- Email: [email protected]
P.1.325: USEFULNESS OF SERUM PEPSINOGENS TO IDENTIFY CHRONIC ATROP H IC GASTRITIS
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264 idazole 250 mg/tid plus ciprofloxacin 500 mg/bid): in all the patients diarrhoea and bloating markedly improved or ceased; a month later we performed GBT and LBT in 14 of the 30 pts (12 positive/2 negative formerly): none showed positive tests. Conclusions: These results show that, in a clinical scenario of pronounced suspicion, performing both GBT and LBT instead only one of them significantly ameliorate diagnostic power in diagnosing of SIBO. Also, we report a scarce concordance of these two tests in the same diagnostic setting.
P.1.322 EUS VERSUS TC MULTI-DETECTOR (MDCT) IN THE STAGING OF GASTRIC CANCER: CORRELATION WITH PATHOLOGIC STAGING N. Muscatiello, M. Di Maso ∗ , C. Panella Az. “oo.Rr.”, Foggia, Italy Background and aim: EUSand MDCT are considered to be valuable tools for preoperative staging of gastric cancer, depiste the major limitations of overstaging and understaging. Withrecent advance in CT technology and introduction of neoadjuvant c hemoterapy, further evalutation of diagnostic accuracies of EUs and MDCT is needed. Material and methods: The aim of this study was determine accuracies of EUS and MDCT in the preoperative T and N stagin of gastric cancer. The medical record of 52 patients from 01/2007 to 10/2010 were analyzed. Clinical staging results from preoperatively performed EUS and MDCT were compared with postoperative pathologic findings. Results: The overall accuracy of EUS for determination of the T stage was 71%. The tumor with submucosal fibrosis or ulceration tended to be overdiagnosis. The overall detection rate of primary tumor with MDCT imaging was 56%. The overall accuracy of MDCT for individual T stage was 61%. The accuracy for discrimination of T2 from T3/T4 tumors was 72% for EUS and 67% for MDCT. The overvall accuracy of the lymphnode involvement was 69% with EUS and 70% with MDCT imaging. Conclusions: EUS provide more accurate T staging result than MDCT. The accuracy for Cancer gastric advance is much lower than that for early gastric cancer in both modalities. The accuracy determing serosal invasion and nodal involvement was similar between EUS and MDCT. The overall diagnostic accuracy of EUS and MDCT is not enough in the preoperative staging of gastric cancer and a new approach to supplement the modalities is needed.
P.1.323 TEMPORARY PLACEMENT OF WALLFLEX FULLY COVERED SELF–EXPANDABLE METALLIC STENT (WFCSEMS) IN BENIGN BILIARY STENOSIS (BBS) IN PREVIOUSLY UNSUCCESSFUL COMMON BILE DUCT PLASTIC STENTING: MIDTERM EVALUTION
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There were no complications. The removal of prostheses was very easy. Conclusions: Placement and removal of WFCSEMS for BBS is safe and may offer an alternative to multiple plastic stenting. Further investigation is needed to confirm these findings and WFCSEMS long-term efficacy.
P.1.324 24 H PH IMPEDANCE MONITORING AND INLET PATCH ACID SECRETION CAPACITY M. Di Stefano, C. Mengoli ∗ , M. Bergonzi, F. Racca, R. Fasulo, G.R. Corazza Clinica Medica I, Università di Pavia - Irccs Policlinico S. Matteo, Pavia, Italy Background and aim: Heterotopic areas of gastric mucosa (inlet patches) are a frequent endoscopic finding in upper endoscopy. Patients are often asymptomatic, but both esophageal and extra-esophageal symptoms may be present and frequently overlap when GERD is evident. We hypothesized that different positioning of pH and impendance sensors may help in the detection of acid production prom the lesions. Material and methods: A 40-year-old male attended our outpatient Clinic due to both reflux-related and globus. He had already undergone gastroscopy which showed erythematosus gastropathy and two areas resembling gastric mucosa at the proximal esophagus. A first standard 24 h pH-impedance monitoring (double pH sensor, Sandhill Scientific) revealed severe acid exposure of the distal third of the esophagus (17.3% of total recording time, 21.8% supine, 12.8% upright) with 29 acid and 41 weakly acid reflux episodes. Visual analysis of the recording showed mismatch between gastric and esophageal pH: in 15 occasions, pH value of distal esophagus was lower than gastric pH and impedance waves were caudally transmitted, suggesting a proximal site of production of this acid material in esophageal, rather than gastric refluxate. To ascertain the origin of acid, we performed a second pH impedance monitoring by using a modified protocol: pH sensors were placed respectively 20 and 5 cm above the LES, and so impedance sensors at a more proximal level, after about two weeks of high dose PPI therapy, due to inadequate response. Results: The patient partially improved during PPI therapy. The second examination showed 35 pH modifications. 8 acidic and 7 nonacidic reflux episodes with proximal extent were observed, not associated with symptoms. The remaining twenty episodes of esophageal pH modification were characterized by an initial fall at proximal level, followed by the fall at distal level, not associated with deglutition of alimentary bolus. Impedance waves revealed acidic liquid descending along the esophagus, with saliva deglutition. The patient reported epigastric pain or heartburn in the majority of these events (SAP respectively 98% and 99%). Conclusions: 24 pH-impedance acid monitoring could be a useful tool in detecting acid secretion originating from the inlet patch, clarifying its role in non-responder GERD patients.
M. Ayoubi ∗ , G. Sansoè, N. Leone, L. Framarin, S. Badalamenti, F. Castellino
P.1.325
Ospedale Gradenigo, Torino, Italy
USEFULNESS OF SERUM PEPSINOGENS TO IDENTIFY CHRONIC ATROPHIC GASTRITIS
Background and aim: To analyze the efficacy and complication rates of WFCSEMS in BBS treatment. Material and methods: Between February and December 2009, 6 patients (4 men, 2 woman; mean age 49 years, age range 40–57 years) with distal BBS obstruction were recruited. Patients had already undergone colecystectomy and unsuccessful endoscopic stenting with placement of two 10 Fr. plastic stents. All 6 patients were then treated with temporary placement of WFCSEMS. BBS in these patients was due to primary sclerosing cholangitis (2 pts), chronic pancreatitis in (3 pts), and pancreatico-jejunostomy stenosis (1 pt). Results: Biliary WFCSEMSs were successfully placed at first attempt in all patients. The median time WFCSEMSs were held in place was 3.8 months (range 1–11 months). Resolution of the BBS was confirmed in 5 out of 6 patients after a median post-removal follow–up time of 4.5 months (range 1 – 12 months).
A. Iori ∗ ,1 , L. Gatta 2 , D. Valenza 1 , P. Crafa 3 , P. Caruana 3 , P. Perazzo 1 , J. Franzè 4 , B. Vaira 5 , G.M. Cavestro 1 , A. Franzè 4 , M. Rugge 6 , C. Scarpignato 1 , F. Di Mario 1 1 Section of Gastroenterology, Dpt. of Clinical Science, University of Parma, Parma, Italy; 2 Gastroenterology and Endoscopy Unit, Versilia Hospital, Lido di Camaiore, Italy; 3 Department of Pathology and Laboratory Medicine, Anatomic Pathology Section, University of Parma, Parma, Italy; 4 Gastroenterology Unit, Parma Hospital, Parma, Italy; 5 Department of Internal Medicine and Gastroenterology, S. Orsola Hospital, Bologna, Italy; 6 Department of Medical Diagnostic Sciences and Special Therapies (Pathology Unit), University of Padova, Padova, Italy
Background and aim: Human pepsinogens are pro-enzymes and are subgrouped according to biochemical and immunological properties into two types: Pepsinogen I (PGI), and Pepsinogen II (PGII). Gastrin is a hormon
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Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
produced predominantly by G cells located in the gastric antrum and to a lesser extent in proximal duodenal mucosa.Chronic atrophic gastritis (CAG) is a well recognised risk factor for dysplasia and gastric cancer (intestinal type) and it is associated with modifications in gastric physiology involving PG1, PG2 and G17. Gastropanel® is a serological tool for assessing PG 1, PG 2, G-17, and antibodies anti-H.pylori and it has been show to be a reliable tool to identify CAG “serologically”. Aims: 1) to assess PG1, PG2 and G17 in a group of patients (group A) with an histological diagnosis of CAG; 2) to assess the histological characteristics in a second group of patients (group B) with a serological diagnosis of CAG. Material and methods: Patients underwent endoscopy with biopsies according to the Update Sydney System. Blood samples were taken immediately prior to endoscopy, Patients being fasted for a minimum of 6 hours. The determination of PGI, PGII, G17 and anti-H.pylori antibodies was made by enzyme-linked immunosorbent assay (Biohit, Helsinki, Finland). Results: In the group A (16 women/4 men, mean age 65 years) according to the histology there were 11 patients with CAG in gastric corpus (55%). 4 patients with CAG in antrum (20%), 4 patients (20%) with pan-atrophy (i.e. atrophy of antrum and corpus) and 1 patient (5%) with normal histology. According to the serological evaluation, there was an agreement of almost 91% for patients with CAG in gastric corpus, whilst there was no agreement for patients with atrophy in antrum and for those with pan-atrophy. The group B (18 women/12 men, mean age 66 years) was characterized by patients with PG1 values below the lower normal limit. According to the histology, there were 22 patients (73%) with CAG of corpus and 4 of these (13%) presented also atrophy in the antrum. 8 patients (27%) did not have atrophy. Overall, there was a significant association between low PG1 values, PGI/PGII values and CAG in corpus (p<0.05). Conclusions: Serum pepsinogens seem to be an accurate non invasive tool to identify patients with CAG. Serum pepsinogens might be used to identify and follow-up patients with CAG in order to improve their management.
P.1.326 PORTAL VEIN THROMBOSIS IN INFLAMMATORY BOWEL DISEASE: A SINGLE CENTER EXPERIENCE G. Maconi ∗ , A. Dell’Era, S. Ardizzone, E. Bolzacchini, R. De Franchis Ospedale Universitario Luigi Sacco, Milano, Italy Background and aim: Portal vein thrombosis (PVT) is a well recognised and frequent complication in advanced cirrhosis but is rare in a previously healthy liver. Inflammatory bowel diseases (IBDs) are characterised by a hypercoagulable state and by a higher incidence of systemic thromboembolic events than in the general population. Material and methods: We describe the presentation, diagnostic approaches, underlying acquired or inherited risks factors for hypercoagulability and clinical outcome of 7 IBD patients followed in our centre who developed PVT during their clinical course. Results: The patients (5 males; mean age: 47.7±11.1) presented with partial PV thrombosis (4 patients) or portal cavernoma. Five had Crohn’s disease (CD) and two had ulcerative colitis (UC). Three CD patients had undergone ileocolic resection for strictures and 1 UC patient had undergone colectomy. One patient had HBV-positive active hepatitis and, in 2 patients, a primitive sclerosing cholangitis was diagnosed during diagnostic work-up of PVT. Mean time from diagnosis of IBD to detection of PVT was 15.7±6.4 years. In 4 patients, the diagnosis of PVT was made while IBD was in clinical remission. No patient showed specific signs or symptoms leading to diagnosis of PVT, which was initially made by ultrasound with colour Doppler in 6 patients and by CT scan in one patient. Most patients showed at least 1 potential risk factor for hypercoagulability: lupus anti-coagulant and protein S deficiency were detected in one patient, 2 patients had von Willebrand factor impairment and 2 patients increased homocysteine levels. None of the patients received anticoagulation following diagnosis of PVT and none experienced other thrombotic events during a median of 5 years (range 2-8 years). Conclusions: PVT may be a potential complication of IBD, frequently associated with underlying acquired or inherited risks factors for hypercoag-
ulability, but not necessarily with active disease. The clinical course of PVT in IBD appears to be benign and does not require long-term anti-coagulation treatment.
P.1.327 EXTRAINTESTINAL MANIFESTATIONS IN A SINGLE CENTRE COHORT OF CHRONIC INFLAMMATORY BOWEL DISEASE PATIENTS C. Corrado, R. Pica, E.V. Avallone ∗ , C. Cassieri, A. De Carolis, P. Paoluzi, P. Vernia Università Sapienza, Roma, Italy Background and aim: Ulcerative colitis (UC) and Crohn’s disease (CD), the two main expressions of inflammatory bowel disease (IBD), may be associated with extraintestinal manifestations (EIMs). Aim of this study has been to investigate the prevalence, type and time of onset of EIMs in a large series of Italian IBD patients. Material and methods: Eight hundred and one consecutive IBD out-patients, first referred to our centre, from 2000 to 2010 with a mean follow-up of 40.7±31.5 SD months, were retrospectively studied. Five hundred and ninetythree (74%) patients were affected by ulcerative colitis (mean age 51.5±15.5 SD years) and 208 (26%) by Crohn’s disease (mean age 49±16.1 SD years). Four hundred and thirty-three (54%) were male and 368 (46%) female. Results: EIMs were observed in 319 (39.8%) patients, 208 with UC and 111 with CD, with a prevalence of 35.1% and 53.3%, respectively. The EIMs found were: 227 arthritis (UC 27.2%, CD 31.7%), 13 ankylosing spondylitis (UC 1.3%, CD 2.4%), 24 uveitis (UC 1.7%, CD 6.7%), 7 pyoderma gangrenosum (UC 0.3%, CD 2.4%), 17 erythema nodosum (UC 1.3%, CD 4.3%), 11 psoriasis (UC 1.2%, CD 1.9%), 6 aphthous stomatitis (UC 0.5%, CD 1.4%), 5 sclerosing cholangitis (UC 0.5%, CD 1%), 9 Hashimoto’s thyroiditis (UC 1%, CD 1.4%). Thirty-six EIMs were observed before the diagnosis of IBD (mean period 4.6±3.1 SD, range 1-24 years), 221 EIMs after diagnosis (mean period 10.4±8.4 SD, range 2-44 years) and 62 were present at the time of diagnosis. Conclusions: The prevalence of EIMs is in keeping with those reported in the literature. Musculoskeletal manifestations were the most commonly EIMs observed, confirming the need for close cooperation with rheumatologists. They were often more severe and disabling than the intestinal symptoms of IBD, thus suggesting that prime attention should be given to EIMs in order to improve Quality of Life of IBD patients.
P.1.328 DISEASE ACTIVITY AND SEX LIFE OF IBD PATIENTS M.D. Franzese ∗ , C. Bucci, E. Troncone, P. Andreozzi, I. Russo, C. Ciacci Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy Background and aim: Inflammatory bowel disease (IBD) has a relevant impact on patients’ quality of life affecting also sexual lives. Aim of this study is to evaluate sexual lives of IBD patients when compared to healthy controls (HC). Material and methods: 46 IBD outpatients with mild-moderate disease activity and 51 healthy age- and sex- matched controls were administered an anonymous, self administered and standardized questionnaire on partnerhood and relationship status, median age at first sexual experience, if the patients considered the partner helping them living a full sexual life, actual frequency of sexual intercourses, if they had sexual desire and/or if they had difficulty and/or pain in attaining orgasm and/or if they were satisfied of their sex lives. IBD patients were also asked about their diagnosis, duration of disease, any surgery, if the disease had influenced their physical appearance or their sex lives. Results: The two groups were similar for relationship status, median age at first sexual experience, frequency of sexual intercourses and the overall satisfaction for their sex lives (p=ns for all measured variables). Sexual desire was significantly lower in IBD patients compared with HC (p=0.001); the difficulty in attaining orgasm (p=0.002) and presence of pain during sexual intercourse
P.1.322 EUS VERSUS TC MULTI-DETECTOR (MDCT) IN THE STAGING OF GASTRIC CANCER: CORRELATION WITH PATHOLOGIC STAGING N. Muscatiello, M. Di Maso ∗ , C. Panella Az. “oo.Rr.”, Foggia, Italy Background and aim: EUSand MDCT are considered to be valuable tools for preoperative staging of gastric cancer, depiste the major limitations of overstaging and understaging. Withrecent advance in CT technology and introduction of neoadjuvant c hemoterapy, further evalutation of diagnostic accuracies of EUs and MDCT is needed. Material and methods: The aim of this study was determine accuracies of EUS and MDCT in the preoperative T and N stagin of gastric cancer. The medical record of 52 patients from 01/2007 to 10/2010 were analyzed. Clinical staging results from preoperatively performed EUS and MDCT were compared with postoperative pathologic findings. Results: The overall accuracy of EUS for determination of the T stage was 71%. The tumor with submucosal fibrosis or ulceration tended to be overdiagnosis. The overall detection rate of primary tumor with MDCT imaging was 56%. The overall accuracy of MDCT for individual T stage was 61%. The accuracy for discrimination of T2 from T3/T4 tumors was 72% for EUS and 67% for MDCT. The overvall accuracy of the lymphnode involvement was 69% with EUS and 70% with MDCT imaging. Conclusions: EUS provide more accurate T staging result than MDCT. The accuracy for Cancer gastric advance is much lower than that for early gastric cancer in both modalities. The accuracy determing serosal invasion and nodal involvement was similar between EUS and MDCT. The overall diagnostic accuracy of EUS and MDCT is not enough in the preoperative staging of gastric cancer and a new approach to supplement the modalities is needed.
P.1.323 TEMPORARY PLACEMENT OF WALLFLEX FULLY COVERED SELF–EXPANDABLE METALLIC STENT (WFCSEMS) IN BENIGN BILIARY STENOSIS (BBS) IN PREVIOUSLY UNSUCCESSFUL COMMON BILE DUCT PLASTIC STENTING: MIDTERM EVALUTION
S255
There were no complications. The removal of prostheses was very easy. Conclusions: Placement and removal of WFCSEMS for BBS is safe and may offer an alternative to multiple plastic stenting. Further investigation is needed to confirm these findings and WFCSEMS long-term efficacy.
P.1.324 24 H PH IMPEDANCE MONITORING AND INLET PATCH ACID SECRETION CAPACITY M. Di Stefano, C. Mengoli ∗ , M. Bergonzi, F. Racca, R. Fasulo, G.R. Corazza Clinica Medica I, Università di Pavia - Irccs Policlinico S. Matteo, Pavia, Italy Background and aim: Heterotopic areas of gastric mucosa (inlet patches) are a frequent endoscopic finding in upper endoscopy. Patients are often asymptomatic, but both esophageal and extra-esophageal symptoms may be present and frequently overlap when GERD is evident. We hypothesized that different positioning of pH and impendance sensors may help in the detection of acid production prom the lesions. Material and methods: A 40-year-old male attended our outpatient Clinic due to both reflux-related and globus. He had already undergone gastroscopy which showed erythematosus gastropathy and two areas resembling gastric mucosa at the proximal esophagus. A first standard 24 h pH-impedance monitoring (double pH sensor, Sandhill Scientific) revealed severe acid exposure of the distal third of the esophagus (17.3% of total recording time, 21.8% supine, 12.8% upright) with 29 acid and 41 weakly acid reflux episodes. Visual analysis of the recording showed mismatch between gastric and esophageal pH: in 15 occasions, pH value of distal esophagus was lower than gastric pH and impedance waves were caudally transmitted, suggesting a proximal site of production of this acid material in esophageal, rather than gastric refluxate. To ascertain the origin of acid, we performed a second pH impedance monitoring by using a modified protocol: pH sensors were placed respectively 20 and 5 cm above the LES, and so impedance sensors at a more proximal level, after about two weeks of high dose PPI therapy, due to inadequate response. Results: The patient partially improved during PPI therapy. The second examination showed 35 pH modifications. 8 acidic and 7 nonacidic reflux episodes with proximal extent were observed, not associated with symptoms. The remaining twenty episodes of esophageal pH modification were characterized by an initial fall at proximal level, followed by the fall at distal level, not associated with deglutition of alimentary bolus. Impedance waves revealed acidic liquid descending along the esophagus, with saliva deglutition. The patient reported epigastric pain or heartburn in the majority of these events (SAP respectively 98% and 99%). Conclusions: 24 pH-impedance acid monitoring could be a useful tool in detecting acid secretion originating from the inlet patch, clarifying its role in non-responder GERD patients.
M. Ayoubi ∗ , G. Sansoè, N. Leone, L. Framarin, S. Badalamenti, F. Castellino
P.1.325
Ospedale Gradenigo, Torino, Italy
USEFULNESS OF SERUM PEPSINOGENS TO IDENTIFY CHRONIC ATROPHIC GASTRITIS
Background and aim: To analyze the efficacy and complication rates of WFCSEMS in BBS treatment. Material and methods: Between February and December 2009, 6 patients (4 men, 2 woman; mean age 49 years, age range 40–57 years) with distal BBS obstruction were recruited. Patients had already undergone colecystectomy and unsuccessful endoscopic stenting with placement of two 10 Fr. plastic stents. All 6 patients were then treated with temporary placement of WFCSEMS. BBS in these patients was due to primary sclerosing cholangitis (2 pts), chronic pancreatitis in (3 pts), and pancreatico-jejunostomy stenosis (1 pt). Results: Biliary WFCSEMSs were successfully placed at first attempt in all patients. The median time WFCSEMSs were held in place was 3.8 months (range 1–11 months). Resolution of the BBS was confirmed in 5 out of 6 patients after a median post-removal follow–up time of 4.5 months (range 1 – 12 months).
A. Iori ∗ ,1 , L. Gatta 2 , D. Valenza 1 , P. Crafa 3 , P. Caruana 3 , P. Perazzo 1 , J. Franzè 4 , B. Vaira 5 , G.M. Cavestro 1 , A. Franzè 4 , M. Rugge 6 , C. Scarpignato 1 , F. Di Mario 1 1 Section of Gastroenterology, Dpt. of Clinical Science, University of Parma, Parma, Italy; 2 Gastroenterology and Endoscopy Unit, Versilia Hospital, Lido di Camaiore, Italy; 3 Department of Pathology and Laboratory Medicine, Anatomic Pathology Section, University of Parma, Parma, Italy; 4 Gastroenterology Unit, Parma Hospital, Parma, Italy; 5 Department of Internal Medicine and Gastroenterology, S. Orsola Hospital, Bologna, Italy; 6 Department of Medical Diagnostic Sciences and Special Therapies (Pathology Unit), University of Padova, Padova, Italy
Background and aim: Human pepsinogens are pro-enzymes and are subgrouped according to biochemical and immunological properties into two types: Pepsinogen I (PGI), and Pepsinogen II (PGII). Gastrin is a hormon
S256
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
produced predominantly by G cells located in the gastric antrum and to a lesser extent in proximal duodenal mucosa.Chronic atrophic gastritis (CAG) is a well recognised risk factor for dysplasia and gastric cancer (intestinal type) and it is associated with modifications in gastric physiology involving PG1, PG2 and G17. Gastropanel® is a serological tool for assessing PG 1, PG 2, G-17, and antibodies anti-H.pylori and it has been show to be a reliable tool to identify CAG “serologically”. Aims: 1) to assess PG1, PG2 and G17 in a group of patients (group A) with an histological diagnosis of CAG; 2) to assess the histological characteristics in a second group of patients (group B) with a serological diagnosis of CAG. Material and methods: Patients underwent endoscopy with biopsies according to the Update Sydney System. Blood samples were taken immediately prior to endoscopy, Patients being fasted for a minimum of 6 hours. The determination of PGI, PGII, G17 and anti-H.pylori antibodies was made by enzyme-linked immunosorbent assay (Biohit, Helsinki, Finland). Results: In the group A (16 women/4 men, mean age 65 years) according to the histology there were 11 patients with CAG in gastric corpus (55%). 4 patients with CAG in antrum (20%), 4 patients (20%) with pan-atrophy (i.e. atrophy of antrum and corpus) and 1 patient (5%) with normal histology. According to the serological evaluation, there was an agreement of almost 91% for patients with CAG in gastric corpus, whilst there was no agreement for patients with atrophy in antrum and for those with pan-atrophy. The group B (18 women/12 men, mean age 66 years) was characterized by patients with PG1 values below the lower normal limit. According to the histology, there were 22 patients (73%) with CAG of corpus and 4 of these (13%) presented also atrophy in the antrum. 8 patients (27%) did not have atrophy. Overall, there was a significant association between low PG1 values, PGI/PGII values and CAG in corpus (p<0.05). Conclusions: Serum pepsinogens seem to be an accurate non invasive tool to identify patients with CAG. Serum pepsinogens might be used to identify and follow-up patients with CAG in order to improve their management.
P.1.326 PORTAL VEIN THROMBOSIS IN INFLAMMATORY BOWEL DISEASE: A SINGLE CENTER EXPERIENCE G. Maconi ∗ , A. Dell’Era, S. Ardizzone, E. Bolzacchini, R. De Franchis Ospedale Universitario Luigi Sacco, Milano, Italy Background and aim: Portal vein thrombosis (PVT) is a well recognised and frequent complication in advanced cirrhosis but is rare in a previously healthy liver. Inflammatory bowel diseases (IBDs) are characterised by a hypercoagulable state and by a higher incidence of systemic thromboembolic events than in the general population. Material and methods: We describe the presentation, diagnostic approaches, underlying acquired or inherited risks factors for hypercoagulability and clinical outcome of 7 IBD patients followed in our centre who developed PVT during their clinical course. Results: The patients (5 males; mean age: 47.7±11.1) presented with partial PV thrombosis (4 patients) or portal cavernoma. Five had Crohn’s disease (CD) and two had ulcerative colitis (UC). Three CD patients had undergone ileocolic resection for strictures and 1 UC patient had undergone colectomy. One patient had HBV-positive active hepatitis and, in 2 patients, a primitive sclerosing cholangitis was diagnosed during diagnostic work-up of PVT. Mean time from diagnosis of IBD to detection of PVT was 15.7±6.4 years. In 4 patients, the diagnosis of PVT was made while IBD was in clinical remission. No patient showed specific signs or symptoms leading to diagnosis of PVT, which was initially made by ultrasound with colour Doppler in 6 patients and by CT scan in one patient. Most patients showed at least 1 potential risk factor for hypercoagulability: lupus anti-coagulant and protein S deficiency were detected in one patient, 2 patients had von Willebrand factor impairment and 2 patients increased homocysteine levels. None of the patients received anticoagulation following diagnosis of PVT and none experienced other thrombotic events during a median of 5 years (range 2-8 years). Conclusions: PVT may be a potential complication of IBD, frequently associated with underlying acquired or inherited risks factors for hypercoag-
ulability, but not necessarily with active disease. The clinical course of PVT in IBD appears to be benign and does not require long-term anti-coagulation treatment.
P.1.327 EXTRAINTESTINAL MANIFESTATIONS IN A SINGLE CENTRE COHORT OF CHRONIC INFLAMMATORY BOWEL DISEASE PATIENTS C. Corrado, R. Pica, E.V. Avallone ∗ , C. Cassieri, A. De Carolis, P. Paoluzi, P. Vernia Università Sapienza, Roma, Italy Background and aim: Ulcerative colitis (UC) and Crohn’s disease (CD), the two main expressions of inflammatory bowel disease (IBD), may be associated with extraintestinal manifestations (EIMs). Aim of this study has been to investigate the prevalence, type and time of onset of EIMs in a large series of Italian IBD patients. Material and methods: Eight hundred and one consecutive IBD out-patients, first referred to our centre, from 2000 to 2010 with a mean follow-up of 40.7±31.5 SD months, were retrospectively studied. Five hundred and ninetythree (74%) patients were affected by ulcerative colitis (mean age 51.5±15.5 SD years) and 208 (26%) by Crohn’s disease (mean age 49±16.1 SD years). Four hundred and thirty-three (54%) were male and 368 (46%) female. Results: EIMs were observed in 319 (39.8%) patients, 208 with UC and 111 with CD, with a prevalence of 35.1% and 53.3%, respectively. The EIMs found were: 227 arthritis (UC 27.2%, CD 31.7%), 13 ankylosing spondylitis (UC 1.3%, CD 2.4%), 24 uveitis (UC 1.7%, CD 6.7%), 7 pyoderma gangrenosum (UC 0.3%, CD 2.4%), 17 erythema nodosum (UC 1.3%, CD 4.3%), 11 psoriasis (UC 1.2%, CD 1.9%), 6 aphthous stomatitis (UC 0.5%, CD 1.4%), 5 sclerosing cholangitis (UC 0.5%, CD 1%), 9 Hashimoto’s thyroiditis (UC 1%, CD 1.4%). Thirty-six EIMs were observed before the diagnosis of IBD (mean period 4.6±3.1 SD, range 1-24 years), 221 EIMs after diagnosis (mean period 10.4±8.4 SD, range 2-44 years) and 62 were present at the time of diagnosis. Conclusions: The prevalence of EIMs is in keeping with those reported in the literature. Musculoskeletal manifestations were the most commonly EIMs observed, confirming the need for close cooperation with rheumatologists. They were often more severe and disabling than the intestinal symptoms of IBD, thus suggesting that prime attention should be given to EIMs in order to improve Quality of Life of IBD patients.
P.1.328 DISEASE ACTIVITY AND SEX LIFE OF IBD PATIENTS M.D. Franzese ∗ , C. Bucci, E. Troncone, P. Andreozzi, I. Russo, C. Ciacci Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy Background and aim: Inflammatory bowel disease (IBD) has a relevant impact on patients’ quality of life affecting also sexual lives. Aim of this study is to evaluate sexual lives of IBD patients when compared to healthy controls (HC). Material and methods: 46 IBD outpatients with mild-moderate disease activity and 51 healthy age- and sex- matched controls were administered an anonymous, self administered and standardized questionnaire on partnerhood and relationship status, median age at first sexual experience, if the patients considered the partner helping them living a full sexual life, actual frequency of sexual intercourses, if they had sexual desire and/or if they had difficulty and/or pain in attaining orgasm and/or if they were satisfied of their sex lives. IBD patients were also asked about their diagnosis, duration of disease, any surgery, if the disease had influenced their physical appearance or their sex lives. Results: The two groups were similar for relationship status, median age at first sexual experience, frequency of sexual intercourses and the overall satisfaction for their sex lives (p=ns for all measured variables). Sexual desire was significantly lower in IBD patients compared with HC (p=0.001); the difficulty in attaining orgasm (p=0.002) and presence of pain during sexual intercourse