Digestive and Liver Disease - Volume 48 - Supplement 2 - February 2016

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Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231 e195
Table 2
Left-sided Extensive/
Proctitis Proctosigmoiditis colitis Pancolitis
Disease activity
Remission 7 (29%) 21 (47%) 13 (65%) 20 (43%)
Mild 12 (50%) 22 (49%) 5 (25%) 17 (37%)
Moderate 4 (16%) 1 (2%) 1 (5%) 7 (15%)
Severe 1 (5%) 1 (2%) 1 (5%) 2 (5%)
Therapy
Oral 7 (30%) 24 (53%) 17 (85%) 35 (76%)
Topical 3 (12%) 3 (7%) 0 0
Combined 12 (50%) 16 (35%) 2 (10%) 10 (22%)
Other* 3 (12%) 15 (33%) 1 (5%) 21 (46%)
No therapy 2 (8%) 2 (8%) 1 (5%) 1(2%)
* Other therapies: Steroids, Immunosoppressors or anti-TNF antibodies
Conclusions: Topical therapy is underused in our coohort of patients,
especially in patients with pancolitis. A dedicated IBD outpatients
unit may help to ameliorate the rate of adherence to medical topical
treatment. Further studies are needed to evaluate factors affecting
adherence and possibile strategies to improve topical therapy use.
P.14.3
CORRELATION BETWEEN CLINICAL RESPONSE AND ANEMIA
RESOLUTION IN PATIENTS WITH INFLAMMATORY BOWEL
DISEASES TREATED WITH ANTI-TNF INHIBITORS
Magarotto A.*1, Shepherd T.2, Balendran P.3, Goodhand J.3, Cronin E.4 ,
Graveson K.2, Wood E.3, Marelli L.3, Hamilton M.2, Conte D.1,
Caprioli F.1, Murray C.2
1IRCCS Ospedale Cà Granda Policlinico di Milano, Milan, Italy,
2Gastroenterology Department, Royal Free Hospital, London, United
Kingdom, 3Gastroenterology Department, Homerton Hospital, London,
United Kingdom, 4United Kingdom
Background and aim: Iron deficiency anemia (IDA) represents
a frequent and undertreated finding in IBD patients. Oral iron
supplementation is considered as effective as intravenous iron for
treating IBD-associated IDA, even if active intestinal inflammation
may limit iron enteral absorption. However, response to oral iron
supplementation in IBD with respect to inflammatory status is
still largely unknown. Present retrospective study was aimed
at determining whether the effectiveness of antiTNF therapy is
associated with response to iron supplementation in IBD-related
IDA.
Material andmethods: Patient series included 174 IBD patients with
IBD-related IDA, examined at the enrollement and after long term
antiTNF regimen given at a single UK center (Royal Free Hospital,
London). Primary response was defined as the combination at least
two of the following: absence of symptoms, steroid withdrawal, and
C reactive protein normalization. Primary non-response was defined
as one or none of the above.
Results: In the present cohort, 155/174 patients (89%) had Crohn’s
disease and 85/174 (49%) were anaemic at anti-TNF initiation, with a
mean [SEM] haemoglobin level of 10.89[0.144] g/dl. At baseline, 51/85
(60%) had iron deficiency anaemia, 15/85 (18%) anaemia of chronic
disease, 4/85 (5%) vitamin B12/folate deficiency and 15/85 (17%)
undefined. Overall, 35 out of the 51 IDA patients (69%) were treated
with oral iron. In this set of patients with iron supplementation (28
with CD and 7 with UC), there was no difference in baseline mean
haemoglobin levels in responders as compared with nonresponders
to antiTNF treatment (11.04[0.158] vs 10.59[0.282]), p=0.14. Notably,
responders had a slightly greater increase in haemoglobin levels at
14 weeks (11.04 to 12.05 vs. 10.59 to 11.16 in non-responders) even
if no significant difference in mean change in haemoglobin was
observed (responders +1.01[0.179]; non-responders +0.60[0.299]),
p=0.21.
Conclusions: Our data suggest that oral iron supplementation is
effective in increasing haemoglobin levels in IBD patients, regardless
to their response to anti-TNF therapy which does not impair oral
iron absorption and could be used at the same time. These results
suggest that oral iron should be considered in all IBD patients with
active inflammation.
P.14.4
ESCHERICHIA COLI NISSLE 1917 IN ULCERATIVE COLITIS
TREATMENT: SYSTEMATIC REVIEW AND META-ANALYSIS
Principi M., Losurdo G.*, Iannone A., Contaldo A., Ierardi E., Di Leo A.
UO Gastroenterologia universitaria, Policlinico di Bari, Bari, Italy
Background and aim: Escherichia coli Nissle 1917 (EcN) has been
advised as a therapeutic tool for Ulcerative Colitis (UC) treatment.
However, to date, no meta-analysis has been performed on the topic.
Material and methods: We performed a literature search on
PubMed, MEDLINE, Science Direct and EMBASE. We evaluated
success rates for induction of remission, relapse rates and side
effects, expressed as Intention-To-Treat. Odd ratios (OR), pooled
OR and 95% confidence intervals (CI) were calculated, based on the
Mantel-Haenszel method. Heterogeneity was assessed by using
the c2 and I2 statistics and, if present, a random-effects model was
adopted.
Results: We selected six eligible trials, with 719 patients, 390
assigned to the study group and 329 to the control group. EcN
induced remission in 61.6% of cases, while in the control group
(mesalazine) the remission was achieved in 69.5% of cases, with a
mean difference of 7.9%. The pooled OR was 0.92 (95% CI 0.15-9.66,
p=0.93). A single study showed a better performance of EcN than
placebo. A relapse of the disease occurred in 36.8% in EcN group and
in 36.1% in control group (mesalazine), with a mean difference of
0.8%, OR=1.07, with a 95% CI of 0.70-1.64 (p=0.74). Side effects were
comparable (OR=1.44, 95% CI 0.80-2.59, p=0.22).
Conclusions: EcN is equivalent to mesalazine in preventing disease
relapse, thus confirming current guidelines recommendations.
EcN seems to be as effective as controls in inducing the remission;
therefore, its use cannot be recommended as in one study the
comparison was performed against placebo despite further studies
may be helpful for this topic.
P.14.5
METASTATIC CUTANEOUS CROHN’S DISEASE OF THE FACE
TREATED WITH INFLIXIMAB: CASE REPORT AND FOLLOW UP
Peruzzi E.*1, Piersimoni F.1, Carella A.1, Giacchetti A.1, Ricotti G.1,
Giangiacomi M.2
1INRCA, Ancona, Italy, 2Azienda OSP Riuniti, ANCONA, Italy
Background and aim: MCD is a rare extraintestinal manifestation of
active CD. Only a few cases of facial involvement have been reported.
Diagnosis can be difficult and treatmenet is largely anedoctal.
Sometime improvement has been reported with drugs used for CD.
We describe a patient with intestinal CD disease in remission but
active MCD refractory to usually drugs used for CD, that improved
after infliximab (IFX).
Material and methods: In 2008 a 58-y-old female was refferred to
Dermatology Department for evaluation of painful erithematous
purple papulas, nodules and plaques on her face, she referred in
2006 a ileocecal resection for stenosing and fistulizing CD and since
then in clinical and endoscopi remission. Empiric treatment with
topical and sistemic antibiotics and steroids and azathioprine was
ineffective, cutaneous biopsywas performed; histologic examination