P0394 Sex- and phenotype-specific patient-reported outcomes and symptoms in newly diagnosed-inflammatory bowel diseases – a prospective population-based study
Authors: Attauabi M , Madsen G R , Bendtsen F , Seidelin J B , Burisch J 
Published: January 2025

Abstract

Background
Sex and disease phenotype contribute to heterogeneity in inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). We aimed to investigate the relationship between sex, phenotype, patient-reported outcomes (PROs), and symptoms in newly diagnosed IBD.

Methods
Between May 1, 2021, and April 30, 2023, all adult and pediatric patients with incident IBD within a catchment area covering 20% of Denmark were enrolled in the prospective, population-based Copenhagen IBD Inception Cohort.1 Adult patients completed multiple PROs and symptom indices at the time of IBD diagnosis. Logistical regression analyses were adjusted for sex, age, and disease phenotype.

Results
A total of 203 patients with UC and 116 patients with CD completed PRO questionnaires within a median of 1.2 months (IQR 0.3–3.0 months) post-diagnosis. Sex- and phenotype-specific analyses revealed significant PRO impairments at IBD diagnosis (Figure 1). Female patients with UC reported worse health-related quality of life (HRQoL; Short Inflammatory bowel Questionnaire) (adjusted odds ratio [aOR]=3.73; 95% CI 1.69-8.22), disability (IBD Disability Index; aOR=7.85; 95% CI 2.86-21.58), and fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue; aOR=3.36; 95% CI 1.60-7.05) compared to males. Females with CD reported more disability (aOR=5.37; 95% CI 1.95-14.77) but not severe fatigue (aOR=1.90; 95% CI 0.85-4.25) compared to males.
Phenotype-specific analyses showed that females with proctitis reported significantly worse HRQoL and fatigue than males, while females with extensive colitis experienced higher rates of disability and fatigue (Figure 1). Among CD patients, sex differences were observed only in moderate-to-severe disability, primarily in ileal and colonic disease (Figure 1).
Table 1 reports the association between gastrointestinal symptoms, and moderate to severe PROs, along with sex- and phenotype-specific interactions. In UC, the relationship between abdominal pain and moderate to severe impairment of HRQoL was modified by sex, with females experiencing a stronger association than males. In addition, the relationship between stool urgency and moderate to severe impairment of HRQoL was modified by disease extent, with proctitis cases experiencing a stronger association than cases with left-sided colitis. No significant interactions were observed in CD.

Conclusion
This prospective, population-based cohort revealed substantial PRO impairments at the time of IBD diagnosis, with more pronounced impairments in females compared to males. These findings highlight the need for sex- and phenotype-specific approaches to optimize IBD management and improve patient outcomes.

References
1.Attauabi M, Madsen GR, Bendtsen F, et al. Influence of Genetics, Immunity and the Microbiome on the Prognosis of Inflammatory Bowel Disease (IBD Prognosis Study): the protocol for a Copenhagen IBD Inception Cohort Study. BMJ Open. 2022;12(6):e055779. doi:10.1136/bmjopen-2021-055779