P014 IBD AND VTE RISK: LET’S TALK ABOUT IT

Abstract Background Patients with inflammatory bowel disease (IBD) have a 1.5–3 fold increase in the risk of venous thromboembolism (VTE). Additionally, VTE in patients with IBD is associated with a 2.1 fold increase in mortality compared to the general population. The risk of VTE is increased with active inflammation. It is speculated that individuals with IBD are inconsistently advised about VTE risk. This study evaluated the frequency of counseling about VTE in IBD patients. Methods A retrospective medical record review of all IBD patients seen at a university gastroenterology practice during a 5 year period was performed. Patients’ age, gender, disease type and documented counselling about VTE risk were obtained. A database was created maintaining patient confidentiality. Analysis was conducted using Fisher’s Exact Test with significance set at p< 0.05. The study was approved by the university IRB. Results Records of 381 patients were reviewed. There were 209 females and 172 males with a mean age of 44 years (range 20–82). 279 had ulcerative colitis, 96 had Crohn’s disease and 6 had indeterminate colitis. Self-reported ethnicity included 195 White, 97 Black/African-American (AA), 11 Asian, 1 Hawaiian, 34 other and 43 did not report their ethnicity. 13 (3.4%) patients (7 females, 6 males) were counselled about VTE risk. The 7 women who were counselled were <50, with no significant difference in counselling of women <50 compared to women >50 (p=0.11). The 6 men who were counseled were <50, with no significant difference in counseling of men <50 compared to men >50 (p=0.09). There was no difference in the rate of counselling based upon gender (p=1.000), ethnicity (Whites vs. non-Whites, p=0.77; Whites vs. AA, p=1.00) or disease type (p=0.31). Discussion Venous thromboembolism is a known risk of inflammatory bowel disease. While VTEs infrequently occur in IBD patients, it is important that there is awareness about the potential risk. This study revealed that VTE risk is rarely discussed with IBD patients. While this study is limited by single institutional design, size and reliance on documentation, it suggests that increased efforts can be made to educate IBD patients about VTEs. Recognition of VTE risks can improve IBD management and optimize clinical outcomes.

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Faculty Opinions recommendation of Value of wireless capsule endoscopy in patients with indeterminate colitis (inflammatory bowel disease type unclassified).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1060732.512650 ◽

2007 ◽

Author(s):

Karel Geboes

Keyword(s):

Inflammatory Bowel Disease ◽

Capsule Endoscopy ◽

Bowel Disease ◽

Wireless Capsule Endoscopy ◽

Disease Type ◽

Indeterminate Colitis ◽

Inflammatory Bowel ◽

Wireless Capsule

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Prevalence of Joint Hypermobility and Patterns of Articular Manifestations in Patients with Inflammatory Bowel Disease

Gastroenterology Research and Practice ◽

10.1155/2009/924138 ◽

2009 ◽

Vol 2009 ◽

pp. 1-5 ◽

Cited By ~ 19

Author(s):

P. Vounotrypidis ◽

E. Efremidou ◽

P. Zezos ◽

M. Pitiakoudis ◽

E. Maltezos ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Study Groups ◽

Joint Hypermobility ◽

Fisher Exact Test ◽

Hypermobility Syndrome ◽

Exact Test ◽

Significant Difference ◽

Healthy Control ◽

Inflammatory Bowel

Objective. The objective is the investigation of Joint Hypermobility (JH) and the Hypermobility Syndrome (HMS) in patients with inflammatory bowel disease (IBD).Methods. We examined 83 patients with IBD and 67 healthy individuals for the presence of JH. Patients were excluded if they were under 18 or over 50 years of age and if they had other conditions which affect joint mobility. Thex2and the Fisher exact test were used appropriately between study groups. Odds ratios (ORs) for the risk of JH and HMS in IBD groups were calculated.Results. A total of 150 individuals (83 IBD patients and 67 healthy controls) participated in the study. 69 IBD patients, 41 with Crohn's Disease (CD) and 28 with ulcerative colitis (UC), were finally eligible. JH was detected in 29 CD patients (70.7%), in 10 UC patients (35.7%), and in 17 healthy control subjects (25.4%). Significant difference was detected on JH in CD patients as compared to UC patients (P=.0063) and controls (P<.0001). The estimated OR for JH was 7.108 (95% CI: 2.98–16.95) in CD and 1.634 (95% CI: 0.63–4.22) in UC patients. HMS was detected in 5 (12.2%) CD and in 1 (3.57%) UC patients. The OR for HMS in CD was 3.75 (95% CI: 0.41–34.007), while 7 (17.1%) CD patients had overlapping symptoms for both HMS and early spondylarthropathy.Conclusions. JH and the HMS are common in CD patients, thus articular manifestations should be carefully interpreted. This implies an involvement of collagen varieties in the pathogenesis of IBD.

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Faculty Opinions recommendation of Capsule endoscopy in inflammatory bowel disease type unclassified and indeterminate colitis serologically negative.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14267162.15779331 ◽

2012 ◽

Author(s):

Karel Geboes

Keyword(s):

Inflammatory Bowel Disease ◽

Capsule Endoscopy ◽

Bowel Disease ◽

Disease Type ◽

Indeterminate Colitis ◽

Inflammatory Bowel

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Capsule endoscopy in inflammatory bowel disease type unclassified and indeterminate colitis serologically negative

Inflammatory Bowel Diseases ◽

10.1002/ibd.21249 ◽

2010 ◽

Vol 16 (10) ◽

pp. 1663-1668 ◽

Cited By ~ 36

Author(s):

Sandra Lopes ◽

Pedro Figueiredo ◽

Francisco Portela ◽

Paulo Freire ◽

Nuno Almeida ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Capsule Endoscopy ◽

Bowel Disease ◽

Disease Type ◽

Indeterminate Colitis ◽

Inflammatory Bowel

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P026 - Capsule endoscopy in indeterminate colitis/inflammatory bowel disease type unclassified — a single-center experience

Journal of Crohn s and Colitis ◽

10.1016/s1873-9946(09)60053-2 ◽

2009 ◽

Vol 3 (1) ◽

pp. S21

Author(s):

S. Lopes ◽

P. Figueiredo ◽

F. Portela ◽

P. Duarte ◽

P. Freire ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Capsule Endoscopy ◽

Bowel Disease ◽

Disease Type ◽

Indeterminate Colitis ◽

Single Center ◽

Single Center Experience ◽

Inflammatory Bowel

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P691 Corticosteroids usage in patients with inflammatory bowel disease: Results of a multi-national audit in Asia

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.819 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S562-S562

Author(s):

D H Kim ◽

D I Park ◽

T Kobayashi ◽

V Ahuja ◽

B I Jang ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Side Effects ◽

Bowel Disease ◽

Disease Duration ◽

Significant Proportion ◽

Patient Characteristics ◽

Case Report Form ◽

Indeterminate Colitis ◽

Significant Difference ◽

Inflammatory Bowel

Abstract Background The use of corticosteroids (CS) has been a well-established treatment for active Inflammatory bowel disease (IBD). While many investigators have reported the efficacy of CS in treating IBD, systemic CS are often associated with various side-effects. The aim of this study was to investigate the present status of CS usage in Asian patients with IBD. Methods Authors reviewed medical records of IBD patients who were regularly followed at multiple centres in South Korea, China, Japan, and India. Patient characteristics including diagnosis, phenotype, severity at diagnosis, and treatment history of CS usage in the prior 12 months were collected using web-based case report form. All cases of CS usage were reviewed of its suitability and were categorised as ‘non-IBD’, ‘appropriate’, and ‘avoidable’ groups. Results A total of 1,291 patients (434 Crohn’s disease [CD], 848 ulcerative colitis [UC], and 9 Indeterminate colitis) from 4 countries (18 physicians from 8 hospitals) were reviewed between May and September 2019. Among them, 339 patients (26.3%) received CS during the past year. There was no significant difference in the incidence of CS use between CD and UC patients. Multiple CS exposure over the recent 12 months were identified in 16 patients (4.7%). The mean duration of CS use was 96.5 days. Short-term and long-term side-effects of CS occurred in 21 (6.1%) and 4 (1.2%) patients, respectively. 285 patients (84.1%) were able to reduce the dosage of CS below the prednisolone equivalent of 10mg/day within 3 months from CS initiation without recurrence of the disease. However, 15 patients (4.4%) relapsed after stopping CS. A total of 340 CS used cases were confirmed in the 339 patients when cases with undeterminable suitability of its use were excluded and 36 events (10.6%) were classified as avoidable CS use. Patients who received ‘avoidable’ CS had longer disease duration than who received ‘appropriate’ CS (3227.5 days and 1450.5 days, respectively. p = 0.007). Both ‘avoidable’ and ‘appropriate’ group had started with similar CS dosage (37.2 and 38.8mg, respectively. p = 0.694). However, ‘avoidable’ group received CS longer than ‘appropriate’ group (125.7 and 37.7 days, respectively. p = 0.013). Multivariate analysis revealed that longer disease duration was significantly related with ‘avoidable’ CS exposure (OR=1.166; 95% CI=1.023–1.329; p = 0.022). Conclusion Treatment for IBD is advancing; however, a significant proportion of patients still receive CS. In particular, the longer the disease duration, ‘avoidable’ CS uses in patients tend to increase. Application of CS in patients with IBD should be delivered with much caution, as ‘avoidable’ CS use is associated with longer CS use.

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P030 WHAT ABOUT DEPRESSION? INCREASED DISCUSSION BY GASTROENTEROLOGISTS MAY BE NEEDED.

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.150 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S59-S59

Author(s):

Katherine Negreira ◽

Jessica Gibilisco ◽

Vinay Rao ◽

Jenny Dave ◽

Marie Borum

Keyword(s):

Psychological Health ◽

Disease Type ◽

Care Utilization ◽

Indeterminate Colitis ◽

Exact Test ◽

Included Patient ◽

Significant Difference ◽

Prevalence Of Depression ◽

Inflammatory Bowel

Abstract Introduction Studies have reported an increased prevalence of depression in patients with inflammatory bowel disease (IBD). Depression rates have been reported as high as 21.2% in IBD patients compared to 13.4% in healthy controls (1). Addressing depression and improvement in psychological health has been associated with decrease in IBD-related morbidity, reduction in health-care utilization and improvement in quality of life (2). This study evaluated the rate at which gastroenterology providers discussed or documented depression and /or anxiety in IBD patients. Methods A 5-year chart review of all IBD patients seen in a university GI clinic was conducted. A confidential database using Microsoft Excel included patient age, gender, race, disease type, depression or anxiety (in GI notes or remainder of electronic medical record) was created. Statistical analysis using Fisher’s Exact Test was performed with significance set at p<0.05. The study was approved by the institutional IRB. Results 381 records of IBD patients were reviewed. There were 209 females and 172 males (mean age 44 years; range 20–82). 96 had Crohn’s disease, 279 had Ulcerative Colitis, and 6 had indeterminate colitis. Self-reported race/ethnicity included 195 White, 97 African American (AA), 11 Asian, 1 Hawaiian, 34 other and 43 did not document an ethnicity. 66 (17.32%) patients had depression and/or anxiety, 298 (78.22%) did not have depression and/or anxiety and 17 (4.46%) patients did not have documentation of mental health discussion during appointments. In patients with depression and/or anxiety, 46.97% had it documented by a gastroenterology provider. There was no statistically significant difference of depression and / or anxiety based upon gender (p=1.000), ethnicity (White vs AA p=1.000; White vs Asian p=0.2129; Asian vs AA p=0.208) or disease type (p=0.091). Conclusion Depression is reported to occur more frequently in patients with IBD compared to the general population. However, this study revealed that university gastroenterology providers did not consistently document the presence of or a discussion about depression and/or anxiety. While this study is limited based upon size and single institution design, it suggests that increased attention to psychological health is needed in IBD patients to optimize health and clinical outcomes. References

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24 ENDOSCOPIC AND CLINICAL CHARACTERISTICS OF POUCHITIS INVOLVING THE RECTAL CUFF IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE TREATED BY PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.031 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S13-S14

Author(s):

Shintaro Akiyama ◽

Jacob Ollech ◽

Victoria Rai ◽

Laura Glick ◽

Jorie Singer ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Multivariate Analysis ◽

Bowel Disease ◽

Ileal Pouch ◽

Univariate Analysis ◽

Ileal Pouch Anal Anastomosis ◽

Indeterminate Colitis ◽

Significant Difference ◽

Anal Anastomosis ◽

Inflammatory Bowel

Abstract Background For patients with inflammatory bowel disease (IBD), surgical intervention is sometimes required due to medically refractory colitis or development of neoplasia. Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the most common procedure for patients with colitis. However, pouchitis can develop in up to 80% of patients after the surgery and significantly impairs quality of life. Despite the high prevalence of pouchitis, endoscopic phenotypes have not been clarified. This study assessed the frequency and characteristics of inflammation involving the rectal cuff. Methods This is a retrospective study from a tertiary IBD center of IBD patients treated by total proctocolectomy with IPAA and subsequently underwent pouchoscopies at the University of Chicago between January 2007 and September 2019. We reviewed the endoscopic findings in different areas of the pouch: the pre-pouch ileum, inlet, “tip of the J”, proximal and distal pouch, anastomosis, rectal cuff, anal canal, and perianal area. This analysis evaluated all available pouchoscopies per patient and included patients with normal cuff and those with cuffitis noted in every pouchoscopy. Demographic and endoscopic data were assessed to compare patients with normal cuff and those with cuffitis. Fisher’s test was used for a univariate analysis to assess factors contributing to cuffitis. Logistic regression analysis was performed as a multivariate analysis including univariate variables with a P-value < 0.15. Results We reviewed 1,081 pouchoscopies from 426 IBD patients who underwent proctocolectomy with IPAA and identified 184 patients (43%) with normal cuff and 107 (25%) with cuffitis. Of these 291 patients, 57% were men, 92% were Caucasian, the mean age at the diagnosis (SD) was 26 ± 12 years, and mean BMI 26 ± 5 kg/m2. The diagnosis before surgery for these patients were for ulcerative colitis (91%), indeterminate colitis (5.8%), and Crohn’s disease (1.7%). A significant difference (P = 0.003) was found in the frequency of pouchitis between patients with normal cuff (126/184, 69%) and those with cuffitis (90/107, 84%) (Table 1). Although not statistically significant, the frequency of pouch failure in patients with cuffitis (13/107, 12%) was higher than those with normal cuff (12/184, 6.5%). Multivariate analysis showed pouchitis was significantly associated with cuffitis (OR = 2.2; 95% CI = 1.2–4.2; P = 0.01) (Table 2). Endoscopic data showed that the pre-pouch ileum was significantly (P = 0.001) involved in patients with cuffitis (45/90, 50%) compared with those with normal cuff (36/126, 29%). Conclusion Our analysis of 291 patients suggested that cuff inflammation can be a significant risk factor of pouchitis and is significantly associated with the development of inflammation in the pre-pouch ileum. Cuffitis can be a therapeutic target to improve J pouch outcomes.

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