AGA Abstracts pouchitis and enteropathy associated arthritis underwent a 1 month trial of doxycycline 100 mg BID after failing a cyclical regimen of ciprofloxacin and metronidazole. On average, within seven days their clinical symptoms improved, approximately 3 days faster than the standard therapy. Their stools became more formed and decreased in number. They all began a “sterile diet” in which raw fruits and vegetables were avoided to prevent recolonization with enterococcus. Two of the three were able to stop methotrexate and adalimumab for arthritic complaints. All of the patients had drastic improvement in their pouchitis disease activity score at 3 months. The remaining three patients had ulcerative colitis and a spondy- loarthropathy treated with anti- tnf's. All of the patient's arthritic symptoms improved on the diet/doxycycline and two of three had improvement in their gastrointestinal symptoms, quantitated by a modified mayo clinic score. The most novel aspect to this new approach tries to reduce or even eliminate alimentary exposure to EC, stressing cooked food which presumably kills the bacteria. Resistant EC could limit this treatment. The possibility of multiple organisms causing IBD could lessen the efficacy of this approach. The risks of prolonged use of a cooked diet absent in fresh fruits and vegetables are unknown. We have no stool culture data to date, however quantitative microarray analysis of the intestinal flora before and after antibiotics are underway. The major innovation in this work is not in replacing traditional antibiotics which do work, but in explaining why patients relapse after stopping them. W1146 The Corticosteroid-Sparing Effect of Infliximab in Inflammatory Bowel Disease Patients Evelien Bultman, Ernst J. Kuipers, Christien J. van der Woude INTRODUCTION AND AIM: The TNF antagonist infliximab (IFX) is effective in inducing remission in patients (pts) with inflammatory bowel diseases (IBD), and is thought to have a corticosteroid-sparing effect (CSE). Corticosteroids are often used in the treatment of pts with IBD. Their use however has been associated with side effects. Common serious side effects include severe infections in the short term and osteoporosis in the long term. When several immunosuppressives are combined, the frequency of serious side effects increases. Therefore, it is important to completely withdraw steroids. Few studies have assessed the CSE of IFX as primary outcome taking complete withdrawal and initiation of steroids during follow-up into account. This study therefore aimed to evaluate the systemic steroid-sparing effect of IFX in IBD pts in a single centre cohort. METHODS: Medical records of pts treated with IFX between January 2003 and January 2007were reviewed. Demographics, disease characteristics and response were assessed. Pts had to be treated with IFX for luminal Crohn's Disease (CD) or Ulcerative colitis (UC). Treatment schedules could be induction or maintenance therapy. We evaluated whether or not pts could discontinue steroids com- pletely, and whether or not pts needed initiation with systemic steroids after IFX therapy. RESULTS: In total 157 pts received IFX for the following indications: fistulizing CD 39% (61/157) and luminal CD and UC 61% (96/157). Of the latter group 39 pts (M/F 20/19, CD/UC 31/8, mean age 33 yrs (range 16-69yrs)) fulfilled the criteria for inclusion. Mean disease duration was 10 yrs (range 1-42 yrs) and mean follow-up from the start of IFX treatment was 32.9 months (6-63). Patients were on the following concomitant medication: corticosteroids 69% (27/39), immunosuppressives 82% (32/39), 5-ASA 28% (11/39) and no medication 8% (3/39). Corticosteroids could not be discontinued during follow up in 59% (16/27). There was no difference with respect to sex, age, type of disease, concomitant medication and disease duration between the patients who could and could not discontinue steroids. However, there was a difference in response to IFX; a larger proportion of patients who could discontinue steroids had a response to IFX (80%) compared to the proportion of patients who could not discontinue steroids (36%). In addition, three patients (25%, 3/ 12) who initially were not on steroids required steroid treatment during follow-up. CONCLU- SION: In this retrospective analysis of a single centre cohort, IFX was limited effective in discontinuing steroids. Therefore it might be necessary to adjust IFX treatment strategy for pts on systemic steroids. W1147 Treatment with Elemental Improves Symptoms of Chronic Pouchitis Following Ileal Pouch-Anal Anastomosis for Ulcerative Colitis Simon D. McLaughlin, Alison Culkin, Susan K. Clark, liljana petrovska, Paris P. Tekkis, Paul J. Ciclitira, Kevin Whelan, Ralph. J. Nicholls Background: Treatment resistant chronic pouchitis causes significant morbidity. Elemental diet (ED) is effective treatment for Crohn's disease. Since pouchitis shares some similarities to Crohn's disease we hypothesised that ED may be an effective treatment. Method: 7 ulcerative colitis chronic pouchitis patients were studied. Exclusion criteria were recent NSAIDs, antibiotics or probiotics. Sufficient ED to achieve energy requirements was provided. Flexible-pouchoscopy, and the Cleveland Global Quality of Life score (CGQoL), Pouch Disease Activity Index (PDAI), and BMI were recorded at baseline and following 28d ED. Data were analysed with a paired t-test. Results: The mean CGQoL score increased from 0.47 to 0.54, Mean stool frequency decreased from 14 to 8, the clinical PDAI decreased from 9 to 7, BMI decreased from 24.6 to 23.4. Conclusion: Patients with chronic pouchitis tolerate ED, resulting in a significant reduction in stool frequency (p=0.03). Its effect on QoL and clinical PDAI (p=0.3) requires further investigation; some patients achieved signific- ant clinical benefit. Endoscopic healing did not occur, similar to some patients who achieve symptomatic remission with antibiotics(1). These preliminary data suggest ED may be efficacious in some patients who are intolerant of or resistant to antibiotics. Further research is warranted. Reference List (1) Madden MV, McIntyre AS, Nicholls RJ. Double-blind cross- over trial of metronidazole versus placebo in chronic unremitting pouchitis. Dig Dis Sci 1994;39(6):1193-6. A-664 AGA Abstracts W1148 Mesenchymal Stem Cells Administered via Novel Selective Mesenteric Artery Cannulation for the Treatment of Severe Refractory Crohn'sDisease Lotte C. Dinesen, Amu Wang, Fabrizio Vianello, Nicholas P. Tait, Edward Leen, John Davis, Francesco Dazzi, Subrata Ghosh Background: Mesenchymal stem cells (MSC) are a population of stromal origin that, in adult life, resides primarily in the bone marrow. MSC have the ability to self-renew and differentiate into tissues of mesodermal origin and produce a potent immunosuppressive effect. Recent results from multicentre clinical trials have described the successful use of MSC in severe graft-versus-host disease (GvHD), in which 60% of patients obtained complete durable remission with no toxicity. We tested their therapeutic potential in a patient with refractory Crohn's disease. We administered MSC for the first time via selective mesenteric artery cannulation to ensure that the cells reached their target. Method: A 35 year old gentleman with severe refractory fistulizing Crohn's disease failing all conventional therapies, biological therapies and surgical defunctioning ileostomy received mesenchymal stem cells from a haplo-identical donor, after informed consent. MSC were injected after catheterisation of the mesenteric artery via the femoral route. Patient received 105/Kg MSC and 4 weeks later a second dose of 106/Kg. Patient was subject to antibiotic prophylaxis for 2 days before and 5 days after MSC infusion with ciprofloxacin. The patient was monitored with MRI and microbubble ultrasonography. The primary read-out of clinical response was CDAI (Crohn's disease activity index) and CRP. Results: The MSC infusion was uneventful and well tolerated. CDAI pre treatment was 384 and dropped to 258 two weeks after the first infusion and remained as such at the time of the second infusion administered after 4 weeks. Three weeks after second infusion the CDAI was further reduced (212), thus making a total fall of 172 points (45% drop). CRP fell from 32mg/dl pre-treatment to 10mg/dl post-treatment. Peri- pheral blood Beta7+ CD8+CD45RO T lymphocytes fell from 12% pre-treatment to 2% six hours post treatment and CD4+CD25+FoxP3 Treg cells fell from 9% pre-treatment to 1% six hours post-treatment suggestive of alteration of gut lymphocyte trafficking. His MRI abdomen/ pelvis pre vs post MSC treatment showed slight changes in the transphincteric fistulae on the right, with an unchanged horseshoe intersphincteric extension on the left side. No side effects have been recorded so far, 14 weeks after the last MSC infusion. Conclusion: Our data suggest that MSC administered directly via novel selective mesenteric route is well tolerated may produce clinical benefits in severe refractory Crohn's Disease. These encouraging preliminary data support the need for further studies. W1149 Response Rate to Oral Corticosteroids Therapy in Patients with Crohn's Disease and Its Clinical Predictive Factors Duk Hwan Kim, Jae Hee Cheon, Chang Mo Moon, Jae Jun Park, Song Yi Han, Eun Soo Kim, TAE IL KIM, Won Ho Kim Objectives: The aim of this study was to determine the natural course of Crohn's disease patients who were first treated with oral corticocorticosteroids, and to find the predictive factors that can indicate their responsiveness to such corticosteroids therapy. Methods: Among patients with active Crohn's disease diagnosed and treated at a single center, those who had been treated with oral corticosteroids from August, 1994 to February, 2008 were enrolled and their medical records were retrospectively reviewed. Clinical outcome was evaluated every 1 month, 4 months, and 1 year after treatment. The clinical and biochemical parameters were compared between patients who showed responses to corticosteroids treat- ment and those who did not. Results: A total of 96 patients were enrolled from 239 patients with Crohn's disease. There were 75 males, and the median age at diagnosis was 23 years (12-64). The most common location of Crohn's disease was the ileocolon (65.6%) by Vienna classification and the most common behavior type was the non-stricturing, non-penetrating type (55.2%). The median dosage of corticosteroids was 0.59 mg/kg (0.31-0.95). There were 37 cases with complete remission (38.5%), 48 with partial remission (50.0%), and 11 patients (11.5%) showed no response to oral corticosteroids therapy after 1 month post- treatment. After 4 months from the treatment, 68 (71.6%) showed prolonged response, 20 (21.1%) showed corticosteroids dependency, and 7 (7.4%) showed refractoriness, respect- ively. After 1 year from the treatment, 49 (58.3%) patients showed prolonged response, 19 (22.6%), corticosteroids dependency, and 16, refractoriness (19.0%). There were no signific- ant differences between corticosteroids responders and non-responders in any parameters except in the Crohn's disease activity index (CDAI) (p=0.007/0.000/0.010, 1 month/4 month/ 1 year after treatment). Conclusion: Short-term response rate to initial oral corticosteroids therapy in Crohn's disease was high (88.5% after 1 month from treatment), but the responses showed tendency along with time (58.3% after 1 year from treatment). CDAI was significantly higher in corticosteroids non-responders than corticosteroids responders.