P-092: The course of anaemia in children with Crohn’s disease included in a prospective registry

s of the 3rd International Symposium on Pediatric Inflammatory Bowel Disease S429 to oral tacrolimus. However, the patient developed a colon perforation afterwards. One patient had maintained remission for 2 years after the dose of IFX was increased to 10mg/kg, and methotrexate was added as combination therapy. Conclusion: The present study showed that the efficacy of IFX was limited in children with steroid-dependent intestinal BD. However, the additional methotrexate may be a new option for maintaining remission of steroid-dependent pediatric intestinal BD. P-092 The course of anaemia in children with Crohn’s disease included in a prospective registry M.M. Van Biervliet1 *, F. Smet2, I. Hofmann3, E. De Greef4, B. Hauser4, P. Bontems5, S. Vande Velde1, W. Arts6, I. Paquot7, P. Alliet8, P. Bossuyt9, E. Louis10, F. Baert11, O. Bauraind12, J. Rahier13, G. Veereman4. 1Ghent University Hospital, Ghent, Belgium, 2Cliniques universitaires Saint-Luc, Brussels, Belgium, 3Catholic University Leuven, Leuven, Belgium, 4UZ Brussel, Brussels, Belgium, 5Hopital des Enfants Reine Fabiola, Brussels, Belgium, 6Ziekenhuis Oost-Limburg, Genk, Belgium, 7Clinique de l’Esperance, Montegnee, Belgium, 8Jessa hospital, Hasselt, Belgium, 9Imelda ziekenhuis, Bonheiden, Belgium, 10Centre Hospitalier Universitaire de Liege, Luik, Belgium, 11Heilig Hart ziekenhuis, Roeselare, Belgium, 12Hopital St Pierre, Brussels, Belgium, 13CHU Mont-Godinne, Namen, Belgium Aim: Description of the anaemia prevalence and evolution in prospectively followed children with Crohn’s disease (CD) [diagnosis until 24 months (mo) follow up (FU)]. Methods: 96 children with CD from the BELCRO registry describing current practice of different centres, were analysed. Data on age, weight, height, body mass index (BMI), pediatric CD activity index, therapy and haemoglobin (Hb) were collected at diagnosis, 12mo and 24mo FU. Height, BMI and Hb were converted into age and sex appropriate z-scores. Anaemia was classified as probable anaemia of chronic disease (pACD) when there was disease activity or as probable iron deficiency anaemia (pIDA) when in remission. Results: 83/96 (86%) were included, 13 drop outs due to insufficient Hb data. 37 girls and 46 boys [median age 13.3 years (2.2 17.8)] had, at diagnosis, a median Hb z-score 2.66 ( 8.4; 1.07) which was associated with disease activity (p = 0.013). At diagnosis 51/83 (61%) were anaemic, classified pACD. HB z-score improved significantly (p < 0.0001), 38% remained anaemic at 12 (26/68) and 24mo (29/76) FU. During FU there was no association with IBD treatment, BMI or disease activity. Children were more likely to be anaemic at 24mo. Patients presenting with anaemia received more iron treatment. Hb z-score did not differ according to iron supplements (n = 30). Only 50% of patients with persisting anaemia received iron supplements (3/30 IV-iron). Conclusion: Anaemia remains the most important extraintestinal manifestation of CD in children. Physicians, lacking optimal treatment strategies, under treat their patients with persistent anaemia. P-093 Exclusive enteral nutrition and infliximab for treatment of ulcerative colitis with extraintestinal manifestation A. Pappas*, L. Lassay, N. Wagner, T.G. Wenzl. University Hospital RWTH Aachen, Aachen, Germany Introduction: Anemia is a frequent symptom of inflammatory bowel disease (IBD). The autoimmune hemolytic anemia (AIHA) is described as a rare extraintestinal manifestation of ulcerative colitis (UC). This circumstance is frequently described as refractory to treatment with corticosteroids, resulting in surgical interventions such as splenectomy or colectomy. Case report: We are reporting about a 16-year-old, diagnosed with UC one year before. Under mesalazine, she presented with hemorrhagic diarrhea and severe anemia. Coombspositive warm autoantibody-AIHA could be diagnosed. By erythrocyte-transfusion and iv-immunoglobulins stabilization, by corticosteroids remission, with Cushing-syndrome. Remission maintenance therapy comprised azathioprine and mesalazine. 4 weeks later relapse with hemolytic activity. The well-informed patient refused corticosteroids and agreed to an exclusive enteral nutrition (EEN) with Modulen® for 8 weeks. Remission could be induced and hemolysis was stopped. Six weeks later next relapse. Treatment with metronidazole and EEN for 2 weeks but again hemolytic activity with drop of Hb. Our patient again refused corticosteroids, gave consent to infliximab, inducing remission. Three years later our patient has become a successful university student. 2 relapses required higher frequency of infliximab and later co-therapy with methotrexate to maintain remission. Discussion: EEN can induce remission in UC, however, in the case of our patient it was just of short duration. Infliximab is indicated for moderate to severe CU, from the age of 6 years. In cases of UC with extraintestinal complications like AIHA it can be an alternative to surgical interventions, modifications and co-therapy have to be defined individually for each patient. P-094 Efficacy of partial elemental nutrition as a maintenance therapy for pediatric Crohn’s disease K. Sekine1 *, T. Ishige2, T. Tomomasa2, R. Hatori2, Y. Igarashi2, M. Tatsuki2, A. Tsuchiya2, N. Sakurai2, H. Arakawa2. 1Takasaki General Medical Center, Takasaki, Japan, 2Department of pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan Introduction: Elemental nutrition (EN) is a commonly used primary therapy for pediatric Crohn’s disease (CD). However, the efficacy of partial elemental nutrition (PEN) as maintenance therapy is still unclear. Aim: We reviewed the prognoses of patients treated with PEN as maintenance therapy, for remission. Methods: Medical records of pediatric patients with CD who received induction therapy at the Gunma University Hospital between July 2005 and January 2014 were reviewed (n = 20). Patients were excluded if they did not receive EN as primary therapy or if they received EN along with thiopurines or antitumor necrosis factor agents as maintenance therapy. Relapse was defined when reinduction therapy was required. The time between remission and the first relapse was calculated. Results: Seventeen patients (age, 7 16 years; median, 14 years) were treated with EN; 14 received PEN alone as maintenance therapy. The observation period was 3 72 months (median, 36 months). Six patients maintained remission throughout the study period, without additional treatment. Eight patients showed a relapse; the time to the first relapse was 0.5 19 months (median, 3 months). Two patients who underwent colonoscopy after 45 months and 61 months of remission, respectively, with PEN as maintenance therapy achieved complete histological remission. Conclusion: Although remission rates with PEN are not high, some patients maintained clinical remission and mucosal healing for years with PEN alone. Considering the safety and advantages for pediatric growth, PEN might be a preferred maintenance therapy for pediatric-onset CD. by gest on Feruary 3, 2016 http://eccoxfordjournals.org/ D ow nladed from