Barriers, Drivers, and Outcomes in Transitioning Patients With Inflammatory Bowel Disease From Intravenous to Subcutaneous Infliximab

Background Patients with inflammatory bowel disease (IBD) carrying the HLA-DQA1*05 allele have a higher risk of developing immunogenicity and loss of response to anti-TNFs. On the other hand, this association has not been observed with ustekinumab, a fact that could help individualize treatment (J. Guardiola ECCO 2024). We do not have data for vedolizumab. Methods: Objective To evaluate the relationship between the HLA-QA1*05 allele and the loss of response and the persistence of treatment with vedolizumab. Methods Design: Unicentric retrospective cohort study from a tertiary hospital. Population IBD patients who have completed induction with vedolizumab. Loss of response need for intensification, change of treatment, hospitalization or surgery. Analysis univariate (Kaplan Meyer) and multivariate (Cox Regression) analyses. Results We included 67 patients with IBD (24 Crohn’s disease and 43 ulcerative colitis) with an average follow-up of 29±21 months. Both cohorts were comparable in relation to baseline characteristics. 44% were carriers of the risk allele. 74% had previous exposure to biologicals. Mean basal and postinduction calprotectin were 866±1103 and 295±1228, respectively. 28 (46%) of the patients lost response during follow-up. During this period 29%, 25%, 7% and 42% required hospitalization, treatment with corticosteroids, surgery or intensification respectively. We found no differences in relation to clinical or biological remission rates at 6 and 12 months, nor differences in discontinuation rates in relation to the status of carriers of the risk allele. The mean duration free of loss of response was 28 months (95% CI: 9-46) in individuals not carrying the HLA-DQA1*05 allele and 13 months (95% CI: 9-16) in those carriers, without significant differences between both groups (Log Rank p=0.517) (Figure 1). In multivariate analysis, after adjusting for treatment with prior biologics, obesity and type of IBD, the presence of the HLA-DQA1*05 allele was not associated with loss of response to vedolizumab or persistence of the treatment. Conclusion The presence of the HLA-DQA1*05 allele is not associated with loss of response or persistence of vedolizumab treatment.

Aim:To compare efficacy and tolerability of phytotherapy (PT) vs. potassium citrate (KC) in patients with minimal nephrolithiasis. To compare and assess changes in value of certain serum (Ca2+, PO43-, uric acid [UA]) and urinary (24-hr Ca2+, PO43-, UA, citrate, oxalate, and urine pH) parameters in patients being treated with PT or KC.Materials and Methods:After clearance by the local institutional ethics committee, 60 patients of nephrolithiasis who had consented for the study, were enrolled (as per entry criteria) and randomized into citrate therapy (group-I) or PT (group-II). PT was administered as a nutritional supplement, using a lupeol-based extract (Tablet Calcury™, two tablets twice a day). They were monitored for the changes in the serum and urinary biochemical, radiological, and clinical parameters (efficacy and tolerability) as per protocol.Results:Group-I patients demonstrated favorable changes in certain biochemical parameters (decreased serum calcium, urinary UA/oxalate, increased urinary citrate and pH) along with significant symptomatic improvement (decrease in visual analogue pain score with increased stone clearance/reduction in stone size). Four (13.3%) patients of group-I had mild upper gastrointestinal discomfort which was controlled with antacids. Group-II patients had favorable changes in biochemical parameters (decreased serum UA and increased urinary citrate) along with significant symptomatic improvement (reduction/clearance in the stone size), but without any noticeable side effects.Conclusions:Medical therapies with both KC and PT (with lupeol extract using Calcury™) were effective in reducing the stone size and symptoms of nephrolithiasis. It appeared that KC was biochemically efficacious in producing some favorable biochemical changes with some side effects, whereas PT was probably clinically efficacious in hastening stone expulsion (<8 mm) without any observed adverse events. Although both the medical therapies were not effective in all aspects, we believe that PT using lupeol-based extract (Calcury™) may be used as an alternative form of medical therapy in select patients with minimal nephrolithiasis. Long-term randomized placebo-controlled trials are needed to better define the precise role of lupeol-based PT vs. citrate therapy in minimal nephrolithiasis.

Background Biologic dose escalation is frequently employed in inflammatory bowel disease (IBD) patients who lose response to standard dosing regimens. Infliximab (IFX), the most commonly used biologic in IBD, has a well-established role in inducing and maintaining remission in IBD, particularly in fistulising Crohn's disease (CD).¹ Secondary loss of response to IFX can occur due to low serum drug levels, primarily from immunogenicity.² We investigated the effectiveness and treatment persistence of IFX dose escalation in IBD patients with inadequate response to standard dosing after initial clinical response. Methods We conducted a retrospective analysis of IBD patients who underwent IFX dose escalation between 2020-2024 at a tertiary IBD centre. Dose escalation was defined as increase in dose (&amp;gt;5mg/kg) and/or frequency [&amp;gt;every 8 weekly (Q8W)]. Primary outcomes included clinical disease activity scores (Simple Clinical Colitis Activity/SCCAI Index for UC, Harvey-Bradshaw Index/HBI for CD), biochemical markers (CRP, faecal calprotectin) and treatment persistence, evaluated at 3-12 months, 12 months, and annually up to 36 months post-escalation. Results The cohort included 47 patients (mean age 29 years, 52% female), comprising 33 CD (70%) and 14 UC (30%) patients. Primary indication for dose escalation was low drug levels (76%), followed by loss of response despite adequate levels (24%). Dose escalation led to significant improvements in disease activity scores (HBI: p=0.01; SCCAI: p=0.04) and CRP (p=0.02) at 3-12 months. These improvements were sustained at 12 months for CRP (p=0.04) but not for clinical scores. Treatment persistence at 36 months was notably high at 100% for biologic-naïve patients and 92% for biologic-exposed patients. Mild adverse events occurred in 5 patients (11%) including psoriasiform rash (n=3), transient liver enzyme derangement (n=1) and shingles (n=1). No serious adverse events occurred. Conclusion IFX dose escalation demonstrates significant improvements in clinical and biochemical parameters in the short term, with high treatment persistence up to 36 months. While both groups showed excellent outcomes, biologic-naïve patients achieved superior persistence (100% vs 92%). These findings support dose escalation as a viable therapeutic option for maintaining response in IBD patients, with an acceptable safety profile. Prospective studies are needed to identify predictive factors for successful dose escalation and optimal timing of intervention.

In the SARSCov2 virus epidemic, pregnant women are more susceptible to infectious diseases due to changes in biochemical parameters and are at higher risk of severe respiratory disease and pneumonia. This study aimed to evaluate the biochemical, inflammatory and coagulation parameters in pregnant women with severe disease conditions (as one of the high-risk groups) as well as prognosis and outcome. This cross-sectional study was performed on 135 pregnant women with COVID-19 admitted to ICU. Demographic and clinical information and laboratory parameters of the patients were evaluated and recorded at the time of admission and in the next follow-up until discharge or death in addition to the outcome and also the pregnancy outcome. The mortality rate of pregnant women with COVID-19 was 9.6%. The mortality rate decreases with increasing Hb (OR (95% CI): 0.68 (0.47-0.99); P value = 0.043) and lymphocytes (OR (95% CI): 0.92 (0.85-0.96); P value = 0.028) and will increase significantly with increasing PT (OR (95% CI): 1.24 (1.01-1.51); P value = 0.037), INR (OR (95% CI): 1.89 (1.26-2.25); P value = 0.004), D-dimer (OR (95% CI): 1.68 (1.10-2.08); P value = 0.027), and LDH (OR (95% CI): 1.20 (1.01-1.61); P value = 0.010). According to the results of the present study, inflammatory factors such as leukocytes, neutrophils, NLR, CRP have an increasing and lymphocytes have a decreasing trend, so that lymphocytopenia is more common in non-survivors. In addition, increase of PT, INR, D-dimer and LDH and decrease of Hb were significantly associated with increased chance of mortality. But fibrinogen, ferritin, ALT and AST were not significantly associated with mortality in these women.

Background Differentiating between infectious gastroenteritis and a flare of inflammatory bowel disease (IBD) can be difficult. Small studies have shown that thrombocytosis may not occur in infectious gastroenteritis. We aimed to determine whether thrombocytosis is a reliable biomarker in distinguishing between these two diagnoses in patients presenting with diarrhoea. Methods A retrospective cohort study was conducted at a tertiary referral IBD centre. From January 2000 and December 2018, patients admitted with acute diarrhoea were included. Inclusion criteria were infective gastroenteritis, IBD flare or both. IBD diagnosis was confirmed by standard clinical, radiological and histopathological criteria. Clinical and biochemical parameters were collected. Results There were 351 infectious and 506 IBD flare cases. Among these 216 (42.8%) had Crohn’s disease, 276 (54.7%) ulcerative colitis, and 13(2.6%) had IBD-unclassified. Table 1 summarises the main results. Those with acute IBD flare had a longer duration of diarrhoea, bloody diarrhoea, lower albumin and anaemia (p &amp;lt; 0.05 for all comparisons). Patients with infectious diarrhoea were more likely to be older, female, have vomiting and fever and leucocytosis (p &amp;lt; 0.05 for all comparisons). Median platelet count was higher in patients with IBD flares, 334 vs. 220 (p &amp;lt; 0.001) and persisted on multivariate analysis (p &amp;lt; 0.001, OR1.45). On multivariate analysis, other significant associations for IBD flare were age (OR.85, p &amp;lt; 0.001) female sex (OR.23, p &amp;lt; 0.110), blood in faeces (OR 5.98, p &amp;lt; 0.001) vomiting (OR .17, p &amp;lt; 0.001) and albumin (OR.83, p = 0.02). A sub-analysis compared patients with known IBD and infectious gastroenteritis with an identified pathogen (n = 47), with those with an IBD flare alone showed no significant difference in platelet count between groups (419 vs. 465, respectively, p = 0.17). Conclusion Our study shows significant differences between clinical and biological markers in patients with acute IBD flares compared with those with infectious gastroenteritis. In particular, thrombocytosis occurs in IBD flares but not in infectious gastroenteritis. This biomarker can be used to differentiate between these diagnoses and guide management.

Background Artemisinin-based Combination Therapies (ACTs) are widely used in the treatment of uncomplicated malaria. Plasmodium falciparum infection is often accompanied by disturbances of hematological and biochemical parameters. The objective of this study was to evaluate the changes in biochemical and hematological parameters during uncomplicated malaria in patients treated with ACTs. Methods Data from patient with uncomplicated Plasmodium falciparum malaria were pooled from different open-randomized trial evaluating the efficacy of Artesunate-Mefloquine (ASMQ), Artesunate-Amodiaquine (ASAQ), Artemether-Lumefantrine (AL), and Dihydro-artemisinin-Piperaquine (DHAPQ) combinations. Biochemical (transaminases, creatinine, and bilirubin) and hematological (hemoglobin and platelet levels) parameters were performed at baseline (D0) and at day 7 after treatment (D7). Data were analyzed as both continuous and categorical variables with 95% confidence interval. Risks and trends were calculated using multivariate logistic random effect models. Results A total of 720 patients with completed biological data were included in the analysis (320 in the AL arm, 160 in the ASMQ arm, 120 in the DHAPQ arm, and 88 in the ASAQ arm). The mean age of the patients was 9.43 ± 9.1 years. Male subjects represented 58.47% (sex ratio was 1.4 for males). The mean hemoglobin level at inclusion (D0) was 9.79 g/dl and anemia (Hb < 11 g/dl) was 71.43% (aOR = 1.16 [0.68 − 1.98]p = 0.57). At D7, hemoglobin level was 9.63 g/dl and anemia was significantly more frequent (78.29% [p = 0.002]). The mean platelet count at day 0 was 154075.5 platelets/mm3 of blood and 339328.7 platelets/mm3 at day 7. Thrombocytopenia was about 53.61% and was associated with malaria (aOR = 3.4 [2.18 − 5.3]p < 10−3). 19.58% of patients had abnormal ALT and 40.28% had abnormal AST at D0. 27.22% of patients had normal bilirubin at D0. Renal function was normal in all patients in the study. Normalization of transaminases was noted between D0 and D7. The percentage of subjects with normal bilirubin increased between D0 and D7. Renal function did not vary significantly between D0 and D7. Conclusion Results from this analysis showed that subjects with high parasitaemia had a greater risk of anemia and thrombocytopenia. Artemisinin combinations were well-tolerated as no major biological disturbances were noted. The effects of ACTs on hematologic and biochemical parameters were not different.

IntroductionMRI enterography has become the gold standard radiological assessment for Crohn’s disease. The radiological response of Crohn’s disease following mono therapy with Adalimumab is not clearly documented. The aim of...

Background The aim of this study was to investigate the factors associated with treatment persistence for infliximab and adalimumab, as 1st or 2nd line anti-TNF therapy, in patients with inflammatory bowel disease (IBD). Methods A retrospective study of patients with IBD from the registry of our department who received infliximab (IFX) or adalimumab (ADA), during the period of 2002–2019 was performed. The persistence rate of IFX and ADA at 1 and 3 years from treatment initiation as 1st and 2nd line anti-TNF therapy respectively was calculated. In addition, possible related factors were analyzed. Results We included 185 patients with IBD, naive to biologics, who initiated with anti-TNF treatment [105 men (57%), mean age (± SD) 44.5 ± 14.7 years, Crohn’s disease 144 (78%), median disease duration (IQR) 13 (7–20) years, 120 (65%) under IFX, 100 (55%) in combination with immunosuppressive therapy for at least 6 months]. In 59 patients [Crohn’s disease 47 (80%)] IFX or ADA was used as 2nd line anti-TNF therapy. The duration of administration and persistence rate of IFX and ADA as 1st and 2nd line treatment are shown in Table 1. In univariate analysis statistically significant associations between the persistence rates of anti-TNF therapy as first-line therapy, with the use of immunosuppressants (P = 0.04) and treatment intensification (P = 0.01) in both 1st and 3rd year (P = 0.01 and 0.04 respectively) were found. No other significant association between demographic, disease type and clinical parameters and treatment persistence was found. Regarding the 2nd line anti-TNF treatment, persistence of therapy in the 1st year was associated with treatment intensification (P = 0.02) and in the 3rd year of administration with the combination with immunosuppressants (P = 0.05). In multivariate analysis only the use of immunosuppresants remained statistically significant associated both in 1st and 3rd year of treatment in 1st line therapy (P=0.05 and P=0.003 respectively). This was also the case in 2nd line therapy but only in the 3rd year of treatment (P=0.05). Conclusion The persistence rates of IFX and ADA used both as a 1st and 2nd line therapy in IBD patients are significantly associated with the combined use of immunosuppressants.

Introduction: Anemia is one of the most common extra-intestinal complications of inflammatory bowel disease (IBD). European literature illustrates that anemic IBD patients are likely to develop more severe disease. However, United States data demonstrates limited literature in this regard. We aimed to assess the IBD characteristics, disease activity, and health care utilization between IBD patients with and without anemia presenting to an urban tertiary referral IBD center. Methods: Patients with IBD presenting to an inner-city tertiary referral center from 2008-2018 were included in this retrospective study. Inpatient and outpatient charts were individually reviewed and demographic and clinical data was collected, including laboratory data, endoscopy reports, imaging, surgery reports, and patterns of IBD medication use. ESR, CRP, endoscopic evaluation, and imaging reports at the time when Hb levels were the lowest was captured. Anemia and its severity was defined according to WHO criteria: men with Hb <13 g/dL, in non-pregnant women <12 g/dL, in pregnant women <11 g/dL. Differences between the two groups were evaluated using the Mann-Whitney U test for non parametric continuous data and chi-square test for categorical variables. Results: A total of 265 patients were included in the analysis. Anemia was noted in 138 patients (52%) at one point during their follow up period (54% with CD vs 48% with UC, p 0.34). IBD demographics, disease activity, and health care utilization were compared between anemic and non-anemic patients with IBD (Table 1). Anemic patients were noted to have more active disease on endoscopy or imaging within 1 year of their lowest hemoglobin level, compared to non-anemic patients (79% vs 42%, p<0.0001). In addition, anemic patients had a higher median ESR and CRP level than non-anemic patients (Table 1). Anemic patients also required higher health care utilization compared to non-anemic patients with IBD; this included greater usage of biologics and immunomodulators, more surgeries for IBD, and more frequent hospital visits (Table 1). Of note, iron replacement therapy was administered in only 43.4% of patients with IBD. Conclusion: Anemia has a high period prevalence in IBD patients followed at our tertiary referral center. While anemia is associated with an increase in disease activity and higher health care utilization, it is evidently undertreated in current practice. Our study indicates anemia in IBD patients requires close attention and should not be overlooked.699 Figure 1. Patient demographics, disease characteristics, and healthcare utilization statistics

Background and Aims Chronic kidney disease patients get affected by mineral bone disease in view of changes in various biochemical parameters. After transplantation there are changes in these parameters with additional effect of immunosuppression on bone mineral density. My study was to observe changes in biochemical parameters like calcium, phosphorus, vitamin D, parathyroid hormone, alkaline phosphatase and compare bone mineral density with the help of DEXA scan post renal transplantation after 3 and 6 months. It was a prospective observational comparative study. Aim of my study is to evaluate changes in Bone Mineral Density post renal transplantation Method Study was conducted at Apollo Tertiary care Hospital, Hyderabad which caters to rural as well as urban population in southern parts of India. This study was carried out form June 2017 to Dec 2018. Total 40 patients were included in study and they were followed up for the period of 6 months and underwent sets of investigations to assess their bone mineral density. Biochemical variables consist of calcium, phosphorus, alkaline phosphatase, vitamin D level and iPTH. Biochemical variables were classified into hypo, normal or hyper based on their lab values. iPTH values were considered high if value was nine times the upper limit of normal or low if value was less than two times the upper limit of normal. DEXA scan results were classified into normal, osteopenia and osteoporosis based on their t value. Results Study showed that patients who got admitted for transplant belong to age group of 31 – 50 yrs (39.8 +/- 12.8 yrs) predominantly male patients 30 (75%). In 25% patients (10) we were unable to find out native kidney disease shown as CKD (u). Other common causes were DM, ADPKD, CGN or CIN. Most patients were undergoing dialysis for more than 1 year, 47.5% (19) had significant loss of BMD as compared to patients whose dialysis was &amp;lt;1 year (p value 0.498 and 0.05). Hypocalcemia was predominantly seen in pretransplant period 26 (65%) but as the patient followed up level improved with few developing hypercalcemia 4 (10%) after 6 months. Hyperphosphotemia was seen in 19 (47.5%) patients before transplant while hypophosphatemia in 4 (10%) patients 6 months post transplantation, others had normal phosphorus level. Patients were on calcium and vitamin D supplements developed sufficiency to high level of vitamin D 33 (82.5%) patients 6 months post renal transplant. In iPTH around 12 (30%) of patients were having iPTH &amp;gt;150 pg/dl after 6 months of transplant. Majority presented for transplant detected to have osteoporosis and osteopenia at lumbar spine 31 (77.5%) and hip joint 27 (67.5%) with fracture risk 4 to 8 times of normal population. There was 8% and 10% increase in number of patients having osteoporosis at lumbar spine and hip joint respectively post-transplant. There was loss of 5.5% (mean t score at 0 month -1.98 and at 6 month -2.09) BMD at lumbar spine and 1.7% (mean t score at 0 month -1.83 and at 6 month -1.9) BMD at hip joint. Net loss of BMD was 3.6% over the period of 6 months. This accounts to increased risk of fractures post renal transplant. Biochemical variable in the form of iPTH has shown to have significant association with DEXA scan at lumbar spine (p value 0.01) and hip joint (p value 0.00) before and after transplant (p value of 0.01 and 0.00) though there was fall in iPTH level. Conclusion Pretransplant bone disease remains predominant cause of post-transplant bone disease with significant association with iPTH. Hypophosphatemia, hypercalcemia and high Vitamin D level are common findings in post-transplant period upto 6 months. Early use of DEXA scan along with follow up of biochemical variables can help to prognosticate and decide treatment strategies to reduce fracture risk in renal transplant recipients.

Background. The outbreak of COVID-19 has attracted the attention of the whole world. Our study aimed to describe illness progression and risk profiles for mortality in non-survivors.Methods. We retrospectively analyzed 155 patients with COVID-19 in Wuhan and focused on 18 non-survivors among them. Briefly, we compared the dynamic profile of biochemical and immune parameters and drew an epidemiological and clinical picture of disease progression from disease onset to death in non-survivors. The survival status of the cohort was indicated by a Kaplan–Meier curve.Results. Of the non-survivors, the median age was 73.5 years, and the proportion of males was 72.2%. Five and 13 patients were hospital-acquired and community-acquired infection of SARS-CoV-2, respectively. The interval between disease onset and diagnosis was 8.5 days (IQR, [4–11]). With the deterioration of disease, most patients experienced consecutive changes in biochemical parameters, including lymphopenia, leukocytosis, thrombocytopenia, hypoproteinemia, as well as elevated D-dimer and procalcitonin. Regarding the immune dysregulation, patients exhibited significantly decreased T lymphocytes in the peripheral blood, including CD3+T, CD3+CD4+Th, and CD3+CD8+Tc cells. By the end of the disease, most patients suffered from severe complications, including ARDS (17/18; 94.4%), acute cardiac injury (10/18; 55.6%), acute kidney injury (7/18; 38.9%), shock (6/18; 33.3%), gastrointestinal bleeding (1/18; 5.6%), as well as perforation of intestine (1/18; 5.6%). All patients died within 45 days after the initial hospital admission with a median survivor time of 13.5 days (IQR, 8–17).Conclusions. Our data show that patients experienced consecutive changes in biochemical and immune parameters with the deterioration of the disease, indicating the necessity of early intervention.

Introduction: While the demographics and clinical manifestations of Inflammatory Bowel Disease (IBD) have been widely described in the general population, little is known about the clinical presentation of patients belonging to the lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) community. The aim of this study was to describe the clinical presentation of IBD in individuals who identify as LGBTQIA+ at their first presentation to an IBD clinic at a tertiary referral center. Methods: This is a retrospective chart review study where patients that identify as LGBTQIA+ and that have IBD were identified using an electronic data retrieval system at a tertiary referral center. We collected information regarding their sexual orientation, gender identity (SOGI), gastrointestinal (GI) symptoms, location of disease, extent of GI tract involvement and their IBD medications at the time of their first visit to the IBD clinic. We used descriptive statistics to analyze the data. Results: The demographics, SOGI, IBD diagnosis and medications of the 93 patients included in our study are described in Table. The median time (interquartile range) from symptom onset to diagnosis and to presentation to IBD clinic were 1.4 (0; 12.7) and 72.1 (10.3; 160.5) months respectively. The extent and location of bowel involvement at the initial visit are displayed in Figure. On presentation, 46% of patients reported abdominal pain, 45% diarrhea, 25% hematochezia, 16% weight loss and 15% fatigue. Ten percent of patients had a history of clostridium difficile colitis. There were 24 patients that had more than one IBD-related emergency department visit and 17 patients that had more than one hospitalization at a tertiary referral center within one year of presentation to IBD clinic. A history of mood or anxiety disorders was assessed in 41 patients (44%), 16 of which had a history of anxiety and 19 of depression. Indications of suicidality were only assessed in 10 patients (11%). Conclusion: While this study is the first to help clarify the GI manifestations and disease characteristics of IBD in patients who identify as LGBTQIA+, further studies are needed to deepen our understanding of the epidemiology and clinical presentations of IBD in this population in comparison to a non-LGBTQIA+ cohort. This will facilitate the identification of potential healthcare disparities and barriers to timely access of patients who identify as LGBTQIA+ with IBD to clinical care.Figure 1.: Gastrointestinal involvement in patients who identify as LGBTQIA+ and who have ulcerative colitis (A, n=25) and Crohn’s disease (B, n=45; C, n=32). Table 1. - Demographics, sexual orientation, gender identity, IBD diagnosis and IBD medications of 93 individuals who identify as LGBTQIA+ All patients (n=93) Age, in years, mean (SD) 30 (15) Sex assigned at birth, Female, N(%) 59 (63) Sexual orientation, N(%) Bisexual 48 (52) Gay/lesbian/homosexual 39 (42) Other 5 (5) Prefer not to disclose 1(1) Gender Identity, N(%) Female 52 (56) Male 30 (32) Genderqueer 2 (2) Transgender female 2 (2) Other 7 (8) Race, N(%) White 85 (92) Black 3 (3) American indian/Alaska native 1 (1) Asian 1 (1) Native Hawaiian/Pacific Native Islander 1 (1) Other 2 (2) IBD diagnosis, N(%) Ulcerative colitis 48 (52) Crohn's Disease 45 (48) IBD medications at initial visit, (n=37) Mesalamine 20 (54) Corticosteroids 15 (41) Thiopurines 10 (27) Infliximab 8 (21) Adalimumab 7 (19) Vedolizumab 2 (5) Ustekinumab 2 (5) Certolizomab 2 (5) Methotrexate 1 (3) IBD: Inflammatory Bowel Disease; Data shown: Number (percentage), unless stated otherwise.

P008 IMPACT OF A MULTIDISCIPLINARY E-BOARD FOR COMPLEX INFLAMMATORY BOWEL DISEASE MANAGEMENT

Managing patients with inflammatory bowel disease (IBD) in the modern era requires an interdisciplinary approach among a wide range of specialties with expertise in IBD. However, specialty IBD care is not available at all medical institutions. We herein assess the impact of a biweekly multidisciplinary IBD case conference at a tertiary referral center that incorporates videoconferencing to community-based centers (IBD eBoard) on the management of complex IBD cases. From February 2017 through October 2018, data was collected prospectively during each IBD eBoard conference. Collected data included the number and role of internal attendees, the number of external attendees (via videoconferencing), external attendee site, case presenter, presented case diagnosis, and specific question(s). Outcomes of the discussion were then recorded, including if the initial diagnosis was changed and any recommended testing, medical, and surgical treatments Since its inception in February 2017, a total of 34 IBD eBoard conferences have taken place, with an average of 18.8 internal attendees and 5.6 external attendees from 6 community-based centers, including one in China. Attendees have included gastroenterologists, colorectal surgeons, radiologists, pathologists, nurse practitioners, fellows, residents, and study coordinators, among others. In total, 85 individual cases were presented (4 cases presented a second time and 1 case presented a third time). Six cases were presented externally via videoconference technology, with a community hospital in China being the furthest location geographically. Of the 85 new cases presented, the initial diagnosis was changed in 8 (9.4%). Recommendations for further diagnostic testing were made in 41 of the 90 presented cases (45.6%), while recommendations for changes in medical and surgical IBD management were made in 60 (66.7%) and 45 (50%) cases, respectively. Our IBD eBoard offers a unique opportunity for improving the care of complex IBD patients by combining the multidisciplinary expertise of a tertiary referral IBD center with videoconference technology to allow for outreach consultation to smaller, community-based centers. Through collaborative discussion, this approach appears to significantly impact the management of presented cases. This model is likely easily reproducible among other IBD centers. To implement more widely, further work is necessary to determine the long-term impact and cost-effectiveness of such an approach.

Characterizing the pre-clinical phase of inflammatory bowel disease