P347 Collagenous colitis: The clinical response after therapy with budesonide plus mesalazine and maintenance with mesalazine

S148 in patients with UC. Six patients (4 male, 2 female, age range 55 71 years) with extensive (pancolitis) long-standing (14 22 years) UC were diagnosed with single colonic strictures (2 in sigmoid, 2 in descenting, 1 in the splenic flexure and 1 in the proximal transverse colon) preventing further insertion of the endoscope. All were in clinical and endoscopic remission under 5-ASA compounds and biopsies taken through-out the examined colon didn’t show any evidence of severe dysplasia. The 2 patients with sigmoid strictures complained for mild to moderate constipation, while the rest 4 were asymptomatic. Their further work-up included double-contrast barium enema and CT colonography without any other abnormal findings, except from the strictures. The option of surgical management was proposed but was either refused (4 patients) or was reserved only if no other alternative was offered to them (2 patients). In all patients the option of endoscopic dilatation was discussed after explaining the risk of complications and/or failure of the procedure. Results: Under concious sedation standard endoscopic dilatation was performed sucessfully in 5/6 patients (over-thewire, with water-filled balloon-Rigiflex/Boston Scientific) under fluoroscopic guidence. In 1/6 with the splenic flexure stricture the procedure was unsucessful because of acute angulation of the bowel lumen. Immediately after dilatation colonoscopy was performed to the caecum. In 1/5 patients a DALM lesion was detected proximally to the stricture and was sucessfully excised endoscopically. Histopathology confirmed high-grade dysplasia and the patient underwent proctocolectomy with pouch formation. Conclusions: Endoscopic dilatation of colonic strictures is feasible in the majority of patients with UC allowing full endoscopic examination of the large bowel. P347 Collagenous colitis: The clinical response after therapy with budesonide plus mesalazine and maintenance with mesalazine A. Scarcelli1 *, A. Bertani1 , M. Di Girolamo1 , A. Merighi1 , V. Boarino1 , A. Antonioli1 , A.M. Primerano1 , E. Villa1 . 1 Policlinico Modena, Italy Background: Collagenous colitis (CC) is a microscopic colitis characterized by watery diarrhoea, normal colonic mucosa at colonoscopy, presence at the histology of a thickened subepithelial collagen band. Many Various case reports proposed different treatments. The aim of this study was to evaluate the clinical response (numbers of daily stools, subject wellness) after starting therapy with budesonide plus mesalazine and after maintenance therapy with mesalazine. We evaluated the daily stools and the subject wellness after 6 months, 1 and 2 years of the ending of the budesonide therapy. Methods: Since January 2005 to September 2011 arrived in our Unit 20 CC. They referred on average 5 6 watery stools evacuations/day. In blood tests VES (erythrocyte sedimentation velocity) and PCR (protein C reactive) were normal. 7 patients didn’t make the budesonide therapy because of other severe pathologies; 1 patient was yet in therapy with metilprednisolone 4 mg for rheumatic disease; 13 patients (7 men and 6 women) started with budesonide 9 mg/day for the first month, 6 mg/day for second months and 3 mg/day for the third month in association with 2400 mg/day of mesalazine that patients maintained also after the budesonide cycle. Results: After 6 months since the ending of budesonide all the patients referred a sensible reduction of the evacuation with normalisation of stool consistence (1 2 evacuation/day) and general wellness. After 1 year 8 patients referred 1 2 normal stools evacuation/day and were in general wellness too. One woman and 1 man had a relapse of watery diarrhoea, so we repeated the budesonide cycle with immediately improvement

Poster presentations of the conditions. Finally after 2 years of follow-up 9 patients are currently in wellness. VES and PCR were always normal. Conclusions: A therapy with budesonide plus mesalazine and a maintenance with only mesalazine can improve clinical conditions (stools’ consistence and number of evacuations) in patients with CC. P348 Retesting for latent tuberculosis in patients with inflammatory bowel disease after exposure to biologics P. Papay1 *, C. Primas2 , A. Eser1 , S. Winkler3 , G. Novacek1 , S. Angelberger1 , A. Mikulits1 , H. Vogelsang1 , W. Reinisch1 . 1 Medical University Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria, 2 Medical University of Vienna, Div. Of Gastroenterology and Hepatology, Vienna, Austria, 3 Medical university of Vienna, Deparment of Internal Medicine I, Division of Infectious Diseases, Vienna, Austria Background: Patients treated with TNF-a inhibitors (TNFi) are at high risk of reactivation of latent tuberculosis (TB). Prospective studies on monitoring for TB reactivation and/or infection in this risk group are lacking. Methods: We retested consecutive patients with inflammatory bowel disease (IBD) under therapy with TNFi for a minimum of 5 months for latent TB by interferon-g release assay (IGRA) and tuberculin skin test (TST). From each subject a detailed patient history and concomitant therapy were captured. Results: After a median of 34.9 weeks (20.7 177.7) IGRA was retested in 184/227 patients (81.1%; Crohn’s disease n = 139, ulcerative colitis n = 45) initially screened for latent TB and subsequently treated with TNFi. Additionally TST was readministered in 144/227 subjects (63.4%). The majority of patients was TNFi naïve (147/227, 79.9%). In 32 subjects isoniazid was provided prior and concurrently to TNFi due to latent TB. In this subgroup retesting for latent TB resulted in a reversion to negative in 6/13 patients (46.2%) and in 3/24 patients (12.5%, P = 0.08) with a positive IGRA and positive TST at baseline, respectively. In patients without latent TB at baseline no permanent IGRA conversion, but 6/144 (4.2%) TST conversions from negative to positive were observed. No single case of TB reactivation or infection was observed during the observation period. Conclusions: A conversion of IGRA during treatment with antiTNF-a agent was not observed, but occurred for TST. IGRA frequently reverts to negative in patients with latent TB after specific therapy and seems to be a sensitive method to monitor patients for latent TB under treatment with TNFi. P349 Risk of lymphoma in patients with inflammatory bowel disease: A Korean single-center study S.-K. Park1 , B.D. Ye1 *, S.-K. Yang1 , D.-H. Yang1 , K.W. Jung1 , K.J. Kim1 , J.-S. Byeon1 , S.-J. Myung1 , J.-H. Kim1 . 1 University of Ulsan College of Medicine, Asan Medical Center, Gastroenterology, Seoul, South Korea Background: Previous studies on the risk of lymphoma in Western inflammatory bowel disease (IBD) patients have shown conflicting results. Moreover, the incidence and risk factors of lymphoma in Asian IBD patients remain unclear. Therefore, we investigated the incidence, clinical characteristics, and risk factors of lymphoma in a Korean IBD patient population. Methods: IBD patients who were also diagnosed with lymphoma were identified from an IBD database of the Asan medical center in Korea. The standardized incidence ratio (SIR) of lymphoma was calculated using data from the Korea Central Cancer Registry (KCCR) of the National Cancer Center. In addition, the clinical characteristics of the IBD patients with lymphoma were