- Email: [email protected]
P389 Reactive oxygen metabolites and antioxidants as biomarkers of disease severity in ulcerative colitis
Clinical: Therapy and observation 7 versus 6 years, smoking 23% vs. 31%, thiopurine use 46% vs. 69% and proportion of patients with pancolitis 90% vs. 69% in the ciclosporin and infliximab group, respectively. The median length of hospital stay after initiation of therapy was 10.3 days in ciclosporin treated patients (range 6 19 days) vs. 4.5 days in the infliximab group (range 2 8 days) (P < 0.0001). Hospital costs without drug costs were significantly greater for ciclosporin than for infliximab treated patients [average costs per patient: 5750 and 2588 euro in the ciclosporin and infliximab group, respectively (P < 0.0001)]. Total treatment costs per patient (including drug costs) averaged to 6041 vs. 4853 euro for ciclosporin and infliximab treated patients, respectively. There was no significant difference in colectomy rates in the years following rescue therapy between the two groups (42.3% and 43.8% for ciclosporine and infliximab, respectively). Conclusions: Length of hospital stay and hospital costs have been reduced significantly since the introduction of infliximab as rescue therapy for severe UC instead of ciclosporin. P388 Recurrence and long term results of laparoscopic versus open ileo-colonic resection in Crohn’s disease. A prospective longitudinal study E. Iaculli1 *, C. Fiorani2 , O. Sara2 , L. Biancone3 , T. Giorgia2 , R. Pezzuto3 , R. Scaramuzzo3 , A.L. Gaspari2 , G. Sica2 . 1 Guy’s and St Thomas’ Hospital, Surgery, London, United Kingdom, 2 Tor Vergata Roma, Italy, 3 Tor Vergata, Italy Background: Impairment in host immune response has been demonstrated in pathogenesis of Crohn’s disease (CD). Likewise laparoscopic resections for cancer have shown different immunitary modifications when compared to open techniques. Relationship between surgical approaches and the rates and severity of CD recurrence after ileo-colonic (IC) resection are unknown. Aim of this study was to assess whether the surgical approach might affect recurrence amongst 2 groups of CD patients undergoing either laparoscopic (LAP) or open ileocolonic resection. Methods: 100 consecutive patients undergoing elective IC resection by either laparoscopic approach (LAP 43%) or conventional open surgery (OPEN 57%) were enrolled in a prospective longitudinal study. Study protocol includes 3-years follow up (FU). Recurrence was investigated by coloscopy and ileoscopy (RC-I) at 12 and 36 months in all patients, CDAI was assessed every 6 months. Patient’s satisfaction to different approach was also analysed with a specific Treatment Satisfaction Questionnaire as part of the protocol. U-Mann Whitney and t-test were used to statistically compare data as appropriate. Results: Endoscopy was performed in 90 patients (90%) at 1 year and 49 patients (86%) at 3 years. Endoscopic recurrence (Rutgeerts’ score >2) was seen in 36% LAP vs 46% OPEN patients at 1 year (p 0.09) and in 48% LAP vs 47% OPEN patients at 3 years (p 0.4). Three patients (1 in the LAP group and 2 in the OPEN group) underwent re-resection during the FU period. Clinical recurrence at 36 months was 2 (8.6%) in the LAP group and 3 (5.2%) in the OPEN group. Patients’ satisfaction by specific questionnaire was significantly in favour of laparoscopy also in the long-term assessment. Conclusions: From preliminary data there was a strong difference although not statistical of endoscopic recurrence rate between laparoscopic group and open group at 1 year assessment. This difference was lost at 3 years. Larger series are required to confirm these outcomes and to explore whether this is due to immunologic definite modifications. Longterm outcome for laparoscopy are comparable to standard procedure. Anyway Treatment Satisfaction assessment showed a strongly significant preference of patients for the miniinvasive approach. Laparoscopic IC resection should be offered to CD patients referred for surgery.
S165 P389 Reactive oxygen metabolites and antioxidants as biomarkers of disease severity in ulcerative colitis B. Canbakan1 *, M. Tuncer1 , E. Koroglu1 , A. Sonsuz1 , H. Senturk2 . 1 Istanbul University Cerrahpasa Medical Faculty, Gastroenterology, Istanbul, Turkey, 2 Bezmi Alem University, Gastroenterology, Turkey Background: Neutrophil accumulation in the mucosa and the subsequent induction of oxidative stress correlate with clinical disease activity in ulcerative colitis (UC). We investigated the redox parameters in tissue specimens and their correlations with clinical activity index in UC. Methods: 35 patients with ulcerative colitis (M/F: 18/17; mean age 38.14±13.6) were compared with 29 control subjects (M/F: 15/14; mean age 45.96±14.43 years). Mucosal biopsies were obtained from patients with active UC. Disease activity was assessed using Truelove Witts classification. Index values below 150, values between 150 and 220, and values above 220 corresponded to mild, moderate, and severe disease, respectively. Oxidative stress was estimated on the basis of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPO), and myeloperoxidase (MPO) levels in tissue specimens, using the thiobarbituric acid-trichloroaceticacid assay for MDA-, phenyltetrazolium chloride assay for SOD-, method of Paglia and Valentine for GPO-, and tetramethyl benzidin assay for MPO measurement. For statistical analysis chi-squared, Student’s t-tests, and Spearman correlation test were used. Results: In control subjects MDA levels correlated positively with GPO, MPO and SOD levels (r = 0.79, p = 0.01, r = 0.76, p = 0.01, r = 0.39, p = 0.030). MDA level of patients with mild AI correlated positively with GPO and SOD levels (r = 0.79, p = 0.01, and r = 0.86, p = 0.01). Patients with high AI had a weak significant positive correlation between MDA and SOD levels (r = 0.68, p = 0.049). Patients with mild and moderate AI had similar MDA levels as the controls. Patients with severe AI had significantly higher MDA and MPO levels than the controls (p = 0.03, and 0.004, respectively). Patients with moderate AI had significantly higher MPO and GPO levels (p = 0.002, and 0.044, respectively). Conclusions: We found increased ROS and antioksidants levels in patients with severe clinical AI. There was a less prominent positive correlation between ROS and antioxidants in patients with moderate and severe AI as compared with control subjects and patients with mild AI. When the oxidative stress overrides the antioxidant capacity, the insufficient production against oxidative stres induces progression of clinical disease severity. Therefore, in UC therapeutic interventions should be aimed to improve the antioxidant status. P390 Re-introduction of infliximab after consecutive failure of infliximab and adalimumab is beneficial in refractory Crohn’s disease J.F. Brandse1 *, C.P. Peters1 , E.J. Eshuis1 , M. Lowenberg1 , C.Y. Ponsioen1 , G.R. van den Brink1 , G.R.A.M. D’Haens1 . 1 Academic Medical Center, Gastroenterology and Hepatology, Amsterdam, Netherlands Background: In the last decade, Infliximab (IFX) and Adalimumab (ADA) have dramatically improved the management of steroid refractory Crohn’s disease (CD). In clinical practice a considerable group of patients are switched from one agent to the other because of failure, intolerance and patient preference. There are no data regarding the long term clinical response of re-exposure to IFX in patients who sequentially used and discontinued IFX and ADA. Therefore we retrospectively assessed clinical response to IFX in CD patients that failed subsequently IFX and ADA and were re-exposed to IFX.
S165 P389 Reactive oxygen metabolites and antioxidants as biomarkers of disease severity in ulcerative colitis B. Canbakan1 *, M. Tuncer1 , E. Koroglu1 , A. Sonsuz1 , H. Senturk2 . 1 Istanbul University Cerrahpasa Medical Faculty, Gastroenterology, Istanbul, Turkey, 2 Bezmi Alem University, Gastroenterology, Turkey Background: Neutrophil accumulation in the mucosa and the subsequent induction of oxidative stress correlate with clinical disease activity in ulcerative colitis (UC). We investigated the redox parameters in tissue specimens and their correlations with clinical activity index in UC. Methods: 35 patients with ulcerative colitis (M/F: 18/17; mean age 38.14±13.6) were compared with 29 control subjects (M/F: 15/14; mean age 45.96±14.43 years). Mucosal biopsies were obtained from patients with active UC. Disease activity was assessed using Truelove Witts classification. Index values below 150, values between 150 and 220, and values above 220 corresponded to mild, moderate, and severe disease, respectively. Oxidative stress was estimated on the basis of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPO), and myeloperoxidase (MPO) levels in tissue specimens, using the thiobarbituric acid-trichloroaceticacid assay for MDA-, phenyltetrazolium chloride assay for SOD-, method of Paglia and Valentine for GPO-, and tetramethyl benzidin assay for MPO measurement. For statistical analysis chi-squared, Student’s t-tests, and Spearman correlation test were used. Results: In control subjects MDA levels correlated positively with GPO, MPO and SOD levels (r = 0.79, p = 0.01, r = 0.76, p = 0.01, r = 0.39, p = 0.030). MDA level of patients with mild AI correlated positively with GPO and SOD levels (r = 0.79, p = 0.01, and r = 0.86, p = 0.01). Patients with high AI had a weak significant positive correlation between MDA and SOD levels (r = 0.68, p = 0.049). Patients with mild and moderate AI had similar MDA levels as the controls. Patients with severe AI had significantly higher MDA and MPO levels than the controls (p = 0.03, and 0.004, respectively). Patients with moderate AI had significantly higher MPO and GPO levels (p = 0.002, and 0.044, respectively). Conclusions: We found increased ROS and antioksidants levels in patients with severe clinical AI. There was a less prominent positive correlation between ROS and antioxidants in patients with moderate and severe AI as compared with control subjects and patients with mild AI. When the oxidative stress overrides the antioxidant capacity, the insufficient production against oxidative stres induces progression of clinical disease severity. Therefore, in UC therapeutic interventions should be aimed to improve the antioxidant status. P390 Re-introduction of infliximab after consecutive failure of infliximab and adalimumab is beneficial in refractory Crohn’s disease J.F. Brandse1 *, C.P. Peters1 , E.J. Eshuis1 , M. Lowenberg1 , C.Y. Ponsioen1 , G.R. van den Brink1 , G.R.A.M. D’Haens1 . 1 Academic Medical Center, Gastroenterology and Hepatology, Amsterdam, Netherlands Background: In the last decade, Infliximab (IFX) and Adalimumab (ADA) have dramatically improved the management of steroid refractory Crohn’s disease (CD). In clinical practice a considerable group of patients are switched from one agent to the other because of failure, intolerance and patient preference. There are no data regarding the long term clinical response of re-exposure to IFX in patients who sequentially used and discontinued IFX and ADA. Therefore we retrospectively assessed clinical response to IFX in CD patients that failed subsequently IFX and ADA and were re-exposed to IFX.