P085 CHARACTERISTICS OF 264 PROSPECTIVELY DIAGNOSED PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD) IN THE NATIONAL IBD REGISTRY

Poster Communications CD is still not clear. Therefore, we examined the relationship between the presence of PAB, disease phenotype, anti-Saccharomyces cerevisiae antibodies (ASCA) and NOD2/CARD15 genotype in pediatric Crohn’s disease patients. Methods: Forty-nine CD patients (2 18 years, M/F=1.7/1) were tested for PAB by indirect immunofluorescence and for ASCA by enzyme-linked immunosorbent assay. All patients had genotyping performed using sequence specific PCR directed against the wild type and the R702W, G908R and 3020insC variants of NOD2/CARD15 gene. Disease location, disease activity at the time of diagnosis and the presence of complicated disease phenotype (penetrating/stricturing) were determined. Results: 34.7% of CD patients were PAB-positive. ASCA (IgG and/or IgA) were found in 63.2% of the patients. 24.5% of CD patients had at least one of the three principal variants of NOD2/CARD15 gene.There was no significant association between the presence of PAB and the carriage of NOD2/CARD15 variants (p = 0.051) and between PAB and the location of the disease (p = 0.574). A positive association of PAB with ASCA (p = 0.001), disease activity at the time of diagnosis (p = 0.003) and more complicated disease phenotype (p = 0.006) was found. Conclusion: A positive association of PAB with ASCA, higher disease activity at the time of diagnosis and more complicated disease phenotype was observed in our study. This observation suggests PAB may be a useful serologic marker for complicated disease behavior in pediatric CD. P082 IBD-ASSOCIATED ANEMIA IN CHILDREN: CONTROLLING INTESTINAL INFLAMMATION IS NOT ENOUGH TO NORMALIZE HEMOGLOBIN L. Pels1 , E. Van de Vijver1 , H. Waalkens2 , J. Uitentuis3 , G. Gonera-de Jong4 , L. van Overbeek5 , O. Norbruis6 , E. Rings1 , P. van Rheenen1 *. 1 Pediatric Gastroenterology, UMCG, Groningen; 2 Pediatrics, Martini Hospital, Groningen; 3 Pediatrics, MCL, Leeuwarden; 4 Pediatrics, Wilhelmina Hospital, Assen; 5 Pediatrics, Scheper Hospital, Emmen; 6 Pediatrics, Isala Clinics, Zwolle, Netherlands Background: Iron deficiency anemia (IDA) is a common manifestation in children with inflammatory bowel diseases (IBD), but its prevalence at the time of IBD diagnosis is unknown. Objectives: (1) To determine the prevalence of IDA at the time of IBD diagnosis; (2) to review the treatment of IDA. Methods: Medical files of 81 consecutive pediatric IBD patients diagnosed at a tertiary care center in the Netherlands were reviewed. Results: The prevalence of anemia was 82%, of which two third was classified as IDA. Initial treatment was mostly exclusively directed to control intestinal inflammation. This approach did not change hemoglobin levels (Hb) in IDA patients, while Hb in patients with other types of anemia improved (mean increase 0.0 and 0.6 mmol/L, resp.; p = 0.007). In IDA patients a rise in Hb was only realized after additional iron therapy (mean increase 1.0 mmol/L). Conclusion: IDA is highly prevalent in pediatric IBD patients at the time of IBD diagnosis. However, this complication receives little attention from pediatricians. In patients with IDA, Hb does not improve on initial antiinflammatory treatment. Present results underline the need to early identify IDA in pediatric IBD patients in order to give these children appropriate and timely iron treatment. P083 PROFILE OF BELGIAN PEDIATRIC CROHN’S DISEASE SUBJECTS (1): DEMOGRAPHY AND BACKGROUND: OF THE FIRST 100 PATIENTS. G. Veereman1 *. 1 Pediatric gastroenterology and nutrition, Queen Paola Children’s Hospital ZNA, Antwerp, Belgium The IBD working group of Bespghan recently established a registry of Belgian pediatric CD in order to study demographical data, treatment and disease course over 5 yrs. IRB approval and informed consents were obtained. We report on the background and history of the first 100 inclusions: 60 boys, 40 girls, 92 are Caucasian. At registration age groups are: 3: 2 5yrs, 15: 6 11yrs, and 82: 12 18yrs old. The youngest patients are mostly boys. Birth history reveals that 85% were delivered by vaginal route, mean gestational age was 38.3 wks and 19 patients were premature. The mean birth weight was 3.24 kg (range 1.6 4.6) and height 49.8 cm (range 40 56). Data on neonatal feeding are available from 77 infants: 67.6% were breastfed for a mean duration of 11.4 wks. The majority (60%) of formula used was cow’s milk based. There was a suspicion of food allergy in 20.9% infants (33.3% to cow’s milk). In their prior history 18.5% needed dietary restrictions and 38.5% underwent surgery. During the last 3 months prior to diagnosis 18.3% took antibiotics, 17.3% suffered a minor infectious episode, 21.4% experienced a major stressful event. FH was positive for IBD (CD and Ulcerative colitis) in 52.3 % and a 1st degree relative in 15.4% or a 2nd degree relative in 27.7% with CD. FH for autoimmune diseases (exc diabetes & hepatitis) was positive in 49.2%. Smoking occurred in 12 families but no patient was active smoker. In conclusion in the Belgian pediatric CD population prior disease

19 history appears unremarkable. Positive FH for IBD and autoimmune diseases is common. P084 PROFILE OF BELGIAN PEDIATRIC CROHN’S DISEASE SUBJECTS (2): SNAP SHOT AT DIAGNOSIS G. Veereman1 *. 1 Pediatric Gastroenterology and Nutrition, Queen Paola Children’s Hospital ZNA, Antwerp, Belgium The IBD working group of Bespghan recently established a registry of Belgian pediatric CD. Diagnosis was made within 12 wks of symptoms in 52.7% & 21 wks in 75%. Mean age was 11.7+2.744 yrs, mean bone age 11.6+3.3 yrs, mean z-score for height was 1.1+1.3. Pubertal stages were 56.8% Tanner stage I and 21.6% stage II. Concomitant conditions (mostly autoimmune type) and extra intestinal symptoms were observed in 4.4% and 26.4%. PCDAI (58 pts): 3 scored less than 10, 18 scored 10 30, and 37 scored >30. PCDAI at diagnosis was correlated negatively with birth weight (p = 0.0473) and birth height (p = 0.407) not with age at presentation or symptom duration. Diagnosis was based on endoscopy and histology in 87.75 %, 97% had (ileo)colonoscopy, 68.7% OGD, 1% sigmoidoscopy. Imaging studies: 61.6% abdominal US, 25.3% small bowel enteroclysis, 14.1% CT and 9.1% MRI. White cell scan was used in 2%, small bowel capsule in none. The most frequently involved intestinal area was the ileocolon (52%). Histological diagnosis was made in 72.7% patients undergoing OGD. Initial therapeutic approach was monotherapy with steroids in 4.05%, 5ASA in 9.45%, antibiotics in 1.35%. Combination of steroids with azathioprine was prescribed in 36.49%, with MTX in none, with 5-ASA in 27.02% and with antibiotics in 10.8%. Enteral nutrition was used in 9.5%, always combined with drugs. Thus, children presented with extensive involvement of the GI tract but the small bowel remains mostly unexplored. The severity of disease at presentation may be related to intrauterine growth. P085 CHARACTERISTICS OF 264 PROSPECTIVELY DIAGNOSED PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD) IN THE NATIONAL IBD REGISTRY G. Veres1 *, M. Papp2 , P. Lakatos3 . 1 Ist Dept of Pediatrics, Semmelweis University, Budapest; 2 2 Department of Medicine, University of Debrecen, Debrecen; 3 1 Department of Medicine, Semmelweis University, Budapest, Hungary Background: Aims: On behalf of the of our Pediatric Gastroenterology Society prospective registry of pediatric inflammatory bowel disease (IBD) was launched from the 1st of January 2007 with the cooperation of 27 institutes (clinics, hospitals, outpatient departments) ensuring the coverage of the whole country. Methods: The participating institutes are requested to fill out a questionnaire (78 parameters) about every newly diagnosed IBD patients younger than 18 years. Results: Between 01.01.2007 and 31.12.2008 264 newly diagnosed cases of IBD were prospectively identified: 165 cases of CD, 83 cases of UC and 16 cases of indeterminate colitis. As a result the incidence of childhood IBD was 6.45-, with the incidence of CD being 4.05-, the incidence of UC 2.05 cases per 100,000 per year. There was a male preponderance in CD (CD/UC= 1.65). Positive family history of IBD was registered in 7.6% of patients and 9.6% of patients with CD were reported to have a fistula. Ileoscopy rate was only 52% technical problem was the most common reason for the lack of ileal intubation. Oesophago-gastro-duodenoscopy was performed in 53% of all cases. In 38% were MRI or CT scan made for the detailed verification of the disease. Conclusion: The incidences reported in the first 2 years of our IBD registry are similar to the European and North American data. Ileal intubation and oesophago-gastro-duodenoscopy were performed in the half of the cases, and this rate should be improved in the future. P086 MAGNETIC RESONANCE ENTEROGRAPHY USE IN PEDIATRIC IBD: REVIEW OF 20 PATIENTS G. Ishak1 *, N. Yee2 , G. Wahbeh3 . 1 Radiology, Seattle Children’s Hospital UW; 2 Radiology, PolyClinic, 3 Gastroenterology, Seattle Children’s Hospital University of Washington, Seattle, United States Background: Magnetic Resonance Enterography (MRE) offers an ionizing radiation-free alternative modality to computed tomography and fluoroscopy in diagnosis and management of inflammatory bowel disease (IBD). Children may be particularly vulnerable to long term radiation effects. Objectives: Review our center’s experience using MRE for children with IBD. Methods: 20 patients (mean age 14 years, range 10 20) with Crohn’s disease, duration 1 month-15 years, underwent MRE. Indications were symptoms of active small bowel disease, stenosis or fistulae. MRE scans were performed on 1.5 T and 3T Siemens MRI scanners, with/without intravenous Gadolinium, after oral contrast (Volumen) and intravenous glucagon. Scans were well