330 High Smoking Cessation Rate in Crohns Disease Patients Attending a Multicenter Anti-Tobacco...
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AGA Abstracts increased median number of UC flares during the last 5 years of follow-up (5.5 vs. 1.5 years, P=0.02). The type of biliary involvement (intrahepatic, extrahepatic, or both) was similar in both groups. (Table 1) Kaplan-Meier curve analysis suggested that patients with elevated IgG4 had shorter colectomy-free survival than patients with normal IgG4. (Log Rank p<0.001) (Figure 1) However the time to OLT and the overall survival was no different. None of the patients had associated autoimmune pancreatitis. Conclusions: Elevated IgG4 was seen in a small number of PSC patients. The majority of these patients had associated UC, were younger at the time of PSC diagnosis, more likely to have backwash ileitis and had reduced colectomy-free survival suggesting more severe colitis than patients with normal IgG4. Table 1. Comparison of Demographic and Clinical Variables between PSC Patients with or without elevated IgG4 329 Adipose-Derived Stem Cell Treatment for Persistent Perineal Wound in Complex Crohn's Perianal Abscess/Fistula Kyu Joo Park, Heung-Kwon Oh, Heon-Kyun Ha, Eun-Kyung Choe, Yoon Suk Song, Mi- Hyung Kim, Hee-Won Yoo Introduction) In order to promote healing of persistent wound sinus after surgical treatment of complex perianal fistula/abscesses in Crohn's disease (CD) patients, we have used a novel approach consisting of injecting autologous adipose-derived stem cell (ASC). Materials & Methods) Subcutaneous adipose tissue was obtained by fat tissue extraction from the abdomen of patients. And then, ASCs isolated from fat tissue were expanded and packaged in single- use vials. After controlling the sepsis with long-term seton drainage and after confirming that internal opening of the fistula has been closed, we injected the 1~ 4 x107 cells/mL ASCs (into the wound wall and sealed off the wound with fibrin glue + ASCs) in 11 CD patients (M;F = 6:5, with mean age of 24.6 years) with 12 persistent non-healing wound cavities resulting from complex perianal abscess/fistulas. Five of these patients had previously been treated with Infliximab. Healing was defined as complete re-epithelialization of the external wounds without evidence of purulent discharge. Results) Duration of persistent wound ranged from 3 to 88 months (mean, 35 months) and these patients had undergone mean of 2.8 (range 1~4) conventional surgical procedures before treatment with ASC. Complete healing was observed between 4~8 weeks in 9 cases (75%), and partial healing in 3 patients. The reasons for failure were aggravation of intestinal CD and activation of proctitis during healing process. After mean follow-up period of 16 months (range, 3~30 months), healing was maintained in all patients whose wound healed initially. Conclusion) We believe that ACS treatment may be a good treatment option in selected cases of CD perianal fistula/abscess where healing cannot be achieved by conventional operative proced- ures. However, control of active septic process is prerequisite for this procedure. S-76 AGA Abstracts 330 High Smoking Cessation Rate in Crohns Disease Patients Attending a Multicenter Anti-Tobacco Program: the TABACROHN Study Tiago Nunes, Maria Josefina Etchevers, Olga Merino, Sonia Gallego, Valle García-Sánchez, Ignacio Marin-Jimenez, Luis A. Menchen, Manuel Barreiro-de Acosta, Guillermo Bastida, Daniel Ginard, Fernando Gomollon, Maite Arroyo, David Monfort, Esther García, Benito Gonzalez, Carme Loras, Carolina Figueroa, Miquel Sans INTRODUCTION: Tobacco smoking has a significant impact on the development of Crohn's disease (CD) and its clinical course, making smoking cessation one of the main goals in CD therapeutic strategy. AIMS: To evaluate the effectiveness of a smoking cessation program specifically designed for CD patients. METHODS: We have designed an ongoing prospective multicenter study involving 14 Spanish centers which enrolled 408 CD smokers. We have included inactive CD patients defined by a Harvey-Bradshaw index and normal PCR. Patients were assessed for demographics, disease features and detailed smoking habit. In relation to smoking, patients were classified as smokers if they had current tobacco consumption ≥ 7 cigarettes per week. All patients were instructed about the risks of smoking and were offered to participate in the smoking cessation program. Each center used different smoking cessation strategies based on available resources. The strategies employed included intensive medical counseling, follow-up by pulmonologist, otolaryngologist or psychologist and pharmacolo- gical treatments (varenicline, bupropion or nicotine replacement therapy). Urinary cotinine and exhaled carbon monoxide levels were evaluated in a subgroup of patients. Follow up visits were performed every 3 months. RESULTS: The cohort presents a current median follow up of 18 months. 62% of the patients accepted to try quitting after the GI counseling, with most patients (56%) accepting to try quitting at inclusion. Regarding the cessation outcome of the entire population (408 smokers), 31% quit smoking and 23% continued smoking-free till the end of their current follow up, with 8% of relapse. Almost 70% did not quit and most non-quitters did not change their smoking habit with only 5% presenting a decrease in tobacco load. Non-quitters presented heavier median tobacco load (15 vs. 10 pack year), longer median disease duration (96 vs. 61 months) and more surgery (42% vs. 29%) when compared to quitters. There were no other detectable differences between both groups. In 63% of patients going through smoking cessation, there was help of another specialist, most frequently, the pulmonologist (47%). Surprisingly, most patients (88%) tried to quit smoking with no pharmacological therapy. Bupropion, varenicline and nicotine replacement treatment were used in few patients. The use of urinary cotinine and exhaled CO levels to follow up patients in cessation was not clinical practice in any of the 14 participating centers. Urinary cotinine and exhaled CO levels were tested in a subgroup of patients reaching a good correlation with the self-reported smoking habit. CONCLUSION: Our results suggest that a smoking cessation program specifically designed for CD patients is well accepted and effective and should be part of the therapeutic strategy in all smokers with CD. 331 A Prospective Study of New Cases of Paediatric Crohn's Disease Treated With Exclusive Enteral Nutrition: Early Clinical, Biochemical, Mucosal and Transmural Outcomes Zubin Grover, Richard Muir, Peter Lewindon Background- The aim of this study is to comprehensively evaluate the short term benefits of Exclusive Enteral Nutrition on clinical, biochemical, mucosal and radiological disease activity. Methods: 21 newly diagnosed paediatric Crohn's patients (Age -Mean 13.13, range 9.5-15.2; 15 males) were offered EEN for 8 weeks as induction therapy with early introduction of Imuran/6MP (<3 months). Comprehensive assessment included: PCDAI, CRP, Endoscopy and MR Enterography at diagnosis and termination of EEN. Clinical remission was defined as PCDAI <10; Mucosal healing as complete Simple Endoscopic Score (SES)-CD=0, near complete = SES 0-3, Incomplete = >3; Transmural healing as validated MRI disease activity scores: 0-1 no activity; 2-6 mild activity; >7 moderate to severe activity (1). Early mucosal recovery was related to sustained clinical remission, need for biological therapy and surgery at last follow up (median 11.1 months). Results: Montreal Disease distribution was extensive in 18/21, 3 had perianal disease and 5 had stricturing behavior, B2. 9/21 had significant linear growth failure with a drop from pre-illness height z-scores >1.0. All had successful paired clinical, biochemical assessments before and after EEN, 19/21 patients had successful paired full Ileo-colonoscopy and 14/21 had follow up MR Enterography. Conventional Immunomodulators commenced a median 28 days after starting EEN. After 8 weeks EEN 19/21 (90%) were in clinical remission ; 18/21(85%)in biochemical remission; 14/21(65%) in mucosal remission. 9/21 (43%) children had complete mucosal healing (SES=0); 5/21 near complete healing (SES 1-3); 5/20 improved but incomplete healing SES >3 ; 2/20 no response; MRE improved significantly in 10/14 (71%). Significant improvement was noted in all parameters after EEN (Table 1). At time of last follow up 14/21 had relapsed and required further intervention with EEN, steroids, biological agents or surgical resection : 6/ 14 (43%) who had complete/near complete mucosal healing vs 6/7(85%) who did not. Those with mucosal healing were more likely to be in sustained, relapse free clinical remission at time of last follow up (Fig 1). 4 children were confirmed at 2nd colonoscopy to have severe stricturing disease and went to early surgery. Conclusions: EEN is a highly effective strategy for inducing remission , clinically 90%, biochemically 85%, mucosal 65% and with improvement in MRE disease activity. Early mucosal remission also predicts less aggressive disease course with sustained, relapse- free clinical remission. Reference: 1.Girometti R, et al MRI scoring system including dynamic motility evaluation in assessing activity of Crohn's disease of terminal Ileum Acad Radiol 2008;15:153-64 Table 1 Clinical, biochemical, endoscopic and MRE Crohn's activity scores before and after EEN.
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sincreased median number of UC flares during the last 5 years of follow-up (5.5 vs. 1.5years, P=0.02). The type of biliary involvement (intrahepatic, extrahepatic, or both) wassimilar in both groups. (Table 1) Kaplan-Meier curve analysis suggested that patients withelevated IgG4 had shorter colectomy-free survival than patients with normal IgG4. (LogRank p<0.001) (Figure 1) However the time to OLT and the overall survival was no different.None of the patients had associated autoimmune pancreatitis. Conclusions: Elevated IgG4was seen in a small number of PSC patients. The majority of these patients had associatedUC, were younger at the time of PSC diagnosis, more likely to have backwash ileitisand had reduced colectomy-free survival suggesting more severe colitis than patients withnormal IgG4.Table 1. Comparison of Demographic and Clinical Variables between PSC Patients with orwithout elevated IgG4
329
Adipose-Derived Stem Cell Treatment for Persistent Perineal Wound inComplex Crohn's Perianal Abscess/FistulaKyu Joo Park, Heung-Kwon Oh, Heon-Kyun Ha, Eun-Kyung Choe, Yoon Suk Song, Mi-Hyung Kim, Hee-Won Yoo
Introduction) In order to promote healing of persistent wound sinus after surgical treatmentof complex perianal fistula/abscesses in Crohn's disease (CD) patients, we have used a novelapproach consisting of injecting autologous adipose-derived stem cell (ASC). Materials &Methods) Subcutaneous adipose tissuewas obtained by fat tissue extraction from the abdomenof patients. And then, ASCs isolated from fat tissue were expanded and packaged in single-use vials. After controlling the sepsis with long-term seton drainage and after confirmingthat internal opening of the fistula has been closed, we injected the 1~ 4 x107 cells/mLASCs (into the wound wall and sealed off the wound with fibrin glue + ASCs) in 11 CDpatients (M;F = 6:5, with mean age of 24.6 years) with 12 persistent non-healing woundcavities resulting from complex perianal abscess/fistulas. Five of these patients had previouslybeen treated with Infliximab. Healing was defined as complete re-epithelialization of theexternal wounds without evidence of purulent discharge. Results) Duration of persistentwound ranged from 3 to 88 months (mean, 35 months) and these patients had undergonemean of 2.8 (range 1~4) conventional surgical procedures before treatment with ASC.Complete healing was observed between 4~8 weeks in 9 cases (75%), and partial healingin 3 patients. The reasons for failure were aggravation of intestinal CD and activation ofproctitis during healing process. After mean follow-up period of 16 months (range, 3~30months), healing was maintained in all patients whose wound healed initially. Conclusion)We believe that ACS treatment may be a good treatment option in selected cases of CDperianal fistula/abscess where healing cannot be achieved by conventional operative proced-ures. However, control of active septic process is prerequisite for this procedure.
S-76AGA Abstracts
330
High Smoking Cessation Rate in Crohns Disease Patients Attending aMulticenter Anti-Tobacco Program: the TABACROHN StudyTiago Nunes, Maria Josefina Etchevers, Olga Merino, Sonia Gallego, Valle García-Sánchez,Ignacio Marin-Jimenez, Luis A. Menchen, Manuel Barreiro-de Acosta, Guillermo Bastida,Daniel Ginard, Fernando Gomollon, Maite Arroyo, David Monfort, Esther García, BenitoGonzalez, Carme Loras, Carolina Figueroa, Miquel Sans
INTRODUCTION: Tobacco smoking has a significant impact on the development of Crohn'sdisease (CD) and its clinical course, making smoking cessation one of the main goals in CDtherapeutic strategy. AIMS: To evaluate the effectiveness of a smoking cessation programspecifically designed for CD patients. METHODS: We have designed an ongoing prospectivemulticenter study involving 14 Spanish centers which enrolled 408 CD smokers. We haveincluded inactive CD patients defined by a Harvey-Bradshaw index and normal PCR. Patientswere assessed for demographics, disease features and detailed smoking habit. In relation tosmoking, patients were classified as smokers if they had current tobacco consumption ≥ 7cigarettes per week. All patients were instructed about the risks of smoking and were offeredto participate in the smoking cessation program. Each center used different smoking cessationstrategies based on available resources. The strategies employed included intensive medicalcounseling, follow-up by pulmonologist, otolaryngologist or psychologist and pharmacolo-gical treatments (varenicline, bupropion or nicotine replacement therapy). Urinary cotinineand exhaled carbon monoxide levels were evaluated in a subgroup of patients. Follow upvisits were performed every 3 months. RESULTS: The cohort presents a current medianfollow up of 18 months. 62% of the patients accepted to try quitting after the GI counseling,with most patients (56%) accepting to try quitting at inclusion. Regarding the cessationoutcome of the entire population (408 smokers), 31% quit smoking and 23% continuedsmoking-free till the end of their current follow up, with 8% of relapse. Almost 70% didnot quit and most non-quitters did not change their smoking habit with only 5% presentinga decrease in tobacco load. Non-quitters presented heavier median tobacco load (15 vs. 10pack year), longer median disease duration (96 vs. 61 months) and more surgery (42% vs.29%) when compared to quitters. There were no other detectable differences between bothgroups. In 63% of patients going through smoking cessation, there was help of anotherspecialist, most frequently, the pulmonologist (47%). Surprisingly, most patients (88%) triedto quit smoking with no pharmacological therapy. Bupropion, varenicline and nicotinereplacement treatment were used in few patients. The use of urinary cotinine and exhaledCO levels to follow up patients in cessation was not clinical practice in any of the 14participating centers. Urinary cotinine and exhaled CO levels were tested in a subgroup ofpatients reaching a good correlation with the self-reported smoking habit. CONCLUSION:Our results suggest that a smoking cessation program specifically designed for CD patientsis well accepted and effective and should be part of the therapeutic strategy in all smokerswith CD.
331
A Prospective Study of New Cases of Paediatric Crohn's Disease Treated WithExclusive Enteral Nutrition: Early Clinical, Biochemical, Mucosal andTransmural OutcomesZubin Grover, Richard Muir, Peter Lewindon
Background- The aim of this study is to comprehensively evaluate the short term benefitsof Exclusive Enteral Nutrition on clinical, biochemical, mucosal and radiological diseaseactivity. Methods: 21 newly diagnosed paediatric Crohn's patients (Age -Mean 13.13, range9.5-15.2; 15males) were offered EEN for 8weeks as induction therapywith early introductionof Imuran/6MP (<3 months). Comprehensive assessment included: PCDAI, CRP, Endoscopyand MR Enterography at diagnosis and termination of EEN. Clinical remission was definedas PCDAI <10; Mucosal healing as complete Simple Endoscopic Score (SES)-CD=0, nearcomplete = SES 0-3, Incomplete = >3; Transmural healing as validated MRI disease activityscores: 0-1 no activity; 2-6 mild activity; >7 moderate to severe activity (1). Early mucosalrecovery was related to sustained clinical remission, need for biological therapy and surgeryat last follow up (median 11.1 months). Results: Montreal Disease distribution was extensivein 18/21, 3 had perianal disease and 5 had stricturing behavior, B2. 9/21 had significantlinear growth failure with a drop from pre-illness height z-scores >1.0. All had successfulpaired clinical, biochemical assessments before and after EEN, 19/21 patients had successfulpaired full Ileo-colonoscopy and 14/21 had follow up MR Enterography. ConventionalImmunomodulators commenced a median 28 days after starting EEN. After 8 weeks EEN19/21 (90%) were in clinical remission ; 18/21(85%)in biochemical remission; 14/21(65%)in mucosal remission. 9/21 (43%) children had complete mucosal healing (SES=0); 5/21near complete healing (SES 1-3); 5/20 improved but incomplete healing SES >3 ; 2/20 noresponse; MRE improved significantly in 10/14 (71%). Significant improvement was notedin all parameters after EEN (Table 1). At time of last follow up 14/21 had relapsed andrequired further intervention with EEN, steroids, biological agents or surgical resection : 6/14 (43%) who had complete/near complete mucosal healing vs 6/7(85%) who did not.Those with mucosal healing were more likely to be in sustained, relapse free clinical remissionat time of last follow up (Fig 1). 4 children were confirmed at 2nd colonoscopy to havesevere stricturing disease and went to early surgery. Conclusions: EEN is a highly effectivestrategy for inducing remission , clinically 90%, biochemically 85%, mucosal 65% and withimprovement in MRE disease activity. Early mucosal remission also predicts less aggressivedisease course with sustained, relapse- free clinical remission. Reference: 1.Girometti R, etal MRI scoring system including dynamic motility evaluation in assessing activity of Crohn'sdisease of terminal Ileum Acad Radiol 2008;15:153-64Table 1 Clinical, biochemical, endoscopic and MRE Crohn's activity scores before andafter EEN.
