S180
Conclusions: Faecal biomarkers outperform CRP for detecting
active CD using combined PET/magnetic resonance (MR) enterography and endoscopy as the gold standard. Lactoferrin levels were
significantly correlated to the SUVmax, which was significantly correlated with SES-CD. Further studies are needed to assess the performance of faecal biomarkers in CD identified by PET/MRI.
P177
Faecal metalloprotease 9 is a reliable
biomarker compared with faecal calprotectin in
detecting endoscopic activity in patients with
inflammatory bowel diseases.
A. Buisson*1, 2, E. Vazeille1, 2, R. Minet Quinard3, M. Goutte1, 2,
D. Bouvier3, F. Goutorbe1, B. Pereira4, N. Barnich2, G. Bommelaer1, 2
1
University Hospital Estaing, Gastroenterology Department,
Clermont-Ferrand, France, 2UMR 1071 Inserm/Université
d’Auvergne; USC-INRA 2018, Microbes, Intestine, Inflammation
and Susceptibility of the host, Clermont-Ferrand, France, 3University
Hospital G. Montpied, Biochemistry laboratory, Clermont-Ferrand,
France, 4GM – Clermont-Ferrand University and Medical Centre,
Biostatistics Unit, Clermont-Ferrand, France
Background: As mucosal healing is to date the therapeutic goal to
achieve in inflammatory bowel diseases (IBD), non-invasive tools are
warranted to avoid repeated colonoscopies. Amongst them, faecal
calprotectin (fCal) correlated with endoscopic scores and was able
to detect endoscopic ulcerations in IBD. Matrix metalloprotease 9
(MMP-9) is involved in the degradation of the extracellular matrix
and could play a role in the neutrophils trafficking and the angiogenesis. In the present study, we aimed to evaluate the accuracy of
using faecal MMP-9 compared with fCal in detecting endoscopic
activity in IBD.
Methods: Overall, 86 IBD adults underwent consecutively and prospectively colonoscopy, with Crohn’s disease (CD) Endoscopic Index
of Severity (CDEIS) or Mayo endoscopic sub-score calculation for
ulcerative colitis (UC), and stool collection. FCal was measured
using quantitative immunochromatographic test. Faecal MMP-9
was quantified by ELISA. MMP-9 cut-off value was determined
using a receiver operating curve.
Results: In 54 CD patients, faecal MMP-9 and calprotectin levels
significantly correlated with CDEIS. The median values of faecal
MMP-9 and fCal were respectively 38-fold and 9-fold higher in the
CD patients presenting with endoscopic ulcerations than in those
with no ulcer (p = 0.01 and p = 0.003, respectively). In ileal CD,
faecal MMP-9 seemed to be better correlated with CDEIS than
fCal (ρ = 0.73 vs ρ = 0.62, p < 0.001 for both). MMP-9 >350 ng/g
detected endoscopic ulcerations in Crohn’s disease with a sensitivity of 0.90 and a specificity of 0.64, compared with faecal calprotectin > 250μg/g, showing a sensitivity of 0.90 and a specificity of
0.59 (Table 1). In 32 UC patients, faecal MMP-9 and calprotectin
levels correlated with Mayo endoscopic sub-score (ρ = 0.58 and
ρ = 0.57, respectively, p < 0.001 for both) and were significantly
increased in ulcerative colitis patients with endoscopic activity
(Figure 1).
In UC patients, faecal MMP-9 > 900 ng/g predicted endoscopic
activity (defined as Mayo endoscopic sub-score ≥ 2) with a sensitivity of 0.91 and a specificity of 0.80, compared with faecal calprotectin > 250 μg/g showing a sensitivity of 0.86 and a specificity of
0.80 (Table 1).
Conclusions: Faecal MMP-9 measurement could be a reliable assay
to assess endoscopic activity in IBD. These data should be confirmed
in independent cohorts.
Poster presentations
P178
Magnetic resonance imaging characteristics of
proctitis in Crohn’s disease in correlation with
endoscopy
C. Tutein Nolthenius*1, S. Bipat1, B. Mearadji1, A. Spijkerboer1,
A. Montauban van Swijndregt2, C. Ponsioen3, J. Stoker1
1
Academic Medical Centre (AMC), Radiology, Amsterdam,
Netherlands, 2OLVG, Radiology, Amsterdam, Netherlands,
3
Academic Medical Centre (AMC), Gastroenterology, Amsterdam,
Netherlands
Background: Pelvic magnetic resonance imaging (MRI) is widely
used in perianal Crohn’s disease (CD). Although diagnosing proctitis
is important for management, MRI criteria are lacking. In our retrospective study, we studied which MRI characteristics are valuable
in assessing proctitis.
Methods: Hospital patient database was searched for CD patients
(≥ 18 years) who underwent proctoscopy, sigmoidoscopy, or colonoscopy and perianal fistula MRI (T2wTSE, fat sat T2wTSE, or fat
sat T1w TSE after gadolinium) within 8 weeks of the endoscopy.
Patients were divided into proctitis and no proctitis, based on endoscopy findings (reference standard). All predefined 15 MRI features
were blindly scored by 3 observers and correlated to endoscopy
using regression analyses. Reproducibility (multirater kappa, intraclass correlation coefficient) was determined for all 3 observer-pairs.
MRI features were considered relevant if there was a significant correlation with endoscopy for at least 2 observers, and reproducibility
was ≥0.40 for at least 2 of 3 observer pairs.
Results: Of 58 CD patients, 26 (45%) had proctitis and 32 (55%) had
no proctitis. Rectal wall thickness, perimural T2 signal, creeping fat,
and size of mesorectal lymph nodes showed a significant correlation
with endoscopy for all 3 observers (all p-values ≤ 0.05) and kappa/
intraclass correlation coefficient were ≥ 0.40 for all 3 observer-pairs.
Perimural enhancement and the presence of rectal mural fat showed
a significant correlation with endoscopy (p = 0.000 and p = 0.011,
0.025 and 0.172, respectively) for at least 2 of 3 observers, reproducibility was ≥ 0.40 for 2 of 3 observer pairs.
Conclusions: Wall thickness, mural fat, and mesorectal tissue features (perimural T2 signal, perimural enhancement, creeping fat,
and size of mesorectal lymph nodes) had the strongest correlation to
endoscopy and were reproducible in diagnosing proctitis.
P179
New approach to endoscopic mucosal healing of
ulcerative colitis using linked colour imaging, a
novel endoscopic enhancement system
K. Uchiyama*, T. Takagi, Y. Toyokawa, Y. Hotta, M. Tanaka,
Y. Naito, Y. Itoh
Kyoto
Prefectural
University
of
Medicine,
Molecular
Gastroenterology and Hepatology, Kyoto, Japan
Background: Mucosal healing and control of intestinal mucosal
inflammation have been reported as important treatment goals for
maintaining clinical remission in ulcerative colitis (UC) patients. In
this study, we investigated the availability and efficacy of linked colour imaging (LCI), a novel endoscopic enhancement system, for the
diagnosis of mucosal inflammation in UC patients.
Methods: All examinations were carried out with an EG-L590WR
endoscope and a LASEREO endoscopic system (FUJIFILM Co.,
Tokyo, Japan). Blue laser imaging-bright data were converted to
LCI by image processing. The images were acquired for LCI by