Prevalence Of Inflammatory Bowel Disease Research Articles

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.

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.

P1163 Incidence and risk of hip replacement rate in patients with inflammatory bowel disease in Taiwan

Abstract Background The incidence and prevalence of inflammatory bowel disease (IBD) are low but increasing in Taiwan. Management of comorbidities such as osteoporosis is becoming increasingly important in treating patients with IBD. Hip fracture is the most serious consequence of low bone mineral quality and is associated with excess risk of mortality. The present study aimed to investigate the total/partial hip replacement in IBD patients in Taiwan. Methods In a matched nationwide cohort study, we evaluated the risk of total/partial hip replacement in IBD patients. We conducted univariable and multivariable Cox models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). The Kaplan-Meier curves were plotted to describe the cumulative incidence of hip replacement among the two cohorts. Results a total of 51,301 patients with IBD and 153,903 patients without IBD were included in this study. In Table 1, distribution of gender, age, comorbidities, and medications were similar between two cohorts (SMD<0.1), except stroke, renal insufficiency, steroid, 5-ASA and anti-osteoporotic agents. The mean (standard deviation) age was 51.00 (17.76) and 49.89 (16.85) years and the sex ratio between female and male was approximately 50% and 50% in two cohorts, respectively. As shown in Table 2, patients with IBD had a significantly higher risk of hip replacement than the control group (adjusted HR=1.11, 95% CI=1.03-1.19). For the sake of a visual picture of cumulative incidence of hip replacement, consider the graphic representation in Figure 1 (Kaplan-Meier plot). Compared to female individuals, male individuals had significantly lower risks of hip replacement (adjusted HR=0.73, 95%CI=0.68-0.78). Older patients had more risk of hip replacement. Individuals aged 40-59, aged 60-79, aged >79 had significantly higher risks of hip replacement (adjusted HR >1, p-value<0.05) compared to individuals aged 20-39. Table 3 showed that IBD patients who are females, aged 40-59, or steroid users tended to have a higher risk of hip replacement compared to individuals without IBD (adjusted HR > 1, p-value < 0.05). We further stratified different dose of steroid use in IBD and non-IBD cohorts in Table 4. IBD patients receiving different steroid doses did not show influence on the risk of hip replacement. We demonstrated no difference in the hospital days, mortalities and morbidities among patients with hip replacement in non-IBD and IBD cohorts in Table 5. Higher rate of GI bleeding in IBD group had a significant difference than non-IBD group.; Conclusion Our present results indicate that patients with IBD had an overall higher total/partial hip replacement in Taiwan.

P1082 A comparative analysis of persistence of advanced therapies among patients with Inflammatory Bowel Disease in Taiwan

Abstract Background The prevalence of inflammatory bowel disease (IBD) has been rapidly increasing in Asia. Advanced therapies have significantly improved outcomes for moderate to severe cases of IBD. With the expanding availability of advanced therapies, the selection of the most suitable treatment option has become crucial. Among various factors, treatment persistence holds paramount importance. We present the first study in Asia that compares real-world persistence rates among advanced therapies in IBD patients in Taiwan. Methods In this retrospective cohort study, we enrolled patients with IBD who were treated with five advanced therapies: infliximab (IFX), adalimumab (ADA), vedolizumab (VDZ), ustekinumab (UST), and tofacitinib (TOF) at Linkou Chang Gung Memorial Hospital between October 2017 and April 2023. UST followed a standard maintenance dosing frequency of every 12 weeks, while TOF was permitted for use only as a second-line treatment option for UC in Taiwan. We compared baseline data and drug persistence rates within the first 52 weeks for the overall group, biologic-naïve patients, and biologic-experienced patients. Results A total of 432 IBD patients were included, with 173 (40%) having ulcerative colitis (UC) and 259 (60%) having Crohn's disease (CD). The majority of patients were male, with a mean age of 43.6 years and a mean BMI of 22.6. UST showed the highest rate of dose escalation (22%). Across all five drugs, the primary reason of discontinuation was secondary loss of response, with IFX having the highest discontinuation rate due to side effects (20%). Other baseline characteristics were presented in Table 1. Kaplan-Meier analysis revealed that all biologics exhibited a persistence rate of over 50% within the initial 52 weeks. UST demonstrated the highest 52-week persistence rates in overall (87.88%, p < 0.001, Figure 1a), biologic-naïve (96.55%, p = 0.002, Figure 1b) and biologic-experienced CD patients (80.56%, p=0.043, Figure 1c). Although no statistically significant differences were observed between advanced therapies in overall UC patients and other subgroup analyses (Figure 1d-1f). VDZ showed highest 52-week persistence in overall (69.05%, p=0.078, Figure 1d) and biologic-experienced (60.87%, p=0.751, Figure 1f) UC patients. UST had highest 52-week persistence in biologic-naïve UC patients (100%, p=0.329, Figure 1e). Conclusion In this pioneering real-world comparison of advanced therapies across one year in Asia, UST exhibited superior 52-week persistence rates in CD patients. However, the rate of dose escalation in UST was also the highest among these therapies. The study's limitations include its single-center nature and relatively small sample size.

P459 The prevalence and characteristics of inflammatory bowel disease-related ocular involvement in children

Abstract Background Ocular manifestations (OM) in patients with inflammatory bowel disease (IBD) are uncommon, particularly in children. We aimed to explore the prevalence, characteristics and risk factors of IBD associated OM in a large epidemiologic cohort-based study. Methods A cross-sectional study was performed using the Maccabi Healthcare Services (MHS) database. The eligible population included all patients diagnosed with IBD as children (<18 years) between January 2005 and July 2023. An additional analysis was conducted on patients diagnosed with ocular disease during childhood (<18 years) and IBD during childhood or adulthood. Results Out of 2,567 children with IBD (males 55%, Crohn’s disease 64%), 78 (3%) were diagnosed with OM at any time during disease course. In 54 patients (69%), the OM occurred after IBD diagnosis with a median time of 2.6 (0.47-7) years between the two events, whereas in 24 patients (31%) OM preceded IBD diagnosis with a median time of 2.1 (0.6-5.7) years. OM was significantly associated with Crohn’s disease, compared with ulcerative colitis (78.2% vs. 63.6% in the entire cohort; p=0.03). The presence of OM was associated with increased usage of systemic corticosteroids (p<0.001), biologic agents (p=0.04) and longer duration since IBD diagnosis (p=0.04). There were 55 patients with OM during childhood who were ever diagnosed with IBD. In this population OM was also associated with increased usage of systemic corticosteroids (p<0.001) and increased hospitalization rate per year (p=0.048). The annual prevalence of OM increased gradually from 10/1000 patients in 2005 to 22/1000 patients in 2022 (p=0.55). Conclusion Ocular involvement in children with IBD is rare and more common in patients with Crohn’s disease with a stable prevalence rate. It is associated with a longer duration of disease, greater usage of systemic corticosteroids and biologic agents and with a higher rate of hospitalizations, potentially representing a more severe disease course.

DOP60 Prevalence of undiagnosed inflammatory Bowel Disease in patients with spondyloarthritis: EISER Study

Abstract Background A significant proportion of patients with inflammatory bowel disease (IBD) have concomitant rheumatological manifestations. Patients with spondyloarthritis (SpA) often report gastrointestinal symptoms, some of them being associated to IBD. However, the exact prevalence of this disorder is still controversial, and the optimal approach to its diagnosis remains unknown. Methods Aim: to determine the prevalence of undiagnosed IBD in patients with axial SpA and psoriatic arthritis (PA). EISER is an observational, cross-sectional study carried out in13 Spanish hospitals. Patients ≥18 years-old diagnosed with PA or SpA were selected. Patients receiving biologics or systemic steroids were excluded. Among patients ≥ 50 years, only those without valid colonoscopy in the previous 3 years were included. Rheumatologists performed a baseline visit and collected demographic, clinical data. Fecal calprotectin (FC) was determined by the Quantum Blue rapid test and this was followed by a gastroenterologist consultation. Figure 1 summarizes study protocol. Results A total of 559 patients were included (51% men; mean 52.2 years; mean disease duration of SpA/PA was 12.3 years). The most frequent disease was radiographic SpA (37%), followed by peripheral APs (36%). Tabla 1 shows demographic characteristics of patients. A total of 40% of patients has FC ≥ 80 ug/g. In the multivariate logistic regression analysis factors associated with a greater likelihood of FC ≥ 80 µg/g were disease duration (OR 1.021, 95%CI 1.000 to 1.042, p<0.05) and disease activity by ASDAS-CRP (OR 2.158, 95%CI 0.906 to 5.139, p<0.1), while general health status by EQ-5D-5L was associated with a lower likelihood of FC ≥ 80 µg/g (OR 0.976, 95%CI 0.960 to 0.993, p<0.01). 28 patients were diagnosed of IBD, leading to a prevalence of 5.7%, 22 out of the 248 patients with axial SpA had IBD (8.9%) and 6 out of the 246 patients with PsA (2.4%). 24 were diagnosed with Crohn’s disease (CD), 3 unclassified IBD, and 1 UC. Seven (25.0%) of these IBD patients showed symptoms. The ROC curve for FC and the diagnosis of IBD is presented in Figure 1 (AUC of 0.870 (p<0.001, 95CI% 83.7 to 89.8). The highest sensitivity(S) and specificity (Sp) corresponded to a FC level >147 µg/g (S= 85.7% and a Sp of 75.5%, a PPV of 17.4% (95%CI 14.5 to 20.8) and NPV of 98.9% (95%CI 97.3 to 99.5). Conclusion - 5.7% of SpA patients have undiagnosed IBD. This prevalence was higher among axial SpA than PsA patients. - CD is the most frequent IBD type observed.· - FC is a useful tool to identify patients with SpA and lesions secondary to IBD. - FC has a high NPV to rule out IBD in axial SpA patients. - Disease duration, quality of life and disease activity of SpA are associated with higher levels of FC.

A Comprehensive Review: Inflammatory Bowel Disease And Its Global Perspective

Inflammatory bowel disease (IBD), comprising ulcerative colitis (UC) and Crohn’s disease (CD), represents a persistent gastrointestinal inflammatory condition. Initially labeled as a "Western disease," IBD was predominantly associated with Western lifestyles, but a shift in dietary and lifestyle patterns has led to a noticeable rise in Asian populations. The global prevalence of IBD reached 6.8 million cases in 2017, with a subsequent decrease to 4.9 million cases in 2019, showcasing a dynamic occurrence. The multifactorial pathogenesis involves genetic susceptibility, environmental factors, and an aberrant immune response to the gut microbiota. IBD is classified into CD, affecting any part of the gastrointestinal tract, and UC, limited to the colon and rectum. A third category, IBD-unspecified (IBD-U), is utilized when the inflammation's origin is unclear. Complications, including strictures, fistulas, and colorectal cancer, emphasize the disease's severity. Treatment options range from aminosalicylates to biologics, with emerging therapies and a focus on the mucosal antibacterial barrier offering potential advancements. Global healthcare organizations, recognizing IBD as a global ailment, aim to summarize epidemiological patterns to guide interventions. In study on global burden of disease 40 million cases were reported, prevalence of more than 1 percent of total global incidence has been seen worldwide, 41.00 thousand deaths, and 1622.50 thousand DALYs globally in 2019. While advancements have been made, further research is crucial to improve prevention and treatment strategies. The shift in the pathogenic focus towards mucosal antibacterial barriers presents a potential avenue for future developments, offering hope for enhanced outcomes and improved quality of life for individuals affected by IBD

P814 Empowering IBD communities worldwide: The global impact of www.ibd-eii.com in disseminating evidence-based information and educational support

Abstract Background In recent decades, the volume of inflammatory bowel disease (IBD) research has surged, presenting a challenge for health care professionals to be updated. This is even more complicated for professionals in countries with low IBD prevalence and for registrars, fellows and other healthcare professionals. Methods IBD-EII website was launched the 8th February 2023 and serves as a comprehensive, unfunded and free platform offering up-to-date IBD evidence-based data. To highlight the impact, analyzing its first 8 months (data extracted via Google Analytics as of October 26, 2023) and using a google form questionnaire that was sent to subscribers in August 2023. Results The website encompasses over 300 trials and study summaries, along with 22 evidence-corner summaries, 102 guidelines from 12 scientific societies, 19 infographics featuring classifications and scores, 65 Cochrane meta-analyses and 13 network meta-analysis. Over the study period, there were 151,736 visits from 139 countries, with an average of 8.29 visits per user. The top-engaged countries were the United States, United Kingdom, Spain, Russia, and India (Figure 1). The site garnered 1058 subscriptions, with 10 (0.9%) individuals unsubscribing during the study period. Of the 850 invited users, 81 (9.5%) filled the questionnaire. Of them 53 (65.4%) were female. There were 49 (60.5%) healthcare professionals, 35 (43.2%) patients/family members of a patient, 4 (6%) were IBD researchers/ pharma industry workers, working for patients organization or both doctor and patient. Among healthcare professionals, 22 (44%) were IBD specialists, 14 (28%) general gastroenterologists, 4 (8%) trainees/ med school, 12 (24%) were IBD nurses/dieticians or pharmacists, 3 (6%) others. Most people have heard of the website in social media 66 (81.5%), by colleagues recommendation 8 (9.9%), congresses 7 (8.6%), or other 5 (6%). Website impact: 80 (98.8%) thought it was useful, 80 (98.8%) recommended to be subscribed. The most valuable sections were "evidence corner" 56 (69.1%) followed by guidelines 48 (59.3%) and timeline 35 (43.2%). Conclusion The data highlights the significant global impact of www.ibd-eii.com in disseminating evidence-based information to a diverse international community of healthcare professionals and patients. The website stands as a novel resource, fostering collaboration and empowerment within the global IBD community.

P940 A glance into paediatric Inflammatory Bowel Disease in Australasia – Crohn’s Colitis Cure (CCC) data insights program

Abstract Background Around 10% of people with inflammatory bowel diseases (IBD) are diagnosed in childhood1. Clinical manifestations are known to differ in children compared to adults2,3. This study aims to describe the real-world characteristics of children with IBD. Methods Crohn’s Colitis Care (CCCare) is an IBD-specific electronic medical record (EMR) used at IBD centres across Australasia. Data feed into a de-identified clinical quality registry (CQR), which was interrogated in November 2023. All children (<18 years at time of extract) under active care (encounter within 14 months) were included. Results Clinical data from 162 children across 14 centres were available for analysis. Of these, 64.8% (n=105) had Crohn’s disease (CD), 31.5% (n=51) ulcerative colitis (UC) and 3.7% (n=6) IBD-unclassified. There was a roughly equal split in gender (male=55.0%), with a minority aged <10 years (9.9%, n=16). The mean recorded body mass index was 20.5kg/m2 (n=101 with BMI data), with 78.2% in the ‘normal’ range (18.5-24.9kg/m2). Five patients (5.0%) were ‘underweight’ (<18kg/m2), and 16.8% (n=17) were overweight or obese (>25kg/m2). Only 7.4% (n=12) were currently receiving steroids, and over half (55.6%, n=90) had received an advanced therapy (biologic or small molecule). Few reported incontinence (n=5, 3.1%), and 6% (n=9) had an IBD-related surgery recorded. Around 20% (11/56) had current or previous fistulising CD. On most recent data, the mean faecal calprotectin was 637μg/g, C-reactive protein 6.1mg/L and ESR 9.4mm/hr. In those with UC, 43.7% had either moderate (S2) or severe (S3) disease activity at last assessment (Figure 1). In those with CD, 31.1% had either stricturing (B2, 21.5%) or penetrating intra-abdominal disease (abscess/perforation/phlegmon, B3, 10.6%). Conclusion This study provides a detailed real-world overview of IBD in children in Australasia, demonstrating the ability of CCCare to help collate data at scale across a large geography. Data show clear changes in phenotype over time. Such data allow for the tracking and benchmarking of outcomes over time across centres, thus promoting evidence-based care improvements. Ongoing real-world data collection is crucial in optimising management strategies and improving care outcomes. 1 - Burgess CJ et al. Paediatric Patients (Less Than Age of 17 Years) Account for Less Than 1.5% of All Prevalent Inflammatory Bowel Disease Cases. J Pediatr Gastroenterol Nutr. doi: 10.1097/MPG.0000000000002842. 2 - Seyedian SS et al. A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. J Med Life. doi:10.25122/jml-2018-0075 3 - Moon JS. Clinical Aspects and Treatments for Pediatric Inflammatory Bowel Diseases. Pediatr Gastroenterol Hepatol Nutr. doi:10.5223/pghn.2019.22.1.50