Su1248 Quality of Life in Inflammatory Bowel Disease: What Does the Short Health Scale Actually Measure?

Su1248 Quality of Life in Inflammatory Bowel Disease: What Does the Short Health Scale Actually Measure?

will likely require sedation using monitored anesthesia care or general anesthesia. Pathology should be assessed for vascular congestion/ectasia which...

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will likely require sedation using monitored anesthesia care or general anesthesia. Pathology should be assessed for vascular congestion/ectasia which may present as an early manifestation of this disease.

Aims: To review cases of microscopic colitis diagnosed in our region since 2004 to assess whether endoscopic abnormalities were present at diagnosis, and to determine the clinical outcome. Method: Cases from 2004-2011 were identified from pathology records. Case notes were retrospectively reviewed and data extracted including subtype of microscopic colitis and clinical details where possible. Results: 82 case notes were obtained and reviewed. 8 cases did not have a clear diagnosis and were excluded. Of the remaining 74 cases, 56 were collagenous colitis, 18 lymphocytic colitis. 17 patients had macroscopic abnormalities (excluding diverticulosis) at endoscopy; 16 of these in the collagenous colitis group, representing 28% of this subgroup. The mean age was 46.1 (range 33-87), female: male ratio of 4.3:1. 18 reported an autoimmune condition including 2 coeliac disease and 7 hypothyroidism. 30(40%) were on a proton pump inhibitor at the time of diagnosis and 15(24%) were on non-steroidal anti-inflammatories. Follow up data was available for 66 patients. Of these 47(71%) reported complete resolution of symptoms and 15(22%) partial resolution. 5(7%) did not respond in the follow up period. Therapeutic strategies included either alone or a combination of stopping/switching PPI, loperamide, mesalazine and steroids. 24/47(65%) of complete responders required simple intervention (PPI withdrawal, switch in brand of PPI, loperamide or even spontaneous resolution) whereas 10/47(21%) required steroids. 7/ 15(47%) partial responders received steroids. Conclusions: Since microscopic colitis was last studied in our region, the female predominance has increased, the mean age has dropped by almost 20yrs, and the ratio of collagenous : lymphocytic colitis has increased from 2:1 to 3:1. This could represent a change in the number of younger people investigated or missing data in our cohort. A significant number of patients with a diagnosis of collagenous colitis had endoscopic abnormalities in comparison to the lymphocytic colitis group, which does raise the question of the nomenclature. The majority of patients have complete resolution of symptoms with simple intervention. 1. Microscopic Colitis in Tayside: Clinical features, associations and behaviour. Mowat C, Heron T, Walsh S. Gastroenterology 2005: 128 (4); A331

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Su1245 Clinical Significance of Nonspecific Colitis Rebecca W. Tsang, Andelka LoSavio BACKGROUND: Colitis describes inflammation in the colon and is classified into defined diseases: inflammatory bowel disease (IBD), microscopic colitis, iatrogenic colitis, ischemic colitis, and infectious colitis. Accurate classification helps guide management, but this is often difficult. Nonspecific colitis, or also known as atypical colitis, describes the cases that do not show characteristic features of a specific colitis. The clinical significance of nonspecific colitis is unclear as there are limited studies. Notteghem et al. (1993) showed that out of 104 patients with nonspecific colitis, 52.3% had another episode within 3 years and 54% were diagnosed with ulcerative colitis, 33% with Crohn's, and 13% remained unclassified, suggesting that nonspecific colitis could potentially be undiagnosed IBD. PURPOSE: The objective of this study is to understand their clinical course by examining subsequent colonoscopies and determining if any presenting symptom can predict subsequent diagnosis. METHODS: Patients who had colonoscopies from 1/2004-12/2006 with biopsies showing nonspecific colitis were enrolled in this retrospective observational study. The inclusion criteria are biopsies from colonoscopies showing nonspecific colitis, follow up with a physician for at least one year, and no previous diagnosis of a specific colitis based on history or biopsy. A chart review of the electronic record was done from the time of colonoscopy until current time or the last note. RESULTS: 101 patients were included in the study with a mean follow-up period of 5.09 years. The most common indications for colonoscopy were diarrhea (44.6%), abdominal pain (29.7%), blood in stool (36.6%), and anemia (7.9%). 50.5% of patients had at least one subsequent colonoscopy with 68.6% of them with normal biopsies, 33.3% with nonspecific biopsies, and 15.7% with biopsies consistent with IBD. No presenting symptom was predictive of subsequent biopsies with IBD, such as abdominal pain (OR, 2.4, 95% CI, 0.57-10.5, p = 0.23) or blood in stool (OR, 3.2, 95% CI, 0.7114.2, p = 0.13). 19 out of 101 patients with nonspecific colitis biopsies were treated for IBD given symptoms (18.8%), and 6 out of the 19 patients had subsequent biopsies showing IBD (31.6%). CONCLUSIONS: 50.5% of patients who have biopsies with nonspecific colitis had a subsequent colonoscopy, and 68.6% of subsequent colonoscopies were normal while 15.7% had IBD. Therefore, although most commonly nonspecific colitis is self-limited colitis, there is a portion that are undiagnosed IBD. In fact, 18.8% of patients with nonspecific colitis were empirically treated for IBD given symptoms, and 31.6% of these patients showed IBD on subsequent colonoscopies. Su1246 Temporal Trends and Natural History of Eosinophils-Related Gastrointestinal Disease in Asia So Yoon Yoon, Hye-Kyung Jung, So-Young Ahn, Yoon Pyo Lee, Hye In Kim, Seong-Eun Kim, Ki-Nam Shim, Sung-Ae Jung, Tae Hun Kim, Sun Young Yi, Kwon Yoo, Il Hwan Moon Background and Aims: The prevalence of eosinophilic esophagitis (EE) is increasing rapidly in Western countries. However, eosinophils-related gastrointestinal disease (EGID), including EE, eosinophilic gastroenteritis (EGE) and eosinophilic colitis (EC), is still rare in Asia. Although it is known that EGID has various clinical manifestations, its epidemiology and natural history is unknown. We aimed to investigate the time trends and natural history of EGID. Methods: Using the GI endoscopy database of Ewha Womans University hospital, we identified the patients with EGID by endoscopic and histological diagnosis between January 2002 and September 2012. The complete medical records were reviewed by gastroenterologists. EGID was defined as significant clinical manifestations with eosinophilic tissue infiltration through endoscopic tissue biopsy. Secondary EGID, such as parasite infection, drug, connective tissue disease, inflammatory bowel disease and reflux esophagitis, was excluded. Results: Among 164,881 patients who had undergone GI endoscopy subjects, 277 potential cases of EGID were found and finally 47 patients met the diagnosis for primary EGID (male, 49%; median age 34 years): EE 5 cases (11%), EGE 24 (51%) and EC 18 (38%). One patient with EGE accompanied with hypereosinophilic syndrome. Among patients with endoscopic examination, EGID showed increased time trend (0.14% in 2002-2007, 0.99% in 2008-2012, P,0.05). The most common symptoms were dysphagia (60%) in EE, abdominal pain (58%) in EGE and hematochezia/melena (44%) in EC. Among the patients of primary EGID, 24% had hypereosinophilia (.1500/μL). Corticosteroid therapy was applied in 51% of patients with EGID. Patients treated with corticosteroid were older than those without corticosteroid (41 vs. 27 years, P = 0.05) and showed more likely to relapse (P = 0.00). The 19.1% of EGID was experienced relapse and 11.1% revealed chronic course during 12.1 months (range 0.5-84) of follow up period. Conclusions: The occurrence of primary EGID is rare in Asia, however, recently increasing. Despite characteristic histological findings in EGID, the clinical manifestations and outcome are diverse. The further studies of combined clinical and morphological studies should be needed to determine the diagnostic criteria and the classification of new disease entities.

Su1248 Quality of Life in Inflammatory Bowel Disease: What Does the Short Health Scale Actually Measure? Vikrant D. Kale, Edel McDermott, Denise Keegan, Kathryn Byrne, Mary Forry, Stephen Patchett, Garret Cullen, Glen A. Doherty, Hugh Mulcahy Introduction: The Short Health Scale (SHS) is a validated four-part visual analogue scale questionnaire designed to assess the impact of inflammatory bowel disease (IBD) on health related quality of life (QOL). The four dimensions include bowel symptoms, activities of daily life, worry and general well being. SHS scores are known to be associated with disease activity, but it is not known if other clinical or demographic features, such as therapy or surgery, are associated with individual domains. Aim: To assess patient factors associated with SHS QOL scores. Methods: 631 patients, (mean age 41 years; 325 males) attending one of two tertiary referral IBD centres completed a survey instrument detailing patient demographics, quality of life (using the SHS) and other social variables. Results: Median SHS score was 162 (range 0-400), with higher scores indicating a poor QOL. The total SHS score was independently associated with both mild (p ,0.001) and moderate (p,0.001) disease activity, female gender (p=0.009) and smoking (p=0.045). Disease activity was also independently associated with each individual dimension (p ,0.001) across all four dimensions. Female gender was associated with more worry, higher symptom burden and poorer well-being, (all p,0.05). In addition, smoking was associated with more worry and poorer well-being (all p,0.05). In contrast, use of immune modulators or biologic agents had no impact on any of the four dimensions. In addition, previous surgery, educational level achieved or family history of IBD had no impact on any QOL dimension. Conclusion: The SHS is closely associated with disease activity, and worsens with increasing activity. However, other specific patient factors, including gender and smoking are also related to

Su1247 Microscopic Colitis in Tayside - Further Observations on Clinical Features, Outcome and Endoscopic Findings Tim Heron, Craig Mowat, Angeliki Meritsi, Sandeep S. Siddhi, Maximillian Groome, Shaun Walsh Background: The aetiology of microscopic colitis remains unknown. We have previously reported our experience of microscopic colitis diagnosed in our region between 1999 2004(1). Although data continue to emerge, the natural history of microscopic colitis remains unclear. Furthermore, there are reports of macroscopic changes in the mucosa at endoscopy.

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of patients with MC. Methods: Patients with biopsy-proven MC, either lymphocytic colitis (LC) or collagenous colitis (CC), were identified from a population-based inception cohort study from Olmsted County, Minnesota between January 1, 2002 and December 31, 2012. Partial (at least 50% symptom improvement) or complete response was assessed within 8 weeks of the initiation of corticosteroids. Recurrence was defined as recurrent diarrhea after corticosteroid discontinuation if not explained by other etiologies, and long-term maintenance was defined as the need to restart and continue corticosteroids for MC after a recurrence. Smoking was categorized as either current or nonsmokers (including former and never smokers). Statistical analyses were performed using JMP version 9.0.1. Results: Of the 183 patients with MC identified, 59 (32%) were treated with corticosteroids. Of the 59 patients treated with corticosteroids, 80% were females, 51% had CC, and 7 (12%) were lost to follow-up. In the remaining 52 patients, complete response was seen in 35 (67%), partial response was seen in 14 (27%), and non-response was seen in 3 (6%). Among the 52 patients with known response status, 19 (37%) were current smokers, and 33 (63%) were non-smokers. Smoking status was not associated with response to corticosteroids (Table 1, p=0.28). Of the 49 patients who responded to corticosteroids, 2 were lost to follow-up. In the remaining 47, recurrence was seen in 35 patients (74.4%), all of whom were treated with maintenance corticosteroids. Smoking status was also not associated with recurrence and the need for maintenance corticosteroid therapy (Table 2, p=0.65). Conclusion: Smoking status does not impact initial corticosteroid treatment response, recurrence or need for maintenance corticosteroids in patients with microscopic colitis. Disclosure: This publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. Table 1. Clinical Response

Su1249 The Association Between Increased Body Mass Index and Failure of Infliximab Treatment for Inflammatory Bowel Disease Clara Y. Tow, Yecheskel Schneider, Melissa H. Rosen, Brian P. Bosworth Introduction: The pathogenesis of inflammatory bowel disease (IBD) is related to an unchecked inflammatory response in the gut mediated by tumor necrosis factor alpha (TNFa). Infliximab, an anti-TNFa chimeric IgG monoclonal antibody, is a staple therapy for moderateto-severe IBD. Recent literature describes obesity as a low-grade inflammatory state as adipose tissue releases cytokines including TNFa. The purpose of this study was to determine if there is greater failure rate of infliximab therapy in obese IBD patients given theoretical increased TNFa activity. Methods: A retrospective study was performed. 103 patients who received infliximab from 2006-2012 were identified. Patient were grouped based on BMI (group 1 BMI , 18.5, group 2 BMI 18.5-25, group 3 BMI 25-30, group 4 BMI . 40). Logistic regression was performed on outcomes of the impact of weight and body mass index on surgery and loss of clinical response within one year of initiation of infliximab. Linear regression was performed on the impact of weight and body mass index on length of time of durable response of infliximab. Results: 52 women and 51 men were evaluated. The average age of the patient population when diagnosed with IBD was 26.38 years old (STD +/- 12.9). The average age of initiation of infliximab therapy was 33.7 years old (STD +/-13.1) with mean disease duration of 11 years (STD +/-10.79). Average BMI was 23.76lbs/ in2 (STD +/-4.44) with average weight of 155.6lbs (STD +/-38.6lbs). Average duration of infliximab therapy was 17 months (STD +/-13.67). There were no patients in group 4 (BMI . 30) that required surgery or hospitalization for complications of IBD within 1 year of initiating infliximab. Among all groups, there was no statistical significance in surgical requirements for IBD complications at 1 year. There was no significant relationship between BMI and duration of infliximab treatment, though there was a trend towards shorter duration in patients with normal BMI. Finally, there was no significant difference in ESR and CRP at 1 month into infliximab treatment across all BMI groups. Conclusions: IBD and obesity are two separate inflammatory states with shared elevated TNFa activity. This study demonstrated no statistical difference in failure rates within anti-TNFa treatment with infliximab in patients with different BMIs as measured by hospitalization and surgery secondary to complications of IBD at 1 year of therapy initiation. This study would benefit from an increase the sample size to determine if there is significance in these outcomes.

Table 2: Recurrence and Need for Maintenance Corticosteroids



Inflammatory Bowel Disease and Selective Immunoglobulin a Deficiency Eric J. Vargas, Claudia M. Ramos Rivers, Miguel Regueiro, Arthur Barrie, Leonard Baidoo, Marc Schwartz, Jason M. Swoger, Michael A. Dunn, Anwar Dudekula, David G. Binion

The Natural History of Inflammatory Bowel Disease (IBD) in an Australian Based Community Cohort: Investigating Predictors of Severe Disease and Risk of Complications Olga Niewiadomski, Nik S. Ding, Ross E. Knight, Paul Dabkowski, Christopjher S. Hair, Emily Prewett, Sina Alexander, Damian Dowling, Benjamin Popp, John McNeil, Jarrad Wilson, Corrie Studd, Paul Desmond, William Connell, Sally Bell

Introduction: Selective Immunoglobulin A Deficiency (SIgAd) is the most commonly encountered immunoglobulin deficiency syndrome, which is identified in 1 in 500 individuals (0.2% of the population). SIgAd has a variable natural history, with some patients reaching adulthood asymptomatic, while others experience recurrent sinopulmonary infections. There is limited information regarding IgA deficiency in inflammatory bowel disease (IBD) which is limited to case reports. We sought to describe the prevalence of SIgAd in a cohort of IBD patients followed in a tertiary clinic and characterize their natural history including IBD treatment patterns, healthcare utilization and complications. Methods: Observational data from a prospectively consented IBD registry was analyzed. Patients who underwent quantitative immunoglobulin testing (i.e. immunoglobulin A (IgA), immunoglobulin G (IgG); immunoglobulin M (IgM)) comprised the study population. SIgAd was defined as serum levels ,0.07g/L along with the presence of intact IgG and IgM in the serum. Descriptive statistics were conducted on the study population. Chi Square analysis on the number of hospitalizations was conducted. Rates of biologic and immunomodulator use were investigated as well using Fisher's exact analysis. Results: There were 547 IBD patients who underwent quantitative immunoglobulin testing. 8% of the patients had elevated IgA and 4% had low levels of IgA. SIgAd was found in one quarter of these individuals (1% of the IBD patients tested; (n=6)). All 6 SIgAd patients had Crohn's disease with colonic involvement. Proximal small bowel involvement was identified in 2 patients, and 1/3 of patients had required surgery. Mean age was 36.8 + 14.9 yrs and 66% were female. Over the 3 year study period, the hospitalization rates were: SIgAd -17%, IgA deficiency -37%, normal IgA - 39%, and elevated IgA- 58% (P=0.034). Rate of anti-TNF biologic treatment in the patient groups were: SIgAd 67%; IgA deficiency - 28%; normal IgA - 38%; elevated IgA - 55% (P=0.037). Immunodulator treatment rates across the populations were similar (50%, 50%, 57% and 62%; P=0.8). Recurrent C difficile infection was identified in one individual, but infectious complications were rare despite immunosuppression. Rheumatologic problems were identified in half of these individuals. Conclusions: The prevalence of SIgAd may be increased in the tertiary referral IBD population. Most cases present with Crohn's colitis and the majority of patients required anti-TNF biologic therapy to achieve remission. Infectious complications in the SIgAd IBD patients while on immunosuppression were not seen.

Background: Recent studies in Australia have demonstrated an incidence rate of IBD of 25 to 29 per 100,000 (1,2). A registry has been set up of all new incidence cases from July 2010 to investigate the natural history of IBD in a population based cohort during the first 12 months from diagnosis. The aim is to assess the disease severity, frequency of complications and prognostic factors. Method: New incidence cases of IBD (defined by the Copenhagen criteria) in the Barwon area were prospectively recruited, from specialist's rooms, endoscopy, hospital, pharmacy, and pathology services. Patients' progress was followed prospectively. Disease severity was assessed by need for hospitalization, surgery and prolonged steroid use. Results: To date, 77 of 130 patients have been followed up for a median of 14 months (table 1). Two cases were found not to have IBD. Of the 7 patients with perianal disease, 72% were on immunomodulator therapy. Mean duration of a steroid course was 2.5 months. Figure 1 displays the percentage of patients requiring more than 1 course of steroids. At the end of follow up, 74% of CD patients were in clinical remission as assessed by the treating specialist, as were 67% of UC patients, and 50% of IBDU patients. Conclusion: A third of patients with CD and UC had at least one admission in the first year of diagnosis. A third of CD patients will require surgery, and perianal procedures accounted for more than half. Most patients will require steroids and 20% need 2 or more courses. Nearly half of CD and IBDU patients use immunomodulators, compared to 20% in UC. The high rate of immunosuppression including steroid and anti-TNF use indicates a severe phenotype. Future data will identify prognostic factors of severe disease. Results

Su1251 Outcomes of Microscopic Colitis and Smoking: A Population-Based Study Nicole M. Gentile, Sahil Khanna, Patricia P. Kammer, William J. Tremaine, Edward V. Loftus, Darrell S. Pardi Purpose: Microscopic colitis (MC) is a chronic diarrheal condition which typically is responsive to oral corticosteroids, although patients often experience recurrence and require longterm maintenance. Cigarette smoking may be a risk factor in the development of MC; however, no studies have evaluated the effect of smoking on outcomes in MC patients treated with corticosteroids. We aimed to study this question in a population-based cohort


AGA Abstracts

AGA Abstracts

disease specific QOL. Further study of psychosocial and biological variables may help explain the wide range in QOL scores and provide a more individually tailored approach to patient care.