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P059 INCREASING CUMULATED PREVALENCE OF INFLAMMATORY BOWEL DISEASE IN CHILDREN AT NORTH-WESTERN MEXICO: EPIDEMIOLOGICAL TRANSITION.
14
Abstracts of PIBD 2009, 9 12 September 2009, Paris, France
Conclusion: This is the largest paediatric series describing mucosal changes in the gut of children with JIA. The type of gut inflammation was mainly chronic inflammation with a quarter having active IBD. The presence of eosinophilic GI disease in 30% of our study group is an important novel finding and may be used to guide therapy such as dietary exclusion, particularly in those with ongoing inflammation despite being on immunosuppressive therapy. P055 INDETERMINATE COLITIS (IC)
A SINGLE CENTER EXPERIENCE
F. Kiparissi1 *, A. Kader1 , M. Elawad1 . 1 Paediatric Gastroenterology, Great Ormond Street Hospital, London, United Kingdom Aim: A single center experience of paediatric IC with its presentation, disease distribution, progression and outcome. Methods: We reviewed data of children with IC over a 7-year period. Patient follow up was at least 2 years. Disease distribution was identified on the basis of histology. Results: 29 children were diagnosed with IC (n = 307 for total IBD), 22 males, mean age 7.4 years (range 1.9 to 15 y). No cases were reclassified as UC or CD.17 had a pancolitis at diagnosis, 10 had left-sided disease and remaining 2 had right sided colitis. Four left sided colitis progressed to pancolitis, and 2 pancolitis became one sided colitis on follow up. 10 cases had significantly increased mucosal eosinophils and 6 of these cases were pancolitis.23 patients received Prednisolone and all were steroid responsive, 7 cases became frequently relapsing or steroid dependent. Azathioprine and 5-ASA was used in 21 cases. Other immunomosuppressive agents were used in 7 cases because of failure to respond. Infliximab was used in 4, of which only 2 responded. Surgery was required only in 1 case (pancolectomy and later proctectomy). In cases with eosinophillic infiltration additionally dietary restriction or elemental diet were used in 6/10 cases. Conclusion: Most of IC-patients did not change distribution with time. No child was later reclassified as UC or CD, this may be due to shorter follow up. Most children responded to standard treatment with Prednisolone and Azathioprine. Coexisting eosinophillic infiltration may suggest allergic aetiology. Longitudinal studies are needed to determine the clinical implications of this paediatric IBD subgroup. P056 EVALUATION OF METALLOPROTEINASE 3 AND 9 CONCENTRATION IN SERUM OF CHILDREN WITH ULCERATIVE COLITIS A. Kofla-Dlubacz1 *, M. Matusiewicz2 , B. Iwanczak1 . 1 2nd Department of Pediatrics, Gastroenterology and Nutrition, 2 Department of Medical Biochemistry, Medical University, Wroclaw, Poland Background: Matrix metalloproteinases (MMPs) are a group of zincdependent proteolytic enzymes participating in the metabolism of connective tissue. It has been suggested that MMPs can be elevated in inflammatory bowel disease. Objective: To evaluate the correlation between MMP-3 and -9 serum concentration and the activity of ulcerative colitis (UC) in comparison to the control group (C). Methods: The studies were conducted on 31 children diagnosed with UC, in various clinical stages of disease and 37 healthy children in the C. The disease activity was estimated using the Truelov-Witts scale and the patients were classified into moderate or mild groups. MMP-3 and -9 concentrations in sera of patients were determined using commercially available tests. The results are presented as means+SD. Results: The mean MMP3 concentrations were: 25.68+17.9 ng/ml for moderate UC, 6.11+4.6 for mild UC and 2.53+1.9 for C. There were statistically significant differences between moderate and mild UC, moderate UC and C and mild UC and C (p < 0.001). The mean MMP9 concentrations were: 18.54+16.7 ng/ml for moderate UC, 2.44+2.7 for mild UC and 2.66+3.6 for C. The concentration in moderate UC group differed statistically from both UC mild and C (p < 0.001). There were no differences between mild UC and C. Conclusion: The results of our studies demonstrated elevation of MMP-3 and -9 along with the exacerbation of the disease. This creates the possibility of application of these MMPs concentrations measurements as a diagnostic tool in the evaluation of disease activity in UC. P057 EVALUATION OF METALLOPROTEINASE 3 AND 9 CONCENTRATION IN SERUM OF CHILDREN WITH CROHN’S DISEASE A. Kofla-Dlubacz1 *, M. Matusiewicz2 , B. Iwanczak1 . 1 2nd Department of Pediatrics, Gastroenterology and Nutrition, 2 Department of Medical Biochemistry, Medical University, Wroclaw, Poland Background: The results of recent studies have been suggesting an upregulation of matrix metalloproteinases (MMPs) in patients with inflammatory bowel disease.
Objective: To evaluate the correlation between MMP-3 and -9 serum concentration and the activity of Crohn’s disease (CD) in comparison to the control group (C) Methods: The study group comprised 45 children diagnosed with CD, in various clinical stages of disease (severe, moderate, mild) estimated by the PCDAI scale and 37 healthy children as a C. The results are presented as means+SD. Results: The mean MMP3 concentrations were: 7.58+8.2 ng/ml for severe CD, 21.95+19.1 for moderate CD, 3.38+2.8 for mild CD and 2.53+1.9 for C. There were statistically significant differences between severe and moderate CD (p = 0.001), severe and mild CD (p = 0.02), severe CD and C, moderate and mild CD, moderate CD and C (p < 0.001). The mean MMP9 concentrations were: 37.6+34.5 ng/ml for severe CD, 13.6+10.0 for moderate CD, 6.39+8.6 for mild CD and 2.66+3.6 for C. There were statistically significant differences in MMP9 concentrations between groups: severe and mild CD, severe CD and C, moderate CD and C (p < 0.001), moderate and mild CD (p = 0.004). Conclusion: The elevation of MMP9 along with the exacerbation of disease was observed. In case of MMP3 the concentration of the enzyme was increasing along with disease activity up to the moderate stage with subsequent decrease in the group of children with the severe form of disease. P058 LUNG MEMBRANE DIFFUSION AND CAPILLARY VOLUME IN CROHN’S DISEASE: A PILOT STUDY T. Lamireau1 *, M. Choukroun2 , L. Rebouissoux1 , H. Clouzeau1 , G. Masse1 , S. Bui3 , M. Fayon3 . 1 Gastroenterologie et Nutrition Pediatriques, 2 Exploration Fonctionnelles Respiratoires, 3 Pneumologie P´ ediatrique, Hˆ opital des Enfants CHU Bordeaux, Bordeaux, France Aim: The aim of this study was to assess capillary blood volume in Crohn’s disease. Methods: Forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), residual volume (RV), and total lung capacity (TLC) were measured by body plethysmography in 10 patients with Crohn’s disease. Diffusing capacity of carbon monoxide (DLCO) and its constituents, i.e. membrane diffusion capacity (Dm) and pulmonary capillary blood volume (Vc) were measured by the method of simultaneous transfer of carbon monoxide and nitric oxide. Results (% of normal values) were compared to the Pediatric Crohn’s Disease Activity Index (PCDAI). Results: Patients (7M, 3F), aged of 13.5 years, were investigated at the time of diagnosis in 4 children or after a 22 month-duration (1 42 months) of disease course in 6 children who were treated with 5-aminosalicylate (n = 1), corticosteroids (n = 3) and/or azathioprine (n = 4). Median PCDAI score was 35 (range: 10 50). Two children had dyspnea during sport, and one had asthma. Capillary blood gazes (PaO2, PaCO2), FVC, FEV1, RV, and TLC were normal in all infants. DLCO was decreased (<80%) in 1/10 children (median: 92%, range: 79 117%), Dm in 2/10 children (median: 93%, range: 69 103%), and Vc in all children (median: 46%, range: 42 74%). Vc was inversely correlated to PCDAI. Conclusion: It is suggested that changes in alveolo-capillary diffusion observed in Crohn’s disease could be due to a decrease of the pulmonary capillary bed. These changes are likely related to the disease activity. P059 INCREASING CUMULATED PREVALENCE OF INFLAMMATORY BOWEL DISEASE IN CHILDREN AT NORTH-WESTERN MEXICO: EPIDEMIOLOGICAL TRANSITION. A. Larrosa1 *, A. Magallanes2 , R. Macías2 , C. Boj´ orquez2 , O. García2 , A. Celis3 . 1 Gastroenterology and Nutrition, UMAE Hospital de Pediatría, CMNO, IMSS, Guadalajara; 2 Hospital de Especialidades, CMNO IMSS., ublica, UDG, Guadalajara, Mexico Guadalajara; 3 Departamento de Salud P´ Background: IBD in children may be considered as one the entities of the epidemiological transition that is taking place in Mexico. Objective: To report the cumulative prevalence of IBD in children in NorthWestern Mexico. Methods: Design: Descriptive, longitudinal. Setting: A GI Department at a pediatric referral hospital. Diagnosis was based on current clinical endoscopic and histopathologic criteria. Cumulative prevalence: number of previous cases plus new cases divided by the number of children admitted to the GI Department per year evaluated. Results: n = 24, mean age 10.1 years, 53.3% females. Diagnosis: Ulcerative colitis was diagnosed in 21 (85%) and Crohn’s disease in 3 (15%). Cumulated prevalence: There was 20X increase in cases with IBD in the study period; comparison of frequencies showed a significant difference (p < 0.001). Cumulative prevalence per 100 admissions through the period evaluated was 2000= 0.2, 2001= 0.4%, 2002= 1.2%, 2003= 2.4%, 2004= 3.0%, 2005= 3.9%, 2006= 4.2%, 2007= 4.3%, 2008= 5.1%.
Poster Communications Conclusion: The population covered by the Mexican Social Security comprises a high proportion of the pediatric population of North-Western Mexico. Although this is not a population study, it probably reflects an emergent pathology in the pediatric population of this region. These observations resemble the already described north-south and west-east trend of increasing cumulative prevalence reported in developed and some developing countries. P060 CLINICAL FEATURES AND OUTCOME OF CHILDHOOD CROHN DISEASE FROM A MULTI-ETHNIC ASIA POPULATION W.S. Lee1 *, Y.S. Hoh2 , P.F. Chai1 , C.C.M. Boey1 . 1 Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia, 2 Department of Paediatrics, University of Aberdeen, Aberdeen, United Kingdom Aim: Little is known about the clinical features and outcome of childhood Crohn Disease (CD) outside the Caucasian population. We aimed to determine the clinical features and outcome of childhood CD from a multi-ethnic Asian population. Patients and Methods: Retrospective review of all newly diagnosed CD (less than 16 years) from 1997 to 2008, referred to the Department of Paediatrics, University of Malaya Medical Centre, Malaysia. CD was diagnosed on a combination of clinical, endoscopic, histological and/or radiological findings. Results: A total of 18 (male=10, 55%) patients with CD were referred during the study period (average 1.5 cases/year). The median age at first onset of symptoms was 6.5 years (range 0.6 14.5 years), while median duration between first symptom and diagnosis was 0.7 years (range 0 6.6 years). Most of the disease were limited to colon only (n = 7, 39%) or ileocolon (n = 6, 33%). Pan-enteric involvement (ileocolon and upper gastrointestinal) was uncommon (n = 2, 11%). Non-stricturing with perianal disease was the most common disease behavior (n = 9, 50%), followed by non-stricturing, nonpenetrating (n = 6, 33%). Two thirds (n = 12, 67%) of the patients responded to medical therapy alone. Six patients (33%) required surgery, the main indication being stricture formation (n = 4). The median PCDAI score at diagnosis was 50 (range 20 85). At latest review, only one patient (6%) was not in remission. Conclusion: CD is uncommon in Malaysia. There are significant differences in the disease behavior as compared to studies based on Caucasian population. P061 LIVING WITH INFLAMMATORY BOWEL DISEASE AS AN ADOLESCENT H.M. Lindfred1 *, R. Saalman2 , S. Nilsson3 , M. Lepp1 . 1 Sahlgrenska Academy, Gothenburg University, The Institute of Health and Care Sciences, 2 Sahlgrenska Academy, Gothenburg University, Sahgrenska University Hospital, 3 Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, G¨ oteborg, Sweden Background: Living with IBD during adolescence, a critical period of physical, psychological and social development can be especially demanding. Objectives: Our aim was to describe how adolescents with IBD experience daily life with IBD. Particular attention was paid to health and self management. Agreement between parents’ and children’s views was studied to explore features of family dynamics. Methods: In this cross sectional, population-based study; a disease-specific questionnaire with psychometric properties (12 VAS-items scoring 0 to 100) combined with semi-structured questions was used. Adolescents between the ages of 11 and 16 years (n = 66) from one referral centre and their parents (n = 119) participated. Conclusion: The majority of the adolescents reported good physical health (median = 89), self image (=74) and satisfactory health habits. However, several adolescents reported problems in everyday life, such as abdominal pain (30%), loss of appetite (20%) and difficulty sleeping (10%). Our data showed a significant correlation between physical health and almost all psychosocial adjustment variables. Results showed poor agreement between parents’ and adolescents’ views in all 12 items, except for the variables of responsibility for medical treatment (r = 0.51), knowledge about the disease (r = 0.32) and exercise habits (r = 0.32). P062 RADIOLOGIC EVALUATION OF THE SMALL INTESTINE IN PEDIATRIC INFLAMMATORY BOWEL DISEASE A. Linn´ er1 *, P. Malmborg1 , U. Ullberg1 , U.L. Fagerberg1 , H. Hildebrand1 . 1 Dept of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden Background: Diagnosing IBD, evaluation of the small intestine is crucial. According to the Porto criteria the small bowel should be investigated, except when a certain UC. Objectives: To evaluate if small bowel imaging (SBI) a) is performed as recommended b) in UC leads to a change in diagnosis c) finds pathology that had not already been diagnosed at endoscopy.
15 Methods: All patients diagnosed with IBD during 2002 07 were scrutinized. The small bowel had been investigated either with barium enteroclysis, small bowel follow-through or MR enterography. Results: 161 IBD patients were diagnosed (CD: 113, UC: 27 and IC: 21). 87% had SBI; 64% with X-ray and 26% with MRT. 39 patients with UC or IC (81%) had SBI, of which none changed the initial diagnosis. In the CD group 90% had SBI, 43% which were positive. With pathology in the distal ileum at endoscopy, 54% had positive radiological signs. Adversely, with a macroscopically healthy ileum, 24% showed positive results upon radiology. The patients with symptoms of stenosis were few (4), but had all positive radiological signs. Conclusion: Radiology did not lead to a change in diagnosis for patients with UC or IC. Radiological findings were uncommon when ileoscopy was normal. However, a normal ileoscopy was sometimes seen in spite of a pathological radiology of the distal ileum. P063 MARKERS OF PERINATAL BOWEL COLONIZATION AND PEDIATRIC CROHN’S DISEASE RISK P. Malmborg1 *, H. Hildebrand1 , A. Kling2 , S.M. Montgomery3 . 1 Department of Women and Child Health, Karolinska Institutet, Stockholm; 2 Department ¨ rebro University Hospital, O ¨ rebro; 3 Clinical of Clinical Medicine, O Epidemiology Unit, Department of medicine, Karolinska Institutet, Stockholm, Sweden Background: Crohn’s disease (CD) involves an inappropriate immune response against normal bowel flora. Disrupted or atypical patterns of microbial colonisation may impair appropriate development of homeostasis and thus increase CD risk. Birth by caesarean section (CS) may represent a risk for atypical patterns of colonization during the critical perinatal period. Method: Detailed information on delivery mode has been collected for all births in Sweden since 1990. Patients with pediatric (<16 years) CD were identified through the national Inpatient Register (born 1990 2006). Prospective case-control study. 746 cases with pediatric CD were identified and matched with 10 controls (n = 7,355) by delivery unit, week of birth and sex. Conditional logistic regression analyses adjusted for gestational age, maternal IBD and socioeconomic index. Stratification by sex, as differences in the prevalence of pediatric CD suggests sex-specific risks. Result: Birth by CS modestly increased the risk for CD among boys (n = 4,693); OR 1.54, 95% CI (1.15 2.07). For girls (n = 3,392) no association was seen between birth by CS and CD risk; OR 0.89 CI (0.60 1.33). Conclusion: Birth by CS is not a major risk for pediatric CD. Sex-specific susceptibility may influence CD risk. P064 APPLICATION OF THE PORTO CRITERIA FOR DIAGNOSIS OF PAEDIATRIC IBD IN A REFERRAL PAEDIATRIC CENTRE J. Martín de Carpi1 *, P. Vilar1 , V. Varea1 . 1 Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de D´ eu, Barcelona, Spain Background: In 2005 the ESPGHAN established the Porto Criteria (PC) to reach an accurate diagnosis of paediatric IBD. The recommendations include: 1) Total colonoscopy with ileal intubation, 2) Upper endoscopy, 3) Multiple biopsies and 4) Intestinal follow-through. Aim: To evaluate the diagnostic procedures used in our IBD patients before and after the PC publication. Patients and Methods: Review of the IBD patients diagnosed in the last ten years in a Spanish paediatric referral hospital. Results: 108 IBD patients have been diagnosed (51 UC, 52 CD, 5 IBDu), 65 boys (60.18%). Location: 1) UC, 40 (78%) extensive colitis, 5 left colitis and 6 proctitis. 2) CD: 44 ileo-colonic (84%), 8 colonic. Mean age: 11 y, 11mo (range 12 mo 17 y, 7 mo). The PC were followed in 49% (33% before 2005, 64% after). Upper endoscopy was performed in 58%: 39% versus 73%. 51% of our CD patients had upper involvement. Total colonoscopy with ileoscopy was achieved in 86%. Mean number of ileo-colonic segments biopsied: 6.6. Up to 38% of the CD patients have inflammation in endoscopically normal segments. During the follow-up, among the IBDu patients, initial diagnosis was changed to CD in 1, to UC in 2. We have not observed other changes in diagnosis in the remaining 103 patients. Conclusion: Our clinical practice in IBD diagnosis has changed after the PC. Upper endoscopy is a useful tool to find upper involvement. Colonoscopy with ileoscopy and performance of multiple biopsies are essential to determine extension of inflammation. We have not observed changes in the final diagnosis in our CD and UC patients.
Abstracts of PIBD 2009, 9 12 September 2009, Paris, France
Conclusion: This is the largest paediatric series describing mucosal changes in the gut of children with JIA. The type of gut inflammation was mainly chronic inflammation with a quarter having active IBD. The presence of eosinophilic GI disease in 30% of our study group is an important novel finding and may be used to guide therapy such as dietary exclusion, particularly in those with ongoing inflammation despite being on immunosuppressive therapy. P055 INDETERMINATE COLITIS (IC)
A SINGLE CENTER EXPERIENCE
F. Kiparissi1 *, A. Kader1 , M. Elawad1 . 1 Paediatric Gastroenterology, Great Ormond Street Hospital, London, United Kingdom Aim: A single center experience of paediatric IC with its presentation, disease distribution, progression and outcome. Methods: We reviewed data of children with IC over a 7-year period. Patient follow up was at least 2 years. Disease distribution was identified on the basis of histology. Results: 29 children were diagnosed with IC (n = 307 for total IBD), 22 males, mean age 7.4 years (range 1.9 to 15 y). No cases were reclassified as UC or CD.17 had a pancolitis at diagnosis, 10 had left-sided disease and remaining 2 had right sided colitis. Four left sided colitis progressed to pancolitis, and 2 pancolitis became one sided colitis on follow up. 10 cases had significantly increased mucosal eosinophils and 6 of these cases were pancolitis.23 patients received Prednisolone and all were steroid responsive, 7 cases became frequently relapsing or steroid dependent. Azathioprine and 5-ASA was used in 21 cases. Other immunomosuppressive agents were used in 7 cases because of failure to respond. Infliximab was used in 4, of which only 2 responded. Surgery was required only in 1 case (pancolectomy and later proctectomy). In cases with eosinophillic infiltration additionally dietary restriction or elemental diet were used in 6/10 cases. Conclusion: Most of IC-patients did not change distribution with time. No child was later reclassified as UC or CD, this may be due to shorter follow up. Most children responded to standard treatment with Prednisolone and Azathioprine. Coexisting eosinophillic infiltration may suggest allergic aetiology. Longitudinal studies are needed to determine the clinical implications of this paediatric IBD subgroup. P056 EVALUATION OF METALLOPROTEINASE 3 AND 9 CONCENTRATION IN SERUM OF CHILDREN WITH ULCERATIVE COLITIS A. Kofla-Dlubacz1 *, M. Matusiewicz2 , B. Iwanczak1 . 1 2nd Department of Pediatrics, Gastroenterology and Nutrition, 2 Department of Medical Biochemistry, Medical University, Wroclaw, Poland Background: Matrix metalloproteinases (MMPs) are a group of zincdependent proteolytic enzymes participating in the metabolism of connective tissue. It has been suggested that MMPs can be elevated in inflammatory bowel disease. Objective: To evaluate the correlation between MMP-3 and -9 serum concentration and the activity of ulcerative colitis (UC) in comparison to the control group (C). Methods: The studies were conducted on 31 children diagnosed with UC, in various clinical stages of disease and 37 healthy children in the C. The disease activity was estimated using the Truelov-Witts scale and the patients were classified into moderate or mild groups. MMP-3 and -9 concentrations in sera of patients were determined using commercially available tests. The results are presented as means+SD. Results: The mean MMP3 concentrations were: 25.68+17.9 ng/ml for moderate UC, 6.11+4.6 for mild UC and 2.53+1.9 for C. There were statistically significant differences between moderate and mild UC, moderate UC and C and mild UC and C (p < 0.001). The mean MMP9 concentrations were: 18.54+16.7 ng/ml for moderate UC, 2.44+2.7 for mild UC and 2.66+3.6 for C. The concentration in moderate UC group differed statistically from both UC mild and C (p < 0.001). There were no differences between mild UC and C. Conclusion: The results of our studies demonstrated elevation of MMP-3 and -9 along with the exacerbation of the disease. This creates the possibility of application of these MMPs concentrations measurements as a diagnostic tool in the evaluation of disease activity in UC. P057 EVALUATION OF METALLOPROTEINASE 3 AND 9 CONCENTRATION IN SERUM OF CHILDREN WITH CROHN’S DISEASE A. Kofla-Dlubacz1 *, M. Matusiewicz2 , B. Iwanczak1 . 1 2nd Department of Pediatrics, Gastroenterology and Nutrition, 2 Department of Medical Biochemistry, Medical University, Wroclaw, Poland Background: The results of recent studies have been suggesting an upregulation of matrix metalloproteinases (MMPs) in patients with inflammatory bowel disease.
Objective: To evaluate the correlation between MMP-3 and -9 serum concentration and the activity of Crohn’s disease (CD) in comparison to the control group (C) Methods: The study group comprised 45 children diagnosed with CD, in various clinical stages of disease (severe, moderate, mild) estimated by the PCDAI scale and 37 healthy children as a C. The results are presented as means+SD. Results: The mean MMP3 concentrations were: 7.58+8.2 ng/ml for severe CD, 21.95+19.1 for moderate CD, 3.38+2.8 for mild CD and 2.53+1.9 for C. There were statistically significant differences between severe and moderate CD (p = 0.001), severe and mild CD (p = 0.02), severe CD and C, moderate and mild CD, moderate CD and C (p < 0.001). The mean MMP9 concentrations were: 37.6+34.5 ng/ml for severe CD, 13.6+10.0 for moderate CD, 6.39+8.6 for mild CD and 2.66+3.6 for C. There were statistically significant differences in MMP9 concentrations between groups: severe and mild CD, severe CD and C, moderate CD and C (p < 0.001), moderate and mild CD (p = 0.004). Conclusion: The elevation of MMP9 along with the exacerbation of disease was observed. In case of MMP3 the concentration of the enzyme was increasing along with disease activity up to the moderate stage with subsequent decrease in the group of children with the severe form of disease. P058 LUNG MEMBRANE DIFFUSION AND CAPILLARY VOLUME IN CROHN’S DISEASE: A PILOT STUDY T. Lamireau1 *, M. Choukroun2 , L. Rebouissoux1 , H. Clouzeau1 , G. Masse1 , S. Bui3 , M. Fayon3 . 1 Gastroenterologie et Nutrition Pediatriques, 2 Exploration Fonctionnelles Respiratoires, 3 Pneumologie P´ ediatrique, Hˆ opital des Enfants CHU Bordeaux, Bordeaux, France Aim: The aim of this study was to assess capillary blood volume in Crohn’s disease. Methods: Forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), residual volume (RV), and total lung capacity (TLC) were measured by body plethysmography in 10 patients with Crohn’s disease. Diffusing capacity of carbon monoxide (DLCO) and its constituents, i.e. membrane diffusion capacity (Dm) and pulmonary capillary blood volume (Vc) were measured by the method of simultaneous transfer of carbon monoxide and nitric oxide. Results (% of normal values) were compared to the Pediatric Crohn’s Disease Activity Index (PCDAI). Results: Patients (7M, 3F), aged of 13.5 years, were investigated at the time of diagnosis in 4 children or after a 22 month-duration (1 42 months) of disease course in 6 children who were treated with 5-aminosalicylate (n = 1), corticosteroids (n = 3) and/or azathioprine (n = 4). Median PCDAI score was 35 (range: 10 50). Two children had dyspnea during sport, and one had asthma. Capillary blood gazes (PaO2, PaCO2), FVC, FEV1, RV, and TLC were normal in all infants. DLCO was decreased (<80%) in 1/10 children (median: 92%, range: 79 117%), Dm in 2/10 children (median: 93%, range: 69 103%), and Vc in all children (median: 46%, range: 42 74%). Vc was inversely correlated to PCDAI. Conclusion: It is suggested that changes in alveolo-capillary diffusion observed in Crohn’s disease could be due to a decrease of the pulmonary capillary bed. These changes are likely related to the disease activity. P059 INCREASING CUMULATED PREVALENCE OF INFLAMMATORY BOWEL DISEASE IN CHILDREN AT NORTH-WESTERN MEXICO: EPIDEMIOLOGICAL TRANSITION. A. Larrosa1 *, A. Magallanes2 , R. Macías2 , C. Boj´ orquez2 , O. García2 , A. Celis3 . 1 Gastroenterology and Nutrition, UMAE Hospital de Pediatría, CMNO, IMSS, Guadalajara; 2 Hospital de Especialidades, CMNO IMSS., ublica, UDG, Guadalajara, Mexico Guadalajara; 3 Departamento de Salud P´ Background: IBD in children may be considered as one the entities of the epidemiological transition that is taking place in Mexico. Objective: To report the cumulative prevalence of IBD in children in NorthWestern Mexico. Methods: Design: Descriptive, longitudinal. Setting: A GI Department at a pediatric referral hospital. Diagnosis was based on current clinical endoscopic and histopathologic criteria. Cumulative prevalence: number of previous cases plus new cases divided by the number of children admitted to the GI Department per year evaluated. Results: n = 24, mean age 10.1 years, 53.3% females. Diagnosis: Ulcerative colitis was diagnosed in 21 (85%) and Crohn’s disease in 3 (15%). Cumulated prevalence: There was 20X increase in cases with IBD in the study period; comparison of frequencies showed a significant difference (p < 0.001). Cumulative prevalence per 100 admissions through the period evaluated was 2000= 0.2, 2001= 0.4%, 2002= 1.2%, 2003= 2.4%, 2004= 3.0%, 2005= 3.9%, 2006= 4.2%, 2007= 4.3%, 2008= 5.1%.
Poster Communications Conclusion: The population covered by the Mexican Social Security comprises a high proportion of the pediatric population of North-Western Mexico. Although this is not a population study, it probably reflects an emergent pathology in the pediatric population of this region. These observations resemble the already described north-south and west-east trend of increasing cumulative prevalence reported in developed and some developing countries. P060 CLINICAL FEATURES AND OUTCOME OF CHILDHOOD CROHN DISEASE FROM A MULTI-ETHNIC ASIA POPULATION W.S. Lee1 *, Y.S. Hoh2 , P.F. Chai1 , C.C.M. Boey1 . 1 Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia, 2 Department of Paediatrics, University of Aberdeen, Aberdeen, United Kingdom Aim: Little is known about the clinical features and outcome of childhood Crohn Disease (CD) outside the Caucasian population. We aimed to determine the clinical features and outcome of childhood CD from a multi-ethnic Asian population. Patients and Methods: Retrospective review of all newly diagnosed CD (less than 16 years) from 1997 to 2008, referred to the Department of Paediatrics, University of Malaya Medical Centre, Malaysia. CD was diagnosed on a combination of clinical, endoscopic, histological and/or radiological findings. Results: A total of 18 (male=10, 55%) patients with CD were referred during the study period (average 1.5 cases/year). The median age at first onset of symptoms was 6.5 years (range 0.6 14.5 years), while median duration between first symptom and diagnosis was 0.7 years (range 0 6.6 years). Most of the disease were limited to colon only (n = 7, 39%) or ileocolon (n = 6, 33%). Pan-enteric involvement (ileocolon and upper gastrointestinal) was uncommon (n = 2, 11%). Non-stricturing with perianal disease was the most common disease behavior (n = 9, 50%), followed by non-stricturing, nonpenetrating (n = 6, 33%). Two thirds (n = 12, 67%) of the patients responded to medical therapy alone. Six patients (33%) required surgery, the main indication being stricture formation (n = 4). The median PCDAI score at diagnosis was 50 (range 20 85). At latest review, only one patient (6%) was not in remission. Conclusion: CD is uncommon in Malaysia. There are significant differences in the disease behavior as compared to studies based on Caucasian population. P061 LIVING WITH INFLAMMATORY BOWEL DISEASE AS AN ADOLESCENT H.M. Lindfred1 *, R. Saalman2 , S. Nilsson3 , M. Lepp1 . 1 Sahlgrenska Academy, Gothenburg University, The Institute of Health and Care Sciences, 2 Sahlgrenska Academy, Gothenburg University, Sahgrenska University Hospital, 3 Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, G¨ oteborg, Sweden Background: Living with IBD during adolescence, a critical period of physical, psychological and social development can be especially demanding. Objectives: Our aim was to describe how adolescents with IBD experience daily life with IBD. Particular attention was paid to health and self management. Agreement between parents’ and children’s views was studied to explore features of family dynamics. Methods: In this cross sectional, population-based study; a disease-specific questionnaire with psychometric properties (12 VAS-items scoring 0 to 100) combined with semi-structured questions was used. Adolescents between the ages of 11 and 16 years (n = 66) from one referral centre and their parents (n = 119) participated. Conclusion: The majority of the adolescents reported good physical health (median = 89), self image (=74) and satisfactory health habits. However, several adolescents reported problems in everyday life, such as abdominal pain (30%), loss of appetite (20%) and difficulty sleeping (10%). Our data showed a significant correlation between physical health and almost all psychosocial adjustment variables. Results showed poor agreement between parents’ and adolescents’ views in all 12 items, except for the variables of responsibility for medical treatment (r = 0.51), knowledge about the disease (r = 0.32) and exercise habits (r = 0.32). P062 RADIOLOGIC EVALUATION OF THE SMALL INTESTINE IN PEDIATRIC INFLAMMATORY BOWEL DISEASE A. Linn´ er1 *, P. Malmborg1 , U. Ullberg1 , U.L. Fagerberg1 , H. Hildebrand1 . 1 Dept of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden Background: Diagnosing IBD, evaluation of the small intestine is crucial. According to the Porto criteria the small bowel should be investigated, except when a certain UC. Objectives: To evaluate if small bowel imaging (SBI) a) is performed as recommended b) in UC leads to a change in diagnosis c) finds pathology that had not already been diagnosed at endoscopy.
15 Methods: All patients diagnosed with IBD during 2002 07 were scrutinized. The small bowel had been investigated either with barium enteroclysis, small bowel follow-through or MR enterography. Results: 161 IBD patients were diagnosed (CD: 113, UC: 27 and IC: 21). 87% had SBI; 64% with X-ray and 26% with MRT. 39 patients with UC or IC (81%) had SBI, of which none changed the initial diagnosis. In the CD group 90% had SBI, 43% which were positive. With pathology in the distal ileum at endoscopy, 54% had positive radiological signs. Adversely, with a macroscopically healthy ileum, 24% showed positive results upon radiology. The patients with symptoms of stenosis were few (4), but had all positive radiological signs. Conclusion: Radiology did not lead to a change in diagnosis for patients with UC or IC. Radiological findings were uncommon when ileoscopy was normal. However, a normal ileoscopy was sometimes seen in spite of a pathological radiology of the distal ileum. P063 MARKERS OF PERINATAL BOWEL COLONIZATION AND PEDIATRIC CROHN’S DISEASE RISK P. Malmborg1 *, H. Hildebrand1 , A. Kling2 , S.M. Montgomery3 . 1 Department of Women and Child Health, Karolinska Institutet, Stockholm; 2 Department ¨ rebro University Hospital, O ¨ rebro; 3 Clinical of Clinical Medicine, O Epidemiology Unit, Department of medicine, Karolinska Institutet, Stockholm, Sweden Background: Crohn’s disease (CD) involves an inappropriate immune response against normal bowel flora. Disrupted or atypical patterns of microbial colonisation may impair appropriate development of homeostasis and thus increase CD risk. Birth by caesarean section (CS) may represent a risk for atypical patterns of colonization during the critical perinatal period. Method: Detailed information on delivery mode has been collected for all births in Sweden since 1990. Patients with pediatric (<16 years) CD were identified through the national Inpatient Register (born 1990 2006). Prospective case-control study. 746 cases with pediatric CD were identified and matched with 10 controls (n = 7,355) by delivery unit, week of birth and sex. Conditional logistic regression analyses adjusted for gestational age, maternal IBD and socioeconomic index. Stratification by sex, as differences in the prevalence of pediatric CD suggests sex-specific risks. Result: Birth by CS modestly increased the risk for CD among boys (n = 4,693); OR 1.54, 95% CI (1.15 2.07). For girls (n = 3,392) no association was seen between birth by CS and CD risk; OR 0.89 CI (0.60 1.33). Conclusion: Birth by CS is not a major risk for pediatric CD. Sex-specific susceptibility may influence CD risk. P064 APPLICATION OF THE PORTO CRITERIA FOR DIAGNOSIS OF PAEDIATRIC IBD IN A REFERRAL PAEDIATRIC CENTRE J. Martín de Carpi1 *, P. Vilar1 , V. Varea1 . 1 Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de D´ eu, Barcelona, Spain Background: In 2005 the ESPGHAN established the Porto Criteria (PC) to reach an accurate diagnosis of paediatric IBD. The recommendations include: 1) Total colonoscopy with ileal intubation, 2) Upper endoscopy, 3) Multiple biopsies and 4) Intestinal follow-through. Aim: To evaluate the diagnostic procedures used in our IBD patients before and after the PC publication. Patients and Methods: Review of the IBD patients diagnosed in the last ten years in a Spanish paediatric referral hospital. Results: 108 IBD patients have been diagnosed (51 UC, 52 CD, 5 IBDu), 65 boys (60.18%). Location: 1) UC, 40 (78%) extensive colitis, 5 left colitis and 6 proctitis. 2) CD: 44 ileo-colonic (84%), 8 colonic. Mean age: 11 y, 11mo (range 12 mo 17 y, 7 mo). The PC were followed in 49% (33% before 2005, 64% after). Upper endoscopy was performed in 58%: 39% versus 73%. 51% of our CD patients had upper involvement. Total colonoscopy with ileoscopy was achieved in 86%. Mean number of ileo-colonic segments biopsied: 6.6. Up to 38% of the CD patients have inflammation in endoscopically normal segments. During the follow-up, among the IBDu patients, initial diagnosis was changed to CD in 1, to UC in 2. We have not observed other changes in diagnosis in the remaining 103 patients. Conclusion: Our clinical practice in IBD diagnosis has changed after the PC. Upper endoscopy is a useful tool to find upper involvement. Colonoscopy with ileoscopy and performance of multiple biopsies are essential to determine extension of inflammation. We have not observed changes in the final diagnosis in our CD and UC patients.