counts were normalized, log2 transformed and batch corrected.

Non-parametric Kruskal- Su1788

Wallis tests assessed differential gene expression across phenotypes. Raw p-values were
corrected for multiple testing by the Benjamini-Hochberg false discovery rate method.
Results: 51 subjects (32 UC, 19 CCD, 47%male, 34yrs mean age) were included in the
CCD vs UC analysis. 39 HC were also included (59% male, 56yrs mean age). See Table for
demographics. There were no significant differences in mean CRP nor among clinical,
Computed Tomography Utilization Abruptly Increases at Age 18 among
Patients with Inflammatory Bowel Diseases, A Nationwide Analysis of the
Insured
Shail M. Govani, Peter Higgins, Joel H. Rubenstein, Ryan W. Stidham, Jennifer F. Waljee,

endoscopic or histologic disease activity between the CCD and UC groups suggesting that
the degree of inflammation was similar in both groups. Comparing CCD and UC, 5 miRNAs
were differentially expressed: miR-129-5p, miR-603, miR-619-3p, miR-874-3p, miR-933
(FDRp = 0.0214 all probes). All probes were upregulated in CCD vs UC. Additionally, all
probes were upregulated in CCD vs HC. Only 1 probe (miR-603) was upregulated in UC
versus HC, the other 4 probes showed either downregulation or no difference from HC.
Conclusion: A PBMC-derived miRNA panel of markers identified here differentiates CCD
from UC independently of the degree of inflammation. These findings may aid individualiza-
tion of patient care through identification of novel diagnostic and therapeutic targets. Further
study will be directed at further replicating these findings and understanding the targets of
the miRNAs identified.
p values for disease activity, medications, WCC and CRP compare disease populations only
AGA Abstracts
Akbar K. Waljee
Background and Aims: Computed tomography (CT) is an important tool in the management
of inflammatory bowel diseases (IBD). However, CT delivers significant radiation with each
scan. Patients with IBD have an increased risk of undergoing repeated CT scans, which can
increase cancer risk. Based on data from atomic bomb survivors, the risk of malignancy is
increased from radiation exposure before age 35. Significant work has been done to improve
awareness of this issue among providers. We aimed to compare the use of CT in IBD patients
in patients <18 years old, 18-35, and >35 using an administrative database. If this physician
education was effective, we expected to see reduced use of CT in IBD patients < 35 years
old. Methods: The Marketscan (Truven) database from 2009-2013 was used to identify
patients with IBD with an Emergency Department (ED) or inpatient visit. Patients were
classified as having IBD based on the presence of 1 inpatient code or 2 outpatient codes
with an ICD-9CM code of 555.x or 556.x and uninterrupted insurance coverage. Analysis
was limited to patients with pharmacy coverage and visits in which the IBD diagnosis code
was the 1st or 2nd diagnosis. CT abdomen/pelvis use was determined by CPT coding.
Logistic regression was used to model the effect of age on the odds of CT use after accounting
for gender, disease type, surgery in the prior 90 days, and medications. Results: Between
2009 and 2013, there were 44,322 patients with IBD with 76,673 ED or inpatient visits in
this cohort. Sixty percent of the cohort had Crohn's disease (CD). During the first visit with
an IBD code, 7.9% were below age 18 and 57.0% were female. CT scans were utilized in
29.7% of these visits. In univariate analysis, patients younger than 18 were much less likely
to undergo CT (OR 0.45, 95%CI 0.42-0.49, p<0.001) compared to those 18- 35. Patients
older than 35 were only slightly more likely to undergo CT (OR 1.11, 95%CI: 1.07-1.15)
compared to those 18-35. Patients with CD and a recent surgery were more likely to undergo
CT while those on narcotics, steroids and immunomodulators were less likely. In multivariate
analysis, adjusting for medications, recent surgery, and gender, younger patients remained
less likely to undergo CT (OR 0.42, 95%CI: 0.39-0.46) compared to those 18-35. Only a
small increase in CT use (OR 1.07, 95%CI: 1.03-1.11) was seen in the patients > 35 years
old. Predicted probability of CT use by age demonstrates the abrupt increase in CT use at
age 18 (Figure). Conclusions: Patients with IBD undergo CT scan 30% of the time in the
ED or inpatient setting. It appears that pediatric providers limit radiation exposure among
those <18 while adult providers are not as cautious with radiation exposure for the young
adult population. Increased awareness of the risks of cumulative radiation exposure in the
young adult population is needed.

Su1787

Pre-Operative Anti-Glycan Antibodies and Anti-Glycan Antibodies Developing

After Pouch Surgery in Patients With Ulcerative Colitis Correlate With Pouch
Complications - A Prospective Longitudinal Case Series
Idan Goren, Lior Yahav, Hagit Tulchinsky, Iris Dotan
Background and aim: pouch inflammation is a common complication in patients with
ulcerative colitis (UC) undergoing proctocolectomy and ileal pouch anal anastomosis (pouch
surgery). Previous data showed similarities in serologic responses, specifically anti-glycan
antibodies in patients with a pouch and those with Crohn's disease (CD). We aimed to
assess the prevalence of CD-associated anti-glycan antibodies in patients before and after
pouch surgery and to prospectively study their correlation with pouch inflammation. Method:
Serum samples were collected before and after pouch surgery. Anti-glycan antibodies includ-
ing anti-Saccharomyces cerevisiae, anti-laminaribioside, anti-chitobioside, and anti-mannobio-
side carbohydrate antibodies (ASCA, ALCA, ACCA, and AMCA, respectively) were tested
using ELISA. Results: Overall 10 patients with ulcerative colitis were recruited and followed
up for 21±25 months after pouch surgery. The first analysis was done 10.42±11.2 months
preoperatively. For each patient 1-3 serum samples were collected before surgery and 1-3
samples after surgery. Average age at first analysis was 37.6±16.2 years, male gender 6/10,
and smokers 2/10. Baseline serologic responses were 24.82±31.2, 28.34±31.6, 33.5±23.6
and 53.0±73 for ASCA, ALCA, ACCA, and AMCA, respectively. Pre-operatively 3/10 patients
were seropositive (ALCA+, ASCA+, and both ALCA+ & AMCA+). Those 3 patients developed
chronic pouchitis during the post-operative follow-up period, during which 2 remained
seropositive and one turned sero negative. After pouch surgery 3 more patients turned Figure demonstrates the predicted probability of CT use during an Emergency Department
positive (ASCA+, AMCA+ and both AMCA+ & ACCA+). Thus, 5 (50%) of patient were or inpatient visit based on age of the patient. Patients are assumed to be males with Crohn's
seropositive after pouch surgery. Of the 3 patients developing post pouch surgery seropositi- with no recent surgery and on no medications. There is an abrupt increase in use at age 18.
viety 2 developed chronic pouchitis and one was lost for follow-up 17 months after surgery.
None of the 4 patients with a normal pouch during follow-up tested positive pre-operatively
to any anti glycan antibody and 3/4 patients with normal pouch remained seronegative post- Su1789
operatively as well. Conclusions: pouch surgery may trigger CD-like immune response to
glycans in UC patients which can be characterized by the de-novo development of anti- Use of an Electronic Nose to Evaluate Disease Activity in Ulcerative Colitis
glycan antibodies. Pre-operative anti-glycan antibodies as well as antibodies developing post- Zibing J. Woodward, Kevin Piro, Sarah Lee, Emile Latour, Jodi Lapidus, Suni Wilson,
operatively may be associated with an increased risk for pouch complications. Preoperative David Lieberman, Judith Collins, Kian Keyashian, Nir Modiano
seronegativity may be associated with lower risk for pouch inflammation. Thus, serologic
markers may assist in determining the prognosis in patients with a pouch. Background and Aims Assessment of disease activity in inflammatory bowel disease (IBD)
reflects a major challenge in clinical practice, relying on invasive endoscopic evaluation,
expensive imaging tests and biomarkers that are difficult to obtain in a timely fashion.
Cyranose 320 is an electronic nose that senses volatile organic compounds; it has been
previously used to distinguish between malignancies, inflammatory states and infections. In
this proof of concept study, we analyzed the urine headspace of active and inactive ulcerative
colitis (AUC, IAUC) patients (pts) as well as non-IBD controls with Cyranose in an effort
to differentiate between groups to enable real-time disease assessment. Methods Urine
samples were collected from consecutive UC pts seen in IBD clinic and during inpatient
admissions; control subjects were those undergoing outpatient upper endoscopy for non-
malignant indications. AUC pts were those with moderate activity classified as a Partial
Mayo score of ‡ 5 or Full Mayo score of ‡ 6, inactive UC were those with a Partial Mayo
score of 0 or 1 and endoscopic Mayo Score of 0 or 1. The urine samples were stored in a

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 -70°C freezer until the analysis was carried out. At that time, samples were thawed in a
40°C water bath and handled in a tissue culture laminar flow hood; urine headspace was
analyzed by Cyranose according to machine protocol. The raw data collected from the 32
proprietary sensors were then analyzed using one-way analysis of variance (ANOVA), Canoni-
cal discriminant analysis (CDA) and logistic regression. Results A total of 41 samples were
analyzed: 12 pts with AUC, 14 with IAUC and 15 controls. One-way ANOVA showed a
AGA Abstracts
statistically significant difference between group means for sensors 5-9, 11, 23, 29 and 31.
False discovery rate was calculated to be < 1.0% for sensors 6 and 31, indicating a significant
difference between group means using these sensors. The importance of sensors 6 and 31 was
also shown using Random forest, a recursive partitioning approach. Canonical discriminant
analysis shows a significant separation between the three groups (Figure 1). Logistic regres-
sions using only sensors 6 and 31 were able to differentiate between pts with AUC and
IAUC with good accuracy (Area under the Receiver Operating Characteristic curve - AUROC =
0.80). Similarly, these sensors were also able to distinguish between AUC and control pts
(AUROC = 0.85), IAUC and controls (AUROC = 0.86) as well as UC pts as a whole and
controls (AUROC = 0.78; Figure 2). Conclusion Cyranose 320 is a novel technology for
analyzing volatile organic compound profiles. This study shows it can be used to distinguish
between pts with active and inactive UC as well as those without IBD. Cyranose may become
a useful tool for point-of-care assessment of IBD disease activity. Larger studies are required
to validate these findings.
Figure 1: Canonical discriminant analysis (CDA) A: Active UC pts, i: Inactive UC pts,
c: non-IBD controls
FIGURE 2: Receiver Operating Characteristic (ROC) curve comparing groups of patients
determined by logistic regression using data from Sensor 6 and Sensor 31
Su1790
Predictive Factors for Differentiating between Crohn's Disease and Intestinal
tuberculosis in Korean
YunHo Jung, Soon Man Yoon, Hoon Sup Koo, Hyun Deok Shin, Jeong Eun Shin, Hee
Seok Moon, Sang Bum Kang, Jeong Rok Lee, Kyu Chan Huh
Background: A differential diagnosis between intestinal tuberculosis (ITB) and Crohn's disease
(CD) is challenging and sometimes has a significant impact on prognosis. The aim of this
study was to investigate the clinical, endoscopic, and histological features and to create a
predictive score model for differentiating CD and ITB effectively. Methods: In total, 261
patients, 99 with ITB and 162 with CD, were recruited from seven tertiary centers from
2005 to 2013 and reviewed retrospectively. For the creation of a validated model, univariate
logistic regression and receiver operating characteristic (ROC) curve analyses were conducted
by randomly dividing the group in half. Then, the other half of the group was used to
validate the model using the same regression equation and ROC analysis. Results: On
univariate analysis, the clinical feature of age, sex, hypertension, abdominal pain, diarrhea,
AGA Abstracts
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hematochezia, weight loss and perianal disease were significantly difference between CD
and ITB. The laboratory feature of platelet, ESR and Quantiferon TB gold test were significantly
difference between both groups. The endoscopic feature of aphthous ulcer, ring shape
ulcer, longitudinal ulcer, cobble stone appearance, scar change, stricture, and fistula were
significantly difference between both groups. The sites of intestinal involvement were signifi-
cant larger in CD and transverse, descending, sigmoid, and rectal involvement were more
frequent in CD. The pathologic feature of caseous necrosis in granuloma was significantly
more frequent in Tb However, cryptitis and crypt abscess were no significant difference
between two groups. Using univariate logistic regression analysis, especially age, diarrhea,
ring shape ulcer, longitudinal ulcer, and sigmoid involvement had high diagnostic values
(area under ROC curves 0.7, p<0.001). With highly significant predictive five variables, the
seven-marker model was created including suspicious radiological pulmonary tuberculosis
and sex. On multivariate analysis of seven markers, odd ratio(95% CI) for ITB was age(1.04,
0.99-1.09), sex(9.26, 1.58-54.20), diarrhea(0.11, 0.02-0.64), ring shape ulcer(10.43, 1.98-
54.93), longitudinal ulcer(0.15, 0.02-0.94), sigmoid involvement(0.12, 0.01-1.06), and
suspicious radiological pulmonary tuberculosis(272.17, 1.28-58110.8). In the seven-marker
model of the validation dataset, the sensitivity, specificity, positive predictive value, negative
predictive value, and ability to classify the two diseases correctly with a cut-off level of 0.35
were 98.0, 92.4, 98.6, and 95.5%, respectively. All of the validity indexes were similar
between the development and validation sets. Conclusions: The seven-marker model seems
to be highly reliable for differentiating between ITB and CD and is conveniently used by
clinicians to obtain results.
Su1791
Degradation Fragments of the Extracellular Matrix Measured in Patients with
Inflammatory Bowel Disease is Related to Differential Diagnosis and
Ileocolonic Involvement in Crohn's Disease
Joachim Høg Mortensen, Michael Dam Jensen, Jens Kjeldsen, Aleksander Krag, Morten
Asser Karsdal, Anne-Christine Bay-Jensen
Background: Inflammatory bowel disease (IBD) is driven by chronic inflammation and
upheld by sustained recruitment and infiltration of leucocytes, especially macrophages.
Matrix metalloproteinases (MMPs) are highly active in IBD, and are partly responsible for
the degradation of the extracellular matrix (ECM). Degradation of the ECM results in release
of protein fragments that are readily released into the circulation where they can be detected
as serum-based biomarkers. We have previously demonstrated that ECM serum biomarkers
are differential expressed in Crohn's disease (CD) and ulcerative colitis (UC) with high
diagnostic discrepancy. Here we demonstrate ECM biomarkers that are linked to different
phenotypes of CD and complications. Methods: MMP degraded ECM proteins including
citrullinated vimentin (VICM), biglycan (BGM), type 5 collagen degradation (C5M) and
formation (Pro-C5) and neutrophil elastase degraded elastin (EL-NE) were measured by
ELISAs in serum of 72 CD patients, 60 UC patients, IBS patients, and 24 healthy controls.
One way-analysis of variance, Mann-Whitney U-test, and receiver operator characteristics
(ROC) curve, and logistic regression was carried. To investigate the origin of the VICM
biomarker, In vitro experiments were carried out on peripheral mononuclear cell's (PBMC's).
Isolated monocytes were treated either with LPS, LPS+CaCl++, or only CaCl++ as control.
Treatment of LPS was 100ng/ml, and CaCl++ was 0.22µg/mL. Results: There were clear
difference in the biomarker levels in patients with IBD compared to IBS patients (BGM+Pro-
C5: AUC=0.85) and healthy controls (C5M+Pro-C5: AUC=80). VICM serum levels was
significantly higher in CD compared to UC (AUC=0.76, P<0.001). Furthermore the in vitro
data showed that the release of VICM was significantly higher in supernatants from activated
macrophages (LPS+CaCl treated) at day 5 and 8 (P<0.01), compared with controls. Upon
LPS stimulation western blotting revealed an increased expression of CD68 and vimentin
compared to controls, and these macrophages also expressed MMP-2/8 (figure 1). In addition,
Pro-C5 correlated with CDAI (r=0.36; P=0.003) in patients with an active disease (CRP
levels >5 mg/L). When looking at the CD patients who had high cumulative level of 3 or
4 biomarkers, the probability of having ileocolonic involvement was 10-times higher com-
pared to only having 1 or 2 biomarkers level elevated. For CD patients with 1 or 2 biomarkers
level elevated had 6-times higher probability to have only ileum involvement Conclusion:
The expression profile of VICM associated with CD and the in vitro data showed that VICM
was released from activated macrophages. Therefore, VICM may be related to granuloma
formation in CD. Furthermore the data suggests that increased surface area of intestinal
involvement is associated with increased elevated numbers of ECM biomarkers.
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