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P.16.20 UTILITY OF ENDOSCOPIC ULTRASOUND TO GUIDE MEDICAL THERAPY FOR PATIENTS WITH CROHN'S PERIANAL DISEASE
S196
Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220
Material and methods: We studied 42 consecutive patients with an established diagnosis of IBD (20 men; median age 40.3 years, range 14-73); 26 age and sex matched controls affering to our unit for uninvestigated dispespia were recruited. We determined clinical symptoms, PCA, H.pylori antibodies and gastrin plasma levels. Gastroscopy with multiple biopsies was carried out in patients with PCA positivity. Results: We found that 3/68 patients had detectable PCA (4.4%), 1 patient with Crohn disease (2.4% of IBD group) and two controls (7.7%).Severe hypergastrinemia was found in none of the patients and subjects. Clinical presentation was also similar in both groups, such as H.Pylori antibodies. All three patients underwent gastroscopy which showed no signs of AG. Conclusions: This preliminary results showed that the prevalence of PCA positivity in patient with IBD was not significantly different when compared to subjects without IBD. Considering the low prevalence of PCA and AG in general population, collection of further data is needed to establish if patients with IBD may have increased prevalence of PCA plasma levels and whether there are higher risk of AG. Patients with PCA positivity and negative histology need to be further investigated over the years.
P.16.20 UTILITY OF ENDOSCOPIC ULTRASOUND TO GUIDE MEDICAL THERAPY FOR PATIENTS WITH CROHN’S PERIANAL DISEASE P. Meddi ∗ , T. Federici, A. Tesi, A. Kohn Uoc di Gastroenterologia Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy Background and aim: To determine if rectal endoscopic ultrasound can be a valid guide in therapeutic management for patients with perianal fistulizing Crohn’s disease. Material and methods: This is a retrospective analysis of 13 patients (7 females and 6 males, main age 32 years) who presented symptomatic persistent Crohn’s perianal disease observed. All patients underwent surgeon examination and magnetic resonance imaging (MRI) to assess the type of fistula, the presence of abscess, according to Parks’ criteria and were placed on medical treatment with 5-asa, antibiotics, azathioprine and infliximab. 7 of them had intersphinteric fistula, 4 with abscess, 3 complex fistula and 3 females had recto-vaginal fistula. Seton placement and incision and drainage were performed in 3 patient with abscess.When the follow up started the patients underwent physical visit and Endoscopic Ultrasound (EUS) to evaluate the efficacy of therapy or to modify it. 7 patients had changed the therapy maximized with Infliximab, 2 of them required seton placement, 2 introduced Ciprofluoxacin and 4 extended the starting therapy. At the end of follow up period, (16-36 weeks) all the patient underwent a physical examination and had an other MRI performed. Results: In 7 (61,6%) patients fistula were not active, all without abscess. 6 (38,4%)patient, 3 of them with starting complex perianal disease, had persistent fistula, but 1 poorly active and in 2 the abscess was disappeared.1 patient required surgical intervention. Conclusions: Crohn’s perianal fistulas are difficult to treat and often lead to a significant morbidity.The treatment has improved with the introduction of anti-TNF antibodies, but only a minority of patients maintain complete fistula closure. The cause can be not accurately assessment of perianal disease before or during the therapy. The use of EUS can be effective to guide therapy for Crohn’s perianal fistulas and can be associated with improved fistula response rates.
P.16.21 PREVALENCE OF COLONIC DIVERTICULOSIS IN PATIENTS AFFECTED BY ULCERATIVE COLITIS VERSUS ADULT PATIENTS IN A SINGLE CENTRE E.V. Avallone, C. Cassieri, R. Pica ∗ , P. Paoluzi Dipartimento di Medicina Interna e Specialità Mediche, Università “Sapienza”, Roma, Italy Background and aim: Diverticulosis of the colon is an acquired condition
that results from herniation of the mucosa through defects in the muscular layer. Several studies have revealed that diverticular formation of the colon occurs primarily in industrialized and Westernized countries. The true prevalence of colonic diverticulosis is difficult to measure because most individuals are asymptomatic. In particularly, in literature, there are few study about the prevalence of colonic diverticulosis in patients affected by ulcerative colitis (UC). Aim of this study has been to investigate the prevalence of colonic diverticulosis in UC and in adult patients referred in a single centre. Material and methods: Six hundred and five consecutive patients, referred to our Institution to undergo a colonoscopy between January 1, 2009 and December 31, 2009, were retrospectively studied. Of these patients, 438 (72.4%) underwent colonoscopy for colorectal cancer screening (Group A) and 167 (27.6%) for UC control (Group B). In group A 224 patients (51.1%) were male (average age of 62.7±14.2 SD years, range 35-86 years), in group B 102 (61.1%) were male (average age of 57.6±12.1 SD years, range 25-84 years). Results: Prevalence of colonic diverticulosis was higher in group A (122 patients, 27.8%) than group B (18 patients, 10.8%) a difference statistically significant (p <0.0001, Fisher’s exact test). In particularly female gender in patients with colonic diverticulosis was higher in group A than group B (68 patients, 31.8% and 4 patients, 6.1%, respectively) with a difference statistically significant (p <0.0001, Fisher’s exact test). No differences were found between the two groups in terms of extension of colonic diverticulosis. Conclusions: Results of our study demonstrated that prevalence of colonic diverticulosis was significantly lower in patients with UC than in adult population, emphasizing the relevance of the coexistence of UC and colonic diverticulosis because could make very difficult the clinical management of these patients.
P.16.22 INFLIXIMAB AS RESCUE THERAPY FOR PATIENTS WITH SEVERE ULCERATIVE COLITIS REFRACTORY TO SYSTEMIC CORTICOSTEROIDS: A SINGLE CENTRE OPEN-LABEL STUDY M. Fortuna ∗ ,1 , R. Montanari 1 , A. Geccherle 1 , A. Sartori 2 , G. Ruffo 2 , M. Chiaramonte 1 1 Multispecialistic Centre For Recto-Perineal Diseases (Ibd Unit), Department of Gastroenterology, Ospedale Sacro Cuore Don Calabria., Negrar (Verona), Italy; 2 Department of General Surgery, Ospedale Sacro Cuore Don Calabria. Negrar, Negrar (Verona), Italy
Background and aim: Infliximab (IFX) is effective for induction and maintenance of clinical remission in patients (pts) with moderate to severe ulcerative colitis (UC). Data concerning its proven efficacy as a rescue therapy (tp) in the severe forms of the disease refractory to intravenous (i.v.) steroids are lacking. We present the results of a single centre open-label study, that has evaluated short-and long-term clinical responses and colectomy rates in severe i.v. steroid-refractory UC treated with IFX. Material and methods: From Jan 2009 to Dec 2010 all hospitalized pts at the Gastroenterology Department of Negrar Hospital (VR) with severe UC, according to Truelove and Witts criteria, were recruited. All patients received metilprednisolone 1 mg/kg i.v. for 7 days. IFX (5 mg/kg at 0, 2 and 6 weeks) was used as rescue tp in steroid-refractory pts. The success of IFX was based on a decrease in disease activity. Pts with lack of response to IFX or steroid-refractory forms of disease considered too severe to initiate an IFX course underwent colectomy. Pts who responded to induction were evaluated after one year of maintenance tp with IFX. Results: 14 pts met our criteria of recruitment (10 males, age 24-70 years). 8 had pancolitis and 6 left-sided colitis. After 7 days on i.v. corticosteroids, 5/14 (35.7%) pts had a clinical response, while 9/14 (64.2%) were steroid-refractory. Of these, one underwent urgent colectomy and 8 were treated with IFX. 1/8 (12.5%) pts failed to respond to induction tp and underwent elective colectomy. 7/8 (87.5%) pts had clinical response after the induction period of IFX. After one year of maintenance tp with IFX, 5/7 pts had sustained clinical response, whereas 1/7 had to stop the tp after 9 months for Aspergillus systemic infection. 1/7 failed to respond and underwent elective colectomy after 12 months of IFX tp. The colectomy rate after one year of IFX was 14.3%.
Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220
Material and methods: We studied 42 consecutive patients with an established diagnosis of IBD (20 men; median age 40.3 years, range 14-73); 26 age and sex matched controls affering to our unit for uninvestigated dispespia were recruited. We determined clinical symptoms, PCA, H.pylori antibodies and gastrin plasma levels. Gastroscopy with multiple biopsies was carried out in patients with PCA positivity. Results: We found that 3/68 patients had detectable PCA (4.4%), 1 patient with Crohn disease (2.4% of IBD group) and two controls (7.7%).Severe hypergastrinemia was found in none of the patients and subjects. Clinical presentation was also similar in both groups, such as H.Pylori antibodies. All three patients underwent gastroscopy which showed no signs of AG. Conclusions: This preliminary results showed that the prevalence of PCA positivity in patient with IBD was not significantly different when compared to subjects without IBD. Considering the low prevalence of PCA and AG in general population, collection of further data is needed to establish if patients with IBD may have increased prevalence of PCA plasma levels and whether there are higher risk of AG. Patients with PCA positivity and negative histology need to be further investigated over the years.
P.16.20 UTILITY OF ENDOSCOPIC ULTRASOUND TO GUIDE MEDICAL THERAPY FOR PATIENTS WITH CROHN’S PERIANAL DISEASE P. Meddi ∗ , T. Federici, A. Tesi, A. Kohn Uoc di Gastroenterologia Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy Background and aim: To determine if rectal endoscopic ultrasound can be a valid guide in therapeutic management for patients with perianal fistulizing Crohn’s disease. Material and methods: This is a retrospective analysis of 13 patients (7 females and 6 males, main age 32 years) who presented symptomatic persistent Crohn’s perianal disease observed. All patients underwent surgeon examination and magnetic resonance imaging (MRI) to assess the type of fistula, the presence of abscess, according to Parks’ criteria and were placed on medical treatment with 5-asa, antibiotics, azathioprine and infliximab. 7 of them had intersphinteric fistula, 4 with abscess, 3 complex fistula and 3 females had recto-vaginal fistula. Seton placement and incision and drainage were performed in 3 patient with abscess.When the follow up started the patients underwent physical visit and Endoscopic Ultrasound (EUS) to evaluate the efficacy of therapy or to modify it. 7 patients had changed the therapy maximized with Infliximab, 2 of them required seton placement, 2 introduced Ciprofluoxacin and 4 extended the starting therapy. At the end of follow up period, (16-36 weeks) all the patient underwent a physical examination and had an other MRI performed. Results: In 7 (61,6%) patients fistula were not active, all without abscess. 6 (38,4%)patient, 3 of them with starting complex perianal disease, had persistent fistula, but 1 poorly active and in 2 the abscess was disappeared.1 patient required surgical intervention. Conclusions: Crohn’s perianal fistulas are difficult to treat and often lead to a significant morbidity.The treatment has improved with the introduction of anti-TNF antibodies, but only a minority of patients maintain complete fistula closure. The cause can be not accurately assessment of perianal disease before or during the therapy. The use of EUS can be effective to guide therapy for Crohn’s perianal fistulas and can be associated with improved fistula response rates.
P.16.21 PREVALENCE OF COLONIC DIVERTICULOSIS IN PATIENTS AFFECTED BY ULCERATIVE COLITIS VERSUS ADULT PATIENTS IN A SINGLE CENTRE E.V. Avallone, C. Cassieri, R. Pica ∗ , P. Paoluzi Dipartimento di Medicina Interna e Specialità Mediche, Università “Sapienza”, Roma, Italy Background and aim: Diverticulosis of the colon is an acquired condition
that results from herniation of the mucosa through defects in the muscular layer. Several studies have revealed that diverticular formation of the colon occurs primarily in industrialized and Westernized countries. The true prevalence of colonic diverticulosis is difficult to measure because most individuals are asymptomatic. In particularly, in literature, there are few study about the prevalence of colonic diverticulosis in patients affected by ulcerative colitis (UC). Aim of this study has been to investigate the prevalence of colonic diverticulosis in UC and in adult patients referred in a single centre. Material and methods: Six hundred and five consecutive patients, referred to our Institution to undergo a colonoscopy between January 1, 2009 and December 31, 2009, were retrospectively studied. Of these patients, 438 (72.4%) underwent colonoscopy for colorectal cancer screening (Group A) and 167 (27.6%) for UC control (Group B). In group A 224 patients (51.1%) were male (average age of 62.7±14.2 SD years, range 35-86 years), in group B 102 (61.1%) were male (average age of 57.6±12.1 SD years, range 25-84 years). Results: Prevalence of colonic diverticulosis was higher in group A (122 patients, 27.8%) than group B (18 patients, 10.8%) a difference statistically significant (p <0.0001, Fisher’s exact test). In particularly female gender in patients with colonic diverticulosis was higher in group A than group B (68 patients, 31.8% and 4 patients, 6.1%, respectively) with a difference statistically significant (p <0.0001, Fisher’s exact test). No differences were found between the two groups in terms of extension of colonic diverticulosis. Conclusions: Results of our study demonstrated that prevalence of colonic diverticulosis was significantly lower in patients with UC than in adult population, emphasizing the relevance of the coexistence of UC and colonic diverticulosis because could make very difficult the clinical management of these patients.
P.16.22 INFLIXIMAB AS RESCUE THERAPY FOR PATIENTS WITH SEVERE ULCERATIVE COLITIS REFRACTORY TO SYSTEMIC CORTICOSTEROIDS: A SINGLE CENTRE OPEN-LABEL STUDY M. Fortuna ∗ ,1 , R. Montanari 1 , A. Geccherle 1 , A. Sartori 2 , G. Ruffo 2 , M. Chiaramonte 1 1 Multispecialistic Centre For Recto-Perineal Diseases (Ibd Unit), Department of Gastroenterology, Ospedale Sacro Cuore Don Calabria., Negrar (Verona), Italy; 2 Department of General Surgery, Ospedale Sacro Cuore Don Calabria. Negrar, Negrar (Verona), Italy
Background and aim: Infliximab (IFX) is effective for induction and maintenance of clinical remission in patients (pts) with moderate to severe ulcerative colitis (UC). Data concerning its proven efficacy as a rescue therapy (tp) in the severe forms of the disease refractory to intravenous (i.v.) steroids are lacking. We present the results of a single centre open-label study, that has evaluated short-and long-term clinical responses and colectomy rates in severe i.v. steroid-refractory UC treated with IFX. Material and methods: From Jan 2009 to Dec 2010 all hospitalized pts at the Gastroenterology Department of Negrar Hospital (VR) with severe UC, according to Truelove and Witts criteria, were recruited. All patients received metilprednisolone 1 mg/kg i.v. for 7 days. IFX (5 mg/kg at 0, 2 and 6 weeks) was used as rescue tp in steroid-refractory pts. The success of IFX was based on a decrease in disease activity. Pts with lack of response to IFX or steroid-refractory forms of disease considered too severe to initiate an IFX course underwent colectomy. Pts who responded to induction were evaluated after one year of maintenance tp with IFX. Results: 14 pts met our criteria of recruitment (10 males, age 24-70 years). 8 had pancolitis and 6 left-sided colitis. After 7 days on i.v. corticosteroids, 5/14 (35.7%) pts had a clinical response, while 9/14 (64.2%) were steroid-refractory. Of these, one underwent urgent colectomy and 8 were treated with IFX. 1/8 (12.5%) pts failed to respond to induction tp and underwent elective colectomy. 7/8 (87.5%) pts had clinical response after the induction period of IFX. After one year of maintenance tp with IFX, 5/7 pts had sustained clinical response, whereas 1/7 had to stop the tp after 9 months for Aspergillus systemic infection. 1/7 failed to respond and underwent elective colectomy after 12 months of IFX tp. The colectomy rate after one year of IFX was 14.3%.