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Su1787 Pre-Operative Anti-Glycan Antibodies and Anti-Glycan Antibodies Developing After Pouch Surgery in Patients With Ulcerative Colitis Correlate With Pouch Complications - A Prospective Longitudinal Case Series
Su1788 Computed Tomography Utilization Abruptly Increases at Age 18 among Patients with Inflammatory Bowel Diseases, A Nationwide Analysis of the Insured Shail M. Govani, Peter Higgins, Joel H. Rubenstein, Ryan W. Stidham, Jennifer F. Waljee, Akbar K. Waljee Background and Aims: Computed tomography (CT) is an important tool in the management of inflammatory bowel diseases (IBD). However, CT delivers significant radiation with each scan. Patients with IBD have an increased risk of undergoing repeated CT scans, which can increase cancer risk. Based on data from atomic bomb survivors, the risk of malignancy is increased from radiation exposure before age 35. Significant work has been done to improve awareness of this issue among providers. We aimed to compare the use of CT in IBD patients in patients <18 years old, 18-35, and >35 using an administrative database. If this physician education was effective, we expected to see reduced use of CT in IBD patients < 35 years old. Methods: The Marketscan (Truven) database from 2009-2013 was used to identify patients with IBD with an Emergency Department (ED) or inpatient visit. Patients were classified as having IBD based on the presence of 1 inpatient code or 2 outpatient codes with an ICD-9CM code of 555.x or 556.x and uninterrupted insurance coverage. Analysis was limited to patients with pharmacy coverage and visits in which the IBD diagnosis code was the 1st or 2nd diagnosis. CT abdomen/pelvis use was determined by CPT coding. Logistic regression was used to model the effect of age on the odds of CT use after accounting for gender, disease type, surgery in the prior 90 days, and medications. Results: Between 2009 and 2013, there were 44,322 patients with IBD with 76,673 ED or inpatient visits in this cohort. Sixty percent of the cohort had Crohn's disease (CD). During the first visit with an IBD code, 7.9% were below age 18 and 57.0% were female. CT scans were utilized in 29.7% of these visits. In univariate analysis, patients younger than 18 were much less likely to undergo CT (OR 0.45, 95%CI 0.42-0.49, p<0.001) compared to those 18- 35. Patients older than 35 were only slightly more likely to undergo CT (OR 1.11, 95%CI: 1.07-1.15) compared to those 18-35. Patients with CD and a recent surgery were more likely to undergo CT while those on narcotics, steroids and immunomodulators were less likely. In multivariate analysis, adjusting for medications, recent surgery, and gender, younger patients remained less likely to undergo CT (OR 0.42, 95%CI: 0.39-0.46) compared to those 18-35. Only a small increase in CT use (OR 1.07, 95%CI: 1.03-1.11) was seen in the patients > 35 years old. Predicted probability of CT use by age demonstrates the abrupt increase in CT use at age 18 (Figure). Conclusions: Patients with IBD undergo CT scan 30% of the time in the ED or inpatient setting. It appears that pediatric providers limit radiation exposure among those <18 while adult providers are not as cautious with radiation exposure for the young adult population. Increased awareness of the risks of cumulative radiation exposure in the young adult population is needed.
p values for disease activity, medications, WCC and CRP compare disease populations only
Su1787 Pre-Operative Anti-Glycan Antibodies and Anti-Glycan Antibodies Developing After Pouch Surgery in Patients With Ulcerative Colitis Correlate With Pouch Complications - A Prospective Longitudinal Case Series Idan Goren, Lior Yahav, Hagit Tulchinsky, Iris Dotan Background and aim: pouch inflammation is a common complication in patients with ulcerative colitis (UC) undergoing proctocolectomy and ileal pouch anal anastomosis (pouch surgery). Previous data showed similarities in serologic responses, specifically anti-glycan antibodies in patients with a pouch and those with Crohn's disease (CD). We aimed to assess the prevalence of CD-associated anti-glycan antibodies in patients before and after pouch surgery and to prospectively study their correlation with pouch inflammation. Method: Serum samples were collected before and after pouch surgery. Anti-glycan antibodies including anti-Saccharomyces cerevisiae, anti-laminaribioside, anti-chitobioside, and anti-mannobioside carbohydrate antibodies (ASCA, ALCA, ACCA, and AMCA, respectively) were tested using ELISA. Results: Overall 10 patients with ulcerative colitis were recruited and followed up for 21±25 months after pouch surgery. The first analysis was done 10.42±11.2 months preoperatively. For each patient 1-3 serum samples were collected before surgery and 1-3 samples after surgery. Average age at first analysis was 37.6±16.2 years, male gender 6/10, and smokers 2/10. Baseline serologic responses were 24.82±31.2, 28.34±31.6, 33.5±23.6 and 53.0±73 for ASCA, ALCA, ACCA, and AMCA, respectively. Pre-operatively 3/10 patients were seropositive (ALCA+, ASCA+, and both ALCA+ & AMCA+). Those 3 patients developed chronic pouchitis during the post-operative follow-up period, during which 2 remained seropositive and one turned sero negative. After pouch surgery 3 more patients turned positive (ASCA+, AMCA+ and both AMCA+ & ACCA+). Thus, 5 (50%) of patient were seropositive after pouch surgery. Of the 3 patients developing post pouch surgery seropositiviety 2 developed chronic pouchitis and one was lost for follow-up 17 months after surgery. None of the 4 patients with a normal pouch during follow-up tested positive pre-operatively to any anti glycan antibody and 3/4 patients with normal pouch remained seronegative postoperatively as well. Conclusions: pouch surgery may trigger CD-like immune response to glycans in UC patients which can be characterized by the de-novo development of antiglycan antibodies. Pre-operative anti-glycan antibodies as well as antibodies developing postoperatively may be associated with an increased risk for pouch complications. Preoperative seronegativity may be associated with lower risk for pouch inflammation. Thus, serologic markers may assist in determining the prognosis in patients with a pouch.
Figure demonstrates the predicted probability of CT use during an Emergency Department or inpatient visit based on age of the patient. Patients are assumed to be males with Crohn's with no recent surgery and on no medications. There is an abrupt increase in use at age 18.
Su1789 Use of an Electronic Nose to Evaluate Disease Activity in Ulcerative Colitis Zibing J. Woodward, Kevin Piro, Sarah Lee, Emile Latour, Jodi Lapidus, Suni Wilson, David Lieberman, Judith Collins, Kian Keyashian, Nir Modiano Background and Aims Assessment of disease activity in inflammatory bowel disease (IBD) reflects a major challenge in clinical practice, relying on invasive endoscopic evaluation, expensive imaging tests and biomarkers that are difficult to obtain in a timely fashion. Cyranose 320 is an electronic nose that senses volatile organic compounds; it has been previously used to distinguish between malignancies, inflammatory states and infections. In this proof of concept study, we analyzed the urine headspace of active and inactive ulcerative colitis (AUC, IAUC) patients (pts) as well as non-IBD controls with Cyranose in an effort to differentiate between groups to enable real-time disease assessment. Methods Urine samples were collected from consecutive UC pts seen in IBD clinic and during inpatient admissions; control subjects were those undergoing outpatient upper endoscopy for nonmalignant indications. AUC pts were those with moderate activity classified as a Partial Mayo score of ‡ 5 or Full Mayo score of ‡ 6, inactive UC were those with a Partial Mayo score of 0 or 1 and endoscopic Mayo Score of 0 or 1. The urine samples were stored in a
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counts were normalized, log2 transformed and batch corrected. Non-parametric KruskalWallis tests assessed differential gene expression across phenotypes. Raw p-values were corrected for multiple testing by the Benjamini-Hochberg false discovery rate method. Results: 51 subjects (32 UC, 19 CCD, 47%male, 34yrs mean age) were included in the CCD vs UC analysis. 39 HC were also included (59% male, 56yrs mean age). See Table for demographics. There were no significant differences in mean CRP nor among clinical, endoscopic or histologic disease activity between the CCD and UC groups suggesting that the degree of inflammation was similar in both groups. Comparing CCD and UC, 5 miRNAs were differentially expressed: miR-129-5p, miR-603, miR-619-3p, miR-874-3p, miR-933 (FDRp = 0.0214 all probes). All probes were upregulated in CCD vs UC. Additionally, all probes were upregulated in CCD vs HC. Only 1 probe (miR-603) was upregulated in UC versus HC, the other 4 probes showed either downregulation or no difference from HC. Conclusion: A PBMC-derived miRNA panel of markers identified here differentiates CCD from UC independently of the degree of inflammation. These findings may aid individualization of patient care through identification of novel diagnostic and therapeutic targets. Further study will be directed at further replicating these findings and understanding the targets of the miRNAs identified.
p values for disease activity, medications, WCC and CRP compare disease populations only
Su1787 Pre-Operative Anti-Glycan Antibodies and Anti-Glycan Antibodies Developing After Pouch Surgery in Patients With Ulcerative Colitis Correlate With Pouch Complications - A Prospective Longitudinal Case Series Idan Goren, Lior Yahav, Hagit Tulchinsky, Iris Dotan Background and aim: pouch inflammation is a common complication in patients with ulcerative colitis (UC) undergoing proctocolectomy and ileal pouch anal anastomosis (pouch surgery). Previous data showed similarities in serologic responses, specifically anti-glycan antibodies in patients with a pouch and those with Crohn's disease (CD). We aimed to assess the prevalence of CD-associated anti-glycan antibodies in patients before and after pouch surgery and to prospectively study their correlation with pouch inflammation. Method: Serum samples were collected before and after pouch surgery. Anti-glycan antibodies including anti-Saccharomyces cerevisiae, anti-laminaribioside, anti-chitobioside, and anti-mannobioside carbohydrate antibodies (ASCA, ALCA, ACCA, and AMCA, respectively) were tested using ELISA. Results: Overall 10 patients with ulcerative colitis were recruited and followed up for 21±25 months after pouch surgery. The first analysis was done 10.42±11.2 months preoperatively. For each patient 1-3 serum samples were collected before surgery and 1-3 samples after surgery. Average age at first analysis was 37.6±16.2 years, male gender 6/10, and smokers 2/10. Baseline serologic responses were 24.82±31.2, 28.34±31.6, 33.5±23.6 and 53.0±73 for ASCA, ALCA, ACCA, and AMCA, respectively. Pre-operatively 3/10 patients were seropositive (ALCA+, ASCA+, and both ALCA+ & AMCA+). Those 3 patients developed chronic pouchitis during the post-operative follow-up period, during which 2 remained seropositive and one turned sero negative. After pouch surgery 3 more patients turned positive (ASCA+, AMCA+ and both AMCA+ & ACCA+). Thus, 5 (50%) of patient were seropositive after pouch surgery. Of the 3 patients developing post pouch surgery seropositiviety 2 developed chronic pouchitis and one was lost for follow-up 17 months after surgery. None of the 4 patients with a normal pouch during follow-up tested positive pre-operatively to any anti glycan antibody and 3/4 patients with normal pouch remained seronegative postoperatively as well. Conclusions: pouch surgery may trigger CD-like immune response to glycans in UC patients which can be characterized by the de-novo development of antiglycan antibodies. Pre-operative anti-glycan antibodies as well as antibodies developing postoperatively may be associated with an increased risk for pouch complications. Preoperative seronegativity may be associated with lower risk for pouch inflammation. Thus, serologic markers may assist in determining the prognosis in patients with a pouch.
Figure demonstrates the predicted probability of CT use during an Emergency Department or inpatient visit based on age of the patient. Patients are assumed to be males with Crohn's with no recent surgery and on no medications. There is an abrupt increase in use at age 18.
Su1789 Use of an Electronic Nose to Evaluate Disease Activity in Ulcerative Colitis Zibing J. Woodward, Kevin Piro, Sarah Lee, Emile Latour, Jodi Lapidus, Suni Wilson, David Lieberman, Judith Collins, Kian Keyashian, Nir Modiano Background and Aims Assessment of disease activity in inflammatory bowel disease (IBD) reflects a major challenge in clinical practice, relying on invasive endoscopic evaluation, expensive imaging tests and biomarkers that are difficult to obtain in a timely fashion. Cyranose 320 is an electronic nose that senses volatile organic compounds; it has been previously used to distinguish between malignancies, inflammatory states and infections. In this proof of concept study, we analyzed the urine headspace of active and inactive ulcerative colitis (AUC, IAUC) patients (pts) as well as non-IBD controls with Cyranose in an effort to differentiate between groups to enable real-time disease assessment. Methods Urine samples were collected from consecutive UC pts seen in IBD clinic and during inpatient admissions; control subjects were those undergoing outpatient upper endoscopy for nonmalignant indications. AUC pts were those with moderate activity classified as a Partial Mayo score of ‡ 5 or Full Mayo score of ‡ 6, inactive UC were those with a Partial Mayo score of 0 or 1 and endoscopic Mayo Score of 0 or 1. The urine samples were stored in a
S-551
X : 10052$CH01 03-28-16 00:57:27 PDFd : 10052B : o
Page 551
AGA Abstracts
AGA Abstracts
counts were normalized, log2 transformed and batch corrected. Non-parametric KruskalWallis tests assessed differential gene expression across phenotypes. Raw p-values were corrected for multiple testing by the Benjamini-Hochberg false discovery rate method. Results: 51 subjects (32 UC, 19 CCD, 47%male, 34yrs mean age) were included in the CCD vs UC analysis. 39 HC were also included (59% male, 56yrs mean age). See Table for demographics. There were no significant differences in mean CRP nor among clinical, endoscopic or histologic disease activity between the CCD and UC groups suggesting that the degree of inflammation was similar in both groups. Comparing CCD and UC, 5 miRNAs were differentially expressed: miR-129-5p, miR-603, miR-619-3p, miR-874-3p, miR-933 (FDRp = 0.0214 all probes). All probes were upregulated in CCD vs UC. Additionally, all probes were upregulated in CCD vs HC. Only 1 probe (miR-603) was upregulated in UC versus HC, the other 4 probes showed either downregulation or no difference from HC. Conclusion: A PBMC-derived miRNA panel of markers identified here differentiates CCD from UC independently of the degree of inflammation. These findings may aid individualization of patient care through identification of novel diagnostic and therapeutic targets. Further study will be directed at further replicating these findings and understanding the targets of the miRNAs identified.