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P.1.272: CLINICAL RELAPSES AND MUCOSAL HEALING IN PATIENTS WITH CROHN'S DISEASE TREATED WITH AZATHIOPRINE
S238
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
Material and methods: We review data on 691 patients (430 M, 261 F, medium age 62.39) referred to screening colonoscopy in our centre from Oct 2008 to May 2010. Results: All colonoscopies were performed in the morning. Completion rate (caecal or terminal ileum intubation) was 96%. Bowel preparation score (Boston Bowel Preparation Scale-BBPS) ranges between 2 and 3 in 94.5% of subjects. Only low bowel preparation quality and stenosing neoplasia impacted the completion rate. Colorectal cancer was diagnosed in 68 cases (9.8%), synchronous colorectal cancers were detected in 2 subjects (0.3%) while =1 colonic adenoma was present in 399 patients (57.74%) and advanced adenomas were 374 in 265 patients (38.35%). All polyps were removed at the time of the initial endoscopy in 88.4% of subjects. No complications were reported during and after diagnostic colonoscopy. Complications during operative colonoscopy were the following: early bleeding in 5.07% and late bleeding in 0.58% all controlled endoscopically or conservatively. Only 1 subject needed blood transfusions. We had 1 post-polypectomy syndrome treated conservatively and 1 perforation successfully treated by surgery. No procedure related mortality was recorded. Conclusions: Over the period reviewed, 691 colonoscopies were performed with excellent completion rates (96%). The risk of significant complications was within acceptable ranges despite a higher therapeutic load. Significant pathology (cancer and adenoma) was found in over 2/3 of patients.The so high rate of cancer/adenomas detected could be explained by: higher incidence of colon cancer/adenomas in our region, the beginning of the screening programme in our population, the initial older age of population studied (most of them older than 60 years old), the good bowel preparation in almost all the subjects and the performance of FIT.
P.1.270 SEQUENTIAL TREATMENT WITH INTRA-HEPATIC INJECTION OF 131-IODINE-LIPIODOL FOLLOWED BY SORAFENIB IN ADVANCED HEPATOCELLULAR CARCINOMA: PRELIMINARY RESULTS M. Tabone ∗ , P. Carbonatto, R. Pellerito, P. Salacone, A. Calvo, R. Rocca A.O. Mauriziano, Turin, Italy Background and aim: Sorafenib has been proposed as the standard of care for patients with advanced HCC, but tumour response rate for Sorafenib mono-therapy is less than 5%. Internal radiotherapy by intra-hepatic injection of 131-iodine labelled lipiodol may be an alternative treatment in patients with advanced hepatocellular carcinoma (HCC). Radiation exposure induce an intracellular stress which may trigger a compensatory activation of intracellular pathway mediators such as MAPK, JNK, NF-kB. Irradiation of HCC cells in vitro may increase vascular endothelial growth factor (VEGF). Sorafenib, by inhibiting the MAPK and VEGF pathways, might improve the efficacy of radiotherapy. Material and methods: From january to june 2010, 6 patients with advanced HCC underwent intrahepatic injection of 1.1 GBeq of 131-I-lipiodol and then were treated with sorafenib 800 mg a day. All patients were Child-Pugh A cirrhotics: 5 males and 1 female, 66% had viral etiology, mean age was 69 years. 4 patients had a multifocal bilobar HCC and the remaining two patients had a large HCC in one lobe with portal thrombosis. No significant adverse effects were registered after intra-hepatic injection of 131-iodine-lipiodol. In contrast, all the patients required a reduction in sorafenib administration due to asthenia, abdominal pain, diarrhea or dermatological side-effects. A quadriphasic abdominal CT was performed every three months in order to investigate the treatment response according to EASL criteria. Results: We observed partial response in 33% of patients and stable disease in 66% at the third month of follow-up. Our previous experience on 66 patients treated with radiotherapy alone showed a partial response rate of 20%, stable disease of 60% and progression of the tumour of 20% of the cases respectively at the third month of follow-up. Conclusions: Our preliminary results seem to confirm the hypothesized role of anti-angiogenic drugs in improving the response to radiotherapy in advanced HCC. Further investigations needs to enforce our data.
P.1.271 ENDOLUMINAL HIGH DOSE RATE BRACHYTHERAPY FOR ESOPHAGEAL CANCER: A FIFTEEN YEARS EXPERIENCE M. Grassini ∗ ,1 , C. Verna 1 , E. Battaglia 1 , U. Giacobbe 1 , P. Niola 1 , D. Nassisi 2 , M. Tessa 2 1 Soc Gastroenterologia Ed Endoscopia Digestiva, Osp. Cardinal Massaia, Asti, Italy; 2 Soc Radioterapia, Osp. Cardinal Massaia, Asti, Italy
Background and aim: Since 1995 we introduced the esophageal high doserate (HDR) brachytherapy (BRT) in our hospital. The aim of this communication is to evaluate the role of BRT in the esophageal cancer therapy setting. Material and methods: In this period we are treated 128 patients affected by esophageal cancer, 72 with a curative intent and 56 with a palliative intent. BRT was administered with a Ir-192 HDR source with the Microselectron projector, in a dedicated bunker; at each session the dose is 7 Gy at 1 cm from the surface of the source to the initial length of tumor, with a 2 cm margin; if necessary the reduction of dose, we chose 5 Gy at 1 cm. If the stenosis cannot be bypassed with the standard endoscope, it was been dilated with a Savary dilator. The number of sessions, always carried out once at week, was defined personally accordingly to the entity of endoscopic response and to the patient’s tolerance, ranged from a minimum of 7 Gy (n.10) to a maximum of 28 Gy (n.8). Results: At the time of treatment, 7 pts showed a moderate dysphagia, which disappeared completely after the last session; 49 pts showed a severe dysphagia, which disappeared entirely in 7 cases (14%) and partially (>50%) in 27 cases (55%); 15 pts (31%) showed no response. Recently a metal stent was placed in 5 partial responders patients, in which the dysphagia reappeared after 2-3 months. The duration of response showed a median of 4 months (range 1-12). No early or late complications have been observed. Conclusions: More recently the first randomized trials has compared BRT with metal stent for the palliation of dysphagia. These studies suggest that the symptom’s relief is more rapid after stent than after BRT, but long-term response is better after BRT. The incidence of complications after BRT, reported in these trials, is less than that after stent placement. In our experience, HDR BRT was prefered to stent placement as the first treatment in pts with progressive dysphagia, beacause it is a feasible approach, that improve patient quality of life, without severe complications. In these patients we obtained a response rate of 69% (CR 14%; PR 55%). We reserved the stent for pts with severe dysphagia and with a short life expectancy, who need more rapid symptom’s relief, or for pts with persistent or recurrent tumor growth after BRT.
P.1.272 CLINICAL RELAPSES AND MUCOSAL HEALING IN PATIENTS WITH CROHN’S DISEASE TREATED WITH AZATHIOPRINE F. Morace ∗ , G. Amalfi, G. Caravelli, M. Di Pierro, M. Schettino, C. Verde, V. Familiari, G. Vespere, S. Monastra Uoc Gastroenterologia, Ospedale San Gennaro, Napoli, Italy Background and aim: The most recent guidelines indicate azathioprine (AZA) as first-line therapy in steroid-resistant or -dependant Crohn’s disease (CD), advising an early administration of it. The effects of AZA on mucosal healing (MH) and characteristics of clinical relapses in CD are insufficiently studied. The value of MH as a primary therapeutic target in CD is debatable. MH is neither a prerequisite for clinical remission nor predictive of clinical relapses of CD, but it is undoubtedly desirable because it may be predictive of better disease outcome. The aim of this study was to determine the characteristic of clinical relapse during AZA treatment in steroid-dependant patients resistant and its relationship with mucosal healing valued after 12 months. Material and methods: We considered 32 (15 M, 17 F) patients affected by steroid-dependant ileo-colonic CD in clinical remission with AZA (2-2.5 mg/kg) for 24 months as therapy. All patients had, at least, last ileal loop involved as showed by endoscopic examination at time 0. We determined severity of clinical relapses during the follow up of 24 months. Then we performed a colonoscopy + ileoscopy of the last loop after 12 months to verify MH.
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264 Results: During the first year 12 patients (37%) had 1 or 2 clinical relapses among which 1 of severe entity that required surgical approach and after Anti-tnf alfa therapy. 21 patients (61%) showed complete MH at colonoscopy, performed after one year, while 4 patients had a low-activity disease endoscopical pattern. Less than half of patients 15 (46%) had a complete ileal endoscopic remission and 5 of them had a partial ilal MH. At 24 months 16 (48%) patients counted a clinical relapse; totally 23 relapses occurred. During the second year 3 severe relapses occurred; these needed Anti-tnf alfa therapy. There was mostly 1 relapse (87%) or 2 relapses (8%). The activity of the relapses was mild (83%) or severe (17%); mild case were treated with oral topical steroid or by adjusting AZA dose. All them that required changing therapy using Anti-tnf alfa had no MH at 12 months. Conclusions: AZA induced total or partial MH after 12 months in about 2/3 of patients. The clinical relapses were generally of low grade during the observed 24 months; 4 patients required anti-tnf therapy. None of patients having total MH had a severe relapse.
P.1.273 NUTRITIONAL ASPECTS AND PREVALENCE OF METABOLIC SYNDROME IN PATIENTS WITH QUIESCENT ULCERATIVE COLITIS G. Valente, G. De Franchis, D. Mattera, R. Sollazzo, M. Sanges, A. D’Arienzo ∗ Area Funzionale di Gastroenterologia, Dipartimento di Medicina Clinica e Sperimentale, Università Federico II, Napoli, Italy Background and aim: Ulcerative Colitis (UC) is typically characterized by alternating periods of activity and remission. The symptoms related to intestinal inflammation often lead to changes in lifestyle food that may also persist during remission with the consequent risk of malnutrition. The aim of our study was to evaluate the presence of nutritional deficiencies in patients with quiescent UC and the prevalence in these patients of the metabolic syndrome (MS), a clinical entity frequently associated with an improper dietary lifestyle. Material and methods: 43 consecutive UC patients (M/F = 25/18, median age 44 years) were enrolled in the study. Patients in remission according to Ulcerative Colitis Disease Activity Index (UCDAI) were only included. The diagnosis of MS was made according to the Adult Treatment Panel III (ATP III). We assessed anthropometric and laboratory parameters. It was administered a food diary to record every single food, four days a week. The estimated daily caloric needs was carried out according to physical activity and ideal body weight. The daily intake of individual nutrients was related to levels of recommended daily intake of nutrients for the Italian population. It was used Winfood Light program for the nutritional assessment. Results: 12 patients (27.9%) consumed a normocaloric diet, 17 (39.5%) a low-caloric diet, 14 (32.6%) a high-caloric diet. The fiber intake was below the recommended amount. A high ratio of dietary animal to vegetable protein was observed. The consume of polyunsaturated fatty acids was below the threshold value. The intake of vitamin A, calcium and zinc was insufficient to fulfill the required recommended daily allowance. MS was present in 13 patients (30.2%). Conclusions: In our study, patients with quiescent UC frequently showed an improper feeding behaviour. This could lead to a lack of micro-macronutrients, particularly vitamin A, zinc and calcium and a decreased intake of fiber, vegetable proteins and polyunsaturated fatty acids. Therefore, in UC patients, also during remission, it is mandatory to correct any nutritional imbalance that can be detected using simple tools such as analysis of food diary. On the other hand, the prevalence of MS in our UC patients was comparable to that of the general population.
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P.1.274 PROTECTIVE EFFECT OF COFFEE ON OXIDATIVE DNA DAMAGE, TELOMERE LENGTH AND APOPTOSIS IN PATIENTS WITH HCV-RELATED CHRONIC HEPATITIS M. Piciocchi 1 , R. Cardin 1 , D. Martines 1 , L. Scribano 1 , N. Cazzagon 1 , A. Floreani 1 , M. Petracco 2 , F. Farinati ∗ ,1 1 Department of Surgical and Gastroenterological Sciences, Padua University, Padova, Italy; 2 Institute of Scientific Information On Coffee (Isic), Rijswijk, Netherlands
Background and aim: In patients with HCV-related liver disease, coffee intake is associated with a reduced risk of disease progression and hepatocellular carcinoma (HCC) development. This study was aimed at assessing the mechanisms underlying the protective effect exerted by coffee with respect to cirrhosis and HCC evaluating the changes in time of oxidative DNA adducts formation, fibrosis, telomere lenght and apoptosis. Material and methods: Forty patients with HCV-related chronic liver disease were recruited and randomized into two groups: the first group consumed 4 cups of coffee/day for 1 month, while the second group remained “abstinent” for the same period. At day 30, the two patients’ groups were switched over. At t0 (before entering the study), during coffee intake and during abstinence, the following parameters were evaluated: AST, ALT, GGT and ALP, viral load [HCV-RNA], oxidative DNA damage [8-hydroxydeoxyguanosine (8-OHdG – HPLC-EC)], telomere length [T/S - RT-PCR], apoptosis [M30 - ELISA test] and liver fibrosis [Pro-Collagen III (PIIINP - ELISA)]. At t0 the patients were categorized in relation to their routine coffee intake (0-2 and 3-5 cups/day). Results: At t0, AST, GGT and ALP levels were significantly lower while HCV-RNA levels significantly higher in patients with higher coffee consumption (p=0.05). During coffee intake, 8-OHdG and PIIINP levels significantly dropped, to regrow during abstinence (p=0.05/p=0.04, respectively), while T/S became significantly shorter (p=0.006). A significant negative correlation was found between T/S and 8-OHdG levels (p=0.03). HCV-RNA and M30 (apoptosis) levels were significantly higher during coffee intake (p=0.002 and p=0.04). Conclusions: Coffee intake, despite an increase in viral load (not a prognostic factor for HCC development) induced lower a level of collagen deposition in the liver, that probably mediates the protection exerted by coffee with respect to progression of HCV-related hepatitis to cirrhosis, a reduction in oxidative DNA damage, correlated with increased telomere length (and consequent genomic stability) and an upgraded apoptosis, that may eliminate mutated cells, factors that potentially mediate the reduced risk of HCC development. Supported in part by ISIC Scientific Committee.
P.1.275 LONG-TERM RESULTS OF SORAFENIB IN ADVANCED-STAGE HEPATOCELLULAR: WHAT CAN WE LEARN FROM DAILY CLINICAL PRACTICE R. Sacco ∗ ,1 , I. Bargellini 2 , B. Ginanni 2 , M. Bertini 1 , A. Romano 1 , G. Federici 1 , G. Parisi 1 , E. Bozzi 2 , M. Bertoni 2 , A. Scaramuzzino 1 , S. Metrangolo 1 , E. Tumino 1 , E. Altomare 3 , A. Capria 1 , G. Bresci 1 , C. Bartolozzi 2 1 Department
of Gastroenterology-Cisanello University Hospital, Pisa, Italy; of Radiology-Cisanello University Hospital, Pisa, Italy; 3 Internal Medicine-University of Foggia, Foggia, Italy 2 Department
Background and aim: Prospective randomized trials have proven that Sorafenib represents a valid treatment modality in patients with advanced-stage hepatocellular carcinoma (HCC). Purpose of this prospective study is to evaluate long-term results of Sorafenib treatment in advanced-stage HCC, under daily clinical conditions. Material and methods: From September 2008 to September 2010, 35 cirrhotic patients (M/F: 26/9, mean age 70.1±7.5 years, range 57-85) with advanced-stage HCC (BCLC C) were treated with Sorafenib, at a dose of 800mg/day in 28 patients (80%) and 400mg/day in 7 cases (20%). Every 3 months, clinical data (side effects), laboratory analyses (in particular, serum alpha-fetoprotein) and radiological data (tumor response according to amended
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
Material and methods: We review data on 691 patients (430 M, 261 F, medium age 62.39) referred to screening colonoscopy in our centre from Oct 2008 to May 2010. Results: All colonoscopies were performed in the morning. Completion rate (caecal or terminal ileum intubation) was 96%. Bowel preparation score (Boston Bowel Preparation Scale-BBPS) ranges between 2 and 3 in 94.5% of subjects. Only low bowel preparation quality and stenosing neoplasia impacted the completion rate. Colorectal cancer was diagnosed in 68 cases (9.8%), synchronous colorectal cancers were detected in 2 subjects (0.3%) while =1 colonic adenoma was present in 399 patients (57.74%) and advanced adenomas were 374 in 265 patients (38.35%). All polyps were removed at the time of the initial endoscopy in 88.4% of subjects. No complications were reported during and after diagnostic colonoscopy. Complications during operative colonoscopy were the following: early bleeding in 5.07% and late bleeding in 0.58% all controlled endoscopically or conservatively. Only 1 subject needed blood transfusions. We had 1 post-polypectomy syndrome treated conservatively and 1 perforation successfully treated by surgery. No procedure related mortality was recorded. Conclusions: Over the period reviewed, 691 colonoscopies were performed with excellent completion rates (96%). The risk of significant complications was within acceptable ranges despite a higher therapeutic load. Significant pathology (cancer and adenoma) was found in over 2/3 of patients.The so high rate of cancer/adenomas detected could be explained by: higher incidence of colon cancer/adenomas in our region, the beginning of the screening programme in our population, the initial older age of population studied (most of them older than 60 years old), the good bowel preparation in almost all the subjects and the performance of FIT.
P.1.270 SEQUENTIAL TREATMENT WITH INTRA-HEPATIC INJECTION OF 131-IODINE-LIPIODOL FOLLOWED BY SORAFENIB IN ADVANCED HEPATOCELLULAR CARCINOMA: PRELIMINARY RESULTS M. Tabone ∗ , P. Carbonatto, R. Pellerito, P. Salacone, A. Calvo, R. Rocca A.O. Mauriziano, Turin, Italy Background and aim: Sorafenib has been proposed as the standard of care for patients with advanced HCC, but tumour response rate for Sorafenib mono-therapy is less than 5%. Internal radiotherapy by intra-hepatic injection of 131-iodine labelled lipiodol may be an alternative treatment in patients with advanced hepatocellular carcinoma (HCC). Radiation exposure induce an intracellular stress which may trigger a compensatory activation of intracellular pathway mediators such as MAPK, JNK, NF-kB. Irradiation of HCC cells in vitro may increase vascular endothelial growth factor (VEGF). Sorafenib, by inhibiting the MAPK and VEGF pathways, might improve the efficacy of radiotherapy. Material and methods: From january to june 2010, 6 patients with advanced HCC underwent intrahepatic injection of 1.1 GBeq of 131-I-lipiodol and then were treated with sorafenib 800 mg a day. All patients were Child-Pugh A cirrhotics: 5 males and 1 female, 66% had viral etiology, mean age was 69 years. 4 patients had a multifocal bilobar HCC and the remaining two patients had a large HCC in one lobe with portal thrombosis. No significant adverse effects were registered after intra-hepatic injection of 131-iodine-lipiodol. In contrast, all the patients required a reduction in sorafenib administration due to asthenia, abdominal pain, diarrhea or dermatological side-effects. A quadriphasic abdominal CT was performed every three months in order to investigate the treatment response according to EASL criteria. Results: We observed partial response in 33% of patients and stable disease in 66% at the third month of follow-up. Our previous experience on 66 patients treated with radiotherapy alone showed a partial response rate of 20%, stable disease of 60% and progression of the tumour of 20% of the cases respectively at the third month of follow-up. Conclusions: Our preliminary results seem to confirm the hypothesized role of anti-angiogenic drugs in improving the response to radiotherapy in advanced HCC. Further investigations needs to enforce our data.
P.1.271 ENDOLUMINAL HIGH DOSE RATE BRACHYTHERAPY FOR ESOPHAGEAL CANCER: A FIFTEEN YEARS EXPERIENCE M. Grassini ∗ ,1 , C. Verna 1 , E. Battaglia 1 , U. Giacobbe 1 , P. Niola 1 , D. Nassisi 2 , M. Tessa 2 1 Soc Gastroenterologia Ed Endoscopia Digestiva, Osp. Cardinal Massaia, Asti, Italy; 2 Soc Radioterapia, Osp. Cardinal Massaia, Asti, Italy
Background and aim: Since 1995 we introduced the esophageal high doserate (HDR) brachytherapy (BRT) in our hospital. The aim of this communication is to evaluate the role of BRT in the esophageal cancer therapy setting. Material and methods: In this period we are treated 128 patients affected by esophageal cancer, 72 with a curative intent and 56 with a palliative intent. BRT was administered with a Ir-192 HDR source with the Microselectron projector, in a dedicated bunker; at each session the dose is 7 Gy at 1 cm from the surface of the source to the initial length of tumor, with a 2 cm margin; if necessary the reduction of dose, we chose 5 Gy at 1 cm. If the stenosis cannot be bypassed with the standard endoscope, it was been dilated with a Savary dilator. The number of sessions, always carried out once at week, was defined personally accordingly to the entity of endoscopic response and to the patient’s tolerance, ranged from a minimum of 7 Gy (n.10) to a maximum of 28 Gy (n.8). Results: At the time of treatment, 7 pts showed a moderate dysphagia, which disappeared completely after the last session; 49 pts showed a severe dysphagia, which disappeared entirely in 7 cases (14%) and partially (>50%) in 27 cases (55%); 15 pts (31%) showed no response. Recently a metal stent was placed in 5 partial responders patients, in which the dysphagia reappeared after 2-3 months. The duration of response showed a median of 4 months (range 1-12). No early or late complications have been observed. Conclusions: More recently the first randomized trials has compared BRT with metal stent for the palliation of dysphagia. These studies suggest that the symptom’s relief is more rapid after stent than after BRT, but long-term response is better after BRT. The incidence of complications after BRT, reported in these trials, is less than that after stent placement. In our experience, HDR BRT was prefered to stent placement as the first treatment in pts with progressive dysphagia, beacause it is a feasible approach, that improve patient quality of life, without severe complications. In these patients we obtained a response rate of 69% (CR 14%; PR 55%). We reserved the stent for pts with severe dysphagia and with a short life expectancy, who need more rapid symptom’s relief, or for pts with persistent or recurrent tumor growth after BRT.
P.1.272 CLINICAL RELAPSES AND MUCOSAL HEALING IN PATIENTS WITH CROHN’S DISEASE TREATED WITH AZATHIOPRINE F. Morace ∗ , G. Amalfi, G. Caravelli, M. Di Pierro, M. Schettino, C. Verde, V. Familiari, G. Vespere, S. Monastra Uoc Gastroenterologia, Ospedale San Gennaro, Napoli, Italy Background and aim: The most recent guidelines indicate azathioprine (AZA) as first-line therapy in steroid-resistant or -dependant Crohn’s disease (CD), advising an early administration of it. The effects of AZA on mucosal healing (MH) and characteristics of clinical relapses in CD are insufficiently studied. The value of MH as a primary therapeutic target in CD is debatable. MH is neither a prerequisite for clinical remission nor predictive of clinical relapses of CD, but it is undoubtedly desirable because it may be predictive of better disease outcome. The aim of this study was to determine the characteristic of clinical relapse during AZA treatment in steroid-dependant patients resistant and its relationship with mucosal healing valued after 12 months. Material and methods: We considered 32 (15 M, 17 F) patients affected by steroid-dependant ileo-colonic CD in clinical remission with AZA (2-2.5 mg/kg) for 24 months as therapy. All patients had, at least, last ileal loop involved as showed by endoscopic examination at time 0. We determined severity of clinical relapses during the follow up of 24 months. Then we performed a colonoscopy + ileoscopy of the last loop after 12 months to verify MH.
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264 Results: During the first year 12 patients (37%) had 1 or 2 clinical relapses among which 1 of severe entity that required surgical approach and after Anti-tnf alfa therapy. 21 patients (61%) showed complete MH at colonoscopy, performed after one year, while 4 patients had a low-activity disease endoscopical pattern. Less than half of patients 15 (46%) had a complete ileal endoscopic remission and 5 of them had a partial ilal MH. At 24 months 16 (48%) patients counted a clinical relapse; totally 23 relapses occurred. During the second year 3 severe relapses occurred; these needed Anti-tnf alfa therapy. There was mostly 1 relapse (87%) or 2 relapses (8%). The activity of the relapses was mild (83%) or severe (17%); mild case were treated with oral topical steroid or by adjusting AZA dose. All them that required changing therapy using Anti-tnf alfa had no MH at 12 months. Conclusions: AZA induced total or partial MH after 12 months in about 2/3 of patients. The clinical relapses were generally of low grade during the observed 24 months; 4 patients required anti-tnf therapy. None of patients having total MH had a severe relapse.
P.1.273 NUTRITIONAL ASPECTS AND PREVALENCE OF METABOLIC SYNDROME IN PATIENTS WITH QUIESCENT ULCERATIVE COLITIS G. Valente, G. De Franchis, D. Mattera, R. Sollazzo, M. Sanges, A. D’Arienzo ∗ Area Funzionale di Gastroenterologia, Dipartimento di Medicina Clinica e Sperimentale, Università Federico II, Napoli, Italy Background and aim: Ulcerative Colitis (UC) is typically characterized by alternating periods of activity and remission. The symptoms related to intestinal inflammation often lead to changes in lifestyle food that may also persist during remission with the consequent risk of malnutrition. The aim of our study was to evaluate the presence of nutritional deficiencies in patients with quiescent UC and the prevalence in these patients of the metabolic syndrome (MS), a clinical entity frequently associated with an improper dietary lifestyle. Material and methods: 43 consecutive UC patients (M/F = 25/18, median age 44 years) were enrolled in the study. Patients in remission according to Ulcerative Colitis Disease Activity Index (UCDAI) were only included. The diagnosis of MS was made according to the Adult Treatment Panel III (ATP III). We assessed anthropometric and laboratory parameters. It was administered a food diary to record every single food, four days a week. The estimated daily caloric needs was carried out according to physical activity and ideal body weight. The daily intake of individual nutrients was related to levels of recommended daily intake of nutrients for the Italian population. It was used Winfood Light program for the nutritional assessment. Results: 12 patients (27.9%) consumed a normocaloric diet, 17 (39.5%) a low-caloric diet, 14 (32.6%) a high-caloric diet. The fiber intake was below the recommended amount. A high ratio of dietary animal to vegetable protein was observed. The consume of polyunsaturated fatty acids was below the threshold value. The intake of vitamin A, calcium and zinc was insufficient to fulfill the required recommended daily allowance. MS was present in 13 patients (30.2%). Conclusions: In our study, patients with quiescent UC frequently showed an improper feeding behaviour. This could lead to a lack of micro-macronutrients, particularly vitamin A, zinc and calcium and a decreased intake of fiber, vegetable proteins and polyunsaturated fatty acids. Therefore, in UC patients, also during remission, it is mandatory to correct any nutritional imbalance that can be detected using simple tools such as analysis of food diary. On the other hand, the prevalence of MS in our UC patients was comparable to that of the general population.
S239
P.1.274 PROTECTIVE EFFECT OF COFFEE ON OXIDATIVE DNA DAMAGE, TELOMERE LENGTH AND APOPTOSIS IN PATIENTS WITH HCV-RELATED CHRONIC HEPATITIS M. Piciocchi 1 , R. Cardin 1 , D. Martines 1 , L. Scribano 1 , N. Cazzagon 1 , A. Floreani 1 , M. Petracco 2 , F. Farinati ∗ ,1 1 Department of Surgical and Gastroenterological Sciences, Padua University, Padova, Italy; 2 Institute of Scientific Information On Coffee (Isic), Rijswijk, Netherlands
Background and aim: In patients with HCV-related liver disease, coffee intake is associated with a reduced risk of disease progression and hepatocellular carcinoma (HCC) development. This study was aimed at assessing the mechanisms underlying the protective effect exerted by coffee with respect to cirrhosis and HCC evaluating the changes in time of oxidative DNA adducts formation, fibrosis, telomere lenght and apoptosis. Material and methods: Forty patients with HCV-related chronic liver disease were recruited and randomized into two groups: the first group consumed 4 cups of coffee/day for 1 month, while the second group remained “abstinent” for the same period. At day 30, the two patients’ groups were switched over. At t0 (before entering the study), during coffee intake and during abstinence, the following parameters were evaluated: AST, ALT, GGT and ALP, viral load [HCV-RNA], oxidative DNA damage [8-hydroxydeoxyguanosine (8-OHdG – HPLC-EC)], telomere length [T/S - RT-PCR], apoptosis [M30 - ELISA test] and liver fibrosis [Pro-Collagen III (PIIINP - ELISA)]. At t0 the patients were categorized in relation to their routine coffee intake (0-2 and 3-5 cups/day). Results: At t0, AST, GGT and ALP levels were significantly lower while HCV-RNA levels significantly higher in patients with higher coffee consumption (p=0.05). During coffee intake, 8-OHdG and PIIINP levels significantly dropped, to regrow during abstinence (p=0.05/p=0.04, respectively), while T/S became significantly shorter (p=0.006). A significant negative correlation was found between T/S and 8-OHdG levels (p=0.03). HCV-RNA and M30 (apoptosis) levels were significantly higher during coffee intake (p=0.002 and p=0.04). Conclusions: Coffee intake, despite an increase in viral load (not a prognostic factor for HCC development) induced lower a level of collagen deposition in the liver, that probably mediates the protection exerted by coffee with respect to progression of HCV-related hepatitis to cirrhosis, a reduction in oxidative DNA damage, correlated with increased telomere length (and consequent genomic stability) and an upgraded apoptosis, that may eliminate mutated cells, factors that potentially mediate the reduced risk of HCC development. Supported in part by ISIC Scientific Committee.
P.1.275 LONG-TERM RESULTS OF SORAFENIB IN ADVANCED-STAGE HEPATOCELLULAR: WHAT CAN WE LEARN FROM DAILY CLINICAL PRACTICE R. Sacco ∗ ,1 , I. Bargellini 2 , B. Ginanni 2 , M. Bertini 1 , A. Romano 1 , G. Federici 1 , G. Parisi 1 , E. Bozzi 2 , M. Bertoni 2 , A. Scaramuzzino 1 , S. Metrangolo 1 , E. Tumino 1 , E. Altomare 3 , A. Capria 1 , G. Bresci 1 , C. Bartolozzi 2 1 Department
of Gastroenterology-Cisanello University Hospital, Pisa, Italy; of Radiology-Cisanello University Hospital, Pisa, Italy; 3 Internal Medicine-University of Foggia, Foggia, Italy 2 Department
Background and aim: Prospective randomized trials have proven that Sorafenib represents a valid treatment modality in patients with advanced-stage hepatocellular carcinoma (HCC). Purpose of this prospective study is to evaluate long-term results of Sorafenib treatment in advanced-stage HCC, under daily clinical conditions. Material and methods: From September 2008 to September 2010, 35 cirrhotic patients (M/F: 26/9, mean age 70.1±7.5 years, range 57-85) with advanced-stage HCC (BCLC C) were treated with Sorafenib, at a dose of 800mg/day in 28 patients (80%) and 400mg/day in 7 cases (20%). Every 3 months, clinical data (side effects), laboratory analyses (in particular, serum alpha-fetoprotein) and radiological data (tumor response according to amended