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P041 - Faecal Calprotectin home test in ulcerative colitis — is it possible?
Abstracts of the 4th Congress of ECCO
the European Crohn’s and Colitis Organisation
Conclusions: Faecal calprotectin and lactoferrin determination may be useful in predicting impending clinical relapse especially during the following 3 months in both CD and UC patients. P040 Reduced muscle mass and bone size in pediatric patients with inflammatory bowel disease S. Bechthold, M. Alberer, T. Arenz, S. Putzker, B. FilipiakPittroff, H.P. Schwarz, S. Koletzko *. Dr. von Haunersches Kinderspital, Munich, Germany Background and Aims: Decreased bone mineral density has been reported in children with inflammatory bowel disease (IBD). We used peripheral quantitative computed tomography (pQCT) to assess bone mineralization, geometry, and muscle cross sectional area (CSA) in pediatric IBD. Methods: In a cross sectional study, pQCT of the forearm was applied in 143 IBD patients (mean age 13.9±3.5 years), 29% were newly diagnosed, 98 had Crohn’s disease, and 45 ulcerative colitis. Auxological data, cumulative glucocorticoid dose, disease activity indices, laboratory markers for inflammation and bone metabolism were related to results of pQCT. Results: Patients were compromised in height ( 0.82±1.1 SD), weight ( 0.77±1.0 SD), muscle mass ( 1.12±1.0 SD), and total bone cross-sectional area ( 0.79±1.0 SD) compared to age and sex matched healthy controls (z-scores). In newly diagnosed patients, the ratio of bone mineral mass per muscle CSA was higher than in those with longer disease duration (1.00 versus 0.30, p = 0.007). Serum albumin level and disease activity correlated with muscle mass accounting for 41.0 % of variability in muscle mass (p < 0.01). Trabecular bone mineral density z-score was on average at the lower normal level ( 0.40±1.3 SD, p < 0.05). Conclusions: Reduced bone geometry was only in part explained by reduced height. The bone disease in children with IBD seems to be secondary to muscle wasting which is already present at diagnosis. With longer disease duration, bone adapts to the lower muscle CSA. Serum albumin concentration is a good marker for muscle wasting and abnormal bone development. Treatment options for Pediatric IBD patients should improve nutritional status and include physical activity programs to improve muscle mass, bone geometry and peak bone mass. P041 Faecal Calprotectin home test in ulcerative colitis possible?
is it
M. Elkjær1 *, J. Burisch1 , A. Røseth2 , V. Voxen Hansen1 , B. Deibjerg Kristensen1 , D. Bremnes3 , J. Slott Jensen4 , P. Munkholm1 . 1 Herlev University Hospital, Copenhagen, Denmark, 2 Aker University Hospital, Oslo, Norway, 3 Skannex AS, Oslo, Norway, 4 Slott Stat, Copenhagen, Denmark Background: Enzyme-linked immunosorbent assay (ELISA) is a quantitative method and the “Gold standard” for faecal Calprotectin (FC) analysis. A new quantitative method, the “Rapid Test” (RT), has been developed to be carried out by the lab technician. This test has further been developed into a “Home Test” (HT) to be carried out by the patients themselves. Aim: To compare the ELISA with the quantitative RT’s for FC measurement, read by a PC-scanner system or using an ordinary cell phone system. Methods: One drop of faecal extract was applied onto the RTdevice and the colour intensity of the test line was read after 10 min incubation time using a lap-top linked with an ordinary table top scanner. In the HT a picture of the same RT-device was taken using a cell phone with special software built in. The user takes a picture and a software package on the cell phone sends the picture to a server in Oslo by using Mobile Internet.
S27
In this study the RT and the HT was carried out by our lab technician. Results: One hundred seventy five faecal samples have been collected from ulcerative colitis (UC) patients involved in a randomised control trail “Constant-care”. The cut off level for normal FC is 50 mg/kg. Comparison between the three tests was assessed with mean difference of 5.05 mg/kg (95% CI; 16.52 26.61) in ELISA vs. RT. ELISA vs. HT mean difference of 26.73 mg/kg (95% CI; 1.31 52.16) and RT vs. HT mean difference 21.71 mg/kg (95% CI; 11.46 31.95) of FC was found. The coefficient of variation (CV %) of ELISA vs. HT was in median 2.81% (range, 0 21.60%) and 6.15% (range, 0 41.59%), p-value <0.01 respectively. Conclusion: A significant difference between ELISA vs. HT was revealed, p-value <0.01. However the CV is acceptable being less than 10%. In future aspects the Home Test can be implemented in UC patients as part of disease self-management. P042 2 year follow up of adalimumab therapy in patients with Crohn’s disease K. Kemp1 *, M. Dibb2 , A.J. Makin2 , S. Campbell2 . 1 Manchester Royal Infirmary/University of Manchester, Manchester, United Kingdom, 2 Manchester Royal Infirmary, Manchester, United Kingdom Introduction: Adalimumab (Ad), a fully humanised, anti-TNFa antibody, has demonstrated ability to induce and maintain remission in Crohns Disease (CD). There remains little data on long-term safety as well as long-term remission maintenance in CD. Method: A database of CD pts who received Ad over a 27 mth period (June 2006 September 2008) was created. Demographic data, SAEs, durability, time to loss of response, previous exposure to infliximab (IFx), concomitant immunosuppressive therapy and smoking status were evaluated. Loss of response to IFx was defined as the first occasion a reduction in dosing interval was required. Remission/relapses were based upon standard clinical/radiological/endoscopic criteria. Kaplan Meier survival analysis was used to compare durability of response. Results: A total of 25 pts, (16F:9M), median age 44 yrs (17 73 yrs) were included. Twenty-one pts received an induction regime of 80/40 mg, 4 pts 160/80 mg followed by 40 mg EOW maintenance. Median follow up was 6 mths (2 27mths). Disease anatomy colonic disease 4 (16%); ileocolonic 20 (80%); duodenal disease 1 (4%). Twenty-three (92%) pts received IFx prior to Ad with a median duration of IFx of 17.5 mths (4 58 mths). Patients were grouped into 3 categories: primary nonresponders, 3 (12%), defined as failure to improve after 0,2 infusions; loss of response 9 (36%) defined as an interval time of <5 weekly; and discontinuation of IFx due to side effects 11 (44%). Eight pts smoked and 12 pts were on concomitant immunosuppressive therapy. Median Rx with Ad was 6 mths (2 27mths). Dose escalation of Ad (40 mg EOW to 40 WKLY) occurred in 5 (20%) pts, median time to dose escalation was 10 mths (range 2 12 mths). The 5 pts received a loading dose of 80/40 mg, with 1 patient on concomitant immunosupression therapy at dose escalation. SAEs were recorded, 1 cellulitis, 1 pneumonia and 1 viral meningitis. These SAEs resulted in the discontinuation of Ad in 2 pts (pneumonia and vial meningitis). There was no malignancy detected. Comparisons were made between smoker vs non smoker as well as primary IFx non-responders vs secondary IFx non-responders. Time to dose escalation for both comparison groups was not significant. The 3 primary non responders to IFx are remission with Ad. Sixteen (64%) the 25 pts are in remission with Ad.
the European Crohn’s and Colitis Organisation
Conclusions: Faecal calprotectin and lactoferrin determination may be useful in predicting impending clinical relapse especially during the following 3 months in both CD and UC patients. P040 Reduced muscle mass and bone size in pediatric patients with inflammatory bowel disease S. Bechthold, M. Alberer, T. Arenz, S. Putzker, B. FilipiakPittroff, H.P. Schwarz, S. Koletzko *. Dr. von Haunersches Kinderspital, Munich, Germany Background and Aims: Decreased bone mineral density has been reported in children with inflammatory bowel disease (IBD). We used peripheral quantitative computed tomography (pQCT) to assess bone mineralization, geometry, and muscle cross sectional area (CSA) in pediatric IBD. Methods: In a cross sectional study, pQCT of the forearm was applied in 143 IBD patients (mean age 13.9±3.5 years), 29% were newly diagnosed, 98 had Crohn’s disease, and 45 ulcerative colitis. Auxological data, cumulative glucocorticoid dose, disease activity indices, laboratory markers for inflammation and bone metabolism were related to results of pQCT. Results: Patients were compromised in height ( 0.82±1.1 SD), weight ( 0.77±1.0 SD), muscle mass ( 1.12±1.0 SD), and total bone cross-sectional area ( 0.79±1.0 SD) compared to age and sex matched healthy controls (z-scores). In newly diagnosed patients, the ratio of bone mineral mass per muscle CSA was higher than in those with longer disease duration (1.00 versus 0.30, p = 0.007). Serum albumin level and disease activity correlated with muscle mass accounting for 41.0 % of variability in muscle mass (p < 0.01). Trabecular bone mineral density z-score was on average at the lower normal level ( 0.40±1.3 SD, p < 0.05). Conclusions: Reduced bone geometry was only in part explained by reduced height. The bone disease in children with IBD seems to be secondary to muscle wasting which is already present at diagnosis. With longer disease duration, bone adapts to the lower muscle CSA. Serum albumin concentration is a good marker for muscle wasting and abnormal bone development. Treatment options for Pediatric IBD patients should improve nutritional status and include physical activity programs to improve muscle mass, bone geometry and peak bone mass. P041 Faecal Calprotectin home test in ulcerative colitis possible?
is it
M. Elkjær1 *, J. Burisch1 , A. Røseth2 , V. Voxen Hansen1 , B. Deibjerg Kristensen1 , D. Bremnes3 , J. Slott Jensen4 , P. Munkholm1 . 1 Herlev University Hospital, Copenhagen, Denmark, 2 Aker University Hospital, Oslo, Norway, 3 Skannex AS, Oslo, Norway, 4 Slott Stat, Copenhagen, Denmark Background: Enzyme-linked immunosorbent assay (ELISA) is a quantitative method and the “Gold standard” for faecal Calprotectin (FC) analysis. A new quantitative method, the “Rapid Test” (RT), has been developed to be carried out by the lab technician. This test has further been developed into a “Home Test” (HT) to be carried out by the patients themselves. Aim: To compare the ELISA with the quantitative RT’s for FC measurement, read by a PC-scanner system or using an ordinary cell phone system. Methods: One drop of faecal extract was applied onto the RTdevice and the colour intensity of the test line was read after 10 min incubation time using a lap-top linked with an ordinary table top scanner. In the HT a picture of the same RT-device was taken using a cell phone with special software built in. The user takes a picture and a software package on the cell phone sends the picture to a server in Oslo by using Mobile Internet.
S27
In this study the RT and the HT was carried out by our lab technician. Results: One hundred seventy five faecal samples have been collected from ulcerative colitis (UC) patients involved in a randomised control trail “Constant-care”. The cut off level for normal FC is 50 mg/kg. Comparison between the three tests was assessed with mean difference of 5.05 mg/kg (95% CI; 16.52 26.61) in ELISA vs. RT. ELISA vs. HT mean difference of 26.73 mg/kg (95% CI; 1.31 52.16) and RT vs. HT mean difference 21.71 mg/kg (95% CI; 11.46 31.95) of FC was found. The coefficient of variation (CV %) of ELISA vs. HT was in median 2.81% (range, 0 21.60%) and 6.15% (range, 0 41.59%), p-value <0.01 respectively. Conclusion: A significant difference between ELISA vs. HT was revealed, p-value <0.01. However the CV is acceptable being less than 10%. In future aspects the Home Test can be implemented in UC patients as part of disease self-management. P042 2 year follow up of adalimumab therapy in patients with Crohn’s disease K. Kemp1 *, M. Dibb2 , A.J. Makin2 , S. Campbell2 . 1 Manchester Royal Infirmary/University of Manchester, Manchester, United Kingdom, 2 Manchester Royal Infirmary, Manchester, United Kingdom Introduction: Adalimumab (Ad), a fully humanised, anti-TNFa antibody, has demonstrated ability to induce and maintain remission in Crohns Disease (CD). There remains little data on long-term safety as well as long-term remission maintenance in CD. Method: A database of CD pts who received Ad over a 27 mth period (June 2006 September 2008) was created. Demographic data, SAEs, durability, time to loss of response, previous exposure to infliximab (IFx), concomitant immunosuppressive therapy and smoking status were evaluated. Loss of response to IFx was defined as the first occasion a reduction in dosing interval was required. Remission/relapses were based upon standard clinical/radiological/endoscopic criteria. Kaplan Meier survival analysis was used to compare durability of response. Results: A total of 25 pts, (16F:9M), median age 44 yrs (17 73 yrs) were included. Twenty-one pts received an induction regime of 80/40 mg, 4 pts 160/80 mg followed by 40 mg EOW maintenance. Median follow up was 6 mths (2 27mths). Disease anatomy colonic disease 4 (16%); ileocolonic 20 (80%); duodenal disease 1 (4%). Twenty-three (92%) pts received IFx prior to Ad with a median duration of IFx of 17.5 mths (4 58 mths). Patients were grouped into 3 categories: primary nonresponders, 3 (12%), defined as failure to improve after 0,2 infusions; loss of response 9 (36%) defined as an interval time of <5 weekly; and discontinuation of IFx due to side effects 11 (44%). Eight pts smoked and 12 pts were on concomitant immunosuppressive therapy. Median Rx with Ad was 6 mths (2 27mths). Dose escalation of Ad (40 mg EOW to 40 WKLY) occurred in 5 (20%) pts, median time to dose escalation was 10 mths (range 2 12 mths). The 5 pts received a loading dose of 80/40 mg, with 1 patient on concomitant immunosupression therapy at dose escalation. SAEs were recorded, 1 cellulitis, 1 pneumonia and 1 viral meningitis. These SAEs resulted in the discontinuation of Ad in 2 pts (pneumonia and vial meningitis). There was no malignancy detected. Comparisons were made between smoker vs non smoker as well as primary IFx non-responders vs secondary IFx non-responders. Time to dose escalation for both comparison groups was not significant. The 3 primary non responders to IFx are remission with Ad. Sixteen (64%) the 25 pts are in remission with Ad.