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Background The management of inflammatory bowel disease (IBD) has substantially changed in the last decades, both in relation to medical and surgical treatments. Aims Principal: To know the rate of surgery in a newly diagnosed IBD cohort within the first year after diagnosis. Secondary: To describe the type of surgeries and indications in this cohort, and to identify predictive factors for surgery (focused on intestinal resection) in these patients. Methods Prospective, population-based nationwide registry. Adult patients diagnosed with IBD -Crohn’s disease (CD) and ulcerative colitis (UC)- during 2017 in Spain were included and were followed-up for 1 year. Kaplan-Meier curves were used to calculate the rate of surgery. In patients with intestinal resections, only medical treatments before surgery were considered. Predictive factors for surgery were identified by Cox-regression analysis. Results 3,454 patients (1,647 CD and 1,807 UC) were included (table 1). The incidence rate for surgery was significantly higher among CD patients (figure 1). A total of 197 patients (6%) underwent surgery within the first 12 months: 126 (64%) intestinal resections, and 71 (36%) perianal surgeries. Fifty-seven percent of intestinal resections were urgent, and 43% elective. The main indications for intestinal resections were: intestinal obstruction in 37%, abscess/fistula in 27%, perforation/acute abdomen in 25%, and refractoriness to medical treatment in 18% of cases. A total of 174 CD patients (10.6%) underwent surgery ¾61% intestinal resections and 39% perianal. Twenty-three UC patients (1.3%) were operated on; the number of surgeries in UC was too low to identify predictive factors. In CD patients, to have been treated with thiopurines [Hazard ratio (HR)=0.2, 95% confidence interval (CI)=0.1–0.3) was associated with lower likelihood of intestinal resection. Disease behaviour at diagnosis [stricturing vs. inflammatory (HR=6.5, 95%CI=4–10) and fistulising vs. inflammatory (HR=13, 95%CI=9–21)] was associated with the risk of intestinal resection. Biologic treatment was not associated with the likelihood of intestinal resection (figure 2). Conclusion Six percent of IBD patients undergo surgery within the first year of diagnosis, being higher in CD (11%) than in UC (1.3%). Sixty percent of intestinal resections are urgent procedures. The risk of surgery is increased in CD patients with fistulising and stricturing behaviour. Thiopurine, but not biologic treatment, is associated with lower risk of surgery.

Background Quality of care (QoC) is a highly important topic in inflammatory bowel disease (IBD). We recently elaborated a decalogue of QoC indicators (IQCARO-QoC) developed by IBD patients. The aim of the present study was to assess the factors associated with patients’ evaluation of QoC in Spain using the IQCARO-QoC Decalogue recently developed by IBD patients. Methods A survey including patients’ socio-demographic and clinical characteristics, and the IQCARO-QoC Decalogue, was completed by IBD patients. We described patients’ assessment of QoC across Spanish patients. A univariable and multivariable analysis was performed to explore the associations between patients’ characteristics and QoC. Results Questionnaires from 788 participant patients were analysed. Participants’ mean age was 43.4 years, 63% were females and 58% had Crohn’s disease. The mean QoC score was 8.1 (± 2.4 SD) points out of a maximum of 10. Items with the lowest score were related to the provision of information and the implication of the medical team throughout the entire patient care. Factors associated with better QoC scores included: being employed better disease control, fewer numbers of unscheduled visits, and being followed by a gastroenterologist specialized in IBD. Conclusions Spanish patients’ reported QoC seems to be globally good although there is room for improvement, especially in providing adequate information to patients. Care provided by specialized IBD gastroenterologists seems to be related with higher QoC scores.

Background Spanish inflammatory bowel disease (IBD) group (GETECCU) mission is to promote healthcare, teaching and research of excellence. Our vision is to establish standards of quality of care and generate a mark of excellence and reliability for IBD patients and the different agents involved in all its processes. The aim of this study was evaluate the impact of a program for certification of IBD units (CUE program). Methods Identification of quality indicator for certification of IBD Units was based on CUE Delphy methodology that finally selected 53 quality indicators (12 structure, 37 process and 4 results), which were subjected to a normalisation process (Calvet X et al. JCC 2014; 8: 240–51). This process consisted of face-to-face protocoled meetings with a committee of experts that proceeded to defined/justified the use of each indicator considering objectiveness and the measure of compliance. Applications for certification in the program are made voluntarily through the GETECCU secretariat. From GETECCU, the candidate units are counselled through a consulting round before an audit drill and finally, the formal audit carried out by an independent certifying agency. This audit consists of the review of all selected indicators and includes a review of 40 random medical records. If 80–90% compliance is achieved, the qualification of ‘advanced’ is obtained and the unit is re-certified in 2 years. If it exceeds 90%, the rating is ‘excellence’ and the unit has to be re-certified in 3 years. An anonymous survey was conducted among certified units to assess satisfaction with the program Results The CUE program started in 2017. As of November 2019, there are 53 IBD units adhered to the certification nationwide program, of which 42 have already been audited and 40 certified. Twenty-three units achieved the qualification of excellence (56%), 17 achieved an advanced qualification and 5% had not passed the certification. The remaining 11 are currently in the process of being audited. After an IBD Unit achieve the certification an act of official delivery is carried out with the presence of patient associations, public care authorities and the board of GETECCU. Results are published in the State Official Gazette. Survey main results were the average perceived improvement, averaged as 8.5, out of 10. The most important aspect of improvement is data recording followed by health and patient satisfaction results Conclusion The establishment of quality standards certification programmes in multidisciplinary units improves the quality of care offered to IBD patients. The acceptance among the health community for adherence to these projects is very high despite being voluntary. The support of patient associations and managers is essential to value these types of projects

Background A less aggressive phenotype of Crohn’s disease (CD) has been reported in patients with elderly onset CD. Despite this, similar surgical rates among younger and older CD patients have been reported. However, scarce data are available about the risk of postoperative recurrence (POR) regarding the age, and no data are available about the use of immunosuppressants and biological agents for prevention of POR in elderly patients. Our aim was to evaluate the management of CD in the postoperative setting and the rate of surgical POR in CD patients according to the age at surgery. Methods Cohort study including all adult CD patients in the ENEIDA registry (a prospectively-maintained database of the Spanish Working Group in IBD –GETECCU-) who underwent a first intestinal resection with ileo-colonic anastomosis. Patients were grouped regarding their age at the moment of the first surgery: over 60 years (elderly) and between 18 and 60 years of age (controls). Preventive treatment for POR, surgical POR (need for a further intestinal resection) and postoperative morbidity were compared between both groups. Results Out of the 69,740 IBD patients included in the ENEIDA database, 3,982 had a first intestinal resection for Crohn’s disease with an ileo-colonic anastomosis between 2005 and 2020. Of them, 535 were elderly and 3,454 controls. Time from IBD diagnosis to surgery was significantly longer in the elderly (114±128 vs. 93±97 months; p Conclusion The elderly patients show similar rates of surgical POR as compared to younger patients. Given the high risk of thiopurine and anti-TNF-related adverse events, elderly patients with inflammatory pattern would benefit from preventive therapy with safer biologicals.

Background Inflammatory Bowel Disease (IBD) can be a cause of disability. To date, the scores that evaluate disability in IBD patient use mainly subjective criteria. The aim of this study was to develop and validate an index of disability in IBD based on objective, measurable criteria. Methods IBD patients from the Catalan and Spanish Crohn and Colitis Associations volunteered to fulfill an online self-administered survey. Demographic, clinical, and therapeutic variables were collected. They also informed on whether they have a recognized disability and whether they receive a work disability pension. Patients were divided into a training and validation set. In the training set, different multivariate analyses were carried out to evaluate objective variables related to having a recognized work disability, a general disability or a moderate or severe degree of disability. The score was elaborated with the statistically or clinically significant variables present in the multivariate analyses. The ROC curves for predicting general and work disability were calculated. Results 981 valid surveys were included. Sixty six percent of the patients were women, mean age was 40.9 years and 59.3% had Crohn’s disease. Of these patients, 85 (9.1%) had a recognized work disability and 429 (45.9%) had a degree of recognized general disability. The results of the multivariate analyses are shown in table 1. Eight variables were selected to develop the inflammatory bowel disease objective work disability index (ODIBD) (table 2). Each variable was scored one point to calculate the final index. The AUROC of the index in the training group was 0.76 for work disability and 0.71 for general disability. The AUROC of the index in the validation group was 0.83 for work disability and 0.67 for general disability (fig1). Conclusion The ODIBD may be useful score to objectively assess of work disability in patients with IBD.

Background The prevalence of penetrating disease in Crohn’s disease (CD) increases progressively over time, and evidence on the medical treatment of this complication is limited. The aim of this study was to evaluate the efficacy of biologic agents in CD complicated with internal fistulising disease. Methods A retrospective analysis of all adult patients from the ENEIDA registry (>68,000 patients) with CD who received at least one biologic agent -anti-TNF, ustekinumab or vedolizumab- for penetrating disease was performed. Exclusion criteria comprised treatment for perianal disease, enterocutaneous, anastomotic or periostomal fistula tracts. The main outcomes were fistula-related surgery and fistula closure on cross-sectional imaging. Preestablished secondary outcomes included the rate of abdominal abscess, the need for percutaneous drainage, the changes in the number of fistula tracts, fistula closure rates, and the safety profile.The baseline characteristics were analyzed by means of descriptive statistics and were compared by non-parametric tests. Predictive factors associated with surgery and fistula closure were evaluated by a multivariable logistic regression and survival analyses. Results A total of 710 patients (median age 38 years [IQR, 28-48], 59% male, 55% L3) receiving 791 biologic treatments were included at 53 sites (701 anti-TNF, 71 ustekinumab, and 19 vedolizumab). Patients had a median of 1 (range 1-5) fistula tracts, 49% of them entero-enteric followed by entero-colic (28%). After a median follow-up of 59 months (IQR, 27-105), 244 patients (31%) required surgery due to internal fistulising complications after 8.5 months (IQR, 3-24). Patients with ileocolonic disease (OR 1.99 [1.22-3.23]), entero-urinary fistulas (OR 2.35 [1.17-4.73]), or with a stricture distal to the fistula (OR 2.1 [1.31-3.36]) showed a higher risk of surgery, with no differences between biologic drugs (Figure 1). Combination therapy reduced the risk of surgery (HR 0.58 [0.37-0.90]). Fistula closure was observed in 24% of patients after a median of 15 months (IQR, 7.5-27). Patients with a lower number of fistula tracts showed a higher probability of closure (OR 1.72 [1.09-2.7]). Conclusion A high proportion of patients with internal fistulizing CD benefit from biologic treatment after a median of 5 years. During this follow-up, around two thirds of patients are free of surgery and one in every four patients achieves fistula closure.

Background Crohn’s disease (CD) can develop fistulizing complications at any time during the disease course. Enterocutaneous fistulas (ECF) are disabling lesions with a significant impact on quality of life. The aim of this study was to describe the characteristics and natural history of ECF complicating CD, and to analyze its medical and/or surgical management. Methods A retrospective analysis of all adult patients with fistulizing CD with at least one episode of ECF from the ENEIDA registry (over 68,000 patients) was performed. ECF were defined as a communication between the gastrointestinal tract and the skin producing leakage of luminal contents. Additional data describing the ECF and its medical or surgical management were gathered. The main endpoint was any ECF-related surgical intervention. Fistula closure was defined as the absence of drainage, with no new abscess or surgery for at least 6 months. A comparison of the characteristics and outcomes after the availability of biologic agents (Jan/2000) was also performed. The baseline characteristics were analyzed by means of descriptive statistics and were compared by non-parametric tests. Factors associated with surgery were further evaluated in a binary multivariable regression and survival analysis. Results A total of 301 ECF in 286 patients from 46 hospitals diagnosed between Jan/1970-Sept/2020 were included (median age 34 years (IQR, 27–46); 59% male; 67% L3). ECF had a median of 1 external opening (range 1–10), 59% with concomitant internal fistulas, and usually involved the ileum (67%) or colon (23%). After 146 months (IQR, 69–233) of follow-up, 37% received thiopurines, 40% anti-TNF, 6% ustekinumab and 2% vedolizumab. Surgery was performed in 208 patients (69%) after a median of 4 months (IQR, 1.4–12). Fistula closure was achieved in 253 patients (84%) after 30 months (IQR, 4–84), mostly after surgery (54%) and in one third after medical therapy. Fistula recurrence was uncommon (11%) after closure. Patient and fistula characteristics were significantly different after the availability of biologics. In fact, anti-TNF biologics and thiopurines reduced surgery risk (HR 0.5; 0.38–0.67; HR 0.64; 0.47–0.86, respectively). The surgery rate in the biologic era tends to be lower than before (OR 0.63;0.33–1.09) while timing is similar. Closure rates are also comparable, but it was obtained more frequently after medical therapy once biologicals were available (OR 2.21; 1.13–4.29). Conclusion ECF complicating CD entail a high burden of medical and surgical resources. Closure rates are high, usually after surgery, and fistula recurrence is uncommon. A number of patients can benefit from medical therapy and achieve fistula closure.

[Background and Aims] To evaluate the clinical outcomes in patients with IBD after switching from Remicade® to CT-P13 in comparison with patients who maintain Remicade®., [Methods] Patients under Remicade® who were in clinical remission with standard dosage at study entry were included. The ‘switch cohort’ [SC] comprised patients who made the switch from Remicade® to CT-P13, and the ‘non-switch’ cohort [NC] patients remained under Remicade®., [Results] A total of 476 patients were included: 199 [42%] in the SC and 277 [58%] in the NC. The median follow-up was 18 months in the SC and 23 months in the NC [p < 0.01]. Twenty-four out of 277 patients relapsed in the NC; the incidence of relapse was 5% per patient-year. The cumulative incidence of relapse was 2% at 6 months and 10% at 24 months in this group. Thirty-eight out of 199 patients relapsed in the SC; the incidence rate of relapse was 14% per patient-year. The cumulative incidence of relapse was 5% at 6 months and 28% at 24 months. In the multivariate analysis, the switch to CT-P13 was associated with a higher risk of relapse (HR = 3.5, 95% confidence interval [CI] = 2–6). Thirteen percent of patients had adverse events in the NC, compared with 6% in the SC [p < 0.05]., [Conclusions] Switching from Remicade® to CT-P13 might be associated with a higher risk of clinical relapse, although this fact was not supported in our study by an increase in objective markers of inflammation. The nocebo effect might have influenced this result. Switching from Remicade® to CT-P13 was safe., This research has been funded by grants from the Instituto de Salud Carlos III [PI13/00041 and FI17/00143].

Background Three anti-TNFs (one intravenous and two subcutaneous) are licensed for the treatment of ulcerative colitis (UC). However, it is not known if the efficacy of a second anti-TNF changes on whether it is intravenous or subcutaneous; this could justify the indication of biological agents with a different mechanism of action in second line. The aim of this study was to compare the efficacy of a second subcutaneous or intravenous anti-TNF in UC. Methods Patients from the prospectively maintained ENEIDA registry treated with consecutively intravenous and subcutaneous anti-TNF, who were naïve to biological agents, were identified. Patients were classified according to the administration route of the first anti-TNF in: IVi (intravenous initially) or SCi (subcutaneous initially). Patients treated for extraintestinal manifestations or pouchitis were excluded. Clinical activity and effectiveness were defined based on Partial Mayo Score (PMS) at baseline, 14 and 52 weeks. Loss of response, dose-escalation and treatment discontinuation were also assessed. Results 372 UC patients were included (270 IVi and 102 SCi). Both cohorts were similar in clinical-epidemiological characteristics, except for a higher proportion of patients with moderate-to-severe clinical activity at the beginning of the first anti-TNF in the IVi group (82% vs. 71%; p = 0.017) and at the beginning of the second anti-TNF (62% vs. 74%; p = 0.04). Clinical response and remission rates at week 14 for the second anti-TNF were 41% and 29% in IVi vs. 47% and 25% in SCi, respectively (p = ns). At week 52, clinical response/remission rates of the second anti-TNF were 37%/32% in IVi vs. 40%/29% in SCi (p = ns). A higher response rate at 14 weeks with the second anti-TNF was detected in the SCi group (40% vs. 68%; p = 0.012) when the reason for withdrawal of the first anti-TNF was secondary loss of response. The cumulative persistence of the second anti-TNF treatment in IVi and SCi were 55% and 54% after 1 year, and 41% and 40% after 2 years, respectively (p = ns). The SCi group had lower rates of dose-escalation with the second anti-TNF than IVi (34% and 29% in SCi vs. 57% and 49% in EVi, at 12 and 24 months, respectively -p = 0.004-). Dose-escalation of the first anti-TNF and moderate-to-severe clinical activity at the beginning of the second anti-TNF were associated with a lower probability of remission with the second anti-TNF in the short- and long-term. Conclusion The efficacy of infliximab after failure/intolerance of a subcutaneous anti-TNF is similar to that of subcutaneous anti-TNFs after infliximab failure/intolerance.

Background There is no information about the frequency of liver dysfunction in patients with inflammatory bowel disease (IBD) treated with immunosuppressants and infected with hepatitis B (HBV) and/or C virus (HCV). Aim To assess the influence of immunosuppressants on the course of HBV and HCV infection in IBD. Methods Patients with IBD with HBV and/or HCV infection from 19 Spanish hospitals were included. Clinical records were reviewed for the type of immunosuppressant used, treatment duration, liver function tests and viral markers before, during and after each immunosuppressant. Logistic and Cox regression analysis were used to identify predictors of outcome. Results 162 patients were included; 104 had HBV markers (25 HBsAg positive) and 74 had HCV markers (51 HCV-RNA positive), and 16 patients had markers of both infections. Liver dysfunction was observed in 9 of 25 HBsAg positive patients (36%), 6 of whom developed hepatic failure. Liver dysfunction in HCV was observed in 8 of 51 HCV-RNA positive patients (15.7%), and only one developed hepatic failure. The frequency and severity of liver dysfunction was significantly higher in HBV-infected patients than in HCV-infected patients (p=0.045 and p=0.049, respectively). Treatment with ≥2 immunosuppressants was an independent predictor of HBV reactivation (OR 8.75; 95% CI 1.16 to 65.66). The majority of patients without reactivation received only one immunosuppressant for a short period and/or prophylactic antiviral treatment. No definite HBV reactivations were found in anti-HBc positive patients lacking HBsAg. Conclusion Liver dysfunction in patients with IBD treated with immunosuppressants is more frequent and severe in those with HBV than in HCV carriers and is associated with combined immunosuppression.

ObjetivoEvaluar la evolución clínica y la utilización de recursos sanitarios en atención primaria un año después del tratamiento erradicador de Helicobacter pylori (Hp) en pacientes con úlcera péptica e infección por Hp.DiseñoEstudio retrospectivo sobre el efecto de una intervención.Ámbito del estudioCentro de atención primaria urbano y reformado.PacientesCiento dos pacientes con enfermedad ulcerosa péptica e infección por Hp.IntervenciónTratamiento erradicador de Hp.Mediciones y resultados principalesa) número de visitas totales (VT); b) visitas por dispepsia (VD); c) número de brotes ulcerosos (BU), y d) fármacos consumidos para tratamiento de la dispepsia. De los pacientes tratados un 79,4% era varón. La edad media global fue de 47,8 ± 12,4 años. Después de la intervención, disminuyeron significativamente las VT (de 8,3 a 6,6; p < 0,001), las VD (3,1 a 1,1; p < 0,00001), y los BU (de 1,2 a 0,06; p < 0,00001). El número medio de fármacos prescritos para la dispepsia por paciente disminuyó de 1,24 a 0,43 (p < 0,0001). La prescripción de ranitidina pasó de 72,7 a 13,8 días (p < 0,001) y la de omeprazol disminuyó de 35,1 a 12,2 días (p < 0,03). El ahorro total estimado por paciente fue de 26.792 pts. con valores económicos de 1998.ConclusionesEn nuestro medio el tratamiento erradicador en pacientes ulcerosos Hp (+) disminuye las necesidades de asistencia y la prescripción de medicamentos antiulcerosos. Ya durante el primer año esto supone un beneficio clínico para estos pacientes y un ahorro económico importante para la sanidad pública.ObjectivesTo evaluate the clinical evolution and the use of Primary Care health resources one year after treatment to eradicate Helicobacter pylori (Hp) infection in patients with peptic ulcers and Hp infection.DesignRetrospective study on the effect of an intervention.SettingUrban, reformed primary care centre.Patients102 patients with peptic ulcers and Hp infection.InterventionTreatment to eradicate Hp.Measurements and main resultsa) Total medical attendance; b) attendance for dyspepsia; c) number of ulcerous outbreaks; d) medicines taken to treat dyspepsia. 79.4% of the patients treated were male. Overall mean age was 47.8 ± 12.4. After the intervention, total attendance (from 8.3 to 6.6, p < 0.001), attendance for dyspepsia (from 3.1 to 1.1, p < 0.00001), and ulcerous outbreaks (from 1.2 to 0.06, p < 0.00001) all dropped sharply. The mean number of medicines prescribed for dyspepsia per patient fell from 1.24 to 0.43, p < 0.0001. Ranitidine prescription fell from 72.7 to 13.8 days (p < 0.001); and omeprazol from 35.1 to 12.2 days (p < 0.03). Estimated total saving per patient was 26792 pesetas at 1998 values.ConclusionsTreatment in primary care to eradicate Hp (+) in ulcerous patients reduced the needs of attendance and the prescription of drugs for ulcers. Just in the first year this supposed a clinical benefit for these patients and important economic savings for the public health service.

Introduccion Los inmunosupresores pueden aumentar la replicacion viral con exacerbacion de la hepatitis B (VHB) y C (VHC). Existe escasa informacion con respecto a la influencia del tratamiento inmunosupresor en pacientes con enfermedad inflamatoria intestinal (EII) e infeccion viral simultanea. En pacientes hematologicos sometidos a terapia antineoplasica, se demuestra reactivacion por el VHB que oscila del 14–78%, con un alto porcentaje de hepatitis fulminante (50% mortalidad), siendo la reactivacion por el VHC menos frecuente. Objetivo Evaluar la influencia del tratamiento inmunosupresor en la evolucion de la infeccion por el VHB y C en pacientes con EII. Metodos Estudio multicentrico retrospectivo que incluye todos los pacientes con EII e infeccion por el VHB y/o VHC actual o pasada y que hayan recibido tratamiento inmunosupresor en 18 hospitales espanoles. Se recopila informacion sobre el tipo y periodo de uso de los inmunosupresores utilizados y se evalua la funcion hepatica y marcadores virales pre, durante y postratamiento. Los datos se introducen en una base electronica ( www.repentina.com ), finalizando el reclutamiento el 31 marzo 2009. Resultados En el momento del envio del resumen, disponemos de datos de los marcadores virales de 77 pacientes; 43 de los cuales con serologia positiva para el VHB y 39 para el VHC. Cinco de estos tenian marcadores de ambas infecciones (antiHBc+AcVHC). En la tabla se muestra la evolucion de la infeccion de los pacientes HBsAg y RNA-VHC positivos, en relacion con la inmunosupresion. Casos Reactivacion No reactivacion Datos incompletos VHB (HBsAg) 13 53,8% (7/13) 46,1% (6/13) 0% (0/13) VHC (RNA) 23 8,7% (2/23) 52,2% (12/23) 39,1% (9/23) La reactivacion del VHB se observo en la mayoria de los casos con la utilizacion simultanea de 2 inmunosupresores (azatioprina+infliximab o esteroides), y se acompano de insuficiencia hepatica grave en 5 de 7 casos (71%). En 1 paciente con marcadores de infeccion pasada por VHB (antiHBc+antiHBs) y tratado con infliximab+azatioprina se detecto DNAVHB en dos ocasiones sin evidencia de reactivacion. Conclusiones 1) Igual como se ha descrito en otras situaciones de inmunosupresion, la reactivacion del VHB (HBsAg positivo) es mucho mas frecuente y grave que con el VHC. 2) La mayoria de las reactivaciones del VHB se producen con la administracion de 2 inmunosupresores simultaneos. 3) Los pacientes con marcadores de infeccion pasada por VHB deben ser controlados de forma estricta por la posibilidad de infeccion oculta.

Objetivo En estudio, parte del estudio COSCOL, se describen los tipos de colectomias y el numero de tiempos en los que se realizan en una poblacion con colitis ulcerosa (CU) y con un elevado uso previo de inmunomoduladores. Metodos Se realizo una revision de las historias clinicas de los pacientes con CU que habian sufrido una colectomia completa entre 2000 y 2005 en 35 centros. Los pacientes fueron seguidos durante un periodo minimo de 24 meses desde la colectomia inicial recogiendose los datos de todas las cirugias realizadas, programadas o no, hasta completar el procedimiento. Resultados 209 pacientes con colectomia total debida a la CU fueron incluidos en el estudio (44,5% mujeres, edad media 41,6±13,2 anos en el momento de la primera colectomia). Duracion media de la enfermedad 5,0±6,3 anos, 19,6% con extension izquierda y 80,4% extensa. 77 pacientes (36,8%) precisan cirugia temprana, definida como aquella que se realizo en menos de dos anos desde el diagnostico de la CU. 143 (68,4%) pacientes recibieron inmunosupresores (30,8% azatioprina y/o mercaptopurina y/o metotrexato solo, 28% ciclosporina solo, y 41,2% ambos). En un 46,9% de los pacientes la colectomia inicial fue realizada mediante un procedimiento de urgencia. La tabla I muestra los tipos de cirugia realizados y los tiempos necesarios para completar el proceso. Conclusiones Aunque la panproctocolectomia con anastomosis ileoanal es reconocida como la cirugia “gold standard” para la CU, solamente se realizo en un 54% de los pacientes. La colectomia debida a la CU supone una grave carga para los pacientes: el 75% de los pacientes requirieron al menos 2 cirugias y un 25% al menos 3 cirugias para completar el procedimiento y un 41% de los pacientes portan una ileostomia permanente. Tabla I: Tipos de cirugia realizada y tiempos necesarios para completar el proceso Tipo de colectomia Numero de tiempos Tipo N o % No de tiempos No de pacientes Panproctocolectomia+anastomosis ileoanal 113 54% 1 3 2 66 3 43 4 1 Proctocolectomia+ileostomia 64 31% 1 28 2 25 3 6 4 3 5 2 Proctocolectomia+anastomosis ileoanal+ileostomia 7 3% 1 3 2 1 3 2 4 1 Colectomia+anastomosis ileorectal 11 5% 1 6 2 5 Colectomia+munon rectal 14 7% 1 13 2 1 TOTAL 209 100% 209

DOP018 Low microbial diversity in Crohn’s disease is due to striking depletion of unknown species N. Borruel1 *, H.B. Nielsen2, F. Casellas1, C. Manichanh3, E. Varela3, M. Antolin3, A. Torrejon1, V. Robles1, P. Nos4, X. Calvet5, F. Guarner1, MetaHIT Consortium6. 1Hospital Vall d’Hebron, Crohn’s and Colitis Attention Unit. Digestive System Research Unit, Barcelona, Spain, 2Technical University of Denmark, Center for Biological Sequence Analysis, Department of Systems Biology, Lyngby, Denmark, 3Hospital Vall d’Hebron, Digestive System Research Unit, Barcelona, Spain, 4Hospital Universitari i Politecnic La Fe, Servicio de Medicina Digestiva, Valencia, Spain, 5Corporacio Sanitaria Parc Tauli, Servei d’Aparell Digestiu, Sabadell, Spain, 6MetaHIT Network, Partner Centres, Paris, France

Objetivo Este estudio, parte del estudio COSCOL, tuvo como objetivo determinar la tasa de fracasos en la colectomia planificada y el numero de cirugias no programadas que se requirieron para completar el procedimiento en pacientes en los que se practico una colectomia total debido a colitis ulcerosa (CU). Metodos Se realizo una revision de las historias clinicas de los pacientes con CU que habian sufrido una colectomia completa en 35 centros. Los pacientes fueron seguidos durante un periodo minimo de 24 meses desde la colectomia inicial recogiendose los fracasos producidos de la cirugia planificada y el numero y el tipo de las cirugias no previstas en esta poblacion. Resultados 209 pacientes con colectomia completa debida a la CUfueron incluidos en el estudio (44,5% mujeres, edad media 41,6±13,2 anos en el momento de la primera colectomia). Duracion media de la enfermedad 5,0±6,3 anos, 19,6% con extension izquierda y 80,4% extensa. 143 (68,4%) pacientes recibieron inmunosupresores. En un 46,9% de los pacientes la colectomia inicial fue realizada de urgencia. La cirugia planificada fracaso en 29 (13,9%) pacientes, no encontrandose diferencias significativas en las caracteristicas basales de los pacientes con fracasos y los que no. La tabla muestra los fracasos de la colectomia planificada y el tipo colectomia realizada finalmente. En la poblacion con fracasos se realizaron 21 cirugias no programadas en 20 pacientes (13 resecciones del munon rectal, 4 reileostomias, 3 protectomias con ileostomia, 2 protectomias, 1 protectomia con anastomosis ileoanal y 1 cierre del munon rectal con ileostomia). Conclusiones Hasta un 14% de las cirugias programadas fracasan. Solamente un 15% de las panproctocolectomias con anastomosis ileoanal desarrollan fracaso del reservorio que precisa reseccion de este u ostomia permanente. La anastomosis ileorectal, considerada como un procedimiento inadecuado en los pacientes con UC, fracaso en un 40% de los pacientes. El 69% de los pacientes con fracasos en la colectomia planificada se requirio al menos una cirugia no programada. Tabla: Tasa de fracasos en la colectomia programada y tipo de colectomia realizada Colectomia programada (no) % de fracaso Colectomia realizada (no) Panproctocolectomia+anastomosis ileoanal 132 15% Panproctocolectomia+anastomosis ileoanal 112 Proctocolectomia+ileostomia 13 Proctocolectomia+anastomosis ileoanal+ileostomia 7 Proctocolectomia+ileostomia 48 4% Proctocolectomia+ileostomia 46 Colectomia+munon rectal 2 Colectomia+anastomosis ileorectal 18 39% Colectomia+anastomosis ileorectal (no fracaso) 11 Proctocolectomia+ileostomia 5 Proctocolectomia+anastomosis ileoanal 1 Colectomia+munon rectal 1 Colectomia+munon rectal 11 0% Colectomia+munon rectal 11 TOTAL 209 209

Objetivo Este estudio, parte del estudio COSCOL, tuvo como objetivo identificar las razones para la colectomia en pacientes con colitis ulcerosa (CU) con un elevado uso previo de inmunomoduladores (IMM). Metodos Se realizo una revision de las historias clinicas de los pacientes con CU que habian sufrido una colectomia completa entre 2000 y 2005 en 35 centros. Los pacientes fueron seguidos durante un periodo minimo de 24 meses desde la colectomia inicial recogiendose los datos de todas las cirugias realizadas, ya fueran programadas o no, para completar el procedimiento. Resultados 209 pacientes con colectomia total debida a la CUfueron incluidos en el estudio (44,5% mujeres, edad media 41,6±13,2 anos en el momento de la primera colectomia). Duracion media de la enfermedad 5,0±6,3 anos, 19,6% con extension izquierda y 80,4% extensa. 143 (68,4%) pacientes recibieron IMM (30,8% azatioprina y/o mercaptopurina y/o metotrexato solo, 28% ciclosporina solo, y 41,2% ambos). En un 46,9% de los pacientes la colectomia inicial fue realizada mediante un procedimiento de urgencia. Los motivos para la colectomia fueron: respuesta inadecuada al tratamiento medico en 131 pacientes (28 corticorrefractarios y 103 corticodependientes; con o sin uso concomitante de IMM), complicaciones graves en 61 pacientes (32 megacolon, 12 perforaciones y 17 hemorragias masivas) y otras razones en 17 pacientes (8 displasia, 6 estenosis colonica y 3 otras causas). En los pacientes con respuesta inadecuada al tratamiento la colectomia se realizo como un procedimiento de urgencia en un 11% de los pacientes. En un 61% de los pacientes la cirugia realizada fue la panproctocolectomia con anastomosis ileoanal y en un 34% se realizo una colectomia con ileostomia permanente. Cuando la colectomia se realizo debido a complicaciones graves (97% como procedimiento de urgencia), solamente se realizo la proctocolectomia con anastomosis ileoanal en un 39% de los pacientes; y hasta un 56% son portadores de una ileostomia permanente. En el grupo de respuesta inadecuada al tratamiento, hasta un 84% de los pacientes recibieron IMM, 58% ciclosporina (sola o en combinacion con otros IMM). En el grupo con complicaciones graves solamente un 42% de los pacientes recibieron IMM (35% ciclosporina sola o en combinacion). Conclusiones En esta poblacion de pacientes con CU y un elevado uso de IMM: 1) La principal causa para la realizacion de la colectomia es la respuesta inadecuada al tratamiento, realizandose una panproctocolectomia con anastomosis ileoanal (cirugia “gold estandar”) en un 61% de los pacientes. 2) Cuando la colectomia fue debida a complicaciones graves la panproctocolectomia con anastomosis ileoanal solamente se realiza en un 39% de los pacientes, portando el 56% de los pacientes una ileostomia permanente. 3) No se realizo ninguna colectomia por proctitis aislada.

Antecedentes Rabeprazol es un IBP de “segunda” generacion, pero su eficacia en la erradicacion de H. pylori, comparada con los IBP de primera generacion, no ha sido suficientemente establecida. Objetivo Revisar sistematicamente la eficacia en la erradicacion de H. pylori de los regimenes triples con rabeprazol y realizar un metaanalisis de los estudios que comparan rabeprazol frente a otros IBP mas “antiguos”. Metodos Seleccion de estudios: ensayos clinicos aleatorizados que comparen rabeprazol frente a otros IBP de “primera” generacion (omeprazol, lansoprazol o pantoprazol). El metaanalisis incluyo unicamente estudios que comparaban regimenes difiriendo unicamente en el tipo de IBP empleado. Estrategia de busqueda: Electronica y manual. Calidad de los estudios: evaluada independientemente por dos revisores. Sintesis de datos: metaanalisis combinando las Odds Ratio (OR), por intencion de tratar. Resultados El metaanalisis (incluyendo 24 estudios, 1.783 pacientes tratados con rabeprazol y 1.992 con un IBP de primera generacion) demostro mejores resultados con los tratamientos con rabeprazol (79,9% vs 75,6%; OR=1,2; IC 95%=1,02–1,4; numero necesario a tratar de 23). El subanalisis basado en la dosis de IBP constato un porcentaje de erradicacion del 79,5% para rabeprazol 20 mg/12 h, significativamente mayor que el obtenido con la dosis estandar de los IBP de primera generacion (76,7%; OR=1,21; IC 95%=1,01–1,45). El subanalisis comparando 10 mg/12 h de rabeprazol (dosis baja) mostro una tendencia a favor del uso de dicho IBP frente a las dosis estandar de otros IBP de primera generacion (78,2% vs 75,6%; OR=1,22; IC 95%=0,95–1,55). Los resultados fueron homogeneos en todas las comparaciones realizadas. Conclusion Rabeprazol, en terapia triple, es ligeramente mas efectivo que omeprazol, lansoprazol y pantoprazol para la erradicacion de H. pylori , aunque la relevancia clinica de este beneficio no es evidente.

Aim: This study, part of the COSCOL study, aimed to establish the types of colectomies and the number of stages for ulcerative colitis (UC) performed in this population with a high previous use of immunomodulators. Design and Methods: A retrospective audit was undertaken at 35 Spanish centres which reviewed the medical records of UC patients who had undergone total colectomy between 2000 and 2005. Patients were followed up for a period of at least 24 months after the initial colectomy and data were recorded for all surgeries needed to complete the staged procedure. Results: 209 patients with total colectomy due to UC were included (44.5% women, mean age 41.6 ± 13.2 years at initial colectomy). Mean duration of the disease was 5.0 ± 6.3 years. UC was left-sided in 19.6% and extensive in 80.4%. Early surgery, defined as colectomy performed within the first two years of disease, was recorded in 77 patients (36.8%). 143 patients (68.4%) received immunomodulators (30.8% azathioprine and/or mercaptopurine and/or methotrexate only, 28% cyclosporine only, and 41,2% were receiving both). In 46.9% of patients the initial colectomy was performed as an emergency surgery. Table I shows the types of colectomy performed and the number of stages needed to complete the procedure. Conclusions: Although restorative proctocolectomy with IPAA has become the gold standard surgery for UC, it was only performed in 54% patients. Colectomy due to UC places a high burden on the patient: in 75% of patients at least two operations are required to complete it, and in 25% at least three. As many as 41% of patients carry a permanent ileostomy. Table I: Type of colectomy and number of stages performed