S188 Poster presentations

patients in remission and 86% in active condition reportingfatigue. However patients report that their complaints offatigue are often not addressed in clinical consultations.To date there are no studies exploring this topic fromthe clinician’s perspective. This study aimed to gain anunderstanding of healthcare practitioners’ (HCPs) perception ofIBD fatigue as experienced by people with IBD, and to identifythe range of methods that HCPs use to assess and managefatigue.Methods: Descriptive phenomenology was carried out toachieve the aims of the study. Purposive sampling wasused to identify a range of professionals (gastroenterologists,IBD nurses, general practitioners, dietitians, psychologistsand pharmacists). In-depth semi-structured interviews wereconducted with 20 HCPs who work with people with IBDbetween June and December 2012. Interviews were audiorecorded and transcribed verbatim. Colazzi’s seven stepframework was used to analyse data. The study was approvedby the local university ethics committee.Results: Three main themes and several sub-themes wereidentified. The main themes were: the phenomenon of fatigueas perceived by HCPs; the impact of fatigue on patients’ livesas perceived by HCPs; and the methods used by HCPs todeal with fatigue. Fatigue was identified as an important, butdifficult and often frustrating, symptom to understand. Thestudy participants perceived fatigue as ‘such a complicatedand complex thing’. HCPs reported that fatigue impacts on theemotional, private and public aspects of patients’ functioning,however there were very few methods suggested on how toassess and manage the fatigue in a systematic way. Manyexpressed a desire for better education and a frustration atnot being able to help patients more. There was consensus thatmanaging fatigue should be a multi-disciplinary effort, but withlittle idea of clearly defined roles.Conclusions: Despite fatigue being one of the symptomsmost frequently reported by IBD patients, it remains poorlyunderstood by HCPs, who find fatigue challenging andfrustrating. There is a need for a systematic and structuredassessment and management of this distressing symptom andHCPs should communicate with each other about care for eachindividual patient. There is a need for an assessment frameworkand for intervention strategies to be tested. It is essentialfor multidisciplinary team members to be involved in planningand managing coordinated care of patients reporting fatigue inIBD.

P298Vitamin D status and inflammatory bowel disease the rolein disease activity and quality of life

F. Dias de Castro1 *, J. Magalhaes1, P. Boal Carvalho1,M.J. Moreira1, P. Mota2, J. Cotter1. 1Centro Hospitalar doAlto Ave, Gastroenterology, Guimaraes, Portugal, 2CentroHospitalar do Alto Ave, Clinical Pathology, Guimaraes,Portugal

Background: Inflammatory bowel disease (IBD), comprisingCrohn’s disease (CD) and ulcerative colitis (UC), is agroup of debilitating conditions associated with deregulatedmucosal immune response to intestinal microorganisms in agenetically susceptible host. Vitamin D is well recognized forits involvement in calcium homeostasis and musculoskeletalhealth. In addition, vitamin D plays a role in a variety of othersystems and pathologies such as the immune response.The aim of this study is to investigate the correlation betweendisease activity and quality of life, in a cohort of IBD patients,with serum vitamin D levels.Methods: We conducted a cross-sectional study in ambulatorycare IBD patients. Clinical disease activity (Harvey Bradshawand Mayo clinical score) and quality of life (Short InflammatoryBowel Disease Questionnaire SIBDQ) were assessed through

validated questionnaires. Serum 25-hydroxyvitamin D levelswere used for vitamin D status, and deficiency was defined asa level less than 30 ng/mL. C-reactive protein (CRP), ferritin,albumin, erythrocyte sedimentation rate (ESR) and hemoglobinlevels were correlated with serum 25-hydroxyvitamin D levels.All samples were collected during summer months.Statistical analysis was performed with SPSS vs 18.0 and a pvalue of less than 0.05 was considered statistically significant.Results: A total of 76 patients were enrolled, 72.4% femalewith mean age 34±10 years, 19 with UC (25%) and 57 withCD (75%). Average serum 25-hydroxyvitamin D levels were low(all 26±10 ng/mL, UC 30±12.54 ng/mL, CD 24.6±8.04 ng/mL)and there was a statistically significant difference betweenUC and CD patients (p = 0.032). Hypovitaminosis D was foundin 68% of all patients, 58% of UC and 72% of CD patients.A significantly higher proportion of patients with low levelsof vitamin D had higher levels of CRP (10.7 vs 4.3 mg/L,p = 0.048). On the other hand, the presence of anemia, lowlevels of albumin, and higher levels of ferritin and ESR didn’tcorrelate significantly with lower levels of vitamin D. MeanHarvey Bradshaw was 2.74 (0 15), mean Mayo clinical scorewas 1.95 (0 8), mean SIBDQ was 51 for UC patients and 50for CD patients. Vitamin D deficiency didn’t correlate withclinical IBD activity (CD p = 0.278; UC p = 0.224) or lower levelsof quality of life (p = 0.993).Conclusions: A significantly high percentage of IBD patientshad vitamin D deficiency, and this condition was significantlymore frequent in CD patients, drawing attention to the needfor supplementation. CRP levels trended towards an inverserelationship with vitamin D status. In our study clinical diseaseactivity and quality of life didn’t correlate significantly withlower levels of vitamin D.

P299Vagus nerve stimulation in Crohn’s disease

B. Bonaz1,2 *, S. Pellissier2, N. Mathieu1, D. Hoffmann3,C. Trocme4, M. Baudrant-Boga1, V. Sinniger2, C. Picq2,5,O. David2, L. Vercueil3, C. Dantzer6, J.-L. Cracowski7,D. Clarencon5. 1CHU de Grenoble, Clinique Universitaired’Hepato-Gastroenterologie, Grenoble, France, 2GrenobleInstitute of Neurosciences (GIN, INSERM U836), CHU Grenoble,Grenoble Cedex 09, France, 3Pole de Neurologie, Departementde Neurochirurgie, Grenoble Cedex 09, France, 4Institut deBiologie, CHU Grenoble, Grenoble Cedex 09, France, 5IRBA,Biologie, La Tronche, France, 6Laboratoire Inter-Universitairede Psychologie (EA4145 UPMF/UDS), Universite de Savoie,Chambery, France, 7Centre d’Investigation Clinique, CHUGrenoble, Grenoble Cedex 09, France

Background: The vagus nerve (VN) has an anti-inflammatoryrole through the cholinergic anti-inflammatory pathway. VNstimulation (VNS) improves colitis in rats (Auton Neurosci2011;160:82 9). We performed a pilot study (ClinicalTrials.govNCT01569503) of VNS in patients with active Crohn’sdisease (CD).Methods: Patients with moderate to severe CD were included.Clinical evaluation (CDAI), CRP, fecal calprotectin (FC), ileo-colonoscopy (CDEIS), contrast-enhanced ultrasound (CEUS),heart rate variability (HRV, a marker of the sympatho-vagalbalance) were performed before VNS and during the follow-upfor one year. An electrode was wrapped around the left VN inthe neck, under general anesthesia, tunnelized subcutaneously,and connected to a pulse generator (Cyberonics, Lyon, France)located subcutaneously in the left chest wall. VNS wasperformed with the following parameters: 0.5 mA, 10 Hz, 30s ON, 5 min OFF, continuous cycle. In case of aggravation,patients were removed from the study and treated with anti-TNF/immunosuppressants or surgery.Results: 4 patients have been included: 3 men/1 women;mean age: 42.5 years (32 50); Montreal classification (A3L1B2,

Clinical: Therapy & observation S189

A2L1B3, A2L2B1, A3L2B1); length of the disease (9.5 years;0.5 26); smoking (2/4). Two patients were naïve of treatmenton inclusion, one was under azathioprine (AZA) and one hadstopped AZA 3.5 years before. The mean CDAI at entrancewas 335 (320 358), CRP: 78 (8 166), FC: 677 (20 1762), CEUS:active disease, CDEIS: 16 (8 30), vagal hypoactivity on HRVwas observed in 3/4 patients and uninterpretable in one. Twopatients are currently in clinical remission with mucosal healing(CDEIS: 3 0) with a respective follow-up of 20 and 8 months.The patient in deep remission under AZA+VNS stopped AZAafter 14 months of VNS and is in remission after 6 months offollow-up. One patient presented an improvement of CDAI andFC but switched to surgery after 2.5 months of VNS becauseof a persistent CD activity with an entero-enteric fistula andabscess; the patient agreed to pursue VNS alone post-surgeryand had endoscopic healing (i0) at 6 months post-surgery. Thelast patient switched to Infliximab (IFX) and AZA because of anuncontrolled disease after 3 months of VNS despite a transientimprovement. Two patients significantly improved HRV vagaltone after 6 months of VNS but not the third one who switchedto IFX+AZA. VNS was well tolerated and no patient withdrewfrom the study due to complications or side-effects.Conclusions: The preliminary data of this pilot study show thefeasibility of VNS which was well tolerated and efficient in 2patients currently in deep remission; one patient with a failureof VNS is in deep remission 6 months post-surgery. We arecurrently pursuing the study.

P300Vaccination routines during anti-TNF treatment in IBD:Do patients adhere to ECCO’s guidelines?K. Risager Christensen*, C. Steenholdt, S. Schnoor Buhl,M.A. Ainsworth, O.Ø. Thomsen, J. Brynskov. Herlev UniversityHospital, Department of Gastroenterology, Herlev, Denmark

Background: TNF-inhibitors used to treat inflammatory boweldisease (IBD) may result in severe infections due to thegeneralized immunosuppression. Accordingly, internationalguidelines now recommend that all patients are screenedfor latent infections prior to initiation of anti-TNF therapy;and receive vaccination against common infectious agents.However, clinical experience indicates that vaccinationguidelines are challenging to implement in practice. Weinvestigated if patients actually receive adequate informationabout vaccinations in a routine clinical setting; and if relevantinformation increases adherence to vaccination guidelines.Furthermore, we identified main reasons for non-adherence.Methods: Observational, cross-sectional cohort study of IBDpatients in ongoing anti-TNF therapy per March 2013 at atertiary Danish IBD center. Vaccination details were obtained byquestionnaire. European Crohn and Colitis Organisation (ECCO)guidelines served as gold standard [1].Results: 130 (83%) (n = 90 Crohn’s disease, n = 40 ulcerativecolitis) of 157 patients responded. Sixty-four percent ofresponders received infliximab and 36% received adalimumab.Sixty-two patients (48%) reported to have received infor-mation from a health care professional about vaccinationrecommendations before initiation or during ongoing anti-TNFtherapy. Information about vaccination guidelines increasedpatients’ adherence hereto. Hence, the percentage of patientswho had hepatitis B vaccination increased from 24% beforeinformation to 52% after information was given (P< 0.001),pneumococcal vaccination increased from 7% to 24% (P< 0.001),human papilloma virus vaccination from 19% to 32% (P< 0.01),and annual influenza vaccination from 26% to 58% (P< 0.001).Information increased overall adherence to ECCO’s vaccinationguidelines: the proportion of non-compliant patients decreasedfrom 43% to 10% after information; partial complianceincreased from 56% to 81%; and full compliance increased from0% to 10%. Main barriers for patients’ adherence to vaccination

guidelines were forgetfulness (36%), financial reasons (32%),skepticism (14%), and worries (7%).Conclusions: Focused information from health care profession-als about recommended vaccinations during anti-TNF therapyin IBD significantly increased patients’ adherence. However,only a minority completely adhered to ECCO’s vaccinationguidelines. Notable barriers were forgetfulness and financialreasons. Proposed strategies for improved adherence includeeducation of health care professionals, repeated informationto patients, and preferably financial support.

Reference(s)[1] Rahier JF et al. J Crohns Colitis 2009; 3: 47 91.

P301Utility of faecal lactoferrin measurement in ulcerativecolitis patients with granulocyte and monocyteadsorptive apheresisK. Hashiguchi *, F. Takeshima, Y. Akazawa, K. Matsushima,H. Minami, H. Ishii, N. Yamaguchi, K. Shiozawa, K. Ohnita,H. Isomoto, K. Nakao. Nagasaki University, Departmentof Gastroenterology and Hepatology, Graduate School ofBiomedical Sciences, Nagasaki, Japan

Background: Inflammatory Bowel Disease (IBD) is associatedwith higher leukocyte disposal in feces. Among the availablefaecal biomarkers, lactoferrin have translated into usefulclinical tools for the diagnosis and monitoring of IBD. However,it remains unclear whether faecal lactoferrin could be useful inevaluating the effect of granulocyte and monocyte adsorptiveapheresis (GMA) in ulcerative colitis (UC) patients. Aim of thisstudy was to assess if faecal lactoferrin can be employed topredict or estimate the effect of GMA in UC patients.Methods: This was a prospective study involving 17 patientswith ulcerative colitis. After written informed consent wasobtained, patients with moderate-to-severe active UC whowere scheduled to undergo GMA were recruited for this study.Each patient received 1 or 2 GMA session/week, up to 11sessions. Patients were included in the study regardless ofother therapies. In case of patients who were already onsteroid treatment, they were allowed in the study only whenthe steroid was continued in same or decreased dose. Faecallactoferrin was measured 4 times; before GMA introduction,1 week and 2 week after GMA introduction, and at the endof GMA sessions. Feces were collected from each patientusing stick type container. We defined GMA effective group(remission; Disease activity index (DAI) score decrease below2 points, effective; DAI score decrease than 3 points) and GMAineffective group (exclude remission and effective). Changesof faecal lactoferrin were compared between GMA effectivegroup and GMA ineffective group. Correlation between faecallactoferrin and endoscopic score or serological markers wasassessed.Results: GMA was effective in 10 of 17 patients (58.8%).Although the rate of effectiveness of GMA in the patientstreated with steroid (7 of 9 patients, 77.7%) was higherthan that in the patients treated without steroid (3 of 8patients, 37.5%), the difference was not significant. In effectivegroup, mean faecal lactoferrin before GMA introductionwas significantly higher than that in ineffective group(2120.9±1297.4 ng/ml vs. 681.9±802.2 ng/ml, P< 0.05). Moreimportantly, significant decrease of faecal lactoferrin wasobserved only in GMA effective group (2120.9±1297.4 ng/mlto 686.0±802.2 ng/ml, P< 0.05). Faecal lactoferrin had weakpositive correlation with endoscopic score, but not withC-reactive protein.Conclusions: Faecal lactoferrin might be able to predictthe response before GMA introduction in UC patients. Ineffective group, faecal lactoferrin may be an indicator for theeffectiveness of GMA.