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scolitis in children. Our study did not demonstrate a benefit or risk to using either high orlow dose treatment. The study was sponsored by Warner Chilcott.Table 1

Table 2

Sa1978

Magnetic Resonance Enterography Detects Response to Treatment in ChildrenWith Crohn's DiseaseCary G. Sauer, Jeremy P. Middleton, Adina Alazraki, Bobby Kalb, Kimberly Applegate,Diego R. Martin, Subra Kugathasan

Background: Treatment decisions in Crohn's Disease (CD) often rely on subjective clinicaldisease activity measures including the Pediatric CD Activity Index (PCDAI) and the CDActivity Index (CDAI). Meanwhile, endoscopy is more objective, but is unable to access amajority of the small bowel and requires anesthesia in children.Magnetic resonance enterogra-phy (MRE) visualizes the small bowel and perianal region; however, there is little data todocument improvement in MRE lesions following treatment. The aim of this study is toexamine change in CD lesions over time during medical therapy and evaluate treatmentchanges following MRE studies. Patients and Methods: An IRB-approved retrospective chartreview was performed on all pediatric CD patients who underwent at least 2 MRE studiesat a tertiary referral Children's hospital. Results: Thirty-three serial MRE studies (24 children)were performed to evaluate small bowel lesions; 4 demonstrated complete response, 10demonstrated a partial response and 19 demonstrated non-response to treatment. Elevenserial MRE studies (7 children) were performed to evaluate perianal disease; 4 demonstratedcomplete response, 1 demonstrated partial response, and 6 demonstrated non-response totreatment. When MRE demonstrated non-response, treatment was altered within one monthafter 24 of 25 MRE studies. MRE response and laboratory response was in fair agreementwith CRP/ESR (k=0.469, p=0.014) but in poor agreement with albumin response (k=0.32,p=0.12) and hemoglobin response (k=0.25, p=0.26). When lesions were accessible bycolonoscopy, endoscopy response and MRE response displayed excellent agreement (k=1.0,p=0.001). Conclusions: Radiologic response was demonstrated in 42% of small bowel and45% of perianal MRE studies. MRE response was in excellent agreement with endoscopyresponse in colonic disease, suggesting small bowel response can be measured with MRE.Treatment was typically altered if MRE demonstrated no response to treatment. A normalor improved MRE is an important piece of medical information documenting treatmentefficacy, even if symptomatic. Serial MRE is a useful tool to monitor small bowel and perianallesions and can be useful for clinical decision making.Comparison of MRE Response to Laboratory and Endoscopic Response

S-372AGA Abstracts

Figure 1: Treatment Following Serial MRE Study for Evaluation of Small Bowel Disease

Sa1979

Determination of Bone Age in Pediatric Patients With Crohn's Disease ShouldBe a Part of Routine CareNeera Gupta, Robert H. Lustig, Michael Kohn, Eric Vittinghoff

Background: Poor growth and delayed puberty are common features of pediatric Crohn'sdisease (CD). Bone age (BA) [skeletal maturation] is important for the proper interpretationof statural growth. Our aims were to determine the frequency of and factors associated withdelayed BA in pediatric CD. Methods: Epiphyses close at BA 15 in females and 17 years inmales. Patients with CD ≤ chronological age (CA) 15 in females and 17 years in malesbetween 1/07 and 7/09 were eligible. Older patients with open epiphyses were excluded toavoid selective inclusion of only older patients with pubertal delay. Left hand/wrist x-raywas obtained for determination of BA. RL interpreted each x-ray for BA. Low BA-Z scorewas defined as BA-Z score < -2. High BA-Z score was defined as BA-Z score > 2. Fisher'sexact test, linear regression, and logistic regression were used to identify factors associatedwith low BA-Z scores. Analyses were adjusted for sex. Results: 49 patients [65% male; 84%Caucasian] qualified. Mean time since IBD diagnosis was 2.5 ± 2.4 (std dev) [range 0.01-11.9] years. Mean CA at the visit was 13.1 ± 2.6 [4.8-16.7] years. Mean BA at the visit was12.2 ± 2.9 [5-17] years. Mean BA-Z score was -1.40 ± 1.50 [-3.68 to +2.68]. Mean BA-Zscore in females [-2.02 ± 1.43] was significantly lower than males [-1.07 ± 1.46] (p=.03).One male patient had BA-Z score > 2.0. Twenty patients (41%) had BA Z score < -2.0. LowBA-Z scores were less common in males [Odds Ratio (OR)=0.21 (95% CI=0.06-0.75); (p=.02)], and among patients with higher height CA-Z scores [OR=0.53 per unit increase inheight CA-Z score (95% CI=0.26-1.06); p=.07], weight CA-Z scores [OR=0.39 per unitincrease in weight CA-Z score (95% CI=0.17-0.87); p= .02], and BMI-CA Z scores [OR=.43 per unit increase in BMI CA-Z score (95% CI=0.20-0.93); p= .03]. Low BA-Z scoreswere more common in Caucasians [OR=6.05 (95%CI=0.62-58.85); p=.12], in patients evertreated with steroids [OR=3.66 (95% CI=0.97-13.83); p=.056] or currently treated withazathioprine/6-mercaptopurine [OR=4.26 (95% CI=0.99-18.25); p=.05]. 62% [8/13] ofpatients with colitis (no small bowel involvement), 39% [12/31] of patients with small boweldisease and colitis, and 0% [0/5] of patients with small bowel disease (no colitis) had lowBA-Z scores (p=.055). Conclusions: Low BA-Z scores are frequent in CD, especially inpatients who are female or are being treated with azathioprine/6-mercaptopurine. Low BA-Z scores are less common in patients with higher height, weight, and BMI CA-Z scores.Determination of BA should be standard of care for CD patients to allow clinically meaningfulinterpretation of growth leading to more appropriate treatment recommendations. Prospect-ive longitudinal studies are required to clarify determinants of bone age delay.

Sa1980

Pre-Operative Nutritional Status and Immunosuppression as Predictors ofPost-Operative Events in Pediatric Crohn's Disease PatientsMelissa Rose, Vesta Salehi, Robbyn E. Sockolow, Aliza B. Solomon

Objective: To evaluate the frequency of post-operative events in children with Crohn'sdisease in relation to nutritional status and use of immunosuppressive medications prior tosurgery. Patients/Methods: A case series was conducted of 13 pediatric patients with Crohn'sdisease who underwent surgical intervention between 2007 and 2011. Age of diagnosis, ageof first surgical intervention, type(s) of surgical intervention(s), pre-operative immunosup-pressive medication use and nutritional status (BMI<5th percentile) were reviewed andevaluated in the context of post-operative events. Results: Average age of diagnosis was11.28 years (median 12). The average age at first surgical intervention was 13.91 years(median 14.92), with the average time from diagnosis to first surgical intervention being2.63 years (median 2.75). Procedures included four partial colectomies (30.7%), two addi-tional partial colectomies with stricturoplasty (15.4%) and one with partial jejunal resection,one total colectomy with ileostomy (7.7%), one ileostomy without colectomy (7.7%), andfive procedures for perianal disease (two I&D with Seton placement, one I&D, one Setonplacement without I&D, and one fistulotomy; 38.5%). Five patients went on to have addi-tional surgical procedures including total colectomy with ileostomy (one patient), partialcolectomy (two patients, one with anastomosis revision) and fistulotomy (two patients, onewith additional multiple I&D and Seton placements for severe perianal disease). Eightpatients had elective procedures and five had emergent procedures. Reasons for emergentsurgical intervention included severe anemia and pain; small bowel obstruction (two patients);persistent pain after multiple admissions; and bowel perforation. Five patients (38.3%) wereon immunosuppressive medications at the time of surgery; two were on steroids (one withbiologics, one with immunomodulators), two on IM and one on biologics. Of the remainingeight, six had been off of immunosuppression for 2-8 weeks and two had never been onimmunosuppression. Pre-operative BMI percentile ranged from 0-94% (median 26%) and