Use In Inflammatory Bowel Disease Research Articles

Recombinant probiotic Lactococcus lactis delivering P62 mitigates moderate colitis in mice.

p62 is a human multifunctional adaptor protein involved in key cellular processes such as tissue homeostasis, inflammation, and cancer. It acts as a negative regulator of inflammasome complexes. It may thus be considered a good candidate for therapeutic use in inflammatory bowel diseases (IBD), such as colitis. Probiotics, including recombinant probiotic strains producing or delivering therapeutic biomolecules to the host mucosal surfaces, could help prevent and mitigate chronic intestinal inflammation. The objective of the present study was to combine the intrinsic immunomodulatory properties of the probiotic Lactococcus lactis NCDO2118 with its ability to deliver health-promoting molecules to enhance its protective and preventive effects in the context of ulcerative colitis (UC). This study was realized in vivo in which mice were supplemented with the recombinant strain. The intestinal barrier function was analyzed by monitoring permeability, secretory IgA total levels, mucin expression, and tight junction genes. Its integrity was evaluated by histological analyses. Regarding inflammation, colonic cytokine levels, myeloperoxidase (MPO), and expression of key genes were monitored. The intestinal microbiota composition was investigated using 16S rRNA Gene Sequencing. No protective effect of L. lactis NCDO2118 pExu:p62 was observed regarding mice clinical parameters compared to the L. lactis NCDO2118 pExu: empty. However, the recombinant strain, expressing p62, increased the goblet cell counts, upregulated Muc2 gene expression in the colon, and downregulated pro-inflammatory cytokines Tnf and Ifng when compared to L. lactis NCDO2118 pExu: empty and inflamed groups. This recombinant strain also decreased colonic MPO activity. No difference in the intestinal microbiota was observed between all treatments. Altogether, our results show that recombinant L. lactis NCDO2118 delivering p62 protein protected the intestinal mucosa and mitigated inflammatory damages caused by dextran sodium sulfate (DSS). We thus suggest that p62 may constitute part of a therapeutic approach targeting inflammation.

Healthy Lifestyle Is a Protective Factor from Moderate and Severe Relapses and Steroid Use in Inflammatory Bowel Disease: A Prospective Cohort Study.

A healthy lifestyle, including good adherence to a Mediterranean diet (MD) and regular physical exercise, may be an important factor during the course of inflammatory bowel disease (IBD). Our aim is to determine whether adherence to MD, physical activity, and the combination of both can impact on IBD course. This prospective cohort study includes 693 IBD outpatients who were in remission with a median follow-up time of 27 months (interquartile range 22-29 months). Each patient completed a survey to assess their adherence to the MD and physical activity. Healthy lifestyle was considered to be a proper adherence to both MD and an active lifestyle. Relapse during follow-up, severity of relapses, need for systemic steroids, and therapy changes were recorded. During the follow-up period, 188 patients (27.1%) experienced relapse, of which 56.1% were moderate or severe. Among patients with relapse, 85 (45%) required treatment with corticosteroids, and 15 (7.9%) were hospitalized. Patients with ulcerative colitis (CU) were more adherent to healthy lifestyle than patients with Crohn's disease (P = .011). Healthy lifestyle was associated with lower risk of moderate and severe relapses (adjusted Hazard ratio [aHR], 0.250; 95% confidence interval [CI], 0.093-0.670) and steroids use (aHR 0.292; 95% CI, 0.103-0.828) in IBD patients and with lower risk of moderate and severe relapses (aHR 0.270; 95% CI, 0.093-0.789) in UC patients. Healthy lifestyle has a favorable influence on promoting a milder disease course, and thus should be a crucial part of clinical management of patients with IBD.

P747 Assessment of a microlearning programme for patients with Inflammatory Bowel Disease (The ADEII project) on ansiety/depression status and illness perception

Abstract Background Information and communication technologies (ICTs) represent a novel approach to chronic disease management. However, their use in Inflammatory Bowel Disease (IBD) is lacking and their results as far unknown, because no specific tools are available, The prevalence of anxiety and/or depression in IBD ranges from 30-35% in clinically inactive phases. Furthermore, negative perceptions of the disease in the dimensions of consequences and emotions have been related to depression and anxiety. We aim to evaluate the outcomes of a novel microlearning programme for IBD patients in.anxiety/depression status and illness perception. Methods Prospective cohort study in adult patients with IBD (18 to 70 years old) who underwent a microlearning programme over a 2-month period, throught 4-minute videos organised in individualised video pathways that were sent via mobile phone using a Telegram bot. All patients received the 4-video main pack, consisting of 2 videos with information about their disease (ulcerative colitis or Crohn's disease), 1 video on adherence and another one on steroid treatment. To these were added as many videos as the number of drugs used by the patient to control IBD. Before starting the programme and at 6 months, patients completed the Hospital Anxiety and Depression Scale (HADS) and the Brief Illness Perception Questionnaire (BIPQ). Results Between June and October 2022, 1226 videos were sent to 200 IBD patients: 51.5% female (103), UC 52.5% (105), mean age 46.1 (13.2) years (Table 1). Median number of videos per patient was 6 (6-7). Attendance to ADEII programme ranged between 78% and 90%.The median score on the HAD anxiety subscale was 8.1 (4.3), while the median score on the HAD depression subscale was 6(4-8), Initially, anxiety was diagnosed in 60 patients (30%) and depressión in 16 (8%) as subescales scores>11. We found significant differences between the pre-intervention versus post-intervention medians and IQR in anxiety score 8(5-11) vs 7(4-11) (p=0.008) but no in depression. Regarding BIPQ test post -intervention there were significant decreases in P8 negative emotions 6(3-8) vs. 5(3-7) (p=0,003) and P5 identity 6(4-8) vs 5(3-7) (p=0,003) as well as a significant increase in P7 comprehensibility of disease 7(5-9) vs. 8(7-9) (p=0,003). Conclusion An ICT-based educational program was widely accepted by IBD patients and showed a decrease in anxiety and negative emotions and representations, along with improvement in the understanding of disease.

P828 Evaluation of adherence and beliefs about medication in patients with Inflammatory Bowel Disease following a novel microlearning programme (The ADEII project)

Abstract Background Information and communication technologies (ICTs) represent a novel approach to chronic disease management. However, their use in Inflammatory Bowel Disease (IBD) is lacking and their results as far unknown, because no specific tools are available. The rate of non-adherence in IBD ranges from 30 to 40%, with medication concerns being one of the main factors. Our aim was to evaluate the outcomes of a novel microlearning programme for IBD patients in adherence and beliefs about medication. Methods Prospective cohort study in adult patients with IBD (18 to 70 years old) who underwent a microlearning programme over a 2-month period, throught 4-minute videos organised in individualised video pathways that were sent via mobile phone using a Telegram bot. All patients received the 4-video main pack, consisting of 2 videos with information about their disease (ulcerative colitis or Crohn's disease), 1 video on adherence and another one on steroid treatment. To these were added as many videos as the number of drugs used by the patient to control IBD. Before starting the programme and at 6 months, patients completed the Medicines Beliefs Questionnaire (BMQ). Adherence was defined as a medication possession ratio (MPR≥80%) at these same dates. MPR values were computed separately for each drug, and patients on combination therapy were considered adherents if they got MPR≥0.8 in every prescribed medication. Results Between 1 June and 31 October 2022, 1226 videos were sent to 200 IBD patients: 51.5% female (103), UC 52.5% (105), mean age 46.1 (13.2) years (Table 1). Median number of videos per patient was 6 (6-7). Attendance to ADEII programme ranged between 78% and 90%. Prior to the study, Initial non-adherence was 29.8% (59 patients), decreasing significatively to 18.1% (36) after the programme (p=0.02). Regarding BMQ test, we also found significant differences between the pre-intervention versus post-intervention medians and IQR of General BMQ score 18 (15 -21,8) vs. 17 (13.3 - 20) (p=0,001), BMQ-Overuse score 8 (7 -9) vs. 8 (6 -9) (p=0,027), BMQ-Harm score 10 (8 -12) vs 9.5 (7-11) (p=0,002) and BMQ-Concern score 13,5 ( 11-16) vs 13 (10-16) (p=0,001), with no changes in BMQ Global Specific and BMQ-Necessity scores. Conclusion Patients with IBD widely accepted an ICT-based educational program, which improved adherence, along with a decrease in negative ideas or beliefs about medications.

N30 Development and implementation of a microlearning programme for patients with Inflammatory Bowel Disease. The ADEII project

Abstract Background Information and communication technologies (ICTs) represent a novel approach to chronic disease management. However, their use in Inflammatory Bowel Disease (IBD) is lacking, as no specific tools are available. Microlearning is a pedagogical concept that facilitates learning by breaking down concepts into micro-contents, which can be easily integrated into everyday activities. We aimed to develop a microlearning programme for IBD patients and implement it in clinical practice. Methods Prospective cohort study in patients with IBD (18 to 70 years old) who underwent a microlearning programme over a 2-month period, Four-minute videos recorded by IBD unit´s own staff, and organised in individualised pathways.were sent via mobile phone. The interaction with the user was maintained through a Telegram bot that uses methods from the Django REST API for content sequencing. The basic sequencing consists of a video followed by 4 quiz questions. Depending on the answers, the user receives more questions, additional content on the same topic or moves on to the next video. We conducted a final survey about the information shown in the videos. All the contents can be found on the website: https://adeii.webs.uvigo.es/ This QR links to the promotional video of the ADEII project (Figure 1). Results We recorded 24 videos about IBD and treatment and another 2 about patients´personal experiences. Between 1 June and 31 October 2022, 1226 videos were sent to 200 IBD patients: 103 females (51.5%), mean age 46.1 (13) years, 105 ulcerative colitis (52.5%), and time from IBD diagnosis 13 (10) years. (Table 1). All patients received by their smart-phone the 4-video main pack, consisting of 2 videos with information about their disease (ulcerative colitis or Crohn's disease), 1 video on adherence and another one on corticosteroids. To these we added as many videos as the number of drugs that each patient used to control IBD. Mean number of videos per patient was 6 (1), range (5-9) and their distribution is shown in Figure 1. Seven patients declined to participate in this course because of fear of information and one left the study. Altogether 156 patients (78%) attended this microlearning programme, 117 fully (58,5%). A telephone contact, planned to solve technical incidents or doubts, rose the attendants to 170 (90%), 152 (76%) fully. After the course, 72,5% of the participants (145) answered correctly more than 83% of the questions based on the IBD information included in this programme. Conclusion A microlearning ICT-based course was widely accepted by IBD patients, and can increase the knowledge about their disease. However there are acceptance and technological barriers that must be taken into account when approaching it.

Implications of Tioguanine Dosing in IBD Patients with a TPMT Deficiency.

Tioguanine is metabolised by fewer enzymatic steps compared to azathioprine and mercaptopurine, without generating 6-methylmercaptopurine ribonucleotides. However, thiopurine S-methyl transferase (TPMT) plays a role in early toxicity in all thiopurines. We aimed to describe the hazards and opportunities of tioguanine use in inflammatory bowel disease (IBD) patients with aberrant TPMT metabolism and propose preventative measures to safely prescribe tioguanine in these patients. In this retrospective cohort study, all determined TPMT genotypes (2016-2021) were evaluated for aberrant metabolism (i.e., intermediate and poor TPMT metabolisers). Subsequently, all IBD patients on tioguanine with aberrant TPMT genotypes were evaluated for tioguanine dosages, adverse drug events, lab abnormalities, treatment duration and effectiveness. TPMT genotypes were determined in 485 patients, of whom, 50 (10.3%) and 4 patients (0.8%) were intermediate and poor metabolisers, respectively. Of these patients, 12 intermediate and 4 poor TPMT metabolisers had been prescribed tioguanine in varying doses. In one poor TPMT metaboliser, tioguanine 10 mg/day induced delayed pancytopenia. In general, reduced tioguanine dosages of 5 mg/day for intermediate TPMT metabolisers, and 10 mg two-weekly for poor TPMT metabolisers, resulted in a safe, long-term treatment strategy. Diminished or absent TPMT enzyme activity was related with a pharmacokinetic shift of tioguanine metabolism which is associated with relatively late-occurring myelotoxicity in patients on standard tioguanine dose. However, in strongly reduced dose regimens with strict therapeutic drug and safety monitoring, tioguanine treatment remained a safe and effective option in IBD patients with dysfunctional TPMT.

Opioid use and associated factors in 1676 patients with inflammatory bowel disease: a multicentre quality improvement project

ObjectiveDespite its association with poorer outcomes, opioid use in inflammatory bowel disease (IBD) is not well characterised in the UK. We aimed to examine the extent of opioid use, the...

ASSOCIATION BETWEEN ANTIBIOTIC USE AND INFLAMMATORY BOWEL DISEASE OUTCOMES

Benefit of antibiotic use in Inflammatory Bowel Disease (IBD) is unclear and has been a subject of research. This study investigated the association between antibiotic use and treatment outcomes among IBD patients using real-world data.

Patients' perspectives on marijuana use for inflammatory bowel disease: a multicenter survey.

As marijuana use is rising among patients with inflammatory bowel disease (IBD), so is interest in its potential use as a therapeutic agent. We sought to survey IBD patients regarding marijuana use, self-reported impact on IBD symptoms, and perceptions of safety. A multicenter anonymous survey was administered to patients with IBD between October 2020 and June 2021. The 70-question survey collected demographic variables, clinical variables, attitudes about marijuana, and perceptions of its safety and efficacy in IBD. Participants were classified by their marijuana use: "rarely/never," "current," and "former". Percentage and chi-square tests were used to compare categorical variables between the 3 groups, and means and 2-group ANOVA were used for continuous variables. Of 181 patients surveyed, 166 were eligible for the study. Of these, 70 (42.2%) participants were rare/never marijuana users, 44 (26.5%) were current users, and 52 (31.3%) were former users. Fifty-three percent thought marijuana would help with IBD inflammation and 80% thought it would help with IBD pain. Over 70% of patients from all groups thought marijuana had a low-to-moderate risk of harm, and 69.6% of the participants who never or rarely used marijuana thought marijuana was addictive, compared to 20.5% of the current users and 44% of the former marijuana users. While many patients thought marijuana use helps with IBD-related pain and inflammation, many expressed concerns about addiction to marijuana and a possible risk of harm. Further studies are needed to examine the benefit and harm of marijuana in IBD.

Cannabis Use and Its Association With Thirty- and Ninety-Day Hospital Readmissions for Patients Admitted for an Inflammatory Bowel Disease Exacerbation.

Though viewed as a potentially safer palliative alternative to opioids, studies of cannabis use for inflammatory bowel disease (IBD) are limited. The impact of opioids on hospital readmissions for IBD has been extensively examined, but cannabis has not been similarly studied. Our goal was to examine the relationship between cannabis use and the risk of 30- and 90-day hospital readmissions. We conducted a review of all adults admitted for an IBD exacerbation from January 1, 2016 to March 1, 2020 within the Northwell Health Care system. Patients with an IBD exacerbation were identified by primary or secondary ICD10 code (K50.xx or K51.xx) and administration of intravenous (IV) solumedrol and/or biologic therapy. Admission documents were reviewed for the terms "marijuana", "cannabis", "pot" and "CBD". A total of 1,021 patient admissions met inclusion criteria, of whom 484 (47.40%) had Crohn's disease (CD) and 542 (53.09%) were female. Pre-admission cannabis use was reported by 74 (7.25%) patients. Factors found to be associated with cannabis use included younger age, male gender, African American/Black race, current tobacco and former alcohol use, anxiety, and depression. Cannabis use was found to be associated with 30-day readmission among patients with ulcerative colitis (UC), but not among patients with CD, after respectively adjusting each final model by other factors (odds ratio (OR): 2.48, 95% confidence interval (CI): 1.06 - 5.79 and OR: 0.59, 95% CI: 0.22 - 1.62, respectively). Cannabis use was not found to be associated with 90-day readmission on univariable analysis (OR: 1.11, 95% CI: 0.65 - 1.87) nor in the final multivariable model after adjusting for other factors (OR: 1.19, 95% CI: 0.68 - 2.05). Pre-admission cannabis use was found to be associated with 30-day readmission among patients with UC, but not with 30-day readmission for patients with CD nor with 90-day readmission, following an IBD exacerbation.

ASSOCIATION BETWEEN ANTIBIOTIC USE AND INFLAMMATORY BOWEL DISEASE OUTCOMES

Abstract OBJECTIVE Benefit of antibiotic use in Inflammatory Bowel Disease (IBD) is unclear and has been a subject of research. This study investigated the association between antibiotic use and treatment outcomes among IBD patients using real-world data. METHODS Data from Study of a Prospective Adult Research Cohort with IBD (SPARC IBD) of Crohn’s & Colitis Foundation’s IBD Plexus program were used. Patients diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) since 2000 were included. The use of antibiotics (ciprofloxacin, metronidazole, rifaximin and vancomycin) for ≥7 days after enrollment was identified from electronic health records and case report forms. Disease activity scores were assessed at the time of enrollment (baseline) and during follow-up using 6-point Mayo score (6-pt MS) and short Clinical Disease Activity Index (sCDAI) for UC and CD, respectively. Patients’ demographic and clinical characteristics were also collected. Remission was defined as 6-pt MS of 0-1 for UC and sCDAI<150 for CD. The association between antibiotic use and outcome during follow-up was assessed in a subset of patients without remission at baseline using a multivariable Cox proportional hazards model. The model included the following covariates for adjustment: age, gender, race, family history of IBD, IBD surgery, disease activity at enrollment and other IBD drug use during follow-up. RESULTS A total of 2,959 IBD patients (UC=1,060; CD=1,899) were included. Mean age at diagnosis was 30±14 years (UC=32±15; CD=28±14). Forty-four percent of the patients were male (UC=49%; CD=41%) and 79% were White (UC=82%; CD=78%). Antibiotic use after enrollment was observed in 29% of the patients (UC=26%; CD=30%). About 60% of UC or CD patients were in remission at baseline. The antibiotic use group had significantly higher baseline disease activity (UC 6-pt MS: 1.7±1.8; CD sCDAI: 167±96) than patients without antibiotic use (UC 6-pt MS: 1.3±1.7; CD sCDAI: 137±89). In the subset of patients with mild, moderate or severe baseline IBD (6-pt MS>1 for UC; sCDAI≥150 for CD), the baseline disease activity scores were largely comparable between patients who used antibiotic and who did not (UC 6-pt MS: 3.6±1.3 vs 3.3±1.3, p-value=0.063; CD sCDAI: 248±83 vs 238±83, p-value=0.169), while patients who used antibiotics were less likely to experience remission during follow-up compared to those who did not use antibiotics (UC adjusted remission hazard ratio [aRHR] 0.39, 95% confidence interval [CI] 0.26-0.60; CD aRHR 0.60, 95% CI 0.46-0.79). CONCLUSION In this study, antibiotic use in patients with IBD was negatively associated with remission during follow-up. The effect of antibiotics on gut microbiome and optimal use of antibiotics in IBD patients need to be further explored.

Polysubstance use in inflammatory bowel disease is associated with increased risk of emergency department visits: a longitudinal study.

Polysubstance use (PSU), the simultaneous use of 2 or more substances of abuse, is common in inflammatory bowel disease (IBD). Preliminary studies suggest it may be associated with poor outcomes. This prospective study evaluated the impact of PSU on disease activity and healthcare resource utilization in IBD. This study was conducted in a tertiary IBD center between October 29, 2015, and December 31, 2019. Participants were assessed over 2 time points (index and follow-up outpatient appointments) separated by a minimum of 6 months. Demographics, endoscopic disease activity, and surveys assessing symptoms, healthcare resource utilization and substance use (tobacco, alcohol, marijuana, cocaine, methamphetamine, heroin, opioid, or benzodiazepine) were abstracted. We identified PSU during the index appointment and computed descriptive statistics and contingency table analyses, and multivariate logistic regression models at follow up to evaluate outcomes. 162 consecutively enrolled IBD patients were included. Seventy-five patients (46%) were polysubstance users at the index appointment. The most common cohorts were utilizing tobacco and alcohol (n=40) or tobacco and opioids (n=13). On bivariate and multivariate analyses, PSU during the index visit was positively associated with emergency department (ED) visits (odds ratio [OR] 2.51, 95% confidence interval [CI] 1.24-5.07; P=0.01) and negatively associated with extraintestinal manifestations (OR 0.37, 95%CI 0.18-0.74; P=0.005). Age, sex, disease activity, disease subtype and IBD-related symptoms were not associated with PSU. IBD patients exhibiting PSU had increased risk of future ED visits. This study highlights the risks of PSU and reinforces the importance of appropriate substance use screening.

S1063 Corticosteroid Use in Inflammatory Bowel Disease (IBD) Patients May Lead to Worse IBD-Related Outcomes After COVID-19 Infection

Introduction: There is growing but limited data on the effects COVID-19 has on the disease course of IBD. COVID-19 can enter epithelial cells of the gut via ACE receptors causing cell dysfunction, inflammation, and dysbiosis. Thus, we set out to evaluate IBD outcomes during and three months after COVID-19 infection. Methods: We performed a retrospective case series comparing IBD patients in remission versus not in remission diagnosed with COVID-19 seen in a single tertiary care center from March 2020 to March 2021. COVID-19 diagnosis was made by positive rapid antigen and/or PCR. We analyzed demographics, medications, need for hospitalization, changes to immunosuppressive therapy, and IBD severity and remission status noted by endoscopic scoring or Physician Global Assessment at the time of COVID-19 diagnosis and 3 months post infection. Results: We identified 57 IBD patients, 30 in remission and 27 not in remission, diagnosed with COVID-19. Comparison of baseline characteristics and COVID-19 and IBD related outcomes are noted in Table. Patients not in remission were more likely to be on steroids, including prednisone and budesonide, and biologics (0% vs 40.7%, p=0.00001; 73.3% vs 96.3%, p=0.03). Patients not in remission were significantly more likely to need escalation in treatment (OR 15.08; CI 2.98-76.3, p=0.001) and had more IBD related hospitalization and surgery at 3 months compared to patients in remission (18.5% vs 0%, p=0.02). We then excluded patients who had changes in IBD medications 90 days prior to COVID-19 diagnosis and found there was still an increased risk for treatment escalation (OR 7, CI 1.27-38.58, p=0.0254). Additionally, patients not in remission on steroids had an increased risk of escalation of IBD related medications, hospitalization, and surgeries than patients not in remission who were not on steroids (OR 12, CI 1.76-81.7, p=0.0111). Conclusion: Our study suggests COVID-19 likely has minimal impact on the clinical course of IBD patients in remission. It remains unclear what the effects are on those not in remission, especially those on corticosteroids. Corticosteroid use is associated with impaired immune response and may lead to dysbiosis by downregulation of protective mucin gene expression as shown in animal models. Thus, infection with COVID-19 in patients on steroids may contribute to an increased risk of dysbiosis and subsequent disease flare. Further study is warranted to study the effects of steroids on IBD related outcomes in patient with COVID-19 infection. Table 1. - Comparison of IBD related outcomes in patients in remission versus those with active disease at time of COVID-19 diagnosis and 3 months afterwards Remission (SD)N = 30 Not in remission (SD)N = 27 P-value Demographics Age 40.2 (16.3) 35.3 (13.7) 0.25 Sex Male 46.7% 33.3% 0.42 Female 53.3% 66.7% 0.42 Race White 70% 74% 0.78 Black 20% 18.5% 1.00 Asian 10% 3.7% 0.61 Hispanic 0% 3.7% 0.47 BMI 26.2 (5.6) 24.8 (4.0) 0.36 Comorbidities Organ transplant 3.3% 7.4% 0.60 Cardiovascular disease 13.3% 11.1% 1.00 Diabetes 3.3% 3.7% 1.00 Chronic lung disease 0% 3.7% 0.47 HTN 10% 7.4% 1.00 Current malignancy 3.3% 0% 1.00 CKD 3.3% 7.4% 0.60 Tobacco use 3.3% 3.7% 1.00 Chronic liver disease 20% 14.8% 0.73 IBD Characteristics Crohn's disease 73.3% 63.0% 0.57 Ulcerative colitis 26.7% 37% 0.57 Activity Mild Moderate Severe 14.8%77.8%7.4% IBD medication use None 6.7% 0% 0.49 5-ASA 23.3% 14.8% 0.51 Immunomodulator 6MP/AZA 3.3% 11.1% 0.34 MTX 10% 7.4% 1.00 Corticosteroids 0% 40.7% 0.00001 Budesonide 0% 18.5% 0.02 Prednisone 0% 22.2% 0.01 Biologics 73.3% 96.3% 0.03 Vedolizumab 16.7% 22.2% 0.74 Anti-TNF 43.3% 51.9% 0.60 Ustekinumab 13.3% 22.2% 0.49 Tofacitinib 0% 0% 1.00 COVID-19 Outcomes Hospitalization 13.3% 7.4% 0.67 ICU with intubation 0% 0% 1.00 Any COVID-19 therapy 3.3% 14.8% 0.18 Death 0% 0% 1.00 IBD medications held 13.3% 29.6% 0.13 IBD Outcomes at 3 months Experienced IBD flare 10% 51.8% 0.005 Escalation of immunosuppression 10% 44.4% 0.00319 Initiation of new steroid therapy 6.7% 22.2% 0.19 IBD related hospitalization/surgery 0% 18.5% 0.02

S919 Factors Associated With Cannabis Use Among Inpatients With Inflammatory Bowel Disease Exacerbation

Introduction: Opioid use for inflammatory bowel disease (IBD) has been associated with an increased risk of disease complications. Many view cannabis as a safer palliative alternative to opioids for IBD. Cannabis use is common in the IBD population and increasingly legally available both for medical and recreational use. Cannabis does not improve inflammation but may mask IBD symptoms, with an unclear impact on disease outcomes. We sought to investigate cofactors associated with cannabis use as a first step before analysis of its impact on patient clinical outcomes. Methods: We conducted a retrospective review of all adult patients admitted for an IBD exacerbation from 01/01/2016 to 03/01/ 2020 within the Northwell Health Care system. Patients were identified by either a primary or secondary ICD10 code (K50.xx, K51.xx, K52.3), limited to those with an IBD exacerbation defined by administration of IV solumedrol and/or biologic therapy. Pregnant patients and those with IBD related surgeries were excluded. A natural language search of admission documents was performed for the terms “marijuana”, “cannabis”, “pot” and “CBD”. Manual chart review was then performed to confirm cannabis use. IBD disease type, age, gender, race, anxiety, depression, alcohol and tobacco use, Charlson comorbidity index (CCI), inpatient opioid use and length of stay were defined. An adjusted analysis was performed of co-factors to determine any association with cannabis use. Results: A total of 1021 patient admissions met inclusion criteria; 47.40% with Crohn’s disease and 53.09% female, and 66.01% white. Pre-admission cannabis use was reported by 7.25% of patients and was mostly (63%) for recreational use. On multivariable analysis, younger age was associated with cannabis use, as was male gender, African American race, tobacco and alcohol use, and a diagnosis of anxiety and/or depression, Table. CCI was associated with cannabis use on univariable, but not on multivariable analysis. Conclusion: Among inpatients with IBD exacerbation, factors associated with cannabis use included age, gender, African American race, tobacco and alcohol use, along with anxiety and depression. Our findings suggest that among IBD patients, cannabis use may be less associated with disease activity than with other patient characteristics. Further analysis of the impact of Cannabis use on IBD outcomes is needed. Table 1. - Association between pre-admission characteristics and cannabis use (N=1021) Cannabis use Cannabis use (n=74), n (%) No cannabis use (n=947), n (%) Univariable OR (95% CI) p-value Multivariable OR (95% CI) p-value Patient characteristics Age (years) Mean (SD) 36.46 (15.52) 45.97 (20.41) 0.98 (0.96, 0.99) 0.0001 0.96 (0.94, 0.99) 0.0009 Gender Female 22 (29.73) 520 (54.91) 0.35 (0.21, 0.58) < 0.0001 0.28 (0.16, 0.50) < 0.0001 Male 52 (70.27) 427 (45.09) (REF) (REF) Race African American/ Black 21 (28.38) 129 (13.62) 2.51 (1.44, 4.40) 0.0012 2.83 (1.52, 5.27) 0.0011 Asian 3 (4.05) 51 (5.39) 0.91 (0.27, 3.04) 0.8757 1.12 (0.32, 3.97) 0.8622 Other/ Multiracial 9 (12.16) 134 (14.15) 1.04 (0.49, 2.19) 0.9240 1.11 (0.50, 2.47) 0.8016 White 41 (55.41) 633 (66.84) (REF) (REF) Tobacco use Current 17 (22.97) 83 (8.76) 3.31 (1.78, 6.15) 0.0002 2.95 (1.46, 5.96) 0.0025 Former 12 (16.22) 160 (16.90) 1.21 (0.62, 2.38) 0.5800 1.72 (0.79, 3.74) 0.1721 Never 36 (48.65) 581 (61.35) (REF) (REF) Unknown 9 (12.16) 123 (12.99) 1.18 (0.56, 2.52) 0.6664 1.27 (0.50, 3.21) 0.6114 Alcohol use Current 17 (22.97) 162 (17.11) 1.32 (0.71, 2.47) 0.3794 1.03 (0.52, 2.05) 0.9246 Former 6 (8.11) 18 (1.90) 4.2 (1.55, 11.37) 0.0047 3.75 (1.21, 11.59) 0.0218 Never 30 (40.54) 378 (39.92) (REF) (REF) Unknown 21 (28.38) 389 (41.08) 0.68 (0.38, 1.21) 0.1893 0.51 (0.25, 1.04) 0.0647 Clinical characteristics Anxiety Yes 14 (18.92) 91 (9.61) 2.20 (1.18, 4.08) 0.0130 2.76 (1.31, 5.81) 0.0074 No 60 (81.08) 856 (90.39) (REF) (REF) Depression Yes 12 (16.22) 53 (5.60) 3.27 (1.66, 6.43) 0.0006 4.07 (1.80, 9.20) 0.0007 No 62 (83.78) 894 (94.40) (REF) (REF) IBD type Crohn’s disease 42 (56.76) 442 (46.67) 0.67 (0.41, 1.08) 0.0961 -- -- Ulcerative colitis 32 (43.24) 505 (53.33) (REF) -- -- CCI Mean (SD) 1.35 (2.35) 2.23 (2.90) 0.87 (0.78, 0.97) 0.0124 0.97 (0.83, 1.13) 0.7044

Perspectives of East Asian patients and physicians on complementary and alternative medicine use for inflammatory bowel disease: results of a cross-sectional, multinational study.

Background/Aims Complementary and alternative medicine (CAM) is prevalent in East Asia. However, information on CAM in East Asian patients with inflammatory bowel disease (IBD) is scarce. We aimed to profile the prevalence and pattern of CAM use among East Asian IBD patients and to identify factors associated with CAM use. We also compared physicians’ perspectives on CAM.Methods Patients with IBD from China, Japan, and South Korea were invited to complete questionnaires on CAM use. Patient demographic and clinical data were collected. Logistic regression analysis was applied for predictors of CAM use. Physicians from each country were asked about their opinion on CAM services or products.Results Overall, 905 patients with IBD participated in this study (China 232, Japan 255, and South Korea 418). Approximately 8.6% of patients with IBD used CAM services for their disease, while 29.7% of patients sought at least 1 kind of CAM product. Current active disease and Chinese or South Korean nationality over Japanese were independent predictors of CAM use. Chinese doctors were more likely to consider CAM helpful for patients with IBD than were Japanese and South Korean doctors.Conclusions In 8.6% and 29.7% of East Asian patients with IBD used CAM services and products, respectively, which does not differ from the prevalence in their Western counterparts. There is a significant gap regarding CAM usage among different Asian countries, not only from the patients’ perspective but also from the physicians’ point of view.

Antidepressant medication use in Inflammatory Bowel Disease: a nationally representative population-based study.

SummaryBackgroundDespite high rates of depression and anxiety, little is known about the use of antidepressants amongst individuals diagnosed with inflammatory bowel disease (IBD).AimsTo evaluate temporal trends in the use of antidepressants; rates of antidepressant initiation and adherence of antidepressant use to international guidelines amongst individuals with IBD.MethodsThis is a study of 14,525 incident IBD cases from 2004 to 2016 compared with 58,027 controls matched 1:4 for age and sex from the Clinical Practice Research Datalink. After excluding tricyclic antidepressants, we performed a Cox regression analysis to determine the risk associated with antidepressant use and logistic regression analysis to determine risk associated with antidepressant undertreatment.ResultsAntidepressant use amongst individuals with IBD increased by 51% during the 12‐year study period, who were 34% more likely to initiate antidepressants in the year after IBD diagnosis compared with controls (aHR:1.34, 95% CI 1.21‐1.49). In those with IBD starting antidepressants, 67% received treatment lasting less than the duration recommended in international guidelines, of which 34% were treated for 1 month or less.18‐24 year olds were twice as likely to discontinue treatment within 1 month compared with those aged 40‐60 years (aHR:2.03, 95% CI 1.40‐2.95). Socioeconomic deprivation was also associated with early treatment discontinuation (aHR:1.40, 95% CI 1.07‐1.83).ConclusionsIn the year following IBD diagnosis individuals are significantly more likely to start antidepressants compared with controls, but treatment duration fell short of recommendations in the majority. Better integration of services may benefit individuals with IBD and psychiatric comorbidity.

A174 PERCEPTIONS OF CANNABIS USE IN WOMEN WITH INFLAMMATORY BOWEL DISEASE OF REPRODUCTIVE AGE: A CROSS-SECTIONAL STUDY

BackgroundCannabis use in inflammatory bowel disease (IBD) may lead to improvement in pain and general health perception. However, its use during pregnancy may result in adverse outcomes such as preterm birth and altered fetal brain development. It remains unknown how women with IBD perceive Cannabis use during pregnancy and whether they discuss its use with their health-care providers.AimsTo determine practices in, and perceptions of, cannabis use during pregnancy in women with IBD of reproductive age.MethodsWomen with IBD (age 18–45) were recruited at Mount Sinai Hospital and via social media platforms. Participants anonymously completed surveys on baseline demographics and IBD characteristics. They also completed a Cannabis questionnaire which asked about current use, perceived risks during pregnancy, and discussions with health-care providers. Categorical variables were reported as frequencies and compared using the chi-square test. Continuous variables were reported as medians and compared using the Mann-Whitney U test.ResultsSixty-four women were included, 26 (40.6%) with ulcerative colitis, 37 (57.8%) with Crohn’s disease, and 1 (1.6%) with indeterminate colitis. Nineteen (29.7%) were preconception, 40 (62.5%) were pregnant, and 5 (7.8%) were post-partum. Eleven (18.0%) patients reported current Cannabis use, 4 (6.3%) during pregnancy. Cannabis users were more likely to have discussed its use with a health-care provider compared to non-users (45.5% vs. 5.7%, p<0.001) and had longer IBD duration (12.00 vs. 9.00 years, p=0.05). Twenty-five (42.4%) were unsure of the risks of Cannabis use in pregnancy, of which only two had discussed this with a health-care provider. Reasons for fear of Cannabis use included risk of fetal oxygen restriction (n=13, 20.3%), impact on brain development (n=29, 46.0%), and risk of fetal respiratory issues (n=18, 28.6%). Only eight (12.5%) patients reported having a conversation about Cannabis use during pregnancy with their health-care provider; all of whom felt its consumption was unsafe during pregnancy.ConclusionsMany women with IBD report being unsure of risks of Cannabis use during pregnancy. With the legalization of Cannabis in Canada, it is imperative patients and health-care providers discuss the risks and benefits of its use, particularly during vulnerable times such as pregnancy.Funding AgenciesNone

P189 Perceptions of Cannabis use in women with Inflammatory Bowel Disease of reproductive age: A cross-sectional study

Abstract Background Cannabis use in inflammatory bowel disease (IBD) may lead to improvement in pain and general health perception. However, its use during pregnancy may result in adverse outcomes such as preterm birth and altered fetal brain development. It remains unknown how women with IBD perceive Cannabis use during pregnancy and whether they discuss its use with their health-care providers. We aimed to determine practices in, and perceptions of, cannabis use during pregnancy in women with IBD of reproductive age. Methods Women with IBD (age 18–45) were recruited at Mount Sinai Hospital and via social media platforms. Participants anonymously completed surveys on baseline demographics and IBD characteristics. They also completed a Cannabis questionnaire which asked about current use, perceived risks during pregnancy, and discussions with health-care providers. Categorical variables were reported as frequencies and compared using the chi-square test. Continuous variables were reported as medians and compared using the Mann-Whitney U test. Results Sixty-four women were included, 26 (40.6%) with ulcerative colitis, 37 (57.8%) with Crohn’s disease, and 1 (1.6%) with indeterminate colitis. Nineteen (29.7%) were preconception, 40 (62.5%) were pregnant, and 5 (7.8%) were post-partum. Eleven (18.0%) patients reported current Cannabis use, 4 (6.3%) during pregnancy. Cannabis users were more likely to have discussed its use with a health-care provider compared to non-users (45.5% vs. 5.7%, p&amp;lt;0.001) and had longer IBD duration (12.00 vs. 9.00 years, p=0.05). Twenty-five (42.4%) were unsure of the risks of Cannabis use in pregnancy, of which only two had discussed this with a health-care provider. Reasons for fear of Cannabis use included risk of fetal oxygen restriction (n=13, 20.3%), impact on brain development (n=29, 46.0%), and risk of fetal respiratory issues (n=18, 28.6%). Only eight (12.5%) patients reported having a conversation about Cannabis use during pregnancy with their health-care provider; all of whom felt its consumption was unsafe during pregnancy. Conclusion Many women with IBD report being unsure of risks of Cannabis use during pregnancy. With the legalization of Cannabis in Canada, it is imperative patients and health-care providers discuss the risks and benefits of its use, particularly during vulnerable times such as pregnancy.

Polysubstance use in inflammatory bowel disease.

We aimed to evaluate the incidence, predisposing factors and impacts of polysubstance use (PSU) (ie, the concurrent use or abuse of two or more drugs or substances) in inflammatory bowel disease (IBD). Data of patients enrolled between 1 January 2015 and 31 August 2019 from a single tertiary care referral center were retrospectively collected. Patients' baseline and clinical characteristics and their antidepressant and/or anxiolytic medications were abstracted. Associations between PSU and patients' characteristics were analyzed. Multivariate logistic regression models were fit, incorporating significant clinical factors. Altogether 315 patients with IBD (166 women, 149 men; 214 with Crohn's disease and 101 ulcerative colitis) were enrolled. Of them, 66 (21.0%) exhibited PSU (CD 21.5%, UC 19.8%); 37.5% had moderate to severe disease activity, 34.3% with extraintestinal manifestations (EIM), 41.6% with an anxious or depressed state and 69.8% had used healthcare resources in the prior 12 months. Moreover, 71.2% used two substances, while 27.3% used three substances. In the total cohort, EIM (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.14-3.34, P = 0.019) and antidepressant or anxiolytic use (OR 2.51, 95% CI 1.45-4.39, P < 0.001) were positively associated with PSU on multivariate analysis. PSU was associated with increased rate of IBD-associated imaging (57.6% vs 47.0%, P < 0.05). PSU is common in IBD. EIM, antidepressant and/or anxiolytic use and imaging studies were independently associated with PSU. This study reinforces the importance of screening patients with IBD for substance use, particularly those with EIM and using antidepressants and/or anxiolytics.

S3347 The Impact of an Educational Intervention Focused on Cannabis Use in Inflammatory Bowel Disease

S3347 The Impact of an Educational Intervention Focused on Cannabis Use in Inflammatory Bowel Disease