P017 - Transrectal endoscopic ultrasound (TRUS) elastography in inflammatory bowel disease (IBD)

S18 P017 Transrectal endoscopic ultrasound (TRUS) elastography in inflammatory bowel disease (IBD) ˇ ukovic C ˇ avka, D. Radic, Z ˇ. Krznari´ N. Rustemovic *, S. C c, M. Opacic, J. Brljak, R. Pulani´ c, B. Vuceli´ c. University Hospital Zagreb, Zagreb, Croatia Background and Aims: Establishing the diagnosis of Crohn’s disease (MC) or ulcerative colitis (UC) sometimes is very difficult. When IBD is confined to the colon, there is a lack of diagnostic tools for distinction between Crohn’s colitis and ulcerative colitis, which is especially important in the definitive phenotyping before surgical decision. The aim of this study was to assess the potential role of the TRUS elastography in distinction between MC and UC. The idea is based upon the fact that MC is transmural disease, and UC is limited to the mucosa and submucosa. These tissue characteristics reflect in differences of the elasticity in rectal and perirectal tissue. Changes in the tissue elasticity can be obtained qualitatively by elastography with different coloures (from red-soft tissue to blue-hard tissue) or quantitatively using strain ratio score. Methods and Results: Rectal wall thickness and elastomode of patients were measured by TRUS elastography. Endoscopist was blind for patient diagnosis. SPSS ver. 17 was used for statistical analysis. In pilot study we included 24 patients; 11 patients (46%) with MC and 13 patients (54%) with UC. Average thickness of rectal wall in all study patients was 6.67 mm (±0.53 SE). In MC group mean rectal thickness was 7.74 mm (±0.93 SE) compared to 5.77 mm (±0.47 SE) in UC group. There was no statistical significant difference between MC and UC groups in perirectal thickness (t = 1.97, df = 22, p = 0.62). Perirectal elastomode showed statistically significant difference between this two groups (c2 = 14.2, df = 2, P < 0.001). Eight (72%) patients in MC group had hard elastomode compared to none of patients in UC group, meaning that hard elastogram had positive predictive value of 100% for patients with MC. Conclusion: TRUS elastography provides valuable information regarding the stiffness of the rectal and perirectal tissue which can help a lot in distinction between MC and UC. This is promising diagnostic tool in the field of IBD. Our study is ongoing and we expect improvement of the method in larger number of patients using strain ratio score. P018 Psychopathological features of patients with ulcerative colitis, Crohn’s disease and irritable bowel syndrome D. Piacentino, M. Cesarini, E. Angelucci, A. Crudeli, P. Vernia, M. Biondi, E. Corazziari *. University Sapienza, Rome, Italy Introduction: previous studies have compared the psychopathological features of patients with inflammatory bowel disease (IBD) occasionally distinguishing between Ulcerative and irritable bowel Colitis (UC) and Crohn’s disease (CD) syndrome (IBS), leading to contrasting results. Some studies (Kovacs et al., 2007; Tang et al., 2008) have reported a higher frequency of psychiatric symptoms and disorders in IBS and IBD patients in comparison with healthy controls, and in IBS patients in comparison with IBD patients. Conversely, other studies (Pace et al., 2003; Jones et al., 2006) have observed comparable levels of psychiatric comorbidity in IBD and IBS patients. Finally, there are studies (Blanchard et al., 1990) which have found a higher severity of psychological distress in IBS patients compared to IBD patients, but no differences between IBD patients and controls. Regarding the two subgroups of IBD patients, in some studies (Guthrie et al., 2002; Farrokhiar et al., 2006) UC and CD patients have shown no significant differences in psychopathological measures, whereas in other studies (Nordin et al., 2002) CD patients have reported significantly more anxiety and depression than UC patients.

Poster Presentations Objectives: the present study aimed to: (a) assess the level of psychopathology in IBD patients, IBS patients and controls; (b) evaluate the psychological differences, if any, between UC patients and CD patients. Methods: 49 IBD outpatients (20 UC patients, F 13, mean age 40.8±15.1 yrs, and 29 CD patients, F 13, mean age 46.5±16.6 yrs), 48 IBS outpatients (F 33, mean age 38.5±9.6 yrs) and 29 controls (F 14, mean age 41.1±14.3 yrs), referred to our third level gastroenterological centre, were consecutively recruited. The subjects defined as controls were free of IBD, IBS or any other chronic disease. The psychological profile of the patients was assessed with a 90-item selfrating questionnaire, the Symptom Checklist 90 Revised (SCL90-R), which measures a general psychological symptom score (Global Severity Index, GSI) and 9 subscales (Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Anger-Hostility, Phobic Anxiety, Paranoid Ideation, Psychoticism). The results were compared with Kruskal Wallis test and Mann Whitney U-test. Results: IBD and IBS patients had significantly higher GSI median scores than controls (P < 0.001), with IBS patients reporting a significantly higher GSI than IBD patients (P < 0.05). No significant differences in the GSI median scores of UC and CD patients were found. The SCL-90-R subscales median scores were significantly higher in IBD and IBS patients compared to controls (P < 0.01). IBS patients reported higher scores than IBD patients on most of the subscales, with Anxiety only reaching statistical significance. UC and CD patients showed comparable scores on the nine subscales.

SCL-90-R scales and subscales in IBD, IBS and controls. Conclusions: IBD and IBS patients are characterized by a higher severity of psychological symptoms than controls, with IBS patients scoring significantly higher than IBD patients on GSI and Anxiety. UC and CD patients do not differ in terms of psychopathology. P019 Diagnostic role of wireless capsule endoscopy in patients with symptoms highly compatible with Crohn’s disease C. Petruzziello *, P. Naccarato, E. Calabrese, S. Onali, G. Condino, E. Lolli, F. Zorzi, F. Pallone, L. Biancone. Tor Vergata University, Rome, Italy Introduction: The role of Wireless Capsule Endoscopy (WCE) in patients with clinically suspected CD remains to be established. Aim: To assess, in a prospective longitudinal study, the diagnostic role of WCE in patients with symptoms highly compatible with small bowel CD, not confirmed by conventional techniques. Methods: From September 2005 to October 2008, all consecutive patients referring to our GI Unit with clinically suspected CD, not confirmed by ileocolonoscopy (IC), Small Bowel Follow Through (SBFT) and Small Bowel Contrast Ultrasonography (SICUS) were prospectively enrolled. Signs and/or symptoms compatible with CD included at least one