Inflammatory Bowel Disease Outpatient Clinic Research Articles

Prevalence of spondyloarthritis in inflammatory bowel disease according ASAS and ultrassonography and its correlation with plasma calprotectin

BackgroundEnteropathic spondyloarthritis is underdiagnosed and inflammatory biomarkers and ultrasonography (US) could be useful for screening inflammatory bowel disease (IBD) patients. The objective of this study was to evaluate the prevalence of spondyloarthritis (SpA) in IBD patients, according to the Assessment of SpondyloArthritis International Society (ASAS) criteria and the correlation of results of US of entheses and joints with plasma calprotectin levels.MethodsThis was an observational cross-sectional study. Patients from the IBD outpatient clinic of a reference center were evaluated according to ASAS criteria classification, results of US of entheses and joints, and inflammatory biomarker measurements (erythrocyte sedimentation rates, C-reactive protein levels, fecal and plasma calprotectin levels). A p value lower than 0.05 was considered significant.ResultsA total of 30.5% of the studied sample (n = 118) of patients with IBD presented at least one inflammatory musculoskeletal manifestation. The overall prevalence of enteropathic SpA was 13.55%, with 10.16% axial SpA and 4.23% peripheral SpA according to the ASAS criteria. A total of 42.1% of patients had an MASEI score greater than 18, 35.2% had synovitis, and 14.7% had tenosynovitis on US, increasing the frequency of diagnosis of enteropathic SpA to 22.8%. Plasma calprotectin levels were similar to those in healthy controls, and correlated only with the fecal calprotectin level (p 0.041).ConclusionsA total of 13.5% of patients met the criteria in accordance with the ASAS criteria for enteropathic SpA, which increased to 22.8% with the addition of US. The prevalence of enthesitis, synovitis and tenosynovitis by US of symptomatic joints and entheses were 42%, 35% and 14.7% respectively. Plasma calprotectin was correlated with fecal calprotectin but not with inflammatory biomarkers or US or ASAS criteria.

Serum Amyloid A as a Potential Biomarker in Inflammatory Bowel Diseases, Especially in Patients with Low C-Reactive Protein.

The acute phase protein Serum Amyloid A (SAA) is synthesised by the liver in response to inflammatory stimuli. Previous studies have revealed that SAA may be a better biomarker of disease activity in inflammatory bowel disease (IBD) compared to C-reactive protein (CRP). This retrospective monocentric study evaluated whether SAA correlates with biomarkers like faecal calprotectin (FC), CRP, the Neutrophil to Lymphocyte ratio (NLR), the platelet count and clinical disease activity of IBD patients. Serum samples from the IBD outpatient clinic of the University Hospital Heidelberg were analysed for SAA concentrations if an FC concentration measurement was available from ±14 days to collection of the serum sample. Three hundred and six serum samples from 265 patients (166 with Crohn's disease, 91 with ulcerative colitis and 8 with IBD unclassified) met the inclusion criteria. There was a significant positive correlation between SAA and FC, CRP, NLR, platelet count and the Simple Clinical Colitis Activity Index (SCCAI). The cut-off for SAA serum concentration at 4.55 mg/L achieved a sensitivity of 57.5% and a specificity of 69.7% for the detection of active inflammation in IBD. SAA may be used as an additional biomarker in the disease monitoring strategy of IBD patients, especially in patients with low CRP concentrations.

56 Audit of assessment, prevalence, and treatment of osteoporosis for patients attending the inflammatory bowel disease Service in Mullingar Regional Hospital

Abstract Background Courses of steroids are common in patients with Inflammatory Bowel Disease (IBD) and are a risk factor for developing osteoporosis. Osteoporosis is a clinically silent entity and osteoporosis-related fractures are associated with chronic pain, disability, and impact quality of life. Screening of high-risk populations is the mainstay of fracture prevention. In this audit, we aimed to assess adherence to international guidelines for osteoporosis risk assessment and bone protection. Methods A retrospective audit was performed with a random sampling of 10% of the patients attending between October 2021 to October 2022 the IBD outpatient clinic in Mullingar Regional Hospital. Data included demographics, IBD diagnosis, FRAX tool components, FRAX score, bone health screening, DEXA results, and use of bone mineral protection. Clinical practice was compared against European Crohn’s and Colitis Organisation (ECCO) recommendations on bone protection in IBD. Results Of 150 charts reviewed, 39 charts were missing essential data and 8 had a diagnosis other than IBD. All 103 patients included in the analysis had received >3 months of systemic steroid use, of which 50 had a diagnosis of Crohn’s disease and 63 with ulcerative colitis. Two (2%) patients had a FRAX risk assessment for osteoporosis, and 22 (21%) had a DEXA ordered, of which 7 (7%) were by the IBD clinic. Two (2%) patients had a previous fragility fracture and 3 (3%) had been diagnosed with osteoporosis. Bone protection was used in 21 (20%) patients receiving steroids, including calcium and vitamin D supplementation (n = 19), and bisphosphonate (n = 2). Conclusion There are low rates of osteoporosis screening for IBD patients attending this service. There was inadequate data in the charts to calculate FRAX scores to assess osteoporosis prevalence. An intervention tool is currently being designed and the audit cycle will be completed with a repeat audit after implementation.

Profiling the Use of Complementary Alternative Medicines among Inflammatory Bowel Disease Patients: Results from a Single Center Survey

Background. Complementary and alternative medicines (CAMs) are used by patients with chronic disorders, such as inflammatory bowel disease (IBD), with a desire to manage their disease. Methods. Patients visiting an IBD outpatient clinic and infusion unit in a tertiary referral center were surveyed through an anonymized Dutch version of the international questionnaire to measure the use of CAMs. Results. Of the 467 IBD patients who responded to the survey, 41.8% ( n = 195 ) reported the use of CAMs. Gender ( p = 0.03 , higher in females), educational qualification ( p = 0.02 , higher in more educated patients), and number of prior IBD medical treatments ( p = 0.05 , higher in patients having received more than one therapy) were significantly associated with CAM usage. Overall, there was no significant difference in CAM-usage between UC (45.3%) and CD (38.2%) patients. Over two-thirds of patients reported using CAMs to alleviate IBD-related symptoms. The most prevalent reason for CAM-usage was to minimize stress and symptoms. The top five nonsupplemental CAMs used by IBD patients included probiotics, curcumin, yoghurt, homeopathy, and yoga. Among CAMs with a minimum of 25 users, yoga (93.5%), cannabis (87.5%), and mindfulness (84.6%) had high self-reported efficacy indices. Fifty-six percent of the patients who affirmed the economic worthiness of CAMs expressed their interest to consult with their gastroenterologist about CAM-conventional therapy interactions. Conclusion. CAM usage in IBD patients is highly prevalent, and consultation of the patients with the gastroenterologist about the use of CAMs is warranted. Since CAMs can interact with conventional therapies, a debate could help optimizing CAM use, eventually resulting in better disease management.

Assessment of quality of life in patients with inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract, occurring mainly in the young, socioeconomically active age group. Both the recurrent-remitting course of symptoms and the chronicity of the disease impact patients’ quality of life (QoL). Objective: determine the contributing factors associatedwith QoL in IBD patients in a tertiary service. Methods: a cross-sectional study of patients seen at the IBD outpatient clinic of the Federal University of Pelotas from January to November 2020, with clinical and laboratory data collection. Disease assessment was performed using Crohn’s Disease Activity Index for Crohn’s disease and Mayo score for ulcerative colitis and quality of life through the Inflammatory Bowel Disease Questionnaire (IBDQ). Results: the presence of a history of depression resulted in a significant impact on the overall QoL (p = 0.005) andmainly in the systemic symptoms (p = 0.04), social (p <0.001), and emotional (p = 0.008) domains. Regarding disease activity, statistical significance was evidenced in the intestinal symptoms domain (p <0.001) and overall QoL (p <0.001). Conclusion: a history of psychiatric illness and IBD disease activity were predictors of poorer QoL assessed by the IBDQ.

Prevalence of anxiety and depressive symptoms in ulcerative colitis patients in Jordan and its relationship to patient-reported disease activity

Inflammatory bowel disease is associated with higher rates of anxiety and depression compared to the general population. We aimed to determine the prevalence of anxiety and depressive symptoms among patients with ulcerative colitis and correlation to disease activity. In this cross-sectional study, we collected data from 70 consecutive ulcerative colitis patients over one year at our inflammatory bowel disease outpatient clinic through an interview and a questionnaire containing patient demographics and disease characteristics. Anxiety and depressive symptoms were characterized using the Generalized Anxiety Disorder-7 questionnaire and Patient Health Questionnaire-9, respectively, with ulcerative colitis disease severity assessed by the Partial Mayo scoring system. The majority of our patients were females (68.6%) and the mean age was 39.3 years. Rates of anxiety and depressive symptoms among ulcerative colitis patients were 65.7% and 58.6%, respectively. Depressive symptoms were significantly associated with patient-reported disease activity (r = 0.361; p = 0.010). Significant percentages of ulcerative colitis patients were appreciated to have anxiety and depressive symptoms, and there was a correlation between patient-reported disease activity and depressive symptoms. At this high rate of prevalence, it is justified to screen patients for the presence of psychiatric comorbidities.

Telehealth model of care for outpatient inflammatory bowel disease care in the setting of the COVID-19 pandemic.

BackgroundAdvances in inflammatory bowel disease (IBD) monitoring, greater number of available treatments and a shift towards tight disease control, IBD care has become more dynamic with regular follow ups.AimsWe assessed the impacts of the COVID‐19 pandemic on outpatient IBD patient care at a tertiary centre in Melbourne. More specifically, we assessed patient satisfaction with a telehealth model of care, failure to attend rates at IBD clinics and work absenteeism prior to and during the pandemic.MethodsWe conducted a retrospective, qualitative analysis to assess our aims through an online survey. We invited patients who attended an IBD outpatient clinic from April to June 2020 to participate. This study was conducted at a single, tertiary referral hospital in Melbourne. The key data points that we analysed were patient satisfaction with a telehealth model of care and the effect of telehealth clinics on work absenteeism.ResultsOne hundred and nineteen (88.1%) patients were ‘satisfied’ or ‘very satisfied’ with the care received in the telehealth clinic. Eighty‐four (60.4%) patients reported needing to take time off work to attend a face‐to‐face appointment, compared to 29 (20.9%) patients who needed to take time off work to attend telehealth appointments (P < 0.001). Clinic non‐attendance rates were similar prior to and during the pandemic with rates of 11.4% and 10.4% respectively (P = 0.840).ConclusionsPatients report high levels of satisfaction with a telehealth model of care during the COVID‐19 pandemic, with clinic attendance rates not being affected. Telehealth appointments significantly reduced work absenteeism when compared to traditional face‐to‐face clinics.

Endoscopic and Histopathological Findings of the Esophagus, Stomach, and Duodenum in Patients with Crohn's Disease from a Reference Center in Bahia, Brazil.

(1) The aim of the present study was to describe the endoscopic and histopathological findings in the esophagus, stomach, and duodenum in patients with Crohn’s disease. (2) Methods: This was a cross-sectional study that included patients receiving treatment from the inflammatory bowel disease outpatient clinic. Esophagogastroduodenoscopies with biopsies of the stomach and proximal duodenum were performed. Presence of Helicobacter pylori bacteria was assessed by Giemsa staining. (3) Results: We included 58 patients. Erosive esophagitis was identified in 25 patients (43.1%), gastritis was diagnosed in 32 patients (55.2%) and erosive duodenitis was found in eight (13.8%). The most frequent histopathological finding in the H. pylori-positive group was increased inflammatory activity in the gastric body and antrum, with a predominance of mononuclear and polymorphonuclear cells. In turn, the most frequent finding in the H. pylori-negative group was chronic inflammation with predominance of mononuclear cells. Focally enhanced gastritis was identified in four patients (6.9%), all of whom were negative for H. pylori. Granulomas were not observed. H. pylori infection was present in 19 patients (32.8%). (4) Conclusions: Nonspecific endoscopic and histological findings were frequent in patients with Crohn’s disease. Focally enhanced gastritis was uncommon and observed only in H. pylori-negative patients. The time from the diagnosis, patient age, and therapy in use may have influenced the nondetection of epithelioid granuloma.

P565 Illness perception as a clinical tool to detect mood disturbances (anxiety or depression) in inflammatory bowel disease patients

Abstract Background In patients suffering from inflammatory bowel disease (IBD), a prevalence of anxiety and/or depression of 30–35% has been reported in phases of clinical inactivity, reaching up to 60–80% in the flare-ups. Moreover, the presence of psychological comorbidity is now considered to complicate the course of IBD. Our aim was to evaluate the relationship between mood disturbances and individual illness perception. Methods Patients attending our tertiary hospital IBD outpatient clinic were enrolled. They filled the “Hospital anxiety and depression scale” (HADS) and the “Brief illness perception questionnaire” (BIPQ). Sociodemographic characteristics, phenotype and clinical course of IBD were reviewed as well. Ethical approval of the study was obtained. Results A total of 201 patients were analyzed: male 102 (50.7%) female 99 (47.3%), UC 113 (56.2%), CD 88 (43.8%). The HADS prevalence of psychological pathology was 24%, (22% anxiety, 6.9% depression), and 17% patients previously were on mood medications. There were no differences between CU and EC, although EC patients tended to show more anxiety. Women had a higher prevalence of anxiety (29% vs 15.6%) and depression (9.6% vs 4.7%) than men (p=0.03 and p=0.009). Anxiety was also associated with previous IBD hospitalization (p=0.005), and depression with living alone (p=0.007). The BIPQ dimensions: consequences, concern and emotional response were statistically associated with the presence of psychological pathology, anxiety and depression (p=0.0005 each). Conclusion Mood disturbances are frequently found in IBD patients, especially among females. A negative individual illness perception of the consequences and emotions related to IBD seems to correlated strongly with the presence of anxiety and/ or depression in these patients.

P182 Bowel wall thickness as seen on point-of-care intestinal ultrasound correlates with endoscopic severity in children with Inflammatory Bowel Disease: A North American diagnostic cross-sectional study

Abstract Background In pediatric patients with Inflammatory bowel disease (IBD), delay in diagnosis can lead to progression of disease and bowel damage. In North America, the current methods to visually assess disease activity are limited to ileocolonoscopies and MR enterography. Point-of-care intestinal ultrasound (IUS) is a non-invasive, cost-efficient tool for assessing intestinal inflammation. We aim to evaluate the correlation between IUS and endoscopic disease activity in children suspected to have IBD. Methods In this cross-sectional study, we recruited consecutive patients newly diagnosed with IBD, presenting to the IBD outpatient clinic, or hospitalized in our pediatric center between August 2020 and February 2021. In addition to ileocolonoscopy, they underwent IUS performed by one gastroenterologist who was blinded to ileocolonoscopy results at the time of performing IUS. Bowel wall thickness (BWT) was measured systematically across different bowel segments (terminal ileum, ascending, transverse, descending, sigmoid colon, and rectum) and recorded twice in longitudinal view and twice in axial view. An average segmental BWT of more than 3 mm was considered inflamed. The inflammation seen on endoscopy was graded using segmental scores of the SES-CD for patients with Crohn’s disease (CD) and the UCEIS for patients with ulcerative colitis (UC). Segments were classified as healed, mild, moderate, or severe disease activity. The association between the BWT and disease severity on endoscopy was assessed using the Kruskal-Wallis test. Numerical correlation between BWT and continuous values of the endoscopic scores was performed using Kendall’s Tau-b. Results Fifteen patients completed both IUS and ileocolonoscopy. A total of 74 bowel segments were assessed. There were 7 girls, median age of 15 years (IQR 12.5–15.5 years). 8 patients were diagnosed with CD, 5 with UC, and 2 had a normal endoscopy. Median PCDAI was 32.5 (IQR 30.0–40.0), and median PUCAI was 70 (IQR 70–75). The Kruskal-Wallis test showed that BWT was significantly associated with disease severity as measured by the SES-CD (chi-square = 14.3, p &amp;lt;0.001, df = 2) for patients with CD, and that the BWT was also significantly associated with disease severity as measured by the UCEIS (chi-squared=12.0, p&amp;lt;0.001, df=3). The numerical correlation between BWT and SES-CD for all segments was 0.43 (p&amp;lt;0.001, 95%CI 0.3–0.58), while the correlation with the UCEIS was 0.52 (p&amp;lt;0.001, 95%CI 0.4–0.66). Conclusion In pediatric patients with IBD, we found that endoscopic disease severity correlates with the degree of BWT seen on IUS. These findings support the use of IUS as an evaluation tool of disease activity in North American pediatric clinical practice.

P572 The influence of beliefs about medication in therapeutic adherence among patients with inflammatory bowel disease

Abstract Background Medication nonadherence in inflammatory bowel disease (IBD) is common and has a negative impact on disease outcome. It is currently not clear whether in patients with IBD, the opinions, beliefs and attitudes towards medicines determine an adequate therapeutic adherence. Our aim was to assess what the real influence of medication opinions is on IBD patients adherence. Methods Patients attending a tertiary hospital IBD outpatient clinic were enrolled. They filled the BMQ (Beliefs about Medication Questionnaire): a 18-item standardized scale assessing specific opinions about medication that a person is taking and beliefs about the potential for harm and overuse of medication in general. Pharmacy refill data were checked for the previous 3 months and their medication possession ratios (MPR) were calculated. Nonadherence was defined as MPR&amp;lt;0.8.Ethical approval was obtained. Results We analyzed 193 IBD patients: 96 women and 97 men with average age 46.1 years. Ulcerative colitis 109 (56.6%) and 84 Crohn′s disease (43.5%). Oral mesalazine was used for IBD control in 48%, immunosuppressnat in 43.5% and targeted therapies, 28.5%. MPR detected non-adherence in 57 patients (29.5%). Patients with CD had a higher adherence than those with UC (78.6 vs 64.2% p=0.03). Non-adherence was higher in patients with mesalazine 41.3% (p=0.001) and lower with targeted therapies 15% (p=0.007). BMQ classified our IBD patients in 60% “ambivalent”, 36% “accepting”, 7% “indifferent” with no “sceptical”: Females had a higher puntuation in BMQ harm about medication scale (p= 0.006). Surgical patients scored higher about the necessity of their IBD medication (0.005) and patients with a low educational level showed many concerns about IBD medication (0.002). Nevertheless there were neither significant differences in BMQ general (abuse/harm) or specific (need/concern) scores nor in attitude profiles between patients with adequate adherence and non-adherent patients. Conclusion Non-adherence behaviour in IBD patients was not associated with beliefs about medication. Ulcerative colitis and oral mesalazine were related to lower adherence, meanwhile patients on directed therapies showed high adherence,

Clinical and Demographic Profile of Inflammatory Bowel Disease Patients in a Reference Center of São Paulo, Brazil.

BackgroundCrohn’s disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the gastrointestinal tract with an increasing incidence in developing countries.PurposeTo report clinical and demographic data of CD and UC at a referral center for inflammatory bowel disease (IBD) in São Paulo.Patients and MethodsWe conducted a retrospective cross-sectional study on adult patients with established IBD. Demographic and clinical data were obtained by medical records analysis from the IBD Outpatient Clinic of EPM-UNIFESP, from October 1997 to October 2017.ResultsOf 658 patients included, 355 had UC (54%) and 303 had CD (46%). UC was more prevalent in women than CD (219 [61.7%] vs 152 [50.2%], p=0.003). The median time between the onset of symptoms and diagnosis was 13 (5–38) months, with a longer duration for CD patients. CD mostly affected the ileocolonic location (47.9%). CD patients with stricture, fistula and/or perianal disease (213/303, 70.3%) were younger at diagnosis, had a longer disease duration, higher rates of corticosteroid, immunomodulatory, and biological therapy, hospitalization, and referral to surgery, compared to patients without complication. Extensive colitis was the most common extension of UC (50.6%), which was more frequently associated with younger age at diagnosis, hepatobiliary disease, increased need for hospitalization, higher use of immunomodulatory, and biologic therapy, compared to patients with less extensive disease. In the last 5 years, CD patients were more frequently on biologic and/or immunomodulatory (70.9%) therapy, and UC patients often received salicylates (78.1%) and immunomodulatory (28.1%) treatments. There was a consistent reduction in salicylate usage for CD in the last 5 years compared to the total period of follow-up.ConclusionDespite the increasing incidence, we highlight the diagnostic delay and a more complicated CD and extensive UC in this cohort, reflecting a high need for immunomodulatory and biological treatment, hospitalization, and surgery.

DETERMINANTS OF INFLAMMATORY BOWEL DISEASE PATIENT SATISFACTION AFTER TRANSITION TO VIRTUAL VISITS

IntroductionDue to COVID-19, traditional inflammatory bowel disease (IBD) patient and provider office-based interactions have shifted to telemedicine platforms to address the ongoing healthcare needs of this population. As telehealth services continue to expand, a better understanding of patient satisfaction is required in order to optimize the patient experience for IBD patients.MethodsWe analyzed patient satisfaction data from a metropolitan tertiary hospital’s IBD outpatient clinic. Three questions were compared between in-person and virtual visits: “Did this provider listen carefully to you?”, “Did this provider seem to know the important information about your medical history?”, and “Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you rate this provider?” We performed Fisher’s exact tests to analyze differences in top-box satisfaction scores between in-person and virtual visits. A qualitative analysis of open-ended questions was performed to identify key satisfaction themes.ResultsWe collected satisfaction data from 309 in-person medical visits and 202 telehealth visits. Top-box satisfaction scores for provider listening and provider medical history decreased overall from in-person to virtual visits, while overall provider ratings remained the same (Figure 1). Decreases were larger among males than among females for both provider listening and provider knowledge (Table 1). After excluding patients who reported problems with the video connection or video quality, no statistically significant changes in top-box scores were found between in-person and telehealth visits (Figure 1). Open-ended answers where overwhelmingly positive, but care coordination issues and technical problems were perceived as barriers.Figure 1.Top-box scores for patient satisfaction questions for in-person visits, virtual visits, and virtual visits without problems with the video quality or ease of video connection.Table 2.Top-box ratings for the different satisfaction questions and visit settings within different demographic subpopulations.DiscussionWe identified a decrease in patient satisfaction with telehealth visits compared to in-person visits, particularly among males. This decrease was not observed after adjusting for those experiencing technical issues with their visit. Efforts to improve telehealth technology platforms, patient preparation for telehealth visits, and provider education regarding handling technology glitches during a visit may help improve overall patient satisfaction with virtual IBD visits.

Young age and shorter duration of Crohn's disease are associated with non-adherence to taking medication.

Objective:The mainstay of Crohn’s disease treatment is medical therapy. Failure to comply with medications causes disease activation, loss of response to treatment, and increased hospitalization rates. Drug non-adherence worsens the course of the disease, leading to fistula, stricture, and surgical interventions. The adherence rates to drug therapy in Crohn’s disease patients and the risk factors vary considerably in the literature. The aim of the study was to investigate drug adherence rates and factors affecting adherence to Crohn’s disease medications.Methods:This study was conducted as prospective cohort study at the tertiary health care institution inflammatory bowel disease outpatient clinic within 1 year. Crohn’s disease characteristics and pharmacy records of consecutive patients were evaluated. Medication adherence was assessed by calculating the medication possession ratio using the amount of medication purchased from the pharmacy.Results:A total of 129 patients were included in the study. It was observed that 43.6% of the patients did not comply with their Crohn’s disease medications. It was determined that the patients who did not adhere to the medication were significantly younger (41±12 vs. 48±13, p=0.039). The duration of the disease is shorter in patients who did not comply with the drugs (4.50 [IQR: 3.00–12.00] vs. 6.00 [IQR: 3.00–12.00, p=0.025]). Adherence with medication is lower in patients with higher education levels (35.7% vs. 64.3%, p=0.023).Conclusion:Medication adherence is of critical importance for Crohn’s disease outcomes. Nearly half of Crohn’s disease patients do not comply with drugs. Young and highly educated patients with shorter disease duration should be targeted for measures to increase the rates of medication adherence.

Elderly-onset vs adult-onset ulcerative colitis: a different natural history?

BackgroundIncidence of ulcerative colitis (UC) in elderly population is increasing because of ageing and because of its minimal impact on life span. Data on natural history, outcomes and therapeutic strategies are limited.Our aim is to characterize UC in elderly-onset patients followed at our Inflammatory Bowel Disease outpatient clinic and compare with adult-onset UC.MethodsFrom January 2000 to June 2019, 94 patients with UC diagnosed after the age of 65 years (elderly group, E-O) were identified and matched 1–1 according to gender and calendar year of diagnosis with patients diagnosed with UC at age between 40 and 64 years (adult age, A-O).ResultsComorbidity Index (3.8 vs 1.6, p < 0.0005) was higher for elderly UC patients. Symptoms at presentation were similar between the two groups, although abdominal pain was more common in adults, and weight loss was more common in the elderly. At diagnosis, left colitis (61% vs 39%) and proctitis (14% vs 26%) (p = 0.011) were more frequent in the elderly. Therapy and clinical behaviour were similar. Surgery was more frequently performed in the elderly (20% vs 9%, p = 0.02), while biological therapy was less used (2.1% vs 22%, p < 0.0005). Complications were more frequent in the elderly. Extraintestinal manifestations were lower in elderly patients (9.6% vs 19.2%, p = 0.061). Time to first relapse was similar between the two groups. Mortality (p < 0.0005) was higher in elderly patients.ConclusionsUlcerative Colitis has similar presentation and behaviour in elderly and adults patients. However, the elderly are more fragile because of comorbidities, increased risk of infections and disease-related complications.

P040 DEPRESSION SCREENING IN A PEDIATRIC IBD CENTER

Abstract Introduction Depression is a common pediatric problem affecting approximately 25% of U.S. adolescents and up to 35% of patients with Inflammatory Bowel Disease (IBD). Suicide is associated with mood disorders and is a leading cause of death for youth ages 10–25. Despite known risks of depression, up to 75% of depressed youth go unrecognized. Recently published guidelines recommend annual screening for youth 12 and older diagnosed with IBD (Mackner et al., 2019). We sought to implement these guidelines in a large outpatient pediatric gastroenterology practice. Methods We used quality improvement (QI) methodology and Plan-Do-Study-Act (PDSA) cycles to design and implement a pilot screening process for depression. We aimed to prospectively screen at least 80% of patients diagnosed with IBD who were at least 13 years old from March 3, 2019 to October 11, 2019. Screening was done using the PHQ-9, a brief and validated screening tool widely used in the medical setting. Initial steps of the PDSA cycle focused on training in tool administration, as well as scoring of the PHQ-9 simulated interviews, management of suicidal ideation, and office staff training. Next steps included eligible patient identification and distribution of screeners. As screening processes were improved, we focused on streamlining process of screener distribution and scoring during the visit, as well as disposition of patients based on screening results. The ImproveCareNow Depression Screening Toolkit was used as a resource for implementation. Results During the study period, screening of all eligible patients with IBD was implemented across three pediatric gastroenterologists within the larger practice of 15 physicians. Weekly screenings improved from 0% per week to over 80% per week at the culmination of this 32-week pilot. Across the pilot, a total of 141 patients were screened, and of these, 32% had actionable scores indicating mild, moderate, or severe depressive symptoms, with 7 of these endorsing suicidal thoughts. Conclusions Development and implementation of a depression screening protocol in an IBD outpatient clinic is feasible and sustainable. A large number of patients were affected by depression and many were previously unrecognized. Next steps include expansion to a larger number of providers and automation of screening tools.

P252 The cardiovascular risk profile in patients with inflammatory bowel disease: A cross-sectional single-centre study (the CARE-IBD study)

Abstract Background Patients with inflammatory bowel disease (IBD) have an increased risk of cardiovascular diseases (CVD). The European Society of Cardiology guidelines recommend to use a 1.5 factor CVD risk multiplier in rheumatoid arthritis, but state a gap in evidence for other inflammatory diseases. The aim of this study was to assess the prevalence of CVD and traditional cardiovascular risk factors in IBD. Methods This is a single-centre cross-sectional study at the IBD outpatient clinic in September and October 2019. Patients ≥18 years underwent body measurements (systolic, diastolic blood pressure (SBP, DBP), length, weight, waist, hip circumference), biochemical analysis (plasma glucose, total cholesterol (TC), triglycerides, HDL, LDL) and completed an extensive cardiovascular questionnaire (history of CVD, thromboembolic events, medication use). To identify groups at risk of hypertension (SBP&amp;gt;140 or DBP&amp;gt;90 mmHg), overweight (&amp;gt;25 kg/m2), hyperlipidaemia (TC&amp;gt;5 mmol/l) and cardiovascular events, comparisons were made between gender, IBD subtype (Crohn’s disease (CD), ulcerative colitis (UC)) and disease activity (Harvey Bradshaw Index or Simple Clinical Colitis Activity Index&amp;gt;5). Results A total of 235 IBD patients were included (112 males (48%), median age 45 years (IQR 33–55): 143 CD (61%), 92 UC (39%)). Median SBP and DBP were 135 (IQR 122–145) and 84 mmHg (IQR 66–93); hypertension was present in 43% of patients. Median BMI was 24.5 kg/m2 (IQR 21.9–27.4); 41% of patients were overweight. Hyperlipidaemia was present in 19% of patients. The self-reported prevalence of hypertension was 13%, hyperlipidaemia 8%, diabetes 4%, cardiovascular disease (heart failure, myocardial infarction, transient ischaemic attack, cerebrovascular accident) 10% and thromboembolic events (deep venous thrombosis, pulmonary embolism) 8%. Male patients showed a higher prevalence of hypertension (61%), greater waist–hip ratio (0.93, all p &amp;lt; .001), higher triglyceride (1.6 mmol/l, p = .003) and lower HDL levels (1.2 mmol/l, p = .000) as compared with females. CD patients were more frequently smokers (16%) with disease activity (51%)(p &amp;lt; .001), but showed lower levels of triglycerides (1.6 mmol/l, p = .013), TC (4.0 mmol/l) and LDL (2.3 mmol/l) (p &amp;lt; .001) as compared with UC. During active disease lower levels of LDL were observed as compared with remission (2.4 vs. 2.7 mmol/l, p = .040). Conclusion CVD are considerably prevalent in IBD patients. Well-known CVD risk factors hypertension, obesity and hyperlipidaemia are highly prevalent and remain undiagnosed in a substantial proportion of patients. Although no significant association is observed between CVD and gender or IBD subtype, CVD risk profile is different. Screening and early treatment of CVD risk factors might be recommended in IBD.

Clinical and Demographic Characteristics of Older Inflammatory Bowel Disease Patients

There is limited data describing management of older Australians with inflammatory bowel disease (IBD). The prevalence of IBD in the elderly is increasing due to an aging population and increasing overall incidence, which presents challenges in management due to comorbidities and polypharmacy. The aim of the study was to describe demographic and clinical characteristics, and management of IBD in older patients. Around 100 consecutive patients (n = 100) aged above 60 years and attending the IBD outpatient clinic of Fiona Stanley Hospital from January 2019 were selected. Demographic and clinical information were compiled from the digital medical record. Around 59 patients had Crohn’s disease (CD), 39 had ulcerative colitis (UC) and 2 unclassified IBD (IBD-U). Around 75% of patients had a Montreal classification recorded, which is a recommended standard of care. For both CD and UC, no patients had onset of symptoms &lt;17 years old, and the majority had symptom onset after 40 years of age (CD—56%, UC—52%). Around 39% of CD patients had undergone at least one surgery, and 5% a second operation. No UC patients had undergone surgery. 5’Aminosalicylates (59%), antitumor necrosis factor alpha (33%), thiopurines (22%), and vedolizumab (11%) were the most common current treatments. Around 9% of patients were currently taking steroids while 36% had previously taken corticosteroids. Immunosuppressive events were recorded, if they occurred, after treatment with steroids, immunomodulatory or biologic agents. Two patients had melanoma, 12 nonmelanoma skin cancer, 3 solid organ tumors (2 prostate adenocarcinoma and 1 bladder transitional cell carcinoma), 3 latent tuberculosis, 1 myelodysplasia, and 1 septic arthritis. Around 14% of the patients had osteoporosis or osteopenia; 43% of these had prior corticosteroid exposure; however, there was a low rate of bone densitometry. Most patients both with CD and UC were diagnosed over 40. Biologics were the most common treatment category in keeping with the aim of achieving deep remission.

P009 Characterization of Health Services That Provide Nursing Care for Inflammatory Bowel Disease Patients in Brazil

BACKGROUND: Nursing care in inflammatory bowel disease (IBD) is essential to the success of the treatment. IBD patients need continuous and specialized care and the characterization of health services is necessary to identify the deficiencies for further resolution in the future. The aim of the study is to identify the characteristics of health services that provide nursing care for IBD patients in Brazil. METHODS: A descriptive study was performed. Participants were nurses who treat IBD patients. The identification of nurses was performed through: analysis of national curricula registered with the National Council for Scientific and Technological Development in Brazil, access to the Brazilian IBD Study Group records and referral by colleagues. A specific online survey questionnaire consisting of 37 questions was developed. RESULTS: 74 nurses were identified. Health services are located in the following Brazilian regions: Southeast (66.22%), Northeast (13.51%), South (9.46%), North (6.76%) and Midwest (4.05%). The most frequent services were public hospital (45.95%), IBD outpatient clinic (25.68%), private clinic (21.62%) and infusion center (10.81%). In the infusion centers were identified emergency trolley (45.95%), bathroom for the patient (43.24%), refrigerator for storing medications (43.24%), comfortable chair for infusion (43.24%) and post nursing (40.54%). Health services are integrated with endoscopic dilation service (40.54%), magnetic resonance imaging (52.70%), pathology department (54.05%), urgency and emergency room (58.11%), endoscopy (70.27%), computed tomography (59.46%), surgical inpatient unit (67.57%) and clinical inpatient unit (72.97%). The services have telephone consultation (28.38%) and communication by email (20.27%). The team is composed of nurses (71.62%), coloproctologist (64.86%), gastroenterologist (58.11%), dietician (56.76%), psychologist (41.89%) and stomatherapist (40.54%). CONCLUSION(S): Most health services are located in the southeast region; the type of service provided is public with access to specific tests. Infusion centers have the minimum required resources recommended. Some health services feature telemedicine service. The multidisciplinary team is present in most services. These findings suggest the need for prompt expansion and improvement to the delivery of services and care for all IBD patients across the nation.

Fecal calprotectin is significantly linked to azathioprine metabolite concentrations in Crohn's disease.

The value of therapeutic drug monitoring during azathioprine (AZA) therapy with respect to clinical outcomes has been convincingly demonstrated in recent meta-analyses. However, the association between AZA metabolites and the mucosal state in inflammatory bowel disease is largely unclear. We investigated the association between AZA's active metabolite 6-thioguanine nucleotides (6-TGN) and fecal calprotectin (FC) as a well-validated surrogate marker of mucosal inflammation in patients with Crohn's disease (CD) on AZA monotherapy. Of 443 6-TGN measurements, 140 values from 88 patients with CD on AZA monotherapy visiting the inflammatory bowel disease outpatient clinic between 2009 and 2016 were retrospectively analyzed. In a subcohort with serial 6-TGN measurements, longitudinal FC measurements in patients with versus without intervention (dose increase, allopurinol, and education) were assessed. In patients with 6-TGN concentrations within a predefined range (250-450 pmol/8×10 red blood cells), FC was significantly lower (median: 119.5 vs. 327.2 mg/kg, P=0.003), and hemoglobin as well as serum protein concentrations were significantly higher than in patients with 6-TGN outside of this range. C-reactive protein and transferrin saturation were not different. In the longitudinal cohort, 6-TGN increased in the intervention group, but only a minority reached the defined range; no significant change in FC was observed. This study is the first to show that in patients with CD receiving AZA monotherapy, 6-TGN concentrations within a defined range (250-450 pmol/8×10 red blood cells) are associated with significantly lower FC. A treat-to-target concept directed by 6-TGN to reach mucosal healing may thus be a promising approach (DRKS00013246).