Treatment In IBD Patients Research Articles

IBD Patients with Primary or Secondary Nonresponse to Ustekinumab Benefit from Dose Escalation or Reinduction.

Ustekinumab is a monoclonal antibody approved for the treatment of IBD. This drug has a well-established efficacy; however, patients may not respond or lose response. The availability of other biological therapies prompts the need for comparative data between different agents to suggest first- or second-line strategies. Aim of this review is to compare the effectiveness of ustekinumab to other biologics in Crohn's disease and ulcerative colitis, as well as report the available data on dose escalation and reinduction. A systematic electronic search of the English literature was performed up to November 2023, using Medline (PubMed), Web of Science, Scopus and the Cochrane Library. Conference proceedings were also screened. Out of 659 citations, 80 relevant articles were selected and included in the present narrative review. Head-to-head comparisons of different biological drugs are relatively scarce, mostly deriving from indirect comparison or retrospective studies. Overall available data indicate similar effectiveness in the treatment of IBD patients. Dose escalation and reinduction strategies are well documented, but the optimal treatment schedule is still to be defined. Response and remission rates vary in different studies, and a proportion of patients fail to achieve clinical and endoscopic outcomes. However, both approaches are effective and safe in nonresponders and secondary loss of response. IBD patients may benefit from dose escalation or reinduction. Both strategies prove effective in regaining response in a proportion of patients, avoiding unnecessary early switch. Head-to-head trials are still needed to determine the exact placement of this drug compared to other biologics.

N-ECCO Grant Spiritual needs of patients with inflammatory bowel disease and their caregivers: a European cross-sectional nursing study

Abstract Aims Spirituality is the search for meaning or purpose in life (Delgado, 2005), not strictly from a religious perspective. Spiritual well-being is positively connected with physical and psychic well-being, and achieving the first is likely to help to maintain the latter (Bożek et al., 2020). Individuals with chronic disorders or experiencing a life-changing condition (e.g. Inflammatory Bowel Disease - IBD), may have gone through a spiritual quest of some sort that can produce spiritual anguish or 'spiritual distress', interpreting the disease as a punishment, feeling as a victim of 'superior injustice', losing faith in prayer (Klimasiński et al., 2022), but data on the spiritual needs (SpNs) of IBD patients are lacking. The main objective of this project is to describe the SpNs of IBD patients to provide information to IBD nurses on how to address these needs. Methods A multilingual cross-sectional electronic survey will be carried on assessing the SpNs of patients using the Spiritual Needs Questionnaire (SpNQ). The tool is made up of items assessing the importance attributed by patients to SpNs using a 4-point Likert scale (Büssing et al., 2010), and is available in ten European languages, but it could be translated and validated in other European languages inside the project in case of anticipated participation by a country that need the questionnaire available in the local language if a collaboration with IBD clinicians and patients in that country will be possible. Anticipated Impact The findings of such a study can provide better consideration of SpNs in the treatment of IBD patients, emphasizing the importance of addressing SpNs for IBD nurses in managing IBD patients, adopting the tools to screen patients for these needs; furthermore, the results of this project can provide additional evidence of the importance of nursing in IBD patients’ care.

P1237 Development of an algorithm to identify the best donor-recipient match for FMT in IBD patients based on immune system/microbiota interactions

Abstract Background IBD are characterized by uncontrolled immune responses, in genetically predisposed individuals, to the dysbiotic microbiota. Its modulation has thus emerged as a potential therapeutic strategy . Fecal microbiota transplantation (FMT) showed encouraging results for the treatment of mild-to-moderate ulcerative colitis (UC) patients. However, currently the success rate of FMT in UC patients is around 30%, and there are no criteria to predict it. We hypothesized that the immune system-microbiota interaction can dictate which graft will be accepted or rejected. Thus, we generated an algorithm to identify the best donor-recipient match for FMT treatment in IBD patients based on the functional interaction of recipient's immune system with possible donors' microbiota . Methods Mucosal and circulating immune cells isolated from 16 active UC patients, potentially eligible for FMT, were exposed to the microbiota of a panel of 8 potential healthy FM donors collected in the FM biobank of the Policlinico Hospital, Milan. The functional profile of recipients' immune cells before and after the in vitro exposure to the possible donors’ microbiota was assessed by cytokine production, gene expression profiling and activatory or inhibitory surface molecules modulation on T cells. Sequencing of the microbiota of each individual FM donor was performed by 16S. These functional data were used to develop an algorithm to identify the best donor-recipient match based on the capability of individual donors’ microbial ecologies to simultaneously reduce the inflammatory functional profile and increase the tolerogenic functional profile of the recipient's immune cells Results We demonstrated that mucosal immune cells from UC recipients exhibited a variety of responses upon exposure to the microbiota from distinct healthy donors, which clusters in two different enterotypes. Each UC recipient exhibited specific preferences for one or more FM donor in the reduction of the inflammatory profile of immune cells and concomitantly enhancement of anti-inflammatory cytokines. On te basis of these data we generated an algorithm capable of predicting the most successful functional interaction between donors and recipients. Conclusion Our study suggest that specific functional characteristics of both the donor microbiota and the recipient's immune system should be considered when selecting an optimal donor-recipient match for FMT. This study contributes to the development of a screening tool for donor selection in FMT, enabling personalized and effective therapeutic interventions for UC patients

P052 Comprehensive proteomic profiling of stool from UC and CD patients reveals expected and novel mucosal pathobiology, enabling identification of candidate non-invasive biomarkers to monitor mucosal disease activity

Abstract Background Inflammatory bowel disease (IBD) is a multifactorial disorder characterized by chronic gastrointestinal (GI) inflammation. In clinical practice, physicians urgently need biomarkers to monitor changes in mucosal disease to manage treatment. Non-invasive tools such as fecal biomarkers could allow for frequent monitoring of mucosal disease activity and may reflect inflammation of the entire GI tract. Towards identification of novel non-invasive fecal biomarkers, we performed a comprehensive, unbiased, analysis of the human fecal proteome from ulcerative colitis (UC), Crohn’s disease (CD) patients, and healthy controls (HC), focusing on human secreted proteins using proteomic approaches. Methods Fecal extraction processes optimized for recovery of secreted proteins were applied to stool samples of mild to severe UC and CD patients and HCs, 20 samples per group. An unbiased survey of the human fecal proteome of the IBD and HC stool extracts was performed using both data-dependent acquisition and data-independent acquisition methods on QExactive HF and Fusion Lumos mass spectrometers. Data were analyzed in Spectronaut for peptide identification, followed by analysis in MS Stats for protein quantification. Fecal calprotectin (fCAL) levels were measured in these stool samples using the Buhlmann EK-CAL immunoassay kit to correlate fCAL levels to proteomic calprotectin (S100A8/S100A9 heterodimer). Results We identified and quantified 594 differentially expressed proteins in stool using proteomics, including known proteins perturbed in IBD pathobiology. Elevated levels of neutrophilic proteins, e.g. fCal, neutrophil elastase, lactoferrin and leucine-rich Α-2 glycoprotein 1 were detected as well as proteins linked to rectal bleeding and ulceration e.g. hemoglobin subunit alpha 1 and beta. Pancreatic enzymes, suggested to be associated with active disease, were also detected. Overall, UC and CD contained many proteins not detected in HC. Differential abundances were observed between UC and CD patients, possibly reflecting differences in mucosal pathophysiology. The abundance of proteomic calprotectin correlated highly with the fCAL levels as determined by immunoassay (Spearman rank order > 0.9 for S100A8 and S100A9 to fCAL), validating the fecal proteomic approach to uncover known and novel proteins of IBD biology. Conclusion We developed and qualified methods to perform fecal proteomics on IBD stool samples, enabling identification of known and novel proteins of mucosal UC and CD disease biology. In depth analysis of these proteomic datasets may reveal novel fecal biomarker candidates, targeted to reflect mucosal disease activity and potentially serve as non-invasive surrogates for endoscopy and help guide treatment in IBD patients.

S0697 Denied! Analyzing Initial Rejection of Prior Authorization Approval for Biologic Treatment in IBD Patients

INTRODUCTION: Initial attempts to obtain prior authorization (PA) for biologics can result in approval delays or rejection. Delayed initiation of biologic therapy can impact clinical outcomes. There is limited data characterizing initial rejections for biologics. This study evaluated the reasons for insurance rejection of biologics and impact upon the time of medication initiation. METHODS: An IRB approved chart review of IBD patients seen in a university GI clinic over a 5-year period was performed. Patient, gender, race, IBD subtype, biologic use, insurance, initial PA rejection and reason for rejection were recorded in a confidential Microsoft Excel database. Insurance type was classified as private or public (Medicaid; Medicare). The time to approval (TTA) was the day between patient agreement to start a biologic and PA approval. The time to first infusion (TFI) was the day between agreement and first administration. Patients were excluded if the biologic was initiated at another institution or if documentation of TTA or TFI was not apparent. Analysis was performed using t-testing and Fisher's exact test with significance set at P < 0.05. RESULTS: 458 records revealed 66 patients on biologics. 42 had private insurance, 16 Medicaid and 8 Medicare. 15.2% (n = 10) of patients experienced an initial PA rejection. Significantly more public insurance patients had an initial rejection compared to private insurance patients (7 vs 3, P = 0.029). 50% of all rejections and 85.7% of public insurance rejections (n = 5) were for infliximab. The most common reason for initial rejection was not choosing a formulary medication or not unsuccessfully trialing one or more alternative medications. There was no significant difference in rejection based on gender (P = 0.732), race (P = 0.717), or IBD subtype (P = 0.299). Patients with an initial PA rejection had significantly longer mean TTA than those not rejected (60.5 vs 23.1 days, P = 0.001). Patients with an initial denial also had a longer TFI (74.9 vs 40.0 days, P = 0.002). CONCLUSION: Delayed initiation of biologics in IBD patients can lead to poorer clinical outcomes. Patients with public health insurance experienced more PA rejections compared to those with private insurance. Initial rejections were often related to insurance company preference for formulary medications or unsuccessful trials of non-biologic medications. It is critical that physicians insist that biologics are administered based upon clinical considerations and administration occurs without significant delay.

The appearance of joint manifestations in the Swiss inflammatory bowel disease cohort.

Background/AimsExtraintestinal manifestations (EIM) involving joints, skin, eyes and liver represent an important problem in the treatment of IBD patients. The aim of this study was to identify factors that are associated with the occurrence of joint EIM and therefore allow an early diagnosis and guide medical treatment.MethodsWe studied clinical and epidemiological data from 3298 patients included in the Swiss IBD Cohort Study (SIBDCS), 1860 suffered from Crohn’s disease (CD) and 1438 from ulcerative colitis or IBD unclassified (UC/IBDU).ResultsWe found female gender as well as a longer disease duration and activity (specified as CDAI or MTWAI, respectively) to be related to the appearance of arthritis/arthralgia, but also sacroiliitis/ankylosing spondylitis in IBD patients. IBD patients with arthritis/arthralgia or sacroiliitis/ankylosing spondylitis were more often treated with anti-TNF and patients with arthritis/arthralgia underwent more often IBD-related surgeries. We revealed that eye or skin EIM were more frequent in patients with arthritis/arthralgia or sacroiliitis/ankylosing spondylitis. In multivariate analysis, we confirmed female gender, longer disease duration, IBD-related surgery, presence of other EIM and treatment with anti-TNF to be independent risk factors for the onset of arthritis/arthralgia in CD and UC/IBDU patients.ConclusionIn this study, we demonstrated that markers for a more severe disease course were associated with the onset of joint EIM in IBD patients. Our data suggest that in particular females under anti-TNF treatment and patients suffering from non-joint and/or IBD-related surgery should be close and carefully monitored for presence of arthritis or sacroiliitis/ankylosing spondylitis.

Genotype-Guided Thiopurine Dosing Does not Lead to Additional Costs in Patients With Inflammatory Bowel Disease.

Background and AimsDecreased thiopurine S-methyltransferase [TPMT] enzyme activity increases the risk of haematological adverse drug reactions [ADRs] in patients treated with thiopurines. Clinical studies have shown that in patients with inflammatory bowel disease [IBD], pharmacogenetic TPMT-guided thiopurine treatment reduces this risk of ADRs. The aim of this study was to investigate whether this intervention impacts on healthcare costs and/or quality of life.MethodsAn a priori defined cost-effectiveness analysis was conducted in the Thiopurine response Optimization by Pharmacogenetic testing in Inflammatory bowel disease Clinics [TOPIC] trial, a randomized controlled trial performed in 30 Dutch hospitals. Patients diagnosed with IBD [age ≥18 years] were randomly assigned to the intervention [i.e. pre-treatment genotyping] or control group. Total costs in terms of volumes of care, and effects in quality-adjusted life years [QALYs], based on EuroQol-5D3L utility scores, were measured for 20 weeks. Mean incremental cost savings and QALYs with confidence intervals were calculated using non-parametric bootstrapping with 1000 replications.ResultsThe intervention group consisted of 381 patients and the control group 347 patients. The mean incremental cost savings were €52 per patient [95% percentiles −682, 569]. Mean incremental QALYs were 0.001 [95% percentiles −0.009, 0.010]. Sensitivity analysis showed that the results were robust for potential change in costs of screening, costs of biologicals and costs associated with productivity loss.ConclusionsGenotype-guided thiopurine treatment in IBD patients reduced the risk of ADRs among patients carrying a TPMT variant, without increasing overall healthcare costs and resulting in comparable quality of life, as compared to standard treatment.

QingBai decoction regulates intestinal permeability of dextran sulphate sodium-induced colitis through the modulation of notch and NF-κB signalling.

ObjectiveChinese Herb QingBai decoction (QBD) has been approved affective in the treatment of IBD patients in clinic. However, the underlying mechanism remains unknown. We aim to investigate the effect of QBD on the mouse model of ulcerative colitis and its possible mechanism.MethodsC57/bL mice were given 5% DSS to induce colitis and were divided as QBD and mesalazine group. Weight, faeces and mental status were recorded each day and the histopathological changes (goblet cells etc) of the colon were observed after sacrificed. Fluorescein isothiocyanate‐dextran 4000 was measured to reflect the intestinal mucosal permeability. In addition, cell junction‐related proteins and possible signal pathways were investigated.ResultsQingBai decoction could significantly alleviate the inflammation and the protection effect of colitis is comparable as those in mesalazine enema group. It was found that the permeability reduced significantly with QBD treatment vs the control group, while no significant difference between the mesalazine and QBD groups. QBD treatment could upregulate the expression of tight junction complex（ZO‐1, claudin‐1 and occludin）and muc‐2 expression. It significantly reduced the production and secretion of serials proinflammatory cytokines (IL‐1β, IL‐6, Kc and TNF‐α) compared with the control group. Meanwhile, NF‐κB and Notch pathways were regulated.ConclusionQingBai decoction can effectively alleviate intestinal inflammation and mucosal barrier function in colitis mice, and the mechanism may be related to the inhibition of inflammatory cascade as well as enhanced mucus layer barrier and mechanical barrier function by NF‐κB and Notch signalling.

PGI42 - NON-PERSISTENCE WITH IMMUNOSUPPRESANT, ANTI-TUMOR NECROSIS FACTOR, AND ANTI-INTEGRIN AGENTS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE CLAIMS DATA ANALYSIS IN GERMANY

The aim of this study was to assess non-persistence (NP) with immunosuppressant (IS), anti-tumor necrosis factor (aTNF) and anti-integrin (aI) treatment in IBD patients. We conducted a retrospective claims data analysis (AOK PLUS database) of ulcerative colitis (UC) or Crohn’s disease (CD) patients who were newly initiating a treatment with IS, aTNF or aI from 01/01/2013-31/12/2015. NP was defined as drug coverage gap >60 days, and was reported after 12, 24, and 36 months, censoring for death and end of follow-up period. Cox regression analysis was used to identify differences in mean persistence between the 3 treatment groups. 1,126 patients (UC: 450; CD: 676) were observed. (mean age of UC/CD 42.5/36.5 years; 47.6%/60.5% female). Among UC patients, IS was the most common (85.8%) index therapy, followed by aTNF (13.6%) and aI (0.7%). Respective numbers for CD patients were 77.7% (IS), 21.2% (aTNF), and 1.2% (aI). By 12 months, 55.7% of UC and 57.7% of CD patients discontinued their index therapy. Of the 990 patients followed for 24 months (UC: 395; CD: 595), 66.2%/67.8% discontinued index therapy. Of the 802 patients followed for 36 months (UC: 325; CD: 477), 73.1%/74.4% discontinued index therapy. Adjusting for baseline characteristics, aTNF was associated with later treatment discontinuation compared with IS (hazard ratio [HR]: 0.364, P<0.001) in UC patients. In CD patients, both aTNF and aI were associated with later treatment discontinuation compared with IS (aTNF HR: 0.562, P<0.001; aI HR: 0.187, P=0.018). Persistence with IBD treatment is far from ideal. As demonstrated in previous studies, IBD treatment discontinuation mainly results from poor effectiveness and/or safety concerns. The NP rate demonstrates the need for development of more effective and safe IBD therapies in an effort to support better real-world outcomes and treatment persistence.

Systematic Review and Meta-Analysis: Preoperative Vedolizumab Treatment and Postoperative Complications in Patients with Inflammatory Bowel Disease.

The impact of vedolizumab, a gut-selective monoclonal antibody, on postoperative outcomes is unclear. This study aimed to assess the impact of preoperative vedolizumab treatment on the rate of postoperative complications in patients with inflammatory bowel disease [IBD] undergoing abdominal surgery. A systematic search of multiple electronic databases from inception until May 2017 identified studies reporting rates of postoperative complications in vedolizumab-treated IBD patients compared to no biologic exposure or anti-tumor necrosis factor (anti-TNF) treated IBD patients. Outcomes of interest included postoperative infectious complications and overall postoperative complications. Pooled risk ratios and 95% confidence intervals were estimated using the random-effects model. Five studies comprising 307 vedolizumab-treated IBD patients, 490 anti-TNF-treated IBD patients and 535 IBD patients not exposed to preoperative biologic therapy were included. The risk of postoperative infectious complications (risk ratio [RR] 0.99, 95% confidence interval [CI] 0.37-2.65) and overall postoperative complications [RR 1.00, 95% CI 0.46-2.15] were not significantly different between vedolizumab-treated patients and those who received no preoperative biologic therapy. In addition, the risk of postoperative infectious complications [RR 0.99, 95% CI 0.34-2.90] and overall postoperative complications [RR 0.92, 95% CI 0.44-1.92] were not significantly different between vedolizumab-treated vs anti-TNF-treated patients. Preoperative vedolizumab treatment in IBD patients does not appear to be associated with an increased risk of postoperative infectious or overall postoperative complications compared to either preoperative anti-TNF therapy or no biologic therapy. Future prospective studies which include perioperative drug level monitoring are needed to confirm these findings.

Oxidative Stress and Effect of Treatment on the Oxidation Product Decomposition Processes in IBD.

Oxidative stress plays an important role in IBD because chronic intestinal inflammation is associated with the overproduction of reactive oxygen species (ROS) leading to oxidative stress, which has been implicated in IBD. Many lines of evidence suggest that IBD is associated with an imbalance between ROS and antioxidant activity which generates oxidative stress as the result of either ROS overproduction or a decrease in antioxidant activity. Our study was to evaluate the influence of oxidative stress and antioxidants on the course of the disease and treatment of IBD patients. Our results show that an increase of LOOH levels positively correlates with an increase in MDA levels; therefore, MDA may be a marker indicating lipid peroxidation. Also, being the decomposition product of oxidation processes, MDA may be applied as a useful biomarker for identifying the effect of endogenous oxidative stress in Crohn's disease patients. The anti-inflammatory efficacy of AZA drugs may be the result of a reduction of the amount of lipid peroxides in the intestinal mucosa cells in CD patients and facilitate mucosal healing.

Adherence to Treatment in IBD Patients

Adherence to Treatment in IBD Patients

Tu1074 - Can we Predict Adherence to Treatment in IBD Patients?

Tu1074 - Can we Predict Adherence to Treatment in IBD Patients?

P728 Changes in the use of biologics in the treatment of IBD patients over time. Results from a comprehensive Norwegian registry study

Background: During the last decade, several new and expensive drugs (including TNFα inhibitors and anti-integrins) have been introduced in IBD treatment. Little is known about the overall treatment pattern for these new biologic pharmaceuticals: What proportion of patients eventually receive biologics and how has this changed over time. Methods: Data was collected from the Norwegian Patient Registry and included information about every individual hospital treatment episode for patients with Crohn's disease and ulcerative colitis from 2008 to 2015 (ICD codes K50 and K51). Altogether 45,767 IBD patients were identified in the registry. The data included a unique patient identifier and information about gender, age, the date of the treatment (month and year) and the use of biologics. The date of diagnosis was set to the earliest observation in which the individual was observed with a K50 or K51 treatment episode. In order to examine development over time, the patients were stratified based on the year of the first diagnosis. Only patients with at least two registered events in which an IBD diagnosis was used, were included when calculating the results. Results: During 2010 to 2014, there were 14,168 new IBD patients. 4,796 (33.8%) were diagnosed with Crohns' disease (CD) and 9,372 (66.2%) with ulcerative colitis (UC). Among CD patients the proportion that received a biological pharmaceutical within one year after being diagnosed, increased from 15.4% in 2010 to about 26% in 2013 and 2014. For UC the share increased from 5% in 2010 and 2011 to 10.3% in 2014. For CD patients, the use of biologics one year after diagnosis increased steadily by about 3 percentage points for every cohort from 2010 to 2013, but there was no increase between 2013 and 2014. For UC patients the increase was more uneven. One year after diagnosis, between 5.1% and 5.6% of the patients from the 2010 and 2011 cohorts had received a biologic. This increased to 7.8% for the 2012 and 2013 cohorts, and among patients diagnosed in 2014 10.3% had received a biologic one year after diagnosis. Figure 1. Percent of CD patients who had received a biologic. Figure 2. Percentage of UC patients who had received a biologic. Conclusions: There was a consistent trend towards an increased use of biological pharmaceuticals over time, but it is still a treatment that is only used on a minority of the patients.

P561 Can we predict adherence to treatment in IBD patients?

P561 Can we predict adherence to treatment in IBD patients?

The transcriptional regulator Bcl-3 impaires the function of regulatory T cells leading to the development of intestinal inflammation

Abstract The oncoprotein and transcription factor Bcl-3 (B cell leukemia-3) is a member of the IκB family of NF-κB inhibitors and was originally identified as a component of a chromosomal rearrangement in some B cell lymphomas. In contrast to other IκB proteins, Bcl-3 associates with p50 and p52 homodimers and is predominantly a nuclear protein involved in regulating nuclear NF-κB activity. We could demonstrate that Bcl-3 plays a crucial role in the maintenance of Treg function as well as in the development of IBD. Data of patient cohorts illustrate that Bcl-3 expression levels correlate with activity of disease. Treatment of IBD patients with anti-TNFa therapy significantly reduced the expression of Bcl-3. To assess the role of Bcl-3 in IBD, we generated mice that overexpress Bcl-3 solely in T cells. Interestingly, these mice develop severe spontaneous colitis. This intestinal inflammation was not mediated by CD4+ T cells, which even display memory formation defects. Instead, we found that the development of disease is caused by an impaired function of Tregs and demonstrate that Bcl-3 regulates NF-κB activity intrinsically in Tregs. Our data emphasize a novel pathway in the maintenance of viability and suppressive function of Tregs in the gut that critically involves Bcl-3 as a negative regulator, qualifying this protein as an interesting pharmacological target for the treatment of IBD.

PTU-079 The Tpmt And Abcb1 Polymorphisms In Ibd Patients In Crete: Impact On Disease And Response To Treatment

IntroductionIt is well known that polymorphisms of the TPMT gene (coding for thiopourine methyl-transferase), influence response to treatment with azathioprine. Polymorphisms of the ABCB1 gene (coding for p-glycoprotein 170) has...

P366 Relevance of chromogranin A according to disease activity and medical treatment in IBD patients

P366 Relevance of chromogranin A according to disease activity and medical treatment in IBD patients S. Vradelis1 *, A. Zissimopoulos2, M. Konialis3, D. Chadolias4, A. Bampali4, T. Konstantinidis5, E. Efremidou6, G. Kouklakis4. 1Democritus University of Thrace, University Hospital of Alexandroupolis, 2nd Department of Internal Medicine, Alexandroupolis, Greece, 2Democritus University of Thrace, Nuclear Medicine Department, Alexandroupolis, Greece, 3Democritus University of Thrace, Molecular Biology School, Alexandroupolis, Greece, 4Democritus University of Thrace, University Hospital of Alexandroupolis, Endoscopy Unit, Alexandroupolis, Greece, 5Democritus University of Thrace, Public Health Laboratory, Alexandroupolis, Greece, 6Democritus University of Thrace, University Hospital of Alexandroupolis, First Surgical Department, Alexandroupolis, Greece

Radiating Disparity in IBD

In remote corners of the rapidly expanding IBD literature universe, two separate areas of investigation and controversy continue to grow independently. The first is in regard to the risks of diagnostic radiation exposure, whereas the second concerns the disparities in access to care and health care resource utilization in IBD patients. Abdominal imaging is frequently utilized to diagnose disease, detect complications, and ascertain response to treatment in IBD patients. Given a 20-fold rise in the amount of CT imaging between 1980 and 2000, it is not surprising that an estimated three-quarters of the radiation to which IBD patients are exposed is due to CT scanning [1, 2], mostly from abdomino-pelvic examinations, which have largely supplanted conventional contrast enterography in IBD patients. As an example, an 840 % increase in CT enterography use was reported between 2002 and 2007 [3]. Further, as many as 1 in 6 IBD patients are exposed to moderate-high cumulative effective doses (CED) of diagnostic ionizing radiation as measured in millisieverts (mSv) [4]. These figures are important, as frequent exposure to low levels of ionizing radiation have been hypothesized to increase the incidence of malignancy, with as many as 2 % of all cancers worldwide attributable to diagnostic radiation exposure [1, 5]. Although equipoise exists as to the legitimacy of this possible association, there is nonetheless a growing interest in and discussion surrounding the limitation of diagnostic radiation exposures in IBD patients to what is truly necessary for optimal patient management [6]. Parallel to concerns about radiation exposure, several studies have revealed that the IBD universe is not immune to some of the issues that plague the field of medicine as a whole. Racial and socioeconomic disparities in the availability, delivery, and utilization of IBD healthcare resources have been repeatedly demonstrated [7–9]. As these disparities have included differences in use of highly effective medical therapies, emergency department (ED) visits, and gastroenterologist subspecialist care, resultant differences in the degree and frequency of diagnostic radiation exposures are likely. Possible reasons may include barriers to highly effective medical therapy, delays in definitive surgical therapy, and reduced access to gastroenterology specialist and IBD subspecialist care. In this issue of Digestive Diseases and Sciences, Hou et al. [10] report the findings of a retrospective cohort study with the aim of identifying factors associated with highdose radiation exposure in a cohort of IBD patients treated in a county-based ‘‘safety net’’ healthcare system in Houston, TX, USA, from 2000 to 2010. Such healthcare delivery systems are designed to offer universal care access regardless of ability to pay. Since these systems have high proportions of uninsured and under-insured individuals, it is likely that this study population is enriched in IBD patients at risk for increased diagnostic radiation exposure stemming from care disparity issues. The authors identified all possible IBD patients from the 3 inpatient and 14 outpatient facilities in the studied healthcare system using ICD-9 codes. The authors subsequently reviewed electronic medical records and applied accepted IBD diagnostic criteria to reasonably verify a racially and ethnically diverse 278-patient IBD cohort. M. Flasar (&) S. Patil Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 100 North Greene Street, Lower Level, Baltimore, MD 21201, USA e-mail: mflasar@medicine.umaryland.edu

W09-04 - Socioeconomic and psychological factors associated with non-adherence to treatment in IBD patients: Results of the isseo survey

IntroductionTreatment is a key condition in preventing relapses in inflammatory bowel disease. The aims of the ISSEO study were specifically to study socioeconomic and psychological factors and adherence to treatment in a large cohort of IBD patients.MethodsA questionnaire concerning demographic, clinical and psychosocial characteristics was mailed to 6000 IBD patients belonging to the French association of IBD patients (AFA). The questionnaire was also available on the website of the AFA for non-member patients to answer. Good adherence to treatment was defined as taking ≥80% of prescribed medication. Socioeconomic deprivation was assessed using the specific EPICES score (http://www.cetaf.asso.fr) developed in France. Anxiety and depression were assessed using the HAD scale.Results1069 women and 594 men (43.6 ± 15.4 yrs) completed the questionnaire, 1450 (87%) of them belonged to the AFA. 1044 had Crohn's disease, 36 indeterminate colitis and 583 ulcerative colitis. Adherence ≥80% was reported by 90% of patients. Logistic regression identified the following factors for good adherence: anti-TNF alpha therapy (OR 2.3, 95% CI 1.46–3.63) and membership of the AFA (OR 1.67, 95% CI 1.05–2.64), while anxiety (OR 0.62, 95% CI 0.42–0.90), and constraints related to treatment (OR 0.32, 95% CI 0.23–0.47) were associated with non-adherence.ConclusionIn this large cohort of IBD patients, psychological distress and constraints related to treatment decrease adherence to treatment, while membership of a patients’ association improves it.