Prevalence Of Inflammatory Bowel Disease Research Articles

In Patients With Inflammatory Bowel Disease, Racial Disparities Exist in Burden of Vaccine-preventable Disease Hospitalizations and Outcomes.

Patients with inflammatory bowel disease (IBD) are at increased risk of vaccine-preventable diseases (VPDs). Despite the increasing prevalence of IBD in non-white populations, little is known regarding racial disparities in VPD burden. Retrospectively analyzing the 2016 to 2020 National Inpatient Sample, we identified adults with IBD hospitalized for a principal diagnosis of VPD. The primary outcome investigated was hospitalization for VPD stratified by patient-reported race. Secondary outcomes were in-hospital morbidity, mortality, length of stay, and health care utilization. Multivariable regression analysis was performed to adjust for patient and hospital characteristics. The search identified 554,114 hospitalizations for VPD, including 4170 hospitalizations in patients with IBD. Patients with IBD had significantly greater odds of hospitalization from herpes zoster virus (adjusted odds ratio [aOR]: 1.73) and varicella zoster virus (aOR: 2.31). Comparing white and non-white patients with IBD, significant racial disparities were noted. Non-white patients were at greater odds of hospitalization from influenza (aOR: 1.74), herpes zoster virus (aOR: 1.77), and varicella zoster virus (aOR: 1.62). In-hospital morbidity was greater in non-white patients, including greater odds of requiring intensive care unit stay (aOR: 1.18). Morbidity was elevated in African Americans, with greater odds of acute kidney injury (aOR: 1.25), venous thromboembolism (aOR: 1.17), respiratory failure (aOR: 1.16), and intensive care unit stay (aOR: 1.18). No differences were found in mortality, length of stay, and health care utilization. Significant racial disparities in VPD hospitalization and in-hospital morbidity were found among adults with IBD in the United States. With the increasing prevalence of IBD in non-white populations, targeted efforts are needed to improve health equity.

Inulin protects against the harmful effects of dietary emulsifiers on mice gut microbiome.

The prevalence of inflammatory bowel diseases is increasing, especially in developing countries, with adoption of Western-style diet. This study aimed to investigate the effects of two emulsifiers including lecithin and carboxymethyl cellulose (CMC) on the gut microbiota, intestinal inflammation and the potential of inulin as a means to protect against the harmful effects of emulsifiers. In this study, male C57Bl/6 mice were divided into five groups (n:6/group) (control, CMC, lecithin, CMC+inulin, and lecithin+inulin). Lecithin and CMC were diluted in drinking water (1% w/v) and inulin was administered daily at 5 g/kg for 12 weeks. Histological examination of the ileum and colon, serum IL-10, IL-6, and fecal lipocalin-2 levels were analyzed. 16S rRNA gene V3-V4 region amplicon sequencing was performed on stool samples. In the CMC and lecithin groups, shortening of the villus and a decrease in goblet cells were observed in the ileum and colon, whereas inulin reversed this effect. The lipocalin level, which was 9.7 ±3.29 ng in the CMC group, decreased to 4.1 ±2.98 ng with the administration of inulin. Bifidobacteria and Akkermansia were lower in the CMC group than the control, while they were higher in the CMC+inulin group. In conclusion, emulsifiers affect intestinal health negatively by disrupting the epithelial integrity and altering the composition of the microbiota. Inulin is protective on their harmful effects. In addition, it was found that CMC was more detrimental to microbiota composition than lecithin.

Leaky gut, circulating immune complexes, arthralgia, and arthritis in IBD: coincidence or inevitability?

Most host-microbiota interactions occur within the intestinal barrier, which is essential for separating the intestinal epithelium from toxins, microorganisms, and antigens in the gut lumen. Gut inflammation allows pathogenic bacteria to enter the blood stream, forming immune complexes which may deposit on organs. Despite increased circulating immune complexes (CICs) in patients with inflammatory bowel disease (IBD) and discussions among IBD experts regarding their potential pathogenic role in extra-intestinal manifestations, this phenomenon is overlooked because definitive evidence demonstrating CIC-induced extra-intestinal manifestations in IBD animal models is lacking. However, clinical observations of elevated CICs in newly diagnosed, untreated patients with IBD have reignited research into their potential pathogenic implications. Musculoskeletal symptoms are the most prevalent extra-intestinal IBD manifestations. CICs are pivotal in various arthritis forms, including reactive, rheumatoid, and Lyme arthritis and systemic lupus erythematosus. Research indicates that intestinal barrier restoration during the pre-phase of arthritis could inhibit arthritis development. In the absence of animal models supporting extra-intestinal IBD manifestations, this paper aims to comprehensively explore the relationship between CICs and arthritis onset via a multifaceted analysis to offer a fresh perspective for further investigation and provide novel insights into the interplay between CICs and arthritis development in IBD.

Forecasting the Incidence and Prevalence of Inflammatory Bowel Disease: A Canadian Nationwide Analysis.

Canada has a high burden of inflammatory bowel disease (IBD). Historical trends of IBD incidence and prevalence were analyzed to forecast the Canadian burden over the next decade. Population-based surveillance cohorts in 8 provinces derived from health administrative data assessed the national incidence (2007-2014) and prevalence (2002-2014) of IBD. Autoregressive integrated moving average models were used to forecast incidence and prevalence, stratified by age, with 95% prediction intervals (PI), to 2035. The average annual percentage change (AAPC) with 95% confidence interval (CI) was calculated for the forecasted incidence and prevalence. The national incidence of IBD is estimated to be 29.9 per 100,000 (95% PI 28.3-31.5) in 2023. With a stable AAPC of 0.36% (95% CI -0.05 to 0.72), the incidence of IBD is forecasted to be 31.2 per 100,000 (95% PI 28.1-34.3) in 2035. The incidence in pediatric patients (younger than 18 years) is increasing (AAPC 1.27%; 95% CI 0.82-1.67), but it is stable in adults (AAPC 0.26%; 95% CI -0.42 to 0.82). The prevalence of IBD in Canada was 843 per 100,000 (95% PI 716-735) in 2023 and is expected to steadily climb (AAPC 2.43%; 95% CI 2.32-2.54) to 1,098 per 100,000 (95% PI 1,068-1,127) by 2035. The highest prevalence is in seniors with IBD (1,174 per 100,000 in 2023; AAPC 2.78%; 95% CI 2.75-2.81). Over the next decade, the Canadian health care systems will contend with the juxtaposition of rising incidence of pediatric IBD and a rising prevalence of overall IBD driven by the aging population.

Pediatric inflammatory bowel disease: What’s new and what has changed?

Abstract The incidence and prevalence of inflammatory bowel disease (IBD) is on the rise in North America and worldwide, with young children being the fastest growing patient population. It is therefore essential for pediatricians and pediatric sub-specialists to be able to recognize signs and symptoms suspicious for a new diagnosis of IBD, as well as potential complications associated with IBD or its treatment. This article reviews the most recent literature regarding clinical presentation, helpful diagnostic clues, newer monitoring tools being used by pediatric gastroenterologists, and emerging new biologic and small molecule treatments.

Relationship between fear of progression and quality of life in inflammatory bowel disease: Mediating role of health literacy and self-care.

The increasing prevalence of inflammatory bowel disease is emerging as a significant global healthcare concern due to its recurrent episodes of intestinal inflammation. This study aims to explore the relationship between fear of progression and health-related quality of life in inflammatory bowel disease patients, investigating the sequential mediating roles of health literacy and self-care. A cross-sectional study. Eligible participants diagnosed with inflammatory bowel disease were recruited through convenience sampling method at a tertiary hospital in Shenyang, China, between May 2022 and May 2023. A total of 241 participants completed the questionnaires regarding fear of progression, health literacy, self-care and quality of life. Data analysis was conducted using SPSS 25.0 and PROCESS plug-ins. (1) Fear of progression was found to be negatively associated with quality of life and had a directly predictive effect on quality of life. (2) Health literacy and self-care could independently mediate the relationship between fear of progression and quality of life. (3) There was a significant chain mediating effect of health literacy and self-care in the relationship between fear of progression and quality of life. Fear of progression could not only directly predict the quality of life in inflammatory bowel disease patients but also indirectly affect their quality of life through the chain mediation of health literacy and self-care. This study highlights the importance of nursing staff focusing on the interplay between fear of progression, health literacy, self-care and quality of life in caring for inflammatory bowel disease patients. Understanding the potential correlation mechanism underlying quality of life may help develop targeted care interventions to synergistically enhance health literacy and self-care in these patients. STROBE guidelines. No public or patient contribution.

Asiaticoside ameliorates DSS-induced colitis in mice by inhibiting inflammatory response, protecting intestinal barrier and regulating intestinal microecology.

Ulcerative colitis (UC) is one of the most prevalent inflammatory bowel diseases and poses a serious threat to human health. Currently, safe and effective preventive measures are unavailable. In this study, the protective effects of asiaticoside (AS) on dextran sodium sulfate (DSS)-induced colitis in mice and the underlying molecular mechanism were investigated. In this experiment, colitis was induced in mice with DSS. Subsequently, the role of AS in colitis and its underlying mechanisms were examined using H&E staining, immunofluorescence staining, western blot, Elisa, FMT, and other assays. The results showed that AS significantly attenuated the related symptoms of DSS-induced colitis in mice. In addition, AS inhibited the activation of signaling pathways TLR4/NF-κB and MAPK reduced the release of inflammatory factors, thereby attenuating the inflammatory response in mice. AS administration also restored the permeability of the intestinal barrier by increasing the levels of tight junction-associated proteins (claudin-3, occludin, and ZO-1). In addition, AS rebalanced the intestinal flora of DSS-treated mice by increasing the diversity of the flora. AS can alleviate DSS-induced ulcerative colitis in mice by maintaining the intestinal barrier, thus inhibiting the signaling pathways TLR4/NF-κB and MAPK activation, reducing the release of inflammatory factors, and regulating intestinal microecology.

Etiology, Epidemiology, and Therapeutic Approaches for Primary Sclerosing Cholangitis in the Context of Concurrent Non-specific Inflammatory Bowel Diseases

Introduction: Primary sclerosing cholangitis (PSC) is a chronic, idiopathic disease characterized by persistent and progressive inflammation of the intrahepatic and/or extrahepatic bile ducts. This leads to fibrosis, cholestatic complications, and liver failure. In over 70% of patients, non-specific intestinal inflammations coexist, particularly ulcerative colitis, and sporadically Crohn's disease. Aim: Our study aimed to assess current literature on primary sclerosing cholangitis (PSC), covering its causes, symptoms, treatment methods, and the connection between PSC and inflammatory bowel disease (IBD) co-occurrence. Materials and methods: We conducted a PubMed literature review using keywords like "primary sclerosing cholangitis pathogenesis," "primary sclerosing cholangitis and inflammatory bowel disease," and "primary sclerosing cholangitis and ulcerative colitis.” Results: Our research extensively covered PSC epidemiology, pathogenesis, and treatment options. Emphasis was placed on the heightened prevalence of inflammatory bowel diseases, including ulcerative colitis, among PSC patients. Summary: Primary sclerosing cholangitis (PSC) is a disease causing gradual damage to bile ducts within or outside the liver. Over 70% of patients also experience inflammatory bowel disease (IBD), mainly ulcerative colitis. The exact causes of PSC and its connection to IBD remain unclear. The theories involve hyperactive "intestinal" T cells or the impact of gut microbiome on their growth. Presently, a liver transplant stands as the sole remedy.

TRENDS IN INFLAMMATORY BOWEL DISEASE INCIDENCE AND PREVALENCE ACROSS EPIDEMIOLOGIC STAGES: A GLOBAL SYSTEMATIC REVIEW WITH META-ANALYSIS

Abstract BACKGROUND Rising incidence and prevalence of inflammatory bowel disease (IBD) observed historically in early-industrialized regions now also appear in newly-industrialized and emerging regions. The epidemiology of IBD has been proposed to progress across epidemiologic stages: 1. Emergence (low incidence and prevalence); 2. Acceleration in Incidence (rapid rising incidence); and 3. Compounding Prevalence (stabilizing incidence, rapid rising prevalence). AIM To gather real-world data on the incidence and prevalence of IBD and characterize global regions in each epidemiologic stage by meta-analyses. METHODS Two previous systematic reviews (database inception–2010; 2010–2016) were updated with a search of MEDLINE, Embase, PubMed, and Web of Science (2017–2023) to identify all population-based studies reporting the incidence or prevalence of Crohn’s disease (CD) or ulcerative colitis (UC). International partners provided a secondary review of the included studies from their local regions. Incidence and prevalence rates (per 100,000 population), stratified by epidemiologic stage, were meta-analyzed to determine pooled rates with associated 95% confidence intervals (95%CI). A Cochrane Q test was used to investigate differences between epidemiologic stages for both CD and UC. RESULTS After assessing 1,250 manuscripts, a total of 491 studies (439 incidence, 228 prevalence) from 80 global regions spanning 1920-2022 were identified by the systematic review (Figure 1). All data identified with our search strategy are available to view in an open-access, online interactive data repository (https://gives21.shinyapps.io/dashboard/) created with Shiny for R. The pooled incidence of CD and UC per 100,000 person-years rose from 0.28 (95%CI: 0.21, 0.36) and 0.57 (95%CI: 0.47, 0.69) in Stage 1 to 2.13 (95%CI: 1.88, 2.42) and 4.05 (95%CI: 3.65, 4.50) in Stage 2 to 9.34 (95%CI: 8.73, 9.99) and 14.07 (95%CI: 13.09, 15.12) in Stage 3 (Table 1). Similarly, the pooled prevalence of CD and UC per 100,000 persons rose from 1.96 (95%CI: 1.41, 2.74) and 6.35 (95%CI: 4.45, 9.07) in Stage 1 to 22.18 (95%CI: 17.96, 27.38) and 45.36 (95%CI: 37.84, 54.38) in Stage 2 to 186.18 (95%CI: 163.18, 212.42) and 255.92 (95%CI: 230.60, 284.02) in Stage 3 (Table 1). Subgroup analysis confirmed differences in both incidence and prevalence for CD and UC between epidemiologic stages (p<0.001). DISCUSSION This is the most comprehensive systematic review on the incidence and prevalence of IBD. The amalgamated real-world data from this study highlight the rising global burden of IBD across three distinct epidemiologic stages: 1. Emergence, 2. Acceleration in Incidence, and 3. Compounding Prevalence. Figure 1 Systematic review study selection flowchart including a brief overview of two previous systematic reviews: Molodecky, N.A. et al. Gastroenterology. 2012;142(1):46-54 and Ng, S.C. et al. Lancet. 2017;390(10114):2769-78. Table 1 Pooled incidence and prevalence rates per 100,000 population for Crohn’s disease and ulcerative colitis. Cochrane Q subgroup analysis for difference in estimates between epidemiologic stages. † Represents the number of study-subregion groups used in the calculation of pooled rates and their 95% confidence intervals.

EVOLVING LANDSCAPE OF INFLAMMATORY BOWEL DISEASE IN G20 NATIONS (1990-2019): A COMPREHENSIVE GLOBAL ASSESSMENT

Abstract BACKGROUND As pivotal players in the global economy, the G20 countries not only lead in economic dynamics but also in health challenges. Recent data reveals an escalating burden of Inflammatory Bowel Disease (IBD) in these nations. Understanding this trend is crucial to frame healthcare strategies and ensure the well-being of a significant portion of the global population. METHOD We employed data on IBD prevalence, incidence, mortality, and DALYs for G20 countries from the Global Burden of Disease (GBD) 2019 study. Using standardized statistical techniques, we analyzed by age, sex, year and location across G20 countries, estimating incidence and prevalence with the DisMod-MR 2.1 tool and mortality through the Cause of Death Ensemble Model (CODEm). RESULTS From 1990 to 2019, IBD prevalence figures in the G20 nations escalated from 2,999,730 (95%UI: 2,625,581-3,416,963) to 4,254,467 (3,809,445-4,751,041), marking a 42% (38-46) surge in the Annual Percentage Change (APC). Meanwhile, the incidence rose by 30% (26-35), mortality by 72% (49-97), and DALYs by 27% (15-43). Among these nations, China witnessed a striking 314% increase in incidence, closely followed by South Korea at 288%. Death rates were most pronounced in European Union members, with Portugal at the helm (441%), trailed by Italy (433%) and Germany (418%). Germany also led in DALYs growth with a 289% APC. Examining Age-standardized mortality rates, Germany again topped the list with a 244% increase, shadowed by Italy (186%) and the United States (147%). Over the past three decades, older populations demonstrated a rising IBD burden. In gender comparisons, males experienced a more significant incidence increase (32% vs. females at 28%) and DALYs (30% vs. females at 24%). Conversely, females had a steeper death rate growth, 77% as opposed to males at 67%. CONCLUSION In 2019, IBD was responsible for 2.02% of digestive disease-related deaths and 2.30% of associated disabilities in the G20 nations. The stark rise in IBD prevalence, especially in countries like China, South Korea, and European Union members, emphasizes a pressing need for targeted clinical approaches and proactive health policies to mitigate this escalating burden. Age-standardized rate (per 100,000 person years) of Inflammatory Bowel Disease in G20 Countries, 2019. A: ASIR, B: ASMR, C:ASDALR.

MACHINE LEARNING CLASSIFICATION OF THE EPIDEMIOLOGIC STAGES OF INFLAMMATORY BOWEL DISEASE ACROSS GEOGRAPHY AND TIME

Abstract BACKGROUND Epidemiologic stages of inflammatory bowel disease (IBD) have been proposed: 1. Emergence (low incidence and prevalence); 2. Acceleration in Incidence (rapidly rising incidence, low prevalence); and 3. Compounding Prevalence (stabilizing incidence, rapidly rising prevalence). To date, these stages have been theoretical without quantified definitions of incidence and prevalence. AIM To use machine learning to determine incidence and prevalence ranges corresponding to the epidemiologic stages and provide stage classifications across time for global regions. METHODS We built a supervised random forest classifier in R to determine epidemiologic stages of IBD from population-based studies (n=340), a subset derived from a systematic review on the incidence and prevalence of IBD. A labelled training data set comprising rates of incidence and prevalence of Crohn’s disease (CD) and ulcerative colitis (UC) extracted from the systematic review was used to predict classifications of stage 1, stage 2, or stage 3 for each region, stratified by decade (1960–2019). Model accuracy was measured using a blind validation data set. The validated model was then used to predict stage classifications for regions in the data set. Interquartile ranges for incidence and prevalence of CD and UC were calculated on the random forest output, and the distributions were compared using negative binomial regression. RESULTS The random forest’s classification accuracy on the blinded validation data was 93.7% (95%CI: 90.6, 96.1) indicating an appropriate model fit and performance. Significant differences between all stages for the incidence and prevalence of CD and UC (p<0.001) were found. The clear distinction across stages defines the incidence and prevalence ranges (25th–75th, per 100,000) for IBD as: CD incidence 0.0–0.3, UC incidence 0.2–0.7, CD prevalence 0.3–2.2, and UC prevalence 1.7–8.1 for stage 1; CD incidence 1.0–4.4, UC incidence 2.3–6.3, CD prevalence 9.0–33.9, and UC prevalence 22.8–73.3 for stage 2; and CD incidence 6.6–14.0, UC incidence 10.1–18.1, CD prevalence 163.2–274.7, and UC prevalence 189.1–323.2 for stage 3 (Figure 1). A decade-by-decade analysis shows global regions transitioning across the epidemiologic stages (Figure 2). By the 2010s, North America, Scandinavia, Western Europe, Australia, and New Zealand were in stage 3. Most regions in Asia and Latin America were in stage 1 in the last half of the 20th century, with many transitioning to stage 2 in the 2010s. DISCUSSION Temporal incidence and prevalence data show that regions transition across epidemiologic stages. Numerical definitions of the epidemiologic stages can be used to establish the anticipated burden growth of IBD by providing estimated rates of the number of incident and prevalent IBD cases a region can expect as it transitions between IBD epidemiologic stages in the future. Figure 1 Coalescing ranges for incidence (panel A) and prevalence (panel B) by Crohn’s disease and ulcerative colitis at epidemiologic stage 1, stage 2, and stage 3. Data were categorized by data type (incidence or prevalence), disease type (Crohn’s disease or ulcerative colitis), and epidemiologic stage, as per results from the random forest classifier. The 25th and 75th percentiles were calculated using the rates across all regions included in the analysis for all available time points for each box group. Figure 2 Global maps depicting epidemiologic stages of IBD evolution from 1960 to 2019 broken down by decade, as predicted by the random forest model. Panel A contains stage classifications from 1960 to 1969; panel B contains stage classifications from 1970 to 1979; panel C contains stage classifications from 1980 to 1989; panel D contains stage classifications from 1990 to 1999; panel E contains stage classifications from 2000 to 2009; and panel F contains stage classifications from 2010 to 2019.

MODELING THE TRANSITION TO THE FOURTH EPIDEMIOLOGIC STAGE OF INFLAMMATORY BOWEL DISEASE: PREVALENCE EQUILIBRIUM

Abstract BACKGROUND A theoretical framework for population-level transition across four epidemiologic stages has been proposed for inflammatory bowel disease (IBD): 1. Emergence (low incidence/prevalence); 2. Acceleration in Incidence (rapid rising incidence); 3. Compounding Prevalence (stabilizing incidence, rapid rising prevalence); and 4. Prevalence Equilibrium (decelerated prevalence), which no region has entered yet. Many regions of the early-industrialized world (North America, Europe, Oceania) are currently in stage 3. AIM To model the transition to the 4th epidemiologic stage of IBD based on real-world data. METHODS Transition to stage 4 involves deceleration of prevalence after a period of rapid increase. Age-specific, population-based incidence and prevalence data from Canada (2007–2014, >97% of population) were used to model changing prevalence using a partial differential equation (PDE) derived from a compartment model (Figure 1). The PDE is built on an average historical incidence value (2007–2014) and accounts for changing population age distributions over time. The PDE prevalence output was internally validated by comparing observed historical prevalence values with model outputs. After validation, the model was used to forecast future age-stratified prevalence and provide an estimate for when the transition to stage 4 is expected. Although incidence is predicted to stabilize in stage 3, the PDE was run on five scenarios to account for variability in future incidence values; therefore, we modeled annual incidence increases of 2% and 1%, stable incidence, and annual incidence decreases of 1% and 2%. RESULTS Internal validation of the model compared observed to predicted prevalence values in 2014: The observed prevalence was 0.677%; the model output was 0.678%. The model predicts gradual prevalence deceleration across 2020–2043 (Figure 2). In 2043, prevalence is modeled to range between 1.101% and 1.293% across incidence scenarios (−2% to 2%). Assuming a stable incidence, as predicted by stage 3, the increase in prevalence slows from a difference in annual percent change of 0.021% in 2020 to 0.011% in 2043, signalling transition towards stage 4 (Figure 2). DISCUSSION Stage 3 (Compounding Prevalence) is characterized by a stabilizing incidence trend, and rapid growth in prevalence. Without a growing incidence rate, the IBD population continues to age until mortality approximates incidence, thereby allowing prevalence to stabilize (Stage 4). Understanding the markers of epidemiologic transition and predicting the future population distribution (age, prevalence) of IBD allows healthcare administrators to anticipate the future needs of gastroenterology clinics to continue offering timely, high-quality care and prepare for an aging IBD population with complications from long-standing disease, age-related comorbidities, and polypharmacy. Figure 1 Compartment model that feeds the partial differential equation. The compartment model has three states: healthy (H), diseased (S), and dead (D); the i = incidence; r = remission, and m0 = mortality rates are dependent on age (a) and time (i), where as m1 = mortality rate is dependent on age, time, and possibly duration of disease (d). Figure 2 Modeled time-dependent prevalence of IBD in Canada for 2%, 1%, 0%, −1%, and −2% change in annual incidence (2015–2043).

YOUTUBE AND INFLAMMATORY BOWEL DISEASE, A 10-YEAR UPDATE

Abstract INTRODUCTION As the prevalence of inflammatory bowel disease (IBD) continues to rise, patients are turning to social media, notably YouTube®, for IBD information. This content has transformed since Mukewar et. al’s 2013 analysis of the top YouTube® videos about IBD. Furthermore, patient-desired information is now better understood, including 1) IBD treatment pros and cons, 2) self-advocacy, 3) IBD health tips, 4) IBD coping strategies, and 5) education on patient experiences. We analyzed YouTube® IBD videos to assess their informational quality and ability to address patient-desired attributes. METHODS Using the query “inflammatory bowel disease OR IBD,” we reviewed the top 50 English YouTube® IBD videos under 20 minutes. We gathered video metadata and assessed informational quality using the Patient Educational Video Score for Inflammatory Bowel Disease (PEVIS-IBD score) designed by Mukewar et al. with disease and treatment advancement updates. Possible scores ranged from 0 to 28. Patient-desired attribute count was noted per video. One-way ANOVA was done to test statistical significance. RESULTS 49/50 videos remain accessible. 35% focus on Crohn’s Disease, 30% on Ulcerative Colitis, and 35% on both. Most videos were MD/RN education (17, 35%), patient stories (14, 29%), and hospital/physician-produced IBD explainers (11, 22%). Only 18 (37%) had YouTube® Health Source Accreditation. MD/RN education videos ranked highest on PEVIS-IBD (13.47). Patient stories ranked lowest (7.57). 24/49 discussed at least one patient-desired attribute, with half of these covering three or more. MD/RN education videos did not address any attributes. Figure 1 shows detailed information about each category of video. DISCUSSION Our study shows a shift in IBD YouTube videos, with ⅓ of the top 50 videos being MD/RN education, a previously undescribed segment. Despite high PEVIS-IBD scores reflecting high-quality factual content, all of these videos lack patient-desired attributes, signaling a need for research to ascertain their value to patients. Of the patient-centric videos (32, excluding MD/RN education), 75% discussed at least one desired attribute, with half discussing 3 or more. Patient story videos had the highest attribute count, but low PEVIS-IBD scores, highlighting an opportunity for videos that simultaneously feature patient stories and facts about IBD. Only 37% of videos had YouTube® Health Source Accreditation, with videos from reputable organizations like the Crohn's and Colitis Foundation lacking this tag. Medical societies should be aware of this feature and ensure their channels are properly accredited. Figure 1 Analysis of key video metadata by category. Reference Mukewar S, et al. YouTube and inflammatory bowel disease. J Crohns Colitis. 2013;7(5):392-402.

THE COST OF INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED ANALYSIS OF ADMINISTRATIVE DATA

Abstract BACKGROUND As the global prevalence of inflammatory bowel disease (IBD) rises, it is important that the direst costs associated with medical care be analyzed to determine the impact on healthcare systems. Components making up the direct healthcare cost to the IBD population (e.g., hospitalizations, colonoscopies, and medications) are constantly changing and with this so may be the cost related to taking care of the IBD population. AIM Analyze component-specific costs, total costs, and the proportion of total costs attributed to each component, and changes over time. METHODS Using a validated algorithm and population-based administrative data from Alberta, Canada (Population: 4.3m), prevalent IBD patients were identified from fiscal year (FY) 2009/10 to 2018/19 (April 1–March 31). Costs from the Discharge Abstract Database, Physician Claims, National Ambulatory Care, and Pharmacy Information Network were converted to 2020 (CAD$) costs using Statistics Canada’s Consumer Price Index. Only IBD-related outpatient dispensed medications were included in the costs (inpatient not captured in data). Annual average costs per patient (with 95% confidence interval [CI]) were calculated. Medication costs per person were stratified on whether or not an individual was on a biologic (e.g. anti-TNF therapy) versus a non-biologic IBD-related medication (e.g., 5-ASA). The cost of an individual’s IBD-related hospitalization, IBD-related surgery, emergency department visit, colonoscopy, or IBD-related medication were calculated. Proportion of the total costs contributed by each category were calculated. Temporal trends of mean annual costs were analyzed using Poisson, or negative binomial, regression and average annual percentage change (AAPC) with 95%CI were reported. RESULTS In FY2018/19, the average cost of an IBD patient was $15,786 (95%CI:15,478, 16,094). This cost significantly increased from the 2009 value ($8,477; 95%CI: 8,407, 8,908) with an AAPC of 6.28% (95%CI: 5.51, 7.05). The annual costs of medications when a patient is on one or more biologics significantly increased (AAPC: 3.48%; 95%CI:2.32, 4.65). In contrast, the average annual cost per patient of IBD-related non-biologic medications significantly decreased (AAPC: -2.32; 95%CI: -3.48, -1.14). The largest contributor to IBD costs is medications (57.6% of the total costs) followed by IBD-related hospitalizations (20.6%). The costs of IBD-related hospitalizations and surgeries have remained stable, whereas the costs for emergency department visits and colonoscopies increased. DISCUSSION The costs associated with treating people IBD is rising and predominantly attributable to the cost of biologics. As the prevalence of IBD continues to increase, healthcare systems, payers and governments need to work to address these costs while ensuring these individuals receive the care they need. *Proportions will not add up to 100% as individuals can be captured in multiple cost categories each year (e.g., an IBD-related surgery cost is also captured as a hospitalization) and not all costs are reported in table. Overall and Biologics are Per Person; Hospitalization and Sugery are Per Event

EPIDEMIOLOGY OF INFLAMMATORY BOWEL DISEASE AMONG EARLY-INDUSTRIALIZED REGIONS OF THE WORLD: CHALLENGES IN SUSTAINABLE HEALTHCARE DELIVERY

Abstract BACKGROUND Early-industrialized regions (e.g., North America, Europe, Oceania) are currently in stage 3 of the epidemiologic evolution of inflammatory bowel disease (IBD), compounding prevalence wherein incidence stabilizes, but prevalence rises rapidly. This epidemiologic stage predicts the trajectory of healthcare infrastructure needs over the coming decades. AIMS 1. Describe current epidemiologic trends in representative stage 3 regions; 2. discuss ways to provide accessible, equitable, and quality IBD care in a sustainable manner; and 3. strategize future steps to prevent disease. METHODS The Canadian Gastro-Intestinal Epidemiology Consortium (CanGIEC) hosted IBD epidemiologists from representative stage 3 regions: Catalonia, Canada, Denmark, Hungary, Israel, New Zealand, Scotland, and the United States and address the rising burden of IBD. Epidemiologic data were reviewed in context using methodological differences between case ascertainment in each region to help explain heterogeneity (Table 1). Attendees engaged in a round-table consensus meeting, voting on priority needs to sustain IBD healthcare delivery given the trajectory of epidemiologic data. Four groups were formed with attendees of various backgrounds to encompass many perspectives, including epidemiologists, clinicians, IBD nurse practitioners, and patient advocates. RESULTS Table 1 describes IBD incidence and prevalence at the most recent year of historical data for each region. Canadian and Scottish studies included the forecasting of future prevalence estimates, a method that allows for proactive decision-making to accommodate the increasing number of individuals living with IBD. In 2028, the forecasted prevalence of IBD in Lothian, Scotland, was 1,023 per 100,000; and in 2030, the forecasted prevalence of IBD in Canada was 981 per 100,000. Table 2 describes the topics brought up in response to the aims, and the level of priority. Limited resources for a growing IBD population are a major cause for concern, negatively impacting access to and quality of care. To optimize quality of care, a multidisciplinary team approach is necessary. Suggestions for support in managing mild IBD cases include virtual care and remote monitoring, nurse-driven clinics, and cooperation with primary care physicians; this would help free-up in-person appointments with specialists for moderate-to-severe cases. Interventions that prevent IBD through modifying environmental and behavioral determinates, will have the largest impact on decelerating prevalence rates over time. DISCUSSION Forefront at the meeting was the fact of the continuing rise of IBD prevalence, augmenting the challenges faced by healthcare systems and practitioners. There are plausible and actionable solutions to achieve successful management of IBD upon initiating changes in healthcare policy.

P1144 Forecasting the Future Prevalence of Inflammatory Bowel Disease in Korea through 2048: An Epidemiologic Study Employing Autoregressive Integrated Moving Average Models

Abstract Background The global escalation of Inflammatory Bowel Disease (IBD) has precipitated an increased burden of disease and economic impact, particularly accentuated within the Asian context. The primary objective of this study is to predict the future prevalence trajectory of IBD in Korea and elucidate the pattern of its evolution. Methods Data from the Korean National Health Insurance Service (2004–2018) were analyzed using a validated diagnostic algorithm to identify IBD patients. An autoregressive integrated moving average (ARIMA) model, employing 2004–2017 data, predicted future trends based on past values and error correction. The model's accuracy was validated against the actual 2018 patient count. We projected IBD patient numbers and prevalence from 2018 to 2048, using a generalized linear model (GLM) to determine influencing factors. Results A consistent annual increase in the number of IBD cases across all age groups was observed from 2004 to 2018, with prevalence peaking in the 20–39 age group. The validation of our prediction model demonstrated an acceptable range of error for IBD prevalence, with a 2.45% error rate and a mean absolute difference of 2.61. The 2018–2048 projections confirm a steady rise in Crohn’s disease (CD), ulcerative colitis (UC), and IBD prevalence across both genders (Figure 1). IBD prevalence is projected to increase from 104.19 per 100,000 in 2018 to 149.59 per 100,000 by 2028, and further to 239.73 per 100,000 by 2048 (95% confidence interval [CI]: 223.73–255.73), marking a 130% increase. By 2048, the prevalence rates for UC and CD were estimated to be 159.40 per 100,000 (95% CI: 137.38–181.42) and 91.11 per 100,000 (95% CI: 0.81–181.41), respectively. The Average Annual Percent Change (AAPC) of IBD is predicted at 4.51%, varying from a 2.77% decrease in those over 60 to a 14.20% increase in the 20–39 age group. Gender-stratified forecasts show a higher AAPC in males (6.17%) compared to females (2.75%) over the next 30 years. The highest AAPC, valued at 19.48, was noted in the male group aged 20–39 years. GLM analysis indicates significant age, gender, and temporal effects on IBD prevalence, with marked gender disparities in specific age groups for both CD and UC. In UC, males aged 20–39 experienced a significantly higher increase in prevalence than females. For CD, males also showed a higher prevalence increase than females in the 20–39 and 40–59 age groups (all interaction p-values < 0.05; Table 1). Conclusion This study forecasts a significant increase in Korean IBD prevalence by 2048, especially among males and the 20–39 age group, highlighting the need to focus on these high-risk demographics in future disease management.

N38 Male patients with Crohn's Disease and perianal fistulae and their experience of sexuality and dialogue with healthcare professionals about their sexuality - a qualitative interview study

Abstract Background The incidence and prevalence of inflammatory bowel disease (IBD) has increased significantly over the last 30 years. IBD most often debuts in young adulthood and can have an impact on the patient's body image, intimate relationships and sexual function. The aim of this study was to explore how male patients with Crohn's disease and perianal fistulae, experience how their disease affects their sexuality, and how they experience the dialogue with healthcare professionals about sexuality and their related challenges. Methods A qualitative study based on a phenomenological hermeneutic approach was applied. Six male participants with Crohn's disease and perianal fistulae were recruited from an outpatient clinic at a regional hospital, Lillebaelt hospital, Vejle and Kolding. Data were collected via semi-structured telephone interviews. The transcribed interviews were analyzed using qualitative content analysis as described by Graneheim and Lundman. The analysis encompassed both a manifest and a latent level. Results The analysis led to the development of five themes: 1) The disease and sexuality. Flare-ups in the participants Crohn's disease posed an obstacle to intimacy, negatively affecting their sexlife during flare-ups. The participants used problem-focused and emotional coping strategies to overcome these limitations in their relationships, regarding intimacy and sex. 2) The phases of life - importance for sexuality. Sexuality was affected at different stages in life, independent of the participants' Crohn's disease. The balance with family, relationships, small children and work life, also had an impact on the participants desire for sex and intimacy with their partner and vice versa. 3) The importance of fistulas for sexlife. Acitive fistuala negatively affected the participants' sexuality. Their masculinity was affected by erectile dysfunction, which was a common complication to surgery. 4) Sexuality - an omitted topic in healthcare dialogue. Sexuality was often an omitted topic in the healthcare dialogue, even though the topic was important to the participants. 5) Is sex taboo? Sexuality was a topic the participants considered to be impacted by taboo, which encompassed both the participants and the health care professionals. Conclusion In patients with Crohn's disease and fistulae, sexuality must be seen in a bio-psycho-social perspective. Gender roles and coping strategies are important topics to include in the health care professionals dialogue with these patients.

P1154 Mediterranean dietary approaches to stop hypertension intervention for neurodegenerative delay (MIND) diet can reduce Inflammatory Bowel Disease risk: a prospective cohort study

Abstract Background The global increasing prevalence of Inflammatory Bowel Diseases (IBD) places a substantial burden on families and society at large. The lack of a definitive cure for this chronic condition underscores the critical need for effective preventive measures. Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, emphasizing natural plant-based foods while limiting animal products and high-saturated fats, emerges as a promising dietary approach. This study aims to bridge the gap in understanding the impact of the MIND diet on IBD risk. Methods We utilized data from 187,549 participants in the UK Biobank who provided dietary information and were free of IBD at baseline. Dietary information including the consumption of over 200 common foods and 30 beverages was collected for five rounds by a validated web-based 24-hour dietary recall questionnaire. A MIND diet score was evaluated based on the intake of ten beneficial and five unhealthy food groups and was further grouped by tertiles. The outcome of interest was Crohn’s disease (CD) and ulcerative colitis (UC), ascertained via inpatient data and primary care data. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Results After a mean follow-up of 10.7 years, we documented 335 and 655 incident CD and UC. The average age of the participants was 56.2 years, of which 55.0% were females. We found that greater adherence to the MIND diet, represented by higher diet score, was associated with a lower risk of CD (HR comparing extreme tertiles 0.66, 95% CI 0.50-0.89, P=0.006; P-trend=0.005) and UC (HR 0.80, 95% CI 0.65-0.98, P=0.030; P-trend=0.029) (Table 1). In the secondary analysis, we investigated the impact of fifteen individual food components in the MIND diet and found that consumption of olive oil was inversely associated with CD, and consumption of wine was inversely associated with UC. Conclusion We found higher adherence to the MIND diet was associated with lower risk of CD and UC. Our findings call for further research on the potential of the MIND diet to prevent IBD.

P244 The first step to IBD prevention exploring rate of pre-clinical inflammation in subset of asymptomatic subjects at risk of IBD: screening stage of the PIONIR trial

Abstract Background With the increasing prevalence of inflammatory bowel diseases (IBD) globally, it is necessary to start focusing efforts on prevention of the diseases. The Genetic, Environmental, Microbial (GEM) study identified biological signatures predictive of developing IBD in first degree relatives (FDR) of patients with Crohn’s disease (CD). The ongoing PIONIR (Preventing IBD ONset in Individuals at Risk) study is a randomized controlled trial aimed to explore whether the Tasty & Healthy diet can change the CD-risk associated biomarkers of healthy FDRs who are particularly high risk of developing CD, originally followed in the GEM cohort. We report here the rate of IBD and pre-IBD inflammation in a subset cohort. Methods Subjects, 6-35 years of age from the GEM cohort who were identified by a combination of predictors at recruitment to GEM to have an increased risk for persistently elevated fecal calprotectin (FC) (i.e. Microbiome Risk Score (MRS), increased gut permeability and/or multiplex family of CD) were approached to perform a new FC test. Subjects who had FC>70µg/g, confirmed by a second sample, were offered a panenteric video capsule endoscopy (VCE), but some elected to proceed to ileocolonoscopy instead. Results For the PIONIR recruitment, a total of 450 subjects were approached from 7 sites in Israel and Canada, of whom 183 consented and provided a stool sample for FC (Figure). FC was elevated in 57 (31%) subjects, confirmed by re-testing in 36 (20%); 25/36 underwent VCE/ileocolonoscopy (Figure). In total, 8 (4.4% of the screened cohort) had normal-appearing mucosa, in 10 (5.5%) there were non-specific mucosal changes (e.g. several erosions or erythema), 6 (3.3%) had ulcers compatible with CD and 1 (0.6%) was inconclusive. The median FC of those eventually diagnosed with CD (816 [IQR 361-1123) was higher than the remaining 30 without IBD with elevated FC (175 [111-281], p=0.003). FC>275µg/g was highly predictive of CD in the entire cohort (AUROC 0.97 (95%CI 0.93-0.99); sensitivity 83%, specificity 94%). Conclusion Preclinical mucosal inflammation in VCE/ileocolonoscopy was found in 18 of 183 (9.8%) screened subjects (i.e. elevated FC with either normal or nonspecific mucosal findings), 134 (73%) had normal FC and 11 (6%) with elevated FC had missing VCE/ileocolonoscopy data. Six had CD (3.3%, or 17% of the 36 with elevated FC). Detecting subjects at risk at their preclinical stages, possibly with FC>275µg/g, is the first necessary step in developing preventive strategies for IBD.

P312 Questionnaire survey for IBD patients in Japan; A Web-based J-CUP Survey

Abstract Background The prevalence of inflammatory bowel disease (IBD) in Japan has been increasing. We aimed to clarify the symptoms of patients with IBD in Japan using an internet-based questionnaire survey. Methods Overall, 805 patients with IBD were asked to complete an internet-based questionnaire addressing their history of disturbances in daily activities, prevalence of fecal urgency, incontinence, and treatment preferences. Results Responses were obtained from 447 patients with IBD (mean age: 54 years; 70% were men), comprising 363 patients with ulcerative colitis (UC) and 84 with Crohn's disease (CD). Notably, 16% of patients with UC and 35% with CD took over 1 year until the diagnosis of IBD, and 5% of patients with CD visited more than five medical institutions. Patients with CD were more likely to experience disturbances in their diet, work, travel, and outings than those with UC. Fecal urgency and incontinence were significantly more frequent in patients with CD than in those with UC (72% vs. 44%, and 50% vs. 26%, respectively). In contrast, 26% of the men and 37% of women with IBD had constipation. Acid reflux, sleep disorders, and depressive symptoms were present in approximately 30% of the patients. Oral administration was preferred. Conclusion Patients with IBD in Japan experience more severe disturbances in their daily activities, and these are more severe in those with CD than those with UC. In addition to fecal urgency and incontinence, care is required for constipation, acid reflux, sleep disorders, and depressive symptoms.