Family History Of Inflammatory Bowel Disease Research Articles

De Novo Inflammatory Bowel Disease after Liver Transplantation: Eleven Years' Experience in Shiraz, Iran

Background: Colon inflammation may occur after solid and liquid organ transplantations at a rate higher than in the general population. Objectives: This study aimed to investigate the incidence of de novo inflammatory bowel disease (IBD) and assess some risk factors after Orthotopic Liver Transplantation (OLT) in liver transplant patients in Shiraz, Iran. Methods: The sample study comprised patients (n = 1702) who had received liver transplants between 2001 and 2012 at the Shiraz liver transplant center. The data were obtained from patient records, which included information on their medical history, colonoscopy reports, family history of IBD, and other risk factors. The study evaluated the status of inflammatory bowel disease (IBD) among patients who had undergone liver transplantations due to Autoimmune Hepatitis (AIH) group, Primary Sclerosing Cholangitis (PSC), and other liver transplant patients. Additionally, case groups were formed, comprising AIH patients (n1 = 10) and other patients with IBD (n2 = 10), and were compared with transplant patients without IBD as the control group (n1 = 21, n2 = 21). Results: Out of the total 1702 patients, 254 (14.92%) had AIH, 211 (12.40%) had PSC, and 1237 (72.68%) had other outcomes. The mean of leukocyte counts (P-value = 0.73), types of immunosuppressant medications, and serum levels of cyclosporine (P-value = 0.77) and tacrolimus (P-value = 0.27) did not show any significant differences between the case and control groups. However, it was observed that IBD developed earlier in patients with AIH compared to other patients (20.1 ± 2.23 vs 53.9 ± 4.42 months). Conclusions: The incidence of IBD after liver transplantation was higher compared to the general population, and it occurred earlier in patients who underwent transplantation for AIH and other groups.

THE IMPACT OF OBESITY ON THE PREVALENCE AND SEVERITY OF PERIANAL COMPLICATIONS OF CROHN'S DISEASE

Abstract INTRODUCTION The incidence of obesity in patients with inflammatory bowel disease (IBD) is increasing and there is limited data on the effects of obesity on disease phenotype. Several studies have investigated the association of obesity with perianal fistulizing disease with conflicting results. In this study, we aim to examine the relationship between obesity and the prevalence and severity of perianal complications in patients with Crohn’s disease (CD). METHODS We conducted a cross-sectional study of CD patients treated at a tertiary care center from 2012 to 2022. Collected data included sex, race, smoking history, family history, maximum body mass index (BMI), and Montreal classification (Table 1). Obesity was defined as maximum BMI ≥30kg/m2 and further subdivided into 5 BMI categories (Table 2). The prevalence of perianal disease was defined by a history of perianal fistula. The severity of perianal disease was measured by four variables including history of perianal fistula surgery, number of perianal surgeries, history of fecal diversion, and median time to first anal surgery. Perianal fistula surgeries included abscess incision and drainage, seton placement, fistulectomy, and/or fistulotomy. Pearson’s chi-squared test was used to compare 2 categorical variables (non-obese vs obese). Exact Cochran-Armitage trend test was used to compare 5 BMI categorical variables. A 95% confidence interval was used with an alpha of 0.5. Values of p <0.05 was considered statistically significant. Data analysis was performed using Excel. RESULTS A total of 704 patients with CD were treated. In all, 68.9% were non-obese and 31.1% were obese. Furthermore, 2.8% were underweight, 36.5% normal weight, 29.5% overweight, 17.9% obese, and 13.2% severely obese. Non-obese patients were more likely to have a family history of IBD (p=0.043). Obese patients were more likely to have extraintestinal manifestations (p=0.004) and/or be former smokers (p=0.004). There was no significant association between obesity and prevalence of perianal fistula (p=0.719), history of perianal surgery (p=0.146), history of one or more perianal surgeries (p=0.220), history of fecal diversion (p=0.705) or median time to first perianal surgery (p=0.192) (Table 1). Increasing BMI category was not associated with the prevalence of perianal fistula (p=0.944), perianal surgery (p=0.583), more than one perianal surgery (p=0.114), fecal diversion (p=0.542) or median time to first perianal surgery (p=0.486) (Table 2). DISCUSSION In conclusion, there was no significant correlation between obesity and prevalence of perianal disease. Additionally, there was no significant correlation between obesity and severity of perianal disease. The overall impact of obesity on CD complications is still unknown and warrants further investigation.

P1176 The Influence of positive family history on the phenotype and clinical course of inflammatory bowel disease: A Systematic review and meta-Analysis

Abstract Background The phenotypes and clinical course of familial and sporadic inflammatory bowel disease (IBD) are not yet well-established. We sought to perform a systematic review and meta-analysis to assess the pooled influences of positive family history on disease characteristics and clinical outcomes in IBD. Methods We searched MEDLINE, EMBASE, and the COCHRANE library to identify full text articles analyzing disease phenotypes and clinical courses in IBD based on the presence or absence of a family history of IBD. A meta-analysis was performed using a random-effects model to pool estimates and report odds ratios [ORs]. Results A total of 14 studies were identified as eligible for the meta-analysis. A positive family history (of any degree) of IBD was associated with a lower prevalence of extensive colitis in ulcerative colitis (OR 0.83, 95% confidence interval [CI] 0.72-0.94) but was not associated with most phenotype features including male gender (OR 0.89, 95% CI 0.74-1.07), small intestine involvement (OR 1.11, 95% CI 0.81-1.52), and stricturing or penetrating disease behavior (OR 0.99, 95% CI 0.76-1.29) in Crohn's disease, extraintestinal manifestations (OR 1.26, 95% CI 0.89-1.78), or perianal fistula (OR 1.02, 95% CI 0.84-1.23). Additionally, various clinical outcomes of IBD including IBD-related hospitalization (OR 1.52, 95% CI 0.93-2.47), corticosteroid use (OR 0.91, 95% CI 0.58-1.44), immunomodulator use (OR 1.07, 95% CI 0.98-1.17), biologics use (OR 1.13, 95% CI 0.91-1.42), and intestinal resection surgery (OR 1.01, 95% CI 0.83-1.23) were not associated with family history. In the subgroup analysis of studies analyzing first-degree family history alone, family history was also not associated with small intestine involvement, stricturing or penetrating behavior, perianal fistula, corticosteroid use, immunomodulator use, biologics use, or intestinal resection surgery. Conclusion Familial cases with IBD exhibited a lower prevalence of extensive colitis compared to sporadic cases, but the overall disease phenotype and clinical course were similar in both types of IBD.

P1131 Epidemiological Characteristics of Inflammatory Bowel Diseases in The Last Decade: Multi-Center Türkiye Data

Abstract Background This study aims to assess the past decade's epidemiology of inflammatory bowel disease (IBD) patients in Türkiye and identify year-to-year variations. Methods A total of 3463 patients diagnosed between 2010 and 2022 were included. The patients' demographic and phenotypic characteristics, smoking habits, and family histories were assessed. Differences between geographic regions and age groups were analyzed. Results Among patients, 1523 (44%) had Crohn's disease (CD), 1768 (51.1%) had ulcerative colitis (UC), and 23 (0.7%) had indeterminate colitis (Table). Male proportions were higher in both CD and UC patients, with the most common age range for diagnosis being 21-30 years (Figure). Over time, newly diagnosed cases and rates per population increased according to Turkish Statistical Institute data (Figure). Patients were divided into two groups based on diagnosis years (2010-2016 and 2016-2022), CD initially dominated, but UC prevalence grew in the last 6 years (p<=0.001). Recently diagnosed CD patients showed higher inflammatory involvement (78.0% vs. 63.4%; p<=0.001), and the inflammatory phenotype rose post-2016 (75.2% vs. 60.4%; p<=0.001). CD patients had more smokers (24.2% vs. 10.9%; p<=0.001) and family history of IBD (6.8% vs. 4.5%; p=0.004) than UC patients. Patients over 60 years old had a higher male gender ratio (64.4% vs. 55.9%; p<=0.001) and UC frequency (62.2% vs. 52%; p<=0.001) compared to those under 60 years old. The inflammatory phenotype in CD patients was lower in those under 60 years old compared to those over 60 years old (70.4% vs. 85.4%; p<=0.001). The frequency of pancolitis in UC patients was lower in those over 60 years old (31.3% vs. 41.4%; p<=0.001). Conclusion In Türkiye, IBD is more prevalent in males and is frequently diagnosed between ages 20 to 30. In CD, inflammatory and ileocolonic involvement is most common, while in UC, pancolitis is observed. The earlier diagnosis peak and increased pancolitis in UC patients might relate to tertiary centers' inclusion with transition clinics and focus on severe cases. Recently, newly diagnosed UC cases have notably surpassed CD cases.

P488 Development and validation of a risk prediction tool for inflammatory bowel disease (IBD) diagnosis in patients presenting in primary care with abdominal symptoms, a UK based study

Abstract Background There are no prediction models for a diagnosis of inflammatory bowel disease (IBD) in primary care. An IBD risk prediction tool has the potential to reduce the length of time patients have undiagnosed IBD symptoms and improve IBD clinical outcomes. Therefore, our aim was to develop and validate a risk prediction model for the diagnosis of IBD, ulcerative colitis (UC) and Crohn’s disease (CD) in men and women separately. Methods A population-based retrospective open cohort study using Clinical Practice Research Datalink (CPRD) Aurum database was undertaken between 1st January 2010 and 31st December 2019, including patients aged 18 years or older. Patients were followed from first presentation with lower gastrointestinal (GI) symptoms potentially related to IBD to the earliest of IBD diagnosis, loss to follow-up, death or study end. 2,054,530 patients were in the model derivation cohort and 673,320 patients in the validation cohort. Cox proportional hazards models were used to derive separate risk equations in men and women for IBD, UC and CD. Candidate predictors included demographic factors (age, sex, smoking, body mass index, Charlson comorbidity score, loperamide use), family history of IBD, co-existing conditions (anxiety, depression, irritable bowel syndrome (IBS), haemorrhoids), extraintestinal manifestations (EIM) (mouth ulcers, ophthalmic, primary sclerosing cholangitis, dermatological), investigations (hemoglobin, mean corpuscular volume, platelets, albumin, vitamin B12, ferritin, C-reactive protein, erythrocyte sedimentation rate, calprotectin level). Measures of calibration and discrimination (C-statistic and D-statistic, higher values indicate better discrimination) were determined in men and women separately in the validation cohort at 1,2,3 and 5 years after symptom presentation. Results In the derivation cohort, 15,105 (0.7%) patients had an IBD diagnosis (10.014 UC (66.3%) and 5,088 CD (33.7%)). The IBD prediction model included 41 and 40 predictors, and the UC model 37 and 36 predictors, in women and men respectively; the CD model included 37 predictors in both men and women. C-statistics and D-statistics in men were as follows: IBD model 0.77 and 1.74; UC model: 0.81 and 1.95; and CD model: 0.77 and 1.95, respectively. Similar values were observed in women.The measures of discrimination showed that the prediction models reliably differentiated patients with and without IBD, UC and CD in both sexes. Model calibration was good, tending to overestimate at higher risk thresholds in validation cohort. Conclusion A risk model of patient demographics, symptoms and investigations performs well for IBD, UC and CD and may help in prioritising suspected IBD referrals in symptomatic subjects in primary care.

Awareness and knowledge of inflammatory bowel disease among the population of Qassim

Objective: This study aimed to assess awareness and knowledge about the symptoms, risk factors, complications, and management of inflammatory bowel disease (IBD), and the differences between IBD and irritable bowel syndrome (IBS), in Al-Qassim population. Results: In this cross-sectional study the data were collected from 648 individuals. The questionnaires were distributed through social media applications, and also online in public places in the Qassim region in the form of an electronic barcode that opened directly to the online questionnaire to reach the maximum diversity of participants. Results: A sizeable majority of participants had some awareness of IBD (42.9%). A significant portion (42%) had acquired information from the media. Most participants (62%) correctly reported abdominal pain or cramping diarrhea as symptoms of IBD. About the same number were aware that family history was a risk factor for IBD. Nearly three-quarters of the participants were aware that medical treatment exists for IBD depending on the case. However, the study identified significant knowledge gaps; only a minority correctly reported that IBD patients have high risks of anemia and colon cancer, and the distinctions among various bowel diseases (e.g., ulcerative colitis, Crohn's disease, IBS, IBD) were generally poorly understood by participants. The results established statistically significant associations between awareness of IBD and age, medical specialty, employment status, education, and family history of IBD. Conclusion: The study highlighted the need for targeted education and awareness campaigns to increase public knowledge and reduce the prevalence of the disease in the community.

Extraintestinal Manifestations and Family History of Inflammatory Bowel Disease Increase the Risk of Pouchitis in a State-Level Epidemiology Study.

Our understanding of the epidemiology of inflammatory conditions of the pouch and effectiveness of treatment is largely based on selected populations. We created a state-level registry to evaluate the incidence of pouchitis and the effectiveness of treatments used in an initial episode of pouchitis. In a state-level retrospective cohort of all patients undergoing proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis between January 1, 2018, and December 31, 2020, we evaluated the incidence of pouchitis and compared the proportion of patients developing recurrent pouchitis and chronic antibiotic-dependent pouchitis according to initial antibiotic therapy. A total of 177 patients underwent surgery with 49 (28%) developing pouchitis within the 12 months after the final stage of IPAA. Patients with extraintestinal manifestations of inflammatory bowel disease (IBD) were significantly more likely to develop pouchitis within the first 12 months after IPAA (adjusted odds ratio 2.45, 95% confidence interval 1.03-5.81) after adjusting for family history of IBD (adjusted odds ratio 3.50, 95% 1.50-8.18). When comparing the proportion of patients who developed recurrent pouchitis or chronic antibiotic-dependent pouchitis with those who experienced an isolated episode of pouchitis, there were no significant differences among the initial antibiotic regimens used. In a state-level examination of outcomes after IPAA for ulcerative colitis, patients with extraintestinal manifestations of IBD were more likely to develop pouchitis; however, the initial antibiotic regimen chosen did not seem to affect long-term outcomes.

Thrombotic Complications in Inflammatory Bowel Disease: The Role of Coagulation Markers and Family History

Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder characterized mainly by intestinal pathology. The risk of thrombosis increases in IBD patients, increasing overall disease morbidity and mortality. We aim to investigate the role of coagulation markers in determining the risk of thrombotic complications in IBD patients compared to healthy controls. Methods: The study was approved by the institutional review board. All patients aged 16 or over, diagnosed with IBD and followed at our center from January 2012 -2022, were included. We investigated the family history and the hemostatic profiles of these patients. Descriptive statistics were computed for continuous variables, including means, standard deviations (SDs), minimum and maximum values, as well as 95% confidence intervals (CIs), where appropriate, and frequencies for categorical variables. Fisher exact test was used for categorical variables. Student t-test was used for continuous variables. Results: A total of 100 patients were included in the study, comprising of 51 (24%) females and 158 (76%) males. 73% of patients were diagnosed with Crohn's disease (CD), and 27% with ulcerative colitis (UC). Deep vein thrombosis (DVT) was observed in 5 (2.3%) of patients. In patients with a family history of DVT, 1.9% had developed a thrombotic event. Among continuous variables, prothrombin time, thrombin clotting time, and fibrinogen levels had mean values significantly different for patients with thrombosis than those without thrombosis ( p-values 0.01, 0.01, and 0.03, respectively). Conclusions: Patients with both UC and CD are at an increased risk of thrombosis. A family history of IBD can increase the risk of these events. The coagulation markers, including PT, TTC, and fibrinogen levels, can be used as biomarkers to predict the risk of thrombosis and the evaluation of the hemostatic profiles of IBD patients regularly, which can help prevent serious thrombotic complications and thus reduce morbidity and mortality resulting from these events. Therefore, such evaluation should be included in the routine examination protocols of high-risk IBD patients. This study may help better understand the biology of disease.

Association of inflammatory bowel disease in first-degree relatives with risk of colorectal cancer: A nationwide case-control study in Sweden.

This study aims to assess the association between inflammatory bowel disease (IBD) history in first-degree relatives (FDRs) and colorectal cancer (CRC) risk. We conducted a nationwide case-control study in Sweden among 69 659 CRC cases and 343 032 non-CRC controls matched on age, sex, birth year and residence county. Through linkage of multi-generation register and the nationwide ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) cohort, we ascertained IBD diagnoses among parents, full siblings and offspring of the index individuals. Odds ratios (ORs) of CRC associated with IBD family history were calculated using conditional logistic regression. 2.2% of both CRC cases (1566/69659) and controls (7676/343027) had ≥1 FDR with IBD history. After adjusting for family history of CRC, we observed no increased risk of CRC in FDRs of IBD patients (OR, 0.96; 95%CI, 0.91-1.02). The null association was consistent according to IBD subtype (Crohn's disease or ulcerative colitis), number of FDRs with IBD (1 or ≥ 2), age at first IBD diagnosis in FDRs (<18, 18-39, 40-59 or ≥60 years), maximum location/extent of IBD or FDR relation (parent, sibling or offspring). The null association remained for early-onset CRC (diagnosed at age <50 years). In conclusion, IBD history in FDRs was not associated with an increased risk of CRC. Our findings suggest that extra screening for CRC may not be needed in the offspring, siblings or parents of IBD patients, and strengthen the theory that it is the actual inflammation or atypia of the colon in IBD patients that confers the increased CRC risk.

P861 Frequency and Influence of a Positive Family History on the Clinical Course of Inflammatory Bowel Diseases

Abstract Background Previous studies on the difference in phenotypes and disease course between familial and sporadic inflammatory bowel diseases (IBD) have resulted in heterogenous conclusions. However, a positive family history is considered the strongest recognizable risk factor for developing IBD and is present in 8-12% of cases. We aimed to compare the frequency of a positive family history between patients with Crohn’s disease (CD) and ulcerative colitis (UC) and additionally to evaluate possible clinical parameters that may influence the clinical course of familial IBD cases, based on retrospectively-prospectively collected data of a cohort of IBD patients followed in daily clinical practice. Methods Patients with biopsy-confirmed IBD aged 10–90 years old were included in the study. A comprehensive questionnaire was used to collect data on each site visit from July 2018 to March 2022. Logistic regression analysis was used to examine clinical parameters that may influence the clinical course of familial IBD cases and the chi-squared test to compare the frequency of a positive family history between patients with UC and CD. Results We collected 300 patients diagnosed with IBD (180 with CD, 113 with UC, and 7 with indeterminate colitis). About 10% of IBD patients had a first degree relative with IBD (13% in CD and 4% in UC group, P&amp;lt; .05), as summarized in table 1. Female IBD patients had a 4-fold increased risk to have a first degree relative with IBD (OR 3.79; 95% CI: 1.44-9.98; P&amp;lt; .01). Similarly, CD patients had a 3-fold increased risk (OR 3.31; 95% CI: 1.08-10.18); P&amp;lt; .05). IBD patients who had a first degree relative with IBD were at greater risk for hospitalization for IBD flare or other complications (OR 3.07; 95% CI: 1.12-8.38; P&amp;lt; .05), to undergo a surgical procedure, mainly colectomy (OR 5.20; 95% CI: 1.98-13.68; P&amp;lt; .01), to develop perianal disease (OR 3.42; 95% CI: 1.25-9.35; P&amp;lt; .05), to develop sacroiliitis (OR 3.72; 95% CI: 1.40-9.91; P&amp;lt; .01), and to being treated with anti-TNF agents (OR 3.21; 95% CI: 1.14-9.08; P&amp;lt; .05). Furthermore, in patients with a family history of IBD there was a trend for extraintestinal manifestations (OR 2.47; 95% CI: 0.91-6.74; P= .078), especially from the musculoskeletal system (OR 2.45; 95% CI: 0.94-6.34; P= .066), skin (OR 2.83; 95% CI: 0.94-8.45; P= .065) and ocular system (OR 4.92; 95% CI: 0.89-27.26; P= .068), as shown in table 2. Conclusion In this retrospective-prospective cohort study, family history of IBD in first degree relatives was present in 13% of patients with CD and 4% of patients with UC, and was associated with increased risk for hospitalization, surgical procedures, occurrence of perianal disease, treatment with anti-TNF agents, and a trend for developing EIMs.

P790 Examining mental health disease burden among Crohn’s Disease (CD) patients in Europe

Abstract Background Mental health is an overlooked aspect of inflammatory bowel disease (IBD) patient care and the most common psychological conditions in patients with IBD are anxiety and depression1. The objective of this study was to examine the possible factors that will impact mental health burden of CD patients in Europe. Methods A multi-centre online medical chart review study of patients with CD was conducted between Jul – Sep 2022 among UK, FR, DE, IT &amp; ES gastroenterologists practicing across hospital and private practices. Physicians were screened for practice duration and patient volume. Charts of patients prescribed with advanced therapy were included in the analysis. Results 206 sampled physicians collectively reported 1178 CD patients. From the reported CD patients, 190 suffered mental health burden (depression or anxiety) and 988 CD patients did not suffered any mental health burden. Among CD patients suffered mental health burden, a higher proportion of CD patients are female vs those who did not suffered any (55% vs 46%). ‘Family history of IBD’ was the co-morbidity more likely to experience in reported CD patients suffered mental health burden vs those who did not (11% vs 7%). When looking at employment status between these two patient groups, reported CD patients suffer mental health burden was less likely to be in full-time employment vs those not suffered mental health burden. A higher proportion of reported CD patients suffered mental health burden were in part-time employment or housewife/househusband. CD patients with mental health burden had greater CRP level than patients without mental health burden (CRP mean: 16 vs 12). This aligns with reported CD patients with mental health burden had frequent surgery times vs without mental health burden (Mean surgery times: 2 vs 1) and had greater steroid usage (% reported patients currently on steroids – 18% vs 13%). Conclusion Comparisons in this study cohort highlight there are other factors could impact CD patients’ mental health burden other than IBD itself. This coincided with low full-time employment rate that attributed to financial stress may increase CD patients’ mental health burden. Also, higher rate of surgery and steroid usage in CD patients experienced mental health burden might suggest they had more severe or complications with their disease that will impact overall mental health. Further investigation using comparator cohort is warranted.

P385 Risk-benefit assessment of IBD drugs: a physicians and patients survey

Abstract Background Treatment choices for patients with inflammatory bowel disease (IBD) are based on the balance between risks and benefits. To date, there are no globally accepted methods for assessing the risk-benefit ratio. Our aim was to compare the perspectives of patients and physicians in evaluating the risks and benefits before initiating therapy for IBD. Methods An anonymous survey was conducted between March and August 2022. Multiple choice questions, similar for physicians and patients, were formulated. The questionnaire was developed in English and was later translated in Italian and French by native speakers. All patients with a confirmed diagnosis of IBD who were followed up at the IRCCS San Raffaele Hospital (Italy), Nancy University Hospital (France), and University Hospital CHU of Liège (Belgium) were invited to participate. All physicians who attended an IBDscope webinar were invited to participate by email. Results In total, 367 patients and 146 physicians participated in the survey from 34 countries worldwide (Tables 1 and 2). For most patients (71.4%) and physicians (89.0%), efficacy and safety were equally important in choosing a therapy. Clinical improvement and clinical remission were the most relevant outcomes for patients (90.9 and 88.4 Likert scales), while clinical remission and endoscopic remission were for physicians (90.0 and 87.6 Likert scales). The main factors in the benefit-risk assessment for patients were quality of life (95.1%), disease activity (87.5%), and presence of comorbidities (84.5%). The main factors for physicians were presence of comorbidities (99.3%), disease activity (97.9%), prior failure to biologics or small molecules (96.6%). Disease duration, family history of IBD, administration interval, therapy duration, and administration route had a limited role for both physicians and patients. Based on patients' and physicians’ opinions, the risk of serious infections (90.5% and 98.6%), malignancies (90.5% and 100.0%), cardiovascular events (88.8% and 98.6%), death (86.4% and 91.8%), relapse (86.1% and 94.5%), all infections (86.1% and 100.0%), surgery (83.1% and 93.1%), and hospitalization (76.6% and 88.4%) should be included in the benefit-risk assessment. The risk percentages considered acceptable by patients and physicians are reported in Figures 1 and 2. Infliximab was the most effective drug for physicians in inducing and maintaining disease remission in both Crohn’s disease and ulcerative colitis, while ustekinumab and vedolizumab were equally considered the safest drugs. Conclusion Physicians and patients have different priorities in evaluating the benefit-risk balance of a new therapy. Treatment decisions should be discussed and shared with patients.

P365 Psoriasis in Inflammatory Bowel Disease: Comparison of Extraintestinal Manifestations and Effect of Anti-TNF Therapies

Abstract Background Psoriatic lesions may develop in inflammatory bowel disease (IBD) patients as an extraintestinal manifestation or an adverse effect of anti-TNF therapy. The aim of this study was to compare the clinical characteristics of IBD patients with psoriasis between extraintestinal manifestations and the effect of anti-TNF therapies. Methods In this cross-sectional study, data was identified between March 2019, and October 2022. Demographic and clinical data of patients with IBD were recorded at baseline and during follow-up. All patients were questioned for psoriasis, and the "onset of psoriasis" was recorded as before or after anti-TNF therapies. Results In our tertiary center, a total of 1125 IBD patients were identified through the database (543 with CD, 549 with UC, and 33 with IBD unclassified (IBDU)) and a 336 (29.9%) had an exposure to adalimumab, 322 (28.6%) to infliximab, and 27 (2.4%) to certolizumab. In our cohort, a total of 37 (3.3%) patients, suffered from psoriasis, in which 18 (48.6%) patients on anti-TNF therapy (7 adalimumab, 10 infliximab and 1 certolizumab) developed a drug-induced psoriasis, while 19 (51.4%) patients had psoriasis as an extraintestinal manifestation before the anti-TNF therapies. In patients with all psoriasis, 24 (%64.9) were female and 28 (75.7%) had CD. CD was statistically significantly more common in patients with psoriasis induced by anti-TNF therapy (17 (94.4%) vs. 11 (57.9%), p=0.019). Anti-TNF therapy induced psoriasis had statistically significantly longer disease duration than psoriasis as an extraintestinal manifestation group (11.5 vs 6 median years, respectively p=0.005), while other baseline characteristics such as age, sex, smoking status, family history of IBD, disease location, behavior, perianal disease, and other extraintestinal involvements were similar. At baseline, serum hemoglobin (13 vs. 12 mg/dL; p=0.069), albumin (4.2 vs.4.3 g/dL; p=0.505), partial MAYO score (6 vs 7 median score; p=0.247) and CDAI (360 vs. 320 median score; p=0.339) were all comparable between the two groups, respectively. Whereas baseline CRP level in extraintestinal manifestation group was significantly higher than anti-TNF therapy induced group (66 vs. 2.8 mg/L; p=0.003). Conclusion In this study, we found that up to 3.3% of all IBD patients had psoriasis; half of these cases were anti-TNF therapy induced psoriasis, and the rates of psoriasis in CD patients and female patients were greater than those in UC and male patients. Anti-TNF therapy induced psoriasis had a statistically significantly longer disease duration and lower baseline CRP in comparison to psoriasis as an extraintestinal manifestation.

P231 Impact of age of Inflammatory Bowel Disease diagnosis on disease phenotype and severity in elderly patients

Abstract Background Up to fifteen percent of inflammatory bowel disease (IBD) patients are diagnosed after the age of 60 years (elderly onset-EO). Additionally, due to the ageing of population and the increasing prevalence of IBD the number of elderly patients (&amp;gt;60) with an earlier diagnosis (adult onset-AO) is rapidly increasing. We aimed to compare disease characteristics and management between EO and AO elderly IBD patients. Methods Data of a prospective longitudinal registry of IBD patients followed in a tertiary center over a ten-year period (2012-2022) were analyzed. Consecutive IBD patients aged over 60 years at study entry were included. They were divided into two groups according to their age at diagnosis &amp;lt;60 (AO) and ≥ 60 (ΕΟ) years. The two groups were compared as for their demographic and clinical characteristics, their treatment and outcomes (disease related surgeries, development of malignancy, death). Results Out of 1104 patients recorded in the IBD registry, 325 were currently ≥ 60 years old (29%) and among them 267 had complete data and were included in the study (Table 1). ΕΟ had 100 (37%) and ΑΟ 167 (63%). Median age at diagnosis (IQR) was 47 years (37-53) for AO and 66 years (62-71) for EO (p&amp;lt;0.0001) whereas median disease duration was 23 (15-31) and 9 (5-14) years respectively (P&amp;lt;0.0001). Male gender (AO:61%, EO:68%) and ulcerative colitis (UC) (AO: 60%, EO: 53%) predominated in both groups. Family history of IBD and extraintestinal manifestations were lower in the EO than the AO group (p=0.02 and p=0.01 respectively). UC localization was most commonly proctitis and left sided in both groups. CD was most often ileal in EO patients when compared with AO (p=0.028) and inflammatory phenotype was more prevalent in both groups (ΑΟ:69% and ΕΟ:79% respectively). Immunomodulators were less frequently used in EO (17% vs 40.8%, p=0.0001) which was not the case for biologics (40.1% vs 32%, p=0.18) and prednisolone (21.5% vs 16%, p=0.27). During a median disease duration of 16 (8-25) years, comparable rates of IBD-related surgeries (12.5% ΑΟ vs 9% EO) and total malignancies (18.5% ΑΟ vs 14% ΕΟ) were observed but there were more deaths in the ΕΟ group (20% vs 8.3%; p=0.0063). Conclusion There are some distinct differences in demographic, clinical characteristics, treatment and mortality between EO and AO elderly IBD patients. The comparable rates of biologic use and IBD-related surgeries probably indicate that EO-IBD does not have a mild disease course. The clinical implication of these findings needs further validation.

P876 Disease course of Inflammatory Bowel Disease Unclassified in adult patients : a population-based study (1988-2014)

Abstract Background Inflammatory bowel disease unclassified (IBDU) represents 1 to 20 % of inflammatory bowel disease (IBD). There are few data on the natural history of IBDU. The aim of this study was to evaluate the disease course of IBDU in a population-based cohort. Methods All patients diagnosed with IBDU between 1988 and 2014, aged &amp;gt; 17 years at diagnosis, and prospectively enrolled in a population-based registry, were followed until diagnostic reclassification as Crohn’s disease (CD) or ulcerative colitis (UC), or date of loss of follow-up. Clinical presentations at diagnosis of IBDU, CD or UC were compared. The probability of diagnostic reclassification of IBDU during follow-up was studied by the Kaplan-Meier method, and its variation factors by Cox models. Results A total of 480 patients with an initial diagnosis of IBDU were included, representing 3.6% of incident IBD cases in the registry. The probability of IBDU diagnosis within IBD significantly decrease over the study period (6.2% from 1988 to 1996, 3.3% from 1997 to 2005 and 2.1% from 2006 to 2014, p&amp;lt;0.0001). Small bowel exploration and gastroscopy rates at diagnosis were significantly lower in IBDU than in UC and CD. Of these 480 patients, 388 were followed up, with a median duration of 2.4 years (IQR: 0.5-9.5). The cumulative probability of reclassification of IBDU was 17% at 1 year, 41% at 5 years, and 54% at 10 years (median time since initial diagnosis: 8.0 years (IQR: 6.3-12.0)); the probability of reclassification to UC was 10% at 1 year, 22% at 5 years, and 30% at 10 years, and to CD was 5%, 13%, and 18%, respectively. The median time to diagnostic reclassification decreased over the study period (14.3 years (IQR: 9.0-17.2) in 1988-1996, 5.1 years (3.1-9.4) in 1997-2005, and 5.6 years (3.4-8.3) in 2006-2014, p&amp;lt;0.0001), in parallel with an increased rate of reclassification during the most recent periods of diagnosis (HR: 1.76 in 1997-2005 and 1.67 in 2006-2014). Presence of rectal bleeding at diagnosis and 1st degree family history of IBD were respectively associated with risk of reclassification to UC (HR: 1.65, p=0.044) and CD (HR: 2.72, p=0.0134). Exposure to anti-TNF increased significantly after diagnostic reclassification (HR: 4.05, p&amp;lt;0.0001). During follow-up, 13.4 % of patients with IBDU required surgery. Conclusion In this population-based study, almost half of the patients with an initial diagnosis of IBDU were reclassified during follow-up, after a median time from diagnosis of 8 years. The rate of IBDU and the delay to diagnostic reclassification decreased over the study period, presumably due to an improvement in primary diagnostic evaluation.

ASSOCIATION BETWEEN ANTIBIOTIC USE AND INFLAMMATORY BOWEL DISEASE OUTCOMES

Abstract OBJECTIVE Benefit of antibiotic use in Inflammatory Bowel Disease (IBD) is unclear and has been a subject of research. This study investigated the association between antibiotic use and treatment outcomes among IBD patients using real-world data. METHODS Data from Study of a Prospective Adult Research Cohort with IBD (SPARC IBD) of Crohn’s &amp; Colitis Foundation’s IBD Plexus program were used. Patients diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) since 2000 were included. The use of antibiotics (ciprofloxacin, metronidazole, rifaximin and vancomycin) for ≥7 days after enrollment was identified from electronic health records and case report forms. Disease activity scores were assessed at the time of enrollment (baseline) and during follow-up using 6-point Mayo score (6-pt MS) and short Clinical Disease Activity Index (sCDAI) for UC and CD, respectively. Patients’ demographic and clinical characteristics were also collected. Remission was defined as 6-pt MS of 0-1 for UC and sCDAI&amp;lt;150 for CD. The association between antibiotic use and outcome during follow-up was assessed in a subset of patients without remission at baseline using a multivariable Cox proportional hazards model. The model included the following covariates for adjustment: age, gender, race, family history of IBD, IBD surgery, disease activity at enrollment and other IBD drug use during follow-up. RESULTS A total of 2,959 IBD patients (UC=1,060; CD=1,899) were included. Mean age at diagnosis was 30±14 years (UC=32±15; CD=28±14). Forty-four percent of the patients were male (UC=49%; CD=41%) and 79% were White (UC=82%; CD=78%). Antibiotic use after enrollment was observed in 29% of the patients (UC=26%; CD=30%). About 60% of UC or CD patients were in remission at baseline. The antibiotic use group had significantly higher baseline disease activity (UC 6-pt MS: 1.7±1.8; CD sCDAI: 167±96) than patients without antibiotic use (UC 6-pt MS: 1.3±1.7; CD sCDAI: 137±89). In the subset of patients with mild, moderate or severe baseline IBD (6-pt MS&amp;gt;1 for UC; sCDAI≥150 for CD), the baseline disease activity scores were largely comparable between patients who used antibiotic and who did not (UC 6-pt MS: 3.6±1.3 vs 3.3±1.3, p-value=0.063; CD sCDAI: 248±83 vs 238±83, p-value=0.169), while patients who used antibiotics were less likely to experience remission during follow-up compared to those who did not use antibiotics (UC adjusted remission hazard ratio [aRHR] 0.39, 95% confidence interval [CI] 0.26-0.60; CD aRHR 0.60, 95% CI 0.46-0.79). CONCLUSION In this study, antibiotic use in patients with IBD was negatively associated with remission during follow-up. The effect of antibiotics on gut microbiome and optimal use of antibiotics in IBD patients need to be further explored.

Inflammatory Bowel Diseases Before and After 1990.

Inflammatory bowel disease (IBD) is caused by interaction of genetic and environmental risk factors. We evaluated potential determinants of the post-1990 increased incidence in North America. Using fitted generalized linear models, we assessed clinical features, smoking and genetic risk scores (GRS) for Crohn's disease (CD) and ulcerative colitis (UC) in the National Institutes of Diabetes, Digestion and Kidney Diseases IBD Genetics Consortium database, before and post 1990. Among 2744 patients (55% CD, 42.2% UC), smoking status and GRS were the main determinants of diagnosis age. After 1990, smoking at diagnosis declined significantly in both UC and CD (34.1% vs 20.8%, P < .001, and 14.7% vs 8.7%, P = .06, respectively). In UC, ex-smoking increased (9% vs 15%, P < .001), and nonsmoking rates remained unchanged, whereas in CD, ex-smoking remained unchanged. CD-GRS and IBD-GRS were significantly associated with young diagnosis age, Jewish ethnicity, IBD family history, and surgery. CD-GRS showed a borderline significant decrease (P = .058) in multivariate analysis post 1990 but only when excluding surgery in the model; surgery significantly decreased post 1990 in both CD and UC. CD-GRS inversely correlated with smoking at diagnosis (P < .001) suggesting that, in the presence of smoking, CD may only require a low genetic risk to develop. Significantly increase in ex-smoking correlates with UC incidence post 1990. Conversely, smoking risk decreased significantly post 1990 despite rising CD incidence. CD-GRS likewise trended to decrease post 1990 only when not accounting for a significant decrease in CD surgery. We therefore deduce that unaccounted risk factors (eg, dietary, obesity, antibiotic use, improved hygiene, etc.) or greater detection or presence of mild CD may underlie post-1990 increased CD incidence.

S943 A New Population With Inflammatory Bowel Disease: Clinical Characteristics of IBD in the Chaldean Population

Introduction: The Chaldean people originate from ancient Babylon, Mesopotamia, known as Iraq in modern times, with a population of approximately 2 million, with 500,000 in the US. It has been anecdotally observed that many Chaldeans suffer from inflammatory bowel disease (IBD), however there is little known about IBD in this population. Cho et al. described four Chaldean families and reported linkage and linkage disequilibrium at chromosome band 1p36 associated with IBD, but no clinical characteristics have been described. The aim of this study is to describe the clinical characteristics of IBD in the Chaldean population. Methods: This was an online survey study sent to the Chaldean community in Michigan via social media platforms. Data collected included demographic information, IBD specific characteristics, family history and barriers to seeking care. Patients who were < 18 years old (y), did not identify as Chaldean or have a diagnosis of IBD were excluded. Results: A total of 74 patients completed the survey (18 excluded due to age, diagnosis uncertainty). Of the 56 completed surveys, 25 (44.6%) with ulcerative colitis (UC), 22 (39.2%) with Crohn’s disease (CD), 9 (16%) with IBD-unspecified (IBD-U). Median age 31y (Range 19-55y), median duration of disease 9y (Range 1-28y) and median age of onset of disease 25y (Range 5-52y). 42 (75%) were females. 12 (21%) have a history of surgery for disease complications. 35% have first degree relative with IBD, 53% have second degree relative with IBD. 66% report delays in seeking medical attention after first symptoms, with minimization of symptoms and embarrassment being the most common reasons. Other reasons included fear, insurance issues and life stressors. (Table) Conclusion: This is the first study to describe clinical characteristics of Chaldean patients with IBD. We found similar rates of UC and CD in our survey population. There are more Chaldean females with IBD, compared to equal rates of males and females with IBD in the general population. In the Chaldean population, we found a significantly higher family history of IBD than the general IBD population which is reported at 8-14%. Despite a strong family history and presumed more exposure to those with IBD, most patients delay seeking medical attention for their symptoms. Further studies are indicated to describe IBD characteristics, clinical course, prognosis and genetic evaluation in the Chaldean population. Table 1. - Title: Demographic and Clinical Characteristics of 56 Chaldean Patients with IBD Variables N=56 Median age, y (Range) 31 (19-55) Median age of diagnosis, y (Range) 25 (5-52) Median duration of disease, y (Range) 9 (1-28) Females, n (%) 42 (75) Delays to seeking care, n (%)1 37 (66) Minimization of symptoms, n (%) 10 (42) Embarrassment, n (%) 6 (25) Fear, n (%) 3 (13) Life stressors, n (%) 3 (13) Insurance barriers, n (%) 2 (8) 1= 24 participants provided reasons for delays to seeking care; y = years

S2792 A Tale of Three Stomas: A Challenging Case of Inflammatory Bowel Disease

Introduction: Inflammatory bowel disease (IBD) and diverticular disease have many overlapping sequelae. It can be difficult to distinguish between them in an acute presentation. Here, we report a challenging case of IBD that originally presented as complicated diverticular disease. We highlight the diagnostic and management considerations. Case Description/Methods: A 75-year-old female without personal or family history of IBD presented in June 2021 with abdominal pain and fever, was diagnosed with uncomplicated diverticulitis and treated with a course of antibiotics. She recovered clinically but presented in July 2021 with worsening abdominal pain and bloody diarrhea. She was found on imaging to have a colonic perforation and abscess. She was taken for a Hartmann procedure with sigmoidectomy and colostomy formation, with surgical pathology suggestive of acute diverticulitis. Abdominal pain and bloody ostomy output continued. She presented to our medical center in September 2021. Evaluation showed deep ulcerations and spontaneous friability, concerning for IBD. She was started on steroids but she proved refractory. We then offered rescue infliximab, after which she clinically improved. She was maintained on infliximab as an outpatient. Before repeat endoscopic evaluation, she presented again to the hospital with abdominal pain and was found to have another colonic perforation. She underwent a completion subtotal colectomy, extensive lysis of adhesions and received an end ileostomy. Pathology showed severely active chronic pancolitis with ulceration. She currently is in clinical remission, not currently on any IBD therapy. Discussion: The diagnosis for this patient has proved difficult, given her initial acute presentation. Complicated diverticulitis has overlapping features with IBD, and is more prevalent than IBD. It is less prevalent in the IBD population, with one study showing prevalence in ulcerative colitis (UC) of 10.8% compared to 27.8% in healthy controls. Endoscopic evaluation was important in understanding the presence of IBD, though it has been challenging to define a distinct entity of UC versus Crohn’s disease given her history of abscess and colonic perforation. The rate of intra-abdominal abscess in UC is low but has been described. In one single center analysis, the rate of intra-abdominal abscess in UC vs Crohn’s disease with 0.8% vs 2.4%, respectively. After surgical recovery, we plan for small bowel evaluation to further delineate the extent of inflammation.Figure 1.: Image from colonoscopy from 9/21/21 showing erythema, ulceration, friability.

S2752 New Onset Inflammatory Bowel Disease Due to Anti-IL-17 Therapy With a Unique Twist

Introduction: Both psoriasis and inflammatory bowel disease (IBD) are driven by inappropriate immune responses. Antibody therapy to the pro-inflammatory cytokine interlukin-17 (IL-17) has been associated with de-novo IBD. We describe two cases of new onset IBD in patients started on anti-IL-17 antibodies ixekizumab and secukinumab, both with unique clinical courses. Case Description/Methods: Patient 1: A 47-year-old woman with hypertension, type 2 diabetes mellitus, and psoriasis presented with 2 weeks of abdominal cramping and rectal bleeding. She had been stable on brodalumab but switched to ixekizumab two months prior to presentation. She denied a family history of IBD. Her labs were notable for mild leukocytosis, thrombocytosis, and elevated CRP. CT showed evidence of descending colitis. Colonoscopy revealed multifocal colitis, with biopsies suggesting IBD or drug-induced colitis. She was started on ustekinumab for Crohn's disease which resolved her GI symptoms. Repeat colonoscopy one year later confirmed endoscopic and histologic remission. Patient 2: A 36-year-old woman with pre-diabetes and psoriasis presented with watery diarrhea, abdominal cramping and stool discharge per vagina one week after switching from adalimumab to secukinumab. She reported a family history of Crohn’s disease in her mother. Her labs were notable for leukocytosis, thrombocytosis, and elevated CRP. CT revealed left sided colitis and MR showed a rectovaginal fistula. Colonoscopy revealed ileo-pancolitis and biopsies were consistent with IBD or drug-induced colitis. Secukinumab was discontinued. One week after discharge, the patient reported cessation of stool discharge per vagina and improvement in diarrhea and abdominal pain. Discussion: These case reports add to the literature that describes a relationship between IL-17 antagonism and IBD. Patient 1 is unique in that she was exposed to two different IL-17 antibodies prior to her diagnosis of IBD and she represents the first reported case of ustekinumab rescue of ixekizumab-induced IBD. Patient 2 is the only case of IL-17-induced IBD with a rectovaginal fistula described in the literature. Although recent meta-analyses do not show a statistically significant relationship between anti-IL-17 therapy and de-novo IBD, further study is warranted. Providers should avoid anti-IL-17 therapies for patients with a personal history of IBD and should monitor patients on these therapies closely for the development of IBD.