Outcomes In Inflammatory Bowel Disease Research Articles

Comparative Evaluation of Conventional Stool Testing and Multiplex Molecular Panel in Outpatients With Relapse of Inflammatory Bowel Disease.

Differentiating between enteric infection and relapse of inflammatory bowel disease (IBD) is a common clinical challenge. Few studies have evaluated the impact of multiplex gastrointestinal polymerase chain reaction (GI PCR) pathogen panels on clinical practice compared to stool culture. Our aim was to compare the impact of PCR stool testing to conventional stool testing in outpatients presenting with relapse of IBD. In a retrospective cohort study of outpatients with IBD presenting to NYU Langone Health with flare from September 2015 to April 2019, we compared patients who underwent stool testing with GI PCR to age-, sex-, and IBD-subtype-matched patients who underwent culture and ova and parasite exam (conventional testing). The primary outcome was IBD therapy escalation after testing. Secondary outcomes included rates of posttesting endoscopy, abdominal radiography, antibiotics, and IBD-related emergency department visits, hospitalizations, and abdominal surgeries. We identified 134 patients who underwent GI PCR matched to 134 patients who underwent conventional testing. Pathogens were more frequently identified on GI PCR (26 vs 5%; P < 0.01). We found that GI PCR was associated with less escalation in IBD therapy (16 vs 29%; P < 0.01) and fewer posttest endoscopies (10% vs 18%; P = 0.04), with no differences in IBD outcomes. On multivariate analysis, testing with GI PCR was associated with an odds ratio of 0.26 (95% confidence interval, 0.08-0.84; P = 0.02) for escalation of IBD therapies. Testing with GI PCR was associated with higher rates of pathogen detection and lower rates of IBD therapy escalation and endoscopy in the outpatient setting. These changes in management were not associated with a difference in IBD outcomes.

Impact of Medications on COVID-19 Outcomes in Inflammatory Bowel Disease: Analysis of Over 6,000 Patients from an International Registry

Impact of Medications on COVID-19 Outcomes in Inflammatory Bowel Disease: Analysis of Over 6,000 Patients from an International Registry

Impact of Epstein-Barr virus infection on inflammatory bowel disease (IBD) clinical outcomes.

to evaluate the role of Epstein-Barr virus (EBV) on the intestinal mucosa in the evolution of inflammatory bowel disease (IBD). The risk factors for EBV infection and the frequency of EBV-associated lymphoproliferative disorders in IBD patients were also investigated. intestinal biopsies of IBD patients with available EBV status determined by Epstein-Barr-encoding RNA (EBER) in situ hybridization were identified in the Pathology Database of our center. Clinical information, including phenotypic characteristics of IBD, previous treatments, diagnosis of lymphoma and patient outcome were reviewed in all cases. fifty-six patients with IBD (28 Crohn's disease, 27 ulcerative colitis and one unclassified colitis) were included. EBV in intestinal mucosa was positive in 26 patients (46 %) and was associated to a lymphoproliferative syndrome in one case. EBV positivity was associated with severe histological activity (52 % vs 17.2 %; p 0.007), the presence of a lymphoplasmacytic infiltrate (50 % vs 33.3 %; p 0.03) and active steroid treatment (61.5 % vs 33.3 %; p 0.03). Multivariate analyses only found an association between EBV and lymphoplasmacytosis (p 0.001). Escalation in previous treatment was significantly more frequent in the EBER+ group (53.8 % vs 26.7 %; p 0.038). No cases developed lymphoma during follow-up. EBV on the intestinal mucosa is associated with a poor outcome of IBD and the need for escalation of therapy. Lymphoplasmacytic infiltrate is associated with EBV infection. EBER+ patients used steroids more frequently compared with EBER- patients. No EBER+ patients developed lymphoma during follow-up.

Obesity in inflammatory bowel disease: A review of its role in the pathogenesis, natural history, and treatment of IBD.

In contrast to previous perceptions that inflammatory bowel disease (IBD) patients are generally malnourished and underweight, there is mounting evidence to suggest that rates of obesity in IBD now mirror that of the general population. IBD is an immune-mediated condition that appears to develop in individuals who have not only a genetic predisposition to immune dysregulation but also likely exposure to various environmental factors which further potentiate this risk. With the surge in obesity alongside the rising incidence of IBD, particularly in developing nations, the role that obesity may play, not only in the pathogenesis but also in the natural history of disease has become a topic of growing interest. Currently available data exploring obesity's impact on the natural history of IBD are largely conflicting, potentially limited by the use of body mass index as a surrogate measure of obesity at varying time points throughout the disease course. While there are pharmacokinetic data to suggest possible detrimental effects that obesity may have on the response to medical therapy, results in this realm are also inconsistent. Moreover, not only is it unclear whether weight loss improves IBD outcomes, little is known about the safety and efficacy of available weight-loss strategies in this population. For these reasons, it becomes increasingly important to further understand the nature of any interaction between obesity and IBD.

The influence of proton pump inhibitor therapy on the outcome of infliximab therapy in inflammatory bowel disease: a patient-level meta-analysis of randomised controlled studies

ObjectiveIn treating patients with inflammatory bowel disease (IBD), how concomitant medications influence the response to infliximab is largely unexplored. We aim to evaluate whether proton pump inhibitors (PPIs) affect the...

Inflammatory bowel disease in sub-Saharan Africa: a protocol of a prospective registry with a nested case–control study

IntroductionThe epidemiology of inflammatory bowel disease (IBD) in sub-Saharan Africa is poorly documented. We have started a registry to determine the burden, phenotype, risk factors, disease course and outcomes of...

P078 Expanded Telehealth Options During the COVID Pandemic Eliminated Racial and Age Disparities in Electronic Health Care Use by IBD Patients.

BACKGROUND: Medical practices have increased electronic messaging and telemedicine visits during the last several years. This rise in electronic health care during the COVID pandemic minimized SARS-CoV-2 exposure and disease transmission. Historically, African-Americans and older patients have less frequently used electronic messaging with their physicians. This study compares the utilization of virtual health care before and during the COVID pandemic by inflammatory bowel disease (IBD) patients. METHODS: A retrospective medical record review of all IBD patients seen at an academic medical center from 2014 to 2020 was conducted to evaluate the use of telehealth options (e-messaging, e-visits) during a pre-COVID and a COVID timeframe. Patient age, gender, race, IBD subtype (Crohn's disease, ulcerative colitis or indeterminate colitis), electronic messaging, and telehealth visits were obtained. A pre-COVID IBD cohort was identified from the 2015–2018 records. The pre-COVID timeframe evaluated was March-August 2018. A COVID IBD cohort was identified from the 2017–2020 records. The COVID timeframe evaluated was March-August 2020. A confidential database was created using Microsoft Excel. Statistical analysis was performed using Fisher Exact test with significance set at P < 0.05. The study was IRB approved. RESULTS: There were 392 patients (174 males, 218 females; mean age 44.4 years) in the pre-COVID cohort. 97 had Crohn's disease, 278 had ulcerative colitis and 17 had indeterminate colitis. There were 204 White, 99 African American, 11 Asian, and 78 ethnically un-identified patients. One hundred sixty (40.8%) initiated E-communication with their physicians, however E-visits were not an option. E-messaging was initiated significantly more by White patients compared to African American patients (62.3% vs 28.2%; P < 0.00001). Patients <50 years of age used e-messaging significantly more than those > 50 (51.1% vs 39.7%; P = 0.0396). There were no significant differences in the use of e-messaging based upon patient gender (P = 0.6840) or IBD type (P = 0.6374). There were 295 patients (130 males, 165 females; mean age 45.7 years) in the COVID cohort. 76 had Crohn's disease and 208 had ulcerative colitis. There were 155 White, 83 African American patients, 24 Hispanic patients, 10 Asian patients, and 22 ethnically un-identified patients. 109 (36.9%) utilized a telehealth option (53 via e-messaging; 56 via telemedicine visit). There was no significant difference in the use of a telehealth option based upon race (42.6% White vs 35.9% African-American; P = 0.2693), age (36.8% < 50 vs 37.25% > 50 years; P = 1.00) or IBD type (P = 0.331). Males used telehealth more than females (46.1% vs 29.7%, respectively; P = 0.0051). CONCLUSION: The COVID pandemic encouraged physicians to incorporate telehealth options into their practice. Prior to the COVID pandemic, patients were able to e-message their physicians. However, the pandemic emergency enabled medical practices to offer e-visits in addition to e-messaging for care delivery. This study revealed that expanded telemedicine options for IBD patients eliminated previously identified racial and age disparities in virtual medical care. Further study is needed to understand gender differences in telehealth utilization. There should be post-pandemic policy consideration for continued telemedicine options to encourage expanded patient-physician engagement, support continuity in care and optimize IBD outcomes.

Immunogenicity of Tumor Necrosis Factor Antagonists and Effect of Dose Escalation on Anti-Drug Antibodies and Serum Drug Concentrations in Inflammatory Bowel Disease.

Infliximab and adalimumab concentrations are associated with important outcomes in inflammatory bowel disease (IBD). Antibodies to infliximab (ATI) and adalimumab (ATA) are associated with reduced drug concentrations and worse outcomes. Because the efficacy of dose escalation to overcome antibodies is unclear, we assessed the impact of this strategy to overcome immunogenicity in IBD. Infliximab and adalimumab dosing, drug, and antibody concentrations were extracted from a database of patients with IBD having specimens collected for therapeutic drug monitoring. The primary outcome compared proportions with either infliximab ≥5 μg/mL or adalimumab ≥7.5 μg/mL and undetectable antibodies between dose-escalated and non-escalated patients. Area under the receiver operating characteristic curve analyses determined antibody concentrations below which dose escalation was associated with the primary outcome. The study included 63,176 patients treated with infliximab and 46,429 patients treated with adalimumab. We detected ATI and ATA in 23.6% (n = 14,900) of patients treated with infliximab and 19.6% (n = 9101) of patients treated with adalimumab. In patients with ATI, infliximab dose escalation (n = 453) yielded higher proportions achieving the primary outcome (47.5% vs 30.9%; P < 0.001), greater drug concentration increases (5.9 μg/mL vs 0.2 μg/mL; P < 0.001), and ATI reductions (4.3 U/mL vs 1.9 U/mL; P = 0.002) compared to no escalation (n = 204). An ATI threshold of 8.55 U/mL was associated with achieving the primary outcome with dose escalation (area under the curve = 0.66). For patients with ATI ≤8.55 U/mL (n = 274), higher proportions (59.1% vs 29.6%; P < 0.001) achieved the primary outcome compared with those with ATI >8.55 U/mL (n = 179). No patients treated with adalimumab achieved the primary outcome (0/390), regardless of dose escalation (n = 87). Dose escalation increased drug concentrations and eliminated antibodies with infliximab but not adalimumab. Initial ATI ≤8.55 U/mL was associated with increased efficacy of dose escalation using this assay.

Emerging use of artificial intelligence in inflammatory bowel disease.

Inflammatory bowel disease (IBD) is a complex, immune-mediated gastrointestinal disorder with ill-defined etiology, multifaceted diagnostic criteria, and unpredictable treatment response. Innovations in IBD diagnostics, including developments in genomic sequencing and molecular analytics, have generated tremendous interest in leveraging these large data platforms into clinically meaningful tools. Artificial intelligence, through machine learning facilitates the interpretation of large arrays of data, and may provide insight to improving IBD outcomes. While potential applications of machine learning models are vast, further research is needed to generate standardized models that can be adapted to target IBD populations.

Inflammatory Bowel Disease Outcomes Following Fecal Microbiota Transplantation for Recurrent C. difficile Infection.

Recurrent Clostridioides difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is a clinical challenge. Fecal microbiota transplantation (FMT) has emerged as a recurrent CDI therapy. Anecdotal concerns exist regarding worsening of IBD activity; however, prospective data among IBD patients are limited. Secondary analysis from an open-label, prospective, multicenter cohort study among IBD patients with 2 or more CDI episodes was performed. Participants underwent a single FMT by colonoscopy (250 mL, healthy universal donor). Secondary IBD-related outcomes included rate of de novo IBD flares, worsening IBD, and IBD improvement-all based on Mayo or Harvey-Bradshaw index (HBI) scores. Stool samples were collected for microbiome and targeted metabolomic profiling. Fifty patients enrolled in the study, among which 15 had Crohn's disease (mean HBI, 5.8 ± 3.4) and 35 had ulcerative colitis (mean partial Mayo score, 4.2 ± 2.1). Overall, 49 patients received treatment. Among the Crohn's disease cohort, 73.3% (11 of 15) had IBD improvement, and 4 (26.6%) had no disease activity change. Among the ulcerative colitis cohort, 62% (22 of 34) had IBD improvement, 29.4% (11 of 34) had no change, and 4% (1 of 34) experienced a de novo flare. Alpha diversity significantly increased post-FMT, and ulcerative colitis patients became more similar to the donor than Crohn's disease patients (P = 0.04). This prospective trial assessing FMT in IBD-CDI patients suggests IBD outcomes are better than reported in retrospective studies.

S3198 Antidepressant Use Is Associated With Poor Clinical Outcomes in the Setting of Inflammatory Bowel Disease

INTRODUCTION: Antidepressant medications (AMs) are frequently used in inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). Many AMs are designed to enhance serotonin (5-HT) signaling. Increased 5-HT availability is associated with inflammation in animal models and human studies of IBD. We hypothesized that use of 5-HT-enhancing AMs would be associated with poor clinical outcomes in IBD. METHODS: We performed a retrospective cohort study using the Truven Health Marketscan® commercial claims database between 1/1/06 and 12/31/12. Participants (18–64 years) had at least 2 appropriate ICD-9 diagnoses for IBD, concurrent use of IBD medications, no other auto-inflammatory disease, at least 1 year of continuous enrollment before index diagnosis and 2 years after, during the study period. We identified new prescriptions of AM (includingselective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic, tetracyclics, monoamine oxidase inhibitors and other varieties) using the medication possession ratio (MPR; 80% adherence).Primary outcomes were: corticosteroid use, IBD-related complication (intestinal stricture and/or fistula), hospitalization, emergency room (ER) visit, IBD-related surgery and death within 2 years of IBD diagnosis or starting AM. We performed descriptive statisticsand calculatedadjusted hazard ratios (aHRs) comparing 2 groups (AM use vs. no AM use) for each of the outcomes above (adjusting for age, sex, comorbidity, IBD medication use and clinic visits). We also performed subgroup analyses considering IBD and AM subtype. RESULTS: 117,255 people had IBD (51.3% male; 55.6% UC). 7.1% used at least one AM during the follow-up period [most often a SSRI (4.9%) and/or SNRI (1.1%)]. AM users were younger, more likely female and to have several comorbidities, and used IBD-targeted medications more often (Table 1). Corticosteroid use, hospitalizations, ER visits and death were independently associated with AM use (Table 2).In the UC cohort, AM users were more likely to have complications [aHR = 1.90 (1.42–2.54), P < 0.0001)]. SSRIs were the only group independently associated with death [aHR = 7.93 (3.62–17.36), P < 0.0001]. CONCLUSION: We demonstrated that AM use is independently associated with an increased risk of many poor outcomes in IBD (including death). While further study is warranted, providers should exercise caution when using AM in IBD, particularly SSRIs.Table 1.: Demographic and Clinical Characteristics of Antidepressant Medication Users and Non-Users. AM = antidepressant medication; SD = standard deviation.Table 2.: Cox Proportional Hazards Model Evaluating Clinical Outcomes Associated with Antidepressant Use in the full IBD cohort.

S0859 Clinical Significance of Positive GI Pathogens PCR Testing in IBD Patients: A Retrospective Analysis

INTRODUCTION: Gastrointestinal (GI) infection in patients with inflammatory bowel disease (IBD) is a common mimic of disease flare. Aside from Clostridioides difficile infection (CDI) there is limited data on the clinical significance of enteric infections in patients with IBD. The aim of this study is to characterize the clinical impact of non-CDI enteric infection in an IBD patient population. METHODS: A retrospective chart review was performed on adult patients with IBD seen in the University of Virginia Health System between 2015 and 2019 who underwent testing for GI infection with the FilmArray Gastrointestinal Panel (BioFire Diagnostics, Salt Lake City, UT), a polymerase chain reaction stool test (GI PCR). Patients were excluded if they tested positive for CDI at or within 30 days of the encounter. Patient demographics, IBD subtype, location of disease, medications at encounter, and laboratory data, imaging and endoscopic results at presentation were recorded. The primary outcome of interest was escalation of IBD therapy or surgery within six months. Statistical analysis included Chi-square testing and student's t-test for categorical variables. RESULTS: A total of 261 patients undergoing 437 GI PCR tests were identified. The mean age was 43 years, and the majority of patients tested were white (83%), female (56%) and had Crohn's disease (60%). Of the GI PCR tests, 59 (14%) had positive results. Hospitalization rates were similar between the groups, but positive PCR was associated with a shorter length of stay (3.3 days vs 5.3, P = 0.01). Compared to a positive GI PCR result, patients with a negative result were more likely to have a change in IBD therapy at the initial encounter (54% vs 31%, P = 0.003). However, there was no significant difference in rates of escalation of IBD therapy or surgery at six months. Secondary analysis for risk factors associated with positive GI PCR showed that patients with a positive GI PCR result were more likely to use non-steroidal anti-inflammatory drugs (NSAIDs) than those with a negative result (18.6% vs 6.9%, P = 0.006). CONCLUSION: This study supports prior data that non-CDI enteric infection does not lead to a difference in long term clinical outcomes including escalation of therapy or surgery in patients with IBD. NSAID use was associated with enteric infections in patients with IBD and merits further investigation with appropriate studies.Table 1.: Characteristics of patients with inflammatory bowel disease (IBD) who underwent stool testing with the FilmArray Gastrointestinal Pane (BioFire Diagnostics, Salt Lake City, UT) (GI PCR)Table 2.: Encounter details of patients who underwent testing with GI PCR*Table 3.: Association of GI PCR* results with clinical outcomes in IBD

S0706 The Outcome of Inflammatory Bowel Disease in Patients With Colon Cancer: A Propensity-Based Nationwide Inpatient Sample Study

S0706 The Outcome of Inflammatory Bowel Disease in Patients With Colon Cancer: A Propensity-Based Nationwide Inpatient Sample Study

S3229 Outcomes of Inflammatory Bowel Disease in Teaching vs Non-Teaching Hospitals: A Nationwide Analysis

INTRODUCTION: Inflammatory bowel disease (IBD) poses a significant health care burden, which from an economic perspective is particularly true for hospitalized IBD patients. The rising cost of hospitalized IBD patients is dictated by the severity, associated complications, and type of intervention used. Data regarding hospitalization outcomes in patients with IBD with respect to hospital teaching status is largely unknown. We attempt to investigate the impact of hospital teaching status on IBD hospitalization outcomes. METHODS: In this retrospective analysis we queried the 2016 and 2017 Nationwide Inpatient Sample (NIS) databases using the International Classification of Diseases 10th revision (ICD- 10) coding system. All adult patients with a principal diagnosis of IBD were included.We stratified the IBD group into Ulcerative colitis (UC), Crohn’s disease (CD), and complicated IBD. Our primary outcome was mortality. Statistical analysis was performed using STATA, version 16.0. RESULTS: Of the 189,950 adult patients with IBD, the majority were admitted to teaching hospitals (70.9%). There was no significant difference in mortality based upon hospital teaching status (aOR 1.18, P = 0.48); however, these patients had an increased mean length of stay (LOS) (adjusted coefficient: 0.82, P < 0.01), charges (adjusted coefficient: $8,732, P < 0.01), and costs ($2,871, P < 0.01). On subgroup analysis, patients with UC admitted to teaching hospitals had a significantly increased in-hospital mortality (aOR 2.11, P < 0.05), while those admitted with CD did not (aOR 0.80, P = 0.4). Among patients with complicated IBD, 73.17% were admitted to teaching hospitals, and no significant difference in in-hospital mortality was seen (aOR 1.06, P = 0.8). CONCLUSION: While outcome differences are likely related to multiple unaccounted factors, greater efforts should be placed to cost-effectively manage IBD patients at teaching institutions. Future studies are warranted to fully comprehend the variation of hospitalization outcomes in patients with IBD.

S0874 Performance Characteristics of Homogenous Mobility Shift Assay Method Against World Health Organization International Standard for Infliximab Bioactivity and Impact of Dosing Regimens on Exposure

INTRODUCTION: Therapeutic drug monitoring (TDM) of Infliximab remains an important clinical decision tool to improve outcomes in Inflammatory bowel diseases (IBD). However, one limitation of TDM in clinical gastroenterology practice is the lack of standardization across available technology platforms. Recently, the 1st international standard for infliximab (IFX) bioactivity was characterized and produced by World Health Organization (WHO). Our objective was to evaluate the performance characteristics of the Homogenous Mobility Shift assay (HMSA) against WHO calibration. METHODS: All IFX testing was conducted in a clinical laboratory accredited by the American College of Pathologists (Prometheus Biosciences, San Diego) using liquid chromatography size exclusion HMSA calibrated in house using IFX standards purchased independently from WHO. WHO Standard (NIBSC code: 16/170) was purchased as lyophilized powder, re-suspended to a final concentration of 50 µg/ml in normal healthy serum and stored at -80°C. IFX concentrations measured using in-house and WHO calibration methods were compared using de-identified specimens submitted for IFX testing. Data were analyzed using Deming’s regression and linear mixed effect models for repeated measures. IFX levels in relation to dosing intervals from patient specimens presenting with ICD-10 specific IBD codes were also evaluated. RESULTS: Between run (n = 6) precision was 9.5% (median CV; range 3.9–19.4%) and 8.6% (range: 5.2–17.8%) for 28 IFX specimens measured using in-house and WHO calibration, respectively. As presented in Figure 1, IFX levels measured using in-house calibration method (mean 13.8 ± 0.9 µg/ml) were comparable to those recovered from WHO calibration method (mean 13.9 ± 0.9 µg/ml) (Deming’s slope 1.00 CI 95%: 0.97–1.03). Linear mixed effect models also indicated comparable IFX levels between calibrations (slope = 0.986 ± 0.012; intercept = 0.11 ± 0.22; R2 = 0.97). Table 1 highlights IFX exposure levels in a total of 19,013 specimens submitted with dosing information between 2015 and 2020. A 5mg/Kg every 8 weeks dosing interval associated with 57% specimens above 5 µg/ml. Shorter intervals resulted in higher exposure. CONCLUSION: Our data indicate that IFX levels measured by HMSA in the reference laboratory yield comparable estimates to those from WHO. Calibration with WHO standards may facilitate harmonization of TDM in clinical gastroenterology practice.Figure 1Table 1

S3204 Patients With BMI &gt;25 Less Likely to Achieve Clinical Response to Anti-TNF or Tofacitinib but Not Mucosal Healing

INTRODUCTION: Increasing evidence suggests that obesity has a negative impact on disease outcomes in inflammatory bowel disease. We aimed to further explore the effect of obesity on treatment response. METHODS: We conducted a retrospective observational cohort study of 157 adult IBD patients receiving either anti-tumor necrosis factor (TNF) therapy or tofacitinib at a single referral center from 2016 to 2020. We assessed the impact of obesity on treatment response as measured clinically and endoscopically. Obesity was defined as a Body Mass Index of ≥25 which encompasses overweight and obese individuals. RESULTS: A BMI of ≥25 at the time of treatment initiation was observed in 25% of patients (n = 23 Crohn’s disease, n = 27 ulcerative colitis). Baseline disease severity was not significantly different between patients with a BMI ≥25 versus those less than 25. Persistent clinical symptoms were observed in 17% (n = 7) of the BMI ≥25 patients versus 9% (n = 8) of the normal BMI patients (P = 0.03). Conversely, persistent endoscopic inflammation was observed in 33% (n = 14) of the BMI ≥25 patients and 50% (n = 44) of the normal BMI patients (P = 0.04). When stratified by biologic type, this effect of obesity on treatment response was greatest among tofacitinib treated individuals. CONCLUSION: In this single-center observational cohort study, we observed an effect of obesity on treatment clinical response which appeared most prominent among tofacitinib treated individuals. However, this was not seen in mucosal healing. Further research in larger cohorts is needed to confirm this observation and better understand potential mechanisms for non-response.

S0647 Endoscopic and Histologic Activity Predict Inflammatory Bowel Disease-Related Hospitalization: A Nationwide Study

INTRODUCTION: Measures of mucosal healing are critical for the study of inflammatory bowel disease (IBD). Since endoscopic and histologic activity do not always concur, it is important to measure their individual associations with IBD outcomes that reflect disease activity. Using nationwide Swedish patient registers, we evaluated the influence of baseline endoscopic and histologic activity on IBD-related hospitalization. METHODS: In a cohort study of patients with incident Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) during 1969–2017, we linked endoscopic inflammation in the Swedish Quality Register for Inflammatory Bowel Disease (SWIBREG) registry with histologic inflammation in the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) registry. We established and validated a SNOMED-based histology score to predict endoscopic scores [Mayo endoscopic subscore (MES) in UC and IBD-U; SWIBREG-CD score in CD (SCS)], and dichotomized these data based on Bayesian rule list scores. We assessed the impact of baseline endoscopic activity and histologic activity on IBD-related hospitalization. RESULTS: We identified 48,449 individuals with incident IBD linked to a histology record in ESPRESSO and 5225 individuals linked to an endoscopic assessment in SWIBREG (Table 1). We created and validated models to calculate a SNOMED-based histology score (ROC for predicting a non-zero endoscopic score: UC 0.80, CD 0.70, IBD-U 0.76). In a subset of 2741 individuals with an IBD diagnosis and a corresponding histology and endoscopy score, baseline scores were associated with time to IBD-related hospitalization (endoscopy log-rank UC P < 0.001, CD P = 0.020, IBD-U P < 0.001; histology log-rank UC P = 0.018, CD P = 0.960, IBD-U P = 0.034; Figure 1). In the larger sample of 48,449 individuals with SNOMED-based histology scores, we observed similar associations with time to IBD-related hospitalization, with a strong association in UC and CD, but no association in IBD-U (log-rank UC P < 0.001, CD P < 0.001, IBD-U P = 0.996; Figure 2). CONCLUSION: In this study using nationwide patient registers, we linked clinical, endoscopic, and histologic data for the study of IBD. Baseline endoscopy and histology scores at IBD diagnosis were associated with time to IBD-related hospitalization, particularly in UC. These data are critical for the further evaluation of longitudinal measures of mucosal healing on IBD outcomes.Table 1.: Description of registry linkageFigure 1.: Time to IBD-related hospitalization by baseline endoscopic scores [a, Mayo endoscopic score (MES) and SWIBREG-CD score (SCS)] and histology scores [b; n = 5225] stratified by IBD subtype.Figure 2.: Association between histology score and time to IBD-related hospitalization in an analysis all individuals (n = 48,449) with IBD in the histology register.

S3197 Impact of Disease Severity and Time-to-Test for Clostridioides difficile Infection on Length of Stay in Inflammatory Bowel Disease Patients Hospitalized With Flare

INTRODUCTION: Guidelines recommend testing inflammatory bowel disease (IBD) patients hospitalized with flare for Clostridioides difficile infection (CDI), though little is known about whether a delay in testing for CDI is related to adverse outcomes. We examined the relationship between time to C. difficile PCR test order, collection, and result with adverse IBD outcomes. METHODS: We performed a retrospective cohort study of IBD patients hospitalized with flare through the emergency department (ED) between 2013 and January 2020 at an urban academic medical center. The time from ED presentation to CDI test order (time-to-order), sample collection (time-to-collection), and test result (time-to-result) were collected. Time-to-result was stratified by within 6 hours, 6–24 hours, and 24 hours or longer. The primary outcome was length of stay (LOS). Secondary outcomes were inpatient anti-TNF administration and surgery. Separately, we used initial hemodynamic and laboratory values to create an IBD hospitalization severity score for evaluation against LOS and time-dependent variables. RESULTS: We identified 122 IBD patients hospitalized with flare. There were no significant differences in baseline characteristics among time-to-result groups. There was no difference in time-to-order between the 6 hours and 6–24 hours groups (Table 1). Despite a shorter time-to-result, the average LOS in the 6 hours group was 7.3 days, longer compared to the 6–24 hours group (4.3 days, P = 0.018) and the 24 hours group (4.2 days, P = 0.035; Table 1). There were no differences in inpatient anti-TNF administration (P = 0.10) or surgery (P = 0.08) among time-to-result groups. Markers of disease severity correlated with longer LOS and earlier time-to-result (Table 2). A composite of these markers was used to stratify patients by disease severity. Those with more severe disease had earlier times-to-result (12.8 hours vs. 32.2 hours, P = 0.014) and had a longer LOS (7.9 vs. 3.4 days, P = 0.007) with no difference in time-to-order compared to patients with less severe disease (P = 0.09; Table 3). CONCLUSION: Earlier time-to-result for CDI is associated with longer LOS in IBD patients hospitalized with flare. This inverse relationship is confounded by disease severity at presentation. Patients with more severe disease have a shorter time-to-result and a longer LOS without any difference in time-to-order. Delay in testing was not associated with higher rates of inpatient anti-TNF administration or surgery.Table 1.: Length of stay is longer in those tested for CDI within 6 hours of presentation compared to those tested after 6 hours. P-value as compared to < 6h group in parentheses.Table 2.: Correlation of markers of disease severity with length of stay and/or time-to-result.Table 3.: Comparing time-to-order, time-to-collection, time-to-result, and length of stay using a composite of severity (CRP >= 10, HR >= 100, diastolic blood pressure <60, or albumin <3.5). P-value for statistical significance in comparison to 1 Marker group in parentheses.

S0770 A Predictive Model of Length of Stay in Inflammatory Bowel Disease Patients Hospitalized With Flare: A Multicenter Study

INTRODUCTION: Hospitalization for flare of inflammatory bowel disease (IBD) is associated with significant morbidity and healthcare costs. We aimed to examine the relationship between IBD severity at presentation and adverse outcomes in patients hospitalized with flare. Additionally, we aimed to create and validate a predictive model for length of stay (LOS) using markers of disease severity. METHODS: We conducted a retrospective cohort study of IBD patients hospitalized with flare at two urban academic medical centers. We collected demographic and IBD-related data including the presence of Clostridioides difficile and markers of disease severity at presentation. The primary outcome was a composite of adverse inpatient IBD outcomes, including LOS >7 days, anti-TNF administration, and surgery. The data was split into training (70%) and validation (30%) samples. Employing variables of disease severity, models (including logistic regression, Classification and Regression Tree (CART), and Random Forest (RF) modeling techniques) were created to predict LOS >7 days using the training sample. These models were adjusted for surgery and anti-TNF administration, and their performance was subsequently validated. RESULTS: A total of 187 IBD patients hospitalized with flare were included (Table 1). The composite primary outcome was achieved in 71 patients (38%) with 51 (27%) hospitalized for >7 days. In univariate analyses, C-reactive protein and C. difficile positivity correlated with anti-TNF administration and surgery (Table 2). Adjusting for anti-TNF administration and surgery, tachycardia (OR 1.07; 95% CI 1.05–1.10), hypotension (1.07; 1.03–1.11), hypoalbuminemia (2.87; 1.81–4.74), leukocytosis (1.17; 1.09–1.27), anemia (1.10; 1.05–1.15) and C. difficile positivity (2.63; 1.27–5.47) were predictive of prolonged LOS (Table 2). In multivariate analyses, tachycardia predicted the primary composite outcome of all adverse effects (OR 1.07; 95% CI 1.03–1.11). C. difficile positivity (OR 4.33; 95% CI 1.36–14.9), hypoalbuminemia (3.25; 1.29–9.01), and tachycardia (1.11; 1.06–1.16) predicted prolonged LOS (>7 days). The CART and RF models had acceptable accuracy, sensitivity, and specificity for predicting LOS >7 days (Table 3). CONCLUSION: C. difficile positivity, hypoalbuminemia, and tachycardia at presentation predicted prolonged length of stay in a multicenter cohort of IBD patients hospitalized with flare. CART and Random Forest models perform well in predicting prolonged length of stay in these patients.Table 1.: DemographicsTable 2.: Univariate logistic regression of disease severity and outcomes, odds ratio (OR). OR for systolic and diastolic blood pressure, albumin, and hematocrit is shown as 1/OR for interpretabilityTable 3.: Performance of predictive models for length of stay >7 days

Review article: how the intestinal microbiota may reflect disease activity and influence therapeutic outcome in inflammatory bowel disease.

Intestinal bacteria produce metabolites and by-products necessary for homeostasis. Imbalance in this equilibrium is linked to multiple pathologies including inflammatory bowel disease (IBD). The role of the gut microbiota in determining treatment response is becoming apparent, and may act as biomarker for efficacy. To describe knowledge about the intestinal microbiota on disease severity and treatment outcomes in IBD METHODS: Descriptive review using PubMed to identify literature on the intestinal microbiota in IBD RESULTS: Severe IBD has a less diverse microbiota with fewer commensal microbiota communities and more opportunistic pathogenic bacteria originating from the oral cavity or respiratory tract. IBD treatments can alter gut microbiota composition, but in vitro/in vivo studies are needed to prove causation. A diversification of the microbiota is observed during remission. Patients with a more diverse baseline microbiome and higher microbial diversity show better response to anti-tumour necrosis factor-α, vedolizumab and ustekinumab therapy. Higher abundance of short chain fatty acid-producing bacteria, fewer mucus-colonising bacteria and lower abundance of pro-inflammatory bacteria have also been associated with a favourable outcome. Predictive models, based on a combination of microbiota, clinical data and serological markers, have good accuracy for treatment outcome and disease severity. The intestinal microbiota in IBD carries a set of promising biomarkers of disease activity and prediction of therapeutic outcome. Current insights may also help in designing microbiota modulation strategies to improve outcomes in IBD.