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P-035: Elevated faecal calprotectin does not differentiate between IBD and a juvenile polyp
Abstracts of the 3rd International Symposium on Pediatric Inflammatory Bowel Disease Methods: Systematic review of the literature (Medline and Embase) until November 2013. Included were cross-sectional, cohort and case-control studies reporting data for extraction of 2x2 tables of non-invasive tests for IBD, confirmed by endoscopy and histopathology or clinical follow up of minimal 12 months, in children with chronic gastrointestinal symptoms, aged 0 18 years. Two independent reviewers selected studies, extracted data and assessed study quality with the QUADAS-2. Meta-analysis was performed using a bivariate model. Results: Nineteen studies were included. Fecal calprotectin (9 studies) had a pooled sensitivity of 0.98 (95% confidence interval 0.92 0.99) and specificity of 0.78 (0.61 0.89). Pooled sensitivity of C-reactive protein (7 studies), erythrocyte sedimentation rate (8 studies), hemoglobin (5 studies) and platelet count (7 studies) were respectively 0.60 (0.43 0.76); 0.63 (0.52 0.73); 0.41 (0.26 0.57); 0.56 (0.33 0.76) and the specificity were respectively 0.93 (0.82 0.97); 0.91 (0.80 0.96); 0.89 (0.80 0.94); 0.92 (0.87 0.95). Conclusion: Fecal calprotectin demonstrated a high sensitivity and is a good test to exclude IBD. Blood tests showed a high specificity and may be helpful to select patients for endoscopy. P-035 Elevated faecal calprotectin does not differentiate between IBD and a juvenile polyp V.M. Wolters *, V.G. Pluimakers, F.T.M. Kokke, P.G.J. Nikkels, M.L. Houben, R.H.J. Houwen. WKZ/UMC Utrecht, Utrecht, The Netherlands Objectives: Faecal calprotectin is used as an initial screening test in patients with suspected IBD. Only a small proportion of non-IBD patients are reported to have a faecal calprotectin above 300 mg/g faeces (Henderson et al, 2012). Our clinical impression was that patients with a juvenile polyp (JP) also frequently present with levels exceeding 300 mg/g faeces. Our aim was to investigate faecal calprotectin levels in patients with JP and compare these levels with patients with newly diagnosed IBD. Methods: Between January 2009 and August 2013 all faecal calprotectin levels of patients with histology proven JP or IBD were retrieved. Results: Amongst 2169 diagnostic endoscopies performed, a total of 37 patients with JP were identified, and 77 patients with newly diagnosed IBD. Faecal calprotectin was determined in 19 of the patients with JP (mean level 1,329 mg/g, range <30 5,250) and in 76 patients with IBD (mean level 3,105 mg/g; range <30 24,013, P < 0.001). All IBD patients had a faecal calprotectin above 50 mg/g faeces, and 18/19 patients with JP. A calprotectin above 300 mg/g was found in 13/20 patients with JP and in 74/76 patients with IBD. Conclusions: Elevated faecal calprotectin levels are frequently found in patients with a juvenile polyp as well as in pediatric IBD. Levels of calprotectine do not help in differentiating these conditions. P-036 Recognize the clinical picture: chronic recurrent multifocal osteomyelitis (CRMO) associated with Crohn’s disease (CD): a case report M.M. Van Biervliet *, C. Van Ommen, J. De Hoorne, F. De Baets, M. Van Winckel, R. De Bruyne, S. Vande Velde. Ghent University Hospital, Ghent, Belgium Case report: A 10-year-old boy complained of persisting ankle pain, despite immobilization, with low-grade fever. Magnetic Resonance Imaging (MRI) was suggestive for osteomyelitis. Laboratory results revealed low grade inflammation [CRP: 13.8 mg/L (0 10); ESR 74 mm/h (0 13)]. Despite treatment with IV flucloxacillin and nonsteroidal anti-inflammatory drugs the clinical picture expanded with hip and knee pain as well as anorexia, vomiting and bloody diarrhea. Cultures remained
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negative. MRI showed expanding edema of the maleolus, distal knee epiphysis and femur metadiaphysis. Bone biopsy and bone marrow aspirate showed inflammation with negative cultures. At transfer, he had 20% weight loss (BMI-3.8 SD), persisting diarrhea, pain and fever. Aseptic bone lesions unresponsive to antibiotic treatment led to the diagnosis of CRMO. The gastrointestinal symptoms were suggestive of CD. Upper endoscopy revealed bulbar erosions and colonoscopy severe ulcerations. Histology was compatible with CD. Combined enteral feeding and steroid therapy resolved symptoms within days. Relapse occurred whilst receiving Azathioprine was and tapered steroids. Therefore Infliximab was started, which induced remission. Conclusion: CRMO is a recurrent aseptic inflammation of the long bones and clavicles. The clinical spectrum varies from self-limited uni- or multi-focal lesions to chronic recurrent courses. This auto-inflammatory disorder is diagnosed based on clinical, radiologic and pathological findings and can lead to permanent disability. The molecular pathophyiology is not completely understood. CRMO is associated with other autoinflammatory diseases (IBD, psoriasis, Wegener’s disease, . . . ) and can precede the symptoms of these diseases by several years. Treatment of the underlying disease is necessary to control symptoms. P-037 Does inflammatory bowel disease (Unclassified) evolve into Crohn’s disease or ulcerative colitis? S.P. Paul *, C. Spray, D. Basude, S. Sandmann, P. Ramani, B.K. Sandhu. Bristol Royal Hospital for Children, Bristol, United Kingdom Introduction: In 5 15% of children diagnosed with inflammatory bowel disease (IBD), histological picture at diagnosis doesn’t fit in with either ulcerative colitis (UC) or Crohn’s disease (CD) and is classified as unclassified-IBD (IBDU). Aim: The aim of this prospective study is to determine whether IBDU evolves into UC/CD. Methods: Data collected on all newly diagnosed children with IBD at the only regional paediatric gastroenterology centre covering southwest England. All patients with suspected IBD had upper and lower gastrointestinal endoscopy and MRE scan or barium meal as recommended by BSPGHAN. Patients diagnosed with IBDU during 2004 2011 were included and followed up for a minimum of 2 years (range 2 9 years). The patient notes were reviewed in 2013 and any changes in diagnosis recorded. Results: 333 children diagnosed with IBD: 193 (58%) CD, 115 (34.5%) UC and 25 (7.5%) IBDU. Age (mean) at diagnosis: 10.2 years (IBDU), 11.5 years (CD), 11.6 years (UC). 6/25 (24%) IBDU patients had pan-colitis and 19/25 (76%) had patchy or left-sided colitis on colonoscopy. After 2 9 years, IBDU evolved into CD in 5 patients (22.8%), UC in 3 (13.6%) and remained IBDU in 14 patients (63.6%). Latest data was unavailable for 3 (11.6%) because of transfer to distant adult services. ANCA was positive in 3 out of 4 patients where IBDU evolved into CD. Average time to revised diagnosis: CD (3 years 2 months) and UC (1 year 6 months). Conclusion: This large prospective study has documented that over 2 9 years, 22.8% evolved into CD, 13.6% into UC and 63.6% remained IBDU. IBDU patients tended to be younger at diagnosis. Evolution into CD took longer than UC. Positive ANCA wasn’t an useful predictive marker.
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negative. MRI showed expanding edema of the maleolus, distal knee epiphysis and femur metadiaphysis. Bone biopsy and bone marrow aspirate showed inflammation with negative cultures. At transfer, he had 20% weight loss (BMI-3.8 SD), persisting diarrhea, pain and fever. Aseptic bone lesions unresponsive to antibiotic treatment led to the diagnosis of CRMO. The gastrointestinal symptoms were suggestive of CD. Upper endoscopy revealed bulbar erosions and colonoscopy severe ulcerations. Histology was compatible with CD. Combined enteral feeding and steroid therapy resolved symptoms within days. Relapse occurred whilst receiving Azathioprine was and tapered steroids. Therefore Infliximab was started, which induced remission. Conclusion: CRMO is a recurrent aseptic inflammation of the long bones and clavicles. The clinical spectrum varies from self-limited uni- or multi-focal lesions to chronic recurrent courses. This auto-inflammatory disorder is diagnosed based on clinical, radiologic and pathological findings and can lead to permanent disability. The molecular pathophyiology is not completely understood. CRMO is associated with other autoinflammatory diseases (IBD, psoriasis, Wegener’s disease, . . . ) and can precede the symptoms of these diseases by several years. Treatment of the underlying disease is necessary to control symptoms. P-037 Does inflammatory bowel disease (Unclassified) evolve into Crohn’s disease or ulcerative colitis? S.P. Paul *, C. Spray, D. Basude, S. Sandmann, P. Ramani, B.K. Sandhu. Bristol Royal Hospital for Children, Bristol, United Kingdom Introduction: In 5 15% of children diagnosed with inflammatory bowel disease (IBD), histological picture at diagnosis doesn’t fit in with either ulcerative colitis (UC) or Crohn’s disease (CD) and is classified as unclassified-IBD (IBDU). Aim: The aim of this prospective study is to determine whether IBDU evolves into UC/CD. Methods: Data collected on all newly diagnosed children with IBD at the only regional paediatric gastroenterology centre covering southwest England. All patients with suspected IBD had upper and lower gastrointestinal endoscopy and MRE scan or barium meal as recommended by BSPGHAN. Patients diagnosed with IBDU during 2004 2011 were included and followed up for a minimum of 2 years (range 2 9 years). The patient notes were reviewed in 2013 and any changes in diagnosis recorded. Results: 333 children diagnosed with IBD: 193 (58%) CD, 115 (34.5%) UC and 25 (7.5%) IBDU. Age (mean) at diagnosis: 10.2 years (IBDU), 11.5 years (CD), 11.6 years (UC). 6/25 (24%) IBDU patients had pan-colitis and 19/25 (76%) had patchy or left-sided colitis on colonoscopy. After 2 9 years, IBDU evolved into CD in 5 patients (22.8%), UC in 3 (13.6%) and remained IBDU in 14 patients (63.6%). Latest data was unavailable for 3 (11.6%) because of transfer to distant adult services. ANCA was positive in 3 out of 4 patients where IBDU evolved into CD. Average time to revised diagnosis: CD (3 years 2 months) and UC (1 year 6 months). Conclusion: This large prospective study has documented that over 2 9 years, 22.8% evolved into CD, 13.6% into UC and 63.6% remained IBDU. IBDU patients tended to be younger at diagnosis. Evolution into CD took longer than UC. Positive ANCA wasn’t an useful predictive marker.