P475 Granulocyte and Monocyte Apheresis (GMA) Adacolumn® in mild to moderate ulcerative colitis patients with steroid resistance or dependence and azathioprine intolerance or resistance: a prospective multicenter study (preliminary data) G. Imperiali1 *, M.M. Terpin2, A. Amato1, A. Bortoli3, G. Meucci4. 1Valduce Hospital, Gastroenterology, Como, Italy, 2Legnano Hospital, Gastroenterology, Legnano, Italy, 3Rho Hospital, Gastroenterology, Rho, Italy, 4S. Giuseppe Hospital, Gastroenterology, Milano, Italy

To describe health care resource utilization in treating patients affected by inflammatory bowel diseases (IBD) and to assess the related direct costs to the Italian health care system (HS) in its most populated region. A retrospective observational study was conducted using data from DENALI, a data warehouse that organizes and integrates the health care administrative databases of the national HS in Lombardy (northern Italy) with a probabilistic approach. The Italian HS provides universal coverage and records the accesses to health care services at regional level. We enrolled adult patients with Ulcerative Colitis (UC) or Crohn’s Disease (CD) diagnosed during the period 2003-2009. Patients were classified in two cohorts in relation to the type of IBD and were followed until December 31st, 2009 to assess the mean annual consumption of resources (hospitalizations, pharmaceutical prescriptions, outpatient services) and the related costs incurred by HS. We identified 5,523 patients with UC and 3,321 with CD and the mean annual cost per-capita was €2,386 (95%CI: 2,241-2,516) and €2,699 (95%CI: 2,538-2,914) respectively. The breakdown of expense was similar in the cohorts: pharmacological treatments accounted for 37% , hospitalizations for 47% and outpatient services for 16%. Use of mesalamine was high in patients with UC and CD:94% and 88% of subjects was respectively prescribed at least one package during follow-up. High adherence (≥70%) to oral mesalamine was observed in 39% of patients with UC and in 24% of CD cohort. Less than 6% of patients used biologics, which were used only from 2008. This study confirms that patients with IBD represent a considerable economic burden for the Italian HS: prescribed drugs, especially mesalamine, account for a substantial proportion of health care costs. The results underline the importance of administrative databases and the need for further research, since the recent widespread use of biologics for treating IBD.

Conclusion:This study demonstrates the efficacy of Romiplostim in thrombocytopenic cirrhotics in optimizing SVR (Group A -53%, Group B -67% and Group C -60%).A larger trial is needed to validate.

To assess the impact of inflammatory bowel diseases (IBD) in the Italian general population: incidence and time trends from 2003 to 2009, as well as population characteristics. A retrospective observational study was conducted in Lombardy, an Italian region with about 10 million of inhabitants, using health care administrative databases of the national health care system (HS) which provides universal coverage. The main administrative databases were integrated in a data warehouse called DENALI using probabilistic record linkage. New cases of Crohn’s Disease (CD) and Ulcerative Colitis (UC) were identified in the adult population between January 1, 2003 and December 31, 2009. Annual age-standardized incidence rates were computed separately for CD and UC using the population living in Lombardy at 2001 census. Moreover we evaluated patients’ baseline main characteristics, coexisting chronic conditions and survival at December 31, 2009. The annual incidence rate per 100,000 person-years of IBD was 15.6 (95%CI 15.2-15.9); UC and CD incidences were 9.7 (9.4-10.0) and 5.9 (5.7-6.1) respectively. Incidence rates of both diseases were higher in men than in women. CD incidence was highest in subjects aged 20-24 (9.2, 95%CI 8.1-10.2) and decreased with age, while UC incidence was stable in the 20-65 year-old population. No time trends in UC and CD incidences were observed from 2003 to 2009, both in the whole study population and in gender and age-specific subgroups. The mean age at CD diagnosis was 44 years (±16.6 sd), which was lower than that at UC diagnosis (46 ± 16.6, p<0.0001). During a mean follow-up time of 3.4 years (± 2.0) 2.2% of IBD patients died. Our study provides updated estimates on current epidemiology of IBD in Italy. IBD incidence in Lombardy is lower than in northern Europe and the data confirm that UC incidence is higher than that of CD.

The impact of pregnancy on the course of IBD is still controversial.

Background and aim: Crohn's disease (CD) is an inflammatory bowel disease (IBD) characterized by reactivity against microbial and self antigens.Zymogen granule glycoprotein 2 (GP2) was identified as the major autoantigen of CD-specific pancreatic autoantibodies (PAB).Aim: To evaluate the positivity of GP2 in patients with IBD such as CD and Ulcerative Colitis (UC), as well as the potential association with the activity and localization of the disease.Material and methods: We enrolled 83 consecutive patients affected by IBD and 35 blood donors (healthy controls).The diagnosis of CD or UC was based on accepted clinical and endoscopic criteria.GP2 serological detection was performed with a commercially available ELISA kit, according to the manufacturer's instructions (cut-off 15 U/ml).Results: The reactivity found in patients with CD was significantly higher than in patients with UC or healthy controls.Preliminary data show that GP2 positivity in CD correlates with moderate-severe activity of disease, ileo-colic localization and structuring e/o penetrating disease.Under a methodological point of view, the anti-GP2 test resulted reproducible, had a good linearity, and showed minor interferences.Conclusions: Anti-GP2 reactivity was significantly higher in CD patients than in UC patients and controls; In contrast to other auto-antibodies found in CD, such as ASCA, Anti-GP2 positivity was found associated to moderate/severe activity disease, ileo-colic localization and structuring e/o penetrating disease.

We read with great interest the article by Worthley et al 1 that recently appeared in your Journal, and the subsequent letter on the same subject.2 We would like to make some comments on this interesting topic. Worthley et al reported a new autosomal dominant syndrome that they named gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS). GAPPS appears to be characterised by proximal gastric polyposis, particularly of the fundic gland type that often displays low and high grade dysplasia with early development of gastric cancer. These patients showed no evidence of colonic polyps, and other genetic syndromes were excluded. Yanaru-Fujisawa et al reported a further family with GAPPS. So far, dysplasia has been described …

Recurrence of diverticulitis is frequent within 5 years from the uncomplicated first attack, and its prophylaxis is still unclear. We have undertaken a multicentre, randomised, double-blind, placebo-controlled pilot study in order to evaluate the role of mesalazine in preventing diverticulitis recurrence as well as its effects on symptoms associated to diverticular disease.