History Of IBD Research Articles

Clinical Phenotype and Disease Course of Inflammatory Bowel Disease: A Comparison Between Sporadic and Familial Cases

The role of genetic and environmental factors in inflammatory bowel disease's (IBD) clinical course is not fully clear. We aimed to assess the clinical phenotype, disease course, and prognosis of familial IBD in comparison with sporadic cases. We conducted a prospective national matched case-control study of registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) recruited from 2017 until 2020. Sporadic and familial IBD patients were matched based on age, sex, and disease duration. Data on demographics, past medical disease, family history of IBD, disease type, clinical phenotype, extraintestinal manifestations, IBD medications, IBD activity using the IBD-control-8 questionnaire and the Manitoba IBD index, emergency visits in the past 12 months, admissions in the past 3 months, history of colon cancer, IBD-related surgeries, and aggressive phenotype were gathered. Variable distributions were compared between sporadic and familial cases. Overall, 5231 patients with ulcerative colitis (UC, 18.3% familial) and 1438 patients with Crohn's disease (CD, 16.7% familial) were registered in the IRCC. Age at diagnosis was similar between familial and sporadic cases. After matching, 3523 UC patients and 908 CD patients were enrolled in the study. Extraintestinal manifestations, UC extent, CD location and behavior, anti-TNF use, disease activity, colon cancer, IBD-related surgeries and the aggressive phenotype were similar between these sporadic and familial cases. The prevalence of familial UC and CD cases in Iran was more similar to western countries, and family history did not show a predictive value for disease phenotype, course, and outcomes in our study.

Prevalence and Impact of Obesity on Disease-specific Outcomes in a Population-based Cohort of Patients with Ulcerative Colitis.

There remains a historical misconception that inflammatory bowel disease [IBD] patients are underweight. However, recent data suggest rates of obesity in IBD parallel to those of the general population. The impact obesity has on the natural history of IBD is unclear. We aimed to determine obesity rates at the time of IBD diagnosis in a population-based cohort of ulcerative colitis [UC] patients. Chart review was performed on patients diagnosed with UC over 1970-2010. Data were collected on demographics, body mass index [BMI], disease characteristics, IBD-specific hospitalisations, intestinal resection, and corticosteroid use. The proportion of patients who were obese at the time of their diagnosis was evaluated over time, and survival free of IBD-related complications was assessed using Kaplan-Meier survival analysis. A total of 417 adults were diagnosed with UC over 1970-2010, 55.4% of whom were classified as either overweight [34.8%] or obese [20.6%]. The prevalence of obesity increased 2-3-fold over the 40-year study period. Obese patients had a 72% increased risk of hospitalisation (hazard ratio [HR],1.72; 95% confidence interval [CI], 1.10-2.71; p = 0.018) when compared with normal weight patients. Additionally, with each incremental increase in BMI by 1 kg/m2, the risk of hospitalisation increased by 5% [HR,1.05; 95% CI, 1.01-1.08; p = 0.008] and risk of corticosteroid use increased by 2.6% [HR,1.026; 95% CI, 1.00-1.05; p = 0.05]. The prevalence of obesity in the UC population is increasing and may have negative prognostic implications, specifically regarding risk of future hospitalisation and corticosteroid use. Additional prospective studies are necessary to more clearly define these associations.

P462 Impact of teduglutide, a GLP-2 agonist, on inflammatory bowel disease-associated short bowel syndrome: a tertiary single-center study

Abstract Background Teduglutide (TED), a GLP2 agonist, have been shown to exert anti-inflammatory effects on the intestinal mucosa in murine preclinical models and evaluated with a positive trend in a phase 2a randomized controlled trial in non-short bowel syndrome (SBS) Crohn’s disease (CD) patients. TED showed efficacy in reducing parenteral nutrition and or intravenous (PN/IV) dependence in SBS with intestinal failure (SBS-IF). However, limited data exists on its specific effect on the natural history of IBD in SBS patients treated with TED. Therefore, we aimed to assess the efficacy and safety of TED in patients with IBD-associated SBS as well as the effect of TED on the course of IBD. Methods We conducted an observational retrospective study. Adult patients SBS-IF due to IBD and who were treated with TED were enrolled. Response was defined as a decrease of at least 20% in total volume of PN. Active IBD was defined based on morphologic and histologic data (CT-scan, colonoscopy and/or enteroMRI). Patients were followed until last news or TED discontinuation. Results We enrolled 14 IBD patients, including 2 patients with ulcerative colitis, with a median follow-up of 4.2 ± 4 years. Of the 12 CD patients, 11 had ileocolonic involvement and 1 had only small bowel involvement. 11 patients had type-1 SBS and 3 had type-2 SBS. 7 patients were only receiving intravenous fluid and 7 were on PN/IV. Patients were in average receiving PN/IV for 9.1 years at TED initiation. Regarding IBD, 4 patients had active disease at inclusion, 3 with a structuring behavior and 1 with a fistulizing behavior. 5 patients were on biologic treatment (antiTNF or ustekinumab) at inclusion. At month 3 (M3), 9 of 14 patients were responders. 3 were weaned from any iv supplementation. 3 of 7 patients initially on TPN were weaned from caloric input, including one still receiving iv fluids. Caloric input was in average at 7330 kcal/week at baseline versus 4615 at M3. Mean total parenteral volume went from 11849 ml/week at M0 to 8223 at M3. 2 of 4 patients with active disease at baseline showed improvement in disease activity while on TED. The latter 2 patients were totally weaned off PN/IV.Six patients withdrew TED during follow-up. 2 patients stopped after a diagnosis of cancer (1 melanoma and 1 chronic myeloid leukemia). Survival without TED discontinuation was estimated at 85.7 % IC95(69.2–100) at 1 year, 78.6% IC95(59.8–100) at 2 years and at 64.3% IC95(43.5–95) at 5 years Conclusion TED appears effective and safe in IBD-associated SBS-IF patients. In specific cases, it may impact positively the inflammatory course of the disease. Further prospective studies are warranted to specifically evaluate TED in IBD-associated SBS, including patients with active IBD.

P667 Characterization of a large Hispanic cohort with Inflammatory Bowel Disease across a 25-year span

Abstract Background Inflammatory Bowel Disease (IBD) in Hispanics has increased, but characterization of this population is limited. We describe the demographic and clinical characteristics of a large Hispanic population with IBD and compare it among two periods, 1995- 2009 and 2010–2019. Methods The Registry of IBD has been recruiting patients with IBD continuously since 1995. Data is obtained from the subject and the medical record. This study includes 1365 Hispanics recruited between 1995 and 2019. Variables include age, gender, age at onset and diagnosis, IBD type, family history, smoking, extraintestinal manifestations (EIM), medications, and surgery for IBD. Descriptive statistics included frequency, median, mean, and standard deviation. SPSS software was used for comparison analysis utilizing Chi square and Fisher′s test. The protocol is approved by the IRB. Results 712 were males and 653 females. Crohn’s disease (CD) was more prevalent in males (479/836, 57.3%) and ulcerative colitis (UC) in females (288/517, 55.7%). The mean age at diagnosis was 34.1 + 15.4 for UC and 24.4 + 12 for CD (p<.001). History of smoking was infrequent (24.3%). Interval between onset of symptoms and diagnosis was 1.8 + 4.7 yrs. for UC and 2.5 + 5.3 yrs. for CD (p=.012). At recruitment, duration of disease was 7.4 + 8.4 yrs. for UC and 5.6 + 7.3 yrs. for CD (p<.001). Family history of IBD was present in 23% of CD and UC participants. The most frequent EIM was arthropathy in 37.9% and 25.9 % of UC and CD (p=.670), followed by skin manifestations in 13.2% and 18.9% respectively (p=.070). Aminosalicylates (94.9%) and corticosteroids (81.6%) were more frequent in UC, and immunomodulators (23%) and anti-TNF drugs (aTNF) (46.2%) in CD (p<.001). At the time of recruitment, 54.5% of CD and 23.7% of UC patients had previous surgery for IBD. Stratification of subjects into two groups by date of recruitment,1995–2009 and 2010–2019, showed similar ages at onset and diagnosis, but the time to diagnosis decreased for UC (2 vs 1.55 yrs.) and increased for CD (2.2 vs 2.6 yrs.) in the later interval. Medications varied between decades, with aTNF increasing markedly in CD and UC (p<.001) and aminosalicylates decreasing in CD (p<.001) in the later years. Surgery for UC decreased from 25.2% to 20.7%, whereas surgery for CD remained the same (52.2% vs 52.5%). Conclusion We describe a large cohort of Hispanics with IBD studied over two decades. Differences over time may reflect changes in disease phenotypes, environmental influences and the impact of physician awareness and new management guidelines and therapies. Further studies are needed to better characterize this population and explore outcomes.

Changing phenotype, early clinical course and clinical predictors of inflammatory bowel disease in Sri Lanka: a retrospective, tertiary care-based, multi-centre study

BackgroundInflammatory bowel disease (IBD) is increasing in the Asia-Pacific region, with changes in disease phenotype and course. We aimed to assess the changing phenotypes of IBD over ten years, describe the early clinical course (ECC) and identify the clinical predictors (CP) of poor outcomes among a large, multi-centre, cohort of Sri Lankan IBD patients.MethodsWe included patients [diagnosed between June/2003–December/2009-Group-1(G1), January/2010–June/2016-Group-2(G2)] with ulcerative colitis (UC) and Crohn disease (CD) from five national-referral centres. Changing phenotype from G1 to G2, ECC (disease duration < 3-years) and CP of poor outcomes (disease duration ≥ 1-year) was assessed. Poor outcomes were complicated-disease (CompD-stricturing/penetrating-CD, extensive-UC/pancolitis, perforation/bleeding/colectomy/malignancy) and treatment-refractory disease (TRD-frequently-relapsing, steroid-dependent/refractory and biologic use).Results375 (UC-227, CD-148) patients were recruited. Both G1/G2 had more UC than CD (77% vs 23%, 54.5 vs 45.5 respectively, p < 0.01). Increase of CD from G1-to-G2 was significant (23–45.4%, p < 0.001). In both groups, left-sided colitis (E2) and ileo-colonic (L3)/non-stricturing, non-penetrating disease behaviour (B1) CD predominated. Extensive-colitis (E3) (36.4% vs 22.7, p < 0.05) and stricturing-CD (B2) (26.1% vs 4.0%, p < 0.01) was commoner in G1. ECC was assessed in 173-patients (UC-94, CD-79). Aggressive disease behaviour and TRD were low among both UC and CD. Immunomodulator use was significantly higher among CD than UC (61.5% vs 29.0% respectively, p < 0.01). Anti-TNF use was low among both groups (UC-3.2%, CD-7.7%). Disease complications among UC [bleeding (2.1%), malignancy-(1.1%), surgery-(2.1%)] and CD [stricture-(3.9%), perforation-(1.3%), malignancy-(1.3%), surgery-(8.9%)] were generally low. CPs were assessed in 271-patients (UC-163, CD-108). Having a family history of IBD (for UC), extraintestinal manifestation (EIM), severe disease at presentation, being in younger age categories and severe disease at presentation, (for both UC and CD) predicted poor outcomes.ConclusionThere was an increase in CD over time without change in disease phenotype for both UC and CD. A relatively benign ECC was observed. Family history (UC), EIMs (UC/CD), severe disease at presentation (UC/CD), younger age (CD/UC) CPs of poor outcomes.

Increased BMI, Sedentary Lifestyle &amp; Metabolic Syndrome as Independent Risk Factors for Development of Colorectal Adenomas: A Prospective Study

<i>Background</i>: Several risk factors for development of colorectal adenomas has been studied over the years. But the effect of increased BMI, sedentary lifestyle and metabolic syndrome on the development of colorectal adenoma has been minimally studied. This study describes the influence of increased BMI, sedentary lifestyle & metabolic syndrome on the prevalence of colorectal adenoma. Secondary objective was to determine whether these factors influence the progression of benign adenomas into advanced adenomas or not. <i>Methods</i>: A total of 697 consecutive cases were included. Asymptomatic subjects aged more than 40 years who were undergoing their first colonoscopy were included in the study. Patients with a history of colonic neoplasia, IBD, colonoscopic polypectomy or colectomy were excluded from the study. Details of colonoscopy, polypectomy and histology were recorded. Data were analyzed by SPSS version 22.0. Chi-square (X²) test was done to assess the association of different risk factors with the development of colonic adenomas. Odds ratio (OR) along with its 95% CI was calculated for every individual risk factor under evaluation. A p-value<0.05 was considered as significant. <i>Result</i>: Colonic polyps were detected in 153 (21.95%) subjects. Out of these 153 subjects 81 (11.62%) had histologically proved adenomas. Benign adenomas were detected in 63 (9.03%) cases, whereas advanced adenomas were detected in 18 (2.58%) cases. A BMI of≥30 showed an OR of 2.94 (1.64-4.24) for the development of colorectal adenomas. Presence of metabolic syndrome showed an OR of 1.74 (1.14-2.34) for the development of adenomas. Sedentary lifestyle showed an OR of 1.91 (1.31-2.51) for the development of colorectal adenomas. An age of≥50 years also showed significant effect (OR=1.39) on the development of colonic adenomas. Lastly the presence of increased BMI, sedentary lifestyle and metabolic syndrome was identified as individual risk factors for the progression of adenoma towards advanced adenomas with an OR of 1.67, 2.14 & 2.92 respectively. <i>Conclusion</i>: This study demonstrates that increased BMI, sedentary lifestyle and metabolic syndrome are associated with increased risk of development of colorectal adenomas. Moreover, increasing age (>50 years) also contribute to the increased risk of development of colorectal adenomas. And lastly it has been showed that increased BMI, sedentary lifestyle and metabolic syndrome individually contribute to the increased risk of progression of benign colonic adenomas to a more advanced adenoma.

Systematic Review of Factors Affecting Transition Readiness Skills in Patients with Inflammatory Bowel Disease.

The incidence of inflammatory bowel disease [IBD] diagnosed before adulthood is increasing worldwide. Transition from paediatric to adult health care requires certain skills. The aim of this study was to identify factors affecting these skills. This review was registered on the PROSPERO database [CRD42019152272]. Inclusion criteria were: 1] studies of factors affecting transition readiness skills in patients with IBD; 2] written in English; 3] published since 1999. MEDLINE, CINAHL, and PsychINFO databases were searched between 1999 and 2019. Quality was assessed using the Joanna Briggs Institute critical appraisal tools. Searches identified 822 papers. Sixteen papers were included. Age was positively associated with skills including disease knowledge and performing self-management behaviours [14 studies]. Improvement often occurs at 18; however, skill deficiency may still remain. Increased self-efficacy [confidence] was associated with greater disease knowledge and performing self-management behaviours [three studies]. Self-efficacy was positively correlated with transition duration [two studies] and health-related quality of life [r = 0.57, p <0.001] [one study], negatively correlated with depression [r = -0.57, p <0.001] and anxiety [r = -0.23, p = 0.03] [one study], and was associated with higher education level [two studies] and a family history of IBD [one study]. Females had higher self-management scores [three studies], and greater health care satisfaction was significantly associated with higher knowledge [one study]. Greater transition communication improved knowledge, self-management, and overall transition readiness [two studies]. Potentially modifiable factors have been identified that could be supported in the transitioning IBD population, to improve transition readiness. Identification of those with non-modifiable characteristics associated with poor readiness may aid targeted support.

S3321 Recurrent Acute Pancreatitis Secondary to Pancreatic Divisum Anomaly

INTRODUCTION: Pancreatic divisum (PD) is a congenital malformation that occurs when the ventral and dorsal ducts of the pancreas fail to fuse. Inadequate drainage of pancreatic secretions from the minor papilla results in ductal distension and recurrent pancreatitis. We present a patient with PD who developed acute necrotizing pancreatitis (ANP) complicated by walled off pancreatic necrosis (WOPN). CASE DESCRIPTION/METHODS: 64-year-old female with history of chronic alcohol abuse and IBD presented with epigastric abdominal pain and emesis. Labs showed normal triglycerides, elevated lipase and amylase. Abdominal US ruled out gallstones. Abdominal CT showed pancreatic inflammation with several cystic-appearing fluid collections. She was treated conservatively. Repeat abdominal CT showed multiple increased peripancreatic fluid collections with mass effect on the stomach (Figure 1). Persistent abdominal pain led to ERCP which displayed complete PD and high-grade pancreatic duct fistula in the body and tail. Ventral and dorsal duct sphincterotomies were done with stent deployment in each duct. EUS revealed 3 peripancreatic fluid collections (consistent with WOPN); the largest was adjacent to the gastric antrum. Purulent drainage was noted after 3 cystogastrostomy incisions. Antibiotics were initiated. Patient eventually had recurrent pancreatitis, requiring repeat minor papilla sphincterotomy with dorsal pancreatic duct stent exchange. DISCUSSION: WOPN is a late complication of ANP, occurring more than 4 weeks after the initial attack. It can cause obstruction and fistula. Due to her PD anatomy, we suspect the patient had previous indolent acute pancreatitis episodes however they were falsely attributed to her IBD. Thus, delaying diagnosis of acute pancreatitis and leading to ANP and WOPN. The lifetime risk of pancreatitis in PD patients is similar to the general population. Consider PD in young, female patients in whom etiologies such as, gallstones and alcohol use, have been excluded. Alcohol abuse in context of her PD anatomy could have amplified our patient’s risk of acute pancreatitis. CT and MRI scans do not reliably detect PD thus ERCP remains the diagnostic test. Minor papilla sphincterotomy, papillary dilatation, stent insertion and pancreatic resection are treatment options. Since recurrent acute pancreatitis can lead to chronic pancreatitis, it is important to detect PD early. Follow up imaging in 3-6 months after pancreatitis resolution is vital, especially in patients with WOPN, to exclude neoplasm.Figure 1Figure 2.: Fig 1. and 2: CT abdomen and pelvis with contrast showing significantly compressed gastric lumen and multiloculated collections surrounding the pancreas, along the fundus of the stomach measuring 8 × 4.3 cm with mass effect, slightly inferiorly along the fundus and body measuring 7.7 × 4.2 cm, and along the antrum measuring 7.9 × 4.3 cm with surrounding fat stranding and mass effect.

S3115 High-Risk Population Excluded by a Computer Algorithm From a Mailed-Out FIT Screening Program Has Low Screening and Surveillance Rates

INTRODUCTION: In an effort to increase CRC screening, a large academic hospital system launched a mailed-out FIT screening program targeting average-risk patients who qualified for routine screening. Patients with family history of CRC or polyps, or personal history of CRC, polyps, IBD or familial adenomatous polyposis were excluded from the program based on a computer-algorithm generated by family history, patient encounter, diagnosis and problem list in the electronic medical records (EMR). The goal of the project is to assess the appropriateness of the computer-generated exclusion and to determine the CRC screening and surveillance rates in this high-risk population. METHODS: A cohort of patients excluded from the mailed-out FIT screening program in 2018 based on the computer-algorithm was identified. We performed a retrospective chart review to identify the reason for exclusion, determine the appropriateness for exclusion, and assess the CRC screening and surveillance rates.Figure 1RESULTS: To date, we have reviewed 135 charts from the cohort that were excluded by the computer algorithm from the mailed-out FIT screening program. Based on the computer-algorithm, 70 had family history of CRC, 15 had family history of polyps, 19 had a diagnosis of IBD, 20 had personal history of polyps and 11 had history of CRC. After thorough review of the EMR, we found that 87.4% were appropriately excluded from the program by the computer-algorithm, 65.9% of the excluded cohort completed the initial screening, and 62.96% were currently overdue for either screening or surveillance colonoscopy. CONCLUSION: A computer-generated high-risk population based on patient encounters, diagnosis and problem list in the EMR had suboptimal accuracy. The high-risk population excluded by the computer algorithm from the mailed-out FIT screening program had low screening and surveillance rates and may require further intervention.

S1844 Early Onset Colorectal Cancer (EOCRC) in a 43-Year-Old Woman: Current Guidelines Miss Patients at Risk for EOCRC

INTRODUCTION: The incidence of colorectal cancer (CRC) among individuals less than 50 years old is increasing and is estimated to double by 2030. Risk factors for early onset CRC (EOCRC), outside of hereditary CRC syndromes or personal history of IBD, are not well understood. We present a case of EOCRC in a 43-year-old woman. CASE DESCRIPTION/METHODS: The patient presented with six months of worsening hematochezia, abdominal pain, and constipation. Her past medical history included cervical dysplasia status post loop electrosurgical excision and thyroid follicular adenoma status post thyroid lobectomy. Her family history was significant for CRC in her father, diagnosed at age 80. CT abdomen/pelvis showed circumferential rectal wall thickening and prominent perirectal lymph nodes. Colonoscopy revealed a partially obstructing 3cm rectal tumor with associated severe stenosis that was only traversed with an EGD scope. Pathology showed colonic mucosa with high-grade dysplasia. A staging CT chest did not reveal metastases. Her clinical picture was suspicious for colorectal cancer and colorectal surgery recommended neoadjuvant chemotherapy followed by low anterior resection with diverting loop ileostomy. DISCUSSION: This patient's presentation was typical of EOCRC, which tends to present with left-sided disease and in patients older than 40 years. Her risk factor was a family history of CRC in her father; although, he was diagnosed at age 80 at an index colonoscopy. A family history of CRC, even in second- or third-degree relatives, has been associated with increased risk. Some studies have suggested that BMI, tobacco use, coronary artery disease, hypertension, stroke, diabetes, and socioeconomic status are risk factors for EOCRC. Other research indicates that combinations of age, male sex, personal history of IBD, or African American or Asian race are risk factors. Our current U.S. Preventive Services Task Force guidelines do not account for EOCRC. It is difficult to balance the cost effectiveness of initiating the American Cancer Society qualified recommendation to start screening at age 45 versus increasing screening rates and diagnostic colonoscopy completion rates among patients over age 50. As evidenced by our patient, simply lowering the screening age may not be an effective intervention to capture EOCRC phenotypes. Further research is needed to improve understanding of the associated biological and environmental risk factors to improve early identification of individuals at high risk for EOCRC.Figure 1.: Partially-obstructing rectal tumor prior to biopsy.

S0884 A Retrospective Review of Factors Associated With Recurrent Ileocolonic Resection in Patients With Crohn's Disease

INTRODUCTION: Additional ileocolonic resection(s) (ICR) in Crohn’s Disease (CD) patients undergoing the first ICR represents an important source of morbidity and complications. The factors that predict time to recurrent ICR are not well defined. Here we reviewed patients with stricturing CD who have had at least two ICRs to inquire if any clinical factors are associated with a short period of time between ICRs. METHODS: A cohort was designed using surgical billing codes for patients with CD who had an ICR between 2007 and 2018 at one institution and validated by manual chart review. Independent variables included age, sex, race, smoking, family history of IBD, duration of disease, Montreal phenotype, perianal involvement, biologic medications, total number of resections, and indication for surgery. The variables were tested independently for association with time between the first and second ICR (T1-2) using a multivariate linear regression model. Rutgeerts score between first and second ICR was tested using one-way ANOVA (using i0 and >=i1, compared to T1-2) for the 29 patients with endoscopic data. RESULTS: From the initial cohort of 365 patients, 294 patients were excluded due to surgical indication other than stricture, location not ileocecum, only one ICR, extreme outlier results (n = 2) and incomplete charts. Demographic data is shown in Table 1. A total of 14 patients used biologic medications prior to index ICR, and an additional 42 patients were started on biologics between first and second ICR. Taking biologics before the first resection was associated with a shorter T1-2 (5.2 vs 10.8 years, P = 0.0009). Starting biologics after index surgery did not impact T1-2. The remainder of the variables tested did not show a significant association with T1-2. The average amount of time for T1-2 was 9.5 years. CONCLUSION: In patients who underwent recurrent ICR, being prescribed biologics before index resection is significantly associated with a shorter time from index to subsequent resection (P < 0.001). However, this variable only explains 12% of the variability, suggesting additional variables affect T1-2. This association may be explained by a confounding factor such as disease activity/more aggressive CD phenotype. It is also possible that in a substrata of CD patients, taking biologics before index ICR accelerates pro-fibrogenic mechanisms. Future studies are needed to identify more clinical and/or molecular factors that would further explain and predict need for subsequent ICRs in CD patients.Table 1.: Demographics

Paediatric inflammatory bowel disease in India: a prospective multicentre study.

Paediatric inflammatory bowel disease (PIBD) is increasing across the world. However, information from India is sparse. This multicentre study evaluated the demographics, clinical phenotype and outcome of PIBD from India. Data of children (≤18 years) with PIBD were collected using a proforma containing details of demographics, clinical profile, extraintestinal manifestations (EIM), investigations, disease extent and treatment. Three hundred twenty-five children [Crohn's disease: 65.2%, ulcerative colitis: 28.0%, IBD unclassified (IBDU): 6.7%, median age at diagnosis: 11 (interquartile range 6.3) years] were enrolled. 6.9% children had family history of IBD. Pancolitis (E4) was predominant in ulcerative colitis (57.8%) and ileocolonic (L3, 55.7%) in Crohn's disease. Perianal disease was present in 10.9% and growth failure in 20.9% of Crohn's disease cases. Steroids were the initial therapy in 84.2%, 5-amino salicylic acid in 67.3% and exclusive enteral nutrition (EEN) in 1.3% cases. Overall, immunomodulators and biologics were given to 84.3 and 17.9% cases, respectively, and 2.9% cases underwent surgery. Very early onset IBD (VEOIBD) was seen in 60 (19.2%) children. IBDU was commoner in the VEOIBD than the older-PIBD (18/60 vs 4/253; P < 0.001). VEOIBD-Crohn's disease patients more often had isolated colonic disease than the older Crohn's disease (45.4% vs 11.8%; P < 0.001). Prevalence of perianal disease, EIM, therapeutic requirements and outcome were not different between VEOIBD and older-PIBD. Disease location and phenotype of PIBD in Indian children is similar to the children from the west. However, the therapeutic options of EEN, biologics and surgery are underutilized. VEOIBD accounted for 19.2% of PIBD.

Clinical Profile of Ulcerative Colitis Patients in a Tertiary Care Center: An Experience from Rural India

Ulcerative colitis is a chronic idiopathic inflammatory condition of the colon, characterized by relapsing and remitting course. This study was done to look at the clinical profile of ulcerative colitis patients in a tertiary care hospital, located in rural area of northern India. All patients with ulcerative colitis and age above 18 years who attended outpatient clinics from November 2019 to January 2020 were included in the study. A total of 45 patients were included in the study. There were 19 males (42.22%) and mean age of the patients was 37.08 (± 11.58) years. The most common presenting complain was blood in stools (88.88%). The majority of the patients (62.22%) had pancolitis. Family history of proven IBD was found in 1 (2.22%) patient only. Extra-intestinal manifestations were seen in 7 patients (15.55%) commonest being arthralgia. Thirty-three patients (73.33%) were on oral mesalazine, 20 patients (44.44%) were on azathioprine, and 9 patients (20%) were on oral corticosteroids. None of the patients was on biologics. Slight female predominance, fewer EIM, less family history of IBD, higher percentage of pancolitis, and significant percentage of patients on oral immunosuppressant (azathioprine) are the key features observed in this study from rural India.

Tu1116 DISPARITIES IN HEALTH: LOWER COLORECTAL CANCER SCREENING RATES AMONG LGBTQ PATIENTS

Colorectal cancer (CRC) screening via colonoscopy can prevent CRC. Socially neglected populations such as ethnic and racial minorities have consistently lower CRC screening rates when compared to the general population. While lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients represent a population who are at risk for CRC screening disparities, an estimate of the existence and magnitude of the disparity remains unknown. The aim of this study is to analyze the rate of CRC screening between the LGBTQ population and the general population to determine if a disparity exists along with the possible magnitude. Data was extracted from our tertiary care medical center’s de-identified patient database (SD) between 2014 and 2018. Search terms for the LGBTQ population included self-identification in the EMR as “lesbian”, “gay”, “bisexual”, “transgender”, “transsexual”, “queer”, “questioning”, or “intersex” or had an associated ICD 9 or 10 code. The 2008 USPSTF criteria for CRC screening were utilized for identification of patients eligible for screening. Search terms for average risk CRC screening included “colonoscopy”, “FOBT”, “FIT”, “flexible sigmoidoscopy”, and ICD 9/10 codes v76.51, v76.41, z12.11, and z12.12. Patients considered as increased risk for CRC were excluded (family history of CRC or advanced polyp; personal history of IBD). Based on the magnitude of data for the general population, the Center for Disease Control (CDC) and Prevention database for our state was utilized in publication years to calculate the CRC screening rate of the state-wide population. Students t-test for was utilized to assess for differences between the groups. A total of 117 LGBTQ patients were found in the SD. 15% were lesbian, 44% gay, 18% bisexual, 23% transgender, and 0% queer/questioning or intersex with a mean age of 58 [50-76] years-old. 85% were Caucasian (90% non-Hispanic; 3% Hispanic; 7% not identified), 11% African-American, 0% Asian, and 4% unknown. Of the LGBTQ patients identified, 35 met 2008 USPSTF eligibility criteria for average risk CRC screening. The LGBTQ CRC screening rate compared to the state population rate was 29.3% v. 64.9% (p<0.01) in 2014, 34.8% v. 66.4% (p<0.01) in 2016, and 29.9% v. 69.1% (p<0.01) in 2018. Despite increased CRC screening rates for the state population over the years of the study, the rate among the LGBTQ population remained low. Although this is a single center study, our data may serve to highlight low CRC screening rates among the LGBTQ population. Future studies to evaluate the etiology of the low rate, barriers to screening in this marginalized population, and implementation of strategies to improve screening rates are underway.

Inflammatory bowel disease symptoms at the time of anal fistula lead to the diagnosis of Crohn's disease

Most anal fistulas are crypto-glandular. Nevertheless, anal fistulas can reveal Crohn's disease (CD). The aim of our study was to evaluate the risk of developing CD in patients undergoing surgery for anal fistula. All patients undergoing surgery for anal fistula in our center between January 1, 2008 and January 31, 2017 were identified through a prospective administrative database. Demographic, clinical, and laboratory data were retrospectively collected. Ninety-three patients underwent anal exploration under general anesthesia. The median age at diagnosis of fistula was 43 years (IQR, 34-56) and 27% (n=29) were women. Twenty-seven percent (n=16) had had at least one previous fistula episode. After a median follow-up of 16.8 months (IQR, 7.2-42.0), seven (7.4%) patients were diagnosed with CD. The median time between the diagnosis of fistula and that of CD was 7.6 months (IQR, 2.7, 26.1). Chronic diarrhea (P=0.0003), weight loss (P=0.001), and chronic abdominal pain (P=0.002) were associated with the diagnosis of CD. Characteristics of the fistulas (number, simple/complex, abscess), smoking, extra-digestive manifestations of CD, or a family history of IBD were not associated with the diagnosis of CD. A medical history of anal fistula surgery resulted in the diagnosis of CD in 7% of cases. Weight loss and the presence of digestive symptoms were associated with the diagnosis of CD. These elements could be used to select patients requiring endoscopic exploration after anal fistula.

Inflammatory Bowel Disease: A Nationwide Study of Hip Fracture and Mortality Risk After Hip Fracture

With rising rates of inflammatory bowel diseases [IBD] in older adults, management of comorbidities such as osteoporosis is becoming increasingly important. Hip fracture [HF] is the most serious consequence of low bone mineral quality and is associated with excess risk of mortality. For older IBD patients, there are only limited data available. Therefore, we aimed to assess the association of IBD with HF, and all-cause mortality risk after HF, among IBD patients older than 50 years. In a national database-registered case-control study, 56 821 HF cases aged ≥50 years, and 113 718 age-, sex- and region-matched non-hip-fracture controls, were analysed between 2012 and 2016. A history of IBD was assessed from data from Austrian social health insurance funds. Logistic regression and Cox proportional multivariate models were used to test the association of IBD with HF and post-hip fracture mortality risk. A total of 531 patients were identified with IBD (25.0% men, mean age 81.2 years, standard deviation [SD] 9.7). Analysis, adjusted for anti-osteoporotic treatment, use of glucocorticoids, and selected medications, showed that IBD patients had an increased odds of HF (odds ratio [[OR] 2.22, 95% confidence interval [CI] 1.86-2.64). Patients with Crohn's disease [CD] revealed a higher HF odds in contrast to patients with ulcerative colitis [OR 2.91, 95% CI 2.17-3.89 and OR 1.89, 95% CI 1.52-2.35, respectively]. Overall mortality risk after HF was higher among female CD patients [HR 1.75, 95% CI 1.28-2.41] than in the general population. IBD was strongly associated with HF in older patients. Post-hip fracture mortality risk was elevated particularly in women with CD.

P059 SIGNIFICANTLY INCREASED MUCOSAL EOSINOPHILS IN PATIENTS WITH POST-IBD IBS-D SYNDROME MAY HAVE A NEW AVENUE

Abstract Introduction Inflammatory bowel disease (IBD) patients in remission who present with irritable bowel syndrome with diarrhea (IBS-D) like symptoms pose a diagnostic and therapeutic dilemma that is called post-IBD IBS-D. This syndrome was first reported by Isgar et al. who documented IBS-type symptoms in 33% of their patients with chronic ulcerative colitis (CUC) in remission in 1983. In their meta-analysis of 13 studies incorporating 1,703 patients, Halpin and Ford in 2012 calculated a pooled prevalence of 35% for IBS symptoms among IBD subjects in remission. The post-IBD IBS-D syndrome represents a source of considerable stress, incurs morbidity and impairs quality of life of these patients. The etiology of this syndrome is unknown and may be multifactorial such as environmental, psychological, GI motility disarray, genetic components and possibly by gut microbiome. Methods We conducted a retrospective, single-center study of patients with history of IBD and IBS-D like symptoms. The demographic characteristics, type of IBD, colonoscopy, biopsy findings and empirical medical management outcome were analyzed. Results We have found significantly increased mucosal eosinophils (&amp;gt;50 HPF in both side of the colon examined) in our patients with post-IBD IBS-D syndrome. In this study, 15 CUC patients and 20 Crohn’s disease patients with this syndrome were investigated and showed no clinical, serological, mucosal or microscopic IBD activity. These patients had non-bloody diarrhea (5–20 x daily), lower abdominal cramps (%90), mild weight loss (4–6 lbs) and fecal incontinence (%25) who were placed on the GI-hypoallergenic diet and budesonide therapy. Sixty seven percent of these 35 patients with post-IBD IBS-D responded well clinically to this management. Increased mucosal eosinophils in these patients with post-IBD IBS-D may have eosinophilic colopathy that may be related to intestinal permeability disarray. The epithelium in these IBD patients who are in remission may have the production of pro-inflammatory cytokines by the eosinophils, especially IL-23 and IL-33. This interesting area investigation is in progress by our research faculty. Conclusion In summary, this is an exciting new finding that significantly increased mucosal eosinophils in our patients with post-IBD IBS-D syndrome may have a new avenue, eosinophilic colopathy. Interestingly, these patients have responded to the GI-hypoallergenic diet and budesonide therapy. Obviously, we need more patients in the near future with longer follow-up and we hope that the other investigators may confirm our findings.

Interrogating the Gut-Brain Axis in the Context of Inflammatory Bowel Disease: A Translational Approach.

This review examines preclinical and clinical studies relevant to our understanding of how the bidirectional gut-brain axis influences the natural history of inflammatory bowel disease. Preclinical studies provide proof of concept that preexisting behavioral illness, such as depression, results in increased susceptibility to inflammatory stimuli and that commonly used classes of antidepressants protect against this vulnerability. However, clinical studies suggesting behavioral illness as a risk factor for IBD and a protective role for antidepressants have relied primarily on symptom-reporting rather than objective measurements of inflammation. In terms of gut-to-brain signaling, there is emerging evidence from preclinical and clinical observation that intestinal inflammation alters brain functions, including the induction of mood disorders, alteration of circadian rhythm both centrally and peripherally, and changes in appetitive behaviors. Furthermore, preclinical studies suggest that effective treatment of intestinal inflammation improves associated behavioral impairment. Taken together, the findings of this review encourage a holistic approach to the management of patients with IBD, accommodating lifestyle issues that include the avoidance of sleep deprivation, optimized nutrition, and the monitoring and appropriate management of behavioral disorders. The review also acknowledges the need for better-designed clinical studies evaluating the impact of behavioral disorders and their treatments on the natural history of IBD, utilizing hard end points to assess changes in the inflammatory process as opposed to reliance on symptom-based assessments. The findings of the review also encourage a better understanding of changes in brain function and circadian rhythm induced by intestinal inflammation.

2095 Hemolytic Uremic Syndrome in a Young Female, Later Diagnosed With Crohn's Disease

INTRODUCTION: Hemolytic uremic syndrome (HUS) is defined by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. HUS has mostly been associated with Escherichia Coli infection but also seen with systemic infections, pregnancy, rheumatic disease and malignancies. Although, HUS has been described in previously diagnosed case of crohn’s, concomitant occurrence of both is a rarity. We describe a case of 37-year-old female, with acute onset of HUS, who was subsequently diagnosed with crohn's. CASE DESCRIPTION/METHODS: 32-year-old female presented with complaints of abdominal pain, and bloody diarrhea for 5 days, which persisted despite antibiotic therapy. In ED, laboratory tests showed anemia, thrombocytopenia, AKI and Lactic acidosis. Her hemoglobin dropped to 6.7 g/dl and platelets went down to 48k. LDH was elevated and haptoglobin was low. Peripheral smear showed moderate schistocytes. However, shiga toxin was negative. Patient was managed symptomatically for HUS but her symptoms persisted. Imaging revealed thick-walled transverse and left colon. Colonoscopy showed mucosal ulceration and severe colitis with shallow and deep ulcers in ascending, transverse, and descending colon but rectum was normal. Push enteroscopy revealed a small esophageal ulcer. Biopsy showed granulomatous inflammation suggestive of Crohn's. Hence the patient was started on sulfasalazine. Patient had significant clinical recovery within a month and repeat colonoscopy showed healing congested mucosa. DISCUSSION: Although HUS is predominantly described in the pediatric population, its incidence is rising in adult population. It has been found to involve the transverse and ascending colon, much like Crohn's disease. A few reported cases has showed interchanging clinical features between HUS and IBD. Cumulative occurrence of the both was considered rare, however, cases of HUS in patient who were already diagnosed with Crohn's has been seen. In this case, the patient presented with the clinical features of HUS as her first and only manifestation of her Crohn's. Rapid recovery and resolution of symptoms within four weeks of starting the appropriate treatment presents the importance of the appropriate management on the clinical recovery. Hence, with the growing incidence of concurrent occurrence of both entities, early colonoscopy with biopsy can be beneficial in cases of HUS not responding to treatment, even if the patient has no history of IBD, as this could be their first presentation.

127 The Epidemiology of Colorectal Cancer in Chronic Kidney Disease in the U.S.: A Population-Based Study (2014–2019)

INTRODUCTION: Recent studies have shown an association between chronic kidney disease (CKD) and increased risk of developing cancer. Limited data is available regarding the prevalence of colorectal cancer (CRC) in patients with CKD. Using a large database, we sought to evaluate this potential risk association. METHODS: We reviewed data from a commercial database (Explorys Inc, Cleveland, OH, USA) that provided electronic health records from 26 major integrated US healthcare systems. Based on the Systematized Nomenclature of Medicine—Clinical Terms (SNOMED-CT), we identified a cohort of patients with a diagnosis of CRC without CKD, from 2014–2019, which served as a control group. Similarly, we identified a cohort of patients with SNOMED-CT diagnosis of first ever with CRC after at least one year of CKD diagnosis. We performed analyses to describe distributions based on age, gender, and race, as well as to evaluate underlying risk factors. RESULTS: Of the 36,770,450 individuals in the database (2014–2019), 1,359,450 had the diagnosis of CKD (3.69%) and 1,438,540 (3.91%) had the diagnosis of CRC. Amongst CKD patients, 73520 (5.4%) individuals had a first ever diagnosis of CRC after at least one year of being diagnosed with CKD. When compared to individuals without a history of CKD, CKD patients were more likely to develop CRC [OR: 1.76; 95% CI 1.74–1.77, P &lt; 0.0001]. Individuals with CKD and CRC were more likely to be males [OR: 1.21; 95% CI 1.19 to 1.23, P &lt; 0.0001], elderly (age &gt;65) [OR: 3.62; 95% CI 3.55 to 3.69, P &lt; 0.0001], and African American [OR: 2.34; 95% CI 2.30 to 2.38, P &lt; 0.0001]. They were also more likely to be smokers [OR: 1.38; 95% CI 1.36 to 1.41, P &lt; 0.0001], diabetic [OR: 5.04; 95% CI = 4.96 to 5.11, P &lt; 0.0001], and with history of IBD [OR: 1.32; 95% CI 1.27 to 1.38, P &lt; 0.0001], obesity [OR: 2.55; 95% CI 2.49 to 2.56, P &lt; 0.0001] and exposure to radiation [OR: 1.14; 95% CI 1.09 to 1.19, P &lt; 0.0001] when compared to individuals without CKD (Figure 1). CONCLUSION: This population-based cohort study indicated a possible increase of 19.2% in the prevalence of CRC in patients with CKD compared to those without CKD. This may be due to either an increased utilization of the health care system by CKD patients or another unknown confounding factor or even a true association. Given the limitations of our study due to the risk of confounding bias in the database and lack of endoscopic and histological data, this association needs to be confirmed in further studies.