A240 ASSESSING THE IMPACT OF AGE AT DIAGNOSIS ON TRANSITION PROCESS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES FROM PEDIATRIC TO ADULT CARE

Abstract

Abstract Background Twenty-five percent of pediatric patients with inflammatory bowel disease (IBD) are diagnosed between the age of 16 and 18 years. They represent a unique challenge associated with the short follow-up time between diagnosis and transition to adult care. Aims The primary aim was to compare the current practices related to the transitional process in adolescents diagnosed before 16 years (early-adolescence (EA)) or after 16 years (late-adolescence (LA)). The secondary aim was to investigate clinical factors associated with age at transfer. Methods Patients diagnosed between 2013 and 2015, at the IBD clinic of CHU Sainte-Justine were included in the study. The date of transfer to adult care was defined as the date of the last visit in the pediatric unit. The factors associated with transition process and transfer included: disease type, disease severity at diagnosis and last pediatric visit, age at diagnosis, treatment group, disease burden (hospitalizations/relapses) and disease education. Results We included 144 patients (77 males; median (interquartile range (IQR) age at diagnosis 15.2(14.3–16.2) years; Crohn’s disease (N=98), ulcerative colitis (N=31) and IBD-unclassified (N=15). The median (IQR) duration of pediatric follow-up was 3.6 (2.7–4.1) years in the EA group as compared to 1.4 (1.0–1.8) yrs in the LA group; P< 0.01. While most of the patients completed the transition at a median (IQR) age of 18.0 (17.9–18.3) years, 15 % of patients were transferred at an older age (18.5 to 20 years). Overall, 75.7% were in remission, 13.9% with mild disease activity and 10.4% with moderate activity at the last pediatric visit. Patients with moderate activity at last pediatric visit tend to be transferred at an older age as compared to patients in remission or mild activity. The median (IQR) age were respectively 18.4 (18.2–19.1), 18.0 (17.9–18.1), 18.0 (17.9–18.3) years; P=0.024. There was a modest correlation between age at diagnosis and age at transfer (R = 0.22; P = 0.0068). Patients were transferred to adult gastroenterologists in academic hospitals (50.8%) or non-academic hospitals (43.1%). However, the disease activity at transfer was not associated with the adult care setting (academic vs non-academic). The number of relapses and hospitalizations during pediatric care were associated with older age at transfer: (> 18.5 yrs vs < 18.5 years): median(IQR) of 0.8(0.4–1.4) vs 0.3 (0.-0.6) for relapses; P=0.009 and 0.4 (0.0–1.1) vs 0.3 (0.0–0.7) for hospitalizations; P=0.009. Conclusions Pediatric IBD diagnosed at late adolescence tend to have more active disease and older age at transfer. Therefore, efforts to design a structured transitional care program are needed in order to improve transition outcomes for IBD patients with a special focus for subjects diagnosed in late adolescence. Funding Agencies CAG