Monitoring Of Inflammatory Bowel Disease Research Articles

P714 Comparison of intestinal microbiota profiles of faecal samples, rectal swabs and mucosal biopsies in patients with Inflammatory Bowel Disease. A multicentre, observational study

Abstract Background Since the gut microbiota is altered in patients with Inflammatory Bowel Disease (IBD), microbiome-based biomarkers may be useful for diagnosing and monitoring of IBD. Currently, endoscopy is the gold standard for diagnosis and monitoring disease activity, which can be a high burden for patients. This study aimed to compare intestinal microbiota profiles between three different sampling methods faecal samples, rectal swabs and colonic mucosal biopsies. This could provide more insight into the microbiota composition in different sample types and might contribute to the development of a less invasive biomarker for diagnosing and monitoring IBD. Methods Patients with IBD (Crohn’s Disease or Ulcerative Colitis) who were scheduled for endoscopy were asked to participate. Prior to bowel preparation, a fecal sample and rectal swab were collected. During colonoscopy, mucosal biopsies were derived 20 cm ab ano. Microbiota composition was analyzed by IS-pro, a PCR technique based on species-specific differences in the 16S-23S interspace region of the bacterial ribosomal DNA. Microbiota profiles of the three different sample types were compared within the same patient (for each patient: fecal sample vs. mucosal biopsy, fecal sample vs. rectal swab, rectal swab vs. mucosal biopsy), and between different patients (for each patient: fecal sample of one patient vs. mucosal biopsies of all patients, fecal sample of one patient vs. rectal swabs of all patients, etcetera). Results A total of 200 patients were included. For each patient, similarity of microbiota composition between two sample types was assessed by calculating the Pearson’s correlation (expressed as R2). R2 values of all patients were combined in boxplots. We found a significantly higher correlation between the microbiota profiles of different sample types within the same patient, than between microbiota profiles of different sample types of different patients (median R2 0.27–0.33 and 0.02–0.03 respectively, Figure 1). However, correlation between different sample types from the same patient was still relatively low. The highest correlation was found between microbiota profiles of faecal samples and rectal swabs (median R2 0.33, ICR 0.17–0.54). On phylum level, the highest correlation was found in the Bacteroidetes phylum (Figure 2). For a global analysis of all versus all samples, we generated a clustered heat map, which confirmed the previous finding that microbiota profiles from faecal samples and rectal swabs were most similar to each other. Conclusion Microbiota composition in different sample types from the same patient were more similar to each other than to profiles from different patients. Microbiota profiles of faecal samples and rectal swabs were most identical.

A systematic monitoring approach to biologic therapies in inflammatory bowel disease: patients’ and physicians’ preferences and adherence

Objectives Treatment of patients with inflammatory bowel disease (IBD) should aim at achieving mucosal healing. However, monitoring schedules to support this goal remain undefined. We aimed to identify patients’ and physicians’ preferences regarding monitoring strategy and investigated the feasibility of such a strategy. Methods Elements considered relevant for monitoring were identified in questionnaire surveys among 1) patients with IBD receiving biologic agents (n = 172) and 2) their physicians (n = 87). Adherence to a monitoring strategy incorporating these elements was investigated in a retrospective cohort of patients with IBD treated with biologic agents (n = 139). Results Patients considered blood and stool samples, endoscopies, and magnetic resonance imaging (MRI) to be relevant aspects of monitoring their disease. However, patients also considered stool samples and endoscopies unpleasant. Physicians considered blood samples (99%), medical consultations (99%), fecal calprotectin (85%), endoscopy (78%), and MRI (71%) to be important aspects of IBD monitoring but considered endoscopies and MRI relevant only at clinical signs of relapse. A review of the clinical use of monitoring strategies including the elements identified above revealed high adherence for blood samples and disease activity indices (92%), but low adherence for fecal calprotectin (38%), therapeutic drug monitoring (38%), and endoscopies (32%). Conclusion Important tools for evaluating mucosal healing (e.g., endoscopy) were rated highly unpleasant by patients, and physicians found endoscopies/MRI relevant only in case of relapse. These findings were reflected by low rates of adherence to use of these monitoring tools. In defining monitoring schedules to help achieve treatment goals, these important barriers must be addressed.

Association of Fecal Calprotectin With Endoscopic and Histologic Activity in Pediatric Inflammatory Bowel Disease

Objectives: Fecal calprotectin (FC) is a noninvasive marker of intestinal inflammation used for screening and ongoing monitoring of inflammatory bowel disease (IBD); it is unclear the association of specific FC values with disease activity. The aim of our study was to examine the association of FC values with endoscopic and histologic severity. Methods: We performed a retrospective chart review of patients who had FC done between 30 days and 1 day before colonoscopy at our institution. IBD patients were graded using the simple endoscopic score for Crohn’s disease or Mayo endoscopic score for ulcerative colitis. Histologic slides were graded using the Geboes method. Results: Three-hundred thirty-one patients were included in the study and 107 had IBD. For endoscopy, median FC was lowest for all IBD patients with no disease (181 μg/g) and highest in severe disease (921 μg/g), with significant difference between no disease and moderate and severe disease (P = 0.019, 0.003), and between mild and severe disease (P = 0.012). For histology, median FC was lowest with no disease (328 μg/g) and highest in severe disease (895 μg/g), with significant difference between no disease and moderate and severe disease (P = 0.021, 0.018). The control population had a significantly lower median FC than the IBD population in endoscopic remission (35.5 versus 181 μg/g; P = 0.018). Conclusions: There was a linear increase in FC values associated with increasing disease severity in the undifferentiated IBD cohort. Values for IBD patients in endoscopic remission were significantly different from our control population. FC may be a useful noninvasive marker to assess disease severity.

E-Health and remote management of patients with inflammatory bowel disease: lessons from Denmark in a time of need.

In Denmark, remote monitoring and management of inflammatory bowel disease (IBD) started two decades ago with the web application Constant Care. The disease monitoring in Constant Care consists of simple disease activity questionnaires and home measurement of faecal calprotectin, a stool biomarker for inflammation. It has now been implemented in clinical practice at North Zealand University Hospital in Denmark. Digital health care solutions facilitate remote contact between patients and healthcare providers and have been shown to reduce time to remission, outpatient visits and hospital admissions, and increase adherence to medical therapy, quality of life and disease and treatment knowledge. In Australia, E-Health is an area of increasing interest, particularly given the significant distances travelled by rural patients to access specialist care. There are several foreseeable benefits to incorporating E-Health/remote monitoring into Australian IBD management, including reduced burdens of time and cost on rural patients, and more efficient management of well outpatients, thereby increasing clinic availability for acutely unwell patients. The significant portion of IBD patients managed in private practice in Australia, and the infrastructure within private practice that is well suited to implementation of E-Health makes Australia a viable setting for an E-Health IBD management model like Denmark's Constant Care model. One pilot study is currently underway investigating the feasibility of rapid and remote IBD monitoring and E-Health in an Australian IBD population. The current COVID-19 pandemic has further illustrated the importance of telehealth as a means of maintaining health services to patients in geographic, or social, isolation.

P229 Standardization of Quantum Blue® rapid TDM assays with WHO international standards for adalimumab and infliximab

Abstract Background Therapeutic drug monitoring of inflammatory bowel disease (IBD) patients under anti-TNF therapy is based on trough level determination of the drug. Rapid assays and multiple ELISAs are available that measure anti-TNF biologics. An international standard is required to improve comparability among different assays. Recently, WHO introduced anti-TNF standards for adalimumab (ADL) and infliximab (IFX). A WHO international reference material (IRM) based standardization is crucial for the harmonization of assays available on the market. Methods The aim of the study was to standardize the BÜHLMANN Quantum Blue® ADL and BÜHLMANN Quantum Blue® IFX based on the WHO IRM for ADL and IFX, respectively. A value transfer from the WHO reference material to the internal calibrator sets for both assays was based on a protocol previously described by Blirup-Jensen et al. (Clin Chem Lab Med 2001; 39(11):1110–1122) and by means of a commercially available ELISA. A method comparison of the ELISA and the rapid test was carried out before the value transfer to guarantee comparability of both assays. Additionally, the correlation of the WHO IRM with the currently used calibrator material was determined for ADL. The correlation of the WHO IFX standard (NIBSC 16/170) with the currently used calibrator material was presented recently (Keller et al. 2020, UEGW 2020). Calibration curves were generated with BÜHLMANN ADL calibrators and with calibrators made from WHO IRM for ADL (NIBSC 17/236). Serum samples, covering a concentration range from 1.0 to 35 µg/mL, were analysed with both calibration curves and compared by Bland-Altman and Passing-Bablok analysis. Results A preliminary value transfer study revealed an relative uncertainty of 12.3% for both drugs. A good comparison of the ADL and IFX rapid test and the ELISA is given: Passing-Bablok correlation coefficient (R) of 0.953 (ADL) and 0.942 (IFX), and a mean bias determined by Bland-Altman of 1.59 µg/mL (ADL) and -0.5 µg/mL (IFX), respectively. The sample values gained with BÜHLMANN calibrators showed an excellent correlation with values gained with the WHO international standard for ADL as calibrator. Passing-Bablok regression analysis revealed a slope of 1.3 and correlation coefficient (R) of 1.0. Conclusion To the best of our knowledge, the Quantum Blue® ADL and Quantum Blue® IFX, are the first commercially available quantitative lateral flow assays comprising a WHO based standardization. Additionally, it was demonstrated that the current standardizations of Quantum Blue® ADL correlates very well with the WHO international standard for ADL.

Point-of-care faecal calprotectin testing in patients with paediatric inflammatory bowel disease during the COVID-19 pandemic

ObjectivesFollowing the disruption of normal paediatric inflammatory bowel disease (IBD) services during the peak of the COVID-19 pandemic, we prospectively audited the first-time use of home faecal calprotectin testing. We...

How Valuable are Noninvasive Tests as ‎Indicators of IBD Activity and Severity in ‎the Primary Health Care‎ ‎

Background and study aims: Inflammatory bowel disease (IBD) is a chronic inflammato­ry and destructive disease of the bowel wall. Chronic inflammation is associated with ulcerations, strictures, perforations and is a risk factor for dysplasia and cancer. To reduce these long-standing complications, IBD patients are continuously in a need for treatment and monitoring. Primary health care centers lack specific IBD management facilities although they receive a reasonable number of IBD patients. Markers, such as ESR, CRP, fecal calprotectin (FC) have been widely used as noninvasive parameters for IBD monitoring. The aim of the current study was to evaluate readily available non-invasive tests (FC, ESR, Platelets, serum total proteins, serum albumin and hemoglobin level) in predicting IBD activity and severity in the primary health care‎‎‎. Patients and Methods: This prospective study included 96 newly diagnosed IBD patients. Patients from many primary health care ‎centers covering the landscape of Kafr-Elshikh governorate in the North of Egyptian Nile delta after giving ‎complete history, clinical examination, and laboratory investigation were referred to IBD clinic at ‎Kafrelsheikh University Hospital for assessment and ileoclonoscopy with biopsies‎.‎ Results: Seventy-eight (81.2%) patients were ulcerative colitis and 18(18.8%) were Crohn's disease, with mean age ‎was 34.40 and 30.94 years respectively (P 0.380).FC, serum total proteins, ESR and HB level showed ‎statistically significant difference between baseline levels and levels at time of remission. However, platelet ‎count and serum albumin were not statistically different. The mean FC level at the time of diagnosis was ‎‎823.61±545.457μg/mg and after remission was 165.18±202.255μg/mg (P 0.000)‎‎‎‎. Conclusion: Markers (FC, ESR, serum total proteins and HB level) can be used as non-invasive markers for monitoring ‎IBD activity and severity in the primary health care centers. Fecal calprotectin correlate with endoscopic ‎disease activity. Furthermore, the initial level of FC is a predictor of early dysplasia in ulcerative colitis ‎patients‎ ‎‎.

A157 REAL-WORLD TIGHT OBJECTIVE MONITORING WITH ADALIMUMAB LEADS TO EARLIER DOSE OPTIMIZATION AND HIGHER CLINICAL REMISSION RATES AT 12 MONTHS.

Abstract Background Data suggests that tight objective monitoring of inflammatory bowel diseases (IBD) may improve one-year clinical outcomes. Aims The goal of this study is to assess the adherence to serial tight objective monitoring, via clinical symptoms and biomarkers, and the effect of such tight monitoring on one year outcome in IBD patients at an academic and an university-affiliated center. Methods We retrospectively reviewed the chart of 428 consecutive IBD patients who started adalimumaby at the McGill University Health Center and Jewish General Hospital (Montreal, Canada) between January 1, 2015 and January 1, 2019 [338 Crohn’s disease(CD), 90 ulcerative colitis(UC)]. Clinical symptoms (assessed by Harvey-Bradshaw-Index and partial Mayo), C-Reactive Protein(CRP), and fecal calprotectin(FCAL) were captured at treatment initiation and at 3, 6, 9, and 12 months. Combined adherence was defined as the evaluation of ≥2 of 3 parameters(clinical, CRP, FCAL). Dose optimization and drug sustainability curves were plotted by Kaplan-Meier method. Results Clinical symptoms were assessed in nearly all patients at 3 (CD-UC:95-94%), 6 (90-83%), 9 (86-85%) and 12 (96-89%) months. CRP was also available for most patients but the frequency of assessment decreased in CD patients over the study period. In comparison, compliance to serial FCAL testing was low throughout the follow-up period. Clinical remission at one-year was significantly higher in patients who were adherent to early assessment visit at 3 months (p=0.001 both for CD and UC). Adherence to early follow-up also resulted in earlier dose optimisation in both CD and UC patients(pLogrank=0.026 for UC and p=0.09 for CD). However, the overall drug sustainability did not differ. Conclusions Clinical assessment and CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Adherence to early objective combined follow-up visits resulted in earlier dose optimization and improved one-year clinical outcomes but did not change drug sustainability rates. Funding Agencies None

The Use of Fecal Calprotectin Testing in Paediatric Disorders: A Position Paper of the European Society for Paediatric Gastroenterology and Nutrition Gastroenterology Committee.

The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children. A literature search was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors. A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9-point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9. Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch-Schönlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.

Detection of fucosylated haptoglobin using the 10-7G antibody as a biomarker for evaluating endoscopic remission in ulcerative colitis.

BACKGROUNDInflammatory bowel disease (IBD) is a chronic, relapsing inflammation of the digestive tract. Although fecal and serum biomarkers have been extremely important and supportive for monitoring of IBD, their low sensitivity and high variability characteristics limit clinical efficacy. Thus, the establishment of better biomarkers is expected. Fucosylation is one of the most important glycosylation modifications of proteins. Fucosylated haptoglobin (Fuc-Hpt) is used as a biomarker for several cancers and inflammation-related diseases. We recently established a novel glycan monoclonal antibody (mAb), designated 10-7G, which recognizes Fuc-Hpt. We developed an enzyme-linked immunosorbent assay (ELISA) to measure serum levels of Fuc-Hpt (10-7G values).AIMTo investigate the usefulness of the serum 10-7G values as a potential biomarker for monitoring disease activity in IBD.METHODSThis was a case control study. Intestinal tissues of IBD patients (n = 10) were examined immunohistochemically using the 10-7G mAb. We determined 10-7G values using serum from patients with ulcerative colitis (UC, n = 110), Crohn’s disease (n = 45), acute enteritis (AE, n = 11), and healthy volunteers (HVs) who exhibited normal (n = 20) or high (n = 79) C-reactive protein (CRP) levels at medical check-up. We investigated the correlation between the 10-7G value and various clinical parameters of IBD patients by correlation analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the usefulness of the 10-7G values as a biomarker for clinical and endoscopic remission of UC compared to conventional serum biomarkers.RESULTSIn the immunohistochemical analysis, positive 10-7G mAb staining was observed in lymphocytes infiltrating into inflammatory sites of the mucosal layer and lymphoid follicles. The 10-7G values were significantly higher in patients with IBD (P < 0.001) and AE (P < 0.05) compared with HVs. In addition, 10-7G values were correlated with clinical examination parameters related to inflammation in patients with UC, particularly the CRP level (rs = 0.525, P = 0.003) and clinical activity index score (rs = 0.435, P = 0.038). However, there was no correlation between 10-7G values and CRP in HVs with high CRP levels, suggesting that the 10-7G values is not the same as a general inflammation biomarker. ROC curve analysis showed that area under the curve (AUC) value of 10-7G values for the diagnosis of endoscopic remission was higher than other biomarkers (AUC value = 0.699).CONCLUSIONThe serum 10-7G value is a novel biomarker for evaluating intestinal inflammation and endoscopic mucosal healing in UC.

Monitoring of inflammatory bowel disease -capsule endoscopy

Monitoring of inflammatory bowel disease -capsule endoscopy

A combination of fecal calprotectin and human beta-defensin 2 facilitates diagnosis and monitoring of inflammatory bowel disease

ABSTRACT Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) show a large overlap in clinical presentation, which presents diagnostic challenges. As a consequence, invasive and burdensome endoscopies are often used to distinguish between IBD and IBS. Here, we aimed to develop a noninvasive fecal test that can distinguish between IBD and IBS and reduce the number of endoscopies. We used shotgun metagenomic sequencing to analyze the composition and function of gut microbiota of 169 IBS patients, 447 IBD patients and 1044 population controls and measured fecal Calprotectin (FCal), human beta defensin 2 (HBD2), and chromogranin A (CgA) in these samples. These measurements were used to construct training sets (75% of data) for logistic regression and machine learning models to differentiate IBS from IBD and inactive from active IBD. The results were replicated on test sets (remaining 25% of the data) and microbiome data obtained using 16S sequencing. Fecal HBD2 showed high sensitivity and specificity for differentiating between IBD and IBS (sensitivity = 0.89, specificity = 0.76), while the inclusion of microbiome data with biomarkers (HBD2 and FCal) showed a potential for improvement in predictive power (optimal sensitivity = 0.87, specificity = 0.93). Shotgun sequencing–based models produced comparable results using 16S-sequencing data. HBD2 and FCal were found to have predictive power for IBD disease activity (AUC ≈ 0.7). HBD2 is a novel biomarker for IBD in patients with gastro-intestinal complaints, especially when used in combination with FCal and potentially in combination with gut microbiome data.

Monitoring of inflammatory bowel diseases -non-invasive biomarkers

Monitoring of inflammatory bowel diseases -non-invasive biomarkers

Abdominal ultrasonography in canine inflammatory bowel disease: A short study

Ultrasonography is a noninvasive and inexpensive tool to examine the gastrointestinal tract of small animals with chronic gastrointestinal signs. It plays a major role in the recognition, diagnosis and monitoring of inflammatory bowel disease (IBD) in human patients. The present study was undertaken to record the ultrasonographic changes associated with canine IBD. Thirty three dogs confirmed with idiopathic IBD were included in the study and subjected to detailed abdominal ultrasonography. This study revealed that dogs with IBD variably have a normal to mildly thickened intestinal wall thickness. Secondary changes recorded in the IBD dogs were gas filled intestinal loops, hypermotility of intestinal loops, dilation of the lumen and mesenteric lymphnode enlargement. In conclusion, intestinal wall measurements do not appear to establish a diagnosis of intestinal inflammation in canine IBD in contrast to humans where ultrasonography has a significant role in establishing the diagnosis.

Remote Monitoring of Inflammatory Bowel Disease: What Kind of Patient-Reported Questionnaires Should We Use?

Remote Monitoring of Inflammatory Bowel Disease: What Kind of Patient-Reported Questionnaires Should We Use?

Understanding attitudes, concerns, and health behaviors of patients with inflammatory bowel disease during the coronavirus disease 2019 pandemic.

Background and AimThe coronavirus disease 2019 (COVID‐19) pandemic has led to a rapid shift in care delivery models for patients with inflammatory bowel disease (IBD); however, little is known about patient perceptions during this period. We aimed to prospectively evaluate the attitudes, concerns, and health behavior of IBD patients during COVID‐19.MethodsAn online survey was sent to patients from a tertiary IBD Service. The survey included demographic information and questions about the impact of COVID‐19, levels of concern caused by COVID‐19, perceived risk of IBD medications, medication cessation, and care delivery preferences.ResultsOf 97 respondents (39%), 95 (98%) reported concern about the impact of COVID‐19 on their health, and 43% felt their risk of contracting COVID‐19 was above average; 62% reported concern about medication‐induced COVID‐19 risk, and 11% stopped medications because of COVID‐19. Patients considered all medications to increase the risk of COVID‐19 susceptibility and severity; 45% preferred telehealth while 16% preferred face‐to‐face clinic reviews. Preference for IBD monitoring tools in decreasing order was blood testing, stool collection, gastrointestinal ultrasound, magnetic resonance enterography, and then colonoscopy.ConclusionsPatients with IBD are demonstrated to experience concern related to their diagnosis and medications. The insights provided by the survey are informative for a possible “second‐wave” of COVID‐19 and routine care, including acceptance of telemedicine, preference for non‐invasive investigations, and a need for dissemination of information and education.

Serum Serotonin Differentiates Between Disease Activity States in Crohn's Patients.

BackgroundDiagnosis and monitoring of inflammatory bowel diseases (IBDs) utilize invasive methods including endoscopy and tissue biopsy, with blood tests being less specific for IBDs. Substantial evidence has implicated involvement of the neurohormone serotonin (5-hydroxytryptamine, 5-HT) in the pathophysiology of IBDs. The current study investigated whether serum 5-HT is elevated in patients with active ulcerative colitis (UC) or Crohn’s disease (CD).MethodsSerum samples were obtained from a German cohort of 96 CD and UC patients with active disease, refractory disease, or remission of disease based upon their disease activity index (DAI) and disease history. High pressure liquid chromatography with tandemmass spectrometry was used to measure 5-HT, tryptophan (TRP), and kynurenine (KYN) levels in the serum samples, and Luminex Multiplex ELISA was used to measure cytokine levels. Intestinal mucosal biopsies were obtained from a separate cohort of healthy and CD patients, and the immunoreactivity of the serotonin transporter (SERT) was determined.ResultsThere was no statistically significant difference in TRP or KYN levels between disease categories in either UC or CD. Interestingly, 5-HT levels were significantly elevated in patients with active CD but not active UC when compared with the levels in remission or refractory disease. Serum 5-HT was superior to C-reactive protein and circulating cytokines in differentiating between disease categories in CD. Additionally, SERT immunoreactivity was decreased in the ileum and colon of patients with CD compared to healthy controls.ConclusionWe have shown that the serum 5-HT can differentiate between active disease and refractory disease or remission among CD patients, emphasizing the potential suitability of serum 5-HT as an auxiliary measure in diagnosing active CD.

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology practice recommendations for medical management and monitoring of inflammatory bowel disease in Asia.

Inflammatory bowel disease (IBD) has increased in incidence and prevalence in Asian countries since the end of the 20th century. Moreover, differences in the cause, phenotypes, and natural history of IBD between the East and West have been recognized. Therefore, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have established recommendations on medical management of IBD in Asia. Initially, the committee members drafted 40 recommendations, which were then assessed according to Grading of Recommendations Assessment, Development and Evaluation. Eight statements were rejected as this indicated that consensus had not been reached. The recommendations encompass pretreatment evaluation; medical management of active IBD; medical management of IBD in remission; management of IBD during the periconception period and pregnancy; surveillance strategies for colitis-associated cancer; monitoring side effects of thiopurines and methotrexate; and infections in IBD.

A164 UPTAKE OF FECAL CALPROTECTIN IN PRACTICE: PATTERNS IN A TERTIARY GI REFERRAL CENTRE

Abstract Background Fecal Calprotectin (FC) is helpful in distinguishing functional from organic bowel disease. Also, it has proven useful in monitoring disease activity in inflammatory bowel disease (IBD). The uptake of its use in clinical practice has increased considerably, though access varies significantly. Studies exploring current practice patterns among GI specialists and how to optimize its use are limited. In 2017, Kingston Health Sciences Centre (KHSC) began funding FC testing at no cost to patients. Aims We aimed to better understand practice patterns of gastroenterologists in IBD patients where there is in house access to FC assays, and to generate hypotheses regarding its optimal use in IBD monitoring. We hypothesize that FC is not being used in a regular manner for monitoring of IBD patients. Methods A retrospective chart audit study was done on all KHSC patients who had FC testing completed from 2017–2018. Qualitative data was gathered from dictated reports using rigorous set definitions regarding indication for the test, change in clinical decision making, and frequency patterns of testing. Specifically, change in use for colonoscopy or in medical therapy was coded only if the dictated note was clear that a decision hinged largely on the FC result. Frequency of testing was based on test order date. Reactive testing was coded as tests ordered to confirm a clinical flare. Variable testing was coded where monitoring tests that varied in intervals greater than 3 months and crossed over the other set frequency codes. Quantitative data regarding FC test values, and dates were also collected. This data was then analyzed using descriptive statistics. Results Of the 834 patients in our study, 7 were under 18 years old and excluded. 562(67.34%) of these patients had a pre-existing diagnosis of IBD; 193 (34%) with Ulcerative Colitis (UC), 369 (66%) with Crohn’s Disease (CD). FC testing changed the clinician’s decision for medical therapy in 12.82% of cases and use for colonoscopy 13.06% of the time for all comers. Of the FC tests, 79.8% were sent in a variable frequency pattern and 2.68% with reactive intent. The remaining 17.5% were monitored with a regular pattern, with 8.57% patients having their FC monitored at regular intervals greater than 6 months, 7.68% every 6 months, and 1.25% less than 6 months. The average FC level of patients with UC was 356.2ug/ml and 330.6 ug/ml for CD. The mean time interval from 1st to 2nd test was 189.6 days. Conclusions FC testing changed clinical decisions regarding medical therapy and use for colonoscopy about 13% of the time. FC testing was done variably 79.8% of the time, where as 17.5% of patients had a regular FC monitoring schedule. An optimal monitoring interval for IBD flares using FC for maximal clinical benefit has yet to be determined. Large scale studies will be required to answer this question. Funding Agencies None

P142 Systematic review: patient perceptions of monitoring tools in inflammatory bowel disease

Abstract Background Management of inflammatory bowel disease (IBD) is directed toward both clinical symptoms as well as objective disease activity as a part of a ‘treat to target’ strategy. Despite the increasing burden of disease activity assessment in IBD, patient preferences for monitoring tools have scarcely been considered. This study aimed to describe the available evidence for patient preference, satisfaction, tolerance and/or acceptability of the available monitoring tools in adults with IBD. Methods A systematic search of Embase, Medline, Pubmed, Cochrane Central and Clinical Trials.gov from January 1980 to April 2019 was conducted using PRISMA best practice guidelines. Included were all study types reporting on the perspectives of adults with confirmed IBD on monitoring tools, where two or more such tools were compared. Outcome measures with summary and descriptive data were presented. Results 10 studies evaluating 1846 participants were included. Study size ranged from 18 to 916 participants. Monitoring tools included venepuncture, stool collection and faecal calprotectin (FC), gastrointestinal ultrasound (GIUS), computed tomography (CT), magnetic resonance imaging (MRI), wireless capsule endoscopy (WCE), barium follow-through, and endoscopy. The measurement tools used were visual analogue scales (VAS), Likert scales or binary preference questions. Outcome domains were patient satisfaction, acceptability of monitoring tool, and patient preference. Meta-analysis was not possible due to heterogeneity of data. Overall, patient preference was for non-invasive tools of disease monitoring and these were associated with a higher level of acceptability. Across all included studies, GIUS was identified by patients as the preferred tool for disease activity assessment. Both FC and other forms of imaging (MRE and CTE) were generally considered preferable to endoscopy, however less so than GIUS. Patient preference for blood testing varied, but in one study was lower than endoscopy. Two studies compared VAS acceptability of multiple IBD monitoring tools. Among 1037 patients, GIUS was considered the most acceptable IBD monitoring tool (mean VAS 9.29), as compared with venepuncture (9.28), WCE (8.5), MRE (8.08), stool collection (7.87), colonoscopy (7.07) and sigmoidoscopy (5.27). Conclusion This is the first systematic review to evaluate patient perceptions of monitoring tools used in IBD. Patients showed a preference for GIUS and more generally for faecal sampling and non-invasive imaging over endoscopy. Further research should address whether clinician selection of more acceptable monitoring tools in IBD engenders greater patient satisfaction, adherence, and a consequent improvement in disease-related outcomes.