P-107: Effect of exclusive enteral nutrition on the course of CD and intestinal microbiota

Abstracts of the 3rd International Symposium on Pediatric Inflammatory Bowel Disease therapy after bowel resection. Four patients completed 12 months follow-up after surgery on clinical remission. Two of these patients have undergone a control colonoscopy, showing Rutgeerts score i0 and i1. The other 3 patients remain in clinical remission three months after resection. Conclusions: Combined treatment with anti-TNF and AZA has shown to be effective as prophylactic therapy in our patients with CD after bowel resection. P-106 The clinical relevance of tacrolimus for ulcerative colitis in children: a national survey of the treatments for pediatric inflammatory bowel disease in Japan T. Yanagi1 *, K. Ushijima1 , T. Shimizu2 , T. Tomomasa3 , H. Tajiri4 , R. Kunisaki5 , T. Ishige3 , H. Yamada6 , K. Arai7 , Y. Ohtsuka2 , A. Yoden8 , T. Aomatsu8 , S. Nagata9 , K. Uchida10 , T. Kazuo11 . 1 Kurume University School of Medicine, Fukuoka, Japan, 2 Juntendo University School of Medicine, Tokyo, Japan, 3 Gunma University Graduate School of Medicine, Gunma, Japan, 4 Osaka General Medical Center, Osaka, Japan, 5 Yokohama City University Medical Center, Kanagawa, Japan, 6 Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan, 7 National Center for Child Health and Development, Tokyo, Japan, 8 Osaka Medical College, Osaka, Japan, 9 Tokyo Women’s Medical University Hospital, Tokyo, Japan, 10 Mie University Hospital, Mie, Japan, 11 Saitama University, Saitama, Japan Aim: To evaluate the effectiveness and safety of FK506 for pediatric UC in Japan. Methods: Fifty-four UC patients aged <17 years treated with FK506 between 2000 and 2013 were evaluated for clinical parameters, disease activity, Pediatric Ulcerative Colitis Activity Index (PUCAI), initial oral dose, short- (2-week) and long-term (1 year) outcomes, and adverse events. Clinical remission and improvement were defined as a PUCAI score <10 and a reduction in the score of 20 compared with baseline, respectively. Results: There were 28 male and 26 female patients (mean age at admission, 13.2 years). Thirty and 22 patients were steroiddependent and resistant, respectively. Forty-six patients had pancolitis. The mean PUCAI score at admission was 55 (10 85). The initial FK506 dose was 0.08 (0.02 0.21) mg/kg/day. The short-term clinical remission rate was 42.5%, and the clinical response rate was 79.6%. The long-term colectomyfree survival rate was 68.5%, although only 9.3% of patients achieved remission without 6-MP, azathioprine, or biologics. Adverse events were observed in 55.6% of cases, with 3 cases experiencing adverse events requiring discontinuation of the therapy. Conclusion: FK506 was effective for the induction therapy of UC in children; however, bridging therapies were required for long-term benefits. No serious adverse events were noted. P-107 Effect of exclusive enteral nutrition on the course of CD and intestinal microbiota B. Pigneur1 *, H. Garnier-Lenglin´ e1 , P. Lepage2 , J. Schmitz1 , O. Goulet1 , J. Dor´ e2 , F. Ruemmele1 . 1 Hˆ opital Necker Enfants-Malades, Paris, France, 2 MICALIS INRA, Jouy en Josas, France Exclusive Enteral Nutrition (EEN) is well-established as induction therapy in pediatric Crohn’s disease (CD). The aim of this work was to compare the anti-inflammatory effects of EEN (ModulenIBD® ) in active CD to steroids and to assess the associated modifications of intestinal microbiota. Methods: 19 patients (6 17 years) with active CD were randomized to induction therapy with steroids (n = 6) or EEN (n = 13). Patients were assessed at months 0, 2 and 6 by HBI, endoscopic findings (CDEIS score) and analysis of biopsies

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and fecal microbiota (fingerprinting and pyrosequencing technologies). Results: At M2, clinical remission (HBI <5) was achieved in 13/13 patients on EEN and 5/6 patients on steroids. Mucosal healing (CDEIS=3) was achieved in 89% with EEN compared to 17% with steroids. The intestinal microbiota profile distinguished EEN- from steroid-induced remission (p = 0.049). Firmicutes, were less while Bacteroidetes and Actinobacteria were more frequent in EEN treated patients. Pyrosequencing identified a decrease in Faecalibacterium and increased Roseburia and Clostridium species. At 6 months, microbiota profiles remain modified in the EEN group but not in the steroid group. Conclusion: Steroids and EEN equally induce clinical remission, however, the rate of mucosal healing is markedly higher with EEN, also associated with a distinct gut microbiota composition shift lasting for six months. P-108 Successful mercaptopurine usage following azathioprine intolerance in paediatric IBD: a regional cohort study V. Merrick1 *, P. Henderson1 , P. Rogers1 , P.M. Gillett1 , D.C. Wilson2 . 1 Department of Paediatric Gastroenterology and Nutrition, RHSC, Edinburgh, United Kingdom, 2 Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom Introduction: Thiopurines are commonly used to maintain remission in paediatric inflammatory bowel disease (PIBD). Use can be limited by intolerable side effects necessitating drug withdrawal and use of other therapies. Adult data suggests that switching from azathioprine (AZA) to mercaptopurine (MP) may be an alternative and effective treatment strategy in some cases. Aims: To determine use, tolerance and safety of MP in PIBD patients who are intolerant of AZA. Methods: AZA intolerance was evaluated within the cohort of all PIBD patients cared for in South East Scotland between August 1997 and December 2011. Case notes and laboratory records were reviewed in all cases on AZA switching to MP. Results: Of 326 children in the PIBD cohort, 21 were switched to MP due to unacceptable AZA side effects. GI toxicity featured in all 21 patients intolerant to AZA, with nausea/vomiting in 19 (91%), flu-like symptoms in 6 and transaminitis in 2 but no cases of hepatotoxicity, pancreatitis or myelosuppression. MP was well tolerated in 14 (67%), but 7 patients were also intolerant of MP with a single case of myelosuppression; the remainder suffered repeat GI toxicity. 15 patients (71%) had a documented TPMT level, of which 2 were low; both patients tolerated MP. Conclusion: Mercaptopurine is tolerated in the majority of PIBD patients who have unacceptable side effects on azathioprine and so should be trialled prior to discontinuing thiopurines. P-109 Autologous haematopoietic stem cell transplantation in two paediatric patients with refractory Crohn’s disease uller2 , G. Kriv´ an3 , K. K´ allay3 , D. Szab´ o2 , B.K. Boros1 *, K.E. M¨ 2 2 2 1 L. Kov´ acs , D. Krikovszky , G. Veres . Semmelweis University, Budapest, Hungary, 2 Ist Dept. of Pediatrics, Semmelweis University, Budapest, Hungary, 3 St. L´ aszl´ o Hospital, Budapest, Hungary Background: Recently, some cases have reported successful remission induction in Crohn’s disease (CD) by means of hematopoietic stem cell transplantation (HSCT). Moreover, life threatening pulmonary manifestation of CD is extremely rare. Case 1: Our first case was a 15-year-old boy with therapy refractory CD. After the course of a 3-year-long unsuccessful conventional therapy, autologous HSCT was performed resulting in complete remission. Finally, after one-year of follow-up he