Management Of IBD Patients Research Articles

Impact of an Education Programme on IBD Patients' Skills: Results of a Randomised Controlled Multicentre Study [ECIPE

Better patient knowledge on inflammatory bowel disease [IBD] could improve outcome and quality of life. The aim of this study was to assess if an education programme improves IBD patients' skills as regards their disease. The GETAID group conducted a prospective multicentre randomised controlled study. IBD patients were included at diagnosis, or after a significant event in the disease course. Patients were randomised between 'educated' or control groups for 6 months. Education was performed by trained health care professionals. A psycho-pedagogic score [ECIPE] was evaluated by a 'blinded' physician at baseline and after 6 and 12 months [M6 and M12]. The primary endpoint was the increase of ECIPE score at M6 of more than 20%. A total of 263 patients were included in 19 centres (male:40%; median age:30.8; Crohn's disease [CD]:73%). Of these, 133 patients were randomised into the educated group and 130 into the control group. The median relative increase in ECIPE score at M6 was higher in the educated group as compared with the control group (16.7% [0-42.1%] vs 7% [0-18.8%], respectively, p = 0.0008). The primary endpoint was met in 46% vs 24% of the patients in the educated and control groups, respectively [p = 0.0003]. A total of 92 patients met the primary endpoint. In multivariate analysis, predictors of an increase of at least 20% of the ECIPE score were randomisation in the educated group (odds ratio [OR] = 2.59) and no previous surgery [OR = 1.92]. These findings support the set-up of education programmes in centres involved in the management of IBD patients.

Corrigendum to: Gut epithelial impairment, microbial translocation and immune system activation in inflammatory bowel disease-associated spondyloarthritis.

Objectives Gut microbiota has been widely reported to be involved in systemic inflammation through microbial translocation and T cell activation in several diseases. In this work we aimed to investigate bacterial infiltration and epithelial impairment in the gut of patients with IBD-associated SpA (SpA-IBD), as well as the relationship of microbial translocation with immune system activation and their putative role in the pathogenesis of joint inflammation in IBD patients. Methods Tight-junction proteins (TJPs) occludin and claudin-1/-4 and bacteria were assessed by real-time PCR analysis and immunohistochemical staining of the ileum. Intestinal fatty acid binding protein (I-FABP), lipopolysaccharides (LPS), soluble CD14 (sCD14), sclerostin and anti-sclerostin antibodies (anti-sclerostin-IgG) were assayed with ELISAs and peripheral mononuclear blood cells with flow cytometry. LPS and sCD14 were used in vitro to stimulate a human osteoblast cell line. Results Compared with IBD, ileal samples from SpA-IBD patients showed bacterial infiltration, epithelial damage and downregulation of TJPs. In sera, they showed higher serum levels of I-FABP, LPS, sCD14 (the latter correlating with sclerostin and anti-sclerostin-IgG) and higher CD80+/CD163+ and lower CD14+ mononuclear cells. In vitro experiments demonstrated that only the LPS and sCD14 synergic action downregulates sclerostin expression in osteoblast cells. Conclusion SpA-IBD patients are characterized by gut epithelium impairment with consequent translocation of microbial products into the bloodstream, immune system activation and an increase of specific soluble biomarkers. These findings suggest that gut dysbiosis could be involved in the pathogenesis of SpA-IBD and it could hopefully prompt the use of these biomarkers in the follow-up and management of IBD patients.

Care of the Patient With IBD Requiring Hospitalisation During the COVID-19 Pandemic.

The management of IBD has been highly impacted in the context of the COVID-19 pandemic, with restriction of hospitalizations and unprecedented redeployment of healthcare resources. Hospital admissions of IBD patients should be limited to reduce the risks of coronavirus transmission. However, delaying hospitalization of IBD patients with severe or complicated disease may increase the risk of poor outcomes. Delaying surgery in some cases may increase the risk of disease progression, post-operative morbidity and disease complications. IBD patients who are infected with SARS-CoV-2 may have a higher risk of poor outcomes than the general population, potentially related to concomitant medications, especially corticosteroids. There is no evidence today that IBD patients with COVID-19 have worse outcomes if they receive immunosuppressant medications including thiopurines, biologics and novel small molecules. This article summarizes recommendations by the international membership of IOIBD regarding hospitalizations of IBD patients, either for active or complicated IBD or severe COVID-19, and for management of IBD patients according to SARS-CoV-2 infectious status.

Gut epithelial impairment, microbial translocation and immune system activation in inflammatory bowel disease-associated spondyloarthritis.

Gut microbiota has been widely reported to be involved in systemic inflammation through microbial translocation and T cell activation in several diseases. In this work we aimed to investigate bacterial infiltration and epithelial impairment in the gut of patients with IBD-associated SpA (SpA-IBD), as well as the relationship of microbial translocation with immune system activation and their putative role in the pathogenesis of joint inflammation in IBD patients. Tight-junction proteins (TJPs) occludin and claudin-1/-4 and bacteria were assessed by real-time PCR analysis and immunohistochemical staining of the ileum. Intestinal fatty acid binding protein (I-FABP), lipopolysaccharides (LPS), soluble CD14 (sCD14), sclerostin and anti-sclerostin antibodies (anti-sclerostin-IgG) were assayed with ELISAs and peripheral mononuclear blood cells with flow cytometry. LPS and sCD14 were used in vitro to stimulate a human osteoblast cell line. Compared with IBD, ileal samples from SpA-IBD patients showed bacterial infiltration, epithelial damage and downregulation of TJPs. In sera, they showed higher serum levels of I-FABP, LPS, sCD14 (the latter correlating with sclerostin and anti-sclerostin-IgG) and higher CD80+/CD163+ and lower CD14+ mononuclear cells. In vitro experiments demonstrated that only the LPS and sCD14 synergic action downregulates sclerostin expression in osteoblast cells. SpA-IBD patients are characterized by gut epithelium impairment with consequent translocation of microbial products into the bloodstream, immune system activation and an increase of specific soluble biomarkers. These findings suggest that gut dysbiosis could be involved in the pathogenesis of SpA-IBD and it could hopefully prompt the use of these biomarkers in the follow-up and management of IBD patients.

Real-World Use of Azathioprine Metabolites Changes Clinical Management of Inflammatory Bowel Disease

BackgroundThiopurines such as 6-mercaptopurine and azathioprine have complex metabolism, resulting in significant inter-individual differences in clinical efficacy and risk of drug toxicity, making conventional weight-based dosing inaccurate and potentially unsafe. Therapeutic drug monitoring (TDM) of thiopurine metabolites improves clinical outcomes through dose optimization and toxicity monitoring. Despite evidence for TDM, use is limited, due in part to test availability and awareness. The objectives of this study were twofold: (1) to investigate how thiopurine TDM impacts clinical management of IBD patients and (2) to evaluate proportion of patients outside therapeutic 6TGN levels or exhibiting signs of toxicityMethodsPatients who received thiopurine TDM as part of routine care underwent chart review of demographics, disease activity, medication dosing, metabolite levels, and adverse events. Changes in clinical management following TDM were measured. Additionally, we conducted a retrospective review of clinical decision making blinded and unblinded to TDM result.ResultsA total of 92 IBD patients were included. Levels of 6TGN were therapeutic in 29% of patients. 6TGN levels correlated weakly with weight-based dosing (r2 = 0.057, P = 0.02). Adverse reactions were observed in 6.5%. TDM informed clinical management in 64%. Significantly more changes to clinical management occurred in those with active disease than in remission (73% versus 48%; P = 0.02) and in those on mono- versus combination therapy (48% versus 27.5%; P = 0.03).ConclusionsTDM informs clinical decision making in over two-thirds of patients. The demonstrated poor efficacy of weight-based dosing and impact of TDM on clinical management contributes to the evidence supporting the need for greater availability and uptake of thiopurine TDM.

P301 Agreement in histologic diagnosis of preneoplastic lesions in inflammatory bowel disease: Results from a national survey in Italy

Abstract Background Inflammatory bowel diseases (IBD) are chronic inflammatory conditions of gastrointestinal tract: the inflammatory damage increases the risk of developing preneoplastic and neoplastic conditions. Therefore, a good agreement between pathologists in the detection of preneoplastic lesion is essential in the management of IBD patients, in order to decrease the risk of progression towards neoplastic lesions. An agreement study on 4 pathologists and 38 cases of dysplasia demonstrated a fair agreement (k=0.4).1 A similar study demonstrated that the lowest level of agreement in the category indefinite for dysplasia (κ = 0.251). Methods The study consisted of a survey about diagnostic agreement in a series of preneoplastic lesions of IBD-affected patients, based on digital images. The occurrence of the disease and the occurrence of dysplasia were considered in the study. The study enclosed biopsy specimens from 30 colonoscopies and 1 surgical specimen, related to 20 patients with a clinical pattern of IBD from 4 reference centres in Italy. Digital slides were uploaded in an open-source learning platform. For each endoscopy, sampling sites with similar morphology were aggregated in 54 ‘blocks’, and a series of close-ended questions about (A) the occurrence of IBD (active, in remission, absent, not evaluable) and (B) the evidence of dysplasia (LG, HG, absent, undefined) have been submitted for every block. For each case, a final comprehensive evaluation about (1) the occurrence of IBD (present, absent, unsuitable for assessment), (2) the disease classification (ulcerative colitis, Crohn’s disease, unfit for differential diagnosis, not possible for lack of clinical data), (3) the occurrence of IBD-related dysplasia (IBD with dysplasia, dysplasia not IBD-related, dysplasia untestable, absent) and (4) the classification of dysplasia (sporadic adenoma, ALM, DALM, unclassifiable) were provided. Twenty gastrointestinal pathologists from as many centres in Italy were enrolled. Results 325 of the 400 tests were successfully concluded. Agreement values Conclusion A preliminary data analysis demonstrated a good agreement about the occurrence of IBD, and a lower agreement about the occurrence of dysplasia and its classification in IBD. Analysis of the correlation between agreement and clinical-histologic parameters could provide interesting spotlights on diagnostic algorithms in this field.

P196 High frequency of undiagnosed mental illness in inflammatory bowel diseases

Abstract Background Inflammatory bowel diseases (IBD) are associated with mental disorders, which can negatively influence the course of IBD. Nonetheless, psychiatric disorder comorbidities (PDCs) remain undiagnosed in many IBD patients. The aim of this study was to assess the frequency of undiagnosed psychiatric comorbidities in IBD patients. Methods Two-hundred-thirty-seven adult IBD [136 Crohn’s disease (CD) and 101 with ulcerative colitis (UC)] outpatients were consecutively recruited in a single university hospital centre between January 2018 and June 2019. After the visit for IBD clinical evaluation, participants completed self-report questionnaires and then underwent a clinical interview by a trained psychiatrist. Results One-hundred-fourteen (48%) IBD patients had at least one undiagnosed psychiatric disorder. Forty-three (18%) patients presented a single PDC, 40 (16.8%) had two PDCs, 11 (4.6%) had 3 PDCs, 12 (5%) had 4 PDCs, 7 (2.9%) had 5 PDCs and 1 (0.4%) had 6 PDCs. PDCs were equally distributed among CD (72/136, 53%) and UC (42/101, 42%) patients. Mood disorders (54/114, 47%) and anxiety (27/114, 24%) disorders were the most common PDC; moreover, 23 (20%) patients suffered from post-traumatic stress disorder (PTSD), 3 (3%) had an obsessive-compulsive disorder, and 7 (6%) a substance abuse/dependence disorder. Fifty-nine per cent of IBD patients diagnosed with a psychiatric disorder during the study did not have a positive psychiatric anamnesis. PDCs were not related to activity, phenotype or localisation of IBD. Conclusion Psychiatric disorders are common in IBD but not related to activity, phenotype or localisation of bowel disease. Overall, these findings suggest the necessity to include psychiatric evaluation in the management of IBD patients.

P362 Prospective study of phArmaCokinetics of InFliximab during induction in patients with Crohn’s disease and ulcerative colitis (PACIFIC)

Abstract Background Loss of response (LOR) to infliximab (IFX) remains a challenge in routine management of IBD patients. We evaluated IFX high-resolution pharmacokinetics (PK) during induction with intermediate and peak PK levels. Methods This is a prospective, multicentre (n = 9), interventional study approved by EC (P2017/484). Fourteen blood samples were collected per patient from baseline to week 30. All patients were IFX naïve with active disease according to clinical, biological and endoscopy criteria. The primary outcome evaluated the inter-individual variability of IFX PK during induction and correlation with remission at week 30. In addition to trough levels (TLs), intermediate (ILs) and peak levels (PLs) were also measured and defined as drug level between two infusions and drug level early on after infusion (+2h), respectively. Remission was defined as having a Harvey Bradshaw Index (HBI) ≤ 4 and C-Reactive Protein (CRP) ≤5 for Crohn’s disease (CD), and as a clinical Mayo score ≤2 and faecal calprotectin <250 µg/g for ulcerative colitis (UC). IFX samples were measured by ELISA (Apdia) while a drug-tolerant affinity capture elution anti-infliximab assay was used to measure anti-infliximab antibodies (ATI) at weeks 6, 22 and 30. Results Demographic and baseline data of the study population are presented in Table 1. Among the 62 patients enrolled, 33.9% of patients (n = 21/62) were in remission at week 30. Eight patients dropped out due to disease worsening. Median TLs at week 6 were higher among patients in clinical remission at week 30 (p = 0.02) confirming previous observations. However, ILs at day 3 as well as PLs after the third infusion were also significantly higher in patients in clinical remission at week 30 (Figure 1a–c). ATI were detected as soon as week 6. At week 2, infliximab levels were significantly lower among patients in which ATI developed at a later time point (p = 0.006) and this observation was confirmed when measuring ILs at day 17 (p = 0.002), TLs at week 6 (p = 0.002) and ILs at week 10 (p = 0.001). Conclusion This multicentre prospective study demonstrates that intermediate levels as early as day 3 predict remission at week 30 in IBD patients. Low IFX levels during induction were correlated to future ATI development. PK modelling may allow to better select patients early on for sustained remission with infliximab.

P091 Factors Predicting Compliance With Passive and Active Monitoring in Inflammatory Bowel Disease Patients

BACKGROUND: Updated goals of management of IBD patients include monitoring disease activity, yet compliance with such strategies is poorly studied. We are performing a multi-year study of patients with active and quiescent IBD to assess the utility of a wearable, continuously active biosensor and validating disease activity with scheduled stool (calprotectin) and serum (CRP) testing. This study assessed compliance with these passive and active monitoring strategies. METHODS: Patients with diagnosed IBD were recruited for a prospective study using a biosensor (Fitbit Alta HR, San Francisco, CA) and mobile application (Litmus Health, Austin, TX). Each patient was instructed to wear a biosensor for a one-year period with stool sample drop-offs and blood draws for the first 6 months. The biosensor collected step count, sleep time, and heart rate during the study. Compliance was calculated as the number of days of heart rate, step count, and sleep data received over the duration of the study measured in days. Compliance was defined as ≥80% data collection in the time studied. A t-test was performed to determine the significant difference (P < 0.05) in compliance based on age, sex, disease activity, and body mass index (BMI); and between day time and night time wear. RESULTS: A total of 40 patients were analyzed; 23 men (57.5%), 24 with ulcerative colitis (60%), and 20 in remission (50%). 28 patients were <50 years of age (70%). The average BMI was 26.5 kg/m2. Overall, there was a 78% biosensor compliance rate among IBD patients. 45% of patients in clinical remission were compliant in stool drop-offs, while 60% of patients with clinically active disease were compliant in stool drop-offs (P > 0.05; 95% CI: -14.8 to 41.39). There were significant differences between biosensor compliance at night (57%) and day (98%) (P < 0.01; 95% CI: 0.31 to 0.5) and active disease (P < 0.01; 95% CI: -1.13 to -0.80). There was no significant difference in compliance and sex (P > 0.05; 95% CI: -0.53 to 0.11), age (P > 0.05; 95% CI: -11.14 to 7.84), and BMI (P > 0.05; 95% CI: -3.62 to 5.57). There were insufficient data to analyze compliance in answering questionnaires. CONCLUSION(S): In this study, patients were more compliant wearing the biosensor during the day than during the night and were more compliant if they had clinically active disease. In future studies, it will be important to provide an incentive and intervention to promote compliance in both active and passive monitoring strategies.

Implication of Medical Treatment for Surgical Strategies in IBD.

Despite changing medical paradigm, still a significant proportion of patients with IBD require surgery. The patient's general condition, including nutritional status and the use of immunosuppressive medications is of great importance with regard to surgical complications, as well as the choice of optimal surgical strategy. The indication and the timing of surgery are key factors for the multidisciplinary management of IBD patients. The purpose of this review is to provide an overview on the impact of medical treatment on surgical strategies in IBD.

Systematic review with meta-analysis: risk factors for thiopurine-induced leukopenia in IBD.

Thiopurine-induced leukopenia, a frequently observed and potentially life-threatening adverse event, complicates the clinical management of IBD patients. To assess risk factors for thiopurine-induced leukopenia in IBD. MEDLINE, EMBASE, BIOSIS and Cochrane library were searched for studies reporting at least one risk factor for thiopurine-induced leukopenia. Pooled odds ratio (OR) was calculated for each potential risk factor using a random effects model. Studies that were not eligible for meta-analysis were described qualitatively. Seventy articles were included, 34 (11229 patients) were included in meta-analyses. A significantly higher thiopurine-induced leukopenia risk was found for TPMT (OR 3.9, 95% [CI] 2.5-6.1) and for NUDT15 R139C (OR 6.9, 95% CI 5.2-9.1), G52A (OR 3.2, 95% CI 1.3-7.9) and 36_37ins/delGGAGTC variant carriers (OR 5.6, 95% CI 2.8-11.4). A potential association between high 6-thioguanine nucleotides (6-TGN) or 6-methylmercaptopurine (6-MMP) levels and leukopenia was observed, since most studies reported higher metabolite levels in leukopenic patients (6-TGN: 204-308 (Lennard method) and 397 (Dervieux method), 6-MMP: 4020-10450pmol/8 x 108 RBC) compared to controls (6-TGN: 170-212 (Lennard method) and 269 (Dervieux method), 6-MMP: 1025-4550pmol/8 x 108 RBC). TPMT and NUDT15 variants predict thiopurine-induced leukopenia. High 6-TGN and 6-MMP levels might induce leukopenia, although exact cut-off values remain unclear. Potential preventive measures to reduce the risk of thiopurine-induced leukopenia include pre-treatment TPMT and NUDT15 genotyping. Routine thiopurine metabolite measurement might be efficient, yet cut-off levels must be validated in advance.

Multiple Cytokine Profiling: A New Model to Predict Response to Tumor Necrosis Factor Antagonists in Ulcerative Colitis Patients.

Ulcerative colitis (UC) is a form of inflammatory bowel disease, and antibodies against tumor necrosis factor (anti-TNF) are used for treatment. Many patients are refractory or lose response to anti-TNF, and predicting response would be an extremely valuable clinical tool. Unlike most biomarkers, cytokines directly mediate inflammation, and their measurement may predict the likelihood of response or no response. Serum samples were obtained from 49 UC patients before infliximab infusions, and levels of 17 cytokines were measured using a multiplex assay. The Fisher linear discriminant analysis (FLDA) was applied to the cytokine values to predict which patients would respond to infliximab. "Response" was defined as clinical remission after the third infusion, and "no response" was defined as lack of remission after the third infusion. The Fisher linear discriminant analysis model identified a subset of seven predictor cytokines: TNF-α, IL-12, IL-8, IL-2, IL-5, IL1-β, and IFN-γ. The obtained canonical coefficients enabled to calculate discriminant scores as linear combinations of the cytokines; model classified thepatients as responders and nonresponders with a sensitivity of 84.2% and a specificity of 93.3%. Overall, the yield of the FLDA model was 89.8% of the total 49 patients. An unbiased, statistically derived, predictive model based on measurement of serum cytokines before therapy may predict a positive or negative outcome from the administration of anti-TNF to UC patients. Because accurately measuring cytokines is simple and inexpensive, the model may be a valuable new tool to complement other laboratory parameters used in the management of IBD patients.

Health-related quality of life of patients with inflammatory bowel disease in Singapore.

Background/AimsInflammatory bowel disease (IBD) is associated with considerable impairment of patients’ health-related quality of life (HRQoL). Knowledge of factors that significantly affect IBD patients’ HRQoL can contribute to better patient care. However, the HRQoL of IBD patients in non-Western countries are limited. Hence, we assessed the HRQoL of Singaporean IBD patients and identified its determinants.MethodsA prospective, cross-sectional study was conducted at Singapore General Hospital outpatient IBD Centre. The HRQoL of IBD patients was assessed using the short IBD questionnaire (SIBDQ), Short Form-36 physical and mental component summary (SF-36 PCS/MCS) and EuroQol 5-dimensions 3-levels (EQ-5D-3L) and visual analogue scale (VAS). Independent samples t-test was used to compare HRQoL between Crohn’s disease (CD) and ulcerative colitis (UC). Determinants of HRQoL were identified through multiple linear regression.ResultsA total of 195 IBD patients (103 UC, 92 CD) with a mean disease duration of 11.2 years were included. There was no significant difference in HRQoL between patients with UC and CD. Factors that significantly worsened HRQoL were presence of active disease (b=−6.293 [SIBDQ], −9.409 [PCS], −9.743 [MCS], −7.254 [VAS]), corticosteroids use (b=−7.392 [SIBDQ], −10.390 [PCS], −8.827 [MCS]), poor medication adherence (b=−4.049 [SIBDQ], −1.320 [MCS], −8.961 [VAS]), presence of extraintestinal manifestations (b=−13.381 [PCS]), comorbidities (b=−4.531 [PCS]), non-employment (b=−9.738 [MCS], −0.104 [EQ-5D-3L]) and public housing (b=−8.070 [PCS], −9.207 [VAS]). ConclusionsThe HRQoL is impaired in this Asian cohort of IBD. The magnitude of HRQoL impairment was similar in UC and CD. Clinical characteristics were better determinants of patients’ HRQoL than socio-demographic factors. Recognizing the factors that impact patients’ HRQoL would improve the holistic management of IBD patients.

PGI7 - The Place of Ehealth Interventions in the Management Pathway of Inflammatory Bowel Disease (Ibd) Patients: A Systematic Review

Electronic-health (eHealth) interventions are becoming increasingly important in the management of IBD patients, with increasing evidence suggesting improved disease and patient outcomes and reduced resource use. Interventional studies were systematically identified via MEDLINE and EMBASE databases. Studies were identified by two independent reviewers following pre-specified study selection criteria. Studies were included if they assessed any eHealth intervention and reported outcomes related to quality of life (QoL), disease activity, adherence or patient satisfaction. Twenty five studies met the inclusion criteria of the review. Five assessed tele-monitoring technologies based on faecal calprotectin (FC) as a biomarker of disease activity, allowing for remote patient monitoring; five looked at the impact on patient and disease outcomes of educational websites and mobile applications. Five of the studies were interventional, comparing the impact of eHealth interventions with a standard of care follow-up. Quality of life and patients satisfaction outcomes were commonly reported (n=7 and n=6, respectively). Cost and resource utilisation impact of eHealth interventions was reported in two studies. Overall eHealth intervention were reported to improve patient satisfaction in general as well as compared to standard of care monitoring. Similarly, QoL was reported significantly higher among patients who were under eHealth intervention. Mixed results across assessed interventions were reported for other outcomes such as adherence and improvements in disease activity. The use of eHealth interventions is likely to be a key development in the future management of chronic diseases such as IBD. Although there is currently no specific consensus on preference of technology, the benefits for patients and health systems across interventions are becoming increasingly clear. Better quality research is needed to show robust benefits from eHealth interventions.

Therapeutic Drug Monitoring in Pediatric IBD: Current Application and Future Perspectives.

as the paradigm for IBD management is evolving from symptom control to the more ambitious goal of complete deep remission, the concept of personalized medicine, as a mean to deliver individualized treatment with the best effectiveness and safety profile, is becoming paramount. Therapeutic drug monitoring (TDM) is an essential part of personalized medicine and its role in the management of IBD patients is rapidly expanding. to review the current knowledge that poses the rationale for the use of TDM, and the present and future role of TDM-based approaches in the management of pediatric IBD. literature review. the concept of TDM has been introduced in the field of IBD along with thiopurines, over a decade ago, and evolved around anti-TNF therapies. TDM-based strategies proved to be costeffective in the management of patients with loss of response to biologics and, more recently, proactive TDM to optimize drug exposure has been shown to reduce treatment failure and drug adverse events. The role of TDM with new biologics and the usefulness of software-systems support tools to guide drug dosing are now under investigation. Therapeutic drug monitoring has the potential to maximize the cost-benefit profile of therapies and is becoming an essential part of IBD management.

P156 Differential characteristics of patients with inflammatory bowel disease onset in paediatric age compared with patients diagnosed in adulthood: Results from the CAROUSEL study of GETECCU

Population-based studies comparing the characteristics of paediatric IBD with IBD diagnosed in the adulthood are scarce. The aims of this study were (i) To compare the characteristics of IBD in patients diagnosed during childhood (≤16 years) with those from patients diagnosed in adulthood; (ii) to compare the incidence rate of initiation of immunosuppressants, biologic agents and surgery between both groups; and (iii) to evaluate the impact of the age at diagnosis on the initiation of immunosuppressants, biological agents and surgery. IBD patients from the ENEIDA registry—a large prospectively maintained Spanish database promoted by the Spanish Working Group in Crohn’s and Colitis (GETECCU), were included. In order to minimise the heterogeneity in the management of IBD patients, the inclusion was limited to those diagnosed after 1998, when the fist biological agent was approved for IBD in Europe. Patients diagnosed at ≤16 years comprised the paediatric cohort (PC), and those diagnosed >16 years were the adult cohort (AC). The cumulative incidences of immunosuppressive therapy, biological therapy and surgery, were estimated using Kaplan–Meier curves, which were compared by the log-rank test. Cox-regression analysis was performed to identify potential predictive factors to receive immunosuppressants, biological agents or surgery. From 35925 patients, there were 1630 paediatric cases (4.5%) and from them, 56 (3.4%) were very-early-onset IBD (<6 years). Median follow-up was 91 months in the PC and 72 months in the AC. The proportion of Crohn’s disease (CD), ileocolonic involvement and inflammatory behaviour at diagnosis was higher in the PC (Table 1). In the multivariate analysis, after adjusting for gender, type of IBD, extra intestinal manifestations, family history and smoking habit, the PC was associated with higher risk of immunomodulator use (hazard ratio [HR] = 1.47, 95% confidence interval [95% CI] = 1.38–1.58) and higher probability of receiving biologic treatment (HR = 1.53, 95% CI = 1.42–1.66). However, paediatric IBD was not associated with higher risk of surgery (Table 2). Paediatric IBD has differential characteristics in comparison with adult IBD. In addition, paediatric IBD seems to be associated with higher use of immunosuppressant and biologics during follow-up. Nevertheless, paediatric IBD is not associated with higher risk of surgery.

P099 RESPONSE OF HEPATITIS B VACCINATION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE; PROSPECTIVE OBSERVATIONAL STUDY IN KOREA

Testing for hepatitis B virus (HBV) serologic markers and appropriate vaccination are required in management of IBD patients. We evaluated the immnunogenicity for HBV in IBD patients and response of HBV vaccination those with non-immune state against HBV. From May 2014 to August 2016, patients older than 15-year old, diagnosed with IBD, and negative for anti-HBs antibody, anti-HBc antibody, and HBs antigen were prospectively included. Patients who had completed the three-time HBV vaccination received a single booster vaccination, while patients who had not completed vaccinations or had unclear memory received a full series of vaccination. Optimal level of response was defined as serum anti-HBs ≥10mlU/ml. Among 73 patients (28 ulcerative colitis (UC), 45 Crohn’s disease (CD); 49 male, 24 female), 44 patients received the booster vaccination and 29 received the full series vaccination. Optimal response was obtained in 70.5% (53.8% UC, 77.4% CD, P = 0.155) in the booster group, and 89.7% (93.3% UC, 85.7% CD, P = 0.598) in the full vaccination group. Age younger than 26 years (odds ratio [OR], 5.20; 95% confidence interval [CI], 1.05-25.71; P = 0.043) and complete previous vaccination (OR, 0.17; 95% CI, 0.03-0.85; P = 0.031) were associated with optimal vaccine response. Complete previous vaccination history ((OR, 0.14; 95% CI, 0.02-0.82; P = 0.029) was only predictive factor for lower compliance of recommend vaccination. The response of HBV vaccination was lower in patients older than 26 years and those with complete previous vaccination. As the patients with complete previous vaccination also has poor compliance, serum HBV-titer should be checked more strictly, and full vaccination should be administered in the case with negative response for booster vaccination.

Animal models for the study of inflammatory bowel diseases: a meta-analysis on modalities for imaging inflammatory lesions.

Inflammatory bowel diseases are lifelong disorders affecting the gastrointestinal tract characterized by intermittent disease flares and periods of remission with a progressive and destructive nature. Unfortunately, the exact etiology is still not completely known, therefore a causal therapy to cure the disease is not yet available. Current treatment options mainly encompass the use of non-specific anti-inflammatory agents and immunosuppressive drugs that cause significant side effects that often have a negative impact on patients' quality of life. As the majority of patients need a long-term follow-up it would be ideal to rely on a non-invasive technique with good compliance. Currently, the gold standard diagnostic tools for managing IBD are represented by invasive procedures such as colonoscopy and histopathology. Nevertheless, recent advances in imaging technology continue to improve the ability of imaging techniques to non-invasively monitor disease activity and treatment response in preclinical models of IBD. Novel and emerging imaging techniques not only allow direct visualization of intestinal inflammation, but also enable molecular imaging and targeting of specific alterations of the inflamed murine mucosa. Furthermore, molecular imaging advances allow us to increase our knowledge on the critical biological pathways involved in disease progression by characterizing in vivo processes at a cellular and molecular level and enabling significant improvements in the understanding of the etiology of IBD. This review presents a critical and updated overview on the imaging advances in animal models of IBD. Our aim is to highlight the potential beneficial impact and the range of applications that imaging techniques could offer for the improvement of the clinical monitoring and management of IBD patients: diagnosis, staging, determination of therapeutic targets, monitoring therapy and evaluation of the prognosis, personalized therapeutic approaches.

P277 Comparative accuracy of US versus MRI and colonoscopy in assessing disease activity and complications and influencing the decision-making process in Crohn's disease

Background: Bowel ultrasound (US) and MRI are accurate in assessing disease activity and complications in Crohn's disease (CD) patients. The comparative accuracy of US versus MRI + endoscopy in assessing disease activity and complications and influencing the decision-making process in Crohn's disease is unknown. Methods: Ileo-colonic CD consecutive patients seen in a tertiary referral Center (Humanitas Research Hospital, Milan, Italy) were prospectively assessed by magnetic resonance imaging (MRI), colonoscopy (CS), and US, within 1 week. Sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) of US in assessing localization and extension, bowel wall enhancement (increase of vascularization at color Doppler), bowel wall thickening (>3 mm), strictures (narrowing of the lumen), fistulas and abscesses, and active disease (presence of ulcers at colonoscopy) were calculated using CS in combination with MRI findings as a reference standard. Two independent blinded IBD specialists reviewed separately MRI and US findings, and were asked to decide the therapeutic strategy (continue therapy vs. optimize/change therapy). Kappa agreement between MRI and US was also investigated. Results: Forty-one consecutive CD patients, irrespectively of disease activity and current therapy, were enrolled. Twenty-five patients had active disease as assessed by MRI and colonoscopy (60.9%), 16/41 (39.1%) had CD-related complications. Sensitivity, specificity, accuracy, PPV and NPV of US are showed in Table 1. Based on US findings alone when compared to MRI and CS, the management of IBD patients (continuing or changing/optimizing therapy) was judged accurate in 85% of patients compared to 75% managed by MRI only (p<0.001). Agreement between MRI and US findings was 80% (p<0.001). Table 1. Performance of US in assessing disease activity and complications Conclusions: US was as accurate as the combination CS + MRI in assessing disease activity and complications. Therapeutic decisions based on US findings alone were appropriate in the vast majority of CD patients. US is a non-invasive, easy-to-use tool to manage CD patients in clinical practice.

Results of the first survey for the current status of inflammatory bowel disease management in Asian countries.

Results of the first survey for the current status of inflammatory bowel disease management in Asian countries.