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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).

P034 Serum concentration of estrogen is associated with inflammatory bowel disease activity P.M. Linares1 *, M. Chaparro1, A. Algaba2, J.P. Gisbert1, M. Guijarro Rojas3, F. Bermejo2, A.C. Urzainqui-Mayayo4, M.E. Fernandez-Contreras1. 1Hospital Universitario de la Princesa-IP, Gastroenterology and CIBEREHD, Madrid, Spain, 2Hospital Universitario de Fuenlabrada, Gastroenterology, Fuenlabrada, Spain, 3Hospital Universitario de la Princesa-IP, Pathology, Madrid, Spain, 4Hospital Universitario de la Princesa-IP, Immunology, Madrid, Spain

years. Among the included patients, 4,734 used thiopurines with median duration of one year. Numbers of lymphoma cases identified were 119 and 18 among non-users and while using thiopurines respectively. The incidence rate of lymphoma among those who never used thiopurines was 0.6 compared to 0.9, 1.6, 1.6, 5, 8.9 per 1000 person-year for the 1st, 2nd, 3th, 4th and .4 years of thiopurine use respectively (Figure). The incidence rates of the fourth and more than four years were significantly different from the incidence rate of non-users, yielding HR of lymphoma of 8 and 14 for the fourth year and more than four year of thiopurines use respectively (p,0.001). Conclusion: In this nationwide cohort of UC patients, the incidence rate of lymphoma significantly increased after the third year of cumulative exposure to thiopurines.

To determine the incidence and characteristics of intestinal and extra-intestinal cancers among patients with inflammatory bowel disease in a Spanish hospital and to compare them with those of the local population.This was a prospective, observational, 7-year follow-up, cohort study. Cumulative incidence, incidence rates based on person-years of follow-up and relative risk were calculated for patients with inflammatory bowel disease and compared with the background population. The incidence of cancer was determined using a hospital-based data registry from Hospital Universitario de Fuenlabrada. Demographic data and details about time from diagnosis of inflammatory bowel disease to occurrence of cancer, disease extent, inflammatory bowel disease treatment, cancer therapy and cancer evolution were also collected in the inflammatory bowel disease cohort.Eighteen of 590 patients with inflammatory bowel disease developed cancer [cumulative incidence = 3% (95%CI: 1.58-4.52) vs 2% (95%CI: 1.99-2.11) in the background population; RR = 1.5; 95%CI: 0.97-2.29]. The cancer incidence among inflammatory bowel disease patients was 0.53% (95%CI: 0.32-0.84) per patient-year of follow-up. Patients with inflammatory bowel disease had a significantly increased relative risk of urothelial carcinoma (RR = 5.23, 95%CI: 1.95-13.87), appendiceal mucinous cystadenoma (RR = 36.6, 95%CI: 7.92-138.4), neuroendocrine carcinoma (RR = 13.1, 95%CI: 1.82-29.7) and rectal carcinoid (RR = 8.94, 95%CI: 1.18-59.7). Colorectal cancer cases were not found.The overall risk of cancer did not significantly increase in our inflammatory bowel disease patients. However, there was an increased risk of urinary bladder cancer and, with less statistical power, an increased risk of appendiceal mucinous cystadenoma and of neuroendocrine tumors. Colorectal cancer risk was low in our series.

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

of IBD and pneumologist experts. Clinical data included age, sex, smoking status, disease duration, IBD phenotype according to Montreal classification, concomitant medication and disease activity at the time of diagnosis of bronchopulmonary manifestations. Clinical and morphological description (HRCT), bronchoscopy, bronchoalveolar lavage, histology, and outcome were reviewed. Results: Eighty patients (F 53%, median age 33.5 yrs, UC 47.5%, active smoking 9%) were included. Pulmonary disease was revealed by cough or dyspnoea (90%), frequently after the onset of IBD (85%; median delay after diagnosis was 6 years). At the time of diagnosis of lung disorder, bowel disease was inactive in 41 cases (51%) and lightly to moderately active in 28 cases (35%). Airway disease was present in 53% cases (bronchiectasis: n=25, chronic bronchitis: n=8 and tracheal involvement: n=5) and parenchymal disease in 45% cases (diffuse interstitial lung disease (ILD): n=20,granulomatous lung disease: n=16). Airway disease occurred mainly in UC (n=23/33; 70%) and followed colectomy in 15 cases with a median delay of 4 years (5 months-23 years). Fifty five patients (69%) had steroids with different modalities (inhaled, oral or intravenous). In 89% of cases, improvement or stabilisation were observed (median follow-up of 4 years). Efficacy of immunosuppressants (n=10) was inconsistent and difficult to assess. In granulomatous lung diseases, outcome was constantly favourable, mainly under steroids (n=10). Airway diseases were complicated by infectious diseases in approximately 50% of cases. The prognosis of ILD depended on the parenchymal disease type. Four deaths were reported, 3 of which were secondary to respiratory failure (tracheal involvement: n=1, ILD: n=2). Conclusions: Bronchopulmonary manifestations associated with IBD can be classified in three different types: airway disease, interstitial lung disease and granulomatous disease. Prognosis appears severe in cases of tracheal involvement or interstitial lung disease.

M.J. Casanova1, M. Chaparro1 *, E. Domenech2, M. Barreiro-de Acosta3, F. Bermejo4, E. Iglesias5, F. Gomollon6, L. Rodrigo7, X. Calvet8, M. Esteve9, E. Garcia-Planella10, S. Garcia11, C. Taxonera12, M. Calvo13, M. Lopez14, D. Ginard15, M. Gomez16, E. Garrido17, J. Perez-Calle18, B. Beltran19, M. Piqueras20, C. Saro21, B. Botella22, C. Duenas23, A. Ponferrada24, M. Manosa2, M. Iglesias3, A. Algaba4, V. Garcia-Sanchez5, J. Mate1, J.P. Gisbert1. 1Hospital Universitario de La Princesa, IP, Gastroenterology and CIBEREHD, Madrid, Spain, 2Hospital Germans Trias i Pujol, Badalona, Spain, 3Hospital Clinico Santiago, Santiago de Compostela, Spain, 4Hospital de Fuenlabrada, Madrid, Spain, 5Hospital Reina Sofia, Cordoba, Spain, 6Hospital Clinico Lozano Blesa, Zaragoza, Spain, 7Hospital Central de Asturias, Asturias, Spain, 8Hospital Parc Tauli, Barcelona, Spain, 9Hospital Mutua de Terrassa, Terrassa, Spain, 10Hospital Santa Creu i Sant Pau, Barcelona, Spain, 11Hospital Miguel Servet, Zaragoza, Spain, 12Hospital Clinico San Carlos, Madrid, Spain, 13Hospital Puerta de Hierro, Madrid, Spain, 14Hospital de Galdakao, Galdakao, Spain, 15Hospital Son Espases, Mallorca, Spain, 16Hospital Virgen de Las Nieves, Granada, Spain, 17Hospital Ramon y Cajal, Madrid, Spain, 18Hospital Fundacion Alcorcon, Madrid, Spain, 19Hospital La Fe, Valencia, Spain, 20Consorcio Sanitario Terrassa, Terrassa, Spain, 21Hospital de Cabuenes, Gijon, Spain, 22Hospital Infanta Cristina, Madrid, Spain, 23Hospital San Pedro Alcantara, Caceres, Spain, 24Hospital Infanta Leonor, Madrid, Spain

Early Use of Azathioprine Has a Steroid Sparing Effect on Recently Diagnosed Crohn's Disease Patients Miquel Sans, Antonio Lopez-San Roman, Maria Esteve, Fernando Bermejo, Valle GarciaSanchez, Yolanda Torres, Eugeni Domenech, Marta Piqueras, Montserrat Aceituno, Maria Gomez-Garcia, Carlos Taxonera, Javier P. Gisbert, Ana Gutierrez, Fernando Gomollon, Daniel Ginard, Antonio Bernal, Antonio Z. Gimeno-Garcia, Carmen Munoz, Fermin Mearin, Miguel Minguez, Manuel Barreiro-de Acosta, Xavier Calvet, Juan Buenestado, Olga Merino, Maria Barrachina, Luis Bujanda, Miriam Manosa, Maria M. Calvo, Esther Garcia, Miguel A. Montoro, Jose Manuel Herrera Justiniano, Montserrat Andreu, Vicent Hernandez, Joaquin Hinojosa, Julian Panes

Introduction: A significant proportion of Crohn's Disease (CD) patients have already been treated with two biologic therapies. Follow-up from current published retrospective or prospective open label studies on patients who have already received 2 biologics does not extend beyond 1 year (1-4) Methods: Our aim was to collect ‘real-life', long-term data on the tolerability and efficacy of the second biologic agent in (re)-capturing response, and to assess whether the reason for stopping the first agent impacted on the successful use of the second agent. We carried out secure data collection from 3 teaching IBD centres on CD patients currently on, or already failed a second biologic. We collected data on disease duration, distribution and behaviour, and report on the aetiology in the failure of the first biologic and the subsequent outcome of the second biologic agent. Response to biologics was assessed by Harvey Bradshaw Index or Physicians Global Assessment. Results: We collected data on 66 patients (F 46%, mean age at diagnosis: 25). The disease distribution was characterised as L1: 11%, L2:32% L3:56% L4:1% and the behaviour as B1: 41% B2: 35% B3: 24% . 17% of our cohort had perianal involvement. 36 patients have had a total of 41 resectional operations. 1st biologic: 64/66 patients had infliximab (IFX) first-line, followed by adalimumab (ADA), and 2/66 patients had ADA followed by IFX. Reasons for swapping were 1o failure in 23%, secondary-loss of response in 38%, intolerance to the first agent in 29%, and fear of hypersensitivity reaction due to previous episodic exposure to IFX in 10% (irrespective of efficacy or tolerance) 2nd biologic: 70% of patients remained on the second biologic after a median follow-up of 22 months. Reasons for discontinuing therapy were 1o failure in 35%, secondary loss of response in 25%, intolerance (or patient concerns regarding potential side-effects) in 25%, and achieving remission in 5%; no reason provided for the remainder 5%. Neither the demographics, disease characteristics nor the reason for failing the first biologic had a statistically significant bearing in predicting the initial response to and subsequent outcome of the second biologic. Conclusion: 1. We report an overall 70% retention on the second biologic at 22 months following all-cause failure of the first agent in CD patients from England and Ireland. 2. Patients responded equally well to the second biologic, irrespective of the reason for the failure of the first biologic. References: 1.Swaminath A et al, APT 2009 2. Seiderer J et al, APT 2007, Peyrin-Biroulet L et al, APT 2007, 4. Papadakis KA et al, AJG 2005.

s of the 4th Congress of ECCO the European Crohn’s and Colitis Organisation S49 the centre of attention of studies which deal with biological therapy because reducing secretion from fistulas and reducing of symptoms are the criteria of therapy’s success. However, fistulas’ tracts remain even after this treatment. We consider as rational to combine biological therapy (reduction of inflammatory response) and surgical eradication of fistulas using excision and advancement flap (AF) method. Aim of study: In our study we retrospectively assess the long term results of combined therapy of perianal fistulas (medicament and surgical) at our department in patients with IBD (1/2002 4/2008) using AF method. Patients and Methods:We treated 37 patients with this method in course of above stated period. After general examination and examination of the proximal intestinal disease we examined all patients under general anesthesia including drainage and discission of secondary tracts; in portion of patients repeated discisions and re-drainages according to finding was needed and after fibrotization and simplification of tracts we performed advancement flap method. Concomitant antibiotic, immunosuppressive and biological therapy was administrated. The sample contained 21 females (average age 37 years) and 16 males (average age 36 years). All patients suffered from complex perianal fistulas; 9 females (42%) suffered from vaginal fistula, 3 of them had additional perianal fistula. Prior to eradication of fistula we had to perform 2.11 drainages or discissions on average in course of 7.6 months (median) including medicamentous therapy. Definitive healing occurred in 78% (28 patients) during the follow-up of 5 72 months (median was 19 months; mean was 29 months). 6 patients from the total number had to underwent more than one AF; definitive healing did not occur in only 2 patients of them. We did not reach the eradication of fistulas in 7 patients (19%), 1 of those patients has permanent ileostomy and another 2 patients from the healed group have permanent stomy due to intestinal reasons. 1 patient died in a car accident. Conclusion: Combination of conservative treatment with rational surgical therapy is very successful in treatment of perianal fistulization and patients profit from this method even according to relatively long follow-up period (78% patient healed completely with the average follow-up of 29 months and with median of 19 months) which present much longer efficacy than it is known in case of biological therapy alone. Combination of both methods increases probably the efficacy of surgical therapy. P097 What factors influence adhesion to therapy in inflammatory bowel disease? F. Bermejo1 *, A. Lopez-Sanroman2, A. Algaba1, J.A. Carneros1, M. Valer1, S. Sanchez1, B. Piqueras1, S. Garcia1, I. Guerra1, F. Garcia1, E. Tomas1, J.L. Rodriguez1. 1Fuenlabrada University Hospital, Fuenlabrada, Spain, 2Ramon y Cajal University Hospital, Madrid, Spain Aims: Inflammatory bowel disease (IBD) is a clinical condition associated with a high risk of deficient adhesion to therapy. Our aim was to analyze the degree of adhesion to treatment in a specialized IBD Clinic, and to study which factors could influence it. Methods: A total of 107 consecutive patients were included during a three-month period. With previous consent and in all privacy, patients filled up an anonymous survey with demographic data (age, gender, study level, working status, personal status), data concerning the disease (type of IBD, year of diagnosis, number of hospital admissions, IBD-related surgical procedures), data about therapy (drug, dose, interval), self-applied adhesion declaration (Sewitch MJ et al. Am J Gastroenterol 2003) and self-medication. An activity index was calculated on the spot (Harvey Bradshaw/Truelove). Results: Mean age was 41.3±11 years, 60% were women, the number of years since IBD diagnosis was 7.9±7. The diagnosis was Crohn’s in 64% (71% inactive), ulcerative colitis 36% (70% inactive). A 66% was treated with aminosalicylates, a 51% with immunosuppressors, 8% with glucocorticoids. A 66% needed an IBD-related hospital admission in the past, and 17% any IBDrelated surgical procedure. A 69% (95%CI: 60 77%) showed some type of non-adhesion. A 66% (95%CI: 57 75%) acknowledged dome degree of involuntary non-adhesion: either forgetting to take their dose (63%) or being careless about having taken it (27%). A 16% (95%CI: 9 22%) showed some kind of voluntary non-adhesion: interrupting the therapy when feeling better (13%) or when feeling worse (6%). A 25% (95%CI: 17 33%) forgot at least a dose a week (mean weekly number of forgotten doses 1.6), and the most frequent cause was to be away form home when they were supposed to take the medication. This was more frequent under mesalazine therapy (30%) than with azathioprine (17%) (p=n.s.). A multivariate analysis identified as risk factors for a lower adhesion the dosing in three or more takes a day (OR 3; 95%CI 1.1 8.4; p = 0.03) and feeling little informed about their disease (OR 4.9; 95%CI 1.1 23.8; p = 0.04). On the other hand, immunomodulator therapy was a predictive factor for better adhesion (OR 0.29; 95%CI 0.11 0.74; p = 0.01). The concordance between patient recall and clinical records was complete in 86%, whereas in 10.3% the patients did not accurately remember the dose and in 3.7% there was confusion about the drug taken. A 9% acknowledged self-medication during flares. Conclusions: In our setting, adhesion to therapy in IBD patients is not satisfactory. Patients treated with immunosuppressors have better adhesion. Optimizing the information on the disease and giving the medication in one or two daily doses could enhance therapeutic adhesion. P098 Optimizing treatment of perianal fistulae in Crohn’s disease results from an interdisciplinary approach U. Strauch*, F. Obermeier, H. Schlitt, J. Scholmerich, I. Iesalnieks. University Clinic of Regensburg, Regensburg, Germany Aim: Perianal fistulae are common in individuals with Crohn’s disease (CD) and occur in approximately 1/3 of all CD patients. Aim of our study was to optimize treatment by a standardized interdisciplinary approach. Materials and Methods: All patients with CD and perianal fistulae were seen together by a specialized surgeon and gastroenterologist. Treatment (medical and surgical) of symptomatic fistulae was planed based upon the type of fistulae that were classified according to Park’s classification in subcutaneous, deep and high intersphincteric, deep and high transsphincteric, suprasphincteric, and extrasphincteric as well as rectovaginal fistulae. Primary treatment for symptomatic deep fistulae was fistulotomy without specific medical therapy. In high transsphincteric fistulae a seton was placed and immunsuppressive therapy with azathioprine was initiated. If efficacy was missing or the drug was not tolerated, antiTNF-treatment was started. Treatment result was called “optimal” if patient was not in need for a stoma, if healing of fistulae was observed after fistulotomy and if symptoms after seton-placement were controlled adequately without need for change of therapy or further surgery. Results: 139 patients with CD and perianal fistulae were admitted to the interdisciplinary ward. 66 of these patients had to undergo surgery. 52% of all patients were asymptomatic despite the presence of fistulae, were treated sufficiently with antibiotics or already received immunosuppressants with good control of fistula symptoms. 10.6% of patients undergoing surgery were in need for abdominoperineal extirpation of the rectum and 4.5% received a temporary stoma. 64% of patients by gest on M arch 1, 2016 http://eccoxfordjournals.org/ D ow nladed from

Objetivos La enfermedad inflamatoria intestinal (EII) constituye una entidad clinica en la que existe un riesgo elevado de baja adhesion al tratamiento. Nuestros objetivos fueron conocer el grado de adhesion al tratamiento en una consulta monografica para pacientes con EII, y estudiar que factores influyen la misma. Metodos Se incluyeron 107 pacientes consecutivos durante 3 meses. Previo consentimiento verbal, los pacientes rellenaron en otra sala una encuesta anonima con datos demograficos (edad, sexo, nivel de estudios, situacion laboral, situacion personal), datos referidos a la enfermedad (tipo de EII, ano del diagnostico, numero de ingresos hospitalarios y de intervenciones quirurgicas por su EII), datos referidos al tratamiento (medicacion, dosis e intervalo de administracion), declaracion autoaplicada de adhesion (Sewitch MJ et al. Am J Gastroenterol 2003) y automedicacion. El medico recogio en hoja aparte tratamiento prescrito e indice de actividad (Harvey-Bradshaw/Truelove). Resultados Edad media 41,3±11 anos, 60% mujeres, anos de evolucion con EII 7,9±7. Padecian enfermedad de Crohn 64% (71% inactiva), colitis ulcerosa 36% (70% inactiva). El 66% tomaba aminosalicilatos, 51% inmunosupresores, 8% esteroides. El 66% de enfermos habia precisado por su EII algun ingreso hospitalario y el 17% alguna cirugia. Globalmente el 69% (IC95%: 60–77%) mostraba algun tipo de no-adhesion al tratamiento. El 66% (IC95%: 57–75%) reconocia algun grado de no-adhesion involuntaria: olvidaron alguna vez tomar la medicacion (63%) y/o se descuidaron en cuanto a si debian tomarla (27%). El 16% (IC95%: 9–22%) reconocia algun grado de no-adhesion voluntaria: la habian dejado alguna vez por sentirse mejor (13%) y/o peor (6%) al tomarla. El 25% (IC95%: 17–33%) olvidaban al menos una toma a la semana (media 1,6 tomas olvidadas/semana, causa mas frecuente: estar fuera de casa), mas frecuentemente con mesalazina (30%) que con azatioprina (17%) (p=n.s.). En el analisis multivariante, los factores de riesgo de una peor adhesion fueron la dosificacion de la medicacion en 3 o mas tomas al dia (OR 3; IC95% 1,1–8,4; p=0,03) y los pacientes poco informados sobre su EII (OR 4,9; IC95% 1,1–23,8; p=0,04); por el contrario, la terapia con inmunomoduladores fue un factor predictivo de mejor adhesion (OR 0,29; IC95% 0,11–0,74; p=0,01). La concordancia medico–paciente en la medicacion administrada fue completa en 86%, en 10,3% hubo diferencias en la dosis y en 3,7% diferencias en la medicacion. Un 9% de enfermos reconocio haberse automedicado en alguna ocasion debido a presentar brote. Conclusiones En nuestro medio, la adhesion al tratamiento en enfermos con EII es insuficiente. Los pacientes en tratamiento con inmunosupresores presentan una mejor adhesion al tratamiento. Debemos intentar optimizar la informacion que proporcionamos al paciente sobre su EII y administrar la medicacion en una o dos tomas al dia para conseguir mejorar el cumplimiento terapeutico.

Antecedentes La respuesta al tratamiento con IFX es inicialmente elevada, aunque con el paso del tiempo se ha observado, con cierta frecuencia, una perdida de eficacia. En estos pacientes con perdida de respuesta se ha recomendado “intensificar” el tratamiento con IFX. No obstante, se desconoce si el efecto beneficioso de esta estrategia se mantiene en el tiempo o es solo transitorio. Objetivos 1) Estudiar la respuesta (tanto a corto como a largo plazo) de los pacientes que precisan intensificar el tratamiento con IFX (aumentando la dosis o disminuyendo el intervalo). 2) Evaluar los efectos adversos asociados a la intensificacion del tratamiento. Metodos Estudio multicentrico retrospectivo. Se incluyeron pacientes con enfermedad de Crohn que hubieran recibido al menos las 3 dosis de induccion del tratamiento estandar con IFX (5 mg/kg) y que despues precisaran intensificacion del tratamiento (10 mg/kg cada 8 semanas o 5 mg/kg cada 4 semanas) por perdida de respuesta. Se analizo la eficacia del tratamiento intensificado en el momento inicial (tras la 1a infusion de la dosis intensificada) y final (en la ultima revision). Se utilizo el indice de Harvey-Bradshaw en el caso de enfermedad de Crohn no fistulizante. En la enfermedad fistulizante, la respuesta completa se definio como el cese del drenaje de todas las fistulas y la respuesta parcial como la reduccion en al menos un 50% del numero o del debito fistuloso. Se valoro la seguridad del tratamiento con la dosis intensificada. Resultados Se incluyeron 34 pacientes (edad media, 43 anos; 50% varones; 31% fumadores; 64% con afectacion ileocolica; 47% con patron fistulizante; 60% con enfermedad perianal). La mayoria (72%) recibia tratamiento concomitante con inmunomoduladores. El tiempo medio de seguimiento con el tratamiento intensificado fue de 56 semanas (rango: 4–169 semanas). El tiempo medio de tratamiento con IFX antes de la intensificacion de la dosis fue de 15 meses (rango: 3–43 meses). Con la primera dosis de tratamiento intensificado respondio el 78% de los pacientes (32% respuesta completa y 46% parcial). Mientras que con la ultima dosis de tratamiento intensificado solo un 61% de los pacientes presentaban respuesta (22% respuesta completa y 39% respuesta parcial). Un paciente sufrio una reaccion infusional tras 36 dosis de tratamiento intensificado, que se soluciono con el enlentecimiento de la infusion. Otro paciente presento infeccion por virus del herpes zoster, no precisando suspension del tratamiento. Conclusiones En ocasiones se requiere la intensificacion del tratamiento con IFX, una media de 15 meses despues del inicio del tratamiento con este farmaco. Un alto porcentaje de pacientes responden inicialmente al tratamiento intensificado, aunque este pierde de nuevo su eficacia en mas de un 10% de los casos. La intensificacion del tratamiento presenta un buen perfil de seguridad, sin observarse reacciones adversas graves.

Objetivo La enfermedad de Crohn (EC) afecta con frecuencia el intestino delgado, lugar donde se absorbe el acido folico y la vitamina B12. El deficit de estas vitaminas puede asociarse a la aparicion de alteraciones hematologicas y al incremento de los niveles de homocisteina, factor de riesgo de trombosis. Nuestro objetivo fue conocer la incidencia del deficit de estas vitaminas en pacientes con enfermedad de Crohn, y los posibles factores predictivos de aparicion de dicho deficit. Metodos Estudio prospectivo durante 1 ano en 96 pacientes con EC seguidos en consulta. Se considero deficit de vitamina B12 y de folato los valores en sangre Resultados La edad media fue de 36,6±12 anos, 57% mujeres. Fumaban el 53%. La prevalencia del deficit de vitamina B12 en pacientes con EC fue del 17,7% (IC 95% 10,6–26,8%) comparado con el 3,3% (IC 95% 0,4–11,5%) en pacientes con CU (p=0,007). Con respecto al deficit de folato, la tasa de incidencia en EC fue del 15,6% (IC 95% 9–24%) comparado con el 4,9% (IC 95% 1–13%) en CU (p=0,04). El 17,6% (IC95% 3,8–43%) de los pacientes con deficit de vitamina B12 y/o folatos presentaba anemia macrocitica. En el analisis univariado los unicos factores que se asociaron al deficit de vitamina B12 fueron la afectacion del ileon (L1 o L3 de Montreal; p=0,006), la existencia de actividad de la EC (indice Harvey-Bradshaw >2; p=0,001) y la duracion (EC de larga evolucion; p=0,004). En el estudio multivariante, los factores de riesgo para el deficit de vitamina B12 fueron la existencia de afectacion ileal (OR 9,86; IC 95% 1,2–80,8; p=0,03) y de actividad de la EC (OR 5,37; IC 95% 1,6–17,7; p=0,006). El unico factor que se asocio al deficit de folato fue la existencia de actividad de la EC (OR 3,1; IC 95% 1,1–9,8; p=0,03). Conclusiones El deficit de vitamina B12 y el de folato aparecen en una proporcion significativa de pacientes con EC y pueden asociarse a anemia. Estos hallazgos refuerzan la actitud de controlar estas vitaminas en los analisis que se realizan periodicamente a los pacientes. Los pacientes con mayor riesgo de deficit de estas vitaminas son aquellos con enfermedad activa, asi como los que tienen afectacion ileal en el caso del deficit de vitamina B12.

The major papilla of Vater is usually located in the second portion of the duodenum, to the posterior medial wall. Sometimes the mouth of the biliary duct is located in other areas. Drainage of the common bile duct into the pylorus is extremely rare. A 73-year old man, with a history of duodenal ulcer, was admitted to hospital with the diagnosis of cholangitis. Dilatation of the extrahepatic biliary duct was observed by abdominal ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP) was performed. No area suggesting the presence of the papilla of Vater was found within the second duodenal portion. Finally the major papilla was located in the theoretical pyloric duct. Cholangiography was performed and choledocholithiasis was found in the biliary tree. The patient underwent dilatation of the papilla with a balloon tyre and removal of a 7 mm stone using a Dormia basket, which solved the problem without further complications. This anomaly increased the difficulty of performing therapeutic interventions during ERCP. This alteration in anatomy may increase the risk of complications during papillotomy, with a theoretically higher risk of perforation. Dilatation using a balloon was the chosen therapeutic technique both in our case and in the literature, due to its low rate of complications.

s of the 4th Congress of ECCO the European Crohn’s and Colitis Organisation S73 Conclusions: This study reveals discrepancy in psychosocial symptoms, and competence between reports of parents and adolescents with IBD. Chronically ill adolescents may deny their problems as part of coping strategy. Further, it is possible that the parents of chronically ill IBD patients observe their children more than the parents of healthy children, and thus report more concerns. Complementary methods should be used while assessing psychosocial well-being of adolescents with IBD. P157 Intensification of infliximab (IFX) therapy in Crohn’s disease: efficacy and safety M. Chaparro1, P. Martinez-Montiel2, M. Van Domselaar3, F. Bermejo4, J.L. Perez-Calle5, B. Casis2, A. Lopez-Sanroman3, A. Algaba4, J. Mate1, J.P. Gisbert1 *. 1La Princesa Hospital, Madrid, Spain, 212 de Octubre Hospital, Madrid, Spain, 3Ramon y Cajal Hospital, Madrid, Spain, 4Fuenlabrada Hospital, Madrid, Spain, 5Alcorcon Hospital, Madrid, Spain Introduction: The response of Crohn’s disease to IFX therapy is initially high. However, a loss of efficacy is observed in some cases over time. In such patients with loss of response, an IFX therapy “intensification” has been recommended. Nevertheless, it is still unknown whether the beneficial effect of this intensification is prolonged or just transient. Aims: (1) To study the shortand long-term response of Crohn’s disease patients treated with IFX intensification (e.g., higher doses or shortened intervals). (2) To evaluate the adverse effects associated to therapy intensification. Methods: Retrospective multicenter survey. We included Crohn’s disease patients who had been treated with at least the three induction doses of the standard IFX therapy (5mg/kg 0 2 6w), and who later on needed treatment intensification (10mg/kg/8w or 5mg/kg/4w), because of loss of response. Short-term (after the first intensification dose) and the longterm (at the end of follow-up) efficacy of the intensified therapy was analyzed. Harvey Bradshaw’s index was used in luminal Crohn’s disease. In fistulizing Crohn’s disease, complete response was defined as closure of all fistulas, and partial response as a 50% or more reduction in the number or the debit of fistulas. Safety was evaluated by collection of adverse effects. Results: We included 34 patients (mean age, 43 years; 50% male; 31% smokers; 64% with ileocolic (L3) disease; 47% with fistulizing (B3) phenotype; 60% with perianal (p) disease). The majority (72%) of the patiens was treated with immunomodulators. The mean follow-up for intensified treatment was 56 weeks (range: 4 169 w). Mean time of IFX exposure before intensification was 15 months (range: 3 43 m). On the short-term, after the first intensification dose, 78% responded (32% complete response, 46% partial response). On the long-term, after the last intensification dose, only 61% were still responding (22% complete response, 39% partial response). One patient suffered an infusion reaction after 36 doses of intensified treatment, which subsided with slower infusion. One patient suffered an episode of herpes zoster, that did not interrupt the treatment. Conclusions: The intensification of IFX therapy is sometimes necessary after a mean drug exposure of 15 months. A high proportion will initially respond, but >10% of all cases lose effect again. Safety profile of IFX therapy intensification is good, having no severe adverse effects. P158 Safety of once daily versus twice daily dosing with mesalazine (Pentasa®) sachets. Results from a 12 month randomised controlled trial in maintenance of remission of ulcerative colitis A. Dignass1 *, B. Bokemeyer2, T. Stijnen3, H. Veerman4. 1Markus-Krankenhaus, Frankfurt/ Main, Germany, 2Gastroenterologische Gemeinschaftspraxis, Minden, Germany, 3University Leiden, Leiden, Netherlands, 4Ferring Pharmaceuticals, Hoofddorp, Netherlands Aims: Patients with quiescent ulcerative colitis (UC) are often non-compliant with their treatment for maintenance of remission. Non-compliance can lead to relapse and the return of symptoms. This study investigated remission and relapse rates in patients with UC in remission receiving once (OD) or twice (BD) daily mesalazine sachets. The primary endpoint was non-inferiority of the OD treatment regime compared to BD dosing. Safety data were collected as a secondary endpoint. Materials and Methods: A 12-month, investigator-blinded, randomised controlled trial was conducted. Patients with mild to moderate UC in remission who had experienced a relapse within the past year were randomised to receive 2 g/day mesalazine sachets given either in a OD or BD regime. Results: 362 patients were randomised. The primary endpoint UC-DAI remission rate at 1 year as measured by the Kaplan Meier showed a statistically significant difference of 11.9% in favour of the OD treatment group. Overall, 42.9% of the patients in the OD group and 36.4% of the patients in the BD group reported one or more adverse events (AE) during the study. The difference in overall incidence was not statistically significant (P= 0.24) and there was no clear difference between the described AEs in the different treatment arms. Six patients from the OD group and four patients from the BD group experienced a serious AE (SAE). All SAEs were not, or unlikely, related to the study medication. The SAEs experienced by the OD group were metastatic prostate cancer, myocardial ischemia, pyrexia, postoperative wound infection, squamous cell carcinoma, coronary artery disease, gastrointestinal ulcer haemorrhage, and cerebral haemorrhage. The SAE experienced in the BD group were meningioma, migraine with aura, spondylolisthesis, chest pain, convulsion, and hypokalaemia. None were related to the study medication. Overall, the most frequently reported treatment emergent AEs (TEAE) were gastrointestinal disorders (abdominal pain, diarrhoea and flatulence) or infections and infestations (bronchitis, gastroenteritis, nasopharyngitis and sinusitis). The majority of the TEAEs were mild or moderate in intensity and considered by the investigator to be unrelated, or unlikely related, to the study medication. P159 Ulcerative colitis might prevent colonic diverticulosis O. Yonal *, S. Ilhan, O. Atug, H. Over Hamzaoglu. Marmara University Hospital Gastroenterology, Istanbul, Turkey Background: Diverticulosis coli is characterized by abnormal thickening of the large bowel wall, luminal overpressure and an increase in sigmoid contractility. The anatomic features intrinsic to the colon, alterations in colonic wall with aging, motor dysfunction, and increased intraluminal pressure, may all play role in the development of diverticulosis. In ulcerative colitis (UC) chronic inflammatory activity causes reduction in bowel wall muscle tone and contractility. Patients with UC often have liquid stools and might result in low intracolonic pressure Aim: To evaluate the frequency of colonic diverticulosis in patients with UC and compare with control group. Methods: Colonoscopy results of patients with ulcerative colitis older than 50 years were retrospectively evaluated and by gest on M arch 1, 2016 http://eccoxfordjournals.org/ D ow nladed from

s of the 3rd ECCO Congress, Lyon, France, February 28–March 1, 2008 23 says, and the inter-observer precision based on the results of two distinct laboratories. Antibody levels to myeloperoxidase (MPO), proteinase-3 (PR3), elastase, lactoferrin, cathepsin G, lysozyme and bactericidal permeabilityincreasing protein (BPI) were measured by ELISA. Agreement was estimated by Weighted Kappa. Results: With the combined application of ethanol-fixed and formaldehydefixed substrates from four different sources, atypical P-ANCA was detected in 9.9%-39.6% of patients with UC and 9.3%-17.8% with CD. Striking differences were observed among the distributions of IIF patterns, resulting in K values ranging 0.14-0.34 for atypical P-ANCA. When atypical and typical P-ANCA patterns were combined together, the consensus greatly improved. Moderate agreement was observed in the inter-observer study regarding atypical P-ANCA (K=0.44), which also improved after grouping typical and atypical P-ANCAs together (K=0.53). Altogether, P-ANCA was detected in UC and CD patients with a frequency of 62.5% versus 20.4% (p