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P.1.220: PREVALENCE OF INFLAMMATORY BOWEL DISEASE IN PATIENTS WITH CELIAC DISEASE IN EASTERN SICILY AREA
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264 P.1.219 IN CROHN’S DISEASE COLONIC MUCINS ARE EXPRESSED IN THE ESTABLISHED ILEAL LESIONS AT SURGERY WHILE ILEAL MUCINS ARE MAINLY EXPRESSED IN THE EARLY POSTOPERATIVE RECURRENCE: A PROSPECTIVE LONGITUDINAL STUDY M. Ascolani ∗ ,1 , C. Mescoli 2 , E. Calabrese 1 , S. Onali 1 , F. Zorzi 1 , G. Condino 1 , G. Sica 1 , G. Palmieri 1 , F. Pallone 1 , M. Rugge 2 , L. Biancone 1 1 Università
Tor Vergata, Roma, Italy; 2 Università di Padova, Padova, Italy
Background and aim: The expression of mucins in Crohn’s Disease (CD) ileum and its possible relation with recurrence is unknown. We aimed to assess, in a prospective longitudinal study, the expression of ileal (sialomucins) and colonic mucins (sulphomucins) in established vs early ileal lesions in CD and its possible relation with recurrence. Material and methods: Twenty patients (pts) undergoing ileo-colonic resection for CD were enrolled from Feb 2007 to March 2010. At 6 and 12 months (mths), clinical (CDAI) and endoscopic (Rutgeerts score) recurrence were assessed. Ileal samples were taken at surgery and colonoscopy at 6mths in 20/20 pts and also at 12mths in 12/20 pts. Samples were stained by histochemistry as follows: sialomucins for ileal- and sulphomucins for colonic-epithelium (iron diamine). Mucins expression scored as % mucins in each sample. Results: Clinical recurrence (CDAI>150) was shown by 2/20 pts at 6 mths and by 2/12 pts at 12 mths. Endoscopic recurrence. (score=1) was shown by 16/20 pts at 6 mths and by 10/12 pts at 12 mths. The endoscopic score did not increase at 12 vs 6 mths (median, range: 2.0-4 vs 2.5.0-4; p=0.83). Histochemistry. Sialomucins (ileal epithelium) were expressed in all ileal samples at surgery, at 6 and 12 mths. The expression significantly increased at 6 and 12 mths vs surgery (median, range: 65%, 1-100 vs 100%, 80-100 vs 100%, 99-100; p<0.001) (Table 1). Sulphomucins (colonic epithelium) in ileal samples were expressed in 20/20 pts at surgery, but in only 8/20 pts at 6 mths and in 3/12 pts at 12 mths. The expression significantly reduced at 6 and 12 mths vs surgery (median, range: 32%, 0-99 vs 0%, 0-20, vs 12 mths 0%, 0-1; p<0.001). At all times, the expression was higher for sialo vs sulphomucins (p<0.001), being comparable between pts with or without recurrence (Table 1). Table 1 Sialomucins (median %, range) Sulphomucins (median %, range) a
Surgery
6 months
12 months
65 (1-100) 32 (0-99)
100 (80-100%)a 0 (0-20)b
100 (99-100)a 0 (0-1)b
p<0.001 6 and 12 months vs surgery; b p<0.001 6 and 12 months vs surgery.
Conclusions: In CD, colonic mucins (sulphomucins) are expressed in the involved ileum at surgery, while ileal mucins (sialomucins) are preferentially expressed in the ileum uninvolved or showing early recurrence.
P.1.220 PREVALENCE OF INFLAMMATORY BOWEL DISEASE IN PATIENTS WITH CELIAC DISEASE IN EASTERN SICILY AREA G. Inserra ∗ ,1 , C. D’Agate 2 , R. Catanzaro 1 , G. Aprile 2 , G. Trama 2 , A. Mangiameli 1 , P. Naso 2 1 Policlinico Universitario “G. Rodolico” Uoc Medicina Interna, Catania, Italy; 2 Policlinico Universitario “G. Rodolico” Uo Endoscopia Digestiva Chirurgica, Catania, Italy
Background and aim: The relationship between celiac disease and inflammatory bowel disease (IBD) is still controversial and may be related to the different geographic areas. The aim of this study was to compare the prevalence of IBD in a cohort of celiac patients of an eastern Sicily area (Italy) to the prevalence of IBD in the only existing study in italian population. Material and methods: A database of patients (474 M–794 F, aged 18 to 77 yrs) with celiac disease seen in our hospital between 2000 and 2010 was analyzed. All celiac disease patients were diagnosed according to current criteria by serology and jejunal biopsy. IBD was identified by clinical history supported by endoscopic and pathologic confirmation. The prevalence of IBD
S221
in celiac patients was compared to the prevalence of IBD in the population of the metropolitan area of Florence. The data were analyzed using chi-square test with Yates correction for continuity. Results: Considering all the 1268 celiac patients, the prevalence of IBD was 6.35‰ in celiac patients vs 1.61‰ in non celiac population (p< 0.01). However the difference between the prevalence of both UC (6.43‰ celiac patients vs 1.55‰ non celiac population, p< 0.001) and CD (4.30‰ celiac patients vs 0.43‰ non celiac population, p< 0.001) was significant only in males while no significant difference in prevalence of IBD was found in celiac females as compared to non celiac population. Conclusions: Within our cohort of patients with celiac disease, IBD was significantly higher than in general population. The difference was significant only in males and not in females. Of course the limitation of this study was to compare two populations of different italian geographical areas. However as far as we know there is no epidemiological study of sicilian population.
P.1.221 SERUM LIPID ALTERATIONS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE TREATED WITH TNF ALPHA ANTAGONISTS L. Amato ∗ , M. Cappello, I. Bravatà, C. Randazzo, P.L. Almasio, A. Craxì Sezione di Gastroenterologia, Di.Bi.Mis., Università di Palermo, Palermo, Italy Background and aim: Studies in patients with rheumatoid arthritis or ankylosing spondilytis have shown that anti-tumor necrosis factor-alpha agents may induce alterations on serum lipids thus affecting the atherogenic risk. Data on patients with Inflammatory Bowel Disease (IBD) are scanty. The aim of our study was to assess the effects of anti-TNF agents on serum lipid profile in a cohort of Italian patients with IBD. Material and methods: Fifty-four patients with IBD (21 males, median age 45 yrs, range 20-69) on anti-TNF therapy were studied. Forty-three had Crohn’s disease (CD), 11 had ulcerative colitis (UC); 23 patients received infliximab at weeks 0, 2 and 6 and subsequently every 8 weeks, 14 patients received adalimumab at weeks 0, 2 and 4 and subsequently every other week and 17 patients received infliximab and then switched to adalimumab for loss of response or intolerance to infliximab. Clinical and demographic characteristics, serum lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides) and Body Mass Index (BMI) were assessed at baseline and at the last follow up visit. Response to biologics was evaluated by CDAI for CD and Mayo score for UC. Results: Mean duration of anti-TNF therapy was 22.4 months (range 195). Remission was achieved in 38 (70.4%) patients. CDAI decreased from 117.9±55.7 to 75.2±37.1 (p<0.001) and Mayo score from 7.3±2.5 to 3.1±1.3 (p<0.001). Statistically significant difference of blood levels at baseline and at the end of follow-up was observed for total cholesterol (179.1±43.9 mg/dl vs. 191.7±46.9 mg/dl, p = 0.034) but not for HDL, LDL cholesterol and triglycerides. BMI increased from 23.97±3.96 to 24.47±4.19 (p = 0.016). Both significant differences were mainly related to treatment response. Nine out of 54 patients (16.6%), who had a normal lipid profile at baseline, experienced an increase of values while on biologics. Conclusions: Anti-TNF therapy in patients with IBD induced only a moderate raise of total cholesterol. This result was related to treatment response and improvement of nutritional status as confirmed by increased BMI. Close monitoring of lipid levels in patients with IBD under anti-TNF therapy cannot be recommended.
P.1.222 MUCOSAL HEALING IN ANTI-TNF REFRACTORY/INTOLERANT CROHN’S DISEASE WITH THALIDOMIDE THERAPY M.L. Scribano ∗ , M. Marrollo, L. Cantoro, R. Cosintino, C. Prantera, A. Kohn Gastroenterology Operative Unit, Azienda Ospedaliera S.Camillo-Forlanini, Rome, Italy Background and aim: Thalidomide is an anti-tumor necrosis factor (TNF)
Tor Vergata, Roma, Italy; 2 Università di Padova, Padova, Italy
Background and aim: The expression of mucins in Crohn’s Disease (CD) ileum and its possible relation with recurrence is unknown. We aimed to assess, in a prospective longitudinal study, the expression of ileal (sialomucins) and colonic mucins (sulphomucins) in established vs early ileal lesions in CD and its possible relation with recurrence. Material and methods: Twenty patients (pts) undergoing ileo-colonic resection for CD were enrolled from Feb 2007 to March 2010. At 6 and 12 months (mths), clinical (CDAI) and endoscopic (Rutgeerts score) recurrence were assessed. Ileal samples were taken at surgery and colonoscopy at 6mths in 20/20 pts and also at 12mths in 12/20 pts. Samples were stained by histochemistry as follows: sialomucins for ileal- and sulphomucins for colonic-epithelium (iron diamine). Mucins expression scored as % mucins in each sample. Results: Clinical recurrence (CDAI>150) was shown by 2/20 pts at 6 mths and by 2/12 pts at 12 mths. Endoscopic recurrence. (score=1) was shown by 16/20 pts at 6 mths and by 10/12 pts at 12 mths. The endoscopic score did not increase at 12 vs 6 mths (median, range: 2.0-4 vs 2.5.0-4; p=0.83). Histochemistry. Sialomucins (ileal epithelium) were expressed in all ileal samples at surgery, at 6 and 12 mths. The expression significantly increased at 6 and 12 mths vs surgery (median, range: 65%, 1-100 vs 100%, 80-100 vs 100%, 99-100; p<0.001) (Table 1). Sulphomucins (colonic epithelium) in ileal samples were expressed in 20/20 pts at surgery, but in only 8/20 pts at 6 mths and in 3/12 pts at 12 mths. The expression significantly reduced at 6 and 12 mths vs surgery (median, range: 32%, 0-99 vs 0%, 0-20, vs 12 mths 0%, 0-1; p<0.001). At all times, the expression was higher for sialo vs sulphomucins (p<0.001), being comparable between pts with or without recurrence (Table 1). Table 1 Sialomucins (median %, range) Sulphomucins (median %, range) a
Surgery
6 months
12 months
65 (1-100) 32 (0-99)
100 (80-100%)a 0 (0-20)b
100 (99-100)a 0 (0-1)b
p<0.001 6 and 12 months vs surgery; b p<0.001 6 and 12 months vs surgery.
Conclusions: In CD, colonic mucins (sulphomucins) are expressed in the involved ileum at surgery, while ileal mucins (sialomucins) are preferentially expressed in the ileum uninvolved or showing early recurrence.
P.1.220 PREVALENCE OF INFLAMMATORY BOWEL DISEASE IN PATIENTS WITH CELIAC DISEASE IN EASTERN SICILY AREA G. Inserra ∗ ,1 , C. D’Agate 2 , R. Catanzaro 1 , G. Aprile 2 , G. Trama 2 , A. Mangiameli 1 , P. Naso 2 1 Policlinico Universitario “G. Rodolico” Uoc Medicina Interna, Catania, Italy; 2 Policlinico Universitario “G. Rodolico” Uo Endoscopia Digestiva Chirurgica, Catania, Italy
Background and aim: The relationship between celiac disease and inflammatory bowel disease (IBD) is still controversial and may be related to the different geographic areas. The aim of this study was to compare the prevalence of IBD in a cohort of celiac patients of an eastern Sicily area (Italy) to the prevalence of IBD in the only existing study in italian population. Material and methods: A database of patients (474 M–794 F, aged 18 to 77 yrs) with celiac disease seen in our hospital between 2000 and 2010 was analyzed. All celiac disease patients were diagnosed according to current criteria by serology and jejunal biopsy. IBD was identified by clinical history supported by endoscopic and pathologic confirmation. The prevalence of IBD
S221
in celiac patients was compared to the prevalence of IBD in the population of the metropolitan area of Florence. The data were analyzed using chi-square test with Yates correction for continuity. Results: Considering all the 1268 celiac patients, the prevalence of IBD was 6.35‰ in celiac patients vs 1.61‰ in non celiac population (p< 0.01). However the difference between the prevalence of both UC (6.43‰ celiac patients vs 1.55‰ non celiac population, p< 0.001) and CD (4.30‰ celiac patients vs 0.43‰ non celiac population, p< 0.001) was significant only in males while no significant difference in prevalence of IBD was found in celiac females as compared to non celiac population. Conclusions: Within our cohort of patients with celiac disease, IBD was significantly higher than in general population. The difference was significant only in males and not in females. Of course the limitation of this study was to compare two populations of different italian geographical areas. However as far as we know there is no epidemiological study of sicilian population.
P.1.221 SERUM LIPID ALTERATIONS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE TREATED WITH TNF ALPHA ANTAGONISTS L. Amato ∗ , M. Cappello, I. Bravatà, C. Randazzo, P.L. Almasio, A. Craxì Sezione di Gastroenterologia, Di.Bi.Mis., Università di Palermo, Palermo, Italy Background and aim: Studies in patients with rheumatoid arthritis or ankylosing spondilytis have shown that anti-tumor necrosis factor-alpha agents may induce alterations on serum lipids thus affecting the atherogenic risk. Data on patients with Inflammatory Bowel Disease (IBD) are scanty. The aim of our study was to assess the effects of anti-TNF agents on serum lipid profile in a cohort of Italian patients with IBD. Material and methods: Fifty-four patients with IBD (21 males, median age 45 yrs, range 20-69) on anti-TNF therapy were studied. Forty-three had Crohn’s disease (CD), 11 had ulcerative colitis (UC); 23 patients received infliximab at weeks 0, 2 and 6 and subsequently every 8 weeks, 14 patients received adalimumab at weeks 0, 2 and 4 and subsequently every other week and 17 patients received infliximab and then switched to adalimumab for loss of response or intolerance to infliximab. Clinical and demographic characteristics, serum lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides) and Body Mass Index (BMI) were assessed at baseline and at the last follow up visit. Response to biologics was evaluated by CDAI for CD and Mayo score for UC. Results: Mean duration of anti-TNF therapy was 22.4 months (range 195). Remission was achieved in 38 (70.4%) patients. CDAI decreased from 117.9±55.7 to 75.2±37.1 (p<0.001) and Mayo score from 7.3±2.5 to 3.1±1.3 (p<0.001). Statistically significant difference of blood levels at baseline and at the end of follow-up was observed for total cholesterol (179.1±43.9 mg/dl vs. 191.7±46.9 mg/dl, p = 0.034) but not for HDL, LDL cholesterol and triglycerides. BMI increased from 23.97±3.96 to 24.47±4.19 (p = 0.016). Both significant differences were mainly related to treatment response. Nine out of 54 patients (16.6%), who had a normal lipid profile at baseline, experienced an increase of values while on biologics. Conclusions: Anti-TNF therapy in patients with IBD induced only a moderate raise of total cholesterol. This result was related to treatment response and improvement of nutritional status as confirmed by increased BMI. Close monitoring of lipid levels in patients with IBD under anti-TNF therapy cannot be recommended.
P.1.222 MUCOSAL HEALING IN ANTI-TNF REFRACTORY/INTOLERANT CROHN’S DISEASE WITH THALIDOMIDE THERAPY M.L. Scribano ∗ , M. Marrollo, L. Cantoro, R. Cosintino, C. Prantera, A. Kohn Gastroenterology Operative Unit, Azienda Ospedaliera S.Camillo-Forlanini, Rome, Italy Background and aim: Thalidomide is an anti-tumor necrosis factor (TNF)