Outcomes In Inflammatory Bowel Disease Research Articles

The Prevalence and Incidence of Irritable Bowel Syndrome and Inflammatory Bowel Disease in Depression and Bipolar Disorder: A Systematic Review and Meta-Analysis.

The increased prevalence and incidence of affective disorders among patients with gastrointestinal disease have been well established. However, few studies have investigated the inverse relationship. We aimed to identify all pieces of evidence of the prevalence and incidence of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) in people with depression and bipolar disorder. We conducted a systematic review of studies reporting the association between affective disorders (exposure) and IBS or IBD (outcome) in adults. Evidence was evaluated for quality using Joanna Briggs Institute Critical Appraisal tools. Where suitable data were available, meta-analyses were performed. We identified 18 studies that met the selection criteria, of which 11 provided data on IBS, 5 on IBD, and 2 on both. Overall, people with depression were significantly more likely to have comorbid IBS (risk ratio = 2.42, 95% confidence interval = 1.98-2.96) and to develop new-onset IBS (risk ratio = 1.90, 95% confidence interval = 1.41-2.56) compared with people without depression. They were also more likely to have and develop IBD, and among patients with IBD, significantly increased rates of depression were observed as early as 5 years before diagnosis. Bipolar disorder was not consistently associated with risk of either condition. People with depression are at an increased risk of both having and developing lower gastrointestinal disorders. These findings have important implications for how we understand, manage, and prevent this comorbidity in clinical practice. Further studies are needed to improve our understanding of the relationship between bipolar disorder and bowel disease as well as the role of psychotropic medication, particularly selective serotonin reuptake inhibitors.

IMPACT OF THIOPURINE DOSE IN COMBINATION THERAPY IN INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND Multiple studies have suggested that combination therapy with thiopurines and anti-TNFs is superior to monotherapy in Crohn’s disease (CD) and ulcerative colitis (UC). The optimal dose of thiopurines in combination therapy remains unclear. Our aim was to determine the impact of thiopurine dosing in combination therapy on the formation of anti-TNF antibodies and clinical outcomes in inflammatory bowel disease (IBD). METHODS This is a single-center, retrospective cohort study of all IBD patients treated with thiopurine and anti-TNF combination therapy between 1/1/2012 and 11/1/2020. Therapeutic dose of thiopurines was defined as ≥ 1 mg/kg for 6-mercaptopurine (6-MP) and ≥ 2 mg/kg for azathioprine (AZA). The primary outcome was anti-TNF antibody formation between patients on a therapeutic dose of thiopurines (TD) versus those on non-therapeutic doses (NTD). Secondary outcomes included steroid-free clinical remission (SFCR), endoscopic healing (absence of ulcers/erosions in CD and Mayo endoscopic score ≤ 1 for UC), and normal serum C-reactive protein (CRP) (defined as ≤ 5 mg/L) in patients who were on combination therapy. Continuous variables were analyzed using an unpaired student’s t-test. Categorical variables were analyzed using a chi-square test. RESULTS A total of 108 patients were included. The median age was 31.5 years (range 13-69), and 58.3% were male (Table 1). A total of 81 patients (75%) were on infliximab (IFX), while 27 patients (25%) were on adalimumab (ADA). Therapeutic dose of thiopurine was used in 19% (n=21). TPMT activity data was available for 56 patients. Normal TPMT activity was noted in 100% (n=7) in the TD group vs. 81.6% (n=40) in the NTD group (p=0.10). There were no significant differences between the TD vs. NTD groups in terms of baseline and disease characteristics (Table 2). Anti-TNF antibody formation was observed in 31 patients (32.1% of patients on IFX and 18.5% of patients on ADA). In the TD group 23.8% developed anti-TNF antibodies vs. 29.9% (p=0.58) in the NTD group. The mean anti-TNF drug level was 19.8 ± 13.8 vs. 16.9 ± 15.5 μg/mL (p=0.44) in the TD vs. NTD groups, respectively. SFCR was observed in 57.1% vs. 60.9% (p=0.75) and 38.1% vs. 37.9% discontinued anti-TNF treatment in the TD vs. NTD groups, respectively. Endoscopic healing was achieved in 55 % vs 60% (p=0.69), and normal CRP was observed in 52.4% vs. 46% (p=0.27) in the TD vs. NTD groups, respectively. CONCLUSION In our cohort, a therapeutic dose of thiopurine in combination therapy was not associated with lower rates of anti-TNF antibody formation compared to non-therapeutic doses. In addition, there were no significant differences in clinical outcomes such as normal CRP, SFCR, and endoscopic healing. Larger and prospective studies are needed to further elucidate the effect of thiopurine dosing in combination therapy for IBD.

EFFECTS OF DELAYED ENDOSCOPIES IN INFLAMMATORY BOWEL DISEASE PATIENTS DURING THE COVID-19 PANDEMIC

OBJECTIVESCare for many chronic conditions was altered during the COVID-19 pandemic. For patients with Inflammatory Bowel Disease (IBD), routine maintenance including endoscopies were postponed. The effects of delaying endoscopies on IBD outcomes are currently unknown. This study aimed to evaluate effects of delays of maintenance endoscopies on patients with IBD during the COVID-19 pandemic.METHODSThis was a retrospective review of all IBD patients scheduled for routine endoscopy at Northwestern Memorial Hospital March 13, 2020 through May 31, 2020. All endoscopic examinations were canceled in this period due to COVID-19. Patients were divided between those whose endoscopies were rescheduled promptly (on-time) or postponed (delayed) after August 31, 2020. Patient outcomes were examined one year after cancellation. Primary outcomes included hospital and emergency room admissions. Secondary outcomes included need for surgery and medication changes.RESULTS100 patients were included in the delayed group and 150 in the on-time group, with a mean age of 47.5 and 42.8 years respectively. 59.2% had Crohn’s disease (CD), 39.2% had Ulcerative Colitis (UC) and 1.2% had indeterminate colitis. Both groups had similar initial severity scores as measured by the Harvey-Bradshaw Index in CD and the Simple Clinical Colitis Activity Index in UC. On average, the on-time group endoscopy was re-scheduled 2.8 months after closure compared to 9.1 months for the delayed group. There was no difference in the number of emergency room visits or hospital admissions during the delay. At one-year post-endoscopy, there was no difference in the number of emergency room visits between the on-time group (n=10, 6.7%) and the delayed group (n=3, 3%), p= 0.17. One-year post-endoscopy there were significantly more hospitalizations in the on-time group (n=14, 9.3%) compared to the delayed group (n=3, 3%), p=0.03. There was one malignancy in the on-time group and two in the delayed group which did not reach statistical significance. Although clinical severity scores were similar at 1 year, there were more IBD related surgeries in the on-time group (16) compared to the delayed group (4), p=0.03.DISCUSSIONPatients with delayed endoscopies due to COVID-19 did not experience worse outcomes compared to patients whose endoscopies remained on-time. There was a trend towards increased malignancies in the delayed group, but higher number of admissions and operations in the on-time group despite similar degree of inflammation on endoscopy. Retrospective nature of this review did not allow us to evaluate all factors that may have influenced the decision for admission and surgery.CONCLUSIONSControlled delay in endoscopies in patients with IBD with closely monitored re-scheduling efforts is safe and can be utilized in times of emergencies without compromising patient outcomes.

LONGITUDINAL STUDY OF THE IMPACT OF HEALTH CONFIDENCE ON INFLAMMATORY BOWEL DISEASE OUTCOMES AND HEALTHCARE UTILIZATION

Abstract INTRODUCTION A growing body of data from the primary care population demonstrates that health confidence (a patient’s belief of their ability and agency to manage their disease and impact the disease course) is an important psychosocial factor associated with chronic disease outcomes (e.g., blood pressure and glycemic control) and emergency department [ED] visits.[1] Health confidence has also been shown to be associated with inflammatory bowel disease (IBD) symptomatic burden, general well-being, and healthcare utilization.[2] We aim to explore factors that influence health confidence and examine its impact on IBD disease outcome and healthcare utilization in a longitudinal, multi-institutional cohort of adults with IBD. METHODS We surveyed adults (age >18) with IBD and their GI providers (verified IBD diagnosis phenotype) at 11 GI clinics across the U.S. as part of the Crohn’s and Colitis Foundation’s IBD Qorus Learning Health System. Included patients reported health confidence, disease activity, and healthcare utilization at baseline and on follow-up 6-12 months thereafter between 2018 and 2021. Health confidence was assessed using the validated Wasson’s health confidence Likert scale from 0 (‘not confident at all’) to 10 (‘very confident’).[1] We identified patient characteristics associated with health confidence using the Kruskal-Wallis test. A Fisher’s exact test was used to examine the associations between baseline low vs high health confidence (score <8 vs ≥8) and adverse IBD outcomes. P<.05 was considered statistically significant. RESULTS Adults with IBD (n=327; 62% Crohn’s disease, 35% ulcerative colitis; 47% in remission) had a median baseline health confidence score of 8 (IQR 7-10; Table 1). Patients with low health confidence (score <8; n=197, 60%) were more likely to have active IBD (p<.0001), use opioids (p=.0001), and have had an ED visit in the preceding 6 months (p=.04; Table 1). Notably, in the subsequent 6-12 months, patients with low baseline health confidence were more likely to have a CT scan (87% vs 13%, p=.03) and be on opioids (100% vs 0%, p=0.02) (Table 2). A higher proportion of patients with low baseline health confidence used steroids (91% vs 9%), had an ED visit (88% vs 11%), and were hospitalized (91% vs 9%) 6-12 months thereafter, though these differences did not reach statistical significance (Table 2). CONCLUSION Symptomatically active disease and ED visits may undermine patients’ confidence to manage their disease, which in turn increases the frequency of subsequent radiographic diagnostic testing. Opioid use was correlated with low health confidence both as a predictor and outcome in this cohort. REFERENCES 1. Wasson, J. et al. Family practice management 21.5 (2014): 8-12. 2. Tse, C. S., et al. Gastroenterology 160.6 (2021): S-58.

FEAR OF THE COVID-19 PANDEMIC IN ADOLESCENTS AND YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE: RELATIONSHIP TO PSYCHOLOGICAL AND PHYSICAL OUTCOMES

BACKGROUNDThe fear of contracting COVID-19 has taken a significant toll on the psychological and physical health of adolescents and young adults (AYA), especially those with chronic health conditions. AYA with Inflammatory Bowel Disease (IBD) are at increased risk for poor psychological and physical well-being. However, to date, there is no published research examining the Fear of COVID-19 Scale (FCV-19S) in AYA with IBD.AIMSTo assess: 1) the reliability of the Fear of COVID-19 Scale in AYA with IBD, and 2) how the fear of COVID-19 relates to key psychological (i.e., anxiety, depression) and physical (i.e., fatigue, pain, disease activity) outcomes in AYA with IBD.METHODSThis ongoing study is a collaboration between Stanford University and ImproveCareNow. Participants included 64 AYA with IBD (M=18.7 years old; 52% Ulcerative Colitis; 60% female; 60% White). Participants completed a one-time online survey. Correlation analyses examined the association between fear of COVID-19, outcome variables (i.e., anxiety, depression, fatigue, pain, disease activity), and demographic variables. Multiple linear regression (MLR) analyses (using the F test) further examined the association between fear of COVID-19, outcome variables, and significant demographic variables (i.e., age, sex).RESULTSThe internal reliability of FCV-19S was measured using Crohnbach’s alpha (α=0.88), indicating high internal consistency. Correlation analyses demonstrated that fear of COVID-19 was significantly associated with anxiety, depression, and fatigue (Table 1). The overall MLR models were significant for anxiety (P<0.001), depression (P=0.002), and fatigue (P=0.031), but not for pain and disease activity. Fear of COVID-19, age, and sex accounted for 29% of the variance in anxiety, 27% of the variance in depression, and 17% of the variance in fatigue. Fear of COVID-19 was not a significant independent predictor of outcomes (Table 2). Female sex was a significant independent predictor for greater levels of anxiety (b=-0.31, P=0.016) and depression (b=-0.35, P=0.008). Older age was a significant independent predictor for greater levels of depression (b=0.29, P=0.031).CONCLUSIONPreliminary results suggest that FCV-19S can be reliably assessed in AYA with IBD. Analyses indicate that fear of COVID-19 is associated with anxiety, depression, and fatigue in AYA with IBD. While COVID-19 fear may be important in explaining these outcomes, female sex independently predicted increased anxiety and depression, and older age independently predicted depression. This highlights the importance of assessing relevant demographic variables (e.g., female sex, young adults) when considering predictors of adjustment in AYA with IBD. Research should further investigate fear of COVID-19 in larger, more diverse IBD populations to better understand its relationship to key IBD outcomes.

P125 Ankylosing spondylitis can influence the outcome of inflammatory bowel disease

Abstract Background Both inflammatory bowel disease (IBD) and ankylosing spondylitis (AS) are inflammatory diseases but there was little previous study that demonstrate the IBD severity and outcome in IBD patients with concomitant AS. Methods Patients’ records were collected from 3 tertiary hospitals (Seoul national university hospital, Seoul national university Bundang hospital, and Seoul metropolitan government Seoul national university Boramae medical center) from October 2004 to June 2021. Patients with IBD and concomitant AS (IBD-AS group) were identified and propensity score matching (PSM) was applied to match the IBD-AS group and IBD patients without AS (only IBD group). Results After PSM, significantly more patients in IBD-AS group had colectomies (p = .017) or were prescribed biologics (p &amp;lt; .001), immunosuppressive agents (p = .021), and steroid (p = .017) than in only IBD group. The number of patients treated with biologics (p &amp;lt; .001) or immunosuppressive agents (p = .032) were significantly greater in UC-AS group than in only UC group. There was no significant difference in outcomes between only CD group and CD-AS group. In logistic regression analyses, identified that concomitant AS was a significant factor associated with biologics treatment in patients with IBD. Kaplan-Meier analyses demonstrated that there was a significant difference in the probability of starting biologics treatment between IBD patients with and without concomitant AS (p = 0.002). In UC patients, the probability of starting biologics was also significantly different according to concomitance of AS (p &amp;lt; 0.001). Concomitant AS was a risk factor for predicting biologics treatment in patients with UC in Cox regression analysis after adjustment UC (adjusted hazard ratio, 6.296; confidence interval, 2.243 to 17.668; p &amp;lt; 0.001) Conclusion Patients with IBD-AS group were more likely to have a higher severity than in only IBD group. The current study result can help IBD specialists understand and treat patients with IBD and concomitant AS better.

P691 Influence of ethnicity on the phenotype and clinical outcomes in Inflammatory Bowel Disease; comparison of a South American with a North American population

Abstract Background Inflammatory Bowel Diseases (IBD) are chronic systemic inflammatory disorders, which affect the gastrointestinal tract. An increased incidence of IBD has been vastly reported in Europe, and North America, however, IBD has now emerged as a global disease affecting people of different genetic backgrounds and geographic locations, with increasing incidence in developing and newly industrialized regions such as South America, offering the opportunity to explore differences and similarities in disease presentation and outcomes across these variables. Methods Our study includes 265 patients with a diagnosis of Ulcerative Colitis (UC) (n=173) or Crohn′s Disease (CD) (n=92). We carried out an exploratory analysis of databases of Chilean and North American IBD patients to compare the clinical phenotype between both cohorts. We used an unsupervised machine learning approach using Principal Component Analysis (PCA), t- Stochastic Neighbor Embedding (t-SNE), among others, for each disease (CD and UC). Finally, we predicted the center (North American versus Chilean) using random forest, among other supervised machine learning methods to confirm these results. Results Several unsupervised machine learning methods separated two main groups supporting differences between North American and Chilean patients in each disease. The variables that explained the loadings of the clinical metadata on the principal components were related to therapies and disease extension/location at diagnose. Our Random Forest (RF) models were trained for cohort classification (Chilean or North American) based on clinical characteristics, obtaining a high accuracy of 0.86 (UC) and 0.89 (CD). Similarly, variables related to therapies and disease extension/location had a higher Gini index. In the same line, univariate analysis showed a later CD age at diagnoses in Chilean IBD patients (37 vs 24; p=0.005) Conclusion Our study suggests a clinical difference between North American and Chilean IBD patients; later CD age at diagnoses with a predominate less aggressive phenotype (39% vs. 54% B1), a more localized disease despite less biological therapies used in Chile for both diseases. The next research steps to confirm these results with more patients and explore more factors between different populations that could determine a less aggressive phenotype. Understanding the causes of these differences could unravel new pathways or protective factors, which could improve treatments.

N12 Systematic Review: The role of psychological stress in Inflammatory Bowel Disease

Abstract Background Psychological stress is a possible factor in the disease course and poor psychosocial outcomes in Inflammatory Bowel Disease (IBD). Understanding the exact relationship between stress and health has been hampered by methodological issues and how stress has been defined and measured. This study aims to explore the association between stress and disease outcomes, investigate the impact of stress on psychosocial outcomes, and evaluate the efficacy of interventions in reducing stress for people with IBD. Methods A systematic review was performed. Medline, CINAHL, Embase, and PsycInfo databases were searched. Prospective studies recruiting people with IBD 16 years old or over and measuring psychological stress or distress were included. Results Thirty-eight studies, from 41 reports, with 4757 people with IBD were included in the review. Studies used thirty-six different instruments to measure stress. Perceived stress was the most frequently studied concept and was found to precede IBD disease exacerbation. Depression and helplessness were positively associated with perceived stress, while social support, resilience, and quality of life were negatively associated. Cognitive-behavioural group programmes may reduce stress and education, stress management, and exercise and other group programmes may reduce disease-specific stress, but more studies are needed where groups have comparable baseline characteristics and potential harms are considered alongside benefits. Conclusion Psychological stress appears to precede IBD disease exacerbation, though what role it plays in psychosocial outcomes and how it is best managed is unclear. Further research is needed to examine the differential effects of stress on disease subtypes and IBD in flare and remission.

P311 Depression and anxiety are associated with poor clinical outcomes in Inflammatory Bowel Disease: A Nationwide Population-Based Study in South Korea

Abstract Background The increase in prevalence of depression and anxiety disorder in Inflammatory Bowel Disease (IBD) is demonstrated from previous studies, but it is uncertain whether the patients with depression and anxiety are at higher risk of poor outcomes of IBD. Therefore we aimed to determine the impact of depression and anxiety on clinical outcomes in patients with IBD. Methods We conducted a nationwide, population-based retrospective cohort study using the Korean national health insurance claims data between, 2010 and, 2017. Patients with Crohn’s Disease and Ulcerative Colitis were targeted through the registration program for rare/intractable diseases, and patients with depression and anxiety were also identified by the International Classification of Disease, tenth revision (ICD-10) code. The primary outcome of this study is the poor IBD-related outcomes and we defined the poor IBD-related outcomes as IBD-related emergency room visits, hospitalization, and surgery in this study. Results A total of, 36,379 IBD patients (10,754 Crohn’s disease (CD) and, 25,625 ulcerative colitis (UC)) were enrolled in this study between, 2010 and, 2017 and among them, 4,335 (11.9%) had depression/anxiety. Multivariate analysis showed that CD patients with depression/anxiety were at an increased risk of ER visits (HR, 1.858, 95% CI, 1.5–2.301) and hospitalization (HR, 1.727, 95% CI, 1.315–2.269). UC patients with depression/anxiety were also at increased risk for ER visits (HR, 1.339, 95% CI, 1.084–1.654) and hospitalization (HR, 1.367, 95% CI, 1.059–1.764). While the risk of surgery in patients with depression/anxiety was not different from those without depression/anxiety in both CD and UC. Conclusion Depression and anxiety disorder was associated with a higher risk for poor clinical outcomes in patients with IBD. The results of this study suggest that psychologic co-morbidities such as depression and anxiety might improve the clinical course of IBD

DOP04 Inflammatory Bowel Disease (IBD) and Solid Organ Transplantation. Natural history of pre-existing and de novo IBD patients. (EITOS study of GETECCU)

Abstract Background Limited data is available of the outcome of inflammatory bowel disease (IBD) in patients with solid organ transplantation (SOT). The aim of our study was to describe the natural history of pre-existing IBD and de novo IBD after SOT. Methods A retrospective, observational, multi-centre, nationwide study was designed. IBD patients with SOT were included. We identified two separate cohorts: (1) patients with pre-existing IBD at the time of SOT and (2) patients without IBD at the time of SOT (de novo IBD). The primary outcome was IBD progression, defined by the escalation of medical treatment, surgical therapy for medically refractory IBD or IBD-related hospitalization during follow-up. Risk factors were identified using multivariate Cox proportional hazard analysis. Results A total of 177 patients (106 pre-existing IBD and 71 de novo IBD) from 31 centres were included. Baseline characteristics are shown in Table 1. Eighty-six patients with IBD and SOT underwent liver transplantation, while 82 required renal, 4 lung, 3 heart, 1 liver/kidney and 1 pancreas/kidney transplantation. Pre-existing IBD patients were followed-up over a median of 4.8 years (range 2.6–9.4). At the time of SOT, 61 patients (59.8%) were not under maintenance treatment or were treated with 5-aminosalicylates, 10 (9.8%) were on immunosuppressive therapy and 31 (30.4%) were receiving biological agents, of which 8 were on combo therapy. At the moment of SOT, only 8 patients (7.5%) had moderate IBD activity whereas the remaining patients were in remission. During follow-up 33.7% of patients with pre-existing IBD had disease progression, with a median time between SOT and IBD progression of 2.2 years (range 1.3–4.6). No differences between Crohn′s disease and ulcerative colitis were found (Figure 1). The median time of follow-up in de novo IBD group was 5.1 years (range 2.1–8.2). In this cohort, 55.9% of patients had disease progression during follow-up (Figure 2), with a median time to flare of 1.9 years (range 0.8–3.9) from diagnosis. In pre-existing IBD cohort, multivariate Cox-regression analysis identified active IBD at the time of SOT (HR=1.80; 95%CI: 1.14–2.84; p=0.012) and the presence of extraintestinal manifestations (HR=3.10; 95%CI: 1.47–6.54; p=0.003) as predictive factors of IBD progression after SOT. Conclusion One third of patients with pre-existing IBD have disease progression, needing medical therapy escalation, surgery or hospitalization after SOT. Active IBD at the time of SOT and the presence of extraintestinal manifestations were identified as risk factors for disease progression. In de novo IBD cohort, about half of patients showed disease progression during follow-up.

P558 Should we introduce early a new biological agent in patients with Inflammatory Bowel Disease after anti-TNF discontinuation due to severe anti-TNF-induced skin lesions? A multicenter cohort study

Abstract Background Data to manage patients with Inflammatory Bowel Disease (IBD) after anti-TNF discontinuation due to severe induced skin lesions are scarce. Our study aimed to assess dermatological and IBD outcomes after discontinuation of an anti-TNF agent related to skin side effects. Methods We conducted a multicenter retrospective study including consecutive IBD patients who discontinued anti-TNF due to induced skin lesions. Objectives were to determine factors associated with remission of induced skin lesions and with IBD relapse in patients with inactive disease at inclusion, particularly the impact of early introduction of a new biological agent within three months of anti-TNF discontinuation. Results Among the 181 patients (134 women, 160 Crohn’s disease) included in the 13 participating centers, 99 (55%) started a new biological agent within the first three months that was mainly ustekinumab in 75% of them. Remission of induced skin lesions occurred in 110 (62%) patients with a median [interquartile range (IQR)] interval of 8.0 (6.8–11.0) months since anti-TNF discontinuation. Scalp location was independently associated with a reduced risk of remission of induced skin lesions [HR 0.64 (95%CI 0.43- 0.94), p=0.02] while early biological therapy was independently associated with a higher probability of remission of skin lesions [HR 1.64 (95%CI 1.1–2.5), p=0.02]. Among the 148 patients with inactive IBD at inclusion, disease relapse occurred in 75 (51%) patients with a median (IQR) interval of 26.0(23.0–39.1) months. Survival rates without IBD relapse at 1 year were 85.8% (95%CI 77.5–94.9) in the early introduction group and 59.3% (95%CI 48.9–71.9) in the other group (p&amp;lt;0.01). Conclusion Early introduction of a new biological is associated with higher probability of healing of anti-TNF-induced skin lesions and significantly reduces risk of IBD relapse.

P608 Systematic review: The impact and importance of body composition in Inflammatory Bowel Disease

Abstract Background Alterations in body composition are common in Inflammatory Bowel Disease (IBD) and have been associated with differences in patient outcomes. We systematically reviewed the literature to consolidate knowledge on the impact and importance of body composition in IBD. Methods We conducted a systematic review according to PRISMA guidelines. A systematic search of MEDLINE, EMBASE and conference proceedings was undertaken by combining two key research themes: Inflammatory Bowel Disease and body composition. Studies which examined alterations in body composition in patients with IBD and studies which explored the impact of body composition on IBD therapeutic outcomes and prognosis were included. Results 55 studies were included in this review. 31 studies focused on the impact of Inflammatory Bowel Disease on body composition with a total of 2,279 patients and mean age of 38.4 years. Of these, 1,071 (47%) were male. 1470 (64.5%) patients had CD and 809 (35.5%) had UC. Notably, fat mass and fat-free mass were reduced, and higher rates of sarcopaenia were observed in those with active IBD compared with those in clinical remission and healthy controls. 24 additional studies focused on the impact of derangements in body composition on IBD outcomes. Alterations in body composition were associated with poorer prognoses including higher rates of surgical intervention, post-operative complications, and reduced muscle strength. In addition, higher rates of early treatment failure and primary non-response were seen in patients with myopaenia. Conclusion Patients with IBD have alterations in body composition parameters in active disease and clinical remission. The impact of body composition on disease outcome and therapy are broad and require further investigation. The augmentation of body composition parameters in the clinical setting has the potential to improve IBD outcomes in the future.

P361 PREPARE-IBD: Physician Responses to disease Flares and Patient Adaptation in Relation to Events in Inflammatory Bowel Disease during the COVID-19 pandemic: A multicentre cohort analysis

BackgroundThe COVID-19 pandemic continues to pose complex problems across Europe and the world, with rising numbers of infections and the ongoing need for drastic public health interventions. This is difficult for patients with immune-mediated disorders like Inflammatory Bowel Disease (IBD), where immunosuppressive medications may affect susceptibility to serious infection. It was particularly challenging for physicians and patients during the first wave of the pandemic, when it was unclear whether anti-inflammatory flare treatment should be adapted to reduce infection risk, whilst trying to ensure symptomatic control and avoid admission to overwhelmed hospitals. Despite the development of various IBD / COVID-19 databases, the treatment adaptations and outcomes of patients experiencing IBD flares during the COVID-19 pandemic remain undefined. We aimed to compare IBD management and outcomes between pandemic and pre-pandemic cohorts.MethodsAn observational cohort study was performed, comprising patients who contacted IBD teams for a symptom flare between March – June, 2020 in, 60 National Health Service trusts in the United Kingdom. Data were compared to a pre-pandemic cohort after propensity-matching for age and disease severity. Statistical analyses were performed using R (version, 4.1.0, Vienna, Austria).ResultsIn total, 3728 patients in the pandemic (n=1864) and pre-pandemic (n=1864) cohorts were included. The principal findings were reduced systemic corticosteroid prescription during the pandemic in both Crohn’s disease (prednisolone: pandemic, 199/752, 26.5% vs, 263/708, 37.1%; p<0.001) and ulcerative colitis (UC) (prednisolone: pandemic, 372/1112, 33.5% vs, 470/1156, 40.7%, p<0.001), with increases in poorly bioavailable oral corticosteroids in Crohn’s (pandemic, 117/752, 15.6% vs, 48/708, 6.8%; p<0.001) and UC (pandemic, 131/1112, 11.8% vs, 60/1156, 5.2%; p<0.001). Ustekinumab (Crohn’s and UC) and vedolizumab (UC) treatment also significantly increased during the pandemic. Three-month steroid-free remission was similar in both Crohn’s (pandemic, 175/616, 28.4% vs, 195/608, 32.1%; p=0.17) and UC (pandemic, 312/858, 36.4% vs, 404/1006, 40.2%; p=0.095). The, 65 patients experiencing a flare and COVID-19 were more likely to have moderate-to-severely active disease at three months compared to those with a flare alone.ConclusionDespite several treatment adaptations during the pandemic, steroid-free outcomes were comparable to pre-pandemic levels, though patients with a flare and COVID-19 experienced worse outcomes. These findings have implications for IBD management during future waves or pandemics

DOP25 Clinical outcomes of COVID-19 and Impact on Disease Course in Patients with Inflammatory Bowel Disease

BackgroundThe impact of COVID-19 has been of great concern in patients with inflammatory bowel disease (IBD) worldwide, including an increased risk of severe outcomes and/or possible flare of IBD. This study aims to evaluate prevalence, outcomes, the impact of COVID-19 in patients with IBD, and risk factors associated with severe COVID-19 or flare of IBD activity.MethodsA consecutive cohort of IBD patients followed at the McGill University Health Care Centre diagnosed with COVID-19 infection was obtained between March 1, 2020, and April 30, 2021. Demographics, comorbidities, IBD (type, treatments, pre-and post-COVID clinical activity, biomarkers, and endoscopic activity), and COVID-related outcomes (pneumonia, hospitalization, death, and flare of IBD disease) were analyzed.ResultsA total of 3,516 IBD cohort patients were included. 82 patients (2.3%) were diagnosed with COVID-19 infection (median age 39.0 (IQR 27.8–48.0), 77% with Crohn’s disease, 50% were female). The prevalence of COVID infection in IBD was significantly lower compared to the general population in Canada and Quebec (3.5% vs. 4.3%, p<0.001). Severe COVID occurred in 6 patients (7.3%); 2 patients (2.4%) died. A flare of IBD post-COVID infection was reported in 8 patients (9.8%) within 3 months. Biologic therapy was held during active COVID infection in 37% of patients. Age ≥55 years (odds ratio (OR):11.1, 95%CI:1.8–68.0), systemic corticosteroid use (OR:4.6, 95%CI:0.7–30.1), active IBD (OR:3.8, 95%CI:0.7–20.8) and comorbidity (OR:4.9, 95%CI:0.8–28.6) were factors associated with severe COVID. After initial infection, 61% of IBD patients received COVID-19 vaccinations. ConclusionThe prevalence of COVID-19 infection among patients with IBD was lower than that in the general population in Canada. Severe COVID, mortality, and flare of IBD were relatively rare, while a large proportion of patients received COVID vaccination. Older age, comorbidities, active IBD disease, and systemic corticosteroid, but not immunosuppressive or biological therapy were associated with severe COVID infection.

P654 Clinical outcomes in familial versus sporadic inflammatory bowel disease diagnosed in the era of biological therapies. Prospective data from the ENEIDA registry

Abstract Background It has been reported that familial aggregation occurs in 10–20% of inflammatory bowel disease (IBD) patients1. Familial IBD has been associated with disease anticipation2 and with an increased need for immunosuppressants3 and surgery4. However, most studies were performed before the widespread use of biological agents and this may impact on the need for surgery. We aimed to compare the clinical outcomes of IBD (by means of the need for biological therapy and abdominal surgery) between familial and sporadic forms of IBD in the era of biological therapies. Methods Data were extracted from the ENEIDA registry by GETECCU, a Spanish, prospectively-maintained, IBD database in which more than 80 centers are participating. Only adult patients diagnosed with IBD since 2005 and prospectively followed in the registry since diagnosis were included. Familial IBD was defined as those cases with at least one first-degree relative diagnosed with IBD. Sporadic IBD was defined as those cases with no familial relative (of any degree) with IBD. Kaplan-Meier survival curves were performed to evaluate the cumulative probabilities of remaining biologic-free and surgery-free. Log-rank test was performed to compare them between familial and sporadic IBD forms. Chi-square test was performed for the rest of variables. Results A total of 5,263 patients (2,627 Crohn’s disease [CD]; 2,636 ulcerative colitis [UC]) were included. Of them, 507 (10%) were familial cases (274 CD, 233 UC; P=0.05). The median follow-up was 38,4 and 35.5 months, respectively (P=0.086). Familial cases were younger (P=0.022) and had a higher proportion of females among UC cases (P=0.048). No differences were observed in the need for biological therapy in both CD and UC between familial and sporadic IBD. Regarding surgery, no differences were observed in the cumulative probabilities of a first intestinal resection for CD and colectomy for UC. Similar results were obtained when all the analyses were restricted to those subgroups at high-risk for surgery (i.e. CD with ileal involvement and extensive UC). Conclusion In patients diagnosed with IBD in the era of biological therapies, familial forms have the same requirements for biological agents and resectional surgery as sporadic forms. Therefore, familial aggregation does not seem to be a factor for a more aggressive disease.

IMPACT OF THIOPURINE DOSE IN COMBINATION THERAPY IN INFLAMMATORY BOWEL DISEASE

Multiple studies have suggested that combination therapy with thiopurines and anti-TNFs is superior to monotherapy in Crohn's disease (CD) and ulcerative colitis (UC). The optimal dose of thiopurines in combination therapy remains unclear. Our aim was to determine the impact of thiopurine dosing in combination therapy on the formation of anti-TNF antibodies and clinical outcomes in inflammatory bowel disease (IBD).

EFFECTS OF DELAYED ENDOSCOPIES IN INFLAMMATORY BOWEL DISEASE PATIENTS DURING THE COVID-19 PANDEMIC

Care for many chronic conditions was altered during the COVID-19 pandemic. For patients with Inflammatory Bowel Disease (IBD), routine maintenance including endoscopies were postponed. The effects of delaying endoscopies on IBD outcomes are currently unknown. This study aimed to evaluate effects of delays of maintenance endoscopies on patients with IBD during the COVID-19 pandemic.

Impact of thiopurine dose in anti-tumor necrosis factor combination therapy on outcomes in inflammatory bowel disease.

Combination therapy with thiopurines and anti-tumor necrosis factor (TNF) is superior to monotherapy in Crohn's disease (CD) and ulcerative colitis (UC). The optimal dose of thiopurines in combination therapy remains unclear. We investigated the impact of thiopurine dose in combination therapy on outcomes in inflammatory bowel disease (IBD). This was a single-center, retrospective study of patients with IBD treated with thiopurine and anti-TNF combination therapy between 1/2012 and 11/2020. A therapeutic dose of thiopurines was defined as ≥1 mg/kg for 6-mercaptopurine and ≥2 mg/kg for azathioprine. The primary outcome was anti-drug antibody (ADA) formation in patients on a therapeutic thiopurine dose vs. a lower thiopurine dose group. Secondary outcomes included steroid-free clinical remission, endoscopic healing (absence of ulcers/erosions in CD and Mayo endoscopic score ≤1 for UC), and normal serum C-reactive protein (CRP) in patients who were on combination therapy. A total of 108 patients were included (median age 31.5 years; 58.3% male). A therapeutic dose of thiopurine was used in 19%. In the therapeutic thiopurine dose group, 23.8% developed ADA vs. 29.9% (P=0.58) in the lower dose group. No significant differences were noted between the therapeutic and lower dose thiopurine groups in terms of steroid-free clinical remission (57.1% vs. 60.9%, P=0.75), endoscopic healing (55% vs. 60%, P=0.69), and normal CRP (52.4% vs. 52.9%, P=0.27). In our cohort of patients with IBD on anti-TNF combination therapy, thiopurine dose was not associated with significant differences in anti-TNF immunogenicity and clinical outcomes.

Outcomes of COVID-19 in Patients with Inflammatory Bowel Disease: Comparison with Household Members and the Role of IBD Medications.

Most data on the effect of inflammatory bowel disease (IBD) and its treatments on coronavirus disease 2019 (COVID-19) outcomes have not had non-IBD comparators. Hence, we aimed to describe COVID-19 outcomes in IBD compared to non-IBD patients. We conducted a prospective cohort study of registered IBD patients with confirmed COVID-19 from six provinces in Iran from February to April 2020. Proven COVID-19 patients were followed up at four weeks and the frequency of outcomes was assessed. Multivariable logistic regression was used to assess associations between demographics, clinical characteristics and COVID-19 outcomes. Overall, 2159 IBD patients and 4721 household members were enrolled, with 84 (3.9%) and 49 (1.1%) participants having confirmed COVID-19, respectively. Household spread of COVID-19 was not common in this cohort (1.2%). While hospitalization was significantly more frequent in IBD patients compared with non-IBD household members (27.1% vs. 6.0%, P=0.002), there was no significant difference in the frequency of severe cases. Age and presence of IBD were positively associated with hospitalization in IBD compared with non-IBD household members (OR: 1.06, 95% CI: 1.03-1.10; OR: 5.7, 95% CI: 2.02- 16.07, respectively). Age, presence of new gastrointestinal symptoms, and 5-aminosalicylic acid (5-ASA) use were associated with higher hospitalization rate in IBD patients (OR: 1.13, 95% CI: 1.05-1.23; OR: 6.49, 95% CI: 1.87-22.54; OR: 6.22, 95% CI: 1.90-20.36, respectively). Anti-tumor necrosis factor (TNF) was not associated with more severe outcomes. Age, presence of new gastrointestinal symptoms and use of 5-ASA were associated with increased hospitalization rate among IBD patients, while anti-TNF therapy had no statistical association.

Association Between Frailty or Sarcopenia and Adverse Outcomes in Inflammatory Bowel Disease: A Systematic Review.

Chronological age often guides the management of patients with inflammatory bowel disease (IBD). Frailty and sarcopenia, which are related but distinct entities that become increasingly prevalent with age, better predict nonsurgical and surgical outcomes in various chronic illnesses. We conducted a systematic review to assess the association between frailty or sarcopenia and adverse nonsurgical outcomes in adult patients with IBD. Through a systematic literature review of 4 online databases (MEDLINE, EMBASE, Scopus, and CINAHL Plus), we identified 16 studies that focused on frailty or sarcopenia and nonsurgical outcomes in IBD. The Newcastle-Ottawa Scale was used to determine the quality of included studies. We identified 16 studies: 8 frailty-based and 8 sarcopenia-based studies (14 high-quality and 2 low-quality studies). All results were presented in a summarized narrative format. Frailty predicted all hospitalization-related outcomes (hospitalization, readmission, and length of stay) and mortality-related outcomes. The outcomes of therapeutic efficacy, need for therapy escalation, and infections had mixed results in relation to their association with frailty or sarcopenia. The data regarding sarcopenia and hospitalizations were also equivocal. This systematic review supports the use of frailty indices to predict hospitalization- and mortality-related outcomes in adult patients with IBD. Future research should focus on identifying and validating frailty and sarcopenia tools in IBD to better help predict adverse clinical outcomes and response to therapy.