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Phenotypic Characteristics and Use of Therapeutic Resources in Elderly-Onset Inflammatory Bowel Disease: A Multicentre, Case-Control Study Miriam Manosa, Margalida Calafat, Ruth de Francisco, Carmen Garcia Caparros, Maria Jose Casanova, Patricia Huelin, Marta Calvo, Luis Fernandez Salazar, Miguel Minguez, Alexandra Ruiz-Cerulla, Yamile Zabana, Guillermo Bastida, Joaquin Hinojosa, Lucia Marquez, Manuel Barreiro-de Acosta, Xavier Calvet, David Monfort, Rosario Gomez, Esther Rodriguez, Jose Maria Huguet, Maria Rojas-Feria, Daniel Hervias, Ramon Atienza, David Busquets, Eva Zapata, Carmen Duenas-Sadornil, Mara Charro, Francesc J. Martinez-Cerezo, Rocio Plaza, Juan Maria Vazquez Moron, Javier P. Gisbert, Eduard Cabre, Eugeni Domenech

Results: Overall, 8673 patient met our inclusion criteria of which 479 went on to have a total colectomy during follow up. 52% of patients were male and the median age of the cohort was 46 years. The overall 5 year colectomy rate over the whole period of follow up was 5.9% (95%CI: 5.4 6.5%). Colectomy was more common in males (62.2% vs 37.8%, p < 0.001). The 5 year colectomy rate was 4.2%, 5.1% and 6.9% for era 1, era 2 and era 3 respectively (p = 0.001 via Log-rank testing) (Figure 1). The 5 year probability of receiving a thiopurine was 10.9%, 19.3% and 27.9% for era 1, era 2 and era 3 respectively (p < 0.001, via Log-rank testing) (Figure 2). Furthermore, the proportion of early thiopurine users within the first year of diagnosis increased by era and was 4.6%, 9.6% and 13.4% (c2 p < 0.001).

Introduccion La colitis ulcerosa (CU) presenta una incidencia de cancer colorrectal (CCR) aumentada, recomendandose el cribado endoscopico segun extension y tiempo de evolucion de la enfermedad. Se dispone de escasos datos al respecto en el area mediterranea y algunos estudios recientes sugieren una reduccion en el riesgo de CCR/displasia en CU en los ultimos anos. Objetivos Evaluar la incidencia de CCR, displasia, y adenomas colicos, asi como los factores de riesgo asociados, en pacientes con CU de larga evolucion. Pacientes y metodos Todos los pacientes con CU de >10 anos (CU extensa) o >15 anos (CU distal) controlados en 2 centros terciarios y de los que se disponia de al menos de una colonoscopia (CS) especificamente solicitada para cribado, fueron identificados de las respectivas bases de datos. Se registraron los resultados de cada CS y de las biopsias de colon, asi como los factores de riesgo para adenoma, CCR y displasia, los datos clinicos y de tratamiento. Se excluyeron aquellos pacientes especificamente derivados por hallazgo de displasia y aquellos con proctitis sin progresion proximal posterior. Resultados Se incluyeron 215 pacientes (50% hombres) con media de edad al diagnostico de la CU de 34±13 anos. La extension de la CU al diagnostico fue 24% proctitis, 43% izquierda y 33% extensa. El 10% de los pacientes presentaban antecedente familiar de EII y el 7% de CCR. Un 2% de los pacientes presentaban colangitis esclerosante primaria concomitante. El tiempo medio de evolucion hasta el fin de seguimiento fue de 21±7 anos, durante el cual el 72% de los pacientes presento progresion proximal de la CU. Se realizaron un total de 608 CS (mediana por paciente 2, IIQ: 1–4), realizandose la primera CS de cribado tras una media de 186±58 meses desde el diagnostico y explorandose hasta ciego o colon ascendente en el 84% de ellas. Se detectaron 9 casos de displasia (6 de bajo grado, 3 displasia moderada) y ningun caso de CCR. Solo 3 de ellos habian requerido inmunosupresores. En 8 de los 9 pacientes se disponia de CS posteriores al primer hallazgo de displasia, confirmandose displasia solo en 1 caso. La probabilidad acumulada de desarrollar displasia fue del 0%, 2,8% y 11,5% a los 10, 20 y 30 anos. No se hallaron factores asociados a un mayor riesgo de displasia. Se hallaron polipos adenomatosos en el 15% de los pacientes durante el seguimiento. Sorprendentemente, el hallazgo de polipos se asocio a un mayor uso de 5ASA (p Conclusiones En nuestro medio, el riesgo de displasia en la CU de larga evolucion parece ser inferior al descrito en otras areas geograficas. Por otra parte, estos pacientes podrian presentar una incidencia de adenomas inferior a la poblacion general.

Background: Although it is well-established which are the early and mid-term outcomes of ulcerative colitis (UC) after a first course of corticosteroids (CS), data on disease evolution of those patients responding to the first CS course are scarce. Aims: To evaluate, in UC patients responding to a first course of CS, the clinical outcome in the long-term and to identify which factors are associated to a poor outcome (steroid-dependency, steroidrefractoriness in further flares, or colectomy). Patients and Methods: UC patients (not ulcerative proctitis) who were diagnosed from January 1995 and who were followed-up in the participating centers from the first CS course because of a moderate-to-severe flare, were identified from each IBD database. Only those who responded to CS and did not start thiopurines or infliximab as maintenance therapy were included. Clinical data at disease diagnosis, at the time CS were first prescribed, and during follow-up, were recorded. Results: 100 patients were included (59 % men; mean age 35.5+/-13.4 years). CS were introduced to treat a moderate (80%) or a severe attack (20%); at that moment, 51% of patients had extensive UC and 49% left-sided, and 9% were current smokers. 98% of patients followed maintenance treatment after CS with mesalamine (mean dose: 2.5+/-0.7 g/d). Mean followup was 83.5+/-44.7 months. During follow-up, 7% of patients with left-sided UC had proximal spread of the disease, and 70% of patients suffered UC relapses. CS had to be reintroduced in 63% of patients (cumulative probability 37%, 61%, 65% at 1, 3, and 5 years, respectively). Immunosuppressants were introduced in 55% (cumulative probability 31%, 46%, 52% at 1, 3, and 5 years, respectively), and infliximab in 22%. Only 11% were colectomized. The cumulative probability of steroid-dependency during follow-up was 26%, 35%, and 38%, at 1, 3, and 5 years, respectively. Finally, the cumulative probability of having a steroid-refractory flare during follow-up was 9%, 17%, and 20%, respectively. Gender, age, UC extension, or severity of the first CS-treated flare, were not associated to a poorer outcome. However, time from UC diagnosis to first CS prescription was inversely associated to the development of steroid-refractoriness in further UC flares. Conclusions: Long-term outcome of UC patients responding to a first course of CS is good, with a low risk of colectomy although almost half of the patients will require immunosuppressants mainly because of steroid-dependency.

Objective: evaluate the influence of inflammatory bowel disease (IBD) on pregnancy evolution and fetal alterations. Method: the protocols of patients with Crohn's disease (CD) and ulcerative colitis (UC), from 1984 and 2006, in fertile age, followed at the ambulatory of IBD, were reviewed. Patients were interviewed by the research medical doctor, to complete some issues not found in their protocols. Patients with others colitis, incomplete investigation, not in fertile age or without cognitive capacity were excluded from this study. Obstetric history before and after the beginning of symptoms related to IBD, clinical conditions of patients, drugs administered during pregnancy period, preterm delivery, low birth weight, stillbirth, congenital anomalies, spontaneous miscarriage, vaginal and cesarean delivery were investigated. Results: 416 pregnancies in 163 patients before the diagnosis of IBD and 140 pregnancies in 104 patients with IBD were evaluated (UC in 63 pregnancies and CD in 77 pregnancies). IBD was associated with increased preterm delivery (x2=6.7205, p=0.009). There was no statistical difference in low birth weight (x2=0.413 / p=0.5204), congenital anomalies (Fisher test: p=0.6447), stillbirth (Fisher: p=0.2245), spontaneous miscarriage (x2= 4.884, p=0.27), vaginal and cesarean delivery (x2= 1.7959, p=0.1802). There were 63 pregnancies in UC patients, with active disease in 28 and inactive in 35 pregnancies. There were 77 pregnancies in CD patients, with active disease in 57 and inactive in 20 patients. There was no difference between the groups of pregnancies in UC and CD, related to preterm delivery, low birth weight, congenital anomalies, stillbirth and spontaneous miscarriage (p > 0.0649). There was statistical difference in active and inactive disease groups in CD, related to preterm delivery and low birth weight (p < 0.0365). Distribution of alterations in fetus and activity of UC and CD is shown on table 1. Conclusions: preterm delivery rates were higher in pregnancies of CD patients, even with inactive disease during pregnancy. There was no influence of IBD on low birth weight, congenital anomalies, stillbirth and spontaneous miscarriage. Table 1. Distribution of alterations in fetus and activity of UC and CD.

La incidencia de alteraciones de la densitometria osea (ADMO) en pacientes con enfermedad inflamatoria intestinal (EII) se encuentra incrementada, con resultados muy variables probablemente por la heterogeneidad de las caracteristicas de los pacientes. Objetivos Evaluar la prevalencia de ADMO en el debut de la EII e identificar factores de riesgo asociados. Pacientes y metodos Se identificaron todos los pacientes con EII a los que se les habia realizado una densitometria osea en los primeros 12 meses desde el diagnostico. Se obtuvieron datos sobre factores de riesgo de osteoporosis en la poblacion general y datos relacionados con la EII, a partir de la historia clinica o por contacto telefonico. Resultados 103 pacientes (52 Crohn, 51 colitis ulcerosa), 52% mujeres, mediana de edad de 34 anos (IIQ: 23-42), 53% fumadores. La actividad inflamatoria de la EII en el diagnostico era moderada o grave en el 70% de los pacientes. En el momento de la densitometria, el 52% habian recibido esteroides (mediana de 20 dias). Ningun paciente habia recibido agentes antiTNF. Solo el 8% no tomaba lacteos habitualmente y el 83% realizaba ejercicio fisico de algun tipo. Solo 3 pacientes eran menopausicas y el 12% de las mujeres tomaba anticonceptivos. La prevalencia de ADMO fue del 37% (33% osteopenia y 4% osteoporosis). Las gestaciones previas, el indice de masa corporal, la albumina serica, la falta de ejercicio fisico y la edad se asociaron a ADMO. El grado de actividad, tipo, localizacion o extension de la EII no se correlacionaron con ADMO. En el analisis multivariado, la albumina serica baja, la edad y la falta de ejercicio fisico fueron factores predictivos independientes de ADMO. Conclusiones Un tercio de los pacientes con EII presentan ADMO en el debut de la enfermedad. Como en la poblacion general, la edad es determinante para el desarrollo de ADMO, pero no constituye un criterio para la decision de realizar estudio densitometrico.

(L1/L4), 1 with colonic localization (L2). PCDAI was 21.9±11.2. Terminal/neoterminal lesions were detected at SICUS in 23 patients, confirmed at ileo-colonoscopy in 22 and at surgery in 1. Terminal/neoterminal lesions were excluded at SICUS in 1 patient with CD of the colon and in 2 operated patients with no recurrence and confirmed at ileo-colonoscopy. SICUS detected additional jejunal/proximal ileum lesions in 7 pts confirmed at radiology and/or WCE or surgery. At SICUS the extension of the proximal and distal SB lesions was 26±22.8 cm and 17±10 cm respectively. Furthermore SICUS detected extraluminal CD findings, namely nodes enlargement and mesenteric involvement, in 21/26 patients. Conclusions: These findings indicate that the non invasive procedure SICUS: 1) has a high accuracy for diagnosing Crohn’s lesions of the SB, 2) is comparable to endoscopic, radiological and WCE examination, in detecting presence and site of SB lesions, and 3) furthermore enables to assess the extension of the SB lesions. These findings support the use of non-invasive SICUS as a first choice examination in the diagnostic work up and follow up of CD pediatric patients.