P402 Faecal calprotectin but not serum CRP predicts post-operative endoscopic recurrence of Crohn's disease

Clinical: Therapy and observation median age was 48 and median disease follow up was 6.5 years. Seventeen percent of were not on treatment; 36% on 5 ASA and 47% of patients were on effective immunosuppression. These included patients on thiopurines 40.3% (19), Methotrexate 4.2% (2) Infliximab 10.6% (5), Thiopurines +Infliximab 23.3% (11), Methotreaxte+Infliximab 2.1% (1), Adalimumab 4.2% (n = 2), Adalimumab+Thiopurines 2.1% (n = 1), Glucocorticoids 8.4% (4) and Infliximab + Prednisolone 4.2% (2). Immunization history was taken in 20% of the patients. Chest radiographs were performed in 42.5% (20) of patients, 25.5% were tested for Hepatitis B, 25.5% for Hepatitis C, 10.6% for HIV and 8.5% were tested for varicella titres. Cervical smears were performed in 19.2% (9) women. Of the patients on immunosuppressant 40.4% had no screening tests. Immunisation was carried out in 57.4% for Influenza, tetanus (38.3%), diphtheria (27.6%), pneumococcal (19.1%), meningococcus (10.6%), Hepatitis B (6.3%), HPV (6.3%) and MMR (17%). Twenty three percent of patients on immunosuppressants had no vaccinations. Conclusions: Our current practice was not in line with ECCO recommendations. IBD physicians must work in collaboration with primary care providers to ensure appropriate screening and vaccination in this vulnerable group. We have taken appropriate steps to ensure prompt screening of patients through a newly designed proforma. Reference(s) [1] J.F. Rahier et al. Journal of Crohn’s & Colitis (2009) 3, 47 91. P401 Long term effect of anti-TNFa agents on the lipidemic profile of IBD patients P. Konstantopoulos1 *, K. Papamichael1 , E. Archavlis1 , A. Smyrnidis1 , N. Kyriakos1 , I. Drougas1 , G. Agalos1 , D. Tsironikos1 , X. Tzanetakou1 , I. Theodoropoulos1 , G.J. Mantzaris1 . 1 Evaggelismos Hospital, A’ Gastroenterology Clinic, Athens, Greece Background: Crohn’s disease (CD) and ulcerative colitis (UC) are associated with increased risk of atherosclerosis and vascular complications. TNF-a, a critical mediator of inflammation, plays an important role in metabolic profile; however, the effect of the anti-TNF agents infliximab (IFX) and adalimumab (ADA) on lipid profile remains controvesial in IBD. This study aimed at assessing the long term effect of IFX and ADA on the lipidemic profile of IBD patients. Methods: Serum total cholesterol (sTC), triglycerides, HDL cholesterol (HDLc), and LDL cholesterol (LDLc) were prospectively measured at baseline and between 52 and 104 weeks (median 71) after successful scheduled maintenance treatment with IFX (n = 90) or ADA (n = 14) in 104 IBD patients (58 females; 79 CD). Fifty six healthy volunteers were served as controls. Results: At baseline, sTC levels were significantly lower in CD but not in UC patients compared to the control group. In contrast, there were no significant differences between CD or UC patients and controls in the levels of triglycerides, HDLc and LDLc. Anti-TNF maintenance treatment resulted in an increase in the body mass index in all IBD patients and an increase in the mean sTC levels compared to baseline in CD (177 vs 158 mg/dl, p = 0.02) but not in UC patients (171 vs 175 mg/dl, p > 0.05). This therapy, however, had no effect on the mean triglycerides, HDLc and LDLc levels over baseline in either CD or UC. Conclusions: Of the lipid profile, only sTC levels and only in CD patients were significantly increased over baseline after successful long term anti-TNFa therapy. Other elements of the lipid profile (triglycerides, HDL-c and LDL-c levels) were not affected by treatment despite a rise in the BMI index. The pathophysiologic and clinical implications of these alterations await confirmation by future larger scale studies.

S169 P402 Faecal calprotectin but not serum CRP predicts post-operative endoscopic recurrence of Crohn’s disease K. Papamichael1 , E. Archavlis1 , N. Kyriakos1 , C. Kalantzis1 , I. Drougas1 , P. Konstantopoulos1 *, D. Tsironikos1 , X. Tzanetakou1 , I. Internos1 , G.J. Mantzaris1 . 1 Evaggelismos Hospital, A’ Gastroenterology Clinic, Athens, Greece Background: Postoperative endoscopic recurrence (PoER) of Crohn’s disease (CD) is documented by ileocolonoscopy but this is a costly and unpleasant procedure. We aimed at assessing the role of clinical, serological and faecal markers of inflammation to predict PoER of CD using endoscopy as the golden standard. Methods: For this single-centre, retrospective analysis of prospectively collected data (2004 2009) eligible were patients with ileocaecal resection for complicated CD at high risk for PoER. Patients were followed for 2 years by a standardized protocol which included start of treatment at 2 weeks after surgery and outpatient visits every 2 months with physical examination, review of CDAI, and full-blood count, ESR, serum CRP and faecal calprotectin [FC, rapid hemiquantitative immuno-chromatographic test (PreventID® Cal Detect, Preventis® ), with a cut off value of 15 mg/g]. Patients were endoscoped at 6, 12 and 24 months. A Rutgeerts score i2 (R-i2s) was considered as PoER. Results: Fifty nine patients [30 males, median age 28.5 years (range 18 69), 39 ileitis, 20 ileocolitis, 15 with perianal disease, 9 with extra-intestinal manifestations, 44 smokers] were included in this study. Pre-operative treatment included mesalazine (n = 26), azathioprine (n = 19) and anti-TNF agents (n = 14). Post-operatively patients received AZA (n = 44) or anti-TNF agents (n = 15). PoER relapse rates were 6.8% (4/59) at 6 months, 16.9% (10/59) at 1 year, and 25.4% (15/59) at 2 years; 9 patients had R-i2s, 5 had R-i3s, and 1 had R-i4s. Ten relapsers were on AZA and 5 on anti-TNFs (p = 0.5). FC was persistently abnormal (>60 mg/g) in all 15 patients prior to confirmation of PoER irrespective of Rs compared with 8/15 (53.3%) with abnormal serum CRP (P = 0.017). CRP was moderately (r = 0.57) but ESR very poorly correlated (r = 0.21) with PoER-R score. Clinical relapse rates (CDAI >150) were 1.7%, 6.8%, and 11.6% at 6, 12, and 24 months. Conclusions: FC, assessed by a rapid test, was the most sensitive test to predict PoER of CD compared with ESR, CRP, or CDAI. P403 Adalimumab sustains deep remission for 3 years: Data from CHARM and ADHERE W. Sandborn1 *, J.-F. Colombel2 , E. Louis3 , R. Panaccione4 , M. Yang5 , J. Chao5 , R. Thakkar5 , A. Robinson5 , P. Pollack5 , P. Mulani5 . 1 University of California, San Diego, La Jolla, United States, 2 Centre Hospitalier Universitaire de Lille, Hˆ opital Claude Huriez, Lille, France, 3 University of Li` ege and CHU Li` ege, Department of Gastroenterology, Li` ege, Belgium, 4 University of Calgary, Director, Inflammatory Bowel Disease Clinic, Calgary, Canada, 5 Abbott Laboratories, Illinois, United States Background: Deep remission (DR), defined as clinical remission and mucosal healing (MH), has been identified as an important therapeutic goal in Crohn’s disease (CD). Evidence of DR beyond one year has not been characterized. We aimed to evaluate the impact of adalimumab (ADA) on DR over a 3-year period. Methods: We analyzed the intention-to-treat (ITT) population from CHARM (56 weeks, randomized at Week 4 to placebo (PBO), ADA 40 mg every other week (eow), and ADA 40 mg weekly) and its 2-year open label extension ADHERE (all patients given open-label ADA 40 mg eow or weekly). Due to the absence of endoscopic measurements in CHARM and ADHERE, a practical index obtained from a Least Absolute Shrinkage and Selection Operator (LASSO) procedure was used