bluuebunny/crossref_metadata_2025 huggingface dataset:
P105 PREDICTIVE FACTORS FOR DEVELOPING SMALL BOWEL OBSTRUCTIONS AFTER ILEAL RESECTION IN PATIENTS WITH CROHN’S DISEASE
Authors: Mulgund Aditi , Patel Nedhi , Schwartz Michael , Beniwal-Patel Poonam , Amir Patel , Stein Daniel , Otterson Mary , Yarur Andres
Published: January 2020

Background and Aims

Patients with Crohn’s disease (CD) may require small bowel resections. Unfortunately, some of these patients may develop post-operative small bowel obstructions (SBO). Many clinicians perceive ileal resections dramatically increase the risk of developing SBO in the future, but the incidence and risk factors to developing SBO are poorly described. The primary aim of this study is to document the incidence and factors associated with the development of SBO not related to recurrence of disease in CD patients that undergo ileal resection. We also sought to assess long-term outcomes of this complication.

Methods

We performed a retrospective cohort study including patients aged 18 years or older with CD, who have had ileocecal resection with ileocolonic anastomosis or segmental small bowel resection. Data abstracted included demographics, phenotype and therapies of CD, disease recurrence post-ileal resection and multiple surgical variables. The primary outcome was the development of SBO within 5 years post-surgery not including obstructions secondary to recurrence of CD.

Results

92 total patients were included in the analysis. All had a colonoscopy within a year of the surgery. The mean Rutgeerts score was 0 (interquartile range [IQR] 0 to 2) and the mean short endoscopic score was 0 (IQR 0 to 4). The remainder of baseline characteristics are shown in Table 1. At 6 months, 1 year, and 5 years, the rate of SBO was 4/92 (4%), 6/92 (6.5%), and 15/92 (16%), respectively. Throughout follow-up, only 5 patients had an SBO attributed to intra-abdominal adhesions and only 2 patients required surgical lysis of adhesions. Patients that were found to have histologic inflammation in the margins of the resected bowel specimen had a significantly higher chance of developing an SBO within 5 years of the initial surgery (OR: 4.5 [95%CI: 1.3–15.3], p=0.02 - Table 2). Conversely, patients with either active endoscopic and/or radiologic inflammation on post surgical surveillance colonoscopy did not have a higher risk of developing an SBO within 5 years of the initial surgery (p=0.37). Finally the length of bowel resected at the index surgery was not associated with the development of an SBO (AUC: 0.62, p=0.18).

Conclusions

The incidence of SBO after ileal resection in CD is low and resolves with medical management on most cases. Inflammation in the margins of the resected bowel and previous bowel resections were associated with new SBO within 5 years. These results must take into account the study population were monitored and cannot be extrapolated to those patients that lost follow-up.
P127 FACTORS ASSOCIATED WITH FECAL URGENCY IN INFLAMMATORY BOWEL DISEASE PATIENTS: A CROSS-SECTIONAL STUDY FROM SPARC IBD
Authors: Jajeh Hamzeh , Dawwas Ghadeer , Lewis James
Published: January 2020

Background

Fecal urgency among patients with inflammatory bowel disease (IBD) can lead to psychological, functional, and social distress. Factors associated with urgency remain poorly understood.

Objective

To examine the association between urgency and fecal calprotectin concentration, rectal bleeding, stool frequency, perianal disease, rectal involvement, and disease duration.

Methods

The results are based on data obtained from the IBD Plexus program of the Crohn’s & Colitis Foundation. This cross-sectional study used data from Study of a Prospective Adult Research Cohort with IBD (SPARC IBD), a multicenter longitudinal study. We included patients with an urgency score at their first study visit. Urgency was rated on a 5-point Likert scale from no to severe urgency. The Kruskal-Wallis test was used to compare fecal calprotectin levels across fecal urgency scores. Logistic regression models were used to evaluate the association of fecal urgency with the amount of rectal bleeding, stool frequency, perianal disease (for Crohn’s disease (CD)), disease involving the rectum (for CD), disease duration, while adjusting for age and gender in each model.

Results

2289 patients were included (54% female, 67% CD, mean age 43). The fecal calprotectin concentration was significantly associated with fecal urgency scores (P-value= 0.01). In adjusted models of the overall population, CD vs UC was not associated with urgency (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.70–1.13). Fecal urgency was associated with stool frequency (> 4 stools more than normal, OR 2.49; 95% CI 1.46–4.25) but not amount of bleeding. Among patients with CD, perianal disease (OR, 3.40; 95% CI, 1.18–9.79) was associated with fecal urgency.

Conclusion

In this study of patients in SPARC IBD, factors associated with fecal urgency were fecal calprotectin levels, stool frequency, and perianal disease.
P128 INCIDENCE AND OUTCOMES OF HOME PARENTERAL NUTRITION IN PATIENTS WITH CROHN’S DISEASE IN OMLSTED COUNTY, MINNESOTA, USA
Authors: Bakhshi Zeinab , Yadav Siddhant , Harmsen William , Tremaine William , Salonen Bradley , Bonnes Sara , Loftus Edward
Published: January 2020

Introduction

Patients (pts) with Crohn’s disease (CD) undergoing multiple surgeries are at risk of extensive bowel resections, short bowel syndrome (SBS) and malnutrition and may need home parenteral nutrition (HPN). The aim of our study was to estimate the incidence of HPN use in pts with CD in a population-based cohort, and to assess clinical outcomes and complications associated with nutritional intervention.

Methods

This study was a retrospective population-based cohort using Rochester Epidemiology Project to identify pts who were diagnosed with CD between 1970 and 2011 in Olmsted County, MN. To identify the individuals who required HPN, these Pts were crossed against the list of those who enrolled in the local HPN program. Descriptive statistics were used to evaluate incidence and clinical outcomes.

Results

Four hundred twenty nine pts with CD were diagnosed in Olmsted County between 1970 and 2011. Of these, 14 received HPN between 1992 and 2018. The pts were followed for a median of 16.85 years after diagnosis of CD (interquartile (IQR), 12.25–24.70) and required HPN a median of 7.67 years after diagnosis (IQR,1.6–15.89). Among the 14 receiving HPN, 85.71% were females. Eleven (78.57%) had moderate to severe CD and 12 (85.71%) pts involved with fistulizing disease. Crohn’s disease involved the ileum in 92.86%, colon in 71.43%, and proximal GI in 14.29% of the pts. Thirteen (92.86%) pts underwent surgery primarily due to obstruction (84.62%). Other indication included: failure of medical therapy (46.15%), fistulizing disease (46.15%), severe pain (30.77%), abdominal abscess (23.08%), bleeding (15.38%), and necrosis (15.38%). Median number of bowel resections was 4 (range, 0–7). Twelve pts (85.71%) had a stoma placed.

The median duration of HPN was 2.48 years (range, 0.11–16.36). Indications for HPN included SBS in 64.28%, malnutrition in 28.57% and bowel rest in 21.43%. The mean number of hospitalizations after the start of HPN was 5 (range, 0–20). Catheter-related bloodstream infections occurred in 10 (71.43%) pts, and 3 (21.43%) had a thrombosis. Four pts had osteoporosis and 2 had osteopenia. Parenteral nutrition-associated liver disease occurred in 2 (14.29%) of pts. The pts’ body weight increased a median of 2.5 kilograms (kg) 6 months after the start of HPN but decreased a median of 1 kg at 12 months. Four (30.77%) pts were on HPN at time of last follow-up. Five (35.71%) pts deceased mainly due to CD.

Conclusion

Less than 4% of pts with CD need HPN. Most pts on HPN have moderate to severe disease who have undergone extensive bowel resection with resultant SBS and malnutrition. Approximately 70% were able to discontinue HPN. Interestingly, after 6 months, pts lost most of the weight they gained during the first 6 months of HPN. It was possible that this was due to noncompliance, or increased metabolic needs because of active disease.
P130 LEADING CAUSES OF MORTALITY IN INFLAMMATORY BOWEL DISEASE: A NATIONWIDE ANALYSIS
Authors: Weber Andrew , Sauk Jenny , Limketkai Berkeley
Published: January 2020

Background

Patients with inflammatory bowel diseases (IBD) often ask whether their condition would affect their life span. However, available data are sparse. The aims of this study were to compare the ages of death between patients with and without IBD and to determine the leading causes of death amongst inpatients with IBD in a large nationwide database.

Methods

The Nationwide Readmissions Database (NRD) provides a nationally representative sampling of patient-linked hospitalizations throughout the United States. For years 2010 through 2016, we identified individuals with Crohn’s disease (CD) or ulcerative colitis (UC) based on International Classification of Diseases-Clinical Modification codes, ninth and tenth revisions (ICD-9, ICD-10). The mean age of death was compared between IBD and non-IBD inpatients. Cluster analyses were used to evaluate the leading causes of death among IBD patients based on the associated codes in the first three diagnosis positions.

Results

Between 2010 and 2016, there were 934,331 CD and 623,596 UC patients admitted. There were more deaths associated with UC than CD (3.11% vs. 1.72%; P <0.01) (Figure 1). Amongst CD patients, the average age of death was 68.2 years, compared to 70.5 years for non-IBD patients (P <0.01). For UC patients, the average age of death was 71.9 years, compared to 70.5 years for non-IBD patients (P <0.01). The most frequent diagnoses for CD patients who died while hospitalized were sepsis (31.1%), respiratory failure (13.0%), and fluid electrolyte and acid-base disorders (12.5%) (Table 1). Interestingly, motor vehicle accidents were associated with a significant number of deaths among CD patients (7.0%). Pre-defined diagnoses of interest associated with death included myocardial infarction (3.3%), deep vein thrombosis/pulmonary embolism (2.0%), and malignancy (6.7%). Diagnoses most frequently noted in UC patient who died while inpatient included sepsis (43.4%), fluid electrolyte and acid-base disorders (13.6%), and respiratory failure (10.9%). Similarly to CD, motor vehicle accidents were again associated with a significant number of UC deaths (5.5%). Pre-defined diagnoses associated with death in UC included myocardial infarction (3.5%), deep vein thrombosis/pulmonary embolism (2.0%), and malignancy (5.8%).

Conclusions

In a large nationally representative database of hospitalized patients, although those with CD and UC were found to have statistically significant differences in age at death when compared with the general population, the absolute differences were small. Diagnoses most frequently associated with inpatient mortality were sepsis, respiratory failure, and fluid electrolyte and acid-base disorders. There was also a large number of motor vehicle-related deaths among IBD patients.
P144
IN SILICO IDENTIFICATION OF PUTATITVE CLAUDIN CHANNEL BLOCKERS
Authors: Wu Emma , Samanta Priyanka , Li Ye , Shen Le , Khalili Fatemeh , Weber Christopher
Published: January 2020

Compromised epithelial barrier function is known to be associated with inflammatory bowel disease (IBD) and may contribute to disease development. One mechanism of barrier dysfunction is increased expression of paracellular tight junction ion and water channels formed by claudins. Claudin-2 and -15 are two such channels. We hypothesize that blocking these channels could be a viable therapeutic approach to treat diarrhea in IBD. In an effort to develop blockers of these channels, we turn to our previously developed and validated in silico models of claudin-15 (Samanta et al. 2018). We reasoned that molecules that can bind with the interior of claudin pores can limit paracellular water and ion flux. Thus, we used docking algorithms to search for putative drugs that bind in the claudin-15 pore. AutoDock Vina (Scripps Research Institute) was initially used to assess rigid docking using small molecule ligand databases. The ligands were analyzed based on binding affinity to the pore and visualized using VMD (University of Illinois at Urbana-Champaign) for their potential blockage of the channel. Overall, a total of eight candidate ligands from the databases were identified: three from the UICentre database of 10000 ligands, one chemically similar structure identified in another online database (Chemspider), and four which are modifications on the chemical structure generated using ChemDraw. The analysis revealed that the eight ligands were docked in two predominant positions. In the first position, the ligands with more rings docked in an almost linear fashion and interacted with both D55 and D64 pore residues. In the second position of binding, the ligands were more flexible and could hence fold to interact only with D55 residues, thus biding predominantly in the center of the pores. To further evaluate these ligands, we will now turn to 1) flexible claudin-15 docking studies, 2) molecular dynamic simulations and, 3) in vitro measurements using monolayers induced to express claudin -15 and claudin-15 mutants. We also developed a claudin-2 homology model on which we will perform docking studies and in vitro measurements, which we expect will result in similar candidate ligands for blocking claudin-2. Finally, other databases will be analyzed for potential ligand blockers of claudin-2 and -15.
19 ROLE OF IL-33 IN PURINE METABOLISM AND ILC2 ACTIVATION DURING COLITIS-ASSOCIATED CANCER
Authors: De Salvo Carlo , Buela Kristine-Ann , Havran Hannah , Pizarro Theresa
Published: January 2020

UC patients have an increased risk of developing colorectal cancer, however, the immune cells and cytokines that mediate the transition from intestinal inflammation to cancer are poorly understood. Mucosal IL-33 is increased in UC patients, in addition, IL-33 and its receptor, ST2, are expressed in polyps in AOM/DSS models of colitis-associated cancer (CAC). Therefore, several studies have implicated IL-33, which is also an important activator of Innate Lymphoid Cells type 2 (ILC2s), in the formation of tumors. Moreover, it has been shown that ecto-5’-nucleotidase (CD73), critical ectoenzyme in purine metabolism which hydrolyzes extracellular AMP to adenosine, is upregulated in cancerous tissues, and an incompetent purine metabolic pathway has been associated with inflammation and inappropriate resolution in numerous inflammatory diseases, including IBD. In order to induce colitis-associated polyposis, we performed AOM/DSS protocol on 10-wk-old C57BL/6, IL-33KO and CD73KO mice as follow: the carcinogen Azoxymethane (AOM) was injected intraperitoneally (i.p.) on day 0. After two weeks, 3% dextran sodium sulfate (DSS) was administered in drinking water for a week, followed by two weeks of recovery with normal water. DSS administration and recovery was repeated one more time before euthanizing mice for tissue collection and analysis. Flow cytometry analysis showed that all ILC2s, and more specifically CD73 expressing ILC2s were significantly decreased in mesenteric lymph nodes (MLNs) of AOM/DSS treated mice lacking IL-33, compared to WT, on the other hand, CD73 deficient mice displayed a strongly reduced number of polyps compared to WT and flow cytometry revealed an ST2 expressing ILC2 cell population that was markedly reduced in CD73 deficient mice in comparison to WT. We next injected AOM/DSS treated C57BL/6 mice with either inhibitor of CD73 or sodium polyoxotungstate 1 (POM-1) CD39 inhibitor, therefore targeting the key enzymes in the purine metabolism pathway. We injected the mice i.p. with 10 mg per Kg body weight per day of either compounds or PBS, every day during the 2 weeks of DSS, to mimic a possible therapeutic treatment to prevent purine metabolism-depentent CAC. Histologic investigation of colon tissues isolated from mice treated with CD39 or CD73 inhibitors showed a significant decrease in inflammation and polyp numbers compared to vehicle-treated mice.

The data so far collected suggest that a cell population of CD73 expressing ILC2s is involved in polyp formation in AOM/DSS-treated mice and that ILC2s expansion and activity depends on IL-33/ST2 and purine metabolism synergy. Therefore the possibility exists that blockade of IL-33/ST2 axis and purine metabolism might be effective in reducing ILC2s expansion and thus be beneficial in preventing or reducing early events promoting CAC.
P071 MODULATION OF THE MUCUS LAYER BY BIFIDOBACTERIUM DENTIUM PROVIDES PROTECTION IN A MODEL OF COLITIS
Authors: Engevik Melinda , Ruan Wenly , Ihekweazu Faith , Versalovic James
Published: January 2020

Background

The intestinal mucus layer serves as a critical interface between the environment and the host. Patients with inflammatory bowel disease (IBD), particularly ulcerative colitis, exhibit reduced synthesis and secretion of the mucus protein MUC2 and decreased mucus thickness. This in turn promotes immune activation and inflammation. The clinical relevance of the mucus layer emphasizes the need to address strategies to modulate this barrier. Although bifidobacteria represent only 3–6% of the healthy adult fecal microbiota, their presence has been associated with numerous health benefits, including bolstering mucus production. However, the molecular mechanisms that underlie these positive effects appear to be strain-specific and are not well defined. We hypothesized that the human-derived Bifidobacterium dentium would increase intestinal mucus synthesis and expulsion via specific metabolites. We also speculated that modulation of goblet cells would be beneficial during colitis.

Methods & Results

In silico genome analysis revealed that B. dentium lacked the enzymatic repertoire required for degradation of mucin glycans. Consistent with these findings, we found that B. dentium could not use mucin glycans as a primary carbon source in vitro. To examine mucus modulation in vivo, germ-free mice were mono-associated with live or heat-killed B. dentium. Live B. dentium mono-associated mice exhibited increased colonic expression of goblet cell markers Krüppel-Like Factor 4 (Klf4), Relmβ, trefoil factor 3 (Tff3), Muc2, and several mucin glycosyltransferases compared to both heat-killed B. dentium and germ-free counterparts. Likewise, live B. dentium mono-associated colon had increased acidic mucin-filled goblet cells as denoted by MUC2 and PAS-AB staining. In vitro, B. dentium secreted products, including acetate, were able to increase MUC2 levels in T84 cells, mouse colonoids and human colonoids. We also identified that B. dentium secreted products, such as GABA, stimulated autophagy-mediated calcium signaling and MUC2 release. To identify whether B. dentium could enhance MUC2 production in mice harboring a complete microbiota, specific pathogen free mice were treated with live B. dentium by oral gavage. Administration of B. dentium increased the inner mucus layer compared to controls. Moreover, in a TNBS model of colitis, B. dentium treated mice had increased goblet cell numbers and MUC2 mRNA. Mirroring these findings, B. dentium treated mice lost less weight, had improved histology and had decreased levels of TNF, KC (IL-8), and IL-6.

Conclusions

This work illustrates that B. dentium enhances the intestinal mucus layer and goblet cell function via upregulation of gene expression and autophagy signaling pathways with a net increase in mucin production. Ultimately, these pathways may be targeted for the development of novel therapeutics.
P168 BACTEROIDETES SPECIES ARE USEFUL BIOMARKER OF CLINICAL ACTIVITY IN ULCERATIVE COLITIS
Authors: Nomura Kei , Ishikawa Dai , Okahara Koki , Ito Shoko , Takahashi Masahito , Haga Keiichi , Shibuya Tomoyoshi , Kobayashi Osamu , Nagahara Akihito
Published: January 2020

Background

We previously reported that there were 13 species of Bacteroidetes phylum with significantly higher or lower relative abundance in patients with ulcerative colitis (UC) than healthy individuals. In this study, we investigated the correlation between Bacteroidetes species components in fecal samples and clinical evaluations of UC.

Method

This study included participants above 20 years of age. Fecal samples were collected for microbial analysis from 54 patients who had active UC based on a Lichtiger’s clinical activity index (CAI) ≥ 4 or an endoscopic Mayo clinic score ≥1. DNA was extracted from the fecal samples and analyzed by next-generation sequencing (the Illumina MiSeq sequencing system) targeting hsp60. We verified associations between Bacteroidetes species and eMayo sum score (total of endoscopic Mayo clinic scores in each intestine: periphery of appendix vermiformis, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum), Robarts Histopathology Index (RHI), and CAI.

Results

Bacteroides uniformis (R = -0.44, p = 0.002) and four others significantly correlated with eMayo sum score. Alistipes shahii (R = -0.35, p = 0.02) and three others significantly correlated with RHI. Bacteroides rodentium (R = -0.37, p = 0.006) and two others significantly correlated with CAI. Furthermore, three Bacteroidetes species (Bacteroides stercoris, Bacteroides uniformis, and Parabacteroides merdae) correlated with two of three clinical evaluations, and the total relative abundance of these three species showed stronger correlation with eMayo sum score (R = -0.52, p = 0.00007).

Conclusion

All eight Bacteroidetes species identified in this study represented negative correlation with the clinical activity, so these species are suggested to be lost by exacerbation. Bacteroidetes species, especially total relative abundance of three Bacteroidetes species (Bacteroides stercoris, Bacteroides uniformis, and Parabacteroides merdae) may become a biomarker for evaluating the clinical activity of UC.
3 MECHANSISMS OF INTESTINAL FUNGI RECOGNITION AND CONTROL
Authors: Leonardi Irina , Iliev Iliyan
Published: January 2020

Background and Objectives

Intestinal fungal communities are perturbed in several autoimmune diseases and have been shown to influence disease outcome. We have shown that intestinal resident CX3CR1+ mononuclear phagocytes (MNPs) can sense gut fungi and are crucial for the initiation of immune responses both locally and at distant sites. These results suggest that recognition of fungi by gut phagocytes might be involved in the pathogenesis of immune-related diseases such as IBD. Despite the identification of a few molecules involved in the recognition and immunity to intestinal fungi the cellular mechanisms governing the initiation and regulation of the mucosal immune responses to the mycobiota remain unknown. We sought to identify the functional role of distinct phagocytic subsets in the response to fungal communities in the gut during health and intestinal disease.

Methods

We used Candida albicans, the main opportunistic fungus found in IBD patients, as model fungal colonizer, with a focus on the mechanisms mediating the adaptive response. To elucidate the mechanisms and consequences of the recognition of fungi by phagocytic subsets in the lamina propria we used genetic models of depletion and deletion of specific subtypes of phagocytes. We further targeted fungal recognition and antigen presentation in phagocytes to investigate the mechanisms leading to the induction of adaptive anti-fungal responses.

Results

C. albicans colonization induced a consistent increase in Th17 cells in the intestinal mucosa that was decreased upon depletion of CX3CR1+ MNPs. Genetic depletion of CX3CR1+ MNPs in mice led to changes in gut fungal communities and to severe chemically induced intestinal inflammation that was rescued by antifungal treatment. Recognition of fungi through a C-type lectin/Syk pathways and antigen presentation via MHC-II were necessary for the induction of adaptive T cell in responses to C. albicans colonization.

Conclusion

Our work aims at defining the role of CX3CR1+ MNPs and cDCs in the initiation of anti-fungal immune responses in the intestine at the steady state. We have demonstrated the essential role of CX3CR1+ MNPs in the initiation of antifungal responses in the intestine at steady state and for the control of fungi at steady state and during inflammation. We have demonstrated the importance of CX3CR1+ MNPs in the control of the intestinal mycobiota.
P004 A PERSPECTIVE ON PORTRAYAL: MEN AND MINORITIES ARE UNDER-REPRESENTED ON BIOLOGIC WEBSITES
Authors: Rao Vinay , Baumgartner Scott , Khan Ali , Borum Marie
Published: January 2020

Introduction

Biologics are important options for inflammatory bowel disease (IBD) management. It has been reported that people of color (POC) with IBD are less frequently prescribed biologics compared to whites. Drug manufacturers’ websites are often designed to improve patient awareness and understanding of medical conditions and treatment. There is a paucity of information evaluating racial minorities depicted on pharmaceutical websites focused on biologic therapy. This study evaluated minority representation on websites of common biologic therapies used for IBD.

Methods

Websites for 4 major biologics were evaluated (Humira, Remicade, Stelara, Entyvio) for minority representation. Stock photos and videos were analyzed. Individuals were categorized based upon perceived ethnicity (person of color [POC], racially ambiguous [RA], white), gender, and role (patient, provider). Individuals were categorized independently by 3 investigators. Repeat images, incomplete facial images, inactive background role in videos, or images in which there was disagreement among all investigators were excluded. Statistical analysis was performed using two-sample t-test with significance set at p<0.05.

Results

In the 4 websites, there were 102 total subjects (49 photos, 53 videos). There were 89 white, 11 POC, and 2 RA subjects with 33 males (32 white, 1 POC, 0 RA) and 69 females (57 white, 10 POC, 2 RA). There were significantly less POC compared to whites in photos (14.2% vs 81.6%; p=0.0003) and videos (7.0% vs 93.0%; p=0.001). Males were less frequently represented than females in photos (33.3% vs 66.7%; p=0.0096) and videos (32.3% vs 67.7%; p=0.0238). There were no males of color in photos. Humira portrayed 10 POC, Entyvio portrayed 1 POC and none were identified on Remicade and Stelara websites. Humira included 1 white, male provider, and Remicade 1 female POC provider. Stelara and Entyvio included no providers in either photos or videos. There were no images or videos about which all 3 reviewing investigators disagreed. All websites included at least 1 image with which a single investigator disagreed. Only Humira and Vedolizumab included a video with single investigator disagreement.

Discussion

Biologic therapy has a significant role in IBD treatment and should be considered for all IBD patients who have the appropriate indications. Pharmaceutical websites can have a role in increasing patient understanding and acceptance of therapy. Patients may have increased acceptance of treatment based upon portrayed images. While this study revealed that males and POC were significantly less represented on biologic websites, it may reflect gender and minority group IBD prevalence. However, consideration should be given to increase minority representation on biologic websites to enhance male and POC acceptance of therapeutic options and potentially improve clinical outcomes.
P005 A SURVEY STUDY OF GASTROENTEROLOGISTS’ VIEWS ON DYSPLASIA SURVEILLANCE AND CHROMOENDOSCOPY IN IBD
Authors: Grossberg Laurie , Farraye Francis , Papamichail Konstantinos , Cheifetz Adam , Feuerstein Joseph
Published: January 2020

Background

Patients with inflammatory bowel disease (IBD) have an increased risk of colon cancer. Current guidelines are equivocal in their recommendations for chromoendoscopy. The objective of this study is to assess gastroenterologists’ current attitudes and barriers toward chromoendoscopy in IBD.

Methods

A 23 question survey was distributed to members of the Crohn’s & Colitis Foundation via email. We collected physician characteristics, practice demographics, and data regarding chromoendoscopy use and barriers to chromoendoscopy.

Results

A total of 57 gastroenterologists from 22 US states [male, n=42 (74%); practicing in an academic university n=44 (77%)] met inclusion criteria. All respondents agree that patients with IBD involving more than 1/3 of the colon have increased risk of colon cancer. Most gastroenterologists agree that patients with extensive UC (100%), left-sided UC (80%), or Crohn’s involving more than 1/3 of the colon (98%) should be in a surveillance protocol, however, 37%, 9%, and 2% also believe that patients with distal ulcerative proctosigmoiditis, ulcerative proctitis, and ileal Crohn’s disease should be in a surveillance protocol respectively. All gastroenterologists perform surveillance in patients without other risk factors within 3 years, however the interval varies: 28% every year, 47% every 2 years, and 25% every 3 years. 61% believe that chromoendoscopy is the preferred method for dysplasia surveillance, but 72% use white light endoscopy most often for surveillance in their clinical practice. Two-thirds (38/57) of gastroenterologists reported ever performing chromoendoscopy. The most common reasons to use chromoendoscopy were history of dysplasia found on random biopsy (89%), history of nonpolypoid dysplasia (76%), or history of primary sclerosing cholangitis (76%). Only 8 gastroenterologists reported using chromoendoscopy for all IBD surveillance. Physicians agree that the top barriers to chromoendoscopy use include longer procedure time (43), lack of standardized training in chromoendoscopy (42), and lack of reimbursement for chromoendoscopy (36); however, most would be likely or very likely to use chromoendoscopy if data showed which patients would benefit most from chromoendoscopy (95%) and if data showed benefits of chromoendoscopy compared to other techniques (93%).

Conclusion

Most gastroenterologists believe that chromoendoscopy is the ideal method for IBD surveillance, yet white light endoscopy is used most often. Physicians agree that longer procedure times and lack of reimbursement deter chromoendoscopy use, but the majority would be willing to use chromoendoscopy if data showed superiority of chromoendoscopy compared to other techniques and identified patients that would benefit the most.
P001 PHARMACIST ROLE IN IBD MEDICATION OPTIMIZATION (PRIMO-IBD)
Authors: Kim Nari , Chu Chau , Tran Hai , Shane Rita , Melmed Gil
Published: January 2020

Introduction

Inflammatory bowel disease (IBD) is a chronic disease state with growing focus, due to its significant medical and economic health burden. Although targeted therapy against tumor necrosis factor (anti-TNF), interleukin receptors, and integrin receptors have established roles in ulcerative colitis and Crohn’s disease management, medication accessibility and literacy contribute to medication non-adherence. Non-adherence to IBD therapy is associated with 62% higher costs for hospitalizations, along with increased disease mortality, relapse, loss of response, and antibody formation. IBD centers recognize the collaborative importance of a pharmacist’s role in medication optimization, patient adherence, and transitions of care.

Methodology

From November 2017 - April 2018, patients discharged from the inpatient IBD Service received a post discharge follow-up (PDFU) call from a pharmacist within 72 hours. Concurrently, the pharmacist provided pharmacotherapy optimization and education during the 4 hour weekly clinic visits, followed by a call within 72 hours.

For all sites of care, the pharmacist performed a comprehensive evaluation for healthcare maintenance (including notable lab values, drug levels, and/or antibody levels), adherence to IBD medications, and drug interactions.

The primary outcome was 30-day readmissions. The secondary outcomes included the number and severity of drug-related problems (DRPs) identified, validated by two gastroenterologists.

Results

132 patients were included in the study (63 inpatient; 69 clinic). The inpatient 30-day readmission rate for the study period was 14.3% versus 22.1% in 2016 (P=0.15). In comparison, the 30-day hospitalization rate for clinic patients remained relatively unchanged.

123 DRPs were identified from 132 patients, averaging 0.93 DRPs per patient. There were 87 DRPs from the inpatient setting and 36 DRPs identified in clinic. Of the DRPs, 60% of DRPs were prescriber-related and 40% were patient-related. 2% (2 cases) were considered life-threatening, and 40% of cases were significant DRPs; the remaining DRPs were low risk. Potential admissions were avoided in 6 patients (11%) by early detection of a drug-related error.

Conclusion

Results demonstrate the opportunities for a pharmacist to be involved in managing biologics and health maintenance therapy in the IBD patient population. There was an overall positive trend of a pharmacist role on IBD admission rates and decrease in medication related errors.
P024 THE MORE YOU KNOW: YOUNGER IBD PATIENTS AND THOSE ON BIOLOGICS ARE MORE FREQUENTLY ASSESSED FOR HEALTH LITERACY
Authors: Baumgartner Scott , Basso Jessica , Szvarca Daniel , Tabbara Nadeem , Clarke Lindsay , Borum Marie
Published: January 2020

Background

Immunomodulator and biologic therapies are important options for individuals with moderate to severe inflammatory bowel disease (IBD). It is critical that IBD patients are aware of potential side effects of all medications. Health literacy can impact upon patients’ understanding of IBD management. This study evaluated the rate at which university gastroenterologists assess health literacy in IBD patients on immunomodulator and biologic treatment.

Methods

A retrospective chart review of all IBD patients seen in the gastroenterology clinic of a university medical center over a five-year period was performed. Patient age, gender, IBD diagnosis, medications (biologics, immunomodulators), and documented health literacy assessment were recorded. A database was generated using Microsoft Excel. Statistical analysis was performed using Fisher’s Exact Test with significance set at P<0.05. The study was approved by the institutional IRB.

Results

392 medical records were analyzed: There were 175 men and 217 women. The mean age was 44.3 years (range 20–82), with 259 (66.1%) <50 years. 278 (70.9%) had ulcerative colitis (UC), 96 (24.5%) Crohn’s disease (CD), 11 (2.8%) microscopic colitis, and 7 (1.8%) unspecified colitis. 48 were on biologics alone, 30 on biologics with an immunomodulator or aminosalicylate, 224 were on immunomodulators and / or an aminosalicylates and 90 were on other medication regimens. 18 (37.5%) on biologics and 14 (46.7%) on biologics with an immunomodulator or aminosalicylate, 63 (28.1%) on an immunomodulators and /or aminosalicylates and 15 (16.7%) on other medication regimens had a documented health literacy assessment. Patients on a biologic regimens were more often assessed for health literacy compared to those on immunomodulators and / or aminosalicylates (p=0.012) or other medication regimens (p=0.0005). Additionally, patients <50 years were assessed for health literacy more frequently than those >50 years (p=0.0008).

Discussion

Health literacy enables individuals to make informed medical decisions and follow treatment recommendations. It is important that individuals with IBD understand their medical regimens, especially those on immunomodulator and biologic therapy. This study revealed that health literacy was inconsistently documented, with patients <50 and those on biologics more frequently evaluated. While this study is limited based on upon size, retrospective design and reliance on literacy documentation, it supports recommendations that providers assess individuals’ understanding of their condition and treatment. Ensuring patients’ IBD health literacy will optimize clinical care and outcomes.
P047 PARENT PERSPECTIVES ON COMPREHENSIVE CARE FOR CHILDREN WITH INFLAMATORY BOWEL DISEASES: BUILDING A CARE DELIVERY MODEL FROM THE FAMILY UP
Authors: Michel Hilary , Kim Sandra , Siripong Nalyn , Noll Robert
Published: January 2020

Background

Patients with Inflammatory Bowel Diseases (IBD) require life-long management by gastroenterology (GI) and primary care providers (PCP). Guidelines exist outlining recommended healthcare services, but it is unclear which provider is responsible for which tasks, and what parents prefer.

Aims

To understand perceptions of healthcare quality and delivery for children with IBD, describe barriers to receiving comprehensive healthcare, and elicit preferences for how care would ideally be delivered.

Methods

Cross-sectional survey of parents of children ages 2–17 with IBD at a large, free-standing children’s hospital, recruited via an institutional research registry. Surveys assessed patient medical history, family demographics, perceptions of health care quality and delivery, barriers to primary and GI care, and preferences for care receipt.

Results

217 parents were recruited, 214 consented, and 161 completed the survey (75% response). Mean patient age 14 years (SD 3); 51% male; 80% Crohn’s, 16% ulcerative colitis, and 4% indeterminate colitis. Most parents were Caucasian (94%), had a bachelor’s degree or higher (61%), and lived in a suburban setting (57%). Most had private insurance (43%) or private primary and public secondary insurance (34%). Most parents (N=149, 94%) thought the GI doctor was responsible for their child’s IBD care, and 8 (6%) reported shared responsibility by the GI doctor and PCP. 113 (71%) said their child’s PCP was responsible for primary care, 8 (5%) said GI doctor, and 37 (23%) said both. 95% of parents were confident in their GI doctor’s primary care knowledge, and 81% with their PCP’s IBD knowledge. 89% were satisfied with their communication with the PCP, and 98% were satisfied with their communication with the GI doctor. 53% did not know how well their PCP and GI doctors were communicating with each other. Only 4% of parents reported unmet healthcare needs, but those who did cited inadequate family support and mental health services. The greatest barriers to PCP care were lack of continuity with providers (22%) and scheduling (24%). The greatest barriers to GI care were scheduling (38%) and traveling to appointments (29%). Parent preferences for specific health care service delivery are found in Figure 1.

Conclusions

Parents of children with IBD are satisfied with provider knowledge and communication skills with them, though most are unaware how well their PCP and GI doctor are communicating with each other. Healthcare needs are being met for most patients in our cohort, but parents cite different barriers to primary vs. specialty care, and mental health services in particular are lacking. Parents seem to support co-management between their child’s PCP and GI provider. Understanding parent perspectives is essential to the development of family-centered healthcare delivery models for children with IBD.
P048 QUALITY OF LIFE AND OTHER PATIENT REPORTED OUTCOMES IN PATIENTS WITH POUCHITIS
Authors: Barnes Edward , Long Millie , Raffals Laura , Zhang Xian , Vyas Anuj , Kappelman Michael , Sandler Robert , Herfarth Hans
Published: January 2020

Background

While restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical approach in patients with medically refractory ulcerative colitis (UC) or UC-related dysplasia, a significant proportion of patients develop pouchitis and/or report decreased health related quality of life (HRQOL) at some point after IPAA. We designed this study to 1) evaluate the association between recently reported pouchitis and specific Patient-Reported Outcome Measurement Information System (PROMIS) domains (anxiety, depression, fatigue, pain interference, sleep disturbance, and social role satisfaction) and HRQOL as assessed by the Cleveland Global Quality of Life (CGQL) scale, and 2) describe the correlations between specific PROMIS domains and overall HRQOL.

Methods

IBD Partners is an internet-based cohort that collects patient reported survey data every 6 months. In patients who reported having an IPAA for UC, we performed cross sectional analyses to compare patient characteristics and patient reported outcomes among patients who reported pouchitis in the prior 6 months versus those without reported pouchitis. To identify the specific social, emotional, and physical domains most associated with HRQOL, we evaluated the correlations between PROMIS domains (measured in T-scores) and CGQL scores using Pearson’s test.

Results

Among 118 patients, 70 (59%) reported pouchitis in the prior 6 months. There were no significant differences in age, sex, race, or number of stages of IPAA between patients with and without recent pouchitis (Table 1). Patients with recent pouchitis were more likely to demonstrate higher levels of anxiety (53.8 vs. 48.5, p=0.005), depression (52.2 vs. 46.9, p=0.005), fatigue (55.8 vs. 47.8, p<0.001), pain interference (54.4 vs. 48.1, p=0.001), sleep disturbance (54.3 vs. 48.8, p=0.001), and lower levels of social satisfaction (47.4 vs. 53.6, p=0.001). As assessed by the CGQL, patients with pouchitis demonstrated decreased Quality of Life (6.64 vs. 7.71, p=0.007), Quality of Health (6.31 vs. 7.63, p=0.001), and Quality of Energy (5.77 vs. 7.17, p=0.001). Social satisfaction was the PROMIS domain that most strongly correlated with Quality of Life among patients with recent pouchitis (r= 0.62, Table 2) while sleep demonstrated the strongest correlation among those without pouchitis (r= -0.74).

Conclusions

Patients with recent pouchitis demonstrated a significant reduction in overall HRQOL as well as decrements in specific areas of social, emotional, and physical health. Among patients without pouchitis, strong correlations between multiple PROMIS domains and HRQOL were also demonstrated. These findings indicate that the PROMIS measures may be useful in assessing these areas of health that are clinically important after IPAA, allowing for tailored interventions in this population.
P052 VALIDITY AND INTERPRETABILITY OF PROMIS PEDIATRIC PATIENT-REPORTED OUTCOMES FOR CHILDREN WITH INFLAMMATORY BOWEL DISEASE
Authors: Schuchard Julia , Forrest Christopher , Clegg Jennifer , Firestine Ann , Kappelman Michael
Published: January 2020

Introduction

Patient-Reported Outcome Measurement Information System (PROMIS) instruments were developed using rigorous psychometric methods to assess health and quality of life across the life course. In two studies, we aimed to evaluate the clinical validity of PROMIS measures for children with inflammatory bowel disease (IBD) and to increase the interpretability of scores on these measures.

Methods

Study 1 recruitment and clinical data collection took place within 14 pediatric gastroenterology practices located across the United States. PROMIS Pediatric measures of Pain Interference, Fatigue, Psychological Stress Experiences, Global Health, and Life Satisfaction were completed by 1,049 children and youth (8–24 years old) with IBD and linked to an IBD registry that included disease activity measures. Study 2 utilized baseline data from a large, multi-center clinical trial to compare the effectiveness of anti-TNF monotherapy versus combination therapy with methotrexate. A total of 199 participants (8–20 years old) across 35 sites completed PROMIS Pediatric measures of Pain Interference, Fatigue, and Positive Affect. PROMIS measures were scored on a T-score metric (mean = 50; standard deviation = 10). Scores on symptom measures were classified as “severe” if they were at or above the 95th percentile, and scores on positive health measures were classified as “poor” if they were at or below the 5th percentile, relative to the United States general population of children ages 8–17.

Results

For nearly all domains across both studies, PROMIS scores were significantly associated with clinical measures of IBD severity. PROMIS measures indicated worse health and/or functioning with corresponding increases in disease activity (inactive to mild to moderate/severe). Comparisons between inactive and mild IBD groups resulted in medium or large effect sizes (Cohen’s d = 0.5 – 0.96) for Pain Interference, Fatigue, Psychological Stress, Global Health, and Life Satisfaction (Table 1). Proportions of children with IBD who were classified as “severe” or “poor” were higher than in the general population and increased with increasing levels of IBD severity (Table 2).

Conclusions

These studies support the clinical validity of PROMIS instruments for assessing the lived experiences of children with IBD. Effect sizes associated with differences between inactive and mild IBD translate to 5–10 points on the PROMIS T-scale, suggesting that 5–10 points is a clinically important difference between group average scores. To aid interpretation of an individual’s score, percentiles derived from the general population may be used to determine whether the score falls within the range of severe/poor scores for the measure.
P053 VARIATIONS IN HEALTHCARE UTILIZATION PATTERNS AMONG HIGH RISK INFLAMMATORY BOWEL DISEASE PATIENTS ENROLLED IN HIGH DEDUCTIBLE HEALTH PLANS
Authors: Berinstein Jeffrey , Cohen-Mekelburg Shirley , Steiner Calen , Mcleod Megan , Noureldin Mohamed , Kullgren Jeffrey , Waljee Akbar , Higgins Peter
Published: January 2020

Background

High-deductible health plan (HDHP) enrollment has increased rapidly over the last decade. Patients with HDHPs are incentivized to delay or avoid necessary medical care. We aimed to quantify the out-of-pocket costs of Inflammatory Bowel Disease (IBD) patients at risk for high healthcare resource utilization and to evaluate for differences in medical service utilization according to time in insurance period between HDHP and traditional health plan (THP) enrollees. Variations in healthcare utilization according to time may suggest that these patients are delaying or foregoing necessary medical care due to healthcare costs.

Methods

IBD patients at risk for high resource utilization (defined as recent corticosteroid and narcotic use) continuously enrolled in an HDHP or THP from 2009–2016 were identified using the Truven Health MarketScan database. Median annual financial information was calculated. Time trends in office visits, colonoscopies, emergency department (ED) visits, and hospitalizations were evaluated using additive decomposition time series analysis. Financial information and time trends were compared between the two insurance plan groups.

Results

Of 605,862 with a diagnosis of IBD, we identified 13,052 patients at risk for high resource utilization with continuous insurance plan enrollment. The median annual out-of-pocket costs were higher in the HDHP group (n=524) than in the THP group (n=12,458) ($1,920 vs. $1,205, p<0.001), as was the median deductible amount ($1,015 vs $289, p<0.001), without any difference in the median annual total healthcare expenses (Figure 1). Time in insurance period had a greater influence on utilization of colonoscopies, ED visits, and hospitalization in IBD patients enrolled in HDHPs compared to THPs (Figure 2). Colonoscopies peaked in the 4th quarter, ED visits peaked in the 1st quarter, and hospitalizations peaked in the 3rd and 4th quarter.

Conclusion

Among IBD patients at high risk for IBD-related utilization, HDHP enrollment does not change the cost of care, but shifts healthcare costs onto patients. This may be a result of HDHPs incentivizing delays with a potential for both worse disease outcomes and financial toxicity and needs to be further examined using prospective studies.