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P557 Complex perianal fistula eradication by mucosal advancement flap in IBD patients
S234 results of this study indicated that along with concomitant immunomodulators and smoking cessation, loss of response to IFX in CD patients appears to be delayed by use of EN 600 kcal/day. Moreover, the economic merit of concomitant EN is superior to intensification of IFX. Concomitant EN should be reconsidered in the clinical management of patients with CD treated with anti-TNF-a regimens. P557 Complex perianal fistula eradication by mucosal advancement flap in IBD patients Z. Serclova1 *, O. Ryska1 , J. Kalvach1 , J. Fulik2 . 1 Central Military Hospital, Department of Surgery, Prague 6, Czech Republic, 2 University Hospital Bulovka, Department of Surgery, Prague 8, Czech Republic Background: Perianal fistulas influence greatly the life of IBD patients. New methods of conservative treatment, including biological therapy, improve patients’ quality of life, but don’t lead towards the complete healing. Success rate of surgical treatment by closure of inner opening by Advancement Flap (AF) varies between 40 80%. We assume that pre-treatment with non-cutting setons, event. multiple drainages prevents residual abscesses, enables good timing of AF and may improve the results. The aim of the study was to evaluate the results of IBD patients, treated step by step by multiple drainages followed by advancement flap. Methods: All IBD patients indicated for AF procedure for complex fistula in the period 6/2006 10/2012 were included in the retrospective analysis. After initial seton placement, re-drainage was performed in case of recurring abscesses or to simplify secondary fistula tracts. Afterwards fistula was eradicated by mucosal AF method. Concomitant medication was recorded. Continuing fistula secretion up to 3 months was assessed as a healing failure otherwise as a recurrence. Fisher’s exact test was used for groups assessment. Results: Fifty-three patients (36; 68% F/17; 32% M) in mean age of 34.3(±8.9) years, 48 (91%) with diagnosis of Crohn’s disease and 5 (9%) ulcerative colitis were enrolled. Median number of drainages prior to the AF was 2 (1 9) during the period 11 (1 58) months. Primary healing of AF was achieved in 48 (91%) patients; afterwards 2/5 failed cases were successfully managed with repeated AF. Fistula recurred in 4 (7.5%) patients in 18 (4 32) months. One of these was successfully healed after repeated AF. Recto-vaginal fistula was recognised as a risk factor of surgical failure (RR: 12.3; CI95%: 1.5 100.5; p = 0.02). Smoking was not found as a risk factor of healing. There was a trend to healing failure in group of 33 pts. (66%) receiving biologic therapy (RR: 2.06; CI95%: 0.248 17.08; p = 0.504) and to lower recurrence rate (RR: 0.17; CI95%: 0.02 1.53; p = 0.115). Five patients had a stoma while AF surgery, 4/5 were later successfully closed. In 5 others a stoma needed to be performed during the follow-up (3 for the luminal disease). Conclusions: Sequent surgical treatment of IBD perianal fistulas; long term drainages followed by AF; is effective in fistula eradication with low failure (9%) and recurrence (7.5%) rate. Totally 47 (89%) patients have healed AF and 45 (85%) live out of fistula and without the stoma in the median follow up of 21 (1 78) months. P558 Complementary and alternative medicine use in Finnish adolescents with IBD and juvenile idiopathic arthritis P. Nousiainen1,2 *, K. Aalto2 , K.-L. Kolho2 . 1 Kuopio University Hospital, Department of Pediatrics, Kuopio, Finland, 2 Helsinki University Hospital, Children’s Hospital, Helsinki, Finland Background: Concept of complementary and alternative medicine (CAM) comprehends practices and products that aren’t considered conventional medicine. Physicians are often
Poster presentations unaware of CAM use, despite potential side effects and interactions with conventional therapy. CAM use is less studied in paediatric populations. The aim of this study was to determine the extent and features of CAM use in a Finnish adolescent IBD and juvenile idiopathic arthritis (JIA) population. Methods: CAM use during last 12 months was assessed by a questionnaire in consecutive outpatient IBD and JIA patients (9.6 18.3 years) in Children’s Hospital, Helsinki. Vitamin D, Ca2++ preparations and supplement nutritional drinks were excluded, being prescribed by the physician. Study protocol was approved by the Ethical Committee of Helsinki University Hospital. Statistical analysis was performed on Prism GraphPad 6. Study ID: T104G0010 Children’s Hospital, Helsinki University Financial support: Finnish Pediatric Research Foundation and Helsinki University Central Hospital Fund Results: 147 out of 225 questionnaires were completed (65%, 97 IBD and 50 JIA patients). Response rate of IBD patients was significantly higher than of JIA patients (76% and 51% respectively, p = 0.0001). Of all patients, 48% regularly used CAM (54% and 38% of IBD and JIA patients respectively, p = 0.08) and 81% had at least tried CAM. Most common forms of regularly used CAM are shown in Table 1. In previous studies mind-body and manipulative CAM have been popular among adolescent IBD and JIA patients. However, in our study use was rare: acupuncture had been used by 4 patients and osteopathy, energy treatments and zone therapy by only one patient each. Table 1. The most common forms of regularly used CAM
Probiotics Multivitamin products Minerals and trace elements Omega 3&6 products Supplementary products for athletes
IBD (n = 52)
JIA (n = 19)
62% 54% 37% 23% 12%
58% 42% 21% 37% 0%
Among IBD patients CAM-users were younger than non-users (14.9 vs. 15.8 years, p = 0.022). Medication (steroids, TNF a blockers, other immunosuppressants) or gender didn’t associate with CAM use. It is notable that 52% of CAM users had special diets, significantly more often than non-users (32%, p = 0.012). Conclusions: CAM use is frequent also among Finnish adolescent IBD and JIA patients. Paediatricians should actively ask about CAM use and special diets, since they may influence the treatment or outcome of the disease. Paediatricians would most likely benefit from familiarising themselves with the basic concepts of CAM. P559 Comparison of health care utilization and costs among patients with fistulizing Crohn’s disease treated with biologics with or without prior seton procedure D.A. Schwartz1 *, S.F. Eichner2 , J. Lin3 , M. Skup2 , M. Yang2 , P.M. Mulani2 , J. Chao2 . 1 Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville, TN, United States, 2 Abbott Laboratories, Abbott Park, IL, United States, 3 Novosys Health, Flemington, NJ, United States Background: Biologics (TNF inhibitors) and/or seton drainage are effective options for treating patients with fistulizing Crohn’s disease (CD). The aims of this study were to compare health care utilization and costs of patients with fistulizing CD who had the seton procedure vs. those who did not have the seton procedure before treatment with biologics.
Poster presentations unaware of CAM use, despite potential side effects and interactions with conventional therapy. CAM use is less studied in paediatric populations. The aim of this study was to determine the extent and features of CAM use in a Finnish adolescent IBD and juvenile idiopathic arthritis (JIA) population. Methods: CAM use during last 12 months was assessed by a questionnaire in consecutive outpatient IBD and JIA patients (9.6 18.3 years) in Children’s Hospital, Helsinki. Vitamin D, Ca2++ preparations and supplement nutritional drinks were excluded, being prescribed by the physician. Study protocol was approved by the Ethical Committee of Helsinki University Hospital. Statistical analysis was performed on Prism GraphPad 6. Study ID: T104G0010 Children’s Hospital, Helsinki University Financial support: Finnish Pediatric Research Foundation and Helsinki University Central Hospital Fund Results: 147 out of 225 questionnaires were completed (65%, 97 IBD and 50 JIA patients). Response rate of IBD patients was significantly higher than of JIA patients (76% and 51% respectively, p = 0.0001). Of all patients, 48% regularly used CAM (54% and 38% of IBD and JIA patients respectively, p = 0.08) and 81% had at least tried CAM. Most common forms of regularly used CAM are shown in Table 1. In previous studies mind-body and manipulative CAM have been popular among adolescent IBD and JIA patients. However, in our study use was rare: acupuncture had been used by 4 patients and osteopathy, energy treatments and zone therapy by only one patient each. Table 1. The most common forms of regularly used CAM
Probiotics Multivitamin products Minerals and trace elements Omega 3&6 products Supplementary products for athletes
IBD (n = 52)
JIA (n = 19)
62% 54% 37% 23% 12%
58% 42% 21% 37% 0%
Among IBD patients CAM-users were younger than non-users (14.9 vs. 15.8 years, p = 0.022). Medication (steroids, TNF a blockers, other immunosuppressants) or gender didn’t associate with CAM use. It is notable that 52% of CAM users had special diets, significantly more often than non-users (32%, p = 0.012). Conclusions: CAM use is frequent also among Finnish adolescent IBD and JIA patients. Paediatricians should actively ask about CAM use and special diets, since they may influence the treatment or outcome of the disease. Paediatricians would most likely benefit from familiarising themselves with the basic concepts of CAM. P559 Comparison of health care utilization and costs among patients with fistulizing Crohn’s disease treated with biologics with or without prior seton procedure D.A. Schwartz1 *, S.F. Eichner2 , J. Lin3 , M. Skup2 , M. Yang2 , P.M. Mulani2 , J. Chao2 . 1 Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville, TN, United States, 2 Abbott Laboratories, Abbott Park, IL, United States, 3 Novosys Health, Flemington, NJ, United States Background: Biologics (TNF inhibitors) and/or seton drainage are effective options for treating patients with fistulizing Crohn’s disease (CD). The aims of this study were to compare health care utilization and costs of patients with fistulizing CD who had the seton procedure vs. those who did not have the seton procedure before treatment with biologics.