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* = Presenting author

P086 The presence of the Epstein-Barr virus is associated to a higher colectomy requirement in patients with Ulcerative Colitis

P. Daffra*1, I. Aldecoa2, I. Ordas3, B. Gonzalez2, E. Ricart3, A. Jauregui Amezaga3, J. De Paula1, A. Martinez2, J. Panés3, M. Cuatrecasas2

1Hospital Italiano de Buenos Aires, Gastroenterology, Buenos AIres, Argentina, 2Hospital Clinic, Patología, Barcelona, Spain, 3Hospital Clinic I Provincial, Department of Inflammatory Disease, Barcelona, Spain

Background

The Epstein Barr (EBV) infection has been related to Inflammatory Bowel Diseases (IBD), but its relevance in the course of the disease is not well established. Our objective is to investigate the relation between EBV and the clinical course in patients with ulcerative colitis (UC).

Methods

The presence of EBV was determined in the colectomy pieces of 27 patients with UC who had been colectomized by medical treatment refractory disease. The presence of EBV was studied by using in situ hybridation (EBER). The clinical caracteristics of the disease were compared between EBV positive patients and EBV negative ones. As an additional comparing group, it was studied the prevalence of the virus in patients with ulcerative colitis with cortico-refractory disease who did not require colectomy (patients who responded to cyclosporine or anti TNF treatment).

Results

Fourteen (52%) from the 27 colectomized patients with refractory disease were found to be positive to EBV in the surgical piece (+EBV). Fifty percent of them were men. The age expressed in median at the time of the colectomy was 46 years old (+/- 16). The comparison with 13 EBV negative patients did not show any significant differences regarding sex, age at the colectomy or in the evolution time of the disease. It was found that a hundred percent of the patients of the + EBV group had severe clinical activity at the moment of the colectomy vs. 53% of the EBV - group (p=0,006). Three patients (23%) of the + EBV group were receiving thiopurines vs. 11 (77%) of the patients of the - EBV group (p= 0,007). Significant differences in the proportions of patients treated with cyclosporine or anti TNF were not found. The EBV presence in colonic tissue was able to be analyzed in 10 of the 14 patients, and it was positive in all of them. The EBV presence in the tissue was also analyzed in 19 corticorrefractory patients who did not required colectomy. It was observed that only 2 (10,5%) patients of these group were + EBV vs. 10 of the group that require colectomy (p=0,03).

Conclusion

In patients with severe, corticorrefractory ulcerative colitis, the EBV presence in colonic tissue is associated with a higher requirement of colectomy. Further reserch is needed to evaluate if the treatment of this infection improve the clinical course of the disease.