Patients with Depressive Symptoms (n = 127)

Significant Correlations Between Domains of Sleep Disturbance and Measures ofCrohn's Disease (CD) or Ulcerative Colitis (UC)

Only significant correlations are shown. ** Correlation is significant at the 0.01 level. *Correlation is significant at the 0.05 level.

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Quality of Life in Pediatric Patients Who Underwent Colectomy for UlcerativeColitisDeepal H. Dalal, Dana Patton, Janet M. Wojcicki, Ann L. Clark, Shinjiro Hirose, MelvinB. Heyman

BACKGROUND: Chronic ulcerative colitis in children can have a negative impact on qualityof life (QOL). Prior studies in adults suggest that colectomy leads to improved measures ofQOL. AIM: To determine QOL in pediatric patients who underwent colectomy for ulcerativecolitis. METHODS: All patients under 20 years of age who underwent colectomy for ulcerativecolitis between 1980 and 2005 at UCSF Children's Hospital were recruited. Of 31 patientscontacted, 16 completed the validated QOL Questionnaire for patients with inflammatorybowel disease (IBDQ-32; McMaster University in Ontario, Canada) and an additional ques-tionnaire that addressed bowel function and reproductive health. Each question was ratedon a scale of 1 (“all of the time”) to 7 (“none of the time”); total scores ranged from 32 to224, higher scores indicating a better QOL. Data are presented as Mean±SD. RESULTS: Ageat the time of diagnosis was 11.2±3.7 (range 3 to 16) years. Age at colectomy was 13.3±3.7(6 to 19) years. All but 5 had at least one surgery since colectomy; one had 11 surgeries.Twelve patients (75%) reported no increase in frequency of bowel movements. Pouchitiswas reported by 9 (56.3%). The survey was administered 8.7±6.2 (2 to 24) years post-colectomy. Total scores were 159.7±43.3 (58 to 210). Two patients (12.5%) had overallIBDQ scores of ≥200, ten (62.5%) had scores of 151-199, two (12.5%) had scores of 101-150, and two (12.5%) had scores ≤100. The two patients with scores ≤100 had repeatedepisodes of pouchitis (16-30 episodes) compared with the other 14 patients (0-3 episodes).Systemic symptoms (fatigue, difficulty sleeping, and maintaining weight) had the lowestscores (4.2±1.9). Social function (attending social engagements, work or school) had thehighest scores (5.6±2.0), and 6/16 patients (37.5%) had scores of 7 (maximum) across allsocial function questions, which was not found for any other system. Patients continuingto have loose bowel movements had the lowest overall scores (3.6±2.2, range 1-7). Patientswith no or minimal rectal bleeding had the highest scores (6.5±1.2, range 3-7). Childrenwho underwent colectomy before 14 years of age had higher scores (better QOL), andchildren diagnosed before 12 years of age had better QOL than children diagnosed at age≥12 years (QOL: 5.5±1.0 vs 4.3±1.6). QOL relating to sexual function was highly rated(5.4±2.1; range 2-7). CONCLUSIONS: Measures of QOL in pediatric patients undergoingcolectomy for ulcerative colitis show highest QOL scores in social function. Younger age attime of colectomy and of diagnosis, specifically under 12 years of age, leads to greaterimprovement of QOL. Complications determined by recurrent surgeries or fecal soiling arecommon, but only pouchitis appears to detract from improved overall QOL.

S-507 AGA Abstracts

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Altered Coagulation in Pediatric Inflammatory Bowel Disease: Role onInherited and Acquired Risk FactorsMarina Aloi, Anna Dilillo, Emanuela Del Giudice, Giovanni Di Nardo, Claudia Alessandri,Federica Nuti, Francesco M. Perla, Elisa Marocchi, Franca Viola, Salvatore Cucchiara

Background and aims. A hypercoagulable state has been demonstrated in inflammatorybowel disease (IBD) and also supposed to be linked to its pathogenetic mechanism. Apossible role of inherited risk factors for thrombosis in determining this state has beensuggested in adults, however no data in pediatric IBD patients are reported. Aim of ourstudy was to identify the abnormalities in coagulation and fibrinolysis status in pediatricIBD patients and to evaluate the role of inherited and acquired risk factors in determiningthese abnormalities. Patients and methods. A cohort of 30 patients, 16 Crohn's Disease(CD), 14 Ulcerative Colitis (UC), age range (years) 9.3-23.2, median 15.6, mean diseaseduration 42.4 months, attending our Pediatric IBD Center were enrolled into the study andcompared with 20 healthy controls matched for sex and age. Prothrombotic factors includingphrotrombin and partial thromboplastin time, fibrinogenaemia, hyperhomocysteinaemia, Cand S protein deficiency, were measured. We analyzed associations between altered coagula-tion status and IBD course stratified both by inherited risk factors, i.e. thrombophilicmutations of methylene tetrahydrofolate reductase (MTHFR) C667T, MTHFR 1298C, factorV Leiden G1691A (FVL), prothrombin G20210A (PT), and acquired risk factors, i.e. age,sex, personal and family history for thromboembolic events, smoking and passive smoking,vitamin B12 and folic acid plasmatic levels, therapy and disease activity. Results. Meanhomocysteine and fibrinogen levels were significantly higher in children with IBD as com-pared to controls (p <0.05). These levels were not significantly higher in CD than UC. Therewas no significant increase in the incidence of MTHFR, FVL and PT mutations in IBDpatients. Among the acquired risk factors, exposition to passive smoking was significantlyhigher in IBD patients with hyperhomocysteinemia than in controls (p 0.01). There was nocorrelation between hyperhomocysteinaemia and low vitamin B12 and folic acid levels.Conclusions. The major inherited risk factors for thrombosis are not increased in childrenwith IBD and altered coagulation status, suggesting that acquired risk factors may play arole in determining predisposition to thromboembolic events. Among the acquired factors,passive smoking seems to be correlated with increased prevalence of hyperhomocysteinemiain children with IBD.

Su1904

The Value of Faecal Calprotectin in the Investigation of Suspected Early-OnsetInflammatory Bowel DiseasePaul Henderson, Aoife Casey, Sally J. Lawrence, Kathleen Kingstone, Pamela Rogers, PeterM. Gillett, David C. Wilson

Introduction: The measurement of faecal calprotectin (FC) in patients with suspected bowelinflammation has become routine in many centres in recent years. Although FC levels havebeen shown to correspond with radio-nucleotide labelled neutrophil scans and endoscopicappearances in those with inflammatory bowel disease (IBD), it is still unclear as to thevalue of FC to inform IBD diagnosis, especially with regard to endoscopic investigation.Methods: Records of the cohort of all IBD patients diagnosed (using standard endoscopicassessment) within the regional paediatric gastroenterology service for SE Scotland between01.01.05 and 30.06.10 (aged 1-17yrs) and with a FC performed during initial workup wereidentified. The local laboratory results system and endoscopy lists were reviewed and a non-IBD control who had similarly undergone endoscopy and also had a referral FC level availablewas identified. Only FC values taken at referral or initial investigation (not repeat samples)in those without any previous gastroenterological diagnosis were included. Patients withinsufficient samples (<2g) and aged <1 year were excluded. Available laboratory referenceranges were <20 and >2500μg/g using the PhiCal Test™ (CALPRO AS, Oslo, Norway).Results: A total of 196 patient samples met the inclusion criteria. These included samplesfrom patients with IBD (n=98) (63 Crohn's disease, 24 ulcerative colitis, 11 IBD-U) and 98controls. The IBD and control group had a male:female ratio of 1.8 and 1.6 respectively(p=0.768). Median values of FC for the IBD group was 1271μg/g (IQR 691-2000, range20-2500) and for the control group 48μg/g (IQR 20-129, range 20-1660). In the IBD group94/98 (96%) had a FC level >50μg/g compared to 49/98 (50%) in the control group (p=<0.0001). However, the number of controls with values greater than >200μg/g was signific-antly lower - 16/98 (16%) compared to 91/98 (93%) for IBD (p=<0.0001). Using a cut offof >50μg/g the sensitivity of FC for IBD diagnosis was 96% [95% CI 90-99], specificity50% [95% CI 40-60] with a PPV of 66% [95% CI 57-73] and NPV of 92% [95% CI 82-98]. However, using the locally-accepted clinical normal range of <200μg/g the specificityincreased dramatically to 84% [95% CI 75-90] with sensitivity 93% [95% CI 86-97], PPV85% [95% CI 71-91] and NPV 92% [95% CI 84-97]. Only two children in the control grouphad FC >1000μg/g (with diagnoses of SMA thrombosis and chronic diarrhea respectively)compared to 61 in the IBD group. Conclusion: This cohort study demonstrates that FC isa useful tool in determining those whomay require endoscopy for suspected bowel inflamma-tion. Those with IBD have significantly higher FC levels at referral and therefore elevatedvalues >200μg/g should prompt further GI investigation whereas values <200 ug/g shouldonly lead to further investigation if conducive clinical assessment.

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Synbiotics for Inflammatory Bowel Disease: Useful in Adults but Problematicin PaediatricsRichard Hansen, Gamal Mahdi, Karen McIntyre, George T. MacFarlane, SandraMacfarlane, David C. Wilson

Introduction: Alterations in the colonic microbiota are thought central to inflammatorybowel disease (IBD) pathogenesis. Adult studies suggest modification of the microbiota bysynbiotics (probiotics+prebiotics) can improve ulcerative colitis (UC)(1) and Crohn's disease(CD)(2). Aim: To assess the feasibility of using a synbiotic in children with IBD by assessingacceptance and tolerability. Methods: Patients with known IBD aged 6 to 16yrs were

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