pharmacol Ther 2000:14;1009). Aim: To perform a pharmacokinetic (PKA) bioequivalence analysis of several antimetabolite formulations in patients with IBD. Methods: Thirty–three consecutive patients with steroid dependent IBD (Crohn’s disease (CD), 25; ulcerative colitis (UC), 8) underwent induction antimetabolite therapy. Thiopurine methyl transferase (TPMT) enzyme activity, the key enzyme involved in AZA catabolism, was measured, as per Weinshilboum et al. (Clin Chem Acta 1978;85:323) and expressed as U/mL blood. A PKA was based on the measure of serial erythrocyte 6 –TG levels as measured by HPLC under UV detection (6 –TG, 340nm) over the 4 months observation period. Each patient was contacted by telephone so that the exact drug formulation could be determined for comparison. Results: Despite high TPMT activity levels, the Imuran treated patients achieved higher 6 –TG metabolite levels compared to those patients on non– generic forms of azathioprine. A conversion factor of 2.08 was used to establish a dose equivalency comparison between azathioprine and 6 –MP treated patients (Table). Conclusions: Imuran has improved bioavailability compared to 6 –mercaptopurine based on the measure of erythrocyte 6 –TG metabolite levels. The enhanced 6 –TG levels observed in patients on Imuran compared to generic azathioprine may influence clinical response in patients with IBD. Future controlled studies are needed to compare the clinical efficacy of these drug formulations.