G3531
INFLAMMATORY BOWEL DISEASE: RESPONSE TO STEROID THERAPY ASSESSED BY
THE FECAL GRANULOCYTE PROTEIN CONCENTRATION.
Palle N Schmidt MD, Copenhagen Univ Hosp Hvidovre, Hvidovre Denmark;
Soeren M Madsen MD, Herlev Hosp, Herlev Denmark; Arne G Roseth MD, Aker
Univ Hosp, Oslo Norway; Magne K Fagerhol MD, Ullevaal Univ Hosp, Oslo Norway;
Johan H Wandall MD, RigsHospet, Copenhagen Denmark
AIM: To study if measurement of granulocyte proteins in feces may help
in assessing response to steroid therapy in inflammatory bowel disease
(IBD).
METHOD: Weekly measurement by ELISA of the fecal lactoferrin (LF) and
calprotectin (CP) concentration in 16 patients with ulcerative colitis
(UC; 12 pancolitis, 4 leftsided) and 5 with Crohn's disease (CD; 4 pancolitis,
1 ileocecal) during systemic prednisolone therapy.
RESULTS: Seven patients (33%; 5UC/2CD) rapidly went into clinical and
endoscopic remission. These patients all demonstrated a rapid decline in
fecal LF and CP concentrations early in the treatment course (median reduction
after 1 week: 86% (LF) and 86% (CP); after 2 weeks: 94% (LF) and 90% (CP))
with full normalization at the end of treatment (initial LF concentration:
median: 330 mg/l (range: 88-3672), final LF concentration: 1 mg/l (1-3);
initial CP concentration: 490 mg/l (164-30250), final CP concentration:
8 mg/l (1-26)). The other 14 patients (66%) were operated (n=13) or transferred
to another hospital for prolonged immunosuppressive therapy (n=1). In this
group no or only a transient response to prednisolone was observed in the
LF and CP concentrations (initial LF concentration: 556 mg/l (81-1628),
final LF concentration: 320 mg/l (25-865); initial CP concentration: 1955
mg/l (50-12200), final CP concentration: 318 mg/l (60-4550)). In several
of these patients periods of clinical remission was seen during the steroid
treatment, whereas the fecal LF and CP concentrations remained abnormal.
CONCLUSION: Measurement of fecal granulocyte proteins may be useful
in the assessment of therapeutic response in IBD. It may disclose treatment
failure, making it possible to avoid prolonged, useless courses of steroids.
In some patients it may even help to avoid operation.
G3453
PROLONGED PRODROME OF GASTROINTESTINAL SYMPTOMS IS ASSOCIATED WITH
CROHN'S DISEASE BUT NOT ULCERATIVE COLITIS
Mark Pimentel, S Tabibzadeh, V Kirit-Kiriak, K Papadakis, E A Vasiliauskas,
L Kam, S Targan, Henry C Lin, Cedars-Sinai Med Ctr, Los Angeles, CA
We have observed that patients with Crohn's disease (CD) appear to have
a prodromal period (symptom duration with negative investigations) longer
than patients with ulcerative colitis (UC).
AIM: The purpose of this study was to compare the duration and symptomatic
characteristics of this prodromal period in these two conditions.
METHODS: Thirty five consecutive patients (23 with CD and 12 with UC)
presenting to the Inflammatory Bowel Disease (IBD) Center were enrolled.
Their diagnosis was confirmed by chart review. All patients were asked
to complete a questionnaire designed to obtain symptoms about their illness
before diagnosis: 1. The proportion of patient with symptoms in with negative
investigations, 2. The duration of illness before diagnosis, 3. gastrointestinal
symptoms experienced during the prodrome and 4. The presumptive diagnosis
given for those symptoms.
RESULTS: 1. A greater proportion of patients with CD (13 out of 20
responses) had a period of illness during which tests were negative compared
to UC (3/9) (Chi-square, 4.8, p<0.05). 2. The length of time with gastrointestinal
symptoms was greater in patients with CD disease (9.7 +/- 11.7 years) than
in patients with UC (1.37 +/- 1.9 years) (p<0.05). 3. IBS was the diagnosis
given in 5/20 responses from Crohn's patients and 0/9 ulcerative colitis
patients response (Chi-square, 2.7, p=0.09). 4. The symptoms most
consistent identified by patients with CD versus UC in the prodromal period
were bloating and gaseousness.
CONCLUSIONS: Patients with Crohn's disease appear to have a prolonged
prodromal period during which investigations are negative. This is in contrast
to the shorter prodrome of ulcerative colitis. The main symptoms during
this period were bloating and gaseousness.
Symptom Chi-square p-value
bloating
19.0
0.00001
gaseousness
3.7
0.05
diarrhea
3.1
0.08
pain
3.1
0.08