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P331 Total, free and bioavailable 25(OH) vitamin D inversely correlate with faecal calprotectin in patients with inflammatory bowel disease
S142 outcome was reported in patients refractory to multiple drugs or with extensive loss of the mucosal tissue (Sands, et al. Gastroenterology 2008). We thought that young UC patients should respond to GMA. Methods: We assessed the efficacy of GMA in growing patients as mono-therapy or in combination with low dose PSL if monotherapy was ineffective. Seventeen children and adolescents, age 11 19 years, each was to receive 5 GMA sessions, 2 sessions in the first week, and then weekly sessions. Patients who achieved a decrease of at least 5 point in the clinical activity index (CAI) were to receive additional weekly GMA, up to 6 sessions, while poor responders were to receive 20 mg/day PSL plus additional GMA session. 5ASA was the only concomitant medication, which had started longer than 8 weeks prior to GMA. At entry and week 12, patients were clinically and endoscopically evaluated, allowing each patient to serve as her or his own control. Results: Five patients did not respond well to the initial 5 GMA sessions and were given PSL plus GMA, while 12 patients responded to the first 5 GMA sessions and received further sessions. At entry, the average CAI was 14.1±0.4, range 11 17, and the average endoscopic index was 9.2±0.3, range 7 11. The corresponding values at week 12 were 2.1±0.2, range 1 4 (P < 0.001) and 2.4±0.2, range 1 4 (P < 0.001), respectively. Therefore, 12 patients achieved remission with GMA as monotherapy and 5 patients achieved remission with GMA plus PSL. PSL was tapered to 0 mg within 3 months. Conclusions: In this study, GMA in children and adolescents with UC, who were corticosteroid naïve was associated with clinical remission and mucosal healing. Therefore, there are patients who may respond well to GMA and be spared from pharmacologicals. Additionally, GMA is favoured by patients for its good safety profile and being a non-drug intervention. P331 Total, free and bioavailable 25(OH) vitamin D inversely correlate with faecal calprotectin in patients with inflammatory bowel disease M. Garg1 *, O. Rosella2 , J. Lubel1 , P. Gibson2 . 1 Monash University, Gastroenterology, Eastern Health, Box Hill, Australia, 2 Monash University, Gastroenterology, The Alfred Hospital, Prahran, Australia Background: The relationships of objective markers of disease activity with circulating total, free and bioavailable 25(OH) vitamin D (25(OH)D), and of vitamin D binding protein (DBP) are unknown. Aim: To measure circulating levels of the key components of the vitamin D axis in patients with IBD and in healthy controls, and to correlate these with markers of disease activity. Methods: Healthy controls (HC), and patients with Crohn’s disease (CD) and ulcerative colitis (UC) attending Eastern Health IBD Clinics were recruited, and demographic and clinical data recorded. Blood samples were analysed for 25(OH)D by chemiluminescence, and in a subgroup DBP by ELISA. Systemic inflammation was assessed via the serum C-reactive protein (CRP) and intestinal inflammation via faecal calprotectin (FC). Results: 21 HC (12 female; mean age 37, range 23 68 y), 37 patients with CD (17 female; aged 41, 23 76 y) and 31 with UC (14 female; aged 45, 22 82 y) were studied. No significant demographic differences were noted between the groups. Serum 25(OH)D concentration was similar across all 3 groups (mean 70 nmol/L in patients with CD, 69 nmol/L in patients with UC and 67 nmol/L in HC, p = NS). A significant inverse correlation between 25(OH)D and log calprotectin (log FC) was noted in patients with CD (Pearson r = 0.38, p = 0.033), UC (r = 0.39, p = 0.039) and all patients with IBD (r = 0.39, p = 0.003). No correlation with CRP was noted. 34 of the 68 patients with IBD were taking vitamin D supplements; in these patients, a significant inverse correlation between 25(OH)D and log FC
Poster presentations was also noted (r = 0.50, p = 0.006). The inverse correlation was also noted amongst patients with only colonic CD or UC (r = 0.36, p = 0.031). There was no significant difference in sunlight exposure between groups. In a subgroup of 20 HC, 20 patients with CD and 15 patients with UC, DBP was similar across the 3 groups, as were calculated free and bioavailable 25(OH)D. Free and bioavailable 25(OH)D significantly correlated with log FC in the IBD group as a whole or with CD and UC alone, whereas DBP did not. Conclusions: Despite total, free and bioavailable 25(OH)D concentrations being similar to those in a healthy control population, they inversely correlate with the degree of intestinal inflammation. This association is not influenced by malabsorption or variations of sunlight exposure; and hence provides further evidence that vitamin D may play an immunomodulatory role in IBD. Studies are required at the intestinal level. P332 To identify various profiles of IBD patients and differences in HRQOL S. J¨ aghult1 *, D. Andersson1 , F. Saboonchi1 . 1 Karolinska Institutet Danderyds sjukhus, Department of Clinical Sciences, Stockholm, Sweden Background: Studies have shown that patients with IBD rate their health-related quality of life (HRQOL) lower compared to the general population. Many studies have been made on patients’ HRQOL related to IBD, and diagnosis, gender and age are considered to be important contributing factors. Aim: The aim of this study was to identify various profiles of IBD patients based on gender, age and diagnosis, and to examine differences on HRQOL across these profiles. Methods: The Short Health Scale (SHS) measures HRQOL in IBD patients and consists of four questions regarding symptoms, function, disease-related anxiety and well-being respectively. SWIBREG is a Swedish national registry for IBD patients, with the aim to eventually include all Swedish IBD patients. For this study, all patients registered in SWIBREG during 2010 2011 that also had completed the SHS questionnaire were included. The data were collected during annual routine controls by telephone, with patients who during their latest outpatient contact had been in clinical remission. Two step cluster analysis was utilised to accommodate for categorical variables. The differences in HRQOL were assessed by means of MANOVA. Results: A total of 203 (94 men, 109 female) patients were included. There were 113 patients with UC, 80 patients had CD, and 10 had indeterminate colitis. The mean age was 55 years (SD 15.501). Cluster analysis returned 4 different profiles; cluster 1 (females with UC, age below average), cluster 2 (men with UC, age below average), cluster 3 (women with predominantly CD (80%), age above average), and cluster 4 (men with CD, age around average). MANOVA with ANOVA and post hoc analysis displayed that cluster 3 reported significantly more symptoms (p < 0.05) compared to all three of the other clusters. Cluster 3 also reported reduced function in their daily life related to their IBD, though this was only significant compared to cluster 2. Conclusions: Present study shows that in this study population, women with age above average suffering from IBD (predominantly CD) reported more symptoms and had reduced function scores related to their IBD even in routine checkups during periods of supposed remission. These results suggests that using data from national register databases like SWIBREG might help IBD centres to identify patient groups that might need more support and increased IBD health care availability.
Poster presentations was also noted (r = 0.50, p = 0.006). The inverse correlation was also noted amongst patients with only colonic CD or UC (r = 0.36, p = 0.031). There was no significant difference in sunlight exposure between groups. In a subgroup of 20 HC, 20 patients with CD and 15 patients with UC, DBP was similar across the 3 groups, as were calculated free and bioavailable 25(OH)D. Free and bioavailable 25(OH)D significantly correlated with log FC in the IBD group as a whole or with CD and UC alone, whereas DBP did not. Conclusions: Despite total, free and bioavailable 25(OH)D concentrations being similar to those in a healthy control population, they inversely correlate with the degree of intestinal inflammation. This association is not influenced by malabsorption or variations of sunlight exposure; and hence provides further evidence that vitamin D may play an immunomodulatory role in IBD. Studies are required at the intestinal level. P332 To identify various profiles of IBD patients and differences in HRQOL S. J¨ aghult1 *, D. Andersson1 , F. Saboonchi1 . 1 Karolinska Institutet Danderyds sjukhus, Department of Clinical Sciences, Stockholm, Sweden Background: Studies have shown that patients with IBD rate their health-related quality of life (HRQOL) lower compared to the general population. Many studies have been made on patients’ HRQOL related to IBD, and diagnosis, gender and age are considered to be important contributing factors. Aim: The aim of this study was to identify various profiles of IBD patients based on gender, age and diagnosis, and to examine differences on HRQOL across these profiles. Methods: The Short Health Scale (SHS) measures HRQOL in IBD patients and consists of four questions regarding symptoms, function, disease-related anxiety and well-being respectively. SWIBREG is a Swedish national registry for IBD patients, with the aim to eventually include all Swedish IBD patients. For this study, all patients registered in SWIBREG during 2010 2011 that also had completed the SHS questionnaire were included. The data were collected during annual routine controls by telephone, with patients who during their latest outpatient contact had been in clinical remission. Two step cluster analysis was utilised to accommodate for categorical variables. The differences in HRQOL were assessed by means of MANOVA. Results: A total of 203 (94 men, 109 female) patients were included. There were 113 patients with UC, 80 patients had CD, and 10 had indeterminate colitis. The mean age was 55 years (SD 15.501). Cluster analysis returned 4 different profiles; cluster 1 (females with UC, age below average), cluster 2 (men with UC, age below average), cluster 3 (women with predominantly CD (80%), age above average), and cluster 4 (men with CD, age around average). MANOVA with ANOVA and post hoc analysis displayed that cluster 3 reported significantly more symptoms (p < 0.05) compared to all three of the other clusters. Cluster 3 also reported reduced function in their daily life related to their IBD, though this was only significant compared to cluster 2. Conclusions: Present study shows that in this study population, women with age above average suffering from IBD (predominantly CD) reported more symptoms and had reduced function scores related to their IBD even in routine checkups during periods of supposed remission. These results suggests that using data from national register databases like SWIBREG might help IBD centres to identify patient groups that might need more support and increased IBD health care availability.