Regional differences of mucosal hydrophobicity in the gastrointestinal tract of healthy subjects

Abstracts administration for 7 days. All patients also received hydrocortisone 100 mg once daily rectally. On admission, a plain abdominal x-ray to exclude colonic dilatation or perforation, a complete blood chemistry including biomarkers of inflammation (Erythrocyte Sedimentation Rate and C-reactive protein), a flexible sigmoidoscopy and a stool culture, including ova/parasites and Clostridium difficile toxin, were obtained. Results: Sixty-six patients were enrolled (35 males, mean age 38±15, range 18-75 years); 15 patients presented at their first attack of UC, while in remaining cases the mean length of the disease was 4.5±5 years. At inclusion forty patients had a pancolitis, while the remaining had a left-sided colitis. Overall, thirty-three patients (50%) were in clinical remission after 7 days of treatment: 16 out of 32 patients in group A, and 17 out of 34 in group E, respectively. Thirty-one patients eventually underwent total colectomy (12 in group A, and 9 in group E, respectively), which was carried out within the first month in 10 patients (5 in each group). Twenty-eight patients (15 in group A and 13 in group E) complained steroid-related adverse reactions. All differences were not statistically significant. Conclusions: Continuous infusion of 6-methyl-prednisolone was no better that the same dose in two bolus administration in term of clinical remission, urgent or delay colectomy and adverse events.

PA.201 REGIONAL DIFFERENCES OF MUCOSAL HYDROPHOBICITY IN THE GASTROINTESTINAL TRACT OF HEALTHY SUBJECTS S. Eertolazzi, A. Mora, F. Lanzarotto, M. Amato, C. Ricd, A. Lanzini*

Gastroenteroly Unit, University awl Spedali Civili, Brescia Background and aim: Gastro-intestinal epithelium is lined with a hydrophobic surface barrier (mainly constituted of mucous gel), that is thought to be important in regulating unmediated diffusion of solutes. The surface hydrophobicity can be quantitated by measuring contact angles (CA) formed with water, but information in humans is limited and mainly restricted to the stomach. The aim of our study was to investigate regional differences in the human gastro-intestinal tract by measuring CA on fresh mucosal biopsies taken at endoscopy in the oesophagus, gastric corpus and antrum, distal duodenum, distal ileum and rectum. Material and methods: CA measurement was carried out using a Rame Hart 100110 goniometer. For validation we assessed the effect on CA of biopsy washing with saline (n = 15 gastric corpus) and of biopsy air drying (n = 15 gastric corpus, n = 15 duodenum) prior to measurements. CA measurement was carried out in 167 biopsies in 60 subjects with normal upper and lower endoscopy, and with normal histology. Results are reported as mean values + SEM. Results: Validation study: biopsies washing with saline decreased coefficent of variation of CA measurement from 11%± 9% to 8% ± 1%, and biopsies air drying increased CA from 50° ± 2° at time 10 min to 64° ± 3° and 65° ± 2° at 20min and 60 min, respectively. CA was 57.8° ± 6.2° in distal oesophagus. 70.7° ± 1.1° in gastric corpus, 73.9° ±1.0° 0 in gastric antrum, 60.36° ± 1.6° in distal duodenum, 46.8° ± 1.T in distal ileum and 65.8° ± 2.5° in rectum. CA values were significantly higher in gastric corpus and antrum by comparison with distal oesophagus (p corpus> rectum> duodenum> oesophagus > ileum. Regional differences of hydrophobicity contributes to explain pathophysiological phenomena, including the high prevalence of acid related diseases not only in the duodenum but also in the oesophagus because the low hydrophobicity acts as a weak mucosal protection against luminal acid.

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PA.202 COMPARISON BETWEEN INTRAVENOUS IRON GLUCONATE ALONE AND INTRAVENOUS IRON GLUCONATE PLUS LEVOFOLINIC ACID FOR THE TREATMENT OF IRON DEFICIENCY ANAEMIA IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE A. Papa *, S. Danese, S. Guglielmo, 1. Roberto, M. Covino, A. Grillo, R. Urgesi, S. Semeraro, M. Eonizzi, G. Fedeli, L. Guidi, A. Gasbarrini, G. Gasbarrini

Internal Medicine, Catholic University, Rome Background and aim: Anaemia is a common clinical feature in IBD patients, with rates between 30% and 50%, leading to impaired quality of life. IBD-associated anaemia has a multifactorial aetiology but iron deficiency is the leading cause. Aim of this prospective open study was to compare the efficacy and safety of two different regimens for the treatment of iron deficiency anaemia (IDA) in IBD patients. Material and methods: We enrolled 30 IBD patients (12 with Crohn's disease and 18 with ulcerative colitis) with IDA, defined as haemoglobin (Hb) value <10.5g/dl and hypochrome and microcytotic erythrocytes. None of the patients had hemolysis, macrocytic anaemia, or renal insufficiency. Patients were consecutively randomised in two groups comparable for disease type, activity and treatment. Fifteen patients were included in group A, receiving 10 daily infusions of 5 ml of iron gluconate (each corresponding to 62.5 mg of Fe 3+) [Ferlixit®, Aventis] and 15 patients were included in group E, receiving daily the same infusion of iron gluconate followed by the intravenous administration of 25 mg of levofolinic acid [Levofolene®, Schering]. Clinical assessment of side effects and laboratory testing (blood cell counts, including iron, reticulocytes, mean corpuscolar volume, transferrin, ferritin, and C-reactive protein) were made at baseline and every five infusions. Results: At baseline, Hb levels, iron and ferritin concentrations were comparable between the two groups. In particular, the mean Hb was 9.4±1.4 g/dl in group A and 9.2±1.3 g/dl in group E. At the end of the scheduled therapy, Hb levels increased to 10.2±1.5 g/dl in group A (P=0.142) and ll.l± 1.8 g/dl in group E (P =0.025). Side-effects were generally mild and transient (2 in group A and 3 in group E); no serious adverse events were reported. Conclusions: The contemporary administration of intravenous iron gluconate and levofolinic acid showed a more consistent increase of the Hb concentration than iron gluconate alone in IBD patients with IDA. This results could be explained by the frequent finding of low levels of folates in IBD patients also in absence of overt macrocytic anaemia.

PA.203 MEDICATION ADHERENCE IN INFLAMMATORY BOWEL DISEASE (IBD) P. Eertomoro*, R. D'Inca, V. Di Leo, M.G. Vettorato, G.C. Sturniolo

Department ofSurgical and Gastroenterological Sciences, Section of Gastroenterology, Padova Background and aim: IBD patients need long term treatment: patient's adhesion to pharmacological prescriptions is crucial to maintain remission and to prevent relapse and colon cancer. We aimed to explore factors associated with medication non-adherence in IBD patients. Material and methods: A questionnaire of 32 items regarding adherence and possible reasons for non-adherence was administered in the out patients clinic. Adherence was also evaluated in maintenance vs relapses. Questionnaire has been validated in a small group of patients. Results: 370 patients (199 ulcerative colitis (DC), 171 Crohn's disease (CD)) entered the study (174 F, 196 M, mean age 41 yrs (15-82).60% of the interviewed referred perfect adherence, 37,3% inadequate adherence and 2,7% non-existent adherence. No difference was detected between