Cases Of IBD Research Articles

Incidence and prevalence of inflammatory bowel diseases in a population from Buenos Aires, Argentina

BackgroundInflammatory bowel diseases (IBD) incidence and prevalence in Latin America have experienced a significant shift in the last decades. There is paucity of IBD epidemiologic data in Argentina. AimTo determine the incidence and prevalence of IBD between 2018 and 2022 of a population from the city of Buenos Aires. Materials and methodsFrom January 1st, 2018 to December 31st, 2022, the total population of two healthcare insurances were studied. ‘Possible’ IBD cases were identified using the following information sources: IBD-unit patient databases; electronic medical record; central laboratory electronic database; histopathology electronic database; pharmacy electronic database. Age-adjusted incidence and prevalence rates for Crohn's disease (CD), ulcerative colitis (UC) and IBD were estimated based on the number of patients compared with the at-risk population and expressed per 100,000 subjects. Trends in IBD incidence and prevalence were estimated as annual percentage changes; we used Poisson regression modeling to calculate significance in these trends over time. ResultsInformation source analysis rendered 172 possible cases, of which 82 cases of IBD were finally confirmed: 27.16% were CD and 72.84% were UC. Mean age-standardized incidence across the study period for IBD, CD and UC was 11.93 (11.28–12.55), 2.88 (2.65–3.07) and 9.05 (8.83–9.2) respectively. Point prevalence on December 31st, 2022 for IBD, UC and CD was 134 (95%CI 132.3–135.6), 98 (96.95–99.52) and 36 (35.69–36.4) respectively. ConclusionsWe found an incidence and prevalence of IBD in a population from Buenos Aires higher than those previously published in epidemiological studies in Argentina.

New-Onset, Treatment-Resistant Inflammatory Bowel Disease after Administration of Secukinumab for Plaque Psoriasis: A Case Report and Review of the Existing Literature.

Aberrant activation of the IL-23/IL-17 axis leads to inflammatory phenotypes with overlapping clinical characteristics. Inhibition of IL-17 has mostly an anti-inflammatory effect, but sporadic cases of new-onset IBD have been reported. We present the case of a 65-year-old male patient with new-onset Crohn's-like disease after treatment with secukinumab for skin psoriasis. Discontinuation of the IL-17 inhibitor and high-dose corticosteroid treatment were efficient initially, but a relapse was noted during corticosteroid tapering. Administration of certolizumab pegol did partially relieve the patient, but disease remission was only achieved with subcutaneous risankizumab therapy. Clinical trials and real-world data indicate sporadic cases of new-onset IBD in patients receiving IL-17 inhibitors. Interestingly, our case is a "treatment-resistant" one since treatment with a biologic disease-modifying drug (bDMARD) usually leads to disease remission. As such, it is crucial to investigate the special characteristics of this clinical entity.

Incidence and prevalence of inflammatory bowel diseases in a population from Buenos Aires, Argentina

BackgroundInflammatory bowel diseases (IBD) incidence and prevalence in Latin America have experienced a significant shift in the last decades. There is paucity of IBD epidemiologic data in Argentina. AimTo determine the incidence and prevalence of IBD between 2018 and 2022 of a population from the city of Buenos Aires. Materials and methodsFrom January 1st, 2018 to December 31st, 2022, the total population of two healthcare insurances were studied. ‘Possible’ IBD cases were identified using the following information sources: IBD-unit patient databases; electronic medical record; central laboratory electronic database; histopathology electronic database; pharmacy electronic database. Age-adjusted incidence and prevalence rates for Crohn's disease (CD), ulcerative colitis (UC) and IBD were estimated based on the number of patients compared with the at-risk population and expressed per 100,000 subjects. Trends in IBD incidence and prevalence were estimated as annual percentage changes; we used Poisson regression modeling to calculate significance in these trends over time. ResultsInformation source analysis rendered 172 possible cases, of which 82 cases of IBD were finally confirmed: 27.16% were CD and 72.84% were UC. Mean age-standardized incidence across the study period for IBD, CD and UC was 11.93 (11.28–12.55), 2.88 (2.65–3.07) and 9.05 (8.83–9.2) respectively. Point prevalence on December 31st, 2022 for IBD, UC and CD was 134 (95%CI 132.3–135.6), 98 (96.95–99.52) and 36 (35.69–36.4) respectively. ConclusionsWe found an incidence and prevalence of IBD in a population from Buenos Aires higher than those previously published in epidemiological studies in Argentina.

Monogenic Cases of Infantile IBD with Discrete Pathological Pathways: a Case Series

Objective − Inflammatory bowel disease (IBD) is a multifactorial auto-immune disease caused by dysregulated immune responses, resulting in chronic intestinal inflammation. IBD in which disease onset is before 2 years of age is known as Infantile IBD. As the disease is rare in this age group, it is often misdiagnosed as infective or allergic colitis. Cases − We present here a case series of three patients with infantile IBD with completely different etiologies, that is, a mutation in the distinct pathways, i.e. the hematological lineage pathway (IL10 RA), autoimmunity (NLRC4), and immunodeficiency (IKBKG). All the cases had chronic diarrhea, however each case was difficult to diagnose conclusively and had a different response to the standard treatment protocol for IBD.Conclusion − Our case series shows that genetic mutations and/or primary immunodeficiency play an important etiological role in this subgroup of IBD (infantile onset). It also highlights that patients with infantile IBD are difficult to diagnose, treat, and usually do not respond to conventional treatment.

P927 Corticosteroid treatment in pediatric IBD patients reshapes the gut microbiota

Abstract Background Inflammatory bowel disease (IBD) in pediatric populations comprises 25% of all cases of IBD, which is a chronic immune-mediated inflammation of the intestinal tract. The clinical course of IBD is demonstrated in relapsing and remitting phases that require lifelong monitoring and treatment. The complex interactions between mucosal immunity and the intestinal microbiota are well-known in the pathogenesis of IBD. Corticosteroids are commonly administered to reduce IBD-associated mucosal inflammation and gastrointestinal symptoms. Whether or not corticosteroids beneficially modulate the mucosal microbiota to help reduce intestinal inflammation in pediatric patients with IBD has not been evaluated with interventional studies. Methods The objective of this study was to evaluate the effects of corticosteroids on the diversity and composition of gut microbiota in pediatric IBD patients. Ten pediatric patients diagnosed with IBD were treated with corticosteroids for 2-3 months. Stool samples were collected before and 8 weeks after treatment. The diversity and composition of gut microbiota were evaluated using 16S rRNA gene sequencing. Results Our results suggest that 3 months of corticosteroid treatment result in an increase in alpha diversity(p<0.05). The community structure of gut bacteria was significantly different (p<0.05) pre and post-treatment, with higher abundances of Bacteroides ovatus Bacteroides fragilis whereas the lower abundance of Prevotella copri and Alistipes finegoldi was observed(p<0.05). In conclusion, the diversity and composition of bacteria differ as a result of corticosteroid administration. Since gut microbiota plays an important role in regulating inflammatory conditions such as IBD Conclusion Reshaping intestinal microbiota through corticosteroid therapy may be a viable treatment option.

Prevalence of IBS and its relationship to vitamin D deficiency in Al- Nasiriyah city, Iraq

Objective: To learn how common irritable bowel syndrome (IBS) is in the city of Al-Nasiriyah and whether or not this disorder is linked to a lack of vitamin D. Methodology: This cross-sectional study included 396 patients based on Raisoft online application's population size. Patients were randomly enrolled from July to December 2022 at three outpatient clinics in various city quarters. Study factors were age (years), gender, family history of IBS, smoking, place of residence, marital status and vitamin D level. Results: We found that 56.06% patients had deficiency of vitamin D while 39.65% had insufficiency of vitamin D. We noted that 18.18% had mixed IBS while 15.15% had unclassified IBS,13.38% had constipation and only 7.58 had diarrhea. There was significant association between Vitamin D level and place of living. Females had significant deficiency in vitamin D level (59.6%) and 50.7% and 45.1% cases of IBD had deficient and insufficient, respectively. Conclusion: Vitamin D deficiency is common. Most urban patients’ features were mixed IBS, unclassified IBS, or constipation, and vitamin D insufficiency. Vitamin D insufficiency was higher in women. Most IBS patients were deficient or insufficient.

Innovative Care for Inflammatory Bowel Disease Patients during the COVID-19 Pandemic: Use of Bedside Intestinal Ultrasound to Optimize Management.

BackgroundThe COVID-19 pandemic caused by SARS-CoV-2 has reduced access to endoscopy and imaging. Safe alternatives, available at the bedside, are needed for accurate, non-invasive strategies to evaluate disease activity. The aim of this study is to establish the impact of clinic-based bedside intestinal ultrasound (IUS) on decision making, reduction in reliance on endoscopy and short-term healthcare utilization.MethodsWe conducted a prospective observational evaluation during the COVID-19 pandemic, of the impact of a regional comprehensive care pathway to manage IBD patients consecutively recruited with acute symptoms, or suspected new diagnosis of IBD. Clinic-based access to sigmoidoscopy and bedside intestinal ultrasound were evaluated, used to direct clinical care and avoid hospitalization or hospital-based endoscopy.ResultsA total of 72 patients were seen between March 15 and June 30, 2020. Of these, 57% (41/72) were female, 64% had Crohn’s disease (46/72) with 14% (10/72) presenting with symptoms requiring investigation, of which 5 new cases of IBD were identified (50%). Immediate access to ultrasound and sigmoidoscopy led to meaningful changes in management in 80.5% (58/72) of patients. Active inflammation was detected by IUS alone (72.5%, 29/40) or in combination with in-clinic sigmoidoscopy (78%, 18/23) or sigmoidoscopy alone (78% 7/9). Six patients were referred to colorectal surgery for urgent surgical intervention including two patients admitted directly.ConclusionImplementation of IUS as part of a clinical care pathway during the COVID-19 pandemic is a useful strategy to enhance care delivery and improve clinical decisions, while sparing other important acute care resources.

P151 Rationalizing colonoscopy utilization for Inflammatory bowel disease diagnosis: time to reset the Calprotectin threshold to >600?

Abstract Background Faecal calprotectin (FC) measurement is used to stratify risk of IBD in primary care. Typically the normal range for FC is 0–50 ug/g, and in established practice FC>200 mandates gastroenterology referral for further investigations, including colonoscopy. The optimal FC threshold for referral is, however, debated: most people with FC>200 do not have IBD and some with IBD have FC<200. We aimed to assess FC at different thresholds, and whether the threshold might be safely raised (hence reducing the numbers referred for colonoscopy) by combining FC with other easily ascertained parameters without significantly impacting IBD diagnostic yield. Methods We included all patients aged 18–45 in whom FC testing was requested in primary care in 2018 and 2019, regardless of FC result, and who subsequently underwent colonoscopy at Cambridge University Hospitals (CUH). We excluded patients with a prior IBD diagnosis. Based on the retrospective review of findings at colonoscopy and case notes, we classified the final diagnosis as one of (1) normal (2) IBD/subtype (3) non-IBD intestinal inflammation (e.g. infection, microscopic colitis, NSAID enteropathy) and (4) cancer. Results 852 patients were included, 60% female, median age 33. The FC ranged from 10 to >600. 98/189 with FC>600 had IBD, compared to 17/166 with FC 200–600 and 15/497 with FC<200 (Figure 1). Only 52% with small bowel CD had FC>600 (Figure 2). 74% of colonoscopies showed no inflammation. 10.5% of these patients had FC >600 and 18.6% had FC 200–600. Of the 32/130 (24.6%) patients with newly diagnosed IBD who had FC<600, 24 reported rectal bleeding, 13 had raised CRP >6, and 6 had a family history (FH) of IBD (table 1). Only one patient with FC <600 subsequently diagnosed with IBD had none of these parameters. Sensitivity and specificity data are provided in table 2. For patients with intermediate FC the UK advice is to repeat the test. In our cohort 168 patients had an initial FC of <600 and had a repeat. In this group the subsequent FC was <50 in 88. 6 cases of IBD were identified in those in whom the repeat FC was >50 but <600, but all had one or more of rectal bleeding, raised CRP or FH of IBD. 12/852 were found to have colorectal cancer, however, 8 of them had been referred to CUH on the ‘suspected cancer’ pathway. Of the 4 referred on the ‘suspected IBD’ pathway, only 1 had FC >600 – others were in the 50–600 range. Conclusion Based on our observations, using an FC threshold of >600, or 50–600 with one or more of rectal bleeding, raised CRP or FH of IBD, would substantially reduce the number of colonoscopies undertaken and have a minimal impact on diagnosis of IBD. Repeat testing following a modestly elevated FC had no further utility. These data require independent validation.

P427 Exploring phenotype and treatment of inflammatory bowel disease in the elderly

Abstract Background On a background of an ageing population, approximately, 10–15% of new cases of IBD are diagnosed in patients over the age of, 60.1,2 Studies show IBD in the elderly is increasing, including both the groups of patients diagnosed at a younger age, and de novo elderly IBD. Older patients are more likely to have other co-morbidities and be concurrently prescribed other medications, which may impact the choice and timing of therapies for their disease. It is not clear if IBD in older age is different phenotypically from that in younger counterparts, and whether current management algorithms can be used safely in this cohort. Aims of the study were to evaluate the IBD phenotype and use of therapies in the elderly (≥75 years) and younger (18–74 years) patients, and to assess for differences in adverse outcomes between both cohorts on immunosuppressants (IMs) and/or biologics. Methods A retrospective study was performed on, 173 IBD patients at Imperial College Healthcare NHS Trust over a two-year period., 91 elderly IBD patients were compared with, 82 younger patients, matched by gender and IBD subtype. Analysis included chi-squared tests with Fisher’s correction. Results There were, 55 elderly patients and, 51 younger matched patients with ulcerative colitis (UC) where no differences in disease extent, remission or surgeries were seen. There were, 36 elderly patients and, 31 younger matched patients with Crohn’s disease (CD). There was less ileocolonic disease in the older CD cohort compared to younger patients (27.8% versus, 51.6%, p=0.046) (figure 1). Medication use in UC was the same regardless of age. There was significantly higher use of IMs and biologics in younger patients with CD (51.6%) versus the older cohort (25%, p=0.047) (figure 2). In elderly patients with CD, a significantly greater mortality was seen in patients on IMs/biologics (27.3%) than those not on these medications (8%, p=0.023) (figure 3). The rate of VTE was higher (18.2% versus, 0%) in those on these treatments with a trend towards significance. Conclusion Overall, this retrospective study demonstrated that elderly IBD patients in this cohort appear to be mostly phenotypically similar to younger patients. However, elderly Crohn’s patients were less likely to be escalated to IMs/biologic treatments than their younger comparators. In view of the higher rate of adverse events recorded in the Crohn’s group managed with these treatments, this may be justified. Further, larger studies in the long-term outcomes of these patients are required. Reference 1. Charpentier C et al. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut., 2014;63(3),423–432

P652 The burden of mental illness, including deliberate self-harm, before and after a diagnosis of IBD, a UK population study

Abstract Background The burden of mental illness among IBD patients is recognised to be greater than among their healthy peers. Due to the bi-directional influence of the gut-brain axis,mental health may be linked to IBD outcomes and vice versa. The aim of this study was to use population level data to describe the incidence of anxiety, depression, insomnia, severe mental illness and deliberate self-harm in patients with IBD. Methods A retrospective cohort study was conducted using The Health improvement Network (THIN) database to estimate the incidence rates of anxiety, depression, insomnia, severe mental illness and deliberate self harm in patients with IBD between 1995 to 2021 and matched controls with no pre-existing mental health illness.The prevalence of pre-existing depression, anxiety and insomnia prior to IBD diagnosis was assessed for IBD patients and matched controls.The association between deliberate self harm and incident mental health diagnoses following IBD diagnosis were estimated using Cox regression analysis. Results We identified 59,613 incident cases of IBD,34,615 (58.1%) had UC and 25,000 (41.9%) had Crohn’s disease. The median age was;41.5 (IQR 29.6–57.5) years,with an equal proportion of males and females with IBD (49.2% vs 50.8%). Patients with a diagnosis of IBD had an increased prevalence of anxiety 10 years (3.0% vs 2.5%,p<0.001) and 2 years prior to diagnosis (6.2% and 5.3%,p<0.001). A similar pattern was seen for insomnia at 10 years (1.0% vs 0.9%, p=0.028) and 2 years (3.4% vs 3.0%, p<0.001) and for depression at 10 years (3.7% vs 4.5%, p<0.001) and 2 years (8.1% vs 9.6%, p<0.001). The incidence of mental illness was higher in IBD patients than controls for; anxiety [6.1 vs 5.3 per 1000 patient years,HR 1.14(1.09–1.20),p<0.001], depression [11.3 vs 7.5 per 1000 patient years,HR 1.34 (1.28–1.39),p<0.001], insomnia [9.6 vs 6.0 per 1000 patient years,HR 1.54(1.5–1.6),p<0.001] and DSH [1.6 vs 1.2 per 1000 patient years,HR 1.20(1.07–1.35),p<0.001]. Associations of deliberate self harm in this patient groups included: IBD (HR 1.20(1.07–1.35),p=0.002),female gender (HR 1.06(1.35–1.60),p<0.001),age quintile <27.4 years (HR 4.48(3.95–5.93),p<0.001) compared to >61.3 years,anxiety (HR 1.57(1.35–1.82),p<0.001),depression (HR 5.97(5.33–6.69),p<0.001),insomnia (HR 2.32(2.02–2.66),p<0.001), and severe mental illness (HR 5.74(4.56–7.22),p<0.001). Conclusion There is an additional burden of mental illness in patients who are later diagnosed with IBD. Following diagnosis,the incidence of depression, anxiety, insomnia and deliberate self harm is higher in individuals with IBD than controls.Patients who develop mental illness in the setting of IBD are at particularly high risk of deliberate self-harm.

New-onset inflammatory bowel diseases among IL-17 inhibitor-treated patients: results from the case-control MISSIL study.

To describe new-onset IBD (new IBD) in patients treated with IL-17 inhibitors (IL-17i), to assess their incidence and to identify their risk factors in real life. A French national registry (MISSIL) aimed to report all cases of new IBD in patients treated with IL-17i from January 2016 to December 2019. Using the estimated number of patients treated by IL-17 in France during the study period, the annual incidence rates of new IBD was reported in IL-17i-treated patients. A case-control study was performed with two controls per new IBD case matched by gender, age and underlying inflammatory disease. Thirty-one cases of new IBD under IL-17i were collected: 27 patients treated for spondyloarthritis and four patients for psoriasis. All were observed with secukinumab (SEK). The median time to onset of new IBD symptoms was 4.0 (1.5-7.5) months. SEK was discontinued in all patients. The evolution was favourable with complete resolution (17/31), improvement (7/31) or stabilization (5/31). Two patients died: one due to a massive myocardial infarction and one due to post-colectomy complications. The incidence of new IBD decreased from 0.69/100 patient-years [PY] (7/1010) in 2016 to 0.08/100 PY (6/7951) in 2019. No previous treatment with etanercept (odds ratio [OR] = 0.33, 95% CI: 0.14-0.80, P = 0.014) and low number of previous biologic therapies (OR = 0.67, 95% CI: 0.47, 0.94, P = 0.021) were significantly associated with new IBD. The incidence of new IBD was low and decreased from 2016 to 2019. The outcome was favourable in 24 out of 31 patients, but two patients died.

S819 Incidence, Outcomes, and Impact of COVID-19 on Inflammatory Bowel Disease: Propensity Matched Analysis of a Large Research Network

Introduction: Several studies have examined outcomes of COVID-19 in patients with IBD however these reports have inherent limitations including a lack of matched controls precluding accurate assessment of risk, and lack of follow up data to assess for IBD flares and risk of de novo IBD in COVID-19 affected populations. Methods: We performed a retrospective cohort study using a multi-institutional research network TriNETX. Patients with IBD >16 yrs of age with COVID-19 (up to Feb 7, 2021) were matched 1:1 with non-IBD COVID-19 patients based on demographic variables and known risk factors for severe COVID-19 infection. Outcomes of COVID-19 disease in IBD were compared to the matched control cohort, and outcomes in IBD subpopulations were explored. The incidence of COVID-19 disease in patients with IBD was compared to the general population, and the relationship of incident cases of IBD with prior COVID-19 disease was investigated. Results: A total of 628,947 patients with COVID-19 met inclusion criteria (3486 in IBD and 625,461 in the non- IBD cohort). Prevalence of COVID-19 in patients with IBD cohort was 5.95%. Patients with IBD had a lower incidence of COVID-19 compared to the general population; IRR: 0.79 (95% CI: 0.72-0.86). The IBD cohort had a higher rate of inpatient treatment with no difference in mortality, mechanical ventilation or AKI noted in the propensity-matched analysis. Patients with IBD corticosteroids at baseline were found to be at increased risk for mortality (RR: 2.08, 95% CI:1.06-4.10, hospitalization and 30-day composite outcome (hospitalization or mortality). No difference in composite outcome was noted in the 5-ASA, biologic agent, and anti-TNF group compared to non-IBD cohort. 210 patients (6.0%) and 243 patients (7.0%) developed an IBD flare in 1 month and 3 months after COVID-19 diagnosis respectively. A total of 774 patients (0.10%) with no prior history of IBD were diagnosed with de novo IBD after COVID-19 infection. The IBD diagnosis rate after COVID-19 was lower compared to a control group of patients who were never diagnosed with COVID-19, on propensity score-matched analysis (RR 0.59; 95% CI:0.54-0.65). Conclusion: In a large cohort of patients with IBD infected with COVID-19, we found a higher rate of in-patient treatment without differences in other clinical outcomes compared to a matched cohort of patients without IBD. The rate of de novo IBD after COVID-19 and disease exacerbations in cases of prior IBD was low, and no IBD therapy was linked to worse outcomes.

The Incidence of Inflammatory Bowel Disease in the Paediatric Population in the District of Lower Silesia, Poland.

The incidence of IBD has been rising over the last decades. The trend applies not only to well-developed countries but also to the regions with limited number of cases so far, e.g., Asia or Middle East. Aim: The aim of the study was to determine the incidence of paediatric IBD in the district of Lower Silesia, Poland, between 2016 and 2018. Methods: The number of newly diagnosed IBD per 100,000 children, living in the region, was calculated. The characteristics of the group were established. Results: There were 81 cases of paediatric IBD diagnosed between the 1st of January 2016 and 31st of December 2018. The diagnosis of ulcerative colitis (UC) was made for 42 children. In the same period of time 39 cases of Crohn disease (CD) were recognised. The incidences were calculated as 2.57 for UC, and 2.38 for CD. The total incidence of IBD between 2016 and 2018 was 4.96/100,000/year which is rise in the last 20 years. Conclusion: An increase in incidence of IBD in the district of Lower Silesia has been observed.

P661 Radon exposure and inflammatory bowel disease in a radon prone area

Abstract Background Inflammatory Bowel Disease (IBD) is a multifactorial pathology with an increasing incidence. There are environmental factors, many unknown, that participate in its development. There is no study having assessed a possible relationship with residential radon exposure, which is very high in the study area. The aim of this study was to analyze if residential radon concentration measured at a municipal level is associated with a higher incidence of IBD and its characteristics (clinical or demographic). Methods We performed an ecological study where we included all incident cases of IBD in the area of Santiago de Compostela between January and December 2017 in order to estimate municipal incidence rates. Radon levels at a municipal level were obtained from the Galician Radon Map and correlated with demographic factors and type of IBD. We used the Spearman’s correlation coefficient to test the existence of any association. Results 96 patients were included, 63 (65.6%) with Ulcerative Colitis, 29 (30.25) with Crohn’s Disease and 4 (4.2%) with indeterminate colitis. Median age was 41 (IQR: 33.5 to 56 years), and 50.0% were women. The incidence rate per 100.000 inhabitants-year in the study area was 21.6 cases. The median radon concentration was 104.9Bq/m3 (IQR: 91.0 to 154.6), without statistically significant differences in function of the location of the house (rural vs. urban) nor the type of edification (flat vs house), p >0.05. There were no statistically significant differences on the type of IBD developed (ulcerative colitis, Crohn’s disease or indeterminate colitis) regarding radon levels either (p>0.05). There were no statistically significant differences (p>0.05) between radon and sex of IBD cases. No correlation between radon levels and age of the individuals was observed (Spearman’s rho = -0.13, p-value 0.2), nor radon levels variation by age groups (p>0.05). There was no correlation between radon concentration and cumulative incidence of IBD at municipal level (Spearman’s rho = 0.13, p-value 0.5), as it is shown in figure 1. Conclusion In the area of Santiago de Compostela there is a higher incidence of IBD in comparison with previous studies taking western countries as reference. It is possible that some environmental risk factors, could be responsible of this difference. In this study we have not found any correlation with municipal average radon concentration and incidence of IBD or any of its types.

A166 INCIDENCE OF INFLAMMATORY BOWEL DISEASE IN SOUTH ASIAN AND CHINESE PEOPLE: A POPULATION-BASED COHORT STUDY FROM ONTARIO, CANADA

Abstract Background Studies using population-based data from Ontario previously found South Asian (SA) and East Asian immigrants develop IBD at lower rates than non-immigrants. However, incidence among the Canadian-born children of SA immigrants was comparable to those of non-immigrants, and younger age at arrival to Canada was associated with an increased risk. Aims The primary aim of the study was to determine the incidence of IBD in South Asian and Chinese people compared with the general Ontario population. Methods All incident cases of IBD in children (1994–2015) and adults (1999–2015) were identified from population-based health administrative data in Ontario, Canada using validated algorithms. Ethnicity was assigned by linkage of a validated surname-based database to health administrative data, immigration records, and hospital birth data. We determined standardized incidence of IBD and the adjusted incidence rate ratio (aIRR) in SAs and Chinese comparable to the general population. Based on existing evidence, we adjusted for confounders selected a priori: immigration status, sex, income and rurality. Results Amongst 14,483,769 people in the general population, standardised incidence of IBD per 100,000 person-years (PY) was 24.7 (95%CI 24.4–25.0), compared with 14.6 (95%CI 13.7–15.5) in 982,472 SAs and with 5.4 (95%CI 4.8–5.9) in 764,397 Chinese. The risk of IBD in SAs was lower to the general population prior to adjusting for immigration, IRR 0.82 (95%CI 0.78–0.86), but comparable after adjusting for confounders (aIRR 1.10, 95%CI 1.05–1.16). Only SA adults (18-64y) had a higher risk of IBD (aRR 1.10, 95% CI 1.02–1.18), not children or seniors. Compared to the general population, SAs had a lower risk of Crohn disease (CD), irrespective of age (aIRR 0.66, 95%CI 0.60–0.77), but a higher risk of ulcerative colitis (UC) (aIRR 1.47 (95% CI 1.34–1.61).). SAs were more likely to develop UC than CD (aIRR 1.51, 95%CI 1.38–1.66). The risk of IBD was much lower in Chinese people, irrespective of age (aIRR 0.24, 95%CI 0.20–0.28). This lower risk was similar in CD (aIRR 0.21, 95%CI 0.17–0.26) and UC (aIRR 0.28, 95%CI 0.23–0.25). The SA population had a considerably higher risk of developing IBD compared to the Chinese population (aIRR 4.29, 95%CI 3.62–5.08), and were more likely to develop UC (aIRR 1.36, 95% CI 1.08–1.73). Conclusions Canadian SAs had a similarly high risk of developing IBD compared with the general population after adjusting for immigration status, a finding distinct from the Chinese population. There was an age-response relationship in SAs only. Furthermore, SAs were more likely to develop UC than people of Chinese origin, potentially owing to differences in genetic susceptibility and/or environmental factors. Funding Agencies None

Prevalence and duration of gastrointestinal symptoms before diagnosis of Inflammatory Bowel Disease and predictors of timely specialist review: a population-based study.

Lack of timely referral and significant waits for specialist review amongst individuals with unresolved gastrointestinal (GI) symptoms can result in delayed diagnosis of Inflammatory Bowel Disease (IBD). To determine the frequency and duration of GI symptoms and predictors of timely specialist review before the diagnosis of both Crohn's Disease (CD) and ulcerative colitis (UC). Case-control study of IBD matched 1:4 for age and sex to controls without IBD using the Clinical Practice Research Datalink from 1998-2016. We identified 19,555 cases of IBD, and 78,114 controls. 1 in 4 cases of IBD reported gastrointestinal symptoms to their primary care physician more than 6 months before receiving a diagnosis. There is a significant excess prevalence of GI symptoms in each of the 10 years before IBD diagnosis. GI symptoms were reported by 9.6% and 10.4% at 5 years before CD and UC diagnosis respectively compared to 5.8% of controls. Amongst patients later diagnosed with IBD, <50% received specialist review within 18 months from presenting with chronic GI symptoms. Patients with a previous diagnosis of irritable bowel syndrome or depression were less likely to receive timely specialist review (IBS: HR=0.77, 95%CI 0.60-0.99, depression: HR=0.77, 95%CI 0.60-0.98). There is an excess of GI symptoms 5 years before diagnosis of IBD compared to the background population which are likely attributable to undiagnosed disease. Previous diagnoses of IBS and depression are associated with delays in specialist review. Enhanced pathways are needed to accelerate specialist referral and timely IBD diagnosis.

A65 VARIATION IN THE CARE OF CHILDREN WITH INFLAMMATORY BOWEL DISEASE: A CANGIEC POPULATION-BASED STUDY

Abstract Background Inflammatory bowel disease (IBD) is rising rapidly in Canadian children. These children require consistent high-quality specialized care to prevent long-term complications. Aims Evaluate variation in health services utilization and surgery rates across pediatric IBD centres in Ontario. Methods Incident cases of IBD &amp;lt;16y (1999–2010), identified from health administrative data using a validated algorithm, were assigned to pediatric IBD centres based on location of IBD hospitalization, endoscopy and outpatient care. Children receiving IBD-specific care outside pediatric centres were also grouped. Frailty models, median hazard ratios (MHR), and Kendall’s t described variation in IBD-related ED visits, hospitalizations, and surgery 6–60 months after diagnosis, adjusting for age, sex, rural/urban household, and income. Mean diagnostic lag (time from first health system contact for an IBD symptom to final IBD diagnosis) and proportion of children with IBD care by gastroenterologists (GIs) at each centre were evaluated as centre-level predictors of variation. Results Of 2584 IBD cases, 73.4% were treated in a pediatric IBD centre. Between-centre differences accounted for 0.18% (MHR 1.06) and 0.41% (MHR 1.09) of variation in hospitalizations and ED visits, respectively. Children treated at centres where a higher proportion of children were cared for by GIs were more likely to be hospitalized (HR 2.09, 95% CI 1.26–3.45). Children treated at centres with a longer mean diagnostic lag were also more likely to be hospitalized (HR 1.01, 95% CI 1.003–1.02). ED visits were not associated with the proportion of children cared for by gastroenterologists or diagnostic lag. Among 1529 CD cases, 14.1% required intestinal resection; 1.79% of variation in the risk of surgery resulted from between-centre differences (MHR 1.20). Surgery was less common among patients at centres where more children were cared for by GIs (HR 0.24, 95% CI 0.07–0.84) and with a longer mean diagnostic lag (HR 0.98, 95% CI 0.97–0.99). After adjusting for these, between-centre differences accounted for 0.005% (MHR 1.01) of variation in care. Minimal variation was observed among the 11.0% of 872 UC cases requiring colectomy, with 0.37% of variation due to between-centre differences (MOR 1.09). Colectomy risk was not associated with GI care or diagnostic lag. Conclusions Variation in ED visits, hospitalizations, and surgery among children with IBD is small; however, centre-level differences in GI specialist care use and time to diagnosis were associated with hospitalization and surgery. It is essential to understand between-centre differences to reduce variation and ensure high-quality care. Funding Agencies CCC

P666 Neutropenia in inflammatory bowel disease patients on TNF inhibitors: A single-centre, retrospective cohort study

Abstract Background Tumor necrosis factor-α inhibitors (TNFi) have become the mainstay of treatment in moderate to severe cases of IBD. The haematological safety profile of these agents has been documented in multiple clinical trials and post-marketing registries. Nonetheless, neutropenia has been reported in patients receiving TNFi for IBD and other diseases (Bessissow et al 2012). In this study, we aim to ascertain the relationship between the use of TNFi and the development of neutropenia in IBD patients. Methods This is a retrospective cohort study including all adult IBD patients receiving TNFi at our centre from the year 2007 to 2018. Our primary outcome was the development of any neutropenic episode after starting a TNFi. Neutropenia was defined as circulating absolute neutrophil count (ANC) less than 1500/mm3. For our secondary outcomes, we evaluated the impact of concomitant use of (5-ASA) or an immunomodulator on the risk of developing neutropenia. We also looked at the effect of baseline neutrophil and WBC counts on the subsequent development of neutropenia. Results A total of 292 patients met the inclusion criteria, 11 patients were excluded for not having neutrophil count done. The final analysis included 281 patients. The mean age of patients in this study was 33. Adalimumab was the most frequently prescribed TNFi. Of those included, 96 patients (34.2%) developed at least one episode of neutropenia while on a TNFi. The majority of these episodes (67.7%) were mild with ANC between 1000 and 1500/mm3. There was no significant difference in the age, gender, agent used or type of IBD between those who developed neutropenia and those who did not. On the other hand, baseline neutrophil count and concomitant use of azathioprine and 5-ASA were significant independent predictors of neutropenia after commencing TNFi. (Table 1). Conclusion In this study, mild neutropenia was common amongst IBD patients on TNFi. Patients were more likely to develop neutropenia if they have been on concurrent therapy with an immunomodulator or 5-ASA. Future prospective studies are required to further clarify the significance of neutropenia in IBD patients receiving TNFi.

Systematic review with meta-analysis: risk of new onset IBD with the use of anti-interleukin-17 agents.

New onset IBD has been reported with the use of anti-IL-17 agents, but it remains unclear to what extent this is attributed to treatment or to underlying disease. To evaluate the risk of new onset IBD with the use of anti-IL-17 agents METHODS: Electronic databases were searched for randomised controlled trials (RCT) of anti-IL-17 agents (brodalumab, ixekizumab and secukinumab). Risk of new onset IBD was compared to placebo by Mantel-Haenszel (MH) risk difference (RD). Sensitivity analyses including meta-analysis using fixed-effect model, MH and Peto odds ratio and MH risk ratio were performed due to incidence of rare adverse events. The risk of diarrhoea was also assessed due to the possibility of underdiagnosis of IBD. Thirty-eight RCTs including 16690 patients treated with anti-IL-17 agents were included. Twelve cases of new onset IBD were reported with anti-IL-17 agents in five studies, whereas no cases were reported with placebo. There was no difference in the risk of developing new onset IBD with anti-IL-17 agents compared to placebo (MH RD 0.00062, 95% CI -0.00072-0.0021, P=0.35). Sensitivity analyses demonstrated no consistent risk with any method. There was no difference in the risk of diarrhoea (MH RD 0.0013, 95% CI -0.0014-0.0041, P=0.34). New onset IBD with the use of anti-IL-17 agents was rare. Interpretation of the results needs caution due to the presence of many zero-event studies.

Effect of Gut Involvement in Patients with High Probability of Early Spondyloarthritis: Data from the DESIR Cohort.

Inflammatory bowel disease (IBD) is a well-known extraarticular feature of spondyloarthritis (SpA). The aims of this study were to evaluate factors associated with IBD and incidence over 5 years of followup in the DESIR cohort. DESIR is a prospective observational cohort of patients with recent-onset inflammatory back pain suggestive of axial SpA. All available variables in the database were compared between patients with and without IBD at baseline and 5 years, and occurrence over 5 years of followup, with uni- and then multivariable analysis. At baseline, of 708 patients, 35 had IBD (prevalence 4.94%, CI 95% 3.3-6.5). IBD was associated (multivariable) with history of uveitis, levels of Dickkopf-1, and tumor necrosis factor, but not with phenotypic presentation (peripheral arthritis, enthesitis, dactylitis, uveitis) or baseline serum levels of other cytokines. At 5 years, 480 patients were analyzed, 58 with IBD. IBD was associated (multivariable) with fulfillment of modified New York criteria, sick leave, Bath Ankylosing Spondylitis Disease Activity Index, and smoking. There was no association with magnetic resonance imaging scores, enthesitis, psoriasis, and bone mineral density. Twenty-three incident cases of IBD were recorded: estimated occurrence rate of 0.95/100 (95% CI 0.57-1.35) patient-years (PY). Incidence of IBD is associated (multivariable) with HLA-B27 (OR 0.36, 95% CI 0.22-0.59), fulfillment of modified New York criteria (OR 3.35, 95% CI 1.85-6.08), and familial history of IBD (OR 3.31, 95% CI 1.62-6.77). In early SpA, IBD occurs with an incidence of 1/100 PY, and is associated with poor outcome, familial history of IBD, absence of HLA-B27, and fulfillment of modified New York criteria.