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P269 Colonic metaplasia of the ileum as a predictive marker of clinical recurrence in Crohn’s disease: a prospective study at 4 years

M. Ascolani1, C. Mescoli2, M. Rugge2, S. Onali1, G. Sica3, C. Petruzziello1, G. Palmieri1, E. Calabrese1, A. Ruffa1, F. Pallone1, M. Rugge2, L. Biancone*4

1University ‘Tor Vergata’ of Rome, Department of Systems Medicine, Rome, Italy, 2University of Padova, Department of Medicine, dimed, Pathology Unit, Padua, Italy, 3University ‘Tor Vergata’ of Rome, Department of Surgery, Rome, Italy, 4University, Department of Systems Medicine, Rome, Italy

Background

Colonic metaplasia of the ileum was reported in Crohn’s disease (CD) patients 1 yr after ileocolonic resection.1 Colonic metaplasia was observed in severe/established ileal lesions, whereas CD ileum with no recurrence or with early recurrence expressed the small intestine type mucin phenotype.1 In a prospective study at 4 yr, we aimed to assess whether colonic metaplasia of the ileum may represent a predictive marker of clinical recurrence.

Methods

The same cohort of CD patients undergoing ileocolonic resection followed-up for 1 yr was followed-up for an additional 3 yr, with clinical recurrence (CDAI > 150) assessed yearly for 4 yr. Ileal samples were already taken from at surgery (T0) and during ileocolonoscopy at 6 (T1) and 12 mo (T2).1 Ileal samples were already stained for histology and immunohistochemistry for assessing the expression of sulfomucins (colon phenotype) and sialomucins (small intestine mucin and phenotype).1 Statistical analysis: Data expressed as median (range),Spearman correlation test, and unpaired t-test.

Results

At 4 yr, the study included 17 patients (12 M; age 41 [17–57]). Endoscopic recurrence occurred in 13/17 patients at T1, in 14/17 patients at T2 (score 0 [0–3]; 0 [0–5]; p = ns, respectively).Clinical recurrence occurred in a low proportion of patients (6 mo n = 1; 1 yr n = 3; 2 yr n = 3; 3 yr n = 2; 4yr n = 1). A significant correlation was observed between the percentage of expression of sulphomucin in the ileal surgical samples vs the CDAI at 4 yr (r = 0.62; p = 0.007), but not at 1, 2, or 3 yr. The percentage of expression of sulphomucin in the ileal biopsies at 6 mo was significantly correlated with the CDAI at 6 mo (r = 0.68; p = 0.003), but not at subsequent yr. Differently, the percentage of expression of sulphomucin in the ileal biopsies at 12 mo was correlated only with the CDAI at 2 yr (r = 0.53; p = 0.02). The median expression of sulphomucin in the ileal surgical samples was significantly higher the sub-group of CD patients developing clinical recurrence at 2 yr (40 [10–99] vs 5 [0–50]; p = 0.05) but not at the other observations. The same finding was not observed for ileal biopsies at 6 mo. The expression of sulphomucins in the ileal samples at 12 mo was significantly higher in the sub-group of patients developing clinical recurrence at 1 and 2 yr (30 [1–40] vs 0 [0–35]; p = 0.025 and 30 [0–40] vs 0 [0–35]; p = 0.029), but not at 3 yr (15 [0–30] vs 0 [0–40]; p = ns).

Conclusion

In CD ileum, the development of a ‘metaplastic’ colonic-mucosa phenotype as observed in the surgical specimens and in severe post-operative recurrence might represent a predictive marker of clinical recurrence.

References

1. Ascolani M, Palmieri G, Sica G, et al. Colonic phenotype of the ileum in Crohn’s disease: a prospective study before and after ileocolonic resection. Inflamm Bowel Dis 2014;20:1555–61.