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P517 Efficacy of antisecretory factor in reducing high intestinal output in patients with ileostomy for Crohn's disease

M.L. Scribano*, R. Monterubbianesi, A. Kohn

AO San Camillo Forlianini, Gastroenterology Operative Unit, Rome, Italy

Background

Crohn's disease (CD) patients (pts) with ileostomy after gut resection can suffer from high-output stoma (HOS) (>1.500 ml/24 h), even in the absence of any inflammatory activity. HOS may cause water and salt depletion, with malnutrition occurring as a late complication, often needing a total parenteral nutrition (TPN). Antisecretory factor (AF) is a protein with anti-secretory and anti-inflammatory effects. High concentrations of AF protein are present in egg yolk and can be administered as egg yolk powder (AF-powder). In addition, endogenous AF stimulation can be induced by intake of specially processed cereals (SPC). A 2-4 wks long period of intake of SPC is necessary for obtaining a significant AF plasma concentration. A diet supplemented with AF has shown to reduce diarrhea in patients with inflammatory bowel disease. The aim of this study was to evaluate the effect of the AF-powder on the intestinal output of CD pts with HOS.

Methods

From January 2014 to July 2014 all CD pts in a remission phase, treated with AF-powder (4 g dissolved in water, 3 times/day for 15 days) associated to SPC (1 gr/kg/day introduced in the fourth day, for 1 month) for HOS, were included in this evaluation. A HOS was considered an ileostomy output >1.500 ml/24 h for at least 7 consecutive days before starting the treatment. Dietary conditions, fluid intake and concomitant therapy did not change during the study period. Clostridium difficile infection was excluded in all pts at the baseline visit.

Results

Ten pts entered the study (6 M; mean age 51.7 yrs, range 30-69 yrs; mean disease duration 24 yrs, range 3-47 yrs; mean weight 57.4 kg, range 43-68 kg; mean height 168 cm, range 158-180 cm). Mean time from ileostomy to study inclusion was 78.5 months (range 1-258 months), and mean ileal resection length 80 cm (range 30-185 cm). Nine pts had been previously treated because of HOS with loperamide, 1 pt with budesonide and 4 pts received TPN. Concomitant therapies included loperamide in 2 pts, TPN in 3 pts, and enteral nutrition in 2 pts. Four pts were receiving adalimumab, 2 pts infliximab, 1 pt mesalazine and 3 pts no therapy for CD. A mean daily intestinal output reduction from 2.160 ml (range 1800-2800 ml) at baseline to 1.650 ml (range 1000-2400 ml) at the end of treatment with AF-powder was observed in 9 out of 10 pts. One pt did not report any improvement. A mean creatinine value decrease from 1.9 mg/dl (range 1.5-2.6 mg/dl) to 1.4 mg/dl (range 1.1-1.7 mg/dl) was observed in 4 out of 6 pts. No adverse events were observed.

Conclusion

To our knowledge this is the first case report of a treatment with AF- powder in CD pts with HOS. This supplement food appears to be effective and deserves further evaluation.