P217 Family functioning and health-related quality of life in children with inflammatory bowel disease

P217 Family functioning and health-related quality of life in children with inflammatory bowel disease

S152 age and symptoms of PSC were related to impairment of HRQoL scores, but gen-der, ERC score or comorbidity with IBD did not have a significant impa...

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S152 age and symptoms of PSC were related to impairment of HRQoL scores, but gen-der, ERC score or comorbidity with IBD did not have a significant impact on them. The total 15D scores between PSC patients (mean 0.934) and the general population (mean 0.939) did not differ significantly but the dimensions of elimination (p < 0.001), depression (p = 0.003), distress (p = 0.003) and vitality (p = 0.005) were significantly lower in PSC. In the newly diagnosed, no significant changes were observed in the 15D scores in a mean 1.58 years’ follow-up. The 15D scores of age-, gender- and IBD activity matched IBD patients were lower than those of the PSC patients (0.876 versus 0.914, p = 0.04). Conclusions: HRQoL of PSC patients was mostly comparable to that of the general population but special attention should be paid to the patients’ psychological well-being. No significant HRQoL changes were observed in the mean 1.58 years’ follow-up after diagnosis of PSC. Newly diagnosed PSC patients have better HRQoL than do newly diagnosed IBD patients, probably because of more intensive follow-up and a different spectrum of symptoms. Reference(s) [1] Haapam¨ aki J, Roine RP, Sintonen H, et al., (2010), Healthrelated quality of life in inflammatory bowel disease measured with the generic 15D instrument. Quality of Life Research. [2] Ponsioen CY, Reitsma JB, Boberg KM, et al., (2010), Validation of a cholangiographic prognostic model in primary sclerosing cholangitis. Endoscopy. P215 Growth pattern and growth failure in paediatric Crohn’s disease are related to inflammatory status but not to duration of steroid therapy D. Ley1 *, H. B´ ehal2 , C. Gower-Rousseau3,4 , A. Duhamel2 , M. Fumery5 , F. Vasseur4 , L. Michaud1 , I. Rousseau4 , G. Savoye6 , D. Turck1 . 1 University and Hospital, Paediatric, Lille, France, 2 University and Hospital, Biostatistics EA 2694, Lille, France, 3 Health, Epidemiology, Lille, France, 4 University and Hospital, Epidemiology, Lille, France, 5 University and Hospital, Gastroenterology, Amiens, France, 6 University and Hospital, Gastroenterology, Rouen, France Background: Growth failure is the main complication of paediatric-onset Crohn’s disease (CD). The respective role of disease activity and steroid therapy in growth faltering is still a matter of debate. The aim of the present study was to investigate whether the growth pattern of children with CD was correlated with the evolution of inflammatory status during the disease course, whatever the cumulative duration of steroid therapy. Methods: 107 patients (63 boys and 44 girls) with a diagnosis of CD made at less than 17 years of age, followed in the same unit during more than years and for whom more than 2 height measures were available during follow-up, were identified between 1998 and 2012. Height, C-reactive protein (CRP), orosomucoid and information on steroid therapy (including date of prescription and daily dose) were collected at each visit. Growth velocity was compared to the evolution of inflammatory status during follow-up in a longitudinal multivariate analysis using a mixed model. Results: Median age at CD diagnosis was 11.7 years (Q1Q3: 9.8 13.5). Growth failure (Height/Age Z-score < 2) was present in seven patients (8%) at diagnosis and in five (5%) at maximal follow-up (median: 4.9 years; Q1-Q3: 3.8 6.4). Among the 75 patients who had achieved their growth at maximal follow up, mean Height/Age Z-score was 0.1±1.2. Twenty patients (29%) reached their final height that was at least 4 cm below their target height. A total of 2112 height measures were available. Growth velocity was not influenced

Poster presentations by the cumulative duration of steroid therapy (median: 7.1 months; Q1-Q3: 4.9 12.5), but was negatively correlated with the evolution of CRP (coefficient of the equation of regression (e) = 0.16; p < 0.0001) and orosomucoid (e = 0.60; p < 0.0001) during follow-up. Conclusions: CD children with uncontrolled inflammatory status have a lower growth velocity and a higher risk for growth failure, regardless of cumulative duration of steroid therapy. The inflammatory status should be kept normal as much as possible in paediatric-onset CD patients in order to optimize their growth pattern. P216 Fecal calprotectin and lactoferrin as predictors of relapse in patients with quiescent ulcerative colitis during maintenance therapy T. Yamamoto *, M. Shiraki, S. Umegae, K. Matsumoto. Yokkaichi Social Insurance Hospital, Inflammatory Bowel Disease Centre, Yokkaichi, Japan Background: Predictive markers for relapse in patients with ulcerative colitis (UC) on mesalazine maintenance therapy have not been fully determined. Levels of fecal calprotectin and lactoferrin have a proportional correlation to the degree of inflammation of the intestinal mucosa. Fecal lactoferrin and lactoferrin may have a role in monitoring disease activity in patients with IBD. This prospective study was to evaluate the significance of fecal calprotectin and lactoferrin for the prediction of UC relapse. Methods: Eighty UC patients in remission for 3 months on mesalazine as maintenance therapy were included. At entry, stool samples were collected for the measurement of calprotectin and lactoferrin. All patients were followed up for the following 12 months. To identify predictive factors for relapse, time-dependent analyses using the Kaplan Meier graphs and Cox’s proportional hazard model were applied. Results: During the 12-month, 21 patients relapsed. Mean calprotectin and lactoferrin levels were significantly higher in patients with relapse than those in remission (calprotectin: 173.7 vs 135.5 mg/g, P = 0.02 and lactoferrin: 165.1 vs 130.7 mg/g, P = 0.03). A cutoff value of 170 mg/g for calprotectin had a sensitivity of 76% and a specificity of 76% to predict relapse, while a cutoff value of 140 mg/g for lactoferrin had a sensitivity of 67% and a specificity of 68%. In a multivariate analysis, calprotectin (170 mg/g) was a predictor of relapse (hazard ratio, 7.23; P = 0.002). None of the following parameters were significantly associated with relapse: age, gender, duration of UC, number of UC episode, severity of the previous episode, extent of UC, extraintestinal manifestation, and lactoferrin level. Conclusions: This study showed that both fecal calprotectin and lactoferrin levels were very significantly increased in patients with UC even during remission as compared with healthy controls. Further, fecal calprotectin level 170 mg/g was associated with a clinical relapse. Fecal calprotectin level appeared to be a significant predictor of relapse in patients with quiescent UC on mesalamine as maintenance therapy. P217 Family functioning and health-related quality of life in children with inflammatory bowel disease L. Caes1 *, C.T. Chambers1,2,3 , A. Otley2 . 1 IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Canada, 2 Dalhousie University, Department of Pediatrics, Halifax, Canada, 3 Dalhousie University, Department of Psychology and Neuroscience, Halifax, Canada Background: The diagnosis of inflammatory bowel disease (IBD) in children, with abdominal pain as a prominent symptom, is emotionally challenging for children and their families, as

Clinical: Diagnosis & outcome evidenced by lower levels of health-related quality of life (HRQOL) especially in children with high levels of abdominal pain. Research examining psychological and social factors related to IBD and associated HRQOL is critical. For children in particular, the family environment might play a crucial role in the their coping with IBD. Dysfunctional levels of overall functioning have been associated with lower HRQOL in chidlren with IBD, yet the impact of specific aspects of family functioning, such as cohesion (i.e., emotional bond or connectiveness), flexibility (i.e., balance between stability and change) and communication patterns (i.e., postive versus negative) is largely unexplored. The purpose of the present study was to investigate the influence of balanced levels of cohesion and flexbility and positive communication on the child’s pain experience and HRQOL. Methods: Thirty children with IBD (14 girls, 16 boys; N = 20 with Crohn’s disease, N = 10 with Ulcerative colitis; Mage = 13.73, SD = 2.30 years) and one parent (25 mothers, 5 fathers Mage = 46.73, SD = 6.47 years) completed questionnaires regarding child’s level of pain and interference, HRQOL (i.e., IMPACT) and family functioning (i.e., Faces IV). Results: Linear regression analyses, controlling for child age, indicated that child report of positive communication and balanced level of cohesion and flexibility were positively associated with their HRQOL. Surprisingly, no significant associations were found between child level of pain and family functioning, while the level of interference in daily functioning due to pain was negatively associated with parent report of balanced cohesion and child report of balanced flexibility and positive communication. Conclusions: The current findings indicate that parent-reported cohesion was only associated with pain-related interference, while child-reported aspects of family functioning were related to HRQOL and pain-related interference. Results also suggest that family functioning is primarily associated with HRQOL and interference in daily functioning rather than the level of pain, adding to our understanding of how family functioning relates to children’s coping with IBD and associated pain. In future research, observational assesment of family functioning (e.g., by means of a conflict-discussion task) and parentchild communication patterns when faced with their child in pain (e.g., observation of parent child interaction during an experimental pain task), will contribute to our understanding of how family functioning influences child functioning and pain experiences. P218 Faecal calprotectin testing reduces need for paediatric colonoscopy T.I. Hassan1 *, C. Hensey1 , M. Hamzawi1 , S. Kiernana1 , A.-M. Broderick1,2 , B. Bourke1,2 , S. Hussey1,2 . 1 Our Lady’s Children’s Hospital Crumlin, Gastroenterology, Dublin, Ireland, 2 University college Dublin, National children reseach centre and school of Medicine and Medical Science, Dublin, Ireland Background: Ireland has a single national centre for paediatric gastroenterology. Up to 70% of children referred to a paediatric gastroenterology centre with suspected inflammatory bowel disease (IBD) do not have the disease. Faecal calprotectin (FC) is a white cell protein and a marker of intestinal inflammation. Faecal calprotectin was recently made available in our institution. Our aim was to assess the clinical performance and cost-benefit of faecal calprotectin (FC) in reducing diagnostic endoscopic procedures in symptomatic children with potential or confirmed inflammatory bowel disease (IBD). Methods: Charts, computerised records and endoscopy results of all patients who had FC testing between Oct 2012 and August 2013 were retrospectively reviewed. New patients with

S153 a high clinical likelihood of IBD do not get routine FC testing and were not included in the analysis. FC values <50 mg/g were considered normal; 51 to 200 mg/g indeterminate and >200 mg/g likely to have active GI inflammation. Results: 133 patients had a FC test; of these, 57 (42.8%) had FC >200 (Group A), 76 had FC <200 (Group B). The results are summarised in Table 1. Table 1. The analysis of the FC and the endoscopy results Faecal Total Colonoscopy No colonoscopy Known IBD New IBD calprotectin (n = 133) (n = 35) (n = 98) (n = 33) (n = 11) (mg/g) <50 50 200

48 28

6 4

42 24

1 3

<200 >200

76 57

10 25

66 32

4 29

11

25/57 patients in group A had colonoscopy (43.8%); 11 were newly diagnosed with IBD; 4 of 6 patients with pre-existing IBD had a change in phenotype or treatment regimen following endoscopy findings. Two patients in group A had normal colonoscopy despite high FC. Of the rest in the same group, one patient was diagnosed as proctitis while three had gastritis. 32/57 patients in group A had no colonscopy performed, 24 of these were known to have IBD and five were found to have bacterial or viral GI infection. 10 out of 76 patients in Group B had colonoscopy performed (13.1%), mostly due to persistent symptoms of diarrhoea and/or abdominal pain. None of these had macro- or microscopic abnormalities. Using estimated costs of FC (euro 75 per test) and colonoscopy (euro1000/test), the calculated net cost saving in the year examined was euro 60,300. Conclusions: Faecal calprotectin is a valuable, cost-effective screening test for excluding significant intestinal inflammatory disease and avoiding colonoscopy in children with non-organic gastrointestinal symptoms that mimic IBD. P219 Faecal calprotectin is an accurate predictor of endoscopic and histological disease activity in IBD G. Chung-Faye *, A. Rahman, K. Sandhu, B. Hayee, J. Tumova, R. Sherwood. King’s College Hospital NHS Foundation Trust, Gastroenterology, London, United Kingdom Background: Assessment of disease activity in inflammatory bowel disease (IBD) is challenging as the gold standards of endoscopy and histology are invasive, expensive and impractical for regular use. Faecal calprotectin (FC) is increasingly being used as a marker of intestinal inflammation in IBD. However, evidence of its role in predicting endoscopic and histological changes in IBD is limited. We explore the role of FC to assess histological disease in IBD, in comparison to C-reactive protein (CRP). Methods: Retrospective analyses of 209 IBD cases who had a colonoscopy with FC (mg/g) and CRP (mg/L) measurements. The most severe histological inflammation found was graded according to the simplified histology score (0, normal; 1, mild; 2, moderate; 3, severe). The Kruskal Wallis test (c2 ) was used to look for differences between the groups. Receiver operating characteristic (ROC) curves were used to differentiate patients with normal/mild disease (histology scores 0 1) from patients with moderate/severe disease (histology scores 2 3). Results: In 100 ulcerative colitis (UC) patients, the median FC values for the histology scores; 0, 1, 2, 3 were; 29, 322, 520 and 2497, respectively (graph). The corresponding values for CRP were; 2.5, 5.0, 12.6 and 13.0. Both FC and CRP showed highly significant differences between the different histology groups (FC c2 = 17.2, p = 0.0007; CRP c2 = 16.3, p = 0.001). With