P114 What factors might contribute to borderline faecal calprotectin levels?
P115 Arthropathies associated to inﬂammatory bowel disease (IBD): A retrospective survey
O.M. Demir1 *, R. Appleby2 , Y. Wang3 , R.P.H. Logan1 . 1 King’s College Hospital, Gastroenterology, London, United Kingdom, 2 West Middlesex Hospital, Gastroenterology, London, United Kingdom, 3 King’s College, Primary Care and Public Health Sciences, London, United Kingdom
S. Cardile1 *, A. Chiaro1 , D. Comito2 , I. Loddo2 , C. Romano1 . 1 AOU G.Martino, Pediatric Department, Messina, Italy, 2 AOU G.Martino, Genetic and Pediatric Immunology, Messina, Italy
Background: In adults, Faecal Calprotectin (FC) ELISA has a sensitivity and speciﬁcity of >93% for detecting IBD (1). However, small case series have shown that other factors (eg NSAIDs, cirrhosis, obesity etc) may lead to false +ve results. It is also unclear if immuno-suppressants, taken for non-GI indications can give false ve FC results. Aim: to determine the size and effect of possible factors which might contribute to borderline FC values to cause false +ve or ve results. Methods: Study population: any patient with a FC result held in the pathology database from May 2005 09 (n = 5943). Patient data were cross referenced to electronic records, radiology (PACS), endoscopy & pathology data sets (SnoMed CT). Exclusions: previous diagnosis of IBD or CRC, or aged <16 yr at study entry. To increase the chance of discovering a signiﬁcant effect, only patients with FC result of >50 mg/g and <150 mg/g were included. Multivariate analysis (generalised linear model) was performed sequentially using SPSS with age, gender, BMI, ethnicity, medication, family history of IBD, smoking/alcohol consumption, liver disease. Histological severity of colonic inﬂammation was only included in the ﬁnal model. Results: From 5943 patients, 569 (10%) were between 50 150 and met the inclusion criteria. 62% were female, mean age 51 yr, range 16 91 yr). Diarrhoea (50%) was the most common indication for testing. In the preliminary model FC values increased with age (B = 0.15, p < 0.04) and with a positive trend for liver disease (B = 7.7, p = 0.06); however neither variable remained signiﬁcant in the ﬁnal model, which was overwhelmingly dominated by the effect of mucosal inﬂammation (B = 41, p < 0.001). Immunosuppressant use (mainly for Rharthritis/SLE) was associated with lower FC values (p = 0.027). There was no effect from any of the other variables at any stage in either model. Final Model BMI smoker liver disease low dose aspirin use regular NSAID use longterm steroid use immunosuppressant use age (per annum change) mucosal inﬂammation
calprotectin change (slope)
0.3 5.6 4.0 5.9 5.1 1.2 13.1 0.13 41.0
0.1 0.1 0.2 0.1 0.42 0.86 0.027 0.064 <0.001
Conclusions: These data show that FC levels are almost entirely determined by the presence of mucosal inﬂammation. Previously suggested confounding factors have no effect. Concurrent immunosuppressant use may slightly lower FC levels. These data show the FC is a robust measure of mucosal inﬂammation.
Background: Arthropathies are considered extraintestinal manifestations (EIMs) of the IBD and can be classiﬁed as pauciarticular and polyarticular peripheral arthropathy, and axial arthropathy (sacroilitis and ankylosing spondylitis). Joint involvement is the most common EIMs in children with IBD and may involve 7 25% of cases. Clinical manifestations can be variable and peripheral arthritis often occurs before gastrointestinal symptoms develop. EIMs are more prevalent in patients with Crohn’s Disease. There is an association between gut inﬂammation and evolution of recurrent articular disease that coincides with a ﬂare-up of intestinal disease. Association between genetic background and HLA-B27 status is less common in pediatric than adult populations. Early diagnosis of these complications may guide therapy and reduce risks of progression and complications. Methods: We performed a retrospective survey in children with IBD to evaluate a prevalence of arthropathies and correlation with intestinal disease activity. Data was collected from January 2001 to December 2010 in 89 children (age 8 15 years) with IBD (34 UC, 55 CD). The diagnosis of IBD was done on the basis of the endoscopic and histological criteria, while rheumatological diagnosis was made according to the European Spondyloarthropathy Study Group (ESSG) criteria, validated also in children. Results: In 9 cases (4 M, 5 F) (10%) was diagnosed joint involvement, 5 (56%) patients with UC and 4 (44%) with CD. The average age at IBD diagnosis was 13.1 years. In 6 patients (67%) arthropathy had preceded diagnosis of the IBD. In 4 (45%) patients was diagnosed peripheral arthropathy, 2 (22%) axial involvement, and 3 (33%) with both axial and peripheral involvement. In all patients, the course of the intestinal disease was not correlated with the joint involvement and activity. No difference in prevalence between males and females and only 3 patients was HLA-B27 positive. No patient had a need for biological therapy for control of joint symptoms and usually bowel disease remission was accompanied by the disappearance of joint symptoms. Conclusions: Arthropathies may be considered the most frequent EIMs of the IBD also in children. There are no signiﬁcant differences in prevalence between UC and CD and the course of joint disease is separate from the intestinal disease activity. The treatment of intestinal disease can to control even the progress of joint disease. Peripheral arthritis HLA-B27 negative is the most frequent arthropathy in children. P116 Impact of arthropathies on health-related quality of life in inﬂammatory bowel disease patients L.K. Brakenhoff1 , L. de Wijs1 *, R. van den Berg2 , D.M. van der Heijde2 , T.W. Huizinga2 , H.H. Fidder3 , D.W. Hommes4 . 1 LUMC, Gastroenterology, Leiden, Netherlands, 2 LUMC, Rheumatology, Leiden, Netherlands, 3 UMCU, Gastroenterology, Utrecht, Netherlands, 4 UCLA, Division of Digestive Diseases, Los Angeles, United States Background: Arthropathies are the most common extraintestinal manifestation (EIM) in inﬂammatory bowel disease (IBD) patients. The aim of this study was to assess the impact of arthropathies on health-related quality of life (HRQoL) in IBD patients, compared to IBD patients without arthropathies. Methods: One hundred sixty-six IBD patients were questioned about joint complaints. These joint complaints were deﬁned as daily back pain for more than three months and/or
Clinical: Diagnosis and outcome peripheral joint pain and/or swelling during the last year. Based on history and physical examination, patients were categorized in one of the two study groups: IBD patients with or without arthropathies. HRQoL was measured using the Short Inﬂammatory Bowel Disease Questionnaire (sIBDQ), Short Form (SF)-36 Health Survey, and the EuroQol (EQ)-5D. Higher scores indicate better QoL. IBD activity was measured with the Harvey Bradshaw Index (HBI) or Simple Clinical Colitis Activity Index (SCCAI). Active disease was deﬁned as a HBI or SCCAI score above 4. Results: A total of 127 IBD patients with arthropathies (77.2% Crohn’s Disease (CD); 33.1% male) and 39 IBD patients without arthropathies (71.8% CD; 48.7% male) completed the questionnaires. The mean age and mean IBD disease duration of all patients were 42.9 and 15.0 years, respectively. Type of IBD (CD and ulcerative colitis (UC)), gender, mean age, mean disease duration, active UC, pouch/stoma, EIMs, smoking at IBD diagnosis and marital status did not differ between the patients with and without arthropathies. However, there were more active CD disease patients (p < 0.001) and smoking patients at study entry (p = 0.001) in the group with arthropathies than in the group without arthropathies. Patients with arthropathies had signiﬁcantly lower mean sIBDQ scores, compared to IBD patients without arthropathies, 47.3 and 54.9 (p < 0.001). All 8 dimension scores of the SF-36 were signiﬁcantly lower for IBD patients with arthropathies than those without arthropathies. Finally, the mean score of the EQ-5D was also signiﬁcantly lower in patients with than without arthropathies (0.68 and 0.85, p < 0.001). Also after adjustment for disease activity, the presence of arthropathies was independently associated with reduced quality of life. Conclusions: The HRQoL scores, measured with the sIBDQ, SF36 and EQ-5D, in IBD patients with arthropathies are signiﬁcantly lower than that of IBD patients without arthropathies. However, disease activity of IBD is the strongest determinant of differences in HRQoL. P117 Inﬂuence of anaemia on health related quality of life in inﬂammatory bowel disease patients R. Ferreiro1 *, M. Iglesias1 , M. Barreiro-de Acosta1 , A. Lorenzo Gonzalez1 , J.E. Domíngez-Mu˜ noz1 . 1 University Hospital, Santiago De Compostela, Spain Background: Anaemia is a relevant and frequent condition in patients with inﬂammatory bowel disease (IBD), which may affect their quality of life (HRQOL). The aim of this study was to evaluate if the presence of anaemia was associated with a worse HRQOL in IBD patients. Methods: A cross-sectional, prospective study with consecutive patient recruitment was designed. All adult patients with IBD who attend the IBD Unit were included. Anaemia was deﬁned as hemoglobin levels above 12 g/dl in females and 13 g/dl in males according to the World Health Organization (WHO). Remission was deﬁned as a Harvey score 4 in Crohn’s disease (CD) and a Mayo score 2 in Ulcerative Colitis (UC) respectively. To asses quality of life we used in all patients the IBDQ-36 and SF-36 questionnaires. IBDQ-36 is a questionnaire with 5 dimensions (Bowel Symtoms, Systemic Symptoms, Functional Impairment, Social Impairment, and Emotional Function). The SF-36 includes 8 scales (Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, RoleEmotional and Mental Health). Results are shown as mean and standard deviation (SD); the t-student test was used for comparing means. Multivariate regression was also used to estimate other sociodemographic and clinical variables associated to HRQOL. Results: 528 patients were consecutively included, 300 were female (56.8%), 306 with UC (58%) and 222 (42%) with CD. Anaemia was observed in 101 (19.1%) patients. Overall, in
S57 most of dimensions of both questionnaires quality of life was better in patients without anaemia, except in three scales of SF-36 where there were not statically signiﬁcant differences between patients with and without anaemia; these items are Vitality (mean with anaemia 48.95 ± SD 25.88; mean without anaemia 57.95 ± SD 25.41, p = 0.07), Role-Emotional (mean with anaemia 71.00 ± SD 41.21; mean without anaemia 70.53 ± SD 41.85, p = 0.92) and Mental Health (mean with anaemia 64.76 ± SD 21.20; mean without anaemia 65.25 ± SD 21.20, p = 0.85). Nevertheless, after multivariate regression analysis we observed that if we adjusted by other relevant sociodemographic and clinical variables, relapse was the most important risk factor for an HRQOL, and anaemia is only relevant in Role-physical of SF-36 (p = 0.048). Conclusions: Anaemia does not seem to diminish quality of life in IBD patients, but anaemia associated to a relapse is a risk factor for an impaired quality of life. P118 Neopterin is a novel reliable fecal marker as accurate as calprotectin for predicting endoscopic severity in patients with inﬂammatory bowel diseases G. Boschetti1 *, S. Nancey1 , E. Cotte2 , A.-L. Charlois3 , D. Moussata1 , M. Chauvenet1 , K. Stroeymeyt1 , D. Kaiserlian4 , B. Flouri´ e1 . 1 Lyon-Sud Hospital, Gastroenterology, PierreB´ enite, France, 2 Lyon-Sud Hospital, Digestive Surgery, Pierre-B´ enite, France, 3 Lyon-Sud Hospital, Statistics, Pierre-B´ enite, France, 4 Inserm, U 851, Lyon, France Background: Fecal biomarkers have emerged as an important and non invasive tool for assessing and monitoring disease activity in patients with inﬂammatory bowel diseases (IBD). Aim: Prospective comparison of the respective diagnostic accuracy of fecal calprotectin (fCal) and neopterin (fNeo) in predicting endoscopic severity in IBD patients. Methods: Ninety-four consecutive IBD patients (56 CD, 38 UC) undergoing 109 colonoscopies whatever the indication provided 109 fecal samples for measurement of fCal and fNeo concentrations by ELISA. Endoscopic disease activities were scored independently according to the Simple Endoscopic Score for Crohn’s disease (SES-CD) in patients with CD and to the Rachmilewitz index in patients with UC. The respective accuracies of individual and combination of the fecal markers with respect to endoscopic disease severity were assessed by computing correlations, sensitivity, speciﬁcity and predictive values at adjusted cutoffs and also tests operating characteristics. Results: FCal and fNeo concentrations differed signiﬁcantly in endoscopically active CD (1234±2065 mg/g and 358±238 pmol/g, respectively) in comparison with those in patients without mucosal lesions (209±262 mg/g, and 163±196 pmol/g, both p < 0.001). UC patients with endoscopic lesions had also signiﬁcantly higher concentrations of fCal (3742±2674 mg/g) and fNeo (468±273 pmol/g) compared with those with endoscopically inactive disease (562±920 mg/g for fCal and 70±83 pmol/g for fNeo, p < 0.001). Both fCal and fNeo concentrations correlated closer with endoscopic scores in UC (r = 0.79 and r = 0.69, respectively; p < 0.001) than in CD (r = 0.57 and r = 0.50, respectively; p < 0.001). Using cutoffs of 250 mg/g for fCal and 190 pmol/g for fNeo previously determined by the ROC curves, the overall accuracy of fCal and fNeo to discriminate between active and inactive mucosal inﬂammation were in CD 70% and 76%, respectively and in UC 79% and 90%, respectively. In addition, the combination of fCal and fNeo did not improve the performance of fCal or fNeo alone to discriminate quiescent from endoscopically active IBD. Conclusions: Fecal neopterin is a novel reliable non invasive biomarker with the potential to identify patients with active mucosal inﬂammation in IBD. The overall accuracy of fNeo as a marker capable of discriminating between the presence and not