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Phenotypic Characteristics and Use of Therapeutic Resources in Elderly-OnsetInflammatory Bowel Disease: A Multicentre, Case-Control StudyMíriam Mañosa, Margalida Calafat, Ruth de Francisco, Carmen García Caparrós, MaríaJosé Casanova, Patricia Huelín, Marta Calvo, Luis Fernandez Salazar, Miguel Minguez,Alexandra Ruiz-Cerulla, Yamile Zabana, Guillermo Bastida, Joaquin Hinojosa, LucíaMarquez, Manuel Barreiro-de Acosta, Xavier Calvet, David Monfort, Rosario Gómez,Esther Rodríguez, José María Huguet, Maria Rojas-Feria, Daniel Hervias, Ramón Atienza,David Busquets, Eva Zapata, Carmen Dueñas-Sadornil, Mara Charro, Francesc J.Martínez-Cerezo, Rocío Plaza, Juan María Vázquez Morón, Javier P. Gisbert, EduardCabré, Eugeni Domenech

Background: It has been reported that IBD onset occurs at old age in up to 10% of cases.Elderly patients have more comorbidities and, therefore, a potential increased risk of drugadverse effects, increased likelihood of hospital admissions and postoperative complicationsAims: To evaluate the phenotypic characteristics and use of therapeutic resources in patientswith elderly-onset IBD. Methods: Retrospective, case-control, multicentre study. All thosepatients diagnosed with IBD over the age of 60 years (cases) since 2000 and with a follow-up >12 months were identified from the IBD databases of each centre. Cases were comparedwith controls, who were diagnosed with IBD between 18 and 40 years of age, and matchedby year of diagnosis, gender, and type of IBD. Results: A total of 1,374 cases and 1,374matched controls were included, of whom 43% women, 62% ulcerative colitis (UC), 36%Crohn's disease (CD) and 2% unclassified IBD. The mean age at diagnosis was 68 years(range, 60-87) within cases and 28 years (range, 18-45) within controls. 59% of the cases(but only 3% of controls) had at least one cardiovascular risk factor (arterial hypertension,dyslipidemia or diabetes). The proportion of active smokers at the time of IBD diagnosiswas 25% among controls and 13% among cases. Phenotypically, elderly-onset patients hada lower proportion of extensive UC (p<0.0001), and a higher proportion of stenosingand a lower proportion of penetrating pattern (p<0.0001) and exclusive colonic location(p<0.0001). Elderly-onset patients had a lower rate of IBD-related complications (p=0.009)but a higher prevalence of thrombotic events (p<0.0001). Regarding the use of therapeuticresources, there was a significantly lower use of corticosteroids (p<0.0001), immunomodula-tors (p<0.0001) and biological agents (p<0.0001) in elderly-onset patients as compared tocontrols, but a similar rate of surgeries. Finally, elderly-onset patients had a higher rate ofhospitalizations (p<0.0001), neoplasms (p<0.0001) and deaths (p<0.0001). In the multivari-ate analysis, elderly-onset of IBD was independently associated to a decreased need ofimmunomodulators and biological agents, and an increased need of hospital admissions.Conclusions: Elderly-onset IBD is associated to a less severe/complicated phenotype andthe lesser use of immunosuppressive therapies, which probably accounts for a non-increasedIBD-related morbidity. Age at diagnosis might explain the increase in the rate of hospitaliza-tions among elderly patients.

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Usefulness of a Faecal Calprotectin Rapid Semiquantitative Test in PredictingRelapse in Patients With Ulcerative Colitis in RemissionEsther García-Planella, Míriam Mañosa, Maria Chaparro, Manuel Barreiro-de Acosta, BelenBeltran, Elena Ricart, Valle García-Sánchez, Maria Esteve, Marta Piqueras, FernandoBermejo, Antonio López-SanRomán, Carlos Taxonera, Jordina Llao, Javier P. Gisbert,Eduard Cabré, Eugeni Domenech

Background: Faecal calprotectin (CALf) is fairly correlated with clinical and endoscopicactivity in ulcerative colitis (UC), and it has also demonstrated to be a good predictor ofrelapse. However, the routinely use of CALf measurement is constrained by the need forthe patient to carry stool samples, as well as handling and processing them in the laboratory.The availability of hand held, single-use devices for CALf measurement that could beperformed by the patient himself, might spread the use of CALf in clinical practice. Aim:To evaluate the usefulness of a rapid semi-quantitative test of CALf in predicting relapse inpatients with UC in remission. Patients and Methods: A prospective, multicentre studythat included patients with left-sided or extensive UC in clinical remission for ≥6 monthson maintenance treatment with mesalazine. At baseline and every 3 months, patients wereevaluated clinically and semi-quantitative CALf was measured using a monoclonal immu-nochromatography rapid test (PreventID Caldetect™, Immunodiagnostic AG, Germany)without manipulation of stools or laboratory analysis, until relapse or 12 months of follow-up. Results: At least one determination of CALf with clinical follow-up was available in192 out 206 patients initially included in the study. 55% with extensive UC, 62% requiredcorticosteroids in the past, and 88% were non-smokers. From a total of 695 measurementsof CALf, 81 (12%) were above the upper threshold of normality of the test (>60 μg/g) and57 (8%) had limiting values (15-60 μg/g). During follow-up, 32 relapses (17% of patients)occurred. Having a CALf >60 μg/g was significantly associated with relapse at follow-up(35% vs. 12%, p<0.0001), with a PPV of 35% and a NPV of 88%. 644 CALf determinationswith a three-month follow-up were available; undetectable CALf was significantly associatedwith absence of recurrence, with a PPV of 100% and a NPV of 93% (0% vs. 6%, p=0.002).Conclusions: Rapid semi-quantitative measurement of CALf, with no need for laboratoryanalysis and faecal samples handling, may be useful for monitoring patients with UC in remis-sion.

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Meta-Analysis: Faecal Calprotectin for Assessment of Inflammatory BowelDisease ActivityJin-Feng Lin, Jin-Min Chen, Biao Nie, Bo Jiang

Background Faecal calprotectin (FC) is a promising biomarker for inflammatory boweldisease (IBD) diagnosis. However, the utility of FC for assessment of IBD activity is lessclear. This meta-analysis is to evaluate the diagnostic accuracy of FC in assessing IBD activityand to determine an optimal cut-off value for discriminating active from inactive disease.Methods The Medline, Web of Science, Cochrane Library, and EMBASE databases were

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searched up to October 2013 for eligible studies of evaluating activity in ulcerative colitis(UC) and Crohn's disease (CD). Hierarchical summary receptor operating characteristic(HSROC) model were constructed, diagnostic odd ratio (DOR) and area under the curve(AUC) were calculated to evaluate diagnostic accuracy. The DORs of each of different cut-off values were compared to identify the most satisfactory for clinical application. Results382 articles were available after initial search. Twelve studies were included, including 744UC and 638 CD. The clinical characteristics and QUADAS scores of these studies are listedin Table. As shown in Fig. 1(A), the AUC was 0.89 (SEM = 0.017) in IBD. HSROC evaluatingUC and CD were constructed for both of them (Fig. 1(B) and (C)). It can be observedvirtually that HSROC of UC was much closer to upper left corner comparing with that ofCD. The summary sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.88, 0.82, 4.52,0.16, 34.57 and 0.93, respectively, in UC and 0.80, 0.82, 3.64, 0.27, 14.94, and 0.86,respectively, in CD. In five studies, the manufacturer's recommended value (50 μg/g, includ-ing 30 μg/g) was used for the results of pooled sensitivity 0.92, specificity 0.60, PLR 2.33,NLR 0.13, DOR 21.42, and AUC 0.92. The Chi-square or Cochrane-Q values for sensitivity,specificity, and DOR were 11.72 (p = 0.0195, I2 = 65.9%), 42.19 (p = 0.0000, I2 = 90.5%)and 21.42 (p = 0.0261, I2 = 63.8%), respectively. In five studies, 100 μg/g was used as anadjusted cut-off value, and the results were: sensitivity 0.83, specificity 0.62, PLR 2.38, NLR0.27, DOR 10.17, and AUC 0.83. The Chi-square or Cochrane-Q values for sensitivity,specificity, and DOR were 8.93 (p = 0.0629, I2 = 55.2%), 14.09 (p = 0.0070, I2 = 71.6%)and 0.5 (p = 0.9738, I2 = 0%). The trade-off of sensitivity and specificity as expected wasshown with an increase of cut-off value, sensitivity became lower and specificity becamehigher. Although the funnel plot of publication bias showed some asymmetry due to thelimited number of studies (Fig. 1(D)), the Deeks' test showed a statistically non-significantvalue (p =0.329), indicating no publication bias among the included studies. ConclusionsFC at a cut-off value of 50ug/g is a reliable surrogate marker for more precise assessmentof IBD disease activity, and may be more useful in UC than CD.Methodological assessment of the 11 studies included.

Plus sign: low risk. Minus sign: high risk. Question sign: unclear.

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