Young Inflammatory Bowel Disease Patients Research Articles

N09 Transition Success Score as a valid quantitative measure to evaluate the effect of transitional care in IBD patients

Abstract Background Transition programs are designed to prepare adolescent patients with inflammatory bowel disease (IBD) for their new role in adult care. The outcome of these programs is often assessed in a qualitative way (patient satisfaction, quality of life, disease burden). However, there is no quantitative measure to evaluate the effect of a transition program. The aim of this study was to develop and validate a Transition Success Score (TSS) by the identified key components of successful transition. Methods The TSS was developed through an international Delphi consensus study, with the expert panel of pediatric and adult healthcare providers and patients. The top 10 key outcome items associated with success of transition were collated into one questionnaire. In every round, the minimum response rate required was 80%, and a consensus of more than 80% was necessary for each item. After four rounds of discussion, a consensus was reached on the initial version of the TSS. This score included seven items for adult healthcare providers to evaluate the patient's disease management behavior, including shared decision making, therapy adherence, and appointment attendance. Additionally, two items concern patient and parent experience concerning the transition period. The TSS was subsequently employed and validated in a prospective multicenter cohort of young adult IBD patients, who made the transfer 9-15 months ago, in the Netherlands. Results In seven hospitals, 160 IBD patients (median age 19.05, male 48.8%, Crohn's disease 56%, median age at diagnose 13.97) completed the TSS, at 9-15 months after transfer to adult care. Hypothesis testing for construct validation revealed significant association of characteristics related to transition care such as knowledge (RTT), independence (TRAQ), and quality of life (IBDQ) (p=<0.005). In addition, Rasch analysis for structural validation showed that the TSS was discriminating at lower levels of transition success (Figure 1). Internal consistency, as measured by Cronbach alpha, was acceptable at 0.64. TSS was significantly lower in patients with high disease burden, exacerbation within the first year after transfer and parental dependency. Also, TSS was lower in certain patient profile types, characterized as either "laid back, nonchalant" or "worried and uncertain". Conclusion The Transition Success Score (TSS) can serve as a quantitative measure to help identify IBD patients who did not have successful transition to adult care. TSS can be utilized for identifying factors that impact successful transition and for measuring the effect of various transition programs in IBD.

Medical trauma in young adults with inflammatory bowel disease: The role of trauma-informed care

Medical trauma is a profound concern for those with chronic conditions like inflammatory bowel disease (IBD), especially young adults. This trauma, arising from both the disease itself and necessary medical interventions, manifests as an accumulation of traumatic experiences impacting a patient’s physical and psychological well-being. The Crohn’s and Colitis Young Adults Network (CCYAN) conducted a roundtable discussion involving young adult IBD patients and healthcare professionals focused on medical trauma and its implications in the treatment of young adults with IBD. This article summarizes the key insights from this discussion, including medical trauma in IBD as an accumulation of ‘micro-traumas,’ the impacts of such trauma and disruptions in care regardless of post-traumatic stress diagnosis, the role of adverse childhood experiences and trauma-informed care, practical strategies to cultivate trust during individual patient encounters, and recommendations for providing trauma-informed care within the clinical setting.

Sexual and reproductive health considerations in the care of young adults with inflammatory bowel disease: A multidisciplinary conversation

The effects of inflammatory bowel disease (IBD) and the medications used to treat it on sexual and reproductive health can be significant, impacting the quality of life of patients across gender identities. This article presents insights from a roundtable discussion facilitated by the Crohn's and Colitis Young Adults Network (CCYAN) between young adult patients with IBD and medical professionals, including physicians, nurses, psychologists, and trainees/medical students. It underscores the distinction between sexual and reproductive health, emphasizing the need to address both aspects comprehensively. The discussion identified key themes, including sexual dysfunction and well-being in IBD patients; discussing sexual health with young adult IBD patients; current research in reproductive health: gaps and opportunities; discussing reproductive health with young adult IBD patients; and providing resources and comprehensive multidisciplinary care.

Providing LGBTQ+ affirming care to young adults with inflammatory bowel diseases

Creating an affirming care environment for young adults with IBD in the LGBTQ+ community is an essential part of inflammatory bowel disease (IBD) care. This article summarizes the discussions held during the Roundtable on Young Adults with IBD, which focused on essential information for adult-care providers to successfully navigate the complexities and intricacies of sexuality and gender identity for young adult IBD patients. The Roundtable on Young Adults with IBD is held through the Crohn’s and Colitis Young Adults Network. Key focus areas include establishing effective communication between providers and patients, maintaining patient safety and privacy, emphasizing trauma-informed practices, and building trust-based provider-patient relationships. Addressing these issues will allow providers to more fully and effectively treat LGBTQ+ young adults with IBD, ensuring a better, safer path into successful adult lives.

Children and Young Adults With Inflammatory Bowel Disease Have an Increased Incidence and Risk of Developing Mental Health Conditions: A UK Population-Based Cohort Study.

The burden of mental health conditions in children and young adults with inflammatory bowel disease remains unclear. We assessed this using a primary care database in the United Kingdom. A retrospective, observational study compared children and young adults with incident inflammatory bowel disease 5 to 25 years of age (2010-2020) against population control subjects. Outcomes comprised incident depression, anxiety disorder, eating disorders, body image disorders, attention-deficit disorders, behavioral disorders, adjustment disorders, acute stress disorder, schizophrenia, bipolar disorder, posttraumatic stress disorder, self-harm, parasuicide (including suicide), and sleep disturbance. The any mental health condition category comprised any of these conditions. A total of 3898 young patients with incident inflammatory bowel disease were matched to 15 571 control subjects. Inflammatory bowel disease patients were significantly more likely to develop new posttraumatic stress disorder (adjusted hazard ratio [aHR], 2.47; 95% confidence interval [CI], 1.23-4.94), eating disorders (aHR, 1.85; 95% CI, 1.05-3.26), self-harm (aHR, 1.49; 95% CI, 1.00-2.21), sleep disturbance (aHR, 1.40; 95% CI, 1.15-1.71), depression (aHR, 1.34; 95% CI, 1.16- 1.56), anxiety (aHR, 1.25; 95% CI, 1.06-1.48), and any mental health condition (aHR, 1.28; 95% CI, 1.12-1.46). Male inflammatory bowel disease patients aged 12 to 17 years, and patients with Crohn's disease appear to have the highest risk for developing new mental health conditions. Young inflammatory bowel disease patients have a significantly higher incidence and risk of new mental health conditions. Mental health remains a critically overlooked aspect of inflammatory bowel disease patient management. Further research into identifying optimal monitoring tools and support for these patients is required to improve patient care. The study protocol was specified and registered a priori.ClinicalTrials.gov study identifier: NCT05206734.

Validation and Reference Scores of the Transition Readiness Assessment Questionnaire in Adolescent and Young Adult IBD Patients.

Transition readiness can predict a successful transition from pediatric to adult care. This study aimed to validate and develop age-dependent reference scores for the (Dutch version of) Transition Readiness Assessment Questionnaire (TRAQ), in adolescents and young adults (AYAs) with inflammatory bowel disease (IBD). TRAQ has 20 items (score 1-5) distributed over 5 domains (total sum score 100) and is completed by AYAs. Following the COnsensus-based Standards for the selection of health Measurement INstruments methodology, we conducted the translation, back-to back translation, pretesting, and validation of the final Dutch version of TRAQ (TRAQ-NL) questionnaire. We used a Rasch model for structural validation, hypothesis testing for construct validity, and Cronbach alpha to demonstrate reliability. Reference scores were calculated using percentiles. Two hundred fifty TRAQ questionnaires were evaluated in 136 AYAs with IBD [56% Crohn disease, 58% male, median age 17.5 years (range 15.7-20.4)]. The overall mean item score was 3.87 (range 1.45-5). With good reliability (Cronbach alpha 0.87), TRAQ-NL discriminated well between knowledge levels, especially in the lower levels. Transition readiness was defined as low, moderate, adequate, or excellent in patients with TRAQ percentile scores (PC) <25th (<3.375 mean item score), 25th-50th (3.375-3.9), 50th-90th (3.91-4.7), or >90th (>4.7). Younger patients, concomitant illness, fewer visits to the transition clinic, and parental dependence were associated with significantly lower TRAQ scores. TRAQ(-NL) is reliable and valid, with age-dependent PC to identify (in)adequate transfer readiness. TRAQ can now be more easily used as a patient-reported outcome measure to monitor transition readiness longitudinally in routine care for AYAs IBD patients.

A191 NONALCOHOLIC FATTY LIVER DISEASE AND LIVER FIBROSIS INCREASE CARDIOVASCULAR RISK IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both NAFLD and cardiovascular diseases seem more frequent in patients with inflammatory bowel disease (IBD). Purpose We aimed to assess the effect of NAFLD and associated liver fibrosis on the cardiovascular risk in people with IBD. Method We prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP &amp;gt;275 dB/m and liver stiffness measurement (LSM) by TE ≥8 kPa, respectively. Nonalcoholic steatohepatitis (NASH) with liver fibrosis was defined as Fibroscan-aspartate aminotransferase (AST) score (FAST) &amp;gt;0.35. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator proposed by the American Heart Association and computed from age, sex, race, lipid pattern, blood pressure, diabetes treatment and smoking. Based on the American Heart Association guidelines, the 10-year cardiovascular risk by ASCVD was categorized as low if &amp;lt;5%, borderline if 5%–7.4%, intermediate if 7.5%–19.9% and high if ≥20% or if previous cardiovascular event.Predictors of intermediate-high cardiovascular risk were investigated by multivariable logistic regression analysis. Result(s) We included 405 patients with IBD (54% female; mean age 45+15 years; mean BMI 26+5 Kg/m; 31% with ulcerative colitis; 7% with diabetes; 14% with hypertension). Overall, 278 (68%), 23 (6%), 47 (12%) and 57 (14%) were categorized as at low, borderline, intermediate and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (32%) and 35 (9%) patients, respectively. NASH with fibrosis was found in 11 (3%) patients. Patients with NAFLD and with significant liver fibrosis diagnosed by TE with CAP had higher proportion of intermediate-high ASCVD risk category (see Figure). These findings were confirmed also in young IBD patients &amp;lt;55 years old with NAFLD. No difference in ASCVD risk was detected for FAST score. After adjusting for IBD disease activity, significant liver fibrosis and BMI, predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% confidence interval [CI] 1.56–5.68), IBD duration (aOR 1.55 per 10 years, 95% CI 1.22–1.97), and ulcerative colitis (aOR 2.32, 95% CI 1.35–3.98). Only 30% of IBD patients classified as intermediate-high ASCVD risk were on statin treatment, with no difference between patients with and without NAFLD. Image Conclusion(s) NAFLD increases cardiovascular risk, independently of age, IBD-related factors and BMI. A potential implication of our finding is the targeted cardiovascular assessment in IBD patients with NAFLD and appropriate initiation of statin, particularly if they have longer IBD duration and ulcerative colitis. Please acknowledge all funding agencies by checking the applicable boxes below CAG Disclosure of Interest None Declared

A34 NONALCOHOLIC FATTY LIVER DISEASE AND LIVER FIBROSIS INCREASE CARDIOVASCULAR RISK IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both NAFLD and cardiovascular diseases seem more frequent in patients with inflammatory bowel disease (IBD). Purpose We aimed to assess the effect of NAFLD and associated liver fibrosis on the cardiovascular risk in people with IBD. Method We prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP &amp;gt;275 dB/m and liver stiffness measurement (LSM) by TE ≥8 kPa, respectively. Nonalcoholic steatohepatitis (NASH) with liver fibrosis was defined as Fibroscan-aspartate aminotransferase (AST) score (FAST) &amp;gt;0.35. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator proposed by the American Heart Association and computed from age, sex, race, lipid pattern, blood pressure, diabetes treatment and smoking. Based on the American Heart Association guidelines, the 10-year cardiovascular risk by ASCVD was categorized as low if &amp;lt;5%, borderline if 5%–7.4%, intermediate if 7.5%–19.9% and high if ≥20% or if previous cardiovascular event.Predictors of intermediate-high cardiovascular risk were investigated by multivariable logistic regression analysis. Result(s) We included 405 patients with IBD (54% female; mean age 45+15 years; mean BMI 26+5 Kg/m2; 31% with ulcerative colitis; 7% with diabetes; 14% with hypertension). Overall, 278 (68%), 23 (6%), 47 (12%) and 57 (14%) were categorized as at low, borderline, intermediate and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (32%) and 35 (9%) patients, respectively. NASH with fibrosis was found in 11 (3%) patients. Patients with NAFLD and with significant liver fibrosis diagnosed by TE with CAP had higher proportion of intermediate-high ASCVD risk category (see Figure). These findings were confirmed also in young IBD patients &amp;lt;55 years old with NAFLD. No difference in ASCVD risk was detected for FAST score. After adjusting for IBD disease activity, significant liver fibrosis and BMI, predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% confidence interval [CI] 1.56–5.68), IBD duration (aOR 1.55 per 10 years, 95% CI 1.22–1.97), and ulcerative colitis (aOR 2.32, 95% CI 1.35–3.98). Only 30% of IBD patients classified as intermediate-high ASCVD risk were on statin treatment, with no difference between patients with and without NAFLD. Image Conclusion(s) NAFLD increases cardiovascular risk, independently of age, IBD-related factors and BMI. A potential deliverable of our finding is the targeted cardiovascular assessment in IBD patients with NAFLD and appropriate initiation of statin, particularly if they have longer IBD duration and ulcerative colitis. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

P261 Rate of Community Acquired Pneumonia, related hospitalization, and mortality among younger unvaccinated Inflammatory Bowel Disease patients

Abstract Background Community Acquired Pneumonia (CAP) is among the most common infections among Inflammatory Bowel Disease (IBD) patients. Current vaccine guidelines recommend vaccination at a younger age in individuals with IBD on immunosuppressive medications. Our aim was to determine the absolute and relative risk of CAP, related hospitalization, and death among unvaccinated IBD patients under the age of 65 years and compare the rates between those exposed and unexposed to immunosuppressive medications. We also sought to determine if exposure to immunosuppressive/immunomodulatory medications was associated with an increased risk of CAP in this group. Methods We conducted a retrospective cohort study utilizing a nationwide cohort of IBD patients under the age of 65 in the Veteran Affairs Healthcare System (VAHS) who were pneumococcal vaccine naive. The unexposed group included those patients on 5-ASA medications only. Exposure was administration of any immunosuppressive medication. The primary outcome was the first occurrence of pneumonia. Secondary outcomes were pneumonia related hospitalization and mortality. We reported event rate per 1000 person-years, hazard ratio, and 95% confidence intervals (CIs) for each outcome. Results A total of 26,707 patients were included in our study. 513 of these patients developed pneumonia (Table 1). The overall crude incidence rate of CAP was 3.2 per 1000 patient-years (4.04/1000 patient years in the exposed vs 1.45/1000 patient-years in the unexposed). The overall crude incidence rates for pneumonia-related-hospitalization and mortality were 1.12 and 0.09 per 1000 patient-years, respectively (Table 2). In Cox regression, exposed group was associated with an increased risk of pneumonia (AHR 2.85; 95% CI 2.21 – 3.66, p &amp;lt; 0.001) and pneumonia-related-hospitalization (AHR 3.46; 95% CI 2.20 – 5.43, p &amp;lt; 0.001) (Table 3). Conclusion Overall incidence of CAP among younger unvaccinated IBD patients was 3.2 per 1000 PY. We observed that while the incidence rates of CAP and CAP-related hospitalization were low overall, they were higher among those who received immunosuppressive therapy compared to those who only received 5-ASA medications. Knowing the exact risk of developing CAP among younger IBD patients will help patients and their physicians make informed decisions during these times of complex vaccine recommendations.

ERGOGENIC AID USE IN ADOLESCENTS AND YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE AND MEDICAL PROFESSIONAL COMFORTABILITY IN NUTRITIONAL EDUCATION

Abstract BACKGROUND There is concern for the lack of data regarding the efficacy and negative effects of ergogenic aids (sport supplements) in patients with Inflammatory Bowel Disease (IBD). This is a prospective research project designed to determine which ergogenic aids are used in pediatric and young adult populations with IBD, the reasons patients use these products, and medical professional comfortability in discussing nutritional concerns with patients. METHODS IRB approval was granted by Oregon Health and Science University prior to patient recruitment. A survey was distributed to patients with IBD, ages 10-35. Recruitment occurred through MyChart. A second survey was distributed among medical students, residents, and fully trained professionals of the gastrointestinal healthcare team (fellows, physicians, dieticians, physician assistants, nurse practitioners, and gastrointestinal psychologists). Recruitment occurred via email. SPSS Statistics and RedCap were utilized for chi-square tests and logistic regression in determining significance. Patients were compensated for their participation with gift cards. RESULTS Patient total was n=124; Female 46%; Male 52%; Non-binary 2.1%; Crohn’s Diagnosis 69%; Ulcerative Colitis Diagnosis 31%. There was a significant difference in the number of patients who reported having used at least one ergogenic aid compared to none (n=77, 62%, p-value=&amp;lt;0.001). Excluding caffeine, majority of respondents utilized at least one other ergogenic aid (n=69, 56%). Specific ergogenic aid usage is detailed in Figure 1. Reasons for choosing to use ergogenic aids are detailed in Figure 2. Medical professional response total was n=157, medical students=93, residents=21, fully trained=43. Majority of medical professionals reported they had not received adequate nutritional training during their didactic curriculum (n=126, 80%) and would have preferred additional nutritional training during their didactic courses (n=135, 86%). Increased comfortability discussing nutrition with patients correlated with an increased level of professional training, p-value=&amp;lt;0.001. CONCLUSIONS A statistically significant majority of surveyed IBD patients reported having used ergogenic aids (62%). The most utilized ergogenic aids are detailed in Figure 1. Primary reasons for using ergogenic aids are detailed in Figure 2. Majority of medical professionals reported they had not received adequate nutritional training during their medical school curriculum and were not comfortable discussing nutrition with their patients. This study highlights the prevalence of ergogenic aid usage among pediatric and young adult IBD patients, as well as the importance of improving both IBD patient and medical professional education regarding ergogenic aid safety and effectiveness. We are currently expanding to include a control of healthy patients, ages 10-35.

Physical activity measured by accelerometry in paediatric and young adult patients with inflammatory bowel disease

ObjectivesPhysical activity in paediatric and young adult patients suffering from inflammatory bowel disease (IBD) may play an important role in the overall health status. However, physical activity in these patients has not been reported using objective methods. We aimed to describe accelerometry-measured physical activity levels in paediatric and young adult IBD patients with either ulcerative colitis (UC) or Crohn’s disease (CD).MethodsWe recruited Danish patients with IBD aged 10–20 years in clinical remission and with a faecal calprotectin below 200 µg/mg. Physical activity was assessed using tri-axial wrist accelerometry over seven days and quantified using the activity-related acceleration derived as the conventional Euclidian Norm Minus One (ENMO) metric expressed in milli-gravity units (mg). Time spent in Moderate-to-Vigorous Physical Activity (MVPA) was classified as ENMO > 210 mg in 5 s epoch resolution (unbouted).ResultsWe included 61 patients with a median age of 17 years [Inter Quartile Range, IQR 14–19]. The total volume of activity expressed as average acceleration (ENMO) per day was 31.5 mg (95% CI 29.1–33.9). Time spent in unbouted MVPA was 32 min per day (95% CI 26–37). There was no significant difference in activity volume between patients with UC to patients with CD, the adjusted linear regression coefficient was − 1.7 mg (95% CI –6.2–2.7). Activity volume was higher for males (36.2 mg, 95% CI 31.9–40.5) than for females (27.8 mg, 95% CI 25.6–30.0), and younger patients were more active than older patients; Activity volume in 10–13 year olds was 37.2 mg (95% CI 28.6–45.7), whereas it was 28.5 mg (95% CI 25.2–31.7) for those aged 18–20 years.ConclusionsWe collected tri-axial accelerometry in young patients with IBD in clinical remission, and described their level of physical activity by the conventional ENMO measure. We found no statistically significant difference in patients with UC compared to patients with CD. The volume of physical activity was higher in males compared to females, and inversely associated with age.

Impact of COVID-19 in Pediatric Patients and Young Adults with Inflammatory Bowel Disease

Introduction: Acute COVID-19 in pediatric and young adult patients tends to be milder in severity compared to adult infection. Recent studies seem to show that inflammatory bowel disease (IBD) patients are at no greater risk than the general population. We aim to describe our experience in the follow-up of pediatric and young adult patients with IBD followed in our center and determine possible risk factors of said population for severe COVID-19. Methods: We performed a retrospective study of all patients aged under 25 years followed for IBD at the Unit of Pediatric Gastroenterology in a tertiary center between December 2019 and April 2021 evaluating the incidence of COVID-19 and characterization of positive cases. Results: Of the 268 participants, 24 had COVID-19: the mean age was 19 years old and gender had an equal distribution; 75% (n = 18) had Crohn’s disease, whereas only 25% (n = 6) had ulcerative colitis. Most patients were in clinical remission (n = 21). The majority of patients were under treatment with a tumor necrosis factor (TNF) antagonist (58%, n = 14), mainly infliximab, and most had no comorbidities other than IBD (83%). Regarding COVID-19, 17% of the patients were asymptomatic while the rest had only mild symptoms. There were no reported gastrointestinal complaints, no complications nor hospitalizations. Most patients did not require interruption of their IBD treatment. Conclusions: Our data suggest that pediatric and young adult IBD patients have a low risk for complications and hospitalization, regardless of IBD treatment. We believe that this experience is encouraging and allows for safe counseling regarding treatment options and school attendance in pediatric and young adult IBD patients.

Diet, Sun, Physical Activity and Vitamin D Status in Children with Inflammatory Bowel Disease.

In the course of inflammatory bowel disease (IBD) malabsorption may lead to a vitamin D deficiency and calcium–phosphate misbalance. However, the reports on the vitamin D status in children with IBD are few and ambiguous. Here, we are presenting complex analyses of multiple factors influencing 25OHD levels in IBD children (N = 62; Crohn’s disease n = 34, ulcerative colitis n = 28, mean age 14.4 ± 3.01 years, F/M 23/39) and controls (n = 47, mean age 13.97 ± 2.57, F/M 23/24). Additionally, calcium–phosphate balance parameters and inflammatory markers were obtained. In children with IBD disease, activity and location were defined. Information about therapy, presence of fractures and abdominal surgery were obtained from medical records. All subjects were surveyed on the frequency and extent of exposure to sunlight (forearms, partially legs for at least 30 min a day), physical activity (at least 30 min a day) and diet (3 days diary was analyzed with the program DIETA 5). The mean 25OHD level was higher in IBD patients compared to controls (18.1 ng/mL vs. 15.5 ng/mL; p = 0.03). Only 9.7% of IBD patients and 4.25% of controls had the optimal vitamin D level (30–50 ng/mL). Despite the higher level of 25OHD, young IBD patients showed lower calcium levels in comparison to healthy controls. There was no correlation between the vitamin D level and disease activity or location of gastrointestinal tract lesions. Steroid therapy didn’t have much influence on the vitamin D level while vitamin D was supplemented. Regular sun exposure was significantly more common in the control group compared to the IBD group. We found the highest concentration of vitamin D (24.55 ng/mL) with daily sun exposure. There was no significant correlation between the vitamin D level and frequency of physical activity. The analysis of dietary diaries showed low daily intake of vitamin D in both the IBD and the control group (79.63 vs. 85.14 IU/day). Pediatric patients, both IBD and healthy individuals, require regular monitoring of serum vitamin D level and its adequate supplementation.

N17 Co Design of young person’s IBD clinic for 16–24 year olds

Abstract Background In Ireland,young people with Inflammatory Bowel Disease (IBD), diagnosed in a paediatric hospital transition to adult services at 16 years of age. Transition is an essential milestone for adolescents with IBD as critical functioning skills necessary for self-management are not fully developed and adolescents often find it difficult to engage with health care professionals about their disease. To date an ideal transition model has not been defined. The aim of this pilot study was to seek input from a transition group to aid the development of future transition and young person clinics. Methods During 2019, 8 patients transitioning into our adult IBD service were assigned to the pilot structured multidisciplinary (MDT) pathway for 12 months. This involved meeting with Consultant, CNS, psychologist and dietitian at each clinic appointment. Patient experience measures were given after each visit and on completion of the pathway participants rated their experience on Likert scales and free text responses. Findings would be useful to steer service development. Results At the end of 1 year excellent satisfaction rates were reported by those attending clinics with MDT input. Nonetheless 50% preferred consultant only clinics. 37.5% opted for full MDT review and 12.5% requested psychology input plus consultant at clinic. Conclusion The project highlights the importance of patient focused studies when designing young patient’s transition clinics. 50% of young IBD patients did not request full MDT on a regular basis. This study is being expanded to review patient experiences from a larger cohort aged 18–24 years and a Randomised Control Trial will be conducted to guide future a transition pathway

Acute Coronary Syndromes and Inflammatory Bowel Disease: The Gut-Heart Connection.

(1) Background: Inflammatory bowel disease (IBD) induces a process of systemic inflammation, sharing common ground with acute coronary syndromes (ACS). Growing evidence points towards a possible association between IBD and an increased risk of ACS, yet the topic is still inconclusive. Therefore, we conducted a systematic review aiming to clarify these gaps in the evidence. (2) Methods: We conducted a systematic search on EMBASE, Cochrane Library, and PubMed, identifying observational studies published prior to November 2020. The diagnosis of IBD was confirmed via histopathology or codes. Full articles that fulfilled our criteria were included. Quality assessment was performed using the Newcastle–Ottawa scale (NOS). (3) Results: We included twenty observational studies with a total population of ~132 million subjects. Fifteen studies reported a significant association between ACS and IBD, while the remaining five studies reported no increase in ACS risk in IBD patients. (4) Conclusions: ACS risk in IBD patients is related to hospitalizations, acute active flares, periods of active disease, and complications, with a risk reduction during remission. Interestingly, a general increase in ACS risk was reported in younger IBD patients. The role of corticosteroids and oral contraceptive pills in increasing the ACS risk of IBD patients should be investigated.

Efficacy of Vedolizumab in a Nationwide Cohort of Elderly Inflammatory Bowel Disease Patients.

The elderly inflammatory bowel disease (IBD) population has historically been under-represented in clinical trials, and data on the efficacy of biologic medications in elderly IBD patients are generally lacking. Our study aims to evaluate the efficacy of vedolizumab (VDZ) among elderly IBD patients and compare it with younger IBD patients in a nationwide population-based cohort of IBD patients. We conducted a retrospective cohort study of patients within the US national Veterans Affairs Healthcare System (VAHS). Patients were stratified into 2 groups based on age at the time of starting VDZ (60 years of age and older or younger than 60 years of age) with outcomes compared between the 2 groups. The primary outcome was steroid-free remission during the 6- to 12-month period after starting VDZ therapy among those patients who were on steroids when VDZ was started. There were 568 patients treated with VDZ, of whom 56.7% had Crohn's disease and 43.3% had ulcerative colitis. Among them, 316 patients were on steroids when VDZ was started. The percentage of patients who were on VDZ and off steroids during the 6- to 12-month period after VDZ initiation was 46.8% and 40.1% for the younger and elderly groups, respectively (P = 0.2374). Rates of hospitalization for an IBD-related reason within 1 year of VDZ start among the whole cohort were nearly identical in the younger and elderly groups (11.2% vs 11.3%, P = 0.9737). Rates of surgery for an IBD-related reason within 1 year of VDZ start were also similar between the young and elderly (3.9% vs 3.9%, P = 0.9851). In a nationwide real-world retrospective cohort study of elderly IBD patients, we found that the efficacy of VDZ was similar among younger and older IBD patients and comparable with the published data in clinical trials.

Risk Factors for and Frequency of CT Scans, Steroid Use, and Repeat Visits in Inflammatory Bowel Disease Patients Seen at a Single-Center Emergency Department: A Retrospective Cohort Study.

Patients with inflammatory bowel disease often present to the emergency department due to the chronic relapsing nature of the disease. Previous studies have shown younger patients to have an increased frequency of emergency department visits, resulting in repeated exposure to imaging studies and steroids, both of which are associated with risks. We performed a retrospective cohort analysis of inflammatory bowel disease patients seen at Houston Methodist Hospital’s emergency department from January 2014 to December 2017 using ICD codes to identify patients with Crohn’s disease, ulcerative colitis, or indeterminate colitis from the electronic medical record. Data were collected on demographics, medications, and imaging. Five hundred and fifty-nine patients were randomly selected for inclusion. Older age was associated with decreased risk of CT scan or steroid use. Patients with ulcerative colitis compared to Crohn’s had decreased risk of CT scan, while there was an increased risk of CT in patients on a biologic, immunomodulator, or when steroids were given. Steroid use was also more common in those with inflammatory bowel disease as the primary reason for the visit. Patients in our study frequently received steroids and had CT scans performed. The increased risk of CT in those on a biologic, immunomodulator, or steroids suggests more severe disease may contribute. Guidelines are needed to reduce any unnecessary corticosteroid use and limit repeat CT scans in young inflammatory bowel disease patients to decrease the risk of radiation-associated malignancy over their lifetime.

DOP49 Effectiveness and safety of vedolizumab in a matched cohort of elderly and young Inflammatory Bowel Disease patients - LIVE Study-Group

Abstract Background Vedolizumab is the first biologic tested for the treatment of elderly patients with moderate-to-severely active ulcerative colitis (UC) and Crohn’s disease (CD) in the GEMINI program. However, little real-life data have been reported on its use in the elderly population. In this work, we present data on vedolizumab effectiveness and safety in a large cohort of elderly UC and CD patients matched to younger patients. Methods The Long-term Italian Vedolizumab Effectiveness (LIVE) study included CD and UC patients started on vedolizumab from April 2016 to June 2017 at 47 centers of the Italian Group for the study of Inflammatory Bowel Disease (IG-IBD). Elderly (E-) patients (≥ 65-year-old) were included for this analysis and matched 1:2 to younger (Y-) patients; patients were then prospectively followed-up until June 2019. Primary endpoints were vedolizumab persistence and safety. Results Of 1111 patients, 198 E-patients (mean age 71 ± 5 years; 108 UC,90 CD) were included in the analysis and matched with 396 Y-patients (45 ±12 years; 205 UC,191 CD). After matching, the 2 cohorts were overall comparable, but patients in the Y-group were significantly more likely to have perianal disease, previous exposure to immunosuppressants, and to anti-TNF-α and less likely to be on concomitant steroids at baseline. For UC, persistence in the E- and Y-groups were 69.9% vs and 81.4% at 12 months, and 51.4% vs 67.6% at 24 months (p&amp;lt;0.05 for both). Significant differences were also observed in terms of steroid-free clinical remission (SFCR) (31.5% vs 42.9%,32.4% vs 42.9% at 12 and 24 months, p&amp;lt;0.05 for both) and biochemical remission (22.2% vs 38%,25.9% vs 40.5% at 12 and 24 months, p&amp;lt;0.05 for both). Endoscopic remission was observed in 17/75 (22.7%) E-patients and 50/141 (35.5%) Y-patients (p=0.05). For CD, persistence was 75.6% vs 75.1% at 12 months, 52.4% vs 59.4% at 24 months, for the E- and Y- group respectively (p=ns for both). Similarly, rates of SFCR were comparable between the 2 cohorts. Notably, a significantly higher rate of biochemical remission was observed in the Y-group at 24 months (21.1% vs 30.9%, p&amp;lt;0.05). Endoscopic remission was observed in 13/48 (27.1%) E-patients and 25/98 (28.1%) Y-patients (p=ns). A total of 51 and 94 adverse events (AEs) were observed in the E-group and Y-group, respectively: the rate of AEs was comparable between the 2 groups (p=ns). Of note, E-patients had a higher likelihood of suspending vedolizumab due to AEs (p&amp;lt;0.05). Conclusion The data show that vedolizumab can be considered a safe option in elderly patients; however, its efficacy in elderly UC patients (in terms of persistence, SFCR and biochemical remission) seems to be reduced compared to younger UC patients, while no difference was observed in CD.

P144 Clock gene expression levels inversely correlate with disease activity in ulcerative colitis and Crohn’s disease

Abstract Background Pathophysiological mechanisms active in inflammatory bowel disease (IBD), such as mucosal barrier repair, innate and adaptive immune responses, intestinal motility and gut microbiome, all exhibit diurnal variations. Chronic disruption of the molecular clock augment inflammatory response. We have shown that newly diagnosed, naïve to treatment, young IBD patients showed reduced clock gene expression in both inflamed and non-inflamed intestinal tissues and in peripheral White Blood Cells (WBC). This reduction correlated with disease activity. Our aim in this study was to determine whether certain clock genes correlate with disease activity scores or inflammatory markers in Crohn’s disease (CD) vs. ulcerative colitis (UC). Methods 17 patients with CD and 13 with UC, 8–22 years old, were recruited. Patients were evaluated upon diagnosis and during medical treatment. Disease activity scores, C-reactive protein (CRP) and fecal calprotectin (Fcal) levels were measured and WBC were analysed for clock gene (CLOCK, BMAL1, CRY1, CRY2, PER1 and PER2) expression. Clock gene expression levels were correlated to disease activity scores (clinically active vs. remission), CRP levels (&amp;lt;5 mg/l vs. &amp;gt;5 mg/l) and Fcal levels (&amp;lt; 250 μg/mg vs. &amp;gt;250 μg/mg) in CD (21 samples) and UC (20 samples). Results In UC, BMAL (p&amp;lt;0.008), CLOCK (p&amp;lt;0.02), CRY1 (p&amp;lt;0.002), CRY2 (p&amp;lt;0.0009), PER1 (p&amp;lt;0.003) and PER2 (p&amp;lt;0.003) showed decreased expression when Fcal levels were &amp;gt; 250 μg/mg. When compared with the clinical status and CRP levels, only BMAL1 showed reduced expression (p&amp;lt;0.003 and p&amp;lt;0.001, respectively). In CD, clinical status correlated with clock gene expression: CLOCK (p&amp;lt;0.035), PER1 (p&amp;lt;0.001) and CRY1 (p&amp;lt;0.028) were reduced in active disease. CRP and Fcal did not correlate with clock gene expression. Conclusion Altered levels of certain clock genes were demonstrated in young CD and UC patients in exacerbation vs. remission. In UC, Fcal levels inversely correlated with all major circadian genes and partially with clinical status and CRP levels. In CD patients clock gene expression inversely correlated with clinical status.

Infliximab in young paediatric IBD patients: it is all about the dosing

Infliximab (IFX) is administered intravenously using weight-based dosing (5 mg/kg) in inflammatory bowel disease (IBD) patients. Our hypothesis is that especially young children need a more intensive treatment regimen than the current weight-based dose administration. We aimed to assess IFX pharmacokinetics (PK), based on existing therapeutic drug monitoring (TDM) data in IBD patients < 10 years. TDM data were collected retrospectively in 14 centres. Children treated with IFX were included if IFX was started as IBD treatment at age < 10 years (young patients, YP) and PK data were available. Older IBD patients aged 10–18 years were used as controls (older patients, OP). Two hundred and fifteen paediatric inflammatory bowel disease (PIBD) patients were eligible for the study (110 < 10 year; 105 ≥ 10 years). Median age was 8.3 years (IQR 6.9–8.9) in YP compared with 14.3 years (IQR 12.8–15.6) in OP at the start of IFX. At the start of maintenance treatment, 72% of YP had trough levels below therapeutic range (< 5.4 μg/mL). After 1 year of scheduled IFX maintenance treatment, YP required a significantly higher dose per 8 weeks compared with OP (YP; 9.0 mg/kg (IQR 5.0–12.9) vs. OP; 5.5 mg/kg (IQR 5.0–9.3); p < 0.001). The chance to develop antibodies to infliximab was relatively lower in OP than YP (0.329 (95% CI − 1.2 to − 1.01); p < 0.001), while the overall duration of response to IFX was not significantly different (after 2 years 53% (n = 29) in YP vs. 58% (n = 45) in OP; p = 0.56).Conclusion: Intensification of the induction scheme is suggested for PIBD patients aged < 10 years.What is Known?•Infliximab trough levels of paediatric IBD patients are influenced by several factors as dosing scheme, antibodies and inflammatory markers.•In 4.5–30% of the paediatric IBD patients, infliximab treatment was stopped within the first year.What is New?•The majority of young PIBD (< 10 years) have inadequate IFX trough levels at the start of maintenance treatment.•Young PIBD patients (< 10 years) were in need of a more intensive treatment regimen compared with older paediatric patients during 1 year of IFX treatment.•The chance to develop antibodies to infliximab was relatively higher in young PIBD patients (< 10 years).