S114 Poster presentations of psoriasis), and 10 (8%), including 7 women, a RPM (all with severe and disabling polyarthralgia). Median ITL were 5.87 (range: 0.52 19.53) mg/mL in patients with CPM and 5.12 (0.00 49.12) mg/mL in those without (P = 0.560), and 1.9 (0.00 13.5) mg/mL in patients with RPM and 5.57 (0.00 49.12) mg/mL in those without (P= 0.058). ATI have been detected in 16 (13%) patients, including 3 with RPM (P = 0.128) and none with CPM (P = 0.605). In multivariate analysis, no predictive factor associated with CPM could be identified and, the sole factor associated with RPM was anti-nuclear antibodies >1/100 at inclusion. Conclusions: ITL and ATI levels were similar in patients developing IFX paradoxical manifestations. As suggested by elevated antinuclear antibodies, RPM could be related to an autoimmune disorder induced by IFX. P262 Patients with refractory pouchitis receiving adalimumab may avoid permanent ileostomy M. Ferrante 1 *, G. Van Assche 1 , S. Vermeire 1 , M. Noman 1 , G. De Hertogh 2 , A. Wolthuis 3 , F. Penninckx 3 , A. D’Hoore 3 , P. Rutgeerts 1 . 1 University Hospital Leuven, Department of Gastroenterology, Leuven, Belgium, 2 University Hospital Leuven, Department of Pathology, Leuven, Belgium, 3 University Hospital Leuven, Department of Abdominal Surgery, Leuven, Belgium Background: A substantial proportion of patients with ulcera- tive colitis (UC) undergoing proctocolectomy with ileal pouch- anal anastomosis (IPAA) develop debilitating complications of the pouch. Since clinical evidence for the use of adalimumab (ADA) in patients with refractory pouchitis is limited, we evaluated the efficacy of ADA in our tertiary referral centre. Methods: Since May 2008, 8 IPAA patients (3 female, median age 40 years) received treatment with ADA (in- duction 160/80 mg, maintenance 40 mg every other week) for chronic refractory pouchitis. Short-term clinical response was evaluated at week 10 and was defined as complete in case of cessation of diarrhoea, urgency, incontinence, blood loss and abdominal pain, and as partial in case of marked clinical improvement, but persisting symptoms. The modified pouchitis disease activity index (mPDAI) was calculated were available. All patients had undergone IPAA for intractable UC and developed pouchitis and chronic refractory pouchitis after a median (IQR) of 0.9 (0.7 2.0) and 3.6 (2.6 4.1) years, respectively. Three patients also developed a pouch fistula, 6 pre-pouch ileitis and 2 cuffitis. In none of the patients the diagnosis was changed to Crohn’s disease after revision of the colectomy specimen by a senior pathologist. Results: Prior to ADA, all 8 patients had been treated with antibiotics and infliximab (IFX), 2 with mesalazine, 7 with corticosteroids and 4 with immunomodulatory agents. Four patients who all had received IFX prior to surgery had to stop IFX after development of severe infusion reactions. The 4 other patients lost response after a median (range) of 17 (11 39) months on maintenance IFX. After 10 weeks on ADA therapy, 7/8 patients showed clinical response (5 partial and 2 complete). Median (IQR) C-reactive protein levels dropped from 12 (5 44) to 5 (1 7) mg/L (p = 0.063) and median (IQR) mPDAI dropped from 9 (9 10) to 4 (4 9) points (p = 0.102). After a median (IQR) follow-up of 13 (7 32) months, 2 patients had a sustained clinical response, while 6 needed dose escalation to ADA 40 mg every week. At the end of follow-up, six patients were clinically still benefitting from ADA therapy. Two needed pouchectomy with permanent ileostomy after 8 and 15 months, respectively. One patient developed a catheter sepsis under ADA therapy. Conclusions: ADA may be effective in IPAA patients with refractory pouchitis facing permanent ileostomy, but more data are required to conclude on its more generalized use. P263 Elaboration and validation of a questionnaire to evaluate patients satisfaction with healhtcare services: CACHE questionnaire F. Casellas 1 *, D. Ginard 2 , A. Torrej´ on Herrera 1 , I. Vera 3 . 1 Hospital Universitari Vall d’Hebron, Ciberehd, Barcelona, Spain, 2 Hospital Universitari Son Espases, Palma de Mallorca, Spain, 3 Hospital Universitario Puerta de Hierro, Majadahonda, Spain Background: The quality of life of patients with inflammatory bowel disease (IBD) is often considered in the centres in which they are treated. However, there is no tool to evaluate satisfaction of these patients with healthcare services. The aim of this study was to design and validate a questionnaire focused on evaluation of the IBD patient’s satisfaction with healthcare services. Methods: The CACHE questionnaire was developed in three steps: (i) literature review identifying a list of 37 items, (ii) focus group meeting with 5 experts to define the items and structure of the questionnaire, (iii) edition of the questionnaire and administration to a sample of 20 patients to evaluate their understanding of the items. The final version of the questionnaire (31 items) was used in the validation. An epidemiological, prospective, naturalistic, multicentre study (35 gastroenterologists) of adult patients with Crohn’s (CD) or Ulcerative Colitis (UC) was performed. All patients were controlled in hospital, had a disease evolution 1 year and were in treatment. Each patient had 3 visits (baseline, 2 months and 4 6 months). Results: The study included 327 patients (171 CD and 156 UC). Slightly more patients were men (53%). The mean (SD) age was 41 (13) years. Ninety one percent of patients answered all items on the questionnaire at the baseline visit. CACHE questionnaire consists in 31 items distributed in six dimensions (healthcare staff attention, doctor attention, facilities, information, accessibility to the centre and received support) which explained the 56% of the information variability. Results are scored in a scale from 0 (minimum satisfaction) to 100 (maximum satisfaction). Four percent of patients showed maximum satisfaction (100), and none reported no satisfaction. The mean overall score was 82 (11). The overall score did not correlate with clinical variables, but correlated with the waiting time in the consultation. The CACHE questionnaire showed good internal consistency (0.925). No statistically significant changes in the overall score of CACHE questionnaire between visits were shown. The effect size was 0.016. Conclusions: The CACHE questionnaire has been shown to be a valid and reliable tool to measure the satisfaction of IBD patients with health care services. The results obtained from the validation process indicated that CACHE is a useful tool for use both in routine clinical practice and clinical studies. P264 Cytokine ratios in Crohn’s disease clinical remission before and after the intake of a probiotic P. Nikolov 1 *, M. Baleva 2 . 1 St. Ivan Rilsky University Hospital, Sofia, Sofia, Bulgaria, 2 University Hospital Alexandrovska, Department of Clinical Immunology, Sofia, Bulgaria Background: There are only several studies discussing changes in a cytokine ratio in Crohn’s disease (CD) and they are all focused on the ratio between the anti-inflammatory IL-1 receptor antagonist and the pro-inflammatory IL-1-beta (IL-1ra/IL-1-beta ratio). We could not find any reports discussing changes in cytokine ratios modified by probiotics in CD clinical remission. The aim of our study was to investigate the changes and the correlations between the ratios of the anti- inflammatory IL-10, IL-13 and the pro-inflammatory IL-8, IL-12 and IFN-gamma in CD clinical remission before and after the intake of a probiotic. Downloaded from https://academic.oup.com/ecco-jcc/article/6/Supplement_1/S114/368170 by guest on 03 March 2023