bluuebunny/crossref_metadata_2025 huggingface dataset:
P698 IBD patients equally tolerate bowel preparation but need higher doses of sedation during colonoscopy in comparison with a population screening programme: Results from a prospective, single-centre study
Authors: Bezzio C , Andreozzi P , Schettino M , Arena I , Della Corte C , Devani M , Manes G , Omazzi B , Saibeni S
Published: January 2020

Background

IBD patients are intended to undergo several times colonoscopy during their lifespan. Adequate bowel preparation and sedation greatly contribute to high-quality colonoscopy and are even more important in this setting. However, few and low-quality studies addressed these issues. Aims: to prospectively evaluate the tolerability of bowel preparation and colonoscopy in ulcerative colitis (UC) and Crohn’s disease (CD) patients compared with subjects participating in a colorectal cancer population screening programme.

Methods

we consecutively enrolled CD and UC patients and screening subjects (SS) undergoing colonoscopy between August 2017 and August 2019. Bowel preparation was done by macrogol 4.000 + simethicone + sodium-sulphate-anhydrous. We recorded endoscopic, clinical and demographic features; quality of cleansing by Boston Bowel Preparation Scale (BBPS; from 0 the worst to 9 the best); sedation dose and need to increase the initial doses of midazolam (3.0 mg) and fentanyl (0.05 mg). Tolerability of bowel preparation, discomfort and pain during colonoscopy were assessed by Visual Analogue Scale (VAS) from 0 to 100 mm.

Results

65 UC (26 women, mean age 50.6 ± 15.4 years), 65 CD (29 women, mean age 44.7 ± 3.9) and 94 SS (47 women, mean age 61.9 ± 6.9) enrolled. Bowel preparation was similarly tolerated in UC (70.3 ± 17.7 mm), CD (73.1 ± 12.7 mm) and SS (73.2 ± 12.6 mm) (p = 0.397). Complete colonoscopy was similarly done in UC (61/65, 93.8%), CD (60/65, 92.3%) and SS (91/94, 96.8%) (p = 0.364). BBPS did not show significant differences between UC (6.5 ± 1.0), CD (6.4 ± 1.1) and SS (6.4 ± 1.0) (p = 0.824). The need to increase sedation doses was significantly higher in CD (26/65, 40.0%) and UC (16/65, 24.6%) than in SS (4/94, 4.3%) (p < 0.0001). The mean increases in midazolam and fentanyl doses were significantly higher in CD (0.446 ± 0.660 mg and 0.009 ± 0.019 mg, respectively) and UC (0.300 ± 0.620 and 0.008 ± 0.018 mg) than in SS (0.042 ± 0.250 mg and 0.001 ± 0.007 mg) (p < p < 0.0001 in both cases). Discomfort and pain during colonoscopy were similar in UC (35.0 ± 23.0 mm and 27.6 ± 24.6 mm, respectively), CD (37.5 ± 22.2 mm and 28.8 ± 22.5 mm) and SS 33.7 ± 18.7 and 26.9 ± 19.8 mm) (p = 0.530 and p = 0.866, respectively).

Conclusion

in IBD patients, higher sedation doses are needed in order to warrant a tolerated colonoscopy. Bowel preparation is equally tolerated and efficacious in IBD patients and in screening subjects.
P701 New onset spondyloarthropathy in vedolizumab treated IBD patients
Authors: Tetley A M , Lobaton T , Truyens M , Katsanos K H , de Boer K H N , Pattinson A , Molnar T , Filip R , Michalopoulos G , Sebastian S
Published: January 2020

Background

Patients with IBD may have associated spondyloarthropathy. Vedolizumab is used for IBD with its actions considered to be gut specific but the impact of this treatment on existing arthritis or development of arthritis is uncertain. Integrins and adhesion molecules play a role in the interception of recirculating activated lymphocytes between the gut and the synovial membrane due to the inhibition of the alpha4beta7 integrin homing at the level of the gut. We aimed to describe characteristics and outcomes of spondyloarthropathy in IBD patients treated with vedolizumab.

Methods

We retrospectively collected data on a multicentre cohort of IBD patients with arthropathy which developed following use of Vedolizumab for IBD. This was a part of the European Crohn`s and Colitis Organisation (ECCO) initiated CONFER (Collaborative Network for Exceptionally Rare case reports) project. Data were recorded on a standardised case report form and analysed with descriptive statistics.

Results

We report data on 14 cases of new onset spondyloarthropathy and 1 case of worsening of pre-existing arthropathy from 7 contributing centres. Vedolizumab was used for 6 patients with CD and 8 patients with UC. IBD was in remission in all but 3 patients at the time of development of the joint features. Sacroiliitis was the manifestation in 10 patients, 3 of whom had both sacroiliitis and peripheral arthritis. Three patients had peripheral arthritis alone and one patient had peripheral arthritis with enthesitis. One patient had worsening of peripheral arthropathy following use of vedolizumab. Raised inflammatory markers (CRP, ESR or both) were recorded only in one-third of the patients. MRI was abnormal in 9 patients being the marrow oedema in SI joints the commonest feature. One patient had abnormal bone scintigraphy and in another patient plain X-ray and ultrasound was used in confirming diagnosis. Eight of the patients developed arthropathy within days after a single infusion of vedolizumab. five patients needed hospitalisation for treatment The treatments used included systemic steroids (11 patients), Intraarticular steroids (3) NSAID (2 patients), Cox inhibitor (1), methotrexate (2) Hydroxychloroquine (1). Vedolizumab was discontinued in 11 of the patients. In the majority of patients (11/15) it took many months to resolve the arthropathy. On re-challenge with vedolizumab, the arthropathy recurred in 2 out of the 3 patients.

Conclusion

This case series demonstrates the potential risk for development of spondyloarthropathy with vedlizumab in IBD patients which is unrelated to the activity of IBD and can have significant impact including need for use for systemic steroids and hospitalisation. Larger prospective cohorts are needed to confirm these results.
P720 Recurrent rectovaginal fistula in patients with Crohn’s disease: How can we improve the success rate of graciloplasty? A bi-centric European study in 30 patients
Authors: Frontali A , Rottoli M , Chierici A , Poggioli G , Panis Y
Published: January 2020

Background

Graciloplasty (GP) is indicated in case of recurrent rectovaginal fistula (RVF), even in patients with Crohn’s disease, after failure of previous local treatments. The aim of this study was to evaluate risk factors for GP failure performed for recurrent RVF in these patients.

Methods

We realised a retrospective study based on a prospective database of GP, realised in two Tertiary expert Centers in Italy (Bologna) and France (Clichy).

Results

Thirty-two patients undergoing 34 GP (2 patients have undergone 2 GP for failure of first GP): we excluded second GP and 2 patients without available follow-up: 30 patients undergoing a first GP for RVF (n = 29) or ileal-vaginal fistula after ileal-pouch-anal-anastomosis (IPAA) (n = 1) with a mean age of 41 ± 10 years (range, 25–64) were analysed. After a mean follow-up of 65 ± 52 months (2–183), a success of GP (considered as absence of diverting stoma and RVF healing) was noted in 17/30 patients (57%). We evaluated risk factors for failure of the procedure and we found only 2 risk factors on univariate analysis: (1) absence of a postoperative prophylactic antibiotherapy: only 2/13 (15%) patients with a GP failure had a postoperative antibiotic-prophylaxis vs. 9/15 (60%) patients with success of GP (p = 0.0238); (2) a postoperative perineal infection: 7/13 (54%) with a GP failure developed a postoperative perineal infection vs. 2/17 (12%) patients (p = 0.0196).

Conclusion

Graciloplasty for recurrent rectovaginal fistula in patients with Crohn’s disease is effective in 57% of patients. Our study underlines the possible benefit of a postoperative antibiotic-prophylaxis because it seems to increase significantly the success rate of the procedure.
P732 The clinical efficacy and safety of indigo naturalis in induction & maintenance therapy for moderate-to-severe ulcerative colitis: A single-centre prospective uncontrolled open-label study
Authors: Matsuno Y , Hirano A , Torisu T , Fuyuno Y , Okamoto Y , Shin F , Tomohiko M , Umeno J , Hirakawa Y , Esaki M , Kitazono T
Published: January 2020

Background

Recently, several studies have shown the high efficacy of Indigo naturalis (IN) in the induction therapy for ulcerative colitis (UC). However, the efficacy and safety in the maintenance therapy remain unclear. Thus, we performed this prospective study to investigate the efficacy and safety of IN for induction and maintenance therapy in patients with moderate to severe active UC.

Methods

We conducted a prospective uncontrolled open-label study at Kyushu university hospital. A total of 33 patients with moderate to severe active UC (clinical activity index (CAI) ≥8) received 2 g per day of IN for 52 weeks. We assessed CAI at week 0, 4, 8, 52, and Mayo endoscopic score (MES) was evaluated at weeks 0, 4, 52. We calculated the clinical remission (CAI ≤4) rate and mucosal healing (MES ≤1) rate at each point. Overall adverse events (AEs) during the follow-up were also estimated.

Results

Clinical remission rates at weeks 4, 8, and 52 were 67%, 76%, and 73%, respectively. Mucosal healing rates at weeks 4 and 52 were 48% and 70%. Seventeen patients experienced adverse events (AEs) during the follow-up. Seven severe AEs, including intussusceptions, acute severe colitis, infectious colitis, portal thrombosis, appendicitis, were observed in 4 patients.

Conclusion

Our prospective study indicated that IN was a promising option for induction and maintenance therapy in UC. However, possible AEs of IN should be paid attention.
P752 A nationwide survey of chronic enteropathy associated with SLCO2A1 gene in Japan
Authors: Umeno J , Fuyuno Y , Torisu T , Hirano A , Esaki M , Yanai S , Ohmiya N , Hisamatsu T , Watanabe K , Hosoe N , Ogata H , Hirai F , Hisabe T , Matsui T , Yao T , Kitazono T , Matsumoto T
Published: January 2020

Background

Chronic enteropathy associated with SLCO2A1 gene (CEAS) is an autosomal recessive disease caused by mutations in the SLCO2A1 gene which encodes a prostaglandin transporter. It is a rare intractable disease characterised by persistent blood and protein loss due to the small intestinal ulcers. Because CEAS mimics Crohn’s disease (CD) concerning ileal ulcers and stenoses, it is often difficult to distinguish CEAS from CD based on gastrointestinal findings alone. Furthermore, SLCO2A1 gene mutations are also known to cause primary hypertrophic osteoarthropathy (PHO) and some CEAS patients manifest digital clubbing, periostosis, acroosteolysis, and thickened skin as extra-intestinal manifestations. Since little is known about the clinical features of CEAS, we conducted a nationwide survey in Japan.

Methods

All study participants provided written informed consent for genetic analysis. The present study was approved by the ethics committee of each institution. During the period between 2012 and 2019, 141 patients suspected of CEAS were enrolled in this study and checked to have SLCO2A1 gene mutations. We reviewed the clinical information of genetically confirmed CEAS patients.

Results

We confirmed 61 CEAS patients (21 males and 40 females) and found 14 different types of recessive SLCO2A1 mutations. The median age at disease onset and diagnosis was 18.5 (range 1–69) and 40 (range 7–70) years, respectively. Parental consanguinity was present in 16 patients (26%). Although anaemia was present in almost all patients, only two patients experienced gross haematochezia. The median haemoglobin and serum protein levels at diagnosis were 9.7 (range 2.3–13.7) and 5.2 (2.7–8.2) g/dl, respectively. Thirty-three patients (54%) had undergone intestinal surgery. They showed relatively low inflammatory markers in blood tests (median CRP, 2.9 mg/l). The most frequently involved gastrointestinal site was ileum (93%), but the terminal ileum was rarely involved (Figure). Mild digital clubbing or periostosis was found in 16 patients (26%), with six male patients fulfilling the major diagnostic criteria of PHO. The major manifestations of PHO were more frequently found in males than in females (digital clubbing 57% vs. 10%; periostosis 52% vs. 11%; pachydermia 62% vs. 0%).

Conclusion

Although CEAS frequently causes intestinal strictures like CD, its clinical features seem to be distinct from those of CD. Also, a gender difference in clinical symptoms needs to be considered, because concurrent PHO can be frequently seen especially in male patients with CEAS.
P755 Congenital chloride diarrhoea and inflammatory bowel disease: an emerging association
Authors: Norsa L , Berni Canani R , Duclaux- Loras R , Bequet E , Koeglmeier J , Russell R K , Ulhig H , Koletzko S , Rodrigues A , Deflandre J , Dembinski L , Castaldo G , Grimaldi G , Shah N , Heinz-Erian P , Janecke A , Leskinen S , Wedenoja S , Lachaux A , Kolho K L , Ruemmele F
Published: January 2020

Background

Congenital chloride diarrhea (CLD) is a rare autosomal recessive disease caused by the mutation in member 3 of the solute carrier 26 (SLC26A3). The phenotypic expression is a life-long severe watery Chloride rich diarrhea. Anecdotal association with inflammatory bowel disease (IBD) has been reported suggesting that underlying molecular mechanisms could represent part of an evolving association between IBD and channelopathies. We aimed to investigate this association in a cohort of CLD pediatric patients.

Methods

A European-based call for cases was made in CLD patients followed up in five different countries. A case report form for each patient was then completed.

Results

A total of 74 patients with CLD with a range of different CLD mutations were enrolled in the study. Twelve patients of 64 (16%) demonstrated colonic inflammation and were finally diagnosed with IBD: 8 patients with Crohn’s Disease, 2 with Ulcerative Colitis, and 2 IBD-like colitis (IBD-U). The diagnosis was made at a median of 12 years old (IQR: 6–30). Patients had different ethnicities (7 European, 2 Middle East, 1 North Africa, 1 Pakistan, 1 Central Africa). Among the 12 IBD, 2 had a 5-ASA-based treatment, 3 required immunosuppressant and 6 had biologics (Infliximab, Adalimumab and Vedolizumab). Three patients underwent surgery for ileostomy formation for CD that was non-responsive to multiple line of biologics (anti-TNF and anti-integrin): one had colectomy the remnant two colon preservation. Clinical characteristics, such as premature delivery, low weight at birth, fecal Cl- at diagnosis and amount of Cl- supplementation (mmol/kg) did not differ between patients with or without IBD. All patients underwent genotyping for CLD diagnosis and we did not find any specific genetic mutation linked to the development of IBD.

Conclusion

Sixteen percent of patients enrolled with CLD in our cohort developed IBD. Despite different presentations (CD, UC, IBD-U) all patients had colonic without ileal/small bowel involvement, in line with preliminary murine models of CLD demonstrating a role of colonic mucous layer in the development of colonic inflammation (Xiao et al Acta Physiol Oxf Engl 2014; 211:161–175). Patients’ IBD treatment included a wide range with variable success. Patients with IBD did not differ in their clinical characteristics or genetic mutations compared with non-IBD CLD patients. The role of genetic variants outside the CLD-gene and the microbiome in this association are under investigation.
P759 Correlation of quality-of-life components with sexual function scores and disease duration in patients with inflammatory bowel disease
Authors: Domislović V , Brinar M , Vujičić L , Novosel M , Grgić D , Krznarić Ž
Published: January 2020

Background

Inflammatory Bowel Disease (IBD) has a negative impact on quality of life (QOL), and sexuality is one of its major determinants. The impact of disease characteristics on sexuality and intimacy is one of the main concerns of IBD patients. Despite the obvious relevance of this problem, knowledge of the extent and the determinants of sexual dysfunction in persons with IBD is limited. The main goal of the study was to determine the correlation of quality of life (QOL) and it’s components in patients with IBD, and to investigate the impact of disease duration on QOL components.

Methods

In this cross-sectional study patients fulfilled anonymous validated questionnaire on their sexual function. In International Index of Erectile Function (IIEF) for males, five domains were evaluated through questions on erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. In women were six domains assessed, desire, arousal, lubrication, orgasmic function, satisfaction and pain. For both scores, higher scores indicated a better function. Patients also fulfilled IBDQ-32, a validated questionnaire for assessing quality of life in IBD patients that consists of four main components (social, emotional, systemic and bowel function).

Results

In this study we have enrolled 202 patients who fulfilled the questionnaire (133 CD, 69 UC). Among them 122 were men and 80 women. Average age of included patients was 39.2 ± 11.02. Prevalence of SD in women was 70% (n = 60) and 18% (n = 22) in males. Female patients with sexual dysfunction had lower emotional and social QOL (p = 0.035 and p = 0.03, respectively). Total male IIEF sexual function score correlated significantly with all of the components of IBDQ; emotional (rho=0.36, p < 0.001) systemic (rho=0.24, p = 0.006), social (rho=0.28, p = 0.002), bowel (rho=0.27, p = 0.002) and with total IBDQ (rho=0.36, p < 0.001). Regarding erectile function score, there was also correlation with all of the components of IBDQ. Total female sexual function FSFI score correlated significantly only with systemic component of IBDQ (rho=0.25, p = 0.02). Interestingly, in male patients disease duration correlate negatively with emotional and social component of IBDQ (rho = −0.21, p = 0.02 and rho=-023, p = 0.01, respectively), which was not the case in female patients.

Conclusion

The results show correlation of sexual function score with components of QOL, which were more correlated in male patients. Our results suggest that longer disease duration might have positive impact on emotional and social life in male patients, which could be connected with achieving disease control and accepting the disease. It is important to provide proper psychological support, medical treatment and educational information.
P762 Prevalence association between HPV and fistulising perianal Crohn’s disease
Authors: RODRIGUES BOARINI L , Sobrado C W , Guzela V R , Pozzebon Gonçalves A , Lina Villa L , Nadal S R , Da Costa Lino Costa A , Nahas S C
Published: January 2020

Background

Perianal Crohn’s disease (PCD) is the main risk factor for squamous cells carcinoma (SCC). The incidence of SCC in PCD patients is 0.26 per 1000 patients-years, affects females more than males, develops on average at 42 years of age, which is earlier than general population. Although epidemiological studies have shown that most anal cancers are associated with HPV infection, predominantly oncogenic types 16 and 18.1 prevalence of HPV on perianal Crohn`s disease (PCD) remains unknown. We aimed to estimate the Prevalence of HPV and the subtypes more frequently associated with PCD.

Methods

Adults with fistulising PCD under immunosuppressed medications who have required surgical intervention, were transversally recruited. A biopsy sample was obtained from perianal fistula tract during under anesthesia exam. INNO-LiPA test was performed on paraffin blocks containing fistula path for HPV testing.

Results

A total number of 45 PCD patients were recruited and underwent surgical intervention. All patients were under biologic therapy, 42.2% Adalimumab, 40.1% Infliximab, 11.1% Certolizumab, 4.4% Ustekinumab and 2.2% Vedolizumab. The prevalence of fistula tract HPV infection in PCD patients was 37.8% and 22.2% for high-risk HPV in particular. The subtypes more frequently identified were HPV-11 (15.5%), HPV-16 (8.9%) and HPV-53 (6.7%).

Conclusion

This study shows a high point-prevalence of HPV, specially high-risk subtypes in fistulising PCD population. More studies are necessary to define a screening for cancer in this population.
P765 Fatigue as one of the most important symptoms in adult patients with inflammatory bowel disease: Croatian tertiary centre pilot study
Authors: Ćaćić P , Tomašić V , Kralj D , Bišćanin A , Dorosulić Z , Lerotić I , Ogresta D , Forgač J , Hrabar D
Published: January 2020

Background

Although there have been revolutionary improvements in care of IBD patients, considering the effect of lifelong disease with numerous relapses, one of our goals is to recognise burden of chronic symptoms such as fatigue which can significantly interfere with performance of everyday activities, and negatively impact on quality of life (QoL).

Methods

Randomly selected IBD patients were invited to anonymously fulfil multiple mixed-methods (quantitave/qualitative) Quality of Life questionnaires (SF-36, IMPACT, SIDBQ, IBD disk) in order to evaluate prevalence of fatigue as well as the variables associated with an increased risk of fatigue (using the Fisher’s exact test).

Results

The study population included 70 patients (50.7% male, mean age 38.1 years, 55.7% Crohn’s disease). The prevalence of fatigue was 48.6% and variables associated with an increased risk of fatigue were: anxiety/depression (p = 0.002), lower perception of general well-being (p = 0.03), sleep disturbance (p = 0.02), inadequate interpersonal interactions (p = 0.03) and unsatisfactory performance in educational and professional daily activities (p = 0.01). The presence of joint pain as a common extraintestinal manifestation of IBD was not associated with fatigue (p = 0.06).

Conclusion

Chronic fatigue is a debilitating symptom among adult patients with IBD. Anxiety/depression, lower perception of general well-being, sleep disturbance, inadequate interpersonal interactions and unsatisfactory performance in educational and professional daily activities were associated with fatigue in this Croatian cohort of IBD patients.
P766 ABO blood groups and ulcerative colitis: A hospital-based study in central Taiwan
Authors: Lai H C , Chou J W , Cheng K S , Wu Y H , Tsai Y Y , Chen T W
Published: January 2020

Background

The variations in ABO blood groups are reported to be associated with multiple disorders. Ulcerative colitis (UC) is a chronic and relapsing disease of the gastrointestinal tract with unclear etiology. The incidence and prevalence of UC are low but increasing in Taiwan The aim of our current study was to investigate the distribution of ABO blood groups in patients with UC and to explore its impact on disease severity.

Methods

From January 2000 to November 2019, we retrospectively collected patients diagnosed as UC in our hospital, a tertiary referral center in central Taiwan. Clinical characteristics of patients with UC including gender, age at diagnosis, ABO blood groups, disease phenotype and behaviour, operation rate and baseline laboratory data were collected.

Results

A total of 129 patients with UC were enrolled into our current study (Table 1). We found out male predominance as 62.8% of all patients. The mean diagnostic age of all UC patients was 39.0 years. Of 129 UC patients, 43 (33.3%) were blood type O, 41 (31.8%) were blood type A, 38 (29.5%) were blood type B, and the remainders 7 (5.4%) were blood type AB. However, there was no significant association between the ABO blood groups and UC patients compared with the general population of Taiwanese1 (p = 0.1906) (Table 2). In the subgroup analysis of each blood type, there were no significant difference of disease location and operation rate between groups. Furthermore, blood type A UC patients had higher hemoglobin level compared with blood type O patients (13.31 g/dl vs. 12.30 g/dl, p = 0.0347). Blood type A UC patients had lower erythrocyte sedimentation rate (ESR) level compared with blood type O patients (12.46 mm/h vs. 21.5 mm/h, p = 0.0288). Blood type O UC patients had the highest ESR level compared with non-O groups (p = 0.0228) (Table 3). We analysed the characteristics of UC patients between the diagnostic age older or younger than 40 years. However, there were no significant difference between two age groups (Table 4).

Conclusion

ABO blood groups were not associated with the prevalence of UC, although UC patients with blood type A had the higher prevalence in our current study compared with the general populations with blood type A. UC patients with blood type O had higher baseline ESR level. UC patients with blood type A had higher baseline hemoglobin level.
P771 Increasing prevalence and direct health care cost of inflammatory bowel disease: A population-based evidence from a western Canadian province
Authors: Osei J A , Peña-Sánchez J N , Fowler S A , Muhajarine N , Kaplan G , Lix L M
Published: January 2020

Background

More than 0.3% of the populations in Europe, North America, and Oceania live with inflammatory bowel disease (IBD). Canada has increasing prevalence trends of IBD with 1% of Canadians estimated to have IBD by 2030. Evidence about IBD prevalence and health care costs over time can contribute to health resources allocation and health care planning. Our study aimed to 1) estimate the prevalence and direct health care costs of IBD in the province of Saskatchewan (SK), Canada, and 2) test if trends in the prevalence and direct health care costs of IBD increased over two decades.

Methods

We conducted a retrospective population-based cohort study using administrative health data of SK between 1999/00 and 2016/17 fiscal years. A validated case definition was used to identify prevalent IBD cases. The costing method adopted by the Canadian Institute for Health Information was used to estimate direct health care costs in 2013/14 Canadian dollars among IBD cases. Generalised linear models (GLMs) with generalised estimating equations were used to test the trends. Negative binomial and gamma distributions were used to, respectively, model prevalence and health care cost trends. Sex and age group were covariates in all models; the Charlson comorbidity index was also included in the cost model. Annual prevalence rates and direct health care cost estimates with their 95% confidence intervals (95%CI) were reported.

Results

In 2016, there were 6468 (Crohn’s disease: 3663 [56.63%], ulcerative colitis: 2805 [43.37%]) IBD cases ascertained in SK. The number of prevalent cases increased over the analysis period by 56%. The total direct health care costs increased from $7.8 million in 1999 to $50.8 million in 2016. The average annual IBD prevalence increased from 341/100,000 (95%CI 340–341) in 1999 to 664/100,000 (95%CI 663–665) in 2016, a 3.3% (95%CI 2.4–4.3) average annual increase. The total average annual direct health care costs of IBD increased from $1.8 (95%CI $1.6–2.0) thousand per patient in 1999 to $7.1 (95%CI $6.7–7.5) thousand per patient in 2016, an average annual increase of 9.2% (95% CI 8.5–9.8), Figure 1.

Conclusion

In the Canadian province of SK, prevalence and direct health care costs, respectively, tripled and quadrupled over two decades. Our results provide relevant information and analysis on the burden of IBD in SK. These findings are in agreement with previous studies from other provinces. The evidence of constant increasing prevalence and health care cost trends of IBD needs to be recognised by health care decision-makers to promote cost-effective health care policies at provincial and national levels and respond to the needs of patients living with IBD.
P773 Patient reported outcomes, partial MAYO score and SCCAI are equally accurate in predicting mucosal healing in UC: Preliminary results from a prospective study
Authors: Golovics P , Gonczi L , Reinglass J , Verdon C , Afif W , Wild G , Bitton A , Seidman E , Bessissow T , Lakatos PhD P L
Published: January 2020

Background

Optimal management of patients with ulcerative colitis (UC) requires the accurate assessment of disease activity. Endoscopic evaluation is considered the gold standard approach, but it is invasive. We aimed to determine how strong patient reported outcomes, clinical scores and symptoms correlate with endoscopy for assessment of disease activity in UC patients.

Methods

One hundred and thirty-six patients were included prospectively (age: 48 (IQR: 38–61) years, duration 12 (4–19) years, 63 females, 53.7% extensive disease, 40.4% on biologicals) at the time of the colonoscopy. The 2 item patient reported outcome (PRO), partial MAYO, Simple Clinical Colitis Activity Index (SCCAI), Mayo endoscopic subscore (MES), Baron and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores were calculated. C reactive Protein (CRP) and fecal calprotectin (FCAL) was available in 58.1 and 33.8% of patients. 20.7% had clinical flare, treatment was escalated in 17.8% of patients. Sensitivity, specificity, PPV and NPV values were calculated, ROC analysis and K-statistics were performed.

Results

Rectal bleeding(RBS), stool frequency(SF) subscore of 0, or total PRO2 remission(RBS0 and SF≤1), partial MAYO(≤2) and SCCAI(≤2.5) remission were similarly associated to mucosal healing defined by MES(0 or ≤1) or Baron (0 or ≤1) scores (Table 1). PRO2 remission (AUCMES0/Baron0:0.747/0.715, AUCMES0-1/Baron0-1:0.867/0.863), SF AUCMES0/Baron0:0.731/0.703, AUCMES0-1/Baron0-1:0851/0.839), RBS(AUCMES0/Baron0:0.708/0.685, AUCMES0-1/Baron0-1:0.828/0.835) partial Mayo (AUCMES0/Baron0:0.792/0.755, AUCMES0-1/Baron0-1:0.917/0.903) and SCCAI (AUCMES0/Baron0:0.738/0.724, AUCMES0-1/Baron0-1:0.908/0.880) were similarly associated with mucosal healing in a ROC analysis. There was a string association between MES and Baron (k=0.798), while moderate agreement between UCEIS and MES (K=0.451) or Baron (K=0.499) scores. Agreement between CRP and clinical remission or endoscopic healing (MES/Baron) was poor (K~0.2), while agreement between FCAL (>100 or >250) and RBS-PRO2 remission (K>250:0.56–0.61) or MES/Baron 0 was moderate to good(K>100:0.54-0.53 and K>250:0.50–0.54)

Conclusion

We found no difference across accuracy of RBS, SF, PRO2, partial Mayo and SCCAI in predicting endoscopic healing. A strong association was found with high PPV for MES/Baron ≤1 and high NPV for MES/Baron 0. FCAL, but not CRP was associated to clinical and endoscopic remission.
P784 A new questionnaire to investigate patients’ knowledge of relevant aspects of inflammatory bowel disease clinical course and outcomes: preliminary results
Authors: Zerboni G , Barello S , Festa S , Aratari A , Graffigna G , Papi C
Published: January 2020

Background

Inflammatory bowel disease (IBD) patient’s knowledge is a key factor for shared treatment decision making. Some studies have already investigated IBD knowledge but never focused on patient’s awareness about the major disease outcomes nor clinical course nor therapeutic aspects. The aim of the present study is to assess disease knowledge in IBD patients using a novel 11 items questionnaire.

Methods

An 11 items questionnaire was developed. The questionnaire explored different aspects of IBD course and prognosis: pattern of symptoms, disease complications, need for surgery, risk and prevention of colon-rectal cancer (CRC), extra-intestinal manifestations (EIMs), predictors of poor prognosis, benefit/risk of immunosuppressive and biological therapy and IBD in pregnancy. The questionnaire was handed out to consecutive Crohn’s disease (CD) and ulcerative colitis (UC) patients in regular follow-up at a referral centre. Clinical and socio-demographic characteristics were collected in a dedicate database. Descriptive analysis of quantitative variables was presented as mean or median. Fisher test and Student’s t-test were used for categorical and continuous variables. A p < 0.05 was considered statistically significant.

Results

Three hundred and four patients were enrolled and 290 completed the questionnaire (95%). Of these 53% UC and 47% CD. The mean age was 51 years (range 18–83); 56% were male. Most of the patients were in clinical remission (85%). The mean number of appropriate answer was 4 upon 11. Overall only 26% answered successfully more than half of the items. Looking at the single items, two third of patients were aware of current strategies of CRC prevention, chance of EIMs and woman capability to become pregnant. The questions about immunosuppression and biologic therapy were more correctly answered by those patients who had experienced them (p = 0.000001), whereas those about the risk of surgery were not influenced by the patient’s previous clinical history (UC p = 1; CD p = 0.067). Only about one third of women were aware of the most relevant risk factor of worst pregnancy outcome. Age <40 years old (p = 0.00003), high level of education (high school and degree, p = 0.0015) and current or previous biologic therapy (p = 0.0007) were associated with a higher level of IBD knowledge.

Conclusion

These results suggest that the overall disease knowledge in IBD patients is low and should be improved. Young age, education and biologic exposure are associated with an adequate awareness of disease course. This questionnaire should be validated and correlated to other patient-related measures such as health engagement and health literacy in prospective studies.
P791 Difference between paediatric Crohn’s disease and ulcerative colitis at diagnosis in Korea: results from a multicentre, registry-based, retrospective cohort study
Authors: Choe B H , Kang B , Suh H R , Kim E S , Park J H , Kim M J , Choe Y H , Kim S , Koh H , Lee Y J , Park J H , Ryoo E
Published: January 2020

Background

Despite its increasing incidence, large-scale data regarding the demographics and characteristics of paediatric inflammatory bowel disease (IBD) at diagnosis in Korea is scarce. We aimed to compare the differences of paediatric Crohn’s disease (CD) and ulcerative colitis (UC) at diagnosis in Korea.

Methods

This analysis was conducted using data from a multicentre, registry-based, retrospective cohort study conducted at five centres in Korea between 2013 and 2018. Baseline demographics, clinical characteristics, results from laboratory, endoscopic, radiologic examinations were compared between paediatric CD and UC patients who were <19 years at diagnosis.

Results

A total 307 patients were included in this analysis. Among them 227 patients were diagnosed with CD (73.9%), and 80 patients (26.1%) with UC. The male to female ratio was 2.49:1 for CD, and 1.29:1 for UC (p = 0.019). Median age at diagnosis was 14.4 years (IQR 12.4–16.2) for CD, and 14.4 (11.7–16.5) for UC (p = 0.962). Symptoms at presentation that were dominant in CD patients compared with UC patients were abdominal pain (76.2% vs. 51.2%, p < 0.001), weight loss (51.5% vs. 22.5%, p < 0.001), perianal fistulas (18.9% vs. 0%, p < 0.001), perianal skin tags (15.9% vs. 1.2%, p < 0.001), fever (20.3% vs. 6.2%, p = 0.007), and oral ulcers (13.7% vs. 3.8%, p = 0.026), while hematochezia was the only dominant symptom in UC patients compared with CD patients (86.2% vs. 30.8%, p < 0.001). White blood cell counts, platelet counts, ESR, CRP were significantly higher, and serum albumin level was significantly lower in CD patients. ASCA was positive in 44.5% and 16.2% of CD and UC patients, respectively (p < 0.001), and ANCA was positive in 15.0% and 58.8% of CD and UC patients, respectively (p < 0.001). Terminal ileal involvement on endoscopy was prominent in CD (62.1% vs. 16.2%, p < 0.001), while rectal involvement was more prominent in UC (52.4% vs. 83.8%, p < 0.001). Small bowel involvement and perianal perforating diseases on radiologic exams were also more prominent in CD.

Conclusion

Clinical symptoms, laboratory test results, radiologic findings, endoscopic findings were significantly different between paediatric Crohn’s disease and ulcerative colitis at diagnosis in Korea. A large-scale study on a nationwide basis is expected to better clarify this difference in the future.
P792 Breastfeeding in our patients with inflammatory bowel disease
Authors: Charro Calvillo M , Charro-Calvillo M , Peña-Gonzalez E , Ber-Nieto Y , Botella Esteban M T , Alcalá Escriche M J , Lacarta García P , Fernandez Bonilla E , Mir Subías A , Arroyo-Villarino M T , Lafambra Cabrejas E , Nerin De la puerta J , Vicente Lidón R , García López S , Corsino Roche P
Published: January 2020

Background

Breastfeeding is one of the most important environmental factors in early childhood for later development of an Inflammatory Bowel Disease. The duration of lactation is essential for it to have a protective effect. In addition to IBD patients, breastfeeding can have a beneficial effect for preventing disease relapse. For these reasons, we plan to know how lactation develops in our group of patients with Inflammatory Bowel Disease (IBD).

Methods

A retrospective analysis of patients followed by gastroenterology consultations, with established diagnosis of IBD and with at least one gestation, in a period from January 2011 to January 2016. The data were collected a posteriori through two simple questionnaires, one completed by the patient, collecting the type of childbirth and breastfeeding she experienced and factors that influenced it. Another form is filled out by the gastroenterologist recording the characteristics of his inflammatory bowel disease. The data is collected in a structured database in Microsoft Excel and analysed with the SPSS statistic package for Windows.

Results

Data from 78 patients diagnosed with IBD are analysed from eight public hospitals in our autonomous community. 61.1% of patients have ulcerative colitis and 38.9% Crohn’s disease. The deliveries were mainly vaginal (82%), compared with 18% of caesarean-sections, four of them directly motivated by digestive disease. More than half of patients (57.7%) started breastfeeding after childbirth, 10.25% breastfeeding and 32.05% mixed breastfeeding But only 34.6% reach six months of breastfeeding, reaching 39.7% if we include mixed breastfeeding. In 17 patients (21.8%) their base-based inflammatory bowel disease directly influenced the development of lactation. Pharmacological treatment is the main cause for breastfeeding, followed by disease outbreaks, hospitalisations and surgery. Only 47.4% of the patients stated that in the IBD consultation they were given some information about breastfeeding, although almost all replied that they would have liked to receive it.

Conclusion

The majority of patients with inflammatory bowel disease in our consultations, do not reach six months of breastfeeding currently recommended by the World Health Organisation, so we have a great opportunity for improvement in this field and as gastroenterologists, we can contribute by providing more information to our patients about breastfeeding and its relationship with IBD.
P793 Patients’ concerns are strongly associated with distress and quality of life among family caregivers of adult inflammatory bowel disease patients in remission
Authors: Argyriou K , Karantanos P , Vasilakis N , Kapsoritakis A , Lalla E , Varytimiadis K , Mpetsios G , Tsakiridou E , Potamianos S
Published: January 2020

Background

Patients’ concerns were negatively associated with adaptation and outcomes in inflammatory bowel diseases (IBD), even when the disease is in remission. Concurrently, relatives overestimate patients’ worries with unknown implications on their quality of life (QoL).Our aim was to investigate the association among disease-related concerns, distress and QoL among family caregivers of adult IBD patients in remission.

Methods

One hundred and ninety-three consecutive IBD patient-caregiver dyads from the outpatient clinic of two referral centres were screened for eligibility. Dyads with psychiatric and other co morbidities were excluded. 66 patients were in remission and recruited. Patients’ concerns and caregivers’ distress were assessed by using the Rating Form of IBD patient Concerns (RFIPC) and the caregiver self-assessment questionnaire ‘How Are You?’ of the American Medical Association, respectively, whereas caregiver’s QoL was measured with the SF-36 questionnaire. Data are presented as median and range. The influence of population characteristics and patients’ concerns on caregivers’ distress and QoL were evaluated with linear regression.

Results

Sixty-six IBD patients (40[47] years, 51.5 % females, 37.9% full-time employment) and caregivers (47[33] years, 60% females, 60% 1st degree relative, 60% full-time employed) included in the analysis. Among patients, the median RFIPC score was 36.8 [43.52], whereas worries about the unknown nature of the disease, feeling out of control, having access to quality medical care, the fear of side effects and the energy level prevailed. Among caregivers, a median of 7 [14] hours were spent on care giving per week with 48.4 % of the caregivers developing distress and achieving low scores on sf-36. Among all examined variables, the increased level of concerns was the sole factor that was independently associated with increased distress (beta=0.947, p = 0.000) and low QoL (beta=–0.567–0.345, p = 0.000) in the caregivers’ population.

Conclusion

In remission, increased patients’ concerns was the only factor that was found to be strongly associated with increased level of distress and low QoL in family caregivers. Potential interventions might seek to provide support to those who care for IBD patients.

References
P797 The inexorable increase of biological exposure in paediatric inflammatory bowel disease: a Scottish population-based, longitudinal study 2015–2019
Authors: Burgess C , Jackson R , Chalmers I , Russell R K , Hansen R , Henderson P , Wilson D C
Published: January 2020

Background

The use of biologics in paediatric inflammatory bowel disease (PIBD) is rapidly changing with the introduction of new mode of action medications, cheaper biosimilar alternatives, improved convenience with home care options and an increasing focus on early intensified management. No nationwide paediatric data is available to objectively capture this shifting landscape and its effect on healthcare resources. We aimed to identify the incidence and prevalence of biologic use within Scottish PIBD services.

Methods

In Scotland, specialist paediatric gastroenterology, hepatology and nutrition (PGHAN) services are coordinated through three tertiary academic centres (Glasgow, Edinburgh and Aberdeen) which act as regional referral hubs covering all district general hospitals. A nationwide cohort of prospectively identified PIBD cases less than 18 years of age with paediatric-onset IBD (A1 phenotype; diagnosed <17 years of age) were captured within paediatric services over a 4.5-year period (01.01.2015–30.06.2019). All patients who received infliximab (IFX), adalimumab (ADA), vedolizumab (VDZ) or ustekinumab (UST) during the study period (prevalent cases) or received their first dose of these biologics (incident cases not including biosimilar switches) were retrospectively audited. Point prevalence was calculated on 30 June each year and period prevalence as 6 month epochs.

Results

In total 495 incident new start biological therapies were commenced on 403 PIBD patients over the study period; 295 IFX (60%), 161 ADA (32%), 24 VDZ (5%), 15 UST (3%). The proportion of new start biologics changed over time with IFX initiation rates decreasing (87–54%) while ADA (13–31%), VDZ (0–10%) and UST (0–6%) all increased. Biosimilar penetration of new start anti-tumour necrosis factor (anti-TNF) biologics increased from 3% to 91% by 30.06.2019. The overall number of prevalent PIBD patients increased from 554 to 644 over the study period. Point prevalent rates of current biologic therapy usage increased from 20.2% on 30.06.15 to 43.5% on 30.06.19; an average annual percentage increase of 29%.

Conclusion

Complete accrual of Scottish nationwide biologic usage within paediatric services demonstrates a rapidly changing PIBD treatment landscape with a significant increase in biologic therapy (from 20% to 43% in just 4 years), a near-complete shift to biosimilar anti-TNF and use of biologics with new modes of action which are as yet unlicensed for PIBD.
P799 Use of anti-TNF agents may reduce a risk of venous thromboembolism in Korean patients with inflammatory bowel disease: A nationwide population-based study from the National Health Insurance Database
Authors: Kim H M , Kim S Y , Kim H S , Lee J K , Park S H , Moon J S , Cho Y S , Kang D R
Published: January 2020

Background

Inflammatory bowel disease (IBD) has a risk of venous thromboembolism (VTE) compared with healthy controls, which justify prophylaxis in practice. There are few data on VTE in Asian IBD patients including Koreans. We aimed to investigate the incidence of VTE and the potential risk factors in Korean IBD patients.

Methods

A nationwide population-based cohort study was performed using claims data from the National Health Insurance service in Korea for 10 years, from 2006 to 2015. VTE, Crohn’s disease (CD) and ulcerative colitis (UC) were operationally defined by using ICD-10 codes, codes for Rare and Intractable Diseases registration, and pharmaceutical prescriptions for IBD-specific drugs. Control group was defined as age- and sex-matched health insurance subscribers without IBD for the same period. The hazard ratio (HR) for the risk of VTE was calculated after adjusting for covariates such as age, sex, rural area, comorbidities, Charlson Comorbidity Index (CCI), admission, and therapeutic drugs use for IBD using multivariate Cox proportional hazard regression.

Results

A total of 45,037 patients were diagnosed with IBD (13,850 CD and 31,187 UC), and 133,019 were defined as controls. VTE occurred in 411 (0.91%) in IBD, 106 (0.76%) in CD, and 305 (0.98%) in UC, whereas 641 (0.48%) in controls. In univariate analysis among IBD patients, old age (>59 years: HR = 6.256), female sex (HR = 1.537), low income (HR = 1.3090), high CCI (>3 score: HR = 4.053), steroid use (HR = 1.872), emergency care (HR = 1.513) and hospitalisation (HR = 1.352) significantly increased a risk of VTE. However, anti-TNF agent use (HR = 0.611) significantly decreased a risk of VTE. In multivariate analysis with adjustment among all subjects, CD (HR = 15.833) and UC (HR = 8.125) significantly increased a risk of VTE compared with controls.

Conclusion

Our study demonstrates that VTE is significantly high in Korean IBD patients compared with controls. In addition, old age, female sex, low income, high CCI, steroid use, emergency care, and hospitalisation are suggested as risk factors of VTE in IBD. Interestingly, use of anti-TNF agents may reduce risk of VTE, which should be considered for prophylaxis strategy suitable for Korean IBD patients.