Stable Inflammatory Bowel Disease Research Articles

N30 Exploring the effects of nurse-led clinics on the Inflammatory Bowel Disease service

Abstract Background The increasing incidence of inflammatory bowel disease (IBD) has led to greater demands on the healthcare system.1 Lack of access due to longer wait times for new referrals to tertiary IBD services can lead to worse health outcomes and reduced quality of life for people affected.2 We sought to determine whether introducing a nurse-led clinic (NLC), can improve clinic wait times and enable new referrals (category 1 <30 days and category 2 <90 days) to be reviewed within their allocated time frame. We also explored the experience and satisfaction of people with IBD reviewed by their usual consultants compared to NLC. Methods Individuals were triaged to NLC based on strict inclusion and exclusion criteria: recent pathology with normal inflammatory markers (faecal calprotectin <200mcg/g, C-reactive protein <8mg/L), a review with consultant in the last 18 months, and have stable IBD over the previous 12 months. People with active perianal disease, significant end-organ damage, coexistent liver disease, other severe comorbidities or those transitioning from paediatric to adult services were ineligible for NLC. Data on clinic wait times was collected over 6 months, from August 2023 to February 2024 and compared to a one-year period from August 2022 to July 2023, prior to the introduction of the NLC. All people attending both NLC and consultant reviews were invited to complete an anonymous patient satisfaction survey where they could rate their experience on a scale of 1-10. (Table 1) Results Of the 65 people seen in NLC, median age 39 years (IQR 23-76); 35 (54%) were female. In this cohort, 41 (63%) had Crohn’s Disease (CD), 23 (35%) Ulcerative Colitis (UC), and 1 (2%) IBD-Unclassified (IBD-U). During the same period, 358 people were seen in consultant clinics; median age 43.5 years (IQR 18-87); 198 (55%) male. In this cohort, 211 (59%) had CD, 126 (35%) UC, 8 (2%) IBD-U and 13 (4%) did not have IBD. Following the introduction of NLC, 80% of urgent category 1 referrals were seen within the recommended timeframe, compared to 60% prior. For semi-urgent category 2 referrals, 95% were reviewed on time, up from 79% at baseline. When combining both categories, the overall proportion of referrals reviewed on time increased from 71% at baseline to 89% during the NLC period, reflecting an 18% statistically significant improvement (p-value = 0.0486). (Figure 1) Surveys were completed by 69 people (52 consultant clinic; 17 NLC). The overall mean score calculated for consultants was 9.1/10, while the overall mean score for nurses was 9.4/10. (Table 1) Conclusion This pilot study showed the potential value of a nurse-led clinic to improve clinic wait times in an IBD service, whilst maintaining patient satisfaction. References Wang R, Li Z, Liu S, Zhang D. Global, regional and national burden of inflammatory bowel disease in 204 countries and territories form 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019. BMJ Open, 2023; 13:e065186. doi: 10.1136/bmjopen-2022-065186. Prentice JC, Pizer SD. Delayed access to health care and mortality. HSR. 2007; Apr;42(2):644-62. doi: 10.1111/j. 1475-6773.2006.00626.x.

P0739 Treatment persistence, clinical, and biological outcomes following an elective switch from intravenous to subcutaneous infliximab and vedolizumab

Abstract Background Subcutaneous (SC) formulations of infliximab (IFX) and vedolizumab (VDZ) are approved for treating ulcerative colitis (UC) and Crohn’s disease (CD). This study reports on treatment persistence, as well as clinical, biological and pharmacological outcomes following an elective switch from maintenance intravenous (IV) to SC IFX and VDZ. Methods We conducted a single–centre, prospective, observational study from November 2021 through June 2024, enrolling stable inflammatory bowel disease (IBD) patients (based on physician global assessment) willing to switch from maintenance IV IFX or VDZ to SC treatment, and with a minimum follow-up of 34 weeks. Data were collected on patient characteristics, prior and current medications, clinical and biological activity, and pharmacokinetics. Assessments were made at time of last IV infusion, baseline (first SC injection, 4 weeks after last IV), week 8, week 34, and last follow-up. The primary objective was SC treatment persistence. Secondary objectives included change in the two-component patient reported outcome (PRO2), C-reactive protein (CRP), faecal calprotectin and serum levels (SL). Results In this study, 140 IBD patients (median age 44.2 years, 78 female, 64 UC, 76 CD) switched from IV IFX (n=59) or VDZ (n=81) to SC treatment. One hundred and fifteen patients were on standard IV dosing versus 25 patients on optimized IV dosing (19 IFX, 6 VDZ). No patient received concomitant immunosuppressants. Over a median follow-up of 20.2 (IQR 13.6-26.4) months, 83.6% of patients remained on the SC formulation, with more patients continuing on SC IFX compared to VDZ (odds ratio 2.56 [95% CI 1.12-5.88], p=0.025, Figure 1). No other baseline factors were linked to treatment persistence. The main reasons for discontinuation were disease flare and side effects (Figure 1). Seventeen patients returned to IV treatment, while six patients switched to another biologic. Median (IQR) PRO2 (for UC: 0 [0-0] at baseline, 0 [0-1] at week 8, and 0 [0-0] at week 34; for CD: 2 [0-7] at baseline, 2 [0-7] at week 8, and 0 [0-6] at week 34), CRP (1.6 [0.7-3.8] mg/L at baseline, 1.4 [0.6-3.7] mg/L at week 8, and 1.9 [0.7-5.1] mg/L at week 34), and faecal calprotectin (30 [30-112] µg/g at baseline, 37 [30-139] µg/g at week 8, and 54 [30-86] µg/g at week 34) remained stable over time. However, median (IQR) IFX and VDZ SL increased significantly over time compared to time of last IV infusion (all p<0.0001) (Table 1). Conclusion Switching from maintenance IV to SC IFX or VDZ is a viable option for stable IBD patients, though 16% experienced flare-ups or side effects after switch. Treatment discontinuation was more common with SC VDZ than IFX.

Outcomes of a mandatory non-medical switch of infliximab to a biosimilar for inflammatory bowel disease in British Columbia, Canada.

Despite infliximab biosimilars becoming widely used in inflammatory bowel disease (IBD) patients, real-world non-medical switching is sparse. A biosimilar non-medical switch was launched in British Columbia in 2019, the first Canadian province to do so, from Remicade to an approved biosimilar (CT-P13 or SB2). This study aims to obtain real-world evidence evaluating the clinical outcomes of non-medical switching from Remicade to the infliximab biosimilars. This is a retrospective observational study of stable IBD patients from the IBD Centre of BC who underwent the non-medical infliximab switch. The primary outcome is treatment continuation at 12 ± 2 months post-switch. Secondary outcomes include frequency of loss of response, adverse events, and immunogenicity within the first 12 months post-switch. A control group of patients maintained on the originator served as a comparison. Patients in the biosimilar switch group (n = 264) and originator group (n = 99), show similar demographics and disease characteristics. There was no difference in infliximab continuation between the biosimilar group (94.9%) and the originator group (90.1%) (P = 0.18). Reasons for discontinuation of infliximab included loss of response (4.04% vs 4.91%), immunogenicity (1.01% vs 0.75%), or adverse effect (1.01% vs 2.3%) in the infliximab originator vs biosimilar switch group, respectively. Similarly, no differences in safety or efficacy were observed between patients switched to CT-P13 or SB2. Non-medical biosimilar switch of infliximab demonstrates similar clinical outcomes compared to originator molecule continuation for therapy of IBD. These data support the safety and efficacy of non-medical infliximab switching in IBD patients.

P1046 Home calprotectin testing: An east London experience

Abstract Background Monitoring of inflammatory bowel disease (IBD) using home faecal calprotectin (FCP) testing kits was adopted widely during the Sars-Cov-2 pandemic. CalproSmart is a kit which allows patients to measure FCP at home and upload the results to a smart phone application allowing remote monitoring. Recent NHS long term recovery plan has highlighted the importance of ensuring equity of access with service development1. Following the British Society of Gastroenterology guidance during the pandemic we introduced the system to our hospital in Newham, one of the most ethnically diverse regions of the UK2. The aim of this pilot study was to evaluate the uptake of the kits, patient acceptability and how they impacted on IBD care. Methods 62 patients with stable IBD were invited to take part in the study over a 12 month period. They were sent four FCP tests and instructions on how to enrol onto the CalproSmart portal. The participants who enrolled on the portal were then sent a post-study questionnaire. Results 28 of the 62 patients invited (45%) enrolled onto the CalproSmart portal. 14 of these 28 patients (50%) completed the post-study questionnaire. The patients invited to take part were from a variety of ethnic backgrounds, the average age was 36 and there were a mix of Ulcerative Colitis (60%) and Crohn’s (40%) diagnoses. When comparing those invited and those who used the home kit, uptake varied according to gender and ethnicity. 57% of women invited used the home kit compared to 34% of males. Additionally, despite 69% of the borough’s population being non-white, 50% of those using the home tests were white (see table 1). The post –study questionnaire showed that both the sample kit and the application were found easy to use by 12 (86%) and 13 (93%) of the patients, respectively. 11 patients (79%) reported they found the results of the FCP home kit helpful and 6 patients (50%) felt the FCP home kit improved the treatment of their disease (see figure 1).10 patients (71%) reported they preferred a home test to dropping stool samples at the hospital. The reasons for this were the convenience of not having to visit the hospital (90%) and the speed in which they got the results (80%). Conclusion This study demonstrates that home FCP tests are an easy-to-use tool and patients prefer them to attending the hospital. The home kit was well received in a diverse area of London with a mix of ethnic groups and socio-economic backgrounds. However, the ethnicity of patients using the home tests did not reflect the diversity of the invited participants or the borough. This suggests there needs to be additional exploration into their barriers to access and consider any extra support needed to improve uptake of patient initiated monitoring.

Feasibility of Reduced Clinical Monitoring in Patients with Inflammatory Bowel Disease Treated with Thiopurine Therapy

BackgroundOutpatient visits and laboratory assessments are routinely scheduled every 3 to 4 months in thiopurine-treated patients with inflammatory bowel disease (IBD) to timely detect thiopurine-related adverse events (AEs). AEs that require therapy adjustment beyond 12 months of treatment are rare.Aim and MethodsThis single-center prospective cohort study evaluated the safety of a reduced 6-monthly monitoring strategy in steroid-free patients with quiescent IBD on stable dose of azathioprine, mercaptopurine, or thioguanine monotherapy. The primary outcome was thiopurine-related AEs requiring therapy adjustments during a follow-up period of 24 months. Secondary outcomes included all AEs including laboratory toxicity, disease flares until 12 months, and the net monetary benefit from this strategy concerning IBD-related health care use.ResultsWe enrolled 85 patients with IBD (median age 42 years, 61% Crohn’s disease, 62% female), with a median disease duration of 12.5 years and median thiopurine treatment duration of 6.7 years. During follow-up, 3 patients (4%) ceased thiopurines due to AEs: recurrent infections, non-melanoma skin cancer, and gastrointestinal complaints (nausea, vomiting). At 12 months, 25 laboratory toxicities were observed (including 13% myelotoxicity, 17% hepatotoxicity); none required therapy adjustments and all were transient. A reduced monitoring strategy had a net benefit of €136 per patient.ConclusionThree patients (4%) ceased thiopurine therapy due to thiopurine-related AEs, while no laboratory toxicity required therapy adjustments. Monitoring frequency of every 6 months seems feasible in patients with stable IBD on long-term (median duration > 6 years) maintenance thiopurine therapy and may contribute to reduced patient-burden and health care costs.

P488 Switch from intravenous to subcutaneous infliximab in patients with Inflammatory Bowel Disease: efficacy, safety and patients’ acceptance

Abstract Background A new formulation of biosimilar infliximab (IFX) has recently been approved for subcutaneous administration (SC) that may offer pharmacokinetic advantages resulting in higher drug exposure. Our purpose was to evaluate the efficacy, safety, pharmacokinetic changes and patients’ acceptability after switching from intravenous (IV) to SC IFX in a cohort of patients with Inflammatory Bowel Disease (IBD) in clinical practice. Methods Observational, prospective and single-center study including patients with IBD in sustained (≥6 months) clinical remission under IV IFX that were switched to SC IFX 120 mg every 2 weeks. Prospective monitoring was performed with clinical and laboratory data including IFX trough levels prior to the last IV infusion (W-IV), prior to the first SC administration (W-0), and after 16 weeks (W-16) and 52 weeks (W-52) of SC treatment. Patients’ satisfaction has been evaluated at W-52. A descriptive analysis of the data has been carried out with the R Studio statistical program using means and Wilcoxon signed rank test. Results Sixty patients have been included, all have achieved W-16 and twelve W-52. Thirty-five (58,3%) are men with a median age of 42,5 (20-71) years. Thirty-eight (63,3%) have Crohn’s disease and twenty-two (36,7%) ulcerative colitis, with a median disease duration of 11,3 years. They have been receiving IV IFX (5mg/kg/8 weeks in 95% of cases) for 5,7 (0,6-21,1) years, at a stable dose (≥6 months). Twenty-seven (45%) received concomitant immunomodulatory treatment and IFX was the first biological in 75% of patients. None of the patients presented clinical relapse during follow-up (Table 1). Median trough IFX levels under IV treatment were 3,9 µg/dl (W-IV) and 4,3 µg/dl (W-0). Compared to W-0, IFX trough levels were significantly higher both in W-16 [17,05 µg/dl (5,59–57,60), p<0,005] and in W-52 [16,75 µg/dl (8,65 –35,01), p=0,007], without significant differences between W-16 and W-52 (p=0,74) (Figure 1). None of the patients developed immunogenicity. Three adverse effects have been detected: 1 allergic reaction to the first SC dose and 2 mild skin reactions. At W-16 and W-52 the number of patients maintaining SC IFX treatment were 58/60 (96,7%) and 10/12 (83,4%) respectively. At W-52, all patients expressed high satisfaction with the change and would not like to return to IV treatment. All place the SC route as a preference above the IV. Conclusion Switching from IV to SC IFX is safe, effective, and well accepted by patients with stable IBD. A significant increase in IFX trough levels is observed with the SC formulation.

S867 Using the Tools of Functional Medicine Improves the Multi-Disciplinary Model of Care of the IBD Patient

Introduction: Inflammatory Bowel Disease (IBD) is a chronic, multifaceted disease that often coexists with extra-intestinal manifestations (EIMs) and persistent GI symptoms despite remission. Functional medicine is a patient-centered, complementary approach to care that focuses on diet and modifiable lifestyle factors (MLF). An individualized functional medicine program was developed for IBD patients at a tertiary care IBD center with the goal of supporting traditional IBD care and improving symptoms and quality of life. Methods: Between December 2020 and April 2022, clinically stable IBD patients with persistent GI symptoms or EIMs were offered access to our IBD functional medicine clinic (FMC), where they had individual appointments with a dietician, functional medicine provider, and social worker. They received education on nutrition and techniques to address stress, sleep quality, and other MLFs. Prior to each visit, the following patient-reported outcome (PRO) surveys were administered: the SIBDQ (Short Inflammatory Bowel Disease Questionnaire), FSS (Fatigue Severity Scale), PSQI (The Pittsburgh Sleep Quality Index), and MSQ (Medical Symptoms Questionnaire). Statistical analysis was performed with Wilcoxon matched-pairs signed-rank test. (Figure) Results: 40 patients were consented. Of those, 27 patients attended FMC and completed PRO surveys at least twice (21 CD, 5 UC, 1 indeterminate; 9 men, 18 women). The range of disease length was 0-35 years. 16 of 27 indicated they were extremely ready to make diet and MLF changes. Median SIBDQ increased from 52 to 58 with statistical significance. There was a trend towards improvement in MSQ, FSS, and PSQI, although without statistical significance. The MSQ subsets of joint and weight symptoms showed significant improvement. Patients who indicated readiness for change significantly improved their SIBDQ, MSQ and PSQI. (Table) Conclusion: In patients with stable IBD, persistent symptoms may be related to dietary or psychosocial triggers, which are the key targets of functional medicine care. A previous retrospective design looked at the functional medicine approach to care in a shared medical appointment standardized program and found improvement in areas of sleep, fatigue, and medical symptoms. This prospective study of an individualized functional medicine IBD program showed that patients who were ready for change improved in MSQ and PSQI compared to the entire cohort, while the entire cohort significantly improved their SIBDQ regardless of readiness for change.Figure 1.: SIBDQ, MSQ, and PSQI significantly improved in patients who indicated readiness for change Table 1. - Median PROs Showed Trends Towards Improvement, with Significant Improvement in SIBDQ First score median (range) Last score median (range) p-value SIBDQ 52 (27-65) 58 (34-68) < 0.05 MSQ 51 (10-120) 37 (1-130) 0.2 FSS 39 (15-57) 35 (17-63) 0.5 PSQI 3 (0-13) 2 (0-5) 0.15

Bioelectrical spectroscopy impedance phase angle is not associated with nutritional status in a stable cohort of paediatric inflammatory bowel disease patients.

Nutritional assessment in paediatric inflammatory bowel disease (IBD) is key to supporting growth whilst minimising adiposity. Bedside assessment using bioelectrical impedance spectroscopy (BIS) has previous identified patients with declining cellular and nutritional health. We aimed to assess BIS measures in stable paediatric IBD patient. Stable IBD patients were recruited at routine hospital visits. All patients underwent BIS, anthropometry and disease activity assessment. Multivariable regression and receiver operator curve (ROC) analyses were undertaken to assess the utility of BIS phase angle 50KHz (PA-50) and 200/5KHz impedance ratio (IR) in nutritional assessment. There were 140 study visits from 97 patients, mean age 14.49 years, 62.9% Crohn's disease. Mean BMI Z-score (BMIZ) was 0.31 (range-2.97 to 3.99), 33% of patients were overweight (BMIZ>1) and 13.8% of patients were underweight (BMIZ<-1). Crohn's disease patients had a lower mean BMIZ score 0.14, compared to ulcerative colitis, 0.68, p=0.007. There was no relationship between PA-50 and BMIZ or disease activity. IR was not related to disease activity but was negatively related to BMIZ in a multivariable regression, accounting for age, sex and disease subtype (beta-0.331, p=0.001). ROC analyses did not identify a clinically useful cut off for either PA-50 or IR to identify patients with active disease, biologic use or BMIZ>1 or<-1. BIS appears to have limited added value in nutritional assessment of stable paediatric IBD patients. Nearly 1/3 patients were overweight and personalised approach to supplementation is vital to avoid overnutrition.

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

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

Refractory neutrophils and monocytes in patients with inflammatory bowel disease after repeated bouts of prolonged exercise.

BackgroundNeutrophils and monocytes are key immune effector cells in inflammatory bowel disease (IBD) that is associated with chronic inflammation in the gut. Patients with stable IBD who perform exercise have significantly fewer flare‐ups of the disease, but no underlying mechanism has been identified. Therefore, the aim of this study was to compare the responsiveness/refractoriness of these innate immune cells after repeated bouts of prolonged exercise in IBD patients and controls.MethodsPatients with IBD and age‐ and gender‐matched healthy controls were recruited from a cohort of walkers participating in a 4‐day walking event. Blood analysis was performed at baseline and after 3 days of walking. Responsiveness to the bacterial/mitochondrial‐stimulus N‐Formylmethionine‐leucyl‐phenylalanine (fMLF) was tested in granulocytes and monocytes by measuring the expression of activation markers after adding this stimulus to whole blood.ResultsIn total 38 participants (54 ± 12 years) were included in this study: 19 walkers with and 19 walkers without IBD. After 3 days of prolonged exercise, a significant increase in responsiveness to fMLF was observed in all participants irrespective of disease. However, IBD patients showed significantly less responsiveness in neutrophils and monocytes, compared with non‐IBD walkers.ConclusionsIncreased responsiveness of neutrophils and monocyte to fMLF was demonstrated after repetitive bouts of prolonged exercise. Interestingly, this exercise was associated with relative refractoriness of both neutrophils and monocytes in IBD patients. These refractory cells might create a lower inflammatory state in the intestine providing a putative mechanism for the decrease in flare‐ups in IBD patients after repeated exercise.

Trends of Liver Stiffness in Inflammatory Bowel Disease with Chronic Hepatitis C.

Concomitant inflammatory bowel disease (IBD) and hepatitis C virus (HCV) infection is a relevant comorbidity since IBD itself exposes to a high risk of liver damage. We aimed to evaluate liver stiffness (LS) in IBD-HCV after antiviral treatment. We enrolled IBD patients with HCV. All patients at baseline underwent LS measurement by elastography. Patients who were eligible for antiviral therapy received direct antiviral agents (DAAs) and sustained viral response was evaluated at the 12th week. A control group was selected within IBD patients without HCV. One year later, all IBD-HCV patients and controls repeated LS measurement. Twenty-four IBD-HCV patients and 24 IBD controls entered the study. Only twelve out of 24 received DAAs and all achieved sustained viral response (SVR). All IBD subjects were in remission at enrollment and maintained remission for one year. After one year, IBD patients who eradicated HCV passed from a liver stiffness of 8.5 ± 6.2 kPa to 7.1 ± 3.9, p = 0.13. IBD patients who did not eradicate HCV worsened liver stiffness: from 7.6 ± 4.4 to 8.6 ± 4.6, p = 0.01. In the IBD control group, stiffness decreased from 7.8 ± 4.4 to 6.0 ± 3.1, p < 0.001. In conclusion, HCV eradication is able to stop the evolution of liver fibrosis in IBD, while failure to treat may lead to its progression. A stable IBD remission may improve LS even in non-infected subjects.

Monitoring biologics in inflammatory bowel disease (IBD) using the Patients Know Best electronic portal: pilot study of uptake, acceptability and outcomes

Background: The number of inflammatory bowel disease (IBD) patients on biologics in the UK is increasing; this and the expansion of available drugs have contributed to delays in delivering treatment. E-health applications, such as the Patients Know Best (PKB) personal online healthcare record system, can improve efficiency of patient management in stable IBD. This pilot study aimed to explore the uptake, acceptability and outcomes of PKB in the management of patients starting biologics. Methods: IBD patients prescribed biologics were invited to register and trained online. The authors measured the number of new starters, PKB registrants, time intervals to treatment and the nature of online activity. Patients using the application received an evaluation questionnaire 6 months after enrolment. Results: Out of 40 patients newly started on biologics, 33 years were included, with a mean (SD) age of 44.3 (13.3) years. The mean time interval from decision to treatment administration was 82.7 days (44.0). Ten patients raised at least one issue on PKB; 45 new issues were raised, mostly relevant to active disease (18/45), adverse events of treatments (6/45) and the funding application process (5/45)—39 were resolved online. Of patients, 16 answered the questionnaire, and 11 found it at least somewhat helpful. More training was requested. Conclusions: The use of PKB did not accelerate the process of drug administration. However, patients engaged with the use of the platform, several issues were raised and most of these were resolved electronically. Regular training and individual treatment plans for patients starting biologics may optimise PKB's use for long-term monitoring.

N810 Audit of patient satisfaction with telephone reviews for inflammatory bowel disease

Background: Patients with inflammatory bowel disease (IBD) require long term follow up. However, many patients attending routine clinic appointments are in remission and require only verbal assessment of their condition. It was noted that the nurse led IBD clinics were often overbooked and access to appointments when required was difficult. Telephone reviews for those with Coeliac disease were already being carried out successfully and it was felt that this may also be a suitable alternative to traditional face to face clinic appointments for patients with stable IBD. Methods: Over a three month period 50 patients scheduled to attend the nurse-led IBD clinic were invited to receive a telephone review rather than face to face consultation. Blood request forms were sent to patients along with the appointment letter notifying them of the time and telephone number they would be contacted on. They were asked to have the blood tests done 1–2 weeks prior to their review. Following the 3 month trial period all patients who had been invited to participate in the telephone clinic were sent a questionnaire to evaluate their satisfaction with the telephone reviews. Results: Of the 50 patients invited to have a telephone review, two had requested to be seen in clinic, of the remaining patients the Clinical Nurse Specialist (CNS) had been unable to contact 3 patients. Two had normal blood results and returned answer phone messages to notify the CNS that they were symptomatically well. 32 questionnaires were returned (64%). There was a fairly even spread of patients in terms of duration of the disease with 16 having IBD for <10 years and 17 patients >10 years. Male and female ratio was also even with 16 male and 14 female (2 had not answered). Two patients who returned the questionnaire had not completed all sections as they had requested to be seen in clinic. Of the 30/32 patients who had received a telephone review general satisfaction was high and the majority would be happy to continue with this method of follow-up. 26 (87%) were happy to continue telephone reviews, 1 (3%) was undecided and 3 (10%) preferred to come in to clinic. In an overall rating for the telephone review 1–10 (1 being very poor) 24 (80%) rated it as 8 or above. Conclusions: The telephone reviews were well received by patients and offer an acceptable alternative to the traditional clinic follow up appointments for those with stable IBD. The level of satisfaction with all aspects of the telephone review was high. Offering telephone reviews meets the recommendations of the IBD Standards in terms of providing choice to patients and maintaining patient-centred care.

PWE-062 The outcomes and benefits of moving stable inflammatory bowel disease patients from a paper based self management system to an supported, self help and management programme (ibd-sshamp) with specialist overview

Introduction Self management in inflammatory bowel disease (IBD) has proven itself to be a safe and cost effective method of managing the more stable IBD patients. It is however not without its issues. In February 2012 we introduced our IBD-Supported, Self Help and Management Programme (IBD-SSHAMP) with specialist nursing and consultant support to try an avoid some of the issues inherent on relying on self management alone. We now have 3 years experience in running IBD-SSHAMP with regular virtual telephone clinics and personalised web-site supported management. Some of the outcomes seen in transferring patients from self management to a supported self management system are presented here. Method In total 425 of our more stable IBD patients are now managed in the community on IBD-SSHAMP. Using hospital coding data, Evolve (the hospital–s electronic record system), the National IBD Registry and HICSS (the endoscopy reporting software) we reviewed the following aspects;- number of flares, steroid courses, emergency outpatient clinics, and hospital admissions. By continuing to keep them under a close monitoring system we were interested to know if improvements would be seen in their compliance with prophylactic medication and their uptake on surveillance colonoscopy. Results In 3 years just 43 flares were experienced in this cohort, and most of these were successfully treated using mesalazines alone. Steroids were however required in 16 of these patients, most of which was directed by telephone consultation. In that 3 year period only 8 required urgent outpatient appointments (OPAs) were required and no patients needed hospital admission. Many patients on pure self management had been lost to follow up and had avoided surveillance colonoscopy. Unfortunately after bringing these patients back into a monitored and supported management system we have subsequently found 3 colorectal cancers (ascending, sigmoid and ano-rectal) within this group. Most of these patients were overdue their surveillance colonoscopy, but despite the known risks 114 still declined surveillance. Other cancers were also found amongst this cohort, including; 2 breast cancers, one prostrate cancer and one skin cancer. Most were happy with the new IBD- SSHAMP, but 3 patients chose to attend standard hospital based OPAs. Conclusion IBD-SSHAMP has been shown to be a highly efficient and cost effective method of keeping community based IBD patients under close specialist review. Reductions in flares, emergency OPAs and admissions have been seen. It has been well received by the patients who prefer to be supported rather than discharged and left alone to self manage. Disclosure of interest None Declared.

PWE-108 Factors Influencing The Management Of Inflammatory Bowel Disease In Primary Care

IntroductionBetween 30–70% of United Kingdom (UK) adults with Inflammatory Bowel Disease (IBD) are managed solely by their General Practitioner (GP).1,2 There is, however, limited knowledge as to how UK GPs...

PTH-051 The First Years Outcome Data From Ibd-sshamp; Uk’s First Remote Web-based Self Management Programme For Stable Inflammatory Bowel Disease Patients

IntroductionIn February 2012 the Luton and Dunstable University Hospital, became the first hospital in UK to use a remote (web-based) programme to help manage stable inflammatory bowel disease (IBD) patients....

OC-080 Ibd-Sshamp (Supported, Self help and Management Programme); UK’S first Internet based Remote Management System for Managing Stable IBD

Introduction In February 2012 the Luton & Dunstable University Hospital in Hertfordshire, became the first hospital in UK to commence a remote management programme for stable inflammatory bowel disease (IBD) patients. The project, entitle IBD-SSHAMP (Supported, Self Help And Management Programme), was funded by an Innovation Award presented by the East of England Primary Care Trust (PCT) Innovation Team. The aim was to discharge patients from routine clinic visits, whilst maintaining an efficient remote monitoring system that could be co-ordinated through our specialist nurses. Methods The first stage was to ensure we had a complete and up-to-date database containing all of our IBD patients. After a retrospective 10 year review we identified a total of 2790 IBD patients, from 19 different ethnic backgrounds. Of these, 26 patients lacked mental capacity with learning disability or dementia and 117 did not have internet access. 370 of our original cohort had died by the time of commencing the project. Using Patient Knows Best we developed individualise websites to offer a communication portal between patients and specialist care, through which we could monitor their symptoms and offer management advice through a traffic light system. An alert is sent out to the IBD nurses and clinician involved if any patients symptom indices deteriorate markedly. Periodic faecal calprotectin and inflammatory markers will also be used to support the monitoring process. Virtual clinics will be held for these patients twice a year. If necessary patients can be seen in hospital clinics usually within 24–48 hrs. Results Of the available 2,277 IBD patients, we have successfully discharged 400 onto the first wave of IBD-SSHAMP, with a further 300 due to follow shortly in the second wave. With confidence in the system building amongst the relevant clinicians the second wave will primarily contain patients stable on immunosuppressants eg. azathioprine. With most patients being seen at 6 monthly intervals, and follow up clinic appointments costing our PCT £85, this project could potentially save them £119,000 per year, whilst still providing a patient friendly and efficient management system. Conclusion IBD-SSHAMP is the UK’s first internet based remote management system for managing stable IBD patients. It aims to reduce cost and free up NHS outpatient time, whilst providing an efficient monitoring and management programme. This is a proof of concept project, from which further data outcomes will be presented. Disclosure of Interest None Declared

The Effect of Liver Transplantation for Primary Sclerosing Cholangitis on Disease Activity in Patients with Inflammatory Bowel Disease

Purpose: The aims of this study were to examine the effects of immunosuppression following liver transplantation (LT) on inflammatory bowel disease (IBD) activity, and to identify predictors of IBD control post-LT, in subjects with who underwent LT specifically for primary sclerosing cholangitis (PSC). Methods: A retrospective analysis of all adult patients with a pre-LT diagnosis of IBD who underwent LT for PSC over a 15-year period was performed. The primary outcome was IBD activity based on symptomatology and endoscopic assessment, and secondary outcomes included recipient mortality and post-transplant development of colorectal cancer or small bowel lymphoma. Results: 105 subjects were transplanted for PSC, and 27 (26%) had a form of IBD diagnosed pre-LT and fulfilled inclusion criteria. Subjects were followed for a mean of 88.5 months. 14 subjects (52%) had stable IBD, 9 (33%) had worsening disease and 4 (15%) had clinical improvement after LT. 2 patients (7%) developed colorectal cancer and 1 patient (4%) developed small bowel lymphoma. The absence of additional maintenance therapy for IBD was found to be associated with good outcome for IBD control. The use of either infliximab or corticosteroids to control symptoms post-LT was found to be associated with poor outcome. Conclusion: Most patients with PSC/IBD have a stable course of IBD post-LT. The need for infliximab or additional corticosteroids after LT is associated with worse outcome.

H1N1 vaccines in a large observational cohort of patients with inflammatory bowel disease treated with immunomodulators and biological therapy

BackgroundSafety data are lacking on influenza vaccination in general and on A (H1N1)v vaccination in particular in patients with inflammatory bowel disease (IBD) receiving immmunomodulators and/or biological therapy.Aims and methodsThe...

Point-of-Care, Peer-Comparator Colonoscopy Practice Audit: The Canadian Association of Gastroenterology Quality Program – Endoscopy

Point-of-care practice audits allow documentation of procedural outcomes to support quality improvement in endoscopic practice. To evaluate a colonoscopists' practice audit tool that provides point-of-care data collection and peer-comparator feedback. A prospective, observational colonoscopy practice audit was conducted in academic and community endoscopy units for unselected patients undergoing colonoscopy. Anonymized colonoscopist, patient and practice data were collected using touchscreen smartphones with automated data upload for data analysis and review by participants. The main outcome measures were the following colonoscopy quality indicators: colonoscope insertion and withdrawal times, bowel preparation quality, sedation, immediate complications and polypectomy, and biopsy rates. Over a span of 16 months, 62 endoscopists reported on 1279 colonoscopy procedures. The mean cecal intubation rate was 94.9% (10th centile 84.2%). The mean withdrawal time was 8.8 min and, for nonpolypectomy colonoscopies, 41.9% of colonoscopists reported a mean withdrawal time of less than 6 min. Polypectomy was performed in 37% of colonoscopies. Independent predictors of polypectomy included the following: endoscopy unit type, patient age, interval since previous colonoscopy, bowel preparation quality, stable inflammatory bowel disease, previous colon polyps and withdrawal time. Withdrawal times of less than 6 min were associated with lower polyp removal rates (mean difference -11.3% [95% CI -2.8% to -19.9%]; P=0.01). Cecal intubation rates exceeded 90% and polypectomy rates exceeded 30%, but withdrawal times were frequently shorter than recommended. There are marked practice variations consistent with previous observations. Real-time, point-of-care practice audits with prompt, confidential access to outcome data provide a basis for targeted educational programs to improve quality in colonoscopy practice.