P004 Correlation Between Histological Activity and Use of Anti-TNF in Patients With Inflammatory Bowel Disease in a Mexican Tertiary Hospital Centre
Authors: Aleman Abitia Dassaev , Jesús López Goméz , Korely Trujillo de la Fuente , Navarro Gerrard Christian , Jhonatan Aguilar Hernandez , Gabriel Klimek Albarrán , Diana Bringas Vásquez , Rodolfo Ramirez del Pilar , Carlos Paredes Amenabar , Salamanca García Moisés , Ramos Gómez Mayra , Cortes Espinosa Tomas 
Published: December 2019

BACKGROUND:
Inflammatory Bowel Disease (IBD) is a group of disorders that are characterized by chronic or recurrent immune activation and inflammation of the digestive tract. The two main forms of IBD are Crohn's disease (CD) and Ulcerative Colitis (UC), both share many clinical and epidemiological characteristics, indicating that the underlying etiopathogenesis may be similar. Even though both illnesses are very different, with divergent treatment and prognosis, from a clinical point of view Crohn's disease cannot be distinguished from UC in approximately 10% of cases, in this particular case the disease is referred to as indeterminate colitis. There are many investigations that relate the use of applied biotechnology (antiTNF) and its immunomodulatory response at the histological level in the treatment of inflammatory bowel disease, however this therapeutic effect has never been reported in the Mexican population.

METHODS:
Objective: To correlate the use of antiTNF drugs and their effect at histological levels in inflammatory bowel disease in patients treated in the gastroenterology ward of the Centro Medico Nacional 20 de Noviembre. Observational, analytical and retrospective study. For qualitative variables, total values and percentages will be used, for quantitative variables central tendency measures such as mean and standard or median deviation will be used with minimum and maximum, as the case may be, according to normality tests (Shapiro-Wilck and kolmogorov-Smirnov). For the intragroup correlation analysis of histological activity and use of anti-TNF in patients with inflammatory bowel disease, Wilcoxon and McNemar test will be used according to the type of variable. The values of p < 0.05 will be considered statistically significant.

RESULTS:
A total of 18 patients with Crohn's disease in which 61.1% were of male sex and a total of 27 patients had UC of which 51.9% were of female sex, were analysed. The most used anti-TNF in patients with Crohn's disease was Adalimumab and Certolizumab in an equitable percentage with 38.9%. On the other hand, infliximab was the least used, with 22.2%. In patients with UC, a predominance of infliximab was observed with 40.7%, followed by adalimumab with 33.3% and certolizumab with 25.9%. The disease activity determined by histopathology indicated that patients with Crohn's disease had mostly moderate histopathological activity indexes with 66.7% and severe only in 33.3%. More severe histopathological activity indexes predominated in UC with 74.1%.

CONCLUSION(S):
The correlation of histological activity and use of anti-TNF in patients with inflammatory bowel disease was demonstrated in this analysis. For IBD in our center, a very high response to biological management was found. However, it is much lower for adalimumab compared to infliximab and certolizumab, showing a significant difference with a “p” of 0.009 for Crohn’s and <0.001 for CUCI.