P259 Disabling Crohn's disease: frequency and predictive factors in hospitalized patients

Clinical: Diagnosis and outcome (20%) and L1 (3.3%). Enteroscopic intervention and operation were conducted in 13.3% (clipping 1, balloon dilatation 2 and capsule endoscopy remove 1) and 3.3% (1/30), respectively. Of 27 patients except three who underwent DBE for therapeutic purpose, DBE identified all of 10 cases that had negative results from other modalities. Therapeutic plans were determined in 63.3% (19/30) on the basis of results from DBE. Conclusions: DBE is a useful diagnostic tool for the diagnosis of CD patients with SB involvement. The clinical significance of DBE is emphasized by the fact that adjustment of therapy in up to 60% of these patients. P258 Do we really have to measure vitamin D in inflammatory bowel disease patients? O. Sent¨ urk1 *, G. Sirin1 , A. Celebi1 , H. Ylmaz1 , G. Dindar1 , S. Hulagu1 . 1 Kocaeli University, Gastroenterology, Kocaeli, Turkey Background: There is increasing interest in the role of vitamin D in inflammatory bowel disease, outside of its traditional role in metabolic bone disease. Recent data suggest an association between vitamin D deficiency and disease activity in IBD. We aimed in this study to determine the prevalence of vitamin D deficiency in IBD patients and the association with disease phenotype and severity. On the other hand we want to investigate whether we are measuring vitamin D levels at any encounter in out IBD patients. Methods: This study was conducted in Kocaeli University Medical Faculty Hospital. Information was gathered using the hospital powerchart system and the IBD database of gastroenterology departments patients. Patients were recruited from outpatient polyclinic consecutively and evaluated retrospectively. Clinical data including demographics, disease phenotype by the Montreal classification, level of deficiency and season tested were recorded from clinical and electronic records. Data regarding IBDrelated surgery and medication prescribed was also collected. Vitamin D (25OHD) levels were classified as insufficient (20 40 ng/mL), deficient (10 20 ng/mL) or severe deficiency (<10 ng/mL). Results: A total of 326 patients were correctly identified as having IBD. Of these, 210 (64.4%) had Ulcerative colitis (UC) and 116 (35.6%) had Crohn’s disease (CD). 130 (36.9%) had a 25OHD level measured subsequent to diagnosis. Of these 69.2% were female and median age at diagnosis was 38 (84 CD and 46 UC). There was no significant difference in the median 25OHD level between CD and UC (34, IQR 21 51 vs 27, IQR 16 48, p = 0.4). 20%, 23.1%, 36.9% and 20% had normal, insufficient, deficient and severe deficiency respectively. In those with severe deficiency 38.5% were tested during winter. 78 of 130 (80%) patients had low 25OHD levels. 38 patients of these were also followed by the Rheumatology team for coexisting arthropathy or arthritis. There were significant differences in disease outcomes in those with severe deficiency compared to normal levels with regard to need for surgery in CD (41.2% vs 17.6%), penetrating disease phenotype in CD (47.1% vs 11.8%), need for oral steroids within 3 months of diagnosis (52.9% vs 23.5%) and diagnosis of pancolitis at presentation in UC patients (23.5% vs 5.9%). Conclusions: This study demonstrates that vitamin D deficiency is common in IBD and may be associated with markers of severe disease. We suggest monitoring of vitamin D levels and correction with eligible supplements in patients with IBD.

S113 P259 Disabling Crohn’s disease: frequency and predictive factors in hospitalized patients M. Serghini1 *, S. Karoui1 , N. Ben Mustapha1 , M. Fekih1 , L. Kallel1 , S. Matri1 , J. Boubaker1 , A. Filali1 . 1 University ElManar, Faculty of Medecine of Tunis, Gastroenterology A, La Rabta Hospital, Tunis, Tunisia Background: In the era of biological treatment of Crohn’s disease, the top-down strategy should be considered only in patients with severe course or those having a disabling Crohn’s disease as defined by Beaugerie et al. in 2006. The aim of our study was to specify in a population of hospitalized patients, the frequency of disabling Crohn’s disease and to identify at diagnosis the predictive factors of this disabling course. Methods: We conducted a retrospective study and we considered for inclusion all the patients with Crohn’s disease diagnosed and hospitalized at our unit between January 2005 and December 2009. For each patient we have specified the clinical, biological, endoscopic and evolutive data. Results: During the period of the study, 201 patients with CD were included (106 males, 95 females) with the median age at diagnosis of 33.6 years [14 65]. The median follow up was of 28.3 months [6 168]. The prevalence of disabling CD during the follow up period was 75% (151 patients). By multivariate analysis, the factors present at diagnosis and significantly associated with a disabling course of the CD after diagnosis were: an age below 16 years (p = 0.03; OR = 2.7 [95% CI 1 7.8]), the initial localization of the disease restricted to the ileum (p = 0.02; OR = 3 [95% CI 1.1 7.9]), a penetrating behavior (p = 0.03; OR = 2.7 [95% CI 1 7.8]), a leucocytes level higher than 8300/mm3 (p = 0.003; OR = 4 [95% CI 1.6 9.8]) and an albumin level below 35.8 g/l (p = 0.05; OR = 2.4 [95% CI 0.9 6.2]). The presence of 4 or 5 of these factors predicted a disabling course of CD with a predictive positive value of 0.93 and 0.95 respectively. Conclusions: A disabling CD was observed in 75% of patients during the follow up period of the study. The identification of the predictive factors of this disabling course must be considered at diagnosis in order to adjust therapeutic strategy. P260 Diagnostic accuracy of zinc protoporphyrin in iron deficiency anaemia in IBD patients M. Wiesenthal1 *, D. Jakobsen1 , F. Hartmann2 , A. Dignass3 , J. Stein1 . 1 Krankenhaus Sachsenhausen, Crohn Colitis Center, Frankfurt, Germany, 2 Marien Krankenhaus, Frankfurt, Germany, 3 Apaglesion Markus Krankenhaus, Frankfurt, Germany Background: In the absence of a feasible, non-invasive gold standard, iron deficiency anaemia (IDA) is best measured by the use of multiple indicators. However, the choice of an appropriate single iron biomarker to replace the multiplecriteria model for screening for IDA at the population level continues to be debated. Zinc protoporphyrin (ZPP) has been shown to be a sensitive and specific screening marker for functional iron deficiency. Methods: This study evaluated for the first time the diagnostic value of ZPP in the diagnosis of IDA and differential diagnosis of IDA and anaemia of chronic disease. The study included 22 non-anaemic individuals as controls, 106 inflammatory bowel disease (IBD) patients (Ulcerative Colitis 52; Crohns Disease 54) with IDA divided into non-inflammatory and inflammatory subgroups. Blood count, transferrin saturation, ferritin, C-reactive protein, and zinc protoporphyrin (ZPP) were determined by routine assays. Results: Receiver operator characteristic curve analysis showed a very high discriminating power for ZPP in the recognition