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Long-term impact of transmural healing on the clinical outcome of pediatric Crohn's disease
Abstracts / Digestive and Liver Disease 49(4S) (2017) e243–e286
P052 Vaccinations and immunization status in paediatric inflammatory bowel disease: Data from the VIP IBD study M. Martinelli 1,∗ , F.P. Giugliano 1 , C. Strisciuglio 2 , V. Urbonas 3 , D. Serban 4 , A. Banaszkiewicz 5 , A. Assa 6 , G. Veres 7 , T. Drskova 8 , I. Hojsak 9 , V.M. Navas Lopez 10 , C. Romano 11 , M. Sladek 12 , M. Aloi 13 , R. Kucinskiene 14 , A. Staiano 1 , E. Miele 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, University of Naples Luigi Vanvitelli, Italy 3 Vilnius University Clinic of Children’s Diseases, Vilnius, Lithuania 4 University of Medicine and Pharmacy Iuliu Hatieganu, Cluj–Napoca, Romania 5 Medical University of Warsaw, Paediatric Gastroenterology and Nutrition, Warsaw, Poland 6 Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Petach-Tikva, Israel 7 Semmelweis University, Budapest, Hungary 8 Charles University, Prague, Czech Republic 9 Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, Zagreb, Croatia 10 Hospital Materno Infantil, Pediatric Gastroenterology and Nutrition Unit, Malaga, Spain 11 Department of Pediatrics, University of Messina, Messina, Italy 12 Department of Pediatrics, Gastroenterology and Nutrition Jagiellonian University School of Medicine, Cracow, Poland 13 Department of Pediatrics, Sapienza University, Rome, Italy 14 Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania Background and aim: The prevention of vaccine preventable diseases (VPD) in children with inflammatory bowel disease (IBD) is an increasingly recognised issue. The aims of this study were to describe the compliance with the ESPGHAN recommendations published in June 2012 for vaccination and immunization status in IBD children and to evaluate differences among patients diagnosed before and after June 2012. Methods: Thirteen ESPGHAN IBD referral centers participated to the enrolment. Each center was asked to retrospectively collect data on the immunization status from children with IBD dignosed before and after June 2012. Results: A total of 430 IBD children were enrolled. Among these, 50.7% and 49.3% were respectively diagnosed before and after June 2012. At diagnosis, the percentages of completion for single vaccination evaluated were no different between the two groups. The main reasons for not vaccinating were: need for immediate immunosuppressive therapies (20.9%), parental refuse (6.7%), vaccination costs (1.9%) and other (44%). Among the 231 children starting azathioprine (AZA), EBV status was checked in 55 children (22%). AZA was started in 27 (11.3%) EBV naïve patients and 109 (45.9%) patients without knowing EBV status. Biological therapy was started in 202 (47%). Tubercolosis screening before starting
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biologics was practised in 189 patients (94%). None of the variables analysed was significantly different when comparing patients diagnosed before and after June 2012. Conclusions: Our data highlight a poor compliance with most of the current recommendations for VPD in IBD children, underlining the need for a greater widespread among physicians and patients. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.056 P053 Long-term impact of transmural healing on the clinical outcome of pediatric Crohn’s disease F. Civitelli 1,∗ , S. Oliva 1 , K. Cersosimo 1 , S. Mallardo 1 , M. Aloi 1 , F. Viola 1 , V. Nobili 2 , S. Cucchiara 1 1
UOC Gastroenterologia ed Epatologia Pediatrica, Sapienza Università di Roma, Italy 2 UOC Malattie Epato-Metaboliche, Ospedale Pediatrico Bambino Gesù, Roma, Italy Background and aims: Transmural healing (TH) is emerging as a new therapeutic goal in Crohn’s disease (CD). Biologic therapy induces clinical remission, mucosal healing (MH) and, in a lower rate of patients, also TH in pediatric CD. The aim of this study is to evaluate the impact of TH on the clinical course of pediatric CD after 24 and 36 months of biologic therapy. Patients and methods: Pediatric CD pts, naïve to biologics, starting biologic therapy with anti-TNF were enrolled (T0) and prospectively followed-up for 36 months. At T0, and after 12 (T1), 24 (T2), and 36 (T3) moths of therapy, clinical disease activity (PCDAI score), endoscopic activity (SES-CD) and transmural disease at ultrasonography (US) were evaluated. MH was defined as SES-CD of 0–1, TH as bowel wall thickness ≤3 mm and normalization of other US parameters. The rates of relapses, corticosteroids use, hospitalizations and surgery were recorded at T2 and T3. At T1 patients were subdivided into two groups: patients achieving MH alone (Group A) and patients with both MH and TH (Group B). The outcome of Group A and Group B were then compared at T2 and T3. Results: 48 pts were included (mean age 13 ± 3 years; 32 males). A complete TH at T1 was achieved in 8 (17%). Complete TH was associated with complete (62%) or partial (38%) MH. At T2 and T3, 46 and 33 patients still were on biologic therapy, respectively and the rates of TH were 20% and 24%, respectively. Group B patients were in clinical remission after 24 and 36 months of therapy, with significantly lower rates of relapses (p = 0.0002 at T2, p = 0.05 at T3) and lower need for surgery (p = 0.04 at T2; p = 0.01 at T3) compared to Group A. There was also a trend in lower rates of hospitalization (p = 0.06 at T2, p = 0.06 at T3) and corticosteroids use (p = 0.07 at T2 and p = 0.06 at T3). Conclusions: Biologic therapy induces TH in a small percentage of pediatric CD patients. The rate of TH increases with the duration of therapy. TH seems to be associated to a better clinical outcome by reducing the relapse and surgery rates. Larger study with a longer follow-up are required to evaluate the role of TH in modifying the natural history of pediatric CD. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.057
P052 Vaccinations and immunization status in paediatric inflammatory bowel disease: Data from the VIP IBD study M. Martinelli 1,∗ , F.P. Giugliano 1 , C. Strisciuglio 2 , V. Urbonas 3 , D. Serban 4 , A. Banaszkiewicz 5 , A. Assa 6 , G. Veres 7 , T. Drskova 8 , I. Hojsak 9 , V.M. Navas Lopez 10 , C. Romano 11 , M. Sladek 12 , M. Aloi 13 , R. Kucinskiene 14 , A. Staiano 1 , E. Miele 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, University of Naples Luigi Vanvitelli, Italy 3 Vilnius University Clinic of Children’s Diseases, Vilnius, Lithuania 4 University of Medicine and Pharmacy Iuliu Hatieganu, Cluj–Napoca, Romania 5 Medical University of Warsaw, Paediatric Gastroenterology and Nutrition, Warsaw, Poland 6 Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Petach-Tikva, Israel 7 Semmelweis University, Budapest, Hungary 8 Charles University, Prague, Czech Republic 9 Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, Zagreb, Croatia 10 Hospital Materno Infantil, Pediatric Gastroenterology and Nutrition Unit, Malaga, Spain 11 Department of Pediatrics, University of Messina, Messina, Italy 12 Department of Pediatrics, Gastroenterology and Nutrition Jagiellonian University School of Medicine, Cracow, Poland 13 Department of Pediatrics, Sapienza University, Rome, Italy 14 Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania Background and aim: The prevention of vaccine preventable diseases (VPD) in children with inflammatory bowel disease (IBD) is an increasingly recognised issue. The aims of this study were to describe the compliance with the ESPGHAN recommendations published in June 2012 for vaccination and immunization status in IBD children and to evaluate differences among patients diagnosed before and after June 2012. Methods: Thirteen ESPGHAN IBD referral centers participated to the enrolment. Each center was asked to retrospectively collect data on the immunization status from children with IBD dignosed before and after June 2012. Results: A total of 430 IBD children were enrolled. Among these, 50.7% and 49.3% were respectively diagnosed before and after June 2012. At diagnosis, the percentages of completion for single vaccination evaluated were no different between the two groups. The main reasons for not vaccinating were: need for immediate immunosuppressive therapies (20.9%), parental refuse (6.7%), vaccination costs (1.9%) and other (44%). Among the 231 children starting azathioprine (AZA), EBV status was checked in 55 children (22%). AZA was started in 27 (11.3%) EBV naïve patients and 109 (45.9%) patients without knowing EBV status. Biological therapy was started in 202 (47%). Tubercolosis screening before starting
e263
biologics was practised in 189 patients (94%). None of the variables analysed was significantly different when comparing patients diagnosed before and after June 2012. Conclusions: Our data highlight a poor compliance with most of the current recommendations for VPD in IBD children, underlining the need for a greater widespread among physicians and patients. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.056 P053 Long-term impact of transmural healing on the clinical outcome of pediatric Crohn’s disease F. Civitelli 1,∗ , S. Oliva 1 , K. Cersosimo 1 , S. Mallardo 1 , M. Aloi 1 , F. Viola 1 , V. Nobili 2 , S. Cucchiara 1 1
UOC Gastroenterologia ed Epatologia Pediatrica, Sapienza Università di Roma, Italy 2 UOC Malattie Epato-Metaboliche, Ospedale Pediatrico Bambino Gesù, Roma, Italy Background and aims: Transmural healing (TH) is emerging as a new therapeutic goal in Crohn’s disease (CD). Biologic therapy induces clinical remission, mucosal healing (MH) and, in a lower rate of patients, also TH in pediatric CD. The aim of this study is to evaluate the impact of TH on the clinical course of pediatric CD after 24 and 36 months of biologic therapy. Patients and methods: Pediatric CD pts, naïve to biologics, starting biologic therapy with anti-TNF were enrolled (T0) and prospectively followed-up for 36 months. At T0, and after 12 (T1), 24 (T2), and 36 (T3) moths of therapy, clinical disease activity (PCDAI score), endoscopic activity (SES-CD) and transmural disease at ultrasonography (US) were evaluated. MH was defined as SES-CD of 0–1, TH as bowel wall thickness ≤3 mm and normalization of other US parameters. The rates of relapses, corticosteroids use, hospitalizations and surgery were recorded at T2 and T3. At T1 patients were subdivided into two groups: patients achieving MH alone (Group A) and patients with both MH and TH (Group B). The outcome of Group A and Group B were then compared at T2 and T3. Results: 48 pts were included (mean age 13 ± 3 years; 32 males). A complete TH at T1 was achieved in 8 (17%). Complete TH was associated with complete (62%) or partial (38%) MH. At T2 and T3, 46 and 33 patients still were on biologic therapy, respectively and the rates of TH were 20% and 24%, respectively. Group B patients were in clinical remission after 24 and 36 months of therapy, with significantly lower rates of relapses (p = 0.0002 at T2, p = 0.05 at T3) and lower need for surgery (p = 0.04 at T2; p = 0.01 at T3) compared to Group A. There was also a trend in lower rates of hospitalization (p = 0.06 at T2, p = 0.06 at T3) and corticosteroids use (p = 0.07 at T2 and p = 0.06 at T3). Conclusions: Biologic therapy induces TH in a small percentage of pediatric CD patients. The rate of TH increases with the duration of therapy. TH seems to be associated to a better clinical outcome by reducing the relapse and surgery rates. Larger study with a longer follow-up are required to evaluate the role of TH in modifying the natural history of pediatric CD. Conflict of interest: None declared. http://dx.doi.org/10.1016/j.dld.2017.09.057