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Ethnicity Age % men Crohn’s (%) OR (95% CI) UC % OR (95% CI) Other Americans (n Z 136,561) 59 48% 884 (0.65%) 1 2,210 (1.62%) 1 Jewish (n Z 19,941) 61 52% 199 (1.00%) 1.54 (1.32 - 1.81) 513 (2.57%) 1.61 (1.46 - 1.77) Hispanic (n Z 42,422) 58 47% 150 (0.35%) 0.54 (0.46 - 0.65) 652 (1.54%) 0.95 (0.87 - 1.04) East Asian (n Z 14,326) 61 53% 22 (0.15%) 0.24 (0.15 - 0.36) 135 (0.94%) 0.58 (0.49 - 0.69) Indian (n Z 3,201) 56 60% 27 (0.84%) 1.3 (0.89 - 1.91) 152 (4.75%) 3.03 (2.56 - 3.59) Tu1534 Methotrexate Treatment for Collagenous Colitis: a Case Series Alvin Y. Ting, Damian Dowling* Gastroenterology, Barwon Health, Geelong, VIC, Australia Background and aim: Collagenous colitis is an uncommon cause of diarrhoea. Whilst methotrexate has been suggested as effective treatment for this disorder, there is currently minimal literature regarding the effectiveness and safety of this drug in the treatment of collagenous colitis. Methods: A retrospective analysis of patients with biopsy proven collagenous colitis identified from a single gastroen- terologist’s practice. Data extracted from medical records included age at diag- nosis, response (clinical and histological) to therapy, dose and duration of methotrexate therapy, adverse effects, and duration to improvement of symptoms. Results20 patients with biopsy confirmed collagenous colitis were identified be- tween 1999 and 2013. 19 cases were female and the mean age at diagnosis was 60.5 years (age range 38 years to 75 years). 10 patients were treated with oral metho- trexate with an initial dose of 10mg weekly. All patients treated with low dose methotrexate had improvement in symptoms, with baseline bowel frequency of 8.4 loose stools per day improving to 1.2 normal stools per day within 4 weeks of treatment. Dose reduction to 5mg weekly occurred in one case for atypical side effect (insomnia), and in one case the dose was increased to 20mg weekly due to refractory symptoms. Histological remission of collagenous colitis was noted in all patients who had repeat colonic biopsies whilst being treated with methotrexate. No patient had a symptomatic relapse whilst continuing methotrexate therapy. There was no haematologic or hepatic toxicity observed with methotrexate treat- ment. Conclusions: Methotrexate is a well-tolerated and safe treatment for collagenous colitis. It is highly effective in improving patient symptoms and inducing histological remission. Controlled trials are required to compare low dose methotrexate to other therapies. Trichrome stain before treatment with methotrexate Trichrome stain after treatment with methotrexate Tu1535 Microscopic Colitis and Colorectal Neoplastic Lesions in Patients With Chronic Non-Bloody Diarrhea: a Prospective, Multicenter Study Gian Eugenio Tontini* 1,2 , Luca Pastorelli 3,1 , Luisa Spina 1 , Federica Fabris 4 , Barbara Bruni 5 , Claudio Clemente 5 , Germana De Nucci 1 , Flaminia Cavallaro 1 , Stefano Marconi 6 , Markus F. Neurath 2 , Helmut Neumann 2 , Milena Tacconi 4 , Maurizio Vecchi 3,1 1 Gastroenterology & Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy; 2 Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany; 3 Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; 4 Gastroenterology & Digestive Endoscopy Unit, Istituti Clinici Zucchi, Monza, Italy; 5 Pathology & Citodiagnostic Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy; 6 Medical Department, Chiesi Farmaceitici SpA, Parma, Italy Background: Lymphocytic and collagenous colitis are emerging as common find- ings in subjects undergoing colonoscopy for chronic non-bloody diarrhea (CNBD). Data concerning microscopic colitis (MC) are still limited and affected by controversial epidemiological evidences. Recent converging lines of evidence suggest that MC correlates with a lower risk of colorectal neoplasia. Accordingly, we prospectively assessed MC prevalence in a multicenter cohort of subjects submitted to colonoscopy for CNBD, thereby defining whether MC influences the risk of colorectal neoplasia. Methods: Consecutive patients with CNBD of unknown origin underwent pan-colonoscopy with multiple biopsies. The demo- graphic characteristics of patients diagnosed as MC were analyzed. The prevalence of neoplastic patients with MC was compared with that observed in negative for MC matched controls with CNBD. Results Out of 8006 colonoscopy, 305 subjects had CNBD as orally indications. Patients with CNBD were more likely to be women than men (odds ratioZ1.5; CIZ1.2-1.9; PZ0.001). Histopathology detected a high prevalence of MC (16%) with a clear predominance of collagenous colitis (70%). A striking age-dependent rise in MC-associated risk was observed, determining outstanding significant differences between varying age groups (P !0.05 comparing each group), as well as in the number-needed to screen one new case (e.g. 10 subjects in the !60 years group and 4 subjects in the R60 years group). Gender distribution was balanced within MC patients (F/MZ1.5/1), especially among lymphocytic colitis (F/MZ1.2/1). MC patients were negatively associated with the risk of colorectal neoplastic lesions compared with controls (odds ratioZ0.22; CIZ0.05-0.97; PZ0.035). Conclusions: MC is the first cause of CNBD in subjects submitted to colonoscopy. Multiple biopsies are strongly recommended, even in the case of irrelevant endoscopic inspection, especially for age R40 years. MC is associated with a reduced risk of colorectal neoplasia, suggesting that this model of chronic inflammation might play a protective effect against colorectal carcino- genesis. AB468 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014 www.giejournal.org Abstracts
