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￭♣ S-3 ￭
A novel endoscopic scoring system predicting relapse after surgery in intestinal Behcet’s disease
1Gastroenterology and Department of Internal medicine, Yonsei University College of Medicine
*Jung Won Park1, Hyun Jung Lee1, Soo Jung Park1, Sung Pil Hong1, Tae Il Kim1, Won Ho Kim1, and Jae Hee Cheon1
Background: Behcet’s disease is a multi-systemic vasculitic disorder including gastrointestinal tract. Cumulative surgery rates of intestinal Behcet’s disease is 6.7% and 15.1% after 2 and 5 years of diagnosis each, and the recurrence rate was approximately 50% at two years postoperatively. This study aimed to establish a scoring system based on follow up endoscopic findings which can predict intestinal Behcet’s disease recurrence after surgery.
Material and Methods: A total of 91 intestinal Behcet’s disease patients who underwent surgical intervention due to bowel complication in Severance hospital between 1986 and 2015 were identified retrospectively. 54 patients with follow-up endoscopic results were selected, and their clinical data in- cluding colonoscopic findings were retrieved. Classification And Regression Tree analysis was used to develop the appropriate model of endoscopic classification which can explain the post-surgical recurrence of intestinal Behcet’s disease most properly; e,0–no lesions; e,1–＜20 mm sized solitary ul- cer; e,2– 20 mm sized solitary ulcer; e,3–multiple ulcers regardless of size. Results: Median age at diagnosis was 36 years (range 12-69) with 28 male and 26 female patients. Clinical relapse occurred in 37 patients (61.52%). Among 37 patients with colonoscopic recurrence, only 28 cases had clinically relapsed. Multivariate analysis identified younger age years) at diagnosis (HR＝0.26; 95%CI, 0.098-0.689, p＝0.007), disease duration(HR＝0.992;
95%CI, 0.984-1.0, p＝0.043) and colonoscopic recurrence(HR＝2.992; 95%CI 1.133-7.904, p＝0.027) as independent risk factors for clinical relapse of intestinal Behcet’s disease. Endoscopic findings were classified in four groups, and multivariate analysis adjusting age at diagnosis, disease duration, previous surgical resection showed the endoscopic score was an independent risk factor of clinical relapse (p＝0.043). Conclusions: According to the results of our study, this new endoscopic scoring system could predict the clinical relapse of patients undergoing surgical resection of intestinal Behcet’s disease. Nevertheless, a larger scale prospective study is needed to validate this scoring system.
￭♣ S-4 ￭
Incidence, predictors and clinical course of PVR to tenofovir in NUC-naïve patients with CHB
1 Department of Internal Medicine, 2 Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
*Sojung Han1, Hye Won Lee1, Beom Kyung Kim12, Seung Up Kim12, Jun Yong Park12, Sang Hoon Ahn12, Kwang Hyub Han12, Do Young Kim12
Background: Partial virological response (PVR) to nucleos(t)ide analogues (NUC) are defined by patients with detectable HBV DNA (＞10-15 IU/ml) at week 24 or week 48. Clinical importance of NUC PVR relates to developing resistance to long-term HBV treatment and requires rescue therapy from potent drugs such as entecavir(ETV) or tenofovir (TDF). Third generation NUCs (ETV, TDF) carry lower risk of resistance to long-term monotherapy, and the association between PVR and secondary treatment failure is not well established. There are studies regarding the efficacy of long–term ETV therapy. However, clinical significance of long term TDF is not known. We aim to assess the prevalence of PVR to TDF, the predictive factors asso- ciated with PVR, and clinical course in treatment-naïve patients with chronic hepatitis B. Methods: We retrospectively analyzed 566 treatment naïve patients with CHB who received TDF monotherapy over 6months at Severance Hospital. PVR at week 24 and week 48 were compared against patients with Complete virologic response (CVR) at 6months. Multivariate analysis was done to evaluate predictive factors of PVR. Cumulative probability of CVR was compared in patients with PVR. Results: Among 566 patients with TDF, 452 (79.9%) patients achieved CVR upon 48 weeks of TDF therapy and 510 (90.1%) achieved CVR after 96 weeks of TDF therapy. 241 (42.5%) of NUC-naïve patients treated with TDF achieved PVR at week 24, and 114 (20.1%) patients achieved PVR at week 48. Using multivariate analysis, HBeAg positivity (Odds Ratio [OR] 2.501, 95% CI 1.56-4.010, p＜0.0001) and baseline HBV DNA level (OR 1.633, 95% CI 1.386-1.909, p＜0.0001) were predictive factors for PVR at week 24. Only baseline HBV DNA level (OR 1.813, 95% CI 1.432-2.295) was predictive factor for PVR at week 48. Cumulative CVR was significantly different (p＝0.005) among patients with PVR at week 24 with HBV DNA levels ＜7 log10 IU/mL and patients with HBV DNA level≥7 log10IU/mL. Conclusions: Elevated baseline HBV-DNA level was both associated with PVR at week 24 and PVR at week 48. HBeAg positivity was associated with PVR at week 24. Prolonged TDF therapy in NUC-naïve patients with PVR leads to CVR of majority of patients.
