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Shortand Long-Term Outcomes of Infliximab Dose Intensification in Patients With Ulcerative Colitis Carlos Taxonera, Manuel Barreiro-de Acosta, Marta Calvo, Cristina Saro, Guillermo Bastida, Maria Dolores Martin Arranz, Javier P. Gisbert, Valle Garcia-Sanchez, Ignacio Marin-Jimenez, Fernando Bermejo, Maria Chaparro, Angel Ponferrada Diaz, Ignacio Fernandez-Blanco, Pilar Martinez-Montiel, R. Pajares, Celia de Gracia, David Olivares, Fermin Estremera Arevalo, Juan L. Mendoza

Background: An increase of oxidative stress (OxS) and a decrease of apoptosis have been reported as key factors in Crohn's disease (CD) pathogenesis. We have previously shown that OxS in CD depends on an increased production of H2O2 which detoxification is independent of catalase (CAT) enzyme because CAT showed permanently inhibited in CD patients1. CAT could be more implicated in regulating cellular processes, as apoptosis, than in detoxifying H2O2. Aims: To characterize the genetic expression of CAT and other OxS and apoptosis related genes in CD at beginning of the disease and when remission has been achieved. Methods: Blood samples were obtained from 18 healthy subjects (H), 20 patients at onset of CD and yet to begin any specific medication (active CD, aCD) and from 10 patients who achieved clinical, analytical and morphological remission (inactive CD, iCD). Patients were diagnosed according to Leonard-Jones criteria and disease activity was scored based on the Harvey-Bradshaw index, serological markers of inflammation (CRP, fibrinogen) and evaluation of morphological lesions (magnetic resonance enterography, colonoscopy or capsule endoscopy). PWMC were isolated by Histopaque sedimentation. Total RNA from leukocytes was extracted according to manufacturer's protocol (LeukoLOCKTM; Ambion). mRNA expression was measured by Sequenom's MassARRAY® quantitative gene expression analysis application. The genes analyzed were: CAT, SOD2, NOS2A, STAT1, NFKB1, PKCgamma, PKCzeta, PSKH1, PPID, ABCB1, ASK1, FASR, FASLG, TERT, IL-2, IL23R. Results: Genes differentially expressed in CD are summarized in the table. Specific upregulated genes during flair were SOD2, STAT1, and PSKH1, and down-regulated were FASL and ABCB1. In iCD, FASR and NFKB1 were up-regulated. The down-regulation of CAT gene expression was persistent. Conclusions: Up regulation of SOD2, STAT1 and PSKH1 only during a flare, indicates the relation between OxS and aCD. Down regulation of FASL and ABCB1 shows an apoptotic and multidrug resistance alteration at onset of the disease. Increased expression of FASR and NFKB1 in iCD could indicate that apoptosis are genetically affected in CD. Permanent inhibition of CAT activity in CD patients correlates to a persistent down regulation of the CAT-gene mRNA. The implications of CAT inhibition in regulating cellular processes such as apoptosis should be studied. 1) Beltran B, et al. Inflamm Bowel Dis. 2010 16:76-86.

P090 Restoration of health in patients with inflammatory bowel disease and mucosal healing F. Casellas Jorda1 *, M. Barreiro-de Acosta2, M. Iglesias2, V. Robles1, P. Nos3, M. Aguas4, S. Riestra5, R. De Francisco5, M. Papo6, N. Borruel1. 1Hospital Vall D’Hebron, Barcelona, Spain, 2University Hospital, Santiago De Compostela, Spain, 3La Fe Hospital, Instituto De Investigacion Sanitaria, Valencia, Spain, 4La Fe Hospital, Valencia, Spain, 5Hospital Universitario Central De Asturias, Inflammatory Bowel Disease Unit, Oviedo, Spain, 6Hospital Joan XXIII, Tarragona, Spain

ileocolonoscopy at diagnosis. Of the 276 patients not receiving an ileocolonoscopy at diagnosis, 80 did in follow-up. CD pts underwent significantly more ileocolonscopies at diagnosis, compared to UC pts (44% vs 17%, p < 0.001) and IBDU pts (44% vs 4.5%, p = 0.001). Reasons for follow-up endoscopy were: relapse of symptoms (76%), evaluating treatment effect and/or disease extension (22%) and cancer surveillance (2.4%). In 71% of the follow-up endoscopies active inflammation was seen, however this led to treatment intensification in only 65%. Conclusions: Endoscopies is an often used tool in IBD patients, although only 29% patients received an ileocolonoscopy at diagnosis. Fourty-five percent of the endoscopies performed at follow-up led to treatment intensification, but in over one third of endoscopies showing inflammation, no adjustments were made.

Introduccion La EII afecta la CVRS de los pacientes, pero existe muy poca informacion de su impacto sobre sus familiares, en los que previamente1 observamos que tienen mayor prevalencia de sindrome de intestino irritable (SII) que la poblacion general. Objetivos Evaluar la CVRS y la prevalencia de sintomas de ansiedad y depresion en familiares de primer grado de pacientes diagnosticados de EII, afectos o no de SII. Material y metodos Se incluyeron 404 familiares de 108 pacientes con EII. Se excluyeron los familiares afectos de EII. Se diferencio tipo de parentesco por consanguinidad (padre, hermano, hijo) o por afinidad (conyuge) y convivencia en el mismo domicilio. La CVRS se evaluo mediante el cuestionario de salud SF-36 y la prevalencia de sintomas de ansiedad y depresion, con la escala hospitalaria de ansiedad y depresion (HADS). A traves del paciente se invito a los familiares a cumplimentar un cuestionario para conocer si cumplian criterios de SII (Roma I y II) y los gastos sanitarios directos utilizados (consultas medicas y autoconsumo de farmacos sin prescripcion medica). La tasa de respuesta evaluable en los pacientes con EII fue del 84,2% (n=91) y en sus familiares del 89,1% (n=360). Resultados La prevalencia de SII en los familiares fue de 49,4% para Roma I y 10% para Roma II. No se encontraron diferencias en las puntuaciones del cuestionario SF-36 entre familiares de pacientes con EII y la poblacion general2 en la mayoria de las dimensiones, pero fueron inferiores (p Conclusion Los familiares de primer grado de pacientes con EII tienen similar CVRS que la poblacion general. Solo es peor en los que cumplen criterios de SII, con similar impacto negativo que los pacientes con EII cuando cumplen criterios de Roma II. La convivencia con el paciente no marca diferencias. 1Aguas M et al. Gastroenterol Hepatol 2008; 31(3): 16.2Alonso J et al. Med Clin (Barc) 1998; 111: 410–16.

Background Portal-mesenteric vein thrombosis, pylephlebitis and liver abscesses are rare complications of inflammatory bowel disease (IBD). The purpose of this case report is to relate an unusual presentation of CD in order to show how conservative treatment could be an appropriate option as a bridge to the surgery, in patients with septic thrombophlebitis and multiple liver abscesses with CD. Case presentation We report a case of a 25-year-old man with Crohn's disease (CD) who developed a superior mesenteric venous thrombosis, multiple liver abscesses and pylephlebitis, diagnosed through abdominal ultrasound and an abdominal computed tomography (CT) scan. The patient was successfully treated with conservative treatment consisting of intravenous antibiotics, subcutaneous anticoagulation and percutaneous catheter drainage of liver abscesses. Conclusion We reported an unnusual case of pylephlebitis in CD. Until now this association has not been reported in adult patients at onset. We hypothesise that the infection developed as a result of mucosal disease and predisposed by corticoid therapy. Adequated management was discussed.

Background: The effect of thiopurine immunomodulators on health-related quality of life (HRQoL) in patients with inflammatory bowel disease (IBD) has been controversial. The aims were to evaluate the HRQoL in patients with IBD treated with thiopurines and assess the short- and long-term impacts of the treatment on HRQoL.Methods: Ninety-two consecutive patients who started treatment with thiopurines were prospectively included. Evaluation of HRQoL was performed at months 0, 6, and 12 using two questionnaires, the Short-Form Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ).Results: Baseline score of IBDQ was 4,6, range (2,31-6,84), with an impairment of the five dimensions of HRQoL compared with inactive patients. Results obtained in 8 dimensions of SF-36 showed worse HRQoL than Spanish general population. At 6 months patients had a significant improvement in overall IBDQ score -5,8 (1,58 -6,97)- and also in all IBDQ dimensions. All the 8 dimensions of SF-36 obtained a significant improvement. At twelve months score of IBDQ was 6,1, range (2,7-6,98), with improvement in all dimensions compared with baseline and 6 months. SF-36 showed a similar significant improvement in all subscales.Conclusions: Thiopurine immunomodulators alone or with other treatments have a positive and long lasting impact on HRQoL of IBD patients. © 2010 Bastida et al; licensee BioMed Central Ltd., Guillermo Bastida MD was supported by a grant from the “Fundacion para la investigación Hospital Universitario La Fe“. Ciberehd is funded by the Instituto de Salud Carlos III.