Menetrier's disease (MD) is a protein-losing gastropathy characterized by acute generalized edema due to hypoalbuminemia. MD is rare in childhood, and it is commonly associated with cytomegalovirus infection. We reported two children, who presented with a history of generalized edema after some days of abdominal pain and diarrhea. Laboratory tests showed hypoalbuminemia with no proteinuria. Thoracic and abdominal ultrasound (US) revealed respectively pleural and pericardial effusion and ascites. A specific gastric echography showed gastric wall thickening (>3 mm) and upper gastrointestinal endoscopy revealed prominent folds in the gastric body and fundus, with a subsequent histological confirmation of Menetrier diagnosis. They were discharged after several albumin infusions. A US follow-up confirmed the remission of the disease after 1 and 6 months. Gastric US revealed accurate in the diagnosis of this rare condition and in its follow-up. avoiding a second endoscopy in the short term.

Teduglutide is a glucagon-like peptide-2 (GLP-2) analog employed in patients with short bowel syndrome (SBS) to reduce the need of parenteral nutrition in these patients, by virtue of its effects on enteric function. The experimental studies reported that the stimulating action of GLP-2 on epithelial turnover implies the potential development of dysplastic and neoplastic lesion. However, the clinical trials could not detect preneoplastic lesions on histologic material, and in a recent pilot study the occurrence of polyps was similar before and after treatment and included only low-grade dysplastic lesions. Another clue in GLP-2 function in stimulating mucosal restore is its enhancement through cooperation with epidermal growth factor (EGF). In this study, we analyzed gastroscopy and colonoscopy samplings from a child successfully weaned off parenteral nutrition with teduglutide. Villous and crypt structure was regular both in duodenal and in colonic samplings; in properly oriented villi, villus/crypt ratio was regular. The absorptive epithelium demonstrated a regular morphology. No atypia was detected in enterocytes, along epithelial structures. At the ultrastructural analysis, only a few enterocytes with vacuolized cytoplasm were observed. An S-phase marker Ki67 stained nuclei in the transitional amplifying zone, while nuclei stained by the cell cycle regulatory proteins p21 and p27 were placed in the differentiated epithelium of the duodenal villi and colonic crypts, as in the control cases. The counts of enterocytes immunostained with the same antisera, evaluated with image analysis software, were in the range of control cases. The ratio of the number of epidermal growth factor receptor (EGFR) signals/the number of centromere probe of chromosome 7 (CEP7) signals was less than 2. The findings available from this single patient are consistent with good preservation of functional capability of intestinal epithelium after treatment with GLP-2, given the histologic and ultrastructural features of enterocytes. In addition, the findings from cell cycle regulatory proteins immunolocalization and quantitative analysis show that cell renewal machinery in our case is comparable to control cases. The gene of the receptor EGFR is regularly expressed in enteric epithelium of our case. Morphologic and functional data from our patient improve evidence in favor of the safety of GLP-2 employ in SBS.

Intestinal graft-versus-host disease (I-GvHD) represents a life-threatening complication in allogeneic stem cell transplantation (SCT). Unfortunately, non-invasive validated diagnostic tools to diagnose I-GvHD, evaluate treatment response, and guide the duration of immunosuppression are still lacking. We employed standard ultrasound and power Doppler to diagnose and follow up on pediatric intestinal GvHD. We herein report on three patients, prospectively evaluated among 24 pediatric patients referred to our center for allogeneic SCT. These three patients presented abdominal pain and diarrhea within the first 200 days after transplantation. In the reported cases, we performed small- and large-intestine ultrasound (US) at clinical onset of lower-intestinal symptoms and, when intestinal GvHD was confirmed, at GvHD flares, if any, and at follow-up. US constantly (3/3 patients) revealed increased bowel wall thickening (BWT) with different bowel segments’ involvement from patient to patient. Further, a moderate or strong increased Doppler signaling was seen in 2 out of 3 patients, according to clinical GVHD staging (e.g., the more the increase, the more the staging). Standard sonography corroborated GvHD diagnosis in all patients considered and was able to detect GvHD progression or complete normalization of findings, thus simplifying ensuing clinical decisions. Our report highlights the need to design clinical trials for the validation of non-invasive radiologic tools for diagnosis and follow-up of GvHD, especially in pediatric patients.

Human endogenous retroviruses (HERVs) represent 8% of our genome. Although no longer infectious, they can regulate transcription of adjacent cellular genes, produce retroviral RNAs, and encode viral proteins that can modulate both innate and adaptive immune responses. Based on this, HERVs have been studied and proposed as contributing factors in various autoimmune disorders. Celiac disease (CD) is considered an autoimmune disease, but HERV expression has not been studied in celiac patients. The aim of this study is to assess the transcription levels of pol genes of HERV-H, -K, and -W and of their TRIM28 repressor in WBCs from celiac children and age-matched control subjects. A PCR real-time TaqMan amplification assay was used to evaluate HERV and TRIM28 transcripts with normalization of the results to glyceraldehyde-3-phosphate dehydrogenase. The RNA levels of pol genes of the three HERV families were significantly higher in WBCs from 38 celiac patients than from 51 control subjects. TRIM28 transcription was comparable between the two study populations. Conclusion: Present results show, for the first time, that pol genes of HERV-H, -K, and -W are overexpressed in patients with CD. Given their proinflammatory and autoimmune properties, this suggests that HERVs may contribute to the development of CD in susceptible individuals.

OBJECTIVES:The aims of the study was to expand the pediatric experience on hepatitis-B virus (HBV) reactivation, a known complication in patients with hematologic malignancies or on immunosuppression. METHODS:Retrospective appraisal of HBV therapy/prophylaxis in immunocompromised children, studied from April 2006 to March 2020. RESULTS:Eighteen HBV-positive patients, 5 girls, median age 11.1 (4.1--17.9) years were included. Seventeen of 18 were immunosuppressed at HBV-infection diagnosis. Seventeen were at high risk of reactivation, 1 at moderate risk. Five of 18 had acute hepatitis B as first infection or reactivation, 6 had HBeAg-positive infection, 1 an HBeAg-negative infection and 6 HBsAg-negative infection. Median follow-up was 2.7 (0.7--12.5) years. No HBV-related mortality was observed. Prophylaxis had to be repeated in 1. Lamivudine was used in 6/12 viremic patients and HBV-DNA negativization obtained in 2/6 (33%). Tenofovir-DF was used in 2/12 and entecavir in 4/12: 100% attained HBV-DNA negativization. Therapy had to be switched from tenofovir-DF to entecavir in 1 patient because of renal impairment. Virological breakthroughs were observed in 1 lamivudine-treated patient, leading to a hepatitis flare; 1 patient on entecavir had a hepatitis flare at immunoreconstitution. Mortality was 33% in the HBsAg-positive group. Seven prophylactic treatments were administered to 6 patients with HBsAg-negative infection: tenofovir-DF in 2 HBV-DNA-positive, lamivudine in 5 HBV-DNA-negative, without reverse HBsAg seroconversion, morbidity or mortality. CONCLUSIONS:There is a residual risk of acute hepatitis B in immunocompromised children, mortality rate was substantial, potentially related to the delays in commencing chemotherapy caused by liver dysfunction. Tenofovir-DF or entecavir are the drugs of choice for HBV treatment in immunocompromised children.

American Gastroenterological Association (AGA), European Crohn's and Colitis Organization (ECCO), and European Society for Clinical Nutrition and Metabolism (ESPEN) currently provide different guidelines for prescribing probiotics in intestinal disorders.These conflicting results cause therapeutic uncertainty in clinicians and an unjustified increase in pharmaceutical spending for the patients, more frequently for patients reporting Inflammatory Bowel Diseases (IBD) in the remission phase.The researchers tried to understand in a group of clinicians and a group of IBD patients whether: a) the indications to prescribe probiotics have to be restricted from clinicians or patients according to recent AGA guidelines, b) the improvement in IBD symptoms during probiotic therapy has to be evaluated based on the opinions of the patient and c) the probiotic to use has to be chosen based on its lower cost.The Authors applied in the general community the Grounded Theory evaluating with the Patients' Outcome Reports (PROs) methodology of investigation.Two reports were addressed twice, in one month, to clinicians and patients selected from those participating in the published educational program "IBD passport", to obtain a critical assessment of the hypotheses.Only 40% of the gastroenterologists adhered to the three assumptions and no patient desired to give up his or her symptomatic treatment with probiotics even when warned that a possible positive result could be due only to a placebo effect.Guidelines for probiotics do not impact the behaviors of clinicians and patients in our area.Clinical trials concerning Live Bio-Therapeutic products (LPBs) could obtain scientifically proven results and clarify when and why to prescribe probiotics in IBD.

Bowel ultrasound (US) is a low-cost, non-invasive, bed side practice and a reproducible procedure that represents a high yield tool in clinical practice and in the diagnostic workup of a consistent group of acute and chronic gastrointestinal (GI) tract disease. Moreover, in case of GI diseases of neonatal and pediatric age, it allows an easier evaluation due to the small body size and scarce presence of fat tissue in the abdominal wall and peritoneal cavity and gas content. No particular preparation of the patient is needed, nevertheless a 3- to 5-hour fasting state improves the quality of the examination. The exam focuses on wall thickness and stratification, lumen content, distensibility and compressibility, presence of peristalsis of explorable segment of the GI tract and includes the investigation of mesentery, perivisceral tissues and nodes features. Color doppler flowmetry admits a qualitative evaluation of GI wall and mesentery vascularization. Healthy GI wall appears at a US evaluation as a multilayered structure in which hyperechoic and hypoechoic layers alternate sequentially. In this article we provide a quickly available overview on findings, signs and applications of US in major GI pediatric diseases.

In February 2020, the COVID-19 pandemic overwhelmed Italy. We retrospectively reviewed all attendances and emergency (A&E) admissions due to foreign-body ingestions (FBIs) to an Italian pediatric referral hospital, from February 24 to April 24, 2020, COVID-19 lockdown and compared them with the same period in the previous 4 years. A total of 101 cases were recorded. Mean age of admission was 4.6 years. Groups did not differ for gender (P = 0.4) or age (P = 0.3). Among FBIs ingestions, 24.0% occurred in children with <2 years of age and 47.5% in children from 2 to 6 years of age. In the 2020 study period, 9 patients were seen for batteries ingestion compared with a median value of one among compared periods. The rates of batteries ingestions increased significantly over the observational period (P < 0.001). We report a dramatic increase in batteries ingestions in children, a potentially fatal event, during the COVID-19 pandemic lockdown.

BACKGROUND AND AIMS:Post-surgical recurrence of Crohn's disease (CD) after ileocolonic resection is common. Early identification of features associated with recurrence is a standard procedure of postoperative management, but the prognostic role of such features when detected at later time points is unclear. We compared the predictivity for Crohn's disease recurrence of common clinical-instrumental variables when assessed early (<12 months) or late (>36 months) after surgery. METHODS:This retrospective study considered CD patients who had ileocolonic resection and were followed for a median of 7.6 years. Clinical characteristics, post-surgical therapy, endoscopy recurrence (Rutgeerts' score ≥i2) and ultrasound features were compared between subgroups who had a early or late post-surgical assessment. Univariate and multivariate analyses were done to identify variables associated with recurrence (clinical and surgical). RESULTS:Of 201 patients, 70 (32%) had a early and 39 (19%) had a late post-surgical assessment. The Early and Late subgroups had similar clinical characteristics. Overall, clinical relapse was observed in 131 patients (66%), surgical relapse in 31 (16%), endoscopic recurrence in 149 (75%) and ultrasonographic recurrence in 132 (66%), without significant differences in frequencies between subgroups. By Cox proportional hazard regression, endoscopic recurrence was a significant predictor of clinical recurrence overall (HR=2.31, P = 0.002) and in the Early (HR=3.85, P = 0.002) but not Late subgroup. DISCUSSION:The most informative postoperative CD assessment is the one done within the first year of surgery. Later endoscopic evaluations have no prognostic value and should be done only for clinical needs or for research purposes.

Calprotectin is a calcium and zinc-binding protein, formed by a hetero complex of S100A8 and S100A9 proteins, which belong to the S-100 protein family consisting in more than 20 different proteins with a tissue-specific expression pattern. This protein is secreted extracellularly from stimulated neutrophils or released by cell disruption or death. The presence of calprotectin in feces quantitatively relates to neutrophil migration toward the gastrointestinal (GI) tract; thus, it represents a useful marker of intestinal inflammation. Fecal calprotectin (FC) has been proven largely useful for determining the inflammatory origin of GI symptoms differentiating between organic and non-organic diseases. Indeed, increased FC levels are also seen in gastroenteritis, microscopic colitis, polyps, malignancies and cystic fibrosis. To date, there are many evidences regarding usefulness in the detection of fecal calprotectin for the management of gastrointestinal disorders, both in children and adults but, especially in the pediatric population, still clear indications for its use are lacking. Its incorporation in primary care reduces the risk of missing an organic disease and facilitates the indication for expensive and invasive investigations as colonoscopy. We herein review and discuss the last evidence on the usefulness of FC in children, with its current indications and future prospective.

Post-operative recurrence of Crohn’s disease (CD) after so-called curative ileocolonic resection is common. Early identification of features associated with recurrence and risk stratification could be essential for the postoperative management of these patients. The aim of the current study was to evaluate the impact of clinical variables and instrumental recurrence on long-term clinical and surgical recurrence. We report data of 125 consecutive patients with CD, undergone ileocolonic resection between July 2000 and January 2010 (median follow-up after surgery 9.4 ± 4.4 years) Clinical-demographic characteristics, post-surgical therapy, endoscopy recurrence (Rutgeerts’ Score ≥ 2) and ultrasound features (bowel wall thickness ≥ 4 mm, loss of wall stratification, mesenteric hypertrophy) were recorded. Kaplan–Meier survival analysis was conducted to identify variables associated with recurrence-free survival (clinical and surgical), both in all patients and in those who performed endoscopy or ultrasound within 18 months after surgery. Time-dependent Cox regression analysis was carried out for multi-variate analysis. Clinical recurrence occurred in 99 patients (80%); in 34/41 patients (83%) within 12 months and in 52/63 (83%) within 18 months. In 25 patients (31%) surgical recurrence was observed, in 3 (4%) cases within 12 months and 4 (5%) within 18 months. The only clinical variables significantly associated with outcomes were stricturing pattern for clinical recurrence and surgical indication for refractory disease for surgical recurrence. Endoscopic recurrence and selected US features were associated to clinical recurrence only. No clinical or imaging predictors were associated to clinical or surgical recurrence in multi-variate analysis. Table 1. univariate analysis results with HR and 95% CI, multi-variate analysis was non-significant for all variables Table 1. univariate analysis results with HR and 95% CI, multi-variate analysis was non-significant for all variables Early evaluation of US and endoscopic features predicts clinical outcomes, apparently not long-term surgical outcomes, in these retrospective series. Prospective long-term follow-up studies with uniform short-term evaluation and therapeutic management are advisable to explore the yields of prognostic prediction through endoscopy or ultrasound, especially in the biologic treatments era.

Background: Inflammatory bowel disease is treated with anti-TNF agents such as infliximab and its biosimilars, but use of biosimilars is limited due to perceived risks of adverse events. Aim: To explore safety and effectiveness of switching from the infliximab originator to a first biosimilar. Patients and methods: Clinical and biological outcomes were compared between 53 patients who switched from the infliximab originator to the biosimilar CT-P13 (Switched group) and 13 patients treated with CT-P13 from the beginning (Naive group). Infliximab trough levels and antidrug antibodies were measured. Results: At enrolment, patients in the Switched group had a longer median duration of infliximab treatment than Naive (4.0 vs. 0.6 years, p < 0.0001) but similar proportions of patients were in remission (77% and 62%, respectively). Infliximab discontinuation due to adverse events or loss of efficacy was less common in the Switched (26%) than Naive group (62%, p = 0.017). Variables independently associated with time to discontinuation were disease activity (p < 0.0001) and immunomodulating treatment (p = 0.019) at enrolment. Trough levels and antidrug antibodies were similar between groups during observation. Conclusion: This study confirms that switching from infliximab originator to a first biosimilar is safe and effective. Patients at highest risk of losing treatment efficacy are those with active disease, irrespective of the therapeutic switch. (C) 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Percutaneous ultrasonography (perc-US) and magnetic resonance enterography (e-MR) are the present standards for staging patients with Crohn’s disease (CD). However, intraoperative data still have some discrepancies with preoperative ones. The contribution of intraoperative ultrasonography (IOUS) has never been evaluated. Sixty-five consecutive patients scheduled for ileal/colonic resection for CD between 2010 and 2014 were prospectively enrolled. All patients had perc-US, e-MR and IOUS. Data from different imaging modalities were compared. The reference standard was the final pathology. Surgery was scheduled because of intestinal obstruction (n = 31 patients), inflammatory mass (n = 21), fistula (n = 10), or abdominal pain/sepsis (n = 3). Fourteen (21.5%) patients had a major discrepancy between preoperative and intraoperative data that required a modification of the surgical planning (five additional ileal lesions, three unknown ileo-sigmoid fistulas, and six not confirmed CD sites). IOUS correctly staged CD in all but one patients (missed ileo-colonic fistula). Pathology data differed from Perc-US data in 13 (20%) patients, from e-MR data in 14 (21.5%), and from IOUS data in one (1.5%). The sensitivity of Perc-US, e-MR and IOUS was: for the identification of CD sites 84.2%, 86.1%, and 100%; for the identification of stenoses 86.8%, 86.8%, and 100%; for the identification of fistulas 75.0%, 81.3%, and 93.8%, respectively. IOUS contributed to the surgical planning in 8 (12.3%) patients. IOUS is a safe, feasible and easy-to-perform procedure that optimizes staging of CD and, in some patients, helps to better define the treatment strategy. It could be helpful to face complex disease presentations on the basis of objective and reproducible data.

Treatment of inflammatory bowel disease (IBD) with anti-TNF drugs is hampered by notable costs. Over the past 2 years, CPT-13, a biosimilar infliximab, was released, on the market with substantial cost savings. Still the switch from originator to biosimilar is not systematically used due to fear of potential side effects. Aim of this study was to perspectively evaluate the effectiveness and safety of switch comparing to treatment outcomes in a consecutive series of patients treated only with biosimilar infliximab Cases were IBD patients undergoing originator infliximab, who were switched to CPT-13 since April 2016 (switch cases). Controls were patients who were started as first biologic on CPT-13, after its commercialisation in Italy (naive cases). Patients were enrolled in a longitudinal cohort study approved by Local Ethical Committee. At basal and following time points also samples for through levels (TL) and antibodies to infliximab (ATI) determination were drawn. Persistence in the treatment, adverse outcomes, infusion reaction and variations in TL and ATI were recorded and compared among the two groups. Sixty-nine consecutive IBD patients (33 Crohn’s disease-, CD, and 36 ulcerative colitis, UC) were enrolled. Switch cases were 54 (group A) and naive cases were 15 (group B). No significant differences in basal characteristics were noted between the two groups, excluding a longer infliximab treatment among switch cases (p < 0.0001). At entry significantly more patients in group A were in remission/mild activity compared with group B (p < 0.01). Clinical adverse events were significantly less in group A (p < 0.05). Preliminary analysis of TL and ATI did not reveal significant variations comparing the two groups. Figure 1 is plotted evolution of TL between basal and subsequent time points. Evolution of drug trough levels (TL) between basal and subsequent time points. https: //planner.smart-abstract.com/ecco2018/submission/en/abstract/6951/content# In this real-life experience of systematic switch between infliximab originator and biosimilar, without patient selection based on clinical characteristics, switch was not associated to adverse outcomes, on contrary, probably due to longer treatment duration, less adverse outcomes were recorded among patients who switched to biosimilar. TL and ATI analysis is still ongoing.

The use of biological and immunosuppressive therapy in Crohn's disease (CD) changed favorably the course of the disease and is currently suggested in the prevention of clinical recurrence. Symptomatic exacerbation is a feature of the natural course of the disease. Endoscopic recurrence may occur earlier than clinical manifestations and its rate is still high ever since the first year after surgery. The severity of mucosal lesions is highly predictive of a new flare of the disease so that the early detection of recurrence warrants strong therapeutic changes or a closer monitoring of the case. Endoscopy is at present the gold-standard technique for the diagnosis and grading of recurrence severity, but is poorly accepted by patients for its invasiveness. A simple and easy repeatable examination able to detect early signs of recurrence could be useful in the follow-up as an alternative or as a backing in the choice of the right timing for endoscopy in questionable cases. The use of bowel ultrasound (B-US) in the management of CD has grown in the past twenty years. Its accuracy in the real time detection of the disease and its complications, known since the 80's, together with the non-invasiveness, low cost and wide availability of the technique have influenced the extension of its clinical use in many referral centers in Europe. The latest generation of ultrasound scanners allows a precise and reproducible morphological assessment of the intestinal tract and the surrounding tissues and enables a complete evaluation of the disease. This review analyzes the literature history about B-US in the diagnosis of postoperative recurrence of CD and outlines the clinical implications of its use. Published works confirm a very good accuracy of B-US in the diagnosis of CD recurrence compared to endoscopy, also in the early phase. B-US shows a good correlation with Rutgeert's score grading, but does not prove significant association with C-reactive protein or CD Activity Index values. A wider use of B-US in the daily practice could allow to set a prompt diagnosis and an earlier and targeted treatment, probably sparing more invasive tests.

Ultrasonographic examination of the gastrointestinal tract is currently employed in many suspected acute and chronic inflammatory conditions, for purely diagnostic purposes and the follow-up of well-known gastrointestinal diseases. Improvement in ultrasonographic technology and investigation techniques of the gastrointestinal tract have overcome to a great extent all impediments and prejudices in using bowel ultrasound for the assessment of digestive diseases. Nowadays, it is possible to assess accurately the main features of the intestinal wall such as its thickness, echo pattern, vascularity, flexibility and motility, to evaluate the diameter and intraluminal content of the bowel and peri-intestinal changes, such as lymph nodes and the status of mesenteric fat. Acknowledgment of these ultrasonographic findings makes it now possible to suspect or detect various gastrointestinal diseases, and improve and speed up diagnostic process of several conditions.

Background Infliximab is effective for treating Crohn's disease (CD) and ulcerative colitis (UC).However, it is unknown if serum drug levels (SDL) and Infliximab antibody (ATI) formation differs between CD and UC patients.Methods SDL and ATI were prospectively determined in CD and UC patients on maintenance Infliximab therapy.Clinical outcomes were based on retrospective chart review.UC and CD patients (1:2 ratio) were matched for treatment (Infliximab dose & interval and percent of patients on combination therapy) and response.Mean SDL and ATI were compared using Chi-square test for categorical variables and Mann-Whitney test for continuous variables.Results Thirty-six responding patients (12 UC, 24 CD) were assessed.There was no difference between UC and CD groups in gender ratio, ethnicity, age at diagnosis, age at start of therapy, duration of therapy, disease duration prior to therapy, smoking status, treatment protocol and response to therapy.Mean ATI levels were significantly higher in the UC group compared with the CD group (10.34 and 1.48 mcg/ml, respectively, p=0.029).ATI positivity (ATI>1 mcg/ml) was significantly more frequent in UC compared to CD (50% & 12.5%, respectively, p=0.036).Mean SDL was 3.63 mcg/ml for UC and 4.32 mcg/ml for CD (p=0.045) and 75% of UC patients had SDL≤1mcg/ml compared to 37.5% of CD patients (p=0.038).Conclusion UC patients on maintenance infliximab therapy develop more ATI compared with CD patients.Serum infliximab levels associated with response to Infliximab maintenance are slightly lower in UC compared to CD. Larger cohorts are required to support these observations.

Clinical: Therapy and observation S213 a first course of endovenous corticosteroids ECT in our tertiary center.Methods: All UC patients admitted to the hospital for an acute flare requiring EC between January 2007 and March 2012 were reviewed.We included only the patients with a first-initial course EC since UC diagnosis time.We defined as "responders" when patients achieved clinical remission in the first seven days of EC and "no responders" when patients needed a rescue therapy because of no clinical response after 7 days of EC.Demographic and clinical features were obtained from the medical records until October 2012.Results: A total of 41 episodes were collected during this period and 14 (34%) completed inclusion criteria.EC "response" was obtained in 9 patients (9/14; 60%, 5F/4M, mean age 36 years).Half of them (5/9), the diagnosis of UC concurred with the hospitalization and EC therapy.After a median follow-up of 24 months (6 56), 4 patients (44%) needed treatment escalation by using IMM for steroid-dependency and 2 (22%) of them used granulocyte aphaeresis before a-TNF therapy.No surgeries were observed in this group.Five patients were EC "no responders" (5/14; 40%, 4F/1M, mean age 30 years).A-TNF therapy was used in 1 patient and 4 received Cyclosporine A (CyA) for steroid-refractoriness and 3 were newly UC diagnose.One patient underwent total colectomy 10 days after EC beginning without further complication or treatment.After 36 months (5 63), 4 patients started IMM (80%) and 1 started a-TNF (20%) but developed a tuberculosis (TBC) infection and after TBC treatment remained with only IMM therapy.Nowadays, 2 more patients (40%) were considered for a-TNF because steroiddependency after acute flare (mean time 6 months).No other surgeries were produced during follow-up.Conclusions: In our center, about half of patients developed a "no responder" to EC flare and most of them will need a-TNF for maintenance therapy even after use of CyA treatment mainly because of steroid-dependence.Even when the UC patients respond to EC, about 40% of them require IMM and even a-TNF for again for steroid-dependence.

Disease 45S (2013) S55-S218 S145 in articular manifestations: 47% (8/17) (CD) and 30% (5/17) (UC) (p=ns).Disease activity index and inflammatory markers decreased in patients in whom joint symptoms had improved at week 14 (p=0.0001;0.004).Conclusions: This preliminary study has shown that treatment with monoclonal antibody anti-TNF alpha (infliximab) improves arthralgia along with gastrointestinal symptoms in patients with Inflamatory Bowel Disease in a statistically significant manner.A larger number of patients is needed to confirm these data.