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e112
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
OC.11.3
DISEASE COURSE AND COLECTOMY RATE IN ULCERATIVE
COLITIS: A FOLLOW-UP COHORT STUDY OF A REFERRAL CENTER
IN TUSCANY
Manetti N.*
1
, Bagnoli S.
1
, Rogai F.
1
, Vannozzi G.
1
, Bonanomi A.G.
1
,
Milla M.
2
, Annese V.
1
1
Department of Emergency, Division of Gastroenterology, AOU Careggi
Hospital, Florence, Italy, Florence, Italy,
2
Department of Oncology, IBD
Regional Referral Center, Division of Clinical Gastroenterology AOU
Careggi, Florence, Italy, Florence, Italy
Background and aim:
The disease course and colectomy rate
of ulcerative colitis (UC) varies largely in population-based and
referral center cohorts. In addition the impact of changing treatment
paradigms with the increasing use of immunomodulators (IM)
and biological agents on the natural history is poorly understood.
We retrospectively evaluated our cohort in order to determine
the disease course and to identify risk factors, including timing of
therapy, that could predict the need for surgery.
Material and methods:
A cohort of 1,772 UC patients (1,011 males,
mean age 34.8 ± 15.3 yrs) was identified and followed for a mean of
11 ± 9 yrs (range 1 - 49 yrs). The cohort was subdivided according
to years of diagnosis: a) before 1980; b) 1981-1990; c) 1999-2000;
d) 2001-2013.
Results:
Disease extension was E1, E2, and E3 at diagnosis in 20%,
54% and 26% of patients, respectively. At final follow-up, disease
extension increased in 20% of cases. Extra-intestinal manifestations
(EIMs) were reported by 11% of patients, while use of systemic
corticosteroids (CS), IM or anti-TNF
a
agents were reported in 68.4%,
20%, and 6.4%, respectively. More specifically, in the cohorts 1991-
2000 and after 2001, the use of IM was 5-fold increased. In addition,
in the cohort diagnosed after 2011, anti-TNF
a
agents were used in
10.1% of patients. The crude colectomy rate was 5.9% (104 pts), with
a Kaplan-Meyer estimation of 1.4% at one year (95% CI = 0.9-1.9)
increasing up to 13% at 30 years of follow-up (95% CI = 5.1-20.9).
The 1-yr colectomy rate did not changed over time (range 0.6-1.9%),
while the 5-yrs and 10-yrs colectomy rates were halved in the
last two decades compared to the previous ones (P=0.001). At the
stepwise logistic regression, disease duration, disease extension, use
of systemic steroids and biologics, were independently associated
with increased risk of colectomy. The colectomy free survival in
patients exposed to IM/anti-TNF
a
agents within 1, 3 and 5 years
from diagnosis compared to those with later or no exposure did not
differ significantly.
Conclusions:
Colectomy rates in our cohort is rather low and was
further reduced in the last two decades. Despite the availability of
anti-TNF
a
agents and earlier use of IM, the 5 and 10 yrs colectomy
rates did not differ significantly in the last two decades.
OC.11.4
FOOD PRESERVATIVES AND ADDITIVES EXACERBATE INTESTINAL
INFLAMMATION
Laudisi F.*
1
, Di Fusco D.
1
, Dinallo V.
1
, Vezza T.
2
, Marafini I.
1
,
Colantoni A.
1
, Ortenzi A.
1
, Monteleone I.
1
, Pallone F.
1
, Monteleone G.
1
1
Department of System Medicine, University of Rome “Tor Vergata”,
Rome, Italy,
2
Department of Pharmacology, IBS Granada, CIBM,
University of Granada, Granada, Spain
Background and aim:
In the last decades, there has been an
increased incidence of IBD, particularly in previously low incidence
areas, and this increase most likely relates to environmental and
lifestyle factors. Food preservatives and additives commonly added
as emulsifiers, stabilizers coating materials or bulking agents are
frequently used in Western diet, and preliminary evidence indicates
that daily consumption of some of these compounds could alter
the intestinal microbiota in mice thereby promoting dysbiosis and
metabolic syndrome.
In this study, we evaluated whether a diet rich in Propylene
Glycol (PG), a diol used as humectant, solvent and preservative,
and Maltodextrin (MDX), a polysaccharide used as food addictive
and energy supplement, can increase the susceptibility of mice to
develop intestinal inflammation.
Material and methods:
Balb/c wild type mice were exposed to
drinking water containing PG or MDX for 5 weeks, while control
mice received only water. Colitis was then induced by the addition
of dextran-sulfate sodium (DSS) dissolved in drinking water. Mice
were sacrificed after 10 days and the colons were harvested for RNA
and protein analysis and histopathology.
Results:
Mice receiving a diet rich in PG or MDX did not exhibit
macroscopic and microscopic signs of intestinal inflammation but
had hyperplasia of mucus-producing cells concomitant with an
increased expression of Muc2 RNA transcripts. PG or MDX-treated
mice expressed high levels of Dual oxidase 2 (DUOX2), an epithelial-
specific NADPH oxidase that is increased in early IBD and regulates
interactions between the intestinal microbiota and the mucosa.
Following DSS administration, mice receiving a diet rich in PG or
MDX exhibited a significant weight loss, destruction of intestinal
epithelium, and higher infiltration of inflammatory cells in the colon
as compared to controls. Moreover, PG and MDX increased colonic
expression of TNF-
a
and IL-6.
Conclusions:
A diet rich in PG or MDX can promote morphological
changes that alter the interaction between luminal flora and mucosal
cells and exacerbate tissue-damaging pathogenic responses.
Altogether, these data suggest that daily consumption of PG or MDX
may contribute to enhance host’s susceptibility to IBD.
OC.11.5
VITAMIN D DEFICIENCY IN EXPERIMENTAL CD-LIKE ILEITIS: A
PRELIMINARY STUDY
Del Pinto R.*
1
, Pietropaoli D.
2
, Corridoni D.
3
, Rodriguez-palacio A.
3
,
Ferri C.
2
, Cominelli F.
3
1
University of L’Aquila, Department of Life, Health and Environmental
Sciences, Division of Internal Medicine, St. Salvatore Hospital,
L’Aquila, Italy,
2
University of L’Aquila, Department of Life, Health and
Environmental Sciences, Division of Dentistry, St. Salvatore Hospital,
L’Aquila, Italy,
3
Case Western Reserve University, Department of
Gastroenterology, UH Hospitals, Cleveland, United States
Background and aim:
LowserumvitaminD (VD) has been associated
with inflammatory bowel diseases (IBD). However, whether it is an
epiphenomenon or it contributes to disease pathogenesis remains
under question. The latter hypothesis is supported by the multiple
functions of the VD axis on immune system modulation and
mucosal barrier integrity. Dysregulation in the immune system and
epithelial barrier dysfunction have been documented in a mouse
model of spontaneous, progressive CD-like ileitis, i.e., SAMP1/YitFc
(SAMP) mice. The aim of this study was to test VD levels in SAMP
mice at different stages of disease progression compared to age-
matched healthy controls (AKR/J and C57/BL6 mice). In addition, we
determined the correlation between VD levels and progression of
ileitis.
Material and methods:
10- and 30-wk old SAMP, and age-matched
parental AKR/J and C57/BL6 controls (n=40), raised under the
same environmental conditions and fed the same standard diet,
were sacrificed. Terminal ilea were collected for histological and
stereomicroscopical assessment of ileitis. Serum was obtained to
perform 25(OH)D ELISA.
Results:
Serum VD levels in SAMP mice were significantly lower
compared to AKR/J (p=0.003) and B6 (p<0.0001) mice, independently
of age. Analysis within strains revealed statistical difference in VD