Background: Chronic systemic inflammation can contribute to development of arterial stiffness increase and accelerated vascular aging. Recent research has demonstrated higher risk of developing atherosclerosis in inflammatory bowel disease (IBD). Noninvasive measurement of aortic pulse wave velocity (PWV) has predictive value for future fatal cardiovascular events and total cardiovascular mortality. The aim of our study was to assess the level of arterial stiffness by measuring aortic PWV as an index of arterial stiffness in IBD patients. Methods: We conducted a pilot observational study on a cohort of IBD patients during the period from December 2015 to October 2016. We measured PWV with validated, noninvasive oscillometric device (Tensiomed Arteriograph device (Medexpert Ltd., Budapest, Hungary)) in all patients enrolled in this study. Select laboratory data were collected, as well as patients' medical history relevant for the analysis. Results: A total of 40 patients diagnosed with IBD with median age of 31 years (range: 18–66 yr) were enrolled: 24 Crohn's disease (CD) patients – median age 28.5 yr (range: 18–58 yr, 62% males), and 16 ulcerative colitis (UC) patients – median age 41.5 yr (range: 18–66 yr, 62% males). Mean±SEM PWV value was 8.11±0.35 m/s, 7.83±0.28 m/s, and 8.52±0.78 m/s for IBD, CD and UC groups, respectively. There was no statistically significant difference between the CD and UC in PWV values (p=0.34) nor age (p=0.10). Stricturing (Montreal classification-B2) and penetrating phenotype (B3) of CD were associated with higher PWV values comparing to non-stricturing, non-penetrating phenotype (B1) (8.23±0.43 m/s (n=8) and 8.39±0.6 m/s (n=7) vs 7.03±0.28 m/s (n=9); p=0.033 and p=0.057, respectively). Significant correlation was found between PWV values and patients' age (p<0.0001, r=0.71) and cholesterol levels (p=0.0206, r=0.3649). Also, patients on steroid therapy (n=8) had higher measured PWV values than the ones on immunomodulatory therapy (n=13) (9.29±0.88 m/s vs 7.58±0.42 m/s), although this result did not reach level of statistical significance (p=0.06). Conclusions: According to our data, CD phenotype and patients' age have a significant impact on arterial stiffness in IBD. Higher PWV values in B2 and B3 CD phenotype could be an effect of more profound systemic inflammation in these patients. Also, higher PWV values in steroid therapy subgroup could be related to current disease activity. There seems to be no difference in aortic PWV between CD and UC patients. However, next step in our research is to measure PWV in a larger cohort of patients with a goal to further elucidate the differences within IBD patient groups, according to disease phenotype, disease length and treatment regimens.

Background: We have previously demonstrated concerningly high 3-year mortality following hospitalisation with ulcerative colitis (UC) between 1998 and 2000 in Scotland [1].We have extended these studies by examining 3-year mortality following hospitalisation with UC in Scotland between 2007 2009, providing an opportunity for comparison with our earlier results.Aim: To compare 3-year mortality, and factors related to mortality, in Scottish patients hospitalised with ulcerative colitis (UC) between Period 1 (1998 2000) and Period 2 (2007 2009).Methods: The Scottish Morbidity Records and linked datasets were used to assess 3-year crude mortality, standardised mortality ratio (SMR) and multivariate analyses of factors associated with 3-year mortality.The 3-year mortality was determined after four admission types: surgery-elective or emergency; medical-elective or emergency.Age-standardised mortality rates (ASR) were used to compare mortality rates between periods.Results: The admission rate with UC increased from 10.6 per 100,000 of the Scottish population per year in Period 1 to 11.6 in Period 2 (p = 0.046).The proportion undergoing colectomy was unchanged (p = 0.7).Among those admitted with UC, the proportion aged <30 yrs increased (p = 0.009).Crude and adjusted 3-year mortality fell between time periods (Crude 12.2% [Period 1] to 8.3% [Period 2], adjusted OR 0.59, CI 0.42 to 0.81, p = 0.04).Following emergency medical admission, 3-year mortality was reduced in Period 2 (OR 0.58, p = 0.003).Within the >65 yrs age group crude 3-year mortality fell (38.8% to 28.7%, p = 0.02).The overall SMR was 3.04 in Period 1 and 2.96 in Period 2. Directly age standardised mortality decreased from 373 (CI 309 437) to 264 (CI 212 316) per 10,000 person years.On multivariate analysis, older age and co-morbid remained associated with 3-year mortality in Period 2. Conclusions: Although the mortality associated with admission remains high at 3 years, crude and adjusted rates suggest significant reductions over the last decade.

Background & AimsHealth-related quality of life (HRQoL) is impaired in patients with Inflammatory Bowel Disease (IBD). The aim was prospectively to assess and validate the pattern of HRQoL in an unselected, population-based inception cohort of IBD patients from Eastern and Western Europe.MethodsThe EpiCom inception cohort consists of 1560 IBD patients from 31 European centres covering a background population of approximately 10.1million. Patients answered the disease specific Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and generic Short Form 12 (SF-12) questionnaire at diagnosis and after one year of follow-up.ResultsIn total, 1079 patients were included in this study. Crohn's disease (CD) patients mean SIBDQ scores improved from 45.3 to 55.3 in Eastern Europe and from 44.9 to 53.6 in Western Europe. SIBDQ scores for ulcerative colitis (UC) patients improved from 44.9 to 57.4 and from 48.8 to 55.7, respectively. UC patients needing surgery or biologicals had lower SIBDQ scores before and after compared to the rest, while biological therapy improved SIBDQ scores in CD. CD and UC patients in both regions improved all SF-12 scores. Only Eastern European UC patients achieved SF-12 summary scores equal to or above the normal population.ConclusionMedical and surgical treatment improved HRQoL during the first year of disease. The majority of IBD patients in both Eastern and Western Europe reported a positive perception of disease-specific but not generic HRQoL. Biological therapy improved HRQoL in CD patients, while UC patients in need of surgery or biological therapy experienced lower perceptions of HRQoL than the rest.

Epidemiology S273with a nation-wide survey in 19 community hospitals and 12 academic referral centers.Methods: The survey was conducted between June and December 2011, using a standardized questionnaire administered during the hospital visits over a one month period.The patients' attitudes and perceptions, adherence to therapy, QoL (assessed by IBDQ), and access to health service was evaluated.Eligible patients (pts) consisted of men and women at least of 15 years of age with UC confirmed by standard clinical, endoscopic and histopathological criteria.Pts with previous colectomy or proctitis were excluded.Results: A total of 858 pts completed the survey.The majority self-reported to be in remission (51%), with a mean of 4.1 flares during the past 5 years with no differences for age and gender.A mean of 1.1 and 0.5 hospitalizations related or not to UC during the past 5 years were reported, respectively.Overall, the IBDQ scores were similar in pts with disease duration over 10 years than in pts diagnosed less than 3 years (4.97 and 5.01, respectively).The IBDQ scores were also lower in pts with active and chronically active disease than in pts with remission (4.18, 4.22 and 5.55, respectively).Only 35% of pts on combined (oral and topical) therapy reported to adhere to treatment, whereas 47% of pts reported to forget at least one pill during last 2 weeks.Twenty-eight per cent of pts reported a poor adherence to therapy, irrespective of gender, education, and employment status.Conclusions: Patients generally revealed a great impact of UC on day-by-day life, including disease burden and control, quality of life, coping skills, and treatment adherence.

Results: 98 patients were recruited. One patient was lost to follow up and the care of 4 patients was transferred to another centre before 12 months of follow up data was available. Of the 93 remaining patients 11 (12%) relapsed within 12 months. The median FC was lower for non-relapsers, 79mg/g (IQR 39 226) than for relapsers, 322mg/g (IQR 136 557) (p = 0.002). The area under the ROC curve to predict relapse using FC was 74.8%. (Figure 1). Utilising a cut-off FC value of 240mg/g to predict relapse of quiescent Crohn’s disease over the course of one year was associated with a sensitivity of 72.7% and specificity of 74.3%, negative predictive value was high at 95.3% and a positive predictive value of 27.6%. On Kaplan Meier plots, there is a significant difference in time to relapse for those with the first FC value below or above 240 mg/g (p = 0.01) (Figure 2).

Background: CDI is the main cause of antibiotic associated infectious diarrhea.Incidence, severity and burden on the healthcare system related to CDI have increased in last decade in many industrialized countries.Epidemiological data of CDI are scarce in Southern Europe.Aims: To evaluate incidence and secular trend of nosocomial CDI between 2000 and 2009 in two Spanish referral hospitals.To analyze the highest incidence rates across specialties.Methods: Setting: Two referral hospitals in the Barcelona metropolitan area.Design: Retrospective surveillance study.Laboratory CDI diagnosis: Positive toxigenic culture and/or toxin detection in fecal samples using cell citoxicity neutralization assay.Patients: All in-patients from whom an appropriate fecal sample was submitted for CDI study between January 2000 and December 2009 were included.Nosocomial CDI case definition: A nosocomial CDI case was defined by the presence of either a positive stool test for C. difficile toxin or toxigenic C. difficile more than 48 hours after admission and that not have been diagnosed of CDI within the previous 28 days.Results: We identified 278 cases.Between 2000 and 2005 CDI incidence remained stable (0.52 and 0.54 cases/10.000inpatient days in 2000 and 2005 respectively).During second half of this decade a four fold increase in incidence occurred (0.79, 1.48, 1.95 y 2.33 cases/10.000in-patient days in 2006, 2007, 2008 y 2009 respectively).During de same period there was an increased hospitalary antibiotics consumption (from 56 to 67 defined daily doses/100 in-patient days between 2000 and 2009) that correlated with nosocomial CDI incidence (r = 0.98, p < 0.001).Hematology, ICU, Infectious Diseases and Gastroenterology Departments had the highest CDI incidence rates.Conclusions: CDI incidence has quadruplicate during second half of last decade coinciding with an increased use of antibiotics.Our results highlight the importance of CDI surveillance in hospitals, specially among high risk departments.

A 54-year-old man was admitted to a regional hospital with fever, weight loss, and malaise. He was found to have infection with the human immunodeficiency virus (HIV). An upper gastrointestinal endoscopy revealed multiple gastric submucosal nodules; biopsies of the nodules were taken, the histopathology of these being reported as gastric adenocarcinoma. The patient was therefore referred to our unit for further evaluation.

ease presented to our unit with a 1-day history of hematemesis. On admission, his blood pressure was 100/60mmHg and pulse rate 102 beats/minute. The initial hematocrit was 29%. Urgent esophagogastroduodenoscopy (EGD) revealed a large esophageal tear at the cardia, measuring 15 × 10mm (●" Fig. 1). A diagnosis of Mallory–Weiss tear wasmade. Placement of the clips seemed insufficient because of the large diameter and length of the tear. In order to bring together the edges of the tear, an endoloop (EndoLoop MAJ 254; Olympus, Tokyo, Japan) was inserted in the esophagus by the endoscope (Olympus EVIS EXERA II GIFH180) in a freehand manner. After the endoloop snare was correctly placed around the tear, the snare was anchoredwith four clips (Quickclip; Olympus) at the margins of the tear (●" Fig. 2a). The loop was then tightened to close the defect (●" Fig. 2b). The clinical course of the patient was uneventful, and followup EGD performed 4 weeks later revealed complete healing of the tear with formation of scar tissue (●" Fig. 3). Application of clips and an endoloop in the esophagus has beendescribed as amethod for closure of large mucosal defects after endoscopic mucosal resection [1], and of esophagomediastinal fistulas [2]. The closure was completed with a single-channel endoscope in a sequential two-step maneuver: first, clips were deployed at the margins of the defect, followed by looping and tightening of the clips with the endoloop. A total of three patients were reported, with a 100% technical success. In our case, the esophagus served as a secondworking channel, allowing us to apply both accessories simultaneously with a favorable outcome. Further studies will be required to prove the feasibility of this approach.

Aims: To perform a more comprehensive analysis of gene expression changes in HCV infected cirrhotic (HCV) liver including both annotated and unannotated genomic regions.We hypothesized that standard RNA isolation techniques may under-represent some gene expression differences in HCV liver and that RNAs from previously undefined genes are differentially regulated in HCV as compared to control liver.Background: To date, no studies have used tiling arrays to assess previously unannotated regions in HCV liver for novel genes altered during chronic HCV infection.Although array studies of annotated genes have been done in HCV liver, they have primary focused on samples of poly(A)+ RNA.Recent data has suggested that many mammalian mRNAs lack or have short 3' polyadenylated ends and are likely to be underrepresented or absent in such studies.Methods: Chronic hepatitis C cirrhotic (HCV) liver and normal human liver were prepared using a high-affinity eIF4E variant which binds 5' capped (Pol II) RNAs with a ten-fold higher affinity than the wildtype protein; poly(A)+ RNA was isolated with oligo(dT).Each sample had cDNA synthesized and probes prepared for Agilent ENCODE tiling array (representing 1% of the genome and tiling both annotated and unannotated regions).Real-time PCR analysis of selected transcripts was done with a total of 7 HCV and 7 control liver specimens.RACE and sequencing was performed on RNA from unannotated regions to better define their 5' and 3' ends.Results: Tiling array analysis of 5' capped RNA samples identified 69 differentially expressed annotated genes (fold change >1.5 and Bonferroni adjusted p-value <0.05) in HCV liver compared to control liver.Analysis of poly(A)+ RNA identified 52 annotated genes that were differentially expressed.Multiple immune response transcripts, including five leukocyte immunoglobulinlike receptor transcripts, interferon regulatory factor 1 (IRF1) and interferon alpha receptor (IFNAR1), were identified exclusively in 5' cap RNA.This analysis also identified three candidate novel Pol II RNAs that were increased in HCV liver.A novel transcript from chromosome 14 was also expressed in Huh7.5 cells following acute HCV infection.This novel RNA may be part of the host antiviral defense response.Conclusion: This study provides evidence that analysis of 5' capped RNA adds information to gene expression studies of HCV liver biospecimens.In addition, this approach to gene expression analysis identified putative novel Pol II genes that were upregulated in HCV liver -one of these was also increased in acutely HCV infected liver cells.The function of this RNA is presently being investigated.

Background: Crohn's disease is a chronic inflammatory gastrointestinal disorder with an unpredictable clinical course characterized by the high incidence of recurrence.In spite of the important role of conservative treatment, up to 90 % of all patients with Crohn's disease require surgery during their lifetime.However, the factors that predict post-operative recurrence remain controversial.Aim: This study was designed to identify the risk factors for recurrence in patients with Crohn's disease and the influence of the primary operation.Methods: From 1994 through 2006, 40 patients affected by Crohn's disease required operative treatment.All these patients underwent a primary procedure.There were 29 men and 11 women (mean age: 33 years).Recurrence was defined by the presence of clinical symptoms.Univariate and multivariate analysis were performed to find the predictors of recurrence.Results: The most common indication for the surgical treatment was stenosis (45%).As the most frequent procedures, the ileocoecal resection (37.5%) and the partial resection of the small bowel (32.5%) were performed.The mean length of the follow-up was 48 months.The overall recurrence rate was 40%.Logistic regression analysis revealed that age at onset of disease (p = 0.01), age at surgery (p = 0.02), smoking (p = 0.005), preoperative treatment (p = 0.04), urgent surgery (p = 0.03) and prophylactic medical treatment (p = 0.00) were associated with the risk of recurrence.Neither gender, form of aggressiveness of the disease, duration of Crohn's disease before surgery and anatomical site of involvement, nor microscopically affected resection margins and typical granulomas were found to predict the recurrence of the disease.Conclusion: In the treatment of Crohn's disease, it is important to identify a group with high risk of recurrence in order to undertake an appropriate medical prophylaxis.This is very important because of the higher risk for complications caused by reoperations.That is why interdisciplinary cooperation including postoperative care and optimal conservative treatment are absolutely essential.

Poster Presentations score) was evaluated: mild 25 (16.1%)cases, moderate 100 (64.5%) patients, severe 30 (19.3%) patients.In CD we assessed surgical traetment rate 24 patients (24.5%) had different types of surgeries done.Conclusion: Over the past 5 years significant increase in number of patients with IBD in Russia was observed according to Russian IBD research group.This is first data reported from our region about IBD epidemiology, it's close to other data from our country, although our research is done in tertiary center population.

s of the 4th Congress of ECCO the European Crohn's and Colitis Organisation S113 families into Swedish and non-Swedish families in order to investigate for a population specific effect of the CLDN2 marker in the family-based approach.Only Swedish families preserved a significant association between the CLDN2 marker and CD (allelic OR = 2.95, 95% 0.99 8.83, p = 0.033).No associations were found between SNPs in CLDN1 or CLDN4 and disease phenotypes IBD, CD or ulcerative colitis.Conclusion: These findings suggest a genetically impaired intestinal epithelial barrier as a predisposing factor in the etiology of CD.

Background/Aim The high incidence of bone disease and the increasing evidence that Crohn´s disease (CD) affects bone status in corticosteroid users and non-users suggest that bone metabolism is affected by the underlying inflammatory process. As the biogenesis of receptor activator of nuclear factor κ B-ligand (RANKL) and its decoy receptor osteoprotegerin (OPG) may be a consequence of intestinal inflammation and because this signal pathway is shared between the immune and bone system, we hypothesized that the action of sRANKL, OPG and other inflammatory cytokines is not limited to the induction of local inflammation but might be directly or indirectly involved in the activation of bone metabolism. The aim of this study was to determine comparative serum levels of proinflammatory cytokines, markers of bone formation and resorption, and regulatory molecules of osteoclast biogenesis in CD patients with and without established metabolic bone disease. Patients and Methods The study population included 95 patients, 15 of them newly diagnosed and untreated. Serum concentrations of free soluble RANKL, OPG, TNF-α , IL-1β , IL-6, osteocalcin and C-telopeptide type I were measured by immunoassay. Reference ranges were derived from 30 age-matched healthy controls. Bone mineral density (BMD) of the spine and total hip was measured by DXA. Results We found 53% of Crohn´s patients with reduced BMD (t-score≤ 1.0) at diagnosis, and low bone mass in 72% of the study population. Elevated concentrations of sRANKL, OPG, TNF-α and IL-6 were found in patients with bone disease (p<0.01). In the newly diagnosed, previously untreated patients there was a good association between TNF-α and free sRANKL (r=0.6 ; p=0.027), and this positive correlation remained unchanged in the unselected study population as a whole (r=0.5 ; p=0.002). Stepwise multiple regression indicated TNF-α to be the best predictor of sRANKL (p<0.001). Patients with increased parameter of bone resorption were characterized by elevation of TNF-α , IL-6, CRP and OPG in systemic circulation. Analysis of the OPG and sRANKL relationship according to subgroups showed absence of correlation in patients with healthy skeleton, and an inverse relationship in those with pathologic BMD (r=-0.36 ; p=0.003). In the newly diagnosed patients with reduced BMD, correlation between free sRANKL and OPG was highly inverse (r=-0.8 ; p=0.02), whereas in those with normal BMD there was no relationship. Conclusion We found low bone mass in 50% of newly diagnosed and untreated Crohn´s patients. In nai ; ; ; ve Crohn´s patients we demonstrated strong relationship between TNF-α and the osteoclastic mediator sRANKL, and this positive correlation persisted across the unselected study population. Free sRANKL and OPG showed highly inverse relationship in patients with pathological bone density but not in those with healthy skeleton. Data on the newly diagnosed patients support the prominent role of inflammation in bone loss. Therefore, bone disease that accompanies Crohn´s disease needs to be considered for therapeutic options already at the diagnosis

A 67-year-old woman was admitted to the hospital for the first time due to obstructive jaundice. Cholecystectomy and choledochotomy with T-drainage were carried out, and 6 days after the operation, an exploratory laparotomy and retroperitoneal necrosectomy were done due to acute hemorrhagic necrotic pancreatitis. One month later, endoscopic ultrasonography (EUS) and multislice computed tomography demonstrated an encapsulated left subphrenic abscess, 10 cm in diameter (Figure [1], [2]). It was decided to carry out EUS-guided drainage, as the abscess was directly adjacent to the stomach and it was considered that EUS would provide a much shorter and safer approach. The procedure was conducted with the Giovannini drainage set and with linear-array ultrasound guidance (Figure [3]). After the drainage, the patient's fever ceased, the C-reactive protein level dropped significantly, and the white blood count showed normal values. The next day, transabdominal ultrasonography demonstrated a residual crescent-shaped abscess cavity measuring 44 × 59 mm. Six days after the drainage, a check-up endoscopy showed that the stent was patent (Figure [4]). Unfortunately, the patient died of multiple organ failure 8 days after the drainage procedure.

Limited data are available on the frequency of inflammatory bowel diseases in East European countries. A recent study from Hungary reported an increasing incidence rate for ulcerative colitis (from 1.6 to 11.0) and for Crohn's disease (from 0.4 to 4.7) from 1977 to 2001. A similar trend was seen in Croatia. In contrast, other countries (for example, Czech Republic, Poland, Romania, Slovakia, and Baltic countries) reported low incidence and prevalence rates. This review will discuss the available data on the epidemiology of inflammatory bowel diseases in Eastern Europe, as well as consider the possible factors responsible for the differences seen between countries and epidemiological trends.