Diagnostic Radiation Exposure in Patients with Inflammatory Bowel Disease

Background. Because of the chronic and relapsing nature of inflammatory bowel disease (IBD), which often requires characterization with CT scan, IBD patients might be exposed to a large amount of radiation. As a cumulative effective dose (CED) ≥ 100 mSv is considered significant for stochastic risks of cancer, it is important to monitor and control the radiation exposure of the IBD patients. In the present work, we aimed to quantify the mean CED in IBD patients to assess any harmful effects of radiation. Methods. This study includes 200 IBD patients, identified retrospectively, from the outpatient clinics of the Centre Hospitalier de l’Université de Montréal between January 1, 2010, and February 15, 2017, from the gastroenterologists’ patients lists. The number and type of each radiology test performed were listed for each patient during the study period and the CED was calculated using our institution’s dose index when available and standardized tables. Results. Among the 200 IBD patients, 157 patients had Crohn’s disease (CD), 41 had ulcerative colitis (UC), and 2 had indeterminate colitis. The mean CED for IBD patients was 23.1 ± 45.2 mSv during a mean follow-up duration of 4.3 years. CED was higher among patients with CD than with UC (27.5 ± 49.5 versus 6.8 ± 14.8 mSv; p<0.01). Six patients were exposed to a high CED (>100 mSv) and all had CD. Conclusion. While potentially harmful levels of radiation exposure are of concern in only a small number of patients, strategies to limit such exposure are encouraged when clinically appropriate.

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P549 Changing Lanes: Switching Therapies in Inflammatory Bowel Disease, An Observational Study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.670 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S517-S518

Author(s):

N Mc Gettigan ◽

E Leung ◽

A Harhen ◽

E Anderson ◽

S McMahon ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Observational Study ◽

Small Molecule ◽

Bowel Disease ◽

Intestinal Resection ◽

Biologic Agent ◽

Indeterminate Colitis ◽

Number Of Patients ◽

Inflammatory Bowel ◽

Therapy Switch

Abstract Background Switching between therapies in inflammatory bowel disease (IBD) is common and a paucity of data exists regarding the optimal switching strategy. A number of new drug therapies have recently emerged for the treatment of IBD. Failure of biologic and small molecule therapies occur regularly, prompting the need for a treatment switch. Our aim is to review trends amongst our patients who switched biologic/small molecule therapy to identify high risk characteristics and to look for predictor variables which may reduce the need to switch in the future. Methods This is a 4 year retrospective observational study of IBD patients who underwent a therapy switch. Patients were identified from a prospectively maintained IBD database of 141 patients. Patient demographics, treatment history, disease history, biomarkers (within 3 months of switch) and endoscopy results were reviewed. Minitab17 was used for statistical analysis. Results Switching of biologic therapy was observed in 39 patients (28%); 21 (54%) were male; mean age was 42.8Y. Of these, 21 (53.9%) had Crohn’s disease (CD), 17 (44%) had ulcerative colitis (UC) and 1 patient had indeterminate colitis. Mean disease duration at time of switch was 78 months. 82% (n=14/17) of UC patients had pancolitis. 43% (n=9/21) of CD patients had a previous intestinal resection. The most common initial therapy was Adalimumab 46% (n=18) (Fig1) with the most common switch to IFX 36% (n=14) (Fig2). Primary LOR occurred in 28% (n=11) and secondary LOR in 44% (n=17), the remainder switched due to infusion reaction/adverse effects (n=10) and clinical remission (n=1). Mean CRP was 13.68 (95% CI: 7.28, 20.09), mean FCP was 874 (95% CI: 418, 1329), mean mayo score was 1.88 (95% CI: 1.37, 2.39), mean SES CD score was 5.79 (95% CI: 3.24, 8.33). Median IFX level was 0.8ug/ml (IQR 0.4, 9.7), 37.5% (n=6/16) of the patients on IFX developed ADAs to IFX. Median Adalimumab level was 5.2ug/ml (IQR 1.4, 13.5) and 11% (n=2/18) developed ADAs to Adalimumab. A significant negative correlation was found between FCP and IFX level using Spearman rank correlation -0.822, p = 0.01. 39% (n=15) were on an immunomodulator, no significant association was found between immunomodulator therapy and primary/secondary LOR, p= 0.67 and p= 0.63. 28% (n=11) were admitted with an IBD flare in the 1st year post switch and 13% (n=5) underwent intestinal resection. 8 (21%) subsequently switched to a 3rd biologic agent. Conclusion The most common therapy switch was within Anti-TNF drug class, mean CRP and FCP were raised at the time of switch and a significant number of patients were admitted in the year post switch with an IBD flare. Pancolitis in UC and previous intestinal surgery in CD were common characteristics of those who switched.

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FLAT MUCOSAL DYSPLASIA IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: EXPERIENCE IN A TERTIARY CARE REFERRAL HOSPITAL

10.36106/ijar/2006716 ◽

2020 ◽

pp. 13-16

Author(s):

Keya Basu

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Tertiary Care ◽

Low Grade ◽

Indeterminate Colitis ◽

Crohns Disease ◽

Risk Of Progression ◽

Duration Of Disease ◽

Inflammatory Bowel ◽

The Mean

Context: Inflammation associated CRC (colorectal carcinoma) develop along an inflammation-dysplasia-carcinoma sequence, with varying progression rates from Low Grade Dysplasia (LGD) or Indefinite for Dysplasia (IND) to High Grade Dysplasia (HGD) Aims: Assessment of the frequency of progression of Inflammatory Bowel Disease (IBD) to LGD and IND including the assessment of factors associated with the risk of progression. Settings and Design: This retrospective analytical study conducted between January 2011 to 2015. Methods and Material: All patients diagnosed with IBD between 2011 to 2015 were reviewed, including Ulcerative Colitis (UC), Crohns Disease (CD), Indeterminate colitis (IC) and Idiopathic colitis. Medical charts, endoscopy, histopathology, and surgery reports were collected. Results: Out of 393 patients diagnosed with IBD, 29 patients developed LGD and 12 showed IND. No association was observed between the subtype of IBD with progression. The mean duration of disease and multifocality correlated with the presence of LGD or IND. The presence of extensive colitis conferred a higher risk of developing LGD over IND. Conclusions: The features favoring the development of LGD or IND include the mean duration of disease at the time of diagnosis, multifocality and the presence of extensive colitis. The use of adjunct biomarkers like p53 may aid in evaluating progression.

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Safety of Ustekinumab in Inflammatory Bowel Disease: Pooled Safety Analysis of Results from Phase 2/3 Studies

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa236 ◽

2020 ◽

Cited By ~ 1

Author(s):

William J Sandborn ◽

Brian G Feagan ◽

Silvio Danese ◽

Christopher D O’Brien ◽

Elyssa Ott ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Adverse Events ◽

Bowel Disease ◽

Safety Profile ◽

Phase 2 ◽

Phase 3 ◽

Number Of Patients ◽

Serious Infections ◽

Inflammatory Bowel

Abstract Background Ustekinumab is currently approved globally in Crohn’s disease (CD) and psoriatic diseases. Recent phase 3 data demonstrate safety/efficacy in ulcerative colitis (UC). Crohn’s disease and UC phase 3 programs had similar study designs, facilitating integrated safety analyses. Methods Data from 6 ustekinumab phase 2/3 CD and UC studies were pooled, and safety was evaluated through 1 year. Patients received 1 placebo or ustekinumab (generally 130 mg or ~6 mg/kg) intravenous induction, then subcutaneous (90 mg) maintenance every 8/12 weeks. Analyses incorporated all patients who received ≥1 ustekinumab dose. Safety outcomes are presented as percentages of patients (induction) and as number of patients with events per 100 patient-years of follow-up (through 1 year). For key safety events, 95% confidence intervals (CIs) are provided, as appropriate. Hazard ratios with 95% CIs from time-to-event analyses for serious adverse events and serious infections were also performed. Results Through 1 year, 2574 patients received ustekinumab (1733 patient-years of follow-up). The number of patients with adverse events per 100 patient-years (placebo 165.99 [95% CI, 155.81–176.67] vs ustekinumab 118.32 [95% CI, 113.25–123.55]), serious AEs (27.50 [95% CI, 23.45–32.04] vs 21.23 [95% CI, 19.12–23.51]), infections (80.31 [95% CI, 73.28–87.84] vs 64.32 [95% CI, 60.60–68.21]), serious infections (5.53 [95% CI, 3.81–7.77] vs 5.02 [95% CI, 4.02–6.19]), and malignancies excluding nonmelanoma skin cancer (0.17 [95% CI, 0.00–0.93] vs 0.40 [95% CI, 0.16–0.83]) were similar between placebo and ustekinumab. Conclusions The safety profile of ustekinumab across the pooled inflammatory bowel disease population through 1 year was favorable and generally comparable to placebo. These data are consistent with the established safety profile of ustekinumab across indications. ClinicalTrials.gov numbers NCT00265122; NCT00771667; NCT01369329; NCT01369342; NCT01369355; NCT02407236.

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EpidemIBD: rationale and design of a large-scale epidemiological study of inflammatory bowel disease in Spain

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284819847034 ◽

2019 ◽

Vol 12 ◽

pp. 175628481984703 ◽

Cited By ~ 5

Author(s):

María Chaparro ◽

Manuel Barreiro-de Acosta ◽

José Manuel Benítez ◽

José Luis Cabriada ◽

María José Casanova ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Large Scale ◽

Hospital Admissions ◽

Financial Burden ◽

Demographic Data ◽

Treatment Patterns ◽

Number Of Patients ◽

Inflammatory Bowel

Background: Inflammatory bowel disease (IBD) is associated with a considerable burden to the patient and society. However, current data on IBD incidence and burden are limited because of the paucity of nationwide epidemiological studies, heterogeneous designs, and a low number of participating centers and sample size. The EpidemIBD study is a large-scale investigation to provide an accurate assessment of the incidence of IBD in Spain, as well as treatment patterns and outcomes. Methods: This multicenter, population-based incidence cohort study included patients aged >18 years with IBD (Crohn’s disease, ulcerative colitis, or unclassified IBD) diagnosed during 2017 in 108 hospitals in Spain, covering 50% of the Spanish population. Each participating patient will attend 10 clinic visits during 5 years of follow up. Demographic data, IBD characteristics and family history, complications, treatments, surgeries, and hospital admissions will be recorded. Results: The EpidemIBD study is the first large-scale nationwide study to investigate the incidence of IBD in Spain. Enrollment is now completed and 3627 patients are currently being followed up. Conclusions: The study has been designed to overcome many of the limitations of previous European studies into IBD incidence by prospectively recruiting a large number of patients from all regions of Spain. In addition to epidemiological information about the burden of IBD, the 5-year follow-up period will also provide information on treatment patterns, and the natural history and financial burden of IBD.

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P541 Efficacy, efficiency and aceptability of telemedicine for inflammatory bowel disease patients follow-up care during the COVID-19 pandemic lockdown

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.662 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S512-S513

Author(s):

L Ramos Lopez ◽

C Reygosa ◽

M Carrillo-Palau ◽

I Alonso-Abreu ◽

Y González ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Disease Transmission ◽

Elective Surgery ◽

Biologic Agents ◽

Indeterminate Colitis ◽

Telephone Consultation ◽

Patient Profile ◽

Inflammatory Bowel

Abstract Background During COVID-19 pandemic, numerous initiatives have been established to reduce disease transmission but ensure care for patients with inflammatory bowel disease (IBD). Ambulatory clinic visits were replaced by the implementation of telehealth modalities in most of IBD units during the pandemic lockdown. However, the efficacy, efficiency, and patient′s acceptability of using telemedicine by telephone consultation has not been evaluated. Methods A prospective cohort study was performed in IBD patients who underwent telephone consultation during lockdown due to COVID-19 pandemic between 16th march and 13th April 2020. To assess the efficacy of this telephone consultation (COVID-visit), change in disease′s activity and treatment, non-scheduled visits, emergency consultation, hospital admission and non-elective surgery from COVID-visit to the next scheduled consultation (postCOVID-visit) were checked. To evaluate efficiency, the time period between COVID-visit and postCOVID-visit were compared with previous consultation (preCOVID-visit). Only patients with a confirmed diagnosis of IBD, regular follow-up in our IBD unit and with full available requested test results were included. A telephone survey was designed (5 questions) and conducted in all patients to rate satisfaction for using telemedicine. Results Out of a total of 274 patients, 220 patients (52.2% male; mean age 49±16 years; crohn′s disease n=126/ ulcerative colitis n=83/ indeterminate colitis n=11) were included. During the COVID-visit 41% patients were using biologic agents, 15% had active disease and 6.8% changed treatment (40% initiated corticosteroids; 30% started immunomodulators or biologic agents; 30% upgraded usual treatment). Only 1 patient consulted at the emergency department, 11 patients needed to rearrange the visit and none patient underwent surgery before the scheduled post-COVID visit. The interval to post- COVID visit compared to pre-COVID visit was reduced in 28.6%, remained equal in 33.6% and increased in 37.7% of patients. The satisfaction survey (n=185) revealed that 81.1% patients rated care as excellent, 94.6% perceived it was effective and solved doubts in 96.2% of patients. However, 44.4% of patients rather prefer on-site consultation for follow-up and only 52% considered that incorporating video would improve care. Conclusion Telemedicine care during the lockdown and despite been abruptly and rapidly implemented in IBD units, shows to be effective and efficient to care IBD patients. In addition, telephone consultation is well accepted by patients for short follow-up periods. Further follow-up studies should be carried out to determine the patient profile that will benefit most from this monitoring.

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Personalised Adherence Support for Maintenance Treatment of Inflammatory Bowel Disease: A Tailored Digital Intervention to Change Adherence-related Beliefs and Barriers

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz034 ◽

2020 ◽

Vol 14 (10) ◽

pp. 1394-1404 ◽

Cited By ~ 2

Author(s):

Sarah Chapman ◽

Alice Sibelli ◽

Anja St-Clair Jones ◽

Alastair Forbes ◽

Angel Chater ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Maintenance Treatment ◽

Intervention Group ◽

Adherence To Medication ◽

Adherence Support ◽

Inflammatory Bowel ◽

The Individual ◽

And Control

Abstract Background and Aims Interventions to improve adherence to medication may be more effective if tailored to the individual, addressing adherence-related beliefs about treatment and overcoming practical barriers to daily use. We evaluated whether an algorithm, tailoring support to address perceptual and practical barriers to adherence, reduced barriers and was acceptable to patients with inflammatory bowel disease [IBD]. Methods Participants with IBD, prescribed azathioprine and/or mesalazine, were recruited via patient groups, social media, and hospital clinics and allocated to Intervention or Control Groups. The online intervention comprised messages tailored to address beliefs about IBD and maintenance treatment and to provide advice on overcoming practical difficulties with taking regular medication. The content was personalised to address specific perceptual and practical barriers identified by a pre-screening tool. Validated questionnaires assessed barriers to adherence and related secondary outcomes at baseline and at 1 and 3 months of follow-up. Results A total of 329 participants were allocated to the Intervention [n = 153] and Control [n = 176] Groups; just under half [46.2%] completed follow-up. At 1 and 3 months, the Intervention Group had significantly fewer concerns about IBD medication [p ≤0.01]; and at three months, fewer doubts about treatment necessity, fewer reported practical barriers, and higher reported adherence [p <0.05]. Relative to controls at follow-up, the Intervention Group were more satisfied with information about IBD medicines, and viewed pharmaceuticals in general more positively. Questionnaires, interviews, and intervention usage indicated that the intervention was acceptable. Conclusions Personalised adherence support using a digital algorithm can help patients overcome perceptual barriers [doubts about treatment necessity and medication concerns] and practical barriers to adherence.

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P290 Long-term disease outcome of ulcerative colitis (UC) in South Ostrobothnia, Finland with a follow-up time of 25 years

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.419 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S297-S298

Author(s):

K Kontola ◽

P Oksanen ◽

H Huhtala ◽

H Tunturi-Hihnala ◽

A Jussila

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Cumulative Risk ◽

Population Based ◽

Study Data ◽

Disease Outcome ◽

Inflammatory Bowel ◽

The Mean

Abstract Background Finland has one of the highest prevalence of inflammatory bowel disease (IBD), especially UC. There is scarce data about long-term disease outcome in UC in population-based cohorts. The aim was to evaluate the long-term clinical outcome of patients with UC in the region of South Ostrobothnia, a district in rural central western Finland with a population of about 190 000. Methods All patients treated with diagnosis of UC or IBDU (inflammatory bowel disease Unclassified) during years 1981–2000 were included in this study. Data were collected retrospectively from the patient registry of the Central Hospital of South Ostrobothnia until 1 August 2019. Results There were 589 patients with a median follow-up time of 25 years. Median age at the diagnosis was 34 years. 59% of patients were male, 93% had UC and 7% IBDU. According to Montreal classification 80% had extensive disease, 15% left-sided disease and 5% proctitis. Medical treatment used at any point during the disease is shown in Table 1. Twenty-two per cent of patients had colectomy. Of operated patients, (pan)proctocolectomy with ileostomy was performed to 50%, IPAA (ileal pouch anal anastomosis) to 40% and IRA (ileorectal anastomosis) to 3%. Median time from the diagnosis to surgery was 11 years; the risk of surgery is shown in Table 2. Twenty-six per cent of the operations were emergency surgeries. The mean age at the time of surgery was 49 years. The indications for colectomy are specified in Table 3. Cumulative risk of colorectal cancer (CRC) and biliary tract cancer was 3.2% and 1.7%, respectively. Twenty-eight per cent of patients died during follow-up, at the mean age of 72 years. The cause of death was recorded for 91/167 and the most common causes were cardiovascular disease and malignancy. Conclusion In this population-based cohort with surveillance of 25 years 22% patients with UC or IBDU were operated. Even after becoming available, biological medication is rarely used for UC patients diagnosed in the prebiologic era.

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P184 Disease activity in Inflammatory Bowel Disease patients is associated with increased liver fat content during follow-up

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.311 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S254-S255

Author(s):

E Van Lingen ◽

M Tushuizen ◽

M Steenhuis ◽

T van Deynen ◽

J Martens ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Liver Fibrosis ◽

Disease Activity ◽

Bowel Disease ◽

Liver Steatosis ◽

Liver Stiffness ◽

Inflammatory Bowel ◽

The Mean ◽

Active Disease

Abstract Background Increased liver steatosis is a frequently reported condition in patients with Inflammatory Bowel Disease (IBD). Different factors, both metabolic and IBD-associated, are believed to be contribute to the pathogenesis. The aim of our study was to calculate the prevalence of liver steatosis (LS) and fibrosis (LF) in IBD patients and evaluate which factors influence changes in steatosis and fibrosis during follow-up. Methods From June 2017 to February 2018, consecutive adult IBD patients were enrolled. Demographic and bio-chemical data were collected at baseline and after 6 to 12 months. The degree of LS and LF was assessed by transient elastography (Fibroscan). LS was defined as a Controlled Attenuation Parameter (CAP) ≥248, LF as a liver stiffness value (Emed) ≥7.3 kPa and IBD disease activity as C-reactive protein (CRP) ≥10 mg/l and/or fecal calprotectin (FCP) ≥150 μg/g. Changes in LS and LF were studied using ∆CAP and ∆Emed (follow-up minus baseline). An independent sample T-test was used to analyze the mean change in ∆CAP and ∆Emed. Univariate and multivariate linear regression analyses were performed, a P-value of ≤0.05 was considered significant. Results A total of 117 IBD patients were enrolled, of which 86 patients were also seen for follow-up. Of these 86 patients, 57% were male with a mean age of 43 (16.1) years. 48% of the patients suffered from Crohn’s disease. The mean Body Mass Index (BMI) was 25.0 (4.7) kg/m2 and 28 patients (33%) had an active episode of IBD at enrollment. The prevalence of LS at baseline was 39%, the prevalence of LF at baseline 13%. The mean change in ∆CAP was 22.44 (75.7) in patients with active disease at baseline and -34.1 (67.5) in patients in remission at baseline (p=0.001). The mean change in ∆Emed was 0.40 (1.9) in patients with active disease at baseline and -0.53 (2.7) in patients in remission at baseline (p=0.075).). Using a multivariate analysis, disease activity at baseline (B=37, 95%CI 6.38–67.61,P=0.018) and LS at baseline (B=-0.4, 95%CI -0.64 – -0.23,P=0.000) were associated with an increase in LS during follow-up. In univariate analyses, no factors associated with LF during follow-up were found. Conclusion Our study reveals a high prevalence of liver steatosis and liver fibrosis in IBD patients. Active IBD at baseline was associated with an increase in liver steatosis during follow up, but not with an increase in liver fibrosis.

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