Inflammatory Bowel Disease Population Research Articles

Handgrip strength and risk of malnutrition are associated with an increased risk of hospitalizations in inflammatory bowel disease patients.

In patients with inflammatory bowel disease (IBD), frailty is independently associated with mortality and morbidity. This study aimed to extend this work to determine the association between the clinical frailty scale (CFS), handgrip strength (HGS), and malnutrition with IBD-related hospitalizations and surgeries. IBD patients ⩾18 years of age were prospectively enrolled from two ambulatory care clinics in Alberta, Canada. Frailty was defined as a CFS score ⩾4, dynapenia as HGS < 16 kg for females and <27 kg for males, malnutrition using the subjective global assessment (SGA), and the risk of malnutrition using either the abridged patient-generated SGA (abPG-SGA), or the Saskatchewan Inflammatory Bowel Disease Nutrition Risk Tool (SaskIBD-NRT). Logarithm relative hazard graphs and multivariable logistic regression models adjusting for relevant confounders were constructed. One hundred sixty-one patients (35% ulcerative colitis, 65% Crohn's disease) with a mean age of 42.2 (±15.9) years were followed over a mean period of 43.9 (±10.1) months. Twenty-seven patients were hospitalized, and 13 patients underwent IBD-related surgeries following baseline. While the CFS (aHR 1.34; p = 0.61) and SGA (aHR 0.81; p = 0.69) did not independently predict IBD-related hospitalizations, decreased HGS (aHR 3.96; p = 0.03), increased abPG-SGA score (aHR 1.07; p = 0.03) and a SaskIBD-NRT ⩾ 5 (aHR 4.49; p = 0.02) did. No variable was independently associated with IBD-related surgeries. HGS, the abPG-SGA, and the SaskIBD-NRT were independently associated with an increased risk of IBD-related hospitalizations. Future studies should aim to validate other frailty assessments in the IBD population in order to better tailor care for all IBD patients.

Comparison of Migraine Characteristics in Patients With and Without Inflammatory Bowel Disease: A Retrospective Cohort Study.

Survey studies have found an increased prevalence of migraine in patients with inflammatory bowel disease (IBD). However, the clinical characteristics of migraines in this population are unknown. We conducted a retrospective medical record review study to characterize migraines in the IBD population. Six hundred seventy-five migraine patients (280 with IBD, 395 without IBD) who were evaluated at Mayo Clinic Rochester, Mayo Clinic Arizona, or Mayo Clinic Florida between July 2009 and March 2021 were included. Patients with ICD codes for migraine and either Crohn's disease (CD) or ulcerative colitis (UC) were selected. Electronic health care records were reviewed. Patients confirmed to have IBD and migraine were included. Demographic, IBD, and migraine characteristics were collected. Statistical analysis was completed using SAS. Patients with IBD were less often male (8.6% vs 21.3%, P < .001) and had a higher Charlson Comorbidity Index (>2: 24.6% vs 15.7%, P = .003); 54.6% had CD and 39.3% had UC. Patients with IBD had migraine with aura and without aura more frequently ( OR 2.20, P < .001 and OR 2.79, P < .001, respectively) than non-IBD patients. Additionally, those with IBD less commonly had chronic migraine (OR 0.23, P < .001) and less commonly had chronic migraine or treatment for migraine (ORs 0.23-0.55, P ≤ .002). Migraine with and without aura have increased prevalence in IBD patients. Further study of this topic will be helpful to clarify the prevalence of migraine, establish this population's response to treatment, and better understand the reason(s) for a low rate of treatment.

Predictive factors of response to infliximab therapy in Brazilian inflammatory bowel disease patients.

Biological therapies have revolutionized the treatment of patients with inflammatory bowel disease (IBD). Infliximab (IFX) has been shown to be effective in inducing and maintaining remission in patients with Crohn's disease and ulcerative colitis. However, about one-third of the patients are primary non-responders, and up to half can lose response over time. Hence, it is important to assess which factors are related to treatment failure. We aimed to identify factors predicting clinical and endoscopic remission with IFX treatment during maintenance therapy in a Brazilian IBD referral center. We conducted a cross-sectional study to describe demographic, clinical, and IBD therapy-related characteristics of IBD patients treated with IFX for at least 6 months in a Brazilian referral center. Subsequently, we evaluated factors associated with clinical and endoscopic remission (primary and secondary outcomes, respectively). We used descriptive statistics to summarize the essential demographic and clinical characteristics of the population. The association of sociodemographic and clinical variables with outcomes was analyzed using multivariable logistic regression. A total of 131 IBD patients (the mean age 41.7 years) were enrolled in this study. Clinical and endoscopic remission were observed in 79.4% and 58.2% of the patients, respectively. In the multivariable analysis, IFX therapy duration and higher albumin levels increased the likelihood of clinical remission, while previous surgery decreased its chance. Prior use of adalimumab and higher C-reactive protein levels reduced the likelihood of endoscopic remission. In summary, this study has enhanced our understanding of the predictive factors of treatment response to IFX in a well-characterized Brazilian IBD population. 4.254.501 and 2.903.748.

Trends in inflammatory bowel disease and pancreatic cancer: an analysis of the National Inpatient Sample database.

An association between inflammatory bowel disease (IBD) and pancreatic cancer has been suggested in the literature. We aimed to determine the trend in prevalence of pancreatic cancer amongst patients hospitalized for Crohn's disease (CD) or ulcerative colitis (UC) in the United States. An analysis of the National Inpatient Sample database was performed to identify adults diagnosed with pancreatic cancer and CD or UC, using validated ICD-9 and ICD-10 codes, from 2003-2017. Age, sex, and racial demographics were also collected. Surveillance, Epidemiology and End Results registry (SEER) data were analyzed for trends in the incidence and mortality of pancreatic cancer amongst the general population in the United States. From 2003-2017, there was a significant increase in the hospitalizations related to pancreatic cancer, from 0.11% to 0.19% (PTrend<0.001), representing a 72.73% increase, in CD patients, and from 0.08% to 0.38% (PTrend<0.001), representing a 375.00% increase, in UC patients. According to the SEER 13 data on pancreatic cancer in the general population, the incidence of pancreatic cancer increased from 11.34 per 100,000 cases in 2003 to 12.74 per 100,000 cases in 2017, thus representing only a 12.35% increase over the study period. Our study indicates a trend for increasing prevalence of pancreatic cancer in patients hospitalized with CD and UC from 2003-2017 in the United States. This increasing trend observed in the IBD population parallels the increase in the incidence of pancreatic cancer reported among the general population, but at a much greater rate.

Inflammatory Bowel Disease Patients' Acceptance for Switching from Intravenous Infliximab or Vedolizumab to Subcutaneous Formulation: The Nancy Experience.

Subcutaneous infliximab and vedolizumab formulations have been developed for maintenance therapy in inflammatory bowel disease. The objective of this study was to explore the inflammatory bowel disease patient's acceptance for switching from intravenous infliximab or vedolizumab to subcutaneous, as well as to describe the causes of refusal or, conversely, the factors associated with acceptance. Patients were prospectively recruited between June 2021 and March 2022 during their infusion of infliximab or vedolizumab in the Medical Day Hospital of Nancy University Hospital. Adult patients with an established diagnosis of inflammatory bowel disease in clinical remission were eligible for inclusion in this study if they had been treated with intravenous infliximab or vedolizumab for at least six months. One hundred and thirty patients were included in this study. Thirty-six patients (27.7%) received vedolizumab and ninety-four patients (72.3%) received infliximab. Median duration of treatment at inclusion was 7.0 years [3.0-11.0]. In this cohort, 77.7% of patients accepted the switch from intravenous infliximab or vedolizumab to subcutaneous. The main reasons for patient's refusal for switching from intravenous to subcutaneous formulation were fear of loss of efficacy, a more spaced-out medical follow-up, increased frequency of administration, and self-administered injection. A short duration of treatment was associated with a high switch acceptance rate (odd ratio (OR) (95% confidence interval (CI)) = 0.9 (0.8-0.9); p = 0.0002). A large majority of the patients included accepted the switch of their treatment with infliximab or vedolizumab from the intravenous form to the subcutaneous form. This study identified one predictor influencing the acceptance rate in inflammatory bowel disease population: short treatment duration. Subcutaneous infliximab and vedolizumab hold potential for greater patient flexibility by self-administration, reducing travel and hospital attendance for infusion.

S45 Cancers Associated With Inflammatory Bowel Disease: A Population-Based Case-Control Study

Background: Individuals with inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are known to have a higher risk of digestive tract cancers as compared to the general population. As the IBD population has gotten older over time, age-related cancers may be more commonly diagnosed. We conducted a population-based study to assess whether incident cancers were being diagnosed more commonly overtime and whether those with IBD were more likely to be diagnosed with cancer. Methods: A population-based surveillance case-control study was conducted in in Alberta, Canada from April 1, 2002 to March 31, 2018. A validated coding algorithm identified all cases of IBD stratified by type of IBD (CD, UC). Each case was age and sex matched to 10 non-IBD cases from the general population, and then linked to the Alberta provincial cancer registry to extract pathology-confirmed incident cancer. Cancer diagnoses were classified: colorectal, small bowel, pancreatic, biliary and liver, breast, cervical, endometrial, thyroid, hematological, lung, neurological, melanoma, non-melanoma skin cancer, prostate, renal, and bladder. Odds ratios (OR), with 95% confidence intervals (CI), compared IBD cases to matched controls using conditional logistic regression. The annual incidence of cancer diagnosis among the at-risk prevalent IBD population was determined with the average annual percentage change (AAPC) calculated using log binomial regression. Results: Overall, 3,695 incident cancers were diagnosed among 35,763 individuals with IBD as compared to 31,365 cancers among 362,248 controls (IBD: OR = 1.22; 95% CI: 1.18, 1.27; CD: OR = 1.42, 95% CI: 1.34, 1.49; UC: OR = 1.13 95% CI: 1.06, 1.20). Annual incident cancers in those with IBD steadily increased by 3.4% per year (AAPC = 3.44%; 95% CI: 2.71%, 4.18%). A higher odds of cancer was observed across digestive tract cancers for those with IBD: biliary and liver (IBD: OR = 7.76; 95% CI: 5.89, 10.22); colorectal cancer (IBD: OR = 1.88; 95% CI: 1.67, 2.15); small bowel (CD: OR = 10.81; 95% CI: 6.89, 16.95; UC: OR = 1.74; 0.73, 4.16); and pancreas (IBD: OR = 8.01; 95% CI: 5.72, 11.20). Outside of the digestive tract the following cancers were more common in those in IBD: hematological (IBD: OR = 1.47, 95% CI: 1.29, 1.67); lung (IBD: OR = 4.16; 95% CI: 3.59, 4.81); neurological (IBD: OR = 4.73; 95% CI: 3.12, 7.18; and renal (IBD: OR = 2.18; 95% CI: 1.77, 2.68). Non-melanoma skin cancers were associated with IBD (OR = 1.11; 95% CI: 1.05, 1.18), but not melanoma (OR = 0.98; 95% CI: 0.82, 1.18). Other solid-organ cancers were not associated or occurred less commonly in those with IBD: prostate (OR = 0.68; 95% CI: 0.60, 0.77); bladder (OR = 0.73; 95% CI: 0.57, 0.92), cervix (OR = 0.83; 95% CI: 0.73, 0.93), endometrium (OR = 0.50; 95% CI: 0.36, 0.70), and thyroid (OR = 0.84; 95% CI: 0.65, 1.10). Conclusion(s): Over time, persons with IBD are being more commonly diagnosed with cancer. Individuals with IBD are more likely to be diagnosed with cancer as compared to the general population with cancers of the digestive tract driving this association. Healthcare providers should be aware of higher occurrence of hematological, neurological, lung and renal cancers in those with IBD.

S105 Association of Inflammatory Bowel Disease With Melanoma and Non-melanoma Skin Cancers- A Nationwide Study

Background: Studies have shown that patients with inflammatory bowel disease (IBD) are at risk for several malignancies. However, the national burden of melanoma (MSC) and non-melanoma skin cancer (NMSC) amongst the IBD population is not widely available. In this study, our aim is to determine the prevalence and association of melanoma and non-melanoma skin cancer (NMSC) in patients with IBD in the United States population. Methods: A retrospective cross-sectional study on Nationwide Inpatient Sample (NIS 2016-2018) was performed in adult US hospitalizations. We identified IBD (Crohn’s Disease-CD and Ulcerative Colitis-UC) using ICD-10 codes. Prevalence MSC and NMSC (squamous cell carcinoma, basal cell carcinoma, and Merkel cell carcinoma) were identified. We performed univariate (unpaired t-test and chi-square) and mixed-effect multivariate regression analyses to identify the prevalence and association of IBD with skin cancers. Results: Out of 87,761,798 USA hospitalizations, 583,765 (0.67%) had CD and 346,515 (0.39%) had UC. Overall prevalence of MSC was 62435 (0.07%), NMSC [squamous cell carcinoma, basal cell carcinoma, and Merkel cell carcinoma] was 4760 (0.01%), 9500 (0.01%) and 4765 (0.01%), respectively. Prevalence of MSC was higher amongst UC (0.13% vs CD: 0.07% vs non-IBD: 0.07%) in comparison without IBD. The prevalence of NMSC was similar (0.01%) in IBD and non-IBD groups. (P < 0.0001) In multivariable regression analysis, we found UC was associated with 51% higher odds (aOR: 1.51, 95%CI 1.22-1.85, P = 0.0001) of having MSC in comparison without IBD. There was no significant association between MSC & CD (0.87, 0.69-1.09, P = 0.2215) and NMSC & IBD (UC: 1.04, 0.58-1.89, P = 0.8867; CD: 1.25, 0.67-2.34, P = 0.4763). Conclusion(s): Our study found an association between melanoma skin cancer with ulcerative colitis. More prospective studies are needed to evaluate this relationship and determine predictors associated with melanoma and non-melanoma skin cancer. Early identification of risk factors will help mitigate the burden of IBD-related skin cancers. The limitation of our study was missing clinical data on the severity of IBD, the establishment of causality between IBD and skin cancer, and the relationship with medication use.

S66 Leukocytoclastic Vasculitis in a Crohn’s Disease patient with recent Sars-CoV2 infection

Case: Prior to the COVID-19 pandemic, leukocytoclastic vasculitis (LCV) had been described in association with a variety of chronic infections, autoimmune disorders, and medications. In the inflammatory bowel diseases (IBD) population, LCV has been reported as a rare cutaneous, extraintestinal manifestation, which may be related to the disease itself or associated with the use of biologic medications, particularly those that target tumor necrosis factor. Several cases of LCV related to infection with SARS-CoV2, not related to IBD, have been reported. We present a case of LCV in a woman with Crohn’s Disease (CD) who was on long-term maintenance infliximab and presented with purpuric papules on bilateral lower extremities shortly after infection with SARS-CoV2. A 37-year-old female with a 26-year history of ileocolonic CD in remission for at least 2 years presents to our IBD clinic with concern of rash on both lower extremities, accompanied by significant ankle pain. She had been on infliximab for 10 years. The symptoms began 1 month prior, 2 months after being diagnosed with COVID-19. She denied any concurrent GI symptoms that were new or worsened from her baseline. Lab evaluation was notable for positive ANA, elevated to 1:160. She had normal ANCA, anti-myeloperoxidase antibody, anti-dsDNA antibody, total IgG and total IgM, and rheumatoid factor. Skin punch biopsy showed fibrinoid necrosis of capillary walls within the dermis with surrounding neutrophils and karyorrhectic debris, findings consistent with LCV. Colonoscopy showed complete endoscopic remission of CD. An oral steroid taper lead only to temporary improvement and symptoms recurred at a dose of 10 mg prednisone. Due to suspicion of infliximab-associated LCV, infliximab was discontinued, and ustekinumab therapy was initiated. She was able to taper off steroids, and the rash completely resolved. LCV falls within a general category of cutaneous small vessel vasculitis; it is limited specifically to the skin, with no systemic or renal involvement. Patients typically present with palpable purpura, at times associated with urticaria. When IBD patients present with these findings, providers should review recent infectious symptoms, medication changes or drug exposure. Direct immunofluorescence should be performed on skin biopsy for lesions lasting >= 4 weeks. For symptoms < 4 weeks, conservative therapy with oral anti-histamine, and compression stockings have been effective. Implicated drugs should be stopped. For severe cases, systemic therapy with prednisone is recommended; dapsone or colchicine have also been used. When LCV has been discovered in the setting of COVID infection, treatment approaches have been varied, including topical and oral steroids, low molecular weight heparin, and intravenous immunoglobulin (IVIG). Prior to this case, there has been one case describing successfully treatment of LCV in CD with IVIG. Because this is a rare entity, no randomized controlled trials have been performed to evaluate safety or efficacy of specific therapies. While rare, LCV is an important pathology that IBD providers should be comfortable diagnosing and may only increase as COVID-19 remains common. Importantly, we must be aware that management of LCV will likely involve change in therapy for IBD, as medications are often implicated.

S40 The Impact of Nutritional Counseling on Growth Velocity in Pediatric IBD Patients

Background: Approximately 1 in 4 patients with inflammatory bowel disease (IBD) will present with the disease during childhood. Pediatric IBD is linked to poor growth outcomes and pubertal delay in both Crohn’s disease (CD) and ulcerative colitis (UC). In up to 46% of pediatric CD patients, a decrease in height velocity is the first symptom to present, before any gastrointestinal. This decreased growth is likely multifactorial and related to decreased caloric intake, poor nutrient absorption, corticosteroid use, and chronic inflammation. In up to 17% of pediatric IBD patients with decreased growth velocity, these early delays can lead to permanent growth deficit. This study aimed to assess the effectiveness of nutritional counseling by a registered dietician on growth velocity in the pediatric IBD population at a major medical center. Methods: This study was conducted as a retrospective chart review. Charts of pediatric IBD patients that were seen at Golisano Children’s Hospital at the University of Rochester, Rochester, NY in the years 2020 and 2021 were collected using billing codes. In all, 140 total charts were reviewed, and 7 were excluded because they did not have an established IBD diagnosis. Demographic, growth velocity, and laboratory data were collected for each of the remaining 133 charts. Results: Of the pediatric IBD population sampled, 56% of patients were male, 44% were female, and the mean age of diagnosis was 11.2 years (SD = 3.74). 80.17% of patients had Crohn’s disease, 19.01% had ulcerative colitis, and 0.83% had an inconclusive IBD diagnosis. 40.60% of patients had at least one appointment or consultation with a dietician or a nutritionist, while 59.40% had not met with a dietician or a nutritionist. The mean height velocity* was 0.31 cm/month (SD = 0.35 cm/month), the mean weight velocity* was 0.63 kg/month (SD = 0.57 kg/month), and the mean BMI velocity* was 0.18 kg*month/m2 (SD = 0.22 kg*month/m2). In terms of height velocity*, there was no significant difference between those who had dietary consultations and those who did not (t(125) = 0.02, P = 0.99). Those who received a dietary consultation had a significantly higher weight velocity* (t(125) = 1.86, P = 0.03). The mean weight velocity for patients who received dietary consult was 0.7 kg/month (SD = 0.07) as compared to 0.54 kg/month (SD = 0.07) for patients who did not receive dietary consultation. Conclusion(s): These results suggest that consultation with a dietician or nutritionist has a significant effect on the growth potential, specifically the weight gain potential, of pediatric IBD patients. We did not see a significant increase in the height velocity, which may be due to the pre/early pubertal mean age of our data. Further multivariate analyses of the laboratory data that was collected are ongoing and may help to identify if any of the laboratory tests are strong predictors of growth or delay in growth. This could then allow physicians to identify patients that are at higher risk of poor growth outcomes and design more targeted interventions for these high-risk patients. Note: *in the 18 months following diagnosis.

S90 An Assessment of Mental Health Needs in Pediatric Patients With Inflammatory Bowel Disease (IBD) During the COVID-19 Pandemic

Background: Inflammatory bowel disease (IBD) is a disorder characterized by chronic inflammation and a dysregulated response to microbiota in the gastrointestinal tract. The severity of the disease can vary and often consists of alternating periods of remission and relapse. While IBD can present at any age, approximately 25% of patients are diagnosed before 20 years of age. Additionally, many studies have indicated that adolescent and pediatric patients with IBD have a poorer quality of life and increased prevalence of psychiatric disorders requiring medications. For example, a significantly greater usage of antidepressants was noted among adolescents with IBD in a nation-wide Finnish study. The aim of this project was to assess the burden and the kind of mental health issues facing our pediatric IBD population during the COVID-19 pandemic. Methods: A retrospective chart review was conducted on pediatric IBD patients (N = 140) seen at the University of Rochester Medical Center (URMC) from 2020 to 2021. Seven individuals were excluded because they did not have an established IBD diagnosis. Patient information, including sex, IBD type, symptoms at diagnosis, and age at diagnosis, was gathered from the medical record. Patient charts were reviewed for psychotropic medications. Medications used to treat ADHD, ADD, and chronic migraines were excluded. Mental health visits within the psychiatry, behavioral health, pediatric psychology, adolescent medicine, and social work departments were reviewed and recorded. Results: Of the pediatric IBD population sampled 56% were male, 44% were female, and the mean age of diagnosis was 11.2 years (SD: 3.74). Most individuals were diagnosed with Crohn’s disease (81%), and a smaller percentage were classified as having ulcerative colitis (19%). Approximately 43% of the pediatric IBD population had at least 1 mental health concern over this time period, and the most common psychiatric diagnoses were depression alone (67%), anxiety alone (3%), or both depression and anxiety (30%). About 36% of patients were prescribed a psychotropic medication and hydroxyzine (53%), sertraline (33%), and fluoxetine (25%) were the most prescribed therapeutics. 24% of patients utilized some form of mental health service but 49% of patients taking psychotropic medications did not appear to receive any formal mental health services. Patients who developed a psychiatric disorder reported more IBD-related symptoms at the time of their diagnosis compared to those without any history of psychiatric diagnoses (t(136)=1.99, P=.02). Conclusion(s): Our results suggest there are high levels of depression and/or anxiety in children with IBD seen at URMC during the time of the COVID-19 pandemic. Additionally, increased IBD symptoms at the time of diagnosis were associated with increased rates of psychopathology. Taken together, these findings suggest that more anxiety and depression screening is needed for pediatric IBD patients and that mental health services may be underutilized in the pediatric IBD population. Future directions include combining and comparing this data set with a previous pre-pandemic study performed at our institution to determine the full impact of COVID-19 on this population.

Molecular epidemiology and clinical characteristics of Clostridioides difficile infection in patients with inflammatory bowel disease from a teaching hospital.

Clostridioides difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is of increasing concern. This study aimed to investigate the molecular epidemiology and antimicrobial susceptibilities of toxigenic C. difficile isolated from IBD patients and to evaluate the risk factors for CDI in IBD population. Loose or watery stools from IBD patients were tested for glutamate dehydrogenase, C. difficile toxins A&B and anaerobic culture. Toxigenic C. difficile isolates were characterized by multi-locus sequence typing, ribotyping and antimicrobial susceptibility testing. The prevalence of CDI in IBD patients was 13.6% (43/317). The dominant sequence types (STs) were ST35 (20.9%), ST2 (18.6%) and ST37 (16.3%). The most common ribotypes (RTs) were RT 017 (18.6%), RT 012 (14.0%), and RT 220 (14.0%), whereas RT 027 and RT 078 were not detected in this study. All the isolates were susceptible to vancomycin and metronidazole. The multidrug resistance rate of C. difficile RT 017 was higher (p < 0.01) than that of other RT strains. Recent hospitalization, use of corticosteroids and proton pump inhibitors were related to increased risk of CDI in IBD patients; of these, recent hospitalization and proton pump inhibitors use were independent risk factors. Patients with IBD have a relatively high incidence rate of CDI. C. difficile RT 017 is most frequently isolated from IBD patients in this region and warrants more attention to its high resistance rate. Clinicians should pay greater attention to CDI testing in IBD patients with diarrhea to ensure early diagnosis and initiation of effective treatment.

C-reactive protein values after surgery for inflammatory bowel disease: is it still a good marker for intra-abdominal complication? A retrospective cohort study of 347 procedures : CRP after inflammatory bowel disease surgery.

C-reactive protein (CRP) is a useful predictive test to early detect abdominal complication after colorectal surgery. Inflammatory bowel disease (IBD) is responsible for chronic inflammation and abnormal basal CRP that could influence the interest of its management after abdominal surgery. The aim of this study is to evaluate CRP as an indicator of postoperative complication in a specific IBD population. Retrospective study of patients undergoing ileocolic resection or ileal pouch-anal anastomosis for IBD between 2012 and 2019. Ileocolic resection represents 242 patients and ileal pouch-anal anastomosis 105 patients. CRP was significantly higher at an early (105.2 ± 56.0 vs 128.1 ± 69.8; p = 0.008) and late stage (112.9 ± 72.8 vs 185.3 ± 111.5; p < 0.0001) for patients having an intra-abdominal complication. A BMI > 25kg/m2 (p = 0.04) and an open surgical approach (p = 0.009) were associated with higher CRP levels in the first postoperative days (POD). In multivariate analysis, preoperative steroid use (p = 0.06), CRP at POD 3 > 100mg/L (p = 0.003), and a rise between CRP values (p = 0.007) at 48h were significantly associated with intra-abdominal complication. A CRP at POD 1 < 75mg/L was associated with a lower rate of intra-abdominal complication (p = 0.01). A score dividing patients into 3 groups according to these values showed significant differences in intra-abdominal complication and anastomotic leakage rates. CRP is a useful predictive marker to detect abdominal complication after surgery in IBD population. Measurement of CRP can help to reduce hospitalization stay and orientate towards complementary examinations.

Aberrant Mucin Expression Profiles Associate With Pediatric Inflammatory Bowel Disease Presentation and Activity.

Intestinal mucosal healing is nowadays preferred as the therapeutic endpoint in inflammatory bowel disease (IBD), but objective measurements at the molecular level are lacking. Because dysregulated mucin expression is suggested to be involved in mucosal barrier dysfunction in IBD, we investigated mucin expression in association with barrier mediators and clinical characteristics in colonic tissue of a pediatric IBD population. In this cross-sectional monocentric study, we quantified messenger RNA (mRNA) expression of mucins, intercellular junctions, and cell polarity complexes in inflamed and noninflamed colonic biopsies from pediatric IBD (n = 29) and non-IBD (n = 15) patients. We then validated mucin expression at protein level and correlated mucin mRNA expression with expression of barrier mediators and clinical data. The expression of MUC1, MUC3A, MUC4, and MUC13 was increased in the inflamed colon of pediatric IBD patients compared with the noninflamed colon of non-IBD control subjects. Especially MUC13 mRNA expression associated with the expression of barrier mediators, including CDH1, OCLN, and TJP2. MUC1 and MUC3B mRNA expression in combination with calprotectin levels most accurately discriminated IBD patients from non-IBD control subjects (90.6% area under the receiver-operating characteristic curve [AUCROC], 92.0% sensitivity, 73.7% specificity), whereas aberrant mRNA expression of MUC1, MUC3A, MUC4, and MUC13 was distinctive for ulcerative colitis and of MUC3B for Crohn's disease. Furthermore, expression of MUC3A, MUC3B, and MUC4 correlated with clinical disease activity (ie, Pediatric Ulcerative Colitis Activity Index and Pediatric Crohn's Disease Activity Index), and of MUC1, MUC2, MUC4, and MUC13 with endoscopic colitis severity in ulcerative colitis patients. Colonic mucin expression is disturbed in pediatric IBD patients and associates with disease activity and presentation, suggesting its use as molecular marker to aid in disease diagnosis and management.

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

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

S976 Recent Trends and Mortality Outcomes Among Inflammatory Bowel Disease Patients With and Without Severe Obesity

Introduction: Inflammatory bowel disease (IBD) comprises crohn's disease and ulcerative colitis. Severe obesity (SO) is defined as body mass index (BMI) >40 kg/m2. Obesity is a known risk factor for developing IBD due to accumulation of intra-abdominal fat, cytokine production, alteration of gut microbiome contributing to mucosal inflammation. Using the National Inpatient Sample (NIS), our study examines trends and mortality outcomes among IBD patients with and without SO. Methods: The NIS database was used to identify patients (pts) aged ≥18 years with diagnosis of IBD using ICD-10 codes between 2016-2019. Chi square, ANOVA, and multivariate regression were used to compare significant associations with variables and primary outcome of mortality among pts with IBD stratified by BMI >40 (Severe Obesity-SO) and < 40kg/m2 (Non- severe obesity) . Propensity Score Matching was used to assess the effect of SO and history of bariatric surgery on the outcome of death. STATA MP 17 software was used for analysis. Results: Of the 222,203 pts meeting inclusion criteria, 13,931 (69.61% female; mean age: 54) had SO and 217,633 (55.85% female; mean age: 54) without SO (p=0.23). There was a positive temporal relationship in death rate over time and SO (p=0.00); but a significant negative relationship generally within the IBD population (p=0.02). There was a positive trend in bariatric surgery over time within the general IBD population (p=0.00) and among the IBD-SO subpopulation (p=0.00). Adjusted odds (aOR) of death were 46.73% higher among those with severe obesity compared to other BMI groups (95%CI 1.180-1.865, p=0.00). In propensity score matching analysis, there was a 2.40% higher risk of death in patients with SO compared to non-SO patients (p= 0.03). History of bariatric surgery was associated with 0.70% (p=.026) and 0.85%(p=.01) decreased risk of death in the IBD population and the SO subpopulation compared to those without a history of bariatric surgery, respectively. (Figure) Conclusion: Among IBD pts, severe obesity was associated with increased mortality compared non severe obesity. Nonetheless, bariatric surgery within the entirety of the population was associated with decreased mortality. There may be some mortality benefit associated with higher weights-possibly related to medication side effects or markers of well controlled disease as weight loss itself was associated with increased odds of mortality. More studies are warranted to analyze efficacy of bariatric surgery in other BMI groups.Figure 1.: Demographics and matched study results

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

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

S891 Risk of Cervical Dysplasia/Cancer in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Introduction: There is inconsistent and conflicting evidence regarding the risk of cervical dysplasia/cancer in patients with inflammatory bowel disease (IBD). This systematic review was conducted to determine the risk of cervical abnormalities in patients with IBD and also estimate the comparative risk with respect to the general population. Methods: We searched various databases for studies which reported about rates of cervical intraepithelial neoplasia(CIN), cervical cancer or high risk HPV in IBD patients. We also extracted the rates of CIN, cervical cancer and high risk HPV in controls. Pooled prevalence of these lesions in IBD and relative risk in IBD patients in comparison to the healthy controls was estimated. We excluded studies which did not provide relevant data. All analysis were done in R version 4.1.1 using the meta and metafor packages. The random effects model was used with inverse variance approach for pooled prevalence and M-H method for calculation of relative risk. Results: We searched Embase, Medline and Pubmed and identified 522 relevant papers on 25th April 2022. Duplicates were removed and after initial screening, 44 papers were selected for full text screening. Eventually, 9 papers (5 case control and 4 cohort studies of 53,781 patients with IBD) were included in the quantitative synthesis. The pooled prevalence of CIN, cervical cancer and high risk HPV in the IBD population was 0.04 (0.01 - 0.11, I2= 100%). Patients with IBD were at a greater risk of cervical dysplasia/cancer when compared with healthy controls (relative risk 3.01, 1.44 - 6.31, I2= 100%). Conclusion: The patients with inflammatory bowel disease are at a heightened risk of developing cervical abnormalities like CIN,cervical cancer and high risk HPV lesions as compared to normal controls. These findings point to the importance of undergoing screening at regular intervals and significance of HPV vaccination in IBD patients in aiding to reduce the risk of developing cervical cancer.

S919 Factors Associated With Cannabis Use Among Inpatients With Inflammatory Bowel Disease Exacerbation

Introduction: Opioid use for inflammatory bowel disease (IBD) has been associated with an increased risk of disease complications. Many view cannabis as a safer palliative alternative to opioids for IBD. Cannabis use is common in the IBD population and increasingly legally available both for medical and recreational use. Cannabis does not improve inflammation but may mask IBD symptoms, with an unclear impact on disease outcomes. We sought to investigate cofactors associated with cannabis use as a first step before analysis of its impact on patient clinical outcomes. Methods: We conducted a retrospective review of all adult patients admitted for an IBD exacerbation from 01/01/2016 to 03/01/ 2020 within the Northwell Health Care system. Patients were identified by either a primary or secondary ICD10 code (K50.xx, K51.xx, K52.3), limited to those with an IBD exacerbation defined by administration of IV solumedrol and/or biologic therapy. Pregnant patients and those with IBD related surgeries were excluded. A natural language search of admission documents was performed for the terms “marijuana”, “cannabis”, “pot” and “CBD”. Manual chart review was then performed to confirm cannabis use. IBD disease type, age, gender, race, anxiety, depression, alcohol and tobacco use, Charlson comorbidity index (CCI), inpatient opioid use and length of stay were defined. An adjusted analysis was performed of co-factors to determine any association with cannabis use. Results: A total of 1021 patient admissions met inclusion criteria; 47.40% with Crohn’s disease and 53.09% female, and 66.01% white. Pre-admission cannabis use was reported by 7.25% of patients and was mostly (63%) for recreational use. On multivariable analysis, younger age was associated with cannabis use, as was male gender, African American race, tobacco and alcohol use, and a diagnosis of anxiety and/or depression, Table. CCI was associated with cannabis use on univariable, but not on multivariable analysis. Conclusion: Among inpatients with IBD exacerbation, factors associated with cannabis use included age, gender, African American race, tobacco and alcohol use, along with anxiety and depression. Our findings suggest that among IBD patients, cannabis use may be less associated with disease activity than with other patient characteristics. Further analysis of the impact of Cannabis use on IBD outcomes is needed. Table 1. - Association between pre-admission characteristics and cannabis use (N=1021) Cannabis use Cannabis use (n=74), n (%) No cannabis use (n=947), n (%) Univariable OR (95% CI) p-value Multivariable OR (95% CI) p-value Patient characteristics Age (years) Mean (SD) 36.46 (15.52) 45.97 (20.41) 0.98 (0.96, 0.99) 0.0001 0.96 (0.94, 0.99) 0.0009 Gender Female 22 (29.73) 520 (54.91) 0.35 (0.21, 0.58) < 0.0001 0.28 (0.16, 0.50) < 0.0001 Male 52 (70.27) 427 (45.09) (REF) (REF) Race African American/ Black 21 (28.38) 129 (13.62) 2.51 (1.44, 4.40) 0.0012 2.83 (1.52, 5.27) 0.0011 Asian 3 (4.05) 51 (5.39) 0.91 (0.27, 3.04) 0.8757 1.12 (0.32, 3.97) 0.8622 Other/ Multiracial 9 (12.16) 134 (14.15) 1.04 (0.49, 2.19) 0.9240 1.11 (0.50, 2.47) 0.8016 White 41 (55.41) 633 (66.84) (REF) (REF) Tobacco use Current 17 (22.97) 83 (8.76) 3.31 (1.78, 6.15) 0.0002 2.95 (1.46, 5.96) 0.0025 Former 12 (16.22) 160 (16.90) 1.21 (0.62, 2.38) 0.5800 1.72 (0.79, 3.74) 0.1721 Never 36 (48.65) 581 (61.35) (REF) (REF) Unknown 9 (12.16) 123 (12.99) 1.18 (0.56, 2.52) 0.6664 1.27 (0.50, 3.21) 0.6114 Alcohol use Current 17 (22.97) 162 (17.11) 1.32 (0.71, 2.47) 0.3794 1.03 (0.52, 2.05) 0.9246 Former 6 (8.11) 18 (1.90) 4.2 (1.55, 11.37) 0.0047 3.75 (1.21, 11.59) 0.0218 Never 30 (40.54) 378 (39.92) (REF) (REF) Unknown 21 (28.38) 389 (41.08) 0.68 (0.38, 1.21) 0.1893 0.51 (0.25, 1.04) 0.0647 Clinical characteristics Anxiety Yes 14 (18.92) 91 (9.61) 2.20 (1.18, 4.08) 0.0130 2.76 (1.31, 5.81) 0.0074 No 60 (81.08) 856 (90.39) (REF) (REF) Depression Yes 12 (16.22) 53 (5.60) 3.27 (1.66, 6.43) 0.0006 4.07 (1.80, 9.20) 0.0007 No 62 (83.78) 894 (94.40) (REF) (REF) IBD type Crohn’s disease 42 (56.76) 442 (46.67) 0.67 (0.41, 1.08) 0.0961 -- -- Ulcerative colitis 32 (43.24) 505 (53.33) (REF) -- -- CCI Mean (SD) 1.35 (2.35) 2.23 (2.90) 0.87 (0.78, 0.97) 0.0124 0.97 (0.83, 1.13) 0.7044

S1021 Inflammatory Bowel Disease, Subclinical Atherosclerosis, and Cardiovascular Disease: A Case-Control Analysis

Introduction: Inflammatory Bowel Disease (IBD) is classified with other immune-mediated inflammatory diseases (IMID). Many IMID such as rheumatoid arthritis and systemic lupus erythematosus have been shown to predispose patients to atherosclerotic cardiovascular disease (ASCVD) even without traditional cardiovascular risk factors. An association between IBD and ASCVD has been reported, but is less well-defined. In addition, there is lacking data on risk of subclinical atherosclerosis in patients with IBD. Methods: We performed a case-control analysis of patients seen at a tertiary medical center who underwent coronary calcium scoring (CCS) as part of routine clinical care. Patients IBD were compared to patients without IBD for differences in CCS and development of cardiac events and/or death. Controls were randomly selected from age and sex matched lists of CCS and excluded if they had a prior history of ASCVD. The association of IBD status with time to cardiac events or death was compared using log rank tests, and Cox regression was used to estimate hazard ratios. Subjects were considered at risk from the time of CCS until they had the event of interest or were censored at last contact. Results: A total of 53 IBD case subjects [28 Crohn’s disease (CD); 24 Ulcerative Colitis (UC)] and 106 controls without IBD were included. There were no significant differences between the two groups regarding BMI, race, smoking status, statin use, diabetes, or aspirin use. The was no significant difference in CCS between the two groups (1.1 vs. 0, p = 0.59). Within the IBD population, there was no difference in the CCS between CD and UC (0 for CD and 7.5 for UC; p = 0.48). There was no significant difference in development of cardiac events or death between IBD cases and non-IBD controls (p = 0.37) during follow up. The hazard ratio for a doubling of the CCS and development of cardiac events or death was significant (HR 1.27, 95% CI 1.09-1.49; p = 0.003); however, IBD status was not found to be significant (HR 1.95, 95% CI 0.53-7.12, p =0.3). (Figure) Conclusion: IBD status does not appear to be associated with increased risk of subclinical atherosclerosis as measured by CCS. Elevation in the CCS is associated with risk of cardiac events and death; however, IBD status does not appear to be associated with risk of cardiac events and death. Larger studies are needed to further define the relationship between IBD, subclinical atherosclerosis, and ASCVD. (Table)Figure 1.: Cardiac event-free Survival in IBD cases vs. non-IBD Controls Table 1. - Demographics by IBD case/control status IBD n=53 Non-IBD n=106 P-value Age 55 56 0.97 Female 18 (34%) 34 (32%) 0.81 BMI 28 27 0.99 Race: Caucasian 53 (100% 100 (94%) 0.21 Smoker 14 (26%) 28 (26%) 1 Statin use 22 (42%) 57 (46%) 0.57 Diabetes 5 (9%) 10 (9%) 1 Aspirin Use 9 (17%) 26 (25%) 0.28

S995 Comparative Trends in Admissions and Mortality in Inflammatory Bowel Disease Patients With Alcohol and Substance Abuse: A 10-Year Retrospective National Cohort Study

Introduction: Recent data suggests that approximately 32 million Americans use illegal drugs. In addition, approximately 15 million Americans meet criteria for alcohol use disorder (AUD). Patients with chronic medical conditions, such as Inflammatory Bowel Disease (IBD), are more prone to have substance use disorder (SUD) or AUD and thus present a preventable strain on the healthcare system. Data suggests worse outcomes in IBD patients with AUD/SUD, however, no current studies assess trends in mortality, admission and healthcare costs for IBD patients with AUD/SUD. Methods: We conducted a retrospective study using the National Inpatient Sample (NIS) database, to analyze alcohol and substance abuse (opioids, cocaine, and cannabis) among the IBD population from Jan 1, 2009, to Dec 31, 2019. Inclusion criteria included IBD patients, 18 years of age or older with a primary diagnosis of alcohol or substance abuse as defined by the International Classification of Diseases (ICD) 9 (before September 2015) and 10 (after October 2015) coding systems. Results: A total of 132,894 IBD patients presented with AUD/SUD related hospitalizations for the study period. Of these patients, 75,172 (57%) were men and 57,696 (43%) were women. Length of stay (LOS) was higher in IBD patients with AUD/SUD compared to IBD patients without AUD/SUD (P < 0.001). There was an increasing trend in mean inpatient cost for IBD patients with AUD/SUD from $48,698.73 ± 1374 in 2009 to $62,672 ± 1528 in 2019 (P < 0.001). We report a 159.5% increase in hospitalizations of IBD patients with AUD/SUD, with the rate of hospitalizations increasing from 3,492 per 100,000 IBD patients in 2009 to 9,063 per 100,000 in 2019 (P < 0.001). In-hospital mortality for IBD patients with AUD/SUD increased by 129.6% (from 250 deaths per 100,000 IBD patients in 2009 to 574 deaths per 100,000 IBD patients in 2019) (P < 0.001). Conclusion: Individuals with IBD are vulnerable to AUD/SUD due to the chronic nature of the disease. IBD patients with AUD are more prone to have flares and disease progression. Opioids do not improve abdominal pain or quality of life in IBD. Our study shows that from 2009-2019, there was a tremendous increase in hospitalizations of IBD patients with AUD/SUD. AUD/SUD in the IBD population led to longer LOS, higher healthcare utilization, costs and mortality. Therefore, it is crucial to identify IBD patients who may be at risk for AUD/SUD by screening for anxiety, depression, pain or other factors leading to an impaired quality of life.Figure 1.: Rate of occurrence of alcohol or substance abuse hospitalization and associated mortality compared with mortality for non alcohol or substance abuse hospitalizations for IBD patients