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P272 Colonic ultrasonography in pediatric ulcerative colitis: comparative study with colonoscopy
S118 capsule. CE could be considered a complementary method of investigating the large bowel. P272 Colonic ultrasonography in pediatric ulcerative colitis: comparative study with colonoscopy F. Civitelli1 *, G. Di Nardo1 , S. Oliva1 , F. Ferrari1 , F. Nuti1 , M. Aloi1 , F. Viola1 , S. Cucchiara1 . 1 Sapienza University, Pediatrics, Gastroenterology and Liver Unit, Rome, Italy Background: Bowel ultrasonography (US) is a non-invasive tool in the evaluation of inflammatory bowel diseases, especially Crohn’s disease. There are only few data on its role in Ulcerative Colitis (UC), particularly in children. We aimed to evaluate the usefulness of bowel US to assess pediatric UC pts and compare US findings with clinical and endoscopic data. Methods: 30 pediatric pts (median age 15 years; range 2 21; 14 males) were prospectively enrolled. Eight pts had a clinical suspicion of UC, 22 had an already established diagnosis and showed a flare-up of disease. All pts underwent clinical evaluation, bowel US with Color-Doppler examination (Toshiba equipment, 3.5 MHz convex and 7.5 MHz linear transducers) and ileo-colonoscopy. US and endoscopy were carried out by different operators, blind to the results of the other technique. For each patient Pediatric Ulcerative Colitis Activity Index (PUCAI) and Mayo endoscopic subscore were calculated. The US parameters assessed were Bowel Wall Thickness (BWT > 3 mm), BW stratification, vascularity and presence of austrae: each parameter was assigned a value of 0 or 1 depending on the presence or absence of alteration. Results: 27/30 pts were finally diagnosed as UC. Extension of disease according to Paris Classification was: E2 (left-side colitis) in 12/27 (45%), E4 (pancolitis) in 15/27 (55%) pts. This extension was independently confirmed in 25/27 pts by US, that yielded a 85% concordance with endoscopy. Disease activity was mild (PUCAI 10 34) in 7 pts (25%), moderate (PUCAI 35 64) in 12 (45%) and severe (PUCAI >65) in 8 (30%). The mean values of PUCAI, Mayo score and US score respectively were: 40.5±24.4, 2±1 and 2.8±1.4. The mean BWT in affected colonic segments was 5±2 mm. The US score strongly correlated with PUCAI (r = 0.85, p < 0.0001) and Mayo index (r = 0.90, p < 0.0001). A positive correlation was also found between PUCAI and Mayo score (r = 0.87, p < 0.05). Multiple regression analysis showed that variables making a significant contribution to the final value of Mayo score were BWT (p < 0.007) and vascularity (p < 0.038). Conclusions: Our preliminary data show a strong relationship between US and clinical and endoscopic findings, thus suggesting that colonic US might represent a useful first line tool in the evaluation of pediatric UC pts. It allows to assess in a relatively rapid manner the extension and activity of disease and to estimate the severity of a flare-up, prior to further invasive tests. P273 Colonic confocal laser endomicroscopy findings in patients with primary sclerosing cholangitis M. Iacucci1 *, X. Gui2 *, S. Ghosh1 , R. Panaccione1 , G. Kaplan1 , J. Love1 , M. Swain1 , B. Eksteen1 . 1 University of Calgary, Gastroenterology, Calgary, Canada, 2 University of Calgary, Pathology, Calgary, Canada Background: 85% of patients with primary sclerosing cholangitis (PSC) suffer from coexisting IBD. Controversy exists as to whether IBD seen in PSC patients represents a different entity to those with isolated IBD and whether the remaining fifteen percent of PSC patients without IBD detectable with standard diagnostic tests truly have normal colonic mucosa. Confocal laser endomicroscopy (CLE) enables real time endoscopic assessment of crypt histology and mucosal vasculature. We
Poster presentations report the colonic features seen at CLE of 15 patients with PSC with or without known IBD. Methods: 15 patients (10 male, median age 43y, range 20 71y) with PSC underwent colonoscopy with CLE (Pentax). Mayo endoscopy subscore were used to grade known UC patients and the SES-CD score were used to describe the white light findings in known CD patients. CLE findings were classified using a 4 grade classification of inflammation describing crypt architecture, vascular alteration and leakage of fluorescein. CLE images were collected for each segment of the colon and targeted biopsies were taken for matched histologic analysis. Results: Of the 15 PSC patients 13 had coexistent clinically quiescent IBD (6 UC, 7 CD). Absence of rectal inflammation based on CLE findings was seen in all 13 known IBD patients. Nine of the 13 IBD patients had moderate to severe inflammation in the right colon with irregular, decreased or necrotic crypts as detected by CLE. Two patterns of fluorescein leakage were observed. In 5 patients we observed leakage of fluorescein into spaces among epithelial cells or non-uniform abundant leakage of fluorescein in the lumen of the crypts associated with moderate to severe histological inflammation; In 5 patients we observed uniform leakage of the fluorescein in the lumen of crypts in the left side of the colon with normal crypts architecture and micro-vasculature in the absence of histological inflammation. Two patients, not known to suffer from IBD and had normal light microscopy findings were shown to have active inflammation by CLE with fluorescein leakage. Conclusions: CLE is a powerful tool to capture sub-clinical inflammation in patients with PSC with or without co-existing IBD which is not detectable by standard light microscopy. CLE in PSC-IBD reaffirms the concept of rectal sparing in PSC with IBD. CLE performed with fluorescein is able to detect subtle alterations in colonic permeability in quiescent IBD and in PSC without IBD suggesting colonic barrier defects in these patients. P274 Clinical utility of measuring serum TNF alpha level, anti TNF alpha levels and antibody titers in critical situations in inflammatory bowel disease and in psoriasis ´. Kunst´ Z. Szepes1 *, E ar1 , K. Farkas1 , F. Nagy1 , R. Gyulai2 , ´ . Kíny´ R. Kui2 , A o2 , A. B´ alint1 , M. Sz¨ ucs3 , T. Wittmann1 , T. Moln´ ar1 . 1 University of Szeged, First Department of Medicine, Szeged, Hungary, 2 University of Szeged, Department of Dermatology and Allergology, Szeged, Hungary, 3 University of Szeged, Department of Medical Physics and Informatics, Szeged, Hungary Background: Pharmacokinetic monitoring of infliximab and adalimumab to control disease activity and optimise the treatment of inflammatory bowel disease (IBD) and psoriasis is not standardized in the daily routine. The aim of this study was to assess TNF alpha and anti TNF alpha serum concentrations and antibodies against anti TNF alpha molecules in patients with IBD who developed loss of response, side effects or allergic reaction during anti TNF alpha therapy and in patients suffering from active psoriasis. Methods: Blood samples of 48 IBD patients (21 patients with Crohn’s disease [CD] and 10 patients with ulcerative colitis [UC]) who lost response, developed side effects or allergic reaction to anti TNF alpha therapy and 51 patients suffering from moderately/severely active psoriasis were collected to measure trough serum TNF alpha level, infliximab (IFX)/adalimumab (ADA) and anti-infliximab (ATI)/ anti-adalimumab concentration (Matriks Biotek Laboratories). Seventeen patients (9 CD, 8 UC-receiving IFX) in complete clinical remission were selected for control group. We examined the correlation between loss of response, the development of side effects or hypersensitivity and serum
Poster presentations report the colonic features seen at CLE of 15 patients with PSC with or without known IBD. Methods: 15 patients (10 male, median age 43y, range 20 71y) with PSC underwent colonoscopy with CLE (Pentax). Mayo endoscopy subscore were used to grade known UC patients and the SES-CD score were used to describe the white light findings in known CD patients. CLE findings were classified using a 4 grade classification of inflammation describing crypt architecture, vascular alteration and leakage of fluorescein. CLE images were collected for each segment of the colon and targeted biopsies were taken for matched histologic analysis. Results: Of the 15 PSC patients 13 had coexistent clinically quiescent IBD (6 UC, 7 CD). Absence of rectal inflammation based on CLE findings was seen in all 13 known IBD patients. Nine of the 13 IBD patients had moderate to severe inflammation in the right colon with irregular, decreased or necrotic crypts as detected by CLE. Two patterns of fluorescein leakage were observed. In 5 patients we observed leakage of fluorescein into spaces among epithelial cells or non-uniform abundant leakage of fluorescein in the lumen of the crypts associated with moderate to severe histological inflammation; In 5 patients we observed uniform leakage of the fluorescein in the lumen of crypts in the left side of the colon with normal crypts architecture and micro-vasculature in the absence of histological inflammation. Two patients, not known to suffer from IBD and had normal light microscopy findings were shown to have active inflammation by CLE with fluorescein leakage. Conclusions: CLE is a powerful tool to capture sub-clinical inflammation in patients with PSC with or without co-existing IBD which is not detectable by standard light microscopy. CLE in PSC-IBD reaffirms the concept of rectal sparing in PSC with IBD. CLE performed with fluorescein is able to detect subtle alterations in colonic permeability in quiescent IBD and in PSC without IBD suggesting colonic barrier defects in these patients. P274 Clinical utility of measuring serum TNF alpha level, anti TNF alpha levels and antibody titers in critical situations in inflammatory bowel disease and in psoriasis ´. Kunst´ Z. Szepes1 *, E ar1 , K. Farkas1 , F. Nagy1 , R. Gyulai2 , ´ . Kíny´ R. Kui2 , A o2 , A. B´ alint1 , M. Sz¨ ucs3 , T. Wittmann1 , T. Moln´ ar1 . 1 University of Szeged, First Department of Medicine, Szeged, Hungary, 2 University of Szeged, Department of Dermatology and Allergology, Szeged, Hungary, 3 University of Szeged, Department of Medical Physics and Informatics, Szeged, Hungary Background: Pharmacokinetic monitoring of infliximab and adalimumab to control disease activity and optimise the treatment of inflammatory bowel disease (IBD) and psoriasis is not standardized in the daily routine. The aim of this study was to assess TNF alpha and anti TNF alpha serum concentrations and antibodies against anti TNF alpha molecules in patients with IBD who developed loss of response, side effects or allergic reaction during anti TNF alpha therapy and in patients suffering from active psoriasis. Methods: Blood samples of 48 IBD patients (21 patients with Crohn’s disease [CD] and 10 patients with ulcerative colitis [UC]) who lost response, developed side effects or allergic reaction to anti TNF alpha therapy and 51 patients suffering from moderately/severely active psoriasis were collected to measure trough serum TNF alpha level, infliximab (IFX)/adalimumab (ADA) and anti-infliximab (ATI)/ anti-adalimumab concentration (Matriks Biotek Laboratories). Seventeen patients (9 CD, 8 UC-receiving IFX) in complete clinical remission were selected for control group. We examined the correlation between loss of response, the development of side effects or hypersensitivity and serum