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OC.10.6 PROGNOSTICATING COELIAC PATIENTS SURVIVAL: THE PROCONSUL SCORE
S78
Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220
OC.10.5 CLUSTER OF ENTEROPATHIES NEGATIVE FOR COELIAC DISEASE GENETICS BUT CARRYING HLA DQ6 P.I. Bianchi ∗ ,1 , F. Biagi 1 , C. Badulli 2 , A. Marchese 1 , M. Martinetti 2 , G.R. Corazza 1 1 Coeliac Centre/first Department of Internal Medicine, Fondazione Irccs Policlinico San Matteo, University of Pavia, Pavia, Italy; 2 Immunohematology and Transfusion Centre, Fondazione Irccs Policlinico San Matteo, Pavia, Italy
Background and aim: Genetic susceptibility to coeliac disease (CD) is strongly associated with HLA DQA1*05-DQB1*02 (DQ2) and HLA DQA1*03DQB1*0302 (DQ8) and a gene-dosage effect of DQB1*02 was shown. Nevertheless, rare cases of patients negative for both patterns were described. Our aim was to look for patients with a flat duodenal biopsy but negative DQ2/DQ8. Material and methods: Among all the patients attending our Clinic from Jan 1999 to Oct 2011, we selected those with a villous atrophy and negative to HLA DQB1*02/*0302. Clinical features, coeliac antibodies and response to gluten-free diet (GFD) were also collected. Results: Among 243 patients with villous atrophy and available HLA-type, there were 9 patients who did not carry either HLA DQB1*02/*0302. They had received the following diagnoses: 3 non-complicated CD, 1 CD complicated by intestinal lymphoma, 3 enteropathy in common variable immunodeficiency (1 sustained by Giardia), 2 undeterminated sprue. Three of them have a very similar HLA pattern (A*03; DRB1*11; DQA1*0102,*0505; DQB1*0301,*06). They all presented with chronic diarrhoea, weight loss, electrolyte malabsorption and hypoproteinemia. They were all negative for coeliac-specific and enterocyte antibodies, immunoglobulin deficiency, HIV serology, stool parasite infestation, familial history of gastroenterologic diseases. Mucosal monomorphic lymphocyte infiltrate and monoclonal rearrangement of T-cell receptor was excluded in all the intestinal biopsies. Moreover, case 1 (female, 29 years-old) presented a complete clinical and histological response after 12 months on a GFD and was considered coeliac. Case 2 (male, 33 years-old) after 91 months of strict GFD, still demonstrated subtotal villous atrophy, but stable clinical conditions in the last four years. He was considered to be affected by underterminated sprue and started budesonide therapy. Case 3 (male, 56 years-old) started a GFD for one month without any clinical improvement. Then he also started steroids and will be re-evaluated in the next months. Conclusions: We described 3 cases of uncommon enteropathy negative for both coeliac serology and genetics, who share HLA-type. They have a similar clinical presentation but only one of them responded to GFD. However the other two patients who have a persistent villous atrophy show an unexpected favourable clinical evolution.
OC.10.6 PROGNOSTICATING COELIAC PATIENTS SURVIVAL: THE PROCONSUL SCORE F. Biagi ∗ ,1 , A. Schiepatti 1 , A. Marchese 1 , G. Malamut 2 , C. Cellier 2 , S. Bakker 3 , C. Mulder 3 , U. Volta 4 , F. Zingone 5 , C. Ciacci 6 , A. D’Odorico 7 , A. Andrealli 8 , M. Astegiano 8 , C. Klersy 1 , G.R. Corazza 1 1 Universita’ di Pavia, Pavia, Italy; 2 Hopital Europeen Pompidou, Paris, France; 3 University Medical Center, Amsterdam, Netherlands; 4 Università di Bologna, Bologna, Italy; 5 Università di Napoli, Napoli, Italy; 6 Università di Salerno, Salerno, Italy; 7 Università di Padova, Padova, Italy; 8 Università di Torino, Torino, Italy
Background and aim: Coeliac disease (CD) is a very frequent chronic enteropathy characterized by an increased mortality caused by its complications, i.e. refractory CD and small bowel lymphoma. It was shown that age at diagnosis of CD, diagnostic delay for CD, pattern of clinical presentation and HLA typing correlate with mortality rates of coeliac patients. Aims: To create a tool that individuates those coeliac patients at higher risk of developing complications. To set up the follow up of coeliac patients according to the specific risk of complications.
Material and methods: Thanks to Fondazione Associazione Italiana Celiachia and Coeliac Common Interest Group, clinical data from 106 patients (68 F, mean age 53±14 yrs at enrolment) affected by complicated CD (i.e. cases) were collected. To set up a multicenter matched case-control study, 171 controls (110 F, mean age 55±13 yrs at enrolment) were selected among coeliac patients without complications. For each case, two (or at least one) controls, matched to cases according to the year of assessment, gender and age, were selected. Diagnostic delay, pattern of clinical presentation, HLA typing and age at diagnosis of CD were used as predictors. Results: Differences between cases and controls were shown for diagnostic delay (median 9 months, IQR 3-27, vs. 19 months, IQR 6-84, p=0.025), classical presentation (75/105 vs. 71/171, Chi2 p<0.001), and HLA DQ2 positivity (96% vs. 85%, p=0.025). Age at diagnosis did not differ between cases and controls. Conditional logistic models based on these statistically different predictors allowed the development of a score system. Tertiles analysis showed a relationship between score and risk of being a case (Chi2, p<0.001). Conclusions: A score that shows the risk of a newly diagnosed coeliac patient to develop complications was developed for the first time. This will allow to set up the follow up of CD patients with great benefits for not only their health but also management of economic resources.
OC.11.1 PRELIMINARY RESULTS ON THE COMPARISON OF LOOP-TIP COOK MEDICAL® WIRE VS TRADITIONAL CANNULATION TECHNIQUE IN THE PREVENTION OF POST-ERCP PANCREATITIS AND BILIARY TREE ACCESS IN HIGH-RISK PATIENTS B. Mangiavillano ∗ ,1 , M. Mangano 2 , E. Limido 3 , G. Bernasconi 3 , G. Spinzi 4 , V. Terruzzi 4 , A. Mariani 5 , P.A. Testoni 5 , G. Manes 6 , C. Paolo 7 , E. Morandi 1 , E. Masci 1 1 Gastrointestinal Endoscopy; Azienda Ospedaliera San Paolo - Universitary Hospital – University of Milan, Milan, Italy; 2 Ospedale Legnano, Legnano, Italy; 3 Unit of Digestive Endoscopy; Busto Arsizio Hospital, Varese, Italy; 4 Unit of Digestive Endoscopy; Valduce Hospital, Como, Italy; 5 Gastroenterology; Vita-Salute Irccs San Raffaele Hospital, Milan, Italy; 6 Unit of Digestive Endoscopy; Sacco Hospital, Milan, Italy; 7 Digestive Endoscopy; Abbiategrasso Hospital, Abbiategrasso - Milan, Italy
Background and aim: Selective cannulation of common bile duct (CBD) by insertion of a guide-wire seems to be associated with fewer complications and post-ERCP pancreatitis (PEP) rate than the conventional biliary tree access with contrast injection. The aim of our study is to test a new guide-wire with a loop in the tip for the prevention of PEP and biliary tree access in high-risk patients. Material and methods: Prospective, randomized, multicenter study. 134 PEP high-risk patients prospectively enrolled and divided in two groups. Inclusion criteria were: previous pancreatitis; CBD diameter <1cm; sphincter of Oddi type-1 dysfunction (SOD1); age<40yrs; female sex associated with another risk factors. In group 1 biliary tree cannulation was obtained with the loop-tip; in group 2 with the traditional technique. The cannulation attempt were composed of two phases with 5 minutes attempts or a maximum of 5 attempts of main pancreatic duct (MPD) cannulation. If there was no CBD cannulation after phase 2 we declared the “technical failure”. After phase 2 the endoscopists decided if stop or continue the ERCP. Serum amylases were dosed before and 24h after ERCP. Results: Group 1 (66pts) and Group 2 (68pts) were matched for sex (39F;27M vs 43F;25M) and age (64.6±15.3 vs 65.2±17.4yrs). Technical success at the end of phase1 was higher in group 1 (54/66pts -81.8% vs 46/68 pts -67.6%). Technical success at the end of phase 2 was higher in group 1 (59/66 pts 89.3% vs 55/68 pts -80.8% p<0.05). Overall technical success was higher in group 1 (66/66pts-100% vs 64/68 pts –94.1%). Number of CBD cannulation attempts was significant lower in group 1 (3.2±3 vs 4±3.2; p=0.05) in phase 1 and in phase 2 (4±2.7 vs 5.7±3.4; p<0.05). PEP was significantly lower in group 1 (4/66pts –6.1% vs 11/68pts –16.1%; p<0.01). Serum amylase 24h after ERCP were significantly lower in group 1 (278.7±469.1 vs 470.3±962.7U/lt; p<0.01). Conclusions: This preliminary results on the use of loop-tip wire shows a
Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220
OC.10.5 CLUSTER OF ENTEROPATHIES NEGATIVE FOR COELIAC DISEASE GENETICS BUT CARRYING HLA DQ6 P.I. Bianchi ∗ ,1 , F. Biagi 1 , C. Badulli 2 , A. Marchese 1 , M. Martinetti 2 , G.R. Corazza 1 1 Coeliac Centre/first Department of Internal Medicine, Fondazione Irccs Policlinico San Matteo, University of Pavia, Pavia, Italy; 2 Immunohematology and Transfusion Centre, Fondazione Irccs Policlinico San Matteo, Pavia, Italy
Background and aim: Genetic susceptibility to coeliac disease (CD) is strongly associated with HLA DQA1*05-DQB1*02 (DQ2) and HLA DQA1*03DQB1*0302 (DQ8) and a gene-dosage effect of DQB1*02 was shown. Nevertheless, rare cases of patients negative for both patterns were described. Our aim was to look for patients with a flat duodenal biopsy but negative DQ2/DQ8. Material and methods: Among all the patients attending our Clinic from Jan 1999 to Oct 2011, we selected those with a villous atrophy and negative to HLA DQB1*02/*0302. Clinical features, coeliac antibodies and response to gluten-free diet (GFD) were also collected. Results: Among 243 patients with villous atrophy and available HLA-type, there were 9 patients who did not carry either HLA DQB1*02/*0302. They had received the following diagnoses: 3 non-complicated CD, 1 CD complicated by intestinal lymphoma, 3 enteropathy in common variable immunodeficiency (1 sustained by Giardia), 2 undeterminated sprue. Three of them have a very similar HLA pattern (A*03; DRB1*11; DQA1*0102,*0505; DQB1*0301,*06). They all presented with chronic diarrhoea, weight loss, electrolyte malabsorption and hypoproteinemia. They were all negative for coeliac-specific and enterocyte antibodies, immunoglobulin deficiency, HIV serology, stool parasite infestation, familial history of gastroenterologic diseases. Mucosal monomorphic lymphocyte infiltrate and monoclonal rearrangement of T-cell receptor was excluded in all the intestinal biopsies. Moreover, case 1 (female, 29 years-old) presented a complete clinical and histological response after 12 months on a GFD and was considered coeliac. Case 2 (male, 33 years-old) after 91 months of strict GFD, still demonstrated subtotal villous atrophy, but stable clinical conditions in the last four years. He was considered to be affected by underterminated sprue and started budesonide therapy. Case 3 (male, 56 years-old) started a GFD for one month without any clinical improvement. Then he also started steroids and will be re-evaluated in the next months. Conclusions: We described 3 cases of uncommon enteropathy negative for both coeliac serology and genetics, who share HLA-type. They have a similar clinical presentation but only one of them responded to GFD. However the other two patients who have a persistent villous atrophy show an unexpected favourable clinical evolution.
OC.10.6 PROGNOSTICATING COELIAC PATIENTS SURVIVAL: THE PROCONSUL SCORE F. Biagi ∗ ,1 , A. Schiepatti 1 , A. Marchese 1 , G. Malamut 2 , C. Cellier 2 , S. Bakker 3 , C. Mulder 3 , U. Volta 4 , F. Zingone 5 , C. Ciacci 6 , A. D’Odorico 7 , A. Andrealli 8 , M. Astegiano 8 , C. Klersy 1 , G.R. Corazza 1 1 Universita’ di Pavia, Pavia, Italy; 2 Hopital Europeen Pompidou, Paris, France; 3 University Medical Center, Amsterdam, Netherlands; 4 Università di Bologna, Bologna, Italy; 5 Università di Napoli, Napoli, Italy; 6 Università di Salerno, Salerno, Italy; 7 Università di Padova, Padova, Italy; 8 Università di Torino, Torino, Italy
Background and aim: Coeliac disease (CD) is a very frequent chronic enteropathy characterized by an increased mortality caused by its complications, i.e. refractory CD and small bowel lymphoma. It was shown that age at diagnosis of CD, diagnostic delay for CD, pattern of clinical presentation and HLA typing correlate with mortality rates of coeliac patients. Aims: To create a tool that individuates those coeliac patients at higher risk of developing complications. To set up the follow up of coeliac patients according to the specific risk of complications.
Material and methods: Thanks to Fondazione Associazione Italiana Celiachia and Coeliac Common Interest Group, clinical data from 106 patients (68 F, mean age 53±14 yrs at enrolment) affected by complicated CD (i.e. cases) were collected. To set up a multicenter matched case-control study, 171 controls (110 F, mean age 55±13 yrs at enrolment) were selected among coeliac patients without complications. For each case, two (or at least one) controls, matched to cases according to the year of assessment, gender and age, were selected. Diagnostic delay, pattern of clinical presentation, HLA typing and age at diagnosis of CD were used as predictors. Results: Differences between cases and controls were shown for diagnostic delay (median 9 months, IQR 3-27, vs. 19 months, IQR 6-84, p=0.025), classical presentation (75/105 vs. 71/171, Chi2 p<0.001), and HLA DQ2 positivity (96% vs. 85%, p=0.025). Age at diagnosis did not differ between cases and controls. Conditional logistic models based on these statistically different predictors allowed the development of a score system. Tertiles analysis showed a relationship between score and risk of being a case (Chi2, p<0.001). Conclusions: A score that shows the risk of a newly diagnosed coeliac patient to develop complications was developed for the first time. This will allow to set up the follow up of CD patients with great benefits for not only their health but also management of economic resources.
OC.11.1 PRELIMINARY RESULTS ON THE COMPARISON OF LOOP-TIP COOK MEDICAL® WIRE VS TRADITIONAL CANNULATION TECHNIQUE IN THE PREVENTION OF POST-ERCP PANCREATITIS AND BILIARY TREE ACCESS IN HIGH-RISK PATIENTS B. Mangiavillano ∗ ,1 , M. Mangano 2 , E. Limido 3 , G. Bernasconi 3 , G. Spinzi 4 , V. Terruzzi 4 , A. Mariani 5 , P.A. Testoni 5 , G. Manes 6 , C. Paolo 7 , E. Morandi 1 , E. Masci 1 1 Gastrointestinal Endoscopy; Azienda Ospedaliera San Paolo - Universitary Hospital – University of Milan, Milan, Italy; 2 Ospedale Legnano, Legnano, Italy; 3 Unit of Digestive Endoscopy; Busto Arsizio Hospital, Varese, Italy; 4 Unit of Digestive Endoscopy; Valduce Hospital, Como, Italy; 5 Gastroenterology; Vita-Salute Irccs San Raffaele Hospital, Milan, Italy; 6 Unit of Digestive Endoscopy; Sacco Hospital, Milan, Italy; 7 Digestive Endoscopy; Abbiategrasso Hospital, Abbiategrasso - Milan, Italy
Background and aim: Selective cannulation of common bile duct (CBD) by insertion of a guide-wire seems to be associated with fewer complications and post-ERCP pancreatitis (PEP) rate than the conventional biliary tree access with contrast injection. The aim of our study is to test a new guide-wire with a loop in the tip for the prevention of PEP and biliary tree access in high-risk patients. Material and methods: Prospective, randomized, multicenter study. 134 PEP high-risk patients prospectively enrolled and divided in two groups. Inclusion criteria were: previous pancreatitis; CBD diameter <1cm; sphincter of Oddi type-1 dysfunction (SOD1); age<40yrs; female sex associated with another risk factors. In group 1 biliary tree cannulation was obtained with the loop-tip; in group 2 with the traditional technique. The cannulation attempt were composed of two phases with 5 minutes attempts or a maximum of 5 attempts of main pancreatic duct (MPD) cannulation. If there was no CBD cannulation after phase 2 we declared the “technical failure”. After phase 2 the endoscopists decided if stop or continue the ERCP. Serum amylases were dosed before and 24h after ERCP. Results: Group 1 (66pts) and Group 2 (68pts) were matched for sex (39F;27M vs 43F;25M) and age (64.6±15.3 vs 65.2±17.4yrs). Technical success at the end of phase1 was higher in group 1 (54/66pts -81.8% vs 46/68 pts -67.6%). Technical success at the end of phase 2 was higher in group 1 (59/66 pts 89.3% vs 55/68 pts -80.8% p<0.05). Overall technical success was higher in group 1 (66/66pts-100% vs 64/68 pts –94.1%). Number of CBD cannulation attempts was significant lower in group 1 (3.2±3 vs 4±3.2; p=0.05) in phase 1 and in phase 2 (4±2.7 vs 5.7±3.4; p<0.05). PEP was significantly lower in group 1 (4/66pts –6.1% vs 11/68pts –16.1%; p<0.01). Serum amylase 24h after ERCP were significantly lower in group 1 (278.7±469.1 vs 470.3±962.7U/lt; p<0.01). Conclusions: This preliminary results on the use of loop-tip wire shows a