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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e199
Concerning UC, NAP-A are older (51,12±15,1yrs) than NAP-B and
AD (respectively 46,18±17,87and 44,30±13,86 yrs, p<0,05); NAP-A
pts have lower educational level than AD pts (primary education
47,78% Vs 26,79%). Therefore, NAP-A CD pts are older than AD pts
(46,59±14,44yrs Vs 39,82±12,00, p<0,05) but no differences were
found in epidemiological- disease features. MoriskyScale showed a
low adherence to therapy (<6) in 59,56% of NAP-A pts and 63,16%
of NAP-B, while 50% of AD pts had a Morisky Scale>7, p<0,05. Care
satisfaction was positive in both.
Conclusions:
We unexpectedly found a false non-adherent pts cohort
who chose other centres for regular follow-up. High prevalence of
non-adherence to therapy was found among patients not attending
regular follow up visits in tertiary centre. However, no differences
in disease activity was found within the groups. NAP are most likely
UC pts and >50yrs old. Non-adherence to follow-up is strictly related
with low adherence to therapy either. Moreover we can focus the
importance of a network of collaboration between secondary and
tertiary centers in order to ensure the best assistance to chronic
pts, which will probably have benefit from a multidisciplinary and
complex approach. More studies are required to understand how to
reinforce adherence to follow-up
P.14.13
ENDOSCOPIC ACTIVITY EVALUATION IN ULCERATIVE COLITIS:
STILL AN UNSOLVED ISSUE
Pagnini C.*
1
, Corleto V.D.
2
, Menasci F.
1
, Desideri F.
1
, Delle Fave G.
1
,
Di Giulio E.
2
1
Sapienza University, Gastroenterology, Sant’Andrea Hospital, Rome,
Italy,
2
Sapienza University, Endoscopy Unit, Sant’Andrea Hospital,
Rome, Italy
Background and aim:
The relevance of the endoscopic evaluation
in ulcerative colitis (UC) management has been recognized from
long time. Nonetheless, the modalities of reporting the endoscopic
activity still represent an unsolved issue. To this purpose, several
endoscopic scores have been proposed, but very few have been
properly validated and the use of such tools remains sub-optimal
and mainly restricted to clinical trials. In the last years, the growing
emphasis of the concept of ‘mucosal healing’ as prognostic marker
and therapeutic goal, has reproposed the need of a more accurate
definition of endoscopic activity in UC.
Material and methods:
We performed a review of the literature of
UC endoscopic scores. The evolution of the problems related to the
endoscopic scores have been analyzed, with particular attention to
the renewed relevance that endoscopic activity has gained in recent
years. The most frequently used scores, and in particular the very
last ones proposed, have been critically examined.
Results:
More than 30 scores have been described in literature, and
we focused on 5 scores (Modified Baron, Mayo Endoscopic Subscore,
UCEIS, UCCIS and Modified Mayo Endoscopic Scores) that represent
the most commonly used or the most recently proposed ones.
Crucial unsolved issues remains the definition of mucosal healing,
the possible evaluation of disease extension, the dualism between
simplicity and accuracy of the scores, inter-observer agreement, and
the implementation of the utilization of the scores.
Conclusions:
At present, despite the growing relevance of the
issue of endoscopic activity, confirmed by the very recent proposal
of novel endoscopic scores, the issue of the evaluation of the
endoscopic activity in UC is still open, and the implementation of
the use of efficacious endoscopic scores, and the better definition
of the absence of activity (mucosal healing), should be improved in
the next years.
P.14.14
EXPLORING THE EPIDEMIOLOGICAL ASPECTS OF IBD:
PRELIMINARY DATA FROM EPIMICI STUDY IN SAN MARINO
Lopetuso L.R.*
1
, Piscaglia A.C.
2
, Laterza L.
1
, Gerardi V.
1
, Boccia S.
1
,
Leoncini E.
2
, Sacchini E.
2
, Armuzzi A.
1
, Gasbarrini A.
1
, Stefanelli M.L.
2
1
Internal Medicine, Gastroenterology Division, Catholic University
of Sacred Heart, Rome, Italy,
2
State Hospital, Endoscopy and
Gastroenterology Unit, San Marino, San Marino
Background and aim:
IBD, including Ulcerative Colitis (UC) and
Crohn’s Disease (CD), are chronic relapsing conditions with an
increasing worldwide incidence. San Marino is the third smallest
country of the world with peculiar epidemiologic aspects and can
represent an ideal population for studying IBD pathophysiological
basis.
Material and methods:
To study the epidemiological aspects of IBD
in San Marino population. This is a study population including all
San Marino persons diagnosed with IBD between 1980 and 2014.
Information on socio-demographic and clinical characteristics of
cases were obtained via linkage to administrative databases. The
principal variables evaluated were age at diagnosis, family history of
IBD, disease localization, extra-intestinal manifestations, therapies
and their outcome, and need for surgery.
Results:
Among all SanMarino inhabitants, the overall IBDprevalence
was 610/100.000, 350/100.000 for UC and 260/100.000 for CD. The
incidence of IBD progressively increased, especially for CD, during
the studied period. 15% of patients for CD and less than 10% for UC
had a family history of IBD. At gender stratification, 52% UC and 51%
CD patients were males. Average age at diagnosis was 38 for UC and
35 for CD. The time lapse between onset of symptoms and diagnosis
was less than 1 year for UC and 1-2 years for CD. Extra-intestinal
manifestations were observed in 10% of patients with UC and in 30%
with CD. Of note, 1 UC patient had sclerosing cholangitis and 1 CD
patient had ankylosing spondylitis. Disease localization for UC was:
rectum (33%), sigma-rectum (28%) and pancolitis (27%); while for
CD was ileum (43%), ileo-colon (41%). Colectomy was needed for 2
UC patients; while 20% of CD patients with ileal stenosis underwent
surgery and 80% of these experienced a disease recurrence after 5
years. Immunosuppressive drugs were needed in less than 10% of UC
patients and in 17% of CD patients. Biologics were used only in 5 CD
patients with achievement of remission.
Conclusions:
Our preliminary data demonstrated that IBD
prevalence is increased and gender distribution is different in San
Marino population when compared to Italian and European data.
Early diagnosis and treatment could explain the overall good
outcome of the patients evaluated. Further data are needed to
confirm and better clarify these findings.
P.14.15
EFFICACY AND SAFETY OF INFLIXIMAB AND ADALIMUMAB
IN CROHN’S DISEASE PATIENTS IN A SINGLE IBD CENTER: A
RETROSPECTIVE REAL-LIFE STUDY
Desideri F.*, Pagnini C., Menasci F., Capasso M., Corleto V.D.,
Delle Fave G.
Sapienza University, Sant’Andrea Hospital, Rome, Italy
Background and aim:
Anti-TNF
a
biologic therapy [infliximab (IFX)
and adalimumab (ADA)] are considered a safe and efficacious option
for Crohn’s disease (CD) patients. Safety profile and efficacy of
the two drugs are considered similar, but comparative studies are
lacking. Moreover, the most of the data come from registrative and
randomized clinical trial performed in tertiary referral centers and
in ideal condition, that may not reflect the real clinical scenario of
many inflammatory bowel disease (IBD) centers. Aim of the study