Diagnosis Of Inflammatory Bowel Disease Research Articles

P1132 Patterns and predictors of steroid use in people with IBD in routine care across ANZ

Abstract Background Despite known side effects, oral steroid use (Hydrocortisone) remains prevalent in the management of inflammatory bowel disease (IBD). We hypothesize that steroid use is multifactorial – historical practices, easy access, and quick response, are some factors that may explain the “overuse” of these medications. We sought to quantify and explore patterns and predictors of steroid use in real world IBD care. Methods Crohn’s Colitis Care (CCCare) is a cloud-based IBD-specific electronic medical record (EMR) used in Australia and New Zealand. Deidentified data prospectively entered by clinicians and consumers were retrospectively analysed, including people with an IBD assessment in the last 14 months. Data were extracted on 15th August 2024. Steroid exposure was defined as short (1-28 days), moderate (29-56 days), or prolonged (>56 days). Recency was defined as recent (within 365 days), previous (365-1085 days), or no exposure. Stepwise logistic regression was used to explore relationships amongst steroid use and demographic and/or disease characteristics. Results In 5441 eligible people, most had Crohn’s disease (CD) 3136 (57.6%), 2165(39.7%) had ulcerative colitis (UC) and 135 (2.4%) IBD-unspecified (IBD-U); 50.2% were female; median age was 42 years (IQR 56-32) and 43.9% were non-smokers. Only 994 people had steroid exposure (18.3%). In those exposed, median oral steroid daily dose was 0.22 mg (IQR 3.2-6.8); median oral steroid total dose was 246.1mg (IQR 351.2-69.2), and median annualized total steroid dose was 18.6 mg (IQR 31.6-13.3). Up to 10 courses of steroids were prescribed per person. IBD diagnosis, age, previous IBD surgery, stoma surgery, IBD therapy and age at disease onset reached statistical significance. Compared to people with UC, those with CD had less likelihood of both recent steroid exposure and prolonged exposure (OR 0.78, P=0.014 & OR 0.72, P=0.018 respectively). Adults between 20-29 years had a much higher likelihood of both recent and prolonged exposure compared to people > 70 years (OR 6.67, P=0.000 & OR 6.58, P=0.000 respectively). People on advanced therapies had a greater chance of both recent and prolonged exposure compared to people on 5-ASA alone (OR 1.65, P=0.05 & OR 1.71, P=0.000). Age at diagnosis reached statistical significance for steroid use parameters (OR 1.03, P=0.000), but with only modest effect size. Conclusion In this large real-world cohort, the majority had no recent steroid exposure. In those exposed, younger people, those with UC, and those with more active disease had higher likelihood of prolonged exposure. This suggests that steroid use may be further reduced by proactive tailoring of effective therapies for those with UC and focusing on disease control in younger people with IBD.

P1244 Differential impact of appendectomy with appendiceal inflammation versus no inflammation on inflammatory bowel disease risk in a population-based cohort

Abstract Background The appendix is implicated in inflammatory bowel disease (IBD) risk. However, the relationship of appendectomy for appendicitis versus other indications, when the appendix is not inflamed, with IBD onset is ambiguous. We conducted a population-based cohort study to explore the risk of ulcerative colitis (UC) and Crohn’s disease (CD) following appendectomy of the inflamed appendix and removal of the uninflamed appendix for other indications. Methods We conducted a matched cohort study where all individuals with appendectomy in the Danish National Patient Register between January 1997 and August 2022 were matched 1:10 by sex, year of birth and municipality of residence at the time of appendectomy to individuals without appendectomy. Study participants were excluded if they were not residents of Denmark for at least two years prior to the index date. Based on cross-linked data from the Danish Pathology Register, we categorized appendectomy cases into those with and without appendiceal inflammation. Follow up started 180 days after appendectomy until IBD diagnosis, based on primary and secondary diagnoses codes in the National Patient Register, emigration, death or end of the study period, whichever came first. We used Cox proportional hazards regression to calculate the hazard ratios and 95% confidence interval for outcomes UC and CD, in appendectomy cases with and without appendiceal inflammation, compared to individuals without appendectomy after adjusting for age at appendectomy (index date), sex, calendar year, urbanization, and municipal-level socioeconomic index. Results A total of 145,147 individuals who underwent appendectomy and 1,451,470 individuals without appendectomy were followed for a median of 12 (IQR 6,19) years. Of all individuals with appendiceal inflammation, no appendiceal inflammation, and individuals without appendectomy, 308, 149 and 6,052 were diagnosed with UC, and 336, 191 and 3,166 with CD, respectively, during follow up. Kaplan Meier curves are demonstrated in the Figure. The adjusted hazard ratio (95% CI) for UC among those with and without appendiceal inflammation, compared to individuals without appendectomy, was 0.65 (0.58 - 0.73) and 1.26 (1.06 - 1.50), respectively. Corresponding estimates for CD were 1.33 (1.19 - 1.50) and 3.13 (2.65 - 3.69), respectively. Conclusion In a nationwide cohort with long-term follow up data, appendectomy following appendiceal inflammation was protective against UC while appendectomy following no inflammation was associated with increase in UC risk. Appendectomy, irrespective of appendiceal inflammation, was associated with CD risk.

P0955 Calcium supplementation, but not the Mediterranean diet, significantly reduced bone resorption metabolite in patients with inflammatory bowel disease (IBD): A randomized controlled trial

Abstract Background Reduced bone mineral density (BMD), osteoporosis and osteopenia, are prevalent comorbidities in IBD. Reduced BMD first line treatment is calcium and vitamin D supplementation. Mediterranean diet (MED) pattern has been associated with lower risk of reduced BMD in the general population. We aimed to assess the effectiveness of MED and vitamin D supplementation versus the standard of care on bone turn-over metabolites in patients with quiescent IBD diagnosed with reduced BMD. Methods Patients with IBD in clinical remission, age 20-50 years diagnosed with reduced BMD defined as DXA scan T score <-1were randomized for a 12-week, dietitian-led intervention to either MED (including calcium rich foods) or Calcium supplementation. Vitamin D supplementation was mandatory in both groups. Bone turn-over metabolites including bone resorption metabolite (CTX) and bone formation metabolite (P1NP) were used to assess bone dynamics within 12 weeks of treatment and vitamin D levels at baselined and after 12 weeks. Adherence to MED pattern was assed via validated MED score. Results Out of 72 patients approached, 38 (52.8%) consented to perform screening DXA and 17 (44.8%) were diagnosed with reduced BMD. Finally, 15 patients were recruited to the RCT- 7(46.6%) male 8 (53.4%) female, median age: 34 (IQR 29-40) years, median years since IBD diagnosis: 8 (IQR 7-16) years. Patients were randomized to MED (8) or Ca (7) groups. MED score increased in the MED group: median of 2.5 (IQR 2-3.75) points, but not the Ca group 0 (IQR 0-1) points (p=0.002). After 12 weeks of intervention Ca group demonstrated a reduction of 12.5% (IQR -126-12.2) in bone resorption metabolite, CTX. In the MED group an increase of bone resorption metabolite, CTX, by 18.2% (IQR -2.5-32) was observed. CTX dynamic significantly differed between groups (p=0.04) (fig 1). Bone formation metabolite, P1NP, decreased in both groups- in Ca group by 5.7 % (IQR -19.1- 9.5) and in MED group 10.2% (IQR -14-1.4). P1NP dynamic was comparable between groups. Vitamin D levels increased after 12 weeks in both Ca group and MED group (23.9 % vs 14.8%) the increase was comparable (p=0.536) Conclusion In this short-term intervention, we found that Ca supplementation significantly improved bone resorption in patients with IBD and reduced BMD, while MED (including calcium rich foods) alone was insufficient. Patients with IBD and reduced BMD should be encouraged to adhere to Ca supplementation for the long run to prevent long term metabolic bone complications.

P1219 Late onset inflammatory bowel disease (IBD): Experience from two tertiary centers in Greece

Abstract Background The incidence of IBD in the elderly has increased in recent years1. Aim of the study was the reporting of disease and patient characteristics when IBD diagnosis was set after 60 years. Methods Data were retrieved retrospectively from patients’ medical records and included demographics, disease phenotype, types of treatment and mortality. Results Of 1017 registered patients, 133 were diagnosed ≥60 years (13.08%). 87 (65.4%) men, mean age at diagnosis 67.7 years (range 61-83). 74 with Crohn's disease (CD) (55.6%): 34 (45.9%) ileal disease (L1), 22 (29.7%) ileocolic (L3), 18 (24.3%) colonic disease (L2). 68 (91.9%) patients had inflammatory phenotype and 6 (8.1%) perianal disease. Of 59 patients with ulcerative colitis (UC), 30 (50.8%) had extensive disease (E3), 24 (40.7%) left sided colitis (E2) and 5 (8.5%) proctitis (E1). 57 (42.9%) patients were treated with mesalamine. 76 patients (57.1%) required biologic therapy: 25 (32.9%) anti-TNFs, 30 (39.5%) vedolizumab and 21(27.6%) ustekinumab. 27 (20.3%) patients underwent surgery for the disease. Co-morbidities: 74 patients (55.6%) suffered with arterial hypertension, 42 (31.5%) dyslipidemia, 33 (24.8%) diabetes mellitus and 19 (14.2%) coronary heart disease. Between the years 2014 - 2024 12 patients were deceased [8M/4F, median age 75.8 years (R65-85)]. 7 with ulcerative colitis (UC) and 5 with CD. The mortality rate in this population was 1.17%. The registered causes of death were: 5/12 (41.7%) malignancy, 4/12 (33.4%) cardiac events, 1/12 (8.3%) infection, 1/12 (8.3%) gastrointestinal cancer and 1/12 (8.3%) other causes. Conclusion 1) Less than 15% of patients were diagnosed with IBD after 60 years in a population from two tertiary centers 2) The majority required biologic therapy. 3) Mesalamine and vedolizumab were the most frequently administered drugs. 4) One fifth required surgery for their disease. 5) Co-morbidities were recorded in almost all cases. 6)Mortality rate was relatively low and the two leading causes of death were malignancies and cardiovascular events.

P0316 Systematic assessment of primary sclerosing cholangitis using magnetic resonance cholangiopancreatography in newly diagnosed inflammatory bowel disease – a prospective population-based inception cohort study

Abstract Background Inflammatory bowel diseases (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD), are associated with increased risk of primary sclerosing cholangitis (PSC). We aimed to determine the occurrence and predictors of PSC in patients with newly diagnosed IBD. Methods Since May 1st, 2021, all adult and pediatric patients with incident IBD within a catchment area encompassing 20% of Denmark were enrolled in the prospective population-based Copenhagen IBD Inception Cohort.1 All adult patients were invited for MRCP and blood tests (albumin, alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin, and INR) at IBD diagnosis. PSC-like lesions on MRCPs were evaluated by two experienced radiologists. Multivariate Cox proportional hazard analyses of the disease course of IBD adjusting for age, sex, smoking, and disease phenotype were performed (adjusted HR, aHR, 95% confidence interval). Results A total of 527 patients (UC: 326; CD: 201) were included in the cohort, with 242 (74.2%) and 147 (73.1%) undergoing MRCP, respectively, within a median of 2.4 months (interquartile range (IQR) 1.3-4.9) of IBD diagnosis. No clinical differences were observed between patients who underwent MRCP and those who did not. Definite PSC or PSC-like lesions on MRCP were detected in 33 patients (8.5%), including 17 (7.0%) and 16 (10.9%) with UC and CD, respectively. Of those, 19 patients (4.9%), including 11 (4.5%) with UC and 8 (5.4%) with CD, had definite PSC. No difference was observed in the occurrence of PSC (p=0.37) or PSC-like lesions (p=0.08) in UC vs. CD, nor according to the phenotype of CD; however, PSC lesions in both intra- and extrahepatic bile ducts were more common in UC than in CD (46.2% vs. 6.3%, p=0.02). In addition, a larger proportion with PSC had extensive UC (62.5% vs. 27.1%, p=0.04) or were males (87.5% vs. 44.9%, p=0.03) compared to those without PSC. During a follow-up of 2.1 years (IQR 1.6-2.6), PSC and PSC-like lesions were both associated with increased risk of intestinal resections (aHR 5.69, 1.13-28.54), biologics (aHR 2.00, 1.04-3.86), hospitalization (aHR 2.70, 1.02-7.12), and systemic steroids (aHR 2.45, 1.02-5.89) in CD but not in UC. None of the PSC cases died, developed cancers, varices, or required liver transplantation within the follow-up period. Conclusion In this prospective population-based cohort, we found a considerable proportion (8.5%) to have undetected PSC or PSC-like lesions, despite normal hepatobiliary biochemistry in half of the cases. Both definite PSC and PSC-like lesions had a negative impact on IBD prognosis. The results underscore the importance of systematic screening to mitigate the risk of overlooking PSC.

P0484 Impact of Early Aggressive Treatment on Long-term Biochemical Marker Patterns in Inflammatory Bowel Disease: A latent class mixed model

Abstract Background Inflammatory bowel disease (IBD) shows a highly variable disease course, making early identification of patients at risk for poor outcomes important for personalized treatment. This study aimed to classify the long-term disease course in patients with IBD using biochemical markers and to investigate the clinical factors associated with different disease trajectories. Methods Longitudinal data on C-reactive protein (CRP) and fecal calprotectin (FCP) levels were collected from patients in a tertiary hospital cohort between 2017 and 2023. Patients with at least two CRP and FCP tests between six months and five years after IBD diagnosis were included. Early IBD-related treatments, ER visits, and hospitalizations were defined as occurring within six months of diagnosis. A latent class mixed model (LCMM) was employed to identify the distinct subclasses based on CRP or FCP changes. Subsequently, univariate analyses and multinomial logistic regression were conducted to evaluate the relationships between different biochemical trajectories and clinical variables. Results Among the patients, 245 with CD and 635 with UC were included in the CRP model, while 256 with CD and 536 with UC were included in the FCP model. Through LCMM, a three-class model was found to be most appropriate for patients with both CD and UC: Class 1, characterized by early and sustained biochemical remission; Class 2, featuring delayed remission; and Class 3, marked by prolonged difficulty in achieving remission for over five years. In the CRP trajectory analysis, early initiation of immunomodulators (IM) in patients with CD was significantly associated with a higher probability of belonging to Class 1 (Class 2 vs. 1, odds ratio [OR] 0.344; Class 3 vs. 1, OR 0.472; p-value = 0.039). In the FCP trajectory analysis, early advanced therapy (AT) significantly increased the odds of belonging to Class 1 for patients with CD (Class 2 vs. 1, OR 0.383; Class 3 vs. 1, OR 0.220; p-value = 0.004). Conversely, no significant factors were identified in the CRP trajectory analysis for patients with UC. In UC, younger age at diagnosis (Class 2 vs. 1, OR 0.969; Class 3 vs. 1, OR 0.980; p-value = 0.004) and early IM initiation (Class 2 vs. 1, OR 2.928; Class 3 vs. 1, OR 2.698; p-value <0.001) were associated with higher odds of belonging to Class 2 or 3, whereas current smoking was associated with a higher likelihood of belonging to Class 1 in the FCP trajectory analysis (Class 2 vs. 1, OR 0.194; Class 3 vs. 1, OR 0.559; p-value = 0.008). Conclusion Early aggressive treatments, particularly the prompt initiation of AT in CD, may contribute to achieving long-term biochemical remission; however, similar associations were not observed in UC.

P0374 Prevalence, risk factors and clinical outcomes of malignancies in patients with Inflammatory Bowel Disease: a case-control study

Abstract Background Up to 30% of patients with inflammatory bowel disease (IBD) develop malignancies during their disease course whichconstitutes the second cause of death, after cardiovascular diseases (1,2), similar to the general population. The present study aims to investigate the prevalence, risk factors and clinical outcomes of malignancies in patients with IBD. Methods This is a retrospective study, based on prospectively recorded data from the IBD registries of two tertiary centres from 2012-2022. Patients with IBD who developed a malignancy were compared with patients with IBD without malignancies [matching 1:3 according to sex, IBD diagnosis (Ulcerative Colitis; UC, Crohn’s Disease; CD) and age (±5 years)]. Results From 2.382 IBD patients, 107 (4.5%) were diagnosed with cancer (CA) [49 (45.8%) females, 54 (50.5%) CD, median (IQR) age 61 (51.3-69.8) years and median IBD duration 10 (0-40) years at CA diagnosis] and these were matched with 321 patients with IBD who did not develop any type of CA. The majority were extra-intestinal CAs, whereas only 12 (11.2%) were diagnosed with colorectal CA. The most common extraintestinal CAs were thyroid (17, 15.5%) and prostate (17, 15.5%) followed by lung (12, 10.9%), breast (9, 8.2%) and non-melanoma skin cancer (9, 8.2%) while other types like kidney CA or cholangiocarcinoma were represented with lower rates. In the univariate analysis shorter IBD duration, inflammatory CD phenotype, ileal CD location, and treatment with other than anti-TNF biologics were protective, whereas colonic CD location and duration of treatment with immunomodulators (IMMs) were risk factors for CA development. In the multivariate analysis only inflammatory CD phenotype (OR 0.25, CI 95%0.10-0.64) and colonic CD location (OR 3.73, CI 95%1.23-11.34) remained significant (Table 1). Twelve patients (11.2%) had CA recurrence and 19 (17.8%) passed away because of the CA, with most events occurring within 50 months from CA diagnosis. In 36 patients (33.6%) IBD therapy was modified after CA diagnosis (biologics and/or IMMs ceased). However, biologics or IMM were introduced in 24.3% after a median time of 3.5 (0-18) years from CA diagnosis but their use was not associated with negative outcomes [neither on survival (p = 0.0385) nor CA recurrence (p= 0.1680)] (Figure 1). Conclusion The prevalence of malignancy in patients with IBD that are followed up in tertiary referral centers in Crete is 4.5%. CD disease phenotype (inflammatory behavior and colonic location) is associated with the development of malignancies while no association with biologics and/or immunomodulators exposure was found. Initiation of biologics or IMMs after CA diagnosis was not associated with an adverse impact neither on survival nor on CA recurrence.

P0263 Comparative analysis of the faecal biomarker potential of Plasminogen activator inhibitor type 1 (PAI-1) to the Calprotectin in Inflammatory Bowel Diseases

Abstract Background Inflammatory Bowel Diseases (IBD) require lifelong treatment and patient monitoring. Current predictors of relapse and therapeutic success have limitations, mostly invasive, time-consuming, and expensive. The faecal biomarker can help in disease activity and therapeutic response monitoring by simple and non-invasive way. Faecal Calprotectin (FC) is the gold-standard, but it has many disadvantages. We previously described that the correlation between the faecal Plasminogen activator inhibitor type 1 (PAI-1) (FP) level and the endoscopic activity and therapeutic response promote that it could be used as a novel non-invasive faecal biomarker in IBD diagnosis.1 To observe the exact faecal biomarker potential, we aimed to define the FP level of IBD patients and subjects with other gastrointestinal (GI) diseases and compare it with the FC. Methods Faecal samples were collected from 84 patients with IBD (CD-active: 12, CD-inactive: 10, UC-active: 9, UC-inactive: 10) and other GI diseases [colorectal cancer (CRC): 10, diverticulosis [DIV]: 9, irritable bowel syndrome [IBS]: 5, Polyp: 10) and 9 healthy subjects. ELISA method was applied to define FP level and it was validated for stool samples by us. In our previous study, 0.68 ng/g PAI-1 level was defined as the cut-off value. For FC observation diagnostic FC ELISA kit (Orgentec) was used. FC cut-off value was 50 mg/g. ROC analysis was applied to define Youden-index, specificity, and sensitivity of the measured values. Results FP level was significantly higher in patients with active IBD compared to inactive IBD and healthy subjects. No significant differences were observed between CD-active and UC-active groups. In addition, FP concentrations were significantly increased in active IBD patients compared to inactive IBD, CRC, DIV, IBS, Polyp, and healthy subjects. However, FC showed the same pattern as FP, except at the inactive IBD and DIV. In these groups, there were no significant differences compared to the active IBD subjects. ROC analysis defined high specificity (88.9%) and moderate sensitivity (47.6%) values (TP: 10, FP: 7, FN: 11, TN: 56, PPV: 0.588, NPV: 0.836) at the FP measurements. Nevertheless, at FC levels 34.9% specificity and 95.2% sensitivity were measured (TP: 20, FP: 41, FN: 1, TN: 22, PPV: 0.328, NPV: 0.957). Calculated Youden-index was higher at the FP (0.37) compared to the FC (0.3). Conclusion Our results suggest that the FP level selectively increased in the active IBD and discriminated more specifically from the other GI diseases compared to the FC. However, the sensitivity was lower, but it could be improved by the increasing patient numbers. Thus, the FP level could be useful in the diagnosis of IBD independently or combined with FC.

P1197 Progression to colorectal cancer or high-grade dysplasia in individuals with inflammatory bowel disease and low-grade dysplasia: A cohort study of risk factors and incidence

Abstract Background Individuals with inflammatory bowel disease (IBD) face an increased risk for colorectal cancer (CRC) and high grade dysplasia (HGD) compared with individuals without IBD.1,2 Low-grade dysplasia (LGD) is recognized as a key risk factor for HGD and CRC development in IBD.3 However, the risk for progression from LGD to HGD or CRC is still debated. Studies report diverging results and are often limited by small sample sizes and selection bias.4 The influence of diagnosis-year and medications is particularly underexplored. Therefore, we sought to utilize the Danish healthcare registers to examine the impact of candidate risk factors for progression from LGD to either HGD or CRC among Danish individuals with IBD. Methods We conducted a cohort study, including all Danish individuals diagnosed with IBD and LGD between 1977 and 2022. IBD with LGD was defined as individuals with a LGD diagnosis up to 180 days before or any time after their first IBD diagnosis, using the latest date as index date. Individuals with a colectomy, HGD, or CRC before the index date were excluded. We investigated the cumulative incidence of progression to HGD or CRC, treating death as a competing risk. A univariate Cox regression model was used to assess hazard ratios (HRs) for potential risk factors. Variables with a P-value of ≤ 0.1 were included in the final multivariable cox regression model. Results We included 7,082 individuals with IBD and LGD for further analysis. As illustrated in figure 1 the cumulative incidence of progression from LGD to HGD or CRC at 15 years post-index was 6.70% (95% CI: 5.93–7.54). Several risk factors were identified (table 1). Of particular interest was the influence of index-year and treatment with prednisone and anti-TNF-α. In the final model, we observed a reduction in progression risk over time, with a decreased risk for progression in the period 2018-2021 (HR: 0.32 [95% CI: 0.21-0.50]) and 2015-2018 (HR: 0.53 [95% CI: 0.34-0.69]) relative to 1977-2010. High-dose prednisone treatment was associated with progression to HDG or CRC (HR: 1.77 [95% CI: 1.23-2.57]), whereas anti-TNF-α treatment was not (HR: 0.81 [95% CI:0.38–1.74]). Conclusion Among Danish individuals with IBD the risk of progression from LGD to HGD or CRC declined over time. Treatment with High-dose prednisone was associated with an increased risk of progression, whereas anti-TNF-α treatment was not. We speculate that recent advancements in biological treatments of IBD, the implementation of 'treat-to-target' strategies, and improved detection and resection of LGD lesions, may partly explain declining progression risk.

P1238 Herpes Zoster Risk in Patients with Inflammatory Bowel Disease and Its Association with Medications Used: A Nationwide Population-Based Study in Taiwan

Abstract Background Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is an immune-mediated disease with lower prevalence in Taiwan. Herpes zoster (HZ) is thought to occur when immunity is weakened. This study aimed to evaluate the time-dependent risk of HZ in IBD patients and investigate the influence of medications used for IBD treatment on this risk. Methods A retrospective cohort and nested case-control study were conducted using administrative data from the Taiwan National Health Insurance Research Database, spanning 2000 to 2021. The index date for the IBD cohort was defined as the first recorded diagnosis of IBD. The non-IBD cohort included individuals without an IBD diagnosis, with a randomly assigned index date between 2000 and 2021. Propensity score matching at a 1:1 ratio was performed to match IBD and non-IBD cohorts based on age, sex, index year, comorbidities, and residence. The risk of HZ was assessed using incidence rates (IRs) and adjusted hazard ratios (aHRs). The association between prescribed medications and the risk of HZ in IBD patients was also evaluated. Results The study included 86,005 patients with IBD (CD: 67,934 patients; UC: 24,850 patients) and 86,005 non-IBD individuals. The risk of HZ in IBD patients was analyzed across different time intervals following diagnosis. IBD patients had an overall increased risk of HZ compared to non-IBD individuals. The risk was highest within the first year after diagnosis and gradually declined over time, reaching its lowest level after six years. Among the subtypes of IBD, CD patients consistently demonstrated the highest risk, with a peak between one and three years post-diagnosis and a sustained elevated risk across all time periods. In contrast, UC patients showed a significant increase in HZ risk within the first year and beyond six years. However, the risk for UC patients between one and six years post-diagnosis was not statistically significant (Table 1) . Medication analysis indicated that immunomodulators were independently associated with an increased risk of HZ. However, 5-aminosalicylic acids and biologic agents were not significantly associated with an increased risk of HZ (Table 2). Conclusion IBD patients face an elevated risk of HZ, particularly during the first year after diagnosis, with CD patients at the highest risk. Immunomodulators further exacerbate this risk. Vaccination should be considered at the time of IBD diagnosis to mitigate the risk of HZ.

P0318 Rapid access clinics for Inflammatory Bowel Disease improve access and outcomes but additional service support is required: Experience from the AWARE-IBD Quality Improvement Programme in the United Kingdom

Abstract Background There is increasing attention to quality of Inflammatory Bowel Disease (IBD) services, which are under pressure from rising disease prevalence, increasing disease complexity and a wide range of treatment options – all within constrained resource and capacity. There is limited information on the impact of patient-led service changes in a ‘real-life’ clinic setting. Methods The Sheffield IBD service (UK) implemented the AWARE-IBD patient-led quality improvement (QI) programme of co-designed service change in a microsystem. Designated clinics were allocated for patients prioritised by the microsystem: 1) those with a suspected flare contacting a telephone advice line; 2) starting or changing advanced treatment; and 3) new IBD diagnosis at endoscopy. Appointments were allocated for each of these groups in 3 clinics per week during 2 tests of change (ToC) (ToC 1: 14/11/22 - 25/11/22; ToC 2: 17/04/23 - 26/05/23) and outcomes compared to a prior baseline interval (01/06/22 - 30/06/22). Qualitative feedback was obtained in semi-structured interviews. Results Group 1. Suspected flare (Figure 1): more patients were seen in defined clinics (baseline 8/202 (4.0%); ToC 62/285 (17.9%; p<0.0001) with reduced admissions (baseline 26/202 (12.9%), during ToC 21/347 (6.1%); p=0.006) and investigation (baseline 57/202 (28.2%), ToC 61/347 (17.6%); p=0.003). Group 2. Advanced therapy: more patients were seen within 14 days of the multi-disciplinary team meeting (MDT) to discuss initiation or change (baseline 7/31 (22.6%); ToC 20/32 (62.5%; p=0.001), but with no difference in numbers starting treatment within 28 days. Group 3. New diagnosis: more patients were seen within 30 days of endoscopic diagnosis (baseline 6/27 (22.2%); ToC 14/20 (70%); p=0.001), but not within 14 days. Time to start treatment was not impacted. Interviews indicated reassurance from rapid help and benefits of in-person consultation, improved trust in the healthcare team, and greater confidence for self-management alongside the clinics. Conclusion Rapid access clinics improve access for defined groups, reducing admission and investigation in those with a suspected flare but a minority were accommodated in clinic. Robust arrangements to train and support staff giving complex advice on an advice line are therefore needed. Additional factors such as patient availability, infusion capacity and screening influence time to start advanced treatments. Rapid review after endoscopic diagnosis supports detailed information provision. Services can use QI programmes and iterative tests of change to inform resource allocation and identify key parts of a pathway to affect outcomes.

P1226 Inflammatory Bowel Diseases and Prior Malignant Diagnoses - A Danish Nationwide Cohort Study 1996-2022

Abstract Background Due to the increasing prevalence of inflammatory bowel diseases (IBD), an ageing population and the increased risk of cancer associated with IBD, the number of patients diagnosed before or while having their IBD is increasing. We aimed to describe the treatment of IBD patients with a prior malignant diagnosis relative to IBD patients without. Methods Danish national registers were used to identify all incident Crohn’s disease (CD) and Ulcerative Colitis (UC) patients in Denmark, their exposure to drugs and surgeries, and cancer status, between 1996-2022. Cox regressions compared the risk of exposure to medications and the risk of surgery for patients with malignant comorbidity. Results 58,402 incident IBD patients (18,383 CD (31.5%), 40,019 UC (68.5%)) were included and followed for a median of 10 years (IQR: 5, 17 yrs). 2,370 (4.1%) had cancer prior to IBD. Of the remaining 56,032 IBD patients, 4,445 (7.9%) had their first cancer diagnosis after their IBD diagnosis. Anti-TNF therapy was used in 16% (n = 92) of CD patients with cancer prior to IBD and in 41% (n = 6,857) of CD patients without cancer. Anti-TNF was used in 9.0% (n = 161) of UC patients with cancer prior to IBD and in 20% (n = 7,159) of UC patients without cancer. Immunomodulators were used in 27% (n = 159) of CD patients with cancer prior to IBD and in 52% (n = 8,594) of CD patients without cancer. Immunomodulators were used in 12% (n = 220) of UC patients with cancer prior to IBD and in 27% (n = 9,555) UC patients without cancer. Exposure to medical therapy was visualised in Figure 1 Being diagnosed with cancer prior to CD diagnosis was negatively associated with exposure to immunomodulators (p = 0.005), while it increased the risk of receiving no medical treatment compared to CD patients without prior cancer (p < 0.001). The need for surgery was not associated with having cancer prior to CD diagnosis (p = 0.705). In UC patients, a negative association was found for both immunomodulators (p = 0.001) and for receiving no treatment (p < 0.001), while a positive association was found for both anti-TNF (p = 0.027) and anti-integrin therapy (p < 0.001) for UC patients with prior cancer. Prior cancer increased the risk of requiring surgery for UC patients (p < 0.001) Conclusion Patients with cancer prior to IBD were treated differently than patients without prior cancer as they received less immunomodulator therapy and more often received no medical therapy at all. UC patients more often required surgery, while this was not the case for CD patients. This supports the need for an individualised approach to immunosuppressive treatment for IBD patients with cancer.

P0363 Explore the application value of serum GOLM1 in the diagnosis of Inflammatory Bowel Disease

Abstract Background Current biomarkers used to monitor the disease activity of inflammatory bowel disease (IBD) have several limitations in specificity and sensitivity, and there is an urgent need to identify novel biomarkers. Previously, Golgi membrane protein 1 (GOLM1) has been proven to protect against colitis by modulating the equilibrium of Notch signaling pathway. Therefore, we aimed to explore the possible value of serum GOLM1 in the clinical diagnosis and disease activity assessment of IBD. Methods Collected clinical data, including serum GOLM1 and inflammatory markers (ESR, CRP, and Interleukin-6 [IL-6]), from 60 IBD patients (30 UC and 30 CD) and 30 control subjects (patients with colon polyps) at the First Affiliated Hospital of Zhengzhou University between August 2023 and August 2024. Mayo score and Crohn’s Disease Activity Index (CDAI) were used to evaluate the clinical disease activity of UC and CD, respectively. In UC, endoscopic disease activity was determined by the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and in CD, it was measured by the Endoscopic Score for Crohn’s Disease (SES-CD). The level of serum GOLM1 was compared between IBD and the control subjects, as well as among different subgroups of IBD patients. Analysed the correlations between serum GOLM1 level and inflammatory markers, and between serum GOLM1 level and disease activity indices. Results 1. Serum GOLM1 levels were all elevated in IBD patients (p < 0.001), UC patients (p < 0.001), and CD patients (p = 0.050) compared with the control patients, and this trend was more pronounced in UC (Figure 1). Serum GOLM1 levels did not differentiate between UC and CD. Also, there was no significant difference in serum GOLM1 levels between remissive and active IBD patients, whether assessed clinically or endoscopically. 2. The level of serum GOLM1 was positively correlated with ESR (r = 0.491, p < 0.001), CRP (r = 0.397, p = 0.002) and IL-6 (r = 0.493, p < 0.001) in IBD patients. The same trend was also observed in UC. Serum GOLM1 level was also positively correlated with UCEIS in endoscopically active UC patients (UCEIS ≥ 1) (r = 0.489, p = 0.048), but not with Mayo score in clinically active UC patients (Mayo ≥ 3) (Figure 2). In CD, serum GOLM1 level was only positively correlated with ESR (r = 0.437, p = 0.016) and IL-6 (r = 0.377, p = 0.040). In endoscopically active CD patients (SES-CD ≥ 3), serum GOLM1 level was not associated with SES-CD. Similarly, no association was found between serum GOLM1 level and CDAI in clinically active CD patients (CDAI ≥ 150). Conclusion This study revealed a significant increase in the serum GOLM1 level in IBD, especially in UC. GOLM1 may be involved in the inflammatory process of IBD and may serve as a potential biomarker of IBD.

P0336 From inflammation to depression: key biomarkers for Inflammatory Bowel Disease-related Major Depressive Disorder

Abstract Background Inflammatory bowel disease (IBD) is a chronic, inflammatory, and autoimmune disorder[1], and its incidence of comorbid with major depressive disorder (MDD) is significantly higher than the general population[2]. However, many patients lack proper recognition and necessary psychological health treatments. We aimed to identify potential biomarkers and mechanisms involved in the development of IBD comorbid with MDD (IBD-MDD). Methods We utilized IBD and MDD-related datasets from the GEO database for differential gene expression analysis, protein-protein interaction (PPI) and pathway enrichment analysis, random forest algorithm, LASSO regression analysis, and construction of a disease prediction model. We assessed the accuracy of the model using ROC curve, explored potential mechanisms through immune infiltration analysis, and validated candidate biomarkers using peripheral blood samples from patients in our center’s cohort. Results We identified 484 IBD-related secreted proteins and 142 key module genes associated with MDD. PPI analysis revealed two crucial modules primarily involved in inflammation and immune regulation. We identified four diagnostic genes (HGF, SPARC, ADAM12, and MMP8) from the 21 shared genes between IBD-related secreted proteins and MDD key module genes, constructed a nomogram model and confirmed its accuracy using ROC curve from an external independent dataset. Immune infiltration analysis revealed significant associations between the four diagnostic genes, and cellular immune dysregulation in MDD. Finally, we validated the expression patterns of the four diagnostic genes in our cohort.The results showed that the serum levels of HGF and MMP8 were significantly elevated in IBD patients with comorbid MDD, SPARC and ADAM12 showed an increasing trend (Figure 1A). Meanwhile, we developed a predictive model for IBD-related MDD based on our cohort (Figure 1B). The calibration curve suggests that the predictive probability of the nomogram model is nearly the same as that of the ideal model (Figure 1C). ROC curve analysis of the efficacy of the joint predictive model based on the 4 diagnostic markers showed that the AUC value was 0.87, indicating that the nomogram have strong diagnostic value for IBD-related MDD (Figure 1D). Conclusion Our study discovered four candidate biomarkers for IBD-MDD, providing new insights for the diagnosis and therapeutic intervention of serum-based IBD comorbid with MDD.

P0165 A highly miniaturized ingestible sensor for measuring gut health along the GI tract

Abstract Background The human gastrointestinal (GI) tract is challenging to examine due to its intricate structure and inaccessibility. Current diagnostic methods are either invasive, like endoscopy, or offer a limited view, such as faecal tests. Endoscopy capsules allow for a visual inspection of the whole GI tract but still require uncomfortable bowel preparation, including laxatives and dietary restrictions, and cannot provide biochemical analysis of the gut environment. Methods To enable non-invasive assessment of in vivo gut health, we developed a highly miniaturized, ultra-low-power ingestible sensor (the Gastrointestinal Smart Module, or GISMO) capable of measuring pH, temperature, and redox balance throughout the GI tract. Redox balance is crucial for maintaining intestinal barrier function and regulating interactions among the host, immune system, and gut microbiota. Imbalances in redox levels can lead to oxidative stress, characterized by an imbalance between oxidants and antioxidants, and are associated with adverse gut processes, such as inflammation1. Redox balance plays as such an important role in inflammatory bowel disease (IBD)2. The GISMO sensor was validated in both in vitro and in vivo pre-clinical models and subsequently tested in a first-in-human trial. Results In the first-in-human trial, the GISMO system demonstrated feasibility, safety, and ease of use, with 66 ingestible sensors administered to 15 healthy participants. Participants reported ease in swallowing the sensors and expressed willingness to ingest multiple capsules. No device-related adverse events occurred throughout the study. GISMO is the first device capable of measuring in vivo redox balance, providing high-resolution data every 20 seconds. The data revealed consistent profiles from an oxidative environment in the stomach to a strongly reducing environment in the colon. Conclusion We successfully developed, validated, and clinically tested miniaturized technology for assessing GI health in a simple, non-invasive manner. Our ingestible sensors are the first to measure in vivo redox balance along the human gut, requiring no uncomfortable bowel preparation, and enabling real-time monitoring. This innovative technology has the potential to enable easy localization and objective quantification of inflammation, revolutionizing the diagnosis and monitoring of IBD and other gastrointestinal diseases.

Clinical diagnosis and management of inflammatory bowel disease in a rabbit (Oryctolagus cuniculus).

Clinical diagnosis and management of inflammatory bowel disease in a rabbit (Oryctolagus cuniculus).

P0607 Opportunistic infections in patients with inflammatory bowel disease under advanced drug therapy. Real-word experience of 8 years from a medium-volume center in Cordoba, Argentina

Abstract Background The frequency of inflammatory bowel disease (IBD) has been rising in Latin American countries. Opportunistic infections (OIs) are a potential complication in patients receiving advanced drug therapy (ADT), particularly when combined with corticosteroids and immunosuppressants. Our objective was to evaluate the frequency of OIs in patients with IBD undergoing ADT in a real-world setting. Methods An observational study was conducted using data from the registry (n=395) of a private center in Córdoba, Argentina. We included adult patients (pts) diagnosed with IBD [ulcerative colitis (UC) or Crohn’s disease (CD)] who had at least one prescribed ATD. We analyzed the presence of OI after starting ADT and the use of concomitant treatments (corticosteroids and immunosuppressants) during follow-up. Qualitative variables were described as percentages and quantitative variables were described as medians and interquartile ranges (IQR 25-75). Variables were compared using the chi-square and Mann-Whitney U tests. Results We included 118 pts (58.5% UC, 41.5% CD) who received 180 ATDs during follow-up (2017-2024). Median age was 44.5 years (IQR 25-75: 32-55.5), and 54.2% were female. A total of 24 (20.3%) pts presented OI during follow-up and 35 episodes of OI were observed out of 180 ADTs prescribed. Two patients (8.3%) presented a fatal outcome. OI episodes were skin and soft tissue infections (n=10, 28.6%), cytomegalovirus colitis (n=7, 20%), Clostridium difficile colitis (n=6, 17.1%), herpes zoster virus infection (n=3, 8.6%), complex herpes simplex infection (n=3, 8.6%), fungal infection (n=3, 8.6%), severe pneumonia (n=2, 5.7%), and intestinal tuberculosis (n=1, 2.9%). OI episodes distribution according to drug class was: Anti-TNF (n=21, 60%), anti-IL 12-23/IL-23 (n=9, 25.7%), vedolizumab (n=4, 11.4%), and JAK inhibitors (n=1, 2,9%). The proportion of OI episodes was similar according to the use of anti-TNF (19.8%) vs. non-anti-TNF drugs (17.7%), p=0.6. In 26 (74.3%) of the OI episodes patients were receiving corticosteroids simultaneously. The simultaneous use of corticosteroids was associated with a higher number (>1 episodes) of OI episodes per patient (100% vs 50%, p=0.04). Within patients with concurrent corticosteroid use, there was a similar number of episodes if the ADT was anti-TNF compared to another class (50% vs. 67% respectively, p=0.7). Conclusion The concurrent use of corticosteroids was a risk factor for OI in patients with IBD receiving ATDs. No higher frequency of OIs was observed in patients receiving anti-TNF agents compared to those receiving ATDs of other classes. Further studies are needed to evaluate OIs in regions with limited access to ATDs. References Balderramo D, Quaresma AB, Olivera PA, Savio MC, Villamil MPG, Panaccione R, Ng SC, Kaplan GG, Kotze PG. Challenges in the diagnosis and treatment of inflammatory bowel disease in Latin America. Lancet Gastroenterol Hepatol. 2024 Mar;9(3):263-272. doi: 10.1016/S2468-1253(23)00284-4. PMID: 38340754.

P0743 Clinical impact of delayed access to advanced IBD treatment in Latin America. Experience of 8 years from a medium-volume center in Cordoba, Argentina

Abstract Background Inflammatory Bowel Disease (IBD) frequency has been increasing in Latin American countries. Argentinapresents significant heterogeneity in healthcare systems, which may delay access to advanced therapeutic drugs (ATDs) for IBD. We aimed to evaluate the delay in access to ADT and its impact on patients with IBD. Methods An observational study was conducted using data from the registry (n=395) of a private center in Córdoba, Argentina. We included adult patients diagnosed with IBD [ulcerative colitis (UC) or Crohn’s disease (CD)] who had at least one prescribed ATD. Patients who accessed ATDs through clinical trials were excluded. We defined access time as the period (in days) between the ATD request and the start of treatment. During this period, complications were assessed based on a composite endpoint including IBD flare (defined as an increase in oral corticosteroid dosage or need of hospitalization), the need for IBD-related surgery, or severe infections (requiring hospitalization and intravenous treatment). Qualitative variables were described as percentages, while quantitative variables were reported as medians and interquartile ranges (IQR 25-75). Variables were compared using the chi-square and Mann-Whitney U tests. Results We included 108 patients (58.5% UC, 41.5% CD) who received 163 ATDs across different lines of therapy during follow-up from 2017-2024 (1L: 108, 2L: 38, 3-5L: 17). The median age was 44 years (IQR 25-75: 30-55), and 55.6% were female. The median access time for all ATD lines was 31 days (IQR 25-75: 28-62), with no significant differences between therapy lines [1L: 31 days (IQR 25-75: 28-76), 2L: 32 days (IQR 25-75: 30-61), 3L-5L: 29 days (IQR 25-75: 20-38), p=NS]. 101/163 (62%) of the requested ADTs were anti-TNF. Access time was similar according to the drug class [anti-TNFs 31 days (IQR 25-75: 27-62) vs. non-anti-TNF agents 31 days (IQR 25-75: 28-63) (p=0.6)]. A total of 36 (22%) ATD indications were associated with complications while patients awaited therapy (32 flare, 3 IBD-related surgeries and one severe infection). Patients who experienced complications had a longer access time compared to those who did not experience complications [61 days (IQR 25-75: 31-122) vs. 31 days (IQR 25-75: 25-61) respectively, p<0.01]. Conclusion A delay of more than 4 weeks was observed in more than half of the patients with an indication for ADT. The delay was similar according to the type of IBD, drug class and line of treatment. A higher frequency of complications was observed in patients with a longer delay in receiving the requested ADT. Policies are needed to improve the time to access ADT, avoiding the complications associated with delayed access. References Balderramo D, Quaresma AB, Olivera PA, Savio MC, Villamil MPG, Panaccione R, Ng SC, Kaplan GG, Kotze PG. Challenges in the diagnosis and treatment of inflammatory bowel disease in Latin America. Lancet Gastroenterol Hepatol. 2024 Mar;9(3):263-272. doi: 10.1016/S2468-1253(23)00284-4. PMID: 38340754.

DOP028 The resolution of fecal calprotectin configurations and their biological functions in gut inflammation

Abstract Background Fecal calprotectin (CP) serves as a worldwide established biomarker used for the diagnosis and management of inflammatory bowel diseases (IBD). However, the biological function of CP in the human gut is still unknown and numerous studies obtained contradictory results. Calprotectin is mainly described to be present as a tetrameric protein complex (S100A8/S100A9)2, while the quaternary protein structure (configuration) of S100A8 and S100A9 in the human gut lumen remains enigmatic.1 In this study we resolved the fecal protein configurations of calprotectin and their biological functions in IBDs. Methods We defined biological functions of S100A8 and S100A9 dimers by antibody-mediated immunoprecipitation of S100A8 and S100A9 from stool obtained from IBD patients coupled with subsequent LC-MS/MS analysis. Next, we analysed human colonic organoids by single-cell RNA sequencing after S100A8 or S100A9 stimulation. Moreover, we orally exposed mice to recombinant human S100A8 and S100A9 protein during experimental gut inflammation and genetically inactivated S100a9 in toxic and genetic mouse models. To identify the protein configurations of S100A8 and S100A9 in the human gut lumen we examined stool samples from IBD patients using size-exclusion chromatography and LC-MS/MS analysis. Results We demonstrate pro-inflammatory actions for S100A8 and S100A9 dimers as oral administration of human S100A8 and S100A9 homodimers, but not CP, worsened experimental enteritis and colitis. In accordance, multi-omic phenotyping revealed that human S100A8 and S100A9 homodimers induce the NLRP1 inflammasome in intestinal epithelium. In turn, genetic deletion of S100a9 ameliorated experimental gut inflammation. S100A8 and S100A9 dimers were frequently detectable in stool from IBD patients from three independent IBD cohorts, but not in healthy individuals. More specifically, fecal S100A9 detection was associated with clinical and endoscopic disease activity in IBD patients with low fecal CP levels (≤150µg/g). Importantly, four fecal CP assays in clinical use were not able to detect S100A8 and S100A9 homodimers. Conclusion Our study is the first to reveal the presence of S100A8 and S100A9 dimers in stool from IBD patients. Moreover, we demonstrate a diagnostic gap for fecal CP assays in clinical use. We establish that fecal S100A9 detection is associated with endoscopic disease activity in IBD patients in which fecal CP fails to identify active disease. We reveal disease-modifying functions for S100A8 and S100A9 homodimers by inducing the NLRP1 inflammasome, while the same effects were not observable for calprotectin. Taken together, our findings may reflect a major advance in the IBD biomarker field. References Jukic, A., Bakiri, L., Wagner, E. F., Tilg, H. & Adolph, T. E. Calprotectin: from biomarker to biological function. Gut 70 , 1978-1988 (2021). https://doi.org/10.1136/gutjnl-2021-324855

P0445 High risk of colorectal cancer after high-grade dysplasia in Inflammatory Bowel Disease patients

Abstract Background Colonic high-grade dysplasia (HGD) is the highest-risk precursor of colorectal cancer (CRC) in inflammatory bowel disease (IBD) patients with reported incidence rates of 1.0-3.5%.1-4 Data on metachronous CRC risk after HGD in IBD are limited and outdated. The aim of this study was to determine the long-term risk of CRC and colorectal neoplasia (including indefinite for dysplasia, low-grade dysplasia, HGD and CRC) after a first diagnosis of HGD in IBD, and to assess HGD treatment strategies. Methods In this nationwide retrospective cohort study, patients with both a colonic IBD and HGD diagnosis between 1991 and 2021 were extracted from the Dutch nationwide pathology databank (PALGA). The primary outcome was the cumulative incidence of metachronous CRC and colorectal neoplasia. Cox proportional hazard models were used to assess associations with metachronous CRC. Kaplan Meier curves were used to show proctocolectomy free survival per decade. Results CRC was diagnosed in 358 of 1,223 patients with HGD (29.3%) after a median 0.3 years (IQR 0.1-2.7, figure 1). Of these, 203 patients (16.6%) were diagnosed with CRC within 6 months after the first HGD diagnosis and were considered synchronous CRC patients. Metachronous CRC was diagnosed in 155 of 1,020 patients (15.2%) after a median 4.1 years (IQR 1.3-11.0). The 1-, 5-, and 10-year cumulative incidences of metachronous CRC after HGD were 2.9%, 10.4%, and 17.2%, respectively. After a median of 2.2 years (IQR 1.0-5.7), 642 patients (62.9%) developed metachronous colorectal neoplasia (indefinite for dysplasia as highest grade: n=12 [1.9%]; low-grade dysplasia: n=243 [37.9%]; HGD: n=220 [34.3%]; CRC: n=155 [24.1%], figure 1). The 1-, 5- and 10-year cumulative incidences of metachronous colorectal neoplasia were 18.0%, 53.9% and 75.0%, respectively. Post-inflammatory polyps (aHR 1.88, 95% CI 1.33-2.65, p<0.01), strictures (aHR 1.62, 95% CI 1.02-2.58, p=0.04), invisible index HGD (aHR 2.04, 95% CI 1.24-3.35, p<0.01), academic follow-up (aHR 1.54, 95% CI 1.10-2.17, p=0.01), and endoscopic vs. surgical treatment (aHR 2.31, 95% CI 1.17-4.57, p=0.02) were associated with metachronous CRC. Proctocolectomy was performed in 209 (17.1%) patients after a median 4.7 years (IQR 1.5-9.7) after index HGD diagnosis. Proctocolectomy free survival did not differ between decades of HGD diagnosis after 8 years of follow-up (p=0.58). Conclusion The high cumulative incidence of synchronous and metachronous CRC after a diagnosis of HGD underlines the high-risk profile for this subgroup of IBD patients. The possible advantages of colon sparing treatment for HGD should be balanced with the subsequent higher risk of metachronous CRC and colorectal neoplasia and resulting need for stringent endoscopic surveillance.