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P.1.156: THIOPURINES IN THE TREATMENT OF INFLAMMATORY BOWEL DISEASES (IBD) – A SINGLE CENTRE EXPERIENCE
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264 disease awareness. Remaining psychological-clinical correlations are still matter of analyses. Conclusions: IBD patients are characterized by relevant alterations of their psychological tracts. Deeper insight in these aspects may be relevant for the amelioration of physician-patient interaction, to better select patients suitable for successful psychological support, and possibly to maximize therapeutic effectiveness (e.g. through amelioration of compliance).
P.1.155 ASSESSMENT OF ULCERATIVE COLITIS ENDOSCOPIC ACTIVITY WITH A NOVEL ROBOTIC COLONOSCOPE: THE ENDOTICS ENDOSCOPY SYSTEM S. Pallotta ∗ ,1 , E. Tumino 2 , G. Manes 1 , R. Sacco 2 , S. Ardizzone 3 , G. Bresci 2 , R. De Franchis 1 1 U.O. Dipartimentale di Endoscopia, Azienda Ospedaliera “l. Sacco”, Milano; 2 U.O. Gastroenterologia e Malattie Del Ricambio, Azienda Ospedaliero-Universitaria Pisana, Pisa; 3 U.O. Dipartimentale di Malattie Infiammatorie Intestinali, Azienda Ospedaliera “l. Sacco”, Milano, Italy
Background and aim: Aim of our study was to compare the diagnostic performance and tolerability of the Endotics Endoscopy System (EES), a soft, self-propelled, disposable colonoscope, with that of standard colonoscopy (WLC) for the staging of ulcerative colitis. Material and methods: Patients with mildly to moderately active ulcerative colitis seen at one of our 2 endoscopy departments (Milan and Pisa) for follow-up colonoscopies were studied first with EES and then with WLC. We assessed the endoscopic activity according to Baron criteria, we also recorded time to reach the caecum, sedation, patient’s pain/discomfort and operator’s difficulty. Results: We studied 12 patients (7M/5F), mean age 41 yrs and disease duration 5.33 yrs. 53 colonic segments (caecum, ascending, transverse, descending and sigmoid colon and rectum in each patient) out of the 54 evaluated had the same assessment of disease activity (absent = 0 points, mild = 1 pt, moderate = 2 pts and severe = 3 pts) with EES and WLC. Mean activity score with EES was 0.35 pts (SD 0.60) and 0.33 pts (SD 0.60) with WLC, without significant difference. The caecum was reached in 11/12 cases by WLC in an average of 29.42 min (SD 28.94), and in 10/12 cases by EES, in an average of 46.67 min (SD 24.98 min), with a mean difference of 17.25 min., not statistically significant. Incomplete colon explorations with EES clustered in Milan, probably because of our smaller experience. An average of 1.45 (SD 0.79) mg of midazolam were used during WLC while 0.41 (SD 0.38) mg during EES. Mean pain/discomfort on a 0-10 scale was 2.08 (SD 1.67) for EES and 4.17 (SD 1.74) for WLC, with a statistically significant difference (p = 0.066) favouring EES. Mean perceived operator’s difficulty on a 0-10 scale was 4.44 (SD 1.78) for EES, and 4.08 (SD 1.44) for WLC, with a mean difference of 0.42 pts favoring WLC, not statistically significant. Conclusions: EES appears to be a promising method for disease staging in patients with ulcerative colitis of long duration, because of reduction in pain and discomfort. The capability of obtaining biopsies is still needed before EES can be proposed as a tool for the long term follow-up and screening for dysplasia in patients with disease of long duration.
P.1.156 THIOPURINES IN THE TREATMENT OF INFLAMMATORY BOWEL DISEASES (IBD) – A SINGLE CENTRE EXPERIENCE F. Furfaro ∗ ,1 , G. Costantino 1 , A. Alibrandi 2 , W. Fries 1 1 Dip
di Medicina Interna, Messina, Italy; 2 Department of Economical, Financial, Social, Environmental, Statistical and Territorial Sciences (S.E.Fi.S.A.S.T.), Messina, Italy Background and aim: Thiopurines (THIO) belong to the standard therapy in IBD. One of the unsolved questions is duration of therapy and the concern regarding adverse events (AE). AE in patients treated with THIO are reported to occur in 15-30%. The aim of our study was to investigate their efficacy and safety.
S199
Material and methods: We analyzed retrospectively the charts of 837 IBD patients followed in our clinic. Harvey-Bradshaw index (HBI) or partial Mayo score (pMS) before and after 6, 12, 24 and 36 months of treatment with THIO were registered. Indications for treatment, mean duration of treatment, and AE were recorded. AE were divided in early (within 4 wks of start), intermediate (from 2 to 6 months) and late (>6 months). Data are mean values ± SD. Comparison was performed with the Wilcoxon signed rank-test. Results: We identified 266 patients (157 CD, 109 UC) treated with THIO. Indications for treatment were steroid dependency in 189 (71%), perianal fistulas in 12 (4.5%), post-surgery recurrence in 22 (8.3%), extensive disease in 36 (13.6%), other in 6 (2.3%). The mean duration of disease prior to IMM was 5.3 yrs ± 8.7; the mean duration of treatment was 2.8 yrs ± 6.0. In CD and in UC, the clinical activity indices (HBI, pMS) fell significantly from pretreatment values to 6 months and up to 3 years (all p<0.001 vs pre-treatment). For analysis of adverse events (AE) 733 patient years were available. Overall 115 AE were identified in 87 patients (32.7%), 14 (16.1%) resolved with dose reduction, 70 patients (80.5%) discontinued THIO because of AE. We observed early AE in 41 patients (47.1%), the most frequent are represented by flu-like syndrome (21 AE), nausea, vomiting or abdominal pain (10 AE), pancreatic hyperenzymemia (9 AE); intermediate AE in 16 (18.4%), the most frequent is represented by hepatotoxicity (10 AE); late AE in 30 (34.5%), the most frequent are represented by leucopenia (11 AE), infections (9 AE), liver toxicity (6 AE). Conclusions: THIO represent an valid treatment in IBD being equally effective in CD and UC, maintaining efficacy over time. AE did occur in 32.7% of patients leading to drug discontinuation in 26.3% of patients. Among late occurring AE, leucopenia, liver toxicity, and infections were the most frequent, emphasizing the need for continuous surveillance of patients.
P.1.157 NON ALCOHOLIC FATTY LIVER DISEASE ASSOCIATED WITH INCREASED CENTRAL BODY FAT BY DUAL-ENERGY X-RAY ABSORPTIOMETRY A. Ludovico ∗ ,1 , P.H. Guzzi 1 , L. Di Renzo 2 , M. Cannataro 1 , F. Luzza 1 , A. De Lorenzo 2 1 Department of Experimental and Clinical Medicine, University “magna Græcia”, Catanzaro, Italy; 2 Department of Neuroscience, Division of Human Nutrition, University “tor Vergata”, Roma, Italy
Background and aim: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in general population. Ultrasound (US) is widely used in the diagnosis of pts with suspected liver disease. In particular US is the least expensive modality for detecting changes associated with NAFLD. Overweight and obesity are common conditions in pts with NAFLD. Central or visceral, obesity seems to be more important than total body obesity. On this basis body composition (BC) assessment is necessary to evaluate nutritional status and thus health and to assess the efficacy of preventive nutritional strategies. A more valid and precise method for measuring BC is dual-energy X-ray absorptiometry (DXA). Aim of this study is to evaluate the relationship between regional body composition and in particular central body fat distribution measured by DXA and degree of NAFLD evaluated by US. Material and methods: In total 31 pts, thirteen (42%) male, were recruited from January to July 2010. Exclusion criteria included alcohol intake (>20 g/d), hepatic virus infection, and presence of other liver disease. Median age of our cohort was 49.16 (±12.14) yrs. Median weight was 87.2 kg (±20.32) and median BMI was 31.53 (±5.95) kg/m2 . In particular, 25 pts (80.6%) reported a BMI value greater than 25 (five without, six with mild, six with moderate and eight with severe US degree of NAFLD). Median value of ALT was 33.6 (±27.3) Ul-1 (four pts with a mild elevation of transaminases blood value, one without, two with mild and one with severe US liver steatosis). Results: Of all DXA parameters analyzed, those that present a significant difference among US liver steatosis degree (p<0.05) are: distribution of fraction of android fat (p=0.045), android tissue mass (p=0.047) and android fat mass (p=0.009). In our cohort, liver steatosis was significantly associated with increased android fat distribution, in particular in overweight patients. Conclusions: Most previous studies have relied on BMI or body weight as a measure of adiposity or have used non-invasive surrogate measures for
P.1.155 ASSESSMENT OF ULCERATIVE COLITIS ENDOSCOPIC ACTIVITY WITH A NOVEL ROBOTIC COLONOSCOPE: THE ENDOTICS ENDOSCOPY SYSTEM S. Pallotta ∗ ,1 , E. Tumino 2 , G. Manes 1 , R. Sacco 2 , S. Ardizzone 3 , G. Bresci 2 , R. De Franchis 1 1 U.O. Dipartimentale di Endoscopia, Azienda Ospedaliera “l. Sacco”, Milano; 2 U.O. Gastroenterologia e Malattie Del Ricambio, Azienda Ospedaliero-Universitaria Pisana, Pisa; 3 U.O. Dipartimentale di Malattie Infiammatorie Intestinali, Azienda Ospedaliera “l. Sacco”, Milano, Italy
Background and aim: Aim of our study was to compare the diagnostic performance and tolerability of the Endotics Endoscopy System (EES), a soft, self-propelled, disposable colonoscope, with that of standard colonoscopy (WLC) for the staging of ulcerative colitis. Material and methods: Patients with mildly to moderately active ulcerative colitis seen at one of our 2 endoscopy departments (Milan and Pisa) for follow-up colonoscopies were studied first with EES and then with WLC. We assessed the endoscopic activity according to Baron criteria, we also recorded time to reach the caecum, sedation, patient’s pain/discomfort and operator’s difficulty. Results: We studied 12 patients (7M/5F), mean age 41 yrs and disease duration 5.33 yrs. 53 colonic segments (caecum, ascending, transverse, descending and sigmoid colon and rectum in each patient) out of the 54 evaluated had the same assessment of disease activity (absent = 0 points, mild = 1 pt, moderate = 2 pts and severe = 3 pts) with EES and WLC. Mean activity score with EES was 0.35 pts (SD 0.60) and 0.33 pts (SD 0.60) with WLC, without significant difference. The caecum was reached in 11/12 cases by WLC in an average of 29.42 min (SD 28.94), and in 10/12 cases by EES, in an average of 46.67 min (SD 24.98 min), with a mean difference of 17.25 min., not statistically significant. Incomplete colon explorations with EES clustered in Milan, probably because of our smaller experience. An average of 1.45 (SD 0.79) mg of midazolam were used during WLC while 0.41 (SD 0.38) mg during EES. Mean pain/discomfort on a 0-10 scale was 2.08 (SD 1.67) for EES and 4.17 (SD 1.74) for WLC, with a statistically significant difference (p = 0.066) favouring EES. Mean perceived operator’s difficulty on a 0-10 scale was 4.44 (SD 1.78) for EES, and 4.08 (SD 1.44) for WLC, with a mean difference of 0.42 pts favoring WLC, not statistically significant. Conclusions: EES appears to be a promising method for disease staging in patients with ulcerative colitis of long duration, because of reduction in pain and discomfort. The capability of obtaining biopsies is still needed before EES can be proposed as a tool for the long term follow-up and screening for dysplasia in patients with disease of long duration.
P.1.156 THIOPURINES IN THE TREATMENT OF INFLAMMATORY BOWEL DISEASES (IBD) – A SINGLE CENTRE EXPERIENCE F. Furfaro ∗ ,1 , G. Costantino 1 , A. Alibrandi 2 , W. Fries 1 1 Dip
di Medicina Interna, Messina, Italy; 2 Department of Economical, Financial, Social, Environmental, Statistical and Territorial Sciences (S.E.Fi.S.A.S.T.), Messina, Italy Background and aim: Thiopurines (THIO) belong to the standard therapy in IBD. One of the unsolved questions is duration of therapy and the concern regarding adverse events (AE). AE in patients treated with THIO are reported to occur in 15-30%. The aim of our study was to investigate their efficacy and safety.
S199
Material and methods: We analyzed retrospectively the charts of 837 IBD patients followed in our clinic. Harvey-Bradshaw index (HBI) or partial Mayo score (pMS) before and after 6, 12, 24 and 36 months of treatment with THIO were registered. Indications for treatment, mean duration of treatment, and AE were recorded. AE were divided in early (within 4 wks of start), intermediate (from 2 to 6 months) and late (>6 months). Data are mean values ± SD. Comparison was performed with the Wilcoxon signed rank-test. Results: We identified 266 patients (157 CD, 109 UC) treated with THIO. Indications for treatment were steroid dependency in 189 (71%), perianal fistulas in 12 (4.5%), post-surgery recurrence in 22 (8.3%), extensive disease in 36 (13.6%), other in 6 (2.3%). The mean duration of disease prior to IMM was 5.3 yrs ± 8.7; the mean duration of treatment was 2.8 yrs ± 6.0. In CD and in UC, the clinical activity indices (HBI, pMS) fell significantly from pretreatment values to 6 months and up to 3 years (all p<0.001 vs pre-treatment). For analysis of adverse events (AE) 733 patient years were available. Overall 115 AE were identified in 87 patients (32.7%), 14 (16.1%) resolved with dose reduction, 70 patients (80.5%) discontinued THIO because of AE. We observed early AE in 41 patients (47.1%), the most frequent are represented by flu-like syndrome (21 AE), nausea, vomiting or abdominal pain (10 AE), pancreatic hyperenzymemia (9 AE); intermediate AE in 16 (18.4%), the most frequent is represented by hepatotoxicity (10 AE); late AE in 30 (34.5%), the most frequent are represented by leucopenia (11 AE), infections (9 AE), liver toxicity (6 AE). Conclusions: THIO represent an valid treatment in IBD being equally effective in CD and UC, maintaining efficacy over time. AE did occur in 32.7% of patients leading to drug discontinuation in 26.3% of patients. Among late occurring AE, leucopenia, liver toxicity, and infections were the most frequent, emphasizing the need for continuous surveillance of patients.
P.1.157 NON ALCOHOLIC FATTY LIVER DISEASE ASSOCIATED WITH INCREASED CENTRAL BODY FAT BY DUAL-ENERGY X-RAY ABSORPTIOMETRY A. Ludovico ∗ ,1 , P.H. Guzzi 1 , L. Di Renzo 2 , M. Cannataro 1 , F. Luzza 1 , A. De Lorenzo 2 1 Department of Experimental and Clinical Medicine, University “magna Græcia”, Catanzaro, Italy; 2 Department of Neuroscience, Division of Human Nutrition, University “tor Vergata”, Roma, Italy
Background and aim: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in general population. Ultrasound (US) is widely used in the diagnosis of pts with suspected liver disease. In particular US is the least expensive modality for detecting changes associated with NAFLD. Overweight and obesity are common conditions in pts with NAFLD. Central or visceral, obesity seems to be more important than total body obesity. On this basis body composition (BC) assessment is necessary to evaluate nutritional status and thus health and to assess the efficacy of preventive nutritional strategies. A more valid and precise method for measuring BC is dual-energy X-ray absorptiometry (DXA). Aim of this study is to evaluate the relationship between regional body composition and in particular central body fat distribution measured by DXA and degree of NAFLD evaluated by US. Material and methods: In total 31 pts, thirteen (42%) male, were recruited from January to July 2010. Exclusion criteria included alcohol intake (>20 g/d), hepatic virus infection, and presence of other liver disease. Median age of our cohort was 49.16 (±12.14) yrs. Median weight was 87.2 kg (±20.32) and median BMI was 31.53 (±5.95) kg/m2 . In particular, 25 pts (80.6%) reported a BMI value greater than 25 (five without, six with mild, six with moderate and eight with severe US degree of NAFLD). Median value of ALT was 33.6 (±27.3) Ul-1 (four pts with a mild elevation of transaminases blood value, one without, two with mild and one with severe US liver steatosis). Results: Of all DXA parameters analyzed, those that present a significant difference among US liver steatosis degree (p<0.05) are: distribution of fraction of android fat (p=0.045), android tissue mass (p=0.047) and android fat mass (p=0.009). In our cohort, liver steatosis was significantly associated with increased android fat distribution, in particular in overweight patients. Conclusions: Most previous studies have relied on BMI or body weight as a measure of adiposity or have used non-invasive surrogate measures for