- Email: [email protected]
Mo1295 Evaluation of Colectomy Rate for Ulcerative Colitis in a Referral Center
co-morbidity. The majority of IBD patients with pain did not demonstrate biochemical evidence of inflammation suggesting additional mechanisms underlie these symptoms.
leaving the workplace than controls. Conclusions: US employees with UC had a 30% increased risk of experiencing work-loss vs. controls. Improving control of UC has the potential to allow patients with UC to stay active in the workforce, likely increasing productivity and off-setting treatment costs. References: 1. Cohen RD, et al. Aliment Pharmacol Ther. 2010;31:693-707. 2. Reinisch W, et al. Inflamm Bowel Dis. 2007;13:1135-40. 5-Year and Overall Risk of Experiencing Work-lossa
AGA Abstracts
Mo1291 Ulcerative Colitis After Orthotopic Liver Transplantation for Primary Sclerosing Cholangitis - A Single Center Experience Pavel Drastich, Lukas Bajer, Pavel Wohl, Marek Benes, Monika Drastichova, Julius Spicak BACKGROUND: The clinical outcome of patients with ulcerative colitis (UC) after orthotopic liver transplantation (OLTx) for primary sclerosing cholangitis (PSC) has been reported as variable including neoplastic potential. PATIENTS AND METHODS: A total of 861 liver transplants were performed in IKEM (Czech Republic) between 1995 and 2011.We analyzed 72 consecutive patients with PSC and UC (52 men and 20 women) with mean age 46.7± 13.4 years who survived more than 12 months and were regularly followed up in our center. Colonoscopy was performed in all patients before OLTx and annually after OLTx. Patients were studied over median follow up period of 80 months (range 16-216) after OLTx. RESULTS: The course of UC was mild or in remission in 48/72 (66.7%) patients after OLTx without relevant clinical symptoms. The remaining 24 patients (33.3%) were suffering from clinically active disease after OLTx, in 3 cases the CMV was detected as triggering factor. Symptoms of all patients except 3 with active colitis were well controlled by conservative treatment. Colectomy was performed in 3 patients because of refractory disease. Low-grade dysplasia (LGD) of colonic mucosa was found in 6/72 (8.3%) patients after OLTx. Highgrade dysplasia (HGD) was detected in 2 (2.8%) patients and colorectal cancer (CRC) was confirmed in 2 (2.8%) patients followed by colectomy. No one patient died because of CRC. On the other hand UC newly developed in 3 patients after OLTx with mild course of disease. CONCLUSION: The course of UC after OLT for PSC is frequently active despite the immunosuppressive treatment. Detection of dysplastic changes and CRC confirm the usefulness of regular colonoscopic evaluations. New onset UC can develop after OLTx.
a Employees who did not leave the workplace after the index date were censored at the end of their eligibility. bP,.001 for patients with UC vs. controls from log-rank test comparing overall risk.
Mo1294 Validating a Measure of Patient Mastery in Disease Self-Management Using a Population-Based IBD Cohort: The IBD-Self-Efficacy Scale Lesley A. Graff, Kathryn A. Sexton, John R. Walker, Ian Clara, Laura E. Targownik, Linda Rogala, Norine Miller, Charles N. Bernstein
Mo1292 Influence of Stress in the Clinical Course of Inflammatory Bowel Disease Patients Manuel Barreiro-de Acosta, Marta Iglesias, Rocio Ferreiro, Francisco Caamaño, Isabel Vazquez, Aurelio Lorenzo, Enrique Dominguez-Munoz
Background and Aims: Chronic disease management relies on patient engagement in their care. This is especially relevant in inflammatory bowel disease (IBD), which can have an unpredictable and fluctuating course. Self-efficacy relates to the person's confidence in their ability to manage demands, and has been found to affect disease management in many chronic conditions. It is predictive of outcomes such as hospitalization and mortality in coronary artery disease, however, meaningful measurement must be domain (eg disease) specific. The IBD Self-Efficacy scale (IBD-SE; Keefer, 2011) was recently developed, with preliminary validation in a small clinical sample. The current study aimed to provide broader validation of this potentially valuable measure, using a larger, population-based sample to assess the scale's validity and utility. Methods: Participants in the population-based Manitoba IBD Cohort Study completed a survey and clinical interview at a mean of 12 years postdiagnosis (n=121 Crohn's disease; n=105 ulcerative colitis; 62% female; mean age 48.7 years, SD=14.7). Validated measures were used to assess psychological functioning (mastery, well-being, perceived stress, distress), disability, disease-specific quality of life (IBDQ), perceived health, and current (Harvey Bradshaw [HB]; Powell Tuck [PT]) and recent (MIBDI) disease activity, in addition to the IBD-SE. Pearson correlations and ANOVAs were used to determine validity. Results: The IBD-SE had high internal consistency (Cronbach's α=0.97). It was correlated with the Mastery Scale (r=.47; p ,0.001), providing support for criterion validity. It was also strongly correlated in the expected directions with Psychological Well Being Scale (r=.66; p,0.001), the Perceived Stress Scale (r=-.76, p ,0.001), the Brief Symptom Inventory (distress; r=-.69; p ,0.001), and the Sheehan Disability Scale (r=-.47, p,0.001). Positive correlations between the IBD-SE and the total IBDQ (r=.63, p ,0.001), the 4 IBDQ subscales (r=0.40 to 0.68, all p's ,0.001), and overall perceived health (r=.49, p,0.001) suggested good concurrent validity. Comparing current inactive and active (HB or PT . 5) disease, the inactive group had higher self-efficacy than the active group (CD: F=18.0, p,0 .001; UC: F= 8.60, p ,0 .01), with similar findings for recent symptomatic disease activity (MIBDI, past 6 months; F=36.6, p ,0 .001). There were no differences in mean self-efficacy between CD and UC. Conclusions: The IBD-SE had strong psychometric properties in this population-based IBD sample, with evidence of good criterion, construct, concurrent, and known groups validity, all supporting its utility in IBD. As self-efficacy is a modifiable psychological characteristic that can contribute to positive health outcomes, this may prove to be a valuable tool in research and for targeted intervention with IBD patients.
Background: Psychological stress has been defined as a process in which environmental equal or exceeds the adaptative capacity of an organism. There is a long but inconsistent history of studies about the relationship between stress and Inflammatory Bowel Disease (IBD). The aim of this study was to assess the influence of stress on the clinical course of IBD patients. Methods: A prospective study was designed. Crohn's Disease (CD) and Ulcerative Colitis (UC) patients older than 18 years of age were included. Stress was assessed with the Spanish version of Perceived Stress scale (PSS). This scale is a self-report instrument that assesses the level of perceived stress during the last month, consisting of 14 items with a response format of a five-point scale (0 = never, 1 = hardly ever, 2 = once in a while, 3 = often, 4 = very often). The sum score obtained indicates that a higher score corresponds with a higher level of perceived stress (range 0-56). In order to assess the clinical course of IBD, during a follow-up period of 18 months all emergency visits and hospitalisations related with IBD were recorded. The influence of stress on clinical course was analyzed by Multiple Regression analysis. Results: 716 patients were included; 343 (47.9%) male, mean age 44.5 years, ages ranging from 18 to 86 years, 297 (41.8%) patients with CD and 413 (58.2%) with UC. The mean in the PSS was 23.67, with an SD of 9.59. The mean of emergency visits was 1.05 (SD: 1.68, range 0-14) and for hospitalizations it was 0.35 (SD: 0.94, range 0-9). At month 18 higher stress at baseline was related with more emergency visits in the follow up (B=0.11; CI95%: 0.01-0.03; p=0.005) but not with more hospitalizations (B=0.02; CI95%: -0.01-0.01; p=0.685). Only the type of disease (CD) (B=-0.13; CI95%: -0.390.11; p,0.0001) and presence of relapse at baseline (B=0.22; CI95%: 0.29-0.57; p ,0.0001) were related with more hospitalizations after 18 months. Conclusions: A higher perception of stress in IBD patients is related with an increased number of emergency visits related with the disease in the following months. These patients could probably benefit from a psychological intervention that would improve their psychological status. Mo1293 High Risk of Leaving the Workforce in US Employees With Ulcerative Colitis Russell D. Cohen, Joanne Rizzo, Martha Skup, Mei Yang, Dendy Macaulay, Christopher Behrer, Beverly Fok, Jingdong Chao, Parvez Mulani
Mo1295
Aim: Ulcerative colitis (UC) can substantially impact quality of life and reduce work productivity.1,2 We evaluated the risk of leaving the workforce for privately insured US employees with UC compared with demographically matched controls without UC. Methods: Active employees ages .18 years with ≥2 UC diagnoses (International Classification of Diseases, Ninth Revision [ICD-9]: 556.xx) between 1/1/1998 and 3/31/2010 were identified from the OptumHealth Reporting and Insights database. Employees with Crohn's disease (CD, ICD9: 555.xx) were excluded. Patients had continuous eligibility for ≥1 year before first UC diagnosis (index date) and were followed until end of eligibility. Patients with UC were matched 1:1 on sex, age (±1 year), region, and company to controls (active employees without UC or CD). Index dates for controls were set to be the same as the matched patient with UC. Risk of leaving the workplace (short- and long-term disability, leave of absence, early retirement) was examined using Kaplan-Meier survival curves and log-rank tests. Analyses were performed for all patients and for those who developed moderate to severe UC defined by UC hospitalization or use of systemic corticosteroids, immunosuppressants, or biologics. Results: 3,889 employees with UC and 3,889 matched controls (mean age, 44.3 years; 65.5% male) met inclusion criteria and were followed for an average of 3.8 years. Regardless of UC severity, patients with UC were more likely to experience shortand long-term disability or take a leave of absence after the UC diagnosis vs. controls (table). Additionally, patients with moderate to severe UC (N=1,917) more frequently experienced
AGA Abstracts
Evaluation of Colectomy Rate for Ulcerative Colitis in a Referral Center Alessia Settesoldi, Natalia Manetti, Stefania Genise, Manuela Coppola, Francesca Rogai, Siro Bagnoli, Andrea G. Bonanomi, Giancarlo Vannozzi, Martina Giannotta, Cristina Cenci, Vito Annese, Monica Milla IBackground: previous studies have reported colectomy rates up to 50% in Ulcerative colitis (UC), although changes in management may have influenced different figures. We sought to evaluate the incidence in colectomy in our cohort and identify risk factors associated with early colectomy (EC) and late colectomy (LC). Methods: we retrospectively interrogated our data base of UC patients evaluating the occurrence of colectomy, subdivided into EC (within three months from diagnosis) and LC. Survival curves were created and stratified by age, gender, duration of disease, presence of extra-intestinal manifestations (EIM) and therapy, including anti-TNF-α agents. Cox proportional hazards modeling was used to determine predictive risk factors. Results: 1164 patients were evaluated (654 male; M:F= 1.28) with a mean age of 45 yrs (range 19-89), and mean disease duration of 25 yrs (range 1-50). The proportion of patients with extensive colitis, left-side colitis, and proctitis were 39%, 50%, and 11%, respectively. Systemic steroids, thiopurines and anti-TNF-alpha agents were used by 53%, 29%, and 5% of patients, respectively. EIM were reported in 14% of patients. Among 1164 UC patients, 64 (5.5 %) underwent colectomy; 16 patients (25%) as
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birth, procedures for CS, and/or for assisting and inducing delivery. Logistic regression was performed to look at the effect of a priori selected risk factors (age, flare of disease and perianal disease) on the occurrence of caesarean section as compared to vaginal delivery. Risk estimates are presented as odds ratios (OR) with 95% confidence intervals (CI). Results: The mean age of patients at conception was 29.9 years (SD 4.5). Mean gestational age at delivery was 38.3 weeks (SD 2.0). Of 127 IBD (38 UC, 89 CD) patients, 116 (33 UC, 83 CD) patients had a live birth. 11/127 (8.6%) patients had a therapeutic or spontaneous abortion, 66/127 (52%) had a vaginal delivery and 50/127 (39.4%) had a caesarean section. The rate of low birth weight was 19.8%, neonatal ICU was 9.5% and congenital abnormalities were observed in 3.4%. In the group of patients with CS 15/50 (30%) were for emergency indications and 35/50 (70%) were planned electively. Of the 35 patients who had a planned elective CS 19/35 had a prior history of CS. Patient preference was recorded as one of the reasons for the planned CS in 18/35 cases. On multivariate logistic regression analysis perianal disease was the primary factor that increased the likelihood of requiring CS in CD patients (OR=15.10; 95% CI: 1.57-145.30) after adjusting for disease flare (OR=2.39; 95% CI: 0.82-6.94). Conclusions: In our population based IBD cohort the majority of caesarean sections (70%) were performed for elective reasons and not for obstetrical concerns arising during labour. Perianal CD increased the likelihood of requiring CS after controlling for flare of disease. When counseling our patients on expected outcomes of pregnancy we can inform them that their chances of requiring an emergency compared to an elective CS is low.
Mo1296 Quality of Life for Patients With Deep Remission vs. Clinical Remission and Deep Remission vs. Absence of Mucosal Ulceration: 3-Year Data From CHARM/ADHERE Jean-Frederic Colombel, Remo Panaccione, Edouard Louis, Martha Skup, Mei Yang, Paul F. Pollack, Roopal Thakkar, Anne A. Camez, Jingdong Chao, Parvez Mulani, William Sandborn
Mo1298 Unplanned Hospital Readmission Rates and Causes in Patients With Inflammatory Bowel Disease: A Critical Analysis Prashant R. Mudireddy, Gary R. Lichtenstein
Background: Deep remission (DR), defined as clinical remission (CR) + absence of mucosal ulceration (AMU), is an emerging treatment goal in Crohn's disease (CD). Aim: We compared quality of life (QOL) outcomes for up to 3 years in patients with DR vs. CR only and DR vs. AMU only. Methods: The 56-week CHARM (Crohn's Trial of the Fully Human Antibody Adalimumab for Remission Maintenance) trial and its 2-year open-label extension ADHERE (Additional Long-Term Dosing With HUMIRA to Evaluate Sustained Remission and Efficacy in Crohn's Disease) were analyzed. Endoscopies were not performed in CHARM/ADHERE; thus, AMU was predicted via an index derived from a combination of biomarkers and patient self-reported symptoms.1 DR was defined as Crohn's Disease Activity Index (CDAI) value ,150 + predicted AMU. The QOL outcomes included achievement of Inflammatory Bowel Disease Questionnaire remission (IBDQ .170) and normal status on the Short Form 36 (SF-36) physical and mental component summaries (SF-36 PCS/MCS .50). Multivariate logistic regression, adjusting for adalimumab (yes/no) and baseline QOL status, was conducted using the observed values at each visit from Week 26 to Week 164 to assess QOL differences between DR vs. CR and DR vs. AMU. Average QOL changes from baseline were calculated. Results: A total of 778 patients were included in this assessment regardless of the treatment patients were randomized to. Odds of achieving normal status on the SF-36 PCS and IBDQ remission were significantly greater for patients who achieved DR vs. CR or AMU only (Table 1). DR was associated with greater likelihood of SF-36 normal mental health status vs. AMU. IBDQ score improvements from baseline were significantly greater for DR vs. AMU at various time points. Improvements were also seen for DR vs. CR only (Table 2). Results for SF-36 improvements between DR vs. CR or AMU only were similar (data not shown). Conclusion: Patients with CD who achieved predicted DR maintained better physical and disease-specific QOL outcomes for up to 3 years compared with patients who achieved only CR or AMU. Reference: 1. Sandborn WJ, et al. J Crohns Colitis. 2012;6(1 Suppl):S3. Table 1. Adjusted Odds Ratios for QOL Remission Over the 3-Year Study Period
Aim: IBD is a chronic inflammatory disease characterized by periods of relapses and remissions. Hospitalizations for exacerbations of IBD are common. Readmission has been deemed a marker of poor quality of care. The aim of this study was to better understand and characterize the rates of unplanned readmissions in IBD patients at 1 mos, 3 mos, 6 mos and 1 yr and to identify the reasons for the unplanned readmissions. Preliminary data was previously presented by our group [AJG 2012 (107) Suppl. 1 S654-S655], however, this represents extensively updated new data and novel findings. Methods: We retrospectively reviewed the electronic medical record database of our institution (3 large urban academic hospitals) to identify consecutive patients admitted between Jan 2007 to Dec 2010 with a primary discharge diagnosis of either UC or CD. Index admission was defined as first unplanned admission with primary discharge diagnosis of either UC or CD during this period. Readmission was defined as unplanned admission (due to any cause) occurring within 1 mos, 3 mos, 6 mos or 1 yr from the index admission. Planned readmissions were excluded. Data analyzed included demographics, type of IBD, length of stay, and primary discharge diagnosis for both index admission and readmission. Results: A total of 975 pts with IBD accounted for 1345 admissions to the health system within this time period. Of these a total of 479 pts had an index admission with primary discharge diagnosis of either UC or CD. The demographics of the cohort were- mean age 38 yrs, 261 Females, 218 Males, 319 Whites, 132 Blacks, 28 Race other than White or Black, 312 had CD and 167 had UC. There were a total of 384 unplanned readmissions during the study period. The unplanned readmission rates were-12.5 %(60/479) at 1 mos, 23.4%(112/479) at 3 mos, 32.2%(154/ 479) at 6 mos and 38% (182/479) at 1 yr. The mean length of stay (LOS) of both index admissions and readmissions was 7.05 days, while median LOS of both Index and readmissions was 5. Among 60 pts readmitted at least once at 1 month, 19 were readmitted within 1-wk. Among the 182 pts readmitted at least once at 1 year, 90 were females,114 were whites, 61 were blacks, 7 were race other than white or black and 119 had CD, 63 had UC. At 1 yr, 85 pts were readmitted at least twice and 43 were readmitted more than 2 times. Please see table for causes of readmissions. Conclusion: The unplanned readmission rate in IBD pts is high, with more than one third of pts being readmitted at least once within 1 yr of discharge. The most common reasons for readmissions were IBD exacerbations and infections. Future large studies are needed to define national rates of readmission and risk factors for readmissions in IBD pts. This has the potential to better understand and possibly alter the standard of care. Causes of Readmissions in IBD patients
a P,.001. Table 2. Unadjusted Differences in IBDQ Change From Baseline
a
P,.05.
Mo1297 Mode of Delivery in Inflammatory Bowel Disease Patients: A Population-Based Study Yvette Leung, Gilaad G. Kaplan, Stephanie Coward, Marie-Claude Proulx, Divine Tanyingoh, Subrata Ghosh, Remo Panaccione, Cynthia H. Seow Aims: Previous studies have cited a higher caesarean section (CS) rate for inflammatory bowel disease (IBD) patients compared to the non-IBD population. However, the clinical factors that influence whether a CS or a vaginal delivery occurs are largely unknown. We studied mode of delivery in IBD patients to determine the indications and risk factors underlying the higher CS rate of this population. Methods: The Data Integration, Measuring and Reporting administrative discharge abstract database was used to identify all women (.= 18 years of age) in the Calgary Health Zone with a diagnosis of CD (ICD-9-CM 555.X or ICD-10-CA K50.X) or UC (ICD-9-CM 556.X or ICD-10-CA K51.X) who were admitted to hospital between April 1, 2006 and March 31, 2010. Hospital chart review was performed on all pregnant women (n=127) to confirm the diagnosis and to extract data on normal
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AGA Abstracts
AGA Abstracts
EC, 12 (19%) for cancer or dysplasia, and the remaining patients for chronically active disease. The 5-, 10-, and 20-year actuarial risk of colectomy was 2.6%, 4%, and 5% respectively. Of note, 48 patients (75%) received a proctocolectomy with ileo-anal anastomosis, and 12 (25%) developed a chromic recurrent pouchitis. In addition, more than 80% of patients received maintenance therapy with mesalazine at least 1.6 gr/daily, and 43% of patients used combined oral and topical (1-2/week) maintenance therapy. Male sex (hazard ratio [HR] = 3.5; 95% confidence interval [CI] 1.5-5.5) and pancolitis (HR = 2.5; 95% CI 1.2-4.3) were predictive for EC, after adjustment for confounders. Age at diagnosis older than 40 yrs (HR = 2.5; 95% CI 1.4-3.8) and intolerance/inefficacy of thiopurines (HR = 3.1; 95% CI 1.4- 5.1) were predictive of LC. Conclusions: Colectomy was rather infrequent in our cohort, being more often performed for chronically active disease. The incidence of cancer an dysplasia was also low, probably because the extensive use and adherence to mesalazine maintenance therapy. The introduction of anti-TNF-alpha therapy in the last five years have not changed this figure so far.
leaving the workplace than controls. Conclusions: US employees with UC had a 30% increased risk of experiencing work-loss vs. controls. Improving control of UC has the potential to allow patients with UC to stay active in the workforce, likely increasing productivity and off-setting treatment costs. References: 1. Cohen RD, et al. Aliment Pharmacol Ther. 2010;31:693-707. 2. Reinisch W, et al. Inflamm Bowel Dis. 2007;13:1135-40. 5-Year and Overall Risk of Experiencing Work-lossa
AGA Abstracts
Mo1291 Ulcerative Colitis After Orthotopic Liver Transplantation for Primary Sclerosing Cholangitis - A Single Center Experience Pavel Drastich, Lukas Bajer, Pavel Wohl, Marek Benes, Monika Drastichova, Julius Spicak BACKGROUND: The clinical outcome of patients with ulcerative colitis (UC) after orthotopic liver transplantation (OLTx) for primary sclerosing cholangitis (PSC) has been reported as variable including neoplastic potential. PATIENTS AND METHODS: A total of 861 liver transplants were performed in IKEM (Czech Republic) between 1995 and 2011.We analyzed 72 consecutive patients with PSC and UC (52 men and 20 women) with mean age 46.7± 13.4 years who survived more than 12 months and were regularly followed up in our center. Colonoscopy was performed in all patients before OLTx and annually after OLTx. Patients were studied over median follow up period of 80 months (range 16-216) after OLTx. RESULTS: The course of UC was mild or in remission in 48/72 (66.7%) patients after OLTx without relevant clinical symptoms. The remaining 24 patients (33.3%) were suffering from clinically active disease after OLTx, in 3 cases the CMV was detected as triggering factor. Symptoms of all patients except 3 with active colitis were well controlled by conservative treatment. Colectomy was performed in 3 patients because of refractory disease. Low-grade dysplasia (LGD) of colonic mucosa was found in 6/72 (8.3%) patients after OLTx. Highgrade dysplasia (HGD) was detected in 2 (2.8%) patients and colorectal cancer (CRC) was confirmed in 2 (2.8%) patients followed by colectomy. No one patient died because of CRC. On the other hand UC newly developed in 3 patients after OLTx with mild course of disease. CONCLUSION: The course of UC after OLT for PSC is frequently active despite the immunosuppressive treatment. Detection of dysplastic changes and CRC confirm the usefulness of regular colonoscopic evaluations. New onset UC can develop after OLTx.
a Employees who did not leave the workplace after the index date were censored at the end of their eligibility. bP,.001 for patients with UC vs. controls from log-rank test comparing overall risk.
Mo1294 Validating a Measure of Patient Mastery in Disease Self-Management Using a Population-Based IBD Cohort: The IBD-Self-Efficacy Scale Lesley A. Graff, Kathryn A. Sexton, John R. Walker, Ian Clara, Laura E. Targownik, Linda Rogala, Norine Miller, Charles N. Bernstein
Mo1292 Influence of Stress in the Clinical Course of Inflammatory Bowel Disease Patients Manuel Barreiro-de Acosta, Marta Iglesias, Rocio Ferreiro, Francisco Caamaño, Isabel Vazquez, Aurelio Lorenzo, Enrique Dominguez-Munoz
Background and Aims: Chronic disease management relies on patient engagement in their care. This is especially relevant in inflammatory bowel disease (IBD), which can have an unpredictable and fluctuating course. Self-efficacy relates to the person's confidence in their ability to manage demands, and has been found to affect disease management in many chronic conditions. It is predictive of outcomes such as hospitalization and mortality in coronary artery disease, however, meaningful measurement must be domain (eg disease) specific. The IBD Self-Efficacy scale (IBD-SE; Keefer, 2011) was recently developed, with preliminary validation in a small clinical sample. The current study aimed to provide broader validation of this potentially valuable measure, using a larger, population-based sample to assess the scale's validity and utility. Methods: Participants in the population-based Manitoba IBD Cohort Study completed a survey and clinical interview at a mean of 12 years postdiagnosis (n=121 Crohn's disease; n=105 ulcerative colitis; 62% female; mean age 48.7 years, SD=14.7). Validated measures were used to assess psychological functioning (mastery, well-being, perceived stress, distress), disability, disease-specific quality of life (IBDQ), perceived health, and current (Harvey Bradshaw [HB]; Powell Tuck [PT]) and recent (MIBDI) disease activity, in addition to the IBD-SE. Pearson correlations and ANOVAs were used to determine validity. Results: The IBD-SE had high internal consistency (Cronbach's α=0.97). It was correlated with the Mastery Scale (r=.47; p ,0.001), providing support for criterion validity. It was also strongly correlated in the expected directions with Psychological Well Being Scale (r=.66; p,0.001), the Perceived Stress Scale (r=-.76, p ,0.001), the Brief Symptom Inventory (distress; r=-.69; p ,0.001), and the Sheehan Disability Scale (r=-.47, p,0.001). Positive correlations between the IBD-SE and the total IBDQ (r=.63, p ,0.001), the 4 IBDQ subscales (r=0.40 to 0.68, all p's ,0.001), and overall perceived health (r=.49, p,0.001) suggested good concurrent validity. Comparing current inactive and active (HB or PT . 5) disease, the inactive group had higher self-efficacy than the active group (CD: F=18.0, p,0 .001; UC: F= 8.60, p ,0 .01), with similar findings for recent symptomatic disease activity (MIBDI, past 6 months; F=36.6, p ,0 .001). There were no differences in mean self-efficacy between CD and UC. Conclusions: The IBD-SE had strong psychometric properties in this population-based IBD sample, with evidence of good criterion, construct, concurrent, and known groups validity, all supporting its utility in IBD. As self-efficacy is a modifiable psychological characteristic that can contribute to positive health outcomes, this may prove to be a valuable tool in research and for targeted intervention with IBD patients.
Background: Psychological stress has been defined as a process in which environmental equal or exceeds the adaptative capacity of an organism. There is a long but inconsistent history of studies about the relationship between stress and Inflammatory Bowel Disease (IBD). The aim of this study was to assess the influence of stress on the clinical course of IBD patients. Methods: A prospective study was designed. Crohn's Disease (CD) and Ulcerative Colitis (UC) patients older than 18 years of age were included. Stress was assessed with the Spanish version of Perceived Stress scale (PSS). This scale is a self-report instrument that assesses the level of perceived stress during the last month, consisting of 14 items with a response format of a five-point scale (0 = never, 1 = hardly ever, 2 = once in a while, 3 = often, 4 = very often). The sum score obtained indicates that a higher score corresponds with a higher level of perceived stress (range 0-56). In order to assess the clinical course of IBD, during a follow-up period of 18 months all emergency visits and hospitalisations related with IBD were recorded. The influence of stress on clinical course was analyzed by Multiple Regression analysis. Results: 716 patients were included; 343 (47.9%) male, mean age 44.5 years, ages ranging from 18 to 86 years, 297 (41.8%) patients with CD and 413 (58.2%) with UC. The mean in the PSS was 23.67, with an SD of 9.59. The mean of emergency visits was 1.05 (SD: 1.68, range 0-14) and for hospitalizations it was 0.35 (SD: 0.94, range 0-9). At month 18 higher stress at baseline was related with more emergency visits in the follow up (B=0.11; CI95%: 0.01-0.03; p=0.005) but not with more hospitalizations (B=0.02; CI95%: -0.01-0.01; p=0.685). Only the type of disease (CD) (B=-0.13; CI95%: -0.390.11; p,0.0001) and presence of relapse at baseline (B=0.22; CI95%: 0.29-0.57; p ,0.0001) were related with more hospitalizations after 18 months. Conclusions: A higher perception of stress in IBD patients is related with an increased number of emergency visits related with the disease in the following months. These patients could probably benefit from a psychological intervention that would improve their psychological status. Mo1293 High Risk of Leaving the Workforce in US Employees With Ulcerative Colitis Russell D. Cohen, Joanne Rizzo, Martha Skup, Mei Yang, Dendy Macaulay, Christopher Behrer, Beverly Fok, Jingdong Chao, Parvez Mulani
Mo1295
Aim: Ulcerative colitis (UC) can substantially impact quality of life and reduce work productivity.1,2 We evaluated the risk of leaving the workforce for privately insured US employees with UC compared with demographically matched controls without UC. Methods: Active employees ages .18 years with ≥2 UC diagnoses (International Classification of Diseases, Ninth Revision [ICD-9]: 556.xx) between 1/1/1998 and 3/31/2010 were identified from the OptumHealth Reporting and Insights database. Employees with Crohn's disease (CD, ICD9: 555.xx) were excluded. Patients had continuous eligibility for ≥1 year before first UC diagnosis (index date) and were followed until end of eligibility. Patients with UC were matched 1:1 on sex, age (±1 year), region, and company to controls (active employees without UC or CD). Index dates for controls were set to be the same as the matched patient with UC. Risk of leaving the workplace (short- and long-term disability, leave of absence, early retirement) was examined using Kaplan-Meier survival curves and log-rank tests. Analyses were performed for all patients and for those who developed moderate to severe UC defined by UC hospitalization or use of systemic corticosteroids, immunosuppressants, or biologics. Results: 3,889 employees with UC and 3,889 matched controls (mean age, 44.3 years; 65.5% male) met inclusion criteria and were followed for an average of 3.8 years. Regardless of UC severity, patients with UC were more likely to experience shortand long-term disability or take a leave of absence after the UC diagnosis vs. controls (table). Additionally, patients with moderate to severe UC (N=1,917) more frequently experienced
AGA Abstracts
Evaluation of Colectomy Rate for Ulcerative Colitis in a Referral Center Alessia Settesoldi, Natalia Manetti, Stefania Genise, Manuela Coppola, Francesca Rogai, Siro Bagnoli, Andrea G. Bonanomi, Giancarlo Vannozzi, Martina Giannotta, Cristina Cenci, Vito Annese, Monica Milla IBackground: previous studies have reported colectomy rates up to 50% in Ulcerative colitis (UC), although changes in management may have influenced different figures. We sought to evaluate the incidence in colectomy in our cohort and identify risk factors associated with early colectomy (EC) and late colectomy (LC). Methods: we retrospectively interrogated our data base of UC patients evaluating the occurrence of colectomy, subdivided into EC (within three months from diagnosis) and LC. Survival curves were created and stratified by age, gender, duration of disease, presence of extra-intestinal manifestations (EIM) and therapy, including anti-TNF-α agents. Cox proportional hazards modeling was used to determine predictive risk factors. Results: 1164 patients were evaluated (654 male; M:F= 1.28) with a mean age of 45 yrs (range 19-89), and mean disease duration of 25 yrs (range 1-50). The proportion of patients with extensive colitis, left-side colitis, and proctitis were 39%, 50%, and 11%, respectively. Systemic steroids, thiopurines and anti-TNF-alpha agents were used by 53%, 29%, and 5% of patients, respectively. EIM were reported in 14% of patients. Among 1164 UC patients, 64 (5.5 %) underwent colectomy; 16 patients (25%) as
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birth, procedures for CS, and/or for assisting and inducing delivery. Logistic regression was performed to look at the effect of a priori selected risk factors (age, flare of disease and perianal disease) on the occurrence of caesarean section as compared to vaginal delivery. Risk estimates are presented as odds ratios (OR) with 95% confidence intervals (CI). Results: The mean age of patients at conception was 29.9 years (SD 4.5). Mean gestational age at delivery was 38.3 weeks (SD 2.0). Of 127 IBD (38 UC, 89 CD) patients, 116 (33 UC, 83 CD) patients had a live birth. 11/127 (8.6%) patients had a therapeutic or spontaneous abortion, 66/127 (52%) had a vaginal delivery and 50/127 (39.4%) had a caesarean section. The rate of low birth weight was 19.8%, neonatal ICU was 9.5% and congenital abnormalities were observed in 3.4%. In the group of patients with CS 15/50 (30%) were for emergency indications and 35/50 (70%) were planned electively. Of the 35 patients who had a planned elective CS 19/35 had a prior history of CS. Patient preference was recorded as one of the reasons for the planned CS in 18/35 cases. On multivariate logistic regression analysis perianal disease was the primary factor that increased the likelihood of requiring CS in CD patients (OR=15.10; 95% CI: 1.57-145.30) after adjusting for disease flare (OR=2.39; 95% CI: 0.82-6.94). Conclusions: In our population based IBD cohort the majority of caesarean sections (70%) were performed for elective reasons and not for obstetrical concerns arising during labour. Perianal CD increased the likelihood of requiring CS after controlling for flare of disease. When counseling our patients on expected outcomes of pregnancy we can inform them that their chances of requiring an emergency compared to an elective CS is low.
Mo1296 Quality of Life for Patients With Deep Remission vs. Clinical Remission and Deep Remission vs. Absence of Mucosal Ulceration: 3-Year Data From CHARM/ADHERE Jean-Frederic Colombel, Remo Panaccione, Edouard Louis, Martha Skup, Mei Yang, Paul F. Pollack, Roopal Thakkar, Anne A. Camez, Jingdong Chao, Parvez Mulani, William Sandborn
Mo1298 Unplanned Hospital Readmission Rates and Causes in Patients With Inflammatory Bowel Disease: A Critical Analysis Prashant R. Mudireddy, Gary R. Lichtenstein
Background: Deep remission (DR), defined as clinical remission (CR) + absence of mucosal ulceration (AMU), is an emerging treatment goal in Crohn's disease (CD). Aim: We compared quality of life (QOL) outcomes for up to 3 years in patients with DR vs. CR only and DR vs. AMU only. Methods: The 56-week CHARM (Crohn's Trial of the Fully Human Antibody Adalimumab for Remission Maintenance) trial and its 2-year open-label extension ADHERE (Additional Long-Term Dosing With HUMIRA to Evaluate Sustained Remission and Efficacy in Crohn's Disease) were analyzed. Endoscopies were not performed in CHARM/ADHERE; thus, AMU was predicted via an index derived from a combination of biomarkers and patient self-reported symptoms.1 DR was defined as Crohn's Disease Activity Index (CDAI) value ,150 + predicted AMU. The QOL outcomes included achievement of Inflammatory Bowel Disease Questionnaire remission (IBDQ .170) and normal status on the Short Form 36 (SF-36) physical and mental component summaries (SF-36 PCS/MCS .50). Multivariate logistic regression, adjusting for adalimumab (yes/no) and baseline QOL status, was conducted using the observed values at each visit from Week 26 to Week 164 to assess QOL differences between DR vs. CR and DR vs. AMU. Average QOL changes from baseline were calculated. Results: A total of 778 patients were included in this assessment regardless of the treatment patients were randomized to. Odds of achieving normal status on the SF-36 PCS and IBDQ remission were significantly greater for patients who achieved DR vs. CR or AMU only (Table 1). DR was associated with greater likelihood of SF-36 normal mental health status vs. AMU. IBDQ score improvements from baseline were significantly greater for DR vs. AMU at various time points. Improvements were also seen for DR vs. CR only (Table 2). Results for SF-36 improvements between DR vs. CR or AMU only were similar (data not shown). Conclusion: Patients with CD who achieved predicted DR maintained better physical and disease-specific QOL outcomes for up to 3 years compared with patients who achieved only CR or AMU. Reference: 1. Sandborn WJ, et al. J Crohns Colitis. 2012;6(1 Suppl):S3. Table 1. Adjusted Odds Ratios for QOL Remission Over the 3-Year Study Period
Aim: IBD is a chronic inflammatory disease characterized by periods of relapses and remissions. Hospitalizations for exacerbations of IBD are common. Readmission has been deemed a marker of poor quality of care. The aim of this study was to better understand and characterize the rates of unplanned readmissions in IBD patients at 1 mos, 3 mos, 6 mos and 1 yr and to identify the reasons for the unplanned readmissions. Preliminary data was previously presented by our group [AJG 2012 (107) Suppl. 1 S654-S655], however, this represents extensively updated new data and novel findings. Methods: We retrospectively reviewed the electronic medical record database of our institution (3 large urban academic hospitals) to identify consecutive patients admitted between Jan 2007 to Dec 2010 with a primary discharge diagnosis of either UC or CD. Index admission was defined as first unplanned admission with primary discharge diagnosis of either UC or CD during this period. Readmission was defined as unplanned admission (due to any cause) occurring within 1 mos, 3 mos, 6 mos or 1 yr from the index admission. Planned readmissions were excluded. Data analyzed included demographics, type of IBD, length of stay, and primary discharge diagnosis for both index admission and readmission. Results: A total of 975 pts with IBD accounted for 1345 admissions to the health system within this time period. Of these a total of 479 pts had an index admission with primary discharge diagnosis of either UC or CD. The demographics of the cohort were- mean age 38 yrs, 261 Females, 218 Males, 319 Whites, 132 Blacks, 28 Race other than White or Black, 312 had CD and 167 had UC. There were a total of 384 unplanned readmissions during the study period. The unplanned readmission rates were-12.5 %(60/479) at 1 mos, 23.4%(112/479) at 3 mos, 32.2%(154/ 479) at 6 mos and 38% (182/479) at 1 yr. The mean length of stay (LOS) of both index admissions and readmissions was 7.05 days, while median LOS of both Index and readmissions was 5. Among 60 pts readmitted at least once at 1 month, 19 were readmitted within 1-wk. Among the 182 pts readmitted at least once at 1 year, 90 were females,114 were whites, 61 were blacks, 7 were race other than white or black and 119 had CD, 63 had UC. At 1 yr, 85 pts were readmitted at least twice and 43 were readmitted more than 2 times. Please see table for causes of readmissions. Conclusion: The unplanned readmission rate in IBD pts is high, with more than one third of pts being readmitted at least once within 1 yr of discharge. The most common reasons for readmissions were IBD exacerbations and infections. Future large studies are needed to define national rates of readmission and risk factors for readmissions in IBD pts. This has the potential to better understand and possibly alter the standard of care. Causes of Readmissions in IBD patients
a P,.001. Table 2. Unadjusted Differences in IBDQ Change From Baseline
a
P,.05.
Mo1297 Mode of Delivery in Inflammatory Bowel Disease Patients: A Population-Based Study Yvette Leung, Gilaad G. Kaplan, Stephanie Coward, Marie-Claude Proulx, Divine Tanyingoh, Subrata Ghosh, Remo Panaccione, Cynthia H. Seow Aims: Previous studies have cited a higher caesarean section (CS) rate for inflammatory bowel disease (IBD) patients compared to the non-IBD population. However, the clinical factors that influence whether a CS or a vaginal delivery occurs are largely unknown. We studied mode of delivery in IBD patients to determine the indications and risk factors underlying the higher CS rate of this population. Methods: The Data Integration, Measuring and Reporting administrative discharge abstract database was used to identify all women (.= 18 years of age) in the Calgary Health Zone with a diagnosis of CD (ICD-9-CM 555.X or ICD-10-CA K50.X) or UC (ICD-9-CM 556.X or ICD-10-CA K51.X) who were admitted to hospital between April 1, 2006 and March 31, 2010. Hospital chart review was performed on all pregnant women (n=127) to confirm the diagnosis and to extract data on normal
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AGA Abstracts
AGA Abstracts
EC, 12 (19%) for cancer or dysplasia, and the remaining patients for chronically active disease. The 5-, 10-, and 20-year actuarial risk of colectomy was 2.6%, 4%, and 5% respectively. Of note, 48 patients (75%) received a proctocolectomy with ileo-anal anastomosis, and 12 (25%) developed a chromic recurrent pouchitis. In addition, more than 80% of patients received maintenance therapy with mesalazine at least 1.6 gr/daily, and 43% of patients used combined oral and topical (1-2/week) maintenance therapy. Male sex (hazard ratio [HR] = 3.5; 95% confidence interval [CI] 1.5-5.5) and pancolitis (HR = 2.5; 95% CI 1.2-4.3) were predictive for EC, after adjustment for confounders. Age at diagnosis older than 40 yrs (HR = 2.5; 95% CI 1.4-3.8) and intolerance/inefficacy of thiopurines (HR = 3.1; 95% CI 1.4- 5.1) were predictive of LC. Conclusions: Colectomy was rather infrequent in our cohort, being more often performed for chronically active disease. The incidence of cancer an dysplasia was also low, probably because the extensive use and adherence to mesalazine maintenance therapy. The introduction of anti-TNF-alpha therapy in the last five years have not changed this figure so far.