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P347 The efficacy of ganciclovir therapy in patients with steroid-refractory ulcerative colitis and cytomegalovirus infection
S148 Methods: We retrospectively reviewed 106 patients with steroid-dependent UC for whom azathioprine was started between October 1998 and May 2009. Six-month and 3-year outcomes after azathioprine therapy were evaluated. Results: Of the 106 patients, 73 (68.9%) were continued on azathioprine for more than six months (azathioprine group) and 33 (31.1%) discontinued azathioprine within six months due to intolerance (intolerance group, n = 20), colectomy (n = 6) or follow-up loss (n = 7). The most common reasons for intolerance were nausea and vomiting (n = 5), elevated liver enzymes (n = 5) and hair loss (n = 5). Six-month and 3-year outcomes for all 106 patients were remission in 70 (66%) and 67 (63.2%), corticosteroid dependence in 17 (16%) and 5 (4.7%), infliximab administration in 3 (2.8%) and 6 (5.6%), colectomy in 8 (7.5%) and 15 (14.2%), follow-up loss in 8 (7.5%) and 12 (11.3%), and death in 0 (0%) and 1 (0.9%), respectively. Six-month and 3-year outcomes for azathioprine group were remission in 57 (78%) and 60 (82.2%), corticosteroid dependence in 16 (22%) and 3 (4.1%), infliximab administration in 0 (0%) and 3 (4.1%), colectomy in 0 (0%) and 2 (2.7%), follow-up loss in 0 (0%) and 4 (5.4%), and death in 0 (0%) and 1 (1.3%), respectively. The azathioprine (n = 73) and the intolerance (n = 20) groups showed no significant difference in median age at diagnosis (37 years vs. 45 years, P = 0.17), proportion of male patients (61.6% vs. 40%, P = 0.12), median age at azathioprine therapy (40 years vs. 46 years, P = 0.27), median duration of UC before azathioprine (35.2 months vs. 17.6 months, P = 0.06), and median dose of azathioprine (1.06 mg/kg vs. 0.83 mg/kg, P = 0.39). The proportion of the patients remaining in remission was higher (88.2% vs. 36.8%, P < 0.001) in the azathioprine group compared with the intolerance group. Conclusions: Azathioprine is an effective treatment for steroiddependent UC. The efficacy of azathioprine is well sustained for 3 years. This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A120176). P346 The experience of restorative proctocolectomy for ulcerative colitis during 1985 2009 I. Nieminen1 *, H. Huhtala2 , M. Hy¨ oty1 , P. Collin1 , P. Aitola1 . 1 Tampere University Hospital, Gastroenterology and alimentary tract surgery, Tampere, Finland, 2 University of Tampere, Finland Background: Restorative proctocolectomy (RPC) has become the operation of choice for most of the ulcerative colitis (UC) patients who require surgery. The aim of this study was to determine the operative technique, early and late complications, and pouch excision rate of the patients undergoing RPC. Methods: Retrospective review of the medical records of all the patients with UC over 18 years of age who underwent RPC in our institution between March 1985 and December 2009; comprising a total of 352 patients, median age 36 (18 72) of which 149 (42.3%) were women. Results: The most frequent indication for surgery was active chronic colitis in 168 (47.7%); acute colitis in 159 (45.2%) and cancer or dysplasia 25 (7.1%). During the early years all anastomosis were handsewn and covering ileostomy was constructed only when considered necessary, whereas today, we perform mainly stapler anastomosis with a routine covering ileostomy. In the whole series, handsewn anastomoses were performed in 283 (80.4%) patients and stapled anastomoses in 69 (19.6%); Covering ileostomy was carried out in 133 (37.8%) patients. Urgent colectomy with end ileostomy was performed before RPC in 170 (48.3%) patients. The total number of any early complications (30 days after operation) was 184 (in 52.3% patients); of these 82 (23.3%
Poster presentations of all) were J-pouch related complications. The operative mortality was 0.3%. When covering ileostomy was used there were significantly less leakages (6.0% vs. 16.9%, p = 0.003) and early reoperations (4.5% vs. 11. 9%, p = 0.02). The median follow up was 5 years. Pouchitis was the most common late complication occurring as at least once in 134 (38.1%) patients. Forty-two (11.9%) patients experienced pouch failure leading to pouch excision in all but one. During the first year pouch excision rate was 2.2%. Seven patients were afterwards found to have confirmed and one probable Crohn’s disease; four of these had had their pouch excised. Conclusions: The technique used in RPC in our hospital has changed over the past years. Covering ileostomy seems to protect from major complications. RPC is still associated with significant morbidity, pouchitis being the most common problem in follow up. Pouch failure is common but not inevitable in patients with a later diagnosis of Crohn’s disease. P347 The efficacy of ganciclovir therapy in patients with steroidrefractory ulcerative colitis and cytomegalovirus infection M.K. Choi1 , G.A. Song1 *, D.U. Kim1 , D.Y. Ryu1 . 1 Pusan National University College of Medicine, Internal Medicine, Busan, South Korea Background: There are some reports that cytomegalovirus infection in patients with active ulcerative colitis is associated with poor clinical course. But, it is still difficult to assess the clinical impact of cytomegalovirus infection in patients with active ulcerative colitis and decide whether to treat the infection. Thus, we evaluated the effect of antiviral therapy against cytomegalovirus infection in patients with steroidrefractory ulcerative colitis, retrospectively. Methods: 71 patients with moderate-to-severe ulcerative colitis were admitted to our hospital for treatment with intravenous methylprednisolone between January 2007 and September 2012. After admission, diagnosis of cytomegalovirus infection was performed by a serologic test and/or a histopathologic examination using immunohistochemical staining. 14 patients without evaluation for cytomegalovirus infection were excluded from the study. All patients were initially treated with a high-dose methylprednisolone (40 60 mg/day) intravenously for 7 14 days. Results: Of 57 patients enrolled, the presence of cytomegalovirus was identified in 18 patients (31.6%). 39 patients with moderate-to-severe ulcerative colitis including 7 patients with cytomegalovirus infection were responsive to initial steroid therapy. Of 18 patients with steroid-refractory ulcerative colitis, 11 patients had the cytomegalovirus infection and were treated with intravenous ganciclovir of 5 mg/kg twice a day for 2 to 3 weeks. Antiviral therapy showed a clear improvement in 10 patients. Only one patient with no response to ganciclovir treatment improved with infliximab subsequently. Of 7 patients who were steroid-refractory and had no evidence of cytomegalovirus infection, 3 patients had a delayed response to steroid therapy, 1 patient improved with infliximab, and 3 patients received ganciclovir therapy based on clinical suspicion of cytomegalovirus-induced colorectal ulcerations. Conclusions: Before rescue medical therapy with cyclosporine or infliximab in patients with steroid-refractory ulcerative colitis, treatment for cytomegalovirus infection should be considered if cytomegalovirus infection was identified.
Poster presentations of all) were J-pouch related complications. The operative mortality was 0.3%. When covering ileostomy was used there were significantly less leakages (6.0% vs. 16.9%, p = 0.003) and early reoperations (4.5% vs. 11. 9%, p = 0.02). The median follow up was 5 years. Pouchitis was the most common late complication occurring as at least once in 134 (38.1%) patients. Forty-two (11.9%) patients experienced pouch failure leading to pouch excision in all but one. During the first year pouch excision rate was 2.2%. Seven patients were afterwards found to have confirmed and one probable Crohn’s disease; four of these had had their pouch excised. Conclusions: The technique used in RPC in our hospital has changed over the past years. Covering ileostomy seems to protect from major complications. RPC is still associated with significant morbidity, pouchitis being the most common problem in follow up. Pouch failure is common but not inevitable in patients with a later diagnosis of Crohn’s disease. P347 The efficacy of ganciclovir therapy in patients with steroidrefractory ulcerative colitis and cytomegalovirus infection M.K. Choi1 , G.A. Song1 *, D.U. Kim1 , D.Y. Ryu1 . 1 Pusan National University College of Medicine, Internal Medicine, Busan, South Korea Background: There are some reports that cytomegalovirus infection in patients with active ulcerative colitis is associated with poor clinical course. But, it is still difficult to assess the clinical impact of cytomegalovirus infection in patients with active ulcerative colitis and decide whether to treat the infection. Thus, we evaluated the effect of antiviral therapy against cytomegalovirus infection in patients with steroidrefractory ulcerative colitis, retrospectively. Methods: 71 patients with moderate-to-severe ulcerative colitis were admitted to our hospital for treatment with intravenous methylprednisolone between January 2007 and September 2012. After admission, diagnosis of cytomegalovirus infection was performed by a serologic test and/or a histopathologic examination using immunohistochemical staining. 14 patients without evaluation for cytomegalovirus infection were excluded from the study. All patients were initially treated with a high-dose methylprednisolone (40 60 mg/day) intravenously for 7 14 days. Results: Of 57 patients enrolled, the presence of cytomegalovirus was identified in 18 patients (31.6%). 39 patients with moderate-to-severe ulcerative colitis including 7 patients with cytomegalovirus infection were responsive to initial steroid therapy. Of 18 patients with steroid-refractory ulcerative colitis, 11 patients had the cytomegalovirus infection and were treated with intravenous ganciclovir of 5 mg/kg twice a day for 2 to 3 weeks. Antiviral therapy showed a clear improvement in 10 patients. Only one patient with no response to ganciclovir treatment improved with infliximab subsequently. Of 7 patients who were steroid-refractory and had no evidence of cytomegalovirus infection, 3 patients had a delayed response to steroid therapy, 1 patient improved with infliximab, and 3 patients received ganciclovir therapy based on clinical suspicion of cytomegalovirus-induced colorectal ulcerations. Conclusions: Before rescue medical therapy with cyclosporine or infliximab in patients with steroid-refractory ulcerative colitis, treatment for cytomegalovirus infection should be considered if cytomegalovirus infection was identified.