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One Hour Infliximab Infusion Can Replace Two Hour Infusion in MaintenanceTreatment of Crohns Disease Without Shortcomings, in Patients Treated forUp to Three YearsRagnar Befrits, Linda Malmström, Anette Forsell, Lars-Åke Bark, Lars Blomquist

Introduction: Infliximab (IFX) in moderate to severe Crohns disease (CD) is usually givenas a 2 h infusion with postinfusion observation of at least 1 h. To simplify treatment andmake it more convenient to pts, shorter infusion with a minimum of observation time hasbeen suggested, and tried in small groups of CD pts with short follow up. Aims: To studyif reduced IFX infusion time is tolerable and endurable in CD pts treated for up to threeyears. Methods: All CD patients on IFX maintenance treatment at this hospital who hadhad at least 4 subsequent 2 h IFX infusions without complications were switched to 1 hinfusion time without postinfusion observation. Altogether 68 pts (51 M, 17 F, median age37 y) from March 2005 until November 2007 were included. Median CD duration was 9y (1-47). Median duration of 1 h infusion treatment was 14 m (0-32). 14 pts (21%) hadfistulizing CD and 8 (23%) pelvospondylitis. 46 pts (68%) were on azathioprin and 37(56%) on steroids at start of infliximab treatment. Premedication with corticosteroids orantihistamines was not given routinely. Results: A total of 465 1 h infusions were given,corresponding to 5 (1-22) per patient. 10/68 patients (15%) had mild to moderate infusionreactions as compared to 5/49 (10%) in our previous 2 h infusion cohort (p =0.58, Fishersexact test). 6 pts returned to 2 h infusions, 1 pt continued with 1 h infusion after premedica-tion. 2 pts changed to adalimumab therapy due to loss of response. 4 pts in remission choseto stop treatment. The number of patients on steroids at the end of the study was 7 (10%)compared to 37 (56%) at start of IFX treatment. Conclusions: Our data favour 1 h IFXinfusion in CD. No increase of infusion reactions or other side effects were noted. Healthcare resources can be better utilized and patient satisfaction will increase.

M1708

Infliximab in Hospitalized Patients with Acute Severe Ulcerative Colitis: RealLife ExperienceKenneth Atkinson, Robert M. Penner, David Pearson, Brian Bressler, Nawal S. ALNahdi,Robert A. Enns, Martin Fishman, Twila Burgmann

Introduction:Management of moderately severe ulcerative colitis (UC) using infliximab iswell established. However, the usefulness of using infliximab in severe acute UC still requiresfurther clarification. This case series evaluates the role of infliximab in hospitalized patientswith acute severe UC. Methods:Hospitalized patients with acute severe UC in 5 TertiaryHospitals in British Columbia, Canada were evaluated. Data collection included patient'sdemographics, disease duration, disease extent and previous therapies. Patients' presentingsymptoms, laboratory results, and abdominal radiological finding were collected. In hospitalresponse to infliximab was the primary endpoint. Results:Nineteen patients with acute severeUC were treated with infliximab from (05/06-11/07). This series consisted of 13 males,mean age of all patients 44.5 years (range 18-71 years). The mean duration of disease was9.5 years (range 3 weeks - 19 years). Five patients were steroid dependent prior to admission.Three patients were on maintenance azathioprine/6MP, and 1 patient was on maintenanceoral cyclosporine. All patients were started on steroids intravenously at admission, the meanof total duration of steroids before first dose of infliximab was 11.5 days (range 4 - 33 days).Nine patients did not respond to infliximab and required a colectomy, 7 during same hospitaladmission, 1 77 days after discharge, and 1 patient after a colonic perforation (63 days afterhis only dose of infliximab). Total admission duration mean 19.7 days (range 3 - 50 days).Of the 10 responders, 8 patients weaned off steroids within 4 months of discharge, 8 werestarted on azathioprine/6MP. Two patients who did respond to infliximab and were startedon azathioprine remained steroid dependent. The only infectious complication noted wasone patient who developed localized herpes zoster after receiving infliximab. Conclusion:Inthis multicenter, real-life case series, approximately half of the patients failing IV steroidsresponded to infliximab as rescue therapy. Earlier use of infliximab during hospitalizationmay improve outcomes of this therapy outside a clinical trial setting.

M1709

Proton Pump Inhibitor Based Triple Therapy Combined with Bismuth IsSuperior to Proton Pump Inhibitor Based Triple Therapy Only for Helicobacterpylori Eradication. (Preliminary Data)HyunJin Jo, Dong Ho Lee

Background/Aims: Helicobacter pylori eradication rates have tended to decrease recently,mostly due to increasing antibiotic resistance. Approximately 20% of patients will fail toobtain eradication with recommended treatment regimen. To overcome the falling eradicationrates, bismuth-based regimen or adjuvant agents have been suggested to be used. But thereis no surveillance of using bismuth-based regimen as first line therapy in Korea.This studyaimed to assess the efficacy of a proton pump inhibitor based triple therapy combined withbismuth as a first line treatment. Methods: From august 2007 through October 2007, 84patients with Helicobacter pylori positive peptic ulcer disease or chronic gastritis who receivedfirst line therapy for 7 days were retrospectively evaluated. 21 patients received ACP (amoxicil-lin 1g bid, clarithromycin 500mg bid, pantoprazole 40mg bid), 36 patients received ACP1/2(amoxicillin 750mg bid, clarithromycin 250mg bid, pantoprazole 40mg bid), 11 patientsreceived ACPB(amoxicillin 1g bid, clarithromycin 500mg bid, pantoprazole 40mg bid, tripot-assium dicitrato bismuth 300mg bid), 16 patients received ACP1/2(amoxicillin 750mg bid,clarithromycin 250mg bid, pantoprazole 40mg bid , tripotassium dicitrato bismuth 300mgbid ).13C-urea breath test was performed for evaluation of Helicobacter pylori eradication atleast 1 month after treatment. Results: There were 39 males and 45 females. Mean age was56.3 years. The eradication rates were 85.7% (18/21) in ACP group, 66.7% (24/36) inACP1/2 group, 100% (11/11) in ACPB group, 62.5% (10/16) in ACPB1/2 group. There wassignificant statistical difference of eradication rate according to antibiotic dose(p=0.009).although there was no significant statistical diffrence of eradication rate according to usingbismuth,in full dose antibiotics groups (ACP and ACPB), eradication rate was higher in

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bismuth containing group.(p=0.188) Conclusion: Proton pump inhibitor based triple therapycombined with bismuth is probably superior to proton pump inhibitor based triple therapyonly. These encouraging results should be confirmed in larger cohorts.

M1710

Severity of Symptoms, Quality of Life (QOL) and Attitudes TowardsTreatment in Greek Adults with ConstipationGeorge Papatheodoridis, Ioannis Karaitianos, Jiannis Vlachogiannakos, Nikos Viazis,Demetrios G. Karamanolis

Background/Aim: The prevalence of constipation in Greek adults was recently found to be16% being higher than in other European countries, but details on its effects are lacking.We evaluated the symptoms severity, their effects on QoL and attitudes towards treatmentin constipated Greek patients. Methods: This survey included 237 constipated Greek adults;133 were found during an Omnibus strategy survey in 1,008 individuals (inclusion criteria:15-64 years, citizens of Athens, Thessaloniki, 11 cities with >10,000 population), while 104subjects with similar epidemiological characteristics were also included. All 237 subjectshad constipation during the last 6 months. Questionnaires were completed for by personalinterviews. Results: Constipation had mean duration: 11 years, frequency: 1.2 times/week;each episode had mean duration 4 days. The majority of patients reported a) additional healthproblems (last 12 months-headache:79%, upper respiratory infection:64%, migraine:33%,heartburn/regurgitation:23% etc); b) constipation to be ≥serious disease than their otherhealth problems (81% or 70% vs migraine or upper respiratory infection); c) symptomsaffecting QoL (heavy:73%, uncomfortable:40%, nervous:39%, tired:31%, unattractive:13%,sleepless:9% etc) and/or associated with defecation (straining:70%, gas:69%, painful defeca-tion:65%, haemorrhoids:21%, bleeding:13% etc). The majority of symptoms appeared in>75% of constipation episodes and were considered as extremely unpleasant by >60%patients. Only 47% of patients reported having ever asked for medical advice (internist:30%,gastroenterologist:13%, other:7%). For long-term pre-emptive management, patients useddietary modifications (75%) and/or traditional products (52%) and/or laxatives (25%) and/or physical exercise (17%), while 10% did nothing. For treatment of constipation, the useof laxatives increased to 46%. Physicians' recommendations included laxatives in 75% ofcases. Patients considered better efficacy (57%) as the main advantage and potential sideeffects (27%) and bowel tolerance (24%) as the main disadvantages of laxatives. Conclusions:The majority of Greek constipated adults with a) consider constipation as a disease withworse or at least equal severity compared to other common health problems; b) haveextremely unpleasant general or defecation associated symptoms, which affect their QoL;c) use only dietary modifications and/or traditional products. Less than 50% ask for medicaladvice. Laxatives are considered to have superior efficacy, but their use is restricted, particu-larly as pre-emptive management, mostly due to unjustified fears of side effects andfuture tolerance.

M1711

Intestinal Polyposis Prevalence in Patients with Metabolic SyndromeJavier Lizardi-Cervera, Genaro Vazquez-Elizondo, Marisol Valdes-Escarcega, NorbertoChávez-Tapia, Misael Uribe

Introduction. Metabolic Syndrome (MS) and its complications are major worldwide healthproblems. Recent evidence demonstrated an association between the presence of MS andintestinal polyposis (IP) but to our knowledge there isn't any study that determines thepresence of this in Mexican population. The aim of this study was to determine if there isan association between MS and IP in Mexican adults. Materials and Methods. All patientsthat went to an annual medical check-up between January and June 2007 were includes,and 850 clinical records where obtained. Patients with IP were drawn from this populationif polyposis where found by rectosigmoidoscopy. Next, a case-control, randomized, genreand age matched study where performed by 1:4 relation. To determine the presence of MS,ATPIII panel criteria where used. Analytical and descriptive statistics where determined andt-Student test and Chi-Square test where used. All analyses where made by SPSS v12.0Software. Results. IP frequency found among population was of 2.3%. 20 cases and 80controls where drawn. Demographic, anthropometric and biochemical results are shown intable 1. Subjects with IP had a lower prevalence of physical activity in relation to thosewithout IP. (40% vs. 62%, p<0.008, OR 0.40). but no other statistically significant differenceswere found. Conclusion. No association between IP and MS where found among Mex-ican patients.Table 1. Demographic, Anthropometric and Biochemical variables studied

M1712

Interaction Between Small Intestinal Small Intestinal Motility and AbsorptionFollowing Major Abdominal SurgeryNam Q. Nguyen, Laura Bryant, Robert Fraser, Carly Burgstad, Jim Burnett, Ross N.Butler, Richard H. Holloway

Introduction. The characteristics of intestinal luminal flows are important in mixing andabsorption of gut contents. Dysmotility and subsequent changes in flow pulses may thusbe a factor in reduced nutrient absorption after abdominal surgery. Aims. To examine theimpact of SI dysmotility on motility, flow and absorption in patients who underwent openabdominal aortic aneurysm repair. Methods. Combined proximal intestinal pressures (mano-metry-35 cm span), luminal flow (intraluminal impedance-7 segments 2cm apart) andabsorption (13C triolein breath test) were measured in 13 patients (12M; 77±2 yrs) duringa 3h duodenal nutrient infusion (Ensure, 222kcal, 21% fat). Studies were performed on 2occasions-within 6 hours of, and 3 days after surgery. The number of phase 3-like activity(bursts), flow events (total, major (=>60 sec duration), and retrograde) was measured togetherwith triolein absorption. Data were compared to 10 healthy humans (9M; 57±4 yrs) studiedonce. Data are mean +/- SEM, compared with ANOVA. Results. Burst frequency increasedafter surgery compared to healthy humans (table). Total and retrograde flow events weredecreased, but major flow events were increased. By day 3, the frequency of bursts andtotal flow events were similar between patients and healthy subjects. The increase in majorand reduction in retrograde flow persisted. On both days, 13C-triolein absorption was lessin patients than in healthy subjects. There was a positive correlation between trioleinabsorption and burst activity (r=0.47; P<0.01) and total flow events (r = 0.49; P<0.01), anda negative correlation with absorption and major flow events (r = -0.37; P=0.03). Conclusions:Disruption in SI flow patterns after major non-GI abdominal surgery is associated withreduced absorption of 13C-triolein. The increase in major and retrograde flow pulses maycontribute to reduced absorption by decreasing the mixing of intestinal contents.

** P<0.001, vs. healthy & Day 3 * P<0.05, vs. healthy

M1713

The Relationship Between Bacterial Overgrowth, Intestinal Permeability andTNF Alpha in Pediatric Short Bowel SyndromeConrad R. Cole, Juliana C. Frem, Andrew T. Gewirtz, Benjamin D. Gold, Thomas R.Ziegler

Background: Short bowel syndrome (SBS) is a devastating clinical problem affecting adultsand children who suffer from its complications, which include recurrent infections andsmall bowel bacterial overgrowth (SBBO). Objectives: To determine the effect of bacterialovergrowth on mucosal inflammation and proinflammatory cytokine TNF-alpha productionand to assess the potential role of fecal calprotectin in the diagnosis of SBBO. Methods: 10children (6 girls; 8 African American) with surgical SBS secondary to necrotizing enterocolitis

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(NEC)were recruited. They were evaluated at enrollment(visit 1) and for 2 additional evalu-ations (visits 2 & 3). Each visit was separated by 60 days. The following procedureswere completed at each visit: nutritional assessment, measurements of breath hydrogen todetermine SBBO, Urinary lactulose/Mannitol ratio to assess intestinal permeability, and stoolcollection to measure fecal calprotectin levels and assess intestinal mucosal inflammation.Serum was collected to assess for TNF-alpha. Normal age-matched infants without historyof NEC or intestinal surgery were recruited for measurement of fecal calprotectin and TNFalpha levels. Results: The mean adjusted age ± SD at the time of initial assessment was7.5±3 months and gestational age at birth of 30.7±2 weeks. All of the infants were dependenton parenteral nutrition for ≥ 90days at the time of enrollment. The mean residual bowellength was 45.5±17 cm. Seven infants (70%) had colon in continuity with the small intestineson enrollment. The majority (80%) had some colonic resection. Bacterial overgrowth wasdiagnosed in 5 (50%) SBS children. Fecal calprotectin levels were significantly higher inSBS children with the diagnosis of SBBO (mean of 665µg/g) compared to age-matchedhealthy controls (mean of 88µg/g) and children with SBS without diagnosis of SBBO (meanof 131µg/g) (p<0.05). Urinary lactulose-mannitol ratios were abnormal (>0.025) in all of thechildren with SBS. Serum levels of the proinflammatory cytokine TNF-alpha was significantlyhigher in the children with SBS at baseline compared to healthy children and adults withSBS. The TNF-alpha level correlated with the urinary lactulose-mannitol ratio in the childrenwith SBS (p=0.007; R2=0.66). Conclusion: SBBO is common in SBS infants and leads tomucosal inflammation. TNF-alpha has a role in mucosal inflammation and permeability inthis population or may be produced in response to bacteria or bacterial products

M1714

Incidence and Implications of Pre-Pouch Ileitis Following RestorativeProctocolectomy with Ileal Pouch-Anal AnastomosisSimon D. McLaughlin, Sue K. Clark, Andrew J. Bell, Paris P. Tekkis, Paul J. Ciclitira,Ralph. J. Nicholls

Background: Pouchitis following RPC for ulcerative colitis (UC) is common. Inflammationproximal to the pouch; pre-pouch ileitis (PI) has recently been described(1). Its incidenceand implications are not well studied , one small study found PI in 14% of patients withpouchitis(2) . Some authors have suggested it may indicate missed Crohn's disease (CD).The aim of this study was to identify the incidence of pre-pouch ileitis at pouchoscopy andcorrelate this with symptoms, diagnosis and outcome. Method: It is routine practice at ourinstitution to intubate the pre-pouch ileum at pouchoscopy. We searched the endoscopydatabase for the terms “pouchitis” and “ileitis” in all pouchoscopy procedures performed atour institution between April 2004 and September 2007, hospital records were then reviewed.Those with CD were excluded. Results: 1448 pouchoscopies were performed on 754 patients(polyposis 179), (UC/indeterminate colitis (IC) 568), (CD 5). Pouchitis was diagnosed in254 (34%) patients. PI was diagnosed in 34 (6.2%) of patients with UC/IC and 1 (0.6%)patient with polyposis. 1 UC patient took NSAIDs and was excluded from the analysis. Allhad concurrent pouchitis. 3 had ileal stricturing. PI length was recorded in 32 procedures(65%), mean PI length =13.3 cm. PI was found in 13% of patients with pouchitis Of the35 patients with PI 25% were asymptomatic. At follow-up (mean 13 months) n= 0 werereclassified as Crohn's disease, and no patient required an ileostomy for poor function.Histology of the terminal ileum at time of colectomy was available in 19 patients, 6 (34%)had histological backwash ileitis. Conclusion: The incidence of pre-pouch ileitis in patientswith UC/IC is 6.2%, and it occurs in 13% of patients with pouchitis; this is in keeping withearlier work. It is rare in polyposis patients. All identified patients had associated pouchinflammation, however not all patients were symptomatic. The incidence of backwash ileitisin this group was twice that expected (18%) at colectomy for UC(3); this may suggest asimilar disease process. Our results demonstrate that PI is relatively common in patientswith pouchitis; it does not imply missed Crohn's disease or predict an increased rate ofpouch failure at least in the short term. Reference List 1. Bell AJ, et al. Colorectal Dis2006;8:402-410. 2. Kuisma J et al. Scand J Gastroenterol 2004;39:544-548. 3. Haskell Het al. Am J Surg Pathol 2005;29:1472-1481.

M1715

Missed Crohn's Disease Is Unlikely As a Cause of Unexplained IronDeficiency in Pouch Patients: Evidence from Video Capsule EndoscopySimon D. McLaughlin, Andrew J. Bell, Aymer Postgate, Sue K. Clark, Chris H. Fraser,Paris P. Tekkis, Paul J. Ciclitira, Ralph. J. Nicholls

Background Iron deficiency anaemia (IDA) is common following restorative proctolectomy(RPC). Causes include pouchitis, pre-pouch ileitis and missed Crohn's disease (CD). Videocapsule endoscopy (VCE) is commonly used to investigate unexplained IDA and excludesmall bowel CD, however there are significant cost implications and no studies of its usefollowing RPC. We aimed to establish whether IDA following RPC is associated with signific-ant pre-pouch small bowel inflammation. Methods: 10 Patients who had VCE for IDA wereidentified from the St. Mark's Hospital database, notes were reviewed. All had pouch and/or pre-pouch ileal inflammation at pouchoscopy. 6 had chronic refractory pouchitis and 1antibiotic resistant pouchitis. Coeliac disease, inadequate diet and NSAID use had beenexcluded as a cause of IDA. Results: Diagnoses; UC (7), indeterminate colitis (1), Familialadenomatous polyposis (2). In all patients the proximal small bowel was well visualised, 1(10%) patient had signs of inflammation. The pre-pouch ileum was visualised in 9 (90%)patients; 3 had signs of pre-pouch ileitis. The pouch was visualised in only 6 (60%) ofpatients, all had visible mucosal inflammation. At follow up (mean 24 months); no patienthas been reclassified as CD. Conclusion: In contrast to a recent Italian study of VCE inwhich all 15 patients with chronic refractory pouchitis (CRP) were found to have diffusesmall bowel lesions, in our study only one of ten had signs of inflammation proximal tothe pre-pouch ileum. Numbers are small but our findings suggest that in IDA followingRPC investigations need go no further than endoscopy of the pouch and pre-pouch ileumif these are inflamed. Re-classification to CD is inappropriate without re-assessment of thecolectomy specimen and classical findings away from the pre-pouch ileum(1),(2). ReferenceList (1) Bell AJ, Price AB, Forbes A et al. Pre-pouch ileitis: A disease of the ileum in ulcerativecolitis after restorative proctocolectomy. Colorectal Dis 2006;8(5):402-10. (2) Goldstein NS,

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