- Email: [email protected]
P299 Vagus nerve stimulation in Crohn's disease
S188
Poster presentations
patients in remission and 86% in active condition reporting fatigue. However patients report that their complaints of fatigue are often not addressed in clinical consultations. To date there are no studies exploring this topic from the clinician’s perspective. This study aimed to gain an understanding of healthcare practitioners’ (HCPs) perception of IBD fatigue as experienced by people with IBD, and to identify the range of methods that HCPs use to assess and manage fatigue. Methods: Descriptive phenomenology was carried out to achieve the aims of the study. Purposive sampling was used to identify a range of professionals (gastroenterologists, IBD nurses, general practitioners, dietitians, psychologists and pharmacists). In-depth semi-structured interviews were conducted with 20 HCPs who work with people with IBD between June and December 2012. Interviews were audio recorded and transcribed verbatim. Colazzi’s seven step framework was used to analyse data. The study was approved by the local university ethics committee. Results: Three main themes and several sub-themes were identified. The main themes were: the phenomenon of fatigue as perceived by HCPs; the impact of fatigue on patients’ lives as perceived by HCPs; and the methods used by HCPs to deal with fatigue. Fatigue was identified as an important, but difficult and often frustrating, symptom to understand. The study participants perceived fatigue as ‘such a complicated and complex thing’. HCPs reported that fatigue impacts on the emotional, private and public aspects of patients’ functioning, however there were very few methods suggested on how to assess and manage the fatigue in a systematic way. Many expressed a desire for better education and a frustration at not being able to help patients more. There was consensus that managing fatigue should be a multi-disciplinary effort, but with little idea of clearly defined roles. Conclusions: Despite fatigue being one of the symptoms most frequently reported by IBD patients, it remains poorly understood by HCPs, who find fatigue challenging and frustrating. There is a need for a systematic and structured assessment and management of this distressing symptom and HCPs should communicate with each other about care for each individual patient. There is a need for an assessment framework and for intervention strategies to be tested. It is essential for multidisciplinary team members to be involved in planning and managing coordinated care of patients reporting fatigue in IBD. P298 Vitamin D status and inflammatory bowel disease in disease activity and quality of life
the role
F. Dias de Castro1 *, J. Magalh˜ aes1 , P. Boal Carvalho1 , M.J. Moreira1 , P. Mota2 , J. Cotter1 . 1 Centro Hospitalar do Alto Ave, Gastroenterology, Guimaraes, Portugal, 2 Centro Hospitalar do Alto Ave, Clinical Pathology, Guimar˜ aes, Portugal Background: Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), is a group of debilitating conditions associated with deregulated mucosal immune response to intestinal microorganisms in a genetically susceptible host. Vitamin D is well recognized for its involvement in calcium homeostasis and musculoskeletal health. In addition, vitamin D plays a role in a variety of other systems and pathologies such as the immune response. The aim of this study is to investigate the correlation between disease activity and quality of life, in a cohort of IBD patients, with serum vitamin D levels. Methods: We conducted a cross-sectional study in ambulatory care IBD patients. Clinical disease activity (Harvey Bradshaw and Mayo clinical score) and quality of life (Short Inflammatory Bowel Disease Questionnaire SIBDQ) were assessed through
validated questionnaires. Serum 25-hydroxyvitamin D levels were used for vitamin D status, and deficiency was defined as a level less than 30 ng/mL. C-reactive protein (CRP), ferritin, albumin, erythrocyte sedimentation rate (ESR) and hemoglobin levels were correlated with serum 25-hydroxyvitamin D levels. All samples were collected during summer months. Statistical analysis was performed with SPSS vs 18.0 and a p value of less than 0.05 was considered statistically significant. Results: A total of 76 patients were enrolled, 72.4% female with mean age 34±10 years, 19 with UC (25%) and 57 with CD (75%). Average serum 25-hydroxyvitamin D levels were low (all 26±10 ng/mL, UC 30±12.54 ng/mL, CD 24.6±8.04 ng/mL) and there was a statistically significant difference between UC and CD patients (p = 0.032). Hypovitaminosis D was found in 68% of all patients, 58% of UC and 72% of CD patients. A significantly higher proportion of patients with low levels of vitamin D had higher levels of CRP (10.7 vs 4.3 mg/L, p = 0.048). On the other hand, the presence of anemia, low levels of albumin, and higher levels of ferritin and ESR didn’t correlate significantly with lower levels of vitamin D. Mean Harvey Bradshaw was 2.74 (0 15), mean Mayo clinical score was 1.95 (0 8), mean SIBDQ was 51 for UC patients and 50 for CD patients. Vitamin D deficiency didn’t correlate with clinical IBD activity (CD p = 0.278; UC p = 0.224) or lower levels of quality of life (p = 0.993). Conclusions: A significantly high percentage of IBD patients had vitamin D deficiency, and this condition was significantly more frequent in CD patients, drawing attention to the need for supplementation. CRP levels trended towards an inverse relationship with vitamin D status. In our study clinical disease activity and quality of life didn’t correlate significantly with lower levels of vitamin D. P299 Vagus nerve stimulation in Crohn’s disease B. Bonaz1,2 *, S. Pellissier2 , N. Mathieu1 , D. Hoffmann3 , C. Trocm´ e4 , M. Baudrant-Boga1 , V. Sinniger2 , C. Picq2,5 , O. David2 , L. Vercueil3 , C. Dantzer6 , J.-L. Cracowski7 , D. Claren¸ con5 . 1 CHU de Grenoble, Clinique Universitaire d’H´ epato-Gastroent´ erologie, Grenoble, France, 2 Grenoble Institute of Neurosciences (GIN, INSERM U836), CHU Grenoble, Grenoble Cedex 09, France, 3 Pˆ ole de Neurologie, D´ epartement de Neurochirurgie, Grenoble Cedex 09, France, 4 Institut de Biologie, CHU Grenoble, Grenoble Cedex 09, France, 5 IRBA, Biologie, La Tronche, France, 6 Laboratoire Inter-Universitaire de Psychologie (EA4145 UPMF/UDS), Universit´ e de Savoie, Chamb´ ery, France, 7 Centre d’Investigation Clinique, CHU Grenoble, Grenoble Cedex 09, France Background: The vagus nerve (VN) has an anti-inflammatory role through the cholinergic anti-inflammatory pathway. VN stimulation (VNS) improves colitis in rats (Auton Neurosci 2011;160:82 9). We performed a pilot study (ClinicalTrials.gov NCT01569503) of VNS in patients with active Crohn’s disease (CD). Methods: Patients with moderate to severe CD were included. Clinical evaluation (CDAI), CRP, fecal calprotectin (FC), ileocolonoscopy (CDEIS), contrast-enhanced ultrasound (CEUS), heart rate variability (HRV, a marker of the sympatho-vagal balance) were performed before VNS and during the follow-up for one year. An electrode was wrapped around the left VN in the neck, under general anesthesia, tunnelized subcutaneously, and connected to a pulse generator (Cyberonics, Lyon, France) located subcutaneously in the left chest wall. VNS was performed with the following parameters: 0.5 mA, 10 Hz, 30 s ON, 5 min OFF, continuous cycle. In case of aggravation, patients were removed from the study and treated with antiTNF/immunosuppressants or surgery. Results: 4 patients have been included: 3 men/1 women; mean age: 42.5 years (32 50); Montreal classification (A3L1B2,
Clinical: Therapy & observation A2L1B3, A2L2B1, A3L2B1); length of the disease (9.5 years; 0.5 26); smoking (2/4). Two patients were naïve of treatment on inclusion, one was under azathioprine (AZA) and one had stopped AZA 3.5 years before. The mean CDAI at entrance was 335 (320 358), CRP: 78 (8 166), FC: 677 (20 1762), CEUS: active disease, CDEIS: 16 (8 30), vagal hypoactivity on HRV was observed in 3/4 patients and uninterpretable in one. Two patients are currently in clinical remission with mucosal healing (CDEIS: 3 0) with a respective follow-up of 20 and 8 months. The patient in deep remission under AZA+VNS stopped AZA after 14 months of VNS and is in remission after 6 months of follow-up. One patient presented an improvement of CDAI and FC but switched to surgery after 2.5 months of VNS because of a persistent CD activity with an entero-enteric fistula and abscess; the patient agreed to pursue VNS alone post-surgery and had endoscopic healing (i0) at 6 months post-surgery. The last patient switched to Infliximab (IFX) and AZA because of an uncontrolled disease after 3 months of VNS despite a transient improvement. Two patients significantly improved HRV vagal tone after 6 months of VNS but not the third one who switched to IFX+AZA. VNS was well tolerated and no patient withdrew from the study due to complications or side-effects. Conclusions: The preliminary data of this pilot study show the feasibility of VNS which was well tolerated and efficient in 2 patients currently in deep remission; one patient with a failure of VNS is in deep remission 6 months post-surgery. We are currently pursuing the study. P300 Vaccination routines during anti-TNF treatment in IBD: Do patients adhere to ECCO’s guidelines? K. Risager Christensen *, C. Steenholdt, S. Schnoor Buhl, M.A. Ainsworth, O.Ø. Thomsen, J. Brynskov. Herlev University Hospital, Department of Gastroenterology, Herlev, Denmark Background: TNF-inhibitors used to treat inflammatory bowel disease (IBD) may result in severe infections due to the generalized immunosuppression. Accordingly, international guidelines now recommend that all patients are screened for latent infections prior to initiation of anti-TNF therapy; and receive vaccination against common infectious agents. However, clinical experience indicates that vaccination guidelines are challenging to implement in practice. We investigated if patients actually receive adequate information about vaccinations in a routine clinical setting; and if relevant information increases adherence to vaccination guidelines. Furthermore, we identified main reasons for non-adherence. Methods: Observational, cross-sectional cohort study of IBD patients in ongoing anti-TNF therapy per March 2013 at a tertiary Danish IBD center. Vaccination details were obtained by questionnaire. European Crohn and Colitis Organisation (ECCO) guidelines served as gold standard [1]. Results: 130 (83%) (n = 90 Crohn’s disease, n = 40 ulcerative colitis) of 157 patients responded. Sixty-four percent of responders received infliximab and 36% received adalimumab. Sixty-two patients (48%) reported to have received information from a health care professional about vaccination recommendations before initiation or during ongoing anti-TNF therapy. Information about vaccination guidelines increased patients’ adherence hereto. Hence, the percentage of patients who had hepatitis B vaccination increased from 24% before information to 52% after information was given (P < 0.001), pneumococcal vaccination increased from 7% to 24% (P < 0.001), human papilloma virus vaccination from 19% to 32% (P < 0.01), and annual influenza vaccination from 26% to 58% (P < 0.001). Information increased overall adherence to ECCO’s vaccination guidelines: the proportion of non-compliant patients decreased from 43% to 10% after information; partial compliance increased from 56% to 81%; and full compliance increased from 0% to 10%. Main barriers for patients’ adherence to vaccination
S189 guidelines were forgetfulness (36%), financial reasons (32%), skepticism (14%), and worries (7%). Conclusions: Focused information from health care professionals about recommended vaccinations during anti-TNF therapy in IBD significantly increased patients’ adherence. However, only a minority completely adhered to ECCO’s vaccination guidelines. Notable barriers were forgetfulness and financial reasons. Proposed strategies for improved adherence include education of health care professionals, repeated information to patients, and preferably financial support. Reference(s) [1] Rahier JF et al. J Crohns Colitis 2009; 3: 47 91. P301 Utility of faecal lactoferrin measurement in ulcerative colitis patients with granulocyte and monocyte adsorptive apheresis K. Hashiguchi *, F. Takeshima, Y. Akazawa, K. Matsushima, H. Minami, H. Ishii, N. Yamaguchi, K. Shiozawa, K. Ohnita, H. Isomoto, K. Nakao. Nagasaki University, Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki, Japan Background: Inflammatory Bowel Disease (IBD) is associated with higher leukocyte disposal in feces. Among the available faecal biomarkers, lactoferrin have translated into useful clinical tools for the diagnosis and monitoring of IBD. However, it remains unclear whether faecal lactoferrin could be useful in evaluating the effect of granulocyte and monocyte adsorptive apheresis (GMA) in ulcerative colitis (UC) patients. Aim of this study was to assess if faecal lactoferrin can be employed to predict or estimate the effect of GMA in UC patients. Methods: This was a prospective study involving 17 patients with ulcerative colitis. After written informed consent was obtained, patients with moderate-to-severe active UC who were scheduled to undergo GMA were recruited for this study. Each patient received 1 or 2 GMA session/week, up to 11 sessions. Patients were included in the study regardless of other therapies. In case of patients who were already on steroid treatment, they were allowed in the study only when the steroid was continued in same or decreased dose. Faecal lactoferrin was measured 4 times; before GMA introduction, 1 week and 2 week after GMA introduction, and at the end of GMA sessions. Feces were collected from each patient using stick type container. We defined GMA effective group (remission; Disease activity index (DAI) score decrease below 2 points, effective; DAI score decrease than 3 points) and GMA ineffective group (exclude remission and effective). Changes of faecal lactoferrin were compared between GMA effective group and GMA ineffective group. Correlation between faecal lactoferrin and endoscopic score or serological markers was assessed. Results: GMA was effective in 10 of 17 patients (58.8%). Although the rate of effectiveness of GMA in the patients treated with steroid (7 of 9 patients, 77.7%) was higher than that in the patients treated without steroid (3 of 8 patients, 37.5%), the difference was not significant. In effective group, mean faecal lactoferrin before GMA introduction was significantly higher than that in ineffective group (2120.9±1297.4 ng/ml vs. 681.9±802.2 ng/ml, P < 0.05). More importantly, significant decrease of faecal lactoferrin was observed only in GMA effective group (2120.9±1297.4 ng/ml to 686.0±802.2 ng/ml, P < 0.05). Faecal lactoferrin had weak positive correlation with endoscopic score, but not with C-reactive protein. Conclusions: Faecal lactoferrin might be able to predict the response before GMA introduction in UC patients. In effective group, faecal lactoferrin may be an indicator for the effectiveness of GMA.
Poster presentations
patients in remission and 86% in active condition reporting fatigue. However patients report that their complaints of fatigue are often not addressed in clinical consultations. To date there are no studies exploring this topic from the clinician’s perspective. This study aimed to gain an understanding of healthcare practitioners’ (HCPs) perception of IBD fatigue as experienced by people with IBD, and to identify the range of methods that HCPs use to assess and manage fatigue. Methods: Descriptive phenomenology was carried out to achieve the aims of the study. Purposive sampling was used to identify a range of professionals (gastroenterologists, IBD nurses, general practitioners, dietitians, psychologists and pharmacists). In-depth semi-structured interviews were conducted with 20 HCPs who work with people with IBD between June and December 2012. Interviews were audio recorded and transcribed verbatim. Colazzi’s seven step framework was used to analyse data. The study was approved by the local university ethics committee. Results: Three main themes and several sub-themes were identified. The main themes were: the phenomenon of fatigue as perceived by HCPs; the impact of fatigue on patients’ lives as perceived by HCPs; and the methods used by HCPs to deal with fatigue. Fatigue was identified as an important, but difficult and often frustrating, symptom to understand. The study participants perceived fatigue as ‘such a complicated and complex thing’. HCPs reported that fatigue impacts on the emotional, private and public aspects of patients’ functioning, however there were very few methods suggested on how to assess and manage the fatigue in a systematic way. Many expressed a desire for better education and a frustration at not being able to help patients more. There was consensus that managing fatigue should be a multi-disciplinary effort, but with little idea of clearly defined roles. Conclusions: Despite fatigue being one of the symptoms most frequently reported by IBD patients, it remains poorly understood by HCPs, who find fatigue challenging and frustrating. There is a need for a systematic and structured assessment and management of this distressing symptom and HCPs should communicate with each other about care for each individual patient. There is a need for an assessment framework and for intervention strategies to be tested. It is essential for multidisciplinary team members to be involved in planning and managing coordinated care of patients reporting fatigue in IBD. P298 Vitamin D status and inflammatory bowel disease in disease activity and quality of life
the role
F. Dias de Castro1 *, J. Magalh˜ aes1 , P. Boal Carvalho1 , M.J. Moreira1 , P. Mota2 , J. Cotter1 . 1 Centro Hospitalar do Alto Ave, Gastroenterology, Guimaraes, Portugal, 2 Centro Hospitalar do Alto Ave, Clinical Pathology, Guimar˜ aes, Portugal Background: Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), is a group of debilitating conditions associated with deregulated mucosal immune response to intestinal microorganisms in a genetically susceptible host. Vitamin D is well recognized for its involvement in calcium homeostasis and musculoskeletal health. In addition, vitamin D plays a role in a variety of other systems and pathologies such as the immune response. The aim of this study is to investigate the correlation between disease activity and quality of life, in a cohort of IBD patients, with serum vitamin D levels. Methods: We conducted a cross-sectional study in ambulatory care IBD patients. Clinical disease activity (Harvey Bradshaw and Mayo clinical score) and quality of life (Short Inflammatory Bowel Disease Questionnaire SIBDQ) were assessed through
validated questionnaires. Serum 25-hydroxyvitamin D levels were used for vitamin D status, and deficiency was defined as a level less than 30 ng/mL. C-reactive protein (CRP), ferritin, albumin, erythrocyte sedimentation rate (ESR) and hemoglobin levels were correlated with serum 25-hydroxyvitamin D levels. All samples were collected during summer months. Statistical analysis was performed with SPSS vs 18.0 and a p value of less than 0.05 was considered statistically significant. Results: A total of 76 patients were enrolled, 72.4% female with mean age 34±10 years, 19 with UC (25%) and 57 with CD (75%). Average serum 25-hydroxyvitamin D levels were low (all 26±10 ng/mL, UC 30±12.54 ng/mL, CD 24.6±8.04 ng/mL) and there was a statistically significant difference between UC and CD patients (p = 0.032). Hypovitaminosis D was found in 68% of all patients, 58% of UC and 72% of CD patients. A significantly higher proportion of patients with low levels of vitamin D had higher levels of CRP (10.7 vs 4.3 mg/L, p = 0.048). On the other hand, the presence of anemia, low levels of albumin, and higher levels of ferritin and ESR didn’t correlate significantly with lower levels of vitamin D. Mean Harvey Bradshaw was 2.74 (0 15), mean Mayo clinical score was 1.95 (0 8), mean SIBDQ was 51 for UC patients and 50 for CD patients. Vitamin D deficiency didn’t correlate with clinical IBD activity (CD p = 0.278; UC p = 0.224) or lower levels of quality of life (p = 0.993). Conclusions: A significantly high percentage of IBD patients had vitamin D deficiency, and this condition was significantly more frequent in CD patients, drawing attention to the need for supplementation. CRP levels trended towards an inverse relationship with vitamin D status. In our study clinical disease activity and quality of life didn’t correlate significantly with lower levels of vitamin D. P299 Vagus nerve stimulation in Crohn’s disease B. Bonaz1,2 *, S. Pellissier2 , N. Mathieu1 , D. Hoffmann3 , C. Trocm´ e4 , M. Baudrant-Boga1 , V. Sinniger2 , C. Picq2,5 , O. David2 , L. Vercueil3 , C. Dantzer6 , J.-L. Cracowski7 , D. Claren¸ con5 . 1 CHU de Grenoble, Clinique Universitaire d’H´ epato-Gastroent´ erologie, Grenoble, France, 2 Grenoble Institute of Neurosciences (GIN, INSERM U836), CHU Grenoble, Grenoble Cedex 09, France, 3 Pˆ ole de Neurologie, D´ epartement de Neurochirurgie, Grenoble Cedex 09, France, 4 Institut de Biologie, CHU Grenoble, Grenoble Cedex 09, France, 5 IRBA, Biologie, La Tronche, France, 6 Laboratoire Inter-Universitaire de Psychologie (EA4145 UPMF/UDS), Universit´ e de Savoie, Chamb´ ery, France, 7 Centre d’Investigation Clinique, CHU Grenoble, Grenoble Cedex 09, France Background: The vagus nerve (VN) has an anti-inflammatory role through the cholinergic anti-inflammatory pathway. VN stimulation (VNS) improves colitis in rats (Auton Neurosci 2011;160:82 9). We performed a pilot study (ClinicalTrials.gov NCT01569503) of VNS in patients with active Crohn’s disease (CD). Methods: Patients with moderate to severe CD were included. Clinical evaluation (CDAI), CRP, fecal calprotectin (FC), ileocolonoscopy (CDEIS), contrast-enhanced ultrasound (CEUS), heart rate variability (HRV, a marker of the sympatho-vagal balance) were performed before VNS and during the follow-up for one year. An electrode was wrapped around the left VN in the neck, under general anesthesia, tunnelized subcutaneously, and connected to a pulse generator (Cyberonics, Lyon, France) located subcutaneously in the left chest wall. VNS was performed with the following parameters: 0.5 mA, 10 Hz, 30 s ON, 5 min OFF, continuous cycle. In case of aggravation, patients were removed from the study and treated with antiTNF/immunosuppressants or surgery. Results: 4 patients have been included: 3 men/1 women; mean age: 42.5 years (32 50); Montreal classification (A3L1B2,
Clinical: Therapy & observation A2L1B3, A2L2B1, A3L2B1); length of the disease (9.5 years; 0.5 26); smoking (2/4). Two patients were naïve of treatment on inclusion, one was under azathioprine (AZA) and one had stopped AZA 3.5 years before. The mean CDAI at entrance was 335 (320 358), CRP: 78 (8 166), FC: 677 (20 1762), CEUS: active disease, CDEIS: 16 (8 30), vagal hypoactivity on HRV was observed in 3/4 patients and uninterpretable in one. Two patients are currently in clinical remission with mucosal healing (CDEIS: 3 0) with a respective follow-up of 20 and 8 months. The patient in deep remission under AZA+VNS stopped AZA after 14 months of VNS and is in remission after 6 months of follow-up. One patient presented an improvement of CDAI and FC but switched to surgery after 2.5 months of VNS because of a persistent CD activity with an entero-enteric fistula and abscess; the patient agreed to pursue VNS alone post-surgery and had endoscopic healing (i0) at 6 months post-surgery. The last patient switched to Infliximab (IFX) and AZA because of an uncontrolled disease after 3 months of VNS despite a transient improvement. Two patients significantly improved HRV vagal tone after 6 months of VNS but not the third one who switched to IFX+AZA. VNS was well tolerated and no patient withdrew from the study due to complications or side-effects. Conclusions: The preliminary data of this pilot study show the feasibility of VNS which was well tolerated and efficient in 2 patients currently in deep remission; one patient with a failure of VNS is in deep remission 6 months post-surgery. We are currently pursuing the study. P300 Vaccination routines during anti-TNF treatment in IBD: Do patients adhere to ECCO’s guidelines? K. Risager Christensen *, C. Steenholdt, S. Schnoor Buhl, M.A. Ainsworth, O.Ø. Thomsen, J. Brynskov. Herlev University Hospital, Department of Gastroenterology, Herlev, Denmark Background: TNF-inhibitors used to treat inflammatory bowel disease (IBD) may result in severe infections due to the generalized immunosuppression. Accordingly, international guidelines now recommend that all patients are screened for latent infections prior to initiation of anti-TNF therapy; and receive vaccination against common infectious agents. However, clinical experience indicates that vaccination guidelines are challenging to implement in practice. We investigated if patients actually receive adequate information about vaccinations in a routine clinical setting; and if relevant information increases adherence to vaccination guidelines. Furthermore, we identified main reasons for non-adherence. Methods: Observational, cross-sectional cohort study of IBD patients in ongoing anti-TNF therapy per March 2013 at a tertiary Danish IBD center. Vaccination details were obtained by questionnaire. European Crohn and Colitis Organisation (ECCO) guidelines served as gold standard [1]. Results: 130 (83%) (n = 90 Crohn’s disease, n = 40 ulcerative colitis) of 157 patients responded. Sixty-four percent of responders received infliximab and 36% received adalimumab. Sixty-two patients (48%) reported to have received information from a health care professional about vaccination recommendations before initiation or during ongoing anti-TNF therapy. Information about vaccination guidelines increased patients’ adherence hereto. Hence, the percentage of patients who had hepatitis B vaccination increased from 24% before information to 52% after information was given (P < 0.001), pneumococcal vaccination increased from 7% to 24% (P < 0.001), human papilloma virus vaccination from 19% to 32% (P < 0.01), and annual influenza vaccination from 26% to 58% (P < 0.001). Information increased overall adherence to ECCO’s vaccination guidelines: the proportion of non-compliant patients decreased from 43% to 10% after information; partial compliance increased from 56% to 81%; and full compliance increased from 0% to 10%. Main barriers for patients’ adherence to vaccination
S189 guidelines were forgetfulness (36%), financial reasons (32%), skepticism (14%), and worries (7%). Conclusions: Focused information from health care professionals about recommended vaccinations during anti-TNF therapy in IBD significantly increased patients’ adherence. However, only a minority completely adhered to ECCO’s vaccination guidelines. Notable barriers were forgetfulness and financial reasons. Proposed strategies for improved adherence include education of health care professionals, repeated information to patients, and preferably financial support. Reference(s) [1] Rahier JF et al. J Crohns Colitis 2009; 3: 47 91. P301 Utility of faecal lactoferrin measurement in ulcerative colitis patients with granulocyte and monocyte adsorptive apheresis K. Hashiguchi *, F. Takeshima, Y. Akazawa, K. Matsushima, H. Minami, H. Ishii, N. Yamaguchi, K. Shiozawa, K. Ohnita, H. Isomoto, K. Nakao. Nagasaki University, Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki, Japan Background: Inflammatory Bowel Disease (IBD) is associated with higher leukocyte disposal in feces. Among the available faecal biomarkers, lactoferrin have translated into useful clinical tools for the diagnosis and monitoring of IBD. However, it remains unclear whether faecal lactoferrin could be useful in evaluating the effect of granulocyte and monocyte adsorptive apheresis (GMA) in ulcerative colitis (UC) patients. Aim of this study was to assess if faecal lactoferrin can be employed to predict or estimate the effect of GMA in UC patients. Methods: This was a prospective study involving 17 patients with ulcerative colitis. After written informed consent was obtained, patients with moderate-to-severe active UC who were scheduled to undergo GMA were recruited for this study. Each patient received 1 or 2 GMA session/week, up to 11 sessions. Patients were included in the study regardless of other therapies. In case of patients who were already on steroid treatment, they were allowed in the study only when the steroid was continued in same or decreased dose. Faecal lactoferrin was measured 4 times; before GMA introduction, 1 week and 2 week after GMA introduction, and at the end of GMA sessions. Feces were collected from each patient using stick type container. We defined GMA effective group (remission; Disease activity index (DAI) score decrease below 2 points, effective; DAI score decrease than 3 points) and GMA ineffective group (exclude remission and effective). Changes of faecal lactoferrin were compared between GMA effective group and GMA ineffective group. Correlation between faecal lactoferrin and endoscopic score or serological markers was assessed. Results: GMA was effective in 10 of 17 patients (58.8%). Although the rate of effectiveness of GMA in the patients treated with steroid (7 of 9 patients, 77.7%) was higher than that in the patients treated without steroid (3 of 8 patients, 37.5%), the difference was not significant. In effective group, mean faecal lactoferrin before GMA introduction was significantly higher than that in ineffective group (2120.9±1297.4 ng/ml vs. 681.9±802.2 ng/ml, P < 0.05). More importantly, significant decrease of faecal lactoferrin was observed only in GMA effective group (2120.9±1297.4 ng/ml to 686.0±802.2 ng/ml, P < 0.05). Faecal lactoferrin had weak positive correlation with endoscopic score, but not with C-reactive protein. Conclusions: Faecal lactoferrin might be able to predict the response before GMA introduction in UC patients. In effective group, faecal lactoferrin may be an indicator for the effectiveness of GMA.