P154 Sinusitis Prompts Evaluation for Co-existing or Subsequent inflammatory bowel disease

Abstract Background The relationship between sinusitis and inflammatory bowel disease (IBD) has not yet been established. Though the two are characterised by dysfunction of the epithelial barrier, there lacks evidence on the relative contributions of infection or inflammation to this co-morbidity in IBD patients. Previous analyses from our group identified an increased prevalence of sinusitis among patients with IBD, predictive factors of developing sinusitis in IBD, and differences in stratifying patients with IBD and sinusitis (IBD+S) based on order in which these conditions were diagnosed. We now report on the factors associated with the development of IBD in patients with sinusitis. Methods This is a retrospective study at our tertiary IBD center. We utilised our institution’s electronic medical record data warehouse of 2.4 million patients to identify those with diagnostic codes for both sinusitis (J32) and IBD (K50.90 and K51.90). Patients with a confirmed diagnosis of IBD and/or sinusitis between 1/2000–5/2019 and age ≥18 years were included. Demographic and disease-related information were collected. Categorical variables were analysed using Fisher’s exact test and continuous variables were analysed using Wilcoxon rank-sum test. Results Of 14,366 patients with IBD, 386 (2.69%) patients have IBD+S. Of the 386 IBD+S patients, 118 patients (30.6%) were diagnosed with sinusitis before IBD. These 118 IBD+S patients were included in univariate and multivariate analysis with 14,753 non-IBD patients with sinusitis. The average age at IBD diagnosis among all IBD patients was 37.32 ± 18.79 years, and the average age at sinusitis diagnosis for sinusitis patients was 40.93 ± 21.42 years. On multivariate analysis, age of sinusitis diagnosis >40 years old (OR 1.52, 95% CI 1.04–2.28), black race (OR 2.82, 95% CI 1.29–7.43), white race (OR 4.33, 95% CI 2.02–11.23), and female sex (OR 1.52, 95% CI 1.03–2.28) were significant predictors of IBD in sinusitis patients (Table 1A). In comparison, multivariate analysis showed that black race (OR 8.09, 95% CI 4.91–14.26), white race (OR 3.35, 95% CI 2.08–5.80), female sex (OR 1.51, 95% CI 1.22–1.87), and bowel obstruction (OR 2.00, 95% CI 1.53–2.58) were significantly associated with sinusitis in IBD patients (Table 1B). Conclusion Sinusitis patients diagnosed older than 40 years old have 1.5 greater odds of subsequent IBD, suggesting that a diagnosis of sinusitis should prompt consideration of co-existing or subsequent IBD risk. Female sex and race are shared factors in the risk of sinusitis in IBD patients and risk of IBD in sinusitis patients.

Download Full-text

P107 SINUSITIS IS A RISK FOR SUBSEQUENT INFLAMMATORY BOWEL DISEASE

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.052 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S22-S23

Author(s):

Victoria Rai ◽

Cindy Traboulsi ◽

George Gulotta ◽

David Rubin

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Categorical Variables ◽

Continuous Variables ◽

Exact Test ◽

Related Information ◽

Diagnostic Codes ◽

Co Morbidity ◽

Inflammatory Bowel ◽

Never Smokers

Abstract Introduction The relationship between sinusitis and inflammatory bowel disease (IBD) has not yet been established. Though the two are characterized by dysfunction of the epithelial barrier, there lacks evidence on the relative contributions of infection or inflammation to this co-morbidity in IBD patients. Previous analysis from our group (ACG 2019) identified an increased prevalence of sinusitis among patients with IBD, but that work did not include a stratified analysis of IBD patients with sinusitis based on the order in which these conditions were diagnosed. Methods This is a retrospective study at our tertiary IBD center. We utilized our institution’s electronic medical record data warehouse of 2.4 million patients to identify those with diagnostic codes for both sinusitis (J32) and IBD (K50.90 and K51.90). Patients with a confirmed diagnosis of IBD and/or sinusitis between January 2000 and May 2019 and age ≥18 years were included. Demographic and disease related information were collected, including dates of diagnosis for both sinusitis and IBD. Categorical variables were analyzed using Fisher’s exact test and continuous variables were analyzed using Wilcoxon rank sum test. Results Of 14,366 patients with IBD, 386 patients (2.69%) were diagnosed with both IBD and sinusitis (IBD+S). The average age of IBD diagnosis in the IBD only group was 37.30 (18.76) years and IBD+S group was 38.36 (19.81) years (p = 0.27). Of the 386 patients with IBD+S, 268 (69.4%) were diagnosed with IBD before sinusitis and 118 (30.6%) were diagnosed with IBD after sinusitis (Table 1). The average age of IBD diagnosis in the IBD before sinusitis group was 33.2 ± 17.3 years, which was significantly younger than patients in the IBD after sinusitis group of 50.2 ± 20.2 years (p < 0.001). The average time between diagnoses was significantly more in the group diagnosed with IBD before sinusitis compared with the group diagnosed with IBD after sinusitis (7.64 ± 8.89 years vs 3.73 ± 3.16 years, respectively; p < 0.001). In addition, patients diagnosed with IBD after sinusitis were significantly less likely to be of white race, never smokers, have Crohn’s disease, bowel obstruction, or be receiving immunosuppressive medications. Conclusions There are significant differences in the characteristics of patients with IBD and sinusitis from IBD only patients, and even greater differences when stratifying the IBD+S group based on the order of diagnoses. Within the subgroup of IBD+S, most notably, patients with sinusitis first have an older age of IBD diagnosis. These findings suggest that a diagnosis of sinusitis should prompt consideration of co-existing or subsequent risk of IBD.

Download Full-text

P567 Pharmacist-managed immunomodulator clinic in titration and monitoring of immunosuppressants in Inflammatory Bowel Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.688 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S527-S527

Author(s):

V Ng ◽

T G Lim ◽

W C Ong ◽

S Y A Wong ◽

E Salazar ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Medication Adherence ◽

Side Effects ◽

Bowel Disease ◽

Care Service ◽

Severe Disease ◽

Categorical Variables ◽

Close Monitoring ◽

Continuous Variables ◽

Inflammatory Bowel

Abstract Background Immunomodulators (IMs) such as azathioprine are the cornerstone in the treatment of inflammatory bowel disease (IBD). However, they are associated with significant toxicity and requires close monitoring for side effects, which puts a stretch on our physician clinics. The pharmacist-run Immuno Clinic (IMC) was set up in 2016 to assist in the monitoring of stable patients and initial titration phase of IMs so that physicians are able to focus their time and energy on patients with more complex diseases. The objective of this study is to demonstrate that IMC is able to effectively and safely carry out its purpose for patient’s disease management, medication adherence and adverse events management, resulting in time and cost savings. Methods This is a retrospective study looking at IBD patients who attended IMC from Aug 2016 to July 2019. Patients’ demographics, disease control, medication adherence and adverse effects were obtained from the IMC database. Descriptive data were analyzed using frequency distribution for categorical variables. Continuous variables were expressed as median and interquartile range (IQR). Results A total of 73 patients were included. Thirty-six (49.3%) patients had CD, while 37 (50.7%) patients had UC. A total of 185 actions were executed over 173 IMC sessions, including dose adjustment (57), recommending additional medications (14), discontinuation or restarting IM (12), side effects detection (25), monitoring recommendations (10), non-adherence detection (39), referral to physician (23), and others (5). In 2 out of 173 visits (1.1%), severe disease flare requiring hospitalization was detected and referred back to the primary physician for inpatient admission. Thirty ADRs were detected (17.3 %) and managed promptly. There were 24 cases of non-adherence detected and counselled (13.9%). Out of 38 patients who were referred for titration of IM, 28 patients (73.7%) achieved the target dose of IM. Patient visits were largely independently managed by pharmacists (150 out of 173, 86.7%). Conclusion Implementation of pharmacist-led IMC is a safe and cost-effective alternative to conventional gastroenterology clinic for monitoring and titration of IMs, enabling physicians to focus on more complicated cases and thus improving access to the IBD ambulatory care service.

Download Full-text

Assessment of Benefit of Advanced Inflammatory Bowel Disease Training: Challenges and Solutions

Crohn's & Colitis 360 ◽

10.1093/crocol/otaa019 ◽

2020 ◽

Vol 2 (2) ◽

Author(s):

Kelly C Cushing ◽

Tomer Adar ◽

Matthew Ciorba ◽

Ashwin N Ananthakrishnan

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Faculty Position ◽

Research Mentoring ◽

Wilcoxon Rank Sum Test ◽

Inflammatory Bowel ◽

Competency Assessments

Abstract Background Advanced inflammatory bowel disease (IBD) fellowships are available for gastroenterologists who wish to increase their expertise in complex IBD. However, little is known about the outcomes of such training. The aims of this study were to assess clinical and academic outcomes following advanced training in IBD. Methods We surveyed gastroenterologists who completed advanced IBD fellowships and compared competency and outcomes to gastroenterologists focusing in IBD who completed gastroenterology training alone. Participants completed a survey via REDCap. Continuous variables were compared using the Wilcoxon rank-sum test. Categorical variables were compared using chi-square or Fisher’s exact tests. Results A total of 104 physicians participated in the study. IBD fellowships were completed by 31 physicians (30%), of whom 29 (94%) felt their training was excellent. Management of complicated IBD (84%), research mentoring (74%), and career mentoring (71%) were felt to contribute most highly to professional development. Compared to non-advanced trained physicians, advanced trained physicians expressed higher levels of comfort with management of IBD during pregnancy (P = 0.003), complicated IBD (P = 0.057), and peri-operative IBD (P = 0.057). No significant advantage was detected in academic productivity. Common barriers to participation in IBD fellowships included feeling it was unnecessary (45%) and desire to begin a faculty position (42%). Conclusions This study suggests there may be clinical benefit to advanced IBD training. Importantly, this study identified that there are also unique challenges to the assessment of clinical competency in IBD training. Efforts by the IBD community to establish a registry of advanced trainees and improve competency assessments are needed.

Download Full-text

A102 ADVERSE PREGNANCY-RELATED OUTCOMES IN WOMEN WITH INFLAMMATORY BOWEL DISEASE

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.100 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 77-79

Author(s):

Y Hanna ◽

P Tandon ◽

V W Huang

Keyword(s):

Inflammatory Bowel Disease ◽

Disease Activity ◽

Bowel Disease ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Categorical Variables ◽

History Of ◽

Inflammatory Bowel ◽

Adverse Pregnancy ◽

Aspirin Prophylaxis

Abstract Background Women with active inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes such as preeclampsia. Though aspirin prophylaxis is prescribed in the general population (prior to 16 weeks’ gestation) for those at high-risk of preeclampsia, its use in patients with IBD has not been established. Aims To determine the frequency of and risk factors for adverse pregnancy outcomes in women with IBD, and to evaluate the risk for preeclampsia and the use of aspirin for primary prevention. Methods All pregnant women with IBD (Crohns disease (CD), ulcerative colitis (UC) and IBD-unclassified (IBDU)) seen at Mount Sinai Hospital from 2016–2020 were retrospectively identified. Demographics, reproductive history, and IBD characteristics including therapy and activity during pregnancy were recorded. Adverse pregnancy outcomes were also identified. Active disease during pregnancy was defined as a fecal calprotectin > 250 ug/g and/or using clinical disease activity scores. Categorical variables were compared using the Chi-square (x2) test and continuous variables using the Mann-Whitney test. A two-sided p-value less than 0.05 was considered statistically significant. Results 127 patients (66 with CD, 60 with UC, 1 with IBDU) were included with a median age of 32 years at conception. The majority were Caucasian (70.9%), married (82.7%), completed post-secondary education (69.3%), had no prior or current smoking (78.7%) or alcohol use history (67.7%), and had no other comorbidities (81.9%). 50.4% of women had a prior pregnancy. 3 had a history of preeclampsia and 15/127 were prescribed aspirin prophylaxis. 73.2% of women were in clinical remission at conception. Compared to women with CD, women with UC were more likely to have infants with low birth weight (LBW) (p=0.031), small for gestational age (SGA) (p=0.002) and had higher rates of active IBD during pregnancy (p=0.005). 13 women with IBD developed preeclampsia (6 with UC and 7 with CD). IBD type (p=0.844) and disease activity (p=0.308) were not associated with preeclampsia. Married women (p=0.001) while those who had a preconception consultation (50/127) (p=0.009) had lower rates of preeclampsia while those with a prior history of preeclampsia had higher rates (p=0.002). Among women who developed preeclampsia, pregnancy outcomes were comparable to those who did not. Women on aspirin prophylaxis (5/13) had a higher rate of preeclampsia (p=0.012), although they were also more likely to have a history of preeclampsia (p=0.002). Aspirin use was not associated with subsequent disease activity in pregnancy (p=0.830). Conclusions Women receiving aspirin prophylaxis had higher rates of preeclampsia, likely owing to a higher baseline risk. Preeclampsia prevention with aspirin prophylaxis does not appear to result in disease flares but larger studies are needed to confirm this finding. Funding Agencies None

Download Full-text

Risk factors for developing high-output ileostomy in CRC patients: a retrospective study

BMC Surgery ◽

10.1186/s12893-021-01288-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dongxiao Bai ◽

Lei Li ◽

Zhiling Shen ◽

Tianchen Huang ◽

Qingbing Wang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Inflammatory Bowel Disease ◽

Multivariate Analysis ◽

Anastomotic Leakage ◽

Bowel Disease ◽

Total Colectomy ◽

Abdominal Infection ◽

Inflammatory Bowel ◽

High Output

Abstract Background Anastomotic leakage is one of the most serious postoperative complications of rectal cancer. Prophylactic ileostomy has been widely used to reduce the risk and severity of complications of anastomotic leakage. However, prophylactic ileostomy itself has some complications, and ileostomy high output syndrome (HOS) is one of them. This study was performed to explore the risk factors of HOS in ileostomy. Methods A total of 114 patients with HOS were screened out from 494 eligible ileostomy patients in the last 5 years. The relationship between HOS and the clinicopathological data was analyzed using the Chi-square test and Fisher’s exact probability. Multivariate analysis was performed by logistic regression. Results The incidence of HOS was 23.07% in this study. Dehydration was the most common symptom of HOS (37.7%). There was no clear correlation between HOS occurrence with sex, age, gross typing, histological grade, tumor location, lymph node metastasis, and TNM stage (p > 0.05). The incidence of HOS was 14/18 in inflammatory bowel disease patients, 18/28 in diabetes mellitus patients, and 23/72 in neoadjuvant chemoradiotherapy patients, 13/17 in total colectomy and abdominal infection patients. Multivariate analysis showed that they are risk factors for HOS (p < 0.05). Conclusion HOS occurred occasionally but rarely studied and lacks attention. Inflammatory bowel disease, diabetes mellitus, neoadjuvant radiotherapy chemotherapy, total colectomy and abdominal infection are the risk factors for HOS.

Download Full-text

QUALITY OF LIFE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: importance of clinical, demographic and psychosocial factors

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032014000300005 ◽

2014 ◽

Vol 51 (3) ◽

pp. 192-197 ◽

Cited By ~ 14

Author(s):

Joana MAGALHÃES ◽

Francisca Dias de CASTRO ◽

Pedro Boal CARVALHO ◽

Maria João MOREIRA ◽

José COTTER

Keyword(s):

Quality Of Life ◽

Inflammatory Bowel Disease ◽

Social Relations ◽

Bowel Disease ◽

Multivariate Regression ◽

Univariate Analysis ◽

Female Gender ◽

Categorical Variables ◽

Inflammatory Bowel

Context Inflammatory bowel disease causes physical and psychosocial consequences that can affect the health related quality of life. Objectives To analyze the relationship between clinical and sociodemographic factors and quality of life in inflammatory bowel disease patients. Methods Ninety two patients with Crohn’s disease and 58 with ulcerative colitis, filled in the inflammatory bowel disease questionnaire (IBDQ-32) and a questionnaire to collect sociodemographic and clinical data. The association between categorical variables and IBDQ-32 scores was determined using Student t test. Factors statistically significant in the univariate analysis were included in a multivariate regression model. Results IBDQ-32 scores were significantly lower in female patients (P<0.001), patients with an individual perception of a lower co-workers support (P<0.001) and career fulfillment (P<0.001), patients requiring psychological support (P = 0.010) and pharmacological treatment for anxiety or depression (P = 0.002). A multivariate regression analysis identified as predictors of impaired HRQOL the female gender (P<0.001) and the perception of a lower co-workers support (P = 0.025) and career fulfillment (P = 0.001). Conclusions The decrease in HRQQL was significantly related with female gender and personal perception of disease impact in success and social relations. These factors deserve a special attention, so timely measures can be implemented to improve the quality of life of patients.

Download Full-text

Do Patients With Inflammatory Bowel Disease Benefit from an Enhanced Recovery Pathway?

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz172 ◽

2019 ◽

Vol 26 (3) ◽

pp. 476-483 ◽

Cited By ~ 4

Author(s):

David Liska ◽

Turgut Bora Cengiz ◽

Matteo Novello ◽

Alexandra Aiello ◽

Luca Stocchi ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Multivariate Analysis ◽

Bowel Disease ◽

Enhanced Recovery ◽

Hospital Costs ◽

Estimated Blood Loss ◽

Enhanced Recovery Pathways ◽

Inflammatory Bowel ◽

Outpatient Operations ◽

Recovery Pathways

Abstract Background Enhanced recovery pathways (ERPs) have been shown to reduce length of stay (LOS), complications, and costs after colorectal surgery; yet, little data exists regarding patients with inflammatory bowel disease (IBD). We hypothesized that implementation of ERP for IBD patients is associated with shorter LOS and improved economic outcomes. Methods An IRB-approved prospective clinical database was used to identify consecutive patients from 2015 to 2017. Patients were grouped as “pre-ERP” and “post-ERP” based on the date of implementation of a comprehensive ERP. Ileostomy closures, redo pouch operations, and outpatient operations were excluded. The relationship between ERP, LOS, and secondary outcomes was assessed using univariate and multivariate analysis. Results Overall, a total of 671 patients were included: 345 (51.4%) with Crohn’s disease (CD) and 326 (48.6%) with ulcerative colitis (UC). Of these, 425 were pre-ERP (63.4%), and 246 were post-ERP (36.6%). The groups did not differ in terms of age, gender, American Society of Anesthesiologist (ASA) scores, comorbidities, estimated blood loss, or ostomy construction. The post-ERP group had a significantly higher mean body mass index (BMI), more patients with CD, longer operative time, and more minimally invasive surgery (MIS; all P < 0.05). The post-ERP group had a significantly shorter LOS (6 vs 4.5 days, median), whereas mean hospital costs decreased by 15.7%. There was no difference in readmissions or complications. On multivariate analysis, MIS and ERP use were both associated with a shorter LOS. Conclusion Inflammatory bowel disease patients benefit from the use of ERP, demonstrating decreased LOS and costs without an increase in complications and readmissions. Enhanced recovery pathways should be routinely implemented in this often challenging patient population.

Download Full-text

Infection with cytomegalovirus in patients with inflammatory bowel disease: prevalence, clinical significance and outcome

Journal of Medical Microbiology ◽

10.1099/jmm.0.45629-0 ◽

2004 ◽

Vol 53 (11) ◽

pp. 1155-1160 ◽

Cited By ~ 135

Author(s):

Janak Kishore ◽

Ujjala Ghoshal ◽

Uday C Ghoshal ◽

Narendra Krishnani ◽

Sanjay Kumar ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Multivariate Analysis ◽

Clinical Significance ◽

Bowel Disease ◽

Fisher Exact Test ◽

Cmv Infection ◽

Igm Antibody ◽

Colonic Biopsy ◽

Inflammatory Bowel ◽

Histological Activity

Despite frequent use of immunosuppressive drugs in patients with inflammatory bowel disease (IBD) and reports of cytomegalovirus (CMV) infection following post-transplant immunosuppression, data on the frequency and clinical significance of CMV in patients with IBD are scant. Sixty-three patients with IBD (61 ulcerative colitis and two Crohn's disease) were evaluated for CMV using serology (IgM antibody, μ-capture ELISA), PCR for CMV DNA in colonic biopsy and histological assessment of haematoxylin and eosin-stained colonic biopsy. Positive result in any test was considered as CMV infection. Various parameters associated with CMV infection were analysed using univariate and multivariate analysis. Ten of 63 (15.8 %) patients (age 36.0 ± 11.2 years, 31 female) were infected with CMV (DNA alone in four, IgM antibody alone in two and both in four, inclusion body in one). Patients with CMV infection were more often female (8/10 vs 23/53, P < 0.05), had pancolitis (10/10 vs 33/53, P < 0.05), histological activity (9/10 vs 17/53, P < 0.005) and used azathioprine (5/10 vs 7/53, P = 0.04; Fisher exact test for all). On multivariate analysis, female gender, pancolitis and histological activity were the independent factors associated with infection. Patients with CMV infection more often required surgical treatment for IBD (4/10 vs 4/53, P = 0.01) and had fatal outcome (3/10 vs 0/53, P = 0.003). CMV infection in patients with IBD may be common and is associated with poor outcome. PCR of rectal biopsy was the most sensitive method of detection followed by IgM antibody for diagnosis.

Download Full-text

P652 Treatment patterns in patients receiving outpatient care for inflammatory bowel disease in Russian Federation

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.772 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S582-S583

Author(s):

Y Uspenskiy ◽

M Galagudza ◽

S Ivanov ◽

Y Fominikh ◽

R Dreval ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Russian Federation ◽

Bowel Disease ◽

Outpatient Care ◽

Treatment Patterns ◽

Continuous Variables ◽

Aminosalicylic Acid ◽

Old Patients ◽

Topical Glucocorticoids ◽

Inflammatory Bowel

Abstract Background There is a global trend of increasing prevalence of inflammatory bowel disease (IBD) worldwide, Russian Federation including. Meanwhile, treatment options for patients with IBD have expanded significantly in recent years with the advent of novel biotherapeutics. However, insufficient information is available on the treatment patterns of Crohn’s disease (CD) and ulcerative colitis (UC) in large cities. We aimed to study the levels of usage of different therapeutic agents in the patients with IBD receiving outpatient care in St-Petersburg, Russian Federation. Methods In a cross-sectional study lasting from January 1, 2019 to December 31, 2019, the data on drug therapy of adult (> 18 years old) patients with IBD were obtained from 42 outpatient clinics of St. Petersburg. The Wilson’s method of 95% confidence interval (CI) determination was used to determine the statistical differences in the levels of usage of different therapeutics. р values ≤ 0.05 were considered significant. The data on continuous variables are presented as “median (25 quartile; 75 quartile)”. Results In total, 535 patients were included. Among them, there were 241 and 294 patients with CD and UC, respectively. Mean age of the patients with CD and UC was 40 (29; 59) and 43 (32; 59) years, respectively (p > 0.05). Among the patients with CD, the ileal, colonic, ileocolonic, and other locations were found in 23.4, 37.6, 34.4, and 4.6 %, respectively. In UC patients, we observed proctitis, left-sided colitis and pancolitis in 24.4, 55.2, and 20.4%, respectively. Oral 5-aminosalicylic acid (5-ASA) drugs, topical 5-ASA drugs, oral (both systemic and topical) glucocorticoids, immunosuppressants, and biologicals were used in 89.3 (84.4–92.8), 32.6 (26.7–39.1), 17.5 (13.0–23.1), 16.5 (12.2–22.0), and 7.3% (0.4–11.7) of patients with CD, accordingly. In UC patients, oral 5-ASA, topical 5-ASA, oral (both systemic and topical) glucocorticoids, immunosuppressants, and biologicals were used in 86.2 (81.4–90.0), 63.1 (56.9–68.8), 12.1 (8.6–16.8), 4.4 (2.5–7.7), and 0.8% (0.02–2.7) of cases, accordingly. Conclusion Oral 5-ASA is the most commonly used class of drugs in Russian patients with both CD and UC. The use of topical 5-ASA formulations was more common in patients with UC as compared to CD patients, while immunosuppressive drugs were more commonly prescribed to CD vs. UC patients. We found relatively rare use of systemic and topical oral glucocorticoids in the patients with IBD receiving outpatient care. In our cohort, the use of biological agents was minimal, which probably reflects the trend of prescribing biologicals mostly at the specialized clinics.

Download Full-text

P320 Thrombocytosis in acute inflammatory bowel disease: a useful biomarker?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.449 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S313-S314

Author(s):

K Gazelakis ◽

I Chu ◽

C Martin ◽

M Ward ◽

M Sparrow

Keyword(s):

Inflammatory Bowel Disease ◽

Multivariate Analysis ◽

Platelet Count ◽

Bowel Disease ◽

Acute Diarrhoea ◽

Inclusion Criteria ◽

Infectious Gastroenteritis ◽

Significant Difference ◽

Inflammatory Bowel ◽

And Biological Markers

Abstract Background Differentiating between infectious gastroenteritis and a flare of inflammatory bowel disease (IBD) can be difficult. Small studies have shown that thrombocytosis may not occur in infectious gastroenteritis. We aimed to determine whether thrombocytosis is a reliable biomarker in distinguishing between these two diagnoses in patients presenting with diarrhoea. Methods A retrospective cohort study was conducted at a tertiary referral IBD centre. From January 2000 and December 2018, patients admitted with acute diarrhoea were included. Inclusion criteria were infective gastroenteritis, IBD flare or both. IBD diagnosis was confirmed by standard clinical, radiological and histopathological criteria. Clinical and biochemical parameters were collected. Results There were 351 infectious and 506 IBD flare cases. Among these 216 (42.8%) had Crohn’s disease, 276 (54.7%) ulcerative colitis, and 13(2.6%) had IBD-unclassified. Table 1 summarises the main results. Those with acute IBD flare had a longer duration of diarrhoea, bloody diarrhoea, lower albumin and anaemia (p < 0.05 for all comparisons). Patients with infectious diarrhoea were more likely to be older, female, have vomiting and fever and leucocytosis (p < 0.05 for all comparisons). Median platelet count was higher in patients with IBD flares, 334 vs. 220 (p < 0.001) and persisted on multivariate analysis (p < 0.001, OR1.45). On multivariate analysis, other significant associations for IBD flare were age (OR.85, p < 0.001) female sex (OR.23, p < 0.110), blood in faeces (OR 5.98, p < 0.001) vomiting (OR .17, p < 0.001) and albumin (OR.83, p = 0.02). A sub-analysis compared patients with known IBD and infectious gastroenteritis with an identified pathogen (n = 47), with those with an IBD flare alone showed no significant difference in platelet count between groups (419 vs. 465, respectively, p = 0.17). Conclusion Our study shows significant differences between clinical and biological markers in patients with acute IBD flares compared with those with infectious gastroenteritis. In particular, thrombocytosis occurs in IBD flares but not in infectious gastroenteritis. This biomarker can be used to differentiate between these diagnoses and guide management.

Download Full-text