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Background: Onset during old age has been reported in upto 10% of total cases of inflammatory bowel disease (IBD). Aim: To evaluate phenotypic characteristics and the use of therapeutic resources in patients with elderly onset IBD. Methods: Case-control study including all those patients diagnosed with IBD over the age of 60 years since 2000 who were followed-up for >12 months, identified from the IBD databases. Elderly onset cases were compared with IBD patients aged 18 to 40 years at diagnosis, matched by year of diagnosis, gender and type of IBD (adult-onset). Results: One thousand three hundred and seventy-four elderly onset and 1374 adult-onset cases were included (62% ulcerative colitis (UC), 38% Crohn's disease (CD)). Among UC patients, elderly onset cases had a lower proportion of extensive disease (33% vs 39%; P < 0.0001). In CD, elderly onset cases showed an increased rate of stenosing pattern (24% vs 13%; P < 0.0001) and exclusive colonic location (28% vs 16%; P < 0.0001), whereas penetrating pattern (12% vs 19%; P < 0.0001) was significantly less frequent. Regarding the use of therapeutic resources, there was a significantly lower use of corticosteroids (P < 0.0001), immunosuppressants (P < 0.0001) and anti-TNFs agents (P < 0.0001) in elderly onset cases. Regarding surgery, we found a significantly higher surgery rate among elderly onset UC cases (8.3% vs 5.1%; P < 0.009). Finally, elderly onset cases were characterised by a higher rate of hospitalisations (66% vs 49%; P < 0.0001) and neoplasms (14% vs 0.5%; P < 0.0001). Conclusions: Elderly onset IBD shows specific characteristics and they are managed differently, with a lower use of immunosuppressants and a higher rate of surgery in UC.

Background and aims: The aims of this study were to evaluate the frequency of entero-urinary fistulas in a cohort of Crohn’s disease (CD) patients and to analyse the outcomes of medical and surgical therapy. Methods: This multicentre retrospective study included all CD patients with entero-urinary fistulas diagnosed by the presence of clinical symptoms and confirmed at surgery or by radiological or endoscopic techniques. We evaluated outcomes of medical and surgical therapy. We defined remission as absence of clinical symptoms with a radiological confirmation of fistula closure. Cox regression analysis was performed to evaluate factors predictive of achieving remission without need for surgery. Results: Of 6081 CD patients screened, 97 had entero-urinary fistulas (frequency 1.6%). Seventy-five percent of fistulas occurred in men. After a median follow-up of 91 months, 96% of patients were in sustained remission. Thirty-three patients (35%) received anti-tumour necrosis factor (TNF) therapy. Of these, 45% achieved sustained remission (median follow-up 35 months) without needing surgery. More than 80% of patients required surgery, which induced remission (median follow-up 101 months) in 99% of them. Only the use of anti-TNF agents was associated with an increased rate of remission without need for surgery (hazard ratio 0.23, 95% confidence interval 0.12–0.44; p < 0.001). Conclusion: In this large cohort of CD patients, the frequency of entero-urinary fistulas was lower than previously described. More than 80% of patients required surgery, and in all but one of them surgery induced sustained remission. In a selected subgroup of patients, anti-TNF may induce long-term fistula remission and radiographic closure, making it possible to avoid surgery.

Plasmablastic lymphoma is a very rare and recently-described subtype of diffuse large B-cell lymphoma. It has a poor prognosis despite intensive chemotherapy treatment. A 57-year old woman with perianal Crohn's disease receiving azathioprine and infliximab developed this type of lymphoma after a short period of time on the treatment. She also had a hepatitis C virus chronic infection which had not been diagnosed or treated before. There is no solid scientific evidence that either immunomodulators or anti-TNF drugs have a definitive role in the appearance of malignancies, and therefore there are no clear recommendations to limit their use. In these patients, there are some other factors we have to take into account, like the inflammatory bowel disease in itself and its behaviour over time, or the comorbidities of the patient, with special attention to virus infections. In this case report, we will analyse the role of these factors in the development of lymphoproliferative disorders and the recommendations given by experts to avoid their appearance.

In the course of inflammatory bowel disease (IBD) a number of extraintestinal manifestations are known to occur, being the dermatological ones often associated to both ulcerative colitis and Crohn's disease. Pyoderma gangrenosum and erythema nodosum are the most frequent, but there are other skin manifestations less frequently reported such as leukocytoclastic vasculitis. We present a case, in which Crohn's disease and leukocytoclastic vasculitis were simultaneously diagnosed, and corticoids treatment achieved complete remission of the both cutaneous and gastrointestinal manifestations.

Sr. Director: Amiloidosis es el termino generico utilizado para referirse al deposito extracelular anormal de proteinas fibrilares insolubles en varios organos. Se identifican en las biopsias por su apariencia en microscopia electronica y su capacidad para unirse a la tincion rojo Congo provocando birrefringencia verde bajo luz polarizada. La amiloidosis sistemica se asocia con afectacion gastrointestinal en un 50-70% de los casos, siendo infrecuente el deposito local confinado a un organo como pueda ser el estomago (< 1%)1. Presentamos el caso de un varon de 87 anos que acude a urgencias por un cuadro de hematemesis con inestabilidad hemodinamica sin ingesta previa de gastroerosivos y en el contexto de una sobredosificacion de acenocumarol que tomaba por una fibrilacion auricular. Se realizo una gastroscopia urgente observandose una cavidad gastrica poco distensible con una mucosa de aspecto atrofico encontrandose en cara posterior de la union de cuerpo y antro una sobreelevacion de la mucosa de gran tamano, con ulceracion profunda en su centro con fondo sanioso muy indicativa de ulcera gastrica maligna, realizandose esclerosis con 4 cc de etanolamina al 5% y tomandose biopsias (Figura 1). El resto de la mucosa antral presentaba numerosas lesiones nodulares, algunas de gran tamano, erosionadas, que parecian senalar en conjunto una infiltracion gastrica. La histologia fue informada como una mucosa con cambios hiperplasicos glandulares, metaplasia intestinal y escara necrotica y fibrino-leucocitaria correspondiente con el fondo y los bordes de una lesion ulcerada. En la porcion profunda de la mucosa y entremezcladas con la escara se observaban acumulaciones de...

One UC patient (9.1%) had synchronous adenocarcinomas at rectum and descending colon. The histologies of CRCs were as follows; moderately differentiated adenocarcinoma in seven (36.8%), mucinous adenocarcinoma in five (26.3%), poorly differentiated adenocarcinoma in three (15.8%), well differentiated adenocarcinoma in three (15.8%), and signet ring cell carcinoma in one (5.3%). The stage distribution of cancer was as follows; I in one (5.3%), II in seven (36.8%), III in three (15.8%) and IV in eight (42.1%). The cumulative risks of CRC at 10 years after UC, CD, and IBD diagnosis were 0.4%, 0.4%, and 0.4%, respectively. They were 4.9%, 6.6% and 5.5%, respectively after 20 years (Figure 1).

Background and Aims The aims of this study were to determine the prevalence of fatigue in patients with inflammatory bowel disease [IBD], to identify the factors associated with fatigue and its severity, to assess the impact of fatigue on quality of life [QoL], and to evaluate the relationship between fatigue and sleep disorders. Methods This was a prospective multicentre study conducted at 22 Spanish centres. Consecutive patients followed at IBD Units were included. Fatigue was evaluated with the Fatigue Severity Scale [FSS] and the Fatigue Impact Scale [FIS]. Quality of life and sleep quality were assessed using the IBD Questionnaire-Short Form [IBDQ-9] and the Pittsburgh Sleep Quality Index [PSQI], respectively. Results A total of 544 consecutive adult IBD patients were included [50% women, mean age 44 years, 61% Crohn’s disease]. The prevalence of fatigue was 41% (95% confidence interval [CI] = 37–45%). The variables associated with an increased risk of fatigue were: anxiety [OR = 2.5, 95% CI = 1.6–3.7], depression [OR = 2.4, 95% CI = 1.4–3.8], presence of extraintestinal manifestations [EIMs] [OR = 1.7, 95% CI = 1.1–2.6], and treatment with systemic steroids [OR = 2.8, 95% CI = 1.4–5.7]. The presence of EIMs [regression coefficient, RC = 8.2, 95% CI = 2.3–14.2], anxiety [RC = 25.8, 95% CI = 20.0–31.5], depression [RC = 30.6, 95% CI = 24.3–37.0], and sleep disturbances [RC = 15.0, 95% CI = 9.3–20.8] were associated with severity of fatigue. Patients with fatigue had a significantly decreased IBDQ-9 score [p < 0.001]. Conclusions The prevalence of fatigue in IBD patients is remarkably high and has a negative impact on QoL. Therapy with systemic steroids is associated with an increased risk of fatigue. The severity of fatigue is associated with anxiety, depression, sleep disorders, and the presence of EIMs. Fatigue was not associated with anaemia, disease activity or anti-TNF therapy.