P-118: Use of complementary and alternative medicines among children with inflammatory bowel disease

S436 needed to confirm efficacy, Adalimumab in children should be considered as treatment option in refractory disease. P-117 Methotrexate as a treatment option in pediatric Crohn’s disease I. Hojsak *, Z. Misak, O. Jadresin, A. Mocic Pavic, S. Kolacek. Children’s Hospital Zagreb, Zagreb, Croatia Introduction: Methotrexate is one of treatment options for Crohns disease (CD) in children. However, actual evidence of its efficacy in scientific literature is scarce. Aim: The aim of this study was to evaluate the efficacy of methotrexate in maintaining remission in pediatric CD resistant to azathioprine. Methods: This retrospective study included children with CD who were treated in our hospital since January 2004 and who received methotrexate for at least 12 months. Results: During the observed period 25 children were treated with methotrexate for at least 12 months [8 girls (32%); median age at diagnosis 13.4 years (range 1 17.3 years)]. Methotrexate was started in average of 1.8 years after the diagnosis (median: 1.3 years; range 0.6 6.9 years). The mean duration of follow-up was 4.6 years (median 4.7 years; range 1.7 9.6 years). During the treatment with methotrexate 6 (24%) children had a relapse during the first year, 8 (32%) children after the first year and 11 (44%) children remained in remission till the end of follow-up period. The mean duration of remission was 1.7 years (median 1.1 years; range 1 3.5 years). The overall remission duration was longer after methotrexate was introduced comparing to remission duration on previous therapy (azathioprine) (0.9 vs 1.7 years; p = 0.022). Survival analysis (Cox proportional hazard regression model) failed to reveal the relapse risk factors (disease location, treatment for remission induction, age at diagnosis, duration of disease and disease location). Conclusion: Methotrexate is an effective treatment option for children with CD who did not respond to azathioprine. P-118 Use of complementary and alternative medicines among children with inflammatory bowel disease S. Carette-Lherbier1 *, D. Turck2 , H. Sarter3 , L. Michaud1 , S. Coopman1 , D. Guimber1 , M. Bridenne1 , C. Spyckerelle4 , F. Gottrand1 , C. Gower-Rousseau3 . 1 Pediatric GI Unit-INSERM U995, CHU Lille & Lille-2 University, Lille, France, 2 University of Lille, Lille, France, 3 Epidemiology Unit, EA 2694, CHU Lille & Lille-2 University, Lille, France, 4 Pediatric GI Unit, Saint Vincent de Paul Hospital, Catholic University of Lille, Lille, France Introduction: The use of complementary and alternative medicine (CAM) is reported to increase in patients with chronic disease. Our aim was to assess the use of CAM in pediatric IBD. Methods: A survey with self-administered questionnaire was conducted from September to December 2013, including IBD patients <18 y. Data were extracted from medical records. Results: Eighty-one questionnaires were completed (response rate: 74%). The underlying IBD was Crohn’s disease (69%), ulcerative colitis (27%), and IBD unclassified (4%). In total, 53% of IBD children used or had used CAM (in 32% for IBD and in 39% for another disease). The most commonly used CAM were homeopathy (58%), osteopathy (27%), naturopathy and kinesiology (15% each). The main reasons for using CAM were the wish that the child ‘feels better’ (88%); the fear of side effects related to the conventional treatment; and the feeling that CAM are more natural and harmless (42%). The predictors of CAM use were: older age (p = 0.03); mother’s high socio-professional group (p = 0.04); use of CAM by the parents (p = 0.0002); current treatment with immunomodulators (azathioprine, methotrexate) (p = 0.03);

Friday, 12 September 2014 and dissatisfaction with conventional medicine (p = 0.02). The IBD characteristics did not influence the use of CAM. Conclusion: The high prevalence of CAM use by IBD children requires that pediatric GI open the dialogue on this issue in order to better guide patients in their choice, and more importantly to prevent harmful effects of CAM. P-119 Tacrolimus use in paediatric inflammatory bowel disease J. Chan1 , R. Foster2 , D.A. Lemberg2 , S.T. Leach1 , A.S. Day3 *. UNSW, Sydney, Australia, 2 Sydney Children’s Hospital, Sydney, Australia, 3 University of Otago, Christchurch, New Zealand

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Introduction: Tacrolimus is an immunosuppressant that can induce remission in inflammatory bowel disease (IBD) which is refractory to other treatments. However, tacrolimus use in paediatric IBD has not been extensively studied. Aim: To evaluate the efficacy of tacrolimus in paediatric IBD patients. Methods: A retrospective chart review was performed on paediatric IBD patients attending Sydney Children’s Hospital, Randwick from 1999 to 2010 who were prescribed tacrolimus for treatment of their disease. Results: Thirteen patients were included. Tacrolimus induced remission in 9 (69%) patients with a mean time to remission of 2 months (range 1 to 3 months) from commencement of treatment and a median duration of remission of 14 months. There was a mean reduction of 23.8 in PCDAI scores following tacrolimus treatment. Four of the 9 patients who achieved remission, experienced a relapse within 6 months following cessation of tacrolimus and 3 patients required colectomy. Seven patients experienced adverse events including low magnesium, headaches and raised creatinine. Conclusion: Tacrolimus can be a useful agent for the induction of remission in paediatric IBD patients with refractory disease and the associated side effects were generally mild. However, given the proportion of patients who experienced relapses upon cessation of tacrolimus, care should be taken when transitioning patients to alternate maintenance therapy.