Inflammatory Bowel Disease Unit Research Articles

P0229 Evaluation of anorectal function and structure in patients with perianal Crohn's disease with a novel 3-D high-definition anorectal manometry technology

Abstract Background Crohn’s disease (CD) is a type of inflammatory bowel disease (IBD) that can have perianal involvement with a fistulizing phenotype (PFCD) and could affect anal sphincter integrity, leading to morbidity and reduced quality of life (QoL) due to fecal incontinence (FI) and rectal pain. High-definition 3D anorectal manometry (HD-ARM) is a novel technique that allows volumetric imaging of the anal canal through 2D and 3D images, enabling visualization of morphology and identification of pressure defects caused by lesions in the sphincter complex. There are no studies in patients with IBD with this modality of manometry. Our aim is to determine the functional and structural abnormalities of the sphincter complex using HD-ARM in patients with CD with and without PFCD and to correlate these findings with magnetic resonance imaging (MRI) results. Methods This is a prospective, longitudinal cohort study of anorectal function using HD-ARM and rectal sensitivity using rectal barostat in patients with CD from our IBD unit. Patients were recruited during follow-up visits regardless of whether or not they reported anorectal symptoms. Findings were correlated with clinical activity of CD (Harvey Bradshaw index), PFCD activity index (PDAI), FI severity index (Jorge-Wexner and St. Marks scores), QoL scores (IBDQ-9 for IBD and FIQLS for FI), and perineal MRI to confirm anatomical abnormalities. Results A total of 19 patients were recruited from December 2023 to September 2024, 68.4% of whom were female. Among patients with PFCD (68.4% of the total), 84.6% had undergone some form of anorectal surgery. Only two patients from the total cohort (10.5%) had normal HD-ARM results. The main manometric diagnoses were: rectal hypersensitivity (36.8%), rectal hyposensitivity (31.6%), internal anal sphincter insufficiency (weakness) (21.1%), incomplete evacuation maneuvers (21.1%), and dyssynergic defecation (15.8%), with no significant differences between the groups with and without PFCD. In 90% of patients with PFCD, MRI findings correlated with the presence or absence of pressure defects on the HD-ARM. Patients with pressure defects on the HD-ARM had higher FI scores on the Jorge-Wexner (7.5 vs. 3.3) and St. Marks (9 vs. 5) scores, although this difference did not reach statistical significance (p=0.07). No differences in quality of life or luminal/perianal disease activity index were found in association with manometric alterations. Conclusion Anorectal sphincter function abnormalities are common in patients with CD, with or without concomitant perianal disease. HD-ARM is a useful tool to correlate functional anorectal abnormalities with anatomic abnormalities on perineal MRI. References Eglinton TW, Barclay ML, Gearry RB, et al. The spectrum of perianal Crohn’s disease in apopulation-based cohort. Dis Colon Rectum 2012;55:773–7. Felt-Bersma, R.J.F., Vlietstra, M.S., Vollebregt, P.F. et al. 3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound. BMC Gastroenterol 18, 44 (2018) R Costache, A Dimitriu, A Les, C Gheorghe, P027 Anorectal Motility Disorders in Inflammatory Bowel Disease patients, Journal of Crohn's and Colitis, Volume 17, Issue Supplement_1, February 2023, Page i197 De Codes LMG, de Jesus ACC, de Codes JJG, Ferreira RF, da Silva Beda Sacramento C, da Cruz IDM, de Castro Ribeiro Fidelis F, de Carvalho AL, Motta MP, de Oliveira Alves C, Netto EM, Santana GO. Anorectal function and clinical characteristics associated with fecal incontinence in patients with Crohn's disease. J Crohns Colitis. 2023 Mar 23:jjad048

P0441 Vitamin D seasonal fluctuation is more prominent in inflammatory bowel disease patients undergoing advanced therapies

Abstract Background The influence of Vitamin D (vitD) has been investigated in inflammatory bowel disease (IBD) patients to see how might affect disease activity. VitD is expected to be lower in winter and higher in summer due to sun exposure. The effect of VitD in IBD patients is thought to be similar to that in healthy subjects. The aim of the study was to evaluate fluctuation of vitD in IBD patients undergoing different treatments during two consecutive seasons. Methods IBD patients (both ulcerative colitis (UC) and Crohn’s disease (CD)) were recruited from two IBD units in Northern Spain and followed-up for at least 6 months. Patients who were being treated with supplement vitD or oral steroids were excluded. Patients with comorbidities that could interfere with vit D, such as advanced kidney disease, were also excluded. Clinical data regarding IBD activity and vitD was collected during two separate seasons (summer from June to September and winter from December to March). For this evaluation we assumed the vitD fluctuation (using mean values) in the general population to be normal. Frequency of vitD fluctuation in IBD patients undergoing advanced therapies and standard treatment were compared with that of the general population using Chi-Square test. Results We followed-up 199 IBD patients (both UC and Crohn’s disease) for at least 6 months. Most patients were in clinical and biochemical remission (77% in winter and 76% in summer had fecal calprotectin <150 microg/g). IBD patients undergoing advanced therapies n=90 (biologics and antiJaks) were compared to IBD patients undergoing standard treatments n=104 regarding vitD fluctuation. Usind data from the general population we established a normal fluctuation of 2.8 ng/ml of vitD from season to season in our cohort (that is we expected at least a 2.8 ng/ml increase from winter to summer and a less than 2.8 ng/ml decrease from summer to winter). VitD fluctuation comparable to the general population was observed in 24% of patients undergoing advanced therapies, which is less frequent than in those undergoing standard treatment (48%). This result was statistically significant (p= 0.0067) Conclusion The difference in seasonal fluctuation of vitD was significantly more prominent in IBD patients undergoing advanced therapies than in those undergoing standard treatment. Patients undergoing standard treatment had a similar VitD fluctuation to that of the general population.

P0218 Dietary Inflammatory Index and disease activity in patients with IBD: is there an association? A Preliminary Analysis

Abstract Background Inflammatory bowel disease (IBD) is increasing in incidence in recently industrialized and developing countries, and this increment is paralleled by Westernization of lifestyle.1 In fact, specific nutrients and additives instigate gut inflammation and increasing evidence demonstrates its impact on developing IBD and disease behavior.2,3 Dietary Inflammatory Index (DII) was developed to assess the inflammatory properties of a diet.4 The aim of this study is to assess the association between higher DII scores and disease activity in patients with ulcerative colitis (UC) and Crohn’s disease (CD). Methods A cross-sectional study was conducted from June to October 2024. Patients undergoing ambulatory treatment at a day care IBD unit were consecutively recruited. A self-applied semiquantitative food frequency questionnaire, validated for the adult Portuguese population, was applied and medical charts reviewed. Blood and feces were collected, and anthropometric parameters measured by a body composition analyzer (Tanita DC-430MA). DII score was calculated according to the Shivappa et al. method, using 30 parameteres.4 The primary outcome was to assess the association between DII scores and 4 disease activity levels defined by clinical and biological activity markers (table 1). Clinical activity was classified according to Mayo Partial score for UC and Harvey-Bradshaw index (HBI) for CD. Biological activity was evaluated through fecal calprotectin. Results A total of 100 IBD patients (37 UC, 61 CD and 2 non-classified) were included; mean age 43.47 ±16.03 years, 41% female. Mean disease duration was 9.72±7.62 years. Baseline characteristics are described at table 2. Mean DII score was 1.49±2.43. The calculated DII score was categorized into quartiles. Comparison of calprotectin, CRP and Mayo Partial score by DII quartile was performed using Kruskal-Wallis test, and HBS using one-way ANOVA. No statistically significant correlations were found. Chi-square test for the association between activity levels and DII quartiles showed no statistically significant differences (p 0.496 DC; p 0.492 UC). Conclusion An association between DII scores and disease activity was not observed. Further studies with larger and more homogeneous samples are needed in the future to clarify the utility of this score in clinical practice. Given the undeniable and growing importance of these tools, other scales should also be studied and validated in IBD population.

P0352 Fecal calprotectin and pseudopolyps in Ulcerative Colitis: Is there a relationship?

Abstract Background Fecal calprotectin (FC) is the main biomarker of inflammatory bowel disease (IBD). Pseudopolyps are lesions that arise after repeated episodes of inflammation following healing processes. The impact of the presence of pseudopolyps on FC levels in patients with ulcerative colitis (UC) is not established. The aim of the study was to analyze FC levels in relation to the presence of pseudopolyps and to investigate the association between these and the risk of relapse. Methods Retrospective study of patients with UC followed up at the IBD unit of a tertiary hospital. We selected adult patients in clinical and endoscopic remission (Mayo endoscopic score 0-1), with a quality screening colonoscopy between 2015 and 2024. Demographic, clinical, analytical and endoscopic variables were analyzed. Results The study included 147 patients with UC, of whom 51 (35%) presented pseudopolyps. Patients with pseudopolyps had a significant proportion of extensive UC, hospitalizations due to UC, and use of immunomodulators and biological drugs. The median FC levels pericolonoscopy were 32 µg/g (IQR 15-53) in those with pseudopolyps and 28 µg/g (IQR 20-42) in those without (P = 0.464). There were also no differences in CF levels according to the use of NSAIDs (P = 0.722) or PPIs (P = 0.945). The median follow-up was 23 months (IQR 13-45). The presence of pseudopolyps was not associated with a greater risk of clinical relapse during follow-up (P = 0.425), neither the time to relapse (P = 0.937). In contrast, the condition of ex-smoker or non-smoker (P = 0.003) and extensive UC (P = 0.007) were associated with relapse. Conclusion In patients in clinical and endoscopic remission, the presence of pseudopolyps is not associated with higher levels of fecal calprotectin neither an increased risk of clinical relapse in the medium term.

P0816 Dietary habits of ulcerative colitis patients under follow-up in a Pediatric Inflammatory Bowel Disease Unit

Abstract Background A Western dietary pattern characteristics was suggested to have a role in the pathogenesis of ulcerative colitis (UC). Poor dietary pattern can exacerbate the patients’ symptoms and lead to significant nutrient deficiencies. However, data regarding dietary habits and nutritional needs are scarce. Our study aimed to prospectively evaluate dietary intake and habits in peadiatric patients with UC at a Spanish tertiary hospital. Methods In this prospective observational study, peadiatric UC patients were followed up, during which their dietary habits were collected. Patients were asked to complete the KIDMED questionnaire for adherence to the Mediterranean diet (MD) and a 3-day food diary. The degree of food processing was assessed using the NOVA classification system, which classifies all food products into four main groups. Results A total of 47 patients were included, with a mean age of 11.9±3.3 years (57% female), and a median follow-up of 2.8±5.4 years. The mean caloric intake was 1919.07 ± 292.8 kcal, and 55.31% of patients did not cover their energy requeriments. Protein and saturated fat intake exceeded the recommended daily intake (RDI): mean protein intake was 2.13±0.8g/kg (239.06% of RDI), and saturated fatty acids was 31.65±7.9% of total fat. In contrast, fiber, calcium and iron intake were below recommendations: mean fiber was 13.44±2.9g (75.1±24.7% of RDI), calcium was 457.7±239.3mg (41.6±26.2% of RDI) and iron 8.3±3.4mg (75.3±37.2% of RDI). The average KIDMED score was 6.2 points, with only 15 patients (31.9%) presenting high adherence to the MD. Of the remaining patients, 26 (55.3%) needed to improve their diet quality, and 6 (12.7%) had very low diet quality. Regarding the NOVA classification, 7 patients (14.9%) consumed more than 40% of their total energy from ultra-processed foods (NOVA 4), while 23 (48.9%) had less than 40% of their energy intake coming from unprocessed or minimally processed foods (NOVA 1). Conclusion Our results highlight that a substantial proportion of pediatric UC patients have suboptimal dietary patterns, characterized by high intake of UPF and saturated fats, alongside low intake of fiber, calcium, and iron. These findings suggest a need for tailored follow-up with a specialized dietitian within the multidisciplinary care team. Further research is essential to clarify the impact of diet on UC.

P1241 Identification and characterization of patients with Crohn's disease and complex perianal fistulas using Natural Language Processing and machine learning: INTUITION-CPF Study.

Abstract Background Crohn’s disease (CD) is an inflammatory condition that can cause perianal fistulas (mostly complex), affecting 26-35% of CD patients. There is no gold-standard treatment for perianal disease, leading to significant unmet needs. This study uses Artificial Intelligence (AI) to analyze electronic medical records (EMRs) to identify and characterize CD patients with complex perianal fistulas (CPF). It offers an overview of patient characteristics, treatment patterns, and CPF incidence in CD patients attending inflammatory bowel disease units in Spain. Methods INTUITION-CPF is a national, multicenter, retrospective study. EMRs of patients with CD, diagnosed or not with CPF (overall CD population) from January 2015-December 2021, were reviewed and processed using an AI analysis based on machine learning and Natural Language Processing (NLP). There were two phases in the study. Phase 1: NLP-identified patients with CD+CPF were manually validated to assess sensitivity and specificity; and Phase 2: characteristics, treatments and visits to departments were analysed in eligible patients with CD+/-CPF. Here, we present results from the phase 2. Results A total of 2,182 patients with CD were identified. Median age (range) was 51 years (21-105). 263 patients (12%) suffered from CPF, of which 70% experienced pain, 48% active (suppurative) disease, and 28% perianal abscesses. The estimated annual incidence of CPF among CD patients was 1.6%. Patients with CD+CPF had more medical treatments (91%) compared to overall CD patients (74%). Proportion of patients receiving biologics was near double for CD+CPF compared to overall CD patients (41% vs 21%) with infliximab the most frequently used (26%) (Table 1). 13% of the overall CD population had ≥1 surgery, compared with 36% of patients with CD+CPF. The main surgeries in patients with CD+CPF included seton placement (14%), advancement flap surgery (FLAP) (16%) and ostomy (13%) (Table 1). Hospitalisation (≥24h) was required for 49% of overall CD patients vs 64% of those with CPF. Gastroenterology (73%) was the most frequently visited department, followed by surgery (31%) and emergency departments (27%) (Figure 1). Conclusion This study demonstrates that CD patients with CPF require more complex and multidisciplinary management, including more biological treatments and surgeries, and exhibit higher hospitalization and emergency visit rates compared to overall CD patients.Inconsistencies with the existing literature highlight the opportunity to further enhance NLP techniques to achieve more accurate outcomes.

MSCT enterography score for prediction of disease severity in patients with active ulcerative colitis

BackgroundUlcerative colitis (UC) is a chronic non-specific inflammatory bowel disease (IBD). It is characterized by diffuse inflammatory process of the bowel mucosa with a relapsing course. The precise evaluation of UC severity is pivotal in the therapeutic decision-making. Modified Mayo score is consistently used for the evaluation of the disease activity which depends on the patient’s symptoms as well as the colonoscopic findings. The aim of this study is to assess the role of the CT enterography (CTE) scoring system in the evaluation of the disease severity in ulcerative colitis. From October 2022 to July 2023, 66 patients with known ulcerative colitis patients at time of disease activity were referred from the inflammatory bowel disease unit for radiological assessment by CTE. CT images were analyzed to determine the anatomical location of the affected bowel segments, mucosal thickening and hyperenhancement as well as the extra-enteric involvement. Correlation with the modified Mayo score was established.ResultsOur results showed a statistical significant correlation between modified Mayo score and CTE with a P value of 0.000. The correlation coefficient is r = 0.964. The cut-off value of the optimal CTE score to predict mild and moderate UC was 7.5 with 0.996 area under the ROC curve, 92%sensitivity and 100% specificity. The cut-off value of the optimal CTE score to predict moderate and severe UC was 10.5 with 0.983 area under the ROC curve, 90.6% sensitivity and 100% specificity.ConclusionsCTE is a reliable diagnostic method in the systematic assessment of the disease severity of active ulcerative colitis. CTE score shows a strong proportionate correlation with modified Mayo score. The aggravation of the course of the disease increased the CTE score. CTE scoring system can help plan the therapeutic strategy and predict prognosis.

Self-care in patients affected by inflammatory bowel disease and caregiver contribution to self-care (IBD-SELF): a protocol for a longitudinal observational study

IntroductionSupporting patient self-care and the contribution of their caregivers is crucial in chronic illness care. Inflammatory bowel disease (IBD) is a chronic condition whose prevalence is expected to double, especially...

Descriptive observational study on the use of virtual reality in patients with inflammatory bowel disease undergoing biological treatment

Virtual reality (VR) is a neurosensory experience in which simulated spaces a person has the sensation of being able to function within them. Some patients with inflammatory bowel disease (IBD) receive intravenous biological treatments in an Adult Day Hospital (ADH) regime. VR has been used in some fields of medicine, demonstrating its usefulness in reducing negative symptoms. However, we do not have any literature showing the applicability in real clinical practice of VR in IBD. Descriptive observational pilot study based on an initial cohort of 87 patients that were obtained from the ADH of the IBD Unit. Satisfaction and acceptance of VR through the use of 3D glasses and the reduction of negative symptoms during intravenous biological treatment in patients with IBD in ADH have been assessed. 43 patients (52.4%) used VR and completed the study. In the comparative analysis of the results of the questionnaires before and after the use of VR, a statistically significant improvement was observed in the patients' view on the ability of VR to achieve a reduction in stress (65% patients improve; p: 0.0021) and pain (VAS, 54% p. improve; p<0.05) during treatment. Likewise, with the applicability of VR in other areas of medicine (53%; p: 0.05) and with the possibility of improving well-being during the stay in the ADH (56%; p: 0.0014). No side effects were reported with the use of the 3D glasses. VR is a useful complementary tool to improve the stay of patients with IBD on ADH during intravenous treatment.

Surgical outcomes in ileal Crohn's disease complicated by ileosigmoid fistula.

The management of Crohn's disease (CD) complicated by ileosigmoid fistula (ISF) remains a challenge, and Australian outcomes have not previously been reported. A retrospective review of a tertiary colorectal inflammatory bowel disease unit, across public and private sites, from 2005 to 2023 to identify adult patients having undergone operative management of ISF. Twenty-nine patients underwent surgery for ISF in the study period. Seventeen were male and the median age was 40 years. The pre-operative diagnosis of ISF was made in 76%, and patients were more likely to undergo resectional surgery if the pre-operative diagnosis was made endoscopically. Sixty-nine percent of cases were performed electively, with 76% completed laparoscopically with an 18.5% conversion rate to an open approach. The ISF was oversewn in three patients, repaired primarily in 14 patients, managed with segmental wedge resection in eight patients and resected via an anterior resection in four patients. The rate of stoma formation at the index procedure was 20.7% overall and 22% in patients being acutely managed with steroids. Emergent cases were more likely to be defunctioned with a stoma. Morbidity was 17.2% with a single anastomotic leak. ISF in CD remains difficult to diagnose pre-operatively, but can be safely managed laparoscopically without formal resection, and with limited use of diverting stoma formation. The specific surgical approach to the sigmoid in ISF is difficult to pre-determine and often requires decisions to be made intra-operatively.

P1023 Variability in Mesalazine Management for Ulcerative Proctitis Include Doses, Route of Administration and Use of Fecal Calprotectin: Insights from Clinical Practice Across Spain Beyond Clinical Guidelines

Abstract Background Despite universal use of mesalazine in ulcerative colitis treatment, many aspects of clinical practice remain unclear or are not even addressed in clinical guidelines, leading to significant variations in mesalazine management among clinicians. We aimed to gather different approaches of mesalazine use in ulcerative proctitis (UP). Methods After discussion of a clinical case, a predefined questionnaire was anonymously answered throughout a series of meetings held at 10 different locations in Spain. Results were categorized according to experience levels and inflammatory bowel disease (IBD) focus. Results 259 IBD treating gastroenterologists were engaged; 84% had &amp;lt;10 years of experience and 25% had a specific focus on IBD. Most participants (84%) manage UP based on clinical symptoms (i.e. fecal urgency). In case of a clinically moderate-severe UP, 81% would initiate treatment with high dose of combined mesalazine, while 11% proposed only suppositories. 60% of participants would assess response at 4 weeks. If clinical remission achieved, 85% would use fecal calprotectin (FC) to assess deep remission. Upon initial failure of combined mesalazine treatment at standard dose, 59% attempt optimizing mesalazine doses, while 38% add beclomethasone dipropionate. Younger physicians without specific focus on IBD prefer modifying mesalazine doses (70.5% vs 37.1%), (P=0,006), whereas more experienced physicians with monographic dedication prefer adding beclomethasone dipropionate (60% vs 29.4%), (P=0,006). For maintenance therapy (oral or topical mesalazine) the most important drivers in therapeutic decision-making were severity of the initial flare (40%) and patient preferences (36%). After a moderate-severe flare of UP, 80% would recommend maintenance therapy with high dose oral mesalazine and 3 suppositories/week. For monitoring, less experienced physicians and those not working in IBD units more frequently relied only on clinical parameters (26.6% vs. 8.7%, p=0.01), using FC to a lesser extent (73% vs. 88%, p=0.1) compared to more experienced and IBD focused physicians. In the case of elevated FC in asymptomatic patients, 49% would prefer to scope, while 47% increase mesalazine dose directly. The preferred high dose of mesalazine was 4g (55%) or 4-5g (44%). 73% would not reduce the dose upon achieving remission. Only 75% actively investigate therapeutic adherence. Conclusion Management of mesalazine in UP patients is highly heterogeneous, and clinical guidelines do not address all issues arising in clinical practice. Nevertheless, clinicians in our setting often use high oral and rectal mesalazine doses for both induction and maintenance and they commonly monitor patients using FC.

P1135 Increased prevalence of migraine in women with inflammatory bowel disease: a cross-sectional study

Abstract Background Data on a possible comorbidity between migraine and inflammatory bowel disease (IBD) are controversial. Our aim was to determine the prevalence of migraine in a cohort of IBD patients. Methods We performed a cross-sectional study in a cohort of IBD patients at our IBD Unit. After informed consent, consecutive IBD patients aged 18-64 years were interviewed. Those who admitted a history of headache in the last year were asked to answer the three questions of the id-Migraine validated questionnaire. Those who answered "yes" to the three of them were classified as "definite" migraine and those who answered "yes" to two were classified as "probable" migraine. For all patients we collected demographic data, IBD subtype, disease duration, hospitalizations or surgeries and medical treatments. Migraine prevalence data of IBD patients were compared with reported local migraine prevalence data at 18-65 years of age (Cephalalgia 2011; 31: 463-70). Statistical analysis was done with SPSS®. Results We interviewed 283 consecutive IBD patients aged 20-65 years. Main characteristics of this population are described in table 1. Headache was present in 176 (62.2%) patients. Of those, 59 (20.8%; 95% CI 16.1-25.5%) met migraine criteria either definite (n= 33; 11.7%; 95% CI 8-15.4%) or probable (n=26; 9.2%; 95% CI 5.8-12.5). When divided by gender, 12 men (9.6%; 95% CI 4.4-14.) and 47 women (29.8%; 95% CI 22.7-36.9%) met migraine criteria. The prevalence of migraine was significantly increased in IBD patients (20.8%) versus that reported for our general population (12.6%; p= 0.0001). By sex, these differences remained significant in women (29.8% in IBD versus 17.2% in our general population; p=0.0001), but not in men (9.6% in IBD vs 8.0%; p=0.45) (Figure 1). By IBD subtypes, there were no significant differences between CD and UC in migraine prevalence (20.7% vs 19.6% respectively; p=0.58). Regarding IBD characteristics, men with total migraine had higher biologic treatment (66.7% vs 44% p=0.032), and immune mediated inflammatory diseases or extraintestinal manifestations of IBD (33.3% vs 9.6% p=0.0016), but the number of men with migraine was low (12). These associations were not significant for women, nor overall population (p&amp;gt;0.05). Additionally, we did not find any significant association in total migraine patients in the use of mesalazine, disease duration, immunomodulators, surgeries or hospitalizations, neither in total number of patients nor stratified by sex. Conclusion Migraine prevalence is higher in patients with IBD than general population, which is a further example of the bidirectional gut-brain interaction. The fact that this association was stronger for women suggests an influence of sex-related factors. ISCIII PI20/01358 and FEDER.

N30 Development and implementation of a microlearning programme for patients with Inflammatory Bowel Disease. The ADEII project

Abstract Background Information and communication technologies (ICTs) represent a novel approach to chronic disease management. However, their use in Inflammatory Bowel Disease (IBD) is lacking, as no specific tools are available. Microlearning is a pedagogical concept that facilitates learning by breaking down concepts into micro-contents, which can be easily integrated into everyday activities. We aimed to develop a microlearning programme for IBD patients and implement it in clinical practice. Methods Prospective cohort study in patients with IBD (18 to 70 years old) who underwent a microlearning programme over a 2-month period, Four-minute videos recorded by IBD unit´s own staff, and organised in individualised pathways.were sent via mobile phone. The interaction with the user was maintained through a Telegram bot that uses methods from the Django REST API for content sequencing. The basic sequencing consists of a video followed by 4 quiz questions. Depending on the answers, the user receives more questions, additional content on the same topic or moves on to the next video. We conducted a final survey about the information shown in the videos. All the contents can be found on the website: https://adeii.webs.uvigo.es/ This QR links to the promotional video of the ADEII project (Figure 1). Results We recorded 24 videos about IBD and treatment and another 2 about patients´personal experiences. Between 1 June and 31 October 2022, 1226 videos were sent to 200 IBD patients: 103 females (51.5%), mean age 46.1 (13) years, 105 ulcerative colitis (52.5%), and time from IBD diagnosis 13 (10) years. (Table 1). All patients received by their smart-phone the 4-video main pack, consisting of 2 videos with information about their disease (ulcerative colitis or Crohn's disease), 1 video on adherence and another one on corticosteroids. To these we added as many videos as the number of drugs that each patient used to control IBD. Mean number of videos per patient was 6 (1), range (5-9) and their distribution is shown in Figure 1. Seven patients declined to participate in this course because of fear of information and one left the study. Altogether 156 patients (78%) attended this microlearning programme, 117 fully (58,5%). A telephone contact, planned to solve technical incidents or doubts, rose the attendants to 170 (90%), 152 (76%) fully. After the course, 72,5% of the participants (145) answered correctly more than 83% of the questions based on the IBD information included in this programme. Conclusion A microlearning ICT-based course was widely accepted by IBD patients, and can increase the knowledge about their disease. However there are acceptance and technological barriers that must be taken into account when approaching it.

P1114 Integral care of the non-Spanish speaking migrant population in inflammatory bowel disease units

Abstract Background In recent years, given the change in the paradigm of management of Inflammatory Bowel Disease (IBD), the different societies have been working to ensure continuous, homogeneous, multidisciplinary social and health care with the patients and their autonomy as the central axis; promoting the creation of Integrated Care Units for IBD patients (ICU-IBD). In the latest analyses of our ICU, attention was drawn to the progressive increase in the demand for care from non-Spanish-speaking migrant patients. This prompted us to carry out this study, with the aim of finding out how this population uses our unit and how it responds to their needs. Methods A retrospective longitudinal descriptive observational study with analysis of demographic, clinical and care variables of all non-Spanish-speaking migrant patients followed in the ICU-IBD of our centre until 30 June 2023. Results Thirty patients of 14 different nationalities were included, with Moroccan being the most frequent (43.3%); only one of them (3.3%) was fluent in Spanish. Other clinical and demographic characteristics of note were: mean age at follow-up of 43.2 years, predominantly female (66.6%) and predominantly Crohn's disease (63.3%) (Table 1). A total of 86.7% of the patients were referred to our ICU-IBD from the Emergency Department, which they attended due to symptoms related to flare-ups of their intestinal disease. After the initial assessments, we observed that 73.3% did not attend for check-ups, 83.3% of the patients attended the emergency department in the event of a clinical flare-up, and 93.3% showed irregular adherence to treatment. In the subsequent follow-up, we observed a significant change, 76.7% regularly attended consultations, 76.7% consulted the unit in the event of an outbreak and 60% followed treatment regularly (Figure 1). These changes coincide with a socio-health intervention carried out by the specialised nurse; in which patients and their environment were provided with information regarding their disease, treatment and use of the UAI-EII; as well as addressing socio-health problems in order to facilitate their wellbeing and integration into the community. Conclusion In view of our results and the data published in other studies, we suggest that the language barrier, the social and healthcare culture of the country of origin, the socioeconomic situation and integration into the new social environment are factors to be taken into account in order to achieve adequate comprehensive care for this migrant population. The role of the IBD nurse is fundamental in the daily work of offering individualised, continuous and comprehensive care to both the patient and their environment; even more so in this population with marked socio-cultural barriers.

P367 Are patients with Inflammatory Bowel Disease and two or more associated Immune-Mediated Inflammatory Diseases different from those with no or one associated disease?

Abstract Background It is well known that immune-mediated inflammatory diseases (IMIDs) are frequently diagnosed in patients with inflammatory bowel disease (IBD). However, few studies have taken into account whether the number of associated IMIDs influences IBD. Our aim was to evaluate the clinical, demographic, and drug needs of patients with IBD based on the number of other IMIDs they present. Methods Cross-sectional study that included patients treated at the IBD Unit of the Central University Hospital of Asturias (Spain) between August 2020 and December 2021. Demographic data and disease characteristics were collected and IMID diagnosis was confirmed in the medical records of each patient. Patients were split into three groups: non-IMID, 1-IMID, and two or more associated IMIDs. Hospitalizations, drugs and surgery requirement were analyzed. The comparison between groups was carried out using the Kruskal-Wallis test, and Pearson's Chi-square test or Fisher's exact test. When there was a significant difference between any of the groups, a post-hoc test was performed with p-value correction following the Benjamini and Hochberg method. Results A total of 1,620 patients were included in the analysis. 1,067 (66%) had no IMID, 394 (24%) had one IMID, and 159 (9.8%) had two or more IMIDs. Overall, the most frequent IMIDs were spondylarthritis (14%), psoriasis (7.5%), erythema nodosum (4.3%), intrinsic asthma (2.8%), and uveitis (2.5%). The presence of an IMID was associated with older age, longer duration of IBD, female sex, and Crohn's disease (Table 1). The use of steroids, immunomodulators, and biologics, as well as the need for hospitalizations, was higher in patients with several IMIDs. When we analyzed the groups of patients with one and with two or more IMIDs, the only significant differences were a longer duration of disease, a greater prevalence of Crohn's disease, and a higher use of steroids, immunomodulators, and biologics among patients with two or more IMIDs. The percentage of patients with joint (spondylarthritis, psoriasic arthritis, juvenile idiopathic arthritis), cutaneous (psoriasis, hidradenitis suppurative, erythema nodosum, pyoderma gangrenosum) and ocular (uveitis and episcleritis) IMIDs and intrinsic asthma was higher in the group with two or more IMIDs than in the group with one IMID. Conclusion 10% of patients with IBD have two or more associated IMIDs. The duration of IBD and the need to use steroids, immunomodulators and biologics is greater than in patients with one IMID.

P559 Descriptive observational pilot study about the use of Virtual Reality (VR) in patients with Inflammatory Bowel Disease (IBD) and biological treatment

Abstract Background Virtual reality (VR) is a neurosensory experience in which simulated images and spaces are created where a person has the sensation of being and being able to function within them. A high percentage of patients with Inflammatory Bowel Disease (IBD) receive intravenous biological treatments in a day hospital (HDD) regime. VR has been used in some fields of medicine, such as Oncology, demonstrating its usefulness in reducing chronic symptoms such as pain or anxiety. However, we don’t have any literature demonstrating the applicability of VR in IBD. Methods Descriptive observational pilot study based on an initial cohort of 87 patients obtained from the HDD of the IBD Unit. Satisfaction and acceptance of VR through the use of 3D glasses and the reduction of negative symptoms during intravenous biological treatment in patients with IBD in HDD have been assessed. Results 43 patients (52.4%) used VR and completed the study. The mean age was 45.3 years. The validated IBDQ-32 questionnaire on quality of life in IBD obtained a mean score of 169 points (range: 32-224). In the comparative analysis of the results of the questionnaires before and after the use of VR, a statistically significant improvement was observed in the patients' view of the ability of VR to achieve a reduction in stress (65% patients improve; p: 0.0021) and pain (VAS, 54% p. improve; p&amp;lt;0.05) during treatment. Likewise, with the applicability of VR in other areas of medicine (53%; p: 0.05) and with the possibility of improving well-being during the stay in the HDD (56%; p: 0.0014). No side effects were reported with the use of the 3D glasses. Conclusion The use of VR could be a useful complementary tool to improve the stay of patients with IBD on HDD during treatment with intravenous biologic drugs. To this end, we believe it is appropriate to complete our research and obtain more data through other studies along the same lines.

Transition from intravenous to subcutaneous biological therapies in inflammatory bowel disease: An online survey of patients.

The transition from in-hospital intravenous administration to subcutaneous therapies to treat inflammatory bowel disease (IBD) can raise some concerns among patients due to the self-administration concerns, the management of potential side effects and the overall worries related to a change of treatment. This study aimed at evaluating patients' opinion about the switch from intravenous to subcutaneous formulations and their knowledge on new available therapeutic options. We conducted a survey using a questionnaire prepared by a team of gastroenterologists and nurses working at the IBD unit. It consists of 31 items and has been divided into four sections: descriptive, commitment, knowledge and passage mode opinion. The questions were formulated in Italian and conceived according to daily consultations with patients in everyday practice, without any previous piloting or specific medical literature reference. The survey was administered to consecutive IBD patients in intravenous biological treatment; patients currently or previously treated with subcutaneous therapy were excluded. Four hundred questionnaires were distributed to participants. As many as 311 patients (77.7%) completed the survey, while the remaining were excluded from the analysis; 155 (49.8%) patients were favorable to switch from intravenous to subcutaneous therapy, while only 78 (25.1%) disagreed. In univariate and multi-variate analysis, the approval rate for home therapy was significantly associated with the distance from the IBD center and work/family/personal commitments. Surprisingly, only a quarter of the IBD patients knew that almost all available therapeutic agents have a subcutaneous administration route. Regarding patients' opinion on the efficacy of subcutaneous administration of biological agents compared to intravenous drugs, 194 (63%) had no definite idea, while 44 (14%) believed that the effectiveness could be reduced. The transition from in-hospital to subcutaneous therapeutic management of biological therapy at home was generally viewed favorably by patients, especially if they have commitments or were residents far from the IBD center.

Evaluation of emergency hospital admissions for inflammatory bowel disease as a possible marker of quality of care of British IBD inflammatory bowel disease units

BackgroundKey performance indicators (KPIs) are required to facilitate quality improvement for inflammatory bowel disease (IBD). Emergency admissions for IBD may represent a possible KPI.MethodsIBD emergency admissions for 2018–2019 from Hospital...

Does cardiovascular risk matter in IBD patients?

Cardiovascular and thromboembolic risks are increasing in the population as a whole and therefore also in inflammatory bowel disease (IBD) patients. Obesity is a worldwide challenge also affecting the IBD population, and a causal association with Crohn's disease may exist. IBD itself, particularly when active, is also associated with a significant risk of thromboembolic and cardiovascular events such as myocardial infarction and stroke. Cardiovascular risk is also a significant consideration when using Janus kinase (JAK) inhibitors and sphingosine 1 phosphate (S1P) receptor modulators to treat IBD. JAK inhibitors - such as tofacitinib - are associated with several cardiovascular and venous thromboembolic risks, including hypertension and alterations in lipid profiles - specifically, increased LDL cholesterol and triglycerides - which may contribute to atherosclerosis and cardiovascular disease. S1P receptor modulators pose a slightly different set of cardiovascular risks. Initially, these drugs can cause transient bradycardia and atrioventricular (AV) block, leading to bradycardia. Moreover, they may induce QT interval prolongation, which increases the risk of life-threatening arrhythmias such as torsades de pointes. Some patients may also experience hypertension as a side effect. In this context, IBD healthcare providers need to be alert to the assessment of cardiovascular risk - particularly as cardiovascular events appear to be confined to specific patient groups with pre-existing risk factors. In addition, the potential for S1P modulator drug interactions requires a higher level of vigilance in patients with polypharmacy compared to biologics. Cardiovascular risk is not static, and updated assessment will need to become part of the routine in many IBD units.

Crohn's Disease Exclusion Diet for the Treatment of Crohn's Disease: Real-World Experience from a Tertiary Center.

The Crohn's Disease (CD) exclusion diet (CDED) has been shown to induce remission in pediatric and adult patients with CD. In this retrospective cohort study, we describe our real-world experience with the CDED at the inflammatory bowel disease (IBD) unit of the Tel Aviv Medical Center between 2018-2021. CD patients with multiple clinical presentations and disease phenotypes who initiated the diet were included. Indications for treatment, medical and nutritional data were collected from dietician clinic visits and medical records. Clinical and biomarker responses were determined. The CDED was recommended to 220 CD patients. Seventy-two patients were included in the analysis for a clinically active disease (n = 48) or for remission maintenance (n = 24). Among patients with a clinically active disease, 62.5% of patients achieved clinical remission at week 6 and at week 12. A positive association between high adherence to the CDED and clinical remission at week 12 was observed (adjusted OR = 7.6, 95% CI 1.07-55.2, p = 0.043). Among patients treated for remission maintenance, remission at week 12 was maintained among 83.3% of patients. We conclude that the CDED may be a promising intervention for multiple CD presentations and indications. These findings should be further validated in larger, prospective, controlled studies.