Sa1224 Usefulness of a Faecal Calprotectin Rapid Semiquantitative Test in Predicting Relapse in Patients With Ulcerative Colitis in Remission

searched up to October 2013 for eligible studies of evaluating activity in ulcerative colitis (UC) and Crohn's disease (CD). Hierarchical summary receptor operating characteristic (HSROC) model were constructed, diagnostic odd ratio (DOR) and area under the curve (AUC) were calculated to evaluate diagnostic accuracy. The DORs of each of different cutoff values were compared to identify the most satisfactory for clinical application. Results 382 articles were available after initial search. Twelve studies were included, including 744 UC and 638 CD. The clinical characteristics and QUADAS scores of these studies are listed in Table. As shown in Fig. 1(A), the AUC was 0.89 (SEM = 0.017) in IBD. HSROC evaluating UC and CD were constructed for both of them (Fig. 1(B) and (C)). It can be observed virtually that HSROC of UC was much closer to upper left corner comparing with that of CD. The summary sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.88, 0.82, 4.52, 0.16, 34.57 and 0.93, respectively, in UC and 0.80, 0.82, 3.64, 0.27, 14.94, and 0.86, respectively, in CD. In five studies, the manufacturer's recommended value (50 μg/g, including 30 μg/g) was used for the results of pooled sensitivity 0.92, specificity 0.60, PLR 2.33, NLR 0.13, DOR 21.42, and AUC 0.92. The Chi-square or Cochrane-Q values for sensitivity, specificity, and DOR were 11.72 (p = 0.0195, I2 = 65.9%), 42.19 (p = 0.0000, I2 = 90.5%) and 21.42 (p = 0.0261, I2 = 63.8%), respectively. In five studies, 100 μg/g was used as an adjusted cut-off value, and the results were: sensitivity 0.83, specificity 0.62, PLR 2.38, NLR 0.27, DOR 10.17, and AUC 0.83. The Chi-square or Cochrane-Q values for sensitivity, specificity, and DOR were 8.93 (p = 0.0629, I2 = 55.2%), 14.09 (p = 0.0070, I2 = 71.6%) and 0.5 (p = 0.9738, I2 = 0%). The trade-off of sensitivity and specificity as expected was shown with an increase of cut-off value, sensitivity became lower and specificity became higher. Although the funnel plot of publication bias showed some asymmetry due to the limited number of studies (Fig. 1(D)), the Deeks' test showed a statistically non-significant value (p =0.329), indicating no publication bias among the included studies. Conclusions FC at a cut-off value of 50ug/g is a reliable surrogate marker for more precise assessment of IBD disease activity, and may be more useful in UC than CD. Methodological assessment of the 11 studies included.

Phenotypic Characteristics and Use of Therapeutic Resources in Elderly-Onset Inflammatory Bowel Disease: A Multicentre, Case-Control Study Míriam Mañosa, Margalida Calafat, Ruth de Francisco, Carmen García Caparrós, María José Casanova, Patricia Huelín, Marta Calvo, Luis Fernandez Salazar, Miguel Minguez, Alexandra Ruiz-Cerulla, Yamile Zabana, Guillermo Bastida, Joaquin Hinojosa, Lucía Marquez, Manuel Barreiro-de Acosta, Xavier Calvet, David Monfort, Rosario Gómez, Esther Rodríguez, José María Huguet, Maria Rojas-Feria, Daniel Hervias, Ramón Atienza, David Busquets, Eva Zapata, Carmen Dueñas-Sadornil, Mara Charro, Francesc J. Martínez-Cerezo, Rocío Plaza, Juan María Vázquez Morón, Javier P. Gisbert, Eduard Cabré, Eugeni Domenech Background: It has been reported that IBD onset occurs at old age in up to 10% of cases. Elderly patients have more comorbidities and, therefore, a potential increased risk of drug adverse effects, increased likelihood of hospital admissions and postoperative complications Aims: To evaluate the phenotypic characteristics and use of therapeutic resources in patients with elderly-onset IBD. Methods: Retrospective, case-control, multicentre study. All those patients diagnosed with IBD over the age of 60 years (cases) since 2000 and with a followup >12 months were identified from the IBD databases of each centre. Cases were compared with controls, who were diagnosed with IBD between 18 and 40 years of age, and matched by year of diagnosis, gender, and type of IBD. Results: A total of 1,374 cases and 1,374 matched controls were included, of whom 43% women, 62% ulcerative colitis (UC), 36% Crohn's disease (CD) and 2% unclassified IBD. The mean age at diagnosis was 68 years (range, 60-87) within cases and 28 years (range, 18-45) within controls. 59% of the cases (but only 3% of controls) had at least one cardiovascular risk factor (arterial hypertension, dyslipidemia or diabetes). The proportion of active smokers at the time of IBD diagnosis was 25% among controls and 13% among cases. Phenotypically, elderly-onset patients had a lower proportion of extensive UC (p<0.0001), and a higher proportion of stenosing and a lower proportion of penetrating pattern (p<0.0001) and exclusive colonic location (p<0.0001). Elderly-onset patients had a lower rate of IBD-related complications (p=0.009) but a higher prevalence of thrombotic events (p<0.0001). Regarding the use of therapeutic resources, there was a significantly lower use of corticosteroids (p<0.0001), immunomodulators (p<0.0001) and biological agents (p<0.0001) in elderly-onset patients as compared to controls, but a similar rate of surgeries. Finally, elderly-onset patients had a higher rate of hospitalizations (p<0.0001), neoplasms (p<0.0001) and deaths (p<0.0001). In the multivariate analysis, elderly-onset of IBD was independently associated to a decreased need of immunomodulators and biological agents, and an increased need of hospital admissions. Conclusions: Elderly-onset IBD is associated to a less severe/complicated phenotype and the lesser use of immunosuppressive therapies, which probably accounts for a non-increased IBD-related morbidity. Age at diagnosis might explain the increase in the rate of hospitalizations among elderly patients. Sa1224 Usefulness of a Faecal Calprotectin Rapid Semiquantitative Test in Predicting Relapse in Patients With Ulcerative Colitis in Remission Esther García-Planella, Míriam Mañosa, Maria Chaparro, Manuel Barreiro-de Acosta, Belen Beltran, Elena Ricart, Valle García-Sánchez, Maria Esteve, Marta Piqueras, Fernando Bermejo, Antonio López-SanRomán, Carlos Taxonera, Jordina Llao, Javier P. Gisbert, Eduard Cabré, Eugeni Domenech

Plus sign: low risk. Minus sign: high risk. Question sign: unclear.

Background: Faecal calprotectin (CALf) is fairly correlated with clinical and endoscopic activity in ulcerative colitis (UC), and it has also demonstrated to be a good predictor of relapse. However, the routinely use of CALf measurement is constrained by the need for the patient to carry stool samples, as well as handling and processing them in the laboratory. The availability of hand held, single-use devices for CALf measurement that could be performed by the patient himself, might spread the use of CALf in clinical practice. Aim: To evaluate the usefulness of a rapid semi-quantitative test of CALf in predicting relapse in patients with UC in remission. Patients and Methods: A prospective, multicentre study that included patients with left-sided or extensive UC in clinical remission for ≥6 months on maintenance treatment with mesalazine. At baseline and every 3 months, patients were evaluated clinically and semi-quantitative CALf was measured using a monoclonal immunochromatography rapid test (PreventID Caldetect™, Immunodiagnostic AG, Germany) without manipulation of stools or laboratory analysis, until relapse or 12 months of followup. Results: At least one determination of CALf with clinical follow-up was available in 192 out 206 patients initially included in the study. 55% with extensive UC, 62% required corticosteroids in the past, and 88% were non-smokers. From a total of 695 measurements of CALf, 81 (12%) were above the upper threshold of normality of the test (>60 μg/g) and 57 (8%) had limiting values (15-60 μg/g). During follow-up, 32 relapses (17% of patients) occurred. Having a CALf >60 μg/g was significantly associated with relapse at follow-up (35% vs. 12%, p<0.0001), with a PPV of 35% and a NPV of 88%. 644 CALf determinations with a three-month follow-up were available; undetectable CALf was significantly associated with absence of recurrence, with a PPV of 100% and a NPV of 93% (0% vs. 6%, p=0.002). Conclusions: Rapid semi-quantitative measurement of CALf, with no need for laboratory analysis and faecal samples handling, may be useful for monitoring patients with UC in remission. Sa1225 Meta-Analysis: Faecal Calprotectin for Assessment of Inflammatory Bowel Disease Activity Jin-Feng Lin, Jin-Min Chen, Biao Nie, Bo Jiang Background Faecal calprotectin (FC) is a promising biomarker for inflammatory bowel disease (IBD) diagnosis. However, the utility of FC for assessment of IBD activity is less clear. This meta-analysis is to evaluate the diagnostic accuracy of FC in assessing IBD activity and to determine an optimal cut-off value for discriminating active from inactive disease. Methods The Medline, Web of Science, Cochrane Library, and EMBASE databases were

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AGA Abstracts

AGA Abstracts

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