Colitis In Practice Research Articles

Knowledge and perspectives towards the use of histology in inflammatory bowel disease by gastroenterologists across the Asia-Pacific region.

Recently, histological mucosal assessment has gained momentum as a potential new treatment target for patients with inflammatory bowel disease (IBD) in the Asia-Pacific region. This study aimed to evaluate and compare the knowledge and acceptability of histological assessment among gastroenterologists across the region. A cross-sectional survey among gastroenterologists in the Asia-Pacific region was conducted and compared against a previous Australian survey. The questionnaire assessed knowledge and attitude towards the role and application of histology in IBD practice. Statistical analyses were employed to compare scores and identify predictors. A total of 221 gastroenterologists from 12 countries, including 77 (34.8%) from Australia, responded to questionnaire, with 185 (83.7%) completing the survey. The mean knowledge score was 9.8 ± 3.3 (51.6%). There was no significant difference in the average score among countries (P= 0.53). IBD specialist (P< 0.01), doctoral degree (P= 0.02), and regular participation in IBD multidisciplinary meetings (P= 0.01) were associated with higher scores. Most respondents (90.7%) agreed on the importance of histology in IBD. While 54.6% of Australians perceived the role of histology as established, only 37.0% of Asians respondents considered this similarly (P= 0.02). Histological activity alone minimally influences treatment escalation in patients with endoscopic remission, but achieving combined histo-endoscopic remission often leads to therapy de-escalation. Although gastroenterologists in the Asia-Pacific region are aware of the role of histology in IBD, their knowledge remains limited, and its clinical utility is not widely adopted. There is a need to promote the routine use of standardized histological assessment in IBD practice.

P484 Intestinal Ultrasound Can Detect Active Inflammation In Inflammatory Bowel Disease Patients Despite Combined Clinical And Biomarker Remission

Abstract Background Intestinal ultrasound (IUS) has only recently been implemented in the USA for inflammatory bowel disease (IBD) monitoring. Colonoscopy is considered the gold standard for evaluation of inflammation but may not be feasible for every assessment due to cost, time, and accessibility. Clinical activity scores and biomarkers are used instead as adjunct measures of disease. Since IUS incurs low cost and time with easy accessibility, our study aimed to demonstrate the utility of incorporating IUS into IBD practice by evaluating the sensitivity and specificity of these adjunct measures of inflammation and the impact of decisions made based on IUS. Methods This retrospective cohort analysis evaluated patients with IBD at our institution who underwent IUS from July 2020 to May 2021. The patients were reviewed for repeat IUS visits until July 2022. Patients received IUS regardless of clinical or biomarker remission, and/or if they were able to receive a colonoscopy. Clinical remission was defined as UCAI ≤ 5 and partial Mayo ≤ 2 or HBI ≤ 5. Biomarker remission was defined as ESR ≤ 40 mm/hour; CRP ≤ 8 mg/L; FCP ≤ 125 mg/mg; and fecal lactoferrin ≤ 30 mcg/mL. Combined remission was defined as both clinical and biomarker remission. The sensitivity and specificity of these groups was evaluated based on IUS. Treatment plans were decided based on IUS findings. Patients with normal IUS maintained therapy while those with positive findings required a change/escalation of therapy. These patients had repeat IUS to ensure the changes resulted in reduction of inflammation. Results In 148 total patients receiving IUS, 62% (N=92) had active disease. Clinical remission (figure 1) was 41% sensitive and 75% specific while biomarker remission was 49% sensitive and 58% specific to IUS findings. When combined (clinical + biomarker remission), sensitivity increased to 62% and specificity decreased to 52% (figure 2). There was a total of 39 repeat ultrasounds. Inflammation was improved at repeat IUS, measured by a decrease in overall bowel wall thickness in 77% (30/39) patients for a mean of 0.121 cm. Vascular flow improved in 79% (15/19) of patients with abnormal Doppler at initial IUS by a mean of 0.65, and mural stratification improved in 80% (20/25) of patients with mural disruption at initial IUS. Conclusion Our study showed that even when combining biomarker results and clinical scores, the sensitivity for detecting inflammation was 62%. Additionally, as demonstrated by the improvement in inflammation at IUS follow up, clinical decisions based on IUS results effectively reduced inflammation in IBD patients. As such, IUS is necessary in the management of IBD to effectively identify and treat patients with masked inflammation.

A call for clarity: a scoping review of predictors of poor outcome after emergency abdominal surgery for inflammatory bowel disease.

The medical management of inflammatory bowel disease (IBD) is rapidly progressing; however, many patients with the disease still require surgery. Often this is done as an emergency. Initiatives such as the National Emergency Laparotomy Audit have shown how evidence-based emergency surgery improves outcomes for the patient. The aim of this scoping review is to describe the current evidence base on risk stratification in emergency abdominal surgery for IBD. A literature search, abstract and full paper screening resulted in 17 articles representing 63 472 patients from seven countries. It is likely that age, the American Society of Anesthesiologists grade, comorbidity and organ dysfunction play a similar role in risk stratification in IBD patients as in other emergency abdominal surgery cohorts. However, the reporting of what is considered an IBD emergency is variable. Six studies include clear definitions of emergency in our study. The range of what is considered an emergency is within 12 h of admission to any time within an unplanned admission. To have data driven, evidence-based emergency surgical practice in IBD we need consistency of reporting, including the definitions of emergency and urgency. Core descriptor sets in IBD would be valuable.

A Digital Health Intervention to Improve the Clinical Care of Inflammatory Bowel Disease Patients.

Inflammatory bowel disease (IBD) is a chronic condition that requires close monitoring. Digital health virtual care platforms can enable self-monitoring and allow providers to remotely surveil patients and efficiently identify those with active disease. The primary aim was to design and implement an IBD remote monitoring program, identify predictors of patient engagement, and determine who found the chat to be a valuable tool. We developed the IBD Virtual Care Chat, an electronic health record (EHR)-integrated chat to monitor electronic patient reported outcomes (ePROs), medication changes, and disease activity, and subsequently report concerning findings to providers via the EHR. All patients in the IBD practice over age 18 with a clinical encounter in the preceding 12 months were eligible to be enrolled. The primary aim was to identify predictors of patient engagement and determine who found the chat to be a valuable tool. Between May 2021 and March 2022, 2,934 patients were enrolled. A total of 1,160 engaged at least once and 687 (23.4%) continually engaged, submitting at least three ePROs. Disease severity (based on Harvey-Bradshaw Index or Simple Clinical Colitis Activity Index) did not impact ePRO submissions. Patients were significantly more likely to be continually engaged if they self-reported the presence of extraintestinal manifestations (7%, 95% confidence interval: 0.01-0.14; p = 0.04). Patient satisfaction remained moderately high with a median score of 8 (interquartile range: 5-10) on a scale of 1 (poor) to 10 (good). Our program demonstrates the potential for EHR-integrated digital health as part of routine IBD care to achieve sustained engagement with high patient satisfaction.

SP10.16 Impact of joint surgical and medical management on outcomes in inflammatory bowel disease. A retrospective review of medical management and surgical outcomes in a District General

Abstract Aim A combined medical and surgical team approach for management of inflammatory bowel disease (IBD) facilitates optimized medical and surgical management through dedicated MDTs and clinics. These benefits were delivered during the COVID-19 pandemic impacting planned medical care. Method Data was collected for all IBD patients undergoing resection surgery over 16 years of age covering a 2-year period before and a 2-year period after the impact of COVID-19 pandemic and start of a combined IBD practice. It included demographics, immune-suppression and planned and unplanned surgery between January 2018 to September 2021. Results 62 patients underwent major resection surgery. Six were excluded for non-IBD related indication (malignancy, infective colitis and volvulus). Of the remaining 56 patients, 20 (35.7%) had Crohn’s Disease, 35 (62.5%) had Ulcerative colitis and one (1.8%) with indeterminate colitis on histopathology. The median age was 43.6 years (16 to 80) with 64.3% females. In the first 2-year period, 73.7% (14) underwent surgery with high perioperative immunosuppression. This reduced to 26.3% (5) in the combined IBD period. Proportion of patients undergoing emergency surgery declined from 59% to 12.5%. Use of biologics increased from 29% to 50% of patients with the average of 0.71 vs 2.13 failed biologics use before surgical intervention. Conclusion Combined medical and surgical IBD practice offers optimised care through timely escalation of medical treatment and reduces risks associated with major emergency surgery. Despite the restrictions to planned surgical treatment during the COVID-19 pandemic, improved outcomes were achieved with combined practice for IBD patients.

Integrating Intestinal Ultrasound into an Inflammatory Bowel Disease Practice: How to Get Started.

Intestinal ultrasound (IUS) offers a safe, noninvasive, point-of-care tool for diagnosing and monitoring disease activity in patients with inflammatory bowel disease (IBD). IUS is used widely in Europe and Canada for IBD, but it remains underutilized in the United States. Growing interest in IUS in the United States has prompted many IBD centers to train their faculty in IUS. This, however, raises questions about how to effectively use this new tool in the United States, which does not use a social medicine model like those implemented in Europe and Canada. Here, we provide a practical framework for incorporating IUS in an IBD practice in the United States, including training requirements, equipment, and protocols for implementing IUS in daily practice.

Use of Standardized Inflammatory Bowel Disease Endoscopy Scores in Clinical Practice.

Inflammatory bowel disease (IBD) treatment targets include mucosal healing based on standardized endoscopic scoring systems. The rates and ease of use of these scoring systems in practice have not been well described. We aimed to assess the rates and factors associated with the use of IBD endoscopic scoring systems in practice from IBD LIVE attendees. IBD Live is an international case-based conference focusing on the management of patients with IBD. We created a web-based survey consisting of 38 questions on the frequency and ease of use of various IBD endoscopic scores. This survey was emailed to the IBD Live listserv in March 2022 with a second email sent 14 days later. We included only respondents who are currently performing endoscopy. Continuous variables were analyzed using an unpaired student's t-test. Categorical variables were analyzed using Pearson's chi-square test. There were 65 responses out of 170 (38.2% response rate) regular attendees. Eleven responses were excluded (4 with no response on the use of endoscopy scores, and 7 were not performing endoscopy). Of the respondents, 72.2% are from the United States, 70.4% are adult gastroenterologists, 53.9% in academic practice, and 40.7% in practice for ≥15 years. Of the endoscopy scores used ≥50% of the time, 74.1% were using the Mayo Endoscopic Subscore (MES), 72.3% using the Rutgeerts Score, 61.2% using the Simple Endoscopic Score for Crohn's Disease, and 28.6% using the Pouchitis Disease Activity Index. Attending IBD LIVE ≥ monthly (P = .028), attending an IBD conference at least every 2 years (P = .020), and having the scoring system incorporated into the endoscopy documentation software (P = .002) were associated with more consistent use of the MES. Attending IBD Live at least monthly (P = .026), having an IBD volume of ≥50% (P = .011), and attending an IBD conference at least every 2 years (P = .004) was associated with more frequent use of the Rutgeerts score. There were no factors that increased the use of other endoscopic scores. The MES and the Rutgeerts score are more commonly used with much lower rates of use of endoscopic scores for Crohn's disease and pouchitis. The use of these endoscopy scores is more common among those who regularly attend IBD conferences, have higher volume IBD practices, and have these scoring systems incorporated into endoscopy software. Further evaluation of barriers to use and ways to improve utilization of endoscopic scoring for Crohn's disease and pouchitis is needed.

Health Communication Research Informs Inflammatory Bowel Disease Practice and Research: A Narrative Review.

In the absence of targeted empirical evidence on effective clinical communication in inflammatory bowel disease (IBD), a broad overview of existing evidence on effective communication in healthcare and available recommendations for communication in telehealth is provided and mapped onto IBD research and practice. A narrative literature review was conducted using Pubmed and Scopus databases and snowballing literature search. Evidence-based relationship building strategies include communicating emotions, acknowledging and addressing patients' hesitancy, and ensuring continued support. A particular recommendation regarding telehealth interaction is to avoid long stretches of talk. Effective informational strategies include facilitating and supporting information exchange and considering patients' preferences in decision-making. In teleconsultations, clinicians should ask direct questions about patients' emotional state, clarify their understanding of patients' concerns and check patients' understanding, address at least one patient-reported outcome when discussing the recommended treatment, and shorten the consultation where possible. Strategies for maximizing effective clinical communication in the spoken communicative mode include using infographics and simple language, and assessing adherence at the beginning of the consultation. For teleconsultations, clinicians are advised to allow patients to explain the reason for their call at the beginning of the teleconsultation, probe additional concerns early and before ending the teleconsultation, and be mindful of technical issues such as voice delays. Use of question prompt lists, decision aids, micro-lessons, and communication training interventions for clinicians could be beneficial in IBD care. Further research into the implementation of such interventions as well as clinical communication concerns specific to IBD is warranted.

P283 Awareness and perceptions of colorectal cancer risk and screening in Inflammatory Bowel Disease

Abstract Background Patients with inflammatory bowel disease (IBD) are at higher risk of developing colorectal cancer (CRC). Guidelines recommend periodic endoscopic surveillance to detect and manage dysplasia. We aimed to explore patient knowledge and perceptions of CRC risk and colonoscopic surveillance and identify potential barriers to surveillance practice. Methods A 44-item questionnaire was administered to IBD patients with colonic involvement attending gastroenterology clinics between July 2021 and April 2022. Results Of 418 respondents (demographics see table 1), 266 (64%) had ulcerative colitis and 145 (34%) had Crohn’s disease, with 177 (42%) diagnosed for ≥10 years. Two hundred and sixty-five (66%) patients rated their IBD control moderate/good (score ≥7/10), and 314 (75%) self-rated their understanding of IBD as good/excellent. Two hundred and ninety-eight patients (71%) recognised that CRC risk is higher in IBD but 83 (20%) felt the risk of CRC was lower in IBD or were unsure. Age (p=0.02), being a Crohn’s and Colitis UK (CCUK) member (p&amp;lt;0.001), patient rated IBD control (p=0.04) and self-rated understanding of IBD (p=0.01) were associated with better CRC risk awareness. One hundred and forty-nine (36%) respondents stated that their IBD healthcare professional (HCP) had previously discussed CRC risk with them; this was associated with better CRC knowledge (p=0.001). On multivariate analysis CCUK membership (OR 2.75; 95% CI 1.57- 4.83; p&amp;lt;0.001), prior HCP discussion (OR 1.57; 95% CI 0.85-2.87; p=0.01) and age ≥65 years (OR 0.3; 95% CI 0.09- 0.99; p=0.05) were predictive of greater CRC risk awareness. Concerning the most appropriate screening test for dysplasia, 369 patients (88%) stated colonoscopy, but only 29 (7%) were aware that colonic surveillance should commence 8-10 years after diagnosis; 153 (37%) recognised that optimal timing is when IBD is in remission. Patient reported information sources included gastroenterology HCPs (43%), patient support groups (28%), and patient leaflets (17%). The majority (78%) stated they would agree to have surveillance colonoscopy if advised by their HCP. Bowel preparation (50%) and discomfort (45%) were factors most likely to dissuade patients from agreeing to surveillance. Conclusion Patient knowledge of CRC risk and surveillance practice in IBD is variable. Modifiable factors associated with improved knowledge are discussion with HCPs and CCUK membership. Our findings underscore the need for better patient education to aid informed decision-making between patients and HCPs and improve adherence to colonoscopic surveillance.

Understanding clinician connections to inform efforts to promote high-quality inflammatory bowel disease care.

Highly connected individuals disseminate information effectively within their social network. To apply this concept to inflammatory bowel disease (IBD) care and lay the foundation for network interventions to disseminate high-quality treatment, we assessed the need for improving the IBD practices of highly connected clinicians. We aimed to examine whether highly connected clinicians who treat IBD patients were more likely to provide high-quality treatment than less connected clinicians. We used network analysis to examine connections among clinicians who shared patients with IBD in the Veterans Health Administration between 2015-2018. We created a network comprised of clinicians connected by shared patients. We quantified clinician connections using degree centrality (number of clinicians with whom a clinician shares patients), closeness centrality (reach via shared contacts to other clinicians), and betweenness centrality (degree to which a clinician connects clinicians not otherwise connected). Using weighted linear regression, we examined associations between each measure of connection and two IBD quality indicators: low prolonged steroids use, and high steroid-sparing therapy use. We identified 62,971 patients with IBD and linked them to 1,655 gastroenterologists and 7,852 primary care providers. Clinicians with more connections (degree) were more likely to exhibit high-quality treatment (less prolonged steroids beta -0.0268, 95%CI -0.0427, -0.0110, more steroid-sparing therapy beta 0.0967, 95%CI 0.0128, 0.1805). Clinicians who connect otherwise unconnected clinicians (betweenness) displayed more prolonged steroids use (beta 0.0003, 95%CI 0.0001, 0.0006). The presence of variation is more relevant than its magnitude. Clinicians with a high number of connections provided more high-quality IBD treatments than less connected clinicians, and may be well-positioned for interventions to disseminate high-quality IBD care. However, clinicians who connect clinicians who are otherwise unconnected are more likely to display low-quality IBD treatment. Efforts to improve their quality are needed prior to leveraging their position to disseminate high-quality care.

S39 Use of Electronic Cigarettes in Inflammatory Bowel Disease: A Pilot Study

Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract likely involving both a genetic predisposition and environmental triggers. Cigarette smoking (CS) has well established links to IBD, as current and former use are risk factors for Crohn’s Disease (CD) and Ulcerative Colitis (UC) respectively. CS may result in increased use of glucocorticoids, immunosuppression and intestinal resection in patients with CD. Nicotine free e-cigarettes can induce gastrointestinal mucosal inflammation, impair the gut mucosal barrier and increase expression of pro-inflammatory cytokines. Data describing the use of e-cigarettes in IBD patients in the US is lacking. We conducted pilot study to determine prevalence and patterns of e-cigarette use in a large academic IBD practice. Methods: This was an IRB-approved study of adult patients with a confirmed diagnosis of IBD. Enrollment occurred in one of 2 arms: (1) MyChart Arm and (2) In-Person Arm. In Arm #1, a query of the electronic medical record (EMR) was performed of all IBD patients (using ICD-10 codes) with a clinic visit between 11/1/2020–10/31/2021. Using the MyChart research functionality within the EMR, eligible patients were directly contacted with a standardized recruitment message. Upon confirming interest, a personalized survey link was created via RedCap (research electronic data capture) and distributed to the patient via e-mail. In-person enrollment (Arm #2) was introduced in August of 2022. Eligible patients were approached by study staff during an existing IBD-related clinic visit. If interested, patients were provided a study information letter and a paper version of the survey to complete. Resulting data was then entered into the RedCap database. Survey questions elicited information regarding: (1) patient demographics, (2) description of current and former use of traditional tobacco products and of e-cigarettes, (3) duration and frequency of use, (4) product preference (5) perception of risk of e-cigarette use, and (6) interest in cessation. Results: A total of 62 patients completed the survey. The majority of our study population was female (n = 41/62; 66.1%), with a mean age of 39.3. Most patients reported a diagnosis of CD (n = 33/62; 53.2%). Approximately 2-thirds of respondents indicated they were “never” cigarette smokers (n = 41/62; 66.1%), and current use of traditional cigarettes was reported at 8.1% (5/62). E-cigarette use (former or current) was reported in 21.7% of patients (n = 13/60), with most beginning as adults (n = 12/13; 92.4%), and using multiple times per day (n = 10/13; 76.9%). Of those reporting e-cigarette use, the majority described their reason for use as “an attempt to quit use of a traditional tobacco product” (n = 7/13; 53.8%). Additionally, of those reporting e-cigarette use, majority considered e-cigarette use to be “less harmful” or “about the same” level of risk compared to CS (12/13; 92.3%). Conclusion(s): This pilot study establishes that e-cigarette use is prevalent in our large volume IBD academic practice, and may in fact be higher than cigarette smoking or other traditional tobacco products. A follow-up project is planned to evaluate implications of e-cigarette use on IBD-related disease outcomes.

Significant Differences in IBD Care and Education across Europe: Results of the Pan-European VIPER Survey

Background: Inflammatory bowel disease (IBD) care and education might differ around Europe. Therefore, we conducted this European Variation In IBD PracticE suRvey (VIPER) to investigate potential differences between countries. Methods: This trainee-initiated survey, run through SurveyMonkey®, consisted of 47 questions inquiring basic demographics, IBD training, and clinical care. Results were compared according to gross domestic product (GDP) per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). Results: The online survey was completed by 1,285 participants from 40 European countries, with a majority of specialists (65.3%) working in academic institutions (50.4%). Significant differences in IBD-specific training (55.9% vs. 38.4%), as well as availability of IBD units (58.4% vs. 39.7%) and multidisciplinary meetings (73.2% vs. 40.1%), were observed between respondees from high and low GDP countries (p < 0.0001). In high GDP countries, IBD nurses are more common (85.9% vs. 36.0%), also mirrored by more nurse-led IBD clinics (40.6% vs. 13.7%; p < 0.0001). IBD dieticians (33.4% vs. 16.5%) and psychologists (16.8% vs. 7.5%) are mainly present in high GDP countries (p < 0.0001). In the current COVID era, telemedicine is available in 73.2% versus 54.1% of the high/low GDP countries, respectively (p < 0.0001). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. Conclusion: Much variability in IBD practice exists across Europe, with marked differences between high and low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardize IBD care and training across Europe.

Genetic Aspects of Micronutrients Important for Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) are complex diseases whose etiology is associated with genetic and environmental risk factors, among which are diet and gut microbiota. To date, IBD is an incurable disease and the main goal of its treatment is to reduce symptoms, prevent complications, and improve nutritional status and the quality of life. Patients with IBD usually suffer from nutritional deficiency with imbalances of specific micronutrient levels that contribute to the further deterioration of the disease. Therefore, along with medications usually used for IBD treatment, therapeutic strategies also include the supplementation of micronutrients such as vitamin D, folic acid, iron, and zinc. Micronutrient supplementation tailored according to individual needs could help patients to maintain overall health, avoid the triggering of symptoms, and support remission. The identification of individuals’ genotypes associated with the absorption, transport and metabolism of micronutrients can modify future clinical practice in IBD and enable individualized treatment. This review discusses the personalized approach with respect to genetics related to micronutrients commonly used in inflammatory bowel disease treatment.

S907 Awareness and Perceptions of Colorectal Cancer Risk and Screening in Inflammatory Bowel Disease

Introduction: Patients with inflammatory bowel disease (IBD) are at higher risk of developing colorectal cancer (CRC). Guidelines recommend periodic endoscopic surveillance to detect and manage dysplasia. We aimed to explore patient knowledge and perceptions of CRC risk and colonoscopic surveillance. Methods: A 44-item questionnaire was administered to IBD patients with colonic involvement attending gastroenterology clinics between July 2021 and April 2022. Results: Of 418 respondents, 266 (64%) had ulcerative colitis and 145 (34%) had Crohn’s disease, with 176 (42%) diagnosed for ≥10 years. Two hundred and sixty-five (66%) patients rated their IBD control moderate/good (score ≥7/10), and 314 (75%) self-rated their understanding of IBD as good/excellent. Two hundred and ninety-eight patients (71%) recognised that CRC risk is higher in IBD but 83 (20%) felt the risk of CRC was lower in IBD or were unsure. Age (p=0.02), being a Crohn’s and Colitis UK (CCUK) member (p< 0.001), patient rated IBD control (p=0.04) and self-rated understanding (p=0.01) were associated with better CRC risk awareness. One hundred and forty-nine (36%) respondents stated that their IBD healthcare professional (HCP) had previously discussed CRC risk with them; this was associated with better CRC knowledge (p=0.001). On multivariate analysis CCUK membership (OR 2.75; 95% CI 1.57- 4.83; p< 0.001), prior HCP discussion (OR 1.57; 95% CI 0.85-2.87; p=0.01) and age ≥65 years (OR 0.3; 95% CI 0.09- 0.99; p=0.05) were predictive of greater CRC risk awareness. Concerning the most appropriate screening test for dysplasia, 369 patients (88%) stated colonoscopy, but only 29 (7%) were aware that colonic surveillance should commence 8-10 years after diagnosis; 153 (37%) recognised that optimal timing is when IBD is in remission. Patient reported information sources included gastroenterology HCPs (43%), patient support groups (28%), and patient leaflets (17%). The majority (78%) stated they would agree to have surveillance colonoscopy. Bowel preparation (50%) and discomfort (45%) were factors most likely to dissuade them from agreeing to surveillance. Conclusion: Patient knowledge of CRC risk and surveillance practice in IBD is variable. Modifiable factors associated with improved knowledge are discussion with HCPs and CCUK membership. Our findings underscore the need for better patient education to aid informed decision-making between patients and HCPs and improve adherence to colonoscopic surveillance.

S1013 Use of IBD Endoscopic Scoring Systems in Practice

Introduction: Inflammatory bowel disease (IBD) treatment targets include mucosal healing based on standardized endoscopic scoring systems. The rates and ease of use of these scoring systems in practice have not been well described. We aimed to assess the rates and potential barriers to using IBD endoscopic scoring systems in practice from IBD Live attendees. Methods: IBD LIVE is an international case-based conference focusing on the management of patients with IBD. We created a web-based survey consisting of 38 questions on the frequency and ease of use of various IBD endoscopic scores. This survey was emailed to the IBD LIVE listserv in March 2022 with a second email sent 14 days later. We included only respondents who are currently performing endoscopy. Continuous variables were analyzed using an unpaired student’s t-test. Categorical variables were analyzed using a Pearson’s chi-square test. Results: There were 65 responses out of 170 (38.2% response rate) regular attendees. Eleven responses were excluded (4 with no response on the use of endoscopy scores, 7 were not performing endoscopy). Of the respondents, 72.2% are from the US, 70.4% are adult gastroenterologists, 53.9% in academic practice, and 40.7% in practice for ≥ 15 years. Of the endoscopy scores used ≥ 50% of the time, 74.1% were using the Mayo Endoscopic Sub-score (MES), 72.3% using the Rutgeert's Score, 61.2% using the Simple Endoscopic Score for Crohn's Disease, and 28.6% using the Pouchitis Disease Activity Index. Attending IBD Live ≥ monthly (p=0.028), attending an IBD conference ≥ every 2 years (p=0.020), and having the scoring system incorporated into the endoscopy documentation software (p=0.002) were associated with more consistent use of the MES. Attending IBD Live ≥ monthly (p=0.026), having an IBD volume of ≥ 50% (p=0.011), and attending an IBD conference ≥ every 2 years (p=0.004) was associated with more frequent use of the Rutgeert’s score. There were no factors that increased the use of other endoscopic scores. (Table) Conclusion: The MES and the Rutgeert’s score are more commonly used with much lower rates of use of endoscopic scores for Crohn’s disease and pouchitis. The use of these endoscopy scores is more common among those who regularly attend IBD conferences, have higher volume IBD practices and have these scoring systems incorporated into endoscopy software. Further evaluation of ways to improve utilization of endoscopic scoring for Crohn’s disease and pouchitis are needed. Table 1. - Results Use of Mayo UC Endoscopic Subscore ≥50% of the time (n=40), n (%) < 50% of the time (n=14), n (%) p-value Endoscopic Score Built into Software 27 (67.5) 3 (21.4) 0.002 Attend IBD Conference ≥ every 2 Years 39 (97.5) 11 (78.6) 0.020 Attend IBD Live:At least monthlyLess than monthly 30 (75)10 (25) 6 (42.9)8 (57.1) 0.028 Number of years in GI Practice:< 10 years≥ 10 years 18 (45)22 (55) 5 (35.7)9 (64.3) 0.55 Specialty:Adult GIPediatric GIColorectal SurgeryOther 32(84.2)4 (80)4 (80)0 6(15.8)1(20)6(60)1(100) 0.012 Use of the Rutgeert's Score ≥50% of the time (n=34), n (%) < 50% of the time (n=13), n (%) p-value Endoscopic Score Built into Software 17 (50) 3 (23.1) 0.45 Attend IBD Conference ≥ Every 2 Years 34 (100) 10 (76.9) 0.004 IBD patient volume ≥50% 22 (64.7) 3 (23.1) 0.011 Attend IBD Live:At least monthlyLess than monthly 23(76.7)7(23.3) 6(46.2)7(53.8) 0.026 Number of years in GI Practice:< 10 years≥ 10 years 14(41.2)20(58.8) 4(30.8)9(69.2) 0.51 Specialty:Adult GIPediatric GIColorectal Surgery 27 (79.4)3(8.8)4(11.8) 7(53.9)2(15.4)4(30.8) 0.19 Use of Simple Endoscopic Score for Crohn's Disease ≥50% of the time (n=30), n (%) < 50% of the time (n=19), n (%) p-value Endoscopic Score Built into Software 18 (60) 6 (31.6) 0.09 Attend IBD Conference ≥ Every 2 Years 29 (96.7) 16 (84.2) 0.12 IBD patient volume ≥50% 17 (56.7) 8 (42.1) 0.32 Attend IBD Live:At least monthlyLess than monthly 23(76.7)7(23.3) 11(57.9)8(42.1) 0.16 Number of years in GI Practice:< 10 years≥ 10 years 15(50)15(50) 5(26.3)14(73.7) 0.10 Specialty:Adult GIPediatric GIColorectal Surgery 24(68.6)2(40)4(44.4) 11(31.4)3(60)5(55.6) 0.25

Drug therapy and monitoring for inflammatory bowel disease: a multinational questionnaire investigation in Asia.

Background/Aims The incidence and prevalence of inflammatory bowel disease (IBD) is rising in Asia recently. The study aimed to obtain a comprehensive understanding of the current status of drug therapy and monitoring for IBD in Asia.Methods A questionnaire investigation on drug therapy and monitoring for IBD was conducted right before the 6th Annual Meeting of Asian Organization for Crohn’s & Colitis. Questionnaires were provided to Asian physicians to fill out via emails between March and May 2018.Results In total, responses of 166 physicians from 129 medical centers were included for analysis. Among the surveyed regions, the most average number of IBD specialist gastroenterologists and nurses was 4.8 per center in Taiwan and 2.5 per center in Mainland China, respectively. 5-Aminosalicylic acid/sulfasalazine (99.4%) was the most preferred first-line choice for mild-moderate ulcerative colitis (UC), meanwhile corticosteroid (83.7%) was widely applied for severe UC. The first-line medication for Crohn’s disease (CD) markedly varied as corticosteroid (68.1%) was the most favored in Mainland China, Japan, and South Korea, followed by infliximab (52.4%) and azathioprine (47.0%). Step-up strategy was preferred in mild-moderate UC (96.4%), while 51.8% of the physicians selected top-down treatment for CD. Only 25.9% and 17.5% of the physicians could test blood concentration of infliximab and antibody to infliximab in their hospitals, respectively.Conclusions The current status of drug therapy and monitoring for IBD in Asia possesses commonalities as well as differences. Asian recommendations, IBD specialist teams and practice of therapeutic drug monitoring are required to improve IBD management in Asia.

A147 SIMILAR OUTCOMES IN PATIENTS SWITCHED TO INFLIXIMAB BIOSIMILARS COMPARED TO THOSE REMAINING ON REMICADE IN A BRITISH COLUMBIA INFLAMMATORY BOWEL DISEASE PRACTICE

Abstract Background In 2019 the Canadian province of British Columbia (BC) launched an initiative to switch inflammatory bowel disease (IBD) patients on the infliximab originator, Remicade, to biosimilars Inflectra or Renflexis. Evidence shows that such switches can be made without compromising efficacy or safety of treatment. Aims We examined results in a large IBD practice, with the hypothesis that patients required to switch to a biosimilar would have similar remission rates to those who remained on Remicade. Methods A total of 113 patients were included in this retrospective chart study. 80 of these were switched to biosimilars and were compared with 33 who remained on Remicade based on availability of private or compassionate coverage. Individual patient timelines were created, the start set as when the mandated switch was discussed. Data was collected retrospectively for 6 months. Outcomes included remission status, occurrence of flares, adverse events, hospitalizations, and necessity of dosage or drug change. Results Pre-switch, 49 of the 113 patients were in complete remission on Remicade (43.4%). 27% of the Remicade patients and 28.8% of the biosimilar patients remained in complete remission throughout follow up (p=0.87). Of the patients who began the study in complete remission, similar numbers of patients in the Remicade and biosimilar groups experienced flares (11.1% vs 27.5%; p=0.3); adverse events (33.3% vs 25%; p=0.61) and hospitalizations (0% vs 5.0%; p=0.49) respectively. 6.1% of patients beginning the trial in complete remission required a change in medication after the switch, all of which were in the biosimilar group (0% vs 7.5%; p=0.39). Among all 113 patients in the study, there was a numerical difference between the Remicade group and biosimilar group of patients who required a change in medication to another biologic. While clinically important, this was not statistically significant (0% vs 8.8%; p=0.08). Other clinical outcomes were similar between Remicade and biosimilar patients in the full group of 113 patients. Conclusions IBD patients remaining on Remicade or switching to biosimilars demonstrated similar patient outcomes after a 6-month period. Funding Agencies None

A169 PRICE: PREVENTING READMISSIONS IN IBD CENTRES OF EXCELLENCE

Abstract Background Hospital readmission rates are high in the inflammatory bowel disease (IBD) population, with 20% of patients readmitted within the same year. Discharge processes are not routinely standardized and deficiencies in transition of care puts patients at an increased risk of recurrent illness and healthcare costs. In addition, hospitalizations for IBD patients are associated with nosocomial complications such as venous thromboembolism. Aims We hypothesize that standardized follow-up by an IBD practice nurse and electronic health outcome monitoring reduces the risk of hospital readmission compared to current approaches of hospital discharge alone. Methods This pilot study uses a prospective parallel randomized control design and includes patients admitted with an IBD flare who were discharged without surgical intervention. Patients randomized to the control arm were discharged with usual standard of care (i.e. discharge summary and/or follow-up). In addition to standard of care, those in the intervention group received organized telephone or email follow-up by an IBD practice nurse at 1, 7 and 30 days post-discharge. These patients also received bi-weekly corespondence from an electronic survey tool, NoviSurvey, to determine clinical disease severity and medication adherence. Based on patient interactions and survey responses, the IBD nurse may arrange for expedited ambulatory visit or readmission for high-risk patients. Results At present, 41 patients have been enrolled into our study, 4 of which were excluded due to surgical management. 19 patients were randomized to the intervention and 17 to the control group. In the intervention group, the 30-day cumulative rate of readmission [0/19 (0%) vs. 4/17 (24%), p = 0.040] as well as the proportion of patients who failed to taper steroids [0/18 (0%) vs. 5/15 (33%), p = 0.013] was significantly lower when compared to the control group. There were no occurrences of deep vein thrombosis within 30 days post-discharge in either group. Conclusions These findings in our pilot study indicate that a nurse led post-discharge intervention may translate to benefits including decreased readmission rates and better medication adherence, warranting a large clinical trial to confirm findings. Patient Demographics and Clinical Outcomes Between Intervention and Control Groups Funding Agencies CAG, CCC

P450 Vaccination strategies in Inflammatory Bowel Disease patients: perspective of physicians and patients

Abstract Background Despite the existence of specific recommendations, patients with Inflammatory Bowel Disease (IBD) have shown low immunization rates. The aim of this study was to evaluate the management of vaccines in clinical practice in IBD from the perspective of physicians and patients. Methods An online anonymous survey was sent to 8000 patients from a national patient association (ACCU-Spain) and 1000 members of the Spanish IBD Working Group (GETECCU). Three invitations were sent between October-December 2020. Forty questions were jointly designed by ACCU and GETECCU in two different surveys for physicians and patients. Descriptive analyses were performed, comparing physician’s and patient’s responses by standard statistical analyses Results 144 physicians and 1302 patients responded to the surveys (overall mean age of 43 years (SD 9.5). 65% of physicians managed more than 200 patients and 80% had &amp;gt;5 years of experience. Most physicians (99%) were concerned about vaccines in IBD patients in their clinical practice, and 63% of them considered vaccines very important. Only 3.5% of physicians recommended live vaccines for their IBD patients with immunosuppressive treatments. One third of physicians did not recommend HPV vaccine. In spite of 69% of physicians recommending influenza vaccine during pregnancy, only 7.2% of pregnant patients indicated that they had received advice on influenza vaccination on their pregnancy (p&amp;lt;0.001). Only 16.6% of physicians recommended live vaccines during the first year of life in children born to mothers exposed to biologics, and 4.4% did not recommend inactive vaccines. Moreover, patients treated with biologics considered that physicians were well trained in vaccines, compared to those treated with other drugs. Table 1 summarizes the perspective of physicians and patients. Conclusion Deficiencies in knowledge regarding vaccination of IBD patients can be frequent. The perspective of physicians and patients is different, with physicians perceiving more recommendations related to vaccines than patients were recommended.

P512 Safety of reduced clinical monitoring in patients with stable Inflammatory Bowel Disease on maintenance thiopurine therapy

Abstract Background Thiopurine-treated inflammatory bowel disease (IBD) patients are monitored every 3 to 4 months with outpatient visits and laboratory assessments to evaluate disease activity and safety of therapy. However, the risk of thiopurine-related adverse events decreases after the initiation phase. The aim of this study was to assess the safety of reduced clinical monitoring in steroid-free quiescent IBD patients on stable maintenance thiopurine monotherapy. Methods This single-centre prospective cohort study evaluated a reduced monitoring strategy that involved 6-monthly laboratory assessment combined with alternating outpatient and phone appointments, during 104 weeks. We enrolled IBD patients who were in steroid-free remission &amp;gt; 6 months on thiopurine monotherapy including azathioprine, 6-mercaptopurine or tioguanine. The primary outcome was thiopurine-related adverse events (AE) requiring change or discontinuation of thiopurine therapy after 104 weeks of follow-up. Secondary outcomes were assessed at week 52 and included other thiopurine-related AEs and laboratory abnormalities. Results We included 85 patients (42 years median age, 61.2% Crohn’s disease, 62% female) with a median disease duration of 12.5 years. At baseline, 47 patients were treated with azathioprine (55.3%), 25 with 6-mercaptopurine (29.4%) and 13 with tioguanine (15.3%) for a median duration of 6.7 years. During 104 weeks of follow-up, thiopurine therapy was ceased in two patients because of multiple infections (n=1) and gastrointestinal complaints (n=1). Other reasons for thiopurine cessation (n=37) were stable remission (n=26), patient preferences (n=9) and high 6-TGN levels (n=2). In total, 20 patients underwent thiopurine dose adjustments due to high metabolite levels (n=9), remission (n=3), disease flare (n=3), patient preferences (n=3), and low metabolite levels (n=2). At 52 weeks, 27 laboratory abnormalities were observed, yet none required therapy adjustments. In 13 patients (15.3%) myelotoxicity was detected, including mild leukopenia (n=11), mild and moderate thrombopenia (n=2). In 16.5%, hepatoxicity was observed (n=14) including mild (n=9) and moderate (n=1) elevated aspartate aminotransferase and mild elevated alkaline phosphatase (n=4). Conclusion A reduced monitoring strategy appeared relatively safe in a strictly selected cohort of stable thiopurine-treated IBD patients. Overall, two patients had to cease thiopurine therapy due to thiopurine-related AEs independent of monitoring frequency. No laboratory abnormalities required therapy adjustments and 57.1% of patients continued therapy throughout 104 weeks of follow-up. This strategy may contribute to safe reduction of time and health care costs for both IBD patients and physicians in daily IBD practice.