Number Of Inflammatory Bowel Disease Patients Research Articles

P0305 The Choice of Endoscopic Surveillance Strategies for IBD Patients Among Taiwanese Physicians: An Anonymous Questionnaire Survey

Abstract Background Chronic inflammation caused by inflammatory bowel disease (IBD) increases the risk of patients developing colorectal cancer or dysplasia. Guidelines recommend that patients with IBD undergo regular colonoscopic surveillance based on factors such as the degree of inflammation, family history, and comorbidities. Previous studies have shown that chromoendoscopy has a higher detection rate for colorectal cancer screening, and most guidelines also recommend chromoendoscopy as the preferred endoscopic technique for colorectal cancer surveillance. Therefore, this questionnaire aims to understand the strategies used by physicians in Taiwan for colorectal neoplasia(CRN) screening in IBD patients. Methods The questionnaire will be distributed using an anonymous online survey at gastroenterology-related conferences and social media groups. It will include questions on the respondents’ hospital level, career duration, number of IBD patients under their care, and the ratio of biologics use. The survey will investigate their IBD surveillance strategies, such as the choice of endoscopic techniques, whether they use image-enhanced endoscopy (IEE), biopsy strategies, and non-invasive tools. The results will be analyzed to determine if there are differences in the selection of endoscopic techniques based on the variance in physician characteristics. Results A total of 53 physicians from Taiwan completed the survey. Of these, 39 (73.6%) were from tertiary-level hospitals, 37 (69.8%) had been practicing for over 10 years, 18 (34.0%) were caring for more than 50 IBD patients, and 11 (20.8%) had more than 30% of their IBD patients on biologics. Regarding the choice of endoscopic techniques, 25 (47.2%) used high-definition white light endoscopy (HD-WLE), 17 (32.1%) used standard-definition WLE, 11 (20.8%) used virtual chromoendoscopy, and none used chromoendoscopy. A total of 41 (77.4%) physicians used IEE (including virtual chromoendoscopy or WLE used in combination with IEE at inflammatory sites) for surveillance. The use of IEE was significantly associated with the number of IBD patients under care (p = 0.018), but there was no significant correlation with other physician characteristics. The reasons for selecting endoscopic techniques were as follows: 28 (52.8%) chose techniques for time efficiency, 20 (37.7%) based their choice on evidence-based medicine, and 5 (9.4%) were limited by the availability of endoscopic techniques. Besides, a total of 46 (86.8%) physicians adopted the target biopsy strategy. Conclusion The proportion of Taiwanese physicians using chromoendoscopy for IBD surveillance is relatively low. Additionally, physicians who care for a greater number of IBD patients are more likely to use IEE as a surveillance tool.

Increasing Exposure to Inflammatory Bowel Diseases Education in Gastroenterology Fellowship: The Pilot IBD 101 Experience.

Inflammatory bowel disease (IBD) management has become increasingly complex, and education varies across fellowship programs. IBD 101 was designed to introduce first-year gastroenterology (GI) fellows to IBD care and training. In 2019, a cohort of fellows participated in a 1-day course with small group learning and group observed structured clinical examinations. Pre- and postcourse surveys were administered to evaluate the course. To assess the long-term impact, surveys were emailed in May 2022 to all third-year fellows from previously participating programs. The primary outcome was comfort managing IBD scenarios and information regarding each fellow's exposure to IBD education. Fifty-five fellows from 32 programs participated. A total of 49 (89%) of 55 completed pre- and postcourse surveys. All fellows agreed that the course content was appropriate. In the postcourse survey, all fellows reported increased comfort managing IBD patients. Ninety-six percent of attendees stated that they would strongly recommend this course. Thirty-six fellows completed surveys in 2022, 21 (58%) attendees and 15 (42%) nonattendees. Attendees reported equivalent or higher levels of comfort compared with nonattendees. Higher global competence was noted among attendees (odds ratio, 5.21; 95% confidence interval, 0.91-29.9; P = .06) after adjusting for presence of a local IBD specialist, number of IBD patients seen monthly (≤5 vs >5), and rotation through an IBD service. IBD 101, an introductory course for first-year GI trainees, was associated with increased comfort managing IBD with a durable benefit independent of individual access to IBD education. Continuation of this program will further enhance the IBD education of future GI fellows.

P300 Overweight and obesity in Inflammatory Bowel disease: epidemiology, disease course and treatment outcomes

Abstract Background The incidence of Inflammatory Bowel Disease (IBD) is increasing in parallel with overweight and obesity. Contrary to conventional belief, a considerable number of IBD patients are at least overweighted. This may contribute to the development of IBD. The objectives of our study were to estimate the prevalence of overweight and obesity in IBD and to compare the epidemiological, evolutive and therapeutic profiles in these patients with those of a BMI (Body Mass index) of less than 25 kg/m². Methods We conducted a retrospective, descriptive and comparative study including patients hospitalized for IBD over a 9-year period [January 2011-January 2020]. Patients with less than 2 years of follow-up were excluded. Patients with a BMI of less than 25kg/m² represented group 1 and patients with a BMI ≥ 25kg/m² represented group 2. Results We included 225 men and 227 women. We enrolled 341 patients diagnosed with Crohn’s disease (CD) and 111 patients with ulcerative colitis (UC). BMI was less than 18.5kg/m², between 18.5 and 25kg/m², between 25 and 30kg/m² and ≥30kg/m² in 27.1%, 48.3%, 19.1% and 5.5% of the patients respectively, resulting in 340 patients in group 1 and 112 patients in group 2. The mean age at diagnosis was 36.15 ± 12.74 years. It was significantly lower in group 1 (32.24 years vs 40.06 years, p<0.001). Smoking was noted in 34.1% of patients and 15.9% were alcohol users, the difference in these habits was not significant between the two groups. Diabetes and hypertension were significantly higher in group 2 (p<0.001 and p=0.002 respectively). The percentage of patients followed up for UC was higher in group 2 (31.8% vs 20.54%, p=0.04). For CD, patients with upper GI tract involvement were more numerous in group 1, without a significant difference between the two groups (16.22% vs. 7.8%, p=0.068). The mean level of albumin was lower than normal in both groups (31.57g/L in group 1 and 34.02g/L in group 2) with a significantly lower level in group 1 (p=0.002). The use of surgical treatment was significantly higher in group 1 (p=0.003). However, there was no significant difference between the two groups in the use of corticosteroid, immunosuppressive agents, anti-TNFα therapy and the responses to these different treatments. The maximum duration of hospitalization was statistically longer in group 1 compared to group 2 (20.95 days vs. 15.32 days, p=0.003). The ratio of years of follow-up to years of active disease was significantly higher in group 2 (5.8 vs. 4.7, p=0.014), reflecting a better disease course in group 2. Conclusion In our series, one fifth of the patients were either overweighted or obese. IBD in these patients was, overall, less severe.

Geosocial Features and Loss of Biodiversity Underlie Variable Rates of Inflammatory Bowel Disease in a Large Developing Country: A Population-Based Study.

The epidemiology of inflammatory bowel disease (IBD) in developing countries may uncover etiopathogenic factors. We investigated IBD prevalence in Brazil by investigating its geographic, spatial, and temporal distribution, and attempted to identify factors associated with its recent increase. A drug prescription database was queried longitudinally to identify patients and verify population distribution and density, race, urbanicity, sanitation, and Human Development Index. Prevalence was calculated using the number of IBD patients and the population estimated during the same decade. Data were matched to indices using linear regression analyses. We identified 162 894 IBD patients, 59% with ulcerative colitis (UC) and 41% with Crohn's disease (CD). The overall prevalence of IBD was 80 per 100 000, with 46 per 100 000 for UC and 36 per 100 000 for CD. Estimated rates adjusted to total population showed that IBD more than triplicated from 2008 to 2017. The distribution of IBD demonstrated a South-to-North gradient that generally followed population apportionment. However, marked regional differences and disease clusters were identified that did not fit with conventionally accepted IBD epidemiological associations, revealing that the rise of IBD was variable. In some areas, loss of biodiversity was associated with high IBD prevalence. When distribution is considered in the context of IBD prevalence, marked regional differences become evident. Despite a background of Westernization, hotspots of IBD are recognized that are not explained by population density, urbanicity, sanitation, or other indices but apparently are explained by biodiversity loss. Thus, the rise of IBD in developing countries is not uniform, but rather is one that varies depending on yet unexplored factors like geoecological conditions.

ANEMIA TREATMENT PATTERNS AND OUTCOMES AMONG A NATIONAL COHORT OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND Anemia is a common complication of inflammatory bowel disease (IBD) and can have a significant negative impact on quality of life by causing fatigue and reduced exercise tolerance. However, system wide patterns of anemia recognition and treatment are lacking. The aim of our study is to identify practice patterns of screening for anemia, assessment of iron stores, and administration of iron repletion therapy among a national cohort of patients with IBD. METHODS We conducted a retrospective cohort study of patients with IBD in the national Veterans Affairs (VA) dataset from 2000-2017. IBD patients were identified using a previously validated algorithm using administrative codes for Crohn’s disease (CD) and ulcerative colitis (UC). Laboratory values, patient demographics, and medical treatment data were extracted from the national VA datasets. Anemia was defined as hemoglobin < 13 g/dL in males and < 12g/dL in females. Initial observation of anemia during the study period was considered index anemia date. Analyses were descriptive of proportion of IBD patients with anemia, treatment, or outcomes. Temporal trends were presented as number patients by calendar year. RESULTS Of the 89,687 patients with IBD identified from 2000-2017, 50,781 (56%) were found to have anemia at least once during the study period. The number of IBD patients with anemia increased five-fold during the study period from 3,260 to 15,579 unique patients per calendar year. Testing for iron deficiency among patients with anemia was low- only 36% of anemic patients had iron studies completed within 6 months of anemia result. Of anemic patients who completed iron studies, the vast majority (89%) were consistent with iron deficiency anemia. Of patients with low iron stores, only 23% of patients received iron therapy within 6 months of lab result. Of patients with anemia, only 19% had anemia resolve within 1 year. Hospitalization within 5 years was observed in 30% of patients with anemia, with 60% of hospitalizations occurring within 1 year of index anemia date. IBD-associated surgery within 5 years of index anemia date was observed in only 2% of patients. CONCLUSIONS In a large national cohort of IBD patients, anemia is a common and undertreated complication, and is frequently followed by hospitalization and steroid use. Although iron deficiency is the most common cause of anemia, adequate iron testing and treatment is lacking, which may contribute to the low rates of anemia resolution. Interventions to improve anemia testing and treatment for iron deficiency anemia are needed.

The psychological impact of inflammatory bowel disease as regards anxiety and depression: a single-center study

BackgroundPatients suffering from inflammatory bowel disease (IBD) are not systematically screened against depression as well as anxiety, although there are high prevalence and adverse influence on the quality of life. The aim of this work was to determine generalized anxiety disorder and major depressive disorder prevalence in patients with IBD, and the secondary objective was to identify patient properties linked to higher psychiatric disorder rates.ResultsWe determined anxiety and depression prevalence in 105 IBD patients (82 having ulcerative colitis and 23 suffering from Crohn’s disease) through a psychiatric interview using the Arabic version of Structured Clinical Interview for DSM IV Axis I diagnosis (SCID I), in addition to severity assessment of major depressive disorder and generalized anxiety disorder using the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A), respectively. Patient data, disease characteristics, and drug information were also gathered. We found a high depression prevalence of 56.2% (n = 59), followed by 37.1% (n = 39), with no significant association between IBD severity and anxiety and depression severity.ConclusionDepression and/or anxiety affected a large number of IBD patients. Such psychiatric disorders’ frequency would warrant detection as well as referral to psychiatric treatment.

P043 IBD in Lebanon: An Observational Descriptive Sstudy.

BACKGROUND: Inflammatory Bowel Disease (IBD), a chronic condition of industrialized societies, is imposing an increasing global health burden. While epidemiological studies are subject to variation between geographical locations, they have shown that the highest occurrences of IBD are traditionally in industrialized countries. In recent years, the incidence of disease has plateaued in those countries, but has been steadily climbing in non-industrialized areas. Lebanon is not an exception: it has seen an increase in the number of IBD patients, but no detailed studies on trends and patient characteristics have been published in the last ten years. The aim of the study was to describe the demographics of patients with Crohn's disease (CD) and ulcerative colitis (UC) in a large Lebanese hospital-based sample between the years 2012 and 2017. METHODS: The electronic medical records of patients with an employment-based health insurance who had a colonoscopy at a large academic medical center in Beirut between 2012 and 2017 were reviewed. Those patients diagnosed with UC or CD based on a combination of endoscopic, histologic and clinical history were analyzed in this study. RESULTS: During the selected period, 2055 patients underwent a colonoscopy. Among those, 63 patients were identified as having IBD of whom 32 (50.87%) were newly diagnosed cases of IBD. Of the 63 IBD patients, 29 (46%) had CD and 34 (54%) UC. The average age of patients with IBD was 35.6 ± 16.3 years with no significant difference between UC and CD patients. Most patients were male (60.3%). This male predominance was mainly present among patients with CD (21, 72.4%) compared to 17 (50%) males in the UC group. Of the 32 new cases of IBD, 17 (51.5%) had CD and 16 (48.5%) UC. The average age of newly diagnosed IBD patients was 36.4 ± 15.7 years. There was no statistically significant difference between the age at diagnosis in the CD group (37.4 ± 15.2 years) and the UC group (35.4 ± 16.7 years). The most common presenting symptom was bloody diarrhea (14, 42.4%) followed by abdominal discomfort/pain (10,30.3%) and then non-bloody diarrhea (5,15.2%). Most CD patients presented with abdominal discomfort/pain (8, 47.1%) while most UC patients presented with bloody stools (9, 69.2%). Average CRP was 25.5 ± 7.5mg/dL which was higher in CD patients (34.8mg/dL) compared to UC patients (8.8mg/dL). Similarly, average ESR was 22.9 ± 17.2 mm/hr, and it was higher in CD patients (28.8mm/hr) compared to UC patients (14.4mm/hr). Only 2 patients had a family history of IBD (6.9%). Only 3 patients (9.7%) had perianal disease and 6 (19.4%) had extraintestinal manifestations (all of whom had arthritis). CONCLUSION: The epidemiological trends and clinical characteristics of Lebanese patients with IBD are similar to Western populations. The next steps are to follow-up on incidence studies and determine if they mirror worldwide trends.

Differences in inflammatory bowel diseases between East and West: a Chinese perspective

Inflammatory bowel disease (IBD), a traditionally “western disease”, has recently been reported to have risen in incidence in China. We summarize differences between Chinese and Western IBD based on relevant literatures published in both Chinese and English. Relevant references published in English were collected from an electronic database via PubMed and relevant references published in Chinese were also collected. Emerging clinical epidemiological data have shown a striking rise in the incidence rate of IBD in Mainland China over the last two decades. Although the current incidence rate of IBD in Mainland China is still lower than that in Western countries, the associated disease burden might be much heavier than previously thought due to the huge population. Clinical data have shown that disease characteristics (e.g., age of onset, male/female ratio, and location and disease severity) of Chinese IBD patients are different to those of Western IBD patients. Unlike the widely used bioimmunotherapeutic agents in Western countries, the management of IBD in China relies predominately on aminosalicylates and corticosteroids. The use of bioimmunotherapeutic agents is limited to a small number of IBD patients in China. Currently, many challenges remain, including the lack of properly trained IBD specialists, poor information availability to support patient self-management, and inappropriate treatment of some patients. Based on the current findings, the disease burden, characteristics, and treatment of Chinese IBD patients are slightly different to those of Western IBD patients. There are still great improvement requirements for the clinical management of IBD in China.

Prevalence, incidence and mortality of inflammatory bowel disease in Catalonia. A population-based analysis

Introduction: Few recent data on the epidemiology of inflammatory bowel disease (IBD) are available, especially in Southern Europe.Aim: To evaluate the prevalence, incidence and mortality of IBD in Catalonia during the period 2011–2016.Material and methods: Data on the prevalence, incidence and mortality of IBD were obtained from the Catalan Health Surveillance System (CHSS). Crude incidence and prevalence rates were calculated for all the Catalan population. Trends in age-sex-adjusted rates were also estimated, and logistic regression was used to calculate the adjusted mortality odds ratio (OR). Data for Crohn’s disease (CD) and ulcerative colitis (UC) were analyzed separately.Results: The prevalence per 100,000 inhabitants in 2016 was 353.9 for UC and 191.4 for CD. The total number of IBD patients rose from 29543 in 2011 to 40614 in 2016. IBD was associated with significantly elevated adjusted mortality ratios: 1.28 (95% CI: 1.6–1.4) for UC and 1.85 (95% CI: 1.62–2.12) for CD.Conclusions: IBD prevalence is very high and is increasing rapidly in Catalonia. Both CD and UC are associated with significantly higher mortality rates.Key messageCrohn disease and ulcerative colitis present a small but significant increase in mortality compared to non-inflammatory bowel disease.The prevalence of inflammatory bowel disease is increasing rapidly in Catalonia.Data on prevalence and incidence suggest that the number of patients may double in approximately 10 years.

Epidemiology of Inflammatory Bowel Diseases (IBD) in Iran: A Review of 740 Patients in Fars Province, Southern Iran

Background: Although the prevalence and incidence of Inflammatory Bowel Disease (IBD) are reaching a stable status in most of the industrialized countries, Asian countries have faced with an increasing number of IBD patients in the last two decades. However, due to the lack of national registry system, a limited amount of data is available on the epidemiology of IBD in Iran, particularly the southern parts of the country. Objectives: The aim of this retrospective analytic study is clarification of multiple aspects of epidemiological factors of IBD patients in area of southern Iran. Patients and Methods: Between 1989 and 2010, 740 patients with IBD, 620 ones with ulcerative colitis (UC) and 120 ones with crohn’s diseases (CD) were diagnosed as IBD cases and referred to our center. Then, their demographic characteristics, disease-related manifestations, complications, and their chief complaints were analyzed, retrospectively. Results: The mean age at diagnosis was 34.68 ± 1.44 (range: 8 – 79 years) for UC patients and 32.97 ± 1.34 (range: 9 – 80 years) for CD ones. The male/ female ratio was 0.9/1 and 0.98/1 for UC and CD patients, respectively. In comparison to rural patients, more urban ones with both UC and CD were registered (86.4 % with UC and 91.74% with CD). No significant change was detected in onset-diagnosis lag time in IBD patients during the study. In this study, a significant positive relationship was found between the type of the disease and positive family history, CD > UC, (χ2(6df) = 14.56, P = 0.024). Furthermore, bloody diarrhea (69.4%) and abdominal pain (54.3%) were the most prevalent presentations in UC and CD patients, respectively. Besides, massive bleeding was the most prevalent complication for both UC and CD patients (32.9% and 19.8% respectively). In addition, 289 UC (46.6%) and 39 CD (33.7%) patients had experience at least one relapse during their course of disease. Nevertheless, no significant correlation was observed between the season of the onset and the type of the disease in UC and CD patients (χ2(6df) = 6.09, P = 0.41). Also, no significant relationship was detected between smoking and the type of disease (χ2(2df) = 3.79, P = 0.13). Conclusions: An obvious increase in the number of IBD patients has been detected in our population during the past decades. This can be attributed to either improvement in the patients’ and the physicians’ knowledge and availability of diagnostic tools or a real increase in the incidence rate of the disease. In either case, this alarming increase should be taken into consideration by both the health authorities (regarding the significant burden) and the researchers of the field in our society.

Recent Advances Using Immunomodulators for Inflammatory Bowel Disease

Use of the immunomodulators thiopurines and methotrexate (MTX) in the treatment of inflammatory bowel disease (IBD), i.e., Crohn's disease and ulcerative colitis (UC), is considered to be good clinical practice. However, despite being administered to a considerable number of IBD patients over the years, questions remain about the most rational treatment regimens of azathioprine (AZA), 6-mercaptopurine (6-MP), and MTX, and results from a range of recent studies necessitate increased attention to how to optimize the use of these immunomodulators. First and foremost, it is of utmost importance to define the subgroup of IBD patients in need of immunomodulators, including those in need of combination therapy with biologic agents, especially because some side effects may be rather severe. Second, colorectal cancer is observed more often in IBD patients than in the background population. However, a recent nationwide Dutch study pointed to a preventive effect of thiopurines. Finally, the need for an appropriate approach to the discontinuation of immunomodulators is emphasized. Since controversy continues regarding the most appropriate use of immunomodulators, this paper is focusing on pharmacokinetics, pharmacogenetics, and therapeutic blood testing, as well as the occurrence of adverse events, when using AZA, 6-MP, and MTX in an attempt to determine a more up-to-date and rational treatment regimen in IBD.

Prognosis for Lymphoma in Patients with Inflammatory Bowel Disease Treated with 6-mercaptopurine or Azathioprine

Purpose: An increased risk of lymphoma in patients with Crohn's disease (CD) and ulcerative colits (UC) has never been confirmed. However, treatment of CD with 6-mercaptopurine (6MP) and azathioprine (AZA) has been associated with a four fold increase in the risk of lymphoma compared to non-treated patients and the general population. Lymphoma occurs in 4 out of every 10,000 CD patients treated with 6MP/AZA. Despite this small number, lymphoma remains a feared complication of treatment. Recent reports of hepatosplenic T cell lymphoma in patients treated with both 6MP/AZA and infliximab have worsened these fears. Currently, little is known about the prognosis of lymphoma occurring in the inflammatory bowel disease (IBD) population, specifically those treated with 6MP/AZA. Methods: A retrospective case series of IBD patients at three academic centers were analyzed from a database of 8,780 total records. All patients with a diagnosis of lymphoma were identified and analyzed for IBD type, medication use, lymphoma type and outcome following medical treatment. Another database of 600 lymphoma patients from an academic Hematology and Oncology center was searched for IBD patients and analyzed in the same fashion. Results: In all, 14 patients with a diagnosis of lymphoma were identified, 12 with CD and 2 with UC. The one female case had CD. There was only one Hodgkin's lymphoma. Cases are summarized in the table below. Conclusion: While the number of IBD patients who develop lymphoma remains small, concern among patients and practitioners remains disproportionately high. While hepatosplenic T cell lymphoma is rapidly progressive and uniformly fatal, there is no evidence that prior 6MP/AZA use alone and non-Hodgkin's lymphoma follows a similar severe course. From our own series only two cases treated with 6MP/AZA exhibited a rapid clinical decline. Our data suggest that those who developed lymphoma after treatment with 6MP/AZA had a prognosis no more ominous than those not so treated.

Are we ready for top-down therapy for inflammatory bowel diseases: pro

Until the 1990s, inflammatory bowel diseases (IBD) were treated with conventional drugs, such as mesalazine, corticosteroids and thiopurines, which are effective in a proportion of IBD patients. Despite the introduction of immunosuppressive drugs, a significant number of IBD patients have a disabling disease course and, on average, a poor quality of life. The discovery of anti- TNF trategies and the development of biologics targeting several other pathways, important in the pathogenesis of ulcerative colitis and Crohn’s disease, introduced a pivotal discussion. Central to this discussion is the question of whether these new therapies should be introduced early or late in the course of the disease. Important factors that are relevant for this discussion are quality of life, need for corticosteroids and surgery. This article aims to explore whether we are indeed ready for a top-down approach toward biologics.

The prevalence and incidence of peripheral arthritis in patients with inflammatory bowel disease, a prospective population-based study (the IBSEN study).

To estimate the occurrence of peripheral arthritis (PA) 6 yr after diagnosis of inflammatory bowel disease (IBD). In a population-based cohort of 654 patients with a definite diagnosis of IBD, 521 patients (80%) were clinically examined by a rheumatologist 6 yr after IBD diagnosis. PA related to IBD (PAIBD) was detected at examination in four patients (point prevalence 0.8%). If the patients' own reports of PA were accepted, 12% of the cases had developed such manifestations. The striking difference may be explained by the nature of PAIBD exhibiting a short-lasting, self-limiting, non-destructive course and by possible differences in the validity of both methods of ascertainment. Our results indicate that PAIBD occurs in a considerable number of IBD patients during the first years after diagnosis, but the point prevalence of PAIBD is low.