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P432 Long term follow-up results of 14 patients with dominant stricture with PSC in IBD
S246 to corticosteroids treatment prior to thiopurines, a higher baseline hemoglobin, and hematocrit. Multivariate logistic regression identified fistulizing CD and postoperative maintenance are best indications for thiopurines maintenance therapy. P432 Long term follow-up results of 14 patients with dominant stricture with PSC in IBD M. Basaranoglu, I. Taskiran, E. Parlak, E. Kayacetin *. T¨ urkiye Y¨ uksek Ihtisas Hospital, Gastroenterology, Ankara, Turkey Background: Cholangiocarcinoma (CC) complicates in 10 20% of the patients with dominant stricture (DS) in patients with primary sclerosing cholangitis (PSC) related with inflammatory bowel diseases (IBD). Methods: We investigated 2200 patients with IBD for PSC with DS. Results: PSC was diagnosed in 41 pts (1.6%). Of the 41 pts with PSC, DS was diagnosed in 14 (34%); 64% were male, and followed for a mean of 4.86 yrs (0 13 yrs). Main finding was pruritis alone in 64% pts with DS as in 15% without DS (p = 0.003). The diagnose date of both IBD and PSC was younger in pts with DS than without DS (36.9 yrs vs. 38.1 and 40.2 yrs vs. 41.1 yrs; p > 0.05, respectively). Only current ALP and GGT levels were differ between the groups (p: 0.003 and p: 0.001, respectively). In this study, ERCP performed in 22 pts with PSC and was the main diagnostic tool for the questioning the occurence of DS (p = 0.011), besides CT, MRI and liver bx. ERCP usually performed more than once. EST and baloon dilation performed in all pts with stenting in 9 pts. Brush cytology performed only in 3 pts with strong suspicious for CC and benign pathology reported. IBD disease duration was longer in pts without DS than with DS (10.4 yrs vs. 8.1 yrs, p > 0.05). During the follow-up, 2 patients dead due to the causes other than CC; one due to endstage liver disease, and one had back wash ileitis complicated with colon malignancy and later died. Liver transplantation performed twice in one patient and still alive and in a good condition. At the same time, we evaluated our last 5-years pathology records for CC in a different study, and found 19 cases. None was related with our IBD or PSC-IBD group. Of the 19, colonoscopy performed in 5, and showed no IBD on biopsy. Conclusions: In our series, dominant strictures with PSC related with IBD showed a relatively benign nature differently from the current literature. P433 Is e-Health, web-based monitoring and treatment, useful for children and adolescents with inflammatory bowel disease? a paediatric clinical trial K. Carlsen1,2 *, C. Jakobsen1 , L.F. Hansen1 , A. Paerregaard1 , V. Wewer1 , P. Munkholm2 . 1 Copenhagen University Hospital, Department of Paediatrics, Hvidovre, Denmark, 2 Copenhagen University Hospital, Department of Gastroenterology, Herlev, Denmark Background: e-Health, web-based monitoring, decrease time from relapse to remission and improve adherence and Quality of Life (QoL) in adult patients with Inflammatory Bowel Disease (IBD) [1,2]. Adherence to medicine in young patients with IBD is low [3]. It is our hypothesis that e-Health can optimize adherence and empower young patients (10 17 years) by integrating themselves in their own disease course. Methods: The adult e-Health web-program Constant Care (ConstantMED© ) is used as a basis to design the web program for young patients. In www.young.constant-care.com paediatric IBD scores (PUCAI and abbPCDAI), medication, need for corticosteroids, QoL (IMPACT III questionnaire), adherence (Medication Adherence Report Scale and Visual Analog Scale), days of absence from school, need for contact to the hospital, surgery and hospitalizations are measured. Two studies are designed to evaluate the value of the web-program: study A,
Poster presentations patients treated with self-administrated medicine and study B, patients treated with Infliximab. The patients enter their symptoms in the web-program and submit a stool sample for fecal calprotectin (FC) analysis at regular intervals. Disease burden is estimated using a combination of FC levels and PUCAI/abbPCDAI. The results red are shown to the patient into a traffic light curve colour indicating severe disease activity, yellow colour light to moderate activity and green colour inactive disease. Depending on the colour different advises are given to the patient. The medical doctor monitors the patients by web-rounds weekly. Results: www.young.constant-care.com is now constructed and available to the young patients. A total of 121 patients aged 10 17 years old have been invited to participate in the projects (83 in project A, 38 in project B). After a 2.5 months of inclusion 53 patients are included, 34 in study A and 19 in study B. 3 patients have been excluded. 42% (51/121) patients were not interested in participating giving following reasons: (1) too time consuming (n = 6); (2) no wish to be reminded of the disease (n = 5); (3) problems with submitting fecal samples (n = 2); (4) other reasons (n = 15); (5) no response to approach (n = 23). Ratio of number entries in the web-program per expected entries is 0.89 (40/45). Ratio of submitted fecal test per expected is 0.85 (23/27). Conclusions: www.young.constant-care.com is established and ready to use. The rate of entries and submitted stool samples indicate that patients in the age group 10 17 years can and are interested in the use of the e-Health system and that regular fecal sampling for monitoring disease activity is possible in this age group. Reference(s) [1] Elkjaer M Gut 2010. [2] Pedersen N APT 2012. [3] LeLeiko N IBD 2012. P434 Iron deficiency anemia in inflammatory bowel disease: are we treating our patients efficiently? D. Trabulo *, C. Teixeira, J. Mangualde, I. Cremers, A.P. Oliveira. Centro Hospitalar de Set´ ubal Hospital de S˜ ao Bernardo, Gastroenterology, Set´ ubal, Portugal Background: Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD) known to negatively impact quality of life. However, this condition appears to be under-diagnosed and undertreated. Guidelines for IDA diagnosis and treatment were recently updated, but their applicability in daily practice is still unknown. Our objectives were to survey the prevalence and characteristics of anemia in IBD patients, to correlate it with the type of disease and to evaluate the effectiveness of several iron compounds in its treatment. Methods: Retrospective study of IBD patients followed-up in our outpatient clinic in a 3 year period. Demographic, clinical and laboratorial data were collected from patient files. Response to therapy with different iron compounds was based on variation of hemoglobin (Hb) complete response if Hb variation 2 g/dL). Statistical analysis with Chi-square and Student’s t tests (significance level = 0.05). Results: From a clinic with 430 registered patients, we evaluated 149 patients: 49 years-old mean-age at study entry; 53% males; 40% had Crohn’s disease (CD) and 60% had ulcerative colitis (UC). Mean duration of disease was 10.4 years. Anemia was found in 31% of the patients, of whom 96% showed associated IDA. Mean baseline Hb was 9.9 g/dL. Prevalence of anemia was higher in CD than in UC (40% vs 27%;p = 0.07). Patients with CD took more years to be diagnosed with anemia (p = 0.01). Presence of anemia was associated with female gender (p = 0.005), higher IBD activity, steroid use, need of hospitalization (p=0), and increased acute phase reactants
Poster presentations patients treated with self-administrated medicine and study B, patients treated with Infliximab. The patients enter their symptoms in the web-program and submit a stool sample for fecal calprotectin (FC) analysis at regular intervals. Disease burden is estimated using a combination of FC levels and PUCAI/abbPCDAI. The results red are shown to the patient into a traffic light curve colour indicating severe disease activity, yellow colour light to moderate activity and green colour inactive disease. Depending on the colour different advises are given to the patient. The medical doctor monitors the patients by web-rounds weekly. Results: www.young.constant-care.com is now constructed and available to the young patients. A total of 121 patients aged 10 17 years old have been invited to participate in the projects (83 in project A, 38 in project B). After a 2.5 months of inclusion 53 patients are included, 34 in study A and 19 in study B. 3 patients have been excluded. 42% (51/121) patients were not interested in participating giving following reasons: (1) too time consuming (n = 6); (2) no wish to be reminded of the disease (n = 5); (3) problems with submitting fecal samples (n = 2); (4) other reasons (n = 15); (5) no response to approach (n = 23). Ratio of number entries in the web-program per expected entries is 0.89 (40/45). Ratio of submitted fecal test per expected is 0.85 (23/27). Conclusions: www.young.constant-care.com is established and ready to use. The rate of entries and submitted stool samples indicate that patients in the age group 10 17 years can and are interested in the use of the e-Health system and that regular fecal sampling for monitoring disease activity is possible in this age group. Reference(s) [1] Elkjaer M Gut 2010. [2] Pedersen N APT 2012. [3] LeLeiko N IBD 2012. P434 Iron deficiency anemia in inflammatory bowel disease: are we treating our patients efficiently? D. Trabulo *, C. Teixeira, J. Mangualde, I. Cremers, A.P. Oliveira. Centro Hospitalar de Set´ ubal Hospital de S˜ ao Bernardo, Gastroenterology, Set´ ubal, Portugal Background: Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD) known to negatively impact quality of life. However, this condition appears to be under-diagnosed and undertreated. Guidelines for IDA diagnosis and treatment were recently updated, but their applicability in daily practice is still unknown. Our objectives were to survey the prevalence and characteristics of anemia in IBD patients, to correlate it with the type of disease and to evaluate the effectiveness of several iron compounds in its treatment. Methods: Retrospective study of IBD patients followed-up in our outpatient clinic in a 3 year period. Demographic, clinical and laboratorial data were collected from patient files. Response to therapy with different iron compounds was based on variation of hemoglobin (Hb) complete response if Hb variation 2 g/dL). Statistical analysis with Chi-square and Student’s t tests (significance level = 0.05). Results: From a clinic with 430 registered patients, we evaluated 149 patients: 49 years-old mean-age at study entry; 53% males; 40% had Crohn’s disease (CD) and 60% had ulcerative colitis (UC). Mean duration of disease was 10.4 years. Anemia was found in 31% of the patients, of whom 96% showed associated IDA. Mean baseline Hb was 9.9 g/dL. Prevalence of anemia was higher in CD than in UC (40% vs 27%;p = 0.07). Patients with CD took more years to be diagnosed with anemia (p = 0.01). Presence of anemia was associated with female gender (p = 0.005), higher IBD activity, steroid use, need of hospitalization (p=0), and increased acute phase reactants