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P261 Determination of faecal haemoglobin is equally effective as faecal calprotectin in identifying inflammatory bowel disease patients with active endoscopic inflammation
S114 of iron deficiency, which was not affected by acute phase reaction. Conclusions: This indicates that ZPP is a sensitive marker of body iron status with an additional value over conventional tests for the detection of iron deficiency in IBD patients due to its reliability even under inflammatory conditions. P261 Determination of faecal haemoglobin is equally effective as faecal calprotectin in identifying inflammatory bowel disease patients with active endoscopic inflammation E. Mooiweer1 *, H.H. Fidder1 , K.J. van Erpecum1 , P.D. Siersema1 , R.J. Laheij1 , B. Oldenburg1 . 1 University Medical Centre Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands Background: Faecal calprotectin is a non-invasive tool to asses colonic inflammation in patients with inflammatory bowel disease (IBD). However, the diagnostic accuracy of calprotectin is modest and analysis is relatively costly and therefore additional markers are needed. We compared the efficacy of faecal haemoglobin and calprotectin in the prediction of active endoscopic inflammation in IBD patients. Methods: Consecutive patients with either Crohn’s colitis (CD) or ulcerative colitis (UC) scheduled for surveillance colonoscopy collected a stool sample prior to the start of bowel preparation. Three experienced endoscopists assessed the presence of active inflammation in each colonic segment. Stool samples were analyzed for calprotectin and haemoglobin, both with a Ridascreen® enzyme-linked immunosorbent assay (R-Biopharm, Germany) and were analyzed without reference to colonoscopy findings and vice versa. ROC statistics were used to determine cutoff values for calprotectin and haemoglobin. Results: A total of 119 patients were included, of which 54 patients had CD, 59 had UC and 6 indeterminate colitis. Median (interquartile range [IQR]) calprotectin and haemoglobin concentrations were 118 mg/g (IQR 31 367) and 0.48 mg/g (IQR 0.27 5.73) respectively. Active inflammation was encountered in 43 patients (36%) (5 severe, 9 moderate and 29 mild). Calprotectin and haemoglobin levels were significantly higher in patients with active inflammation compared to patients with no inflammation [451 mg/g vs 52 mg/g, p < 0.01 and 10.34 mg/g vs 0.34 mg/g, p < 0.01 respectively (Mann Whitney U test)]. A cutoff value of 172 mg/g for calprotectin predicted endoscopic inflammation with 79% sensitivity, 80% specificity, 69% positive predictive value and 87% negative predictive value. The predictive accuracy of calprotectin (area under the curve [AUC]) was 0.88 which was similar for patients with CD and UC (AUC 0.86 and 0.86 respectively). For haemoglobin, a cutoff value of 1.45 mg/g indicated endoscopic inflammation with 77% sensitivity, 88% specificity, 79% positive predictive value and 87% negative predictive value. The predictive accuracy of haemoglobin was 0.88 (AUC) which was similar for patients with CD and UC (AUC 0.87 and 0.81 respectively). A combination of both tests did not increase the predictive accuracy compared to each test alone (AUC 0.88). Conclusions: Faecal haemoglobin can identify IBD patients with active inflammation with a predictive accuracy similar to faecal calprotectin.
Poster presentations P262 Demographic characteristic of children with early clinical manifestation of the inflammatory bowel disease S. Szymanska1 *, M. Szczepanski1 , P. Landowski2 , G. CzajaBulsa3 , E. Jarocka-Cyrta4 , B. Korczowski5 , E. Krzesiek6 , E. Szymanska1 , J. Kierkus1 . 1 The Children Memorial Health Institute, Hepatology and Feeding Disorders, Warsaw, Poland, 2 Medical University of Gdansk, Poland, 3 Pomeranian Medical University, Poland, 4 Medical University of Bialystok, Poland, 5 Medical College. University of Rzeszow, Poland, 6 Medical University of Wroclaw, Poland Background: Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and Ulcerative colitis (UC) is a chronic condition of the colon and small intestine. The disease is common in young people (children and young adults) yet it is rather rare in children younger than 2 years of age. Therefore, IBD developing during the first years of life (under the age of 5) is called an early-onset IBD (EO-IBD) and it is considered to be a specific entity with a distinct phenotype. However, the available data on that issue are still insufficient. The objective of the study was to determine the characteristics and clinical course of children with early-onset IBD. Methods: We performed a retrospective database analysis of 47 infants younger than 5 years old diagnosed with IBD. The data on patient’s demographics, including age, sex, and age at disease onset have been collected through six pediatric hospitals in Poland. Disease location was established on the basis of a review of all endoscopic, colonoscopic, histopathological, and radiological records. All possible complications were reported as well as treatment and its efficacy. Since the diagnosis was established all patients have been on follow up. Results: Among 47 children registered in the database, 23 (49%) had a diagnosis of CD, 16 (34%) had UC, and 8 (17%) had IC. The mean age at diagnosis was 28.5±27.5 months; 57.4% were male. 17 (36.2%) of patients had proctitis (L2); ileocolonic disease (L3), and 20 (42.5%) left8 (17%) sided colitis whether CD, UC, or IC. 1 UC patient (2.15%) had affected only the upper gastrointestinal (GI) tract (L4), and 1 UC patient (2.15%) presented with extraintestinal symptoms (the diagnosis was established through histopatological examination of the biopsy taken during endoscopy done as a part of diagnostic process). The most common complication of IBD was anemia found in 30 (63.8%) children. The observed course of the disease was either severe or moderate. In 4 children younger than 2 years surgery was performed. Conclusions: IBD in children younger than 5 years old includes UC, CD, and a relatively high proportion of IC. In early onset IBD severe and moderate course of a disease is usually observed. Disease manifestation in these patients is predominantly colonic (both proctitis and left-sided colitis). P263 Definition of phenotypic characteristics of late onset IBD A. McNichol1 , S. Din1 *, M. Porteous1 , C. Lees1 , J. Satsangi2 , I. Arnott1 . 1 NHS Lothian, GI Unit, Edinburgh, United Kingdom, 2 University of Edinburgh, GI Unit, Edinburgh, United Kingdom Background: Categorisation of disease guides individualised therapeutic strategies and predicts response and prognosis. The Montreal classification of the inflammatory bowel diseases divides Crohns disease and ulcerative colitis into multiple subphenotypes. Rigorous analysis of phenotypic characteristics demonstrated that paediatric IBD varied significantly with that of the adult population; resulting in a defined age category for paediatric IBD. Similarly, late onset IBD may indicate a lower genetic preponderance and less aggressive disease behaviour.
Poster presentations P262 Demographic characteristic of children with early clinical manifestation of the inflammatory bowel disease S. Szymanska1 *, M. Szczepanski1 , P. Landowski2 , G. CzajaBulsa3 , E. Jarocka-Cyrta4 , B. Korczowski5 , E. Krzesiek6 , E. Szymanska1 , J. Kierkus1 . 1 The Children Memorial Health Institute, Hepatology and Feeding Disorders, Warsaw, Poland, 2 Medical University of Gdansk, Poland, 3 Pomeranian Medical University, Poland, 4 Medical University of Bialystok, Poland, 5 Medical College. University of Rzeszow, Poland, 6 Medical University of Wroclaw, Poland Background: Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and Ulcerative colitis (UC) is a chronic condition of the colon and small intestine. The disease is common in young people (children and young adults) yet it is rather rare in children younger than 2 years of age. Therefore, IBD developing during the first years of life (under the age of 5) is called an early-onset IBD (EO-IBD) and it is considered to be a specific entity with a distinct phenotype. However, the available data on that issue are still insufficient. The objective of the study was to determine the characteristics and clinical course of children with early-onset IBD. Methods: We performed a retrospective database analysis of 47 infants younger than 5 years old diagnosed with IBD. The data on patient’s demographics, including age, sex, and age at disease onset have been collected through six pediatric hospitals in Poland. Disease location was established on the basis of a review of all endoscopic, colonoscopic, histopathological, and radiological records. All possible complications were reported as well as treatment and its efficacy. Since the diagnosis was established all patients have been on follow up. Results: Among 47 children registered in the database, 23 (49%) had a diagnosis of CD, 16 (34%) had UC, and 8 (17%) had IC. The mean age at diagnosis was 28.5±27.5 months; 57.4% were male. 17 (36.2%) of patients had proctitis (L2); ileocolonic disease (L3), and 20 (42.5%) left8 (17%) sided colitis whether CD, UC, or IC. 1 UC patient (2.15%) had affected only the upper gastrointestinal (GI) tract (L4), and 1 UC patient (2.15%) presented with extraintestinal symptoms (the diagnosis was established through histopatological examination of the biopsy taken during endoscopy done as a part of diagnostic process). The most common complication of IBD was anemia found in 30 (63.8%) children. The observed course of the disease was either severe or moderate. In 4 children younger than 2 years surgery was performed. Conclusions: IBD in children younger than 5 years old includes UC, CD, and a relatively high proportion of IC. In early onset IBD severe and moderate course of a disease is usually observed. Disease manifestation in these patients is predominantly colonic (both proctitis and left-sided colitis). P263 Definition of phenotypic characteristics of late onset IBD A. McNichol1 , S. Din1 *, M. Porteous1 , C. Lees1 , J. Satsangi2 , I. Arnott1 . 1 NHS Lothian, GI Unit, Edinburgh, United Kingdom, 2 University of Edinburgh, GI Unit, Edinburgh, United Kingdom Background: Categorisation of disease guides individualised therapeutic strategies and predicts response and prognosis. The Montreal classification of the inflammatory bowel diseases divides Crohns disease and ulcerative colitis into multiple subphenotypes. Rigorous analysis of phenotypic characteristics demonstrated that paediatric IBD varied significantly with that of the adult population; resulting in a defined age category for paediatric IBD. Similarly, late onset IBD may indicate a lower genetic preponderance and less aggressive disease behaviour.