S152 Poster presentations

age and symptoms of PSC were related to impairment ofHRQoL scores, but gen-der, ERC score or comorbidity withIBD did not have a significant impact on them. The total 15Dscores between PSC patients (mean 0.934) and the generalpopulation (mean 0.939) did not differ significantly but thedimensions of elimination (p < 0.001), depression (p = 0.003),distress (p = 0.003) and vitality (p = 0.005) were significantlylower in PSC. In the newly diagnosed, no significant changeswere observed in the 15D scores in a mean 1.58 years’follow-up. The 15D scores of age-, gender- and IBD activitymatched IBD patients were lower than those of the PSC patients(0.876 versus 0.914, p = 0.04).Conclusions: HRQoL of PSC patients was mostly comparable tothat of the general population but special attention should bepaid to the patients’ psychological well-being. No significantHRQoL changes were observed in the mean 1.58 years’follow-up after diagnosis of PSC. Newly diagnosed PSC patientshave better HRQoL than do newly diagnosed IBD patients,probably because of more intensive follow-up and a differentspectrum of symptoms.

Reference(s)[1] Haapamaki J, Roine RP, Sintonen H, et al., (2010), Health-

related quality of life in inflammatory bowel diseasemeasured with the generic 15D instrument. Quality of LifeResearch.

[2] Ponsioen CY, Reitsma JB, Boberg KM, et al., (2010),Validation of a cholangiographic prognostic model inprimary sclerosing cholangitis. Endoscopy.

P215Growth pattern and growth failure in paediatricCrohn’s disease are related to inflammatory status but notto duration of steroid therapy

D. Ley1 *, H. Behal2, C. Gower-Rousseau3,4, A. Duhamel2,M. Fumery5, F. Vasseur4, L. Michaud1, I. Rousseau4, G. Savoye6,D. Turck1. 1University and Hospital, Paediatric, Lille, France,2University and Hospital, Biostatistics EA 2694, Lille, France,3Health, Epidemiology, Lille, France, 4University and Hospital,Epidemiology, Lille, France, 5University and Hospital,Gastroenterology, Amiens, France, 6University and Hospital,Gastroenterology, Rouen, France

Background: Growth failure is the main complication ofpaediatric-onset Crohn’s disease (CD). The respective role ofdisease activity and steroid therapy in growth faltering is stilla matter of debate. The aim of the present study was toinvestigate whether the growth pattern of children with CD wascorrelated with the evolution of inflammatory status during thedisease course, whatever the cumulative duration of steroidtherapy.Methods: 107 patients (63 boys and 44 girls) with a diagnosisof CD made at less than 17 years of age, followed in the sameunit during more than years and for whom more than 2 heightmeasures were available during follow-up, were identifiedbetween 1998 and 2012. Height, C-reactive protein (CRP),orosomucoid and information on steroid therapy (including dateof prescription and daily dose) were collected at each visit.Growth velocity was compared to the evolution of inflammatorystatus during follow-up in a longitudinal multivariate analysisusing a mixed model.Results: Median age at CD diagnosis was 11.7 years (Q1-Q3: 9.8 13.5). Growth failure (Height/Age Z-score < 2) waspresent in seven patients (8%) at diagnosis and in five (5%)at maximal follow-up (median: 4.9 years; Q1-Q3: 3.8 6.4).Among the 75 patients who had achieved their growth atmaximal follow up, mean Height/Age Z-score was 0.1±1.2.Twenty patients (29%) reached their final height that was atleast 4 cm below their target height. A total of 2112 heightmeasures were available. Growth velocity was not influenced

by the cumulative duration of steroid therapy (median: 7.1months; Q1-Q3: 4.9 12.5), but was negatively correlated withthe evolution of CRP (coefficient of the equation of regression(e) = 0.16; p < 0.0001) and orosomucoid (e = 0.60; p < 0.0001)during follow-up.Conclusions: CD children with uncontrolled inflammatorystatus have a lower growth velocity and a higher risk for growthfailure, regardless of cumulative duration of steroid therapy.The inflammatory status should be kept normal as much aspossible in paediatric-onset CD patients in order to optimizetheir growth pattern.

P216Fecal calprotectin and lactoferrin as predictors ofrelapse in patients with quiescent ulcerative colitis duringmaintenance therapyT. Yamamoto*, M. Shiraki, S. Umegae, K. Matsumoto. YokkaichiSocial Insurance Hospital, Inflammatory Bowel Disease Centre,Yokkaichi, Japan

Background: Predictive markers for relapse in patients withulcerative colitis (UC) on mesalazine maintenance therapy havenot been fully determined. Levels of fecal calprotectin andlactoferrin have a proportional correlation to the degree ofinflammation of the intestinal mucosa. Fecal lactoferrin andlactoferrin may have a role in monitoring disease activityin patients with IBD. This prospective study was to evaluatethe significance of fecal calprotectin and lactoferrin for theprediction of UC relapse.Methods: Eighty UC patients in remission for �3 monthson mesalazine as maintenance therapy were included. Atentry, stool samples were collected for the measurement ofcalprotectin and lactoferrin. All patients were followed upfor the following 12 months. To identify predictive factorsfor relapse, time-dependent analyses using the Kaplan Meiergraphs and Cox’s proportional hazard model were applied.Results: During the 12-month, 21 patients relapsed. Meancalprotectin and lactoferrin levels were significantly higher inpatients with relapse than those in remission (calprotectin:173.7 vs 135.5mg/g, P= 0.02 and lactoferrin: 165.1 vs130.7mg/g, P= 0.03). A cutoff value of 170mg/g for calprotectinhad a sensitivity of 76% and a specificity of 76% to predictrelapse, while a cutoff value of 140mg/g for lactoferrinhad a sensitivity of 67% and a specificity of 68%. In amultivariate analysis, calprotectin (�170mg/g) was a predictorof relapse (hazard ratio, 7.23; P= 0.002). None of the followingparameters were significantly associated with relapse: age,gender, duration of UC, number of UC episode, severity of theprevious episode, extent of UC, extraintestinal manifestation,and lactoferrin level.Conclusions: This study showed that both fecal calprotectinand lactoferrin levels were very significantly increased inpatients with UC even during remission as compared withhealthy controls. Further, fecal calprotectin level �170mg/gwas associated with a clinical relapse. Fecal calprotectin levelappeared to be a significant predictor of relapse in patientswith quiescent UC on mesalamine as maintenance therapy.

P217Family functioning and health-related quality of life inchildren with inflammatory bowel disease

L. Caes1 *, C.T. Chambers1,2,3, A. Otley2. 1IWK HealthCentre, Centre for Pediatric Pain Research, Halifax, Canada,2Dalhousie University, Department of Pediatrics, Halifax,Canada, 3Dalhousie University, Department of Psychology andNeuroscience, Halifax, Canada

Background: The diagnosis of inflammatory bowel disease (IBD)in children, with abdominal pain as a prominent symptom,is emotionally challenging for children and their families, as

Clinical: Diagnosis & outcome S153

evidenced by lower levels of health-related quality of life(HRQOL) especially in children with high levels of abdominalpain. Research examining psychological and social factorsrelated to IBD and associated HRQOL is critical. For childrenin particular, the family environment might play a crucialrole in the their coping with IBD. Dysfunctional levels ofoverall functioning have been associated with lower HRQOLin chidlren with IBD, yet the impact of specific aspects offamily functioning, such as cohesion (i.e., emotional bondor connectiveness), flexibility (i.e., balance between stabilityand change) and communication patterns (i.e., postive versusnegative) is largely unexplored. The purpose of the presentstudy was to investigate the influence of balanced levels ofcohesion and flexbility and positive communication on thechild’s pain experience and HRQOL.Methods: Thirty children with IBD (14 girls, 16 boys;N = 20 with Crohn’s disease, N = 10 with Ulcerative colitis;Mage = 13.73, SD = 2.30 years) and one parent (25 mothers, 5fathers Mage = 46.73, SD = 6.47 years) completed questionnairesregarding child’s level of pain and interference, HRQOL (i.e.,IMPACT) and family functioning (i.e., Faces IV).Results: Linear regression analyses, controlling for child age,indicated that child report of positive communication andbalanced level of cohesion and flexibility were positivelyassociated with their HRQOL. Surprisingly, no significantassociations were found between child level of pain and familyfunctioning, while the level of interference in daily functioningdue to pain was negatively associated with parent report ofbalanced cohesion and child report of balanced flexibility andpositive communication.Conclusions: The current findings indicate that parent-reportedcohesion was only associated with pain-related interference,while child-reported aspects of family functioning were relatedto HRQOL and pain-related interference. Results also suggestthat family functioning is primarily associated with HRQOLand interference in daily functioning rather than the level ofpain, adding to our understanding of how family functioningrelates to children’s coping with IBD and associated pain. Infuture research, observational assesment of family functioning(e.g., by means of a conflict-discussion task) and parent-child communication patterns when faced with their child inpain (e.g., observation of parent child interaction during anexperimental pain task), will contribute to our understandingof how family functioning influences child functioning and painexperiences.

P218Faecal calprotectin testing reduces need for paediatriccolonoscopy

T.I. Hassan1 *, C. Hensey1, M. Hamzawi1, S. Kiernana1,A.-M. Broderick1,2, B. Bourke1,2, S. Hussey1,2. 1Our Lady’sChildren’s Hospital Crumlin, Gastroenterology, Dublin,Ireland, 2University college Dublin, National children reseachcentre and school of Medicine and Medical Science, Dublin,Ireland

Background: Ireland has a single national centre for paediatricgastroenterology. Up to 70% of children referred to a paediatricgastroenterology centre with suspected inflammatory boweldisease (IBD) do not have the disease. Faecal calprotectin(FC) is a white cell protein and a marker of intestinalinflammation. Faecal calprotectin was recently made availablein our institution.Our aim was to assess the clinical performance and cost-benefitof faecal calprotectin (FC) in reducing diagnostic endoscopicprocedures in symptomatic children with potential or confirmedinflammatory bowel disease (IBD).Methods: Charts, computerised records and endoscopy resultsof all patients who had FC testing between Oct 2012 andAugust 2013 were retrospectively reviewed. New patients with

a high clinical likelihood of IBD do not get routine FC testingand were not included in the analysis. FC values <50mg/gwere considered normal; 51 to 200mg/g indeterminate and>200mg/g likely to have active GI inflammation.Results: 133 patients had a FC test; of these, 57 (42.8%) hadFC >200 (Group A), 76 had FC <200 (Group B). The results aresummarised in Table 1.

Table 1. The analysis of the FC and the endoscopy results

Faecalcalprotectin(mg/g)

Total(n = 133)

Colonoscopy(n = 35)

No colonoscopy(n = 98)

Known IBD(n = 33)

New IBD(n = 11)

<50 48 6 42 150 200 28 4 24 3

<200 76 10 66 4>200 57 25 32 29 11

25/57 patients in group A had colonoscopy (43.8%); 11 werenewly diagnosed with IBD; 4 of 6 patients with pre-existingIBD had a change in phenotype or treatment regimen followingendoscopy findings. Two patients in group A had normalcolonoscopy despite high FC. Of the rest in the same group,one patient was diagnosed as proctitis while three had gastritis.32/57 patients in group A had no colonscopy performed, 24of these were known to have IBD and five were found tohave bacterial or viral GI infection. 10 out of 76 patientsin Group B had colonoscopy performed (13.1%), mostly dueto persistent symptoms of diarrhoea and/or abdominal pain.None of these had macro- or microscopic abnormalities. Usingestimated costs of FC (euro 75 per test) and colonoscopy(euro1000/test), the calculated net cost saving in the yearexamined was euro 60,300.Conclusions: Faecal calprotectin is a valuable, cost-effectivescreening test for excluding significant intestinal inflammatorydisease and avoiding colonoscopy in children with non-organicgastrointestinal symptoms that mimic IBD.

P219Faecal calprotectin is an accurate predictor of endoscopicand histological disease activity in IBDG. Chung-Faye*, A. Rahman, K. Sandhu, B. Hayee, J. Tumova,R. Sherwood. King’s College Hospital NHS Foundation Trust,Gastroenterology, London, United Kingdom

Background: Assessment of disease activity in inflammatorybowel disease (IBD) is challenging as the gold standardsof endoscopy and histology are invasive, expensive andimpractical for regular use. Faecal calprotectin (FC) isincreasingly being used as a marker of intestinal inflammationin IBD. However, evidence of its role in predicting endoscopicand histological changes in IBD is limited. We explore the roleof FC to assess histological disease in IBD, in comparison toC-reactive protein (CRP).Methods: Retrospective analyses of 209 IBD cases who had acolonoscopy with FC (mg/g) and CRP (mg/L) measurements.The most severe histological inflammation found was gradedaccording to the simplified histology score (0, normal; 1, mild;2, moderate; 3, severe). The Kruskal Wallis test (c2) was usedto look for differences between the groups. Receiver operatingcharacteristic (ROC) curves were used to differentiate patientswith normal/mild disease (histology scores 0 1) from patientswith moderate/severe disease (histology scores 2 3).Results: In 100 ulcerative colitis (UC) patients, the median FCvalues for the histology scores; 0, 1, 2, 3 were; 29, 322, 520and 2497, respectively (graph). The corresponding values forCRP were; 2.5, 5.0, 12.6 and 13.0. Both FC and CRP showedhighly significant differences between the different histologygroups (FC c2 = 17.2, p = 0.0007; CRP c2 = 16.3, p = 0.001). With