P321 Mucosal healing in a cohort of inflammatory bowel diseases paediatric patients in clinical remission
F. P. Giugliano1, C. Strisciuglio*2, M. Martinelli1, M. Andreozzi1, S. Cenni1, A. Staiano1, E. Miele1
1University Federico II, Department of Translational Medical Science, Section of Paediatrics, Naples, Italy, 2Second University of Naples, Department of Woman, Child and General and Specialised Surgery, Naples, Italy
Mucosal healing (MH) has now become an important endpoint to assess the therapeutic efficacy in patients affected by inflammatory bowel diseases (IBD). MH is related to a long-term remission and a reduction of disease complications. The aim of our study was to compare histologic findings with endoscopic features and serological markers of inflammation in a cohort of paediatric IBD patients, both Crohn’s disease (CD) and ulcerative colitis (UC), who reached clinical remission after 1 year of immunosuppressive therapy with azathioprine (AZA).
Between December 2012 and July 2015, we prospectively enrolled all IBD paediatric patients in clinical remission, defined as Paediatric Crohn’s Disease Activity Index (PCDAI)/PUCAI ≤ 10, after at least 1 year of AZA therapy at 2–2.5 mg/Kg/die. Blood and faecal samples were collected to evaluate serological markers of inflammation and faecal calprotectin (FC). All enrolled patients underwent colonoscopy. To compare serologic, endoscopic, and histologic findings before starting AZA, all data before AZA introduction were also collected. Macroscopic disease activity was assessed by SES-CD and Mayo endoscopic scores for CD and UC, respectively. For microscopic assessment, an average histology score (AHS) was obtained by dividing the sum of individual intestinal segmental scores by the total number of intestinal explored segments. An AHS reduction of at least 50% compared with the time of AZA introduction was considered statistical significant.
In total, 50 consecutive children, 23 (46%) with CD and 27 (54%) with UC, were enrolled in the study. The mean age was 15.5 years (range 9–17) for CD and 15.4 years (range 8–17) with a mean disease duration of 5 years for both groups. Endoscopic healing was detected in 14/23 CD patients (60.8%) and in 21/27 UC patients (77.7%) reaching a statistical significant difference compared with the time of AZA introduction (p < 0.001 for UC and CD, respectively). Consistently with these findings, for both CD and UC, we found a significant reduction of the inflammation parameters such as erythrocyte sedimentation rate (p = 0.03 and p = 0.001, respectively), C-reactive protein (p = 0.05 and p < 0.001, respectively), and FC (p = 0.001 and p = 0.01, respectively). In CD patients, there was also found a significant increase of albumin (p < 0.001). Only 6 UC (22%) and 2 CD patients (8.6%) showed mean AHS values reduction of at least 50% compared with baseline (p = 0.8 and p = 0.5, respectively).
In our population of paediatric IBD patients, clinical remission after 1 year of AZA is associated with endoscopic but not with histologic MH. Endoscopic healing is also related to an improvement of serologic markers of inflammation.