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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e79
of deep remission. The aim of this study was to assess the rate of
TH evaluated by bowel sonography (BS) and magnetic resonance
enterography (MRE) in CD patients treated with biologics, directly
comparing the two cross-sectional procedures.
Material and methods:
We performed a 2-year observational
longitudinal prospective study evaluating steroid-free clinical
remission (CR), mucosal healing (MH), and TH in all patients with
CD who would complete a 2 years period of maintenance treatment
with biologics. All patients underwent endoscopy, BS and MRE
before starting biologics and 2 years later. Furthermore, the Crohn’s
Disease Activity Index (CDAI) score was calculated before treatment
and 2 years later.
Results:
The study included 40 CD patients biologics (38% infliximab
and 62% adalimumab). TH was evident in 10 patients (25%) at BS
and in 9 patients (23%) at MRE (k=0.84; P < 0.01). No significant
differences were noted about TH in relation to the type of biologic
used (P = NS). MH was obtained in 14 subjects (35%). A good
agreement was observed between MH and TH at BS (k = 0.63; P <
0.001) and TH at MRE (k = 0.64; P < 0.001). CR was achieved in 24
patients (60%). A poor agreement was found between CR and TH,
both at BS and MRE (k = 0.27 and 0.29, respectively; P < 0.01).
Conclusions:
TH can be reached in about 25% of CD patients treated
with biologic with high agreement between BS and MRE on defining
this outcome. After considering the advantages of BS (high diagnostic
accuracy, low costs, high patient compliance, high availability) and
the limitations or MRE (high costs, low availability), we suggest the
use of BS as first cross-sectional procedure in defining TH in patients
with CD.
OC.02.10
ADHERENCE OF ITALIAN GASTROENTEROLOGISTS TO
GUIDELINES FOR THE MANAGEMENT OF ULCERATIVE COLITIS:
A MULTICENTRE PROSPECTIVE OBSERVATIONAL ITALIAN AIGO
STUDY
Scribano M.L.
1
, Costa F.
2
, Bortoli A.
3
, Papi C.
4
, Cappello M.
5
,
Bortoluzzi F.N.
6
, Caserta L.
7
, Ferronato A.
8
, Cortelezzi C.C.
9
,
Manguso F.
10
, Kohn A.*
1
on behalf of the AIGO IBD study group
1
UOC Gastroenterologia AO San Camillo Forlanini, Roma, Italia,
2
UOC Gastroenterologia AOUP, Pisa, Italia,
3
UOC Gastroenterologia
UAO G. Salvini, Ospedale di Rho, Rho, Italia,
4
UOC Gastroenterologia
Ospedale San Filippo Neri, Roma, Italia,
5
UOC Gastroenterologia ed
Epatologia, AOU Palermo, Palermo, Italia,
6
UOC Gastroenterologia ULSS
12 Veneziana, Mestre, Italia,
7
UOC Gastroenterologia Ospedale San
Martino, Genova, Italia,
8
UOSD Endoscopia Ospedale Alto Vicentino,
Santorso, Italia,
9
UOC Gastroenterologia Ospedale di Circolo, Varese,
Italia,
10
UOC Gastroenterologia Ospedale Cardarelli, Napoli, Italia
Background and aim:
Several guidelines and consensus are available
for the therapeutic management of patients with ulcerative colitis
(UC). Only few studies evaluated the use of evidence-based therapy
by physicians in their clinical practice. The aim of this study was to
assess the extent of physicians’ adherence to prescribing guidelines
in the management of UC.
Material and methods:
A multicentre observational prospective
study on the adherence to guidelines in UC was conducted in 28
gastroenterology (GI) unit across Italy. Consecutive outpatients
with a flare of UC were enrolled in the study. A questionnaire
was administered to the attending physicians consisting of two
sections, the first (A) included questions about the GI unit, personal
experience in IBD, number of IBD/UC patients followed by the unit,
the second (B) included questions on the extension and severity
of UC, on the specific medical treatment undertaken and on the
adherence to guidelines.
Results:
546 patients were enrolled. An interim analysis of the first
446 patients, enrolled by high (27%), medium (47%) and low (26%)
IBD volume unit, included 39% extensive, 49% left-distal colitis, 12%
proctitis. The extension did not differ by hospital volume; severe
flares were less frequent in patients enrolled by medium volume
IBD units (8% vs 21% high and 19% low volume unit). In 88.8% of
flares, the management was based on guidelines regardless of
the physician’s experience in IBD and size of the IBD population
followed by the unit. Physicians referred mainly to ECCO guidelines,
to a greater extent physicians from high volume if compared to low
volume IBD units (89.3% vs 63%).
Conclusions:
The adherence of Italian gastroenterologists to
guidelines for the management of ulcerative colitis is high. In the
clinical practice, the compliance with guidelines is not affected by
the size of the IBD unit and the physicians experience in IBD.
OC.03 Liver
OC.03.1
QUANTIFICATION OF SERUM HBSAG IS A USEFUL PARAMETER TO
OPTIMIZE ANTIVIRAL NUC THERAPY IN CHRONIC HBV INFECTION
Guarino M.*
1
, Portella G.
2
, Bonavolta R.
2
, Auriemma F.
1
, Cossiga V.
1
,
Granata R.
1
, Caporaso N.
1
, Morisco F.
1
1
Department of Clinical Medicine and Surgery, Gastroenterology
Unit, University of Naples “Federico II”, Naples, Italy,
2
Department
of Translational Medical Science, University of Naples “Federico II”,
Naples, Italy
Background and aim:
Serum HBsAg loss is the recommended
stopping rule in nucleo(t)side-analogues (NUC) responders, yet
this event occurs rarely. Decreasing serum HBsAg levels, preceding
HBsAg seroclearance (HBsAg <20 UI/ml), has not been sufficiently
investigated and the predictive value of baseline and on-treatment
quantitative serum HBsAg levels in the therapeutic response to
NUC in chronic hepatitis B patients remains unclear. We aimed
to investigate the kinetics of HBsAg levels during NUC therapy to
evaluate the treatment period to achieve HBsAg seroclearance.
Material and methods:
Patients with chronic HBV infection,
receiving NUC antiviral therapy with stable viral suppression (HBV-
DNA < 20 IU/ml), were recruited at the Gastroenterology Unit of the
University of Naples “Federico II”. Sequential serum samples from
these patients were tested for quantification of HBsAg with the
“HBsAg II quantitative immunoassay”(Roche). HBsAg levels were
determined at baseline, where possible, and on-treatment every 12
months.
Results:
A total of 95 HBsAg-positive, HBeAg-negative patients
(male/female: 73/22, median age 58 yrs, range 35-79 yrs, 33%
cirrhotic) virally suppressed with different NUCs, were enrolled.
Precisely 56 patients were in therapy with Tenofovir (TDF), 22 with
Entecavir (ETV) and 17 with Lamivudine (LAM).
The median treatment duration was 110 months, range 48-183
months.
There was a significant decrease of the HBsAg levels during NUC
therapy (p value <0.001); in particular, at time of enrollment, the
HBsAg baseline mean value was 3471 UI/ml (450-28948 IU/ml),
while the mean value at the last determination of HBsAg was 1758
IU/ml (20-21905 IU/ml). Only 2/95 patients (1,9%) didn’t show a
substantial decrease in HbsAg levels.
The statistically significant decrease of HBsAg levels was also main
tained when the patients were clustered according to antiviral
therapy, presence of cirrhosis and previous treatment with inter
feron (table 1).