Consecutive Inflammatory Bowel Disease Outpatients Research Articles

P259 Metabolic associated Liver Disease and sex as key factors of cardiovascular risk in Inflammatory Bowel Disease

Abstract Background Atherosclerosis is the main factor for the development of cardiovascular (CV) events. Patients with systemic inflammatory conditions such as inflammatory bowel disease (IBD) are supposed to be at risk of early atherosclerosis. However, data are still contentious. IBD patients are also at risk of other comorbidities such as metabolic associated fatty liver disease (MAFLD), a well-recognised entity associated with increased CV risk. The aim of this study is to demonstrate the impact of MAFLD on CV risk for IBD patients. Methods Prospective cohort study of consecutive IBD outpatients (Leonnard-Jones criteria, > 1 year) was performed from October 2020 to April 2021. Of 947 patients, 50 with IBD who met criteria for MAFLD and 50 with IBD and without MAFLD were matched by sex, age and IBD location. Patients with a previous diagnosis of CV disease, type II diabetes mellitus and under treatment for dyslipidaemia were excluded. Fatty liver disease (FLD) was diagnosed by ultrasonography, controlled attenuation parameter (CAP TM), fatty liver index (FLI), hepatic steatosis index (HSI) and lipid accumulation product (LAP). To assess early atherosclerosis, alterations in carotid artery intima-media thickness (CIMT) and SCORE as non-invasive CV risk test were performed in both groups. Statistical analysis was performed using SPSS, a binomial generalized linear model with logistic regression was performed, with CIMT alteration as dependent variable. For all tests a two-sided p value <0.05 was considered significant. Results Of 100 IBD patients included 51 (51%) were women with median age of 51.0 (41–59). There were 49 (49%) patients diagnosed of ulcerative colitis (UC) and 51 (51%) of Crohn’s disease (CD). Comorbidities and disease patient’s characteristics are shown in table 1. Most of the patients had an abnormal CIMT (58 (58%)). Of all the variables obtained, only female sex (OR (CI 95%) 3.322 (1.03–10); p=0.033) and MAFLD (OR (CI 95%) 5.05 (1.71–14.92); p=0.003)) were significatively associated with CIMT alterations. SCORE test did not associate with a significatively CIMT alteration. Among the different options to assess FLD, only ultrasonography and CAP were statisticaly associated with CIMT alterations (specificity 66%, sensibility 62%, p=0.005). Conclusion Female sex and MAFLD are associated with early atherosclerosis defined by CIMT alterations in IBD patients. Ultrasonography and CAP are better than biochemical test not only to predict FLD but also to assess CV risk.

P226 Nuclear magnetic resonance spectroscopy measure of protein glycosylation is a biomarker of activity and metabolic complications in Inflammatory Bowel Disease

Abstract Background Plasma glycoproteins are acute-phase proteins, which can contribute to the development of many complex inflammatory diseases as Inflammatory Bowel Disease (IBD). Glycoprotein concentration as measured by nuclear magnetic resonance (NMR) spectroscopy has been proposed as a biomarker for monitoring activity of IBD, but has been also related to metabolic syndrome. Our goal is to further define the role of this new biomarker in IBD patients with MAFLD. Methods Prospective cohort study of consecutive IBD outpatients (Leonnard-Jones criteria, > 1 year) seen at reference centre, was performed from October 2020 to April 2021. Of 947 outpatients, 50 patients with IBD who met criteria for MAFLD and 50 patients with IBD and without MAFLD were matched by sex, age and IBD severity. Every IBD patient was also matched with 4 controls without IBD. Patients and controls with a previous diagnosis of CV disease, type II diabetes mellitus and under treatment for dyslipidaemia were excluded. Serum samples were analysed by NRM Spectroscopy with glycoprotein (Glyc-B, Glyc-F and Glyc-A) analysis by Biosfer Teslab, Spain. Demographic, clinical, biochemical and anthropomorphic variables were obtained prospectively in all cases. Wilcoxon Rank-sum test was used for comparison between groups with R (v 4.1.1). Results A total of 100 IBD patients and 400 controls were included. The median age were 51.0 (41–59) years old for each group. There were no differences in body mass index (BMI) between groups (26.4 (23.1–29.9) for IBD and 27.1 (24.4–30.4) for controls p=0.130). Regarding IBD patients, 49 (49%) had ulcerative colitis (UC) and 51(51%) Crohn’s disease (CD). Both IBD groups (with or without MAFLD) were well-matched excepting BMI as expected (table 1). Glycoprotein concentrations were significatively higher in IBD when compared to controls (table 2, p<0.001). In IBD patients with MAFLD glycoprotein concentrations were the highest (p<0.001) with no overlap with controls (table 3). Conclusion This prospective study confirms that glycoprotein concentrations can be a biomarker in IBD and for the first time suggests that it can be a very useful biomarker to identify MAFLD.

Azathioprine in the maintainance remission in inflammatory bowel disease patients: 7-year follow up

Abstract Background Azathioprine (AZA) and thiopurine are widely used for induction and maintenance of remission in steroid dependent patients with inflammatory bowel disease (IBD). Methods Aim of this study has been to investigate its efficacy and safety in maintaining steroid-free remission in steroid dependent IBD patients seven year after the institution of treatment. Data from consecutive IBD outpatients referred in our Institution, between 1985-2016, were reviewed and all patients treated with AZA were included in this retrospective study. AZA was administered at the recommended dose of 2-2.5 mg/kg. Results Out of 2802 consecutive IBD outpatients visited in the index period, AZA was prescribed to 433 patients, 236 (54.5%) were affected by Crohn's disease (CD) and 197 (45.5%) by ulcerative colitis (UC). One hundred and seventy-nine patients with a follow-up < 84 months were excluded from the study. Two hundred and fifty-four patients were evaluated, 141 (55.5%) with CD and 113 (44.5%) with UC. One hundred and thirty-nine (54.7%) were male and 115 (45.3%) female (average age of 35.62 ± 14.20 SD years, range 14-74 y.). Seven year after the institution of treatment, 127 (50%) patients still were in steroid-free remission (83 CD vs 44 UC, 58.8% and 38.9%, respectively, p = 0.0024), 71 (27.9%) had a relapse requiring retreatment with steroids (29 CD vs 42 UC, 20.6% and 37.2%, respectively, p = 0.0047), 56 (22.1%) discontinued the treatment due to side effects (29 CD vs 27 UC, 20.6% and 23.9%, respectively). Loss of response from 1st to 7th year of follow-up was low, about 20%. Conclusions Seven year after the onset of treatment 50% of patients did not require further steroid courses. After the first year loss of response was low in six subsequent years. In the present series the maintenance of steroid-free remission was significantly higher in CD than in UC patients. The occurrence of side effects leading to the withdrawal of AZA treatment has been low. Key messages An important therapeutic moment of IBD is mantaining remission in steroid dipendent patients. AZA can be a viable and inexpensive alternative to treath these patients.

P605 Eight-year efficacy and safety of azathioprine treatment in the maintenance of steroid-free remission in inflammatory bowel disease patients

Abstract Background Azathioprine (AZA) and thiopurine are widely used for induction and maintenance of remission in steroid-dependent patients with inflammatory bowel disease (IBD). The aim of this study has been to investigate its efficacy and safety in maintaining steroid-free remission in steroid-dependent IBD patients eight years after the institution of treatment. Methods Data from consecutive IBD outpatients referred in our Institution, between 1985–2017, were reviewed and all patients treated with AZA were included in this retrospective study. AZA was administered at the recommended dose of 2–2.5 mg/kg. Results Out of 2992 consecutive IBD outpatients visited in the index period, AZA was prescribed to 446 patients, 245 (54.9%) were affected by Crohn’s disease (CD) and 201 (45.1%) by ulcerative colitis (UC). One hundred and ninety-six patients with a follow-up < 96 months were excluded from the study. Two hundred and fifty patients were evaluated, 140 (56%) with CD and 110 (44%) with UC. One hundred and thirty-eight (55.2%) were male and 112 (44.8%) female (average age of 35.48 ± 14.26 SD years, range 14–74 years). Eight year after the institution of treatment, 123 (49.2%) patients still were in steroid-free remission (82 CD vs. 41 UC, 58.6% and 37.3%, respectively, p = 0.0009), 71 (28.4%) had a relapse requiring retreatment with steroids (29 CD vs. 42 UC, 20.7% and 38.2%, respectively, p = 0.0030), 56 (22.4%) discontinued the treatment due to side effects (29 CD vs. 27 UC, 20.7% and 24.5%, respectively). The loss of response from first to eighth year of follow-up was low, about 21%. Conclusion Eight years after the onset of treatment about 50% of patients did not require further steroid courses. After the first-year loss of response was low in seven subsequent years. In the present series, the maintenance of steroid-free remission was significantly higher in CD than in UC patients. The occurrence of side effects leading to the withdrawal of AZA treatment has been low.

Usability of IBDoc, a Novel Fecal Calprotectin Home-Based Rapid Test in Clinical Practice

The aim of this study was to examine sustained usability and adherence to a fecal calprotectin (FC) home-based rapid test in an inflammatory bowel disease (IBD) monitoring program in clinical practice. Methods In total, 59 consecutive IBD outpatients were recruited. The participants were asked to measure FC with a home-based rapid test, IBDoc, every second month for a period of 14 months. At start and termination of this time period, they were invited to answer a questionnaire concerning the IBDoc device. The participants were also asked to deliver one stool sample for FC to be analyzed with enzyme-linked immunosorbent assay and analyze the same sample with the home-based FC test at start and termination. Results In total, one-third (34%) of the participants were adherent to the IBDoc program. No patient characteristics were significantly associated with being adherent. The home-based test correlated well with enzyme-linked immunosorbent assay method (Spearman rank correlation coefficient was 0.92, P < 0.001 and 0.74, P < 0.001, at study start and termination, respectively). After having used the IBDoc for over a year, all except for 1 of the 36 participants answering the follow-up questionnaire completely agreed with the statement “I would like to use IBDoc in the future.” Conclusions We found a low adherence to home-based FC measurements every second month for a period of 14 months. Nevertheless, all but 1 of the 36 participants who answered the follow-up questionnaire were interested in continuing using the IBDoc test.

Treatment of inflammatory bowel disease: is your patient at risk of non-adherence?

Adherence to therapy is a key factor when analyzing the efficacy of a treatment in clinical practice. The aim of our study was to assess the frequency of non-adherence to treatment among patients with inflammatory bowel disease and evaluate which factors could be related. One hundred thirty eight consecutive inflammatory bowel disease outpatients (55.8% with Crohn's disease and 44.2% with Ulcerative Colitis) filled in an anonymous questionnaire, which included information about demography, duration of the disease, specific therapy for inflammatory bowel disease, and data possibly related to extent of non-adherence to treatment. Statistics were performed with SPSS v.18.0. Categorical variables were compared with Fisher's exact test. A p value < 0.05 was considered statistically significant. Significant variables in univariate analysis were included in the logistic regression analysis. Overall non-adherence was reported by 29.7% of patients. 70.7% of them reported unintentional non-adherence and 51.2% forgot at least one dose per week. Non-adherence was statistically associated with: short disease duration (p < 0.001); young age (p = 0.001); topical aminosalicylates (p = 0.005); the perception that medical therapy isn't effective enough (p = 0.007) and high educational level (p = 0.011). In a logistic regression analysis, topical aminosalicylates use (p = 0.004), short disease duration (p = 0.006) and young age (p = 0.027) were identified as significant predictors of non-adherence. Young patients, patients with short disease duration and under topical aminosalicyates presented a higher risk for nonadherence to treatment. Gastroenterologist's attention should be focused on the identification of risk factors potentially involved in non-adherence to therapy and in the promotion of measures to improve it.

Su1234 Microscopic Severity Is Related to Earlier Surgery in Newly Diagnosed CD Patients: Results From the DELTA Cohort

Background: Adherence to therapy is a key factor when analyzing the efficacy of a given treatment in clinical practice. Inflammatory bowel disease (IBD) is associated with high rates of non-compliance to therapy. The aim of our study was to assess the prevalence of non-adherence to treatment among patients with IBD and evaluate which factors could be related. Methods: One hundred consecutive IBD outpatients (60% with Crohn’s disease and 40% with Ulcerative Colitis) filled in an anonymous questionnaire, which included information about demography, duration of the disease, specific therapy for IBD, and data possibly related to extent of non-adherence to treatment. Statistics were performed with SPSS v.18.0. For continuous variables, mean and standard deviation were calculated and for categorical variables percentages were provided. Categorical variables were compared with Fisher’s exact test. A p value <0.05 was considered statistically significant. Results: Overall non-adherence was reported by 38% (n = 38) of patients. 78.9% (n = 30) of patients reported unintentional non-adherence and 55.3% (n = 21) forgot at least one dose per week. Non-adherence was statistically associated with: high educational level (p < 0.001); the perception that medical therapy isn’t effective enough (p < 0.001); therapy with corticosteroids (p = 0.019); recent diagnosis (p = 0.020); and young age (p = 0.007). On the other hand, different factors such as gender (p = 0.668), disease type (p = 0.211), smoker status (p = 0.626), occurrence of minor side effects (p = 0.217), use of alternative medicine (p = 1.000), previous IBD-related admissions (p = 0.676) or previous surgeries (p = 0.794) did not correlate with the degree of adherence. Conclusions: The overall non-adherence is relatively high among IBD patients and gastroenterologist’s attention should be focused on it. Risk factors of non-compliance must be evaluated at each follow-up visit to improve adherence to therapy. P431 Microscopic severity is related to earlier surgery in newly diagnosed CD patients: results from the DELTA cohort V. Nuij1 *, C. Looman2, M. Rijk3, R. Beukers4, R. Ouwendijk5, R. Quispel6, A. van Tilburg7, T. Tang8, H. Smalbraak9, K. Bruin10, F. Lindenburg11, L. Peyrin-Biroulet12, C.J. van der Woude13. 1Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands, 2Erasmus Medical Center, Public Health, Rotterdam, Netherlands, 3Amphia Hospital, Gastroenterology & Hepatology, Breda, Netherlands, 4Albert Schweitzer Hospital, Gastroenterology & Hepatology, Dordrecht, Netherlands, 5Ikazia Hospital, Gastroenterology & Hepatology, Rotterdam, Netherlands, 6Reinier de Graaf Hospital, Gastroenterology and Hepatology, Delft, Netherlands, 7Sint Franciscus Gasthuis, Gastroenterology & Hepatology, Rotterdam, Netherlands, 8IJsselland Hospital, Gastroenterology & Hepatology, Capelle aan den IJssel, Netherlands, 9Lievensberg Hospital, Internal Medicine, Bergen op Zoom, Netherlands, 10Tweesteden Hospital, Gastroenterology & Hepatology, Tilburg, Netherlands, 11Franciscus Hospital, Gastroenterology and Hepatology, Roosendaal, Netherlands, 12Nancy University Hospital, Universite de Lorraine, Gastroenterology and Hepatology, Vandoeuvre-les-Nancy, France, 13Erasmus Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands

High prevalence of fatigue in inflammatory bowel disease: A case control study

Background and Aims Many outpatients with Inflammatory Bowel Disease (IBD) complain about fatigue, even in a quiescent disease. The aim of this study is to examine prevalence of fatigue in IBD outpatients and define possible determinants of fatigue. Methods A case–control study was conducted in consecutive IBD outpatients, with Lynchsyndrome gene carriers (Lynch) as a control group. Demographics, laboratory results and Harvey Bradshaw Index (HBI) were obtained from medical records. Subjective fatigue was measured by the revised Piper Fatigue Scale (PFS). Mean PFS scores were compared between groups. Secondly, possible determinants of fatigue were assessed. Results Three hundred patients were enrolled. 74% returned the questionnaires (117 CD; 55 UC; and 50 Lynch). Demographics were not different between groups. Mean overall PFS is 4.03. PFS score in IBD patients was significantly higher compared to Lynch. Mean (SD) PFS score was 4.8 (2.09) for CD, 4.2 (2.3) for UC versus 1.9 (2.03) for Lynch (P < 0.01). Fatigue was present in 40% of the IBD patients in remission. HBI was positively, but not significantly, correlated with PFS scores (r = 0.37). Conclusion We found a high prevalence of fatigue in IBD patients, compared to a control group, even in a quiescent disease. None of the studied determinants was significantly associated with fatigue.

Tobacco dependence and awareness of health risks of smoking in patients with inflammatory bowel disease

Smoking is a risk factor for developing Crohn's disease (CD) and worsens its outcome. Conversely, in ulcerative colitis (UC), the onset may be triggered by the smoking cessation and smoking may be beneficial. To help to ascertain whether patients with inflammatory bowel disease (IBD) would benefit from attending a smoking cessation clinic, we assessed: first, the prevalence of smoking; second, patients' awareness of the effects of smoking, and finally nicotine dependence in IBD patients compared with the healthy and disease-matched controls. A total of 246 consecutive IBD outpatients (173 patients with CD, 73 patients with UC) completed a questionnaire on smoking habits and its effect on IBD. Smokers were assessed for dependence using the Fagerstrom test for nicotine dependence (FTND) score and their results were compared with those of age, sex, and ethnicity-matched healthy (five controls for each IBD patient) and asthma controls (one control for each IBD patient) attending a smoking cessation clinic. Thirty five out of 173 patients (20%) with CD and nine out of 73 patients (12%) with UC were current smokers, with 52 out of 173 patients (30%) with CD and 28 out of 73 patients (38%) with UC being ex-smokers. Ninety out of 173 patients (52%) with CD knew that smoking worsens CD, whereas only 15 out of 73 patients (21%) with UC knew of the beneficial effects of smoking on their disease (P=0.032). Knowledge was unrelated to smoking status. In patients with CD, the median (range) FTND score was 3 (0-8) compared with 7 (2-10) in healthy (P<0.001) and 6 (2-9) in asthma controls (P<0.0001). Only seven of the 35 (20%) smoking patients with CD were highly dependent (FTND score ≥6). Similarly, in the patients with UC, the FTND score was 1 (0-4), lower than in healthy, [6 (2-10)], and asthma controls, [7 (4-10); (P<0.004 for both groups)]. Patients with CD were better informed about the effects of smoking on their own disease than the patients with UC. Nicotine dependence in IBD patients is lower than in smokers' clinic clients and comparable with that of the general population. Their low nicotine dependence suggests that most IBD patients could be weaned off the smoking habit successfully in the IBD clinic and referral to a smoking cessation clinic was offered to the highly dependent minority and others expressing interest in attending.

Application of the WHO fracture risk assessment tool (FRAX) to predict need for DEXA scanning and treatment in patients with inflammatory bowel disease at risk of osteoporosis

Although patients with inflammatory bowel disease (IBD) are at increased risk of osteoporosis, low bone mineral density (BMD) alone confers only a modest increase in risk of fracture. The FRAX score, developed by the WHO, is a free web-based clinical scale assessing the 10-year fracture risk and need for lifestyle advice/reassurance, dual X-ray absorptiometry (DEXA) scanning or preventive treatment. To assess the accuracy of pre-BMD FRAX scores in identifying at risk IBD patients needing BMD measurement (intermediate risk) and/or therapy (high risk). We calculated FRAX scores retrospectively in 116 consecutive IBD out-patients (81 Crohn's disease, 35 ulcerative colitis), who were having DEXA scans in 2005-2009 because they were considered at risk of osteoporosis. On DEXA scans, 47% (38/81) and 12% (10/81) patients with Crohn's disease were osteopaenic and osteoporotic, respectively; equivalent figures for patients with UC were 34% (12/35) and 14% (5/35). The clinical FRAX score alone, when compared with the FRAX score including the BMD result, had a sensitivity of 100% (95% CI: 70-100%), specificity of 40% (95% CI: 31-50%), positive predictive value of 16% (95% CI: 9-27%) and negative predictive value of 100% (95% CI: 90-100%) in identifying those patients needing BMD measurement (intermediate risk) or preventive therapy (high risk). In patients with IBD perceived to be at risk of osteoporosis and/or osteopaenia, the clinical FRAX score alone can predict accurately the risk of osteoporotic fracture, and thereby reduce the need for DEXA scans and unnecessary anti-osteoporosis treatment.