P440. Influence of induction therapy with infliximab on histological changes in children with ulcerative colitis - preliminary data
S. Szymanska1, A. Wiernicka2, J. Cielecka-Kuszyk1, E. Szymanska2, M. Dadalski2, J. Kierkus2, 1The Children's Memorial Health Institute, Pathology, Warsaw, Poland, 2The Children's Memorial Health Institute, Gastroenterology, Hepatology and Feeding Disorders, Warsaw, Poland
Infliximab (IFX) is an effective therapy in inflammatory bowel disease (IBD). Most data proved its clinical efficacy and very little is known about the influence on histology, specially in children with ulcerative colitis (UC). The aim of this study was to verify the impact of induction therapy with IFX on histopathological changes in children with UC.
Sixteen children with active UC were enrolled to this study. Colonoscopy with collected samples was performed in all patients before and after three injections of IFX. PUCAI index was used to assess clinical condition of the subjects, endoscopic features were classified according to Baron scale, disease location was classified according to Paris Classification and histological changes were precisely described according to protocol of The British Society of Gastroenterology. The condition of each patient before and after induction therapy with IFX was compared with special focus on histological changes.
4 (25%) patients had left-side UC (E2); 8 (50%) had extensive UC (E3) and 4 (25%) had pancolitis (E4), respectively. Clinical improvement was observed in 14 (87.5%) patients: average PUCAI index before induction therapy with IFX was 49.0625 (max 85, min 10) and 16.25 (max 65, min 0) after IFX, respectively. General histological improvement expressed by normal surface of the intestines, normal crypt architecture, normmal number of crypts and lamina propria celularity were observed in 6 (37.5%) patients; there was no improvement in 9 (56.25%) patients; aggravation was observed in 1 patient (3.75%). Changes were not related to UC location. Reduction of inflammatory process was observed in 9 (56.25%) patients; there were no changes in 5 (31.25%) patients; in 2 (12.5%) patients inflammation was more severe. The average Baron scale before induction therapy with IFX was 2.5 (max 3, min 1); after IFX 1.5 (max 3, min 1) respectively.
Induction therapy with IFX has positive influence on histological changes in 37.5% of the patients. The treatment is more effective in reducing inflammatory process in the intestines (56.25% of the patients) and in improving clinical condition of children (87.5%).