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P229 Is quality-of-life worse in perianal Crohn's disease patients?
Clinical: Diagnosis and outcome P228 IgG4-positive plasma cells in the colon of patients with ulcerative colitis are markers of endoscopic and histological disease activity K. Orlicka1 *, E.L. Culver2 , A.C. Bateman3 , R. Sadler4 , R.W. Chapman2 , S. Keshav2 , E. Barnes2 , S.P. Travis2 . 1 John Radcliffe Hospital, Translational Gastroenterology Unit, Oxford, United Kingdom, 2 John Radcliffe Hospital, Translational Gastroenterology Unit and Nuffield Department of Medicine, Oxford, United Kingdom, 3 Southampton General Hospital, Histopathology Department, Southampton, United Kingdom, 4 Churchill Hospital, Clinical Immunology Department, Oxford, United Kingdom Background: A lymphoplasmacytic infiltrate with abundant IgG4-positive plasma cells are key features of IgG4-related disease (IgG4-RD); a condition characterised by elevated serum IgG4, multiple organ involvement and rapid steroid response. The relevance of elevated serum IgG4 or prominent colonic IgG4-positive plasma cells in patients with ulcerative colitis (UC) is unknown. Aims: (1) To measure serum IgG4 and tissue IgG4 in patients with UC; (2) To investigate the relationship of IgG4 with disease activity; (3) To determine if patients with UC and elevated IgG4 had IgG4-RD. Methods: Patients with histologically confirmed UC were identified from a prospective inflammatory bowel disease serum and tissue biobank. Serum total IgG and IgG4 were measured by nephelometry in patients and 50 sex-matched healthy controls. Colonic biopsies were reviewed for disease activity and IgG4 immunostaining (mean of 3 high power fields) by a specialist histopathologist. Endoscopy reports were scored for disease activity (vascular pattern, bleeding & ulcers) by two gastroenterologists. Demographics and clinical details were collected retrospectively. Results: 54 UC patients, median age 46yrs (range 19 69yrs) and 56% female with a median UC duration of 12yrs (0 40yrs) were included. Most had left-sided disease or proctitis (67%), CRP < 0.5 mg/dL (69%) and disease remission or mild activity (93% endoscopic, 80% histological), with all on 5-ASA, 31% immunomodulators, 19% prednisolone and 4% anti-TNF. Colectomy in 6/54 (3 refractory disease, 2 dysplasia and 1 colorectal cancer). PSC in 3/54 (5.6%). Serum IgG4 was elevated (>1.4g/L) in 3/54 (6%) patients with UC and 1/50 (2%) controls; associated with male gender (13% v 0%, p = 0.046) and PSC (33% v 4%, p = 0.031). Tissue IgG4 was elevated (>10 cells/HPF) in 22% (12/54) with UC, median 4 (0 65 cells/HPF); associated with endoscopic severity (p = 0.012) and histological activity (p = 0.001). Tissue IgG4 >20/HPF in 9.3% and >50/HPF in 1.9% of patients was associated with histological severity (p < 0.0001). Patients with elevated tissue IgG4 (>10/HPF) were more likely to require prednisolone (50% v 16%, p = 0.022) or immunomodulators (38% v 11%, p = 0.03). No patients fulfilled diagnostic criteria for IgG4-RD. Conclusions: Elevated serum IgG4 and tissue IgG4 occurs in a minority of patients with UC in the absence of IgG4-RD. IgG4positive plasma cells in the colon are associated with disease activity and severity. Prospective follow-up will determine if any develop IgG4-RD. P229 Is quality-of-life worse in perianal Crohn’s disease patients? M. Barreiro-de Acosta1 *, M. Iglesias-Rey1 , A. Lorenzo1 , J.E. Dominguez-Munoz1 . 1 University Hospital, Gastroenterology, Santiago, Spain Background: A high proportion of Crohn’s disease (CD) patients develop perianal behavior during the evolution of the disease, these kinds of patients being those who need more aggressive therapies. The aim of this study was to assess if perianal
S101 disease was associated with a worse health-related quality of life (HRQOL) in CD patients regardless of the activity of the disease. Methods: A cross-sectional, prospective study with consecutive patient recruitment was designed. All adult patients with CD who attended our IBD Unit were included. Perianal disease was defined as presence of fistulas, abscesses and stenosis, alone or in combination in accordance with the p subgroup the in Montreal Classification. To assess quality of life we used the IBDQ, which included five dimensions (Table 1). Total scores range from 36 to 252. We also used the SF-36 questionnaire, which included 8 scales (Table 2). Total scores range from 0 to 100. In both cases, higher scores indicate better HRQOL. Results are shown as mean and standard deviation; the t-student test was used for comparing means. Results: 323 patients were consecutively included (mean age of 39 years, age range 18 81 and a mean of 10.5 years since diagnosis); 186 (57.6%) were female and 206 patients (63.8%) were in remission. 44 patients (14%) presented perianal behaviour. In all the dimensions from both questionnaires there were no significant differences in quality of life among CD patients with or without perianal disease. In Tables 1 and 2 the means and p values of IBDQ and SF-36 dimensions are shown respectively. Table 1. IBDQ Questionnaire in patients with and without perianal disease Perianal
Bowel Symptoms
Systemic Symptoms
Functional Impairment
Social Impairment
Emotional Function
Yes No p
5.60 5.31 0.19
5.22 4.99 0.37
5.43 5.20 0.44
5.72 5.76 0.85
5.42 5.22 0.59
Table 2. SF-36 Questionnaire in patients with and without perianal disease Perianal
General Health
Physical Functioning
RolePhysical
Vitality
RoleEmotional
Social Functioning
Bodily Pain
Mental Health
Yes No p
83.23 81.36 0.67
69.5 61.23 0.35
49.45 47.60 0.66
54.03 52.94 0.84
75.0 74.29 0.90
68.14 72.04 0.64
66.06 65.11 0.83
66.83 61.58 0.35
Conclusions: Patients with perianal CD, irrespective of the activity of the disease, do not have worse quality of life than those without perianal disease. P230 Influence of stress in the clinical course of inflammatory bowel disease patients M. Iglesias-Rey1 *, M. Barreiro-de Acosta1 , R. Ferreiro1 , F. Caama˜ no2 , I. Vazquez3 , A. Lorenzo1 , J.E. DominguezMunoz1 . 1 University Hospital, Gastroenterology, Santiago, Spain, 2 University Hospital, Epidemiology, Santiago, Spain, 3 Univesity of Santiago, Psychology, Santiago, Spain Background: Psychological stress has been defined as a process in which environmental equal or exceeds the adaptative capacity of an organism. There is a long but inconsistent history of studies about the relationship between stress and Inflammatory Bowel Disease (IBD). The aim of this study was to assess the influence of stress on the clinical course of IBD patients. Methods: A prospective study was designed. Crohn’s Disease (CD) and Ulcerative Colitis (UC) patients older than 18 years of age were included. Stress was assessed with the Spanish version of Perceived Stress scale (PSS). This scale is a self-report instrument that assesses the level of perceived stress during the last month, consisting of 14 items with a response format of a five-point scale (0 = never, 1 = hardly
S101 disease was associated with a worse health-related quality of life (HRQOL) in CD patients regardless of the activity of the disease. Methods: A cross-sectional, prospective study with consecutive patient recruitment was designed. All adult patients with CD who attended our IBD Unit were included. Perianal disease was defined as presence of fistulas, abscesses and stenosis, alone or in combination in accordance with the p subgroup the in Montreal Classification. To assess quality of life we used the IBDQ, which included five dimensions (Table 1). Total scores range from 36 to 252. We also used the SF-36 questionnaire, which included 8 scales (Table 2). Total scores range from 0 to 100. In both cases, higher scores indicate better HRQOL. Results are shown as mean and standard deviation; the t-student test was used for comparing means. Results: 323 patients were consecutively included (mean age of 39 years, age range 18 81 and a mean of 10.5 years since diagnosis); 186 (57.6%) were female and 206 patients (63.8%) were in remission. 44 patients (14%) presented perianal behaviour. In all the dimensions from both questionnaires there were no significant differences in quality of life among CD patients with or without perianal disease. In Tables 1 and 2 the means and p values of IBDQ and SF-36 dimensions are shown respectively. Table 1. IBDQ Questionnaire in patients with and without perianal disease Perianal
Bowel Symptoms
Systemic Symptoms
Functional Impairment
Social Impairment
Emotional Function
Yes No p
5.60 5.31 0.19
5.22 4.99 0.37
5.43 5.20 0.44
5.72 5.76 0.85
5.42 5.22 0.59
Table 2. SF-36 Questionnaire in patients with and without perianal disease Perianal
General Health
Physical Functioning
RolePhysical
Vitality
RoleEmotional
Social Functioning
Bodily Pain
Mental Health
Yes No p
83.23 81.36 0.67
69.5 61.23 0.35
49.45 47.60 0.66
54.03 52.94 0.84
75.0 74.29 0.90
68.14 72.04 0.64
66.06 65.11 0.83
66.83 61.58 0.35
Conclusions: Patients with perianal CD, irrespective of the activity of the disease, do not have worse quality of life than those without perianal disease. P230 Influence of stress in the clinical course of inflammatory bowel disease patients M. Iglesias-Rey1 *, M. Barreiro-de Acosta1 , R. Ferreiro1 , F. Caama˜ no2 , I. Vazquez3 , A. Lorenzo1 , J.E. DominguezMunoz1 . 1 University Hospital, Gastroenterology, Santiago, Spain, 2 University Hospital, Epidemiology, Santiago, Spain, 3 Univesity of Santiago, Psychology, Santiago, Spain Background: Psychological stress has been defined as a process in which environmental equal or exceeds the adaptative capacity of an organism. There is a long but inconsistent history of studies about the relationship between stress and Inflammatory Bowel Disease (IBD). The aim of this study was to assess the influence of stress on the clinical course of IBD patients. Methods: A prospective study was designed. Crohn’s Disease (CD) and Ulcerative Colitis (UC) patients older than 18 years of age were included. Stress was assessed with the Spanish version of Perceived Stress scale (PSS). This scale is a self-report instrument that assesses the level of perceived stress during the last month, consisting of 14 items with a response format of a five-point scale (0 = never, 1 = hardly