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P.14.6 PREVALENCE AND CLINICAL SIGNIFICANCE OF HYPERGAMMAGLOBULINEMIA IN INFLAMMATORY BOWEL DISEASE PATIENTS: A RETROSPECTIVE CROSS-SECTIONAL STUDY
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Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
showed focal cronic follicular dermatitis with non caseating granulomas; periodic PAS and ZiehlNielsen and Gram stains reaction were negative. A diagnosis of MCD was made, although the patient refused colonoscopy, we decided to treat with IFX. Results: IFX (5 mg/kg of body weight) was administered at weeks 0 (first dose 09/2010), 2 and 6 and every 8 weeks, after 3th infusion we observed marked improvment and after 5th infusion complete resolution of the lesions. The treatment was continued to 18 months and 3.2012 was interrupted. A follow-up was started, we revised the patient every 12 weeks and after 42 months non relapse was observed.
level above the normal lab-reported value)] parameters. Exclusion criteria were: uncertain diagnosis, presence of monoclonal HGG, hematologic or autoimmune disorders. From a total of 388 IBD patients, 81 patients were excluded (uncertain diagnosis=12, lack of data=64, monoclonal HGG=3, multiple myeloma=1, autoimmune thrombocytopenia=1). 307 patients were included (UC=212, CD=95). Prevalence of HGG was calculated. Clinical and biochemical features in patients with and without HGG were compared by t-test and chisquared test for parametric and non parametric data, respectively. Multivariate analysis was performed with presence of HGG set as independent variable. Odd Ratio (OR) and 95% Confidence Interval (CI) were calculated. Results: HGG was found in 46/307 (15%) of IBD patients [CD: 11/84 (13%), UC: 35/177 (20%)]. IBD patients with HGG had significant higher prevalence of UC (76% vs. 68%, p=0.05) and extra-intestinal manifestations (28% vs. 14%, p<0.05). At the multivariate analysis, UC (p<0.05) and extra-intestinal manifestations (p<0.005) were independently associated with presence of HGG. UC patients with HGG had significant higher association with presence of extraintestinal manifestation than UC patients without HGG (OR 4.5, 95%CI 1.6 to 12.1, p=0.0032), while CD patients with HGG did not displayed significant difference (OR 2.3, 95%CI 0.7 to 8.5, p=0.19). Conclusions: In the present retrospective study, HGG was quite frequent in IBD patients, and it was associated with higher prevalence of extra-intestinal manifestation in UC patients.
P.14.7 DRUG ADHERENCE IN IBD PATIENTS Conclusions: MCD is a rare cutaneous manifestation of active CD of variable clinical appaearance remote from bowel. Diagnosis is difficult and must be differentated from infectious and non infectious skin’s disease; skin biopsy should be performed to assess characteristic granulomas of CD and rule out infection or other etiologies; the treatment is not standardized. Our experience suggest that: 1) MCD can be not related to active intestinal CD; 2) IFX can be a effective and well tolerated treatment; 3) efficacy of IFX is very fast; 4) the effect of IFX remains long after discontinuation of therapy.
P.14.6 PREVALENCE AND CLINICAL SIGNIFICANCE OF HYPERGAMMAGLOBULINEMIA IN INFLAMMATORY BOWEL DISEASE PATIENTS: A RETROSPECTIVE CROSS-SECTIONAL STUDY Menasci F.*, Pagnini C., Desideri F., Sanna A., Delle Fave G. Sapienza University, Sant’Andrea Hospital, Rome, Italy Background and aim: Hypergammaglobulinemia (HGG) is an alteration commonly described in patients with autoimmune, infective or inflammatory disorders where an increment of antibodies production is observed. No data are available for the prevalence and clinical significance of HGG in inflammatory bowel disease (IBD) patients. Aim of the present study was to evaluate the prevalence and clinical significance of HGG in IBD patients in a retrospective cross-sectional study. Material and methods: We included IBD patients referred at S. Andrea Hospital in Rome, Italy, in outpatient visit, between January 2013 and December 2014. Inclusion criteria were: firm diagnosis of IBD [ulcerative colitis (UC) or Crohn’s disease (CD)], and complete records of clinical [age, sex, localization, comorbidities, extraintestinal manifestations (articular, dermatologic or ocular IBDrelated diseases), disease activity, presence of flare at 1 year of followup) and biochemical [hemoglobin, C reactive protein, presence of HGG (defined as polyclonal increment of the gammaglobulins
Bucci C.*1, Cersosimo G.2, Tammaro S.3, Iovino P.1, Ciacci C.1 Gastroenterologia, University of Salerno, Salerno, Italy, 2Sociologia della Salute e della malattia, Università di Salerno, Salerno, Italy, 3 Unità di endoscopia digestiva, P.O. Fucito, Mercato San Severino, Italy 1
Background and aim: Therapeutic adherence to multiple drugs has become one of the major issues in the management of inflammatory bowel disease (IBD), especially in remission periods. A recent review showed that non-adherence rates ranged from 7 to 72%, and a scarce adherence has been associated with frequent relapses, more complications and increased social costs. Aim of the present study was to investigate the rate of non-adherence among our IBD patients. Material and methods: Patients were recruited at a IBD referral centre of the University Hospital in Salerno (Italy). All patients with a scheduled office visit were asked to fill in a self-administered and anonymous questionnaire available online on a specific website. The questionnaire explored in the long-, middle- and shortperiod (months, weeks and days, respectively) the adherence to the 4 major class of drugs used as long term therapy (mesalazine, immunosoppressors (IMM), steroids and biologic). Also, the presence of confounders (travels, harassment of taking drugs in social contests, being worried of adverse events) and the severity of the disease were considered. Results: Complete data are available on 37 IBD patients (63,4% male, age 21-30 years, 48% Crohn’s disease, 52% RCU). 62% were in clinical remission, 80% were on mesalazine, 32% on mesalazine plus an IMM drug, and 21% on mesalazine plus a biologic drug. About half of the patients (46%) were totally compliant to the prescribed therapy, while mesalazina was the most frequently forgotten drug among non-adherent patients. The patients showed a good adherence to IMMs, steroids and biologics in the long, middle and short term period. When adherence was evaluated according to disease activity, 12 (30%) of the patients admitted to forget mesalazine when in clinical remission, 7% forgot IMMs and 10% forgot to inject biologics or to show up at clinical appointment for anti-TNF infusion. When outside home, patients tended to forget mesalazine (10%), but none
Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
showed focal cronic follicular dermatitis with non caseating granulomas; periodic PAS and ZiehlNielsen and Gram stains reaction were negative. A diagnosis of MCD was made, although the patient refused colonoscopy, we decided to treat with IFX. Results: IFX (5 mg/kg of body weight) was administered at weeks 0 (first dose 09/2010), 2 and 6 and every 8 weeks, after 3th infusion we observed marked improvment and after 5th infusion complete resolution of the lesions. The treatment was continued to 18 months and 3.2012 was interrupted. A follow-up was started, we revised the patient every 12 weeks and after 42 months non relapse was observed.
level above the normal lab-reported value)] parameters. Exclusion criteria were: uncertain diagnosis, presence of monoclonal HGG, hematologic or autoimmune disorders. From a total of 388 IBD patients, 81 patients were excluded (uncertain diagnosis=12, lack of data=64, monoclonal HGG=3, multiple myeloma=1, autoimmune thrombocytopenia=1). 307 patients were included (UC=212, CD=95). Prevalence of HGG was calculated. Clinical and biochemical features in patients with and without HGG were compared by t-test and chisquared test for parametric and non parametric data, respectively. Multivariate analysis was performed with presence of HGG set as independent variable. Odd Ratio (OR) and 95% Confidence Interval (CI) were calculated. Results: HGG was found in 46/307 (15%) of IBD patients [CD: 11/84 (13%), UC: 35/177 (20%)]. IBD patients with HGG had significant higher prevalence of UC (76% vs. 68%, p=0.05) and extra-intestinal manifestations (28% vs. 14%, p<0.05). At the multivariate analysis, UC (p<0.05) and extra-intestinal manifestations (p<0.005) were independently associated with presence of HGG. UC patients with HGG had significant higher association with presence of extraintestinal manifestation than UC patients without HGG (OR 4.5, 95%CI 1.6 to 12.1, p=0.0032), while CD patients with HGG did not displayed significant difference (OR 2.3, 95%CI 0.7 to 8.5, p=0.19). Conclusions: In the present retrospective study, HGG was quite frequent in IBD patients, and it was associated with higher prevalence of extra-intestinal manifestation in UC patients.
P.14.7 DRUG ADHERENCE IN IBD PATIENTS Conclusions: MCD is a rare cutaneous manifestation of active CD of variable clinical appaearance remote from bowel. Diagnosis is difficult and must be differentated from infectious and non infectious skin’s disease; skin biopsy should be performed to assess characteristic granulomas of CD and rule out infection or other etiologies; the treatment is not standardized. Our experience suggest that: 1) MCD can be not related to active intestinal CD; 2) IFX can be a effective and well tolerated treatment; 3) efficacy of IFX is very fast; 4) the effect of IFX remains long after discontinuation of therapy.
P.14.6 PREVALENCE AND CLINICAL SIGNIFICANCE OF HYPERGAMMAGLOBULINEMIA IN INFLAMMATORY BOWEL DISEASE PATIENTS: A RETROSPECTIVE CROSS-SECTIONAL STUDY Menasci F.*, Pagnini C., Desideri F., Sanna A., Delle Fave G. Sapienza University, Sant’Andrea Hospital, Rome, Italy Background and aim: Hypergammaglobulinemia (HGG) is an alteration commonly described in patients with autoimmune, infective or inflammatory disorders where an increment of antibodies production is observed. No data are available for the prevalence and clinical significance of HGG in inflammatory bowel disease (IBD) patients. Aim of the present study was to evaluate the prevalence and clinical significance of HGG in IBD patients in a retrospective cross-sectional study. Material and methods: We included IBD patients referred at S. Andrea Hospital in Rome, Italy, in outpatient visit, between January 2013 and December 2014. Inclusion criteria were: firm diagnosis of IBD [ulcerative colitis (UC) or Crohn’s disease (CD)], and complete records of clinical [age, sex, localization, comorbidities, extraintestinal manifestations (articular, dermatologic or ocular IBDrelated diseases), disease activity, presence of flare at 1 year of followup) and biochemical [hemoglobin, C reactive protein, presence of HGG (defined as polyclonal increment of the gammaglobulins
Bucci C.*1, Cersosimo G.2, Tammaro S.3, Iovino P.1, Ciacci C.1 Gastroenterologia, University of Salerno, Salerno, Italy, 2Sociologia della Salute e della malattia, Università di Salerno, Salerno, Italy, 3 Unità di endoscopia digestiva, P.O. Fucito, Mercato San Severino, Italy 1
Background and aim: Therapeutic adherence to multiple drugs has become one of the major issues in the management of inflammatory bowel disease (IBD), especially in remission periods. A recent review showed that non-adherence rates ranged from 7 to 72%, and a scarce adherence has been associated with frequent relapses, more complications and increased social costs. Aim of the present study was to investigate the rate of non-adherence among our IBD patients. Material and methods: Patients were recruited at a IBD referral centre of the University Hospital in Salerno (Italy). All patients with a scheduled office visit were asked to fill in a self-administered and anonymous questionnaire available online on a specific website. The questionnaire explored in the long-, middle- and shortperiod (months, weeks and days, respectively) the adherence to the 4 major class of drugs used as long term therapy (mesalazine, immunosoppressors (IMM), steroids and biologic). Also, the presence of confounders (travels, harassment of taking drugs in social contests, being worried of adverse events) and the severity of the disease were considered. Results: Complete data are available on 37 IBD patients (63,4% male, age 21-30 years, 48% Crohn’s disease, 52% RCU). 62% were in clinical remission, 80% were on mesalazine, 32% on mesalazine plus an IMM drug, and 21% on mesalazine plus a biologic drug. About half of the patients (46%) were totally compliant to the prescribed therapy, while mesalazina was the most frequently forgotten drug among non-adherent patients. The patients showed a good adherence to IMMs, steroids and biologics in the long, middle and short term period. When adherence was evaluated according to disease activity, 12 (30%) of the patients admitted to forget mesalazine when in clinical remission, 7% forgot IMMs and 10% forgot to inject biologics or to show up at clinical appointment for anti-TNF infusion. When outside home, patients tended to forget mesalazine (10%), but none